Question
Does a physician have the final word on artificial nutrition and hydration for a patient?
Answer
In my experience, surveyors have explained to administrators waivers do not hold up in court and the power of attorney should not be making those decisions either. This was kind of a surprise to me. They said as long as the doctor discontinued the order for the modified diet and the thickened liquids that is all they needed. They did not need the waiver. Again I would be very clear about the decision in your education note, so the patient and the family cannot come back and say they did not know. Be very clear about that informed education session, and that it is informed refusal of whatever recommendations we made based on the instrumental assessments and/or the bedside evaluation.
Denise Dougherty is a solo practitioner in Pennsylvania and consults for The Arijah Children's Foundation in Anguilla, BWI, providing evaluations and therapy for special needs children. Denise serves as the President of the American Academy of Private Practice in Speech Pathology and Audiology (AAPPSPA), and is the AAPPSPA liaison for ASHA Health Care Economics Committee. Ms. Dougherty is a member of the Technical Experts Panel for Quality of Insights of Pennsylvania, working on initiating quality measures for CMS to improve effectiveness, efficiency, economy and quality of services delivered to Medicare beneficiaries.
