OCOCA Information for Providers

Kōkua Mau does not take a position on the Our Care, Our Choice Act, but we are experts in helping healthcare professionals learn how to have quality conversations with patients about serious illness, choices in end-of-life care, life-sustaining treatments, advance directives and POLST

Key Information About the Our Care, Our Choice Act for Healthcare Professionals

Message to Providers:

Kōkua Mau has prepared responses to the most commonly asked questions concerning provider participation in the Our Care, Our Choice Act. These responses highlight important actions required of participating providers. This information is offered strictly as guidance on provisions in the legislation and is not specific methodology for provider participation.

Providers and patients can access downloadable checklists and forms relating to the Our Care, Our Choice Act on the Office of Planning Policy and Program Development’s website (http://health.hawaii.gov/opppd/ococ/). Familiarity with these forms may assist both healthcare providers and patients to understand and comply with the process. Kōkua Mau recommends healthcare professionals review all forms to ensure all required information is collected and documented.

DISCLAIMER: Nothing on this web page is intended to be, and should not be interpreted as, specific medical or legal advice regarding this complex piece of legislation and related medical issues. This information may serve as a guideline for providers who are seeking general information about participation in the Our Care, Our Choice Act (OCOCA).

Note: Key terms defined in the legislation are listed in bold

What Are the Obligations of an Attending Physician?

Before writing an OCOCA prescription, an attending physician must make an initial determination of whether a patient is a qualified individual.

An individual patient is qualified if he or she:

  • Is an adult (18 years of age or older)
  • Is a Hawaii Resident
    • Residency requirement includes but not limited to:
    • Hawaii driver's license or civil identification card
    • Registration to vote in Hawaii
    • Evidence that the person owns or leases property in Hawaii
    • Filing of a Hawaii tax return for the most recent tax year.
  • Has an incurable and irreversible terminal disease (6 month prognosis)
  • Has the capacity to make medical decisions
  • Is making an informed decision
  • Is making a fully voluntary request for the OCOCA prescription and the request does not arise from coercion or undue influence
  • Is physically and mentally able to self-administer the drugs, meaning a conscious and physical act of administering and ingesting the drugs to bring about death
  • Has submitted the signed, dated and witnessed request form

The attending physician must receive, from the patient directly and not through a designee, two oral requests separated by not less than 20 days, and a written request. The law does not specify when the written request should be submitted.

All written and oral requests must be recorded in the medical record. (There is no specific language required in the documentation.)

The attending physician must refer the patient to a consulting physician.

The attending physician must refer the patient for counseling by a licensed psychiatrist, psychologist, or clinical social worker in order to determine that the patient is capable, and does not appear to be suffering from undertreatment or nontreatment of depression or other conditions which may interfere with the patient’s ability to make an informed decision.

The attending physician must discuss with the patient about the importance of:

  • Having another person present when the drug is ingested
  • Not ingesting the drug in a public place or place open to public view or access
  • Notifying next of kin of a request for OCOCA prescription (failure to do so is not reason to deny the patient the OCOCA prescription)
  • Participating in a hospice program
  • Maintaining the drug in safe and secure location until self-administered. (Although this is not in the law, we recommend it as best practice.)

During discussions with the patient, the attending must remind the patient that he or she may rescind their request for OCOCA prescription at any time in any manner.

To confirm that the patient is making an informed decision, the attending physician must discuss the following with the patient:

  • The patient’s diagnosis and prognosis
  • The risks associated with taking the drug
  • Probable result of taking the drug
  • The possibility that the patient may at any time choose not to fill the OCOCA prescription or may obtain the drug and choose not to take it
  • Feasible alternatives or additional treatment options, such as comfort care, hospice care, palliative care, pain control, voluntarily stopping eating and drinking link to the appropriate km webpages

The attending physician must comply with all documentation requirements and submit all necessary forms.

