1. PALLIATIVE CARE INFORMATION ACT Webinar Tuesday, April 12, 2011 Presented by: Laurie T. Cohen, Esq. Wilson, Elser, Moskowitz, Edelman & Dicker LLP 677 Broadway – 9 th Floor, Albany, New York 12207 Phone: (518) 449-8893 / Facsimile: (518) 449-4292 Email: laurie.cohen@wilsonelser.com

2. PALLIATIVE CARE INFORMATION ACT Effective Date ~ February 9, 2011 Basic Requirement of Act: Attending physicians and nurse practitioners to offer terminally ill patients information and counseling concerning palliative care and end-of-life options appropriate to the patient.

3. DEFINITIONS “Attending physician or nurse practitioner” – has primary responsibility for care and treatment of patient. If more than one attending, both have a duty to offer information and counseling unless there is an agreement that one will accept responsibility. “Terminally Ill” – an illness or condition which can reasonably be expected to cause death within six (6) months with or without treatment.

4. DEFINITIONS “Palliative Care” – health care treatment, including interdisciplinary end-of-life care, and consultation with patients and family members, to prevent or relieve pain and suffering and to enhance the patient’s quality of life, including hospice care. “Appropriate” – consistent with legal, health and professional standards, the patient’s clinical condition and the reasonably known wishes and beliefs of the patient.

5. INFORMATION TO BE OFFERED Information and counseling regarding palliative care and end-of-life care, including, but not limited to: Range of options appropriate to patient. Prognosis, risk and benefits of various options. Patient’s legal rights to comprehensive pain and symptom management at end of life.

6. HOW AND BY WHOM CAN COUNSELING AND INFORMATION BE PROVIDED Information and counseling may be provided orally or in writing. Attending physician or nurse practitioner can arrange for another qualified individual to provide information and counseling. If patient lacks capacity to understand options and make decisions, information and counseling shall be offered to a person authorized to make health care decisions for the patient (i.e. an agent or surrogate). If unwilling to provide information and counseling, attending must arrange for such or refer or transfer patient to another physician or nurse practitioner willing to do so.

7. OTHER CONSIDERATIONS Patient must be offered information and counseling but patient may decline to receive. In such cases, attending physician or nurse practitioner is advised to document the offer in the patient chart and the declination. Note: It may be appropriate to make another offer of information and counseling at a later time.

8. OTHER CONSIDERATIONS [CONTINUED] If more than one attending physician or nurse practitioner is involved in the ongoing care or care coordination for a terminally ill patient and one has agreed to offer the information and counseling, each should document who accepted the responsibility. There are no cultural or therapeutic exceptions to the obligation to offer the information and counseling about end-of-life care. Violations – fines as well as potential to trigger professional misconduct action.

9. RESOURCES Palliative Care Information Act – Guidance for Practitioners, NYS Department of Health Frequently Asked Questions and Answers Link to Other Resource: http://www.health.ny.gov/professionals/patients/patient_right s/palliative_care/practitioners/