Or: Five words make a big difference
Thank you to everybody who submitted testimony:
- SB2529 SD1 was heard and passed “as is” by the Committee on Judiciary (JDC) on Friday Feb 16
- SB2529 was heard and passed the Senate Committee on Health and Human Services January 31
We have heard from our Hawaiʻi hospices that an administrative adjustment is needed in our current POLST law and we have created a bill for the 2024 Legislative session to address the issue.
This will help to improve access to POLST, especially for some of the most vulnerable patients in hospice care. It will bring us in line with other states and will not decrease the integrity or importance of POLST. Nor will it affect the current wording of our Hawaiʻi POLST Form.
A team from Kōkua Mau has been working on this with Senator Moriwaki’s office since December and we are pleased to announce that:
- Sen. Sharon Moriwaki has introduced a bill in the Senate SB2529. Track SB2529 here. PDF of SB2529. PDF of SB2529 SD1
- SB2529 first hearing in the Senate Committee on Health and Human Services was on Wed 1/31.
- SB2529 SD1 is being heard by the Committee on Judiciary (JDC) on Friday Feb 16 at 10 am.
- Rep. Della Au Belatti introduced HB2285 in the House. Track HB2285 here. PDF of HB2285
The bills have the same wording but introducing them in both houses doubles our chances of success
We are asking for your help in writing letters of support for this change: Please submit your testimony in strong support of SB2529 and HB2285.
We have laid out the issues and how to write and submit testimony below.
We suggest writing the testimony now as hearings can be scheduled quickly, and we need to be ready to go at a moments notice once the bill is scheduled for a hearing. The bills will be heard by two committees – Health and Judiciary. (FYI: You cannot submit testimony before a hearing has been scheduled. Once a hearing is scheduled, by clicking on the yellow button, a form will appear for you to easily cut and paste or attach testimony as a PDF.)
What is the issue?
In Hawaiʻi, we strive to care well for people throughout their lives, including in the last phase of life. One of the most important documents that people with very serious illness should complete is a POLST (Providers Orders for Life Sustaining Treatment), a portable medical order that documents a patient’s care plan out of the hospital. Hawaiʻi was one of the first states to adopt POLST in 2009 and we have a widespread and strong program across the state.
Currently, there is language in the POLST legislation that presents a barrier for some patients getting POLST in a timely manner. This means that the most vulnerable and sickest patients may not be able to have a POLST and risk getting unwanted and unnecessary care.
The proposed wording change will strengthen the ability of hospices and other healthcare providers to help their patients complete or update a POLST.
The current wording in 327K-1 [link] defines that signing providers (MD, APRN, PA) are those “who have examined the patient”, which could be interpreted as requiring a face-to-face encounter.
Our proposal is simple: remove those 5 words “who have examined the patient”.
- Full text of current POLST statute is 327K
Why is this change important?
Across the state and in a variety of settings, POLST conversations are initiated by other healthcare professional team members, especially nurses and social workers, which is in accordance with the law, before the document is passed along to the signing medical provider.
Currently in 327K-2, which will not be changed, it is well laid out how a patient is to be evaluated:
(b) The patient’s physician or a health care provider shall explain to the patient the nature and content of the form, including any medical intervention or procedures, and shall also explain the difference between an advance health-care directive and the form. The form shall be prepared by the patient’s physician, or a health care provider based on the patient’s preferences and medical indications.
However, Medicare hospice regulations do not mandate a face-to-face encounter before 6 months for authorized signing providers Physicians, APRNs or PAs. This causes potential problems for hospice patients – as most patients in hospice do not have face-to-face encounters with signing providers before 6 months but do, of course have lots of interaction with other clinical staff.
If you support this administrative change, we need you to write testimony in support.
You can submit testimony easily online (see below.) It will help to know that healthcare providers support this change.
Key Talking points:
- I/we am/are in strong support of SB2925 SD1 and/or HB2285 (HB not scheduled for a hearing yet as of 1/27/24)
- Hawaiʻi has a strong POLST program and POLST is widely used across the state.
- POLST is the gold standard for having out of hospital medical orders honored. EMS and first responders will honor a POLST as it is a medical order.
- This administrative improvement will bring our POLST legislation into alignment with other states as we are the only one with our current wording.
- This change in no way changes the obligation for providers to evaluate and assess the patientʻs appropriateness for POLST and the care plan that is laid out. Professional standards for Physicians, APRNs and Physician Assistants will all remain as they are.
