I agree - I think you did well to 'hold your tongue' - as it was happening - but I think the only way to combat such ignorance (or paranoia on the part of the head/director of the facility [not following through on GP's orders, problem with patient, retirement facility held liable for his further illness or death]) is to lodge a formal complaint about the situation. You have the knowledge and the experience to liaise with the patient and to discern whether or not he needs to be treated by A&E - clearly there is some serious mismanagement and a worrying lack of education/information within the training of the staff... If this were my grandfather/father/otherwise, I would be relieved to know that someone like you was more concerned with his health and well-being than following the orders of an absent GP! I probably would've wanted to give her an earful too - very difficult to maintain one's composure in situations like that! Good on you!