PART 4 OF 4: What Healthcare Providers Need to Know

Provider obligations when a patient has a directive.

Advance healthcare directives create obligations for the practices and facilities that receive them. Understanding those duties protects patients and reduces liability exposure for providers. This article addresses what California healthcare providers should know about honoring directives and managing them within their practices.

The duty to follow the directive

A health care provider who knows of a patient's directive generally must comply with the individual's instructions and with the decisions of a properly designated agent, to the extent those decisions are within the agent's authority and consistent with law. Providers should confirm the document's validity and the scope of the agent's authority rather than assuming either.

Determining capacity

A directive typically becomes operative on a determination that the patient lacks capacity to make health care decisions. That determination should be made and documented by the primary physician in accordance with generally accepted standards. Capacity is decision-specific and can fluctuate; a patient who regains capacity resumes making decisions.

Conscience-based objections

California law permits a provider to decline to comply with an instruction or decision for reasons of conscience, or where the request is contrary to generally accepted health care standards. A provider who declines must promptly inform the patient or agent, must not abandon the patient, and must provide continuing care and cooperate in transferring the patient to another provider willing to comply.

Documentation and records

Practices should have a process for handling directives:

• Ask about and document the existence of a directive at intake.

• Retain a copy in the medical record and confirm it is the most recent version.

• Record the identity and contact information of the agent and any alternates.

• Document capacity determinations and the basis for them.

• Note any conscience-based objection and the steps taken in response.

Immunity and good faith

California law affords providers protection from liability when they act in good faith and in accordance with generally accepted standards in complying with a directive or an agent's decision. That protection depends on acting reasonably and on the quality of the documentation supporting those actions.

Training staff

Front office and clinical staff should know how to receive a directive, where it belongs in the record, and whom to notify. A directive sitting in a scanning queue serves no one.

How West Coast Health Law Can Help

We advise California healthcare practices on directive compliance — developing intake and documentation protocols, addressing capacity determinations and conscience-based objections, and training staff to handle these documents correctly. If your practice is establishing or reviewing its process, we can help you build it on solid footing.

West Coast Health Law offers a FREE consultation which you may schedule by clicking the button on our website.

This article is provided for general informational purposes only and does not constitute legal advice or create an attorney-client relationship. Laws change and every situation is different; consult a qualified attorney about your specific circumstances.