Surrogate Decision Making in New York

 SURROGATE DECISION MAKING

NY has a law that establishes procedures when a person lacks the capacity to make their own treatment decisions and somone else has to do it for them.  Following is part of the law

§ 80.01 Legislative findings and purpose.

  The  legislature  hereby  finds and declares that timely access to health care for people who are mentally disabled is an important objective for New York  state;  that the autonomy of persons with decision-making capacity to make health care decisions for themselves must be respected; and  that,  in cases  involving  persons  with  impaired decision-making capacity, efforts should be made to ensure that health care decisions are based on  the  best interests of the patient and reflect, to the extent possible, the patient’s own personal beliefs and values. The legislature  further  finds  that  the exclusive  utilization  of  judicial  authorization  to  obtain consent for medical care for the mentally disabled has in some cases resulted in  undue delay  in  the  provision  of  necessary  care, needlessly jeopardizing the health of the mentally disabled. The legislature further finds and declares that the public interest will be served by the establishment of a statewide quasi-judicial surrogate decision-making  process,  which  would  determine patient  capacity  to  consent  to  or  refuse medical treatment and assess whether the proposed  treatment  promotes  the  patient’s  best  interests, consistent  with  the  patient’s  values  and preferences. The process will strengthen the surrogate decision-making role of parents and  other  family members,  while  assuring  that  those individuals without available familymembers have access to medical care.

§ 80.03 Definitions.

  When used in this article:

  (a)  “Major medical treatment” means a medical, surgical or diagnostic intervention or procedures where a general anesthetic is used  or  which involves  any  significant  risk  or  any significant invasion of bodily integrity  requiring  an  incision  or   producing   substantial   pain, discomfort,  debilitation  or having a significant recovery period. Such term does not include: any routine diagnosis or treatment  such  as  the administration    of    medications    other   than   chemotherapy   for non-psychiatric conditions or nutrition  or  the  extraction  of  bodily fluids  for  analysis;  electroconvulsive therapy; dental care performed with a  local  anesthetic;  any  procedures  which  are  provided  under emergency circumstances, pursuant to section twenty-five hundred four of the public health law;  the  withdrawal  or  discontinuance  of  medical treatment  which  is  sustaining life functions; or sterilization or the termination of a pregnancy.

  (b)  “A  patient in need of surrogate decision-making” means a patient as defined in subdivision twenty-three of section 1.03 of  this  chapter who  is  at  the time of the commission’s receipt of the declaration:  a resident of a mental hygiene facility including a  resident  of  housing programs  funded by an office of the department or whose federal funding application was approved by an office of the department or for whom such facility  maintains  legal admission status therefor; or, receiving home and  community-based  services  for  persons  with  mental  disabilities provided pursuant to section 1915 of the federal social security act; or receiving individualized support services; and, for whom  major  medical treatment   is   proposed,  and  who  is  determined  by  the  surrogate decision-making committee to lack the ability to consent  to  or  refuse such  treatment,  but  shall  not include minors with parents or persons with  legal  guardians,  committees  or  conservators  who  are  legally authorized, available and willing to make such health care decisions.

  (c)  “Lack of ability to consent to or refuse major medical treatment” means the patient cannot adequately understand and appreciate the nature and  consequences  of  a proposed major medical treatment, including the benefits and risks of and alternatives to  such  treatment,  and  cannot thereby  reach  an  informed  decision  to  consent to or to refuse such treatment in a knowing and voluntary manner that promotes the  patient’s well-being.

  (d)  “Best  interests”  means  promoting  personal  well-being  by the assessment of the risks, benefits and alternatives to the patient  of  a proposed  major medical treatment, taking into account factors including the relief of suffering, the preservation or restoration of functioning, improvement  in   the quality of the patient’s life with and without the proposed major medical  treatment  and  consistency  with  the  personal beliefs and values known to be held by the patient.

  (e)  “Surrogate  decision-making  committee”  means  a committee of at least twelve persons established  pursuant  to  section  80.05  of  this article.

  (f)  “Panel”  means  a  subcommittee  of four members of the surrogate decision-making committee.

  (g)  “Commission”  means  the  commission  on  quality of care for the mentally disabled.

