I have the DPOA for my sister. What recourse do we have other than remove her to another facility?

Let him know he can make suggestions BUT decisions MUST be cleared by you first, as you are your sister's DPOA. If he doesn't like that, too bad. You know best if your sister's on a medication that is not serving her. If the psychiatric nurse continues to push back disrespectfully with you, it's time to move your sister out and explain to management your concerns and that you were pushed into this option.

Sounds like NPs must not have to take a bedside manner class. This guy is completely out of line.

Go over his head, make it real clear to the supervising doctor and the administrator in charge that the NP has a people problem and request that he not see your sister any longer.

You state that the psychiatric nurse practitioner prescribed a drug for your sister which is not FDA approved. But specifically, it isn't approved for use with "in older adults with dementia-related psychosis."

That isn't the basis of your complaint. There may be a sound rationale for the prescription of a drug which is not contraindicated by age or vascular dementia alone. The point is that we will never know, because the practitioner did not see fit to explain the rationale but instead became antagonistic.

Of course, we also can't know if the practitioner was actually able to get a word in edgeways before s/he became antagonistic. But that's for you to reflect on.

The basis of your complaint is that the practitioner refused to explain the prescription to you, the medical decision-maker for your sister, whose informed consent is required to her taking medication. If you want to take the matter further, you contact these people:

https://www.ncbon.com/discipline-compliance-public-complaint

Meanwhile, you have to decide whether the risks involved in taking the drug outweigh the intended benefits. Assuming you're not willing to rely on the facility's staff for help with this, is there anyone else you can consult?

Yes Drs and Nurses do not like it when we disagree with them... My doctor doesn't but I do. I have refused medication and that is just too bad. If you can move her. Ask for a social worker to assist you in this. My daddy was in a large facility, covid hit and I was not allowed to see him. (which I was doing 3x's a day) during that first month and a half he cut his big toe and it festered to the point that it had to be amputated. Yes he had diabetes and I had always been there to help him to bed and when I did I checked his feet daily. Well after his toe was amputated (remember covid happening at this time) that facility would not accept him back because they would have to allow the wound specialist to come in and out and they did not want that. It came to the point that I had to put him in a group home! That turned out to be the best thing ever! Even during covid I could visit my daddy 3x's a day because each room had a separate entrance and I just needed to be 6 feet from him. OH that was great! They treated him like family and I treated them like family. So that might be the avenue you may need to take. prayers for you and yours!

Despite the answers posted you may have no recourse other than a move. Here’s why. Certainly you can seek out a better medical practitioner, but the treatment - disrespect in addition to harmful prescription- coming from the facility’s nurse practitioner could be a reflection of problematic underlying attitudes and practices. We moved my mother shortly after admission to an AL when a relatively small problem couldn’t be resolved due to a complicated hierarchy in the facility.

Careforcarol1: Find a medical doctor in lieu of a nurse practitioner.

Get another doctor asap. Any doctor that exhibits the anger and reaction to family questions that you describe, should be reported to medical board.
If this doctor is a staff doctor at the facility where she is presently, report your experience and questions to the facility administrator or whoever the " top dog/ buck stops with me" person in charge is.
If this is a personal physician who is not a part of the facility treating her , still report your concerns to the facility and, arrange for a new physician to assess her. There could be any number of issues contributing to her decline and behaviors.

Or, insist that she be transported to a hospital ER for symptoms observed and, have her assessed by staff at ER, possibly admitted for more observation, assessment and, share your concerns with the hospital staff. Then go from there regarding placement when she is ready to be discharged.

You say the issue is a nurse practitioner, not an actual doctor, yes? Is there anyway to go over his/her head and get a medical opinion from an actual psychiatric doctor?

If your POA also mentions health and mental decisions then you have the right to refuse the drug. The doctor has to listen to you or escalate the matter. This happened to my mom, when I found out they prescribed her some pain medication instead of trying to treat her UTI that developed hemorrhoids. Took mom immediately out of the facility.

I heard recently that 50% of doctors do not accept any challenge to their treatment or prescription choices. Outside a facility, doctors may dismiss a patient who does not comply. Would you know if the doctor at another facility would be more responsive? Maybe the Hospice idea is a way to bypass this inflexible doctor.

