Critically ill pts wanting to go AMA?

[Cuddleswithpuddles]

I will not go into many specifics but basically I had a critically ill patient who wanted to leave AMA, but expected the nursing staff to help him/her out to a taxi. This person had an unresolved medical issue that obviously warranted critical care, had many invasive lines, was alert and oriented enough at this point to say he/she wanted to go home but was physically incapable of doing so. No family to carry her out. Just us.

So, yeah, sticky situation!

I understand that every patient has the right to leave AMA, but what happens if the exit involves way more than just signing an AMA form and walking out? What if the hospital staff, who believe that it would be in this patient's best interest to leave, seem to have to participate in the patient leaving? What if I loaded this person onto a wheelchair and something happens between my unit and the lobby?

What do you do these situations? Have you encountered this situation in your career? What does your hospital have to say about situations like these?

Thanks guys!

[itsmejuli]

Did something happen?

Was your manager aware of this person signing AMA?

[Cuddleswithpuddles]

Patient ended up staying but I just got to thinking about the situation in general terms. It feels like a potentially very juicy ethical and legal situation.

[itsmejuli]

Did you read the AMA papers that the patient would sign?

[xoemmylouox, ASN, RN]

Wow that is something to think about and maybe ensure the AMA form your hospital uses addresses this problem.

[Cuddleswithpuddles]

Did you read the AMA papers that the patient would sign?

No, I have not read my hospital's AMA form yet. I am at home but I did look up other hospital's published AMA forms. I do not know if the AMA criteria lists I am seeing are facility-specific or in accordance to state law or similar governing body but you've piqued my curiosity.

Looking at the forms still do not give me a picture of what an AMA "exit" for a patient who is incapable of walking and liable to pass out/hemorrhage/code etc. from unit to lobby.

Am I obligated to help them to the door?

What if they refuse to be touched and have invasive lines?

What if they do code?

[NRSKarenRN, BSN, RN]

Our docs always wrote on AMA forums: Risk of death. I would not help someone who cannot transfer themselves when no family available --- they only get home, can't care for self, homecare sends em right back next day if 911 not already called.

[TheCommuter, BSN, RN]

Generally speaking, the hospital and its employees are no longer held liable for any poor outcomes once an AOx4 patient has signed the A.M.A. paperwork.

[Cuddleswithpuddles]

After some reading into AMA discharges, I found this neat article on what constitutes a proper AMA discharge.

http://www.medscape.com/viewarticle/770719_2

This paragraph was particularly striking to me.

Courts have found that a proper AMA discharge terminates the physician-patient relationship, and with it, the physician's duty to treat the patient. For example, in Brumbalow v. Fritz, the plaintiff fell in an ED hallway and fractured her hip after she had left AMA.^[17] The court found that the emergency physician had no duty towards the plaintiff at the time of her fall because her AMA had effectively ended the physician-patient relationship.^[17] Similarly, in Griffith v. University Hospitals, the court found that the decedent had terminated the physician-patient relationship when she left the ED AMA without informing hospital staff.^[18] Finally, in Lyons v. Walker Regional Medical Center, Inc., the court affirmed a jury verdict for the hospital partially on the grounds that the patient's AMA discharge ended the physician-patient relationship.^[19] In each of these cases, the courts held that because the physician had no duty to treat, he/she could not be liable for injuries the patient suffered subsequent to the AMA discharge.

I am sorry but what in God's green earth makes you think you can sue the doctor who you turned your back against??

I wonder if this applies to nursing as well.

I imagine that the docs simply won't see a patient or give orders but what about the nurses who have to deal with this hapless fool who fell down because SURPRISE it was not safe to leave?

[Ruas61, BSN, RN]

Scary, scary.

I have had them do that on our LTC but ICU???????

[Cuddleswithpuddles]

Scary, scary.

I have had them do that on our LTC but ICU???????

Yeah! I am used to walky talky patients refusing care and just leaving. I am new to ICU so this threw me for a loop.

[Mandychelle79, ASN, RN]

It if is a case where the patient would be a danger to themselves if they left it is also possible to have them involuntarily committed/ treated. I see orders like that for a lot of our transfers, patient is unsafe to go home, if attempts to leave AMA consult psych to start the comittment process