Medical kidnap? Discuss

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Ruas61, BSN, RN

1,368 Posts

Specializes in MDS/ UR.

Mayo in Rochester is not the golden castle everyone thinks it to be.

elkpark

14,633 Posts

Anyway, I read the article on CNN yesterday and the police who investigated the case had valid points- the hospital was accepting her consents for treatment then saying that she was incompetent to make her own decisions. It can't be both ways- she's can't be competent to consent to treatment but incompetent to decide to discharge AMA.

"Competency" is a legal concept that is decided through the courts. The issue in most healthcare situations is "capacity," the mental capacity to make informed decisions. Capacity is a v. specific question, and, yes, it is certainly possible to have the mental capacity to make an informed choice about a particular treatment or procedure and lack the capacity to make an informed choice about another, including signing out AMA. Capacity is not "all or nothing." I work on the psychiatric consultation liaison service of a large academic medical center, and we are the people who get consulted when there are questions about an individual's capacity that the primary team doesn't feel comfortable deciding on their own, so I deal with these kinds of questions all the time.

dbabz

157 Posts

Would Mayo be legally allowed to discuss the issue, though?

According to the article, they (Mayo) said they would if the pt signed a waiver allowing them to do so. She complied, but they still refused to discuss it.

MunoRN, RN

8,058 Posts

Specializes in Critical Care.
"Competency" is a legal concept that is decided through the courts. The issue in most healthcare situations is "capacity," the mental capacity to make informed decisions. Capacity is a v. specific question, and, yes, it is certainly possible to have the mental capacity to make an informed choice about a particular treatment or procedure and lack the capacity to make an informed choice about another, including signing out AMA. Capacity is not "all or nothing." I work on the psychiatric consultation liaison service of a large academic medical center, and we are the people who get consulted when there are questions about an individual's capacity that the primary team doesn't feel comfortable deciding on their own, so I deal with these kinds of questions all the time.

Leaving against a psychiatric hold isn't technically leaving AMA, a person can be held legally held on a psych hold but still be considered to have the right to legally decline certain medications or treatments.

Capacity to make medical decisions is just that, a patient has or lacks the capacity. This is where the Mayo story doesn't jive, they had made no attempted claim that the patient lacked capacity where a question of guardianship would even come into play, and even then the default guardian would the parents and there was no attempt to legally take away their place as the medical POA in the event the patient lacked capacity to make medical decisions.

Apparently the Rochester Police looked into and didn't see any reason why the patient shouldn't have been allowed to leave, or that Mayo even disputed the patient's capacity to make that decision, the hospital's official statement was that they didn't agree with all of the decisions they were making.

elkpark

14,633 Posts

Leaving against a psychiatric hold isn't technically leaving AMA, a person can be held legally held on a psych hold but still be considered to have the right to legally decline certain medications or treatments.

Capacity to make medical decisions is just that, a patient has or lacks the capacity. This is where the Mayo story doesn't jive, they had made no attempted claim that the patient lacked capacity where a question of guardianship would even come into play, and even then the default guardian would the parents and there was no attempt to legally take away their place as the medical POA in the event the patient lacked capacity to make medical decisions.

I'm not talking about psychiatric holds or a psychiatric setting (how did psychiatric holds come up, and what do they have to do with the discussion?); I'm talking about medical decisions in a general medical/surgical setting.

And I wasn't commenting on the specifics of the Mayo case, with which I'm not familiar, just commenting generally on the other poster's statement that a facility couldn't say that a person had capacity to make one kind of decision but not another kind. Capacity is a v. specific question. We all make lots of different kinds of decisions every day that have different levels of complexity and import. Although there is a lot of confusion and misunderstanding about capacity, there is no such thing as "lack(ing) capacity to make medical decisions" generally, unless you are talking about someone who is globally demented, delirious, or otherwise impaired cognitively and unable to decide anything. Otherwise, it's a "case by case" situation, in which people may or may not have the capacity to make specific, individual medical decisions.

dbabz

157 Posts

I must say, it does sound to me like Mayo was essentially saying that the pt was capable of giving consent for medical treatment, but not capable of making the decision to decline medical treatment?!? Where's the logic? I'm not familiar with specific policies or laws, but to say a pt is capable of making some types of decisions, but not others smacks of double-speak (and CYA.) In essence, the pt has the capacity to make medical decisions when the hospital agrees with those decisions, but does not have the capacity when the hospital doesn't agree with other decisions. Reminds me of "Animal Farm."

