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Medical DPOA for my mother, constant refusal to give me information even with the official form

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Specializes in Instructor of Nursing and Med/surg nurse. Has 13 years experience.

1 hour ago, JKL33 said:

I should have been more clear. Recently my own family was in a position where they thought that because a DPOA had been responsibly set up by a lawyer ahead of time (before anyone lacked capacity), that when the time came and our elder was not able to make decisions, we should just begin acting on his behalf, on the basis of those papers that he had previously drawn up. Then we found out that they have to be activated. My family didn't literally wave papers in anyone's face, we aren't like that. But I know for a fact that the designees/agents thought they had necessary powers when they actually didn't. They knew that papers had been properly drawn up and that they were in possession of them. They thought that's all that was needed. [Just for further clarification, there was nothing negative about any of it, all members are attempting to lovingly care for another member according to wishes and best interests]. I have to believe that there are other families who have difficulty understanding how to assert the patient's rights, as my own family includes a number of well-educated people and yet it was just unfamiliar territory that wasn't as straightforward as it might seem.

I agree with you that patients have the right to designate someone whom they would like to receive their health care information along with themselves. In some places there is a BIG problem with honoring this. It's almost like it's too much trouble. I think that is unacceptable and have never understood it as a family member or as a nurse caring for patients.

Yes, definitely. You are right that a lot of what we are discussing is well worth the money to consult an attorney, even if it has to be scraped together.

You've included a lot of avenues for families to pursue as they try to navigate this. An informative thread.

I appreciate your explaining your family situation. I wish you the best. I wish I could say that I have found surefire answers that make it possible for one to be effective in the moment in advocating for one's family member's rights as a patient. As the OP said on this thread, if it is this difficult for nurses to do this, how hard must it be for lay people. You used the term bureaucracy and I think that is apt.

canoehead, BSN, RN

Specializes in ER. Has 30 years experience.

On ‎7‎/‎20‎/‎2020 at 4:25 AM, Susie2310 said:

The patient's Agent under their DPOA for health care needs to be present with the patient in order to be able to observe the patient's condition and how the patient is responding to their treatment and to be able to advocate for them when necessary; they can't do this or fulfill their legal responsibility if someone on a power trip, or someone for some other reason, often convenience, decides it is best/fine to shut the family member/Agent out from being with the patient.

As long as the POA isn't activated, we have to respect the patients wishes, even if we think they are making the wrong decision.

Once the doc comes in if we ask the patient again, or word it differently, they may agree to have visitors, or allow us to share information. Give us a bit of time to sweet talk them, and stress the need for your help when they get home.

I can also tip off the doc that the POA wants to come in and the patient refuses, so they can start the competency assessment. It's not a decision I make, it's what is legally required.

18 hours ago, canoehead said:

As long as the POA isn't activated, we have to respect the patients wishes, even if we think they are making the wrong decision.

Once the doc comes in if we ask the patient again, or word it differently, they may agree to have visitors, or allow us to share information. Give us a bit of time to sweet talk them, and stress the need for your help when they get home.

I can also tip off the doc that the POA wants to come in and the patient refuses, so they can start the competency assessment. It's not a decision I make, it's what is legally required.

It seems it would be rather unusual for someone to go to the trouble and expense (assuming they involved a lawyer in drawing up their Advance Directives) of appointing a person they presumably trust and have confidence in, to be their Agent under their DPOA for Health Care, and, then, when hospitalized, tell the health care staff that they don't want to receive a visit from this person. I can more easily see a person who is using a DPOA for Health Care form they purchased online or in a store, who has named as their Agent someone who they are not particularly close to, doing this, but even then I would be surprised if this happens very often. Of course, there is always the possibility that the patient was pressured by someone into preparing this document. While it is necessary to safeguard the patient’s rights, I have some thoughts about this situation.

On the subject of a patient refusing visitation from the person that they have selected and designated as their Agent under their DPOA for Health Care; besides the possibility that this is what the patient genuinely wants; the possibility that the patient has become unable to give informed consent; and the possibility that the patient has been coerced into preparing the document and designating an Agent; there are also other possibilities:

It is possible that some kind of interaction has taken place between the patient and the staff that has influenced or prejudiced the patient towards the person whom they have designated as their Agent. It is also possible that the staff have said to the patient something like: “You seem to be doing fine without your wife,” or: “You don’t appear to need your wife to be with you,” and the patient wants to please the health care staff and goes along with this, or the patient can’t find a way at that moment (patients are usually very sick when they are hospitalized) when that comment is made to them, to disagree. This may have then been interpreted by staff as the patient actually not wanting their wife/Agent to visit them.

