dr RAM,HIV /AIDS,HEPATITIS ,SEX DISEASES & WEAKNESS expert,New Delhi,India, profdrram@gmail.com,+917838059592,+919832025033,ON WHATSAPP
Doctors in their Clinical Practice often encounter many times a situation where a patient wants to leave Clinic or Nursing Home or Hospital himself or through attendants or legal guardians as patient is not cured or relieved by medicine or some complications developed or they are not satisfied with the facilities or cant pay the treatment or wants referral to other place or just wants discharge to carryout further treatment at home or under another doctor at another Hospital or clinic .
Many of such patients even pay the charge of hospital in private setup or pay less citing this or that justified or irrelevant reasons and some time wants to leave hospital without paying any thing and force Doctors to give them discharge or referral slip or write them full treatment done and provide case history and investigations.In Government setup some misbehaving ,shouting or gathering of few peoples or instructions from Politicians,bureaucrats and senior administrations bound Doctors to discharge patient immediately and provide all documents of treatment,case history and investigations undertaken.
In both cases whether Government or private treating Doctors should be always alert that if proper paper work is not done and if Doctor provides simple discharge even if patient improved but no satisfactorily or patient deveolped complications or patients deterioates and patients attendants are not satisfied then before providing a discharge from the Hospital or Nursing Home Doctors must takes in writing that Patient is willing to leave Hospital and care provided by Doctor willingly knowing all its aftermath or results or complications without any pressure in fully alert condition duly attested by his her legal attendants or if patients cant write one legal guardian of patients should sign it in presence of two witness of patients with full name,address of these witness ,if possible patients attendants should write it in their own language with their own hand .Such discharge is called "LAMA" or Left Against Medical Advice of DAMA ,Discharged Against Medical Advice and Doctor should taken in writing that all case history, treatment and investigations done were provided to attendants and if full payments not done then it should be also mentioned.If a Doctor himself refer the patient to a higher centre or another centre even then if complications of this refer must be explained to patient and attendants and such explanations must be recorded in file and signed by patient or attendants.Paper work and completing file is a must.
These precautions are necessary as such preserved documents save Doctors and Hospital from consumer as well as civil and criminal cases.In a recent incidence ,In chhattisgarh,one elderly lady was admitted in ICU of a Hospital but as not improved so discharged from the hospital and then expired at another place her attendants filed a case in district Consumer court and the court fined the hospital of Rs 18 lacs but as Hospital moved to state commission,the commission relieved hospital,so now patient's attendant filed a revision plea in national commission.National commission ordered that It is pertinent to note that the petitioner in the complaint has taken a plea that the hospital authority on 29.1.2014 suddenly discharged the patient Smt. Purnima Devi although she was not fit for discharge. Aforesaid plea of the complainant is falsified by the record which contains a duly signed statement of one Mukesh (family member of Smt. Purnima Devi) stating that he has got the patient discharged against medical advice on his responsibility.Even in the discharge document issued by the hospital authorities it is recorded, “LAMA” which means left against medical advice. From this it is clear that the petitioner is not a truthful person. As such the State Commission was justified in rejecting the claim of the petitioner on the basis of enquiry report of the Drug Inspector, Food & Drug Department, Durg, Chhattishgarh.
Therefore doctors and Hospital should learn a lesson from this and in any case,before discharging any patient before good cure or control of disease,even patients want early discharge on request then it should be mentioned on Discharge Certificate and get undertaking from patients in writing of request too and if patient not cured or unsatisfied then it is better patients are sent LAMA or DAMA and if patient does not pay doctor and hospital full and write so then it provided a good help in consumer court if patients file a case against doctor or hospital in consumer forum.If patients forcefully leave hospital without or with paying but no writing taking all papers ,The local police must be informed immediately in writing as patients left hospital own and such diary or first information report must be acknowledged by local police station and preserved in file and if left suddenly without any notice of Nursing or attendant staff then Police should be informed immediately as patient is Absconding otherwise if anything happens to patient then it will be assumed it happens in that hospital as patient is at least admitted here on papers.
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