A patient will often visit a doctor at a fairly distressing time, often at the height of the patient's vulnerability. As a result, a doctor may harm a patient merely by declining to provide treatment or by ceasing the provision of care before it is medically reasonable to do so.
A doctor's abandonment of a patient who is in need of care can give rise to a medical malpractice lawsuit. This article discusses the applicable laws, as well as how patients must prove their medical malpractice cases when they have been harmed by a doctor's failure to treat.
If a patient arrives at a hospital in the midst of an emergency health issue, federal law requires the hospital to treat the patient, regardless of the patient's ability to pay and other factors such as the patient's citizenship or immigration status. This law is called the Emergency Medical Treatment and Active Labor Act.
According to the act, when the patient arrives at the ER or urgent care center, the hospital must determine whether the patient's condition constitutes an emergency. If it does, the hospital must make all reasonable efforts to stabilize the patient. If a hospital fails to comply with the act, the patient may sue the hospital for both the monetary equivalent of the harm caused by the failure, and for an additional penalty of up to $50,000.
When the Emergency Medical Treatment and Active Labor Act (discussed above) does not apply, a patient may still have a case for abandonment under general medical malpractice rules. In order to win such a case, a patient must prove the basic elements necessary to win any medical malpractice case:
In the sections below, we'll describe some common patient abandonment fact patterns and then take a closer look at how the elements of a malpractice case apply to those fact patters.
A doctor might simply forget about a patient or the patient might become "lost in the system" due to a computer glitch. In some cases, doctors have argued that they should not be held liable for abandoning a patient because there was no intent to abandon. This argument has failed almost without exception because a doctor has a duty to continue treatment of a patient until the patient is properly released. The only difference between an intentional and an inadvertent abandonment case is that punitive damages might be available in a case where there is evidence of an intent to cause harm.
Once a doctor initiates treatment of a patient, the doctor must not only terminate care at a proper time, but also in a proper manner. If a doctor transfers a patient to the care of a second doctor, the second doctor may not be familiar with crucial details of a patient's care. So, the first doctor has an ongoing obligation to provide the second doctor with proper instructions and all relevant records (treatment notes, test results, etc.). Failure to do so could rise to the level of medical malpractice.
A doctor cannot terminate care of a patient when the patient is at a critical stage of treatment, solely because the patient is unable to pay for the care. However, if the patient is in a stable condition and is given ample warning of the termination, a doctor may be able to stop treatment. For example, in a 1989 case in Iowa called Surgical Consultants, P.C. v. Ball, a patient had gastric bypass surgery and suffered abscesses afterwards. She sought treatment from the operating physician, who saw her 11 times post-surgery but then refused to continue seeing her because she had not paid her bill. This was not considered abandonment because the patient was not considered to be at a critical stage of treatment.
A doctor can be liable for medical malpractice when he or she fails to provide treatment that meets the applicable standard or care, and the patient is harmed as a result of that failure.
The "medical standard of care" is a legal concept that refers to the type and amount of care that a similarly-skilled and trained doctor would have provided under the circumstances. In abandonment cases, standard of care basically boils down to the question, "Would a reasonable doctor have terminated the doctor-patient relationship at the same point in treatment, and in the same way?"
In the vast majority of cases, establishing the answer to this question requires testimony from an expert medical witness. The patient (usually through an attorney) consults a doctor who specializes in the relevant field, and the doctor offers an opinion as to the proper procedures to follow when deciding whether to terminate care in cases like the patient's -- and if the proper decision is to end care, the expert will also set out the appropriate way to go about ending the doctor-patient relationship under the circumstances.
The next step is to prove that the defendant doctor breached the standard of care. What should the doctor have done, and what was actually done? For example, if the standard of care required the doctor to refer the patient to a specialist before terminating the doctor-patient relationship, failure to do so would constitute a breach of the standard of care. The expert's opinion comes into play at this stage as well, painting a picture of how the care provided was sub-standard under the circumstances.
In order to win a medical malpractice lawsuit, the patient must prove that the doctor's negligence caused foreseeable harm. This harm can take many forms, including:
The critical issue in these cases is usually whether the abandonment actually caused the harm suffered by the patient. If abandonment occurs and a patient dies, but it turns out that the patient had an acute health condition that was both untreatable and incurable, it may be difficult to show how the patient was harmed through the abandonment.
An expert's opinion can be used in this situation as well, to show that the patient would have at least been made more comfortable and as stable as possible had the abandonment not occurred. On the other hand, if treatment would have had a significant chance of sustaining the patient's life, the family would probably have a more clear-cut case of medical malpractice case against the doctor.