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I am POA for Health Care and Financial on my mother. She began having chest pains and was rushed to hospital via ambulance. I took in her Health Care Directive and I am her agent but I was NEVER consulted as to her treatment. Tonight I find out her heart doctor has talked to my sister, not me, and has written in her medical record DNR and signed off on it.

At that moment I did not realize the significance of this until I came home and re-read the document. It seems that I have the power to either allow or withhold treatment. In this case I would definitely want her to receive treatment
however I do not know who made the decision to DNR my mother, her doctor or my sister who is not the Agent in her Directive.

Mom is doing well and received treatment (because no one had seen the Directive,) and will be coming home tomorrow but what should I do to set this record straight and inform the hospital that I am the Agent and I MUST or at least I feel that I am suppose to be contacted on this matter so I can make the decision. Isn't that my job as her agent?

My sister has been spending the nights with Mom and I am there during the day. Her doctor comes to see her early in the morning before I arrive, therefore my sister is the person who spoke to her doctor, however she has failed to share any information about the tests or echo cardiogram nor did she tell us the complete facts on the conversation regarding the Directive or the doctor charting DNR in her medical records.

I know she and my mother are at odds many times and she would like to obtain her inheritance but I would hate to think this has become a power struggle or she would purposely do anything to cause or allow my mother's demise by withholding treatment. Mom has moderate dementia and still lives in her home with our help and I am her caregiver, she is 85 years of age.

How should I approach this from all angles, sister, doctor, hospital?

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Thank you all so much for your replies. I have decided to write a letter to the doctor and include a copy of the Directive along with a letter stating that I am her Agent and that before anything in this Directive is implemented, I, Me and Me alone, must be contacted and I will give the okay if this is what I feel is in her best interest. I am also going to contact the hospital and find out who is in charge of Healthcare Directives and after asking numerous questions, I will file a copy of the letter with them as well.

And to answer you questions about alternates on these forms, yes, both of my sisters are listed as alternates to me, only if I cannot act or chose not to act as the primary agent. My older sister is the one who had the doctor institute the DNR on Mom. She has been angry and upset that Mom did not choose her as the oldest child to perform this duty. But I do not blame Mom, Sister has told her loud and clear that she will be glad when she is gone, she will have hit the lottery and will take her inheritance and leave! Mom should have written her out of the Trust after that remark! I honestly think sister has a mental problem brewing as well, even she believes she has the beginning of Dementia or Alzheimer's. I just thought she was nuts and mean. She is a micro manager who tells everyone what to do all the time. The male RN in the hospital with my Mom, tracked down my younger sister and I and told us that my older sister and mother do not get along, there is a lot of fighting between them because Mom does not like older sister always telling her what to do. He said, "It is different when you come, she is calm and listens to you, but not other sister." He said he thought he might have to ask older sister to leave because she was upsetting his patient, my Mom.

This has been an ongoing problem my entire life, it is called sibling rivalry and she has never gotten over the fact that I was born. True fact. So, I am not worried about hurting her feelings, she tried to have me arrested and thrown in jail for abusing HER not Mom but her. She filed a completely false report with APS telling them I had beat her. Younger sisters daughter was there the entire time and was my only witness that what she had stated was completely false! A total lie. This is what frightens me that if she would do this to me, she would have no qualms about lying to doctor. None.
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It seems to me that your Mom's doctor may have violated the HIIPPA privacy laws by discussing your Mom's medical information with your sister. They should have contacted you and filled you in on the situation. I am pretty sure that as the MPOA, and DPOA, you are the only one authorized to receive/obtain or make decisions about her care when she is unable to do so. It might be a good idea to have a chat with your Mom's attorney about the specific procedures that should have been followed in the case you described. For sure, if I were in your place, I would write a letter, signed as the MPOA/DPOA, that you and no one else should be consulted on all future medical information or legal decisions concerning your Mom. Don't give a thought to offending the doctor - they deal with these issues every day-strictly business protocol. I would send the letter to the doctor and to the hospital for them to keep on file. I think they must have some sort of flagging mechanism in their computer system highlighting that you are the only authorized point of contact. What you care to share with your sister is your business, not anyone elses. By the same token, your sister needs to understand that she cannot speak for you or your Mom in your absence, and you must be contacted and given full disclosure by her and/or medical personnel concerning your Mom's condition and treatment. It's a tough spot to be in, as you don't want to cause hard feelings with your sister. You may want to assure her that you value her opinion and are willing to include her in any discussions, but the ultimate decision is legally yours. By chance do either of the POA documents mention an alternate POA if you (the first POA) cannot act or refuses to act in your appointed capacity?
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Best guess is hospital went with sister because they either read the POA papers and thought she was you, or didn't read anything and assumed sister was legitimately calling the shots! It sounds like things could get hostile with sis real fast, and if there is any way to talk to her and explain you think mom has a quality of life and should not only be treated fully but also resuscitated in the event of cardiac arrest. You do have the right to ask for that, to keep Mom a "full code" if you think that's best.

