Bring a Phone Charger to the Hospital: A Lawyer and Nurse Practitioner Discuss COVID-19
A week into the pandemic I decided to provide a new legal service for my clients: a last will and testament package, including a medical power of attorney and advance directives. At first blush, this may sound dark. However, I’ve always been interested in this type of law. And working from home gave me the time to learn something new.
I did the first batch of documents for my friends (who are mostly in their mid to late 40s). None of them had wills or advance directives yet. As I answered their questions, I grew curious about how the medical documents were being used in hospitals and what I can do to make them better. Luckily, I knew who to ask: my sister-in-law, Lexa Rijos, a Hospitalist Nurse Practitioner in San Antonio. She has been handling COVID-19 cases everyday.
Lexa’s job is to obtain a patient’s medical history and establish the medical plan of care. She is the first person a patient sees after finishing up in the ER. Her immediate task is to gather information, which is not always easy when the patient is elderly and/or already under distress from COVID-19.
I called Lexa and asked her about the legal documents I’ve been creating.
Are they valuable?
Lexa: Absolutely. The most important documents for us are the advance directive and medical power of attorney. These will also include the necessary contact information that we need.
The advance directive (also commonly known as a living will, physician’s directive, or DNR) lets the doctor know whether to put you on life support if you have a terminal or irreversible condition. A medical power of attorney designates who you would like to make medical decisions for you if you become unable to make them for yourself. These forms can be found online for free. While I recommend that you get an attorney to help you, it is not necessary. They can be completed without legal help. For example, here are the advance directive documents for Texas. With a little googling, you should be able to find them for every state.
How often do patients have these documents available?
Lexa: Not very often. Usually they have no documents. I just ask the patient if they want to be resuscitated and placed on life support then put the order in their medical chart. That is… if they are able to communicate and in a lucid state of mind.
Unfortunately, there are scenarios where the patient and family’s wishes conflict. Maybe the patient verbally told us not to resuscitate, but after the patient is incapacitated, the family contradicts that instruction. Without a written advance directive, the hospital is going to follow the family’s wishes.
Without a medical power of attorney, Texas law presumes the spouse should make decisions, then after that, the adult children. The problem is that the medical staff would much rather be providing medical care than trying to figure out who has the legal authority to make decisions.
It is estimated that more than half of American adults do not have a will or advance directives. This is unfortunate because it is not hard to create these documents. In general, you only need to answer two questions: Who do you want to get your stuff when you pass? And who are the three people you trust the most (in order)? Most will/estate attorneys can create these documents very quickly (or you can find templates online). There are some situations when a notary may be required. But there are now options to get the documents notarized virtually. In other words, do not be intimidated. You can do them now.
Is there also a problem getting contact info for the patient’s family?
Lexa: Occasionally. Sometimes the phone numbers are entered wrong into the chart because of clerical mistakes or sometimes not entered at all. Frequently patients are under stress and can’t remember a phone number. Sometimes they are having difficulty breathing, then take a serious downturn and are unable to communicate. Having a list of three family members and their phone numbers is important.
The advance directives and medical power of attorney will both have contact information for family and friends that you designate as agents. Another document that is extremely valuable in this situation is a HIPAA release. This document gives permission for the doctor to release medical information to designated people. This may be important if family members need to accomplish tasks for the patient (usually through a statutory power of attorney) while they are incapacitated; such as paying rent, etc.
So what is the ideal situation?
Lexa: Hopefully, the patient has all of the documents in a folder with them when they arrive at the ER. However, the family can deliver these documents at any time.
Do the documents need to be the originals?
Lexa: No. A printed copy of the documents is fine.
As we spoke about the legal documents, Lexa kept mentioning other items that patients should bring to the hospital. The most unexpected item she suggested was a phone charger.
The patients should bring phone chargers to the hospital?
Lexa: Yes. Patients rarely think to bring their charger. Unfortunately, this disease moves so fast that people don’t realize they could be staying at the hospital for weeks.
Cellphones are even more important now because families aren’t allowed into the hospital. The only information the families get is from the doctors and nurses via phone. But the nurses get crazy busy and often can’t even answer the nurse’s station phone. So families are left without many updates. Ideally, when able, the patient is encouraged to communicate with their family. We recommend unlocking the phone too. We once had a patient that was so winded he couldn’t talk to communicate the pass code for his phone nor unlock it himself because he was too weak to enter the key strokes.
Do families sometimes wait outside in the hospital parking lot for information?
Lexa: Yes, but that isn’t advisable. We don’t have the time to go out to talk with them. And with all the PPE we are wearing, it feels like 120 degrees. Talking on the phone is really the only option.
What about Zoom?
Lexa: Most of my patients are elderly and don’t know how to use it. Or they have flip phones. Whenever able, and if we are not drowning in work, we will show them how to Zoom. So, yes, it would be nice if that app was already downloaded on their phone.
Anything else that would be helpful?
Lexa: Have a current list of medications that the patient takes. Even better, bring the medication bottles to the hospital (in a small cooler bag if necessary) so we can inspect the bottle and obtain all the necessary information. Also provide the name of the pharmacy in case the nurses have questions. This helps us to know where to send their prescriptions after they discharge.
What should the family do if their loved one doesn’t have everything they need at the hospital?
Lexa: Put everything into a bag with the patient’s name on the outside. Include paper documentation of the names & phone numbers of their spouse and/or family members inside the bag. If the family delivers the bag to the ER or the hospital’s information desk, a staff member will come get it and bring it to the patient.
Before we ended the phone call I knew I was going to write it all down. This is a horrible time for the world and it is impossible to comprehend the pain that families are experiencing. Lexa, and medical professionals everywhere have risen to a challenge that most of us can’t even imagine. I am humbled to hear her describe what she does. And I’m distressed that she will most likely be doing it for a long time.
As far as the legal documents, it is not difficult to find them online. An attorney will certainly make it easier and improve the chances that they are filled out correctly, but you can do it on your own. At the minimum, do the advance directives and medical power of attorney for all of your loved ones.
