California Advocates for Nursing Home Reform v. SmithAnnotate this Case
Health and Safety Code section 1418.8 concerns nursing home residents who lack the capacity to make their own health care decisions and are without family members or other legal surrogates. The superior court held that the statute, on its face, violates due process under the California Constitution by failing to require notice to residents of a physician’s predicate determinations that the patient lacks capacity, has no surrogate decision-maker, needs a recommended medical intervention, and has a right to judicial review; was never intended to authorize interdisciplinary team (IDT) decision-making for administration of antipsychotic medication, and violates due process, as applied, when used to authorize such drugs; and violates the patient’s privacy rights and is unconstitutional as applied to decisions regarding end of life withdrawal of care.
The court of appeal reversed, construing the statute to uphold its constitutionality rather than enjoining its use, and directing the superior court to enter a modified judgment, requiring nursing homes to adopt additional procedures. Written and oral notice must be provided to every resident for whom section 1418.8 is invoked, of any determination of the resident’s incapacity; any determination that no surrogate decision-maker is available; any proposed medical intervention; the fact that a decision will be made by the IDT; the resident’s right to have a patient representative participate in IDT decision-making; and the resident’s right to judicial review of IDT decisions. Except in emergency circumstances, no medical treatment decision by an IDT on behalf of a resident may be implemented until the resident has been given a reasonable opportunity to seek judicial review. Except in emergency circumstances, every IDT must include a patient representative, and where the resident has no family or friend willing to serve, someone unaffiliated with the nursing home must serve as the patient representative. The IDT process may be used to authorize the administration of antipsychotic medications and for decisions to create or change physician orders for life-sustaining treatment, DNRs or comfort care orders, and to transfer patients to hospice care.