By: Anne Hamilton
Indiana’s new Physician Orders for Scope of Treatment (“POST”) was passed into law on July 1, 2013. This newly enacted law, Indiana Code 16-36-6, et seq., establishes a form to document a patient’s treatment preferences, or their desire to decline certain treatments, into a medical order that physicians can follow.
In order to be eligible to complete a POST form an individual must be a “qualified individual”. In order to be qualified the individual must (1) have an advanced chronic progressive illness; (2) an advanced chronic progressive frailty; (3) a condition caused by injury, disease or illness from which there could be no recovery and death will occur within a short period of time; or (4) a medical condition that, if the person were to suffer cardiac or pulmonary failure, resuscitation would be unsuccessful.
The POST form is given to an eligible individual for contemplation and discussion with family members and will include the following: (1) a medical order specifying whether CPR should be preformed if a patient is in cardiac arrest; (2) a medical order concerning the level of medical intervention to be provided to a patient including comfort measures; (3) a medical order that specifies whether antibiotics should be provided to the patient; and (4) a medical order that specifies whether artificially administered nutrition should be provided to the patient.
A POST form cannot be required of an eligible individual. However, if an individual is eligible to complete the form and desires to do so, the form must be signed by the patient or their authorized representative, and a physician’s signature is required. A physician may not sign the form unless the orders are “reasonable and medically appropriate for the individual.” The physician or the physician’s designee must discuss the patient’s goals and treatment options before the POST is signed and the POST must be executed in good faith and in the best interest of the qualified individual. By following these requirements physicians are not subject to criminal or civil liability or to be found to have committed an act of unprofessional conduct.
Indiana has liberal override measures to prevent unintended death under a POST. Doctors can refuse to follow a POST if the orders are medically inappropriate. A surrogate can revoke a POST for an incapacitated patient. The qualified individual may revoke a POST at any time. There is also a judicial override provision in the POST statute by petition to the probate court in the county where the individual is located.
The POST form does not replace a traditional Appointment of Health Care Representative and Power of Attorney, but it can revoke an existing appointment of Health Care Representative if a new appointment is made on the POST form. Further, it is not an advanced directive or living will. A living will allows healthy adults an opportunity to express their wishes regarding comfort care measures in the event of imminent death.
The goal of the Indiana POST legislation is to improve the lives of individuals with chronic progressive illness by encouraging conversations in advance and ensuring medical decisions are documented as medical orders that can be followed by health care professionals.