Improper Authorization for Advance Directives on MOLST Form
Penalty
Summary
The facility failed to ensure that the appropriate individual had the legal authority to make decisions regarding Advance Directives for one resident. Specifically, a MOLST (Massachusetts Medical Order for Life-Sustaining Treatment) form was completed and signed by the resident's legal guardian, who did not have the required court-ordered expansion of authority to make decisions about life-sustaining treatments. The guardianship documents on file did not include authorization for the guardian to refuse or discontinue life-sustaining treatments on behalf of the resident. The resident involved had diagnoses of Paranoid Schizophrenia and Dementia and had been admitted to the facility with these conditions. The MOLST form, signed by the unauthorized guardian, included orders for DNR (Do Not Resuscitate), DNI (Do Not Intubate), DNH (Do Not Hospitalize), no dialysis, no artificial nutrition, and no artificial hydration. Despite the lack of proper legal authority, physician orders were in place to follow the instructions on the invalid MOLST form. Interviews with facility staff confirmed that the guardian did not have the necessary legal authority to make these decisions.