Dr. Susan Cohen with a patient in Bellevue Hospital's Palliative Care Service.

A new state law requires all New York doctors who treat patients with a terminal illness to offer information about their prognosis and their options for palliative care and end-of-life care. But thousands of New Yorkers served by HHC did not have to wait for the state mandate to benefit from the compassionate and patient-centered approach palliative care treatment services have to offer.

HHC was among the first public safety net systems in the nation to develop Palliative Care services. For more than a decade, medical staff at Coney Island Hospital have been empowering patients to make decisions about their end-of-life care. And today all of HHC's 11 hospitals have palliative care teams that ensure patients and families learn to manage symptoms, relieve pain, plan medical treatment and achieve the best possible quality of life.

Signed by former Gov. David Paterson in August, the New York Palliative Care Information Act goes into effect Feb. 9. The law directs doctors to discuss treatment options for people with six months to live that include pain management and hospice care as well as life-sustaining and prolonged treatment.

"The law reaffirms our belief that all patients who suffer from serious chronic conditions or a terminal illness need to learn about their options for less invasive treatment, for pain medications they may not have otherwise considered, and for living with dignity their last months or days of life," said HHC President Alan D. Aviles.

At HHC things aren't likely to change much since the public hospitals have long offered palliative care to patients. But HHC officials agree the law will incite other healthcare providers across the city and state to start palliative medicine consult services.

"This law is very timely and very significant," said Dr. Lauren Shaiova, Director of Palliative Care at Metropolitan Hospital. "It will ask providers of medical care to at the very least put forth choice to their patients who have a life-threatening illness. The onus is on the doctor to raise the issue, and the patient can choose not to have the discussion. If the attending physician or health care provider is unable or unwilling to provide palliative care, the patient is entitled to be transferred to another provider who will do so."

Palliative Care at HHC is a $3 million program that saw 4,360 in-patients and 1,868 outpatient visits in FY 2009. The program is built around teams that include doctors, specialists, nurses, social workers, chaplains, psychologists, ethicists and others who diagnose and treat patients for end of life pain and symptoms.

As a sign of its growing expertise in palliative care, Coney Island Hospital opened a 19-bed Pain and Symptom Control Palliative Care Unit in November to expand the existing service and deliver coordinated care to patients.

A recent study from the Dartmouth Atlas Project found that across the U.S., about 29 percent of patients with advanced cancer were dying in the hospital after receiving aggressive treatment at the end of life, rather than being counseled in palliative care or hospice care or other less aggressive procedures that would offer the opportunity for a better quality of life in their final days.

"Patients who are gravely ill and suffering from uncontrolled symptoms can manage their pain enough to enjoy special occasions and quality time with their families," Dr. Shaiova said. "We cared for a patient who had advanced cancer and wanted to dance the traditional Greek dances at his son's wedding. With pain and symptom control, he was able to do it."

January 2011