NO Pain medicines for my Mom!

Batman24 · Jan 9, 2008

I'm not a nurse yet (doing pre-reqs and entrance exams at present) and this post really disturbs me. Why can't the nurse go to the patient's doctor for a prescription for pain meds?! Wouldn't doctors be able to trump the family here even though the son is a doctor?! My guess is the father/son have POA over her, but doesn't that come with limits?! This is very disturbing to read. Can Social Services be called?! I would get someone involved ASAP so this woman doesn't have to suffer a minute longer. This seems abusive on the family's part. I also wonder if she is getting released from other places as the family is nuts.

leslie :-D · Jan 9, 2008

i'm probably not the right person to respond...

my (defiant) attitude has basically demonstrated, "screw you" to the poa, and go medicate.

i tell the doctor, if s/he doesn't want the pt to get the med, then don't order it.

and as my bosses know, if push came to shove, any court of law would protect the pt's well being, citing the cruelty in letting one suffer.

with all this said, i document meticulously, including conversations w/all involved.

and of course, i do medicate, knowing i can be fired.

but if i observe pain and suffering, i'll be damned if i let an ignorant family member dictate the poc, to appease their delusional misconceptions.

of course, when a poa orders me not to medicate, i immediately share my plan of care with them, including the use of narcotics.

and, that if they are not satisfied, they are welcome to take their loved one, elsewhere.

but as far as i'm concerned, hospice is for comfort of the pt.

it's their life, their death.

deal w/it.

leslie

Laughs-a-lot, RN · Jan 9, 2008

I agree with possible involvement of soial worker, because this is a form of abuse. I can guarantee you that if the son had that wound he would be taking a little more that roxanol. As far as getting orders for pain med from doctor, I believe that if the all powerful POA has already made it very clear that he does not want any pain meds ordered. Something has to be done though, she should not be made to suffer through this daily. I really find it hard to comprehend that he is refusing if the request for pain meds only with drsng changes. It makes me sick, especially with him already being in the medical field, he is being ignorant.

Irish339 · Jan 9, 2008

This is a dilemma that I have dealt with myself. I assume you have tried to reson with the son regarding exactly WHAT his objection to pain medication is. Doctors aren't always as knowledgable about drugs as we think they are. Secondly, is he REALLY a doctor? We had one that was dictating his mothers' care, only to find out he was a med school drop out. So, either he is a typical egomanical fiend, he holds some longstanding grudge against his mother, or he's just scared. I have to say, usually the only way to deal with this is to have your medical director talk to him. Hospice IS about pain control. If he won't allow the staff to follow your Doc's orders, then it can become a legal issue. What kind of POA interferes with comfort orders for a Hospice patient. Obviously if the patients' husband won't stand up to this guy...we have some real family dynamic problems. I think at this point, Doctor to Doctor might be your last resort. Good luck, and I'm sorry this woman has to suffer.

Katnip, RN · Jan 9, 2008

Has anyone ever tried to report this as elder abuse? I'm just curious. I can't imagine someone would be allowed to force an elderly person to suffer regular pain.

Weeping Willow · Jan 9, 2008

To all,
I am a Hospice RN/Case Manager who just recently assumed care of an elderly Nursing home Pt who has a son who is an ER Doctor. This man is completely involved in the care of his mother...can't blame him for that,.....except that we can't do a single thing with his mother without clearing it with him. I mean, I can't even have the mattress changed without running it past him.
THe issue that I have a real problem with is that this lady has a Stage III wound on her heel which requires daily wound care. It is very painful to her. I can tell, even if the lady is aphasic, because she pulls her foot away, and starts breathig heavy and "sputters", and moaning. When I first took care of her, I called this son, and asked him if I could PLEASE order up some Roxanol liquid Morphine for her to have 1/2 hour before wound care, to ease her pain. I got an earful about how "I don't want anybody doping my Mom up, my mom doesn't do well on morphine, she received it post-op, and it just knocked her out." I told him that I wasn't going to give her a large dose (POst-op doses are much higher and usually given IV, are they not??) but he cut me off, saying, that "I know how nursing homes operate, if they have it, they'll give it, and pretty soon, she'll be a zombie." Getting nowhere with him, I next consulted with the lady's husband who is her next POC. I told him that I was concerned about her pain, but that their son said no, and we have to go by his decision. Ten minutes later, I got a callback from this same son chewing me out for "trying to go behind his back." I told him of course that I did no such thing, that I was talking to his dad at his request, and was reporting on my observations as her new Case Manager. But again, his mind was made up, don't confuse him with facts. He said that his decision was final and under no circumstances, was his mother to receive any narcotic medicines.
A couple of days later, I was taking care of this lady at the same time as her husband was there, and I did her wound care. He would not stay in the rom while I did it, but waited in outside. When I was done, I wheeled her out to him, and of course she was still showing s/s pain. I told him "Do you see, sir, that she hurts? THat would care is very painful to her, see she still hurts." HIs answer was "Look, she is just going to have to hurt. MY son and I have made our decision, she is not going to get any narcotics of any kind, and that's all I am going to say about it, so I'd appreciate it if you din't bring it up again." I of course documented everything that was said, and reported same to the facility nurses who basically just shook their heads and said "we've all dealt with that son!"
THis lady has actually been with several different hospice providers before us, and was d/c'd from the last one for long-term prognosis, or as the son said "she wasn't sick enough." I feel very stymied by all this. My first instinct is to recommend that this lady be discharged, and tell the son, you want to take care of her, well here she is, have at it, since we can't do anything without his sayso anyways. THis lady has a past history of seizures and Tegretol was ordered, and the next day this son cancelled the order. Anybody got any thoughts on how to deal with this unfortunate situation?

