Minnesota’s Provider Order for
Life Sustaining Treatment
http://www.polstmn.org
Edward Ratner, MD
Associate Professor of Medicine, University of
Minnesota Medical School
Chair, Minnesota POLST Task Force
ratne001@umn.edu
June 2011
Learning Objectives
To be able to:
• Describe POLST history
• Describe POLST in Minnesota
• Prepare a Health Care Directive that can
be used to create a POLST
• Give legal advice regarding POLST
National POLST Effort
• Led by Oregon
• The National POLST Paradigm Initiative
Task Force
• Endorses state
initiatives
Minnesota POLST History
• Considered since1990’s
• Minnesota Medical Association Ethics
Committee considered ~ 2006
• POLST Task Force: 2007-09
• Implemented by Minnesota health systems
in 2010
• Endorsed by EMSRB, MMA, and others
POLST Task Force
• Sponsored by Minnesota Medical Association
• Open to anyone interested
• Invites to those participating in national
POLST teleconferences
• Representatives from:
– Medical, nursing, health law, hospice, EMS
– Metro and outstate
• Started with tools used by Allina and Echo
Purpose of POLST in Minnesota
• To provide communication of the patient’s
preferences from primary care provider to
EMS, ER, nurses, and doctors in case of
an emergency.
• Allows RNs, EMS, and doctors to act on
patient preferences.
• Informs until AD or agent can be
consulted.
In Minnesota, POLST Is NOT
•
•
•
•
•
•
A contract
Defined in statute
Binding from one doctor to another
Unchangeable
An order of a legal court
A piece of paper
Target patients for POLST
Intended for those in last 1 to 2 years of life
including:
– all hospice enrollees
– long-term nursing home residents
– assisted living facility residents
– other high-risk institutionalized populations
Minnesota POLST Form
Title: Provider Order…. (not physician)
Section A: CPR preferences
Do Not Resuscitate (DNR), also referred to as
Allow Natural Death
Section B: Goals of treatment
– If not to be hospitalized, what alternatives?
– If hospitalized, what interventions are to be
pursued-comfort care, intubation, etc.
Minnesota POLST Form (continued)
Section C: Interventions and Treatment
Antibiotics
Hydration
Nutrition
Section D: Summary of Goals
Discussed with
The basis for these orders is
Section E: Signatures:
Must be signed by the patient or guardian
POLST Signatures
• Required:
– Person completing (e.g. RN/SW/Chaplain)
– MD/NP/PA signature
• Optional:
– Patient/Surrogate
• Ethically and legally not required
• Some institutions do require, however
Health Care Directives (HCD)
and POLST
If POLST is based upon HCD, agent and
medical provider have legal protection under
Minnesota law.
145C.11 IMMUNITIES.
Subdivision 1.Health care agent.
• A health care agent is not subject to
criminal prosecution or civil liability if the
health care agent acts in good faith.
145C.11 IMMUNITIES.
Subd. 2.Health care provider
• (a) With respect to health care provided to
a patient with a health care directive, a
health care provider is not subject to
criminal prosecution, civil liability, or
professional disciplinary action if the
health care provider acts in good faith and
in accordance with applicable standards of
care.
145C.11 IMMUNITIES.
Subd. 2.Health care provider
(b) A health care provider is not subject to
criminal prosecution, civil liability, or
professional disciplinary action if the
health care provider relies on a health care
decision made by the health care agent
and the following requirements are
satisfied:
145C.11 IMMUNITIES.
Subd. 2.Health care provider
(1) the health care provider believes in good
faith that the decision was made by a health
care agent appointed to make the decision
and has no actual knowledge that the health
care directive has been revoked; and
(2) the health care provider believes in good
faith that the health care agent is acting in
good faith.
145C.11 IMMUNITIES.
Subd. 2.Health care provider
(c) A health care provider who administers
health care necessary to keep the principal
alive, despite a health care decision of the
health care agent to withhold or withdraw
that treatment, is not subject to criminal
prosecution, civil liability, or professional
disciplinary action if that health care provider
promptly took all reasonable steps to:
145C.11 IMMUNITIES.
Subd. 2.Health care provider
(1) notify the health care agent of the health
care provider's unwillingness to comply;
(2) document the notification in the
principal's medical record; and
(3) permit the health care agent to arrange
to transfer care of the principal to another
health care provider willing to comply with
the decision of the health care agent.
Health Care Directives
and POLST
• If patient is “competent” and high-risk, do
both HCD and POLST
• Without HCD, POLST clarifies and
communicates – but is not legally
protective for family member or provider
Implications for Lawyers
1. Advise clients to create HCD when patient is
competent.
2. Write HCD to address POLST issues.
a. Name agent, give broad powers.
b. Leave instructions blank; OR address specifics of
resuscitation, feeding tubes, and other invasive
treatments.
3. Discuss POLST issues with agent.
Implications for Lawyers (continued)
4. Advise POLST when illness is advanced
– Patient when competent
– Family/named agent/conservator
5. Advise agents and families as POLST forms acted upon,
before and after death
6. Comfort families after deaths
Summary
• After long wait, Minnesota has POLST.
• POLST complements HCD near the end of
life.
• Elder law professionals have multiple roles
related to POLST.
• Forms available at http://www.polstmn.org.