Leaving the Hospital Against Medical Advice

How to Make an Informed Choice

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Most of the time, doctors and patients will agree when it is time to be discharged from the hospital. However, there are circumstances when there may be disagreement.

In cases where a patient decides to leave against the doctor's recommendations, the case will be labeled a discharge "against medical advice" (AMA). The AMA designation is used in part to legally shield the doctor and hospital from liability if a patient gets ill or dies as a result of the premature discharge.

Why Hospitals Want Patients to Stay

As patients, we sometimes hold a lingering suspicion that hospitals are money-making schemes whose aim it is to keep us in care and perform as many tests as possible to increase their billings. While it is true that there have been abuses, sometimes serious, there are numerous stopgaps in place today to prevent such abuse.

This includes a mechanism under the Affordable Care Act called the Hospital Readmissions Reduction Program (HRRP) which penalizes hospitals if Medicare patients are readmitted within 30 days of their discharge. It was designed to ensure that patients are not released before they are well enough to go home for the completion of their recovery.

Ethical and Legal Concerns

In some cases, there may be larger ethical and legal concerns that will induce a doctor to keep patients in care for longer than is needed, particularly in an age where medical malpractice is rife. Even then, there is no evidence of the widespread practice, particularly with regards to AMA discharges.

Most evidence, in fact, suggests that AMA discharges are declared solely for medical reasons and that patients discharged prematurely are at an increased risk of hospital readmission and even death.

If anything, doctors appear conflicted and largely misinformed about declaring an AMA discharge. According to research from the University of Chicago, 44 percent of attending doctors and 67 percent of residents incorrectly believed that an AMA discharge places their patients in breach of their health insurance and leaves them fully liable for their medical costs. In fact, there were no cases of payment refusal because a patient left AMA.

In the United States, the total number of patients discharged AMA increased by 41 percent between 1997 and 2011. Even more surprisingly, the number of patients discharged against the advice of Medicare increased from 25 percent to 31 percent between 1997 to 2011.

Before You Decide to Leave AMA

Leaving a hospital AMA is not a decision to take lightly. One of the most common reasons why people do so is cost. For instance, if you have high-deductible health insurance or are paying cash, every day in hospital can leave you with mounting medical bills that you would be hard-pressed to afford.

Dealing With Billing Concerns

While the high cost of hospital care may very well be a concern, many patients will make the decision to leave without first meeting with the hospital’s patient advocate, patient representative, or ombudsman to review the actual billing and discuss ways to defray or subsidize the costs. In many cases, being uninsured can result in an automatic bill reduction. Proof of low income may further reduce costs.

Moreover, you can request a reduction or even forgiveness of your bill with the billing department if you provide evidence of extreme financial distress. Most hospitals will also offer a 0% repayment plan. If all else fails, you can consider applying for a credit card with a 0% introductory APR on purchases.

Addressing Legitimate Complaints

If you decide to leave because you are not receiving adequate care, are in disagreement over your care, or have experienced errors or mistakes that could place your health at risk, do not do so without first lodging an official complaint with the hospital administrator.

Hospitals do not take serious reportable events (SREs) lightly given the legal liabilities and will typically take swift action to correct the error or meditate a solution (including your transfer to another hospital).

However, until a satisfactory solution is reached, avoid signing any document that absolves the hospital of liability for the SRE, and insist that a patient advocate be on hand to help mediate. If a proposed solution incurs further medical expense, insist that the hospital cover those costs. If your complaint is warranted and actionable, they will more likely than not accede.

Weighing the Pros and Cons

On the other hand, if you are leaving because you had a bad experience in the past, are afraid of hospitals, or have fears about MRSA or other potential risks, it is important to speak with your doctor and keep an open mind when discussing your concerns.

In the end, you need to remain as objective as possible so that you can weigh the benefits and consequences of leaving with the benefits and consequences of staying.

If you are in poor health and are unable to make an informed decision, find a family member, a trusted friend, or a private patient advocate to advocate on your behalf. Contact the National Patient Advocacy Foundation at 800-532-5274 for assistance with professional referrals.

If You Decide to Leave AMA

In deciding whether or not to be discharged AMA, there are several things you should be aware of:

  • If you want to leave, you most likely can. The only exception may be mental health patients for whom a discharge may place them or others at risk of harm.
  • AMA discharges do not void the terms of your insurance. Doing so will not result in a refusal of payments or trigger an increase in premium. Be aware, however, that you will incur additional medical expenses if you have to be readmitted as a result of the premature discharge.
  • You will be asked to sign discharge papers. This document is separate from any SRE complaint you may have filed. The discharge papers state that you have decided to leave against your doctor's advice. Have an advocate on hand to review the document and help you understand the terms.
  • You do not have to sign the papers. It is not illegal to leave, and there is no law requiring you to sign any discharge documents. With that being said, you should prepare a letter explaining why you have decided to leave. Keep a copy of the letter for yourself and give a copy to the hospital administrator.

    A Word From Verywell

    While it is your absolute right to accept or refuse any treatment offered you, never do so to the detriment of your health. In all cases, try to work out problems if you can and never undermine your treatment or recovery over a fight or disagreement.

    In the end, the best way to avoid rash decisions is to never make a decision alone. Having a friend or family member at your side can help guide you past emotions, confrontations, or even medications that may be impairing your good judgment.

    If you do decide to leave, have a loved one stay with you in case of an emergency, and do not sever communications with your doctor or hospital if you have questions, concerns, or problems of any sort.

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