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Patient Abandonment - Home Health Care

CGHS circulars

Elements of the Cause of Action for Abandonment

Each of the following five elements has to be present for a patient to have a proper civil source of action for the tort of abandonment:

1. Health care treatment was unreasonably discontinued.

2. The termination of medical was contrary to the patient's will or with no patient's knowledge.

3. Medical care provider failed to arrange for care by another appropriate skilled physician.

4. The health care provider should have reasonably foreseen that trouble for the patient would arise from your termination of the care (proximate cause).

5. The person actually suffered harm or loss as a result of the discontinuance of care.

Physicians, nurses, and also other health care professionals have an ethical, and also a legal, duty to prevent abandonment of patients. The health care professional includes a duty to give her or his patient all necessary attention providing the case required it and cannot leave the patient within a critical stage without giving reasonable notice or making suitable arrangements for that attendance of another.

Abandonment from the Physician

When a physician undertakes treating a patient, treatment must continue before the patient's circumstances no longer warrant the treatment, health related conditions and the patient mutually accept to end the treatment with that physician, or the patient discharges health related conditions. Moreover, the physician may unilaterally terminate the partnership and withdraw from treating that patient only if he or she provides the patient proper notice of his / her intent to withdraw and an opportunity to obtain proper substitute care.

In the home health setting, the physician-patient relationship doesn't terminate merely because a patient's care shifts in its location from the hospital to the home. If the patient is constantly on the need medical services, supervised healthcare, therapy, or other home health services, the attending physician should make certain that he or she was properly discharged his or her-duties on the patient. Virtually every situation 'in which home care is approved by Medicare, Medicaid, or an insurer will be one in which the patient's 'needs for care have continued. The physician-patient relationship that existed within the hospital will continue unless it is often formally terminated by notice on the patient and a reasonable make an effort to refer the patient to an alternative appropriate physician. Otherwise, the doctor will retain his / her duty toward the person when the patient is discharged in the hospital to the home. Failure to follow along with through on the part of the doctor will constitute the tort of abandonment if your patient is injured therefore. This abandonment may expose the physician, the hospital, and the home health agency to liability for the tort of abandonment.

The attending physician inside the hospital should make sure that a proper referral was created to a physician who will be in charge of the home health patient's care while it is being delivered from the home health provider, unless problems intends to continue to supervise that homecare personally. Even more important, if your hospital-based physician arranges to have the patient's care assumed by another physician, the patient must fully understand this transformation, and it should be carefully documented.

As based on case law, the types of actions that will cause liability for abandonment of the patient will include:

• premature relieve the patient by the physician

• failure with the physician to provide proper instructions before discharging the person

• the statement from the physician to the patient how the physician will no longer treat the person

• refusal of the physician to answer calls or to further attend the patient

• the physician's leaving the individual after surgery or unable to follow up on postsurgical care.

Generally, abandonment doesn't happen if the physician in charge of the patient arranges to get a substitute physician to take his or her place. This change may occur because of vacations, relocation with the physician, illness, distance through the patient's home, or retirement from the physician. As long as care by an appropriately trained physician, sufficiently knowledgeable with the patient's special conditions, or no, has been arranged, the courts in most cases not find that abandonment has occurred. Even when a patient refuses to spend the money for care or is struggling to pay for the care, the physician is not at liberty to terminate the partnership unilaterally. The physician must still take the appropriate steps to have the patient's care assumed by another as well as to give a sufficiently reasonable stretch of time to locate another just before ceasing to provide care.

Although the majority of the cases discussed concern the physician-patient relationship, as pointed out previously, the same principles affect all health care providers. Furthermore, since the care rendered through the home health agency is provided pursuant to a physician's plan of care, whether or not the patient sued the physician for abandonment because of the actions (or inactions of the home health agency's staff), health related conditions may seek indemnification through the home health provider.


Similar principles to those who apply to physicians apply to the home health professional and also the home health provider. A home health agency, because the direct provider of want to the homebound patient, could possibly be held to the same legal obligation and duty to supply care that addresses the patient's needs as is problems. Furthermore, there may be both an authorized and an ethical obligation to keep delivering care, when the patient has no alternatives. A moral obligation may still exist to the patient even though the home health provider has fulfilled all legal obligations.

