In busy emergency rooms, patients sometimes leave before a doctor determines their discharge plan, often due to long wait times or feeling their condition has improved. Individuals retain rights regarding their own healthcare decisions, even in this setting. The central question of whether a person can simply walk out is answered by balancing the hospital’s medical responsibility against the patient’s legal right to self-determination. The decision to depart against the advice of medical professionals, known as leaving Against Medical Advice (AMA), carries significant implications for both the patient’s health and the hospital’s administrative process.
The Right to Refuse Care
Every competent adult patient has the legal right to refuse any medical treatment, diagnostic procedure, or hospitalization, even if that refusal is medically unwise. This principle of patient autonomy dictates that individuals decide what happens to their own bodies. This right is not suspended simply because a patient has entered an emergency room.
Exercising this right hinges on the patient being deemed competent. Competence means they have the capacity to understand their condition, the proposed treatment, and the risks of refusing care. Physicians must assess this capacity, ensuring the patient is not impaired by factors like severe intoxication, head trauma, or altered mental status. If a patient is competent, their decision to leave must be respected, even if the medical team believes it will lead to serious harm.
The Formal Process of Leaving Against Medical Advice
When a patient insists on leaving without a formal medical discharge, the healthcare facility initiates an administrative procedure centered on documenting “informed refusal.” This process protects both the patient and the hospital by clearly outlining the risks associated with the departure. The patient is typically asked to sign an AMA form.
The AMA form documents that the patient was fully informed of the dangers of premature departure, rather than waiving the hospital’s liability for care already provided. By signing, the patient acknowledges understanding the risks of leaving without a definitive diagnosis or treatment plan. If the patient refuses to sign, staff will note the refusal in the medical chart, often with a witness signature, as this refusal does not negate the patient’s right to leave.
Staff must ensure the chart contains a detailed record of the conversation, including the specific risks explained and the patient’s reason for leaving. This documentation serves as evidence that the healthcare team fulfilled its duty to educate the patient about the potential consequences, providing medicolegal protection for the providers.
Medical Consequences of Premature Departure
Leaving the emergency room before a complete medical workup or stabilization poses a significant risk of medical deterioration outside of a monitored environment. Conditions that present with vague symptoms can be missed, leading to a delay in diagnosis that can turn a manageable issue into a life-threatening emergency.
Patients with serious conditions like internal bleeding, blood clots, or severe infections may feel temporarily better, only to have their condition rapidly worsen once they are home. Leaving mid-treatment, such as removing an intravenous line or discontinuing necessary medication, can lead to complications like uncontrolled infection or severe rebound symptoms. The lack of a follow-up plan or prescription upon departure can also compromise the patient’s recovery and increase the chances of an emergency readmission.
Hospital Duties When a Patient Leaves
Even when a patient chooses to leave against medical advice, the hospital maintains obligations to ensure the patient’s immediate safety and encourage continuity of care. The institution must make every effort to educate the patient about the specific risks of leaving, including explaining the potential for disability or death related to their specific symptoms.
The hospital is required to take a “harm reduction” approach. This means providing any treatment, prescriptions, or follow-up instructions the patient is willing to accept, even if the patient refuses the full course of recommended care. For example, a patient may be given a prescription for pain relief and specific instructions on when to return immediately. Additionally, federal regulations require that a hospital stabilize a patient determined to have an “emergency medical condition” before they leave, regardless of their ability to pay for the services. Staff should also offer to help arrange safe transportation for the patient’s departure.