A Properly Executed "Release From Responsibility For Discharge" Form May Not Actually Release a Hospital

On December 23, 2016, the Appellate Division, Fourth Department, held that a former patient of Rochester General Hospital had properly alleged a medical malpractice claim against a hospital, despite the patient's execution of a form titled, "Release From Responsibility for Discharge" (RFRD). Ingutti v. Rochester Gen. Hosp., 2016 N.Y. App. Div. LEXIS 8466 (4th Dep't 2016).

The patient, Frederick Ingutti, left Rochester General Hospital on his own volition after signing the RFRD, but was found approximately two hours later by police, disoriented and with frostbitten fingers that required partial amputation. As a result, an action was commenced against the hospital for negligence, medical malpractice, and lack of informed consent. Specifically, the complaint alleged that the hospital was negligent in failing to prevent Mr. Ingutti from leaving and in failing to ensure his safety at the time of departure, inasmuch as the hospital's staff did not contact his wife or make arrangements for someone to pick him up.

In an earlier 2014 decision limited to Mr. Ingutti's negligence claim, a three-judge majority of the Fourth Department held that the hospital did not have a duty to prevent him from leaving the facility against medical advice, or for that matter, a concomitant duty to ensure his safe return home. See Ingutti v Rochester Gen. Hospital, 114 A.D.3d 1302 (4th Dep't 2014). Citing to Kowalski v. St. Francis Hosp. & Health Ctrs., 21 N.Y.3d 480 (2013), the Court dismissed the ordinary negligence claim.

Following the Fourth Department's 2014 decision, the hospital moved to dismiss the remaining causes of action for medical malpractice and lack of informed consent on the grounds that it did not owe a duty to Mr. Ingutti under Kowalski, however, the motion was denied. On appeal, the Fourth Department affirmed, despite its earlier decision.

In a split decision, the majority found that that Mr. Ingutti's medical experts raised genuine issues of material fact as to whether the hospital properly assessed the patient's medical and mental status prior to his execution of the RFRD. More specifically, Mr. Ingutti's experts asserted that the hospital deviated from the standard of care in the treatment and assessment of Mr. Ingutti prior to the time that he executed the RFRD. Furthermore, whereas the hospital argued that Mr. Ingutti was not "discharged," but rather, left the hospital at his own free will, the Court held that the form itself (i.e., "Release From Responsibility for Discharge") belied this contention. Therefore, the majority concluded that the complaint stated a cause of action for medical malpractice based on a duty and standard of care distinct from the now-dismissed ordinary negligence claim.

In dissent, Justice Centra opined that Mr. Ingutti's complaint should have been dismissed in its entirety for the same reason as his negligence cause of action, namely, that all of his claims were based on similar allegations that he was permitted to leave the hospital against medical advice. In Kowalski, the plaintiff also alleged causes of action for negligence and medical malpractice, which were both dismissed given the absence of any duty owed by the hospital to a patient who leaves that facility against medical advice.

Ingutti II is important for several reasons. From a practical standpoint, the title of the RFRD form undercut the hospital's argument that the plaintiff left voluntarily and against medical advice; as opposed relying upon the hospital in clearing him for discharge. At first blush, this appears to be a matter of semantics, but reading the decision, it seems that the Court is accepting the notion that the hospital had a duty to assess the patient before he signed the document. So, it is not clear that a differently worded title would have made any difference in the end result. But, the point remains: the characterization of legal documents and properly identifying them is important. The title of the form certainly did not help the hospital's position.

Secondly, while both Kowalski and Ingutti II recognize the "basic" tenet that "members of a free society may"¦come and go as they please," there are "limited exceptions," but exceptions nonetheless, when it comes to the provision of medical care. In those circumstances where patients are discharged or requested to execute a "discharge" form similar to the one in Ingutti II, it is incumbent upon the hospital to evaluate the patient for purposes of determining whether they present a danger to themselves or others given their present condition. If so, the patient should not be discharged, or for that matter, be asked to execute a form consenting to their "discharge." This leaves open the question of what should then be done. To be clear, a hospital does not have the right to detain a patient against his or her will, at least under the circumstances presented in Ingutti II. Perhaps the Court is suggesting that the duty is to make the patient aware that his condition is such that his refusal of treatment could have dire consequences.

Finally, there remains the question of what the future holds for this case. Will we see an Ingutti III decision in which the Court explains how a patient who voluntarily left a hospital against medical advice can recover under the circumstances here? Will the Court clarify the burden such that a plaintiff has to prove that the failure to assess the patient was a substantial factor in the patient's decision to leave? It seems this decision leaves too many unanswered questions.