AMA resulting in death

Question

My daughter died 1/26/09. on 1/25/09 She collapsed at work, was in agonal respiration(near death). EMS was called, discovered she took methadone and they revived her with narcan(antidote).She arrived in the ER around 11:40 pm. She was conscious but uncooperative wth treatment. She had a history of bulimia/depression(was on antidepressents)and drug abuse which she told the ER doctors. She ended up signing out AMA at about 2:15. They warned her of probable death because she needed the narcan to combat respiratory depression. I question why they allowed her to sign out when she most probably was mentally impaired. She had to be intoxicated still from the overdose,she may have suffered hypoxia as her O2 SAT was in the 80's when they found her. With her history of depression there were previous suicide attempts although she had lied and told them no. I don't know if psych ever evaluated her and even so, someone who just overdosed with a history of depression wouldn't you be worried about suicide especially when told she had a strong possibility of death/brain damage if she left. Wouldn't they have thought her mentally incompetent. I am a nurse and I would have definitely questioned her judgement. On a legal standpoint, what do you think?

Answer

I'm very sorry to hear about your loss. The law does allow people to refuse treatment, but if your daughter wasn't mentally capable of making such a decision, you may be able to make a case for wrongful death. I think this is certainly a matter which you should seek the input of an experienced medical negligence lawyer on.

I did find this quote which seems to support your feelings on the matter: "Prior to discharging a patient AMA, the physician should be convinced that the patient has given and informed refusal, and has had an opportunity to ask questions. The physician must determine and document that the patient is functionally competent. Refusal of care is invalid for persons who have been committed to the care of the hospital by legal proceeding or who are not competent."

Here are some articles you might be interested in:

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Answer

I'm sorry to hear that. I think she's not entirely incapacitated to make decisions for herself. The fact that she was able to narrate her past condition was enough manifestation that she could decide for herself.If you are in doubt, you might as well consult a lawyer just to know your legal options.

Answer

Methadone is a very long acting narcotic - typically

it's effects last days. As with any narcotic in

overdose, methadone overdose can cause respiratory

depression leading to death. It sounds as if this is

what occurred in your daughter's case.

Narcan is the "antidote" for narcotic overdose. It's a

very effective antidote, but it's effects typically

start to dissipate after 30 minutes or so.

Your daughter's death was entirely forseeable. If she

had sufficient methadone on board to cause respiratory

distress, she still would have had sufficient narcan on

board to cause respiratory distress for many hours

later - long after the initial doses of narcan would

have worn off in the emergency room.

There is no way she should have been allowed to leave

the emergency room against medical advice. It should

have been explained to her that failure to be

continuously treated with Narcan for at least a day or

so would have resulted in her death. If she still

wanted to leave at that point, a case could easily be

made that she was actively suicidal and she should have

been hospitalized under a mental health hold.

Sorry for your loss.

AMA resulting in death

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