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Lawdoctor
Lawdoctor, Lawyer
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Experience:  22+ years legal practice including corporate, business, criminal, entertainment and litigation
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What is the violation of an RN seeking information from a Medical

Customer Question

What is the violation of an RN seeking information from a Medical Power of Attorney before consulting with the physician concerning the aggressive treatment the patient is receiving. The patient was of sound mind when her advanced directives where completed and stated she did not want agressive treatment. When the patient started to actively die and unable to speak for herself, contact with the Medical Power of Attorney was made before conculting with the physician.
Submitted: 2 years ago.
Category: Legal
Expert:  Lawdoctor replied 2 years ago.
Was there a DNR in place?
Customer: replied 2 years ago.

No DNR on file. Just the MPOA. Pt's code status was DNR with care and comfort.

Expert:  Lawdoctor replied 2 years ago.
One last question. Did the MPOA specifically address the issue of aggressive treatment? Also, did the physician order the aggressive treatment in spite of the MPOA directive? Was the patient advocate informed?

Thanks
Customer: replied 2 years ago.
Yes the MPOA did address the aggressive treatment issue. Yet the physician continued to order the IV nutrition and Palliative chemo. His progress read to continue care and comfort and IV nutrition. My critical thinking skills was to double check with the MPOA to see if there were changes in the current plan of care. The MPOA was not aware of any changes which told me the physician did not know about the changes to her plan of care. I wanted to find out what the MPOA said beford approaching the physician in order go have all my resources in place, since the physician is difficult to approach. I got in an extreme amount of trouble for doing this and have ask be find another position because I'm considered inefficienct, negligence, and incompetent to my job preformance and am inadequate to function independently as a nurse. I have been a nurse for 13 years.
Expert:  Lawdoctor replied 2 years ago.


Thank you for allowing me to assist you with your question.



Your question is very important to me, but please remember that I can only respond to the information you provide and I do not know your entire situation. My response is limited to what you have written to me and the answer may change with additional facts.



Also, due to site reasons, there are times I am initially only able to see a portion of post, so I apologize in advance if it means that you have to duplicate information.



There may be future facts that are as yet undetermined in your matter, that can and must leave some areas of information provided by me broad in nature. However, don't hesitate to ask for clarification if needed! At times, there can also be a delay of an hour or more in between my answers because I may be helping other customers or taking a break. Now, let’s address your question!

 

I am sorry you have been punished in this manner. The physician was acting in direct violation of the MPOA and was exposing the hospital to liablity. It may have been a better course of action to have approached your supervisor before addressing the MPOA, but I do not see a HIPAA violation since the MPOA holder stands in the place of the patient and thus it is not a violation of the patient's privacy.

 

Unless the hospital has a policy, I do not know if a nursing violation or skills violation in what you did. If the hospital has a policy as such, then you should be able to be shown the policy.

 

I would consider addressing this with the Supervisor of Nursing. It sounds like the doctor is heaving his weight around because you 'disrespected' him. If you explain as you did here, that you were making a clinical determination of the current status of the DNR via the MPOA, then your actions should have been with proper medical protocol and your termination is retaliatory. If this is the case, then you may have a cause of action as a whistle blower. I would think that the doctor issuing orders for the treatment could be construed as a attempt to run up the bill with the insurer or Medicare... If so there could be issues for him and the hospital if they are not careful. Medicare fraud is very serious.

 

If you feel that this may be the case, you will want to consult with an attorney near you who has experience in Whistle blower act and the possibly of a Quai Tam Act for Medicaid Fraud.

 

I wish you the best.

 

 





Please remember that we have not created an attorney-client relationship, and that my post is not intended to be specific legal advice. The answers given are limited to the information you have provided in your post. For specific legal advice, please consult with an attorney licensed in your state.



DISCLAIMER: Please understand that the complexities of most legal problems cannot be adequately addressed in this setting, and that I am only licensed to practice law in the states of Florida and Mississippi. Accordingly, you acknowledge (1) that we have not formed an attorney-client relationship, and (2) that my post is general information only and not specific legal advice.



 




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Please remember that we have not created an attorney-client relationship, and that my post is not intended to be specific legal advice. The answers given are limited to the information you have provided in your post. For specific legal advice, please consult with an attorney licensed in your state.

DISCLAIMER: Please understand that the complexities of most legal problems cannot be adequately addressed in this setting, and that I am only licensed to practice law in the states of Florida and Mississippi. Accordingly, you acknowledge (1) that we have not formed an attorney-client relationship, and (2) that my post is general information only and not specific legal advice.



Lawdoctor, Lawyer
Category: Legal
Satisfied Customers: 1400
Experience: 22+ years legal practice including corporate, business, criminal, entertainment and litigation
Lawdoctor and 3 other Legal Specialists are ready to help you
Customer: replied 2 years ago.
Thank you for your time. I believe this will help tremondously with protecting myself against loosing my job. This is the current threat I have been given and I have been unable to find any information in out employee handbook for the Texas Board of Nursing concerning this matter. I just looking for information to rebuttal the circumstances I have been charged with.
Expert:  Lawdoctor replied 2 years ago.
I understand and I cannot imagine the pressure you are under at this time. One thing I can recommend that may be of great help is to contact the BON if they have an ethics department and ask for an opinion on the matter if you can do so anonymous. If it is a favorable opinion, then you will want it in writing.

Also, I did not see a HIPAA violation at all since the MPOA was in charge if the patient was not cognizant of her surroundings. The doctor may defend that you are not qualified to make that decision, but common sense is common sense.

You were merely confirming the status of the MPOA and frankly, that is your job. Think about it, who asks the patient or patients family if there is a MPOA or other directives? The nurses or the admissions staff...hello! You were following up. It seems that this doctor has gotten his or her knickers in a knot because of his or her own insecurities because they were violating the patients directives and knew it. They are pointing the finger at you to misdirect the attention to you while the doctor walks away scott free from ordering treatment that the patient emphatically rejected.

This is the point you need to bring out! I wish you the best. Stay cool, calm and collected and let this doctor go ballistic, it will just prove his or her guilt!

Good luck!





Please remember that we have not created an attorney-client relationship, and that my post is not intended to be specific legal advice. The answers given are limited to the information you have provided in your post. For specific legal advice, please consult with an attorney licensed in your state.



DISCLAIMER: Please understand that the complexities of most legal problems cannot be adequately addressed in this setting, and that I am only licensed to practice law in the states of Florida and Mississippi. Accordingly, you acknowledge (1) that we have not formed an attorney-client relationship, and (2) that my post is general information only and not specific legal advice.



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