Your Rights as a Hospital Patient in New York State

Planning in Advance For Your Medical Treatment

Your Right to Decide About Treatment

Adults in New York State have the right to accept or refuse medical treatment, including life-sustaining treatment. Our constitution and state laws protect this right. This means that you have the right to request or consent to treatment, to refuse treatment before it has started and to have treatment stopped once it has begun.

Planning In Advance

Sometimes because of illness or injury people are unable to talk to a doctor and decide about treatment for themselves. You may wish to plan in advance to make sure that your wishes about treatment will be followed if you become unable to decide for yourself for a short or long time period. If you do not plan ahead, family members or other people close to you may not be allowed to make decisions for you and follow your wishes.

In New York State, appointing someone you can trust to decide about treatment if you become unable to decide for yourself is the best way to protect your treatment wishes and concerns. You have the right to appoint someone by filling out a form called a Health Care Proxy. A copy of the form and information about the Health Care Proxy are available within this publication and may be printed directly from the Department of Health website at www.nyhealth.gov and click on Info for Consumers.

If you have no one you can appoint to decide for you, or do not want to appoint someone,you can also give specific instructions about treatment in advance. Those instructions can be written, and are often referred to as a Living Will.

You should understand that general instructions about refusing treatment, even if written down, may not be effective. Your instructions must clearly and convincingly cover the treatment decisions that must be made. For example, if you just write down that you do not want "heroic measures," the instructions may not be specific enough. You should say the kind of treatment that you do not want, such as a respirator or chemotherapy, and describe the medical condition when you would refuse the treatment, such as when you are terminally ill or permanently unconscious with no hope of recovering. You can also give instructions orally by discussing your treatment wishes with your doctor, family members or others close to you.

Putting things in writing is safer than simply speaking to people, but neither method is as effective as appointing someone to decide for you. It is often hard for people to know in advance what will happen to them or what their medical needs will be in the future. If you choose someone to make decisions for you, that person can talk to your doctor and make decisions that they believe you would have wanted or that are best for you, when needed. If you appoint someone and also leave instructions about treatment in a Living Will, in the space provided on the Health Care Proxy form itself, or in some other manner, the person you select can use these instructions as guidance to make the right decision for you.

Deciding About Cardiopulmonary Resuscitation (CPR)

Your right to decide about treatment also includes the right to decide about cardiopulmonary resuscitation (CPR). CPR is emergency treatment to restart the heart and lungs when your breathing or circulation stops.

Sometimes doctors and patients decide in advance that CPR should not be provided, and the doctor gives the medical staff an order not to resuscitate (DNR). If your physical or mental condition prevents you from deciding about CPR, someone you appoint, your family members or others close to you can decide.


Patients are provided with the description of state law prepared by the State Health Department entitled "Planning in Advance For Your Medical Treatment"; the publication, "Appointing Your Health Care Agent— New York State's Proxy Law," which contains a sample (usable) health care proxy form; and a summary of the hospital's policy regarding the implementation of these rights.
10NYCRR, 400.21 (d) (1) (i, ii, iii)

Deciding about Cardiopulmonary Resuscitation (CPR): Do-Not-Resuscitate (DNR) Orders

A Guide for Patients and Families

What do CPR and DNR orders mean?

CPR – cardiopulmonary resuscitation — refers to the medical procedures used to restart a patient's heart and breathing when the patient suffers heart failure. CPR may involve simple efforts such as mouth-tomouth resuscitation and external chest compression. Advanced CPR may involve electric shock, insertion of a tube to open the patient's airway, injection of medication into the heart and in extreme cases, open chest heart massage.

A do-not-resuscitate (DNR) order tells medical professionals not to perform CPR. This means that doctors, nurses and emergency medical personnel will not attempt emergency CPR if the patient's breathing or heartbeat stops.

DNR orders may be written for patients in a hospital or nursing home, or for patients at home. Hospital DNR orders tell the medical staff not to resuscitate the patient if cardiac arrest occurs. If the patient is in a nursing home or at home, a DNR order tells the staff and emergency medical personnel not to perform emergency resuscitation and not to transfer the patient to a hospital for CPR.

Why are DNR orders issued?

