Patient Abandonment – Home Health Care


Elements of the Cause of Action for Abandonment Each of the following 5 elements needs to be present for a patient to have a proper civil motive of action for the tort of abandonment:

1. Health care remedies turned into unreasonably discontinued.

2. The termination of fitness care was contrary to the affected person’s will or without the affected person’s understanding.

3. The fitness care issuer failed to arrange for care with the aid of another suitably skilled fitness care issuer.

4. The health care provider ought to have fairly foreseen that harm to the patient would arise from the care’s termination (proximate reason).

5. The patient genuinely suffered damage or loss as a result of the discontinuance of care.

Physicians, nurses, and different health care experts have an ethical and a prison responsibility to avoid abandonment of patients. The health care professional has an obligation to give his or her affected person all necessary interest so long as the case required it and ought to no longer go away the affected person at a critical level without giving reasonable observer or making suitable preparations for the attendance of some other. [2]


Abandonment by way of the Physician

When a physician undertakes treatment of a patient, treatment has to keep until the patient’s situations no longer warrant the treatment; the physician and the patient mutually consent to cease the remedy through that medical doctor or the affected person discharges the doctor. Moreover, the medical doctor may also unilaterally terminate the relationship and withdraw from treating that patient best if he or she presents the affected person’s right note of his or her intent to withdraw and an opportunity to attain the right replacement care.

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In the house fitness putting, the medical doctor-affected person courting does no longer terminate simply because a patient’s care shifts in its location from the sanatorium to the house. If the patient maintains to need clinical services, supervised fitness care, therapy, or other domestic health services, the attending medical doctor must make sure that they were well discharged his or her duties to the patient. Virtually every state of affairs ‘in which home care is authorized through Medicare, Medicaid, or an insurer could be one in which the patient’s ‘needs for care have continued. The physician-patient relationship that existed within the health facility will continue unless it’s been officially terminated with the aid of word to the patient and an inexpensive try and refer the patient to any other appropriate health practitioner. Otherwise, the health practitioner will keep their duty toward the patient whilst the affected person is discharged from the hospital to the house. Failure to follow via on the part of the physician will represent the tort of abandonment if the patient is injured. This abandonment might also divulge the doctor, the medical institution, and the home health enterprise to legal responsibility for the tort of abandonment.

The attending health practitioner inside the clinic must ensure that a proper referral is made to a physician who might be liable for the home fitness affected person’s care at the same time as its miles being introduced via the house fitness company unless the health practitioner intends to continue to supervise that home care for my part. Even more critical, if the hospital-primarily based health practitioner arranges to have the patient’s care assumed by using another physician, the affected person has to apprehend this transformation absolutely. It needs to be carefully documented. As supported through case regulation, the sorts of moves to cause liability for abandonment of a patient will consist of:

• premature discharge of the affected person via the physician

• failure of the physician to offer proper instructions earlier than discharging the affected person

• the statement with the aid of the medical doctor to the affected person that the doctor will not deal with the patient

• refusal of the physician to reply to calls or to further attend to the affected person

• the health practitioner’s leaving the patient after the surgical operation or failure to comply with post-surgical care. [3]

Generally, abandonment does not arise if the medical doctor chargeable for the affected person arranges for a replacement health practitioner to take their vicinity. This change may also arise because of vacations, relocation of the health practitioner, infection, distance from the affected person’s home, or the doctor’s retirement. As long as care using a correctly skilled health practitioner, sufficiently knowledgeable of the affected person’s special situations, if any, has been arranged, the courts will typically not discover that abandonment has befallen. [4] Even where a patient refuses to pay for the care or cannot pay for the care, the health practitioner isn’t at liberty to terminate the connection unilaterally. Nonetheless, the physician needs to take steps to have the affected person’s care assumed by any other [5] or to offer a sufficiently reasonable time frame to locate every other previous to ceasing to offer care.

Although the maximum of the instances mentioned concern the physician-affected person courting, as talked about formerly, the equal principles follow to all health care vendors. Furthermore, due to the fact the care rendered by way of the home health organization is provided under a physician’s plan of care, although the affected person sued the physician for abandonment due to the moves (or inactions of the home health agency’s body of workers), the medical doctor may also search for indemnification from the house fitness issuer. [6]


Similar ideas to people who observe physicians follow to the house health professional and the house fitness company. A domestic health employer, because the direct company of care to the homebound affected person, may be held to the equal felony duty and obligation to supply care that addresses the affected person’s wishes, as is the health practitioner. Furthermore, there can be both a legal and a moral obligation to keep handing over care if the patient has no options. A moral duty may also exist to the affected person even though the house fitness company has fulfilled all criminal responsibilities. [7]


When a domestic fitness provider furnishes treatment to an affected person, the duty to keep providing care to the affected person is a duty owed by using the enterprise itself and not by the man or woman expert who can be the employee or contractor organization. The domestic health provider does no longer have an obligation to preserve providing the same nurse, therapist, or aide to the patient at some point of the course of remedy, so long as the issuer maintains to apply suitable, ready employees to manage the path of treatment continuously with the plan of care. From the attitude of patient pleasure and continuity of care, it can be in the home fitness issue’s quality pursuits to try to offer the same individual practitioner to the patient. The development of personal dating with the company’s personnel may improve communications and an extra degree of consideration and compliance on the part of the patient. It should help to relieve some of the troubles that get up inside the health care’ putting.

