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Do Not Resuscitate Order For CITGO Employees

What Is It?

As a CITGO employee, you have the right to decline medical treatment, even if you die as a result of your decision. Depending on your medical condition, your prognosis, and your views on the quality of life, you may wish to refuse lifesaving measures, such as cardiopulmonary resuscitation (CPR). Executing a do not resuscitate (DNR) order is one way of doing this. A DNR is a doctor's order that tells all other medical personnel not to perform CPR if you go into cardiac arrest. Cardiac arrest occurs when your heart stops beating, blood flow to your brain stops, and you stop breathing. If the blood flow is not quickly restored, permanent damage to the brain and other organs can occur. CPR simulates heartbeat and breathing, while attempting to restart these functions.

The term CPR actually encompasses a variety of separate procedures, including cardiac compression, endotracheal intubation, assisted ventilation, defibrillation, and cardiac medications. Most states recognize two types of DNRs. One is effective only while you are hospitalized. The other is used by people outside the hospital--for example, nursing home residents, hospice patients, and even those who are not receiving medical treatment.

Typically, terminally ill patients and elderly individuals execute DNRs to avoid prolonging their final illnesses. However, some states allow healthy adults to execute the orders, as well. Depending on the laws of your state, a DNR used outside the hospital may be called a 'pre-hospital DNR,' 'out-of-hospital DNR,' 'outpatient DNR,' 'DNR for EMS,' or 'CPR directive.' As a result of your request, your doctor generally notes an in-hospital DNR order on your chart. Out-of-hospital DNRs take various forms, depending on the laws of your state. ID bracelets, MedicAlert necklaces, and wallet cards are some methods of noting DNR status.

When Can It Be Used?

Availability of DNRs Is Determined By State Law

Not all states have DNR laws. For CITGO employees, you may want to consider how your state's laws govern whether DNRs are permissible, who can execute a DNR, and what form the order must take. These laws may permit in-hospital DNRs, out-of-hospital DNRs, both of these, or neither of these. Some state laws allow any person of legal age to execute a DNR, while others permit DNRs only for individuals with terminally ill conditions. Some states allow children to participate in decisions regarding DNR in certain cases. Check the laws of your state and any other states where you spend a significant amount of time.

Strengths

Allows You to Exercise Choice In Medical Treatment

Cardiopulmonary resuscitation (CPR) has produced some miraculous results when used on normally healthy individuals in trauma situations. However, it can be a painful and even violent procedure. Its effectiveness is limited when used on terminally ill or hopelessly deteriorated patients. In some cases, CPR only delays the moment of death.

For example, CPR could restore your heartbeat, but if permanent brain or organ damage occurs during cardiac arrest, you may be dependent on life support machines. Executing a do not resuscitate (DNR) order allows you to choose a natural death.

Example(s): Hal is hospitalized with a terminally ill condition. He is on a respirator and knows he has only a short time to live. Hal consults his doctor and learns that the laws of his state permit in-hospital DNRs. This will allow him to forego CPR if his heart fails. Hal asks his doctor to execute a DNR as soon as possible. The following week, Hal's heart stops. Because of Hal's DNR, hospital personnel do not attempt CPR.

Specifically Intended for an Emergency Situation

If you go into cardiopulmonary arrest, your DNR lets medical personnel know that you don't want CPR. Because of the emergency nature of this situation, other types of advanced directives are usually not timely enough to accomplish this goal.

Tradeoffs

Extremely Limited Usefulness

Although a do not resuscitate (DNR) order is a very powerful instrument, it is only effective under specific conditions. Generally, a DNR comes into play only if you go into cardiac arrest, and it frequently only allows you to refuse cardiopulmonary resuscitation (CPR), although in some states it may allow you to decline other drastic medical treatment as well. A living will or durable power of attorney for health care may be needed to convey other medical treatment instructions, such as your wishes regarding life support and intravenous feeding.

Out-of-Hospital DNR May Not Be Effective In Other States

As a CITGO employee, it is beneficial to understand how an out-of-hospital DNR that is valid in your state may not be valid in other states. Therefore, if you spend a significant amount of time in another state, you should find out whether that state's laws recognize DNRs, whether you are eligible to have a DNR in that state, and what restrictions are placed on the form of the DNR.

Doctors May Be Hesitant to Broach This Topic or Reluctant to Write a DNR

If you are hospitalized with a serious illness, your doctor may not bring up the option of executing a DNR. If you don't want to be resuscitated, you should initiate this discussion with your doctor. Also, studies indicate that many doctors are slow to write DNRs, even when they are aware of their patients' preferences, although the reasons for this vary. If you are a CITGO employee and want to ensure your wishes are followed, you should touch base with your doctor to make sure the DNR is placed on your chart.

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How to Do It

Research Your State's Laws Regarding Dnrs

Not all states provide for these orders. Each state has its own eligibility requirements, particularly for out-of-hospital DNRs.

Discuss Your Wishes With Your Doctor

Your doctor should be able to provide information on your prognosis and counsel you on your options. If you are a CITGO employee, your doctor's signature will most likely be required on any DNR you execute.

