The number of hospital stays that ended with patients leaving against the advice of medical staff increased from 264,000 cases to 368,000—about 39 percent—between 1997 and 2007 according to the latest News and Numbers from the Agency for Healthcare Research and Quality (AHRQ).
For cases in which patients left against medical advice in 2007, the Federal agency also found that:
- The top five reasons were chest pain with no determined cause (25,600); alcohol-related disorders (25,300); substance-related disorders (21,000); depression or other mood disorders (13,900); and diabetes with complications (12,500).
- Medicaid and Medicare patients each accounted for about 27 percent and privately insured patients accounted for 19 percent. About 22 percent of the cases in 2007 involved uninsured patients.
- Men were roughly 1.5 times more likely to leave against medical advice than women.
- In the Northeast, patients left hospitals against medical advice at twice the rate of that of the rest of the country—2 per 1,000 population versus an average of 1 per 1,000 population in all other regions.
The report uses statistics from the 2007 Nationwide Inpatient Sample, a database of hospital inpatient stays that is nationally representative of inpatient stays in all short-term, non-Federal hospitals. The data are drawn from hospitals that comprise 90 percent of all discharges in the United States and include all patients, regardless of insurance type, as well as the uninsured.
http://www.hcup-us.ahrq.gov/reports/statbriefs/sb78.jsp
DOCBLAWG COMMENT: Patients who leave AMA (against medical advice) is a problem in litigation. Believe it or not, patients and families of those patients who leave AMA do file malpractice lawsuits if something goes wrong later. In the cases I have handled which involve patients leaving AMA it is always difficult and most times ends up being a “he said, she said” case with the patient claiming that there was insufficient information given by the doctor regarding the pitfalls of leaving the hospital without recommended treatment. Hospitals do have preprinted forms with boilerplate language on them which an AMA patient is supposed to sign. It is often not enough for the doctor’s dictation to state that the patient left AMA when the hospital has a policy that the AMA form be completed. If the patient refuses to sign the AMA form it should state that in place of the patient’s signature and signed by a witness.
Another pitfall involves the patient that leaves AMA from one doctor in the ER only to return to the hospital later that same day and leave AMA again. In that event, the second ER doctor should protect himself by having the patient sign another AMA form albeit for the same date but at a different time; the second doctor should not rely on the earlier AMA form that the patient signed. I once litigated a case where this scenario played out and experts could not support the second doctor’s acceptance of the AMA form signed earlier in the day. Experts believed that the second visit required the patient to sign a second AMA form despite it being the same day. This information may come in handy should an ER doctor be faced with a similar situation.
Filed under: Breaking News, Healthcare, Legal Issues, Medical Issues, Patients | Tagged: Breaking News, Healthcare, Legal, Medical, Patients
