Failure to Complete Required AMA Discharge Procedures
Penalty
Summary
The facility failed to follow required procedures when a resident was discharged against medical advice (AMA). Specifically, there was no documentation that nursing staff discussed the risks associated with leaving AMA, no signed AMA form was present, and there was no evidence that the physician, administrator, or director of nursing were notified as required by facility policy. The incident involved a resident with multiple medical conditions, including narcolepsy, edema, type 2 diabetes mellitus, and morbid obesity, who had been admitted for therapies and ongoing medical management. Prior to the discharge, the resident's family expressed a desire to take the resident home, and caregiver training was scheduled for a later date. On the day of discharge, the family demanded an in-person visit from a provider, which was not accommodated as providers did not come in on weekends unless it was an emergency. The family then called 911, and EMS arrived to transfer the resident. The family informed staff they were leaving, and EMS removed the resident without speaking to facility staff about the discharge. Interviews with facility staff confirmed that the expected protocol for AMA discharges was not followed. Staff acknowledged that the AMA form should have been explained and signed, or refusal documented, and that the physician and administrative staff should have been notified. However, there was no documentation of these actions in the resident's medical record. The facility's policy required these steps, but the record lacked evidence that they were completed in this case.