CPR, when successful, restores heartbeat and breathing and allows a patient to resume his/ her previous lifestyle. The success of CPR depends on the patient's overall medical condition. Age alone does not determine whether CPR will be successful, although illnesses and frailties that go along with age often make CPR less successful.

When patients are seriously ill or terminally ill, CPR may not work or may only partially work, leaving the patient brain-damaged or in a worse medical state than before the heart stopped. In these cases, some patients prefer to be cared for without aggressive efforts at resuscitation.

Can I request a DNR order?

Yes. All adult patients can request a DNR order. If you are sick and unable to tell your doctor that you want a DNR order written, a family member or close friend can decide for you.

Is my right to request or receive other treatment affected by a DNR order?

No. A DNR order is only a decision about CPR and does not relate to any other treatment.

Are DNR orders ethically acceptable?

It is widely recognized by health care professionals, clergy, lawyers and others that DNR orders are medically and ethically appropriate under certain circumstances. For some patients, CPR offers more burdens than benefits, and may be against the patient's wishes.

Is my consent required for a DNR order?

Your doctor must speak to you before entering a DNR order if you are able to decide, unless your doctor believes that discussing CPR with you would cause you severe harm. In an emergency, it is assumed that all patients would consent to CPR. However, if a doctor decides that CPR will not work, it is not provided.

How can I make my wishes about DNR known?

During hospitalization, an adult patient may consent to a DNR order orally or in writing, if two adult witnesses are present. When consent is given orally, one of the witnesses must be a physician affiliated with the hospital. Prior to hospitalization, consent must be in writing in the presence of two adult witnesses. In addition, the Health Care Proxy Law allows you to appoint someone you trust to make decisions about CPR and other treatments if you become unable to decide for yourself.

Before deciding about CPR, you should speak with your doctor about your overall health and the benefits and burdens CPR would provide for you. A full and early discussion between you and your doctor will assure that your wishes will be known.

If I request a DNR order, must my doctor honor my wishes?

If you don't want CPR and you request a DNR order, your doctor must follow your wishes or:

  • transfer your care to another doctor who will follow your wishes; or
  • begin a process to settle the dispute if you are in a hospital or nursing home.

If the dispute is not resolved within 72 hours, your doctor must enter the order or transfer you to the care of another doctor.

If I am not able to decide about CPR for myself, who will decide?

First, two doctors must determine that you are unable to decide about CPR. You will be told of this determination and have the right to object.

If you become unable to decide about CPR, and you did not tell your doctor or others about your wishes in advance, a DNR order can be written with the consent of the person highest on the following list:

  • your health care agent — the person chosen by you to make health care decisions under New York's Health Care Proxy Law (if you have appointed one);
  • a court appointed guardian (if there is one);
  • your closest relative (spouse, child, parent, sibling);
  • a close friend.

How can I select someone to decide for me?

The Health Care Proxy Law allows adults to select someone they trust to make health care decisions for them when they are no longer able to do so themselves, including decisions about CPR. You can name someone by filling out a health care proxy form. (See page 33 for Proxy Form.)

Under what circumstances can a family member or close friend decide that a DNR order should be written?

A family member or close friend can consent to a DNR order only when you are unable to decide for yourself and you have not appointed a health care agent to decide for you. Your family member or friend can consent to a DNR order when:

  • you are terminally ill; or
  • you are permanently unconscious; or
  • CPR will not work (would be medically futile); or
  • CPR would impose an extraordinary burden on you given your medical condition and the expected outcome of CPR.

Anyone deciding for you must base the decision on your wishes, including your religious and moral beliefs, or if your wishes are not known, on your best interests.

What if members of my family disagree?

In a hospital or nursing home, your family can ask that the disagreement be mediated. Your doctor can request mediation if he or she is aware of any disagreement among your family members.

What if I lose the ability to make decisions about CPR and do not have anyone who can decide for me?

A DNR order can be written if two doctors decide that CPR would not work or if a court approves of the DNR order. It would be best if you discussed your wishes about CPR with your doctor in advance.

Who can consent to a DNR order for children?

A DNR order can be entered for a child with the consent of the child's parent or guardian. If the child is old enough to understand and decide about CPR, the child's consent is also required for a DNR order.