  (h)  “Providers  of  health  services” means, for the purposes of this article, those defined in subdivisions five and six of section  1.03  of this  chapter; hospitals, as defined pursuant to article twenty-eight of the public health law; physicians and dentists.

  (i)  “Declarant”  means a person who submits a declaration pursuant to the provisions of this article and may include any  provider  of  health services,  the  director  of  the  patient’s  residential  facility or a relative or correspondent of the patient.

  (j)  “Declaration”  means  a written statement submitted in accordance with section 80.07 of this article.

  (k)  “Correspondent”  means  a  person  who has demonstrated a genuine interest in promoting the best interests of  the  patient  by  having  a personal   relationship  with  the  patient,  by  participating  in  the patient’s care and treatment, by regularly visiting the patient,  or  by regularly communicating with the patient.

§ 80.05 Surrogate decision-making committees and panels; organization.

  (a)  Surrogate  decision-making  committees of at least twelve persons shall be established by the commission in geographic areas of the state, as may be designated by the commission.  A  committee  designated  after April first, nineteen hundred eighty-eight shall not accept applications for  review pursuant to this article until April first, nineteen hundred eighty-nine and within appropriations made therefor.

  (b) The members shall be appointed by the commission.  The  commission shall  designate one member of each of the committees to serve as chair-person, who shall serve at  the  pleasure  of  the  commission.  Members appointed  as  of July thirty-first, nineteen hundred ninety shall serve for terms expiring on July thirty-first,  nineteen  hundred  ninety-one.  Upon  expiration  of such terms, such members may be appointed for terms of two years commencing on August first,  nineteen  hundred  ninety-one.  Any  additional  members and members appointed due to vacancies shall be appointed for terms of two years commencing on the date of completion of training by the commission. Members may be  reappointed  for  additional two  year  terms  of  office  but  the provisions of section five of the public officers law shall not apply to such members. The commission  may assign a committee member to serve on an additional committee or commit-tees as deemed necessary or appropriate by the commission.

  (c) Members of the committee and panel shall include members from each of the following groups:

  (i)  physicians,  nurses,  psychologists, or other health care profes-sionals licensed by the state of  New  York;  (ii)  former  patients  or parents,  spouses,  adult  children,  siblings  or advocates of mentally disabled persons; (iii) attorneys admitted to the practice of law in New York state; and (iv) other persons with recognized expertise  or  demon-strated interest in care and treatment of mentally disabled persons.

  (d)  A  member  who has failed to attend three consecutive meetings of the committee or panel to which the member has been appointed  shall  be considered  to  have  vacated  his  or  her office unless the commission determines that the absences should be excused.  The  members  shall  be reimbursed  for their actual and necessary expenses and shall be consid-ered public officers for the purpose of sections seventeen, nineteen and seventy-four of the public officers law.

  * (e) The committees shall have  available  to  them  such  staff  and assistance  as  may  be deemed necessary by the commission. In providing for such staff and assistance, the commission may enter into  agreements with community dispute resolution centers authorized under article twen-ty-one-A of the judiciary law, and the staff of such centers in carrying out  such  functions shall be considered public officers for the purpose of sections seventeen, nineteen and seventy-four of the public  officers law. Provided, however, the commission may not delegate pursuant to such agreements  responsibility  for  the  appointment of members to serve on surrogate decision-making committees, the training of any such  members, the review of declarations, maintenance of the record of the hearing and original  file,  and general oversight of panel activities. Any informa-tion, books, records, or data which are confidential as provided for  by law, received by such a center pursuant to an agreement with the commis-sion,  shall  be kept confidential by the center, and any limitations on the further release thereof, imposed by law upon  the  party  furnishing the information, books, records or data, shall apply to the center.

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 * NB Effective until 00/06/30

  * (e)  The  committees  shall  have  available  to them such staff and assistance as may be deemed necessary by the commission.

  * NB Effective 00/06/30

  (f) Each  surrogate  decision-making  committee  shall  undertake  its responsibilities  through  panels  composed  of four of its members. The chairman of each committee or his or her designee  shall  designate  the chairman  of  the panel who shall serve at the pleasure of the committee chairman or his or her designee.

