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Who will SIL listen to about meds? She needs to hear from someone she trusts that the meds prescribed are for her mom's health and needn't be held or changed.
Also, find out from the cardiologist what % your MIL is using the pacemaker. For example, my Father's pacemaker is used 97% of the time to make his heart beat according to his tests. If we didn't change his battery, it would be an instant death sentence. If that doesn't convince wife's sister, then another 3-way appointment with the Cardiologist is in order to discuss this issue.
Blessings for all that you do.
Jamie
I will say that I don't think the sister should be involved at all in medication management. Is this something you or your wife could take over, to "relieve" the sister of that obligation? Any way you can think of to get her out of the medication mismanagement aspect?
As to the pacer battery, they obviously have limited life, which a cardiologist can check. If the battery needs replacement and is not, well, it's going to reach the point that it's not effective. And that defeats the purpose of having a pacer if the battery isn't operating it.
Depending on her % reliance on the pacer, she could suffer a fatal cardiac event. The daughter who's meddling in this issue could conceivably be blamed. I don't know enough about your MIL's other needs, cardiac dysfunction, and % reliance on the pacemaker to predict this (that's a cardiologist's province) but I think there might be some consideration of elder abuse or criminal negligence.
Do you think a very frank talk by the cardiologist with your MIL and the mismanaging daughter would bring some medical and common sense to the issue?
I would think a cardiologist should know about the pacer battery issue, and one of your MIL's doctors should be informed about the medication mismanagement issue. They would probably document their files, as I assume they don't want to be accused of malpractice in the event of a negative reaction or inaction.