Today our topic of discussion is Admission and Discharge.
Admission and Discharge
- Whenever a medicolegal case is admitted or discharged, the same should be intimated to the nearest police station at the earliest. It is always better to inform the police through the casualty of the hospital where the medicolegal register is usually maintained and necessary entries can be made in it.
- While discharging or referring the patient, care should be taken to see that he receives the Discharge Card/Referral Letter, complete with the summary of admission, the treatment given in the hospital and the instructions to the patient to be followed after discharge.
- Failure to do so renders the doctor liable for “negligence” and “deficiency of service”
- If the patient is not serious and can take care of himself, he may be discharged on his own request, after taking in writing from him that he has been explained the possible outcome of such a discharge and that he is going on his own against medical advice
- Police have to be informed before the said patient leaves the hospital. Sometimes the patient, registered as a medicolegal case, may abscond from the hospital. Police have to be immediately informed, the moment such an instance comes to the notice of the doctor/hospital staff.
Death of a person admitted as a medicolegal case: The following are the do’s and don’ts in case a person admitted as a medicolegal case expires.
- Inform the police immediately
- Send the body to the hospital mortuary for preservation till the legal formalities are completed and the police releases the body to the lawful heirs
- Request a medicolegal postmortem examination
- Do not issue a death certificate – even if the patient was admitted
- The dead body should never be released to the relatives; it should only be handed over to the police.
The medicolegal implications of LAMA need to be given serious consideration as the caregiver might not be protected from malpractice charges. There is little evidence that LAMA provides any malpractice protection.
Many hospitals have a release form for patients to read and sign prior to leaving hospital against medical advice, relieving the hospital and medical staff of any responsibility related to the patient’s decision or its consequences.
Hospital authorities should recognize that forms signed by a patient who is leaving against medical advice designed to protect the hospital in the event of an untoward consequence might have no legal protective value.
The danger in such forms is that a physician may be tempted to rely on them instead of good clinical judgment and adherence to the recommended guidelines. The legal standard for protection from lawsuits continues to be good clinical practice with thorough documentation. Use of discharge against medical advice is not a safe road to legal immunity.
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