  (g)  A  panel  shall  be  convened as often as deemed necessary by the chairman of the committee or his or her designee to assure timely review of pending declarations; provided, however, that neither article six nor article seven of the public officers law shall apply to the  conduct  of such  committee  or panel. The proceedings of the panel may be conducted with only three persons.  Provided,  however,  if  a  panel  chairperson receives  reasonable  notice  that  a  panel  member will not be able to attend a panel hearing, such chairperson or his or  her  designee  shall undertake  efforts to identify another appropriate member of the commit-tee to serve on such panel.

  (h) No member who is a provider of health services or  an  officer  or employee  of  any provider of health services to a patient whose case is under consideration by a panel may serve with respect to such patient.

§ 80.07 Procedures of the committees and panels.

  (a)  The  committee  shall  receive  declarations  filed  on behalf of patients, as follows:

  1. A declaration may be filed by a declarant on behalf of any patient, residing within the geographic area served  by  the  committee,  who  is believed  to  be  in  need  of  major  medical treatment and to lack the capacity to consent to or refuse major medical  treatment.  Jurisdiction by  the  surrogate decision-making committee may continue throughout all subsequent proceedings related to the major medical  treatment  proposed in  the  initial  declaration  notwithstanding  the  patient’s  transfer outside of the geographic region or discharge from the facility.

  2.  A declaration shall be signed by the declarant and shall state the following:

  (i) the patient does not have a parent, spouse, adult child, committee of the person, conservator or legal  guardian;  or  that  the  patient’s parent,  spouse,  adult  child,  committee of the person, conservator or legal  guardian  is  willing  to  allow  the  panel  to  act  upon   the declaration;

  (ii)  the reasons for believing that the patient lacks the capacity to consent to or  refuse  major  medical  treatment  and  the  factual  and professional  basis  for  this  belief, which may include an independent evaluation by a person qualified to assess  the  patient’s  capacity  to make such medical decisions;

  (iii) a description of the proposed major medical treatment and of the patient’s medical condition which requires such  treatment;  the  risks, alternatives  and benefits to the patient of such treatment; a statement of declarant’s opinion of whether the  best  interests  of  the  patient would  be  promoted by such treatment and the basis for the opinion; the patient’s view of the proposed  treatment,  if  known;  and  such  other information  as  may  be  necessary  to  establish  the  need  for  such treatment.

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  (b)  Upon  receipt of the declaration, the committee shall send a copy of the declaration forthwith to the patient and to the patient’s parent, spouse,  adult  child,  committee  of  the  person,  conservator,  legal guardian or correspondent, if  known,  the  director  of  the  patient’s residential mental hygiene facility, if any, or such director’s designee and the mental hygiene legal service which serves the same region as the committee. The chairperson of the committee or his or her designee shall assign the declaration to one of its panels,  whose  members  will  also receive  a copy of the declaration. The declaration shall be accompanied by a notice of the time, place and date of  the  panel  hearing  on  the declaration.  The  hearing  shall be scheduled no earlier than five days after such declaration  is  sent,  except  where  medical  circumstances require  a  more immediate hearing or where the consent of the patient’s parent, spouse, adult child, committee of the person, conservator, legal guardian  or  correspondent,  if  known,  the  director of the patient’s mental hygiene residential facility, if any, or such director’s designee and  the mental hygiene legal service has been obtained for conducting a more immediate hearing.  The  notice  shall  inform  recipients  of  the procedures of the panels, including the opportunity for the recipient to be present and to be heard.

  (c)  The declaration shall, prior to the date of the panel hearing, be reviewed by the panel chairman or  his  designee  to  ascertain  whether additional   information  may  be  necessary  to  assist  the  panel  in determining the patient’s need  for  surrogate  decision-making  and  in determining  whether  the  patient’s  best  interests  will be served by consenting to or refusing  major  medical  treatment  on  the  patient’s behalf. The panel chairman or his designee may:

  1.  Request  and shall, notwithstanding any other law to the contrary, be entitled to receive from any physician, mental  hygiene  facility  or health  care  facility  or  person  licensed  to render health care, any information which is  relevant  to  the  patient’s  need  for  surrogate decision-making   or   for   the   proposed   major  medical  treatment.  Information, books, records or data which are confidential  as  provided for  by  law shall be kept confidential by the panel and any limitations on the further release thereof imposed by law upon the party  furnishing the information, books, records or data shall apply to the panel.

