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Leaving a hospital against medical advice and malpractice

If a patient decides to leave a hospital of his or her own accord -- against the attending physician's recommendation -- does that relieve the attending physician of any liability for malpractice if something later goes wrong?

There's no easy answer to this question.

When a patient chooses to leave against medical advice (AMA), hospitals rush to get releases signed that are designed to waive all liability should the patient experience an adverse reaction shortly after leaving. The biggest worry, naturally, is that the patient will die -- although other long-term health consequences could also be a problem.

Patients do decide to leave hospitals AMA all the time. Some leave because they aren't happy with their care and others leave because they're simply feeling better than when they arrived and don't see the need to go through a longer wait and more tests for no good reason. It's generally up to the doctor on duty to try to talk a patient out of leaving AMA whenever possible, although there's no justification for keeping a competent patient against his or her will.

That all changes, however, if a patient has any condition that may be impairing his or her judgment. When a patient's judgment is genuinely impaired, he or she may not be able to appreciate the danger of leaving AMA. At that point, it's the physician's responsibility to force a patient to stay.

For example, imagine that a patient has just undergone surgery and the anesthesia causes a temporary delusional state. It would be malpractice to allow a patient in that state to sign himself or herself out of the hospital -- no matter how insistent he or she becomes.

There are numerous other situations that could also lead to a malpractice case against a physician after a patient leaves a hospital AMA. For example, a patient with a serious head injury or intoxication due to drugs or alcohol may also exhibit disordered thinking and be temporarily unable to make an informed decision.

Ultimately, every case is unique -- but a signed release by a patient isn't always enough to overcome a claim of medical malpractice if there's credible evidence that the patient wasn't able to think clearly enough to understand the danger of leaving AMA.

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