TERMINATION OF SERVICES:
HOW CASE MANAGERS CAN COMPLY WITH NATIONAL STANDARDS OF CARE AND
AVOID LIABILITY FOR ABANDONMENT
by Elizabeth E. Hogue
2003
According to revised national standards of care published by the Case Management Society of America (CMSA) in 2002, case managers must take certain steps in order to appropriately terminate case management services. When case managers follow these steps they are likely to achieve compliance with national standards of care and practice effective risk management in order to avoid liability for abandonment:
1. Definition - Abandonment is: Unilateral termination of the case manager/patient relationship by the case manager without reasonable notice, when further attention is required.
2. Patients must prove all of the requirements of this definition in order to prove abandonment. By the same token, case managers must defeat only one (1) of these elements in order to successfully defend against claims of abandonment.
3. If the patient terminates the relationship, there is no liability for abandonment.
4. There is no liability for abandonment when the patient and the case manager agree to terminate the relationship. Case managers should seek mutual agreement when third-party payors 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.
5. 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 relevant to termination of case management services should be considered at case conferences that include case managers' supervisors. The results of case conferences should be documented.
6. Case managers should verbally notify patients of the decision to terminate services and the reasons for this decision and document that they have done so.
7. Case managers should also verbally notify patients' current providers.
8. Notice of termination should be given in writing and should be hand-delivered to the patient via a staff member, courier, messenger or via overnight delivery service. It is not necessary to obtain patients' signatures verifying receipt.
9. A copy of the notice of termination should be faxed to patients' current providers.
10. Throughout the notice period, case managers should "spread the risk," which may include notifying protective services or initiating involuntary commitment proceedings.
11. Whether further attention was needed is determined retrospectively based upon whether or not patients were injured as a result of the termination of care.
Case managers should rely upon their knowledge, judgment, and experience in order to predict whether patients are likely to be injured by termination of care.
Copyright, 2003. Elizabeth E. Hogue, Esq. All rights reserved.
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