Archive for April, 2019

Advance directives and an in-hospital DNR

Each state has different rules( using Texas rules here) but here are three advance directives to communicate your medical wishes and to designate your spokesperson: 1) a Directive to Physicians (the so-called Living Will), 2) a Medical Power of Attorney, and 3) an Out-of-Hospital Do-Not-Resuscitate (OOH-DNR) Order. Lawyers typically include the first two in basic estate planning packages. Only doctors can complete the third.
The Directive to Physicians applies when you cannot communicate and have a terminal or irreversible condition. The standard choices are withhold life support or do not withhold life support. Custom language is allowed, e.g., let my doctor and my agent decide together.

The Medical Power of Attorney applies when your doctor certifies you are incompetent to make medical decisions. The agent is supposed to communicate the decision you would have made.

The OOH- DNR allows you to refuse CPR, airway management, ventilation, and cardiac pacing or defibrillation. It applies to nursing homes, clinic, and other out of Hospital settings, e.g., home or a restaurant. (www.dshs.texas.gov/emstraumasystems/dnr.shtm).

DNRs are not just for the terminally ill. Skilled nursing and assisted living facilities tend to offer them to all new residents, not just the sick ones. Cardiac patients who live at home may also have a DNR. These people have not given up hope, but are skeptical about being revived with CPR or sustained on a ventilator. Many lead happy normal lives. They take their vitamins, see their doctors and get flu shots.

DNR patients also go to the hospital. When transported a copy of the OOH- DNR must go with the patient. The OOH-DNR is effective in the emergency room. It is not effective once the patient is admitted to the hospital.

Covering For Threats by Paul Ferraresi

One risk area that is often overlooked involves liability risk. And something that you may not even think twice about – such as that backyard trampoline – could pose major financial risks.

Consider the case of a couple will call Rick and Sue Smith. They have a net worth of $1.75 million – $275,000 in home equity and $1.475 million in investable accounts.

While playing on that backyard trampoline, one of their friend’s children is severely injured. The child’s parents sue Rick and Sue for 2 million dollars in medical damages and negligence and they collect. The Smiths have $100,000 in homeowners liability coverage and a $1 million umbrella policy to cover losses over the policy limit.

Because their insurance covers only $1.1 million of the $2 million losses – not to mention hefty legal fees of $500,000 over the course of the lengthy case- the Smiths must come up with $1.4 million! If you’re assuming the couple will have to deplete their $1.475 million investment accounts, you’re right.

The solution would have been for the Smiths to have had a larger umbrella policy that also covered legal defense cost outside of the policy limit. A $5 million umbrella policy of that type would have covered the entire judgment and the Smiths legal bills – and left their savings, investment accounts and children’s college portfolios untouched. And while such a policy would have cost more than their original $1 million umbrella coverage, it probably would have cost just a few hundred dollars incremental annually.