This month we look at a case involving leaving the hospital against medical advice (often referred to as leaving ‘AMA’). Generally, if a patient leaves the health-system AMA, and it was thoroughly documented by the physician, then the physician is protected if the patient suffers consequences from his own actions. However, there are some instances where AMA is far less likely to work as a defense. This case is a good example of one of these instances.

Dr M, 42, was an emergency medicine physician working in the emergency department of a large and busy hospital. In his years in the emergency department, Dr M had seen almost everything, including several patients who were brought into the ED in police custody. Therefore, he wasn’t surprised when one afternoon the police showed up in the ED with an injured man in tow.

The police informed Dr M that the patient, a 24-year old named Mr G, had been the perpetrator of an assault and in the process was hit in the head with a blunt object by a bystander. The police were called, and found him lying on the street, clearly intoxicated and with a bloodied head. They took him to the ED, but Mr G was uncooperative and initially refused any treatment. 

“I don’t need anything,” the patient said belligerently to Dr M. “I just want to leave.”

Dr M calmly explained that a head injury could be dangerous and that some tests should be done. Eventually, Mr G consented to a skull x-ray and a blood test. The blood test showed that the patient was over the legal intoxication level. Dr M read the x-ray as normal but wanted to keep the patient for observation. However, Mr G was adamant that he did not want to remain in the hospital. The physician attempted to explain the reasons why Mr G should stay for further observation, but the patient remained insistent that he wanted no further treatment.

The physician noted in the patient’s file that the patient was leaving the hospital against medical advice. Mr G was released to the custody of the police and taken to jail. 

Later that day, a hospital radiologist read the patient’s x-ray and noted a markedly depressed left parietal skull fracture. The police were notified, and the patient was taken from jail back to the hospital. At the hospital, he was monitored for several hours and then taken to surgery where the depressed fracture fragments were elevated. However, Mr G ended up suffering a brain injury from the fracture which affected his cognitive abilities, and which prevented him from being able to hold down a job.

The patient and his family consulted with a plaintiff’s attorney who agreed to take the case. Dr M was stunned to find out that he was being sued for medical malpractice. The lawsuit claimed that Dr M had failed to recognize the patient’s skull fracture and improperly released him when he was intoxicated, and that the delay in treating the fracture was attributable for approximately half of the patient’s neurological deficits.