In addition, the attending physician must:

  • Offer the patient an opportunity to withdraw/rescind the request before writing the OCOCA prescription
  • Verify the patient is making an informed decision immediately before writing the OCOCA prescription
  • Confirm all requirements are met and that appropriate steps are carried out before writing the OCOCA prescription
  • Fulfill all documentation requirements
  • Within thirty calendar days of writing a prescription, the attending physician shall submit a copy of the patient's written request, as well as copy of all the documentation required to the Department of Health

Medical record documentation requirements  

  • All oral requests
  • All written requests
  • The attending physician’s diagnosis and prognosis, that the patient is capable, acting voluntarily, and has made an informed decision
  • The consulting physician’s diagnosis and prognosis and verification that the qualified patient is capable, acting voluntarily, and has made an informed decision
  • The counselor's statement of determination that the patient is capable, and does not appear to be suffering from undertreatment or nontreatment of depression or other conditions which may interfere with the ability to make an informed decision
  • The attending physician’s offer to the patient to rescind the request at the time of the second oral request
  • A statement by the attending physician indicating that all requirements have been met and indicating the steps taken to carry out the request, including identification of the medication prescribed.
  • Give the requesting patient the Final Attestation for a Request for Medication to End My Life form and instruct the patient about completing it
  • Within thirty calendar days following notification of the patient's death from use of a prescribed medication, or any other cause, the attending provider shall submit any follow-up information to the documentation required to the department of health.
What Are the Responsibilities of the Consulting Physician?

The consulting physician must:

  • Examine the patient and his or her relevant medical records
  • Confirm in writing and submit to the attending physician, the diagnosis and terminal prognosis of the patient and;
  • Verify that the individual has capacity to make medical decisions; is acting voluntarily; and, is making an informed decision
Who Can Serve as a Consulting Physician?

A consulting physician must:

  • Be qualified by specialty or experience to make a diagnosis and prognosis regarding the patient’s terminal disease
Who is Considered a Counselor?

A counselor is a licensed psychiatrist, psychologist, or clinical social worker

Which Physicians can Prescribe an Aid-In-Dying Drug?

Only a physician who meets the statutory definition of attending physician may write the OCOCA prescription.

Under the law, an attending physician is the physician who has primary responsibility for:

  • The health care of the requesting patient AND
  • Treatment of the requesting patient’s terminal disease
What Forms are Used and Where Do I Get the Forms?

As of 12/18/18- According to Hawaii DOH (http://health.hawaii.gov/opppd/ococ/)- “The Department of Health is preparing online resources for the public. Now under construction is a dedicated section on the Office of Planning, Policy and Program Development website with downloadable checklists and forms relating to the Our Care, Our Choice Act that can be easily accessed by providers and patients. The provider forms and documentation will be required for submission to the Department of Health to ensure annual reporting is met according to the new law.”

How Do I Submit the Forms?

Within 30 calendar days of writing an OCOCA prescription, the attending physician must submit the following completed, signed, and dated forms and documentation to the Hawaii Department of Health:

  • A copy of the qualifying individual’s written request
  • All required documentation found on Attending Physician’s Checklist

Within 30 calendar days of a qualified individuals’ ingestion of the drug obtained under the terms of the Act, or death from any other cause, the attending physician shall submit any follow-up information to the documentation required

How Will Cause of Death Be Reported?

The death certificate shall list the terminal disease as the immediate cause of death.

 

OCOCA Information for Patients and Families         Our Care Our Choice Act in Hawaii 

DOH webpage: Health Care Provider Resources

For background information you can listen the two webinars

End of Life Option Act: Learnings from California’s ExperienceThe Coalition for Compassionate Care of California (CCCC), a sister organization to Kōkua Mau, hosted a free webinar in September 2018 about what they have learned from a research project that’s been conducted by CCCC, UCLA and UCSF over the past two years.

Medical Aid in Dying: Perspectives and lessons from California. Presented by Coalition for Compassionate Care of California in Collaboration with Kōkua Mau a recording of the webinar from August 2018 is available via this link.

Upcoming trainings:

We will list trainings for providers here. Please also visit our calendar, and/or sign up for our newsletter that lists many training opportunities in Hawaii.

January 16, 2019: HSCO Medical Aid in Dying Workshop (pau)

February 1, 2019 FULL TO CAPACITY End-of-Life Care Options in Hawaii: Critical communications with seriously ill patients and families

February 2, 2019: SAVE-THE-DATE: End-of-Life Care Options in Hawai‘i: Critical Communications with Seriously Ill Patients and Families


DISCLAIMER:  Nothing on this web page is intended to be, and should not be interpreted as, specific medical or legal advice regarding this complex piece of legislation and related medical issues. This information may serve as a guideline for providers who are seeking general information about participation in the Our Care, Our Choice Act (OCOCA).