If the physician is unable to persuade the patient, or if the patient seems unwilling to wait for the physician, the hospital administrator should discuss with the patient the decision to leave. In many cases, the patient may have valid complaints that can provide valuable information to the quality control manager. Irrespective of the reason, if the patient still insists on leaving, most hospitals will try to persuade the patient to sign a release of liability, colloquially called an "against medical advice" (AMA) form. The AMA form typically states that the patient was warned of the risks of leaving the hospital prematurely and waives any cause of action against the health care provider. This type of waiver, called a blanket release, is ineffective in court because public policy prohibits releasing a person from liability for negligence. The only value of this form is as evidence that the patient was warned about the risks of leaving the hospital. Unfortunately, the release section in the form causes many patients to refuse to sign it.
A better approach is to use a questionnaire-type, elective discharge form that provides information about the patient's complaints and details the risk that we told to the patient. This form should not contain any release of liability; this will increase the chances of its acceptance by the patients. The legal value of the questionnaire form is that it delineates the patient's complaints. The hospital may offer to correct any legitimate problems and will be alerted to any misunderstandings that need to be documented in the medical record. If the patient later sues on a new complaint, the hospital will be able to document that it was never notified of the problem and thus had no opportunity to correct it. This will also diminish the patient's credibility as a witness because of the conflicting complaints. In effect, a properly designed elective discharge form has the legal standing of a statement by the patient, rather than the appearance of a coerced release. The courts will look on this much more favorably than they do the usual AMA form.
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