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Updated by user Jul 11, 2018

When examining the copy of my mother's original HCP for which I was the agent, please note that the hospital filing demarcations are that of Brookhaven Memorial Hospital and not Mather Hospitals.

Original review posted by user Jul 10, 2018

Being my mother’s recognized Health Care Proxy Agent, general power of attorney, Medicare information recipient and Legal representative I was shocked to find that Mather hospital had utilized another Health Care Proxy Document.

With my motivation justified I attempted numerous times to receive the other HCP document that was referred to in justifying the revocation of my mothers original notarized HCP which I was the Agent. After 4 years and experiencing some difficulty, I was shocked to have received fraudulent documents.

Mather Hospital’s documentation of my mother’s original notarized HCP I provided on 1/13/13.

“Patient has a health care proxy. Name of Health Care Proxy: My name, 631-***-****, Mather Hospital Nurses Notes, 1/13/13, print time 1/15/13, 14:18:22, page 1).

After the acceptance of a copy of my HCP, Mather Hospital sought my signature in place of my mother’s on the discharge instructions. (John T. Mather Memorial Hospital Discharge Instructions, 1/13/13, Page 2 of 2.)

My Attempts

“On 4/22/13 I received medical records void of any Health Care Proxy, Advance Directives or DNR Documents”… I submitted another request via USPS on 10/18/16 utilizing my Record Release Form used on 3/27/13. After the initial 10 day and 30 day limits expired, I did not receive a response. I submitted a third request, form dated 11/22/16 sent via UPS on 12/5/16, arriving on 12/6/16. Again the 10 day and 30 day thresholds were met without a response as required by law”. (Your Medical Record Rights in New York A Guide to Consumer Rights under HIPAA, Written by Joy Pritts, J.D. Health Policy Institute Georgetown University).

Mather Hospital’s Official Response

Email response, 3/22/17: “Furthermore, the Director verified that the account number that is listed on your invoice does not match your mothers medical record number.” Receipt Page 1 of 1 John T Mather Memorial 75 North Country Road Port Jefferson, NY 11777 Customer Receipt Number: 2227**** Merchant ID: JTMA Transaction ID: VLFE8EFA1A41 Auth Code: 00214B Account Number Account Name Payment Amount Trans Type ************** Total Payment Amount: $112.50 Payment Information Date of Payment: 4/22/2013 11:50:07 EDT Payment Type: Master Card Credit Card Number:****************8528 Thank you for your payment Please save this receipt for your records.

Is it a universally accepted fact that the official Mather Hospital Medical Record Release receipt cannot verify the specifics of the record release transaction?

Claim made of requests not received.

“Since the facility has not received your letter, we will not be taking any further actions regarding your concerns. Please contact the Medical”

: (631)724-****

DELIVERY NOTIFICATION

INQUIRY FROM:OTH THE UPS STORE

34 E MAIN ST SMITHTOWN NY 11787

SHIPMENT TO:HEALTH INFORMATION MANAGEMEN JOHN T MATHER HOSPITAL

75 N COUNTRY RD PORT JEFFERSON NY 11777

Shipper Number............................R4R268Tracking Identification Number...1ZR4R268031****885

According to our records 1 parcel was delivered on 12/06/16 at 10:30 A.M., and left at DOCK. The shipment was received. NPT3CXA:000A0000

SHIPPERPKGTRACKINGADDRESS NUMBERID NO.NUMBER(NO/STREET,CITY)SIGNATURE

R4R2681ZR4R268031****88575 N COUNTRY RD PORT JEFFERSON

Concerned that someone was possibly unlawfully intercepting my requests; on 4/7/17 I notified the Office of the Postmaster General and United Parcel Service of a potential Obstruction of Mail Delivery and / or Obstruction of Correspondence, both punishable by imprisonment. (UPS Incident #170405-****71, USPS: “Thank you for contacting the Office of the Inspector General”).

On 4/22/17 I received the copies of the Health Care Proxy and DNR Documents filed in my mother’s Mather Hospital Medical Records. The long sought after documents that were used to justify an assumed revocation, limits of visits and calls, denial of medication; treatments, diagnostics, nutrition, hydration and the issuance of a DNR order were obviously fraudulent.

Mather Hospital’s validation and authority granted to the document.

“Therefore, we can only conclude that at some point, your mother revoked her prior proxy document and executed a new one (Actual execution date 1/30/13, while in Mather Hospital Telemetry Unit), which authorized your sister to act as her proxy agent. This information was confirmed by our social worker”. (John T. Mather Memorial Hospital Administrative Director Professional & Regulatory Services.)

“the hospital acted reasonably with respect to the Health Care Proxy (HCP) Form during your mother’s 1/30/2013 admission”. (NY Letter November 28, 2017).

NYPH S 2985 2(A+B) “Duty to record revocation”. revocation was not documented in the record.

“We were entitled to accept in good faith the requests by the Proxy Agent…” (Letter, 7/17/13, response to complaint 2, John T. Mather Memorial Hospital Administrative Director Professional & Regulatory Services.)

“When your mother’s condition deteriorated and warranted a DNR order, consent was properly obtained from the Proxy Agent. A DNR order was than properly issued by a physician and implemented by our staff”. (John T. Mather Memorial Hospital Administrative Director Professional & Regulatory Services.)

“Pt’s Family/ HCPXY- refusing labs”, (Medical Decision Making Information: John T. Mather Memorial Hospital ER Enc, 2/9/13, page 3 of 3).

