Understanding Your Right to Leave
As a competent adult, you have the fundamental right to autonomy over your body and your medical treatment. This principle extends to your hospital stay. If you feel your wait is excessive or you simply wish to leave, you can, even if your healthcare provider advises against it. The legal term for this is discharging yourself "Against Medical Advice" or AMA.
What does "Against Medical Advice" (AMA) mean?
Leaving AMA means that a patient chooses to leave a medical facility before the treating physician recommends discharge. When this happens, the hospital will document that you left without completing the recommended course of treatment or evaluation. This is a protection for the hospital and its staff, not a tool to prevent you from leaving.
Exceptions to the rule
Your right to leave is not absolute. There are specific circumstances under which a hospital can legally prevent you from leaving:
- Mental Health Hold: If a healthcare provider determines you are an imminent danger to yourself or others due to a mental health condition, the hospital may place you on a temporary psychiatric hold, the length of which is determined by state law.
- Legal Guardianship: If a legal guardian has been appointed to make medical decisions for you, their decision to keep you hospitalized will override your own wishes.
- Minors: Patients who are not yet of legal age to make their own medical decisions cannot leave without the consent of a parent or legal guardian.
- Incarcerated Patients: Patients in the custody of law enforcement are not free to leave, and only the correctional facility can authorize their release.
The Risks of Leaving AMA
Choosing to leave before a physician deems it safe comes with significant health risks. It is a decision that should not be taken lightly and should be discussed with your care team before acting.
Potential health complications
- Worsening Condition: Leaving before a condition is fully treated can cause it to worsen rapidly, leading to more severe illness or even death.
- Higher Readmission Rates: Studies show that patients who leave AMA are significantly more likely to be readmitted to the hospital, often within a short period of time. These readmissions can result in longer hospital stays overall.
- Serious Adverse Events: Complications from inadequately treated issues, such as infections, heart problems, or post-surgical issues, are more likely to occur outside of the supervised hospital environment.
Financial implications
While many people worry that leaving AMA will cause their insurance to deny their claim, this is generally not true. However, leaving early can lead to higher long-term medical costs if your condition deteriorates and requires readmission and more extensive treatment.
How to Handle a Prolonged Hospital Stay
If you find yourself waiting for discharge, there are several steps you can take to address the situation without immediately leaving AMA.
Communicate your concerns
Open and direct communication is the most powerful tool you have. Speak to your nurse, a charge nurse, or the hospital administrator to express your frustrations. Explain your reasons for wanting to leave, such as personal obligations or anxiety. Your care team may be able to provide a more specific timeline or help you find solutions to your concerns.
Involve a patient advocate or social worker
Hospitals have dedicated staff whose job is to assist patients. Patient advocates or social workers can act as a bridge between you and the clinical team to help address your issues. They can also help coordinate discharge planning and find resources to address personal obligations that are causing your stress.
Be proactive with discharge planning
Discharge planning should begin shortly after you are admitted. Ask your care team about the discharge plan and what needs to happen before you can leave. Making sure you have all the necessary paperwork, prescriptions, and follow-up appointments arranged ahead of time can help prevent delays on the day of discharge.
A Comparison of Discharge Options
| Feature | Formal Discharge | Leaving Against Medical Advice (AMA) |
|---|---|---|
| Medical Supervision | Complete treatment under professional supervision. | No medical supervision, potentially unfinished treatment. |
| Treatment Completion | Completed evaluation and care plan before leaving. | Incomplete evaluation and treatment plan, significant health risks. |
| Insurance Impact | Standard claim processing; covered services paid. | Generally not a reason for claim denial, but potential for higher costs if readmitted. |
| Legal Liability | Hospital remains liable for negligence or error. | Patient may waive the right to sue the hospital for consequences related to early departure. |
| Follow-up Care | Carefully arranged plan with necessary prescriptions and appointments. | Requires patient to proactively arrange own follow-up care immediately. |
The AMA Discharge Process
If you ultimately decide to leave AMA, here's what to expect and what you should know about your rights.
Discussion with the care team
Your physician will talk to you about the specific risks of leaving early. They will explain why they recommend you stay and what the potential negative health outcomes might be. This discussion is for your safety and to ensure you are making an informed decision.
The AMA form
The hospital will likely ask you to sign an AMA form. This form essentially documents that you were informed of the risks of leaving and that you are choosing to do so anyway. Signing this form is an acknowledgement, but you are not legally required to sign it. The hospital will simply document that you refused to sign if you decline.
Important next steps
Before you leave, you should still request any prescriptions you will need for your immediate care. The hospital has a duty to provide clear instructions for continued care or signs to watch for that indicate you need to return. Make sure you have a follow-up plan, even if you arrange it yourself, to avoid exacerbating your condition. The Emergency Medical Treatment and Labor Act (EMTALA) ensures that if your condition worsens and you need to return to the emergency room, you will be treated regardless of your prior AMA discharge.
Conclusion: Prioritize Communication and Safety
While long waits and delays can be frustrating, your health is the most critical consideration. Before you make the decision to walk out, exhaust all options by communicating with your care team and utilizing patient resources. Understanding your rights means knowing you can leave, but also being fully aware of the potential health consequences. Your autonomy as a patient is important, but a conversation with a trusted healthcare provider can help you make the safest choice for your well-being. For more information on patient rights and responsibilities in a medical setting, visit the American Hospital Association.
