Signing POA During a Hospital Stay at Mount Sinai or NYU Langone

Assessing Clinical Capacity and “Alert & Oriented” Status

Before any legal document can be signed in a clinical setting, the absolute prerequisite is the patient’s mental capacity․ In nursing terms, we document this as the patient’s “Alert and Oriented” (A&O) status․ For a Power of Attorney to be valid, the patient must understand what they are signing, the powers they are granting, and the consequences of that choice․

• The A&O x4 Standard: We assess if the patient knows Person (who they are), Place (where they are), Time (the date/year), and Situation (why they are hospitalized)․ If a patient is confused or delirious, a notary cannot proceed․
• Medication Timing: If the patient is receiving narcotics (like Morphine or Dilaudid) or sedatives (like Ativan), there is a window of impairment․ You must coordinate with the bedside nurse to schedule the signing when the patient is most lucid, ideally before the next dose of pain medication, not immediately after․
• Delirium Protocol: Elderly patients often suffer from “sundowning” or hospital-acquired delirium․ Signings should generally be attempted in the morning when cognition is typically highest․

The Strict “No Witness” Policy for Hospital Staff

Families are often surprised and frustrated when they ask a nurse or social worker to “just watch” a signature, and the request is denied․ This is not because the staff is unhelpful, but because of strict hospital risk management policies prevalent at major NYC systems․

• Conflict of Interest: Hospital employees provide care for which the hospital is paid․ If a POA is used to access funds to pay that hospital bill, an employee witnessing the document creates a conflict of interest․
• Union and Liability Rules: Most nursing unions and hospital legal departments strictly forbid staff from getting involved in patient legal affairs to prevent future litigation․ If the POA is contested later, the nurse could be subpoenaed, taking them away from patient care․
• The Solution: You must bring your own “disinterested” witnesses․ These cannot be people named in the POA (the agents) or people who stand to inherit from the patient․ Friends, neighbors, or colleagues are best․

Coordinating Mobile Notaries at NYU Langone and Mount Sinai

Since the hospital does not provide notary services for patients, you must utilize a “Mobile Notary Public․” NYC has many services specifically familiar with the logistics of navigating large hospital complexes․

• Security Clearance: Both Mount Sinai (on Fifth Ave) and NYU Langone (on First Ave) have stringent security․ The notary will need a valid government ID and may need to wait in line for a visitor pass․ Instruct the notary to arrive 30 minutes early․
• Unit Specifics: If the patient is in an ICU (Intensive Care Unit) or a specialized isolation room, the notary must adhere to PPE (Personal Protective Equipment) guidelines․ They may be required to wear a gown, gloves, and mask․
• Ombudsman Exception: In very rare cases involving long-term care placements or discharge disputes, a patient representative might be involved, but for standard financial POAs, the private mobile notary is the standard path․

Differentiation: Financial POA vs․ Health Care Proxy

It is vital to distinguish between the documents you are signing․ A General Power of Attorney handles finances (paying rent, accessing bank accounts), while a Health Care Proxy handles medical decisions․ The hospital is primarily concerned with the Health Care Proxy․

• The NY State Health Care Proxy: This document does not require a notary, only two witnesses․ Hospital staff can sometimes assist with facilitating this specific document because it relates directly to care, unlike the financial POA․
• The Statutory Short Form POA: This is the complex financial document requiring notarization․ It is governed by New York General Obligations Law․
• Resource: For the official Health Care Proxy form and information on patient rights, you can verify protocols via the NY State DOH (Department of Health)․

Overcoming Physical Limitations at the Bedside

Patients at Mount Sinai or NYU Langone may be physically weak, have IV lines in their dominant hand, or be recovering from strokes that affect motor control․ New York law provides mechanisms for this․

• Signature by Mark: If the patient can hold a pen but cannot write their full name, a mark (like an ‘X’) is valid if properly witnessed and notarized․
• Direction to Sign: If the patient cannot physically sign at all (e․g․, paralysis), they can verbally (or through communication boards) direct another person to sign for them․ This “proxy signer” signs the principal’s name in their presence․
• Preparation: Ensure the clipboard is sturdy and the pen is a felt-tip or easy-flow ballpoint, as patients often lack the grip strength for standard pens․

Post-Signing: Filing with Hospital Administration

Once the POA is signed, it is not automatically effective within the hospital system until it is registered with the appropriate departments․

• Patient Accounts/Billing: If you need to manage the patient’s hospital bills or discuss insurance issues, you must present the original or a certified copy of the POA to the Patient Accounts department․
• Medical Records: To access medical records (if the POA grants HIPAA powers), the document must be scanned into the Electronic Medical Record (EMR)․ Provide a copy to the Unit Clerk or Case Manager immediately․
• Social Work: Ensure the assigned Social Worker has a copy on file, as they will need to communicate with the agent regarding discharge planning to rehab facilities or home care․

Frequently Asked Questions