“MI-POST: What Are They and Why & When May I Want to Sign One?”

MI-POST:  WHAT ARE THEY AND WHY & WHEN MAY I WANT TO SIGN ONE?

            Michigan recently joined over 40 other states in adopting what are called Physician Orders for Scope of Treatment, or POST, or MI-POST.  In some states these are referred to as POLSTS, an acronym for Physician Orders for Life –Sustaining Treatment, or MOSTS, short for Medical Orders for Scope of Treatment.  These type of eve-of-death medical treatment orders have been around for over 25 years and are fairly straight forward state-produced forms that enable a person who typically has an advanced terminal disease that will likely result in their death in less than a year to specify the exact degree of medical care they desire to receive in their last stages of life.  If they have properly designated another to act for them, they can also give such power to their Patient Advocate or Guardian. 

            Before such form or order existed, the only end of life care designations one could make were to execute a Do-Not –Resuscitate (DNR) directive or to sign a Patient Advocate Designation.  The Patient Advocate Designation would typically specify, in general terms, the type and degree of care the author, or patient, would like to receive going forward, if and only if they could not make medical decisions for themselves, and would name a person(s) to make those decisions for them.  

            The POST is a document, signed by the party and their physician, nurse practitioner or physician assistant, that is in the form of a medical order, which indicates the type of medical intervention a person who has limited time to live desires to receive.  While the straightforward form covers only a limited number of medical treatment decisions that might arise, these include resuscitation, ventilation, defibrillation, comfort measures, and the like. The patient’s desires are reflected as a medical order and are written in medical terminology (rather than in “legalese” that might be hard to understand).   

            As a POST is presumed to express the patient’s current wishes, its provisions supersede directions given in a previously executed Patient Advocate Designation, Living Will, or DNR directive.   It applies in an out-of-hospital setting to a person who is terminally ill and is in a residence or under Hospice Care, is in an assisted living facility or skilled nursing home, home for the aged or adult foster care facility, or is the subject of an EMS-type event. Similar to a DNR, it does not apply to an individual who is in a hospital, as hospitals have their own internal physician directed end- of -life medical orders and protocols.  The statutes, however, allow hospitals to use a POST as a “communications tool”. 

            A  POST is intended to provide a person who is seriously ill with an additional standardized form with more treatment options than simply a DNR directive.  Its primary goal is to convert a patient’s treatment decisions into medical orders that are transferable throughout the healthcare system so as to improve the chances that the medical choices of the seriously ill person will be carried out by the healthcare providers throughout the continuum of care.    Before a POST can take effect, the patient must first meet with their attending health care professional, who is to provide them with an informational booklet on POST.  Such a meeting should address the patient’s present diagnosis, prognosis, treatment options, the patient’s goals and preferences, and the medical implications of selecting various preferences under a POST.

             To be effective the POST must be signed by the patient (or their authorized representative) as well as by the patient’s attending health care professional and 2 witnesses.   There is no need for it to be notarized. The POST should be reviewed periodically so that it continues to reflect the patient’s present desires. It can be revoked at any time by the patient or their authorized representative simply by writing “Void” on the document and dating and signing it.   It can also be modified by the patient or someone they have properly authorized to do so (such as their Patient Advocate).  It is typically printed on brightly colored paper, so that it will be easily noticed, and should accompany the individual whenever they are transferred or discharged.  The provisions of HIPAA permit disclosure of a POST to other health care professionals, as necessary.

            A POST cannot be used for a minor or a developmentally disabled person. It also cannot be used by someone whose life expectancy is expected to exceed one year in length.  Further, the person must be capable of participating in medical treatment decisions.  If a person lacks such capacity and has not designated a person under a Patient Advocate Designation to sign such a form, while they were capable of making such decisions, then it may be necessary to have a Guardian appointed by the Probate Court to establish a POST.

            The MI-POST form and related informational handbook are still in the developmental stages.  As of the time of this writing (January, 2019) they are not yet available but should be soon through the Michigan Department of Health and Human Services (MI DHHS).  Again, these are not attorney produced forms and should be used in conjunction with a Patient Advocate Designation and other appropriate estate planning documents to help carry out ones last wishes, from a medical perspective. 

            If you or a relative have questions about the possible need for a POST, need a Patient Advocate Designation or Living Will prepared, have a need for a Durable Power of Attorney (to handle financial matters for someone else), or need legal assistance in regard to preparing a suitable estate plan, please contact the estate planning attorneys with Damon, Ver Merris, Boyko & Witte, PLC, at (616) 975-9951. We are here to assist you in making these important, often end-of-life, decisions, and to formulate an estate plan that is right for you and your loved ones.  Give us a call.    – Larry A. Ver Merris  /  January 22, 2019