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Patient Abandonment - Home Healthcare CGHS CGHS pensioner card Elements of the Cause of Action for Abandonment

Each of the following five elements must be present for a patient to experience a proper civil source of action for the tort of abandonment: CGHS hospital CGHS circulars

1. Health care treatment was unreasonably discontinued.

2. The termination of healthcare was contrary to the patient's will or minus the patient's knowledge.

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

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

5. The patient actually suffered harm or loss as a result of the discontinuance of care. CGHS dispensary CGHS card

Physicians, nurses, as well as other health care professionals have an ethical, in addition to a legal, duty to stop abandonment of patients. Medical care professional features a duty to give his or her patient all necessary attention providing the case required it and cannot leave the patient inside a critical stage without giving reasonable notice or making suitable arrangements for your attendance of another.

Abandonment with the Physician


When a physician undertakes treating a patient, treatment must continue until the patient's circumstances not warrant the treatment, the doctor and the patient mutually consent to end the treatment by that physician, or the patient discharges health related conditions. Moreover, the physician may unilaterally terminate the connection and withdraw from treating that patient as long as he or she provides the patient proper notice of their intent to withdraw plus an opportunity to obtain proper substitute care.

In the home health setting, the physician-patient relationship won't terminate merely must be patient's care shifts in the location from the hospital to the home. If the patient continues to 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 to the patient. Virtually every situation 'in which home care is approved by Medicare, Medicaid, or perhaps insurer will be one in which the patient's 'needs for care have continued. The physician-patient relationship that existed inside the hospital will continue unless it has been formally terminated by notice for the patient and a reasonable try and refer the patient to a new appropriate physician. Otherwise, the doctor will retain his or her duty toward the sufferer when the patient is discharged from your hospital to the home. Failure to follow along with through on the part of the physician will constitute the tort of abandonment in the event the patient is injured because of this. This abandonment may expose the physician, the hospital, and the home health agency to liability for the tort of abandonment.

The attending physician within the hospital should be sure that a proper referral was designed to a physician who will be in charge of the home health patient's care though it may be being delivered with the home health provider, unless health related conditions intends to continue to supervise that home care personally. Even more important, if 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 backed up by case law, the kinds of actions that will result in liability for abandonment of the patient will include:

• premature turmoil the patient by the physician

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


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

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

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

Generally, abandonment doesn't occur if the physician responsible for the patient arranges for the substitute physician to look at his or her place. This change may occur because of vacations, relocation in the physician, illness, distance through the patient's home, or retirement in the physician. As long as care by an appropriately trained physician, sufficiently knowledgeable in the patient's special conditions, if any, has been arranged, the courts will usually not find that abandonment has occurred. Even the place where a patient refuses to pay for the care or is not able to pay for the care, problems is not at liberty to terminate the relationship unilaterally. The physician must still make a plan to have the patient's care assumed by another as well as to give a sufficiently reasonable time period 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, because the care rendered through the home health agency is provided pursuant to a physician's plan of care, whether or not the patient sued health related conditions for abandonment due to actions (or inactions of the property health agency's staff), the doctor may seek indemnification from your home health provider.

ABANDONMENT From the NURSE OR HOME HEALTH AGENCY

Similar principles to those that apply to physicians apply to the home health professional along with the home health provider. A house health agency, because the direct provider of desire to the homebound patient, might be held to the same legal obligation and duty to deliver care that addresses a person's needs as is the doctor. Furthermore, there may be both a legal and an ethical obligation to continue delivering care, if the patient has no alternatives. An ethical obligation may still exist on 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 with the agency itself rather than by the individual professional who seems to be the employee or the contractor with the agency. The home health provider doesn't need a duty to continue giving the same nurse, therapist, or aide towards 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 with 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 provide the same individual practitioner to the patient. The development of an individual relationship with the provider's personnel may improve communications plus a greater degree of trust and compliance by the patient. It should assistance to alleviate many of the problems that arise in the health care' setting.

If your patient requests replacement of a particular nurse, therapist, technician, or home health aide, your home health provider is still equipped with 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 discover the reasons regarding the dismissal, to detect "problem" employees, and to ensure no incident has brought place that might bring about liability. The home health agency should continue providing care to the patient until definitively told to refrain from doing so by the patient.

Handling THE ABUSIVE PATIENT

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

Other less serious circumstances may, nevertheless, lead the property health provider to determine that it should terminate its relationship having a particular patient. Examples can sometimes 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 different), or consistently noncompliant patients. Once treatment solutions are undertaken, however, your home health provider is usually obliged to continue providing services until the patient has had a good opportunity to obtain a substitute provider. The identical principles apply to failure of a patient to pay for the help or equipment provided.


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

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

2. Your home health provider should give or send directions to the patient explaining situations surrounding the termination of care.

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

4. When possible, the patient should be given a particular period of time to obtain replacement care. Usually 30 days is sufficient.

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

6. The individual should be informed with the location of the nearest hospital emergency department. The patient should be told to either go to the nearest hospital emergency department in the event of a medical emergency in order to call the local emergency number for ambulance transportation.

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

These steps mustn't 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, as well as the patient's attending physician.


The inappropriate turmoil a patient from medical care coverage by the home health provider, whether due to termination of entitlement, being unable to pay, or other reasons, can also lead to liability for your tort of abandonment.

Nurses who passively uphold and observe negligence by the physician or anybody else will personally become accountable for the patient who is injured due to that negligence... [H]ealthcare facilities in addition to their nursing staff owe a completely independent duty to patients beyond the duty owed by physicians. Whenever a physician's order to discharge is inappropriate, the nurses will be help liable for following a purchase order that they knew or should know is below the standard of care.


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