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Hi and welcome to JA. My name is Ray and I am the expert that will be assisting you today.
I agree with you here that you have the legal powers as her health care surrogate to make such decisions.The way to prevent this again is to present this to her doctor and have them copy it for their records.They would then be obligated to follow your wishes.You have a problem with the caretaker here about who makes medical decisions for your mother.A caretaker should notify you when there are such decisions to be made.Here you dealt with this in advance and she ignored you.
Honestly you have to resolve this to avoid future problems.It is your judgment after talking with her about whether to keep her employed or consider a different one.This is basically intentional subordination on her part to ignore you.I cannot blame the doctor until you put the health care surrogate document on file with him.At that point if he ignores you you have a medical board complaint and he has liability.
Dee I am so sorry that you had to have this happen.You did the proper thing here, your caregiver should have involved you in this matter.Certainly you advised her of your medical decision acting as her surrogate.You have to resolve this with the caregiver.You may decide to put her on notice that if she violates your instructions again you would have to consider terminating her services.
I know good caretakers are hard to find so some delicacy is required but you have valid reason to be frustrated and angry and take steps to make sure this doesn't happen again.I can only imagine how you would feel if something bad happened to your mother.