What happens if I change my mind after a DNR order has been written?

You or anyone who consents to a DNR order for you can revoke consent for the order by telling your doctor, nurses or others of the decision.

What happens to a DNR order if I am transferred from a nursing home to a hospital or vice versa?

The DNR order will continue until a doctor examines you and decides whether the order should remain or be canceled. If the doctor decides to cancel the DNR order, you or anyone who decided for you will be told and can ask that the DNR order be entered again.

If I am at home with a nonhospital DNR order, what happens if a family member or friend panics and calls an ambulance to resuscitate me?

If you have a nonhospital DNR order and family members show it to emergency personnel, they will not try to resuscitate you or take you to a hospital emergency room for CPR.

What happens to my DNR order if I am transferred from a hospital or nursing home to home care?

The order issued for you in a hospital or nursing home will not apply at home. You, your health care agent or family member must specifically consent to a nonhospital DNR order. If you leave a hospital or nursing home without a nonhospital DNR order, a DNR order can be issued by a doctor for you at home.

Patients are provided with information developed by the State Health Department that describes the Do-Not-Resuscitate( DNR) law. It must also be furnished to each member of the hospital's staff involved in the provision of medical care, and it must be posted in a public place in each hospital.
Patient Self-Determination Act in OBRA '90 amending 1902 (a) (58) of Social Security Act Public Health Law 2979

Health Care Proxy - Appointing Your Health Care Agent in New York State

About the Health Care Proxy Form

Frequently Asked Questions

Health Care Proxy Form Instructions

Health Care Proxy


Statewide Planning and Research Cooperative System (SPARCS)

This is to notify all hospital patients that the New York State Department of Health has developed a statewide data system known as the Statewide Planning and Research Cooperative System (SPARCS)) and that all acute care hospitals are required to submit to (SPARCS) certain billing and medical record information for all patients. This information in (SPARCS) will be used for financial studies, rate setting, utilization review, health planning, epidemiology and research studies.

Please be assured that under this program:

  1. The New York State Department of Health will not receive the name of any patient or any information which will enable a patient to be identified within the SPARCS system.
  2. Regulations have been enacted protecting a patient's privacy and confidentiality by restricting access to any sensitive information in SPARCS and assuring review of all requests by an independent public review board.
  3. Additional regulations have been enacted to control all access to SPARCS and to provide physical security for SPARCS data.
  4. SPARCS is not designed to identify specific patients; instead it is structured to provide information on patterns of illnesses and costs of care in hospitals.

This hospital is required to submit patient medical record and billing data to the Department of Health pursuant to Section 400.18 of Article 1, Subchapter A, Chapter V, Title 10 (Health) of the OFFICIAL COMPILATION OF CODES, RULES AND REGULATIONS OF THE STATE OF NEW YORK. The privacy, confidentiality and security of the information supplied is protected pursuant to Section 400.18( e) of Article 1, Subchapter A, Chapter V, Title 10 (Health) of the OFFICIAL COMPILATION OF CODES, RULES AND REGULATIONS OF THE STATE OF NEW YORK.

For further information concerning SPARCS, please contact:

Coordinator
Statewide Planning and Research Cooperative System
New York State Department of Health
800 North Pearl
Menands, New York 12204
Hospitals must provide patients with a notification letter from the New York State Department of Health that relates to the statewide data collection system known as SPARCS
10NYCRR, 400.18 (b) (2) and (C) (2) (SPARCS Letter)

Maternity Information

Hospitals (and birth centers) must provide prospective maternity patients (at the time of prebooking) and the general public, upon request, with written information that includes statistics specific to each hospital's maternity-related procedures and practices, insurance coverage, and postpartum events.

This written information can help you to better understand what you can expect, learn more about your childbirth choices, plan for your baby's birth and prepare for postpartum recovery. It will also direct you to appropriate sources to obtain further information.

