Plaintiff Ricks suffered a serious hand laceration that later became infected. He sought and received professional care from Dr. Budge and associates, thereby creating a physician–patient relationship. After providing initial treatment—including suturing and subsequent care as the wound showed signs of infection—the physicians admitted Ricks for continued observation and treatment. When Ricks fell behind on his account and could not promptly pay or provide security for the outstanding bill, the physicians refused to render further services and caused or directed his discharge from care without arranging substitute medical attention and without affording him reasonable time to obtain another provider, despite his still-infected condition. Ricks later secured treatment elsewhere, but by then the infection had advanced and an amputation was required. He sued, alleging that the defendants' withdrawal constituted negligent abandonment and that this abandonment proximately caused the progression of the infection and the ultimate loss of his limb. A jury returned a verdict for Ricks. The physicians appealed, challenging both duty and causation.
After undertaking treatment of a patient with an ongoing, serious medical condition, may a physician terminate services for nonpayment without reasonable notice and opportunity for the patient to secure other medical care, and, if so terminated, can the physician be held liable when the patient's worsened condition is proximately caused by the abandonment?
Once a physician–patient relationship is formed, the physician owes a duty to continue necessary care so long as the patient requires attention for the condition undertaken, unless the physician withdraws after giving reasonable notice and a reasonable opportunity for the patient to obtain substitute care (or until the patient's condition is stabilized so that withdrawal will not endanger the patient). Abrupt cessation of services in the face of a continuing need constitutes abandonment and a breach of the physician's duty; if the abandonment is a proximate cause of the patient's subsequent injury, the physician is liable for malpractice.
The Utah Supreme Court held that physicians who had undertaken Ricks's care could not lawfully abandon him without reasonable notice and opportunity to obtain other medical assistance while his condition still required treatment. The evidence supported a finding of abandonment and proximate causation of the ensuing harm. The judgment for the plaintiff was affirmed.
The court began by distinguishing between the absence of a general duty to accept a patient and the duty that arises once a physician has undertaken treatment. By providing care, the defendants formed a physician–patient relationship and assumed a continuing obligation commensurate with the patient's ongoing medical needs. Although a physician may withdraw for legitimate reasons—including nonpayment—the withdrawal cannot be effected in a manner that unreasonably endangers the patient. The court emphasized that reasonable notice and an opportunity to secure substitute care are essential preconditions to termination, particularly when the patient's condition, like a spreading infection, requires prompt and competent attention. On breach, the record showed that defendants demanded immediate payment or security and, upon the patient's inability to comply, refused further care and precipitated his discharge without arranging a transfer or providing adequate time to find another provider. Given the still-active infection, this constituted abandonment. On causation, the court reasoned that it was foreseeable that untreated or insufficiently managed infection could rapidly worsen and lead to severe consequences, including amputation. The jury could permissibly infer that, had defendants continued necessary care or facilitated a timely transfer, the harm likely would have been averted or diminished. The patient's poverty did not break the causal chain, nor did his departure, where it was prompted by the physicians' withdrawal. Questions of proximate cause in such circumstances are properly left to the jury, and sufficient evidence supported the verdict. Finally, public policy supports the rule: disputes over fees can be resolved through civil collection remedies, whereas precipitous withdrawal from a patient in need risks grave, irreversible injury. Professional standards and the common law align in requiring physicians to either continue treatment until it is safe to stop or to withdraw only with reasonable protective measures for the patient.
Ricks v. Budge is a leading case on physician abandonment. It complements Hurley v. Eddingfield by illustrating the flip side of the no-duty-to-accept principle: once treatment begins, physicians assume a duty not to withdraw in a way that endangers the patient. The case is frequently taught to demonstrate how duty arises from a voluntary undertaking, how breach can take the form of abandonment, and how proximate cause may be inferred from the foreseeable progression of medical conditions left untreated. It also serves as an early common-law analogue to later statutory stabilization mandates and ethical rules, making it a useful springboard for discussions of modern healthcare obligations.
Ricks v. Budge anchors a core principle of medical malpractice: once a physician undertakes a case, the physician must not terminate care in a manner that exposes the patient to unreasonable risk. The duty to provide reasonable notice and an opportunity for substitute treatment operationalizes this principle and ensures that financial disputes do not eclipse immediate patient safety.