Prove AMA patient was fully informed

Plaintiffs in malpractice suits typically refute signed forms stating that they knew the risk of leaving against medical advice (AMA) by claiming they were not informed of the significance of leaving before the evaluation or treatment was completed.

"The issue is not whether the patient’s attestation exists on a form, but what the attestation signifies," says Edward Monico, MD, JD, assistant professor in the Section of Emergency Medicine at Yale University School of Medicine in New Haven, CT.

In a study performed at Yale University, only 4.8% of providers documented that patients leaving AMA were informed of the risks of terminating their emergency evaluation, and only 5.7% documented alternatives to treatment. About 50% documented they actually informed patients they were leaving AMA.¹

Monico says these points should be documented for patients leaving AMA:

that patient has the competence and capacity to make healthcare decisions;
that the patient was informed of the extent and limitation of the evaluation that occurred;
that the patient has an understanding of presenting signs and symptoms and the healthcare provider’s concern about that presentation;
that the patient was informed of the foreseeable risks of terminating the medical evaluation or treatment prematurely;
alternatives to suggested treatment, if any exist;
an explicit statement that the patient was informed that he or she is leaving AMA.
that the patient was provided an opportunity to ask any and all questions.

"Explain the specific concern the provider has, like chest pain signifying angina, and the risk posed to the patient by leaving AMA, such as occlusion of a coronary vessel and arrhythmia or sudden death," says Monico.

Reference

Monico EP, Schwartz I. Leaving against medical advice: facing the issue in the emergency department. J HealthCare Risk Management 2009; 29(2): 6-15.