Thursday, March 24, 2005
Time to plan for medical emergencies is now

By Dr. Anthony Policastro
Nanticoke Memorial Hospital

Some medical events are predictable. Many are not. That is the main reason that people have medical insurance. If people could predict exactly how much they would spend each year on medical care, they would not necessarily need medical insurance. For that reason, most people carry health insurance. Many of those who do not have insurance would like to have it. However, they are not necessarily in a situation that allows them to get it. There is another type of insurance that is a good idea to help with unexpected medical problems. That comes in the form of legal documents. Because medical events are unpredictable, we should make advance preparations. There are several examples of this. The first is related to our children. There are times when parents go on a trip and do not take the children with them. The children are left with the grandparents or other relatives. In these situations, there should be a medical power of attorney prepared to give permission for the children to get medical care. Without such permission, any illness or injury will require a phone call to the parents to get verbal permission for treatment. Emergencies will still get treated while waiting for that permission. However, things that are not life and death emergencies will require a call to the parents. The medical power of attorney in these situations is not a complex thing to do. Every parent should get a blank form. They can then make copies of the blank form. That will allow them to fill it in specifically for each occasion. The time frame for the permission can be specifically listed on the form. While this is a little inconvenient, it is often easier than the inconveniences of trying to track the parents down after an illness or injury. The second type of document is a durable power of attorney. This is a document that allows someone to make medical decisions for someone if they become incapacitated. Many people get financial powers of attorney when they get older. This allows their relatives to help them with financial matters. However, a special clause is needed to allow assistance with medical decisions. For example, if someone gets into an accident and is unconscious, they are incapacitated and cannot make medical decisions. If someone gets seriously ill, they may be too incapacitated to make decisions. In both of these situations it is a good idea to have a document that makes it clear as to who will make those medical decisions for them. When the people improve, they can make the decisions on their own again and the power of attorney is no longer in effect. It would only go into effect once more if they became incapacitated again.
Some people become permanently incapacitated. Alzheimer’s disease is a good example of this. It is important to have the power of attorney prepared ahead of time. It is a good idea to enlist the aid of a lawyer to draw up this kind of power of attorney. The third type of document is called an advance directive. This is related to decisions about end-of-life care. It involves things like withdrawing life support. This is a document that every one should have. It is different from a medical power of attorney. While it also only becomes effective when a person becomes incapacitated, there is an additional requirement. That requirement is that the person must have a qualifying condition. The two qualifying conditions in the state law are a terminal illness and what is called permanent unconsciousness. A terminal illness is one for which there is no expected cure. The patient is expected to die from it. Two physicians must state in the medical record that the patient has a terminal illness. Permanent unconsciousness refers to the person who goes into a coma with no chance of recovery. The coma must last at least four weeks. It must be declared as permanent unconsciousness in the medical record. That declaration needs to come from a neurologist and one other physician. Some patients have advanced directives that say that they do not want to be put on a breathing machine. If that person gets into a car accident, they could have reversible lung damage. They would need a breathing machine to get better. The family might say that the patient did not want a breathing machine. That would be correct. However, this would not be a terminal illness. The patient is expected to recover. Therefore, the advanced directive is not in effect. If a person does not have an advanced directive and has a terminal illness, the state law decides who the decision maker will be. It is possible that the individual would want someone else making the decisions for them. The only way this can happen is if there is an official advanced directive. The time to think about these things is now. If you wait until after the medical event happens, it could create major problems for you and your family.

Dr. Anthony Policastro is medical director at Nanticoke Memorial Hospital.