Medical orders for terminally ill patients and seniors in Washington state are sometimes ignored, due to a loophole that intimidates caregivers and assisted-living facilities from following the POLST form, Physician Orders for Life Sustaining Treatment. Last week, a Senate health care committee approved a bill that would guarantee protections to caregivers who follow patients’ POLST and remedy this problem.

POLST, first developed during the 1990s in Washington and now used in 14 states, indicates orders for emergency medical providers. Patients with this form may choose to forgo medical treatments, such as CPR and antibiotics, and indicate comfort care preferences. The neon colored form, which must also be signed by a physician, exempts medical providers who follow such orders from liability.

However, last year, the Department of Social and Health Services sent a letter to adult care centers warning they may have no legal protection for following their patients’ POLST.

“Since the POLST is intended for emergency medical personnel, there are issues related to legal immunity for others to follow the POLST directions,” the letter from Joyce Pashley Stockwell, director of residential care services, read.

Since then, some patients in assisted-living facilities have been resuscitated against their wishes by caregivers who fear being held liable.

The Seattle Times reports 12 of the state’s 39 adult care centers told workers they must do CPR, even on residents with POLST forms specifying that they do not want resuscitation.

“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 Senate health care 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,” the Times reports.

If approved by the full Legislature, SB 5562 would extend POLST protections to include assisted-living facilities and nursing homes. But the bill’s fate is unclear, as recent attempts to expand the POLST have been stymied in committee.

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