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in danish so we will look forward to that but for now we appreciate that we can still do this and teach people things and um you're probably even could be sitting in your backyard right now so that's kind of nice too getting some fresh air so thanks for joining us um we're talking about making medical decisions and other end-of-life issues um kind of a heavy topic for a saturday beautiful saturday morning but not a cloud in the sky not much smoke in the sky either but we appreciate you joining us to learn about some of this stuff so we do want to remind you this is like a legal perspective on these things um chris did you go to medical school no not yet me neither uh so we are lawyers um but lawyers sometimes have to draw up documents that affect medical decisions so um we will talk about that side of things okay um my name is erica johnson um beth mitchell is not joining us today we've divided and conquered we have another seminar next saturday and beth and chris is stuck on that one too uh beth and chris will be um presenting next saturday um i am a graduate of northern arizona university i sold radio ads for some years and uh then worked in the jewelry industry but we won't talk about that we will talk about law okay today so chris good morning everybody my name is chris scalari if we have not met um i've been here with amber keenan mitchell johnson for about a year i'm a colorado native uh born and raised in boulder we're the university of kansas for undergrad uh university of denver here locally for law school and i'm involved with a number of different related organizations here locally as well as nationally thanks chris um also again here is emily our client coordination person and does our marketing and just an awesome person and hopefully you've had some contact with her uh she's fairly new at the firm now but just doing a great job so we're all here for you if you need us ground rules usually this is when i say please turn off the ringer on your cell phone but really you don't have to you can be uh texting or doing your fan dual bets the whole time we're talking if you want so we're going to get started so congratulations again wanting to spend a saturday morning learning some kind of tough topics but we'll try to keep it keep it light enough as as we can so seminar agenda we're going to talk about proxy decision makers that's the law that applies in colorado if you don't have a health care power of attorney we're going to talk about guardianship um i'm going to talk about medical power of attorney or sometimes called healthcare power of attorney living wills uh then chris is going to pick up with a quick conversation about i don't know if it's quick five wishes cpr directives dnr's most forms again those medical devices but we do want to touch on those for sure so you're aware of those and what we can do and what we can't do here at the firm hipaa releases last remains declarations uh organ donation body donation and then we'll wrap up chris will wrap up talking a little bit about a company that some of our clients use called document to store their medical directives electronically so uh there is a q a button we do not have a chat open but if you have questions we'll try to catch those in the q a someone did email and a question previously i i'm not checking my email during this thing um but i will hit on that as well okay so let's start proxy decision makers so let's say i get hurt and they haul me off to the hospital and i can't talk and they need to know if they're going to do surgery or they need to figure out what to do well if i don't have a healthcare power of attorney here's what colorado law says and again this is colorado only if you're watching from out of state the laws are going to be different in every state but what colorado law says is my attending physician um says i lack decisional capacity so let's say i'm again laying there and this doctor that's helping me says she can't act maybe very obviously okay they must then put that into my medical record that i am lacking decisional capacity i have no guardian at this point i'll explain what a guardian would be i have no agent under a medical power of attorney and therefore i have no person with legal authority to make decisions for me if i am over the age of 18 this is a situation for every person over the age of 18 in colorado if they don't have a medical power of attorney okay so what it says is the physician or his or her designee whoever that would be a nurse or something make they must make reasonable efforts to notify me that i can that i lack decisional capacity uh again i kind of chuckle but sometimes that isn't all that clear but let's say in this case it's really clear i'm i'm not confident from this accident that i've been in now that doctor is supposed to find as many interested persons you see that language there in the last bowl interested persons as practicable and notify them that the patient lacks decisional capacity so now we have a team effort uh of sorts and sometimes in some families that works just fine and in some families that does not work well at all which is where we get the medical power of attorney to solve this problem but this again this in this situation i don't have one of those so who are these interested persons under colorado law the doctor is supposed to try to find as many of these people as they can spouse parent adult children siblings grandchildren and any close friend oh that sounds great that all those people are gonna all agree i'm sure during this time of great trauma okay but those are the interested persons and they have the right to uh chime in all those people okay now they have to those people are supposed to take reasonable efforts to reach a consensus as to who is going to make my decisions so if they're all standing there and everybody agrees it's going to be this person then that will happen but if they're all standing there and they don't agree that's where we get a problem okay so they're supposed to pick somebody that i'm in a close relationship with but there are no rules forcing that they are supposed to pick the person that's most likely currently informed of my wishes but again what if someone disagrees to that effect and if they disagree an interest per person can go off to court and say i don't like this okay once they've picked a proxy if a proxy has been picked or this person that's going to make my decisions they are supposed to notify me if i am able to know that again in my example here i'm out of it and i have no idea what's going on um so that's how the proxy decision maker act works okay the proxy can get assistance through if