Master Utah Supreme Court holds that a physician who has undertaken treatment may not abandon the patient without reasonable notice and opportunity to secure substitute care, and may be liable when such abandonment proximately causes injury. with this comprehensive case brief.
Ricks v. Budge is a landmark medical malpractice decision that crystallizes the common-law doctrine of physician abandonment. The case sits at the junction of tort and contract principles governing the physician–patient relationship: while a doctor is generally free to decline to form such a relationship in the first instance, once the doctor undertakes treatment, a duty arises to continue care or to withdraw only in a manner that does not unreasonably endanger the patient. Ricks articulates the contours of that duty, emphasizing that withdrawal for nonpayment cannot occur abruptly and without reasonable notice when the patient's condition requires continuing medical attention.
For law students, Ricks is a staple in torts and professional responsibility courses. It contrasts sharply with the no-duty-to-treat rule of Hurley v. Eddingfield and illustrates how duty, breach (abandonment), causation, and damages play out in a professional negligence context. The decision also foreshadows modern stabilization requirements and ethical norms by insisting that economic disputes over fees must yield to the immediate safety of the patient.
Ricks v. Budge, 91 Utah 307, 64 P.2d 208 (Utah 1937)
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.
Hurley holds that a physician has no general duty to accept a stranger as a patient. Ricks addresses the next step: once a physician undertakes treatment, a duty arises not to abandon the patient without reasonable notice and opportunity to secure substitute care. Thus, no initial duty to accept, but a robust duty to withdraw safely after acceptance.
Reasonable notice is context dependent. The physician must give the patient sufficient time, given the urgency and complexity of the condition, to arrange alternative care and should provide necessary information to facilitate transfer. In emergencies or with rapidly evolving conditions, the physician must continue care until the patient is stabilized or a suitable substitute provider has affirmatively taken over.
Yes, but not abruptly and not in a way that endangers the patient. Nonpayment is a legitimate ground for withdrawal only if the physician provides reasonable notice and a reasonable opportunity to secure other care (or continues until it is medically safe to stop). Economic disputes should be handled through billing and legal collection remedies, not by leaving a patient in jeopardy.
The court treated proximate cause as a jury question. It found that the worsening of an untreated infection and the resulting amputation were foreseeable consequences of abandonment. The evidence permitted the inference that continued care or timely transfer would likely have prevented or mitigated the harm, supporting liability.
Ricks's common-law rule underlies modern doctrines of physician abandonment and aligns with ethical obligations and statutes like EMTALA that require stabilization before discharge or transfer. While EMTALA applies to hospitals receiving Medicare funds and focuses on emergency conditions, Ricks supplies the broader tort principle governing individual physicians' withdrawal from ongoing care.
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.
For students and practitioners, the case provides a clear framework for analyzing professional duty, breach by abandonment, and proximate cause in medical settings. It remains a touchstone for evaluating when and how physicians may ethically and legally withdraw from a case, and it offers enduring guidance that resonates with contemporary statutory and ethical regimes.
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