Medical Orders for Life-Sustaining Treatment - Professionals

Background: The MOLST Community Pilot

NOTE: This page is for historical purposes only.  The MOLST Community Pilot was a success and resulted in an amendment to NYS PHL§2977(13) allowing MOLST to become statewide and permanent on July 8, 2008! >read the legislation >read the news release

Governor Pataki signed the MOLST bill (A.8892, S.5785) establishing a pilot of the MOLST program in Monroe and Onondaga Counties on October 11, 2005. This bill allowed for the use of the MOLST form in lieu of the New York State Nonhospital Do Not Resuscitate (DNR) form. The Pilot was officially launched on May 1, 2006.

A Chapter Amendment (A.9479, S.6365), signed by Governor Pataki on July 26, 2006, permitted EMS to honor Do Not Intubate (DNI) instructions prior to full cardiopulmonary arrest only in Monroe and Onondaga Counties during the MOLST Pilot and provided a carve out for persons with mental retardation and developmental disabilities without capacity.  The carve out is still in effect and individuals with mental retardation and developmental disabilities with capacity can complete a MOLST form. A Chapter Amendment was needed as Do Not Intubate (DNI) was not covered in Nonhospital DNR Law (PHL §2977).

The MOLST Community Pilot studied whether a completed, signed MOLST form could act as a suitable replacement for the New York Nonhospital Order Not to Resuscitate (also called the Out-of-hospital Do Not Resuscitate (DNR) Order).

During the MOLST Community Pilot

Emergency Medical Service (EMS) personnel followed orders on the MOLST form for individuals living in Monroe and Onondaga Counties.

• Individuals living in Monroe or Onondaga Counties
  A completed, signed MOLST form can replace the New York State Department of Health Nonhospital DNR form. EMS can follow Do Not Intubate (DNI) orders prior to full cardiopulmonary arrest.
  
  
• Individuals living outside of Monroe and Onondaga Counties
  The New York State Department of Health Nonhospital DNR form must be completed in addition to the MOLST. In counties other than Monroe and Onondaga, EMS cannot directly follow Do Not Intubate (DNI) orders prior to full cardiopulmonary arrest. However, as always, EMS can contact Medical Control as is currently within the scope of practice.

All hospitals, long-term care facilities, home care and hospice agencies and community health care professionals in Monroe or Onondaga Counties are encouraged to participate in the MOLST Community pilot. A successful Pilot will help to ensure the MOLST Program moves beyond the pilot phase.

Timeline

• June 2005: The MOLST Pilot Project Legislation (A.8892, S.5785) passed.
  
• October 2005: Governor Pataki signed the bill with a carve-out for Office of Mental Health (OMH) and Office of Mental Retardation and Developmental Disabilities (OMRDD). Individuals with mental illness and/or developmental disabilities with capacity can complete a MOLST form.
  
• October 2005: The New York State Department of Health (NYSDOH) approved the MOLST form for use in institutions throughout New York State as the legal equivalent of an inpatient Do Not Resuscitate (DNR) form.
  
• January 2006: A Chapter Amendment (A.9479, S.6365) was introduced. This amendment authorized EMS in only Monroe and Onondaga Counties to honor Do Not Intubate (DNI) instructions prior to full cardiopulmonary arrest during the MOLST pilot.
  
• May 2006: MOLST pilot study launched in Monroe and Onondaga Counties.
  
• June 2006: The Chapter Amendment (A.9479, S.6365) passed.
  
• July 2006: Governor Pataki signed the Chapter Amendment
  
• June 30, 2008: The MOLST Pilot legislation expired.  The MOLST Pilot was a success!
  
• July 8, 2008: NYS PHL§2977(13) was amended to allow MOLST to become statewide and permanent! >legislation >news release

The Monroe and Onondaga Counties MOLST Community Implementation Team was formed to help introduce and oversee the pilot. Team members include representatives from hospitals, long term care facilities, hospice and home care agencies, EMS personnel, NYSDOH Western Region – Rochester and Syracuse offices, local medical societies, local bar associations and the respective county health departments. 

The team has:

1. Helped to introduce and oversee the pilot in Monroe and Onondaga Counties.
   
2. Assured adequate regional training and utilization of the MOLST form and program.
   
3. Collected, reviewed and tracked quality data to ensure accurate form completion.
   
4. Worked to establish standardized metrics..
   
5. Developed a system that ensures that the form and program are appropriately used as the project moves beyond the pilot phase.
   
6. Assisted in facility implementation throughout state.