they're not sure what decisions to make through a medical ethics committee at the hospital the proxy ends up on my death or if i regain capacity okay and the law says health care providers are held harmless if they make reasonable attempts to locate the proxy before they act so really what it is is a team effort to try to pick somebody to make my decisions and sometimes again that works smoothly and sometimes that does not but that is the current colorado law if you're running around without a health care power of attorney that's the process that's supposed to happen so let's say i'm going to be long-term incapacitated and this proxy thing is i mean let's say i've had a stroke and i'm not able to make decisions that i'm and and i'm not likely to recover uh or at least recover fully if i have again no medical power of attorney someone is gonna have to go to court and get appointed as my guardian okay so in colorado we call the person handling medical decisions through a court a guardian we call a person which we're not talking about today handling financial decisions through a court appointment a conservator so in colorado a guardian is a court appointed person to making medical and everyday decisions a conservator is someone making financial decisions all of which can be avoided with good powers of attorney but remember here i don't have one of those okay so priority for appointment somebody's going to have to traipse off the court and get appointed by a judge first of all does that happen very quickly no not usually uh who has priority for the judge to appoint first if i have a guardian act from another state they have priority to be appointed here but we're going to assume that i don't already have a guardian okay if i have nominated a guardian in writing then that person has priority so you will see in our medical powers of attorney that we draw up it does say if i need a guardian long-term guardian and somebody wants to go to court to get appointed that that court is supposed to appoint the person in my power my medical power of attorney we have that in there as a safety net i mean with a medical power of attorney i really shouldn't need a guardian but if i am going to be long-term incapacitated years and years and years and years it is sometimes easier for someone to have a court appointment to prove that they are in charge of me rather than carrying around a medical power of attorney so that's why we put it in there okay next priority let's say i don't have not uh i don't have another guardian i haven't nominated anyone in writing then my agent under my medical durable power of attorney has the next power to be appointed this is by the court again agent under my financial power of attorney has the next priority now does a court have to appoint those people no um this is all at the discretion of the judge if there's a good reason not to appoint somebody in one of those positions they don't have to okay the judge can look at it and they people could fight over who's going to do this if i don't have any of those because now we're probably saying well this clear person doesn't have any um estate plan then my spouse would be the next person to have priority to be appointed if my spouse is gone my adult children well this is where your kids can go into world war three right you've got two kids you've got three kids more well they all have equal priority to be appointed as your guardian okay and so sometimes that gets a little messy if i don't have a spouse adult children my parent or parents and finally on the list a priority as an adult i've lived with for the past six months as you can see it's a it's a list there's some guidance but it does require a guardianship requires a court okay who can't be my uh guardian an owner operator or employee or of a long-term care facility okay cannot act obvious reasons there uh a professional uh cannot act as both a guardian handling my medical and a conservator handling my financial there are professionals who get appointed by judges to be guardians and there are professionals who get appointed by judges to be conservators and handle finances if somebody hasn't done an estate plan and they get hurt but the same company or person cannot do both it was all around trying to protect me the protected person or the hurt person from having somebody in charge of everything and no one having any checks and balances when it's not somebody that's related to me all right so uh petition so the guardianship you have to ask the court that you in the county where you live they have to petition a hearing gets set so there will be a court hearing a court then appoints once the petition's filed the judge appoints what's called a court visitor so if you think about it the judge is standing there are sitting there on the bench looking at all this paperwork or in their office looking at all this paperwork and they used to just say yeah this looks legit uh have a hearing the person the protected person me the hurt person never even had to be there that is not the case anymore now for to protect me again a court will appoint someone usually a social worker type person to go out visit me visit the person that's petitioning make sure this is legit okay so people don't get guardians and conservators appointed for them when they're really just fine and someone's off stealing their stuff or making decisions over their objection okay so i can have my own lawyer if i want okay in that case so the court interviewer interviews the proposed guardian visits the dwelling talks to the doctors and files a written report now they are like the eyes and the ears of this judge so the judge can know yeah we really need this or we don't think we need it okay responded me that's the person who's hurt i have the right to my own attorney i have the right to ask for an evaluation i have the right to be present at a hearing um if i can't get to the hearing they need to get to me um so it all happens really in the as open as possible okay and the guardian then has to file a report 60 days after being appointed and then annual reports that the state has put together so that all happens on a daily basis but it's not great and it takes a long time and it costs a lot of money usually um so we're going to talk about healthcare power of attorney how do we avoid the proxy decision maker act how do we avoid a guardianship it really isn't that hard a good written durable healthcare power of attorney or durable medical power of attorney okay durable just means it's effective while i'm hurt okay but we call it a healthcare power medical power i am saying in writing this is the person i want to make my medical decisions our powers of attorney