# POA vs Pt.



## ffemt8978 (Apr 12, 2008)

What would you do?

Dispatched to SNF for 78yoF c/c fall last night.  It is now early evening, and patient has been refusing treatment/transport all day.  Pt. has noticeable bruising and swelling to hand and wrist, but no other injuries.  Vitals WNL, and pt. is CAOx4.  Pt. is adamant about not going to hospital or doctor, but daughter wants pt transported.  Daughter has POA, but is unable to produce the document.  



I'll post what I did later.


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## Arkymedic (Apr 12, 2008)

ffemt8978 said:


> What would you do?
> 
> Dispatched to SNF for 78yoF c/c fall last night. It is now early evening, and patient has been refusing treatment/transport all day. Pt. has noticeable bruising and swelling to hand and wrist, but no other injuries. Vitals WNL, and pt. is CAOx4. Pt. is adamant about not going to hospital or doctor, but daughter wants pt transported. Daughter has POA, but is unable to produce the document.
> 
> ...


 
If the pt is CAO x 4 and can answer my questions, I will encourage her to go but if she does not want to and no signed and notarized POA is present, its witnessed refusal time. As I always tell families that want members transported against their will, I don't wear and have no desire to wear bracelets for kidnapping.


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## EMTMandy (Apr 12, 2008)

> I don't wear and have no desire to wear bracelets for kidnapping.


 
well said Arky...If one is determined to be mentally competent, they are not obligated to accept treatment of any kind. If the provider enjoys charges such as battery and false imprisonment, then by all means..


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## Ridryder911 (Apr 12, 2008)

It depends. If the hand does have swelling, then I might try to convince the patient. Power of attorney, does not usually mean that they have the right to make decisions for the patient while they are alert, and appear informed. Time As well, there are different types of "power of attorney". Some is for day to day operations such for paying bills, checking account, and does not allow them to make decisions for care, etc. 

No paper and no proof, sorry Charlie. She should be more responsible, I might try call the patient's PCP (since she is in a SNF), he may talk to the family or staff members for orders.
No need to ever transport....

R/r 911


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## certguy (Apr 12, 2008)

Shouldn't the SNF have a copy of the paperwork also ? And is that POA for medical care decisions ?


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## katgrl2003 (Apr 12, 2008)

certguy said:


> Shouldn't the SNF have a copy of the paperwork also ? And is that POA for medical care decisions ?



They should, but usually don't.  I can't even begin to count the number of times I've been cussed out for not transporting the pt when the POA (with no paperwork) insists they go.  If they're A&Ox3, refusing transport, and there's no POA paperwork, I can't transport.

-Kat


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## mdtaylor (Apr 12, 2008)

Ridryder911 said:


> Power of attorney, does not usually mean that they have the right to make decisions for the patient while they are alert, and appear informed.



Absolutely!  Powers of Attorney do NOT diminish the rights of the grantor, it only grants a bilateral right for specific duties. If the person with the power of attorney desires to exercise any right he may have he must be capable of producing that document.

The only thing that removes any rights from an adult CAOx4 pt is a court order.


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## JPINFV (Apr 12, 2008)

If the patient is A/Ox4 and understands the results of their decision then they get to stay in their warm bed. A POA (or even a POA: Health Care) doesn't mean squat as long as the patient is able to make their own decisions. Now if it was a conservatorship, *then* the patient wouldn't have a choice.


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## BossyCow (Apr 13, 2008)

There are different types of POA. We had a frequent flyer/911 abuser who has friend with POA but it was only regarding her finances, had no power to consent for or determine medial treatment. 

I've found a powerful tool in convincing someone to go to the hospital is "Look, your family seems really worried. If there is nothing wrong with you, lets just go in and get it checked out so they won't worry." Often the pt will agree to go in to get his wife off his back. It makes it more about them taking care of their family than in being weak or injured. I've also found that calling their personal physician can be helpful. If the doc says to come into the office in the next day or so, then its no longer our concern.

Aside from that, document, document, document what you told them about possible complications, what it might be, how what it might be could kill them. Cover your butt legally for when it turns life threatening and they say.. "But why didn't they tell me????"


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## Flight-LP (Apr 13, 2008)

If the daughter is adamant, then tell her to take her mom to the ER...................


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## Ops Paramedic (Apr 14, 2008)

It sounds like she knows what she wanted, hence sign the refusal of treatment form (Obviously trying to convince her to go failed).  Also give them entry back into the EMS system, should she change her mind, i.e. ensure she has the number to dail to get the EMS activated.


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## CFRBryan347768 (Apr 14, 2008)

Flight-LP said:


> If the daughter is adamant, then tell her to take her mom to the ER...................



Thats the best move.


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## traumateam1 (Jun 9, 2008)

If the patient was adamant about not going to the hospital, I do not have the power or right to over rule the patients rights. If she is AOx4 can answer my questions properly and does not want to go, then I get her to sign a refusal form and tell the family that I cannot over rule what a patient wants, when they are alert as she was. And an absent POA is like an absend DNR, if I don't see it then I assume it's not real, and I continue what my protocols tell me to do.


