Ok in my state it's called Durable POA for everything except healthcare and 'Healthcare proxie' for what most other states call 'Medical POA'. So I have durable POA, didn't actually get the papers physically signed for the proxie, but I definitely know my mom, currently being held in a hospital for 2 and a half weeks, with a severe case of 'hospital delirium'.
So now here we are, with everyone's favorite catch-22. She does not understand why she's there, but she just wants to go home. The staff are delighted that I visit, but tell me as little as possible.
Before being admitted, I would communicate with doctors via her patient portal. I would sign a message with [her name] + [my name]. And begin a correspondence with "This is ------'s son helping her access this.
It was a convneient way to get a refill for an RX, etc. etc.
After coming in to the hospital they kicked me off. And her capacity has gone from mild impairment to very bad. I had maybe a minute of access to see that they had restrained her and put her on seraquil; and another stronger anti-psychotic. When I asked, they did not deny it. But I wouldn't have known to ask, were it not or the 2 min that I had access to her patient portal.
I told them this, and asked them if I could please get access again. Just in case, of course I asked my mom if she was ok with that. The notion that she wouldn't be was laughably absurd to her.
Her English was never great, but now that she doesn't generally know the year or where she is, I have to ask her such things in Russian, and with much constraint they occasionally get a russian interpreter in there (and I have to guess and play 'detective' to figure out why).
Once I came by and the interpreter was there and so was the attending doctor. So I asked her, "Would you like me to have access to your medical records?" She said "Of course". The interepreter translated. And I asked, if I could please have access again. Doc replies:
"Well I'll definitely make a note that she said this and put it in her chart."
I take a breath, "Well that's great Doc, but see the problem is, I can't access the chart (remember?). Any chance you could maybe fax or email me this note?"
"No I can't do that" he replies.
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At this time I was not yet aware of HIPAA release forms, nor did I know yet about Personal Representative status. Healthcare Proxie requires two witnesses, and 2 visitors is the maximum allowed. And indeed, she really could not show the required capacity to sign the proxie form.
So until this new idea I was planning to just come back with the hospitals standard HIPAA compliant medical records release, and establish her contractual aka testamental capacity which she already passed when testing it. As in, she needs to understand who I am, what she is signing, what the risks are, and voice her decision about it.
That she can do. Furthermore, I've been with her all along, and I'm the only one she could trust to interpret medical records for her, for good reason!
Perhaps I would need an attorney or a notary to add a note about her capacity.
Now I have a simpler idea:
I walk in. In Russian I remind her "Hey mom, I can't do anything for you or really get anywhere in getting you out of here without knowing what is going on, remember? So do -YOU- want to see -YOUR- chart? OK, and I can help you unerstand it as usual, ok? She will say of course.
Then I tell the nurse or who ever is there, my mother just told me that she wants to see her chart, and needs my help understanding it. (due to english, to due delerium, and who knows what else, but seeing the chart would reveal the rest of the story!)
I can't imagine what they could come up with to justify refusing such a request?
Otherwise I'm not even sure the HIPAA release form approach will really work because it's jsut another department at the very same hospital that will decide if the form is good enough, and well, they could just say no.
Feedback cherished!
You can also break down the problems and suggest solutions, adding that those have been rejected, and querying what it does in fact take to get this situation resolved, short of your removing her to another hospital (even if you don't plan to).
I had to do that once when my father was hospitalized and wasn't getting nurse response on the floor for an emergency situation. But I called his treating physician, spoke with one of his office staff, and asked for guidance, with the anticipated result that she said she would intervene.
I also said that my father was ready to leave AMA, that I had significant medmal experience and would be considering contacting one of the firms for which I worked if Dad didn't get immediate relief (which he needed; he was in agonizing pain, but the floor staff weren't listening.)
It worked; someone from another floor came up shortly and resolved the situation.
One doctor advised me to make final preparations, as did one ICU nurse. Instead I focused on what could be done, including mobilizing his church support when he did emerge from the coma. He then lived until 2018 and died 6 months short of 100. (He also built a woodshop for himself during period.)
Second "let him die" events occurred a few months before he did pass. A sort of teeny bopper hospitalist told him, in front of me, and two church friends (w/o even considering who they might be), that "you've had a long life; it's time to just let go." She harped on the topic.
When I'd had enough, I told her firmly to back off. Although I don't recall specifically what I did say, I made it clear that she knew nothing about his personality, his determination, his hardening through Natl. Guard and WWII flight service, or what he was thinking now. (She never asked; she just took a "you should be considering death" approach.
I also told her bluntly that I didn't think she had the maturity or experience to analyze his mind or advise ANYONE what she thought should be done. She was stunned and clearly wasn't used to such frank criticism. She began to walk out before I had even finished. I don't recall if I contacted the charge nurse or administrator, but I got a doctor with a good reputation for dealing with older people.
ITRR, thanks for sharing your experience. For a time I wondered if I might have been too blunt, but still to this day, I don't regret it.
NerdMafia, stand your ground.
I don't feel bad for what I did. If the staff would have behaved as medical professionals the situation would not have been escalated to the point it was.
