Leaving the Hospital Against Medical Advice

Most of the time, doctors and patients agree on when it is time to leave the hospital. Sometimes, though, they may have different ideas about what is best for the patient.

Sometimes a patient decides to leave the hospital against a doctor's advice. When this happens, the case is labeled a discharge "against medical advice" (AMA).

This label is used in part to protect doctors and the hospital from liability. This is important because it's possible the patient may become ill or die as a result of the early discharge.

This article discusses AMA discharge and its potential risks. It also looks at some of the reasons why patients may want to leave the hospital early, and what you should consider before making this decision.

Why Hospitals Want Patients to Stay

Patients sometimes think hospitals might not have their best interests in mind. They may feel like hospitals are only keeping them so they can charge more. Usually, though, the reasons have to do with the patient's safety.

Some discharge guidelines are built into law. The Hospital Readmissions Reduction Program (HRRP) under the Affordable Care Act is one example. Under HRRP, hospitals are penalized if Medicare patients return to the hospital within 30 days of discharge.

This program is meant to ensure that patients don't leave the hospital before they are well enough.

Ethical and legal concerns may also encourage doctors to keep patients in care for longer than necessary. This may be because medical malpractice is such a big concern.

Still, there is no evidence that hospitals often hold patients for nonmedical reasons. This is particularly true when it comes to AMA discharges.

If anything, healthcare providers seem unsure about AMA discharge. Research suggests some may even be misinformed.

According to one study, 44% of doctors and 67% of residents thought patients who leave the hospital AMA have to pay their own hospital bills. This is untrue. In fact, there were no cases where insurance refused to pay a bill because a patient left AMA.

In the United States, the total number of patients who leave the hospital AMA is increasing. Between 1997 and 2011, the numbers increased by 41%. Among Medicare patients specifically, the number who left the hospital AMA also increased from 25% to 29%.

Before You Decide to Leave AMA

Leaving a hospital AMA is a serious decision. Many people make this choice because of cost.

If you have a high-deductible health insurance or are paying cash, every day in the hospital costs you more money. Extra days can leave you with mounting medical bills you can't afford.

Dealing With Billing Concerns

The high cost of hospital care is an important concern. Before you decide to leave, though, there are people on staff at the hospital who can help you with these concerns.

A patient advocate, patient representative, or ombudsman can meet with you to review your bill. They can also discuss ways to get help with the costs or pay your bill in installments.

If you have proof of extreme financial distress, you can request a reduction of your bill. In some cases you may even be able to ask for forgiveness. Most hospitals also offer a 0%-interest repayment plan.

Addressing Legitimate Complaints

Sometimes people choose to leave the hospital because they feel they are receiving poor care. They may also disagree about what type of care they should get. Sometimes they may feel that hospital errors have put their health at risk.

If this describes your experience, do not leave without first lodging an official complaint. You can bring your concerns to the attention of hospital administration or speak to a hospital social worker.

For legal reasons, hospitals take serious reportable events (SREs) seriously. They usually take swift action to correct the error or find a solution. They may even transfer you to another hospital.

Until the problem is resolved and you are happy with the outcome, don't sign anything that absolves the hospital of liability for the SRE. Make sure you have a patient advocate to help you negotiate.

If the hospital's solution will increase your medical costs, insist that the hospital cover those costs. If your complaint is valid, they will almost certainly agree.

Weighing the Pros and Cons

Some patients may leave simply because they do not like hospitals. They may have had a bad experience in the past. They may also have fears about antibiotic-resistant infections like methicillin-resistant Staphylococcus aureus (MRSA).

If these are your concerns, speak with your healthcare providers. Keep an open mind when discussing your concerns.

Try to stay objective. Weigh the costs and benefits of leaving with the costs and benefits of staying.

If you are in poor health, you may not be able to make an informed decision on your own. In this case, find a family member, a trusted friend, or a private patient advocate to advocate on your behalf.

Contact the National Patient Advocate Foundation at 800-532-5274 for help with professional referrals.

If You Decide to Leave AMA

If you are considering leaving the hospital AMA, there are a few things you should be aware of:

• If you want to leave, you probably can. The only exception may be for mental health patients who are at risk of harming themselves or others.
• AMA discharges do not void the terms of your insurance. Leaving AMA will not result in a refusal of payment. It will not trigger an increase in your insurance premium, either. It is possible, though, that you will have more medical expenses if you have to be readmitted because of the early discharge.
• You will be asked to sign discharge papers. This document is separate from any SRE complaint you may have filed. These papers state that you have chosen to leave against your healthcare provider's advice. Have an advocate on hand to review the document. Make sure you understand the terms.
• Know that you do not have to sign those papers. You have the legal right to leave. There is no law that requires you to sign discharge documents. Still, you should prepare a letter that explains why you decided to leave. Keep a copy of the letter and give a copy to the hospital administrator.

Summary

You have a right to leave the hospital against the advice of your healthcare providers. Still, you should be aware of the risks of doing so.

Hospitals usually decide whether to keep you in care based on valid medical reasons. However, you may decide to leave because of high costs, poor care, or past bad experiences.

Whatever your decision, it is important to talk to a patient advocate and hospital administration first. You may be able to resolve your problems without having to leave AMA.

If you do leave, make sure you understand your rights and the consequences of your decision.

A Word From Verywell

It is your absolute right to accept or refuse any treatment offered you. Still, you should never do so if it will harm your health. In all cases, try to resolve problems first. Never undermine your treatment or recovery over a fight or disagreement.

The best way to avoid rash decisions is to never make a decision alone. Have a friend or family member at your side. A trusted person can help guide you past emotions, confrontations, or even medications that can impair your judgment.

If you do decide to leave, have a loved one stay with you at home. It is important you are not alone if there is an emergency. Do not stop talking to your doctor or the hospital. They will still be able to address your questions, concerns, or problems.