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Toni Talks about PT Today

Patient Abandonment

Published December 31, 2008 8:15 AM by Toni Patt

The hot topic at lunch this week was the definition of patient abandonment.  We all agreed that it involved leaving a patient who needs therapy without it.  What we can't agree on is at what point does the abandonment occur?

Taken to an extreme it could mean someone who doesn't see all the patients on caseload and makes no arrangements for someone else to do so had committed abandonment.  It could also refer to a therapist leaving a facility without another therapist available to assume the caseload.  I think this is the definition that most frequently comes to mind.

Our scale is much smaller.  Our question is if someone misses work without calling in and no additional coverage is available... is that abandonment?  That happened last weekend.  A PT who was on the schedule didn't come in and couldn't be reached by phone.  He had a caseload assigned to him.  When we realized he wasn't coming the caseload was divided among everyone else.  As a result not everyone on caseload received therapy that day.  If the PT had come to work it could reasonably be assumed all the patients would have been seen.

One side of the debate says yes, that was abandonment.  He left those patients without making arrangement for them to receive therapy.  Because he didn't come to work some of those patients weren't seen.  The opposite side says no, it was poor judgment and not responsible behavior.  It wasn't abandonment.  The PT knew there would be others present to treat those patients.  One individual thinks we should contact our state board and report him so that disciplinary action can be taken.

What that PT did was definitely wrong.  There is no excuse for him to just not show up for work.  Disciplinary action of some kind is appropriate.  In this case, I think the facility is more likely than the PT Board to take action.  The question still remains.  Is what he did considered patient abandonment?  If it isn't, what is considered abandonment?  I'm on the side of very wrong but not abandonment.  To me abandonment implies something more permanent like the example of leaving before a replacement is hired.  This isn't the first time patients have been missed because of staffing issues and won't be the last.  The discipline should be for the no call, no show and not abandonment. 

This has made me start thinking about what would be considered abandonment.  Several years ago I worked for a large hospital.  They were notorious for lacking adequate weekend staffing.  Some patients weren't seen again until Monday because there weren't enough people.  Some of my co-workers felt that was abandonment.  The staffing level was a decision on the part of manager who knew patients were being missed.  Is that abandonment?  What about a facility that suddenly loses a PT?.    The remaining PTs would be expected to pick up the slack.  In that situation it's reasonable to assume some patients would be missed.

Maybe the question isn't what constitutes abandonment.  Maybe the question is at what point is a disciplinary action necessary and at whom?  Is it the therapist who left?    The remaining ones trying to take up the slack?   Or the facility for allowing it to happen?  It isn't fair to discipline the therapists with expanded caseloads.  They are trying to see everyone.  Is it fair to discipline someone who gives adequate notice before resigning?  Should the facility be punished because it can't find a replacement?   If these are the standards a lot of PTs and facilities are in trouble. 

Prior to writing this I checked the Texas PT Board Rules.  I couldn't find anything that specifically addressed the issue of patient abandonment.  I couldn't even find a definition of what is considered abandonment.  I checked the APTA website with the same result.  I found statements addressing ethical treatment.  I found statements concerning how a therapist goes about providing care.  I found statements forbidding patient endangerment.   If current healthcare trends continue this problem isn't going to go away.  If anything, as staffs are cut to save money the problem with exacerbate.  What is a debate now could become a reality in the future.

4 comments

What about if an insurance company refuses to pay for needed treatment?  No arangements can be made because there is no money to pay.  Is this not patient abandonment?  When a patient is discharged prematurely because of money, Is this not abandonment?

Michael, PTA - Student August 3, 2011 6:02 PM
Cincinnati OH

Very well said. I for no reason considered I would agree with this thoughts and opinions, however I’m starting to view things from a different view. I have got to research much more on that as it would seem really exciting. One issue I don’t understand though is how almost everything is associated together.

Matthew Silva February 19, 2011 7:55 AM
New Paltz NY

...yet again, Toni...another interesting post.

I agree with you, abandonment is the actual TERMINATION of a patient caregiver relationship without adequate follow-up.

I found the following regarding legal definitions of patient abandonment:

"Medical abandonment results when the caregiver-patient relationship is terminated without making reasonable arrangements with an appropriate person so that care by others can be continued."

"Abandoning or neglecting a patient or client under and in need of immediate professional care, without making reasonable arrangements for the continuation of such care, or abandoning a professional employment by a group practice, hospital, clinic or other health care facility, without reasonable notice and under circumstances which seriously impair the delivery of professional care to patients or clients."

www.definitions.uslegal.com

I think one of the things we should consider is:

"in need of immediate professional care"...it makes me think, is what we do really of an "immediate" need.  Sure, what we do is important, but I've yet to hear of anyone who died or had a complication due to one missed day of therapy.

Definetely irresponsible, but I would not consider abandonment.

Christie, Physical therapist January 1, 2009 8:34 PM
Streamwood IL

Toni,

Willful neglect comes to mind with abandonment.  However, if I close a curtain for a patient to get dressed or to use the restroom It could be considered abandonment especially if the patient fell or recieved an injury while I was not with them.

Abandonment is something lawyers fight about in court and I would not be surprised if we see more lawsuits based on this.  Abandonment also has to do with time frames.

If I leave a patient in the bathroom for one minute to transfer another patient did I abandon the first.  What if I left for 10 minutes, or 1/2 hour?  Definitions of abandonment are difficult to address.  

As far as a no show - this should be dictated in the P and P manual.  State boards can be called, investigations done, but in reality the PT could say they had a family emergency which superseded patient care.  And if there were others to treat the patients why wasn't everyone seen?  Could a PT/PTA stay an extra 1/2 hour to an hour to see everyone and is the facility willing to pay overtime for this?

And, every facility should have a per diem list.  Why weren't your per diem therapists called?  This seems more like a management problem that everyone was not seen.  No therapist was at fault if the facility is not willing to take some action to ensure patients are cared for.  

Karen January 1, 2009 1:01 PM

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