In Kruse v. Farid, Slip. Op. No. 18-0464 (W.Va. Nov. 8, 2019), the Supreme Court of Appeals of West Virginia affirmed summary judgment “finding that [the defendant physician] did not have a duty to provide follow-up medical care after Ms. Kruse left Raleigh General Hospital against medical advice (‘AMA’).”
After Dr. Farid performed a procedure which included the placement of stents that had to be later removed, Kruse left the hospital AMA after signing a “Leaving the Hospital Against Medical Advice” form:
I, Kruse, Misty, a patient in Raleigh General Hospital of Beckley have determined that I am leaving the hospital and I acknowledge and understand this action of so leaving the hospital is against the advice of the attending physician and of hospital authorities.
I further acknowledge that I have been informed of the possible dangers and risks to my health and the health of others by my so leaving the hospital at this time, and I have been given full explanation of the consequences of my leaving the hospital and I do not wish any further explanation.
I assume the risk and accept the consequences of my departure from Raleigh General Hospital at the time and hereby release all health care providers, including the hospital and its staff, from all liability and responsibility for the ill effects that may result to myself, my family and to others resulting from this discontinuance of treatment in the hospital.
I have read and fully understand this document, and understand the risk and benefits of leaving Against Medical Advice.
“The nurses who witnessed her signature indicated that she did not appear to be intoxicated or confused and that they had informed the appropriate person of Ms. Kruse’s departure.” Suing Dr. Farid, Kruse claimed she “believed that she was being discharged and did not appreciate that she was leaving AMA.” And she claimed that “Dr. Farid did not inform Ms. Kruse that they needed to be removed.” The Court noted “as to this point, Dr. Farid stated that his customary practice is to inform stent patients that the stents would need to be removed and to schedule a follow-up appointment for that purpose, but that Ms. Kruse had already left the hospital AMA when he went to speak with her. Moreover, Ms. Kruse did not, on her own, follow up with Dr. Farid regarding the removal of her stents.” The circuit court granted summary judgment.
Addressing Kruse’s claims that “she did not receive competent medical treatment both before and after she left the hospital AMA” the Court agreed “with the circuit court’s assessment that the act of signing out AMA, itself, signifies the termination of the physician-patient relationship such that the patient has indicated an intention to refuse medical treatment, and, consequently, the physician no longer has a duty to provide medical care to the former patient” and “the circuit court did not err by concluding that Ms. Kruse departed from the hospital AMA.” The Court bound Misty to her signed AMA. “While Ms. Kruse claims that she did not realize she was leaving the hospital AMA, Ms. Kruse does not dispute that her signature appears on the AMA form. We previously have recognized that “‘the failure to read a contract before signing it does not excuse a person from being bound by its terms.’ … In other words, ‘[a] person who fails to read a document to which he places his signature does so at his peril.’”
The court rejected Kruse’s argument that the circuit court improperly applied contract law, finding the circuit judge “concluded that, because the physician patient relationship ended when Ms. Kruse left the hospital AMA, Dr. Farid no longer owed a duty to provide medical treatment to Ms. Kruse as she was no longer his patient and had, by virtue of signing the AMA form, indicated her intention to refuse further care.” Also, “we disagree with Ms. Kruse’s contention that the circuit court erred by relying upon authority from other jurisdictions insofar as the issue presently before us is one of first impression for this Court, and reference to extrajurisdictional case law, though not controlling, was instructive to the circuit court’s, as well as to this Court’s, decision of the case.” On this point, other states’ cases were “plentiful regarding AMA situations but scant regarding the nature of a physician’s duty to his/her patient, if any, under such circumstances,” and noted the “preeminent case” is Collins v. HCA Health Services of Tennessee, Inc., 517 S.W.3d 84 (Tenn. Ct. App. 2016), holding patients have the right to refuse care and when they do it terminates the physician patient relationship (as does the physician’s decision to dismiss the patient). A patient’s right to refuse care, the Court noted, has been recognized by SCOTUS and the WV Legislature. Cruzan by Cruzan v. Dir., Mo. Dep’t of Health, 497 U.S. 261, 269-70, 277 (1990); W. Va. Code § 16-30-2(b)(1) (“Common law tradition and the medical profession in general have traditionally recognized the right of a capable adult to accept or reject medical or surgical intervention affecting one’s own medical condition[.]”).
In light of the foregoing authorities, we 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. Thus, once Ms. Kruse was determined to leave the care of Dr. Farid AMA, she had the right to do so, and Dr. Farid’s duty to provide medical treatment to her ceased as a result of her termination of the physician-patient relationship.
Further, “we conclude that Ms. Kruse has failed to establish an essential element of her negligence claim, namely that Dr. Farid had a duty to provide medical care to her after she terminated their physician patient relationship when she refused further medical care and left the hospital in which she was Dr. Farid’s patient AMA. Having thus failed to establish the existence of a duty, summary judgment in Dr. Farid’s favor was appropriate as a matter of law.”
Last the Court rejected “the circuit court misapplied the MPLA and failed to recognize the public policy implications of enforcing the AMA form at issue…” While “[t]he MPLA codifies the obligations of health care providers in West Virginia to their patients” the Court “disagree[d] that the public policy expressed by the MPLA forecloses the decision obtained by the circuit court…” The Court analyzed cases regarding “releases of liability contravened the public policy of this State because they sought waivers of causes of action secured by statute, we emphasized that the plaintiff seeking to avoid the release must be a member of the class contemplated to be within the protection afforded by the referenced statute,” concluding “Ms. Kruse’s assignments of error in this regard must fail because, by virtue of her discontinuation of the physician-patient relationship she had with Dr. Farid when she left the hospital AMA, Ms. Kruse removed herself from the class of individuals sought to be protected by the MPLA, i.e., patients.”
This is an important opinion because it recognizes there is no further duty to a patient who ends the health care relationship by leaving AMA. Important to the case was the detailed and properly executed AMA form. Language in the case also suggests a similar result where the relationship is ended by the dismissal of the patient by the health care provider.