Understanding the Right to Leave
In the United States, mentally competent adults generally have the right to refuse medical treatment and leave a hospital, even if it is against medical advice (AMA). When a patient chooses to leave AMA, they are often asked to sign a form acknowledging they understand the potential health risks. However, signing this form is not legally required for a patient to leave. It primarily serves to protect the hospital from legal liability should the patient's condition worsen due to leaving prematurely. Financial reasons, such as an inability to pay, are not legal grounds for a hospital to hold a patient.
Involuntary Commitment for Mental Health
One of the most common reasons a hospital can legally hold a patient is through involuntary commitment, also known as a psychiatric hold. This is a legal process, governed by state law, that allows a person with a severe mental health condition to be admitted to a psychiatric unit against their will. This serious action is only taken when a person is deemed a danger to themselves or others, or is unable to provide for their own basic needs due to their mental state.
- Emergency Holds: In urgent situations, a police officer, healthcare provider, or crisis team can initiate a temporary hold, often for up to 72 hours. During this time, the patient is evaluated by medical professionals. A grave and immediate danger is required for this type of hold without a court order.
- Court-Ordered Commitment: For a longer involuntary stay, a court order is typically required. This process, which can be started by a family member, medical professional, or law enforcement, involves a hearing where evidence is presented to a judge to prove that the individual meets the criteria for continued confinement. A patient has the right to legal counsel during this process.
The Definition of 'Danger'
For involuntary commitment, the concept of "danger" is interpreted seriously and is not based on mere inconvenience or a difference of opinion. Criteria for determining dangerousness often include:
- Threats or attempts at suicide.
- Homicidal or other violent behavior toward others.
- Inability to meet essential needs like food, shelter, and medical care due to a mental illness, which puts the person at risk of serious harm.
It is important to remember that having a mental illness alone does not make a person dangerous or qualify them for involuntary commitment.
Other Legal and Incapacitation Scenarios
Beyond mental health concerns, other legal situations can result in a hospital being able to enforce a stay:
- Legal Guardianship: If a patient has a court-appointed legal guardian, that guardian's decisions can override the patient's wishes if the patient is legally declared incompetent.
- Minors: A minor cannot discharge themselves from a hospital. This decision rests with their parents or legal guardians until the age of emancipation.
- Incarcerated Individuals: If a patient is in law enforcement custody, their freedom to leave is restricted. Only the correctional facility can authorize their discharge, though the patient still has the right to refuse care.
What Happens When You Leave Against Medical Advice (AMA)?
When a patient leaves AMA, they are not only signing a waiver of liability but are also departing without completing the recommended course of treatment. While a hospital cannot physically detain a competent adult, they will take steps to ensure the patient understands the risks involved. This includes documenting the event in the patient's medical record.
Leaving AMA can have several consequences:
- Health Complications: The most immediate risk is that leaving without completing treatment can worsen the medical condition, potentially leading to readmission or more severe issues.
- Loss of Future Care: In some cases, a physician may refuse to continue treating a patient who repeatedly leaves AMA, though this is not a universal practice.
- Financial Liability: While leaving AMA does not automatically void insurance coverage for care already received, the patient is still responsible for their portion of the bill. It's a misconception that insurance companies deny all claims for AMA discharges.
Hospital Holds for Different Circumstances
Let's compare the different types of holds a hospital can enforce.
| Feature | Mental Health Hold | Incapacitation Hold | Custody Hold (Incarcerated Patient) |
|---|---|---|---|
| Initiator | Healthcare provider, police, or crisis team. | Court-appointed legal guardian. | Law enforcement agency or correctional facility. |
| Underlying Reason | Danger to self or others due to mental illness, or inability to care for self. | Legal declaration of incompetence to make medical decisions. | Patient is legally in custody during hospitalization. |
| Legal Basis | State involuntary commitment laws (e.g., 5150 hold). | Court order granting guardianship. | Law enforcement authority and custody rules. |
| Patient's Rights | Retains right to legal counsel; informed of rights. | Rights are exercised by the legal guardian. | Right to refuse treatment still applies, but physical liberty is limited. |
The Importance of Patient Advocacy
For patients concerned about their rights, especially when facing pressure to stay, patient advocates are a valuable resource. An advocate can help navigate complex situations, understand state-specific laws, and communicate with the healthcare team. Having an advocate can ensure that all patient rights are respected throughout the hospital stay. More information on patient rights can be found at The American Hospital Association.
Conclusion
While the right to leave a hospital is a fundamental patient right, it is not absolute. The ability of a hospital to force a patient to stay is strictly limited to specific legal and medical circumstances, predominantly involuntary commitment for mental health crises and cases of legal incapacitation or custody. For competent adults, leaving against medical advice remains an option, though it carries significant health and potential legal ramifications. Understanding these boundaries is critical for both patients and their families.
