Discharge Against Medical Advice (DAMA):Day 3(A Three days series)

28 April, 2018

V.P SINGH v. DR. M.P. CHANDRAKAR & 7 ANR. (National Commission Disputes Redressal Commission - First Appeal No. 740/2015)
ORDER DATED: 12.07.2016

The Complainant’s son was admitted was admitted in the Chandulal Memorial Hospital, Bhilai, under the care of OP-1 and OP-2. He was admitted at 5 a.m. but no medicines were given and was later on shifted to ICU only after sponging. It was alleged that during the stay, the patient experienced a lot of irregularities in the treatment and no improvement in the health condition. It was further alleged that OP-2 made some unpleasant remark which resulted in demoralizing the patient and the family. The Complainant got his son discharged from the Hospital and admitted him in Joshi Hospital, Pune. However, the patient died due to stomach infection which was due to infected water or highly infected previous hospital condition. The Complainant filed a complaint before the Chhattisgarh State Consumer Disputes Redressal Commission, Raipur claiming compensation of Rs. 99,99,999, which however got dismissed and hence the appeal.
  1. The National Commission observed that the OP-1 is a reputed doctor with vast experience and that the treatment given by him was standard treatment and there was no deficiency in the services provided by him
  2. The Commission further relied on the medical board’s report reproduced by the State Commission wherein it was highlighted that the patient took discharge against the medical advice from the Chandulal Memorial Hospital and that the death of the patient was due to cirrhosis of liver with Hepatitis B infection. It was further written that overall the patient had very advanced liver disease with multiple complications and was in serious condition and the Hospital at Bhilai had given him adequate care
  3. The National Commission appreciated the treatment given by both the Hospitals, the Chandulal Memorial Hospital and Joshi Hospital, to the patient of liver failure with the best possible available mode and that there were no any lapses or shortcomings in the treatment given by Drs and hence rejected the claim of Rs.99,99,999

  • Identify patient expectations
  • Be direct and honest
  • Find the best way to communicate with the patient as when patients don’t understand, they get nervous and anxious, making them more inclined to leave
  • Provide the patient with a brief written summary of his/her diagnoses, treatments, medications, and follow-up plans
  • Avoid using too many medical terms
  • Establish communication protocols for Doctors/Nurses/Support Staff
  • The more patience you show with your patient and other staff, the more confidence the patient will feel with the process
  • Anticipate problems ahead of time
  • Answer all the queries of the patient along with reasoning as to why is this diagnosis reached, why these tests are necessary etc.
  • Conversations with family, apart from complete medical records
  • Explain the discharge Instructions to the patient and his family regarding DAMA and follow-up plans
  • If Patient leaves DAMA, record every intervention you attempted


Discharge against medical advice discharge continues to be a prevalent and frustrating problem for patients and their doctors. Data for doctors on how to effectively manage and intervene in these complicated patient encounters are scant.
Prospective studies of medical patients, focusing on patient, doctor, and hospital variables, are most likely to reveal reliable and valid data about how best to address, prevent, and treat DAMA behaviour. Focusing on providing informed consent, with attention to the vulnerabilities and health literacy levels of hospitalized patients, can ensure the best care possible for patients while respecting their autonomy.
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