Decision Making for Unrepresented Patients Webinar
Court decision expands patient protections, prompts change in policies and procedures

Webinar Recorded Live on October 13, 2015


On June 24, the Alameda County Superior Court found unconstitutional a California law that permits skilled-nursing facilities (SNFs) to use interdisciplinary teams to make medical decisions for patients who lack capacity and have no one to make decisions for them. While the law applies to SNFs, many hospital interdisciplinary teams have also been operating under a model policy developed by the California Hospital Association, the California Medical Association and the Alliance of Catholic Hospitals, which is based the SNF law.

It is unclear whether the decision will be appealed. However, to protect patient rights, SNFs and hospitals should revise their policies and procedures. This webinar explains the implications of the case, California Advocates for Nursing Home Reform v. Chapman, and how policies and procedures should be revised to comply. An updated model policy for consent for treatment of unrepresented patients is provided, along with other tools to operationalize the new process.

Recommended for:

Risk managers, health information officers, privacy officers, compliance officers, in-house legal counsel, health care attorneys, nurses and nurse managers, social workers, quality management staff, admissions staff, emergency department staff, discharge planners, clinical and skilled nursing staff and administrators.                             


Informed consent — why it’s needed, how it’s done

  • Procedures requiring informed consent, emergency exception
  • Psychotherapeutic drugs, end-of-life decisions in the SNF
  • What you need to communicate — risks, benefits, alternatives to procedure
  • Determining capacity — who decides and how

Who can decide for the patient lacking capacity?

  • Surrogates and agents — patient selected
  • Public and private conservators — government selected
  • Relatives or close friends — case law guidance

There’s no one to decide for the patient — now what?

  • Interdisciplinary team consent
  • Recent Superior Court case changes the status quo
  • Practical implications in acute care and SNF settings
  • CHA/CMA/ACH model policy, tools and checklists

Other options for consideration

  • Decline to provide care unless/until emergency situation
  • Role of ethics committee
  • Resolving the court’s concerns with interdisciplinary team consent
  • Probate Code Section 3200 — when the court decides

Pick your risk — case examples to test decision making skills


Susan Penney is director of risk management for the University of California, San Francisco (UCSF) clinical enterprise, including UCSF’s Medical Center and Medical Group, San Francisco General Hospital, UCSF Benioff Children’s Hospital Oakland and UCSF Fresno. Previously, Ms. Penney served as legal counsel for the California Medical Association and as an attorney in private practice.

Lois Richardson is CHA’s vice president of privacy and education/publications. In addition to her current role, Ms. Richardson has served as CHA’s legal resource for the past 19 years, primarily as legal counsel. She is the author of numerous CHA publications, including the Consent Manual, California Hospital Compliance Manual, California Health Information Privacy Manual and Mental Health Law. Ms. Richardson is also the executive director for the California Society for Healthcare Attorneys.