always appoint at least one person and at least one backup but i beg people to come up with two why well if i have a power of attorney with three people on it and something happens to one of those people i'm still gonna have a primary and a backup now i don't have to run off and say oh i should do a new power of attorney and that costs me money right so we're trying to have as many you could have five lists of five different people in order is what is way preferred okay sometimes people want to appoint two people to make their medical decisions and i i will do my best to try to talk people out of that quite frankly this is not just uh it's one day in the hospital and somebody needs to decide if i'm having surgery if i've had a stroke i need somebody to take me to the doctors go and get my medicine uh everything i do medically two people doing that block step is almost impossible okay so that's why i really prefer we do at our firm prefer the in successive order okay uh our medical power of attorney says that the agent i've appointed has the right to visit me in the hospital some parts of hospitals or healthcare facilities will only let a family member in if i've appointed my best friend to be my medical power of attorney she's not a family member so it says right in our power of attorney she can visit me even though she is not a family member we again nominate a guardian in our power of attorney just in case of that long-term need and in our powers of attorney we also discuss organ donation okay which uh chris is going to talk a little more about later how you can do that in colorado so that's helpful the agent that i've appointed that's the person i've appointed to make my medical decisions should do by law as opposed to do what they know what they think i would want if they have no clue they do what they think is in my best interest i mean you're you're putting this person in your shoes okay if you have an out-of-state medical power of attorney colorado law says that if it was drawn up correctly in the state where you were it should work here now i still think it's safest to have a medical power of attorney that doesn't say this is governed by the laws of kansas and the doctors here are going i don't know what that means we don't know kansas i you know so i think an in-state medical power is safest but they can't i'll say it this way they can't refuse to honor a medical power attorney that was not drawn up in colorado okay what if i've appointed my spouse to make my medical decisions in my medical power of attorney and we get divorced so now yes i'm saying this sends shutters through lots of people uh your ex-spouse is making your medical decisions but are they well actually there's a colorado law that's helpful the colorado law says if i've appointed my spouse and to make my medical decisions in this document and we get divorced they are automatically removed as y agent now i don't know if hospitals and doctors are aware of that law quite frankly so i suggest upon divorce you probably do a new one and if you want your ex-spouse to be making your medical decisions which some of my clients still do uh we do a new one so it doesn't to say i know i'm divorced from this person but i still want them in okay but if you have not updated your medical power of attorney and you are divorced your spouse by law legally really wouldn't have the right to be the agent it would move to the next person okay um so just something to keep an eye on there i think i already have those two things on the same slide so i'll go to the next if uh we need to transfer me okay sorry let me yeah so here's a scenario here if the person i've appointed sorry if the facility i'm in will not honor my say living will okay they have religious beliefs or whatever um that withholding or withdrawing medical treatment are not allowed in their facility then by law i they must transfer me to another facility now again do the hospitals know this law exists i would guess their legal department does um families i mean they're not going to come to you but your family could go to them and say we want mom transfer okay you're not doing what mom said in her medical directives and we are fine with that but you need to move her to another facility okay so that is uh buried in the laws of colorado there i've had people ask me what if they won't honor my living will there is a law that covers that believe it or not um so this is a conversation now about these living wills okay if i'm over the age of 18 i can sign what we call a living will the other great term for a living will is an advance directive okay i am directing in advance uh what i want done in certain circumstances i mean it is pretty specific very specific uh the colorado living will is very specific about what it's covering okay people often when they are appointing somebody in a medical power of attorney they'll say oh they'll never be able to pull the plug or oh they'll be pulling the plug in five minutes right if you have a living will the person you appointed in your medical power of attorney isn't having to pull the plug that's the whole point of a living will or advance directive now i will say i have clients that don't want a living will and that's fine we never force somebody into a living with okay that's a personal decision not our decision your decision so but let's say you say yeah i want a living will or advance directive and the colorado living will says first i am directing whether i want life-sustaining procedures to be withheld or withdrawn life-sustaining procedures is defined in the law as basically um a respirator okay i have a machine that is breathing for me that's what life-sustaining procedures is okay so then we say okay so i'm probably i'm on a risk i'm on a respirator and two doctors now have come and said and it has to be in writing so i should probably have that in my slide two doctors say in writing erica is terminal that is in their i i call it another term i would use for that is actively dying okay because i have people joke they say what kind of joke we're all terminal like i i do get that okay so but you have to be declared terminal by two doctors not just terminal in network human beings okay so i not only have to be terminal but i have to be either unconscious or unable to the way i describe it in easier terms is unable to receive information or communicate terminal is not enough i and then have to get sick enough that i'm not able to receive information or communicate okay this also means i get a lot of questions now about well what if i have covid and i want to stay on the respirator because i need it to get better then you're not terminal okay then they're not looking at