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"The Patient Wants To Leave. The Hospital Says ‘No Way’" - Paula Span

  • The New York Times
  • New York, NY
  • (2017-07-07 00:00:00.0)

William Callahan, an 82 year old with a long history of cardiac problems and several years into Alzheimer’s disease nearly fainted last spring after walking down the block to visit a neighbor in his New Jersey suburb. He quickly revived, but the neighbor called 911. His daughter, Eileen Callahan, MD, associate professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai met her dad at the local emergency room. The ER doctor would not let Mr. Callahan leave the hospital, where Dr. Callahan knew her father was prone to sleeplessness and delirium. In unfamiliar surroundings he might fall. The family decided after the hospital still wouldn’t discharge Mr. Callahan, that they would sign the against medical advice form that hospitals typically demand before releasing patients against physician recommendations. Such events happen more commonly than one might think. Though these discharges occur far more frequently in younger patients, a recent study analyzed a large national sample from 2013 and found that 50,650 hospitalizations of patients over 65 ended with AMA discharges. “This is a very conservative number,” said the senior author of the study, Jashvant Poeran, MD, PhD, assistant professor of population health science and policy, orthopaedics, and medicine at the Icahn School of Medicine at Mount Sinai. And numbers are rising, Dr. Poeran found: a decade earlier, 45,535 hospitalizations of older patients ended with AMA forms.

- Jashvant Poeran, MD, PhD, Assistant Professor, Population Health and Policy, Medicine, Orthopaedics, Icahn School of Medicine at Mount Sinai

- Eileen Callahan, MD, Associate Professor, Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai

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