  2.  Order  an independent assessment of the patient, or of information concerning  the  patient,  to  be  undertaken,  including  obtaining  an independent  opinion,  where  such  independent assessment or opinion is determined by the panel chairman to be necessary.

  3.  Consult  with  any  other  person  who  might  assist  in  such  a determination  of  the  best  interests  of   the   patient,   including ascertainment of the personal beliefs and values of the patient.

  (d) The panel shall conduct a hearing, at which the patient, any other person requested by the patient to appear on his or her behalf, and  the mental  hygiene  legal  service  have  the right to be present and to be heard. Where practicable, the panel members shall  personally  interview and  observe the patient prior to making their decision. The panel shall be empowered to administer oaths to  and  to  take  testimony  from  any person  who  might assist the panel in making its decision. Such hearing shall  be  recorded  and  any   information,   record,   assessment   or consultation submitted to or considered by the panel shall be maintained as part of the record of the deliberations of the panel. Formal rules of evidence shall not apply to the proceedings of the panel.

  (e)  The  panel  shall  make  a  determination,  based  on  clear  and convincing evidence, as to whether the patient is in need  of  surrogate decision-making;  provided, however, that minor patients shall be deemed to lack such capacity, to the extent that minors generally are deemed to lack   such   capacity.   Unless  three  panel  members  concur  in  the determination that the patient is in need of surrogate  decision-making, the  patient  shall  be deemed not to need surrogate decision-making. In such event, a record  of  such  determination  shall  be  made  and  the patient’s  consent to such treatment, if given, shall constitute legally valid consent.

  (f)   For   any   patient  determined  to  be  in  need  of  surrogate decision-making, the panel shall make  a  further  determination  as  to whether  the  proposed  major medical treatment is or is not in the best interests of the patient based on a fair preponderance of the  evidence; provided,  however, that evidence of a previously articulated preference by the patient concerning the proposed treatment  shall  be  given  full consideration  by  the  panel.  The  panel shall provide a record of its determination which consents to or refuses major  medical  treatment  on the  patient’s behalf, which shall reflect the opinion of at least three of the panel members.  If  the  panel  determination  consents  to  such treatment,  such  consent shall constitute legally valid consent to such treatment in the same manner and to the same extent as  if  the  patient were  able  to  consent  to  or  refuse such treatment on his or her own behalf.

  (g)  If  at  anytime  during  the  pendency of a proceeding, a parent, spouse or adult child objects to the panel acting upon  the  declaration or  a  committee  of  the  person,  conservator or legal guardian who is legally authorized to  consent  to  or  refuse  such  treatment  on  the patient’s  behalf, objects to the panel acting upon the declaration, the proceedings regarding  such  patient  shall  cease.  A  record  of  such person’s  objection  shall be included as part of the record as provided for by this section.

  (h)  A  copy  of any determination made pursuant to this section shall contain a statement describing the right to appeal set forth herein  and shall  promptly  be  sent  or  provided  to  the  patient; other persons requested by the patient to appear on  his  or  her  behalf;  declarant; parent, spouse, adult child, legal guardian, committee of the person or, in the absence of such persons, known correspondents of the patient; the director  of  the patient’s mental hygiene residential facility, if any; and the mental hygiene legal service. Where practicable, the panel shall reach its determination or determinations at the time of the hearing and provide notice to  the  above  persons  forthwith.  The  terms  of  such determinations and the giving of such notice shall be made a part of the record. The decision shall state when the consent shall become effective after  such  determination  has  been  provided or mailed to the parties specified in this section. The panel may delay the effective date of its decision  for  up  to five days in order to enable an objecting party to § 80.07 Procedures of the committees and panels.