your living will they're treating you if they are treating you and saying they're they can help this living will isn't kicking in if you if they are saying there is nothing else we can do this living will is what's designed to kick in okay now i will admit this is not a perfect process there's probably i don't know how many of you on this webinar uh lots of you have probably had stories from your family where the doctors did this or the nurses did this or i'm not in the hospital at the time this is happening i'm not sure that it would help that i was it wouldn't what i'm saying is these are human beings this is a sick human being and doctors and nurses who are medically trained so does this always work perfectly i'm going to say absolutely not but if you direct what you want the idea is that it takes that off of your family okay again i know there are stories where that isn't happening in the real world but i still think it's worth having a living will if you want so um so there's life-sustaining procedures any medical procedure that if administered would serve only to prolong the dying process i'm dying and this machine is keeping me going now colorado law separates out life-sustaining procedures is an intervention that is just prolonging the dying process but it does not include by definition life-sustaining procedures does not include procedures or intervention for nourishment artificial nutrition my stomach tube if i have one in okay uh it also does not include what the doctor considers necessary to provide comfort or alleviate pain so crank up the pain meds keep me comfortable but what i'm directing is if i'm on some uh again a machine that's basically breathing for me and i'm dying i don't want to stay on it okay so what do we do about nutrition nutrition is separated out for political reasons really nutrition was separated out to get the law passed there were people that did not want this law passed if they could not say i do not want my nutrition stopped okay generally i find that that is uh this is a generalization that is um a religious belief of theirs and so we want to honor that religious belief and they can say on their living will to keep the nutrition going okay so after i mention what i want done with my life sustaining procedures then i have another section in my living will we all do that says do i stop the artificial nourishment at the same time as the respirator do i continue it for a number of days or do i continue it indefinitely okay and each client gets to pick and that is uh a second section okay and their living will so remember your terminal you're not receiving information or communicating in that very specific situation you're directing what to do about life-sustaining procedures and nourishment that's all a living will does it doesn't cover anything else okay well it does cover one other thing sorry but it doesn't do any other magic okay it has to be executed personally by me if i can't physically sign it i can direct someone else to sign it for me the person signing it for me can't be my doctor or an employee of a facility or a person who's inheriting from me that makes sense uh so your kid can't sign your living will for you um and they also shouldn't be a witness on a living will anybody who would be potentially inheriting should not be a witness nor the person directing or signing at my direction okay um sorry that's kind of a duplicate slide but i will say again at the bottom spouse's child are not supposed to be a witness on a living will okay or the person that uh works at the hospital technically um what if i don't have a living will but i and i don't have a medical power of attorney my proxy decision maker where i started all this right the family got together they picked my sister carla to make my decisions my attending physician and a neurosurgery neurology or neurosurgery physician okay can say in writing uh that we're just keeping her alive by this machine she's not gonna get back to better um and to restoration to independent neurological function and in that case my proxy can decide okay i am going to stop there and say i think somehow i'm anyway i've talked about the living will having a section about terminal and not responding right there's also another section of the living will now that says what if i'm in a persistent vegetative state a persistent vegetative state not a coma a persistent vegetative state i'm going to be vegetative forever do i want to stay on that respirator do i want to stay on that artificial nutrition so we cover both topics in our living wheels here and colorado law added the persistent vegetative state section to its living will in 2010. um it didn't really wasn't on the radar before that but you may recall that terri shibo in florida she was she didn't have a living will she had a spouse who disagreed with her parents about feeding tubes and she was in a persistent vegetative state for years and years at that point colorado and a lot of other states amended their um basically amended the law around living wills to say we're going to cover this in our living wills so you should check your living will if you if you don't have it covered well if you don't have persistent vegetative state covered then your medical power of attorney would make that decision if that ever happened okay but if you want to take that off of them in 2010 we did a lot of new living wills after that because people wanted to cover it more specifically along those lines uh well i'll get to that question that was emailed in but um basically that is what we're covering in a living will now who can challenge a living will actually a lot of people parent adult child spouse um though i had financial power of attorney or a durable power of attorney they may challenge the validity of the declaration it's not just that they don't like what i've said really they're only supposed to be able to challenge if they're arguing mom had no idea what she was signing when she signed it okay the validity of the declaration they can get a temporary restraining order this is when a legal battle would ensue thank goodness we don't do those here a legal battle would ensue around this and a guardian ad litem can be appointed to act on my behalf and then my family can duke it out okay um again if a doctor won't comply with my living will or the quarter they have to transfer my care to another facility so i i don't you know we don't litigate so i don't think there are that many court cases around living wills they certainly exist okay but there are probably more court cases where there is no living will and we don't know what the person wanted okay that's where it's a little harder to know so i think again the