After the therapist explained that the tasks fell outside the scope of her expertise, the patient made a veiled threat to her safety. Following the incident, Babich says, the therapist made an immediate call to her supervisor, who then contacted the patient to address where the dissatisfaction lay, discussed what could be done to resolve it, and conveyed the agency's stance that if the threatening behavior continued, services would be terminated. Asked whether she had the right in that situation to leave the scene without being liable for patient abandonment, certainly the answer is yes. There is no obligation on the part of a therapist to carry out treatment under danger of death or bodily harm. One factor to consider is the mental acuity of the patient.
Patient abandonment is a problem that has been ballooning under managed care.
There has been a lot of prominent case law in this area, as well as admonitions by judges that not only third-party payers will be held liable, but also providers who bear primary responsibility. In the case of a patient with limited cognition, some sort of team-generated remedy to eliminate the behavior while maximizing safety during treatment would be more appropriate than just terminating care. Babich recalled a case in which a patient suffering from Alzheimer's disease began swearing at him and hurling racial threats at a home health aide. Babich has sharpened his skills dealing with patients with Alzheimer's. He maintains a calm demeanor, doesn't raise his voice and attempts to quell or redirect any agitated behavior.