Ramona VNA & Hospice - Changing Lives, One Patient at a Time

Dr. Cochrane- Medical Director for Ramona VNA & Hospice treats Haitian Child

On Tuesday January 12th, a 7.0 magnitude earthquake hit Haiti near the capital city of Port au Prince. To date 212,000 people are estimated dead, with another 300,000 injured and over 1.2 million living in temporary shelters. On January 23rd I had the privilege of joining a medical team from my church and the Haiti Endowment Fund (www.haitiendowmentfund.org ); a Temecula based missions organization which has been ministering to the people of Haiti for over 25 years. Our team consisted of surgeons, an anesthesiologist, physicians, nurses, and a variety of construction and other support personnel. One of our biggest challenges was getting our team and over 40 cases of relief supplies from the States to the town of Hinche which is located about 40 miles north of Port au Prince.

Because the Port au Prince airport was only allowing military aircraft to land, we boarded a small charter plane from Ft. Lauderdale Florida and flew to Cap Haitien, a city on the North Coast of Haiti. From there we received a UN security escort and took a 4 hour trip over a rugged dirt road to reach the town of Hinche. Because many of the hospitals in Port au Prince were destroyed, thousands of patients evacuated to Hinche where the hospital was still standing. Once there we worked quickly to help as many people as possible. Some of our team provided much needed surgical care at the local hospital along with physical therapy and post operative wound care. I was able to help by seeing patients in various clinics set up at the mission compound as well as some of the outlying villages. Our team treated an estimated 2,000 patients while we were there in addition to securing 20,000 pounds of rice and beans for emergency food relief. When it was time to leave we were spared the bumpy dirt road thanks to an organization called Mission Aviation Fellowship ( www.maf.org ), who made several trips in a small plane which landed on the dirt runway in Hinche (after we chased the goats off the runway). I was sad to say goodbye to my new Haitian friends; but sense that I will be back again.

I would like to thank all the folks at Ramona VNA & Hospice and Hemet Hospice Volunteers for their whole hearted support. I would also encourage anyone interested in helping the earthquake victims in Haiti to consider supporting the above listed organizations, there is still much work to be done.

If you would like to submit a question please contact Jennifer Trebler at jtrebler@ramonavna.org.

Antibiotics for Colds?

Ask the Doctor
Leslee B. Cochrane, MD.
Medical Director

Ramona Visiting Nurse Association and Hospice

Question: I am having a cold that has lasted for over a week. I want to see my doctor and get an antibiotic so I can get better soon, what antibiotic would you suggest?

Don’t take antibiotics for colds because they won’t help. During the winter season, I see many patients with cold and flu symptoms who ask the same question and are convinced that they need an antibiotic to get better. Antibiotics are one of the wonders of modern medicine; but they must be used judiciously or patients run the risk of serious side-effects or worse yet, patients can develop drug resistant infections such as MRSA (methicillin resistant staph aureus); which can lead serious complications.

Where did I get this cold from?
Cold symptoms including fever, runny/stuffy nose, sore throat, and coughing are nearly always caused by a virus infection. When an infected person coughs or sneezes, small droplets of saliva and mucus containing the virus float through the air and ultimately land on doors, counters and other objects. When you touch these objects, some of the microscopic particles end up on your hands. Later when you rub your eyes, face or nose those particles infect you with symptoms usually beginning 2-3 days later. Because of this delay, it is often not possible to tell exactly where your cold came from.

Why won’t antibiotics help?
Although there are a few anti-viral medications that can slow down some of the more aggressive influenza viruses, there are no medications effective against most of the over 200 different viruses which cause the common cold. Antibiotics, which can help the body fight against bacteria such as strep throat, are completely powerless against viruses. When your body is infected with a virus, your immune system must make antibodies to attack the virus which is why the average cold lasts about 7 – 10 days.

What can I do for my cold?
Rest, and drink lots of fluids (you knew that was coming, didn’t you!). Regularly washing your hands will decrease your chances of catching a cold by 20% and people who get less than 7 hours sleep per night are 3 times more likely to catch a cold as well. My final advice, take two cookies and call me in the morning.

If you would like to submit a question please contact Jennifer Trebler at jtrebler@ramonavna.org.

