“Physician Orders for Life-Sustaining Treatment” (POLST) Legally Recognized
Effective January 1, California law gives "Physicians Orders for Life-Sustaining Treatment" (POLST) equal status to "Do Not Attempt Resuscitation" (DNR) orders.  The POLST form has been promoted by physicians in numerous states across the country, and has been endorsed by the ACCMA, other county medical societies, and the CMA.  It is intended to be used for patients with a serious illness or whose life expectancy is a year or less.  The form compliments an advance directive by turning a patient's treatment preferences into actionable medical orders. Moreover, POLST seeks to improve care by ensuring that treatment orders follow patients across the continuum of care, from skilled nursing facilities to the hospital and to home. Like DNR forms, physicians and all other health care providers are required to treat patients in accordance with the treatment preferences expressed on the POLST form.  Physicians may refuse to honor the form if it requires medically ineffective health care or is contrary to generally accepted medical standards.  Physicians may also evaluate a patient and, in consultation with the patient (or if incapacitated, the patient's legal representative), issue a new order consistent with the patient's current medical condition and goals for care.  Importantly, this new law (AB 3000 -Statutes 2008, Chapter 266, located in Probate Code section 4780-4785) provides health care providers immunity from civil liability and criminal prosecution or any other sanction for following the POLST order.

Hallmarks of POLST are (1) immediately actionable signed medical orders on a standardized form; (2) orders that address a range of life-sustaining interventions as well as the patient's preferred intensity of treatment for each intervention; (3) a brightly colored, clearly identifiable form; (4) that is recognized, adopted, and honored across treatment settings.

The ACCMA is a recipient of a small grant from the California HealthCare Foundation to promote POLST in the East Bay.  A coalition is being formed comprised of physicians and representatives of EMS, accute and long-term care facilities, and hospice providers as part of this effort.  A more detailed discussion about the POLST form will appear in the January issue of the ACCMA Bulletin. 

Additional information may be found at www.finalchoices.org  or www.polst.org.