living will well not perfect um is some guidance at least um to the doctors and nurses and family as to what i wanted okay i'm going to take a quick look uh the open questions so i think we're going to move on to chris um i will come back at the end and we could take some questions i will again touch on this email that came in with a question over the yesterday and i will see you in a little while i'm going to stop share here chris okay hopefully correct everybody should be able to hear me now i'm going to start sharing uh from my screen and then we'll get going with the remainder of the presentation is it letting you pull it up yep okay i didn't know if i had it open that was there we go okay so we should be all set there you should all be now seeing my screen that says uh five wishes living role replacement etcetera so we just talked about here what erica just talked about was the living will so people often ask us as well what if i already have a five wishes document in place how does that work with the living will is it the same thing does it replace that what we want you all to know is that a five wishes document must replace a living will you do not want to have both of these if you do have both problems that they'll inherently conflict with each other and that's a problem certainly within the law we want to have is a very clear direction very clear directions for you that's why we really prefer living wills now the five wishes document is different and what those five wishes in particular are are first who is to make decisions for me what kind of medical treatment do i want or do i not want how comfortable do i want to be how do i want people to treat me and what do i want my loved ones to know in the event of an emergency at the end of my life so these documents these five wishes kick in only and only once somebody is close to death or if they have severe and permanent brain damage or of course if they're in a coma and at that point are not expected to wake up from that coma the bottom line is that these only have applicability when we kick in if it's very clear from the facts at issue that that person is really at the end of their lifetime the end stage of their life so the colorado most form or the medical orders for scope of treatment form is different it's different from both the living will and from the five wishes document that i just mentioned the difference here to keep in mind is that a couple things well first while the five wishes formed places of living will the most form does not the most form mentions living will but does not replace it deals with some different things the most form is designed to deal with things at the event of an emergency things like cpr medication medical intervention things like that so if somebody wants this form a specific wishes around things like cpr and again medication things like that this form has to be obtained from your doctor and what it's designed to do is to say first number one i want you i want the paramedics to follow my directions in this order regarding cpr regarding medication regarding um artificial nutrition hydration other interventions things like that then at that point once that's all been done if applicable and if that's what the document indicates then you want the doctor or the nurse or somebody else to be contacted for additional measures if not the most one can say that as well it can say simply i don't want cpr i don't want medication i don't want the doctors to be contacted that's one of the functions of this as well the key to this and really the challenge with the most form is that it must be immediately and obviously available so what i mean by that is that if somebody shows up to your house to take care of you as a paramedic for instance and they can't find this form then it won't be used if they can find that it's available it's obvious it'll be followed but if it can't be found then what happens is under the law somebody's consent to cpr is presumed so in that event you will get cpr anything else that those medical practitioners those paramedics think might save your life and even under an emergency and keep in mind too especially in an emergency the medical workers are not going to be looking for a document they're going to be worried about taking care of that person taking care of that person and doing what they think needs to be done to help save their life so what this means is that if somebody has a most form our suggestion is to make sure it's as obvious as possible so if they have that and they live in uh assisted care facility for instance this should be on their front door if not to live at home this should be on their fridge for instance it should be somewhere that it's obvious and that somebody won't have to search for it in the event of an emergency if so then whatever directions are on that form will be followed will be given credence and everything will run from there now another document that we always do or very often do for our clients is what's called a general hipaa release so hipaa is the medical privacy law that many of you are probably familiar with and it basically says that no one can get your medical information unless you give them authorization unless you say yes chris can get that or my spouse can get that or my mother can get that so in my opinion this hipaa release every bit as important as the medical power of attorney because this says that your agent under the power of attorney can get your medical information and then can use that to make the best decisions possible for your care this document says that your fiduciaries your powers of attorney agents as well as anybody else that you list by name to get your medical information that way again they can make the right decisions for you they can know what you might need and they can do that as seamlessly as possible another document that we always do for our clients is what's called the declaration of disposition of last remains so to preface this people often ask us you know how can i make sure that i plan ahead for funeral costs and weight of expenses i don't my family have to deal with this i want this to be taken care of from my state well there are a few ways so you can make that direction known through gift whether it's in your will or your trust uh or certainly you can put that in a prepaid plan we have lots of clients that put plans together with her and mcconnelly or olingers whatever else they might want to do here in town but that way they can pay for their plan ahead of time make their decisions ahead of time and everything is done nothing for their family really to pay for out of pocket or do this can be accomplished in a separate contract or a