Refusal of Care Form
In human medicine, a patient can leave a medical facility of their own free will regardless of their condition, unless cognition is severely impaired.
All they have to do is basically be aware of person, place, and time and sign a form known as “Refusal of Care Against Medical Advice,” or an AMA form.
I first saw this when drug overdose victims were brought to the emergency room where I worked as a paraprofessional. If they’d OD’d on opiates and were unconscious and unresponsive, under controlled ventilation, a competitive antagonist was administered IV and soon they popped up and wanted to know how they got there. Fearing arrest and feeling the impending withdrawal symptoms, they often signed themselves out AMA despite explanations of rebound effects when the antagonist wore off. And yes, there have been reports of subsequent deaths afterwards.
So does your practice employ such a form? You can see an example here: http://www.cvm.umn.edu/vmc/prod/groups/cvm/@pub/@cvm/documents/asset/cvm_29225.pdf from the University of Minnesota’s Veterinary Medical Center.
There are lots of attendant legal questions and qualifications that should be in place so to read how the human side is dealing with the matter see: www.co.marin.ca.us/hhs/ems/documents/Policies/8104.pdf , “Against Medical Advice: When Should You Take ‘No’ for an Answer?” It is a year-old presentation given by Dr. Catherine Marco, a professor in the Department of Emergency Medicine at the University of Toledo College of Medicine.
The reason I ask if you use such a form is, I got a call yesterday from a competing practice that was to assume care of an animal with a now unneeded feeding tube in place but the current practice would not release the animal to the owner. The bills were paid and the animal was stable but the Doc was out of town and the staff was told before he left not to release the animal until he’d seen it again.
Instead of a form, do you just make a notation in the medical record and think that covers the matter? Do we have any DVM/JDs reading that would offer a non-binding opinion?
