Medical kidnap? Discuss

[dbabz]

Disturbing in manner of Justina Pelletier and the Diegle sisters...but...I don't know what I don't know and I've discovered that the other side of the story often turns up new details. In this case, however, Mayo's reluctance to discuss the issue makes me wonder if overstep is a new trend in medical care.

'Kidnapped' by the Mayo Clinic; Death by Colonoscopy; Health Officials' Secret Finances | Medpage Today

[kbrn2002, ADN, RN]

It's not at all surprising that Mayo has no comment on this matter. I'm sure their high price attorneys have told them in no uncertain terms to zip it. Just because the patient hasn't filed a lawsuit yet doesn't mean she won't. So of course we haven't heard their side of the story. Just reading from the families point of view though, there's no way that situation should have escalated to the point it did. Sounds like from their point of view the girl and her family were being railroaded by a powerful "I am the closest thing to God you'll find on earth" physician and the team he directs. I have no doubt that such doctors exist and even less doubt that the hospitals they work with put up with whatever stunts they pull.

[RNNPICU, BSN, RN]

I often wonder when I hear these one-sided stories where the truth really lies. This patient was probably admitted when she was 17, a minor. The family was likely an over the top grieving family that something this devasting happened to their child and may have acted inappropriately at times, especially since they were banned. Hospitals do not just ban family members from coming, it is a LONG process for that to happen. One possibility could have been that the hospital felt that someone with a significant brain injury should have a guardian ad lidum to ensure that HER needs were met,. If the family refused to do this, or were blocking care, then other the hospital may look for the besst interest of the patient. Many hospitals need to have a document when you are over 18.

Here is how I could see the scenario..

Hospital to family: Your daughter is approaching 18 and is still recovering from a significant brain injury. We think it is in your DAUGHTERs best interest to have someone assigned as a GAL. As she is recovering we want to esnure HER needs are met. As parents you can but since she is 18, you would need to have an official legal document stating you can make medical decisions for her. It is a legal process.

Family could have refused despite encouragement. If this was the case, the hospital could then seek legal action to find someone to be an appointed GAL.

It does sound like the patient, from the video, had some delays. Based purely off the video I think she should have someone acting as her GAL, making sure what SHE wanted, not her family or any one else, but what SHE wanted.

[djh123]

I just skimmed the whole article (both parts), and wow ... although I think we're still not getting the total story from both sides, it sounds like the Mayo was at fault. A pretty bizarre story.

[MunoRN, RN]

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.

I referenced psych because it's generally the one circumstance where someone can be held (not allowed to leave) yet still be allowed to refuse treatment.

Capacity to make medical decisions is either there or not, it's not dependent on what is being consented to.

UpToDate

[babyNP., APRN]

If another well-regarded hospital said she was competent and actually discharged her home and didn't have to stay in the hospital- and now the young woman has made just about a full recovery...hard to see what side Mayo is trying to take. I will reserve judgement for the case trial though because crazier things have happened that you would never guess came down on the right side of the hospital, but TBH it's hard to do.

[Neats, BSN]

I think what this shows is how powerful we can be with peoples lives. All it takes is a few well chosen words to a person who can get the ball rolling and bam what could have been a little hiccup, now is a huge mess that will take the courts months/years to unravel and at the direction of not medical personal but attorneys and Judges.

As someone who has made difficult medical decisions with regard to inpatient stays I can tell you I am so grateful I have always used a decision tree of moral compass, I am not without mistakes though. We do not know the whole story and more than likely never will. We just need to know that these things can and do happen.

Of Note: I have never witnessed or assigned nurses to a patients room regardless of the potential that there maybe some threat...this is left up to hospital security. In the Nursing Home we just called the police when a friend/family member was going to leave with the patient and the patient always had to have the diagnosis of mentally incompetent. If they did not have that and wanted to leave we had them sign AMA, attempted education and let them leave.

[KelRN215, BSN, RN]

I often wonder when I hear these one-sided stories where the truth really lies. This patient was probably admitted when she was 17, a minor. The family was likely an over the top grieving family that something this devasting happened to their child and may have acted inappropriately at times, especially since they were banned. Hospitals do not just ban family members from coming, it is a LONG process for that to happen. One possibility could have been that the hospital felt that someone with a significant brain injury should have a guardian ad lidum to ensure that HER needs were met,. If the family refused to do this, or were blocking care, then other the hospital may look for the besst interest of the patient. Many hospitals need to have a document when you are over 18.

Here is how I could see the scenario..

Hospital to family: Your daughter is approaching 18 and is still recovering from a significant brain injury. We think it is in your DAUGHTERs best interest to have someone assigned as a GAL. As she is recovering we want to esnure HER needs are met. As parents you can but since she is 18, you would need to have an official legal document stating you can make medical decisions for her. It is a legal process.

Family could have refused despite encouragement. If this was the case, the hospital could then seek legal action to find someone to be an appointed GAL.

It does sound like the patient, from the video, had some delays. Based purely off the video I think she should have someone acting as her GAL, making sure what SHE wanted, not her family or any one else, but what SHE wanted.

