Tools to Improve Medical Planning and Decision Making

By Deborah Bickel

In my last article for Atención, I described the profoundly troubling events of two weeks ago surrounding the tragic case of an elderly, otherwise healthy, expatriate admitted to a small hospital after a fall shattered his face and skull on the lakeside rocks. 

Over the course of far-too-many hours to sustain any credible sense of urgency, the “team” managing his care recruited a neurosurgeon from Guadalajara to perform what can only be described as exploratory brain surgery to assess the extent of any bleeding or injury. The team also put him on a ventilator and placed a PICC line or feeding tube to deliver nutrients and insisted on replacing the first smaller line with a longer lasting and more durable one.

A fall, head trauma, and any unanticipated or early deaths are sad and troubling events but not really the stuff of nightmares. No, this nightmare began when decisions and actions of the care team overrode all efforts to broker the peaceful dignified death Alan (not his real name) and his wife imagined. Indeed, those wishes are a part of a medical directive on file in the United States. 

It took five full days, my own efforts, advice from my Be Well partner, Dr. Emilio Ramirez, and two law firms to get Alan released from the hospital—against medical advice. He was finally placed in a palliative care facility and was expected to die over the course of the next few days.  He never regained consciousness.  

I admit to finding these events unbelievable and would not blame the reader for suspecting writerly exaggeration for shock value. Unfortunately, the only departure from the facts are those events left out of the narrative that detail criminal behavior. I am leaving that discussion to the lawyers or to the family to decide how to proceed once the trauma has faded. 

Now for the promised advice on how to prevent/prepare for similar miscarriage of the law and malpractice of medicine. 

1. Make an advanced medical directive legal in whatever state in Mexico you reside. This document does not have to be expensive to prepare nor extensive in detail. Be Well San Miguel works with a firm of lawyers who offer a very fair price. Working with them, we can guide you through the process in a couple of meetings. 
2. Once you have a directive in place, keep it and current medical records with you and make sure your physician has copies and understands your wishes. Dr. Ramirez and I are willing to serve as signatories for a small fee. Even if we are not signatories, make sure we or your doctors are familiar with your wishes and have a copy of the document. 
3.    As soon as you are hospitalized, arrange to speak with the billing department to better understand the fees associated with your care. The lawyers I spoke with in the case above stated that, “By law, any hospital in Mexico must provide, upon request, a written record of diagnosis and a treatment plan including all associated costs in the patient’s native language.” 
4.    Do everything in your power to have an advocate in your corner, whether it is a friend, family member, or a professional patient advocate. Their services can be invaluable to ensuring your interests are well represented. 
5. Appoint a power of attorney that can act on your behalf in Mexico as well as your country of origin. If Alan’s family had someone serving in this role, they could have brought greater weight to bear on care decisions, particularly ensuring that the hospital honors the patient’s wishes.