Kitiger, RN

1,834 Posts

Specializes in Private Duty Pediatrics.

This link gives a better explanation of what happened.

Escape from the Mayo Clinic: Parents break teen out of world-famous hospital - CNN

morte, LPN, LVN

7,015 Posts

ego and/or money.

dbabz

157 Posts

ego and/or money.

I was thinking the same. The family does sound difficult. Why wouldn't the staff welcome the opportunity to get rid of this pt if not for the reasons you cite above? But, again, I don't know the other side of the story.

elkpark

14,633 Posts

I must say, it does sound to me like Mayo was essentially saying that the pt was capable of giving consent for medical treatment, but not capable of making the decision to decline medical treatment?!? Where's the logic? I'm not familiar with specific policies or laws, but to say a pt is capable of making some types of decisions, but not others smacks of double-speak (and CYA.) In essence, the pt has the capacity to make medical decisions when the hospital agrees with those decisions, but does not have the capacity when the hospital doesn't agree with other decisions. Reminds me of "Animal Farm."

It's not "double speak," it's the way capacity works. We're all "capable of making some kinds of decisions, but not others," depending on our knowledge and understanding of the risks/benefits/alternatives involved in a specific decision, and how well we can manipulate that info to arrive at a decision, which is what is evaluated when determining capacity. And the "bar" for having capacity to make a decision is higher or lower depending on the import of the particular decision. To offer an extreme example, you can have capacity to refuse blood draws or vital signs, but lack the capacity to refuse life-saving surgery. And, yes, capacity mostly comes into question when someone is refusing something that the professionals agree is necessary. If people are agreeing to treatment, providers don't usually question that, or their capacity to make that decision.

Caprica6

72 Posts

According to the article, they (Mayo) said they would if the pt signed a waiver allowing them to do so. She complied, but they still refused to discuss it.

Typically, the organization will decline to discuss anything related to a case regardless of waivers, to prevent from accidental self-incrimination. This doesn't necessarily indicate wrongdoing on the part of the hospital, just savvy lawyers.

trytounderstand

101 Posts

And the "bar" for having capacity to make a decision is higher or lower depending on the import of the particular decision. To offer an extreme example, you can have capacity to refuse blood draws or vital signs, but lack the capacity to refuse life-saving surgery. And, yes, capacity mostly comes into question when someone is refusing something that the professionals agree is necessary. If people are agreeing to treatment, providers don't usually question that, or their capacity to make that decision.

I come away with the impression that in this case the patient was asking to be moved to a different facility for rehab. If the patient had the capacity to make the decision to have the life saving surgery and was recovering and wanted to be moved to another facility that would provide healthcare what was the problem? Why did the doctors think they had the right to force her to stay where she didn't want to be? She was not asking to go home she was wanting to move to a different facility. If she was planning on moving to an accredited care facility what was the hold up?

In this case it sounds like it got out of hand and strong personalities and ego on all sides was harming the patient's recovery. As far as saying the family was out of line perhaps they were too outspoken and to quick to respond to some nurses but at times they are the only advocate a patient truly has once the medical team has decided they know better than anyone else what the patient needs. Was the medical team including her in their behind closed doors decisions or just making the decision on their own? Should not the patient be part of the team? Been my experience in some instances and hospitals that the care team does not consider a patient part of the team and wants to make decisions and believe because you signed a consent form they are now in charge and you do not have the right to ask "Why", say "No", or say I am not comfortable with you and want someone else to take my case.

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