A signed medical Power of Attorney (POA) sits in your desk drawer, and you assume that's enough. But when your appointed agent arrives at the hospital to make decisions on your behalf, the staff refuses to honor the document. The very tool you created to protect your healthcare wishes has failed at the moment it matters most.
This scenario plays out in Texas and Arkansas hospitals more often than most people realize. Our team of Texarkana Estate Planning Lawyers has seen families scramble when healthcare providers reject Powers of Attorney that looked perfectly fine on paper but failed under real-world pressure.
Medical Powers of Attorney vs. Durable Powers of Attorney
A medical Power of Attorney (also called a healthcare Power of Attorney) authorizes your agent to make medical treatment decisions on your behalf when you cannot. A durable Power of Attorney, by contrast, grants authority over financial matters, like managing bank accounts, paying bills, handling real estate transactions, and making other financial decisions.
You need both documents for complete protection. Your medical agent cannot access your bank account to pay hospital bills, and your financial agent cannot authorize surgery or discuss treatment options with doctors.
Why Hospitals Reject Medical Powers of Attorney
Healthcare facilities turn away medical Powers of Attorney for surprisingly common reasons that have nothing to do with your agent's willingness to help.
Document Doesn't Meet State Requirements
Texas and Arkansas have different legal standards for medical Powers of Attorney. Under Texas Health & Safety Code § 166.154, a medical Power of Attorney must be signed in front of two qualified witnesses or acknowledged before a notary. At least one witness must not be:
- The agent themselves
- Related by blood or marriage to the principal
- An heir or otherwise entitled to any part of the principal's estate
- The attending physician
- An employee of the attending physician
- Certain employees or officers of a healthcare facility where the principal is a patient
- A person who has a claim against the principal's estate
The Arkansas Healthcare Decisions Act (§ 20-6-101 et seq.) governs healthcare Powers of Attorney in the state. An Arkansas healthcare POA must be either notarized or witnessed by two witnesses. Neither witness may be the agent, and at least one witness must not be related by blood, marriage, or adoption and must not be entitled to any part of the principal's estate.
Missing HIPAA Authorization Language
The Health Insurance Portability and Accountability Act (HIPAA) creates federal privacy protections that sometimes conflict with state-level POAs. Even if your agent has legal authority to make medical decisions, hospitals may refuse to share your medical information with them without explicit HIPAA authorization language in the document.
Healthcare Provider Questions Authenticity
Hospital staff aren't legal professionals, and they face liability concerns when accepting Powers of Attorney. If your document looks unusual, contains handwritten changes, or differs significantly from forms they regularly see, staff members may reject it out of an abundance of caution.
Important Medical Power of Attorney Considerations
The laws governing Powers of Attorney differ from state to state, though Texas and Arkansas share many similarities, too.
Out-of-State Documentation
Distinctions matter for families living near the Texas-Arkansas border. Both states generally recognize properly executed out-of-state advance directives if they substantially comply with local law, but healthcare providers may still question unfamiliar forms during emergencies.
Ross & Shoalmire, P.L.L.C. recommends that clients with connections to both states create documents that satisfy the requirements of both jurisdictions to eliminate any uncertainty when medical decisions can't wait.
When the Power Takes Effect
The default Texas statutory form makes the medical Power of Attorney effective when your physician certifies in writing that you lack the capacity to make healthcare decisions. By default, certification by one physician is sufficient.
You can customize this language, like requiring certification by two physicians, but adding such conditions may create practical challenges. If your document requires "certification by two physicians that I am incapacitated," but you arrive at a small rural hospital with only one doctor on duty, your agent may face delays while staff locate a second physician to provide certification.
Revocation Upon Divorce
Life changes can automatically revoke parts of your medical Power of Attorney without you realizing it. In both Texas and Arkansas, if you name your spouse as your agent and later divorce, that designation is automatically revoked unless the document provides otherwise.
However, automatic revocation doesn't mean healthcare providers will know about your divorce. You should still execute a new document immediately after any divorce to eliminate confusion.
