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Person making medical decisions for their spouse. Physician disregard instructions

Discussion in 'Power of Attorney & Living Wills' started by masey, Nov 9, 2017.

  1. masey

    masey Law Topic Starter New Member

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    I am a Paramedic with over 30 years experience. I recently experienced an unusual situation for the first time.

    I responded to an emergency call for a patient in their 70's who experienced sudden cardiac arrest at home. The patient was in cardiac arrest between 6 and 10 minutes until help arrived and started CPR; which means that some irreversible brain damage had started.

    We provided aggressive resuscitation efforts for about 20 minutes; the same treatment that the ER would provide.

    However, the patient never regained a pulse.

    Our state EMS treatment protocols instruct us that, if the patient hasn't responded to treatment by this time, any further efforts are futile. The protocols discourage transporting these patients to the hospital and prefer that we end treatment in-the-field.

    In order to end treatment, EMS providers must contact a Medical Command physician at the ER and obtain approval.

    In addition, the patient's spouse told us that the patient "would not want all this done. and would not want to be hooked up to machines" for life support.

    After discussing the patient's condition and that further efforts would be futile, I offered to transport to the ER, or, the spouse could refuse further treatment for the patient. I said that, as the spouse, they can make medical decisions since the patient was unable to do so.

    The spouse repeated that the patient "would not want all this," and then said "You may stop treatment."

    The problem is that the Medical Command physician, after hearing about the futility of the patient's condition, and being told that the spouse instructed us to stop resuscitation, ordered us to transport anyway. This was very unusual and the EMS providers on the scene were stunned.

    We deal with people refusing medical care all the time. Medical Command does not have authority to compel a competent adult to accept treatment against their will. We maintain that the same right belongs to the spouse who is refusing care for the incapacitated patient.

    Our state protocols instruct us that we must obtain medical command approval to end resuscitation efforts in the field. But, under Refusal of Care, they also say that, if the patient is incapacitated, then we "shall comply" with the decision of another competent person who we believe in good faith to has the authority to consent to, or to refuse care or refuse transport. So, we have two protocols that are in conflict with each other.

    Pennsylvania Act 169 states that a spouse may act as a health care representative, by default, if there is no designated agent.

    In sum, the EMS providers on this call believe that the Medical Command physician issued an inappropriate, if not an unlawful order, when he disregarded the spouse's instructions to stop treatment. Who do we listen to when the patient and family have rights, but the physician has power?

    Our ambulance service is a private company and not affiliated with the hospital where the physician worked, and not a government agency
     
    Last edited: Nov 9, 2017
  2. army judge

    army judge Super Moderator

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    Whatever you do as a licensed EMS/EMT is done under the auspices of a licensed MD or DO.

    I suggest you do two things: 1) discuss this situation with your management; 2) discuss it with YOUR own legal counsel.

    My guess is that whatever was told to you by anyone on scene is merely HEARSAY to the physician.

    The physician was wise to order you to transport.

    If further investigation shows the person wasn't DEAD (in a legal and medical sense), the physician will be the one getting sued. You and your agency will be secondary targets.
    I suspect the physician was acting upon common sense and an abundance of caution.

    Finally, you had no way of ascertaining the man claiming to be the patient's husband was LEGALLY her spouse.

    Caution is always a wise alternative.

    This PA licensed lawyer offers insight for you:

    PA Health Care Power of Attorney / Living Will - Pappano and Breslin
     
  3. mightymoose

    mightymoose Well-Known Member

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    I know of people who appeared to be "obviously dead" at the time who are still walking the street today.... A head injury with brain matter on the ground would indicate to most people efforts are futile. It isn't always so.

    Your scenario makes me think of the recent news story of the nurse who was arrested for trying to prevent the police from drawing blood from an unconscious patient. Your knowledge and training and experience guide you in the decisions you make, and you just have to rely on them when you have a conflict.

    In your case, I wonder if the solution might have been to transport per the doctor's order but to take no further action while en route per the spouse request.

    As suggested above, your employer is the appropriate authority to guide you with this dilemma.
     
  4. ElleMD

    ElleMD Well-Known Member

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    Transporting is not illegal. If there were any heroics to be taken once he arrived at the ER, that is a different matter. For all you know the physician asked you to bring him to the ER to simply get the body out of the house. The hospital has a morgue; private homes do not (one hopes). In any case there is a reason the protocol is to contact a physician and not make the call in the field.
     

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