How to discontinue services and avoid abandonment
If you must discontinue services to a patient because of safety concerns, be sure you do so in a manner that doesn’t leave you liable for abandonment, says Elizabeth E. Hogue, Esq., a Burtonsville, MD, attorney. The following information will help you determine if the situation constitutes abandonment and what your agency can do to protect itself from charges of abandonment:
- Definition: Abandonment is unilateral termination of the provider or patient relationship by the provider without reasonable notice, when further attention is required.
- Patients must prove all of the requirements of this definition to prove abandonment. By the same token, providers must defeat only one of these elements to successfully defend against claims of abandonment.
- If the patient terminates the relationship, there is no liability for abandonment.
- There is no liability for abandonment when
the patient and the provider agree to terminate the relationship. Providers should seek mutual agreement when third-party payers will not pay for needed services by offering patients the option to private pay for such services. If patients decline to pay privately, providers should document their decisions. - Reasonable notice may be determined only by taking into account the facts and circumstances of individual cases. Factors to be considered include, but are not limited to, the patient’s physical and mental condition, the patient’s financial resources, the availability of alternate sources of care, what the patient wants, and whether supportive individuals are available to assist the patient. All factors related to termination of services should be considered at case conferences that include members of the treatment team. The results of case conferences should be documented.
- Providers should verbally notify patients of the decision to terminate services and the reasons for this decision and document that they have done so
- Providers also should verbally notify patients’ attending physicians and other providers and case managers, if applicable.
- Notice of termination should be given, in writing, and should be hand-delivered to the patient via a staff member, courier, messenger, or overnight delivery service. It is not necessary to obtain patients’ signatures verifying receipt.
- A copy of the notice of termination should be faxed to patients’ attending physician and other providers and case managers, if applicable.
- Throughout the notice period, providers should "spread the risk," which may include notifying protective services or initiating involuntary commitment proceedings.
- Whether further attention was needed is determined retrospectively based upon whether or not patients were injured as a result of the termination of care. Providers should rely upon their knowledge, judgment, and experience to predict whether patients are likely to be injured by termination of care.
(Editor’s note: Termination of Services: Avoiding Liability for Abandonment includes an in-depth analysis of abandonment and a complete set of policies and procedures to help case managers meet applicable standards of care and avoid liability for abandonment. To order, contact Elizabeth E. Hogue. The cost is $105 including shipping and handling.)
If you must discontinue services to a patient because of safety concerns, be sure you do so in a manner that doesnt leave you liable for abandonment, says Elizabeth E. Hogue, Esq., a Burtonsville, MD, attorney.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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