7/14/08

If you don't know what a POA is, then you need to read this.

If you do and you haven’t designated one, then you really need to read this.

I’m going to tell you a little story to illustrate my point.

This story is true. It happened to me last week. I wish I could say that it was a rare event, but, unfortunately, I witness some variation of it on an almost weekly basis.


I was sitting at the nurses’ station last Monday night waiting for a call from the ER. I had already been alerted by the night shift supervisor that the next admission was mine and when I saw the caller ID flash “EMER” I picked up the phone on the first ring.

I leaned forward onto the desk and took notes as the ER nurse told me my patient’s story. Ms. X was a middle aged woman who was suffering from symptoms of end stage liver disease. She had uncontrolled internal bleeding and was slipping in and out of consciousness.

Her blood pressure was unstable. She had received IV fluids and blood transfusions, but these interventions were only marginally helpful and her overall prognosis was very poor.

I listened as she gave me further details and I asked a few questions of my own including, lastly, “How’s her family?”“She has no family…” she hesitated. “Well, she has a boyfriend.” “Oh goodness,” I sighed. “No POA? No anything like that?” “Nope. No anything like that.”

Fast forward about twenty minutes. I hear a familiar click and the double doors at the back entrance to the unit swing open. A nurse backs through holding a travel monitor in one hand and pulling a stretcher with the other. I stand up and move toward the room that I have prepared with everything I can imagine I might need. IV pumps, fluid, gauze, suction tubes and an assortment of other equipment line the tray on the opposite side of the bed. Ms. X’s boyfriend stands outside her new room, his hands shoved deeply into the pockets of his jeans. He rocks back and forth on his heels and looks on anxiously. As we begin to move her from the stretcher to the ICU bed I think about what I’m going to say to him, how I’m going to handle this.

That’s when I see the nursing supervisor appear. She takes his arm and leads him toward the waiting area. I feel sorry for him because I know all too well the conversation that is about to ensue and yet I am relieved and grateful that I am not the messenger. I cannot afford to have my attention divided right now. Despite our best efforts, over the course of the night Ms. X’s condition continues to deteriorate. We try giving her more IV fluids and medications to stop the bleeding and to support her blood pressure. Nothing seems to be working.

Meanwhile, through her discussion with the boyfriend, the supervisor is able to determine that Ms. X has an estranged daughter. They have not spoken in many years. The boyfriend does not know a phone number. He does not even know where she lives, but he does recall that she is married and that her husband serves in the Navy.

After several hours and even more phone calls, the supervisor is able to contact Ms. X’s son-in-law via the Red Cross. He is serving in Iraq. He gives us a number where we can reach his wife, Ms. X’s daughter. She lives in Arizona. We call her and relay the news of her mother’s condition.

She takes the first available flight and arrives at Ms. X’s bedside the next day. She is the next of kin. She has not spoken to her mother in over four years, but whatever issues kept them apart have not been forgotten or forgiven. She is angry.

She does not want Ms. X’s boyfriend to be allowed in her room and Federal laws (HIPAA) are on her side.

Two days later Ms. X dies alone.

My story is true and, unfortunately, it is all too common. I am sharing it with you because I cannot possibly emphasize enough the importance of designating a POA (Power of Attorney, sometimes called a “proxy”) for healthcare.

A POA is someone you chose to make decisions on your behalf in the event that you become incapacitated. You may think that because you are young and healthy that this is not something that concerns you. No one expects to have a car wreck or to be diagnosed with cancer. No one chooses to lose consciousness (except, perhaps, temporarily for an elective surgery), but if you do lose consciousness, for any reason, while under medical care in the United States, your decision maker will automatically become your next of kin. First your spouse, then your parents or children (depending on your age) will be consulted regarding your medical decisions.

They will be given authority over who can receive information within your family and they will also control who will be allowed to visit and who will not. This is of particular concern to same sex couples. Unfortunately, our community suffers disproportionately from issues of prejudice and estrangement. To put it plainly, my partner’s mother is not my best friend. Not by a long shot and, even though Massachusetts and California both now recognize same sex marriage, in most cases the license will not be honored across state lines.

The good news is that a designated POA will trump any familial relation when it comes to medical decision making. This is an individual right and fortunately, even in the most hostile environment; a well informed same sex couple can use it to their benefit.

The bad news is that there are people out there who will discriminate against you even when the law is on your side. You may recall Paula’s recent article about the incident involving a lesbian couple at Jackson Memorial Hospital in Miami: “Lesbian Partner Sues Hospital…” Janice Langbehn had her dying partner Lisa Pond’s POA paperwork on hand and, in an indefensible act of ignorance and discrimination, staff at the hospital still denied her access. Langbehn, represented by Lambda Legal, is suing the hospital. The law is clear. She will win this case.

In a similar case, also in Florida, in January of this year Eric Breidenbaugh was unable to obtain information regarding the status of his life partner, Joseph Bellamy. Bellamy, a pilot, had taken his parents up for a short flight earlier that day. When Breidenbaugh was unable to reach him after multiple attempts he knew something was wrong. He called the airport and the hospital. All he was told was,You really not an actual family member.






While these episodes of overt discrimination are beyond disheartening they can serve as a reminder to us all to not only complete our paperwork and keep it on hand, but to continue the fight for equal protection under the law.

You can read more about Eric Breidenbaugh and Joseph Bellamy at the HRC Action Center.

You can read more about Langbehn v. Jackson Memorial Hospital on Lambda Legal’s front page.

Lambda Legal also provides a great guidance tool under their "tool kits" section for establishing your POA and other documents regarding potential healthcare vulnerabilities.

4 comments:

Becky C. said...

I really hate to drum up business for lawyers. But beware of do it yourself POA's. The states vary in how these work, and you need a lawyer familiar with the state law.I would not trust any software or books.

One good place to find a sympathetic knowledgeable lawyer is to consult with GLAAD.

They are relatively inexpensive item to get prepared---something like $25--but as you point out--very important.

Another important thing for gay and lesbian couples--is be sure an have a will. Your partner will get nothing if you die intestate.

But better than a will is a Living Trust. This is a way to pass on your property in the event of death outside the probate courts. The advantage of this, is it is all done privately--nothing in court is needed--and this avoids the problems that often occur of relatives challenging wills.

Again, GLAAD can help with this, You must get a lawyer who specializes in Estate planning. On these, again, never trust do it yourself software or books.

~Becky

Paula the Surf Mom said...

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Hahn at Home said...

I was perfectly well aware of this when I was with my partner and we had all such documents drawn up in every variety known to man.

Now, I still do, because I'm single, I don't want the decisions left to the wrong people or people who do not understand my desires.

This is a critically important part of any long-term relationship and extremely worth the money.

No matter how well you know your family and are sure they won't do the wrong thing as it relates to your significant other, things can get weird.

I'm directing some people I know over here to emphasize the same point I made to them recently.

karen said...

"No matter how well you know your family and are sure they won't do the wrong thing as it relates to your significant other, things can get weird." I totally agree with you on that point, Lori! This is something that you just can't leave to blind faith or trust.

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