“HCP states she does not want anything one to patient no labs, work up or anything that will “disturb her”. (Nurses Notes, 2/9/13, 20:10, page 1 and 2 under Assessment).

“Resistant to obtaining vital signs, I explained need for assessing vital signs and rationale for same”, (Nursing Progress Note, 2/10/13, 12:33, page 1.)

“Declined a full body assessment”, (Nurses Notes, 2/9/13, page 2).

“She is the Health Care Proxy and wants comfort care. The patient is DNR and DNI.” ( John T. Mather Memorial Hospital Discharge Summary, 2/9/13, page 1.)

The intentional utilization of such a powerful document giving it the authority to revoke my mothers original HCP, order a DNR and deny medications, diagnostics, treatments, nutrition and hydration tells me that the copies of the HCP that was sent to me on two occasions, despite the official Mather Hospital demarcations dated 2/9/13, must not be the same that was utilized.

The specific references to the intentional authority granted for and utilization of the HCP and Agent in Mather Hospital disqualifies any possibility that a surrogate was instead assigned in compliance with the Family Health Care Decisions Act of 2010 (Article 29-C).

Additionally the Health Care Proxy Document I was provided did not have an execution date, a legible principal signature and had two different Witness signature dates, 1/31/13 and 1/20/13.

However it is claimed that on the admission Date 1/30/13, Mather Hospital was presented with a Health Care Proxy which was recognized, utilized and a claim was made that the execution of it was witnessed at the same time within Mather Hospital’s Telemetry Unit at or about midnight, 1/30/13 and 1/31/13.

“Your mother was admitted in the telemetry unit just before midnight on 1/30/13, and the hospital was presented with the HCP form with dates of 01/30/2013 and 01/31/2013 by the witnesses”. (Official Letter November 28, 2017.)

While an explanation of an error was not made the witness dates of 1/30/13 and 1/31/13 were adamantly defended. In reading the dates, closely examine the signature date of witness #2, 1/20/13, which was referred to as 1/30/13.

I am seeking assistance in obtaining a copy of the valid Health Care Proxy empowered by Mather Hospital so I can be satisfied that my mother’s Hospital induced starvation, dehydration and death were in fact in line with my mother’s inferred newly founded beliefs and wishes.

Attached is a copy of the Health Care Proxy that was inserted in the record on the 2/9/13 admission. Examine witness 1 and 2 signature dates, which were to witness the one signing by my mother. Determine for yourselves if there is any way to confuse the date’s identification. The insistence of date’s 1/30/13 and 1/31/13 demands that there must be another HCP!

I have not received an apology as of yet.

Reason of review: Poor customer service.

Preferred solution: Let the company propose a solution.

Location: 75 North Country Road, Port Jefferson, NY 11777, USA

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Lacrystal Ljt

With the copy of the HCP that was provided to me with the execution date blank and the two witness dates clearly represented as 1/20/13 and 1/31/13, I can only conclude that there is a valid Health Care Proxy Document still retained by Mather Hospital. It is relevant due to the fact only the valid HCP could authorize, initiate and sustain starvation and dehydration.

My position of a missing valid document is substantiated and corroborated by two independent sources on two separate occasions. Source 1: Mather Hospital Spokesperson relating Social Worker confirmation. “Your sister advised staff upon your mother’s final admission that she was your mother’s Health Care Proxy and provided a copy of the proxy document, which revoked and superseded her prior proxy. Therefore, we can only conclude that at some point, your mother revoked her prior proxy document and executed a new one, which authorized your sister to act as her proxy agent.

This information was confirmed by our social worker”. (Letter, 7/17/13, response to complaint 2, page 1, John T. Mather Memorial Hospital Administrative Director Professional & Regulatory Services.) Source 2: Independent Investigative Agency Representative. “Your mother was admitted in the telemetry unit just before midnight on 1/30/13, and the hospital was presented with the HCP form with dates of 01/30/2013 and 01/31/2013 by the witnesses”.

(Official Letter November 28, 2017.) It is well within my rights as my mother’s child and recognized representative to request and receive A copy of the Valid Health Care Proxy Document. This will provide me with the opportunity to have closure knowing for a fact that my mother had indeed suddenly changed her wishes and beliefs and agreed with the decision to deny the diagnosis and treatment for Carbon Monoxide Exposure, Metoprolol Withdrawal Phenomena, Secondary Adrenal Insufficiency, Selective Serotonin Reuptake Inhibition Syndrome and the establishment of the starvation and dehydration process.

Lacrystal Ljt
reply icon Replying to comment of Lacrystal Ljt

To date unfortunately the Health Care Proxy with confirmed witness dates of 1/30/13 and 1/31/13 has not been provided. It is the insistence by a state agency that the Health Care Proxy Document in question was iin fact without question signed on 1/30/13 and 1/31/13 that has me concerned. I hope Mather Hospital will release this document.

Guest

How can a valid health care proxy be signed in witness on separate dates? How CAN the limitation be DNR? As a human being, any person who is a train healthcare provider does not want to see harm come to patients therefore, please make sure you take steps to protect yourself in future events by filling out state forms appropriately.

Lacrystal Ljt
reply icon Replying to comment of Guest-1530770

The real question is why misrepresent the witness dates when it was known that it was concealed from outside the hospital?

Guest

If a copy of a valid Health Care Proxy is not released to the legal representative it would be reasonable to suspect that it did not exist to be inserted in the record. This being a recent event, perhaps it is within a statute of limitation for some damages due to misrepresentation and misinformation dissemination.

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