Today our topic of discussion is DAMA: Discharged Against Medical Advice.
DAMA: Discharged Against Medical Advice
- Doctor has clearly explained that taking the patient out may endanger life, but still patient/patient’s relatives want to take the patient to some other hospital
- They sign a declaration saying that the risks were informed to them–by taking the patient out of hospital, they are immediately endangering the life
- Hospital gives a discharge summary.
Occasionally, the patient or his family may demand discharge against medical advice (AMA). If this occurs, notify the physician immediately. If the physician fails to convince the patient to remain in the facility, he’ll ask the patient to sign an AMA form releasing the facility from legal responsibility for any medical problems the patient may experience after discharge.
If the physician is not available, discuss the discharge form with the patient and obtain his signature. If the patient refuses to sign the AMA form, do not detain him. This violates his legal rights. After the patient leaves, document the incident thoroughly in your notes and notify the physician.
As a guide to the AMA process, consider the following list of Do’s and Don’ts:
- Don’t ignore the patient who wants to leave AMA. If at all possible, stop what you are doing and prepare to address the issue
- Do determine the decision-making capacity of the patient.
- Do they comprehend the information and conse- quences and understand the risks and benefits of the options, and can they communicate these back to you?
- Don’t blame or berate the patient or anyone else for his dsire to leave
- Do apologize of the patient has been waiting or if there have been delays in the patient care process. Apologies are free. Lawsuits cost millions
- Don’t just ask the nurse to have the patient sign a generic AMA form and leave. This course of action provides little protection for the practitioner
- Do enlist the patient’s family and friends in your attempt to convince the patient to stay
- Don’t express your frustration and anger to the patient. Instead, earnestly convince him that your overriding interest is his well-being, Make sure he knows that you are on his side against a potential threat to his health
- Do document the patient’s “informed refusal” of crucial diagnostic testing (e.g. blood work or X-rays), procedures (e.g. LP to rule out meningitis or subarachnoid hemorrhage), or treatments (e.g. medications or transfusions) in the same detail as you would an AMA
- Don’t refuse to provide treatment; this could be considered abandoning the patient. Provide whatever treatment, prescriptions, follow-up appointments, and specific discharge instructions the patient will accept.
- Do document the details of the AMA patient encounter in the patient’s chart. Include documentation of the patient’s decision-making capacity, the specific benefits of your proposed treatment and risk of leaving AMA, what you did to get the patient to stay, and your compassionate interest in having the patient return for any reason. Have the patient sign an AMA form that addresses these details, witnessed by a family member and/or staff member
- Don’t worry about whether or not the patient’s insurance will deny payment if he signs out AMA. His insurance is not your problem, but a malpractice suit will definitely be your problem.
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