The board of Citizens Medical Center approved Wednesday a new do-not-resuscitate policy to comply with state law.
The hospital’s new policy states that a patient’s wish to bypass resuscitation if they stop breathing or if their heart stops beating must meet certain requirements before a do-not-resuscitate order is valid. All patients at Citizens will receive CPR or advanced cardiac life support if they’re in the midst of cardiac or respiratory arrest, unless they have a valid do-not-resuscitate order specifying otherwise.
The policy was adopted in accordance with Senate Bill 11, which went into effect last year. The legislation is the first time that do-not-resuscitate orders have been regulated statewide in hospitals and other health care facilities.
The major difference under the new law is that physicians in a Texas hospital cannot unilaterally impose a do-not-resuscitate order in most cases. Although most Texas hospitals already required physicians to get consent before approving a do-not-resuscitate order, the law creates a uniform policy throughout the state. Previously, a patient at Citizens or their next-of-kin could notify the physician if they wanted a do-not-resuscitate order in certain circumstances, explained Dr. Daniel Cano, the hospital’s chief medical officer, during Wednesday’s board meeting. The physician would write the order and the process would stop there, Cano said.
“Now, we have a whole list of people that have to be involved in the process, approvals and signatures that have to be there and done and in ink before that order can be enacted,” Cano said.
The board of managers for the county-owned hospital voted to approve the new policy.
A major change under the policy, and the law that spurred it, is that most advance directives will not be valid if someone is admitted to the hospital. Advance directives are legal documents that outline a patient’s medical plans if the patient is incapacitated. So, for example, a resident of an assisted living facility who has specified that they want to forgo CPR in the event of an emergency through a living will would not have a valid do-not-resuscitate order if they were to be admitted to inpatient care in the hospital.
“I wonder how many people out there really don’t realize that, right now, they think they’re covered with the DNR but they’re really not when they come to the hospital,” said County Commissioner Kevin Janak.
Cano said patients with advance directives can amend their legal documents to specify that they don’t want to receive CPR.
“So everybody’s going to have to start rewriting their advances, is what this means,” said Dr. Tanya Seiler, the chairwoman of the board.
“If they truly want to be do-not-resuscitate throughout the continuum of their care, then yes,” Cano responded.
The board of managers also discussed the hospital’s monthly operating report and received an update on the Citizens Run Against Cancer. The annual 5K and half-marathon races are organized to support local cancer patients. At least 732 people ran in the Feb. 23 race, said hospital CEO Mike Olson. The net amount raised is still being determined but is estimated to be about $32,000, he said.