I think these people get god complexes and too many people defer to their knowledge as authority and get intimidated. I think that an attitude because you are questioned is the biggest, waving red flag there is. A competent doctor welcomes a second opinion and others input. It's the idiots that think they are infallible that make going to the hospital as dangerous as playing Russian roulette.
Ok THAT is interesting. This forum is , as we all know, very lucky to have you, and many others of course.
I have been trying to take your advice in a different thread about having specific questions, and learning their jargon.
Example:
The last time I visited, the nurse just didnt know what to say and offered to get the attending (nurse practioner in this case). Once she was in the room, I recall her defending anti-psychotics:
"It's really a shame that they earned such a name. People automatically have negative associations thinking, well the person being treated is now called 'psychotic'."
And I replied: "Oh yes that makes perfect sense. So in that case, seratonin, dopamine, norepinephrine, ANtagonists" really stressing that first syllable, the last thing I want is to be 'that guy' that doesn't know his Agonists from his Antagonists, ugh.
Anyway I told her never would I just write off an entire class of a medication by calling it 'good or bad'. That would just be way too primitive. I explained that Of course plenty of circumstances absolutely call for the use of such drugs. and I even can empathize with their usage in elder care settings. But just that specifically, since, her mental capacity, is being constantly assessed and re-assessed, and just MAYYYYYBE, ties in to matters perHAPS even outside the scope of medical care....that maybe it would be a good idea to not use them.
Well surprise surprise, she then tells me that this is exactly why they have been adjusting the dosage, and weening her off of them. The expression on her face was like "leave me alone, i have to go, stop interrogating me" hah well I thanked her for informing of such a wonderful developmnt, and i meant it!
So it's a doctor and 2 nurse practioners that are the 'attending body'.
Well, i know the hospital us part of a network, and there is: a 'president'.
I know their name. The advocate told me they would call me back, it's about 2pm, and not a squeek. My plan was
1. advocate
2. office of elderly affairs(for the state) - ombudsman
then if that's not enough
3, state complaint process for the office of professional licensure. They have specific forms and options for doctors, and then for nurses, and then for other sorts of healthcare staff. And unlike the hospital's advocate, they REQUIRE that everything be in writing, where as the hospital advocate, REQUIRES everything to be done via voice over on the phone(by not offering any other option)
4. Next indeed, would be medical malpractice attorneys. I didn't even think of dropping the casual threat of such a thing. It is a very large hospital, and , ugh don't even get me started, but is supposed to be kind of a leader in the field, and publishes a lot of research and people just assume it's the best hospital. It's not.
I'm just not sure who to express my (true) intentions to, about persuing a malpractice, misconduct lawsuit. I have no doubt that if and when I find an attorney able and willing to help, that it would be a landmark case that they would do pro bono(and of course I know just how to slap that comment in) Just not sure who would care? I guess the attending Doctor, with max staff in the background listening, just might.
Many thanks!
I appreciate the compliments; they mean a lot to me. You're very kind. But excuse me for a moment while I go outside to cool down as my face is becoming hot and red with embarrassment!
As to a Subpoena duces tecum, med mal attorneys used them frequently in 2 different situations:
1. When a medical facility wasn't responding to a patient/potential client's request for documents, and/or appeared to be deliberately delaying.
2. When accepting a potential client for a medmal case wasn't certain. The med files would be subpoenaed; the facility had to respond, and the attorneys could then have the medical history reviewed by their own in-house nurse, NP, or a physician experienced in the field, to determine whether or not a case existed. This was of benefit not only to the firm, but to the potential client, so he/she could understand why or why not a case could successfully be pursued.
It is inevitable that you will get denials of valid requests due to misinformed administrators at hospitals and doctors’ offices and in many cases you will receive an incomplete set of the medical records. The authorization should request that the medical record administrator identify any record withheld with sufficient particularity to support a further effort to secure full disclosure should you believe it is necessary.
The medical records administrator should be asked to warrant under oath that all requested records have been fully disclosed or identified as withheld. This request could be ignored and there are no consequences if it is. But at least you have made your best effort to address this potential problem.
What can you do if the hospital still refuses to honor your HIPAA authorization?
Many medical records administrator (believe it or not) are sorely misinformed about HIPAA and are threatened by new authorization forms that are not on forms generated by the NYS Department of Health. When this happens, you should send a letter by certified mail to the medical records administrator with a specific warning that you intend to file a complaint with the Office of Civil Rights of the U.S. Department of Health and Human Services for its violation of HIPAA.
You might want to add a footnote at the bottom of your letter referencing a multi-million fine levied by the Office of Civil Rights for failing to comply with valid HIPAA authorizations against a hospital in Kentucky. This should get their attention.
Keep in mind that you are not alone. Hospitals and doctors routinely ignore HIPAA (out of ignorance and stupidity most of the time) and they will bank on the fact that you will not know your rights and just give up. Don’t give in to this nonsense! Be proactive in enforcing your rights."
https://protectingpatientrights.com/blog/six-requirements-of-a-valid-hipaa-release-authorization/
It's just a small legal practice that fusses in particular about medical malpractice. I find the writer's unrestrained vocabulary on these issues a rare treat and pretty useful actually. Too bad i'm not in NY state.
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