Against Medical Advice

The term “against medical advice“, also referred to as “AMA” typically arises when a patient wants to be discharged from a hospital or other medical health facility and the physician is opposed. The patient will be informed that the discharge will be against the doctor’s medical advice. In most cases the patient will not be restrained from leaving but will be asked to sign a statement that they have been informed they are leaving against medical advice. The patient does not have to sign the document but may be pressured to sign it anyway. The statement is requested to support the treater and facility in limiting exposure to liability in the event that injury follows.

A patient admitted in a mental hospital setting may have additional difficulty. The patient may be told they are required to give notice. This notice is requested to provide the treater the opportunity to begin involuntary commitment proceedings on the basis that the patient would be a danger to himself or others and must be compelled to remain in the hospital for treatment.

Some patients are told that if they leave AMA, their insurance will not cover their treatment. This is false information. On this issue, the University of Chicago Medicine published an article dated February 3, 2012, which discussed their study (funded by The Agency for Healthcare Research and Quality and the National Institute on Aging) of the misconception of who picks up the tab when patients walk out. They concluded from their survey of general internal medicine doctors that two-thirds of residents and almost half of attending physicians believed that when a patient left the hospital AMA, insurance companies would not pay. They also found that some physicians go as far as using the financial obligation as a threat to persuade a patient to stay.

It has been this attorney author’s experience in representing patients seeking discharge from nursing homes, that it is not just the physicians making these false threats. Threats are also made by the facility administration, by social workers and nursing administrators. Such threats are perceived as particularly persuasive to the elderly patient and typically their family members, who may yield to this threat.

The researchers from the University of Chicago Medicine reviewed records of more than 46,000 patients admitted between July 2001 and March 2010 and found that about 1 percent left against doctor’s orders. Most of the patients had government-funded insurance, either Medicare or Medicaid, or no insurance. Of the insured patients who left AMA, none were denied coverage for leaving against doctors’ orders.

In the United States there have been attempts to enshrine a patient’s bill of rights into law. To date, it is left to the individual states to provide this protection. Michigan does have a Patient Bill of Rights providing a list of guarantees for those receiving medical care. Most states’ legislatures have embraced Patients Bills of Rights empowering the patient and codifying the obligations of a health care delivery system relative to them. The Michigan Bill of Rights, MCL 333.2021, provides that the patient or resident has the right to refuse treatment and be informed of the consequences of that refusal. They have the right to receive all information necessary to be informed and consent or deny a proposed treatment or procedure. This includes a description of the significant medical risks involved, alternatives, and costs.

If you or your loved one is attempting to procure discharge and the advice is that the discharge would be AMA or if there is a delay in addressing the issue of discharge, the Michigan Patient Bill of Rights provides protection. Know that each nursing home patient shall be afforded the opportunity to discharge himself or herself from the nursing home. Furthermore, they have the right to communicate with an attorney or other advocate privately to assist them in enforcing their rights.

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