It probably does make sense to go to the patient family representative at the hospital with copies of the POA and find out what went wrong and get it sorted out for the future. They should explain and go over all the options for the advance directive that should be in place for Mom so she gets the care you want her to get, but not anything you don't want for her because you think she wild not want it for herself. It's a big responsibility, sometimes hard to make the decisions and then live with them, believe me I know. Mom was ready for DNR way before I was....I did things the way I knew she wanted though. Hugs.
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Have just experienced this in our family. So I can identify with what you are going through.

First, if your mother was taken by ambulance to the hospital, they are required to do everything they can in the ambulance to keep her alive. That is unless you have an Out of Hospital DNR in addition to a regular DNR in a Medical Directive. Then the EMTs would not perform lifesaving maneuvers that might leave him/her in a worse physical condition. Nature would take its course.

Medical Directives can vary in interpretation by the persons reading them. It is good to be specific in them. My understanding from speaking with my daughter, who is a doctor, Medical Directives do not prevent the patient from receiving medicines, such as antibiotics for an infection. The directives are for circumstances where the "cure" would cause harm to the patient and reduce the patient's quality of life. For example, to resuscitate an elderly patient would certainly break the patient's ribs, a very painful procedure. Recovery is much longer because physically the elderly take much longer to heal. If the doctor places a tube down the throat, the elderly can develop pneumonia or the reflexive valve between the throat/lungs may cease functioning properly. Consequently, food could go down into the lungs, causing an infection and a probable death.

While all of us want to take care of our parents in the best way we can and follow their wishes, until you have a doctor speaking with you on the phone (like I did) about acting on a DNR, it doesn't hit you that you have their life in your hands.

Luckily, my father didn't die then. He died 6 months later on May 25, 2013. He had dementia and basically gave up. He was 90 and ready to go. But I learned a lot about DNRs and Out of Hospital DNRs.

As far as your Medical POA, do your siblings have copies? Is there a back up POA to you? I made sure that all doctors and family members had copies. It is also good to have a set at her house that can be taken with her if she has to return to the hospital. In emergencies, most hospitals are trusting of whomever accompanies the patient. Yes, family members overstep their boundaries, but doctors also must err on the side of caution. As far as a lawsuit, my brother tried this one but in reality that is very costly to you and your mother's estate, not to mention the emotional toll on everyone.

I say this from experience, too. My brothers went behind my back and had me removed as my mother's DPOA after my father's death and reduced my role in her medical decisions. My mother inherited 100% from my father. This just happened two weeks ago. My mother has been diagnosed with dementia. So I would be in control and they wouldn't. I don't believe they disclosed to the new attorney mother's diagnosis. What they did was fraudulent. I am too drained to fight them, emotionally and financially. I had been taking care of everything! She lives in an AL facility. To their surprise, I just informed them they are in charge of everything - bills, dr visits, dr bills, social security, pensions, income taxes, her house and its upkeep...everything! I will still visit my mother but I must, like many others have said, take care of myself, my family, and my financial future. It was an incredibly hard decision to make but I had to. I also told them not to contact me or my family. It was/is a very toxic situation.

I am the youngest in my family. My older siblings did not like that I had control. It wasn't about my mother's care, or the money, but about the fact that my mother picked me, not them, to look after her. I hope your relationship with your older sibling doesn't go "south" like mine. In situations like these, it is amazing what comes out in people! Good luck to you.
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From my understanding the DNR question is asked each time the patient enters the hospital; at least that has been our experience.

You and sister need to sit down and have a conversation about the care of your Mother. Obviously, your sister is involved no matter the hard feelings. If needed have a minister, friend, lawyer whoever present to mediate and get both of you on the same page. It shouldn't matter who has a piece of paper, you should both have the same goal in taking care of your Mother. Quite frankly, that piece of paper is about as valuable as the cost of the individual sheets of paper.

As long as the doctor feels your Mother is capable of making the decision, her wishes will be honored.

