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Guardianship (1.2.12)

Guardianship (1.2.12) - Policies, Clinical, UW Health Clinical, Administrative, Legally Driven Care

1.2.12


UW HEALTH CLINICAL POLICY 1
Policy Title: Guardianship
Policy Number: 1.2.12
Category: UW Health
Type: Inpatient
Effective Date: May 26, 2017

I. PURPOSE

To provide information and guidelines for UW Health staff and providers on guardianship of patients.

II. POLICY ELEMENTS

UW Health will petition for guardianship and protective placement in cases where the Legal Department
determines that it is necessary for decision making concerning treatment or to discharge a patient from UW
Health facilities when those with primary responsibility (patient's family or responsible county) do not have
the ability to initiate the process.

III. PROCEDURE

A. Guardianships are appropriate for patients who lack decision making capacity either because the patient is a
minor or because of an impairment (due to developmental disability, serious and persistent mental illness,
degenerative brain disorder, or other line incapacities) rendering the patient unable to make or communicate
decisions, or care for themselves, and:
i. Staff requires a decision-maker to proceed with recommended treatment options;
ii. The patient needs to be discharged to a nursing home or other restrictive environment (called
"protective placement") and there is not a valid, activated power of attorney that authorizes the
health care agent to consent to the admission; or
iii. The patient is a minor and the parents are absent or may be making decisions contrary to the best
interest of the child.
B. Contact the patient’s social worker to initiate the guardianship proceedings. Whenever possible, next of kin
or the department of human services located in the county where the patient resides should be responsible
for initiating guardianship and protective placement. Hospital social workers can assist in identifying
resources. When other resources are not available, the Legal Department should be contacted to assist with
the initiation of a petition for guardianship and protective placement on behalf of the patient.
C. Guardianship proceedings are not normally initiated for those who are mentally ill. If a patient is acutely
mentally ill, refer to UW Health clinical policy #1.2.1, Emergency Detention-State Mental Health Act.
Guardianship may later be determined to be appropriate, but it is not the usual first step. Where the primary
diagnosis and treatment of the patient will be for mental illness, the mental health process should be elected.
Where there is a request/decision to transfer such a patient to the Inpatient Psychiatric unit, the patient him
or herself must give informed consent to admission to the Inpatient Psychiatric unit (UW Health clinical
policy #3.1.2, Adult Patient Acknowledgement of Voluntary Inpatient Psychiatric Admission and Alternative
Procedures) or the patient must be admitted following the filing of a Statement of Emergency Detention (UW
Health clinical policy #1.2.1, Emergency Detention-State Mental Health Act). Neither a patient's guardian,
nor the patient's next of kin, can give consent to admission to the Inpatient Psychiatric unit.
D. Follow UWHC policy #4.17, Informed Consent, to identify a decision-maker for patients who lack decision
making capacity and do not have a guardian. The attending physician should consult with legal counsel
where there are questions about the appointment of a guardian to consent to necessary medical treatment.
E. In an emergency involving risk of death or serious injury, consent is presumed (unless there is a contrary
advance directive), and delay to obtain the appointment of a guardian is not appropriate. See UWHC policy
#4.17, Informed Consent.
F. Wisconsin law restricts the authority of court-appointed guardians to limit life-sustaining treatment in the
absence of a prior written or oral statement from the patient that clearly demonstrates that the patient would
have supported the limits on treatment. In the absence of such statements it is recommended that the Ethics
Committee or the Attorney-on-Call should be consulted on these issues. When there is disagreement among
caregivers and/or family as to the decision to limit life-sustaining treatment, a consult with the Hospital Ethics
Committee and/or Legal Counsel is required (see UWHC policy #8.25, Guidelines for Decisions to Limit Life-
Sustaining Medical Treatment).
G. The Circuit Court, Juvenile Judge can assume jurisdiction over children (under 18) who are alleged to be
neglected because parents fail or refuse to allow or to provide needed medical care. For assistance contact
Risk Management or the Attorney-on-Call and refer to UW Health clinical policy #1.2.4, Suspected Child



UW HEALTH CLINICAL POLICY 2
Policy Title: Guardianship
Policy Number: 1.2.12

Abuse and Neglect.

IV. COORDINATION

Author: Manager, Social Work and Spiritual Care
Senior Management Sponsor: SVP/Chief Nurse Executive
Reviewers: Director, Patient Relations; UW Health Legal Department
Approval committees: UW Health Clinical Policy Committee
UW Health Clinical Policy Committee Approval: May 15, 2017

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospitals and Clinics
and the University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs
administered by the University of Wisconsin School of Medicine and Public Health. Each entity is
responsible for enforcement of this policy in relation to the facilities and programs that it operates.

V. APPROVAL

Peter Newcomer, MD
Chief Clinical Officer

J.Scott McMurray, MD
Chair, UW Health Clinical Policy Committee

VI. REFERENCES

Wisconsin Statutes, Chapter 54, et seq. (Guardianship)
Wisconsin Statutes, Chapter 55, et seq. (Protective Placement)
UWHC policy #4.17, Informed Consent
UW Health clinical policy #3.1.2, Adult Patient Acknowledgement of Voluntary Inpatient Psychiatric
Admission and Alternative Procedures
UW Health clinical policy #1.2.1, Emergency Detention -State Mental Health Act
UWHC policy #8.25, Guidelines for Decisions to Limit Life-Sustaining Medical Treatment
UW Health clinical policy #1.2.4, Suspected Child Abuse and Neglect

VII. REVIEW DETAILS

Version: Revision
Last Full Review: May 26, 2017
Next Revision Due: May 2020
Formerly Known as: Hospital Administrative policy #4.18