When a home health provider furnishes treatment into a patient, the duty to remain providing care to the sufferer is a duty owed through the agency itself rather than by the individual professional who may be the employee or the contractor with the agency. The home health provider doesn't need a duty to continue supplying the same nurse, therapist, or aide for the patient throughout the treatment, so long as the provider will continue to use appropriate, competent personnel to give the course of treatment consistently using the plan of care. From the perspective of patient satisfaction and continuity of care, it may be in the best interests of the home health provider to provide the same individual practitioner for the patient. The development of a personal relationship with the provider's personnel may improve communications along with a greater degree of trust and compliance from the patient. It should help to alleviate many of the problems that arise in the health care' setting.

In the event the patient requests replacement of a particular nurse, therapist, technician, or home health aide, your home health provider retains a duty to provide desire to the patient, unless the sufferer also specifically states he / she no longer desires the provider's service. Home health agency supervisors would be wise to follow up on such patient requests to look for the reasons regarding the dismissal, to detect "problem" employees, and to ensure no incident has had place that might help with liability. The home health agency should continue providing care to the patient until definitively told not to do so by the patient.


Home health provider personnel may occasionally encounter an abusive patient. This abuse mayor will not be a result of the medical condition which is why the care is being provided. Personal safety of the people health care provider should be paramount. When the patient pose a physical danger to the individual, she or he should leave the premises immediately. The company should document in the medical record the facts around the inability to complete the therapy for that visit as objectively as possible. Management personnel should inform supervisory personnel in the home health provider and should complete an internal incident report. Whether or not this appears that a criminal act has had place, such as a physical assault, attempted rape, or another such act, this act must be reported immediately to law enforcement agencies. The home care provider should also immediately notify the patient and the physician the provider will terminate its relationship with the patient and that a different provider for these services needs to be obtained.

Other less serious circumstances may, nevertheless, lead your home health provider to discover that it should terminate its relationship which has a particular patient. Examples may include particularly abusive patients, patients who solicit -the home health provider professional to get rid of the law (for example, through providing illegal drugs or providing non-covered services and equipment and billing them as something more important), or consistently noncompliant patients. Once treatment solutions are undertaken, however, the property health provider is normally obliged to continue providing services prior to the patient has had a good opportunity to obtain a substitute provider. The identical principles apply to failure of the patient to pay for the help or equipment provided.

As medical professionals, HHA personnel should have training on how to handle the difficult patient responsibly. Arguments or emotional comments needs to be avoided. If it becomes clear a certain provider and patient are not likely to be compatible, an alternative provider should be tried. Should it appear how the problem lies together with the patient and that it is necessary for the HHA to terminate its relationship with all the patient, the following seven steps must be taken:

1. Instances should be documented in the patient's record.

2. The home health provider should give or send a letter to the patient explaining the circumstances surrounding the termination of care.

3. The letter needs to be sent by certified mail, return receipt requested, and other measures to document patient receipt of the letter. A copy of the letter should be put in the patient's record.

4. Whenever possible, the patient should be given a specific period of time to obtain replacement care. Usually 1 month is sufficient.

5. When the patient has a life-threatening condition or possibly a medical condition that might deteriorate even without the continuing care, this problem should be clearly produced in the letter. The need of the patient's obtaining replacement home health care should be emphasized.

6. The person should be informed from the location of the nearest hospital emergency department. The person should be told to either go to the nearest hospital emergency department in the case of a medical emergency in order to call the local emergency number for ambulance transportation.

7. A duplicate of the letter needs to be sent to the patient's attending physician via certified mail, return receipt requested.

These steps shouldn't be undertaken lightly. Before such steps are taken, the patient's case should be thoroughly discussed with the home health provider's risk manager, an attorney, medical director, along with the patient's attending physician.

The inappropriate turmoil a patient from medical care coverage by the home health provider, whether because of termination of entitlement, lack of ability to pay, or other reasons, may also lead to liability for that tort of abandonment.

Nurses who passively get ready and observe negligence by the physician or someone else will personally become accountable for the patient who is injured because of that negligence... [H]ealthcare facilities in addition to their nursing staff owe an impartial duty to patients after dark duty owed by physicians. Whenever a physician's order to discharge is inappropriate, the nurses is going to be help liable for following a purchase order that they knew or should be aware of is below the standard of care.