"Physician Orders for Life-Sustaining Treatment" (POLST) Promote Appropriate End-of-Life Care
Effective January 1, 2009, California law gave "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 California Medical Association.  It is intended to be used for patients with a serious illness or life expectancy of a year or less, to compliment 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 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.

It is intended that the more precise POLST order will ultimately replace the current Pre-hospital DNR form in California.  POLST is an improvement on the Pre-hospital DNR form because it addresses treatment preferences beyond just "cardiopulmonary resuscitation."  For example, POLST will allow mechanical ventilation for a patient that would not choose full CPR if found pulseless.  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.  Also, its important to note that the POLST form does not replace advanced health care directives.  Rather, it serves as a mechanism to implement the preferences expressed by patients in an advanced health care directive.

In the Fall of 2008 the California HealthCare Foundation committed $120,000 to promote adoption of POLST in  local medical communities throughout California, and the ACCMA is a recipient of a small portion of those funds to promote POLST in the East Bay.  A coalition has been formed comprised of physicians and representatives of hospitals, EMS, long-term care facilities, and hospice providers as part of this effort. 

The ACCMA can arrange for presentations to introduce the POLST paradigm to health care professionals and more in-depth train-the-trainer programs to help health care professionals in the East Bay fully implement use of the POLST form in their health care facilities and systems.  To arrange for a presentation or more in-depth training contact Donald Waters, ACCMA Executive Director, at (510) 654-5383 or dwaters@accma.org, or Sharon Jeans, Director of the Alameda-Contra Costa POLST Coalition, at jeanss@sutterhealth.org. Additional information on POLST, including the form, guidelines for its use, and educational materials, go to www.capolst.org.