Every article I've read said she was 18 and a legal adult the entire hospitalization.

[Triddin]

I really hope for all who were involved the the documentation is clear, non biased and concise

[elkpark]

Ooops, duplicate post somehow.

[elkpark]

I referenced psych because it's generally the one circumstance where someone can be held (not allowed to leave) yet still be allowed to refuse treatment.

Capacity to make medical decisions is either there or not, it's not dependent on what is being consented to.

UpToDate

I'm assuming you posted the uptodate link because it supports your position on this, but one can't read the article unless one is a subscriber. However, elsewhere in the literature:

Clinical capacity is specific to a particular health care decision and thus is limited to that decision. The level of clinical capacity needed to make a health care decision depends on the complexity of that decision. A patient with some decrease in capacity, even one with fairly severe cognitive deficits, may still have enough capacity to make simple health care decisions, such as whether to allow a rectal examination or placement of an IV. However, the same patient may lack the capacity to decide whether to participate in a clinical trial.

Capacity (Competence) and Incapacity - Special Subjects - Merck Manuals Professional Edition

Decision-making capacity, medical or otherwise, is always specific to the task requiring the decision.1,4 Certain patients may be able to decide some aspects of their care, but not others. For example, a patient with mild-tomoderate Alzheimer's disease who experiences chest pain may be able to understand the need for antibiotics to fight pneumonia but not the indications for, or the risks and benefits of, cardiac catheterization and angioplasty for coronary artery disease.

Can the Patient Decide? Evaluating Patient Capacity in Practice - - American Family Physician

Table 1. Ten Myths About Capacity

1.Decision-making capacity = competency.

2.Against medical advice = lack of decision-making capacity.

3.There's no need to assess decision-making capacity unless a patient goes against medical advice.

4.Decision-making capacity is all or nothing.

5.Cognitive impairment = no decision- making capacity.

6.Lack of decision-making capacity is permanent.

7.Patients who have not been given relevant information about their condition can lack decision-making capacity.

8.All patients with certain psychiatric disorders lack decision-making capacity.

9.All institutionalized patients lack decision-making capacity.

10.Only psychiatrists and psychologists can assess decision-making capacity.

How Do I Determine if My Patient has Decision-Making Capacity? | The Hospitalist (Bolding mine)

A physician must recognize that capacity to make reasoned decisions is task-specific. Therefore, it is conceivable that a patient might lack capacity to make reasoned medical decisions, but may be fully capable of selecting a proxy.

Competency and the Capacity to Make Treatment Decisions: A Primer for Primary Care Physicians

One of the most common reasons medical colleagues seek consultation with a psychiatrist is to address the question of capacity. Indeed, this referral question often is posed as, "Is the patient competent?" This referral question is incomplete and incorrectly phrased. The question should include the domain in which capacity is being questioned-for example, "Is the patient competent to refuse surgery?" Specifically identifying the area in which competency is questioned is necessary because a person might be competent in one area and incompetent in another.

Performing capacity evaluations: What's expected from your consult | MDedge Psychiatry (The article goes on to explain, also, that "capacity" is the correct term in this context, not "competency.")

Decision-making capacity is decided by clinicians regarding a specific question, while competence is decided by a court and is implemented over a functional domain, such as finances or medical decisions ... Decision-making capacity is not an all or none phenomenon. All of us can have decision-making capacity for some decisions but not for other decisions.

Psychiatry Online

Decision-making capacity is protocol-specific and situation-specific. Thus a subject may have capacity to consent to a low-risk research protocol in usual circumstances, but not have the capacity to consent to a high-risk protocol or when he or she is confused or under duress.

UCSD Human Research Protection Program - Decision Making Capacity Guidelines

•Capacity is time and decision specific. This means you should assess a patient's ability to make a specific decision at the time the decision needs to be made.

Assessing capacity - The MDU

It is important to remember that this capacity relates to the specific medical decision at hand and does not imply a global ability to make any or all decisions about health care or other matters. Only a court can deem a patient incapable of making global health care decisions.

Decision Making Capacity

Shall I go on? There are plenty more sources out there. Frankly, I'm surprised that you found a source that would support your position. Does the uptodate article specifically say that capacity is a global concept that applies to all healthcare decisions, or does it just not specify? I'm finding articles that discuss the process for determining capacity to refuse surgery, dialysis, whatever, but don't come out and specifically say that capacity is situation-specific and not a global concept.

[Kooky Korky, BSN, RN]

This is really frightening. Why were the parents banned?

Won't public court documents show why Mayo sought guardianship? Would Mayo have been the guardian or the State/Court?

[FSZ Student Nurse, RN]

If you're interested: Mayo Clinic claims CNN did not fully and accurately portray the situation in their article.

You can read Mayo Clinic's response here Mayo Clinic responds to false, sensational CNN story – Mayo Clinic News Network , including the rebuttal they sent to CNN https://newsnetwork.mayoclinic.org/CNN-Letter-08-15-2018.pdf