Power of Attorney Question

[JohnJ]

A few weeks ago my partners and I responded to a 93-year-old female who had fallen. Following protocol, she met criteria for mandatory full spinal precaution. Upon placing her on a backboard she began to feel a significant amount of pain, so we had ran into a problem. One of my partners called medical control and the other called our assistant chief; medical control stated that she needed to be secured onto a backboard unless she refused. It turns out that this patient's daughter had POA and ended up signing off on the refusal. Here's where we all argued (afterwards, of course).

I was taught that a the opinion/choice of a POA means nothing if the patient is coherent. One partner agreed with me but the other partner claimed that a POA can make any decision he/she wants for the patient, even against the patients will, regardless of the mental status of the patient.

Here are my thoughts:

If a patient is coherent and says that she wishes to be transported to a specific hospital and her POA says otherwise, I'm going to do what the patient wishes. What are your thoughts?

 

[STXmedic]

*Disclaimer: I have absolutely zero legal training or significant knowledge*

To my understanding, you're spot-on. Medical POA goes into effect once the patient is not of sound mind and not able to appropriately make informed decisions.

Legal Guardianship, I believe, is a little different, and more in-line with your partners train of thought.

 

[JohnJ]

*Disclaimer: I have absolutely zero legal training or significant knowledge*

To my understanding, you're spot-on. Medical POA goes into effect once the patient is not of sound mind and not able to appropriately make informed decisions.

Legal Guardianship, I believe, is a little different, and more in-line with your partners train of thought.

I thought so. There's just no way I would force a patient on a backboard simply because her POA demanded it... I'm no expert, but I'd say that's a good way to get yourself arrested.

 

[vcuemt]

In Virginia, POA, living wills, etc. are fantastic if you want to make your patient's family happy. Follow that stuff right up until it conflicts with patient care or the actual patient's desire. Because in this state it's completely meaningless. Unless the patient or their family can produce a DNR, and your patient needs CPR, none of it is legally binding.

I'd recommend you looking up your state's laws and your agency's guidelines. Virginia varies from NREMT in many ways, some slightly and some widely. For instance, in this state, the only mandatory reports are child and elder abuse.

 

[Angel]

Isn't the pain of being on the board a contraindication?
In my county if the pt doesn't tolerate it we don't force then on it. We just do our best with padding and document.
Obviously depending on the circumstances

 

[ZombieEMT]

I was taught that a the opinion/choice of a POA means nothing if the patient is coherent. QUOTE]

This is how I was tought and was told in medical/legal class.

 

[medicsb]

There is a HUGE difference between being "coherent" and having "decision making capacity".

A patient can be coherent enough to tell me to go "F' myself", but whether or not I listen to them is based on whether they have "capacity".

 

[mycrofft]

So what protocols are you following anywhere to establish coherence?

LE can determine if they are a threat to self or others. Sometimes.

Remember too that of you do something and it causes MORE pain, maybe something else has to be done?

 

[Wheel]

So what protocols are you following anywhere to establish coherence?
LE can determine if they are a threat to self or others. Sometimes.

Remember too that of you do something and it causes MORE pain, maybe something else has to be done?

It's a judgement call, in reality. You can have protocols out of the nose, but this is an area with a lot of grey regardless of how your protocol is written.

 

[CFal]

In Virginia, POA, living wills, etc. are fantastic if you want to make your patient's family happy. Follow that stuff right up until it conflicts with patient care or the actual patient's desire. Because in this state it's completely meaningless. Unless the patient or their family can produce a DNR, and your patient needs CPR, none of it is legally binding.

I'd recommend you looking up your state's laws and your agency's guidelines. Virginia varies from NREMT in many ways, some slightly and some widely. For instance, in this state, the only mandatory reports are child and elder abuse.

yep, we don't report domestic abuse

 

[mycrofft]

"Your Honor, may it please the court, my clients strapped this woman onto an unpadded backboard due to the requirement of protocols for all patients of her class, and despite her protests, because they felt she was incompetent".

"Are your clients licensed psychologists, psychiatrists, mental health workers…no? Hm-m-m-m-m-m-m…..".

But besides fear of being sued and/or charged with three or four felonies, and being stripped of your licensing ability because of "elder abuse", is it medically indicated and will that measure cause more harm than good? (EG, is it a smart or dumb move?).