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Originally published Sunday, February 24, 2013 at 8:00 PM

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Bill tackles loophole in law on end-of-life wishes

To allow workers in residential facilities to follow patients’ end-of-life wishes without legal fears, a bill in the Legislature aims to close a loophole in state law.

Seattle Times health reporter

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“Clara” was in her late 80s, with serious heart disease and early dementia. She wanted to die a natural death, without medical intervention, in familiar surroundings.

With her daughter, she talked to her doctor about what she wanted, and filled out the official form called Physician Orders for Life-Sustaining Treatment (POLST), used in this state to allow patients facing the end of their lives to specify their wishes for CPR and other medical treatment.

Emergency medical responders, under current law, are protected from legal liability if they forgo emergency measures when summoned to the side of a patient who has signed the form indicating they don’t want to be rescued.

The bright-colored form was designed to be a sort of portable do-not-resuscitate order that could go with end-of-life patients wherever they went.

But as it turned out, Clara fell into a loophole in state law because she lived in an adult family home. Last summer, the state sent out a “dear provider” letter telling providers who work in adult family homes and assisted-living facilities that they might not have legal immunity if they followed a resident’s no-CPR instructions.

So Clara’s caregivers started CPR — against her wishes — and she ended up in a hospital, where she spent four days in intensive care before her heart gave out for the last time. It was four days of “very invasive, very painful, very unpleasant care,” said Gregg VandeKieft, the medical director of Providence Hospice at Providence St. Peter Hospital in Olympia.

VandeKieft told Clara’s story to the Senate health-care committee last week, which later passed a bill — SB 5562 — that, if approved by the full Legislature, would extend the law’s protections to include a complete range of health providers in assisted-living facilities, adult family homes, nursing homes and hospitals.

“Based on my experience, the POLST has been an essential tool for our sickest and oldest patients when they make it clear they want death to occur naturally at home,” Debra Everson of the Adult Family Home Nurses’ Association told the committee. “Many of the patients have made it abundantly clear they never want to return to the hospital — but some of the residents’ decisions to refuse CPR and die a natural death are being disregarded.”

When that happens, VandeKieft said, “families are devastated.”

No objecting testimony was offered.

The POLST protocol began in Oregon in the early 1990s, and by 2010 at least 12 states, including Washington, had similar programs.

Washington’s law, originally written in the early 1990s, addressed only emergency responders. The POLST form itself, developed and adopted as the state standard, has been widely promoted since the mid-2000s as being portable, accompanying a patient moving from home to hospital to residential care settings.

But last summer, questions arose as to whether workers in those facilities were legally safe in following patients’ wishes as spelled out in the POLST form, said Joyce Stockwell, director of residential care services for the state Department of Social and Health Services, in her letter warning adult-family-home providers their workers might not have legal protection.

After the warning letter, Everson said, a survey found that 12 of 39 adult family homes had told workers that they must do CPR even on residents with valid POLST forms specifying that they did not want resuscitation.

Earlier attempts to expand the protections, in 2008 and again last year, got through committees but ran into trouble when critics worried that some health-care workers might not get enough training to properly interpret the form, or that the form might be misused, particularly in situations involving patients with disabilities.

But Sean Atterridge, a family physician who represents AARP, told the committee that Washington is the only one of 14 states now using similar forms that doesn’t protect everyone on the health-care team from liability. The bill isn’t about insulating health providers, he said, “it’s mainly protecting you and I in our final hours.”

Laird Pisto, an attorney with MultiCare Health System in Pierce County, who was representing Washington State Hospital Association, said the law was created to address emergency medical responders. But as soon as a patient moves to a residential facility, those protections vanish, resulting in health-care providers providing care to patients who have said clearly they don’t want it, he said. “Everybody wants to follow patients’ wishes — every health provider in this state.”

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com. On Twitter @costrom

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