Petitioner underwent gall bladder surgery at Raleigh General Hospital on July 14, 2009. On July 16, Petitioner returned to the hospital, at which time Respondent performed a follow-up procedure using temporary stents. Because the stents were temporary, it was necessary for them to be removed within a matter of months to prevent infection, occlusion, or other potentially life-threatening complications. Petitioner left the hospital on July 19 after completing and signing a form bearing the title “Leaving the Hospital Against Medical Advice.” Respondent did not, at any time, advise Petitioner that the stents he had used were temporary and, therefore, had to be removed at a future time. On December 27, 2013, Petitioner presented at a Charleston hospital in acute distress and was diagnosed with an infection and other complications relating to the temporary stents.
Thereafter, Petitioner sued Respondent alleging medical malpractice. Respondent moved for summary judgment, alleging that Petitioner’s departure from the hospital against medical advice terminated any duty he might otherwise have owed. Citing Collins v. HCA Health Services of Tennessee, 517 S.W.3d 84 (Tenn. App. 2016), the trial court concluded that “once a patient terminates treatment and decides to leave against medical advice, his or her status as a patient ceases along with the health care provider’s duty of care.” Accordingly, judgment was entered in Respondent’s favor. Petitioner appealed.
Whether a health care provider owes any legal duty to a patient who voluntarily departs a hospital or treatment facility against medical advice?
The Supreme Court affirmed the summary judgment order, concluding that the physician/patient relationship and Respondent’s duty of care terminated when Petitioner left against medical advice.
First, the Court was careful to differentiate between Respondent’s duty before and after Petitioner left the hospital. The issues involving Respondent’s conduct before Petitioner’s discharge were not properly before the Court and, therefore, were not addressed. The Court’s sole focus was the nature of Respondent’s duty post discharge.
In this regard, the Court cited and applied the general law of release, finding that Petitioner had, in fact, accepted the risk of harm by signing the hospital’s form for discharge against medical advice. The Court noted that a patient has the right to refuse medical treatment. By signing the form, she effectively terminated the physician/patient relationship. Quoting Collins, the Court noted that: “Once she terminated treatment and decided to leave against medical advice, however, her status as a patient of the [provider] ceased as well as the [provider’s] general duty of care to her as a patient.” The Court did not formally adopt a new syllabus, but the following language from the opinion reads like one:
“[W]e conclude that when a patient voluntarily leaves a health care facility against medical advice and executes a release of liability indicating that he/she understands and assumes the risks of leaving the health care facility against medical advice, the patient thereby terminates the physician-patient relationship such that the released medical providers do not thereafter have a duty of care to the patient.”
Petitioner also argued that Respondent’s position was contrary to the Medical Professional Liability Act, W.Va. Code 55-7B-1 et seq. However, the Court noted that the MPLA only applied to health care providers and their “patients.” Because Petitioner terminated the physician/patient relationship by leaving the hospital against medical advice, she was no longer a patient and, therefore, was no longer covered by the MPLA.
The outcome in this case is not too surprising. The Court kept its analysis case-specific. There is no discussion of general tort law except the familiar adage: “No action for negligence will lie without a duty broken.” Thus, the case will probably have little impact other than establishing a bright line rule that can be applied to patients who voluntarily refuse treatment and leave a health care facility against medical advice.