If the patient requests a substitute of a selected nurse, therapist, technician, or domestic fitness aide, the home health issue nevertheless has a responsibility to offer care to the affected person, except the patient additionally especially states he or she now not desires the issuer’s provider. Home health employer supervisors need to always observe up on such affected person requests to determine the dismissal’s motives, discover “trouble” employees, and ensure no incident has taken place that could give rise to legal responsibility. The home fitness organization must keep imparting care to the affected person until definitively informed no longer to accomplish that by using the affected person.


Home health issuer employees may additionally once in a while come upon an abusive patient. This abuse may or may not result from the medical circumstance for which the care is provided. Personal protection of the man or woman, fitness care provider, should be paramount. Should the patient pose a bodily risk to the person, they need to go away from the premises right away. The issuer needs to report within the clinical document the facts surrounding the incapability to finish the remedy for that go to as objectively as possible. Management employees must tell supervisory personnel at the house health provider and have an inner incident record. If it appears that a crook act has taken a region, which includes a physical attack, attempted rape, or different such act, this act should be stated at once to nearby law enforcement groups. The domestic care provider should add right now notify both the patient and the medical doctor that the company will terminate its dating with the patient and that an opportunity provider for these services needs to be acquired.

Other less serious occasions may additionally, although, lead the home health provider to determine that it should terminate its courting with a particular patient. Examples may also include especially abusive patients, patients who solicit -the house fitness issuer professional to break the regulation (as an example, using providing illegal drugs or supplying non-covered services and system and billing them as something else), or continually noncompliant sufferers. Once the remedy is undertaken, the house health provider is usually obliged to hold supplying offerings until the patient has had an inexpensive possibility of acquiring a replacement issue. The same concepts apply to the failure of a patient to pay for the offerings or system supplied.

As health care professionals, HHA personnel ought to have the education to deal with the tough patient responsibly. Arguments or emotional comments should be averted. If it becomes clear that a positive company and affected person are not in all likelihood to be compatible, a replacement issue ought to be tried. Should it appear that the trouble lies with the patient and that the HHA needs to terminate its courting with the patient, the following seven steps have to be taken:

1. The occasions must be documented within the affected person’s report.

2. The home fitness company has to give or send a letter to the patient explaining the situations surrounding the termination of care.

3. The letter has to be sent with the aid of certified mail, return receipt asked, or different measures to document the affected person’s receipt of the letter. A copy of the letter ought to be located in the affected person’s document.

4. If feasible, the patient should be given a sure time frame to attain replacement care. Usually, 30 days is sufficient.

5. If the patient has an existence-threatening situation or a medical circumstance that would deteriorate within the absence of persevering with care, this situation must be absolutely stated in the letter. The necessity of the patient’s acquiring substitute home fitness care should be emphasized.

6. The patient needs to be knowledgeable of the place of the nearest clinic emergency branch. The affected person should be informed to go to the closest clinic emergency branch in case of a clinical emergency or to name the neighborhood emergency range for ambulance transportation.

7. A replica of the letter ought to be despatched to the affected person’s attending medical doctor via certified mail, go back receipt asked.

These steps need not be undertaken gently. Before such steps are taken, the affected person’s case must be very well discussed with the home health issuer’s threat supervisor, criminal recommends, medical director, and the affected person’s attending health practitioner. The inappropriate discharge of a patient from health care insurance through the house fitness issuer, whether because of termination of entitlement, lack of ability to pay, or other motives, may additionally result in legal responsibility for the tort of abandonment. [8]

Nurses who passively stand by way of and have a look at negligence using a medical doctor or all of us else will, in my opinion, come to be responsible for the patient who is injured due to that negligence… [H]healthcare facilities and their nursing team of workers owe an independent duty to patients beyond the duty owed via physicians. When a doctor’s order to discharge is irrelevant, the nurses may be assisted in following an order that they knew or ought to recognize under the usual care. [9] Similar ideas may additionally observe to make the home fitness issuer vicariously in charge, as properly.

Liability to the patient for the tort of abandonment may result from the home health care professional’s failure to examine, have a look at, verify, or screen an affected person’s situation. [10] Liability for abandonment may arise from failing to take well-timed motion, in addition to failing to summon a physician when a medical doctor is needed. [11] Failing to provide a good enough workforce to meet the affected person’s desires can also represent abandonment on the part of the HHA. [12] Ignoring an affected person’s complaints and failing to follow a doctor’s orders may additionally likewise constitute a tort of abandonment for a nurse or other expert team of workers member.

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Harlan J. Whelan
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