Banks and the Proper Use of Powers of Attorney

LAW OFFICE OF GEORGE F. DICKERMAN

3879 Brockton Avenue
Riverside, California USA 92501
Tele: (951) 788-2156
Fax: (951) 788-0906

Elder Law Newsletter

A primary purpose in executing a power of attorney for financial matters, is to grant an “agent” (attorney-in-fact) the authority to conduct banking transactions if, and when, the elder (principal) is no longer able. However, sometimes a bank employee has a problem with recognizing the validity of the power of attorney. They hand the agent the bank’s own power of attorney form, and instruct the agent to have the elder’s signature notarized on it. Hmmm …

First, some clarification. Most powers of attorney are called “springing powers”. That term may not actually be included in the document itself, but the language of the document states that the power is effective only if the elder becomes mentally incapacitated and unable to make sound financial decisions. Most powers of attorney require the written declaration, under penalty of perjury, of at least one qualified medical doctor who states - for example: “The elder is my patient, she suffers from A, B, and C, and as a result, is no longer able to make sound financial decisions.”

The doctor’s declaration can then be stapled to the back of the power of attorney and has now “sprung” into being, so to speak.

Contrast that with a power of attorney that becomes effective immediately - without regard to incapacity (i.e., not a “springing power”). These should seldom be used. This immediate power of attorney may also state that, even if the elder becomes incapacitated, the authority will continue. This is known as a “durable” power of attorney.

Now back to the problem with the bank.

The purpose of the power of attorney was to have it executed by the elder while s/he still had the mental capacity to do so - that is, the ability to understand that by signing such a document, they were giving their financial authority to their agent in case of the elder’s subsequent incapacity. Now, when the elder is incapacitated, the bank says the original power of attorney is no good.

California Probate Code Section 4300, et seq., govern the use and authority of these financial powers of attorney. A third person (i.e., bank)must give an attorney-in-fact acting pursuant to a valid power of attorney the same rights and privileges that would be given the principal (elder) if the principal were personally present and able to act.

Of course, the bank wants to protect both itself and its elderly client from any improper use of the power of attorney by the agent. In so doing, the bank may first request that the agent provide proper identification, and even samples of signatures of both the agent and elder (principal) to confirm the identity of both. If the bank made this request, it would require that the agent locate other documents that contained the elder’s signature and present those to the bank as further evidence. The bank can also require the agent to provide the current and permanent residence addresses of the elder before agreeing to honor the power of attorney - and agree to transact any banking business with the agent.

The bank will not be held liable for relying, in good faith, upon the validity of a power of attorney so long as the following conditions are met:

1. The power of attorney is presented to the bank by the agent.

2. The power of attorney appears on its face to be valid.

3. The power of attorney includes a valid notary public’s certificate of acknowledgment or is signed by two witnesses.

If, after all this, the bank still refuses to honor the power of attorney, then the recourse is to petition the court and obtain an order that confirms the validity of the document and the agent’s authority.

Testamentary Capacity

George F. Dickerman, Esq.
3879 Brockton Avenue
Riverside, California, USA 92501
(951) 788-2156

Elder Law Newsletter

In California, anyone who is at least 18 years old and of sound mind can make a will. However, the term “sound mind” means having testamentary capacity, and the law describes this as being “mentally competent”.

Mental competency means that, at the time the will was signed, the “testator” (person signing the will) was able to do all of the following:

(1) Understand the nature of the testamentary act. That is, they knew that they were giving specific instructions on who their beneficiaries would be and what property (real or personal) the beneficiaries would receive.

(2) Understand and recollect the nature and situation of their property. Did they know what their estate consisted of? A house? A bank account? Some stock certificates? They need not know, for example, the actual bank account numbers, or even the total number of accounts they have. But they must know that they have bank accounts, and a general understanding of the assets that make up their estate at the time the will is signed.

(3) Understand who their close relatives are and how they will be affected by the will. If the person cannot remember that s/he is married, or has children, then the will is likely to be determined invalid, because only a mentally incompetent testator could have forgotten that such relationships existed.

(4) The testator must not suffer from a mental disorder. This includes hallucinations or delusions that result in the testator leaving property to individuals or entities that, absent any such delusions, s/he would never have done.

An example would be where the testator suffered from a delusion that he was being visited by ghosts every night and believed that the only way to stop the haunting would be to name a paranormal group (like the ghostbusters) as a major beneficiary to the will.

Other circumstances exist, however, that would allow a will to be made even though a person has been declared mentally incompetent.

In a conservatorship (http://www.elder-law-advocate.com/conservatorships) case, where the court has appointed a conservator, a will can be executed on behalf of the conservatee. However, for the will to be valid, the conservator would have to first petition the court and obtain a court order for such authorization.

From the above rules, you can see that testamentary capacity is not a high bar to hurdle. When issues such as hallucinations and delusions appear, then a will may be challenged through a procedure known as a will contest ( http://www.elder-law-advocate.com/wills/will-contests).