What is the Surrogate Decision-Making Committee (SDMC) program?

The Surrogate Decision-Making Committee (SDMC) program is the only program of its kind in the nation.  It is authorized to provide consent for non-emergency major medical treatment and end-of-life decisions on behalf of qualifying individuals. The SDMC panels are convened to provide a quicker, more easily accessible, cost-free and personalized decision on behalf of individuals with disabilities.

Who is eligible for the SDMC program?

Eligible individuals are persons believed to be incapable of providing informed consent, who lack an individual authorized to act on their behalf and either:

·         Currently reside or have formerly resided in a residential program operated, licensed, approved or funded by the Office for People With Developmental Disabilities (OPWDD), the Office of Mental Health (OMH), or the  Office of Alcoholism and Substance Abuse Services (OASAS)

·         Currently or previously receive(d) services under the federal  Home and Community Based Waiver

·         Currently or previously receive(d) individual support services or case management approved or funded by OPWDD 

When is a person considered to be incapable?

An individual is considered to be incapable when he or she is unable to assess the risks, benefits and alternatives to a proposed medical treatment, including the risks of non-treatment and cannot make an informed decision to consent or refuse such treatment. 

Who serves on SDMC panels?

A Surrogate Decision Making Committee (SDMC) relies on 12 volunteers appointed by the Justice Center. These volunteers serve on committees throughout New York State. When a panel is convened it must consist of at least 3, and no more than 4 members.

The committees and panels consist of one member from each of the following categories:

·         NYS Licensed Health Care Professional (e.g., physician, nurse, clinical social worker)

·         NYS Attorney

·         Family Member or Former Client

·         Advocate for Persons with Mental Disabilities (e.g., persons with recognized expertise or demonstrated interest in the care and treatment or individuals with behavioral health or developmental disabilities)

To date, the Justice Center has appointed and trained more than 1,600 volunteers who serve throughout New York State.

What determinations must the SDMC panels make?

After carefully reviewing the submitted case filing forms, the SDMC panels will make as many as three decisions:

1.    Determination of the individual’s ability to consent to or refuse the proposed major medical treatment decision.

2.    Determination of whether there is an authorized surrogate who is willing and available to consent to or refuse the proposed major medical procedure on behalf of the individual.

3.    Determination of whether the proposed major medical treatment decision is in the best interest of the patient.

The panel must make these decisions in this order to protect the individual’s rights. In all cases, the individual will be seen by the panel or one of its members, before a decision is made.

What medical decisions can be made by the SDMC program?

 Medical, surgical, dental, or diagnostic interventions or procedures which involve:

·         The use of a general anesthetic

·         Any significant invasion of bodily integrity requiring an incision or producing substantial pain, discomfort, debilitation, or having a significant recovery period

·         Significant risk (e.g., colonoscopies, endoscopies, MRIs, CT Scans with contrast)

·         HIV testing

·         Chemotherapy

·         Hospice

·         Withdrawal or withholding of life sustaining treatment as provided in the Health Care Decisions Act for persons with an intellectual or developmental disability

·         Any other treatment or procedure for which informed consent is required by law

What treatment is excluded by law from the SDMC program?

·         Routine diagnosis or treatment including the administration of routine medications

·         Dental care performed under a local anesthetic

·         Emergency medical treatment

·         Electroconvulsive therapy (ECT)

·         Withdrawal or discontinuation of life sustaining medical treatment except as provided in the Health Care Decisions Act for persons with an intellectual or developmental disability

·         Sterilization

·         Termination of pregnancy

How do I apply for a determination on behalf of an individual?

To have the Surrogate Decision-Making Committee consider a case, you must submit the request in writing (Declaration) on special  Case Filing Forms. The Case Filing Forms and instructions may be downloaded and completed for submission to SDMC for processing.  Additional supporting information must be obtained from the facility or program where the individual resides. Assistance with completing forms may be obtained by calling (518) 549-0328.   

Who may serve as the declarant in an SDMC case?

The individual making the request for a determination regarding medical treatment on behalf of an individual is the declarant.  A declarant could include the director or staff member from the patient’s residential facility, the patient’s service coordinator, physician, dentist, staff from hospitals, a relative or a correspondent of the patient.

SDMC does not dictate what member of the treatment team or staff should act as a declarant.  The declarant should be able to speak about why he or she feels that the individual lacks the ability to make the decision, why there is no legally authorized, willing and available person to act on the individual’s behalf and why the proposed procedure is in the best interest of the individual.

What is the role of the declarant?

·         Act as the provider agency coordinator of the SDMC process  

·         Serve as contact for SDMC staff when additional information is required

·         Serve as contact for regional coordinator to schedule the case for the hearing

·         Ensure other interested parties from the agency are notified and attend the hearing

·         Serve as contact for SDMC following the hearing if issues arise

May the declarant submit a partial case to SDMC?

All four (4) forms of the Major Medical Treatment (200) series must be submitted at the same time if seeking assistance for non-emergency medical treatment.

All five (5) forms of the End of Life Care (300) series must be submitted at the same time if seeking the withdrawal or withholding of life sustaining treatment.

Who qualifies as a correspondent and what is the role of a correspondent in a case?

Any person who has demonstrated a genuine interest in promoting the best interest of the individual by having a personal relationship with the person, participating in their care and treatment, by regularly visiting the individual or by regularly communicating with the individual would qualify as a correspondent. A correspondent may file a declaration on behalf of a patient.

What is an expedited case?

·         A case where the care need does not rise to the level of the definition of an emergency but a more urgent hearing is required to meet the individual’s care need.

·         A case where the procedure will be scheduled within the next 7 to 10 days.

·         All cases where the individual is in the hospital will be treated as an expedited case.

Who qualifies as an authorized surrogate?

The SDMC program and OMH and OPWDD regulations define an authorized surrogate as:

·         Parent                                          

·         Spouse

·         Adult Child                        

·         Court Appointed Guardians and Committees

·         Health Care Proxy

What is the role of an authorized surrogate?

When there is an authorized, willing and available surrogate he or she may make the treatment decision on behalf of the person.  An authorized surrogate may decide to waive his or her right to make the decision and defer decision-making to the SDMC panel.

What is the definition of active involvement by a family member?

An actively involved family member is someone 18 years of age or older and who has demonstrated significant and ongoing involvement in a person’s life so as to have sufficient knowledge of the person’s needs. 

Is SDMC case preparation training available?

Yes, training is available. Contact the SDMC Program for more information at 518-549-0328 or 800-624-4143.

Where can I obtain more information about the SDMC program?

Please visit the Justice Center’s website at http://www.justicecenter.ny.gov/services-supports/sdmc[LD1]  or contact SDMC staff directly at (518) 549-0328, or by fax at (518) 549-0460 or by email at SDMC@justicecenter.ny.gov