## Facts

- Silas Ricks injured the middle finger of his right hand on barbed wire, developing swelling and infection.
- Ricks was treated at a hospital by Dr. S.M. Budge, who incised and drained the finger and provided inpatient care from March 11–15, 1935.
- During hospitalization, Ricks improved with customary treatment; he left the hospital on March 15 against Dr. Budge’s advice.
- At discharge, Dr. Budge instructed Ricks to continue home treatment and return if the condition worsened.
- On March 17, Ricks’s condition worsened; Dr. D.C. Budge examined him and directed him to go to the hospital for further care.
- After Ricks arrived at the hospital and was placed in a room, Dr. S.M. Budge allegedly refused to treat him unless Ricks paid an unrelated prior account.
- Ricks left and went to another hospital, where a different physician determined he needed immediate surgery and operated.
- Ricks ultimately underwent amputation of part of his finger/hand.
- Ricks sued the Budge physicians for (1) negligent treatment and premature discharge, and (2) refusal to treat and abandonment on March 17.
- The trial court directed a verdict for defendants on both claims after plaintiff’s evidence.

## Issues

1. Whether the evidence was sufficient to submit to the jury a malpractice claim for negligent treatment and premature discharge during the March 11–15 hospitalization.
2. Whether a physician–patient relationship existed on March 17 such that defendants owed a duty to continue treatment absent proper termination.
3. Whether refusal to treat an existing patient because of an unpaid, unrelated bill could constitute wrongful abandonment and, if so, whether causation and damages were for the jury.

## Decision

- The directed verdict for defendants was affirmed on the negligent-treatment/premature-discharge claim.
- The directed verdict for defendants was reversed on the refusal-to-treat/abandonment claim, and the case was remanded for a new trial on that claim.
- The court held that the evidence permitted a finding that the physician–patient relationship continued through March 17 and that refusal to treat for nonpayment could breach the duty of continued care.
- The court held that whether the refusal and resulting delay caused additional harm, including amputation, presented a jury question.
- A partial dissent agreed abandonment evidence existed but would have found the proof of resulting damages insufficient to reach the jury.

## Legal Principles

- A physician who undertakes treatment must continue providing necessary care unless the service is properly terminated.
- The duty of continued care may be terminated only by (1) cessation of the medical necessity giving rise to the relationship, (2) discharge of the physician by the patient, or (3) the physician’s withdrawal after reasonable notice allowing the patient to obtain other medical attention.
- Wrongful abandonment may occur when a physician refuses to provide continued care at a critical stage without sufficient notice and without enabling substitute care.
- On review of a directed verdict for a defendant, the evidence must be viewed in the light most favorable to the plaintiff.

## Conclusion

The court rejected liability for the physicians’ initial treatment and discharge where the patient improved and left against medical advice, but held that a physician who has established an ongoing treatment relationship may not refuse needed care based on an unpaid, unrelated account without properly terminating the relationship; whether such refusal caused additional injury was for the jury.


Ricks v. Budge, 91 Utah 307, 64 P.2d 208 (Utah 1937)