Revocation for Other Reasons
You can also revoke your medical power of attorney at any time for any reason. Revocation is simple: notify your agent or healthcare provider orally or in writing that you're revoking the document. Written revocation provides the clearest evidence and should be delivered to anyone who has a copy of the original.
How to Create a Medical Power of Attorney That Works
The following steps will help you create a legal document that healthcare providers accept without hesitation when your family needs it most.
Use State-Specific Forms or Attorney-Drafted Documents
Both Texas and Arkansas provide statutory forms that healthcare facilities recognize and accept more readily than custom documents. Hospital staff see these statutory documents daily and know they meet legal requirements. Standard forms work well for straightforward situations, but families with specific religious beliefs, strong end-of-life preferences, or disability planning needs benefit from attorney-drafted documents.
Include Comprehensive HIPAA Authorization
Your medical Power of Attorney should specifically authorize your agent to:
- Receive all protected health information. This includes mental health records, substance abuse treatment records, HIV/AIDS test results, and genetic testing information.
- Communicate directly with healthcare providers. Your agent needs authority to discuss your condition with doctors, nurses, specialists, and facility administrators without staff having to verify each conversation's permissibility.
- Access and copy medical records. Your agent should have written authorization to obtain copies of all medical records, test results, imaging studies, and treatment plans.
Execute the Document Properly
Technical execution errors doom otherwise valid documents. The execution process should follow these steps:
- Verify witness eligibility before signing
- Gather all witnesses and the notary to be physically present while you sign
- Use blue ink for original signatures to make it obvious which copy is the original document
- Add notarization, even if not required, making hospitals more comfortable accepting the document
The Hospital Acceptance Checklist
What you do with that legally valid document after signing it determines whether it actually works during a medical crisis.
Make Multiple Originals and Distribute Strategically
One original document sitting in your safe deposit box doesn't help when you're unconscious in an emergency room. Create and distribute multiple fully executed originals to:
- Your primary care physician's office
- Your designated agent's possession
- Each hospital where you might receive care
- Your attorney's office
Arkansas law provides that copies of your medical Power of Attorney have the same legal effect as originals, which can simplify distribution in urgent situations.
Update Every Three to Five Years
Medical Powers of Attorney don't expire under Texas or Arkansas law, but aging documents raise questions about whether they still reflect your wishes. Even if nothing has changed, re-executing the same document with a current date eliminates any hospital concerns.
Communicate With Family Members
Hold a family meeting to discuss your document. Explain why you chose your specific agent, discuss your healthcare preferences and end-of-life wishes, and identify where original documents are located. Family members who understand your wishes can support your agent rather than second-guessing decisions during stressful moments.
When Your Medical Power of Attorney Doesn't Work
Even properly executed documents sometimes face challenges at healthcare facilities. Knowing your legal options before a crisis prevents delays that could affect critical medical decisions.
Emergency Guardianship
If a healthcare facility won't accept your Power of Attorney, and medical decisions can't wait, your family may need to petition for emergency guardianship. Texas courts can appoint temporary guardians within 24 hours when someone faces immediate and substantial harm. Arkansas contains similar emergency provisions.
Hospital Ethics Committee Review
Most hospitals maintain ethics committees that resolve disputes about patient care, including disagreements about whether to honor Powers of Attorney. When hospital staff refuse to accept your document, your agent can request a review by the ethics committee. These committees typically include physicians, nurses, social workers, and patient advocates who issue recommendations about whether the document should be honored.
Work With an Experienced Elder Law Attorney
Generic online forms might cost less upfront, but they frequently fail when tested in real-world medical situations. An experienced attorney brings knowledge of state-specific requirements, healthcare facility practices, and potential legal challenges that generic documents don't address.
Ross & Shoalmire, P.L.L.C. approaches medical Powers of Attorney as part of comprehensive Estate Planning rather than standalone documents. Your lawyer will review your current health status, discuss your healthcare preferences in detail, evaluate potential agents, and address coordination with other Estate Planning documents like your will, durable (financial) power of attorney, and living will.
For families anticipating long-term care needs, your medical Power of Attorney should integrate with Medicaid Planning and Asset Protection strategies. If you're the parent of a disabled adult child, your document needs provisions that protect your child's government benefits through Special Needs Trust Planning.