- This change will help to ensure that hospice patients are able to get a POLST in a timely manner, so they are able to avoid unwanted and unnecessary treatments.
Write your testimony early and please create two versions.
- The Senate Bill is addressed to Senate Committee on Health and Human Services (HHS) and the House Bill to the House Committee on Health & Homelessness (HLT). Wording can be the same for both since the wording of the bill will be identical.
- Senate Committee on Health and Human Services (HHS); Chairs: Sen Joy San Buenaventura, Chair, and Sen. Henry Aquino, Vice Chair. Other members: Jarret Keohokalole, Maile Shimabukuro, Brenton Awa
- House Committee on Health & Homelessness (HLT); Rep. Della Au Belatti, Chair, and Jenna Takenouchi, Vice-Chair. Other members: Terez Amato, Greggor Ilagan, Bertrand Kobayashi, Lisa Marten, Scott Nishimoto, Diamond Garcia
Get ready to submit testimony:
To submit testimony, several things to consider (unless you do this all the time.)
- To submit testimony, several things to consider (unless you do this all the time) .
- Start with Public Access Room, Engagement 101 video to get started: Please register or log in on the capitol website. Input the bills that you are following so you can get updates as hearings are usually scheduled quickly with little lead time.
- Read about writing testimony. Or watch the submitting testimony video (10 min from the public access room) or How to Submit Testimony (more technical, by the state).
- Let us know so I can include you in any updates we receive.
- If the bill progresses, it will also go to the Judiciary Committee so you will need to submit testimony a second time. You can submit the same letter, but it should be addressed to the respective committee.
If you have questions about the whole process, call the Public Access Room at (808) 587-0478 for help. That is what they are here for and they are wonderful.
From our POLST Page: Background from 2009 to 2024:
Background and Legislation on POLST for Hawaiʻi
As of May 2023, we have an Improved Hawaiʻi POLST Form!
With input from local key informants, reviewing the national POLST form and best practice in other states, the Hawaiʻi POLST Task made improvements to our Hawaiʻi POLST Form. This change was approved by the DOH in May 2023. We encourage everyone to use the updated version of POLST (download link on the POLST Information for Provider page).
- Learn about the 2023 Improvements of the Hawaiʻi POLST Form
- Video: Improved Hawaii POLST Form 2023 step-by-step essentials with Dr. Daniel Fischberg
July 2022 Physician Assistants are able to sign POLST in Hawaiʻi. All POLST forms are still valid.
The information is from the Hawaii Academy of Physician Assistants:
Act 293 (HB1575 HD2 SB2) was signed into law on July 12, 2022. Among other expansions to physician assistant (PA) scope of practice, Act 293 amends Hawaii Revised Statutes 327K-1 and 327K-3 to include PAs as providers.
In doing so, Act 293 adds PAs to physicians and Advanced Practice Registered Nurses (APRNs) as providers authorized to execute a POLST in Hawai’i.
Act 154, the POLST legislation to expand signing privileges to APRNs (Advanced Practice Registered Nurse). It was signed June 30 by the Governor and went into effect on July 1, 2014 more
As of July 1, 2014 Hawai‘i has a new (and improved) POLST form. The Kōkua Mau website is the central source for POLST information for Hawai‘i. You may download the new POLST form and updated POLST information for providers and consumers here.
While the ‘old’ POLST forms with the word ‘physician orders’ are still valid, we recommend that you only use the new POLST Form after July 1, 2014. It has a new added section E and quite a few wording changes.
The ‘comfort care only‘ bracelet or necklace (DNR bracelet) program has been suspended indefinitely in Hawaii. More from the DOH here
- Download a PDF file of Act 154 signed into law July 1, 2014
Timeline and history of Hawaii’s POLST Law
Track House Bill 2052 (Relating to Provider Orders for Life-Sustaining Treatment), or Act 154 from the 2014 legislative session in Hawai‘i
From 2009: POLST or Physician Orders for Life Sustaining Treatment is now law in Hawai‘i as Act 186.
About the legal process of Act 186: On July 16, 2009 POLST introduced as HB1379 HD2 SD2 CD1 became law without the Governor’s signature as Act 186, (Gov. Msg. No. 543). Track the bill
Download the pdf of the (2009) bill, (now Act 186).
Hawaii Revised Statutes Title 19 Health Chapter 327K Physician Orders for Life-Sustaining Treatment.