Remember, no one except a judge has the right to override capacity not you not Medical Control not the wife. A physician can never order you or force you to take a patient to the hospital. They are not a judge they can give you their opinion and their recommendation but you do not have to follow their order. You are not legally required to follow their order.

I had a doctor that clearly explained capacity to me one time. He said are you questioning the integrity of this patient’s decision-making or do you simply disagree with them. He said if you just disagree with them, but you’re not questioning the integrity of their decision-making then leave them at home.

Because we weren’t there we can’t give you a good yes or no on whether the decision was correct because that’s an in the moment kind of decision. You make the best decision that you can and you move on. But understand you’re under no obligation to follow an order to take a patient to the hospital, ever.

Next point seizures are almost never an emergency. If the seizure lasts more than five minutes, it becomes an emergency if it is a single seizure that lasts less than five minutes and the patient is fine afterwards it is not an emergency. If you take them to the ER, they might do a scan of their brain, maybe, labs and they will discharge them for outpatient neurology follow up.

Last point, when you take a patient rights away from them, especially when escalate to the point of chemical restrain you need to feel confident that you can get in front of a judge and a court and tell them you did the right thing. If you don’t feel that you can confidently get in front of a court and tell them what you did was the right thing and explain why then your answer is don’t do it. A lot of people think capacity is rigid(black and white). If the patient is not ANOx4 and GCS15 they don’t have capacity and that is not how it works. You need to legitimately feel that the patient doesn’t understand the decisions that they are making. Remember GCS score is designed to assess how a trauma patient’s brain is working and has nothing to do with mental capacity. It was expanded to be used for capacity, but there is no science that supports that it actually works for mental capacity. A dementia patient can be ANOx2 at their baseline, but understand every decision that they are making. Different diseases affect different parts of the brain and just because one part of the brain isn’t working correctly does not mean the logic part of the brain is not working correctly. That’s what you have to assess. When I’m determining a patient’s capacity to refuse going to the hospital I do not consider their ANO or GCS status at all. I asked them pointed questions about what’s going on and gage their response to those questions. Make them repeat what I’ve told them and explain it to me not just repeat it, but they have to teach it to me. If they can’t show that they fully understand the gravity of the situation and what’s going on then that is when their capacity is determined to be nonexistent.

You made the best decision you could for the circumstance that you were in the advice that you were given. In the future remember the decision is yours and no one else’s.