Components of the Cause of Action for Abandonment.
Every one of the accompanying five components must be available for a patient to have a legitimate common reason for activity for the tort of abandonment:
- Health care treatment was absurdly ceased.
- The end of health care was in opposition to the patient’s will or without the patient’s learning.
- The health care supplier neglected to orchestrate care by another proper gifted health care supplier.
- The health care supplier ought to have sensibly anticipated that mischief to the patient would emerge from the end of the care (proximate reason).
- The patient really endured mischief or misfortune because of the discontinuance of care.
Physicians, nurses, and other health care professionals have an ethical, and in addition a lawful, obligation to maintain a strategic distance from abandonment of patients. The health care professional has an obligation to give his or her patient all important consideration as long as the case required it and ought not leave the patient in a basic stage without giving sensible notice or making appropriate courses of action for the participation of another.
Abandonment by the Physician
At the point when a physician embraces treatment of a patient, treatment must proceed until the patient’s conditions never again warrant the treatment, the physician and the patient commonly agree to end the treatment by that physician, or the patient releases the physician. In addition, the physician may singularly end the relationship and pull back from treating that patient just on the off chance that he or she gives the patient legitimate notice of his or her expectation to pull back and a chance to get appropriate substitute care.
In the home health setting, the physician-patient relationship does not end only in light of the fact that a patient’s care moves in its area from the hospital to the home. On the off chance that the patient keeps on requiring medical administrations, administered health care, treatment, or other home health benefits, the going to physician ought to guarantee that he or she was legitimately released his or her-obligations to the patient. For all intents and purposes each circumstance ‘in which home care is affirmed by Medicare, Medicaid, or a safety net provider will be one in which the patient’s ‘requirements for care have proceeded. The physician-patient relationship that existed in the hospital will proceed unless it has been formally ended by notice to the patient and a sensible endeavor to allude the patient to another fitting physician. Something else, the physician will hold his or her obligation toward the patient when the patient is released from the hospital to the home. Inability to finish with respect to the physician will constitute the tort of abandonment if the patient is harmed thus. This abandonment may uncover the physician, the hospital, and the home health organization to obligation for the tort of abandonment.
The going to physician in the hospital ought to guarantee that an appropriate referral is made to a physician will’s identity in charge of the home health patient’s care while it is being conveyed by the home health supplier, unless the physician plans to keep on supervising that home care actually. Considerably more important, if the hospital-based physician masterminds to have the patient’s care expected by another physician, the patient should completely comprehend this change, and it ought to be carefully reported.
As upheld by case law, the kinds of activities that will prompt risk for abandonment of a patient will include:
- untimely release of the patient by the physician.
- disappointment of the physician to give legitimate guidelines previously releasing the patient.
- the statement by the physician to the patient that the physician will never again treat the patient.
- refusal of the physician to react to calls or to additionally go to the patient.
- the physician’s leaving the patient after surgery or neglecting to catch up on postsurgical care.
By and large, abandonment does not happen if the physician in charge of the patient orchestrates a substitute physician to assume his or her position. This change may happen in light of get-aways, movement of the physician, disease, separate from the patient’s home, or retirement of the physician. For whatever length of time that care by a fittingly prepared physician, adequately learned of the patient’s extraordinary conditions, assuming any, has been orchestrated, the courts will for the most part not find that abandonment has happened. Indeed, even where a patient decline to pay for the care or can’t pay for the care, the physician isn’t at freedom to end the relationship singularly. The physician should even now find a way to have the patient’s care accepted by another or to give an adequately sensible timeframe to find another preceding stopping to give care.
Albeit a large portion of the cases examined concern the physician-patient relationship, as pointed out beforehand, similar standards apply to all health care providers. Moreover, in light of the fact that the care rendered by the home health organization is given according to a physician’s plan of care, regardless of whether the patient sued the physician for abandonment due to the activities (or inactions of the home health office’s staff), the physician may look for reimbursement from the home health supplier.
ABANDONMENT BY THE NURSE OR HOME HEALTH AGENCY
Comparable standards to those that apply to physicians apply to the home health professional and the home health supplier. A home health office, as the immediate supplier of care to the home bound patient, might be held to the same legitimate obligation and obligation to convey care that tends to the patient’s needs just like the physician. Moreover, there might be both a lawful and an ethical obligation to keep conveying care, if the patient has no options. An ethical obligation may in any case exist to the patient despite the fact that the home health supplier has satisfied every single lawful obligation.