Also, given that patients usually have to be very sick to be admitted to hospital, it is quite possible that when the patient said or indicated that they didn’t want their Agent to visit them, they were severely stressed both mentally and physically during an acute illness, or were just showing improvement from an acute illnesss, or were under the influence of a medication, or had had a reaction to a medication, or were experiencing toxicity from a medication, or polypharmacy, and it is also possible that they have experienced a stroke, intracranial hemorrhage, acute renal failure, delirium, dehydration, hypoxia, or another condition that could affect their mental status or result in an altered mental status, or that they had undergone a medical procedure that could result in a changed mental status. These conditions may result in an altered mental status, or in the patient's state of mind being different to the way it normally is, and thus affect the patient's behavior. These condition/s and others may not be considered or identified by staff.

Edited by Susie2310

amoLucia

Specializes in LTC.

This is prob one of the most informative, explanatory, detailed but understandable pieces I have read here on AN. And the fact that it is so sorely needed for all HC providers to be cognizant of is an understatement.

Just a wish that staff in any care delivery capacity were to read this.

Thank you to all the respondents who took the time to provide this valuable information.

On 6/20/2020 at 8:49 AM, InSchool4eva20 said:

I am medical DPOA for my mother and she has dementia. She see's several physician's and I even though her signed official DPOA form is uploaded and I carry it with us, front desk people don't pass on information or give me access to her information. Luckily, most have the EMR charts I have access to, but I'm constantly floored at the lack of education for this form. My mother can't make decisions, but she will have a wonderful conversation with you she just doesn't retain it.

Last general physician's visit the woman at the front desk told me if my mother didn't consent verbally in front of her I could not go in with her to see her physician due to precautions. My mother pleasantly confused said no and that she had to use the bathroom. When the nurse came to get her I held up my forms and she took them just to tell me later they were in the system already. Then didn't update me and I found out through the EMR they changed her medication and she had no clue.

Does anyone have this experience?

Why are you not getting a supervisor? And an Administrator if the Sup also has her head where it doesn't belong?

If that doesn't work, get your lawyer on speed dial.

If that fails, take your Mom home. Just cancel the appointment.

File a c/o with the Chief of Staff for whatever service is involved.

Get the ignorant, incompetent front line people schooled and then fired. They are not comprehending that YOU are caring for and speaking for your Mom LEGALLY.

Edited by Kooky Korky

On 7/27/2020 at 6:32 PM, amoLucia said:

This is prob one of the most informative, explanatory, detailed but understandable pieces I have read here on AN. And the fact that it is so sorely needed for all HC providers to be cognizant of is an understatement.

Just a wish that staff in any care delivery capacity were to read this.

Thank you to all the respondents who took the time to provide this valuable information.

Wish smish. Action is required.

Yes there is valuable info herein. I just get so frustrated when nurses don't take action.

Edited by Kooky Korky

1 minute ago, Kooky Korky said:

Why are you not getting a supervisor? And an Administrator if the Sup also has her head where it doesn't belong?

If that doesn't work, get your lawyer on speed dial.

If that fails, take your Mom home. Just cancel the appointment.

File a c/o with the Chief of Staff for whatever service is involved.

Get the ignorant, incompetent front line people schooled and then fired. They are not comprehending that YOU are caring for and speaking for your Mom legally.

That's a pretty good idea to just take mom home. Pretty unlikely to be a helpful visit if no one is going to communicate with the caregiver anyway; might as well leave.

I was with you up to the part about the incompetent front-liners. I guess I come from a relatively low enough station in life that I hardly ever see them as the primary problem in whatever positions they hold. In an office setting you're likely talking about people who probably have a high-school education and maybe a certificate or a little further vocational training (or maybe not). These are people who are solidly in the position to say "how high" when their supervisor says "jump." Short of rudeness and dangerous levels of ignorance about things they are supposed to know, I will almost always put their shortcomings on the ones supervising them and giving them their directives and workplace education.

1 minute ago, JKL33 said:

That's a pretty good idea to just take mom home. Pretty unlikely to be a helpful visit if no one is going to communicate with the caregiver anyway; might as well leave.

I was with you up to the part about the incompetent front-liners. I guess I come from a relatively low enough station in life that I hardly ever see them as the primary problem in whatever positions they hold. In an office setting you're likely talking about people who probably have a high-school education and maybe a certificate or a little further vocational training (or maybe not). These are people who are solidly in the position to say "how high" when their supervisor says "jump." Short of rudeness and dangerous levels of ignorance about things they are supposed to know, I will almost always put their shortcomings on the ones supervising them and giving them their directives and workplace education.

