Discharge CTMA “Contrary to Medical Advice”

A 29-year-old man, recently diagnosed with Type I diabetes, attended an Accident & Emergency Department. He was found to be developing a diabetic keto-acidosis, which is a severe, life-threatening complication of the condition, which he had never experienced before.

He was told he would require immediate hospital admission and intensive management, but he stated he was too busy to come into hospital at that time.

His mother was with him, and the full seriousness of the situation was explained to both of them. His mother states she begged the hospital staff to admit him, but he was adamant he was not coming into hospital, and therefore signed himself out contrary to medical advice (CTMA). Four hours later, he suddenly collapsed and died at home. The family initiated action against the hospital staff on the grounds it was obviously unreasonable for him to sign himself out, and therefore he must have been mentally ill and should have been held under the Mental Health Act.

The enquiries from the lawyer occurred before the case was heard in a Coroner’s Court.

Patients have autonomy, and it is only in very specific circumstances that this can be overridden. The coroner concluded that this gentleman had no significant mental condition apart from his fear of hospitals, that he was given full relevant information in the Accident & Emergency Department, and that he was perfectly within his own rights to refuse admission. His death was therefore not a breach of the duty of care by the hospital staff or due to inadequate information being given to him in terms of a consent process.

MDU figures for 2024 show that fewer than one in six actions in medical negligence actually succeed, with the vast majority failing on the grounds of causation. It must be remembered that subsequence is not the same as consequence.

Initial screening is therefore essential to manage client expectations at an early stage. This avoids unnecessary effort and costs for all concerned. Too many cases are taken to court with no chance of success. This is stressful for both the client and their legal adviser, and indeed for the medical personnel involved.

For fast and effective screening of all potential medical negligence cases, contact Peyton Medico Legal Services now on +44 (0)28 87724177 or email rpeyton@rpeyton.com