At the point when a home health supplier outfits treatment to a patient, the obligation to keep giving care to the patient is an obligation owed by the office itself and not by the individual professional who might be the representative or the temporary worker of the office. The home health supplier does not have an obligation to keep giving a similar medical caretaker, advisor, or helper to the patient over the span of treatment, inasmuch as the supplier keeps on utilizing proper, skilled staff to direct the course of treatment reliably with the plan of care. From the point of view of patient fulfillment and progression of care, it might be to the greatest advantage of the home health supplier to endeavor to give a similar individual expert to the patient. The advancement of an individual relationship with the supplier’s staff may enhance interchanges and a more prominent level of trust and consistence with respect to the patient. It should ease a large number of the issues that emerge in the health care’ setting.
In the event that the patient solicitations substitution of a specific medical caretaker, specialist, expert, or home health assistant, the home health supplier still has an obligation to give care to the patient, unless the patient additionally particularly states he or she never again wants the supplier’s administration. Home health office directors ought to dependably catch up on such patient solicitations to decide the reasons with respect to the expulsion, to recognize “issue” representatives, and to guarantee no episode has occurred that may offer ascent to risk. The home health organization should keep giving care to the patient until completely advised not to do as such by the patient.
Adapting to THE ABUSIVE PATIENT
Home health supplier work force may every so often experience an abusive patient. This manhandle chairman may not be an aftereffect of the medical condition for which the care is being given. Individual wellbeing of the individual health care supplier ought to be fundamental. Should the patient represent a physical peril to the individual, he or she should leave the premises promptly. The supplier should archive in the medical record the actualities encompassing the failure to finish the treatment for that visit as dispassionately as could be expected under the circumstances. Administration faculty ought to illuminate supervisory work force at the home health supplier and should finish an inward episode report. In the event that it gives the idea that a criminal demonstration has occurred, for example, a physical attack, endeavored assault, or other such act, this demonstration ought to be accounted for promptly to neighborhood law requirement organizations. The home care supplier ought to likewise instantly tell both the patient and the physician that the supplier will end its relationship with the patient and that an elective supplier for these administrations ought to be gotten.
Different less genuine conditions may, in any case, lead the home health supplier to discover that it ought to end its relationship with a specific patient. Illustrations may incorporate especially abusive patients, patients who request – the home health supplier professional to infringe upon the law (for instance, by giving illicit medications or giving non-secured administrations and gear and charging them as something unique), or reliably resistant patients. When treatment is embraced, be that as it may, the home health supplier is generally obliged to keep giving administrations until the point when the patient has had a sensible chance to get a substitute supplier. Similar standards apply to disappointment of a patient to pay for the administrations or hardware gave.
As health care professionals, HHA faculty ought to have preparing on the best way to deal with the troublesome patient capably. Contentions or enthusiastic remarks ought to be stayed away from. In the event that it turns out to be evident that a specific supplier and patient are not liable to be good, a substitute supplier ought to be attempted. Should it create the impression that the issue lies with the patient and that it is fundamental for the HHA to end its relationship with the patient, the accompanying seven stages ought to be taken:
- The conditions ought to be archived in the patient’s record.
- The home health provider should give or send a letter to the patient explaining the circumstances surrounding the termination of care.
- The letter should be sent by certified mail, return receipt requested, or other measures to document patient receipt of the letter. A copy of the letter should be placed in the patient’s record.
- If possible, the patient should be given a certain period of time to obtain replacement care. Usually 30 days is sufficient.
- If the patient has a life-threatening condition or a medical condition that might deteriorate in the absence of continuing care, this condition should be clearly stated in the letter. The necessity of the patient’s obtaining replacement home health care should be emphasized.
- The patient should be informed of the location of the nearest hospital emergency department. The patient should be told to either go to the nearest hospital emergency department in case of a medical emergency or to call the local emergency number for ambulance transportation.
- A copy of the letter should 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 with the home health provider’s risk manager, legal counsel, medical director, and the patient’s attending physician.
The inappropriate discharge of a patient from health care coverage by the home health provider, whether because of termination of entitlement, inability to pay, or other reasons, may also lead to liability for the tort of abandonment.
Nurses who passively stand by and observe negligence by a physician or anyone else will personally become accountable to the patient who is injured as a result of that negligence… [H]ealthcare facilities and their nursing staff owe an independent duty to patients beyond the duty owed by physicians. When a physician’s order to discharge is inappropriate, the nurses will be help liable for following an order that they knew or should know is below the standard of care.
Similar principles may apply to make the home health provider vicariously liable, as well.
Liability to the patient for the tort of abandonment may also result from the home health care professional’s failure to observe, examine, assess, or monitor a patient’s condition. Liability for abandonment may arise from failing to take timely action, as well as failing to summon a physician when a physician is needed. Failing to provide adequate staff to meet the patient’s needs may also constitute abandonment on the part of the HHA. Ignoring a patient’s complaints and failing to follow a physician’s orders may likewise constitute a tort of abandonment for a nurse or other professional staff member.