Sunday, September 18, 2016

Health Care Representation Agreement

This from the Health Professions Review Board:

2016-HPA-024(a); 2016-HPA-025(a); 2016-HPA-026(a); 2016-HPA-027(a) re: The College of Physicians and Surgeons of British Columbia(Group File No. 2016-HPA-G03)
Stage 1 hearing of an application for review of an Inquiry Committee disposition under s.50.6 HPA - Inquiry Committee disposition confirmed. The complaint to the College alleged that four Registrants ignored the Complainant’s designated health care representation agreement concerning his mother and that she was over-medicated with narcotics without proper consent. The mother subsequently passed away from numerous untreatable medical conditions. The original complaint concerned the actions of Registrant 1 and after the mother passed away was expanded to include the actions of three additional Registrants. The Inquiry Committee conducted a thorough investigation that provided key information. The investigation revealed the mother was experiencing significant severe pain on a constant basis and that treating health care staff were very distressed by her continued painful condition and the Complainant’s restriction on the use of pain analgesics through his enforcement of the health care representation agreement. Concerned that they were not acting in the mother’s best interests, on behalf of the mother, Registrant 1 removed the Complainant from the medical decision making role and began prescribing analgesics to alleviate her pain. In a disposition that is detailed, transparent, intelligible and justified the Inquiry Committee had no criticism of the Registrants’ actions. The investigation was deemed thorough and adequate. The disposition is detailed, transparent, intelligible and defensible with respect to the law and facts.
June 6, 2016 (Posted July 4, 2016)

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copy to Andrew Macfarlane, VCH. I have been asking you why I was stripped of my representation agreement and power of attorney and you have arrogantly refused to tell me.  Am I to assume from your decision that you can do this without due process. What was your legal justification.  In Randy's Representation Agreement he said that he did not want a DNR and yet VGH put a DNR on him.

According to the following, you are going to have to do some serious explaining.  From this HPA- 024 it would suggest that a representation agreement (the voice of the patient) can be overruled by a possee of doctors after the fact.  One of the reasons for refusal of drugs is that some patients do not want to take drugs as drugs dull their senses.

In Carter on page 66
[212] The Court concluded that provisions of the Ontario Mental Health Act, R.S.O. 1980, c. 262, granting a physician the authority to override the competent wishes of a patient where deemed to be in the patient's best interests, unjustifiably infringed the security of the person guarantee in s. 7 of the Charter. 

How was the complainant removed from the decision-making process in HPA-024.  By an invisible wave of the hand!

It is not what is in the best interest of the patient, it is what the patient wants.

What is the purpose of a representation agreement when doctors can overrule it at any time.   And it now seems that the BC high medical tribunal can also overrule the Charter. I think not.

On the flip side of this no mention was made whether or not the mother was competent to make medical decisions.  From what I understand, you can be incompetent to make financial decisions but you can still make medical decisions that can hasten your death. Am I mistaken in this belief.

In Carter on page 66
[212] The Court concluded that provisions of the Ontario Mental Health Act, R.S.O. 1980, c. 262, granting a physician the authority to override the competent wishes of a patient were deemed to be in the patient's best interests, unjustifiably infringed the security of the person guarantee in s. 7 of the Charter. 




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