Negligence when a patient leaves?

Guest219794 · May 22, 2013

What have others experienced or know about negligence findings after a person leaves the ER in the waiting room?
A recent learning experience that I am not familiar with is making all these possible scenarios run through my mind...
In a nutshell, a person was brought in to the ER by family members for xyz. They were not registered yet. They visually appeared in no distress. Sitting up, looking around, breathing well ect. The family did not want to wait, so they stated they were taking them to another ER. They left, went, and were Dx with something never in a million years, based on presenting complaint, could be associated.
I'm just looking for some input on the lines of negligence for I guess allowing a patient to leave before they are triaged.

In some ways, the negligence issue is a moot point. You have no choice, but to allow the patient to leave.

What the OP is asking, is whether this is, or ever has been, a liability issue. i have never heard of it.

**canoehead, BSN, RN** · May 27, 2013

If someone just shows up in the ER area they may look around and decide they wanted the main entrance, or the office down the street, and they leave. Unless they have consulted with me about their symptoms I have no right to urge them to stay. The 250ft rule brought our hospital's liability into the next-door neighbor's house, at another hospital I worked in, so it can't be taken literally. Even in a dump-and-run situation, if that person can managed to get up and hobble away, and refuses our care, we have to let them go. In the situation the OP describes I'd feel no liability, unless I saw signs of coercion from the family, not just a discussion and making a decision.

Sassy5d · May 27, 2013

I'm completely changing the symptoms and Dx for obvious reasons here but..

Lets just say a pt came in with family and wrote 'sore throat' on paper. I was not triage nurse, I came up front and registration asked me to speak to a family member.

I eyeballed the pt, color good, posture good, resp good. No distress. Hindsight, the family members were hospital staff. The waiting room was full. I could not give exact time when they would come back, they said they were not waiting, going to another hospital.

Then the phone calls start, about the 'rude' nurse who was sending patients away. Then they keep calling, saying they are at the other hospital, and the person is having a heart attack.

Again, I'm changing the presenting complaint and Dx as you never know WHO would be reading these forums and this is sensitive.. But I'm emphasizing the presenting complaint had absolutely nothing to do with the possible Dx at the other hospital.

I was just wondering what the possibilities of having an infraction, even legal, brought against me because they presented, were not brought back, left and possibly ended up with a serious Dx at another hospital

Pudnluv, ASN, RN · May 28, 2013

In my ED we have a 15 minute door to triage rule which I believe is a health department thing. Did the person sign in? If someone comes in and signs in, then immediately decides to leave registration will call the triage nurse who can then speak to the person and at least advice the person to stay and be seen. This can be documented on the sign in sheet along with the time that the person leaves. This way there is a paper trail and documentation that the person was advised to stay and at least be medically screened. If the person comes to the window, looks around and leaves before signing in there is no written record that the person was ever at the facility, hence no liability. If the person leaves after signing in, without saying anything about it to anyone, it is also documented on the sign in sheet. This would help to decrease the chances of being held liable for anything that happens after the person leaves.

TheSquire, DNP, APRN, NP · May 29, 2013

I am not a lawyer, but as I was taught in school Negligence requires four elements in order to be proven in court:

1. Duty

2. Breach of Duty

3. Proximal Cause

4. Actual Harm

As I read your (admittedly altered) account of events, you were not the triaging nurse, and acted appropriately based upon the presenting complaint (which is an ESI 4/5 unless complicating factors are present - which you were not in a position to know about) and your judgement of the patient as presented to you. It was the decision of the pt/family and not you which caused the pt to leave without triage. As such, it appears to me that you met your Duty and that no Breach of Duty occurred. As I said, though, IANAL.