Patient’s leaving AMA present a medical-legal dilemma for the entire ED staff and the hospital. The staff should be inserviced on management of these difficult cases. A standard approach to this patient is protective. Review of the case literature is instructive. If the physician provides the best care possible under the circumstances, and there is not question regarding the patient’s mental status, the jury will typically find for the defendant. There is no immunity from liability, these cases have to be litigated. However, it is unusual to find a case of liability, where the appropriate steps were taken and there is supporting documentation.

1. Jeffer EL. Against Medical Advice: Part I, A review of the literature. Military Medicine 1993. 158;2:69-72.
   
2. Jeffer EL. Against Medical Advice: Part I, A review of the literature. Military Medicine 1993. 158;2:69-72.
   
3. Dubnow D.: Emergency Department Discharges Against Medical Advice. The Journal of Emergency Medicine. 1992;Vol 10:513-516.
   
4. Cruzan v. Director, Missouri Department of Health, 110 S. Ct. 2841, 111 L.Ed. 2d 224 (1990)
   
5. For example see: In the matter of Lawrence, 579 NE 2d 32 (Ind. 1991); Werth v. Taylor, 475 NW 2d 426 (Mich. App. 1991); McKenzie v. Doctors Hospital of Hollywood, Inc., (No. 90-6961-Civ U.S. Dist. CT S.D. Fl., June 24, 1991); In Re Marrazzo, No. 90-14709, New York Supreme Court, Suffolk County, Jan. 2, 1991
   For example, see: Norwood Hospital v. Munoz, 564 N.E. 2d 1017 (Mass. 1991)
   
6. State v. Perricone, N.J.Rep., Vol. 37, p. 463, Atlantic Reporter, 2d Series, Vol 181, p. 751, 1962.
   
7. Fidel Salazar, et al v. Mission Hospital Los Angeles County (Ca) Superior Court at Norwalk, No. Sec 58177 California
   
8. Benesch K. Legal issues in determining competence to make legal decisions. In: Miller Red, et. Legal implications of hospital policies and practices. San Francisco: Jossey-Bass, 1989.
   
9. Gregory Cole v. Doe Hospital and Roe Emergency Room Physician Los Angeles County (Ca) Superior Court, No. California
   
10. In the Matter of Harvey “U:, 116 AD 2d 351, 501 NY S 2d 920 (1986).
    
11. Lane v. Candura, 376 NE2d 1232 (Mass App 1978).
    
12. Strub RL, Black FW. The mental status examination in neurology. Philadelphia: F.A. Davis Co., 1977.
    
13. Applebaum PS, et al. Assessing patients’ capacities to consent to treatment. N Engl J Med 1988;319:1635-8.
    
14. Searight, HR. Assessing patient competence for medical decision making. American Family Physician, 1992. 45;2:751-759.
    
15. Dubnow D.: Emergency Department Discharges Against Medical Advice. The Journal of Emergency Medicine. 1992;Vol 10:513-516.
    
16. Daniel Hopf as Trustee for the next of Kin of Gordan A. Hopf V. Marvin Timm, M.D. Wabasha County (Mn) District Court, No. Cx-91-334 Minnesota
    
17. Ann Murphey V. Yong-min Chi, M.D. Worcester County (Ma) Superior Court, No. 85-30649 Maine.
    
18. Michelle Marsh V. Wesley Curry, M.D. and Pomona Valley Community Hospital Los Angeles County (Ca) Superior Court, No. EAC53647
    
19. Isaac Cruz V. Santa Monica Hospital, and Janzen, Johnston and Rockwell Los Angeles County (Ca) Superior Court, No. C-629,468 California.
    
20. Dick V. Spring Hill Hospital, Inc. 551 So. 2d 1034 (Ala. 1989) Alabama
    
21. Robert L. George V. St. Anthony's Medical Center, Dr. Daniel O’Sullivan
    
22. St. Louis City (Mo) Circuit Court, No. 842-1424 Missouri
    
23. Arkansas Blue Cross & Blue Shield v. Long 792 S.W. 2d 602 (Ark. 1990)
    
24. Delia Rivera v. Queen of the Valley Hospital, American Emergency Physicians Medical Group, and Janet Michon Los Angeles County (Ca) Superior Court, No. Eac-71719 California.