APMA News - June 2013 - (Page 42)

Coverage Corner By Larry M. Waranch, Esq., and Christina N. Billiet, Esq. Editor’s Note: This month, APMA News introduces a new column from the Podiatry Insurance Company of America. Coverage Corner will cover a wide variety of topics, from liability insurance to legal concerns. Watch for Coverage Corner each month in this space. This month also marks the retirement of Insurance Advisor, written by William F. Munsey, DPM. APMA News thanks Dr. Munsey for his many years of contributions to the magazine. The Powers That Be The term “power of attorney” is used frequently in the medical and legal fields, although often without a clear understanding of what “power” it actually denotes. In the simplest sense, a power of attorney is a document that allows a person (the “principal”) to appoint another person to handle affairs while the principal is unable to do so. The person appointed is referred to as an “attorney-in-fact” or “agent.” Physicians are often faced with situations in which a patient has a health-care power of attorney. A health-care power of attorney, also referred to as a medical power of attorney, is now more appropriately titled an advance health-care directive. It allows the patient (the “principal”) to appoint someone (the “agent”) to make health-care decisions if the principal becomes incapacitated. Virtually every advance health-care directive is drafted so that it is “durable,” meaning that the document will remain in effect or take effect if the patient becomes mentally incompetent. When Does an Advance Health-Care Directive Take Effect? Under normal circumstances, a patient has the right to control all aspects of his or her medical treatment, including the right to decline medical treatment or to direct that it be withdrawn, even if death results. However, if a patient becomes unable to direct his or her medical care, the right to control treatment may be denied unless he or she has delegated that right to another person through an advance health-care directive. Practically speaking, an advance health-care directive will immediately spring into effect if a patient is so ill or injured (mentally or physically) that he or she cannot competently express his or her health-care wishes. Sometimes, however, there is a question about the patient’s ability to understand treatment choices and communicate his or her decisions clearly. In that case, it is up to the physician to decide whether the principal is mentally competent and whether the advance health-care directive should become operative. What “Powers” Does an Advance Health-Care Directive Create? The health care “powers” that may be delegated to an agent include: the power to consent to, authorize, refuse, withhold, or withdraw consent to any and all types of medical care or treatment relating to the patient; the ability to admit or discharge the patient from hospitals, institutions, residential or nursing facilities, treatment centers, and other health-care institutions; • • 42 APMA News June 2013 • • • the ability to contract for any and all types of health-care services and facilities, in the name of, and on behalf of, the patient; the ability to examine and authorize disclosure of medical records of the patient; and in the case of death, the ability to authorize an autopsy and/or the disposition of any remains. Are There Any Potential Pitfalls Physicians May Face? An advance health-care directive involves important medical and legal decisions. It is not surprising, therefore, that a physician whose patient becomes incompetent may face difficult situations such as the following: What happens if family members disagree with medical decisions made by the agent? If a patient becomes incompetent and he or she does not have an advance health-care directive, the right to make medical decisions lies with immediate family members, such as a spouse, adult children, or a parent. Disagreements as to the appropriate care of the patient may arise. Therefore, most states require an advance health-care directive to identify a primary agent who is solely responsible for making health-care-related decisions. A physician must follow the directions of the agent identified, regardless of the wishes or disagreements of other family members. What happens if the physician disagrees with medical decisions made by the agent? In every state, physicians are legally required to respect the treatment decisions of the patient, as expressed by his or her legally appointed agent. A physician may refuse to comply with a decision based on an objection of conscience or if the physician considers the treatment or decision to be medically inappropriate. In that case, the physician may have an obligation to transfer the patient’s care to another health-care provider who is willing to comply with the agent’s decision. n • • Larry M. Waranch, Esq., is national counsel to the Podiatry Insurance Company of America (PICA) and is a managing member of Waranch & Brown, LLC, in Lutherville, MD. Christina N. Billiet, Esq., is an associate at Waranch & Brown, LLC. Contact PICA Director of Risk Management Barbara Bellione, RN, CPHRM, ARM at 800-251-5727, ext. 2052, or e-mail bbellione@picagroup.com.

Table of Contents for the Digital Edition of APMA News - June 2013

APMA News - June 2013
President’s Message
Table of Contents
The Boston Marathon Bombings: Podiatrists on the Front Line
Committee Nominations Requested
What’s the Deal with Biomechanics? How One APMA Member Helped Jerry Seinfeld End Years of Pain
The New Wave of HIPAA Changes: The Final Omnibus Rule of 2013
APMA State Advocacy Forum
Resolutions Submission Deadlines
Emotional Intelligence and Residency Education
Practice Survey Data: Practice Owner Type
It’s All Happening at The National!
Annual Scientific Meeting Registration Forms
Annual Scientific Meeting Sponsors
APMAPAC Chair Report
Coverage Corner
IT Consultant
Inside APMA’s Social Media
Bylaws Propositions Due
Website Wisdom
On the Road with APMA
Small Business 101
CPME Update
Young Physicians’ Accomplishments
Worthy of Note
Affiliates Corner
New Members
Death Notices
APMAPAC Update
Development Update
Classified Advertising
Dates to Remember
Advertising Index
10 Questions
Your APMA

APMA News - June 2013