Compassion and Support
Legislative Update

eMOLST Registry S7883/A10644
Legislation surrounding an eMOLST registry was introduced into the New York State Senate by Senator Rich Funke and Assembly by Assemblyman Joseph Morelle. It was brought to the Health Committees of both the Senate and the House, but did not pass during the 2016 legislative session. Bill S7883 (Funke)/A10644 (Morelle) would make changes to public health law, so that the words “Medical Orders for Life Sustaining Treatment (MOLST)” would exist in PHL. The bill also establishes an eMOLST registry. This registry would require practitioners who complete a MOLST form to submit to the eMOLST registry within 14 days. Efforts will resume in the 2017 legislative session.

Nurse Practitioner (NP) S6314/A09859
Bill S6314/A09859 passed the Senate but was referred to the Assembly Higher Education Committee. Since it never moved beyond this Committee, it was not brought to the Assembly for a vote. Both the Assembly and Senate need to pass the bill before it is brought to the Governor for signature. This NP bill was helpful in changing the processes needing change – far beyond merely having an NP sign a MOLST. Thus, NYSPHL remains unchanged and no change can be made to the NYSDOH MOLST Checklists as part of the MOLST process or eMOLST. Efforts will resume in the 2017 legislative session.

New York State Task Force on Life and the Law Recommendations
The Family Health Care Decisions Act (FHCDA) became law in New York on March 16, 2010. FHCDA amended public health law, the mental hygiene law and the surrogate’s court procedure act, in relation to establishing procedures for making medical treatment decisions on behalf of persons who lack the capacity to decide about treatment for themselves and realed certain provisions of the public health law and the mental hygiene law. FHCDA also directed the New York State Task Force on Life and the Law (Task Force) to form a special advisory committee to consider whether the FHCDA should be amended:

1. to incorporate procedures, standards and practices for decisions about the withdrawal or withholding of life-sustaining treatment from patients with mental illness or mental retardation or developmental disabilities, and from patients residing in mental health facilities.

2. to apply to health care decisions in settings other than general hospitals and residential health care facilities.

The Task Force completed its work and released its report, “Recommendations for Amending the Family Health Care Decisions Act to Include Health Care Decisions for Persons with Developmental Disabilities and Patients in or Transferred from Mental Health Facilities.” The MOLST Statewide Implementation Team Executive Committee is reviewing the report.

Featured Resource: Demonstrating The 8-Step MOLST Protocol

The video Thoughtful MOLST Discussions: Hospital and Hospice Settings illustrates a compassionate physician guiding a family through the MOLST process using the 8-Step MOLST Protocol. After completion of the process and the MOLST form, care planning and caregiver education are essential.

MOLST FAQ: How is a MOLST Form Completed?

Completion of the MOLST begins with a conversation or a series of conversations between the patient, the health care agent or the surrogate, and a qualified, trained health care professional that defines the patient’s goals for care, reviews possible treatment options on the entire MOLST form, and ensures shared, informed medical decision-making. Follow the 8-Step MOLST Protocol. The conversation must be documented in the medical record. Although the conversation(s) may be initiated by any qualified and trained health care professional, a licensed physician must always, at a minimum: (i) confer with the patient and/or the patient’s health care agent or surrogate about the patient’s diagnosis, prognosis, goals for care, treatment preferences, and consent by the appropriate decision-maker, and (ii) sign orders derived from the discussion. See MOLST General Instructions & Glossary.

eMOLST Champion:
New York – Reducing Avoidable Hospitalizations

The New York–Reducing Avoidable Hospitalizations (NY–RAH) project introduced the MOLST form as a means of uniformly documenting advance directives during palliative care counseling or care planning meetings. The project has seen the percent of NY–RAH residents with a Medical Orders for Life-Sustaining Treatment (MOLST) form has increased from 11% in 2014 to 37% in 2016.

Sponsored by GNYHA Foundation and the Icahn School of Medicine at Mount Sinai, NY–RAH works with nursing facilities to implement interventions to reduce avoidable hospitalizations. It is one of seven demonstration projects across the country under the Centers for Medicare & Medicaid (CMS) Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents. Twenty-four of the 29 nursing facilities in New York City and Long Island that are part of the NY–RAH project have implemented the MOLST form since July 2014 when it was first introduced.

To promote MOLST forms throughout the nursing facilities, NY–RAH has designated palliative care “champions” at each site. Patricia Bomba, MD, has lead trainings on the MOLST form along with NY–RAH Medical and Palliative Care Director, Joseph Sacco, MD. The NY–RAH project management team and the RN Care Coordinators at each participating facility continue to emphasize to facility staff the importance of completing the MOLST form in its entirety as well as promoting the benefits of the eMOLST system into existing workflows.

The MOLST rate exemplifies NY–RAH facilities’ progress with documenting advance directives and implementing a valuable intervention which can be honored across care settings.

Dr. Bomba, eMOLST Program Director adds, “As a result of our collaborative partnership, nursing homes are beginning to implement These nursing homes will be featured in future editions.”

Lessons Learned in South Korea

By Patricia A. Bomba, MD, FACP
VP & Medical Director, Geriatrics, Excellus BlueCross BlueShield

As follow-up to the visit by the Korean delegation as described in the June NY MOLST Update, I was privileged to travel to South Korea. In addition to the formal presentations, breakfast, lunch and dinner meetings afforded the opportunity to meet colleagues from across the globe. I was able to strengthen my relationships with Korean visitors, Dr. Ilhak Lee, Dr. Eunmi Ahn and Ms. Bobae Kim, RN, as well as Dr. Yoon-seong Lee and Dr. Myung-Hee Kim, leaders of the Korean National Institute for Bioethics Policy (KoNIBP) as we shared best practices from New York. To round out the experience, I was able to spend some personal time with my family exploring the culture and foods of South Korea.

KoNIBP Program
KoNIBP sponsored an all-day program, “The Implementation of the Act on Life-Sustaining Treatments and Hospice & Palliative Care” to support enactment of the new law that becomes effective in 2018. The international symposium was held at The Catholic University of Korea. My talk, “Seriously Ill Persons Deserve Shared Medical Decision-Making Regarding Life-Sustaining Treatment” addressed the clinical process and the ethical framework for making decisions regarding resuscitation, intubation and mechanical ventilation and other specific life-sustaining treatment. In addition, I discussed, as the Korean Act includes development of an electronic system and registry. An in depth meeting with KoNIBP leadership and IT staff followed later that week.

International Conference
Dr. Yijong Suh, SSK Project Leader of Aging and Bioethics, organized the International Conference held at Seoul National University. The symposium offered the opportunity to explore commonalities in providing quality end-of-life care by comparing the current state of end-of-life care and data from China and South Korea. Participants agreed the key issue facing all nations is the burgeoning aging population and the burden on families, caregivers and society as a whole.

SWSD Conference
The 2016 Joint World Conference on Social Work, Education and Social Development (SWSD), “Promoting the Dignity and Worth of People” was held at the COEX Convention and Exhibition Center. I was privileged to participate on the symposium, “Older Persons’ Rights for End of Life Care Decision: Bioethics and Politics Perspective,” organized by Sooyoun K Han, Founder of Care Right, NGO and Dr. Yijong Suh. I spoke on “Advance Care Planning: A Basic Human Right” and shared the findings and recommendations of the Institute of Medicine Report Dying In America, including the National POLST Paradigm. I ended my presentation by sharing New York’s community-wide approach to advance care planning, including eMOLST implementation, supported by clinician training and public education, engagement and empowerment.

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