In The News: Boulder Community Health Sets Policies on Aid-in-Dying Law

Sunday's Daily Camera had an extensive article on page one about BCH’s implementation of the Colorado End-of-Life options act.

Chief Medical Officer Dr. Ben Keidan and Vice President and Chief Nursing Officer Jackie Attlesey-Pries were quoted extensively to explain the thoughtful approach BCH took in implementing this complex law.

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Boulder Community Health sets policies on aid-in-dying law

Hospital is 'better prepared today than ... when the law came out'

By Charlie Brennan

Staff Writer
Boulder Daily Camera

Boulder Community Hospital this week announced implementation of its policies for supporting patients who choose to end their lives in accordance with Colorado's aid-in-dying law, and now has 13 of its physicians qualified with privileges to assist those who choose to use it.

BCH officials discussed the policies Thursday, the same day that the Colorado Department of Public Health and Environment reported that in 2017, 69 terminally ill Coloradans received a physician's prescription for aid-in-dying medication required to voluntarily end their lives.

CDPHE statistics showed that the aid-in-dying medication was dispensed by Colorado pharmacies to 50 patients. State data do not show whether people ingested the aid-in-dying medications dispensed by pharmacies.

However, among those prescribed the medication, the department has received death certificates for 56 patients through routine vital records registration. Of those 56, some may have died from ingesting the aid-in-dying medication, their underlying terminal illness or other causes, according to the state.

Separately, BCH officials said this week that it was aware of two BCH patients who have completed the process to receive a prescription for medical aid-in-dying medication since the law took effect Dec. 14, 2016, and had used those prescriptions — but had not done so on hospital property, which is not permitted.

The BCH board approved its policies Jan. 31, 2017, relating to what is formally known as the Colorado End-of-Life Options Act — which passed in Boulder County with nearly 79.5 percent of the vote in November 2016.

But it took the better part of the year to complete the process of educating the hospital's staff and care providers on how to most effectively respond to the dictates of the law as written, which require that a patient be terminally ill with less than six months to live, to have support of a primary care and second, consulting physician, and to be able to self-administer the prescribed medication.

Three local hospitals last year — Longmont United Health, Good Samaritan in Lafayette and Avista Adventist in Louisville — decided to opt out of participating in the measure.

UCHealth spokeswoman Kelly Tracer said all UCHealth locations, including the new Longs Peak Hospital in Longmont, have opted in and are allowing providers to work with patients who want to pursue the aid-in-dying option.

'Not for everybody'

"This is not for everybody, from a provider's standpoint, and obviously, from a patient's standpoint, as well," said Jacqueline Attlesey-Pries, vice president of operations and chief nursing officer at BCH.

"We needed to assure our physicians that no one was going to force them to do it, and no one was going to prevent them from participating. All of that took conversations with our medical staff, in order to kind of figure out how we would move forward. And then, of course, implementing those and getting those all set up, so that if someone gets a call in scheduling or gets a phone call from a patient, how do we direct them appropriately within the system?"

BCH Chief Medical Officer Dr. Ben Keidan said establishing medical aid-in-dying privileges for 11 of its 110 to 120 staff physicians — plus another two who are community-based — was not a simple process.

"The idea was to give people the easy access to education, and then we developed policies that you can sort of follow line by line," Keidan said. "I'm not sure I could recite all the requirements off the top of my head, so (the goal was) having them in front of the providers at the time that they might need them, and having resources like nursing care coordinators who could help us organize and coordinate this in a safe and effective manner."

In a statement, the hospital announced, "BCH will offer medical aid-in-dying counseling and prescriptions to qualified patients who have an established relationship with an affiliated physician or advanced practice provider (physician assistants and nurse practitioners). The process adopted by BCH is designed to inform terminally ill patients about the full range of end-of-life options, including hospice, palliative care and pain management, as well as the potential use of medical aid-in-dying medication. Participating physicians can counsel and write prescriptions for patients at any BCH facility."

'There was no such list'

The fact that the new law took effect just five weeks after its passage — Colorado was only the seventh jurisdiction to approve such a measure, along with Oregon, Washington, Montana, California, Vermont and the District of Columbia — perhaps made it inevitable that there would be confusion and unanswered questions surrounding its launch.

