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02 Jan 2016
Elements of the Cause of Action for Abandonment

Each of the following five elements should be present for a patient to possess a proper civil cause of action for the tort of abandonment:

CGHS card
1. Medical care treatment was unreasonably discontinued.

2. The termination of medical care was contrary to the patient's will or without the patient's knowledge.

3. Medical care provider did not arrange for care by another appropriate skilled health care provider.

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

5. The person actually suffered harm or loss because of the discontinuance of care.

Physicians, nurses, and other health care professionals have an ethical, and a legal, duty in order to avoid abandonment of patients. Medical care professional features a duty to give their patient all necessary attention so long as the case required it and should not leave the patient inside a critical stage without giving reasonable notice or making suitable arrangements to the attendance of another.

Abandonment from the Physician

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

In the home health setting, the physician-patient relationship does not terminate merely must be patient's care shifts in its location from the hospital for 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 homecare is approved by Medicare, Medicaid, or perhaps insurer will be one out of which the patient's 'needs for care have continued. The physician-patient relationship that existed from the hospital will continue unless many experts have formally terminated by notice towards the patient and a reasonable attempt to refer the patient to a different appropriate physician. Otherwise, the physician will retain his / her duty toward the patient when the patient is discharged through the hospital to the home. Failure to follow along with through on the part of health related conditions will constitute the tort of abandonment in the event the patient is injured because of this. This abandonment may expose the doctor, the hospital, and the home health agency to liability for your tort of abandonment.

The attending physician from the hospital should ensure that a proper referral is built to a physician who will be in charge of the home health patient's care even though it is being delivered through the home health provider, unless the physician intends to continue to supervise that home care personally. Even more important, when the hospital-based physician arranges to get the patient's care assumed by another physician, the individual must fully understand this variation, and it should be carefully documented.

As sustained by case law, the types of actions that will result in liability for abandonment of the patient will include:

• premature launch of the patient by the physician

• failure from the physician to provide proper instructions before discharging the patient

• the statement through the physician to the patient that this physician will no longer treat the person

• refusal of the physician to reply to calls or to further attend the individual

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

Generally, abandonment doesn't occur if the physician to blame for the patient arranges for the substitute physician to take his or her place. This change may occur because of vacations, relocation with the physician, illness, distance in the patient's home, or retirement of the physician. As long as care by an appropriately trained physician, sufficiently knowledgeable from the patient's special conditions, if any, has been arranged, the courts will usually not find that abandonment has occurred. Even in which a patient refuses to pay for the care or is can not pay for the care, problems 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 in order to give a sufficiently reasonable stretch of time to locate another just before ceasing to provide care.

Although most of the cases discussed concern the physician-patient relationship, as pointed out previously, the same principles connect with all health care providers. Furthermore, because the care rendered through the home health agency is provided pursuant to a physician's plan of care, set up patient sued health related conditions for abandonment due to actions (or inactions of your home health agency's staff), the doctor may seek indemnification through the home health provider.


Similar principles to people who apply to physicians sign up for the home health professional and the home health provider. A property health agency, as the direct provider of want to the homebound patient, could possibly be held to the same legal obligation and duty to provide care that addresses the patient's needs as is problems. Furthermore, there may be both a legal and an ethical obligation to carry on delivering care, if 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.

Each time a home health provider furnishes treatment to some patient, the duty to remain providing care to the individual is a duty owed through the agency itself instead of by the individual professional who might be the employee or the contractor with the agency. The home health provider doesn't have a duty to continue giving the same nurse, therapist, or aide on the patient throughout the procedure, so long as the provider is constantly use appropriate, competent personnel to manage the course of treatment consistently using the plan of care. From your perspective of patient satisfaction and continuity of care, it could be in the best interests of the home health provider to attempt 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 on the part of the patient. It should help alleviate many of the conditions that arise in the health care' setting.

If the patient requests replacing of a particular nurse, therapist, technician, or home health aide, your home health provider retains a duty to provide choose to the patient, unless the sufferer also specifically states he or she no longer desires the provider's service. Home health agency supervisors must always follow up on such patient requests to look for the reasons regarding the dismissal, to detect "problem" employees, and to ensure no incident has brought place that might help with liability. The home health agency should continue providing care to the patient until definitively told to avoid so by the patient.


Home health provider personnel may occasionally encounter an abusive patient. This abuse mayor may not be a result of the medical condition for 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, they should leave the premises immediately. The company should document in the medical record the facts surrounding the inability to complete the treatment for that visit as objectively as you can. Management personnel should inform supervisory personnel at the home health provider and should complete an internal incident report. If it appears that a criminal act has taken place, such as a physical assault, attempted rape, or other such act, this act should be reported immediately to local law enforcement agencies. The home care provider must also immediately notify both patient and the physician that this provider will terminate its relationship together with the patient and that a different provider for these services should be obtained.

Other less serious circumstances may, nevertheless, lead the home health provider to discover that it should terminate its relationship using a particular patient. Examples might include particularly abusive patients, patients who solicit -the home health provider professional to break the law (for example, through providing illegal drugs or providing non-covered services and equipment and billing them as something different), or consistently noncompliant patients. Once treatment solutions are undertaken, however, the property health provider is normally obliged to continue providing services before 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 assistance or equipment provided.

As physicians, HHA personnel should have training on how to handle the difficult patient responsibly. Arguments or emotional comments must be avoided. If it becomes clear a certain provider and patient are not likely to be compatible, a replacement 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 using the patient, the following seven steps must be taken:

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

2. The house health provider should give or send directions to the patient explaining instances 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 put into the patient's record.

4. If possible, the patient should be given a particular period of time to obtain replacement care. Usually Four weeks is sufficient.

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

6. The sufferer should be informed with the location of the nearest hospital emergency department. The sufferer should be told with the idea to go to the nearest hospital emergency department in the event of a medical emergency or 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 should not be undertaken lightly. Before such steps are taken, the patient's case should be thoroughly discussed together with the home health provider's risk manager, a lawyer, medical director, and also the patient's attending physician.

The inappropriate discharge of a patient from healthcare coverage by the home health provider, whether because of termination of entitlement, inability to pay, or other reasons, can also lead to liability for the tort of abandonment.

Nurses who passively stand by and observe negligence by way of a physician or anybody else will personally become accountable on the patient who is injured as a result of that negligence... [H]ealthcare facilities along with their nursing staff owe an unbiased duty to patients after dark duty owed by physicians. When a physician's order to discharge is inappropriate, the nurses will likely be help liable for following a purchase order that they knew or ought to know is below the standard of care.


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