separate document as well really anything as long as it's written down as long as it's available with the rest of your estate plan this will work for the declaration of last remains form there are three primary goals that we want to accomplish first we want to make sure that any wishes around cremation burial uh etc are known and can be followed we want to make sure that any wishes around a funeral or memorial service are known and can be followed and then finally want to make sure that somebody is put in charge of making those arrangements and making those plans and carrying them out based on what you have said here regarding cremation burial and services so this form is designed to say what the wishes are around cremation and burial what the wishes are around services and who's in charge of taking care of all of that it can also state any other information or directions that somebody might have for instance where they might want their ashes to be spread who they might want to be contacted where they might want their ashes to be stored things like that the thing to keep in mind with this document is that the declaration of disposition of last remains is legally enforceable it's designed to ensure that your directions are carried out that the person that you want to be in charge is in charge and has that legal authority and also help make sure that your agents are not liable by granting them immunity making sure that they can't be sued for carrying out your wishes here the goal really with this form as with many of the documents that we do in our office is to make sure that your wishes are known so that there's no conflict among family or friends in an already very stressful time now to be valid the declaration of this position of last remains has to be signed by the declarant signed by the person who's making these directions it also has to be dated when it's signed and it must be either notarized or witnessed our documents our last remains declarations are always notarized here in the office at the time they're signed again like i said also has a held harmless clause so unless there's a challenge then your people will be safe from any sort of liability on this so what if there is no declaration of disposition of last remains in place when somebody passes away well much like eric mentioned with the powers of attorney the state has a backup plan here the state has a plan to say who's going to be in charge in that event so what the state says there's an order of priority to say who is going to serve and who can make these decisions the funeral home has the obligation to look for this person with quote unquote reasonable care so the funeral home somebody passes away will try to contact their family members in this order and what that order is is first your pr your personal representative also called your executor the person that you have said is in charge under your will and if that person can't be found or if there is no will in place then it would be the person's spouse or their partner when they passed away alternatively would be a majority of their adult children if they have any or if they don't then their parents or legal guardians if not then it would be their adult siblings and finally if nobody can be found within the family it would be somebody else who's willing to assume responsibility for this job so what you can see here is that really in general the goal of the state has here is to keep this within what the law thinks is your next closest living family member as much as possible and that's really very consistent with a lot of what the law says around fiduciaries for wills powers of attorney guardianships conservative ships things like that so as i mentioned the funeral home would look with what's called reasonable diligence for the person supposed to act under the last remains form and to help make these final disposition uh decisions so what does that mean what do i mean by that well basically what that means is that if the funeral home cannot find somebody within either uh five days of the home providing notice that someone's passed away or within 10 days of the actual passing of that person which everyone is earlier then the funeral home will stop looking so they will not exhaust all possible avenues but they'll try to contact people that they believe should be in charge one final note in this declaration of last remains form these are legally enforceable documents just like the living will and other documents that eric had talked about so they go a long way to help avoid conflict among your family members because they make your wishes known they make your wishes very clear and they say who is in charge of carrying those wishes out so the goal there is to have no misunderstanding no lack of clarity among your loved ones and to make sure these also are as enforceable as they can be they're valid across state lines so they're valid in kansas nebraska wyoming wherever you might be whether you move there or are just traveling there very helpful document so organ donation is also topic that comes up pretty frequently for organ donation there are a few things that i suggest keeping in mind number one the medical power of attorney that our office does has a place as eric mentioned where the declarant the person executing that can elect to be an organ and tissue donor if they want to be and if they do want to be that's an important thing to select however the colorado donor registration list has the final say that really is the most important spot to make this decision so if somebody plans to be a donor what i would suggest doing is checking the colorado donor registry to see if they are on it and if so what that means is that they've effectively given what's called first person consent they've said that their wishes are to be an organ and tissue donor so at that point if somebody passes away their doctor does not have to ask their family members or their power of attorney agent because that person already has given their first person consent that already made their wishes known regarding organ and tissue donation this also means that your agent cannot refuse to make a donation of your organ and tissue in the event that somebody passes away now people often sometimes don't quite understand is that the donor or to be a donor a lot of things really have to line up just right they have to be just a certain set of circumstances so what i mean by that is that for organs to be donated and used for transplantation the person that passed away must have passed away in a hospital there must have been a declaration by the doctors of brain death meaning no additional pardon me no additional blood flow to any portion of the brain