Best wishes. Count your blessings you only have one sister to deal with!
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geewiz: Yes it does say that she does not want to be resuscitated BUT prior to saying that it says this.... "If I should have an incurable injury, disease or illness certified by two physicians to be a terminal condition, and if the application of life-sustaining procedures would serve only to artificially prolong the moment of my death, and if my treating physician determines that my death is imminent, whether or not life-sustaining procedures are utilized, then i desire that all life-sustaining treatment be withheld or removed."

It also states "If I become incapable of making informed health care decisions, I hereby grant to my agent (ME) full power and authority to consent, refuse consent or withdraw consent to any type of health care procedure (including any procedure to maintain, diagnose or treat any physical or mental condition), or to make any other health care decision to the same extent that I could if i had capacity to do so. Before acting, my agent shall attempt to communicate with me regarding my desires unless such attempt would be futile. If my desires are unknown, then my agent should decide for me, having my best interests in mind.

There is so much written in here that states that I, ME, HER AGENT is to decide for her what to do or when to put her wishes to work. She was having heart arrhythmia, Dear God it isn't like she is brain dead or in an irreversible coma!

I do not want to get in an argument with her doctor because he is a good doctor I just do not understand how this could happen. On my siblings part I believe I do see what went on, but how could he do this without consulting ME, the AGENT? He evidently does not understand that there are reasons WHY certain people are given positions as POA or AGENT and others are not.

I realize they are very busy as doctors but failure to do what they are suppose to do, can and probably does lead to death for some people unnecessarily....not to mention a possible lawsuit!?!

You are right about being in the room when the doctor shows up, I was there during the day and my sister the night, however he came very early in the morning on the day this happened. The following day I made sure I was there early and he never came, another doctor showed up to release her.

Do I need to contact someone in the hospital to make sure they understand MY wishes for Mom or that they at least speak to ME DIRECTLY to find out my wishes for her? I do not want them putting that Directive in their files and just writing on it DNR so the next time she goes into emergency they do nothing because their records show that notation.
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Raven, my observation? This happens all the time in hospitals. The physician deals with whomever is present when he/she visits. You want a say? Be there when the doctor comes. Alternatively, you can meet with the social worker upon admission to state the issue and work out a solution. Have your papers ready and ID and when you visit, accompany upon admission or whatever, bring your packet of papers. Doctors don't have time to figure out family dynamics, you have to assert your role.
But, let me ask a question? Does your Mom's health care proxy state that she does not want to be resuscitated? Perhaps that is why the DNR was instituted, b/c it was your Mom's written request.
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I would file a formal complaint with the hospital (they likely have a department that deals with these sorts of things) and a complaint with the state agency that regulates that hospital. What they did--ignoring your agency, is very wrong.
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you copy her directive and give it to doc with a request she not be a DNR. If mom has been declared incompetent, then do it.
on a totally other topic, WHY would you want someone of advanced age to linger and suffer unless mom has said take heroic measures. Is it just to keep sis out the $? My dad doesn't want another pill much less life saving or prolonging treatment....just comfort care only in that type of crisis(pain med ect)
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My mother has dementia and cannot remember what was said to her 10 minutes ago. The Directive says that I became her agent for her the minute she signed the form. That form gave me the right to make the decisions for her because she was unable to make a sound judgement call now, not at the time she signed it.

I was under the impression when I was made the Agent for her that what was written on the form is what would actually happen, I was to be spoken to and I would make the call on is she too far gone to try to save or is she still in good enough health and yes, try to save her.

I feel like my mother was in good enough health to work with her and save her which, Thank God is what happened, however when I got cryptic messages from my sister who never actually flat out told me that she had spoken to the doctor and they had decided to put down DNR in her medical record, it mad me angry.

I am not the oldest child but I was given the DPOA for Mom and I am her Agent in the Health care Directive, sibling is ticked about this fact, she is awaiting her inheritance....need I say more?

I do not know if she passed herself off as me or if the doctor did not especially care or what, but it ticks me off that he would take it upon himself to write DNR in her medical chart without consulting me. Mom still works in the garden and takes care of her own personal needs and walks her dog with me, if anything would have happened and they had not stepped in I would be irate!!!!!!!! What should I do from here?
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If the Dr thinks your Mom is of sound mind then your Mom said YES to DNR...

Every time she enters hospital they will speak with her if she is coherent and ask her what her wishes are..If they have a DNR on record and she goes in hospital and she can,t answer THEN they will consult you about directive... People change their minds!

You know her wishes and if she is unable to answer for herself then you make decision for her.
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