Relates to orders not to resuscitate and decisions regarding life-sustaining treatment and hospice care

◆ The sponsor's argument

Why Samra Brouk says this is needed

These changes are necessary to address unnecessary complications in the law, ensure equal treatment for patients with terminal health conditions regardless of what type of hospital they are admitted to, and to imple- ment the recommendations of the New York Task Force on Life and Law Special Advisory Committee report from 2016. Current statutes do not enable the execution of MOLSTs or hospice election forms for patients of OMH facilities who lack capacity and do not have a properly empowered guardian or health care proxy to perform surrogate decision-making. Additionally, for OMH hospital patients for whom a MOLST has been executed while the patient was transferred to a DOH facility, there currently is no formal, legal mechanism for the transfer and continued applicability of these orders when the patient returns to the OMH hospital. Presently, the transferability of such orders depends on an interpretation that the legislature's intent in enacting the FHCDA was for such orders to transfer with an individual to any setting. However, because hospitals as defined in the Mental-Hygiene Law are not included in the provisions of the FHCDA regarding orders other than DNR and DNIs, it is unclear if all orders are transferable, or only the DNR or DNI. These changes will also ensure that individuals in hospital settings are treated equally, regardless of their health status, and with appropriate dignity when they are terminally ill and where lifesaving or life-sus- taining treatments would pose an extraordinary burden. For example, under the current legal framework, a common fact pattern emerges: a patient of a hospital operated or licensed by OMH is trans- ferred to a DOH licensed hospital for medical treatment and the hospi- tal, either in conjunction with a FHCDA surrogate or on their own accord pursuant to the FHCDA, determines that it is appropriate to execute a MOLST if the patient is terminally ill and the treatment would be an extraordinary burden. The MOLST includes orders not to resuscitate or intubate the patient and to provide comfort care measures only. The patient is stabilized and returned to the OMH hospital with these orders. Under applicable law, upon their return to the OMH hospital, since an OMH hospital cannot execute medical orders for life-sustaining treatment or other comfort care measures and the FHCDA does not provide for the transferability of the entire order to the OMH hospital, only the DNR and DNI orders may be continued at the facility. As a result, the OMH hospital may be required to provide life-sustaining treatments or transport the patient back to the DOH hospital for such treatment, even though this treatment may provide no benefit to the patient, because the OMH hospital cannot rely on the hospital order regardi ng comfort care. This cycle may occur multiple times before the patient can be transferred to hospice or passes away. This scenario presents both ethical and legal concerns for OMH staff who are faced with the decision to pursue medical treatments for patients at the end of their life. Lastly, the inability to OMH hospital staff to execute MOLSTs and hospice elections for qualifying patients, pursuant to the terms of the FHCDA which requires independent ethics review, makes it more challeng- ing for OMH hospitals to refer and transfer patients for palliative care services in more appropriate settings.

This is the sponsor's own case for the bill, quoted from their memorandum. It is not Agora's description of what the bill does.