Author Question: Medical Power of Attorney

Stacy Asks:

Is it possible for a father to grant a Medical Power of Attorney to another person for the general health care of their child? In my WIP, I’m dealing with an emotionally abusive father who isn’t particularly concerned with the health and well-being of his minor daughter (the mother is dead.) I wondered if her best friend’s parents might convince him to give them a MPOA (or whatever the abbreviation is) so they could take her to the doc when she is sick, etc.

Later in the story he turns physically abusive and she ends up in the hospital and will need treatment — he’ll be at home passed out from alcohol and won’t be able to grant it, so … would the friend’s parents be able to grant that? Would they even need the MPOA? How would she be treated if there was no responsible adult available?

Oh, and this takes place in 1999, not today.

Jordyn Says:

Interesting question.

Yes, the father can grant medical power of attorney to whomever he wants.

But… if there is not paperwork what happens when the child presents for medical care?

If the child presents with a life threatening situation– we will begin treatment regardless of ability to obtain consent.

If no life threatening situations exist the hospital is required under EMTALA to provide what’s called a Medical Screening Exam (MSE) to determine if the patient is having an emergency or not. If the patient is not having an emergency, the emergency department can opt out of treatment. However, in this case we could do the MSE and then try and contact next of kin for consent. Hospital policies generally dictate who can give consent in cases like this.

However, if there is concern for abuse– we will sign the patient in and get social work involved and follow their direction. We would likely treat this patient under those conditions.

EMTALA and the Writer

What is EMTALA and why should I, as an author (and maybe a healthcare consumer), care about it? EMTALA, like HIPAA, sounds like a foreign language but has large ramifications for healthcare providers. Here’s a series I did on HIPAA and how it is often dealt with poorly in fiction writing.

1. http://jordynredwood.blogspot.com/2011/12/author-beware-law-hipaa-part-13.html
2. http://jordynredwood.blogspot.com/2011/12/author-beware-law-hipaa-part-23.html
3. http://jordynredwood.blogspot.com/2011/12/author-beware-law-hipaa-33.html

EMTALA stands for the Emergency Medical Treatment and Active Labor Act. It was passed in 1986 as part of the Omnibus legislation and is sometimes referred to as COBRA. COBRA is the legislation that dictates how you’re covered by medical insurance when you change jobs.

The reason behind EMTALA was to prevent patients (those covered by Medicare, Medicaid, or without insurance) from being “dumped” to other institutions because of poor reimbursement or no reimbursement on part of the patient.

When refusing care (problem #1), the patients condition can deteriorate while they’re trying to get to another hospital. This is overall, of course, bad.

This only applies to those hospitals that receive Medicare and/or Medicaid funding which is virtually all US hospitals. If a hospital is found to have an EMTALA violation– heavy fines can be imposed and hospitals can lose their government funding. If that were to happen, the hospital would likely have to close its doors.

Dr. Tanya Goodwin covered how this relates to a patient in active labor in this post.

I thought I’d talk a little about how it relates to the emergency department.

Any patient that presents to the ER must be given a “medical screening exam”. This will vary from state to state on who can provide these exams. Some may require a physician while others may be okay having an RN complete it. This is dictated by that state’s scope of practice. Here are a few previous posts that deal with scope of practice issues:

1. http://jordynredwood.blogspot.com/2011/09/perinatal-providers-scopes-of-practice.html
2. http://jordynredwood.blogspot.com/2011/08/author-beware-wrong-medical-procedure.html

If the patient does not have an emergency, the hospital can “screen” that patient out to another facility, urgent care, or their doctor’s office to be seen later.

Let’s look at a real life example. I work in a pediatric ER. We generally treat patients up to age 21. After that– they need to transition to adult care.

So, let’s say I’m in triage and a 65 y/o male presents to the ER for treatment of an uninfected ingrown toe nail. Based on our treatment guidelines– being a pediatric facility– the on-duty physician can either treat or “medically screen” the patient out because though an ingrown toe nail may be painful– it is not a medical emergency.

Now, can you do this in your manuscript? A physician is fed up with a patient and kicks him out of the ER. Is that an EMTALA violation? Did he provide an exam? Was the patient having an emergency?

As a result of this law– generally a patient who collapses (maybe a patient suffering a gun shot wound is “dropped off” at the hospital) on hospital property needs to be given care. There have been instances of this on the news where someone collapsed and based on their position in relation to hospital property– care was or was not provided. EMTALA dictates the hospital’s response in these circumstances.

For more on EMTALA– you can read here.
http://www.emtala.com/faq.htm

Have you ever dealt with an EMTALA issue in your manuscript?