Wednesday, December 31, 2008

It is illegal & unethical to abandon a patient

To all of those lay and medical profession advocates for the patients:

I feel the need to write this because some hospitalists on a great site (The Happy Hospitalist) actually think they can abandon a patient because they are annoyed by the patient. Good grief.

It is illegal and unethical to abandon a patient. Period. Advocates should not feel intimidated from asking a million questions and demanding proper care from the medical care provider. Any medical care provider that cannot handle that (especially when the patient is in need of continuing medical care) is frankly and IMHO not much of a doctor. (In my case, read: Duke's Dr. Alison Toth.)

I simply asked Dr. Alison Toth to explain why the Duke anesthesiologist (that Toth referred me to for diagnostic tests) said it was wrong to cut a nerve in the leg. Cutting that nerve was precisely what Toth wanted to do to me. I would have been an uninformed patient if I did not get the question answered.

With my most sincere thanks to the law firm of Gilliland & Markette in Indianapolis, Indiana, I provide my readers with the following article:

A health care provider may decide to terminate services to a patient for any one of a variety of reasons. Although terminating services to a patient is certainly a significant and undesirable event, it is legally permissible if the provider carefully follows certain steps before discontinuing services. If the physician fails to follow these steps, that physician may find himself liable to the patient based on the theory "abandonment" if the patient alleges he or she suffered injury because the provider terminated services without sufficient notice.

A provider may want to quit providing services to a patient for many reasons, including:

∑ The patient refuses to cooperate with the provider and its staff.

∑ The patient will not pay his or her bills.

∑ The patient is unruly and obnoxious to the point where it is in the best interests of all concerned for the provider to quit providing services.

∑ Reimbursement for services has been denied or the provider has ceased to be a Medicare or Medicaid provider.

∑ Environmental factors exist which endanger the provider's staff (e.g., physical threats, a dangerous dog, sexual harassment).

A medical care provider must not "abandon" a patient.

Abandonment generally means a unilateral severance of the professional relationship between a health care provider and a patient without reasonable notice at a time when there is still a need for continuing health care.

Court decisions involving patient abandonment generally deal with abandonment by physicians but are instructive for other medical care providers. Still, the legal principles established by those cases are instructive for other providers. A long-standing case interprets Ohio law in 1965. Therein the United States District Court for the Northern District of Ohio quoted an earlier Ohio decision which stated:

"....although a patient may, in the absence of an agreement to the contrary, discharge a physician at any time, before a physician or surgeon can withdraw from the case, it is necessary for him to give reasonable notice to the patient in order that another physician may be procured, the character of the services of the physician and his relation to the patient being such that he is not permitted under the law to arbitrarily quit the services at any time without any cause, and leave his patient without medical attendants."

Three elements must exist for patient abandonment to occur:

1. The termination of services must be unilateral, i.e., not by mutual agreement.

2. The termination must occur without reasonable notice, meaning notice adequate to give the patient a sufficient opportunity to secure alternative care; and

3. The termination must occur when there is still the necessity of continuing care.


Because the issue of patient abandonment arises in a situation in which the health care provider, itself, desires to unilaterally terminate services at a time when there is a need for continuing care, the key to avoiding patient abandonment is to give reasonable notice of the termination of services. The underlying rationale is that reasonable notice affords the patient time to secure alternate care and the patient therefore is not "abandoned." If reasonable notice is given, that critical second element for patient abandonment does not exist.

The following steps are generally expedient when a medical care provider feels compelled to discontinue services to a patient:

(1) Examine the Patient's Records

First, the patient's records should be carefully examined to determine the degree of need, if any, for continuing care and the availability of other sources of care, i.e., other providers.

If a patient is in the midst of ongoing care by the provider and is unable to find comparable care or has not been given adequate notice of the provider's intention to discontinue services, then the provider should not discontinue services without pursuing the remainder of these steps.

(2) Notify Attending Physician

Second, assuming the provider is not the patient's physician, the patient's attending physician should be notified in writing of the problems the provider is experiencing with the patient and that it is the provider's intention to stop providing services.

The physician may be able to intervene to correct the problem or to assist the patient in finding another provider that will provide services comparable to those provided by the provider terminating services.

(3) Give Reasonable Notice to the Patient

Third, the patient, or those responsible for the patient's care, should be notified in writing as to the date the services will end, the reason or reasons for the action and the ways in which the provider will assist the patient in securing appropriate services elsewhere.

The letter should advise the patient that the medical care provider will make available to the patient, and other providers retained by the patient, copies of all medical records and other information relating to the patient. This helps in maintaining continuity of care for the patient.

It also could be useful for the letter to give the names, addresses and telephone numbers of other providers in the area that would be available to provide services to the patient.
Contrary to what some hospitalists and clinic physicians believe, a medical care provider cannot simply dump or abandon a patient.

The letter should be sent by certified mail, return receipt requested, so the provider can prove the letter was received by the patient or the responsible party. A copy of the letter should be sent to the patient's physician as well. A copy of the letter and the return receipt should be kept in the patient's records.

This notice must be received by the patient far enough in advance of the date services will terminate to give the patient sufficient time to secure alternate care, i.e. it must be "reasonable". How far in advance will be held to be reasonable will depend upon the facts of each case including the patient's condition, the availability of other providers, the ramifications if alternate care is not secured, and the reason for termination of services.

Remember, the patient is the person who is in need. take a deep breath and confront the doctor who intimidates you. Then, IMHO, contact the hospital or clinic administration and the physician's accreditation boards.

If doctors who abandon patients are board certified then their certification should be in jeopardy ---- the same way as the physician carelessly and without consideration places patients' safety in jeopardy.

Shame on these doctors.

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