Health Care Proxies and Advance Directives help Doctors in critical care of patients

The New Jersey Department of Health issued a comprehensive statement concerning triage and the care of COVID-19 patients in different kinds of licensed health care facilities. This is one among many directives issued in the past six weeks. Read the directive here: FinalAllocationPolicy4.11.20v2

As the patient is being treated, many decisions need to be made along the way, often in rapid-fire fashion. The patient may not be able to communicate or make decisions. It is very important that patients or potential patients have a signed Advance Directive, or Health Care Power of Attorney (proxy) so that if the patient loses his or her capacity to make medical decisions, they have an authorized person who can communicate with the medical professionals as critical decisions need to be made. Certain treatment will be rendered automatically as a response to the patient’s emergency, but in areas where choices and decisions need to be made, it’s vital that there be a designated person. A well-written advance directive will be explicit and reasonably easy to interpret. Whenever possible, naming several back-ups to the primary Health Care Representative (decision-maker) is preferable because if the primary person cannot be reached or has become ill, having a backup to make a crucial decision is vital. If the patient is incapacitated, it would be their representative who has the discussions with the doctor or nurse pertaining to filling out the POLST formPhysician’s Orders Concerning Life Sustaining treatment — which is now a regular part of hospital practice..

We will continue to monitor developments that affect the delivery of crucial health care to our clients If you have concerns or a problem, call for a telephone consultation with one of our attorneys…. 732-382-6070

Governor Christie vetoes bill allowing Medicaid payment for end-of-life counselling

Governor Chris Christie has vetoed A-4233/ S-2435 , which means that NJ doctors treating Medicaid can’t get paid for counselling their patients on end of life planning. Perhaps he’s pandering to the absurd claims made in the 2008 Presidential election that by paying doctors to assist their patients to understand the treatment alternatives and choices about foregoing treatment at the end of life, the government would be running “death panels.” Given that he signed the POLST law in 2011, this decision is inconsistent with what the state evidently wants.

New Jersey adopted the Advance Directives law back in 1991. Under the law — N.J.S.A. 26:2H-53 to 78 –, any person who has capacity can write up a statement of their wishes with respect to the use of life supports. The document was called a “Living Will” because it speaks for the person after they lose capacity to express their wishes. Essentially, these documents say that if the patient is mentally incapacitated AND is terminally ill, has severe and irreversible brain damage or is close to death, AND suffers a life-threatening condition (such as kidney failure, inability to swallow, respiratory failure) whereby their life can only be sustained by the use of artificial or mechanical means, THEN the person does not want those mechanisms to be used since they will prolong life but will not solve the underlying chronic condition.advance_directives

I have to say that the vast majority of my clients tell me that if they were at a stage of life that they no longer had capacity and were already terribly debilitated, they would not want their health care agents to initiate the use of such life support if one of their vital systems failed. I counsel clients on these issues all the time, and answer questions from their agents about just what a certain health care document means. Wouldn’t it be sensible to enable them to discuss these issues with their physician as well?

Medical visits are unfortunately getting shorter and shorter. A meaningful discussion of advance directives can’t happen within the ten or fifteen minutes often allocated to an annual checkup. Why would the Governor have disallowed payment to the doctor for an extended or special visit to help the patient understand these issues? The state’s fiscal estimate showed a truly negligible cost to the state, with full federal reimbursement likely.

Call us for advice and representation concerning advance directives and elder care … 732-382-6070