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man o' the year

Legal status of patient notes

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Anyone help with advice regarding my rights to read the medical folder for my mother in hospital please? I had a confrontation with a jobsworth nurse today and would like to pursue my rights to read. She feels that the medical terminology used would worry me - patronising witch! I said "what have you got to hide/ What are you ashamed of? To be honest the care is so variable I am most concerned.

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You are in a grey area as, legally, you are not allowed to look at the records of anyone else. You can only look at the records of a relative if they are deceased.

However, the exceptions are when, in your case, a parent has signed a form indicating that a certain child is allowed to do so - my surgery operates this policy. Also, if a doctor is open-minded he or she will be more than happy to facilitate this. Of course, lots are control freaks or they do not want you seeing what they have written either to not hurt you or because they fear legal action.

You can go to the Records Manager in the hospital, explain your situation and ask to see the records. There is a maximum £10 charge for electronic records and £50 for paper records. A friendly word with the doctor in charge of your mother's treatment might work though.

It is an awful position to be in as, technically, you have no rights. Too many doctors still act like gods when it comes to records whilst being fearful of you finding out what is in them.

When I was in hospital earlier this year an elderly lady was dying in a bed opposite me. Her doctor was my doctor and he came in several times a day to see her, looked at her records and made notes. One morning he came in, looked at the notes and said out loud "Someone has written 'do not resuscitate' in here. Who has done that?". The only people who had been near that woman since his last visit were the nurses. Go figure.

 

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2 hours ago, paulokes said:

If mum says 'please let him read notes' you can.

If not you can't.

This (although even better in writing).  A subject access request under the Data Protection Act are the magic words.

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9 hours ago, man o' the year said:

Anyone help with advice regarding my rights to read the medical folder for my mother in hospital please? I had a confrontation with a jobsworth nurse today and would like to pursue my rights to read. She feels that the medical terminology used would worry me - patronising witch! I said "what have you got to hide/ What are you ashamed of? To be honest the care is so variable I am most concerned.

I work in Health Records at a hospital trust. Where I work there is a 'Patient Access Coordinator' ( a few of grades above my role) who is the point of contact for viewing medical records. The person who does this job at my workplace is very nice and extremely good with people. I think our fee is £20.00 to view the records. I think our PAC has to get authorisation from the consultants in charge of that person's hospital care which can delay things a little.

If your mother is unable to consent but you are listed as 'next of kin' on your mother's demographic info then this may help. Good luck!

9 hours ago, The Masked Tulip said:

You can only look at the records of a relative if they are deceased.

The PAC gets a few of these requests. We must retain deceased patients' notes for at least 8 years before they are destroyed.

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1 hour ago, paulokes said:

When you say your mum isn't able to consent, what do you mean?

Has she lost her vocal speech?  How far has dementia progressed?

P

She would not the understand the question. I could explain the situation to her and have her agree, then call a nurse across and ask the same question and she would not answer or remember.

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2 hours ago, paulokes said:

^ And if you think there is evidence that she is not capable, you can push to have this assessed...so you can step in in certain areas (like being involved in care) without necessarily taking on everything such as with Power of Attorney

P

That (being involved in care) has already happened. I have been looking after her alone for 10 months. the complication comes from her hospitalisation and the medical staff.

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I was my elderly Mother’s principal carer for over a year before she was taken into a nursing home and then hospital before her death. She did not have dementia and I did have full power of attorney but both she and I were concerned about aspects of her care.

If you feel you don’t know enough about your Mother’s condition and the treatment on offer then formally requesting access to her medical notes may help as a “lever” to get someone to sit down with you and explain precisely what is happening.  No matter how patronised you may feel, don’t be tempted to expend vast amounts of time and energy chasing the release of notes unless you really feel they will be of help.

If your concerns are more to do with the quality of nursing care and you still have enough of a relationship with the people on ward to talk with them, explain you need more than a brief word and ask for a time when you can talk to the staff nurse in charge.

If that will not work then ask for a meeting with the charge nurse (responsible for all nursing staff on a particular shift) or nurse manager (in overall charge of all nursing).

Don’t underestimate the strain you have been under or be surprised if you come across to medical staff as overly anxious, even aggressive. I’m normally calm and easy going but family members tell me I became combative and argumentative and I certainly know I had to “count to ten” when I felt nursing staff were prioritising tales of their social life over providing care.

Whatever…try to get some rest, being in reasonable shape yourself is probably the best way you can help her. Very best wishes.

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man o' the year - don't forget, you mum did tell you in front of a few of your close family / friends that she wanted you to be fully responsible for her well-being and affairs several years back.