  • Hospital-specific statistics will give you the percentages regarding deliveries and use of special procedures during births occurring at your hospital of choice. You will also be informed of the hospital's special practices, including the availability of birthing rooms or rooming in. This information is important to the planning of your childbirth experience.
  • Inpatient insurance coverage in New York State is provided for a mother and her newborn for at least 48 hours after childbirth for vaginal delivery and at least 96 hours after a caesarean section. In addition, each hospital must provide patient education, assistance and training in breast or bottlefeeding and any necessary maternal or newborn clinical assessments. Check with your insurance company for more details on your maternity coverage.
  • Postpartum depression or baby blues may occur after giving birth. Your body has undergone physical and hormonal changes, which may leave you with feelings of sadness, mood swings, anger, anxiety and low self-esteem, for days or weeks following birth. The baby blues are very common and will pass in time. Your doctor can suggest some ways to help you feel better. Less common is postpartum depression( PPD). The symptoms are severe and can include feelings of hopelessness, high anxiety, eating problems, feeling "out of control," and thoughts of harming yourself or the baby. Contact your doctor regarding these symptoms, as PPD is treatable. Your doctor must be contacted immediately if you feel as though you may hurt yourself or your baby.
  • Shaken baby syndrome refers to the injuries that result from the violent shaking of an infant or child. New parents need to be aware of the danger of shaking their infant or small child. Often, a frustrated caregiver loses control and shakes an infant in an attempt to stop the baby from crying. Usually, there is no intent to harm the child, just to have the baby stop crying. The stress of caring for a newborn can place any caregiver, including parents, at risk for shaking a baby. For more information about shaken baby syndrome, visit the Department of Health website at www. health. state. ny. us.
Hospitals must also (1) assure that prenatal childbirth education classes are available for all prebooked women; (2) distribute newborn screening educational literature; (3) provide all prebooked women with a written description of available options for labor, delivery and postpartum services.
Public Health Law 2803-j Maternity patients information leaflet 10NYCRR, 405.21 (c), 405.21 (c) (8)

Notice for Prenatal and Maternity Patients

This notice contains information that will be valuable to you if you are a victim of domestic violence. If you are a victim of domestic violence you should request to speak with someone about your situation and be given this information in a private and confidential manner. Your rights as a patient will be violated if hospital staff asks if you are a victim of domestic violence in front of any accompanying partner or family member.

Are You And Your Baby Safe?

You might not be, if there is domestic violence in your life. Here are some questions to help you know if you're being abused:

  • Does your partner hurt you with words?
  • Does he insult you and make you feel worthless?
  • Does he put you down in front of other people?
  • Does he hurt you physically? Does he push, slap, hit, punch, kick, choke or beat you?
  • Does he make you do sexual things you don't want to do or hurt you during sex?
  • Is he in charge of everything? Does he tell you who you can and cannot see or talk to?
  • Does he control all the family's money?
  • Does he scare you?
  • Does he lose his temper, get very jealous or break things?
  • Does he threaten to hurt you, the kids, pets or himself?

Victims of domestic abuse are not always physically hurt. If you answered "yes" to any of the questions above, you might be abused. You or your children could be in danger.

You are not alone.

You are not to blame.

You do not deserve to be abused.

Did you know that domestic violence sometimes starts or gets worse during pregnancy?

And you're not the only one getting hurt:

  • A woman who is abused during pregnancy may be more likely to have a miscarriage, infections, bleeding, anemia and other health problems. These can affect both her and her baby.
  • She is twice as likely to have a low birthweight baby.
  • Most men who hit their partners also beat their children. Some also sexually abuse children.
  • Kids whose fathers beat their mothers can suffer from health problems, sleep problems, anger, guilt, fear and anxiety.
  • Each year, more than 1,000 children in the U. S. die from injuries caused by their parents, guardians or others.

You and your baby do not deserve to be treated this way.

You have a right to be safe.

Help is available.

What type of help do you need?

The services listed below are available in most communities. Anything you say is confidential.

  • Hotlines: a counselor will talk to you on the phone and give you information, or just listen. She or he will also tell you places near you to call or go to for more help, if you want it. Hotline numbers are listed below.
  • Support groups: you can talk with other women who have gone through what you're going through (a support group). It can help you feel less alone and you can share ideas and information on safety.
  • Services for children: many programs have counseling and support for kids to help them understand what is happening. It gives them a chance to talk about their feelings.
  • Advocacy and other support services: someone can help you through the "system." This person is a domestic violence advocate. Advocacy services often include help finding legal advice, counseling, health care, housing, a job and social services.
  • Police and the courts: police can help in many ways, such as getting you and your children to a safe place in an emergency. Family and criminal courts can help by issuing an order of protection or by deciding custody, visitation or child support.
  • Shelters: most counties have shelters and safe homes where you and your children can stay. Shelters can help you get many of the services listed above. You are important. No woman deserves to be abused. No one "asks for it," and no one should have to live in fear. You owe it to your children to keep them — and yourself — safe.

