If, for any reason, the Facility or an individual physician cannot comply with the health care instructions of a Resident, or the Resident's Agent or surrogate, the Facility will undertake the following procedures.

1. Transfers.

The Attending Physician will inform the person giving the instruction that:

1. The Facility (or Attending Physician) declines to carry out the instruction;
2. The person may request a transfer to another physician's care or another facility; and
3. If a transfer is sought, the Facility, with the Attending Physician's assistance, will make reasonable efforts to transfer the Resident to another facility.

The Facility and the Attending Physician will assist in the transfer.

Pending the transfer, the Facility and the Attending Physician will comply with the Resident's, Agent's, or surrogate's instruction if a failure to comply would likely result in the death of the Resident. However, if the Facility or Attending Physician believes that the Agent's or surrogate's instruction is in conflict with the Resident's clear and unambiguous instructions in an Advance Directive, the Facility or Attending Physician should seek the advice of the Patient Care Advisory Committee or legal counsel, since such instructions must be lawful.

The Maryland Attorney General's Office has issued an advice letter discussing the procedures a nursing facility should follow where a health care agent insists that life-sustaining treatment be used, despite an unambiguous instruction in the Resident's advance directive that the treatment not be used. The letter is available at: www.marylandadvancedirectives.com/pdf/advice-sollins-022007.pdf

2. Petition to Patient Care Advisory Committee or Court.

If the Facility believes that an instruction to withhold or withdraw a life sustaining procedure for a Resident incapable of making an informed decision is inconsistent with generally accepted standards of Resident care or is contrary to the known wishes of the Resident, the Facility will:

1. Petition the Patient Care Advisory Committee for advice concerning the withholding or withdrawal of the life-sustaining procedure from the Resident; OR
2. File a petition in court seeking injunctive or other relief relating to the withholding or withdrawal of the life-sustaining procedure from the Resident.