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I went through a similar experience as baby boomer. It crushed me physically and I have never recovered - so heed baby boomer's words about your own health and looking after yourself.

That aside, I also had full power of attorney but, in truth, it was worthless at the time as SOME doctors & nurses either did not understand it or just ignored it. It is shocking the attitude of some medic staff in hospital. It might sound a cruel thing to say but I hope that some doctors & nurses one day endup being treated in hospital in the same way that they have treated others.

The problem, even if you have full POA, is that you would have to go to court to stop X, Y or Z and that is just impractical when healthcare decisions are often unexpected and immediate. I also had, in addition to POA, signed letters from my Mum, witnessed by our solicitor, detailing why she wanted me responsible. I had a sibling problem.

Be firm but not confrontational. Try to have independent witnesses to any conversations. Take on board much of the good advice already given.

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Medical records are considered highly sensitive, and the ICO has recently reported on a number of huge fines to hospitals and GPs who have revealed medical records to relatives (in this case, the relatives were malicious - e.g. an estranged father wanted the phone number for the ex, who was carer for their child, and managed to get the GP to reveal the child's case notes in a subject access request). This has prompted a lot of hospitals and GPs to significantly tighten access to medical records.

Where I work, the local policy is that if an adult lacks mental capacity, then their medical records should only be disclosed to a third party only on receipt of proof of legal authority (e.g. court order, documentary proof of lasting power of attorney or documentary proof of deputyship from the court of protection).

It may be sufficient to use a witnessed verbal granting of consent if she can't sign, but I suspect that most hospital legal departments would say that is not sufficient. Also bear in mind, that for such serious purposes, most nursing staff and care assistant staff are advised not to act as witnesses to consent, and that this should be only be done by the most senior nurse available, preferably sister, or referred to a specialist team who deals with mental capacity issues.

However, as a relative who has been responsible for care in the past, you are in a good position to be consulted over treatment decisions. The legal position is very clear in that without LPA/deputyship/court order you cannot make treatment decisions, and in that case the treatment decision rests with the treating doctor alone; and this can be problematic as it pushes doctors into taking the decision which they think is less likely to leave them open to legal criticism (and which is not necessarily the best decision). However, you have a right to to be consulted as regards what might the person might have wanted, and the doctor should weigh that view in their decision making. That could potentially extend to reading medical notes, but guidance is that this should be restricted only to the information directly relevant to the treatment decision.

As regards, how to deal with your concerns at present, the best advise has already been given above, which is to try to arrange a face-to-face meeting with the charge nurse or consultant (or both) to highlight your concerns. A written complaint would also work, but is time consuming and you risk your complaint being misunderstood which may slow the whole process down. In the interests of pragmatism, if your relationship with the staff will allow it, a scheduled meeting is probably the best thing to do.

You may wish to consider applying to the court of protection for deputyship. This is expensive, the application fee is £400 each for personal and financial deputyship, but once you have legal authority to make decisions, it should make at least some situations a bit more straightforward.

 

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Thanks for all the advice given. The truth is closer to Boomer Baby's experience. I am only trying to be allowed to read the day to day care notes in the folder at the end of her bed. Nursing staff are variable but on the whole pretty poor and mostly rude and confrontational. The situation is not helped by the fact that my father was on the same ward earlier in the year so I already know the laissez faire attitude of particular staff but nevertheless tried hard to start afresh. It wasn't long before the same attitude showed by almost all the same nurses,( to be accurate day 2). The lack of care and preoccupation with socialising seems pretty endemic and I now have intimate knowledge of three Nottinghamshire (3 Sherwood trust and one City of Nottingham) hospitals.

I have seen nurses wait for 20 minutes to respond to patient buzzers on a routine basis not because they are busy but because they can ignore.

As for other medical records, being an only one, I already have full knowledge (better than medical staff and have advised them of particular histories when pertinent) of both my parents. I have sat for 21/2 hours because the cannula in my mum was placed so that as soon as she bent her arm the flow stopped. the staff were happy for me to reset the pump so that the drip restarted for this time on the first night I did so and for a shorter time (about1 1/2 hours) on a second night. Last night I also pointed out that if the stand for the drip was on the other side of the bed it would not stretch across my Mum and continually irritate her. I returned today to find that she had pulled out the cannula and that the blood soaked tissues the staff had used to wipe up the mess were left on her bedtable.

Of particular concern is her eating (and drinking) as nobody helps her so I try to arrive for meal time to help her eat. I have advised them of her likes and dislikes and so was somewhat taken aback when jam sandwiches arrived as Mum hates jam. I insisted on a change and eventually managed to get her to eat half a portion of cottage pie despite it being repulsive slop.

It's just so bloody frustrating.

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