I agree. That's why I said at the outset that she should get a Supervisor.

I will say that some frontliners are rude and officious. Or vapid and immature. These do get on my nerves, although I have learned to relax enough to be civil. I still get a Supervisor.

4 minutes ago, Kooky Korky said:

I will say that some frontliners are rude and officious.

Yes, there is no excuse for abject rudeness, and I do sometimes wish they wouldn't be so...uh...enthusiastic when they are wrong. Then I tell myself that if they knew they were wrong they wouldn't be doing X wrong thing in the first place. What I usually perceive behavior-wise (maybe this is gracious) is just sort of unrefined customer service combined with an enthusiasm to do what they believe they are supposed to be doing. They don't get a whole lot of info because employers believe it's just too complicated for them to understand and don't want them to use discernment anyway; they're just supposed to follow directions. So...if the main thing pounded into their skull is patient's rights and HIPAA and violations of these...that's what they go with. I can imagine that they mostly believe it is a "violation of [some xyz thing]" to allow someone back with the patient unless the patient insists they come back.

It's all just sad.

Agree with supervisor though. Practice manager, physician, someone who should know better.

amoLucia

Specializes in LTC.

Kooky - I usually find myself agreeing with much of your postings. You DO have a passion at times, but sometimes you seem to go just a weeeeee bit over the top.

44 minutes ago, Kooky Korky said:

Wish smish. Action is required.

Yes there is valuable info herein. I just get so frustrated when nurses don't take action.

I'm retired, so I have no audience with which to provide this info, so my comment was just an open suggestion that others, who SHOULD KNOW, be so provided with the info. Not all nurses have the ability or inclination to take action. Wish it weren't so.

Edited by amoLucia

Hannahbanana, BSN, MSN

Specializes in Physiology, CM, consulting, nsg ED, LNC, COB. Has 51 years experience.

On 7/2/2020 at 6:38 PM, InSchool4eva20 said:

What is scary is as a nurse this is happening, but what are other people doing? This was at several facilities.

I made multiple copies on hot pink paper and had them notarized (took about fifteen minutes with a free notary at our bank). I had them put it in the front of the chart so it was easy to find ("If you look at that pink page in the front, you'll see my notarized authorization...") If it "somehow" got lost, I always had a few extras on me.

amoLucia

Specializes in LTC.

Sounds like a LTC place I worked. We had the POA/Adv Dir/lPOLST/DNR legal document stuff copied on hot pink paper also. Then it was placed in a plastic sheet protector in a designated chart section. Always was the quickest and easiest grab for emergencies.

We were VERY conscientious about code status, but I guess with HIPAA information release that could also be an excellent approach for LTC/NH residents or others.

And like you, we always had a few extra copies of the 'pink papers' in each chart for spares.

Edited by amoLucia

Hannahbanana, BSN, MSN

Specializes in Physiology, CM, consulting, nsg ED, LNC, COB. Has 51 years experience.

On 7/20/2020 at 12:17 PM, Susie2310 said:

In regard to competency (I am not a lawyer) my understanding is that patients are considered to be legally competent unless a Court has determined otherwise; but that the determination of competency for health care decision making purposes is made by the physician, I.e. the physician determines whether the patient is capable of understanding their medical condition and of making informed decisions about their care.

85% right- the physician may or may not be able to make that on-the-spot determination. The physician or others in the care situation may throw the “competence” word around but it has a specific legal meaning that’s not the same as the lay meaning. The previous points about staff and others not knowing there’s a very real difference between assent and consent, and competence and capability, underlies a lot if confusion and hurt feelings

You might look up the famous NJ case of Candura for some interesting points regarding these distinctions on consent. Briefly, Mrs C was old and diabetic but making her own decisions, and told her drs she did not want that gangrenous leg off and was ready to die, as they explained that she would. She got sicker and was no longer with the program; they refused to amputate. Her dtr didn’t want her mom to die and took them to court to say Mrs C was no longer able to decide, so she(dtr) as next of kin wanted to consent to the surgery and compel them to do it. The court refused her demand, saying it was unconscionable to know what Mrs Candura wanted and clearly expressed consistently, and then to do something they knew she refused when she was no longer able to express herself. The amputation did not take place and Mrs C died in peace. 

On 6/20/2020 at 7:49 AM, InSchool4eva20 said:

 Luckily, most have the EMR charts I have access to, but I'm constantly floored at the lack of education for this form.

Are you saying that you look up your mother's records on the EMR?  I was under the impression that was illegal.

6 hours ago, mfci said:

Are you saying that you look up your mother's records on the EMR?  I was under the impression that was illegal.

It is rather likely that it is the patient portal that is being referred to.