The Role Physicians Play in Life Care Planning

Greg Vigna, MD, JD, is a certified life care planner and injury attorney practicing in Southern California. Today, I am speaking with him about the role that physicians can play in care planning. This discussion should not be ignored. First, it can potentially reduce legal costs down the road. Second, some states, such as Colorado, enable physicians to be compensated $80 for 30 minutes of time. Physicians could also generate additional income by working with lawyers who practice in this area.

Rachel Rose: Starting with the basics, would you please define what a life care plan is and who is considered a life care planner in the medical profession?

Greg Vigna: A life care plan is a dynamic (one that is capable of changing) document based on published standards that represents all necessary and appropriate care to prevent medical complications and improve the psychosocial welfare of a patient who suffers either a catastrophic or non-catastrophic injury that will affect the life expectancy of the patient.

RR: The AMA's Opinion E-2.037 indicates that "[w]hen further intervention to prolong the life of a patient becomes futile, physicians have an obligation to shift the intent of care toward comfort and closure." How does a life care plan comport with the AMA's objectives?

GV: The AMA objective in Opinion e-2.037 appears to set a policy statement regarding end of life care when medical interventions will merely prolong life, when death is the expected outcome of an acute illness. A life care plan is one that is developed to prevent medical complications and improve the psychosocial welfare of patients who have an acute condition which is expected to become a chronic condition. It provides all medically necessary and appropriate care for acute medical problems and for chronic medical problems anticipated when a patient ages with a disabling injury.

When is a life care plan needed?  A life care plan is needed in patients with both catastrophic and non-catastrophic injuries. Unfortunately it is too often used in the setting of litigation to determine future cost associated with medical and non-medical care of an injured patient, to determine special damages associated with injuries. In best practice management of an injured patient a life care plan is developed at the time of the acute injury. By designing a life care plan families, patients, and caregivers will be better educated in the necessary steps related to medical care, and will become a more active participate in the care of the injured. Also, life care planners, because of their training and experience, will know the best providers of acute and sub-acute medical care, rehabilitation facilities, long-term acute hospitals, transitional care facilities, outpatient therapy, and vocational rehabilitation services in the area.

RR: In your experience, what are essential elements that should be contained in a life care plan and what considerations are taken into account for varying conditions?

GV: The essential parts of a life-care plan address the complexities of a catastrophic or serious injury, and generally include these components:

• A comprehensive assessment of the patient's injuries and medical history;

• Projections for assessments that patients may require on an ongoing basis;

• A description of medical treatment requirements/options;

• Projections for needed testing, therapy services, or counseling;

• An assessment of home and lifestyle accommodation needs (i.e. those needed for mobility, transportation, independent functioning etc.);

• An assessment of potential complications that can arise for patients; and

• An assessment of available resources or support groups.

RR: Where can physicians get a life care plan or who should they consult?

GV: A life care plan is developed by a certified life care planner. These are medical personnel with exposure to rehabilitation that include nurses, physician assistants, physical therapists, occupational therapists, speech therapists, vocational rehabilitation specialists, psychologists, or any physician. These individuals are required to obtain education and training in the principles and the application of life care planning that are based on recognized published standards that are exposed to peer review.  Rarely will a doctor ask for a life care plan - it is generally a tool used in litigation. Unfortunately, doctors rarely will deal with or plan long-term future management of a patient in all of the respects discussed above, since they will have a narrow scope within the life care plan. A life care planner will bring in all aspects of the care to plan a reasonable care plan.

Greg Vigna, MD, JD, is a physician, lawyer, and entrepreneur. He lives in Southern California and can be reached at gregvigna8@gmail.com.