You are not alone.

Help is available.

New York State Hotlines
Adult Domestic Violence: 24 hours, 7 days a week
English 1-800-942-6906 Spanish 1-800-942-6908
National Committee to Prevent Child Abuse
Prevention Information and Parent Help-Line 1-800-342-7472
Office of Children & Family Services
To Report Child Abuse 1-800-342-3720
Public Health Law 2803-p Disclosure of Information Concerning Family Violence

Domestic Violence Victim's Rights Notice

The Victim's Rights Notice was prepared to inform victims of domestic violence, of their legal rights and remedies available under the law. If you are a victim of domestic violence you are encouraged to request to speak privately with a social worker or someone who can help you. You should be interviewed privately out of eyesight or earshot of anyone who accompanies you. Your rights as a patient will be violated if hospital staff asks if you are a victim of domestic violence in front of any accompanying partner or family member.

If you are the victim of domestic violence:

The police can help you:

  • get to a safe place away from the violence.
  • get information on how the court can help protect you against the violence.
  • get medical care for injuries you or your children may have;
  • get necessary belongings from your home for you and your children;
  • get copies of police reports about the violence;
  • file a complaint in criminal court, and tell you where your local criminal and family courts are located.

The courts can help:

  • If the person who harmed or threatened you is a family member or someone you've had a child with, then you have the right to take your case to the criminal courts, the family court or both.
  • If you and the abuser aren't related, weren't ever married or don't have a child in common, then your case can be heard only in the criminal court.
  • The forms you need are available from the family court and the criminal court.
  • The courts can decide to provide a temporary order of protection for you, your children and any witnesses who may request one.
  • The family court may appoint a lawyer to help you in court if it is found that you cannot afford one.
  • The family court may order temporary child support and temporary custody of your children.

New York Law States: "If you are the victim of domestic violence, you may request that the officer assist in providing for your safety and that of your children, including providing information on how to obtain a temporary order of protection. You may also request that the officer assist you in obtaining your essential personal effects and locating and taking you, or assist in making arrangements to take you and your children to a safe place within such officer's jurisdiction, including but not limited to a domestic violence program, a family member's or a friend's residence, or a similar place of safety. When the officer's jurisdiction is more than a single county, you may ask the officer to take you or make arrangements to take you and your children to a place of safety in the county where the incident occurred. If you or your children are in need of medical treatment, you have the right to request that the officer assist you in obtaining such medical treatment. You may request a copy of any incident reports at no cost from the law enforcement agency."

"You have the right to seek legal counsel of your own choosing and if you proceed in family court and if it is determined that you cannot afford an attorney, one must be appointed to represent you without cost to you. You may ask the district attorney or a law enforcement officer to file a criminal complaint. You also have the right to file a petition in the family court when a family offense has been committed against you. You have the right to have your petition and request for an order of protection filed on the same day you appear in court, and such request must be heard that same day or the next day court is in session. Either court may issue an order of protection from conduct constituting a family offense which could include, among other provisions, an order for the respondent or defendant to stay away from you and your children. The family court may also order the payment of temporary child support and award temporary custody of your children. If the family court is not in session, you may seek immediate assistance from the criminal court in obtaining an order of protection. The forms you need to obtain an order of protection are available from the family court and the local criminal court. The resources available in this community for information relating to domestic violence, treatment of injuries, and places of safety and shelters can be accessed by calling the following 800 numbers. Filing a criminal complaint or a family court petition containing allegations that are knowingly false is a crime."

Get Help Now, Get Safe, Stay Safe
Call: 1-800-942-6906 (English) (24/7)
or
Call: 1-800-942-6908 (Spanish)
or
Call Your Local Domestic Violence Program
Public Health Law 2803 (1) (h) Notice to Victims
Glossary

Table of Contents