MOLST

The Medical Orders for Life-Sustaining Treatment (MOLST) program is designed to improve the quality of care seriously ill people receive at the end of life. MOLST is based on the patient’s current health status, prognosis, and goals for care. The discussion emphasizes shared medical decision-making that helps the patient understand what can and cannot be accomplished. The result is a set of medical orders that must be honored by all health care professionals in all settings. MOLST is not an advance directive. MOLST is New York’s endorsed National POLST Paradigm Program.

New York State Public Health Law was amended to allow the Commissioner of NYSDOH to approve an alternate form (MOLST) to be used statewide and in all settings, including non-hospital (community) settings. MOLST is the alternate form approved by the Commissioner of NYSDOH. EMS can now honor DNR and DNI orders on MOLST forms statewide. The MOLST form is the only tool for non-hospital DNI orders in New York State.

Development and Legislative History

2001 – The Community-Wide End-of-Life / Palliative Care Initiative (the Initiative) is formed in Rochester, NY through the leadership of Excellus BlueCross BlueShield. Membership is comprised of leaders from the community in the fields of medicine, nursing, religion and law.

2003 – The first New York State MOLST Form is created in Rochester by the Initiative.

2004 – Discussions about MOLST began with NYSDOH. As a result of deliberations with NYSDOH, it was established that legislative action would be needed for NYSDOH to allow a community MOLST pilot project that permitted use of the MOLST in lieu of the NYS Non-hospital DNR form.

2005 – New York State’s legislature and Governor George Pataki authorize a pilot to study MOLST usage in lieu of the 1987 Non-Hospital DNR in Monroe and Onondaga Counties. MOLST Pilot Project Legislation (A.8892) was passed in June 2005.  The Governor signed the bill on October 11, 2005 with a carve-out for Office of Mental Health (OMH) and Office of Mental Retardation and Developmental Disabilities (OMRDD).   The MOLST Community Pilot formally began on October 11, 2005.

2006 – MOLST is approved for use by the New York State Department of Health in all hospitals and nursing homes.  A Dear Administrator Letter (DAL) is issued January 17, 2006.

On July 26, 2006 the legislature and Governor Pataki authorized a Chapter Amendment to allow Emergency Medical Services (EMS) to honor “Do Not Intubate” (DNI) orders on the MOLST form in Monroe and Onondaga counties as part of the MOLST Community Pilot. MOLST provides the first legal non-hospital DNI order in New York State in these counties.

The Surrogate Court’s Procedure Act Article 17-A, sub-section 1750-b, was updated to allow guardians of individuals with Developmental Disabilities to make end-of-life decisions for these individuals.

2008 – The MOLST Pilot successfully ends. The New York State Legislature and Governor David Paterson amend NYS Public Health Law to allow MOLST to be used statewide and in all settings, including non-hospital (community) settings. EMS can now honor DNR and DNI orders on MOLST forms statewide. The MOLST form is the only tool for non-hospital DNI orders in New York State.

2010 – Family Health Care Decisions Act (FHCDA) is passed by the Legislature and signed by Governor Paterson, creating surrogacy laws in NYS. FHCDA is based on the 1992 Task Force report. FHCDA applies in hospitals and nursing homes only. MOLST becomes a NYSDOH Form (Form DOH-5003).

2011 – FHCDA is updated to include hospice

2017 – FHCDA is updated to allow “attending nurse practitioners” to act the same as “attending physicians” can when they are withholding/withdrawing life-sustaining treatment under the legal pathways that are governed by FHCDA. This will go into effect on May 28, 2018.