The California Court of Appeal for the First Appellate District yesterday upheld the state law permitting skilled-nursing facilities (SNFs) to use an interdisciplinary team to make medical decisions for patients who lack decision-making capacity and have no friends or family members to make those decisions. CHA filed an amicus brief in this case and is pleased the court agreed with our position.
The court held that the SNF — in addition to following the procedure outlined in the law — must notify the patient orally and in writing that he or she:
- Has been determined to lack decision-making capacity
- Has no available surrogate decision maker
- Has received a physician recommendation for specified treatment
- Has the right to judicial review
In addition, the SNF must give a copy of the notice to “one other competent person whose interests are aligned with those of the resident.” Finally, the court declared that SNF interdisciplinary teams must include a patient representative who is independent of nursing home staff. The recipient of the notice and the patient representative could be a family member or friend who is involved with the patient’s care but not willing to be a sole decision maker, a lawyer, public guardian, or ombudsman.
The court explicitly permitted the use of interdisciplinary teams to obtain consent for:
- The administration of antipsychotic medications
- Creation or modification of a Physician Order for Life-Sustaining Treatment or Do Not Resuscitate order
- Initiation of hospice or comfort care
The court opined that there might be limits on using an interdisciplinary team to consent for the withdrawal of life-sustaining treatment, but declined to draw a bright line to guide health care providers on this point. The decision in the case, California Advocates for Nursing Home Reform v. Smith, is available here.