Advance Directive
Policy

AN ADVANCE DIRECTIVE IS A WRITTEN INSTRUCTION, SUCH AS A LIVING WILL OR DURABLE POWER OF ATTORNEY
FOR HEALTHCARE, RECOGNIZED UNDER STATE LAW, RELATING TO THE PROVISION OF HEALTHCARE WHEN THE
INDIVIDUAL WHO HAS ISSUED THE DIRECTIVE IS INCAPACITATED.

THIS FACILITY RECOGNIZES THE PATIENT’S RIGHT TO HAVE ADVANCED DIRECTIVES AND A LIVING WILL ACCORDING
TO THE FEDERAL AND STATE OF ARIZONA LAWS AND STATUTES. (REFER TO SECTION I.) FACILITY STAFF WILL IMPLEMENT
AND COMPLY WITH PATIENT ADVANCE DIRECTIVES EXCEPT AS OTHERWISE EXPRESSLY PROVIDED IN THIS POLICY. THE
ADVANCE DIRECTIVE POLICY WILL BE PROVIDED TO EACH PATIENT PRIOR TO ANY SURGICAL PROCEDURE.

THIS FACILITY ALSO RECOGNIZES THAT THE PURPOSE OF BEING AN AMBULATORY SURGERY CENTER IS TO PROVIDE ELECTIVE SURGICAL PROCEDURES TO ASA CLASS I, II AND STABLE CLASS III PATIENTS, MEANING THE FACILITY TREATS GENERALLY HEALTHY PATIENTS. IN ALL INSTANCES OF EMERGENCY OR LIFE THREATENING SITUATIONS, LIFE-SUSTAINING TREATMENT (INCLUDING RESUSCITATIVE SERVICES) WILL BE INSTITUTED FOR STABILIZING PURPOSES AND PATIENTS IMMEDIATELY TRANSFERRED TO A HIGHER LEVEL OF CARE.

SECTION I. STATE OF ARIZONA

IN THE STATE OF ARIZONA, ALL PATIENTS HAVE THE RIGHT TO PARTICIPATE IN THEIR OWN HEALTH CARE DECISIONS AND TO MAKE ADVANCE DIRECTIVES OR TO EXECUTE POWERS OF ATTORNEY THAT AUTHORIZE OTHERS TO MAKE DECISIONS ON THEIR BEHALF BASED ON THE PATIENT’S EXPRESSED WISHES WHEN THE PATIENT IS UNABLE TO MAKE DECISIONS OR UNABLE TO COMMUNICATE DECISIONS. THE FACILITY RESPECTS AND UPHOLDS THOSE RIGHTS AND WILL IMPLEMENT AND COMPLY WITH PATIENT ADVANCE DIRECTIVES EXCEPT AS OTHERWISE EXPRESSLY PROVIDED HEREIN. THE FACILITY HAS NO BLANKET POLICY OF REFUSAL TO COMPLY WITH ANY ADVANCE DIRECTIVE. HOWEVER, THE FACILITY’S COMPLIANCE WITH CERTAIN ELEMENTS OF AN ADVANCE DIRECTIVE IS SUBJECT TO THE LIMITATIONS DELINEATED BELOW.

CANDIDATES FOR PROCEDURES PERFORMED AT THIS FACILITY ARE REQUIRED TO BE ASA CLASS I, II, OR STABLE III, MEANING THE FACILITY TREATS GENERALLY HEALTHY PATIENTS, HAS LIMITED CAPABILITIES AND DOES NOT ROUTINELY PERFORM PROCEDURES OR SERVICES THAT CREATE THE LIKELIHOOD OF HAVING TO IMPLEMENT OR WITHDRAW LIFE-SUSTAINING TREATMENT OR SERVICES. ANY LIFE THREATENING SITUATION WITHIN THE FACILITY WOULD LIKELY BE DUE TO AN UNEXPECTED COMPLICATION, RATHER THAN THE CONDITION OF AN INDIVIDUAL PATIENT OR AN EXISTING CO-MORBIDITY. ACCORDINGLY, THIS FACILITY CANNOT IN GOOD CONSCIENCE IMPLEMENT AN ELEMENT OF ANY ADVANCE DIRECTIVE THAT REQUIRES THE WITHHOLDING OF EMERGENT RESUSCITATION OR OTHER LIFE-SUSTAINING SUPPORT. IN ACCORDANCE WITH THE FACILITY’S RULES AND REGULATIONS AND 42 C.F.R. §416.41(B), ANY PATIENT THAT REQUIRES CARE FOR AN EMERGENCY MEDICAL CONDITION THAT IS BEYOND THE CAPABILITIES OF THE FACILITY WILL BE IMMEDIATELY TRANSFERRED TO A HOSPITAL, PURSUANT TO A TRANSFER AGREEMENT, OR TO ANOTHER LOCAL MEDICARE-PARTICIPATING HOSPITAL.

ACCORDINGLY, IT SHALL BE THE POLICY OF THE FACILITY, FOR REASONS OF CONSCIENCE, TO REFUSE TO COMPLY WITH THE ELEMENTS OF A PATIENT’S ADVANCE DIRECTIVE THAT REQUIRE THE WITHHOLDING OF EMERGENT RESUSCITATION OR LIFE-SUSTAINING TREATMENT. THE FACILITY SHALL ALWAYS PROMPTLY AND IMMEDIATELY SO NOTIFY PATIENTS OF THE FACILITY’S UNWILLINGNESS, PURSUANT TO ARIZ. REV. STAT. §36-3205(C) (1). IN THE EVENT THE FACILITY REFUSES IMPLEMENTATION OF A PATIENT’S ADVANCE DIRECTIVE AS SET FORTH HEREIN, THE FACILITY WILL PROMPTLY TRANSFER THE PATIENT TO ANOTHER PROVIDER WHO IS WILLING TO ACT IN ACCORDANCE WITH THE DIRECTIVE. ARIZ. REV. STAT. §36-3205(C) (1). ADDITIONALLY AND PURSUANT TO ARIZ. REV. STAT. §36-3204(A), THE FACILITY MAY ELECT TO NOT COMPLY WITH HEALTH CARE DECISIONS MADE BY THE PATIENT’S SURROGATE IF THE FACILITY HAS TRANSFERRED RESPONSIBILITY TO ANOTHER PROVIDER WHO IS WILLING TO ACT IN ACCORDANCE WITH THE DIRECTIVE. A MEMBER OF THE MEDICAL STAFF MAY SIMILARLY DECLINE TO COMPLY WITH ELEMENTS OF A PATIENT’S ADVANCE DIRECTIVE FOR REASONS OF CONSCIENCE BY FOLLOWING THE SAME PROCEDURES AND PROCESSES DELINEATED HEREIN AND AS PERMITTED BY ARIZONA LAW.