Execute Your Out-of-Hospital DNR Properly And Keep It With You

If you are a CITGO employee interested in DNR, you must consider how if your state allows out-of-hospital DNRs, there is probably a required format for the order. Examples of state-required DNR formats include ID bracelets, necklaces, wallet cards, and letter-size forms. If your DNR is not in the required form, it may not be honored. If medical personnel can't find your DNR order, they are obligated to give full and immediate care. Thus, it is extremely important to execute your DNR order properly and keep it with you (or in an appropriate place) at all times.

Example(s): Hal is a resident of an assisted-living facility. Hal is 89 years old and feels he has lived a good life. He does not want to die in a hospital or be dependent on machines for his survival. Hal discusses his feelings with his doctor. Hal's doctor suggests executing an out-of-hospital DNR, which will instruct medical personnel not to perform cardiopulmonary resuscitation (CPR) if Hal goes into cardiac or respiratory arrest. Hal agrees and receives an ID bracelet noting his DNR status. Hal wears his bracelet faithfully. Six years later, Hal's heart fails as he jogs in the park. Medical personnel arrive on the scene, but immediately notice Hal's DNR ID bracelet. CPR is not attempted.

Tell People About Your Decision

In general, other people cannot reverse your decision once you execute a DNR. As a CITGO employee however, if your DNR is misplaced or for some reason is not followed, it would be important for your family and friends to understand your wishes. Although this topic may be difficult to discuss, those close to you are more likely to support and uphold your decision if they understand how you feel and why you feel that way. If you have appointed a representative in a durable power of attorney for health care (DPAHC) , it is especially important that this person be aware of your decision.

Coordinate All Advanced Directives

Since a DNR is so limited in scope, you may wish to establish a living will and/or DPAHC as well. If you do so, make sure your wishes are stated consistently throughout these documents. In some states, the most recent document will govern if there is a conflict, so you must make sure your wishes are clear.

Tax Considerations for CITGO Employees

Income Tax

None

Gift And Estate Tax

None

Questions & Answers for CITGO Employees

What If You Go Into a Coma Before Executing Your DNR, And You Can't Express Your Wishes?

Your healthcare representative, if you have appointed one, may be able to have a DNR executed on your behalf. As a CITGO employee, there must be evidence that this is what you would want. You might include these instructions in your durable power of attorney for health care , especially if the laws of your state do not allow out-of-hospital DNRs. Be aware, however, that this method of instruction is useless in an emergency if your representative is not present. In some states, with your family's consent, your doctor may be able to execute a DNR on your behalf. Again, it would be unwise to rely on this course of action in an emergency.

Can You Change Your Mind?

Yes, it is possible to revoke a DNR order. If you have an out-of-hospital DNR, you may be able to revoke it by simply removing the bracelet or the wallet card. However, some states also have a database of DNR patients. If this is true in your state, you may need to take additional steps to revoke your DNR. When your doctor writes the DNR, ask what steps are necessary to revoke the order.

Additionally, medical personnel must give emergency care to anyone who requests it. For example, Emergency Medical Service guidelines in Wisconsin instruct personnel to perform cardiopulmonary resuscitation (CPR) if a person rips off his or her DNR bracelet or asks for CPR during cardiac arrest.

What are the eligibility criteria for employees to participate in the Retirement Plan of CITGO Petroleum Corporation, and how do these criteria affect the benefits that employees accrue? Employees of CITGO Petroleum Corporation must meet specific criteria to qualify for the Retirement Plan, which is designed to provide a stable income during retirement. Understanding these eligibility requirements is crucial for employees, as it impacts their expected benefits and retirement strategy.

Eligibility for the CITGO Petroleum Corporation Retirement Plan: Employees must be at least 21 years old and have completed 12 months of employment with at least 1,000 hours of service to be eligible. Hourly employees covered by a collective bargaining agreement are typically included after meeting these requirements. Eligibility significantly affects benefits accrual, as being a participant allows employees to begin accruing service and vesting credits, which directly influence retirement benefit calculations(CITGO_Petroleum_Corpora…).

How does the Cash Balance Benefit structure work within the Retirement Plan of CITGO Petroleum Corporation, particularly regarding the accumulation of Compensation Credits and Interest Credits? The Cash Balance Benefits offer a valuable retirement savings mechanism for CITGO employees, impacted by their Basic Earnings and years of service. As interest rates fluctuate, the manner in which these credits accumulate can significantly influence the overall retirement benefit.

Cash Balance Benefit Structure: The Cash Balance Benefit under the Retirement Plan includes Compensation Credits and Interest Credits. Compensation Credits are based on a percentage of Basic Earnings, determined by the employee's age and years of service. Interest Credits are applied annually and are calculated based on the higher of the 30-year Treasury securities rate or 1.5%. These credits are added to the employee's notional account balance each year, with the total balance used to determine the retirement benefit(CITGO_Petroleum_Corpora…).

