5053 Medical Consent

Georgia State Seal

Georgia Division of Aging Services
Public Guardianship for Adults Manual

Chapter:

5050 Health and Medical Care

Effective Date:

03/01/2022

Section Title:

Medical Consent

Reviewed or Updated in:

MT 2022-02

Section Number:

5053

Previous Update:

MT 2019-02

Summary Statement

Representatives of the Department of Human Services (DHS), in making decisions on behalf of DHS as guardian of last resort, shall consider the expressed desires and personal values of the person under guardianship to the extent known.

Staff representatives shall attempt to find out what are or were the prior expressed wishes regarding the provision of healthcare services of the person now under guardianship. Staff shall inquire about and obtain a copy, if located, of any Healthcare Power of Attorney, Advance Directives or Living Will.

Unless the court’s order specifies that one or more of the following powers are to be retained by the ward, the appointment of a guardian shall remove from the ward the power to: (3) Consent to medical treatment… O.C.G.A. § 29-4-21(a)

Unless inconsistent with the terms of any court order relating to the guardianship, a guardian may: (2) Subject to Chapters 9, 20, and 36 of Title 31 and any other pertinent law, give any consents or approvals that may be necessary for medical or other professional care, counsel, treatment, or service for the ward… O.C.G.A. § 29-4-23(a)

In regard to Mental Health Treatment (Title 37): (b) It shall be the policy of this state to protect, within reason, the right of every individual to refuse medication except in cases where a physician determines that refusal would be unsafe to the patient or others. If the patient continues to refuse medication after such initial emergency treatment, a concurring opinion from a second physician must be obtained before medication can be continued without the patient’s consent… O.C.G.A. § 37-3-163

Basic Considerations

If there are any questions or concerns about a particular medical treatment, the Division of Aging Services’ (DAS) policy is that staff consult with Public Guardianship Office (PGO) management and as needed, the DHS Medical Director and the DHS Associate General Counsel (AGC) for DAS. Appropriate documentation must be completed.

In the event of an emergency or disaster, PGO case managers making decisions on behalf of DHS, as guardian of last resort, may not have sufficient time to consult with PGO management and/or DAS leadership and obtain all documentation. If PGO staff has unsuccessfully made attempts to consult with PGO management or DAS leadership, staff shall make a reasonable assessment of the factors required for a decision on medical treatment in order to achieve informed consent and consult with PGO management and DAS leadership as soon as possible.

Levels of Approval

The three levels of consent for medical treatment are as follows:

Routine

Approval is at the DHS representative’s discretion. Medical treatment such as medical, vision, dental care that does not administer general anesthesia, and general admittance into hospice (except when client is entering hospice with life expectancy of 30 days or less).

Although routine medical consent does not require a supervisor’s approval, the supervisor should be fully briefed in advance, when possible, and in a timely manner.

Examples include:

  • Vaccines

  • Dental work

  • Diagnostic x-rays

  • Sutures/removal of sutures

  • Administration of local anesthesia

  • Mental health/mental retardation behavior support plans

  • Psychotropic medications (if person under guardianship does not refuse)

  • Hospice (where life expectancy is more than 30 days)

Intermediate

Approval by a supervisor or PGO District Manager is required. A second physician’s written opinion must also be obtained.

Supervisors must make this decision based upon what a reasonable supervisor making a medical consent decision in the particular situation would do in accordance with DHS/DAS training and policy.

Examples include:

  • Administration of general anesthesia

  • Minor surgery with little risk to person under guardianship

  • Advanced diagnostic testing

  • Emergency Surgery (if Division Director approval not required)

  • Hospice (if life expectancy is 30 days or less)

Division Director

Approval by or notification of the Division Director, Deputy Director, or his or her designee is required when there is substantial risk to the person under guardianship or end of life care is involved.

Examples include:

  • Neurosurgery

  • Amputation or other similar surgeries

  • Sterilization, in accordance with state law

  • Treatment by Court order

  • Organ transplant

  • Bypass surgery

  • Electro-Convulsive Treatment (ECT)

  • End of life care (e.g. Order not to resuscitate, DNR order, removal of ventilator, etc.) notification only

The DHS, as guardian of an incapacitated adult, shall not authorize a “No Code,” “DNR,” or “Do Not Resuscitate” order.

Procedures

Medical Recommendation

The Physician Medical Treatment or Procedure Form located in PGO MAN5800 Appendix B must be completed by the treating physician prior to treatment. It must include:

  • Diagnosis

  • Why treatment is needed

  • Recommended treatment and details of treatment

  • Use and type of anesthesia, if applicable

  • Risks/Benefits

  • Prognosis

  • Alternatives to treatment

  • Anticipated outcome

  • Expected recovery

PGO staff must obtain and upload the completed Physician Recommended Medical Treatment or Procedure Form in DAS Data System (DDS).

Based on the person under guardianships decisional capacity, PGO staff must provide adequate information to the person so they may fully participate in making an informed decision. If the person does not have the decisional capacity to give informed consent, PGO staff must make the decision based on the preference of the person if known and the person’s best interest. PGO staff must also complete the Medical Consent Authorization form under the Assessment tab in DDS.

Summary Note

When seeking Director Level Approval, a summary note along with relevant medical records must accompany the treatment recommendation form(s). The note shall include but is not limited to:

  • Client identifiers: name, date of birth, case number.

  • Client’s diagnoses

  • History of illness

  • Treatment alternatives

  • Client’s preference

  • Why option was selected

  • Why other alternatives were not selected

Follow-up Note

PGO staff must enter a collateral note, Note Type: “Stakeholders/Community Partners/Service Contact or Referral Made”, Note Sub-Type: “Medical Provider/Staff”, after treatment which states the treatment outcome and planned follow-up.

References

O.C.G.A. § 29-4-22