As far as how he got out, I have little doubt in my mind that he just got up and said I'm out. I imagine if someone is well enough to get up and walk out on their own, and they're determined to do so, the hospital might not have any legal grounds on which to stop them.
In order to leave before they think it's medically safe to let you go, tou have to sign an AMA and that takes some time, but after that, they have no real choice but to let you go. But if you're a stumbling, vomiting delirious drunk/druggie, saying some nefarious "i'm gonna kill someone/myself" type shit, an AMA won't help you. They don't care about you being able to pay the bills either. Most hospitals legally cannot deny you care even if you're broke.
Both correct here. Altered mental status/legally unable to make decisions/threats of harm/self-harm: cannot leave against medical advice. Mentally competent but making a bad decision: educate the patient, make sure they know they might die, they can leave.
EMTALA: every patient who presents must be
assessed and stabilized to the capacity of the hospital (e.g. if patient has a brain bleed and the hospital has no Neuro,
then they can transfer) regardless of ability to pay. That "assessment" is a big part of why ED wait times are so long; someone with no primary care doctor can go to the ED with an non-emergent complaint and get in line.
Not to mention withdrawing from cigarettes might be actual hell, makes me wonder how hospitals deal with that when they have to basically immobilize a smoker in bed for a good while.
Nicotine patch, nicotine lozenges. Blade would probably start out being medicated for alcohol withdrawal, though, and benzos would help blunt everything for a bit.
Ardent dedication to smoking as a lifestyle is going to inform the surgeons' decision on amputation vs. attempt at revascularization, though.
Policy is going to vary from hospital to hospital on letting patients go outside to smoke,
based on how long it's been since a patient went out to smoke, got shot up by their girlfriend and died in the bushes. Some zero tolerance/you're AMA now, some have smoker's areas, some have tacit understanding that a patient going out for "fresh air" is smoking and will do it outside of the magical dotted line of hospital campus. Also varies if patient is on telemetry or IV infusion.
In hospitals where patients can go out to smoke, it's jokingly referred to as the "early ambulation program." Nobody more motivated to get out of bed post-op than a smoker.
