A woman is in her eighties. I've known her nearly 20 years. She developed significant progressive dementia. She had never been compliant with her blood pressure medications. In addition, her B12 level was quite low. We tried to get her regular B12 shots, but her presentation to the office was spotty (maybe 8 times a year at best). Her children are not fully supportive due mainly to their own personal problems. She has an old umbilical hernia and several times over the years became convinced she was pregnant, and would make an appointment to ask how a woman her age could be pregnant. She was always clearly skeptical of my answers.
During her annual physical, which required us calling the taxi for her and calling her at home to get ready, she would not recall her medications and it was clear she was not compliant.
Her son never returned our phone calls. An ex-daughter-in-law became involved and helped get her to the office. She is frustrated because no one in her family will listen to her, regarding the woman's dementia. On the last visit she reports wandering out into the street and urinating on the floor. She has lost weight from lack of attention to food.
We are told that the son "will call" us by tomorrow. If he doesn't, was it my obligation? Does a woman have the right to refuse care, even if she is demented? If she sets her house on fire, it will only kill her. If she wanders off into the night and dies, it will only affect her? Or do I HAVE to call Adult Protective Services? The police?
Subscribe to:
Post Comments (Atom)
3 comments:
First off welcome to Blogger-land! Your presentation has posed a situation that most healthcare professionals hope they never see, and if they do, they normally don't want to touch it with a ten-foot pole because it gets complicated and messy because you are about to enter "The Personal Involvement Zone."
When you sit down, stare at yourself in the mirror, your first reaction is a burning desire to gather all the siblings and family members together and slap some common sense into them. However this can and probably will land you in a heap of trouble, despite the fact you'll feel pretty good about doing it, until the police show up!
So what to do?
Since you've had contact with this lady as your patient for over 20 years, you have a good point of reference of her declining mental condition and have good reason to believe her family is unaware and/or unwilling to intervene in monitoring her. You also have the common sense and good judgment to believe it is possible she may injure herself due to declining mental state. Don't be surprised if she has attempted to "snow" the family on her health, or that she becomes difficult and combative when out of your sight. It is a common problem.
The reality check is most states where I've worked as a hospital administrator have laws on the books that compel healthcare workers (and a variety of professionals,) to report to the designated State Social Services Agency or the police, any and all cases of suspected or known abuse or neglect of women, children and the elderly. From what you have presented here I suspect you have a pretty good case of neglect and elder abuse.
If I were you, I'd call your state agency, or the police and get clarification on the process and the law, without reporting it first. Tell them you want to be sure if you need to report a situation you would be going the right and legal thing. Then I would call the son and deliver a stern and concerned message yourself (no office staff or nurse,) to have him call you about his mother, it is serious and he needs to call you ASAP. If he doesn't call-- call the local police department, and talk to the desk sergeant and ask they drop by the office for a talk. Be prepared to explain you have attempted to call the son, X number of times, and not received any call back. You can do all this without violating HIPAA as you are advocating in her best interest and welfare.
I personally wish you the best of luck. I've been down this road a couple times and it was personally draining, but rewarding when the end result was seeing to it that a patient got taken care of who could not take care of themselves.
Well, the family has filled out the paper work for the nursing home and I believe this will have a happy ending. Meanwhile we did call Adult Protection on another case, outlined in a more recent post. Thanks for your comments.
Dr. Jim
Dear Dr. Jim,
Sorry to have been away so long, but family issues with my 81 yrs old MIL, whom we care for got in the way. (She's back in the pink and doing fine.)
I'm really glad to see you got active on these situations. If I'd have been in your shoes, I'd have probably done the same thing. Hopefully they will both get the care they need to receive and be treated with dignity.
Just remember Doc, if you can stare yourself in the mirror and say honestly "I did the right thing. Or I did it for them." you're doing the right thing. No one ever said healthcare was going to be easy!
**Big Hug** (and yes I hugged my Doc when I was an Admin' for doing the right thing.)
I'm proud of you.
Mary Lu
Post a Comment