Patient Tests Positive For Coronavirus, Then Leaves Against Medical Advice: A New Problem

With COVID-19 becoming increasingly rampant, containment and isolation policy will continue to be difficult in the coming weeks. The growing number of affected individuals in the context of limited resources, healthcare staff, and patient autonomy poses unique complications. This was especially evident in Kentucky earlier this week, when an individual tested positive for coronavirus, but decided to leave against medical advice (AMA) and refused to self-isolate. With the support of Kentucky Governor Andy Beshear, state officials enacted forced isolation, seeking legal remedies as well as having law enforcement surround the patient’s house day and night to ensure containment.

This raises an interesting concern— how many more of these patients can be expected to leave against medical advice after testing positive, and how can forced isolation be enforced? The reality is that the number of positive cases is growing, while supplies are continuing to run low, including face masks, personal protective equipment, and most importantly, respiratory ventilators that are critical to patient recovery. This may force healthcare providers to make tough choices in rationing equipment, but moreover, may encourage patients to leave healthcare facilities if they feel that there is no value added by being at the hospital. Even if treatment is available and being offered, cost and affordability remains a critical problem during this time; though legislation has been passed to cover diagnostics and testing for the virus, coverage of treatment costs is still largely ambiguous, which may be especially problematic for the approximately 27+ million uninsured individuals in America.

Currently, discharge against medical advice is a common issue that physicians deal with on a daily basis. Patients may have many reasons for choosing to be discharged against a physician’s advice, including financial reasons, refusal of treatment due to personal grounds/beliefs, or lack of convenience. Typically, though not encouraged, providers respect this choice given that patient autonomy is a critical aspect of modern healthcare. However, coronavirus poses a unique problem, as so much is still unknown about the transmission, spread, and long term impacts of this deadly virus. While patients may theoretically still be able to exercise their right to leave AMA, hospital systems, government officials, and community watchdogs will need to determine how to manage this conundrum if it indeed does start becoming prevalent.

In the case of Kentucky, law enforcement was deployed to force containment; but this is by no means a scalable solution. The government needs to start contemplating more formal and legal measures to enforce isolation; if that is not possible, perhaps the use of a database or reporting system specifically for this purpose may be required. As a general response, communities are increasingly instituting curfews in an effort towards promoting isolation. However, as positive cases will continue to grow exponentially, a more sustainable and targeted solution may need to be mandated in the coming weeks. Until there is a more permanent way to address this, for those that are worried about this new problem in their communities and fear possible exposure to someone that may have tested positive and left AMA, social distancing remains the best policy, and may soon become a temporary, yet necessary routine.