Patients and doctors don’t always agree on their treatment plan or progress in treatment.  The patient may leave the hospital AMA after signing release of liability and discussion.  A patient may decline the ambulance attendant’s advice and refuse to be transported to the hospital and he/she then signs an AMA form. There are many reasons given for leaving AMA.

My most memorable AMA didn’t involve any forms or witnesses to the discussion and signature which usually accompanies an AMA event.

About mid-morning in the office the nurse told me that “Mel’ had come in and looked so bad they had moved hm ahead of everyone else and put him in a room.  I entered the exam room to see my barber seated  on the table end, pale, perspiring profusely, and breathing a bit rapidly. 

“My chest hurt me most of the night and I couldn’t wait for an appointment,” he informed me. 

I assured him he had been right to seek medical attention but thought he should have gone to the hospital emergency room.

“I’m not going to that hospital, never have.  You take care of me here,” was his demand.

The nurse entered the room with the EKG machine as I listened to his loudly pounding heart and the sounds in his chest that indicated fluid was building up in his lungs.

The EKG tracing indicated that a myocardial infarction was occurring-he was having a heart attack.

“Mel, I’m telling you this is really serious and you need to be in the hospital.  We need to call the ambulance and get you there right away, like NOW.”

“No, I will not ride in an ambulance to the hospital.  You just write out the papers and I’ll drive myself.”

We dickered for a minute or two and I said I would go write the orders for admission.  I also planned to call his wife from their home nearby to drive him to the hospital.  I quickly wrote the orders and returned to the room to find the door open and Mel absent.

The nurse was looking flustered and said he had come out of the room in a rush saying he would take care of things himself. 

“He just wouldn’t listen.  He just rushed out the door yelling he’d take care of things himself”, she reported.

I alerted the hospital that he was on his way and called his wife to alert her to the situation and enlist her help.

The morning passed with no further word about Mel or his location or condition.

About five hours after Mel’s abrupt departure from my office the nurse told me I had a call from a doctor at Scripps Hospital north of San Diego.  I picked up the phone and the doctor immediately began to berate me for allowing Mel to leave my office and drive 210 miles through desert, across the coastal mountain range and through the city of San Diego while he was suffering a myocardial infarction.

I finally got him to realize the only way to have kept Mel in Yuma for treatment was to have physically restrained him.

Mel was 210 miles away AGAINST MEDICAL ADVICE.

P.S. Mel survived and lived another 4-5 years, a tribute to pure cussedness.