Liability for nursing home care
The standard of care doesn't require you to provide or refer patients only to perfect facilities.
Call or visit the nursing home's medical director or staff physician to discuss your patient's care.
Abandonment means ending the doctor-patient relationship before treatment is finished.
Q: As my patient population ages, I've admitted several people to a local nursing home, but I have serious concerns about the quality of care there. Nevertheless, I've advised them to continue their care under the home's staff physician. Is that considered abandonment? Do I need to dismiss those patients first? What are my obligations to them?
A: If you use good judgment now, and do a little follow-up later, you should be clear of liability for both abandonment and malpractice.
Not every medical facility or nursing home is perfect. But the standard of care doesn't require you to provide or refer patients only to perfect facilities. It simply requires that you make your best judgment of the medical facilities available at that time in your location. Is there a better nursing home that's within a reasonable distance, even if it costs more? If so, you should explain the advantages and disadvantages of each one, including your opinion of the medical care they provide.
If the patient doesn't have the capacity to understand or make an informed choice about the options, discuss them with her family or her legal representative, and have them sign the consent form. Their participation in the consent process should help protect you if something goes wrong at the nursing home.
Most states require the nursing home's medical director or staff physician to do an intake exam and make periodic reports on each patient. Unfortunately, this requirement is sometimes viewed as a formality, and many patients fall by the wayside. For that reason alone, your ongoing consultation regarding the patient's continuing care may be essential.
You could call or visit the nursing home's medical director or staff physician to discuss your patient's care. If ongoing treatment is needed, he may call you in for a consult. Even if such treatment isn't necessary, let him know that you're interested and available. Make sure you document such visits and discussions in the chart.
Abandonment means ending the doctor-patient relationship before treatment is finished. If you stopped treatment in a continuous care situation because your patient entered a nursing home, or if you failed to follow up on outstanding lab or test results, you could be found liable for abandonment. For example, if you've been treating a patient on dialysis for kidney failure, you may be responsible for seeing that that treatment is continued after admission to the nursing home.
If you're convinced that the patient's care at the nursing home is negligent, or jeopardizing her health, your duty could extend to presenting the matter to the home's administration, or to the state medical board. But don't document that opinion in the patient's chart. If the patient suffers an injury at the home, your written opinion could become evidence of your failure to take appropriate action to protect her.
If you have real concerns about the patient's treatment at the home, you should also express them to the patient or her family. But don't voice a gratuitous complaint since that could foment an unnecessary lawsuit in which you could be named, as well.
Lee Johnson. Malpractice Consult: Liability for nursing home care. Medical Economics Aug. 6, 2004;81:68.