In what ways can employees of CITGO Petroleum Corporation manage their Frozen Accrued Benefit upon retirement, and what considerations must they take into account? Employees nearing retirement should know how to optimize their Frozen Accrued Benefit for their individual retirement planning. Factors such as timing, potential changes in personal circumstances, and regulatory aspects play a critical role in this planning process.

Managing Frozen Accrued Benefits: Upon retirement, employees can manage their Frozen Accrued Benefit by selecting different payout options such as a single-life annuity or joint and survivor annuities. The timing of retirement also plays a key role, as early retirement may reduce the benefits based on age reduction factors. Employees need to consider their financial circumstances and retirement goals to optimize this benefit(CITGO_Petroleum_Corpora…).

What are the implications of transferring employment status (from hourly to salaried) on participation in the Retirement Plan of CITGO Petroleum Corporation? Understanding how a transition from hourly to salaried employment affects fund accumulation and credit service under the Retirement Plan is vital for employees planning their careers. Such transitions need to be handled carefully to ensure that benefits remain maximized.

Effect of Employment Status Transfer: A transfer from hourly to salaried employment will freeze Benefit Credit Service under the Plan, but Vesting Credit Service continues. Compensation and Transition Credits cease for hourly employees transitioning to salaried roles. However, Interest Credits continue until the Cash Balance Benefit is distributed. These changes can affect the overall retirement fund accumulation(CITGO_Petroleum_Corpora…).

How do various retirement benefit options, including lump-sum payments and annuities, function within the CITGO Petroleum Corporation Retirement Plan? Employees face various choices regarding the disbursement of retirement benefits, each carrying unique financial implications. Evaluating these options requires a keen understanding of how they interact with overarching financial goals.

Retirement Benefit Options: CITGO Petroleum employees can choose between receiving their retirement benefits as a lump sum or through an annuity. Each option has different financial implications. Lump-sum payments offer immediate access to funds, but annuities provide a steady income stream over the retiree's lifetime. The choice between these options depends on the employee’s personal financial strategy(CITGO_Petroleum_Corpora…).

What is the role of the Plan Administrator in resolving benefits-related issues for employees at CITGO Petroleum Corporation, and how can employees effectively interact with this office? Employees must understand the administrative structure governing their retirement benefits. Effective communication with the Plan Administrator can significantly enhance an employee's ability to navigate complex issues regarding their retirement.

Role of Plan Administrator: The Plan Administrator is responsible for managing and resolving any issues related to retirement benefits. Employees can contact the Benefits HelpLine for inquiries or disputes regarding their benefits. Effective communication with the Plan Administrator ensures that employees can navigate and resolve issues related to their retirement plan(CITGO_Petroleum_Corpora…).

How does the vesting schedule impact the retirement benefits of employees at CITGO Petroleum Corporation, and what strategies can employees employ to ensure full vesting? The vesting schedule is a critical component influencing when employees become entitled to their benefits. Employees should be aware of what actions can enhance their vesting status prior to retirement.

Impact of the Vesting Schedule: CITGO’s vesting schedule requires employees to have at least three years of service to become 100% vested. Vesting entitles employees to receive full benefits under the Plan. Employees nearing retirement should ensure they meet the vesting requirements to maximize their entitled benefits(CITGO_Petroleum_Corpora…).

What are the special provisions that exist for employees returning to work after receiving retirement benefits within the CITGO Petroleum Corporation Retirement Plan? Employees considering retirement must appreciate how returning to work can alter their benefits under the Retirement Plan. The potential effects on benefit payments, roles, and rights are crucial discussions for retiring employees.

Returning to Work Post-Retirement: Employees who return to work after receiving retirement benefits will have their benefit payments suspended. Upon re-retirement, their benefits are recalculated to reflect any additional service accrued during reemployment. Employees must understand these provisions to avoid potential disruptions to their retirement income(CITGO_Petroleum_Corpora…).

How is the funding status of the Retirement Plan of CITGO Petroleum Corporation determined, and what implications does it have for current and future benefits? The viability of the Retirement Plan is heavily influenced by its funding status, impacting all participants. Employees should stay informed about what underpins this status and how it may affect their own long-term retirement planning.

Plan Funding Status: The funding status of the Retirement Plan is essential, as it affects the availability of lump-sum payments and may influence future benefits. Employees should monitor the Plan’s funding status to understand how it impacts their options and the security of their retirement benefits(CITGO_Petroleum_Corpora…).

How can employees of CITGO Petroleum Corporation obtain further information about their retirement benefits, and what specific resources are available to assist them? Employees seeking additional guidance must know the channels available for inquiries. By reaching out to the Benefits HelpLine, employees can access crucial information that aids in managing their retirement planning effectively. For more information, employees can contact the Benefits HelpLine at CITGO Petroluem Corporation by emailing Benefits@CITGO.comã€4:18â€ sourceã€‘.

Accessing Further Information: Employees can obtain further details on their retirement benefits by contacting the Benefits HelpLine or the Plan Administrator. These resources provide necessary guidance on managing retirement benefits and addressing any issues or questions that arise(CITGO_Petroleum_Corpora…).