Against Medical Advice: Court Rules Nurse Is Not At Fault For Discharging Patient.

Against Medical Advice: Court Rules Nurse Is Not At Fault For Discharging Patient.

Legal Eagle Eye Newsletter for the Nursing Profession

Request a complimentary copy of our current issue

The patient's nurse acted in good faith by respecting the patient's expressed wish to leave the hospital against medical advice. A healthcare provider who in good faith believes that a person is capable of withholding informed consent for health care is not subject to civil liability for following that person's directions. The patient's nurse ascertained to her own satisfaction that the patient was capable of making a rational choice as to the course of his own healthcare.

The nurse testified the patient's sedating medications were short acting and generally wore off quickly. He was fully alert and oriented and did not seem to be still under the influence when he left. The nurse obtained the patient's consent to do so and contacted three physicians, none of whom objected to the patient leaving against medical advice. The nurse's experience told her that patients not uncommonly leave against medical advice for a variety of reasons. This patient was agitated, but only because he was anxious to leave. SUPREME COURT OF SOUTH DAKOTA December 9, 2015

The thirty-seven year-old patient drove himself to the emergency department at 1:00 a.m. after being struck in the throat and head during a fight in a bar. When he complained at 2:00 a.m. that the pain in his neck and throat was getting worse a CT scan was done. He was intubated to protect his airway and was moved to the ICU. In the ICU he was sedated with propofol, Versed and fentanyl.

At 11:00 a.m. the sedating medications were stopped and he was extubated. At 11:55 a.m. he began asking his nurse when he would be allowed to leave. The nurse told him a physician would discharge him sometime that week. He became agitated and started pulling at his heart monitor leads and IV tubing. The patient gave the nurse permission to contact his physicians and discuss his desire to leave right away. The nurse spoke with the on-call trauma surgeon. She called the physician who had intubated him, who wanted him to drink fluids before leaving, but told the nurse not to try to force him to drink fluids. The nurse also contacted the patient's primary care physician. None of the physicians were willing to discharge him, yet all of them told the patient's nurse they had no objection if he wanted to leave against medical advice.

The nurse had the patient sign forms indicating he was leaving against medical advice. He refused to take his printed discharge instructions. The nurse asked if she could phone someone for a ride, but the patient insisted he was driving himself. After the patient left at 12:30 p.m. he drove to his mother's home where he got a bottle of liquor which he drank while driving to his own home. There at 2:30 p.m. in a stupor he brutally attacked his neighbor. Based on a psychiatric evaluation which resulted in a mental health hold he was ruled not guilty of criminal assault charges by reason of mental illness. The Supreme Court of South Dakota dismissed the lawsuit the patient filed against the hospital. Klein v. Hospital, __ N.W. 2d __, 2015 WL 8482790 (S.D., December 9, 2015).