Public Health Committee

JOINT FAVORABLE REPORT

Bill No.:

SB-938

Title:

AN ACT CONCERNING THE DEPARTMENT OF PUBLIC HEALTH'S RECOMMENDATIONS FOR THE STATE-WIDE ADOPTION OF THE MEDICAL ORDERS FOR LIFE-SUSTAINING TREATMENT PROGRAM.

Vote Date:

3/24/2017

Vote Action:

Joint Favorable Substitute

PH Date:

3/20/2017

File No.:

SPONSORS OF BILL:

Public Health Committee

REASONS FOR BILL:

Currently, DPH is operating a “medical orders for life-sustaining treatment” (MOLST) pilot program. This bill requires DPH to establish such a program state-wide.

MOLST is a voluntary program. A MOLST is a written order by a physician, APRN, or PA that records a patient's treatment preferences when the patient is approaching the end of life or is in a condition of advanced, chronic progressive frailty.

The bill also:

1. establishes, within available appropriations, a MOLST advisory council to make recommendations to the DPH commissioner and

2. allows the commissioner to adopt regulations on various matters to implement the MOLST program, such as ensuring that (a) MOLST documents are transferrable and recognized by various types of health care institutions and (b) any procedures and forms for the program require the signature of the patient or the patient's authorized representative and a witness.

RESPONSE FROM ADMINISTRATION/AGENCY:

Raul Pino, Commissioner, Connecticut Department of Public Health:

Dr. Pino testified that he supports the bill, stating that a statewide adoption of the use of MOLST, which is a volunteer program, would help improve the quality of care for patients who are very ill or frail by documenting and honoring patient medical treatment wishes through portable medical orders. MOLST documents prevent confusion and suffering by accompanying the patient wherever they go, making it easier for providers to know that person's preferences.

NATURE AND SOURCES OF SUPPORT:

Michelle Lee Beltrano, J.D., Attorney, Beltrano Law LLC:

Ms. Beltrano supported the bill, saying that it allows those individuals who are approaching the end of their life to independently make decisions about their treatment wishes. A statewide MOLST program will serve as a voluntary planning tool providing Connecticut residents with the best legal tools available to communicate their end of life care wishes.

Connecticut Hospital Association:

The Connecticut Hospital Association (CHA) supports the bill, saying that the MOLST program ensures that seriously ill patients get the treatment they want and avoid treatment they do not want. The CHA added that they would amend the language of the bill to make it clear that the MOLST program must accommodate federal ordering, prescribing and referral laws under programs like Medicare. CHA also said they would add language to ensure clarity with respect to the impact of a statewide MOLST program on healthcare providers. Third, CHA recommended adding language to achieve greater clarity between MOLST orders and other existing measures. Lastly, CHA recommended that the committee clarify the definitions of “health care provider” and “legally authorized representative.”

James D. McGaughey:

Mr. McGaughey, who served on the task force which developed the proposal for the MOLST program, testified in support of the bill, stating that expanding the program statewide will improve communications between medical practitioners and those nearing the end of their lives. He added that the Department of Public Health should be required to adopt the safeguards listed in section 2(b) and that the definition of “legally authorized representative” should be clarified and tightened so that the terms “parent” and “guardian,” as currently defined, cannot be used to circumvent safeguards.

Christina Morrissey, Co-Chair, Health Policy Committee, CT APRN Society:

Ms. Morrissey supports the bill, stating that the MOLST program provides standardized, easy to understand documents for healthcare providers to follow regarding patients end of life wishes. She also supports the updated language that allows APRNs to sign MOLST orders. Ms. Morrissey recommended that section 1 be amended with respect to the word “physician,” so as not to cause confusion if an APRN signs a MOLST document, which is permitted by law.

Elizabeth Visone, Member, DPH MOLST Committee:

Ms. Visone, a nurse practitioner and member of the Department of Public Health's MOLST committee, testified in support of the bill, citing a case in which she was able to accommodate a patient's end of life wishes through the MOLST pilot program. She added that she fully supports statewide implementation of the program.

Anthony J. Visone Jr., Member, MOLST Education Subcommittee:

Mr. Visone supported the bill by sharing the story of his father, who made a number of trips to the emergency room towards the end of his life. Mr. Visone was the one to initiate the conversation when he felt Hospice was appropriate, and he believes that had they used MOLST, he and his father could have saved multiple trips to the emergency room and hospital. Through his experiences, he believes MOLST helps families and medical teams have much needed conversations about end of life care.

The following people affiliated with Second Thoughts Connecticut testified in support of the bill saying that the MOLST program has key protections that other states do not have in similar programs. They added that they would amend the bill in a few ways: 1) imposing criminal penalties for forgery or unilateral medical provider completion of MOLST documents; 2) requiring out of state forms to comply with Connecticut's standards; 3) tightening the definition of “legally authorized representative” ; and 4) prohibiting the pre-ordering of lethal prescriptions.

Stephen Mendelsohn, Second Thoughts Connecticut

Catherine D. Ludlum, Second Thoughts Connecticut

NATURE AND SOURCES OF OPPOSITION:

None

Reported by: Geoff Simpson, Assistant Clerk

Date: 3/30/17