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(a)  The  committee  shall  receive  declarations  filed  on behalf of patients, as follows:

  1. A declaration may be filed by a declarant on behalf of any patient, residing within the geographic area served  by  the  committee,  who  is believed  to  be  in  need  of  major  medical treatment and to lack the capacity to consent to or refuse major medical  treatment.  Jurisdiction by  the  surrogate decision-making committee may continue throughout all subsequent proceedings related to the major medical  treatment  proposed in  the  initial  declaration  notwithstanding  the  patient’s  transfer outside of the geographic region or discharge from the facility.

  2.  A declaration shall be signed by the declarant and shall state the following:

  (i) the patient does not have a parent, spouse, adult child, committee of the person, conservator or legal  guardian;  or  that  the  patient’s parent,  spouse,  adult  child,  committee of the person, conservator or legal  guardian  is  willing  to  allow  the  panel  to  act  upon   the declaration;

  (ii)  the reasons for believing that the patient lacks the capacity to consent to or  refuse  major  medical  treatment  and  the  factual  and professional  basis  for  this  belief, which may include an independent evaluation by a person qualified to assess  the  patient’s  capacity  to make such medical decisions;

  (iii) a description of the proposed major medical treatment and of the patient’s medical condition which requires such  treatment;  the  risks, alternatives  and benefits to the patient of such treatment; a statement of declarant’s opinion of whether the  best  interests  of  the  patient would  be  promoted by such treatment and the basis for the opinion; the patient’s view of the proposed  treatment,  if  known;  and  such  other information  as  may  be  necessary  to  establish  the  need  for  such treatment.

  (b)  Upon  receipt of the declaration, the committee shall send a copy of the declaration forthwith to the patient and to the patient’s parent, spouse,  adult  child,  committee  of  the  person,  conservator,  legal guardian or correspondent, if  known,  the  director  of  the  patient’s residential mental hygiene facility, if any, or such director’s designee and the mental hygiene legal service which serves the same region as the committee. The chairperson of the committee or his or her designee shall assign the declaration to one of its panels,  whose  members  will  also receive  a copy of the declaration. The declaration shall be accompanied by a notice of the time, place and date of  the  panel  hearing  on  the declaration.  The  hearing  shall be scheduled no earlier than five days after such declaration  is  sent,  except  where  medical  circumstances require  a  more immediate hearing or where the consent of the patient’s parent, spouse, adult child, committee of the person, conservator, legal guardian  or  correspondent,  if  known,  the  director of the patient’s mental hygiene residential facility, if any, or such director’s designee and  the mental hygiene legal service has been obtained for conducting a more immediate hearing.  The  notice  shall  inform  recipients  of  the procedures of the panels, including the opportunity for the recipient to be present and to be heard.

  (c)  The declaration shall, prior to the date of the panel hearing, be reviewed by the panel chairman or  his  designee  to  ascertain  whether additional   information  may  be  necessary  to  assist  the  panel  in determining the patient’s need  for  surrogate  decision-making  and  in determining  whether  the  patient’s  best  interests  will be served by consenting to or refusing  major  medical  treatment  on  the  patient’s behalf. The panel chairman or his designee may:

  1.  Request  and shall, notwithstanding any other law to the contrary, be entitled to receive from any physician, mental  hygiene  facility  or health  care  facility  or  person  licensed  to render health care, any information which is  relevant  to  the  patient’s  need  for  surrogate decision-making   or   for   the   proposed   major  medical  treatment.  Information, books, records or data which are confidential  as  provided for  by  law shall be kept confidential by the panel and any limitations on the further release thereof imposed by law upon the party  furnishing the information, books, records or data shall apply to the panel.

  2.  Order  an independent assessment of the patient, or of information concerning  the  patient,  to  be  undertaken,  including  obtaining  an independent  opinion,  where  such  independent assessment or opinion is determined by the panel chairman to be necessary.

  3.  Consult  with  any  other  person  who  might  assist  in  such  a determination  of  the  best  interests  of   the   patient,   including ascertainment of the personal beliefs and values of the patient.