Will Eiserman is on the faculty of Utah State University, but resides in Boulder. In the past year, he became deeply involved in assisting a 47-year-old Boulder woman suffering from terminal breast cancer. As her illness was progressing toward an inevitable conclusion, he and other friends assisted her in many ways — including helping her explore the possibility of utilizing the aid-in-dying option.

With Eiserman's help, she finally located a physician to write the prescription for the Secobarbital needed to end her life. However, by the time she was physically compromised to the point of wanting to use it, she had lost the capacity to self-administer the drug, as the law requires.

Eiserman said he was less than satisfied when he joined her weeks earlier in approaching BCH last fall for assistance in pursuing the option afforded by the new law.

"When I was in Boulder Community Hospital with my friend, we met with the chaplain there and the social worker, and they said, 'I have a list I can give you. It will tell you exactly who to go to.' I was surprised but cautiously encouraged," Eiserman recalled. "I waited, and then he didn't give it, and they eventually said, 'Just go to CompassionandChoices.org (a national nonprofit devoted to education and assistance concerning end-of-life options).' That website is very helpful, but it clearly states that it does not give information about specific providers who can assist. There was no such list."

Eiserman said: "They assuaged our worries that it was going to be hard, and then they didn't really follow through on this important part. They didn't really want to come out and say, 'We won't help you with that,' but clearly, they couldn't, or wouldn't."

Attlesey-Pries said a patient asking the same questions at BCH today would have a different experience.

"They would, because back last fall, we did not even have anybody credentialed yet, or privileged to do it," she said. "We were still not clear on all of our processes internally.

"We're better prepared today than we were last fall, or we were a year ago, when the law came out very quickly, without any ability to be able to prepare ahead of the law going into effect. So that was a little bit of a problem."

No 'slippery slope'

Dr. Cory Carroll, a solo family practitioner in Fort Collins, pointed out that the 75,000-member Colorado Medical Society's board of directors in 2016 voted to take a neutral stance on the law, after a survey showed 56 percent of its members in favor of physician aid in dying, with 35 percent opposed.

Carroll is among those who supported it, and he had requests from six of his patients in 2017 for the medication needed to complete the aid-in-dying process. He is not surprised by difficulties people have met in the first full year of the law — but declined to comment on BCH requiring a full year to publicly roll out its policies around the measure.

He voiced compassion for patients who are having difficulty finding a doctor who will participate in the process, and that its broad acceptance across the medical community has been slow.

"I do think it is more because doctors are more constrained today, with (circumstances of) their employment, and the fear of what may happen," Carroll said. "But I don't think there is any evidence of a slippery slope, or flaws that make this a bad thing."

Dr. David Hibbard, of Boulder, fought for passage of the law, and is now devoting his practice solely to people who are facing their end of life and want to exercise their right under the provisions of the Colorado End-of-Life Options Act.

"I'm pretty much happy with it," he said of its implementation. "Among my colleagues who are dealing with this, there does seem to be a feeling that there are not quite enough physicians who are taking the spot of the (second) consulting physicians. There are not as many of those as would be desirable."

Hibbard is now focusing on making himself available to fill that role.

Keidan, at BCH, believes a significant positive of the law is that it has set people to talking about an often uncomfortable subject.

"This law has created a lot of opportunities to explore all of these other things, like hospice, palliative care, end-of-life even," Keidan said.

"In my own clinic, people have asked me, 'Will you do medical aid-in-dying?' And I think that's kind of an opening ... to explore just a little bit more about what people are hoping for at end-of-life, and what their options are. That's a really good thing, and that will touch a lot more people than the number of people — that hopefully will be small — that go through the medical aid-in-dying process."

Requirements for obtaining end-of-life medicine under Colorado law

Proposition 106 created the Colorado End-of-Life Options Act, which allows individuals with a terminal illness to request from their physician and self-administer medical aid-in-dying medication. To be eligible to request medication, the individual must:

Charlie Brennan: 303-473-1327, brennanc@dailycamera.com or twitter.com/chasbrennan

• Be a Colorado resident 18 years of age or older
• Be able to make and communicate an informed decision to health care providers
• Have a terminal illness with a prognosis of six months to live that has been confirmed by two physicians, including the individual's primary physician and a second consulting physician
• Be determined mentally capable by two physicians, who have concluded the individual understands the consequences of his or her decision
• Voluntarily express his or her wish to receive the medication
• Be capable of self-administering the aid-in-dying medication