How can we appeal a hospital's decision to insert a feeding tube in our father?
My father has Parkinson's Disease and as a result has lost his ability to swallow properly. As a result, he often aspirates, and pneumonia is becoming common. In his most recent stay at the hospital, he failed his swallow test and the hospital now wants to put him on a feeding tube. My father, his primary care physician, and his children all agree that this would be the final straw and destroy what little quality of life he has left (Parkinson's is one of several medical problems he has). As a result of refusing the feeding tube, the hospital has retaliated by refusing to feed him. I have 2 questions. 1) Do we have recourse, short of bringing him food ourselves against the hospitals wishes, or just not taking him to the hospital? 2) If we go against medical advice and refuse the feeding tube, can Medicare refuse to pay for the treatment of future episodes of pneumonia?
You must act quickly"”and steel yourself to be a firm but aggressive advocate"”to get the hospital personnel to listen to and honor your father's wishes. Be aware that if a feeding tube is inserted, even for what is painted to be a short time, it becomes much more difficult to have it removed.
If your father does not yet have an advance directive stating that he wishes to refuse a feeding tube, make sure he completes one at once. Ironically, you should be able to get a copy from the hospital"”or from his primary care physician if hospital personnel are uncooperative. Advance directives are serious, sanctioned documents"”and treating physicians and institutions are duty-bound to honor the wishes expressed in them or to transfer the patient to someone who is willing to honor them.
It is unclear who at the hospital is refusing to listen"”or whether feeding tubes are simply the commonly accepted method of treatment there. But you have the best possible evidence on your side"”so use it. Ask for a meeting with the hospital's ombudsman, patient care representative, or ethics committee"”or possibly all three of them. Come prepared with a copy of any advance directive and with statements from your father's primary care physician"”or ask him or her to appear at the meeting with you. If your father is up to attending and can express his wishes clearly, make sure he attends, also"”along with interested and supportive family members.
For now, concentrate on the feeding tube issue and don't worry about Medicare coverage. There is always a possibility that you will have to appeal a Medicare decision, but you have very strong evidence on your side, so are in a good position to get a decision in your favor. For tailored information, you may wish to contact a Medicare Customer Service representative at 800-633-4227.
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