Do Not Look to the Surrogate If the Patient Still Has Capacity

Washington Adventist Hospital in Takoma Park, Maryland was recently sanctioned by CMS for looking to a surrogate rather than to the patient herself when the patient still had capacity.



"According to her medical record patient #1 was alert and oriented x4 with a period of delirium for several days while in ICU. There was no documentation in the medical record that patient #1 lacked capacity."



"Patient #1's granddaughter in Florida expressed concerns over the fact that patient #1 had MRSA in the nares and that she was on Xeralto. The note read in part 'she (granddaughter) wants the Xeralto discontinued' . . . The physician stated she was aware of the concerns and will discontinue Xeralto . . . ."



"This progress note as well as others reveal the hospital making changes in the patient's treatment based on Patient #1's granddaughter's wishes rather than those of the patient who was not identified at the time as lacking capacity to make her decisions nor was there documentation that the patient had agreed to her granddaughter making her decisions."