Let’s face it: There are some circumstances where you can no longer provide the care your patient needs. But while you may want or need to end the relationship, it’s not always easy. In some cases, you might get cited for patient abandonment. So how exactly can you legally and ethically dissolve a patient-provider relationship? Here’s what you need to know about “breaking up” with patients, and how to do it the right way.
What Is Patient Abandonment?
In the most general sense, patient abandonment — also formally known as “medical abandonment” — is a form of medical malpractice where a healthcare professional terminates a patient relationship without properly informing the patient and finding acceptable replacement care for them.
What Constitutes Patient Abandonment?
Edie Brous, a New York-based attorney and registered nurse, says the specific definition of patient abandonment varies by state. An expert in litigation and transactional matters affecting nurses, Brous says that, in general, there are four elements that must be demonstrated to legally prove patient abandonment:
- There must be an existing patient-provider relationship.
- The provider must unilaterally sever that relationship.
- The patient still requires the services of the provider.
- The provider cannot make provisions for another qualified provider to take over the patient’s care.
For nurse-patient relationships in particular, it’s important to note that the relationship does not have to be instituted only within a workplace. A nurse-patient relationship could be created, for instance, when a nurse volunteers their services outside of a work environment.
In a civil lawsuit, another important factor is whether the patient suffered an injury as a direct result of the alleged abandonment, says Brous. Take this hypothetical example: A nurse dismisses a patient from home care visit rotations without informing her or transferring her care to another nurse. The patient then suffered an infection in her leg wound as a direct result of not being cared for. Such an injury would almost certainly be determined to have been caused by patient abandonment. That said, it’s important to remember that patient abandonment is considered to be professional misconduct and can be disciplined, even if the patient is not directly injured.
To make matters even more complicated, different states, professions, and specialties have varied thresholds for what constitutes “patient abandonment.” A doctor, for example, generally has to be actively treating a patient and must sever the relationship without transferring care in order to establish patient abandonment. In contrast, nurses in many states have a much lower threshold for what is considered abandonment. A nurse only must have entered into a nurse-patient care relationship (not necessarily “actively treating”) and severed that relationship without giving reasonable notice to a supervising professional to ensure that the patient will be cared for.
External factors not directly in the nurse’s control are also considered when determining if a patient has been abandoned. For instance, if a hospital doesn’t provide adequate staffing for a nurse to properly care for her patients, she may not be legally responsible for patient abandonment. State laws define what constitutes patient abandonment for each healthcare profession, so you’ll want to keep yourself up-to-date on the state laws for your field.
What Is Not Patient Abandonment?
In a legal sense, it would not be considered patient abandonment if any of the following conditions apply:
- You, as the healthcare professional, are dismissed by the patient.
- You, as the healthcare professional, and the patient mutually agree to dissolve your relationship.
- You find adequate replacement care for the patient and inform them of the new care, with the patient’s agreement.
- You are removed from the patient’s care by a supervisor.
- Your care relationship with the patient comes to a natural end (e.g., the patient is discharged).
- The patient does not comply with care policies, procedures, or otherwise acts inappropriately toward the practice or provider.
Can a Hospital Discharge a Patient Without Their Consent?
Whether a hospital can discharge a patient without the patient’s consent depends entirely on the circumstances, Brous says.
“Patients have the right to challenge a discharge if they consider it premature,” Brous says. “But remaining in the hospital when hospitalization is no longer necessary causes other problems for the facility, such as resource management, ED patients awaiting inpatient beds, increased costs, greater risk of hospital-acquired problems, etc.”
The discharging provider needs to understand why the patient wants to stay after the provider thinks they are medically cleared to depart, Brous says. The patient might just need to be educated about realistic expectations and the plan of care if they don’t understand that they are medically cleared to leave. As one study points out, there may be many different reasons a patient would be motivated to try to stay, such as inadequate post-discharge arrangements or mental health issues that would lead them to inappropriately challenge medical advice.
The study also notes that after consulting with the entire medical team, including the legal and ethical departments of a hospital, a physician may turn to security to help a patient leave. Or, the patient may elect to stay, knowing that his or her insurance may not cover any costs incurred after being medically cleared for discharge.
What Are the Consequences of Patient Abandonment?
Brous explains that some of the consequences of patient abandonment can include civil lawsuits (i.e., the patient or the family sues you), licensure discipline (i.e., from your licensing board), and even criminal prosecution (i.e., if the severity of the abandonment is deemed a crime), depending on the situation. Which of the three you will face — and in some cases, you could see all three — depends totally on the circumstances, she says. Brous says if you’re charged with a civil lawsuit for abandoning a patient, you will not face jail or fines, which are reserved for criminal matters. If your case is escalated to a criminal lawsuit, however, you could be sued and face both jail and monetary fines, as the other party will seek payment for damages.
Real-Life Examples of Patient Abandonment & Their Consequences
Wondering what exactly this looks like in real life? Here are two examples of real cases of healthcare professionals who were charged with patient abandonment.
Example #1: Miller v. Tennessee Board of Nursing, 256 S.W.3d 225 (Tenn. Ct. App.2007)
In this case, an RN was charged with leaving her patients on a hospital medical/surgical unit before her shift was over. She was ordered to pay a $1,000 civil penalty and had her nursing license suspended, pending a psychological evaluation to determine if her mental health played a role in her ability to care for patients. After a lengthy trial, it was eventually determined that her license would be reinstated because the Division of Health Related Boards of the Tennessee Department of Health did not follow proper protocol with the notice of charges they provided her. Specifically, the division’s “notice did not fairly appraise Ms. Miller that the Division was seeking either the revocation or the suspension of her nursing license.” On top of that, the division also wasn’t able to provide evidence that Miller was “mentally incompetent.”
Example #2: Tierney v. University of Michigan, 669 N.W.2d 575 (Ct. App. Mich.2003)
In this case, a patient brought a claim of patient abandonment against two doctors in a practice. The patient alleged that she had a miscarriage as a result of negligent treatment by one doctor in the practice. When she became pregnant again, she was scheduled for a cerclage procedure with the second doctor. However, Doctor #2 refused to perform the procedure, citing the patient’s lawsuit that she’d filed against his colleague, Doctor #1. However, Doctor #2 did refer her to a third doctor. The patient underwent the cerclage four days later but still had another miscarriage. In the end, the court found that patient abandonment had not occurred because Doctor #2 had not entered into a relationship with the patient, had referred her on appropriately, and the patient’s experience was not a direct result of his actions.
How to Break Up With Patients the Right Way
According to All Law, a healthcare professional-patient relationship can be legally ended in one of three ways:
- The healthcare professional and the patient mutually agree to end the relationship.
- The patient decides to leave the healthcare professional’s care.
- The health professional terminates the relationship after giving the patient written notice and a reasonable amount of time to find another provider, with referrals as appropriate, and consulting with legal expertise as necessary to ensure the termination is done correctly.
However, the best practices for “breaking up” with a patient will depend on the patient and provider’s specific circumstances. A healthcare professional should also seek professional legal advice before ending a patient relationship to ensure that no steps are missed for that individual circumstance. Brous recommends that if any nurse or other healthcare professional wants to discontinue an established relationship with a patient, they should do what they can to make sure the patient is not left without care. Additionally, she advises that the professional seek legal advice before doing so. Most importantly, Brous recommends that the provider take steps to ensure that the patient is aware that the professional relationship is ending, actively document that the relationship is ending, and confirm that the patient is under new care before permanently severing the relationship.
Disclaimer: This article is meant for educational purposes only and should not be taken as legal advice. Always consult with your own legal professional before taking any actions that could affect your career.