Whether she acted unreasonably in discharging herself against medical advice was a question of fact for the jury. On appeal, the court held that since she had been ill for 4 years, had been in and out of hospitals, had a plethora of tests, and was frustrated from years of unsuccessful tests coupled with her extremely poor health, the jury found that Ms Ott did not act unreasonably when she discharged herself from the hospital.
In Suria v Shiffman,13 the court held that the patient’s actions in leaving the hospital against medical advice did not afford a complete defense in a malpractice case (brought in connection with the administration of silicone injections to a transsexual male), but would warrant a reduction in damages to the degree that the patient’s actions increased the extent of the injury.
In Pollicina v Misericordia Hospital Medical Center and Hospital of the Albert Einstein College of Medicine,14 the patient discharged herself against medical advice from the Misericordia Hospital but was immediately admitted to Einstein Hospital. The patient died 1 week later of pulmonary thrombosis. In this medical malpractice case, the trial court granted motions to dismiss the complaint against Misericordia on the basis that the actions of the hospital had not led directly to the damage to the patient. The protective factor was that following her discharge against medical advice, she was admitted to another hospital.
In Hawkins v Brooklyn-Caledonian Hospital,15 the patient brought an action against the hospital claiming that the failure of a physician to obtain assistance inserting a subclavian catheter and to properly insert the catheter, the tip of which broke off inside the patient’s body during the procedure, was a departure from good and accepted medical practice. The patient was warned that physical activity could cause the tip of the catheter to migrate, causing his death. He also suffered the painful effect of thrombophlebitis and its continued consequences, including the use of illicit drugs after a period of sobriety in an attempt to self-medicate. Mr Hawkins left the hospital against medical advice, missed 2 scheduled appointments, failed to take his medication, and was later readmitted with another bout of phlebitis. He was discharged 2 days later but failed to keep his next clinic appointment.
In this case, although some of the damages claimed were the result of the patient’s failure to comply with recommended medical treatment, the court of appeals ruled in a 3 to 1 decision that the trial court’s verdict against the hospital and damages should stand.
Psychiatric Discharges
In Kelly v United States of America and John Doe, John Roe, and John Shoe,16 the decision of a Veterans Affairs Medical Center to release Arnold Shockley against medical advice was challenged. After Shockley was released, he stabbed Officer Kelly. The court held that there were no reasonable grounds for the treating psychiatrist to seek involuntary commitment of Shockley, and judgment was made in favor of the medical center.
In Solbrig v United States of America,17 the Solbrig family brought an action alleging that the veterans hospital in Milwaukee, Wisconsin, and 2 of its nonpsychiatric physicians should not have released Mr Solbrig because he was a clear suicidal risk. He died by suicide within hours of his discharge against medical advice. The court found that although Mr Solbrig had expressed suicidal tendencies in the past, he showed no signs of being a genuine suicidal risk on the morning of his discharge, and the physicians were not found negligent in their treatment of the patient.
The Use of a Waiver
A hospital may not, as a condition of allowing a patient to leave against medical advice, require the patient to sign a form releasing the hospital from liability for malpractice claims by the patient. In Dedely v Kings Highway Hospital Center,18 a mother requesting the release of her infant son was required to sign a form by which she assumed “all risks, responsibilities and liabilities, whatsoever” and released “Kings Highway Hospital Center, Inc, its physicians, surgeons, authorities, and employees from all risks, claims, responsibilities whatsoever.” The court found this type of form to be contrary to public policy and therefore worthless. It also observed that “a hospital’s failure to release a patient unless it sought judicial relief, would undoubtedly subject the hospital to an actionable tort.”
Hospital Detention Orders
In the matter of City of New York v Antoinette R,19 the New York City Health Commissioner sought enforcement of an order requiring forceful detention in a hospital setting of a person with active infectious tuberculosis to allow for completion of the appropriate regimen of medical treatment. The Supreme Court of Queens County decided that evidence that the patient had discharged herself against medical advice on a number of occasions justified detention, despite evidence of her recent voluntary cooperation in adhering to the recommended medication regimen.