With a few exceptions, every patient has the right to informed consent and the right to refuse medical care. It’s one thing to discuss the risks and benefits of a flu shot with a primary care physician during a check-up and decide against vaccination. However, refusing treatment in acute care settings and even leaving the hospital against medical advice (AMA) comes with significant risks.
There is a great deal of misinformation circulating among patients and even medical professionals like nurses and doctors about hospital discharges against medical advice. Family caregivers and seniors should be aware of their rights and how AMA discharges work to avoid feeling pressured into staying in the hospital or consenting to medical procedures.
The Right to Refuse Treatment
If a person is of sound mind, is not exhibiting changes in mental status, and does not pose a threat to themselves or others, they have the right to refuse medical treatment. Psychiatric testing may be required to determine whether a patient lacks mental capacity. If a patient is not fit to make medical decisions for themselves (for example, a senior who has dementia) then their legal representative (E.g., agent under medical power of attorney, health care proxy or appointed guardian) is able to make this and other healthcare decisions on their behalf.
Individuals who have been hospitalized for mental health reasons and pose a threat to themselves or others may not be able to check themselves out of the hospital. And, in emergency scenarios where a patient’s safety or life is at stake, informed consent may be skipped over to provide prompt treatment.
Eagerness to Leave the Hospital
Family caregivers are usually familiar with their loved ones’ repeated desires to go home while hospitalized. Nobody wants to spend time in such a disruptive, uncomfortable environment with so little privacy. Frustrations are fueled further by the appearance that hospital staff take their time diagnosing, treating and discharging patients, all while substantial medical bills accrue. In fact, financial strain is a leading reason why patients choose to leave the hospital prior to receiving “official” clearance to go home.
Risks of Leaving AMA
Leaving the hospital before a physician deems it advisable can jeopardize your health. Studies have shown that patients who leave AMA are at higher risk for early rehospitalization and are therefore likely to incur additional healthcare costs. Even more seriously, those who self-discharge from the hospital experience higher risks of morbidity and mortality.
AMA Discharges Do Not Affect Insurance Coverage
One of the most pervasive myths surrounding AMA hospital discharges is that health insurance companies will refuse to pay for associated care and hike up a patient’s premiums. This is simply not true, although doctors frequently tell patients who wish to leave AMA that they will be solely responsible for their medical bills if they do so. Surveys have found that a substantial number of residents and attending physicians believe this false information and pass it on to other staff and to patients in an attempt to curtail discharges AMA.
A survey of nearly 50,000 patient medical records from the University of Chicago Medicine found that, of 453 patients who had left against medical advice, not a single patient was denied insurance coverage for their care due to their discharge decision. It’s worth noting that the majority of these patients had government-funded health insurance through Medicare and/or Medicaid.
If you have any questions about the financial or insurance implications of an AMA discharge, be sure to discuss them with the financial services department beforehand.
AMA Discharge Protocol
The reason for labelling discharges as AMA serves to protect the hospital and treating physicians from liability if a patient gets sick or dies as a result of their early release. It’s important to discuss all treatment and payment options with the proper staff members to gather all the information needed to make an informed care decision.
For example, if you are worried about covering mounting costs for a hospital stay, work with the billing department first to determine if there are avenues for reducing the amount owed. If you have a complaint about the care a loved one is receiving, file an official report with the hospital administration. It is probable that they will work with you to resolve the issue or help transfer your loved one to another health care facility.
Patient advocates, ombudsmen and social workers are available to answer questions and help patients and their families navigate care costs and difficult medical decisions. Be sure to contact these staff members and discuss all available options and their consequences prior to leaving AMA. Candid conversations with a patient’s care team about values, goals and concerns can often shed light on alternative options that are safer and more appealing to the patient. Communication and shared decision-making are vital for creating positive health outcomes.
If a patient still decides to discontinue inpatient medical care against a physician’s recommendations, it is crucial to ask for clear discharge instructions, prescriptions and information for follow-up appointments. This will help limit adverse health outcomes despite their early discharge. If you have any questions or concerns about a loved one’s condition once they have returned home, do not hesitate to contact or return to the hospital.
Discharge procedures may vary slightly, depending on the hospital and the physician, but there is often some paperwork that must be signed to obtain the patient’s informed consent (or that of their representative) and formalize the AMA discharge process. Patients should be sure to clearly communicate their refusal for certain treatment options and reasons for leaving against medical advice and keep copies of all related paperwork on file in case any issues arise.