On December 20, 2011, Governor Christie signed into law bi-partisan legislation creating a POLST program in New Jersey. POLST stands for “Physician Orders for Life-Sustaining Treatment.”
The New Jersey law requires the Commissioner of Health to designate a Patient Safety Organization (PSO) operating pursuant to the Federal “Patient Safety and Quality Improvement Act of 2005” (P.L. 109-41) to prescribe the form for use in New Jersey; to define the procedures for completion, modification and revocation of the form; and to provide on-going training for health professionals in the use of the form. The Commissioner has selected the Institute for Quality and Patient Safety at the New Jersey Hospital Association as the PSO to function in this regard.
A POLST form is considered completed, and therefore valid, if it contains information indicating a patient’s health care preferences; has been voluntarily signed by a patient with decision-making capacity, or by the patient’s representative in accordance with the patient’s known preferences or in the best interests of the patient; and includes the signature of the patient’s attending physician or advanced practice nurse (APN) and the date of that signature. A document executed in another state, which meets the requirements of the New Jersey act for a POLST form, shall be deemed to be completed and valid to the same extent as a POLST form completed in New Jersey.
Modification or Supersedure
It is, of course, possible that the treatment goals of a patient may change. The Act permits the patient’s attending physician or APN, after evaluating the patient and obtaining the informed consent of the patient or patient’s representative, if so authorized, to issue a new order, which modifies or supersedes the original POLST. At any time, a patient with decision-making capacity may modify or revoke the POLST, or request alternative treatment.
In the event of a disagreement between or among the patient, his/her representative and the attending physician or APN, the parties may turn to procedures and practices established by a health care institution, such as consultation with an ethics committee, or may seek resolution in court.
Patient and Provider Rights
The law preserves a patient’s right to refuse treatment, and does not require health care professionals or emergency care providers to act contrary to law or medical standards. Private, religiously-affiliated institutions are not required to act contrary to their policies or practices, as long as such policies and practices are properly communicated, and the patient is not abandoned or treated disrespectfully.
Comparison to Advance Directives
One of the concerns identified in the past regarding the use of Advance Directives was that physicians were not always well-trained in dealing with end-of-life decision making. In a very significant provision, the New Jersey legislature has required that the continuing education provisions applicable to physicians and APNs include at least two credits of educational programs or topics related to end-of-life care.
If you have any questions or concerns regarding the POLST program or any related issue, please contact William P. Isele of Archer’s Health Care Group at 609.580.3780 or firstname.lastname@example.org.
(Published in May 2012 edition of Mercer Business Magazine) By: William P. Isele