Pt signed out AMA then died! what do you think?

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Specializes in Telemetry.

i recently worked a shift monday and walked in to a patient who wanted to sign out AMA, his INR was 4.5 and explained to him that i didnt think it was a good idea and to stay one more night, so we can check his levels in the morning. He didnt buy it...no i work on a tele unit.

he signed the AMA form i told him no coumadin and to see his md for repeat labs on wednesday per the physicans orders...all documented real well he left approx at 5 pm

anyway.....i find out from my supervisor that morning(tuesday) around 4 am (yes i worked a double) that he came into the ER after a fall in his bathroom, with a HIGE sub dural hematoma, was intubated and shipped to a different facility for emergent operation.

i look in the paper today (thursday) and saw he died later that day on wednesday

CAN WE TALK ABOUT ? LAWSUIT! I AM FREAKING OUT HERE....any advice anyone ever encounter this i have had people sign out ama before...but now a death related how good is this AMA form for legallity?

i need your responses guys...please help :sniff:

jen

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Specializes in Med/Surge, Psych, LTC, Home Health.

I'm thinking that if the guy knew ALL the facts, all of the risks associated with discontinuing his care at that time, AND all of that is well documented, PLUS he was totally competent... there really wasn't anything else that could be done. You can't hold someone against their will without a court order.

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Generally as long as we are competent adults we are able to make our own decisions. Some decisions turn out to be good, some poor. His decision was obviously poor. In today's environment we often like to blame other people or factors, etc.

While you have the right to make decisions, you unfortunately do not have the right to make decisions without consequences.

As long as there is good documentation of the risks, I think you will be fine.

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Specializes in Acute Care.

Did you document all the education you gave him.... eg. No coumadin and why?

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Let me first say I understand that you probably feel bad about what happened to this man. But you did your best to warn him that his AMA had consequences and you are not responsible in anyway. There is no way you could have held him there. If you documented as well as you say you have you most likely have nothing to worry about. Not to say that some relative might be looking for someone to blame. However, sounds to me like you are covered. Try not to worry.

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Specializes in Emergency, Trauma.

As long as you documented that all risks were explained and understood by the pattient and that he was mentally clear, you'll be fine.

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Specializes in ER/Trauma.

Lawsuit? Why? Was he not competent (mentally alert, oriented) when he signed the form that said he was going home Against Medical Advice???

If he was competent when he signed the form and there was no scope that he was coerced into signing it, there is no way anyone can legally hold you responsible for his death.

Let the ED staff, transport team, OR team who worked on him after his fall worry about it themselves. You were out the picture the second he signed the AMA form...

cheers,

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Specializes in ICU/Critical Care.

Damn..

Sorry, anyhow, no you are not liable. As long as he was explained the potential consequences of his actions by a doctor, you are not liable. It was his choice. He signed out...he signed his name to a form that states he was aware of what the potential consequences of his actions were.

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I think so long as all the charting has i's dotted and t's crossed you'll be fine.

Can't fix stupid. Sorry if I sound cold but I didn't meet the guy.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

if you documented everything real well, as you say, and he signed the ama form there should be no problem. this is a free country. remember oj just got convicted of kidnapping for merely telling people they had to stay in the hotel room he was robbing! to have demanded the patient stay would have been the same thing! i'll bet his family, if he has any, would probably tell you he was a cantankerous dude that had a history of always doing things his way. well, look where it got him. my brother has a fil like that.

i would call his name to the attention of the risk management people in case his doctor hasn't already done so.

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I had this happen once to a pt of mine who signed out AMA. In her case, I *knew* it was a matter of days--hell, I was scared she was going to fall down outside (gait was not steady) and bleed to death before we could get her back into the ER. She didn't immediately, but did die about a day later. I documented the crap out of it that night. All night we had been trying to make her happy to keep her from leaving; but she did it anyway. One of her last poor choices in a lifetime of poor choices.

Honestly, I'm sorry she died, but it was only a matter of time. Self destructive lifestyle + poor personal responsibility + platelets of less than 10 = not much time left on this earth. I did have a couple of days of "holy crap, what happens now?" The family was ******, saying we shouldn't have let her sign out AMA. In any case, it came to nothing, no one even contacted me, although I'll bet my documentation was reviewed.

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Specializes in Maternal - Child Health.

We can't save people from themselves.

Peace to you

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