If you haven't heard of it you haven't been properly informed. Nursing homes and hospitals have a duty of care and legal liability, civil and criminal for any incidents that happen on or off the premises due to negligence on their part. Part of that negligence includes anything they might do or any injury they might sustain if they are allowed to leave unsupervised. Hospitals are not permitted to allow you to leave the building unescorted and the hospital property for any reason, until you are discharged as a patient.
how does that agree with 42 CFR, specifically 482.13 which specifies that physical restraints must be least restrictive and in accordance with the patient's care plan (it can be argued that physical restraints can include physically preventing a patient from leaving)? i'm not a medical professional, i was a sheriff's deputy, however i've never heard of a hospital's "duty of care" to include being able to either imprison a patient without court order or written order of consent (guardianship), or to mandate that patients be unable to voluntarily leave a care facility independently. patients in the states i've worked in (and to my knowledge the entirety of the US) have a right to refuse treatment and this also includes voluntarily removing themselves from a care facility with or without a discharge. a discharge is an administrative process - the patient being physically barred from leaving is, to the best of my knowledge and training, false imprisonment.
https://www.law.cornell.edu/cfr/text/42/482.13 (federal regs, note that states can be more restrictive though)
https://www.cityofhope.org/location...insurance/patient-rights-and-responsibilities (LA county medical system)
https://www.ucsfhealth.org/your-hospital-stay/patient-rights-and-responsibilities (SF bay area, where i was a sheriff's deputy for 8 years active, now 7 years as a reserve officer)
https://www.summerlinhospital.com/patient-rights-and-responsibilities (this is nevada)
https://www.olympiamc.com/Olympia-Patient-Rights (olympia washington)
each care facility should have their own unique statement on patient rights tailored to their specific situation and locale. honestly, the only "duty of care" i'm really familiar with is 28 CFR, which is when i have duty of care for prisoners or others in detention facilities - i've never worked for a hospital, just sometimes taken people to/from and stood guard sometimes.
"duty of care" as a search phrase also doesn't appear in the CFR (
https://www.ecfr.gov/search?search[date]=current&search[query]="duty+of+care"&view=standard)
or in CA law except where it applies to government facilities/property and specific family situations like adoptions or patient record keeping (which is intended to be added onto HIPAA regs in CA):
https://leginfo.legislature.ca.gov/faces/codesTextSearch.xhtml
this is not the same as a patient discharging themselves from care. a hospital or nursing home or other care facility does not, to my knowledge, personally/professionally, have the legal means to imprison a patient against their will under the auspices of "duty of care". duty of care generally means that they can temporarily restrain a combative patient, seclude a patient for the safety of themselves, of staff, or administer live-saving care without active participation of a patient (for example a patient in a coma is assumed to want to be cared for if they have a heart attack or something and are unable to consent). nursing homes have some modified care regarding various exposure to activities, food preparation, facility management and oversight, drug administration, security (facility and special needs like locked cabinets, separated bio-hazard waste, sharps bins, et c). group homes further have modified care regarding therapy programs and managing day-to-day operations in a way to provide assisted living, et c.
i think you are taking "duty of care" too far and believe it provides some legal basis for keeping Lucas at Mallon when it does not. Lucas seems free to come and go as he pleases as long as he pays for the services at Mallon and obeys the rules there, which includes a curfew and probably a bunch of other things. i genuinely do not think Lucas has a court order that authorizes Mallon to detain Lucas at Mallon and only allow him to leave with an escort. further, i do not think Lucas is under a custodial order that allows Mallon to force him to do anything. Mallon's ability to "force" Lucas is to reject him as a program participant and kick him to the curb if he proves disruptive, combatitive, habitual rule breaker, refusing treatment, et c.
to your specific example of Uncle Joe with a bad kidney self-discharging and falling over and breaking a hip or something. in CA, a hospital can only keep a patient on premesis legally if the care manager has a written court order that allows it, if the patient is incapacitated in some way where consent can be assumed (coma, mental delirium, et c) temporarily until such an order can be signed and issued to the hospital, or if a person has guardianship, power-of-attorney, or is their legal decision-maker (wife or parent of a minor for example). some special situations like if the patient is a danger to themselves or others, or is there under observation in a crises, et c can also permit temporary custody or even physical restraint and modification of their care plan. but "duty of care", to the best of my knowledge, would not forbid a patient like Lucas, who (to my knowledge) doesn't have such an order remanding him to Mallon, and Mallon (to my knowledge) also doesn't seem to have a rule that forbids Lucas from leaving as long as he's obeying program/facility rules.
i'd really like to see the regulations in the CFR or maybe it's WA specific (?) for duty of care that would allow that type of thing.