Living Will Law Is Often Unenforced, Report Says : Health: Study by consumer group finds that many hospitals and nursing homes fail to provide necessary documents for decisions on medical treatment.

Many Los Angeles-area health care facilities are failing to properly inform patients about their rights to make out living wills, a consumer advocacy group says in a study scheduled for release today.

The Welfare Advocacy Project, after visiting 26 hospitals and 21 nursing homes, concluded that more education and enforcement are needed to fully implement the Patient Self-Determination Act. The law was enacted to allow patients to make life-or-death treatment decisions while they are still able, or to designate family members or a legal guardian to make the choices for them.

Release of the report is timed to coincide with the second anniversary of the law. An advance copy of the report was obtained by The Times.

The report was compiled by researchers who went to the institutions unannounced and asked for the brochure and other documents required by the law, saying they were picking up the materials for an older friend who would soon be admitted to the hospital. Although virtually all hospitals and nursing homes provided a brochure detailing patients’ rights, as required by the law, most did so only after repeated requests, the authors said. None of the hospitals or nursing homes were identified.

The study also said that 35% of the hospitals and 66% of the nursing homes could not provide a required written statement indicating how treatment decisions would be implemented at the institutions. It found that 36% of the institutions could not produce another required document, a Durable Power of Attorney for Health Care form, and 60% could not provide a third, called the Natural Death Act Declaration.

David Langness, a spokesman for the Hospital Council of Southern California, noted that 65% of the hospitals did provide the researchers with the required documents. “We think that’s pretty good for compliance with a law that is only 2 years old,” Langness said. “It takes time for people to get used to a new law. Still, it’s not good enough. We need to do a lot more work.”

Sandra Risdon, the chief researcher for the project, criticized the state Department of Health Services, which is required to enforce the law, for relying on the institutions for self-policing. “They call up institutions and ask if they are complying,” she said, rather than monitoring the institutions.

The researchers found that hospital administrators are familiar with the law. But they found that admissions desk personnel, many of them volunteers, often are unaware of the requirement to pass out the documents to patients.

“Visits to hospital admissions departments were frequently characterized by confusion, misunderstandings and repeated requests (even when using the exact titles of the documents) for material,” the study said.

Victor Arkin, chief of the Los Angeles office of the state health department’s licensing and certification division, said complaints about lack of information had not surfaced during any of his agency’s inspections of nursing homes.