Grace Cottage Hospital
Grace Cottage Hospital
Saturday June 22, 2013

TOWNSHEND -- Vermont's smallest hospital has become the latest medical facility to opt out of the state's new aid-in-dying law.

But the decision, rendered by the Grace Cottage Hospital board of trustees on Friday, was deemed "temporary."

Hospital administrators expect to revisit the matter in no more than 90 days, and in the meantime they'll work out the complex details of accommodating terminally ill patients who request lethal doses of medication.

"Opting out doesn't mean that we are not going to implement the law," Dr. Maurice Geurts, Grace Cottage medical staff president, said in a statement issued after the vote.

"We just need to take time to make sure that our employees, medical staff, board and patients understand all aspects of this law," Geurts said. "We want to have a clear plan for education and communication as we develop policies and procedures for how to handle these situations."

State lawmakers approved the controversial legislation as the 2013 session ended last month, and Gov. Peter Shumlin signed it into law on May 20.

It allows doctors to legally prescribe lethal medication to Vermont residents who are suffering from terminal disease. And it took effect immediately, leaving hospital administrators across the state scrambling to decide how to comply.

There is a provision, however, that allows hospitals to restrict the prescription of lethal medication in some instances. A health-care facility "may prohibit a physician from writing a prescription for a dose of medication intended to be lethal for a patient who is a resident in its facility and intends to use the medication on the facility's premises," the law says.

So Grace Cottage's decision to opt out means doctors cannot write a lethal prescription for a hospital patient who wants to take the medication on site.

It comes less than two weeks after Brattleboro Memorial Hospital's board of directors also opted out after what was called a "thoughtful and contentious discussion."

"The staff thinks the hospital is a facility people come to for healing, and the intent of the law is not to make the hospital a place where people come to die," Dr. Kathleen McGraw, BMH chief medical officer, said of the June 11 vote.

Vermont's largest hospital, Fletcher Allen in Burlington, also has opted out. But in a June 5 post on the hospital's website, Fletcher Allen Chief Medical Officer Stephen M. Leffler said the exemption was enacted "on an interim basis" to give administrators the opportunity to "develop a thoughtful, compassionate policy that will respect our patients and providers."

Grace Cottage administrators are following a similar path.

"We want to make sure not only that we make the right decision, but that we put into place the policies, procedures, protocols, education and communication for all of our constituencies," said Jeffrey White, Grace Cottage interim chief executive officer.

In other words, White said, "we're wanting to take the time to do this right."

He acknowledged that, in spite of the board's opt-out decision, there is "gray area" that would allow a Grace Cottage physician to prescribe lethal medication to be taken off hospital grounds.

Nonetheless, White said, "the spirit of our medical-staff decision is, we want to have policies and procedures in place" before such prescriptions are written.

Even after those policies are developed, however, it is not a given that Grace Cottage will opt into the law.

"It's still ultimately a board decision," White said.

Mike Faher can be reached at mfaher@reformer.com or 802-254-2311, ext. 275.