Patient Abandonment - Home Health Care

Elements of the Cause of Action for Abandonment

All the following five elements must be present for a patient to get a proper civil cause of action for the tort of abandonment:

1. Healthcare treatment was unreasonably discontinued.

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

3. The 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 in the 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 other health care professionals have an ethical, as well as a legal, duty to stop abandonment of patients. The health care professional includes a duty to give his / her patient all necessary attention providing the case required it and should not leave the patient in a critical stage without giving reasonable notice or making suitable arrangements for your attendance of another.

Abandonment through the Physician

When a physician undertakes treatments for a patient, treatment must continue before the patient's circumstances not warrant the treatment, health related conditions and the patient mutually accept to end the treatment by that physician, or the patient discharges health related conditions. Moreover, the physician may unilaterally terminate the relationship and withdraw from treating that patient only if he or she provides the patient proper notice of their intent to withdraw and an opportunity to obtain proper substitute care.

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

The attending physician in the hospital should ensure that a proper referral was designed to a physician who will be accountable for the home health patient's care though it may be being delivered with the home health provider, unless the physician intends to continue to supervise that homecare personally. Even more important, if the hospital-based physician arranges to offer the patient's care assumed by another physician, the sufferer must fully understand this variation, and it should be carefully documented.

As supported by case law, like actions that will lead to liability for abandonment of the patient will include:

• premature relieve the patient by the physician

• failure of the physician to provide proper instructions before discharging the sufferer

• the statement through the physician to the patient the physician will no longer treat the individual

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

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

Generally, abandonment does not occur if the physician in charge of the patient arranges to get a substitute physician to look at his or her place. This modification may occur because of vacations, relocation in the physician, illness, distance in the patient's home, or retirement from the physician. As long as care by an appropriately trained physician, sufficiently knowledgeable of the patient's special conditions, if any, has been arranged, the courts will often not find that abandonment has occurred. Even the place where a patient refuses to spend the money for care or is unable to pay for the care, problems is not at liberty to terminate the connection unilaterally. The physician must still do something to have the patient's care assumed by another as well as to give a sufficiently reasonable time frame to locate another just before ceasing to provide care.

Although a lot of the cases discussed concern the physician-patient relationship, as pointed out previously, the same principles affect all health care providers. Furthermore, for the reason that care rendered with the home health agency is given pursuant to a physician's plan of care, whether or not the patient sued the physician for abandonment due to actions (or inactions of your home health agency's staff), the doctor may seek indemnification from the home health provider.


Similar principles to those who apply to physicians connect with the home health professional and also the home health provider. A house health agency, as the direct provider of care to the homebound patient, could be held to the same legal obligation and duty to provide care that addresses a person's needs as is health related conditions. Furthermore, there may be both a legal and an ethical obligation to continue delivering care, in the event the patient has no alternatives. An ethical obligation may still exist for the patient even though the home health provider has fulfilled all legal obligations.

Each time a home health provider furnishes treatment into a patient, the duty to remain providing care to the person is a duty owed by the agency itself and never by the individual professional who seems to be the employee or the contractor in the agency. The home health provider doesn't have a duty to continue offering the same nurse, therapist, or aide to the patient throughout the procedure, so long as the provider is constantly on the use appropriate, competent personnel to administer the course of treatment consistently using the plan of care. In the perspective of patient satisfaction and continuity of care, it could be in the best interests of the house health provider to attempt to provide the same individual practitioner for the patient. The development of an individual relationship with the provider's personnel may improve communications and a greater degree of trust and compliance on the part of the patient. It should help to alleviate many of the conditions arise in the health care' setting.

If your patient requests replacement of a particular nurse, therapist, technician, or home health aide, the property health provider continues to have a duty to provide care to the patient, unless the person also specifically states he or she no longer desires the provider's service. Home health agency supervisors should follow up on such patient requests to ascertain the reasons regarding the dismissal, to detect "problem" employees, and to ensure no incident has taken place that might help with liability. The home health agency should continue providing want to the patient until definitively told to refrain from doing so by the patient.


Home health provider personnel may occasionally encounter an abusive patient. This abuse mayor is probably not a result of the medical condition in which the care is being provided. Personal safety of the person health care provider should be paramount. If your patient pose a physical danger to the individual, he or she should leave the premises immediately. The provider should document within the medical record the facts all around the inability to complete the procedure for that visit as objectively as you possibly can. Management personnel should inform supervisory personnel on the home health provider and really should complete an internal incident report. Whether it appears that a criminal act has taken place, such as a physical assault, attempted rape, or another such act, this act needs to be reported immediately to law enforcement agencies. The home care provider should also immediately notify both the patient and the physician the provider will terminate its relationship with the patient and that an alternate provider for these services should be obtained.

Other less serious circumstances may, nevertheless, lead the property health provider to discover that it should terminate its relationship with a particular patient. Examples might include particularly abusive patients, patients who solicit -the home health provider professional to get rid of the law (for example, by giving illegal drugs or providing non-covered services and equipment and billing them as another thing), or consistently noncompliant patients. Once treatment is undertaken, however, the house health provider is often obliged to continue providing services until the patient has had a fair opportunity to obtain a substitute provider. Exactly the same principles apply to failure of your patient to pay for the services or equipment provided.

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

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

2. The house health provider should give or send correspondence to the patient explaining conditions surrounding the termination of care.

3. The letter ought to be sent by certified mail, return receipt requested, or any other measures to document patient receiving the letter. A copy with the letter should be placed 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. If your patient has a life-threatening condition or a medical condition that might deteriorate even without the continuing care, this problem should be clearly produced in the letter. The necessity of the patient's obtaining replacement home medical care should be emphasized.

6. The patient should be informed of the location of the nearest hospital emergency department. The sufferer should be told either to go to the nearest hospital emergency department in case there is a medical emergency or call the local emergency number for ambulance transportation.

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

These steps really should not be undertaken lightly. Before such steps are taken, a person's case should be thoroughly discussed with the home health provider's risk manager, legal services, medical director, along with the patient's attending physician.

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

Nurses who passively the stand by position and observe negligence by a physician or someone else will personally become accountable on the patient who is injured on account of that negligence... [H]ealthcare facilities along with their nursing staff owe an impartial duty to patients beyond the duty owed by physicians. Each time a physician's order to discharge is inappropriate, the nurses will probably be help liable for following a purchase that they knew or should know about is below the standard of care.