  (d) The panel shall conduct a hearing, at which the patient, any other person requested by the patient to appear on his or her behalf, and  the mental  hygiene  legal  service  have  the right to be present and to be heard. Where practicable, the panel members shall  personally  interview and  observe the patient prior to making their decision. The panel shall be empowered to administer oaths to  and  to  take  testimony  from  any person  who  might assist the panel in making its decision. Such hearing shall  be  recorded  and  any   information,   record,   assessment   or consultation submitted to or considered by the panel shall be maintained as part of the record of the deliberations of the panel. Formal rules of evidence shall not apply to the proceedings of the panel.

  (e)  The  panel  shall  make  a  determination,  based  on  clear  and convincing evidence, as to whether the patient is in need  of  surrogate decision-making;  provided, however, that minor patients shall be deemed to lack such capacity, to the extent that minors generally are deemed to lack   such   capacity.   Unless  three  panel  members  concur  in  the determination that the patient is in need of surrogate  decision-making, the  patient  shall  be deemed not to need surrogate decision-making. In such event, a record  of  such  determination  shall  be  made  and  the patient’s  consent to such treatment, if given, shall constitute legally valid consent.

  (f)   For   any   patient  determined  to  be  in  need  of  surrogate decision-making, the panel shall make  a  further  determination  as  to whether  the  proposed  major medical treatment is or is not in the best interests of the patient based on a fair preponderance of the  evidence; provided,  however, that evidence of a previously articulated preference by the patient concerning the proposed treatment  shall  be  given  full consideration  by  the  panel.  The  panel shall provide a record of its determination which consents to or refuses major  medical  treatment  on the  patient’s behalf, which shall reflect the opinion of at least three of the panel members.  If  the  panel  determination  consents  to  such treatment,  such  consent shall constitute legally valid consent to such treatment in the same manner and to the same extent as  if  the  patient were  able  to  consent  to  or  refuse such treatment on his or her own behalf.

  (g)  If  at  anytime  during  the  pendency of a proceeding, a parent, spouse or adult child objects to the panel acting upon  the  declaration or  a  committee  of  the  person,  conservator or legal guardian who is legally authorized to  consent  to  or  refuse  such  treatment  on  the patient’s  behalf, objects to the panel acting upon the declaration, the proceedings regarding  such  patient  shall  cease.  A  record  of  such person’s  objection  shall be included as part of the record as provided for by this section.

  (h)  A  copy  of any determination made pursuant to this section shall contain a statement describing the right to appeal set forth herein  and shall  promptly  be  sent  or  provided  to  the  patient; other persons requested by the patient to appear on  his  or  her  behalf;  declarant; parent, spouse, adult child, legal guardian, committee of the person or, in the absence of such persons, known correspondents of the patient; the director  of  the patient’s mental hygiene residential facility, if any; and the mental hygiene legal service. Where practicable, the panel shall reach its determination or determinations at the time of the hearing and provide notice to  the  above  persons  forthwith.  The  terms  of  such determinations and the giving of such notice shall be made a part of the record. The decision shall state when the consent shall become effective after  such  determination  has  been  provided or mailed to the parties specified in this section. The panel may delay the effective date of its decision  for  up  to five days in order to enable an objecting party to exercise the right of appeal, pursuant to section 80.09 of this article.

§  80.11  Effect  of determination that a person is in need of surrogate decision-making.

  The  determination  by  a panel that a patient is in need of surrogate decision-making under this article shall not be construed or  deemed  to be  a determination that such person is impaired or incompetent pursuant to article seventy-seven or seventy-eight of this chapter, nor shall  it be  valid  for  any other purpose or any other future medical treatment, unless the determination explicitly applies  to  related  or  continuing treatment  necessitated  by  the  original  treatment.   Nothing in this article shall be construed to limit the  availability  of  other  lawful means  to  obtain  substitute  consent  for  medical  treatment, without utilizing the procedures set forth in this article.  No person shall  be deemed to have failed to exhaust administrative remedies by commencing a legal action to obtain consent to or refusal of medical treatment in the absence   of   or  prior  to  a  review  of  the  case  by  a  surrogate decision-making committee or panel.

§ 80.13 Committee reports.

  The  chairman  of  each committee shall provide a quarterly report on the activities of the committee and its panels to the commission on quality  of care  for the mentally disabled.  Such report shall provide all information in the  manner and form requested by the commission.(Posted 2/1999)

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