P J Devitt1, A C Devitt, M Dewan. 1. Department of Psychiatry, State University of New York Health Science Center, Syracuse 13210, USA. cncdpjd@ohm.state.ny.us
Abstract
OBJECTIVE: Many physicians believe that documenting a discharge as "against medical advice" protects them from legal actions for adverse consequences related to the discharge. The authors examined case law for evidence of such protection. METHODS: MEDLINE and PsycINFO databases were searched for relevant articles. The medmal. base of Lexis and West Group was searched for annotated case law. RESULTS: Four relevant cases were found in which medical authorities and physicians were sued for medical malpractice even though they discharged a patient against medical advice. In all cases the defendants prevailed. However, their success was not due to the fact that they used the procedure of discharging patients against medical advice. Rather, it was based on the plaintiffs' failure to prove negligence. The authors offer guidelines for physicians faced with the decision to discharge against medical advice. Physicians should perform a careful and well-documented examination. They should assess the severity of illness and the severity of the risk if the patient is discharged. They should engage in a constructive dialogue with the patient about grievances. They should ensure that the patient's withholding of consent for further hospitalization is informed with respect to risks, benefits, and alternatives. If the patient meets criteria for involuntary hospitalization, the patient should be committed. CONCLUSIONS: Good clinical practice and thorough documentation remain the best legal protection. Discharging a patient against medical advice may provide partial protection, but it is not a royal road to legal immunity.
OBJECTIVE: Many physicians believe that documenting a discharge as "against medical advice" protects them from legal actions for adverse consequences related to the discharge. The authors examined case law for evidence of such protection. METHODS: MEDLINE and PsycINFO databases were searched for relevant articles. The medmal. base of Lexis and West Group was searched for annotated case law. RESULTS: Four relevant cases were found in which medical authorities and physicians were sued for medical malpractice even though they discharged a patient against medical advice. In all cases the defendants prevailed. However, their success was not due to the fact that they used the procedure of discharging patients against medical advice. Rather, it was based on the plaintiffs' failure to prove negligence. The authors offer guidelines for physicians faced with the decision to discharge against medical advice. Physicians should perform a careful and well-documented examination. They should assess the severity of illness and the severity of the risk if the patient is discharged. They should engage in a constructive dialogue with the patient about grievances. They should ensure that the patient's withholding of consent for further hospitalization is informed with respect to risks, benefits, and alternatives. If the patient meets criteria for involuntary hospitalization, the patient should be committed. CONCLUSIONS: Good clinical practice and thorough documentation remain the best legal protection. Discharging a patient against medical advice may provide partial protection, but it is not a royal road to legal immunity.