I asked an attorney friend of mine who teaches other lawyers about guardianship matters how I can write a letter to the judge about loose ends in a guardianship. Her reply was, "I wouldn't because it's done and nobody asked."
Well, the loose ends are that nobody asked. Law and justice sometimes interface with health care. Guardianship involves mental health, keeping up with medications, preventive health, and making crucial decisions in a hospital. Questions about health and health care cannot be left as loose ends at the time of judgment. People who need guardians by definition are marginalized and more often than not have serious health issues around which they themselves cannot self-advocate. The average observer holding the scales of justice is blindfolded to the medical issues.
I left the courtroom at 60 Center Street, specifically room 355, officially ambiguious. There was the former doctor sitting behind me who had been dismissed for failing to provide nursing care to a pressure ulcer for one year, failing to communicate with a health care agent, failing to tell everyone that the skin cancer she scraped off was still in the skin and would come back, and failing to give the flu vaccine to an old bed bound person. It was official in the court record that she could visit the patient as a friend because the old bed bound person, a ward of the court, likes her so much. I also heard say the judge that the current doctor should be replaced with an "independent" physician but no such “independent” physician was identified in courtroom 355 on Friday at 4 pm. Neither was the appointed guardian in the courtroom. Only five lawyers could raise their hands and asked for "specific language in the settlement" and "clarification about a co-guardian," advocating for their clients. Left loose and off the record was a provision for health care on Friday at 4 pm. I have been providing her health care 24 hours no matter business, lunch or after hours, but I wasn't given the last name or phone number of the guardian. I know him as "cousin Sam." The most I could do was to give my card to "cousin Sam's" attorney, but she didn't give me hers. My patient's appointed attorney took my card, but said she didn't need to know me the reason being that she is the old bed bound person's lawyer and apparently not her advocate.
I woke up Friday night with a nightmare that my bed bound patient who has no fat padding rolled out of bed on to the linoleum with an INR of 3.4 and the home health aide called for blood on the floor, but it was only a dream that I could not notify “cousin Sam” that I had sent her to the nearest ER unconscious or that I had sent a fax of her medical conditions and lab report to the hospital. What isn't a dream is that tomorrow while the guardian and his attorney might have time to take up the search for an "independent" home visit physician during business hours, the nurse coming to do wound care will have run out of the state of the art wound care supplies for the bedsore and the ambiguously current geriatric care manager has no access to funds to order more of them and she doesn't know the guardian either.. And if the guardian and his attorney haven't found an "independent" home visit physician a week from now, the seven-day-four-slot pill box with mission critical medications will be empty and the home health aide won't be able to cue the bed bound patient that it’s time for the before breakfast pill, the after breakfast pill and the after dinner pill too.
The official court record does omit addressing if everyone who has an ethical obligation to stay involved has adequate access to everything that they need to meet the 24 hour needs of the bed bound person. The official court record says that the former physician can come over to play chess because the patient requested that, but "nobody asked" if the ambiguously current physician and new guardian know how to contact each other. Justice sees the guardianship as “done” while medicine sees the ward of the court as being invisible to the blindfolded.
