Dear Lou,

Goodness, this is a strange thing. No, I did not write the note
and did not place it in Don's chart.

Perhaps some of the legalities and rules of medical chart keeping
can help us figure this out. These legalities/ rules are constant
for all hospitals.

A chart is maintained and compiled only by employees of the
institution who have responsibility for the patient's care. Being
that a chart is a legal document, access to it is restricted. No
one is allowed to write into it directly unless they are a
professional employee of the health care institution that is
caring for the patient.  Those who could write into Don's chart
would be any of his therapists, his social worker or placement
worker,the  physicians who are directly responsible for his care
or any medical consultants brought in by those physicians. A
doctor must be either on staff, or have attending priviledges in
order to write into a chart.  (For example: I could not go into a
hospital and write in a patient's chart even if I had been caring
for the patient before he was hospitalized unless I had been
"vetted" by that hospital and awarded attending priviledges
for that hospital. If I do not have attending priviledges,
a doctor who does has priviledges assumes full responsibility
for my patient's care while he is hospitalized.)

Also, no one other than a professional employee of a hospital can
add anything to a chart. So we know that whoever wrote the note,
it was put into the chart by someone who worked at Kentfield.

On occasion, a letter written by a family member might be put in
a chart by an employee, but that letter must be a complete legal
document....ie it must be signed and dated. It is not common for a
letter from a family member or friend to be included in the chart
but could happen.  Usually the employee who inserts the letter
will write a dated note directly into the chart itself stating:
Mr Jones' wife sent this letter and asked that it be included in
Mr Jones' chart and then sign this explanatory note themselves.
Most commonly, letters that are included in the chart come from
the doctors who have cared for the patient in the past and have
written their conclusions on their letterhead or are summary
letters from doctors at other hospitals who have referred the
patient. All these are of course legal documents and are signed
and dated.

So it is very odd for an unsigned, undated note to be in a
patient's chart.

Is this note written on a separate piece of paper? Or is it one
of a series of chart notes written day after day directly into
the chart on a the same piece of paper as other chart notes. If
it is written on the same piece of paper as other chart notes it
would be highly unlikely that anyone who was not an employee of
Kentfield would have written it and it could have been written
by any of Don's doctors or his social workers or therapists.
If it is on a separate piece of paper and not signed, I would
think that only a hospital employee would have written it as an
unsigned piece of paper written by someone not employed by the
hospital has not legal validity at all.

I do not recall Kentfield's policy for the sharing of patient
information .......in many hospitals only immediate family
(brothers, sisters, children), married couples or those who
have legal guardianship are told the diagnosis or prognosis
of the patient or the results of tests and this usually done
only by the physician(s) who have direct care of the patient.
Friends are only told how the patient is doing that day (patient
status)...i.e. he is awake, he had a good day, he is not aware of
people around him, he is in the recovery room and the like. If
this is the case at Kentfield, the note suggests to me that it
was written by a hospital employee to remind other employees of
the specific hospital policy on the sharing of information.

I seem to remember that Kentfield was quite stiff about sharing
information. I recall that information was only shared with me
by Dr.	Doherty (who shared what the therapists had concluded
in  their weekly meeting on Don's progress) after she had seen
for herself the signed paper documenting that I had legal power
of attorney.

So, a very strange thing....I hope some of this information is
helpful in figuring this out.

Blessings,
RACHEL