I believe the son is breaking the law by doctoring his mother, his relative. Make a discreet, anonymous inquiry to the doctor licensing board in your state and go from there. do not name him to the officials just yet but do get the information. does your administration know he is doing this? They need to step in and go to bat for the patient, if she really is suffering.

I guess you could report this as abuse to the proper authorities, too, or just refust to take care of her any more if you think she is in too much pain.

What does he want her so alert for anyway? If she is that sick, being doped would be a blessing for her. Is there an ethics committee?

Maybe it was better when we had no antibiotics, transplants, and lots of other modern "miracles", which seem so often to be used as torture devices. Better a good quick stroke, accident, or heart attack that kills instantly without all this suffering for patients, their loved ones, and their caregivers.

**Elektra6, ASN, BSN, RN** · Jan 9, 2008

I ran into this SEVERAL times in my LTC. The patient's families dictated the care and in ALL cases I felt the patient suffered.

We had almost the same scenario once except they couldn't make up their mind whether to put mom on hospice or not. MD son refused to allow pain meds. We had her MD & medical director speak to him but he wouldn't budge. Our MD refused to treat her. I documented everything and got an order to send to hospital for eval. The MD at our place refused to readmit her but she died in the hospital. It's a shame when a patient gets worse care because of their family than if they had no one!

Weeping Willow · Jan 9, 2008

I agree with possible involvement of soial worker, because this is a form of abuse. I can guarantee you that if the son had that wound he would be taking a little more that roxanol. As far as getting orders for pain med from doctor, I believe that if the all powerful POA has already made it very clear that he does not want any pain meds ordered. Something has to be done though, she should not be made to suffer through this daily. I really find it hard to comprehend that he is refusing if the request for pain meds only with drsng changes. It makes me sick, especially with him already being in the medical field, he is being ignorant.

What more is there than morphine? Fentanyl patch? Other ? Induced coma?

Weeping Willow · Jan 9, 2008

I'm not a nurse yet (doing pre-reqs and entrance exams at present) and this post really disturbs me. Why can't the nurse go to the patient's doctor for a prescription for pain meds?! Wouldn't doctors be able to trump the family here even though the son is a doctor?! My guess is the father/son have POA over her, but doesn't that come with limits?! This is very disturbing to read. Can Social Services be called?! I would get someone involved ASAP so this woman doesn't have to suffer a minute longer. This seems abusive on the family's part. I also wonder if she is getting released from other places as the family is nuts.

If someone has the interest and nerve, they can even get a judge to order proper care, issue restraining orders against family members who interfere with proper care, and even appoint a guardian to see that all of this is carried out. But someone has to involve the court system and that has to start with the Administrator of wherever this poor soul is located. The OP should bring it to Admin's attention.

leslie :-D · Jan 9, 2008

If someone has the interest and nerve, they can even get a judge to order proper care, issue restraining orders against family members who interfere with proper care, and even appoint a guardian to see that all of this is carried out. But someone has to involve the court system and that has to start with the Administrator of wherever this poor soul is located. The OP should bring it to Admin's attention.

this is precisely why i do what i do.

we (the facility) are fully aware of a pt's right to humane and compassionate care: and if we intervened on behalf of the pt., we would indeed, win.

i have worked w/my med'l dir for a long time, and he knows me and my work.

and so, he fully supports me in how i deal w/the families that protest.

when they ultimately complain to the higher-ups, the social worker is always present in these meetings, carefully explaining the steps 'we' are prepared to take in protecting our pt population.

once they realize they risk severing all connections w/their loved one, they usually back down.

leslie

DutchgirlRN, ASN, RN · Jan 9, 2008

I'm not understanding this situation. The son is a doctor but surely he is not her primary doctor? How can he override what the primary doctor orders? How can he cancel orders written by the primary doctor?

I would get the med order from the primary and give it regardless of what the son has to say. What's the worst that could happen? She could die comfortably in hospice? Isn't that the whole point of hospice?

I worked on a similar case years ago. This hospice patient was at home and was dying of Lou Gehrigs disease and was vented. She cried all the time. Her primary would not let her have a sedative or any pain meds he said "she'll just have to get over it". I spoke with the daughter and finally insisted she change doctors. She did and the new doctor promptly ordered Ativan and a pain med. The patient continued to decline but not in tears. How can a doctor or a son be so cruel. What goes around, comes around. I believe that. Good Luck Hon.