It is Thursday afternoon. You receive a call from one of the hospital Discharge Planners, Zahra. Zahra requests your assistance with decision making about a patient named Mr. Roberts. She provides you with a summary of what has happened since Mr. Roberts was admitted to the hospital six weeks ago.
Zahra explains that Mr. Roberts is an 83 year old who police brought to the hospital six weeks ago. The police had received a call about an elderly man walking back and forth on the same street over the course of two hours during a snowstorm, without a winter coat or boots. The police told the Emergency Department staff that Mr. Roberts was unable to tell them his address, and that he appeared disoriented and confused. Mr. Roberts was admitted to hospital with a urinary tract infection (UTI), delirium, and ‘failure to thrive.’
Dr. Suleman identifies and contacts Mr. Roberts’ substitute decision maker
Dr. Suleman was Mr. Roberts’ physician on admission to the general medicine unit. She wanted to discuss the plan to treat urinary tract infection and delirium, but Mr. Roberts was not able to understand and appreciate relevant information, and so, he was not capable under Ontario’s Health Care Consent Act. The unit’s Social Worker was able to locate contact information for Mr. Roberts’ son, David.
Dr. Suleman reached David by phone and confirmed that he was the highest ranked person on the hierarchy of substitute decision makers in Ontario’s Health Care Consent Act.
David was not surprised that his dad had been found wandering. He shared that his dad had been more forgetful and moody lately, but had always refused help even though he lived alone. David informed Dr. Suleman that three years ago his father had been admitted to a different hospital for severe food poisoning and the physician there had told David privately that his father might be showing early signs of dementia.
David tells Dr. Suleman that he does not want his dad to return to his own home.
Dr. Suleman informs David about the plan to treat the UTI and delirium and obtains consent. She then assures David that his concerns about discharge will be addressed in the coming weeks. Dr. Suleman documents the discussion.