MOLST advisory council approves minutes, discusses survey, policy review, slide wording and website updates

Barbara Cass, senior adviser to the commissioner for the Department of Public Health for long-term care, called the MOLST (Medical Orders for Life-Sustaining Treatment) Advisory Council to order at 9:33 a.m. and led the meeting’s business. The council approved minutes for meetings in May, June, July and August by voice vote after a motion to approve was made by Dr. Sussman and seconded by Jim (voice and affiliation not specified). The council then focused on implementation tasks: a membership survey, the status of policy and procedure review and training, suggested wording changes to training slides, and website and FAQ updates.

The council is re-surveying members to determine who will continue on the advisory council, the frequency of meetings after the group finishes its current work, and priorities going forward. “I did send a survey out about two weeks ago… it was three or four questions,” Cass said, and she told members she will resend the survey and share collated results once Microsoft produces the trends. Members who have responded identified a shared interest in continuing to track and monitor implementation and in continuing discussions about the feasibility of an electronic MOLST registry.

Dante, who described the internal review route for policies and procedures, said the draft documents are in legal review and at the commissioner’s office level for combined legal and policy review. “That’s where we’re at, engaging with them on the policy directions proposed in the policies and procedures, and we will be looking forward to reporting back, once that's completed,” Dante said. Cass said the leadership meeting on the drafts is scheduled next week and the council should have a report at the next meeting.

Committee members spent substantial time on suggested wording changes for training slides that will be used in recorded trainings. Kathy (last name not provided), who reviewed the slide deck before recording, proposed replacing the phrase “medical feeding” with clearer examples. “I think what we mean is a feeding tube,” she said. Scott (last name not provided) noted that total parenteral nutrition (TPN) is also included in some cases; the group agreed to either list “feeding tubes, TPN, or ventilators” or keep examples on the slide and provide narration to clarify. Members also debated replacing phrasing that read “significant disability does not disqualify an individual from having a MOLST” with more process-focused language; one suggested phrase was “participating in the MOLST process.” Several members recommended removing redundancy in bullets so slides present a more positive, concise message and rely on narration to provide nuance.

The council reviewed website content and FAQs prepared for a public-facing page. Cass and Malia (staff) asked members to submit any remaining feedback this month. Jim flagged statutory language about who may sign on behalf of a patient and requested precise wording: “parent of a minor child, guardian appointed by a probate court, or a health care representative,” rather than the plain word “parents,” because parents of adult children are not authorized signatories under the governing statute. Council staff said they would make that correction and continue to compile suggested resources and edits for the redesign. The council noted the platform that hosts the site will change in October, and staff are coordinating content updates with that migration.

There were no extended public comments recorded. The group moved to adjourn and the meeting ended at about 10:03 a.m.

Votes at a glance: Approval of minutes for May, June, July and August meetings — motion to approve made by Dr. Sussman; second by Jim; approved by voice vote (no roll-call tally recorded).