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## BossyCow (Jun 9, 2008)

So, re-reading this initial post, what's the likelyhood that the hand, wrist swelling is from physical abuse at the hands of the daughter. Of course we can't transport without the visible POA stating the holder has the right to determine medical treatment, but if I suspected that the bruising was related to the daughter pulling on Mom's arm, then I might try to get some time without the daughter in the room to see if mom wants to go in for protective reasons and to document the injury to herself.


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## mikeylikesit (Jun 9, 2008)

your probably right bossy, maybe the mother feared that if she went in then the authorities would question what took place possibly placing the daughter in a lot of trouble. Of course then why would the daughter be so adamant about bringing her mother in. i think the daughter had been trying to get her mom to go to the hospital all day and just figured that the EMT's will strap her to a cot and take her away. so... did the mom ever end up going to the hospital?


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## JPINFV (Jun 9, 2008)

BossyCow said:


> Of course we can't transport without the visible POA stating the holder has the right to determine medical treatment,


But you can't transport with a POA anyways if the patient is competent. Saying that POA has complete power is like saying that a patient with a DNR can't revoke the DNR. If the patient had zero power to make his/her own decisions, then it would be a conservatorship, not a POA.


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## Jon (Jun 10, 2008)

First... you are at an SNF. I'd hope they've got a copy of the POA on file. Have them get it. 
Call medical command, explain your situation to him.

So... FFEMT... what DID you do?


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## ffemt8978 (Jun 10, 2008)

Jon said:


> First... you are at an SNF. I'd hope they've got a copy of the POA on file. Have them get it.
> Call medical command, explain your situation to him.
> 
> So... FFEMT... what DID you do?



SNF couldn't produce a copy of the POA, and neither could the daughter.  After speaking with the patient and trying to convince her to go in and get checked out, I called medical control and explained the situation.

Doc said the following...if patient in competent and alert, it's patient's choice regardless of whether or not there is a POA.   Since the daughter couldn't produce the paperwork, we had no way of determining if she had a POA or a conservatorship so we reverted to the "if I don't see it, it doesn't exist" practice.

As I'm walking back into the room, after having stepped out in the hallway to call medical control, the patient looks straight at her daughter and says, "I verbally revoke your Power of Attorney over me."

I handed the paperwork to the patient and said sign here, press hard, you're making two copies.


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## jazminestar (Jun 10, 2008)

yeah here in san diego, you have to have a *specific *POA and it has be to be signed and nortarized....or it's a no go.........tough cookies to the daughter and sucks for the pt, especially if she has any broken bones....


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## JPINFV (Jun 11, 2008)

jazminestar said:


> yeah here in san diego, you have to have a *specific *POA



Which POA is that? 


Ok, seriously, since it's been said about a billion times by about as many people in this thread.




> •When to get a Conservatorship versus a Durable Power of Attorney
> -A Conservatorship is obtained when an individual assumes the rights and responsibilities of a person who no longer has the capacity to care for himself or herself.
> -A Durable Power of Attorney is the authorization one individual, who is mentally capable to do so, gives to another individual to act on his or her behalf as to legal and business issues.


http://davidandturner.com/services1/


> *
> What is the Difference Between a Power Of Attorney and a Guardianship? Which is Appropriate for Someone With Alzheimer’s?
> by: William G. Hammond, JD *
> 
> ...


http://www.resourcesforattorneys.com/alzheimersarticle.html



> Durable Power of Attorney
> 
> Durable Power of Attorney is a written legal document giving someone other that the Principal the authority to handle the Principal's financial decisions. It must be signed by the Principal while the Principal is still legally competent. _The DPA is valid without time limit* until the Principal either revokes the DPA* or dies, or the court revokes the DPA due to mismanagement._ The preferences of the Principal regarding the management of assets can be specified. This power to manage assets can be transferred immediately or can be designated to go into effect when it is determined that the Principal has become mentally incapacitated. Financial decisions made by an individual given DPA by the Principal are binding on the Principal and his/her successors, so caregiver and care-receiver are urged to seek the advice of an attorney.
> 
> ...



http://www.longtermcarelink.net/eldercare/the_caregivers_handbook.htm


POA=Means jack squat if patient is able to make their own decisions. 

Conservatorship=Patient unable to make own decisions regardless of mental status according to the conditions of the conservatorship.

Hence patient that is A/Ox4 with appropriate mentation and able to understand and acknowledge the risks and benefits of refusing treatment and transport and declines transport should not be transported. Period. Any variation of a situation that involves a patient that is able to make their own decisions and does not include the words "psych hold," conservatorship," or "guardianship," the proper response is to politely tell the POA to go pound sand. Transporting this patient would be kidnapping. Feel free to tell the nursing home staff to pound the same sand since they can't override such decisions either.


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## 1799687 (Jun 14, 2008)

If the daughter cant produce the document she has no say. 
I'd encourage the pt to go with, and if not have her sign off. Of course this is as long as she is cao4


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## emt19723 (Aug 13, 2008)

in PA, it doesnt matter if the daughter is POA or not, if the pt is CAOx4, its the pt's decision. i can try and talk the pt in to going by giving them possibilities as to why they feel/felt the way they did, but if they say no, all you can do is do a pt refusal.  had one of those a couple weeks ago actually and i almost had to remove the pts husband from the room cuz he was getting that upset. of course, my partner could have been a little more tactful, but in his defense, the pt's husband got an attitude first!     lol


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