Long wait times in the Emergency Room (ER) can lead a patient to consider leaving before receiving care. The ER prioritizes patients based on the severity of their condition, often resulting in significant delays for those with less acute issues. While you have the autonomy to leave at any time, the consequences depend heavily on how far you have proceeded through the medical process. Understanding the administrative, medical, and financial distinctions of leaving is important. The two main categories of leaving without a formal discharge are “Left Without Being Seen” and “Leaving Against Medical Advice,” each carrying different implications.
The Administrative Difference When Leaving While Waiting
The most straightforward scenario involves a patient who has completed registration but departs before receiving a medical screening exam (MSE) from a qualified healthcare provider. This event is formally tracked as “Left Without Being Seen” (LWBS). While federal regulations, such as the Emergency Medical Treatment and Active Labor Act (EMTALA), protect a patient’s right to leave, the hospital must document that the patient left voluntarily and that a screening was offered if possible.
If you choose to leave before any clinical interaction, you should notify the registration desk or triage nurse of your intent to depart. This notification is important for administrative tracking and ensures staff can attend to other patients.
A patient who only registers and then leaves has not yet received medical advice, making the documentation less complex than a formal discharge. The hospital’s primary administrative concern is to record that the patient was never fully assessed by a physician, which mitigates certain regulatory and liability concerns.
The Medical and Legal Implications of Leaving Against Medical Advice (AMA)
When a patient has been seen by a qualified provider, received a medical evaluation, and is advised to stay for further treatment or observation but chooses to leave, this becomes a formal “Leaving Against Medical Advice” (AMA) event. The process involves a physician or delegate explaining the specific health risks of departing prematurely. Patients who leave AMA have a higher readmission rate and increased morbidity and mortality compared to those who complete their treatment plan.
The physician must determine that the patient possesses decisional capacity, meaning they understand their condition, the proposed treatment, and the specific hazards of refusing care. These hazards can include the worsening of an underlying condition, permanent disability, or even death, especially in cases involving conditions like chest pain, head injuries, or infections. The physician ensures that the patient is fully informed before they make a decision to leave.
If the patient maintains the desire to leave, they will be asked to sign a formal AMA document. This form documents the patient’s informed refusal of treatment and protects the hospital and physician from liability related to the premature departure. If the patient refuses to sign the form, the physician will still thoroughly document the conversation, including the specific risks discussed and the patient’s refusal, often with a witness signature. The patient is always free to leave, provided they do not lack decisional capacity or pose a threat to themselves or others.
Understanding the Financial Impact of an Uncompleted ER Visit
Even if a patient leaves the ER early, they will typically receive a bill for any services rendered up to the point of departure. This applies to both the LWBS and AMA scenarios, though charges differ based on the extent of services received. For a patient who leaves LWBS, charges may include an administrative registration fee and the cost of the triage assessment.
If the patient leaves AMA, the bill will be more comprehensive, covering the cost of any diagnostic services completed, such as blood draws, laboratory analysis, X-rays, or electrocardiograms (EKGs). Hospitals are legally entitled to bill for the services provided, and leaving AMA does not automatically void these charges. Insurance companies may not always pay for a repeat visit for the same symptoms if the patient left AMA, but they usually cover the initial services rendered.
The larger financial risk for a patient leaving AMA is the potential for subsequent complications requiring readmission and more extensive, costly care. Patients who leave prematurely often return within 30 days, resulting in significantly higher overall medical expenses. The financial impact is tied to the medical outcome, where an uncompleted treatment plan can turn a modest initial problem into a major health crisis.