that person also must have been on a respirator or a medical ventilator in the hospital and that person must have not had any active cancer outside of their corneas and there must have been no infectious disease present when they passed away so if these things are all satisfied donation is possible if not surprising to some people donation organization donation would not be possible based on those circumstances so now as i mentioned colorado has the donor registered list and in fact every other state does as well and washington dc does as well so in colorado the way it works is that if somebody passes away and is a valid organ donor and is on the donation list meaning they match those categories i just mentioned then the people with the first priority to receive organs and tissue from that person would be first family members immediate family members then if there are no family members that need a donation from that person's body then it would be anyone in colorado or anyone in wyoming that could benefit or would need that if there's nobody in colorado wyoming that would need organ tissue from that person then it would be anyone in a different state so as a prior slide mentioned very briefly there are about uh there's a waiting list of some 1700 people i want to say uh currently waiting for organ and tissue transplants in colorado wyoming you can see very quickly that if there is a viable donor and viable donation is possible there's probably going to be somebody here in colorado or wyoming that can benefit from that now one final note on this some people are interested in whole body donation a very different thing from organ and tissue donation this is not for everybody and that's certainly fine but for people that are interested or curious about this we generally advise them to contact the state's anatomical board and this is their contact information here the key to this is that somebody must sign up to be a whole body donor in advance meaning during their lifetime and while they're competent and that decision must be witnessed by two people for it to be valid so uh when we first started out eric also mentioned this service docubank this is not one that we offer but a company that we work with fairly closely does offer this and it's a lot it's a very good thing for a lot of our clients so what docubank does basically is it stores your medical documents it stores all the various things that erica and i have discussed this morning keeps them online makes them accessible and makes them easily findable in case of an emergency so what happens basically is that docubank stores your medical powers of attorney your hipaa release your uh living will last remains declaration and then gives you a little card for your wallet kind of goes behind your license so that for example if you get in a car accident or if i were to get in a car accident and the paramedics were looking for my license they would also find my document card they would then know who's in charge they know that i have those documents in place they'd be able to figure out who's in charge what my wishes are and it would be much more efficient and much more smooth and if they had to search for that contact my people and uh go from there so in addition to those uh documents like living will medical power return hipaa release document also can store if you wish information on allergies medical conditions medications that you might be taking things like that as well as critical emergency contacts family member contacts and docubank also offers to update everything annually so they'll contact you annually with a letter saying if anything's changed please get us new information so that what we have available is as current as possible a docu bank also offers a pretty cool program called the ice program this is specifically for college age students so people that are over 18 years of age and older the reason for that is that once somebody turns 18 their parents no longer have a legal uh legal authority to get their medical information to make medical decisions for them so what we do sometimes is put together medical powers of attorney for those college age kids and then their parents will use docubank's ice program to first store their documents and also in the event the document or a doctor accesses those documents because of an emergency the parents get an immediate notification from docubank saying that there's been an accessing of those documents and there probably is an emergency that they need to be involved with so for this we have our firm charges about 600 to put together medical powers of attorney hipaa release everything else for college aid students and then with that is include the docubank ice program registration as well so it's a pretty cool program for people that have college age kids so that is about the extended information that we have here for you this morning as eric has said we're happy to hang out for a while answer any questions that you all might have uh one thing i will mention before we wrap up all the attorneys here erica myself and of course of course beth mitchell all do a lot of speaking opportunities around town we do them on estate planning and related topics we do them for a wide variety of audiences including professional audiences and continuing education and for public audiences client groups of course but also civic groups churches community groups anyone that might find benefit from this we're certainly happy to help and we really enjoy doing this final thing i'll mention is that you all should have received an evaluation form with your registration documents we do ask that you fill this out if you don't mind it really helps us uh to perfect the uh presentations that we give it helps us make sure that we know the information we're providing is relevant and timely and if you have any suggestions please let us know that as well and with that eric i'll open it back up to questions um i believe that we have the q a box here open looks like there are a couple questions coming in already all right uh hopefully everybody can hear me thanks chris i hope that was helpful everybody um we i'm gonna hit this first question here uh can a medical durable power of attorney be changed there are some facts about this person's life that i'm not gonna read but um if the person who signed it wants and wants to do a new one yes they can do a new one now they have to have the mental capacity to do so um and we're not doctors so if it's ever questionable whether someone has the mental capacity given the met the comments you've made here to sign one uh you know we would sometimes have to have a note from a doctor saying that this person they believe is competent