Chris DeWald: Stroke and recent health-care inserts

I have had enough of hearing about death panels for the elderly and the sickly in the new health-care law. There is so much to try and understand. Each political organization has a different take in the outcome of this legislation. I believed it was removed, but it made headlines again during Christmas. Gee, how wonderful and spiritual.

I am going to attempt to read the actual truth as it slams on some of you effective Jan. 1, 2011. Those with strokes, I am sure are in panic, because you do not understand. I don’t like any party telling me I have little choice and will be Soylent Green. Yes, the movie with Charlton Heston, Edward G Robinson and the Riflemanb(Chuck Conners). Well, here we go people, into the land of documents not fully read by most of the Senate and Congress.

Text of Section 1233 (pp. 425-430) of the actual health care reform bill (House Bill 3200), which, as far as I can tell after wading through several pages of legalese, merely amends Title 18 of the Social Security Act to stipulate that Medicare will pay for – not mandate – “advance care planning consultations” between individuals and physicians every five years, during which a spectrum of end-of-life options can be explained and discussed so said individuals can knowledgeably choose their own treatment preferences in advance:

I have taken the following directly from the bill located at:

Please read the bill because there is so much horse hockey out there and this is important. I shall be writing what I see in this of course.

Page 424, Line 15:



(1) IN GENERAL.–Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended–

(A) in subsection (s)(2)—

(i) by striking “and” at the end of subparagraph (DD);

(ii) by adding “and” at the end of subparagraph (EE); and

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

Page 425:

“(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,

STOP !!! Chris time(Took “Hammer Time”) I have worked for and under State regulatory agencies. There are two easy words all good administrators see. The use of “Shall” and “May”. Shall means you must do. May means a suggestion to do without penalties. So first we see if you do not have a consultation within 5 years, a consultation shall include the following. This means sit down and hold on as it is mandatory now to receive advance care planning consultation. The consultation does not seem “horrific”. This may free up some courts with wills and hospital wishes. I have a living will and an actual will. I have advanced resuscitate documents and the weeding out of my organs. So this I see as no big deal. Now we have a lot more to look at.

Page 426:

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 requirements in which such individual resides so that the treatment wishes of that individual will be carried out if the individual is

Page 427:

unable to communicate those wishes, including requirements regarding the designation of a surrogate decisionmaker (also known as a healthcare 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)

(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;

“(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;

Hokie Patokie! You talk about clouds and fog. You have to have a congressional degree in the Land of Oz to understand this. There are parts that trouble me, but please consider, I have a brain injury. But I do know the difference between raining on my leg and other wet agents.

Look above at F 1.bThis starts to lead me down the stink language. Then go to ii. then iii. I am trying to shorten this as most reading this article have issues reading or understanding. A program for orders for life sustaining treatment for states. I do believe programs have a beginning and an end.

Page 428:

“(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).

Page 429:

“(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;

Page 430:

“(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

Here I am again. The wrench in the works does not like page the start of page 428. The goals and use of life sustaining equipment? What are the goals? Who interprets if my life is to be sustained? Does every health care provider have the same sheet of music? Yikes! is guided by whom? Among the list are stakeholders? Are they profit-margin driven? Page 429 gets worse.

People, please read this! I am and this is scary stuff. Read “B” please. Is this you? Is this your parent? Is this your relative? I know its me and I am sorry, I am not ready to give the government any more of what I have given them. This includes my body to decrease the debt. This is the way I am reading this, so show me wrong. Then you read page 430 and it just confuses me from page 429.

This is not an easy bill to read. I have given how I interpret this section of the health-care law. I hope it stirs some type of thread and some other opinions. I welcome anyone who agrees or disagrees with my post. There are some points that are wise, then it gets harrowing. Thank you.

Column by Chris DeWald

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