HospitalInspections.org

Based on document review and interview, it was determined, for 1 of 6 patients (Pt. #1) who left the hospital Against Medical Advice (AMA), the hospital failed to ensure patients were provided information regarding the risks of leaving the hospital before discharge.

Findings include:

' 1. Hospital policy no. 21.53, titled, " Patient Leaving Against Medical Advice " , reviewed by the hospital on 7/11, was reviewed by the surveyor on 7/30/12 at 2:00 PM. The policy required, " Any adult with decisional capacity has the right to refuse treatment even if it is thought that refusal of treatment might result in serious harm or death ... The patient/guardian ' s signature is witnessed by the director of nursing, patient care manager, house operations administrator, and/or staff nurse ... Documentation of physician and RN should include ... Patient condition prior to leaving the hospital. Discharge instructions ... "
2. On 7/29/13 at 9:30 AM, Pt. #1 ' s clinical record was reviewed. Pt. #1 was a 55 year old male, treated in the Emergency Department (ED) on 7/2/13, for complaints of chest pain and seizures. Pt. #1 was admitted to 2 West, telemetry unit on 7/2/13 at 6:04 PM. Pt. #1 was discharged Against Medical Advice from the hospital on 7/5/13 at 5:30 PM.
3. A nursing note (E #11) dated 7/5/13 at 5:00 PM, contained, " Received patient angry and verbally abused to staff. Threatening staff with lawsuits ... Patient refusing medication for anxiety... Patient refusing to cooperate with staff. Unable to assess patient at this time ... Patient states he is leaving Against Medical Advice (AMA). Patient denies pain. Patient alert and oriented times 3 [knows person, place, and time]. Spoke to Doctor [MD #7] ... several time this shift about patient ' s behavior and patient threatened to leave AMA. No new orders received. House supervisor on unit and making transportation arrangements for patient ... Charge RN removed IV and telemetry. Patient given personal belongings and security on unit to escort patient to lobby. " An AMA form was not found nor a note that Pt. #1 refused to sign an AMA form.
4. MD # 7 is on vacation until 8/9/13, and was not available for interview.
5. On 7:30/13 at 11:50 AM, an interview was conducted with the Registered Nurse (E #11) who was assigned to Pt. #1 at the time he left the hospital. E #11 repeated the information provided in her notes and added that the charge nurse gave her an AMA form to complete for Pt. #1, but the House Supervisor [House Operations Manager] (E #12) told her it wasn ' t necessary to complete it. E #11 did not have the AMA completed or document that Pt. #1 refused to complete/sign an AMA.
6. On 7:30/13 at 10:10 AM, an interview was conducted with the House Operations Manager (E #12) on duty when Pt. #1 left the hospital. E #12 stated she was called by the charge nurse to assist with Pt. #1 who was insisting on going home. E #12 gave Pt. #1 seventy-two dollars from petty cash for a taxi to go home. E #12 stated Pt. #1 refused to sign AMA and was given discharge instructions. Pt. #1 " stormed out of the room " to go home.