VVH, other hospitals opt out of Colorado’s end-of-life law, for now | PostIndependent.com

VVH, other hospitals opt out of Colorado’s end-of-life law, for now

Valley View Hospital in Glenwood Springs has joined other area hospitals in opting out of a new state law, at least for now, that gives terminally ill people the right to pursue life-ending options, which earned overwhelming support from Colorado voters last November.

"Valley View and its medical staff support the autonomy of patients as well as their right to make informed choices about their care," according to a statement issued by the hospital's medical staff and board of trustees last week.

Final rulemaking on the Colorado End-of-Life Options Act, which is ongoing, may better inform a future decision by Valley View to participate at a later time, the hospital said.

However, without a better understanding of how the new law is to be implemented so that it protects patients, physicians and hospital staff, Valley View as a medical facility is exercising its right under the new law to not participate, according to the statement from Stacey Gavrell, chief community relations officer for VVH.

The decision means that physicians associated with the hospital can still write a prescription for terminally ill patients who want to end their life, but only if it’s taken at home or in another facility that has decided to participate.

The new law, which went before voters as Proposition 106 and was approved by a 2:1 ratio, went into effect on Dec. 16. But it made participation by hospitals and other health-care providers voluntary.

Hospitals around the state have been asked to decide if they want to participate. For now, three area hospitals, Valley View, Grand River Health Center in Rifle and Aspen Valley Hospital, have decided to opt out.

That could change in the future, Valley View officials said.

"We want to allow the rulemaking to continue and revisit this when that process is complete," Gavrell said. "Valley View is part of the community, and we want to support our patients."

Dr. David Brooks, the newly appointed chief medical officer for Valley View, said that while the hospital is opting out until there is more regulatory guidance, physicians remain committed to supporting patients and the broader community when it comes to making end-of-life decisions.

"We hope to provide the administrative support to help in those decisions," he said. "If we were to opt in, we want to support or medical providers and make sure we are following the law appropriately."

Colorado's law is modeled after one in Oregon that has been in place since the late 1990s. The End-of-Life Options Act in Colorado allows terminally ill residents with a diagnosis that they have less than six months to live to request a drug to end their life. Patients must be at least 18 years old and have at least two physicians conclude that they are mentally capable of making their own decision, among other stringent requirements.

Patients must also administer the drug themselves. In Oregon, that generally has occurred in a private home under the care of hospice, and not in a hospital setting, Gavrell and others have noted.

Grand River Hospital also decided soon after the law took effect to opt out, but it too is taking a wait-and-see approach, hospital spokeswoman Anick Pruitt said.

"We did review it and neither our physicians nor our board thought it was a prudent thing to opt in to, because there is just too much unknown at this point," she said.

Likewise, Aspen Valley Hospital decided soon after the law went into effect that it would opt out for the interim. But CEO David Ressler told the Aspen Times that the hospital ultimately intends to opt in at a later date once more is known and once the hospital has time to prepare.

Opting in would require a hospital to create an end-of-life policy, as well as making sure a support network of pharmacists, nurses, a compliance officer and attorneys are on board, Aspen hospital officials indicated.

Home Care and Hospice of the Valley is working with AVH to develop that policy, and is willing to do so with other facilities that it works with, said Markey Butler, executive director for the hospice organization.

"Our stance in this is that we are neutrally engaged," Butler said. "Hospice is there for the comfort of our patients, and we want to be a layer of support for those who are going through the dying process."

Butler noted that in Oregon, Washington and other places that have right-to-die laws, more than 90 percent of those who choose to die do so in the arms of hospice, and most often in the home. Since Colorado's law passed, three people on the Front Range have gone through the rigorous requirements to end their life, said Butler, who is also president of the Hospice and Palliative Care of the Rockies board.

Besides the patient having to be deemed of sound mind to make their own decision, the expensive life-ending drug has to be paid for out of pocket, because it's not covered by insurance. The patient then has to administer the drug themselves on their own schedule. Oftentimes, a patient will die naturally in the meantime, and in the end some choose not to take the drug, Butler explained.

If the patient desires, "Our role is to be with the patient offering comfort and making sure they safely administer the drug," she said.

It does get to be a complicated issue for hospitals, she said, but rarely would a hospital come into play as the setting for someone to end their life under the law. A possible scenario would be if someone panicked at the last minute and ended up in the emergency room, then decided to take the drug, she said.

Butler said many other hospice organizations around the state have also taken a neutral stance, although one Catholic-run hospice has specifically opted out. Catholic organizations were among those that had opposed Prop 106 during the election for faith reasons.