OLR Bill Analysis
sSB 938 (File 615, as amended by Senate "A")*
AN ACT CONCERNING THE DEPARTMENT OF PUBLIC HEALTH'S RECOMMENDATIONS FOR THE STATE-WIDE ADOPTION OF THE MEDICAL ORDERS FOR LIFE-SUSTAINING TREATMENT PROGRAM.
By law, the Department of Public Health (DPH) currently operates a “medical orders for life-sustaining treatment” (MOLST) pilot program, scheduled to end in October 2017. This bill requires DPH to establish a statewide program. As under the pilot program, patient participation must be voluntary.
The bill requires the commissioner to adopt regulations on various matters to implement the statewide program, such as ensuring that (1) MOLST orders are transferrable and recognized by various types of health care institutions and (2) authorized providers intending to write these orders receive training on specified matters.
The bill also establishes, within available appropriations, a MOLST advisory council to make recommendations to the DPH commissioner.
Under the bill, a MOLST is a medical order written by a physician, advanced practice registered nurse (APRN), or physician assistant (PA) to effectuate a patient's request for life-sustaining treatment when a physician or APRN has determined the patient is approaching the end stage of a serious, life-limiting illness or is in a condition of advanced, chronic progressive frailty.
*Senate Amendment “A” (1) requires, rather than authorizes, the commissioner to adopt regulations; (2) makes minor and clarifying changes to certain topics to be addressed in the regulations; and (3) narrows the bill's definition of “health care provider.”
EFFECTIVE DATE: October 1, 2017
STATEWIDE MOLST PROGRAM
The bill requires the DPH commissioner to establish a statewide program to implement the use of MOLST by health care providers. To agree to participate, the patient or the patient's legally authorized representative and a witness must sign the MOLST form. A “legally authorized representative” is a minor patient's parent, a guardian appointed by the probate court, or a health care representative appointed under law.
The bill requires the DPH commissioner to adopt regulations for the MOLST program to ensure that:
1. the orders are transferrable among and recognized by various types of health care institutions, subject to any limitations in federal law;
2. any procedures and forms developed for recording such orders require the signature of the patient or the patient's legally authorized representative and a witness, and the patient or representative is given the original order immediately after signing it and a copy is immediately placed in the patient's medical record; and
3. before a physician, APRN, or PA asks for the patient's or representative's signature on a MOLST order, he or she discusses with the patient or representative the patient's goals for care and treatment and the benefits and risks of various ways to document the patient's wishes for end-of-life treatment, including MOLST.
In addition, the bill requires regulations to ensure that each physician, APRN, or PA who intends to write a MOLST receives training on:
1. the importance of talking with patients about their personal treatment goals;
2. methods for presenting choices for end-of-life care that elicit information on patients' preferences and respect those preferences without directing patients toward a particular option;
3. the importance of fully informing patients about the benefits and risks of a MOLST that takes effect immediately;
4. awareness of factors that may affect the use of MOLST, including advance health care directives, race, ethnicity, age, gender, socioeconomic position, immigrant status, sexual minority status, language, disability, homelessness, mental illness, and geographic area of residence; and
5. procedures for properly completing and effectuating a MOLST.
The bill allows the DPH commissioner to implement policies and procedures needed to administer the bill until regulations are adopted.
Department of Developmental Services
The bill specifies that its provisions do not limit the existing authority of the Department of Developmental Services (DDS) commissioner as to certain medical orders for individuals receiving services under his direction. This law provides that the DDS commissioner (1) can make treatment decisions for such individuals only in limited circumstances and (2) may not seek to impede a properly executed medical order to withhold cardiopulmonary resuscitation under specified conditions (CGS § 17a-238(g)).
§ 2 — MOLST ADVISORY COUNCIL
The bill establishes a MOLST advisory council, within available appropriations, to advise the DPH commissioner on the program. The council must meet at least once a year to receive updates on the status of the program and advise DPH on possible ways to improve it.
The DPH commissioner must appoint the council members by January 1, 2018. The membership must consist of:
1. a public health practitioner;
2. two physicians, including one emergency department physician;
3. an APRN;
4. a PA;
5. an emergency medical service provider;
6. two patient advocates, including one advocate for persons with disabilities;
7. a hospital representative;
8. a long-term care facility representative; and
9. any person or a representative from any other organization who the commissioner determines is familiar with MOLST issues.
Public Health Committee
Joint Favorable Substitute