I am so sorry this is so unfair I understand and I’ve been through this.. if it’s a private facility, unfortunately there may only be one doctor used Buy that facility..however, you can always see if hospice will take her on as a patient. hospice always overrides the doctors one had prior. With Hospice, YOU have a voice. I only use HOV Hospice. if you do not wish to move her or think that the move may be too hard on her and if she improves, she can go off of Hospice.
It is sickening that drugs that were once used for paranoid. Schizophrenic’s in acute psychosis are now being called mood stabilizers and they use them so heavily in facilities for our loved ones now. Make sure she is checked for UTI before all of this. You can buy your own at Walgreens since I Do not trust that doctor.. He may very well know that checking for a UTI is questioning his choices to put her on this terrible drug. It really sounds like she could have one which she should’ve checked for..best of luck to your family &
loved one

Refuse the medication a find another doctor. You have Rights.

We had a similar doctor at my father's NH. He accused us of micro-managing him. Ask for a copy of the MAR (Medication Administration Record) to see what else your sister may be getting that is not in her best interest. Do your research, be sure you are using websites of the manufacturers of drugs in question, or other respected websites such as Mayo, NIH, Medical Universities, etc. Do not quote anything on wikipedia or other non-medical websites. Especially since she is new, ask for weekly copies of her record (if there is a charge, at least to sit down and review them) which will include the MAR and look for red flags. When we did this (unfortunately too late) we found notes where the doctor said he was prescribing Prozac and was sure the family would not like it! We also found there was a document saying our father was not competent to make his own medical decisions, signed by this doctor and another doctor as required in our state. (Again, we found this too late.) Without knowing this document was in his file, we constantly were telling nurses we did not want him to have certain meds creating tension with the staff because they had to follow doctors orders. They obviously weren't even aware of the document because we were told our father had to refuse them! So we would have to tell our father to tell them he did not want them and if we weren't there he got them. One was a huge red pill (over the counter) that was hard to swallow that was suppose to slow down his cancer... yet it was on record he had requested stopping all cancer treatment... age 90). My father too was over medicated with the Prozac on top of Haliperidol along with others. Once we demanded they stop those drugs he miraculously became much more alert and functioning! We wish we would have removed him to another facility but of course you never know if it will be an improvement. I hope you or another family member are able to be there often to observe the care she receives.

As someone else has said, you should have the right to take your sister for appointments outside of the facility. This may depend on her insurance program.

FYI, in our state a DPOA (Durable Power of Attorney) is only for financial issues. A Health Care Power of Attorney is required to make health care decisions.

I have not had good experience with the AL np but I did have good experience with the doctor at AL. I would switch or take your mom to a private psychiatrist and get the medications straight and the AL will use what you bring in. However, this NP is going to be a problem. We ended up changing docs and writing a written complaint of facts to the provider.

He isn’t a Doctor he is a nurse practitioner - Big difference - most of these nursing homes and assisted living don’t have regular Doctors . I would definitely report his behavior and take her off this drug . And If you don’t get anywhere remove her . A lot of times one Doctor will cover 20 nursing homes .

Is this Moms private NP or supplied by the facility.

Sorry, I know that a NP can prescribe meds, but I would go over this persons head. There has to be a doctor who oversees a NP. The NP either works for a doctor or if allowed to have a private practise in ur state have a doctor they answer to. Find out who this NP answers to and talk to them.

It's a mood stabiliser isn't it? Also to reduce hallucinations?

Of course you have the right to ask questions & report differences - you know your sister best!

I am wondering if there can be a 'family meeting' set up? Kind of like they do in rehab, where OT, PT & Doctor give their opinions for a more wholistic approach to the care plan.

This could involve the Facility Manager or Nurse in Charge, that Doctor & yourself & sister. Discuss how she is settling in, what is going right, what is not going so right. A wider view. I dunno... maybe this could help get everyone (inc Dr Ego) onto the same page??

It can be a balancing act... reducing hallucinations is a good aim but if the meds cause more or cause falls ir other negative effects, then another approach is required.

* Do no harm *

That's the aim afterall: a care plan that is best for your sister.

Wishing you success.

I would be interested to learn how this doctor threatened you.
I am also wondering did your sister exhibit reasons to prescribe an antipsychotic? You mention that she has anxiety. I think it is a giant leap from anxiety to psychosis.

Each facility should have posted the number for the State Ombudsman. I think a call to that office might help.

If you do not want to change facilities maybe a change her doctor. Does she have to be seen by the one that saw her initially?