to sign a new one if they don't have that capacity then you'd go to court and get appointed as a guardian or asked to be appointed as a guardian if the person who's making the medical decisions is not doing what you feel they should do so yes one can be a new medical power of attorney can be changed but if the person has some sort of mental incapacity it will depend on how advanced that is okay uh chris the the recording of the webinar uh can you see the note the mess the questions i can so there are a few other questions here the first one is uh regarding the recording of the webinar we are recording it this morning we have some attendees that couldn't be here so we're going to record it we're going to post that online and we'll ask emily to do is uh share that recording with the attendees once we wrap up and have that available so you can see that from the beginning if you would like to okay and then uh is this presentation available i believe um a handout or a copy of the slides is available if it was not sent to you you can email emily at ambler kenan.com and she can send you a pdf of the handout that we used to hand out at the library um so again it's emily ambler kenan.com uh and then the six hundred dollar question does the six hundred dollars for the document program for the college kids include a will also and no it does not however most college kids don't need a will um i mean we can do it well we just add that on most college kids i find don't own anything or very little and what they own they say oh just give it to my parents if i die if that's not what they want they would need a will if that is what they want the law of colorado would provide assuming they're not married and have no kids that their parents inherited what they did own anyway so we usually don't do a will but we can't it just would be added on to the cost um then i got this question on he email so i'm going to go ahead and answer that one first when laws change regarding a state or health care documents does that invalidate old documents um and it mentions being reviewed every year if you're a client of ours you should get our newsletter if the laws change we put a an insert about the law changes in that newsletter there has been one time in my 20-year career where the law changed enough that documents needed to be changed and that was in 2010 colorado had a significant change to their um financial durable power of attorney law so we did a lot of new um powers of attorney if your powers of attorney are pre 2010 i'd suggest probably getting new ones and i guess there were two the living will i mentioned that the living wills often before 2011 did not cover last remains declaration or sorry did not cover persistent vegetative state so let me repeat that financial power of attorney pre-2010 you probably should have updated ones and living wills you'd have to look maybe your living will covers persistent vegetative state pre-2011 but often they did not we try in passing these laws not to make things have to be redone so again the question was does it invalidate everything no um and again once in 20 years uh the last 20 years at least the law was passed was changed enough that i thought it was worth redoing those particular documents but for the most part the law changes are kind of incremental and fairly slow and don't cause a need to change everything where do i get a copy of the most form chris i think you can just google it i believe yeah you can ask your doctor as well your doctor can provide that for you yeah so and if you i know there's pretty good website on in colorado if you google colorado most form and put colorado because there's it's started in another state and they have a different topic or a different name of it but yeah you do want to have the colorado most form if you just google that you can find it and download it there or the next time you're at your doctor's office they can give you the form and you can fill it out and attach it to your fridge or your door cool chris uh do you see then the question about the hipaa yep so the hipaa release one of the cool things about paper release is that copies of it are valid so you can have copies of that and keep that with your doctor keep that with your medical power of attorney but the way it works is if you were to go to your doctor you would sign a specific hipaa release good for that practice and if not this one is a general hyper release and that can be filed with your medical documents or your medical records and that way it can be accessed anytime somebody might need it or of course if you have docubank it's available there online and by fax as well the other thing about the hipaa sometimes it's necessary for dealing with someone's health insurance company so um i found that again the question if i called up my dad's health insurance company to help them with something they would often say i can't talk to you it's a violation of hipaa um luckily my dad is competent right now but if he were not uh i would need that hipaa that general hipaa release that's why we don't rely on just the one for the doctor that he was seeing at the time we rely you have to sign that one at the office so they're not going to see you but this is just more general so as chris said it can be used anywhere excellent thank you i think uh well we'll hang for a minute here and um again we'll have it recorded we'll get that technology worked out and figure out where we'll post that on our youtube page via our website give us a little time for that you can get a hand the handouts um and if you don't didn't get them or whatever check your spam file might have stuck in there because it's a pdf file chris do you have anything else on your end nope nothing else for me all right well thank you chris for sharing the load here and uh we appreciate all of our clients friends family members we hope that this has been helpful it is a lot as a couple people said in the emails um we don't expect to make you experts uh but i do appreciate that you want a handout of the slides and yes you can get that and feel free to share this information with folks about uh you know that they will we will have this online we're gonna record it so it can be seen again okay so thank you thank you for the thank yous on the messages so we appreciate you guys um let's see if that's a question yeah so we'll hang for a minute and then uh we hope you all have a wonderful wonderful weekend [Music] yeah i think we're good okay thanks chris yeah all right thanks everybody i'm going to shut this off now if you have any other questions feel free to reach out of course otherwise hope you all enjoy this nice colorado day and this weekend thanks very much