By Mitch Gurney

August 2009

After reading a posting on “The Cheat Sheet” regarding Sarah Palin’s “Obama’s death panel may kill her son” Facebook posting I did some research to determine how she arrived at her interpretations. A spokes woman for Palin had referenced to page 425 of the H.R. Healthcare Bill as support for her claims.

I must admit I am no fan of Palin and place no trust in anything she says but this holds true for me with most politicians and I am equally suspicious of our government and tend not to be Pollyanna over anything these characters do. But I quite honestly do not comprehend how Palin arrived at her interpretations which were very dramatic to say the least. Overall I find I agree with the interpretations shared by the author of the “Cheat Sheet” commentary.

I have posted the segment of the bill in question below, beginning with page 424 through page 430. You may read it for yourself and form your own conclusions. The only revisions I made were to format the text layout in paragraph style for easier reading, and deleted some of the numbers typically found along the left side of legislative bills otherwise the verbiage is left intact as found in the bill.

Although as with most legislative bills it is written in legal terminology it seems fairly clear in what it states regarding the consultations and other services outlined in this segment of the bill. These services are intended for the individual. Any discussions and decisions appear to be between them and their primary care provider or providers and or family members acting on their behalf regarding care and the fulfillment of the individual’s wishes.

Palin’s spin on this matter is in my opinion yet another example of how information is often twisted and rather than serve a value to society by contributing constructively to the national debate only distracts and creates misinformation. I recently wrote a commentary that aligns with the theme that unfolded in this event; “Drowning in a Sea of Spin.”

The Healthcare industry is powerful with massive influence over Washington. They have an agenda. They have a vested reason to keep things as they are – in their control…we cannot underestimate what they will do and who they might “buy” to get what they want.

My take away from this experience is that no matter whom the politician is regardless of party affiliations very likely they may be some PR front person for a network of multinational corporations or some other interest group and have an agenda to serve. We need to know who funds these characters and who it is that they represent – in other words follow the money trail. Most importantly we should step aside THEIR jargon and lip service and take responsibility to read, learn, and form OUR OWN understandings of important matters such as healthcare etc.

H.R. Healthcare Bill

Beginning with Pg 424, # 15 section 1233, through pg 430

15 SEC. 1233. ADVANCE CARE PLANNING CONSULTATION.

16 (a) MEDICARE.-

17 (1) IN GENERAL. – Section 1861 of the Social

18   Security Act (42 U.S.C. 1395x) is amended-

19 (A) in subsection (s) (2)-

20 (i) by striking ‘‘and” at the end of

21 subparagraph (DD);

22 (ii) by adding ‘‘and” at the end of

23 subparagraph (EE); and

24 (iii) by adding at the end the following new subparagraph:

(Pgs 425 – 427)

‘‘(FF) advance care planning consultation (as defined in subsection (hhh)(1)) and (B) by adding at the end the following new subsection:

‘‘Advance Care Planning Consultation ‘‘(hhh)(1) Subject to paragraphs (3) and (4), the term ‘advance care planning consultation’ means a consultation between the individual and a practitioner described in paragraph (2) regarding advance care planning, if, subject to paragraph (3), the individual involved has not had such a consultation within the last 5 years. Such consultation shall include the following:

‘‘(A) An explanation by the practitioner of advance care planning, including key questions and considerations, important steps, and suggested people to talk to.

‘‘(B) An explanation by the practitioner of advance directives, including living wills and durable powers of attorney, and their uses.

‘‘(C) An explanation by the practitioner of the role and responsibilities of a health care proxy

‘‘(D) The provision by the practitioner of a list of national and State-specific resources to assist consumers and their families with advance care planning, including the national toll-free hotline, the advance care planning clearinghouses, and State legal service organizations (including those funded through the Older Americans Act of 1965).

‘‘(E) An explanation by the practitioner of the continuum of end-of-life services and supports available, including palliative care and hospice, and benefits for such services and supports that are available under this title.

