Does AMA discharge protect physicians from lawsuits?
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This week’s article is written by Dr. Kelly Wong, MD.
Many physicians feel a false sense of reassurance that a patient discharged against medical advice (AMA) protects them from liability.
While there are many instances where attorneys are dissuaded from taking a plaintiff’s case after learning the patient left AMA, even a properly-documented discharge AMA does not provide complete legal protection.
An article by Devitt et al. used medical databases and case law to find several cases of physicians who were sued after an AMA discharge.
Verdicts in favor of the physician
In instances where physicians prevailed, it was not purely because the patient left AMA, but rather—like all other medical malpractice cases—on the basis of their clinical decision-making leading up to the discharge and failure of the plaintiff to prove negligence.
Two instances describe psychiatric patients who left AMA. One patient stabbed a police officer and the other died by suicide, both within 24 hours of discharge.
In both cases, the courts found that because the psychiatrists had no grounds for involuntary commitment at the time the patient requested to leave AMA, that neither the physician nor the hospital were negligent in their care. Therefore they were not responsible for the future actions of the patients.
Psychiatric patients in particular are at higher risk of discharge AMA, and studies of this population found certain features that are associated with increased risk of AMA discharge: short length of stay, higher bounceback rates, more severe symptoms at time of discharge, and living independently.
Verdicts in favor of the plaintiff
In cases where the jury found for the plaintiff, patients may sometimes be “contributorily negligent” by leaving AMA, which decreases the damages by a proportional amount determined by a jury.
Case 1
In Suria v Shiffman, $2,000,000 of in damages were awarded but the plaintiff was found to be 25% contributorily negligent, reducing the damage award to $1,500,000.
The principles of contributory negligence vary from state-to-state, and in some states, any contributory negligence that is “more than slight” can completely bar a plaintiff from recovering damages.
Case 2
In Hawkins v Brooklyn-Caledonian Hospital, a patient left AMA and failed to appear at subsequent outpatient appointments after a piece of a subclavian catheter broke off during placement. He suffered pain and a relapse in substance use.
Even though he left AMA and was advised of the risk of worsening of condition or death, the hospital was held responsible in full due to the departure from standard of care during the catheter placement.
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Best Practices
Devitt et al. describes the best practices for a discharge AMA:
ensuring the patient is aware of all risks and alternatives
they are competent to make their own medical decisions
they do not meet the standard for involuntary commitment.
Charting to reflect these details is crucial.
“There is no substitute for good clinical care and thorough documentation.”