“(F)(i) Subject to clause (ii), an explanation of orders regarding life sustaining treatment or similar orders, which shall include-‘‘(I) the reasons why the development of such an order is beneficial to the individual and the individual’s family and the reasons why such an order should be updated periodically as the health of the individual changes;

‘‘(II) the information needed for an individual or legal surrogate to make informed decisions regarding the completion of such an order; and ‘‘(III) the identification of resources that an individual may use to determine the requirements of the State in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a health care proxy).

‘‘(ii) The Secretary shall limit the requirement for explanations under clause (i) to consultations furnished in a State-‘‘(I) in which all legal barriers have been addressed for enabling orders for life sustaining treatment to constitute a set of medical orders respected across all care settings; and ‘‘(II) that has in effect a program for orders for life sustaining treatment described in clause (iii).

‘‘(iii) A program for orders for life sustaining treatment for a States described in this clause is a program that-

‘‘(I) ensures such orders are standardized and uniquely identifiable throughout the State; ‘‘(II) distributes or makes accessible such orders to physicians and other health professionals that (acting within the scope of the professional’s authority under State law) may sign orders for life sustaining treatment;

(Pg 428)

(1) ‘‘(III) provides training for health care professionals across the continuum of care  about the goals and use of orders for life sustaining treatment; and ‘‘(IV) is guided by a coalition of stakeholders includes representatives from emergency medical services, emergency department physicians or nurses, state long-term care association, state medical association, state surveyors, agency responsible for senior services, state department of health, state hospital association, home health association, state bar association, and state hospice association.

‘‘(2) A practitioner described in this paragraph is-‘‘(A) a physician (as defined in subsection (r)(1)); and ‘‘(B) a nurse practitioner or physician’s assistant who has the authority under State law to sign orders for life sustaining treatments.

‘‘(3)(A) An initial preventive physical examination under subsection (WW), including any related discussion during such examination, shall not be considered an advance care planning consultation for purposes of applying the 5-year limitation under paragraph (1).

(Pgs 429 – 430)

‘‘(B) An advance care planning consultation with respect to an individual may be conducted more frequently than provided under paragraph (1) if there is a significant change in the health condition of the individual, including diagnosis of a chronic, progressive, life-limiting disease, a life-threatening or terminal diagnosis or life-threatening injury, or upon admission to a skilled nursing facility, a long-term care facility (as defined by the Secretary), or a hospice program.

‘‘(4) A consultation under this subsection may include the formulation of an order regarding life sustaining treatment or a similar order.

‘‘(5)(A) For purposes of this section, the term ‘order regarding life sustaining treatment’ means, with respect to an individual, an actionable medical order relating to the treatment of that individual that-‘‘(i) is signed and dated by a physician (as defined in subsection (r)(1)) or another health care professional (as specified by the Secretary and who is acting within the scope of the professional’s authority under State law in signing such an order, including a nurse practitioner or physician assistant) and is in a form that permits it to stay with the individual and be followed by health care professionals and providers across the continuum of care; ‘‘(ii) effectively communicates the individual’s preferences regarding life sustaining treatment, including an indication of the treatment and care desired by the individual; ‘‘(iii) is uniquely identifiable and standardized within a given locality, region, or State (as identified by the Secretary); and ‘‘(iv) may incorporate any advance directive (as defined in section 1866 (f) (3) if executed by the individual.

‘‘(B) The level of treatment indicated under subparagraph (A)(ii) may range from an indication for full treatment to an indication to limit some or all or specified interventions. Such indicated levels of treatment may include indications respecting, among other items- ‘‘(i) the intensity of medical intervention if the patient is pulse less, apneic, or has serious cardiac or pulmonary problems; ‘‘(ii) the individual’s desire regarding transfer to a hospital or remaining at the current care setting; ‘‘(iii) the use of antibiotics; and ‘‘(iv) the use of artificially administered nutrition and hydration.”

Mitch Gurney

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