Text: HSB00622 Text: HSB00624 Text: HSB00600 - HSB00699 Text: HSB Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 Section 1. Section 144A.2, Code 2001, is amended to read 1 2 as follows: 1 3 144A.2 DEFINITIONS. 1 4 Except as otherwise provided, as used in this chapter: 1 5 1. "Adult" means an individual eighteen years of age or 1 6 older. 1 7 2. "Attending physician" means the physician selected by, 1 8 or assigned to, the patient who has primary responsibility for 1 9 the treatment and care of the patient. 1 10 3. "Declaration" means a document executed in accordance 1 11 with the requirements of section 144A.3. 1 12 4. "Department" means the Iowa department of public 1 13 health. 1 14 5. "Emergency medical care provider" means emergency 1 15 medical care provider as defined in section 147A.1. 1 164.6. "Health care provider" means a person, including an 1 17 emergency medical care provider, who is licensed, certified, 1 18 or otherwise authorized or permitted by the law of this state 1 19 to administer health care in the ordinary course of business 1 20 or in the practice of a profession. 1 21 7. "Hospital" means hospital as defined in section 135B.1. 1 225.8. "Life-sustaining procedure" means any medical 1 23 procedure, treatment, or intervention, including 1 24 resuscitation, which meets both of the following requirements: 1 25 a. Utilizes mechanical or artificial means to sustain, 1 26 restore, or supplant a spontaneous vital function. 1 27 b. When applied to a patient in a terminal condition, 1 28 would serve only to prolong the dying process. 1 29 "Life-sustaining procedure" does not include the provision 1 30 of nutrition or hydration except when required to be provided 1 31 parenterally or through intubation or the administration of 1 32 medication or performance of any medical procedure deemed 1 33 necessary to provide comfort care or to alleviate pain. 1 34 9. "Out-of-hospital do-not-resuscitate order" means a 1 35 written order signed by a physician, executed in accordance 2 1 with the requirements of section 144A.7A and issued consistent 2 2 with this chapter, that directs the withholding or withdrawal 2 3 of resuscitation when an adult patient in a terminal condition 2 4 is outside the hospital. 2 56.10. "Physician" means a person licensed to practice 2 6 medicine and surgery, osteopathy or osteopathic medicine and 2 7 surgery in this state. 2 87.11. "Qualified patient" means a patient who has 2 9 executed a declaration or an out-of-hospital do-not- 2 10 resuscitate order in accordance with this chapter and who has 2 11 been determined by the attending physician to be in a terminal 2 12 condition. 2 13 12. "Resuscitation" means any medical intervention that 2 14 utilizes mechanical or artificial means to sustain, restore, 2 15 or supplant a spontaneous vital function, including but not 2 16 limited to chest compression, defibrillation, intubation, and 2 17 emergency drugs intended to alter cardiac function or 2 18 otherwise to sustain life. 2 198.13. "Terminal condition" means an incurable or 2 20 irreversible condition that, without the administration of 2 21 life-sustaining procedures, will, in the opinion of the 2 22 attending physician, result in death within a relatively short 2 23 period of time or a state of permanent unconsciousness from 2 24 which, to a reasonable degree of medical certainty, there can 2 25 be no recovery. 2 26 Sec. 2. Section 144A.3, subsection 2, unnumbered paragraph 2 27 1, Code 2001, is amended to read as follows: 2 28 The declaration must be signed by the declarant or another 2 29 person acting on behalf of the declarant at the direction of 2 30 the declarant, must contain the date ofitsthe declaration's 2 31 execution, and must be witnessed or acknowledged by one of the 2 32 following methods: 2 33 Sec. 3. Section 144A.3, subsection 2, paragraph a, 2 34 subparagraphs (1) and (2), Code 2001, are amended to read as 2 35 follows: 3 1 (1) A health care provider attending the declarant on the 3 2 date of execution of the declaration. 3 3 (2) An employee of a health care provider attending the 3 4 declarant on the date of execution of the declaration. 3 5 Sec. 4. Section 144A.7, subsection 1, paragraph a, Code 3 6 2001, is amended to read as follows: 3 7 a. The attorney in fact designated to make treatment 3 8 decisions for the patient should such person be diagnosed as 3 9 suffering from a terminal condition, if the designation is in 3 10 writing and complies with chapter 144B or section 633.705. 3 11 Sec. 5. NEW SECTION. 144A.7A OUT-OF-HOSPITAL DO-NOT- 3 12 RESUSCITATE ORDERS. 3 13 1. If an attending physician issues an out-of-hospital do- 3 14 not-resuscitate order for an adult patient under this section, 3 15 the physician shall use the form prescribed pursuant to 3 16 subsection 2, include a copy of the order in the patient's 3 17 medical record, and provide a copy to the patient or an 3 18 individual authorized to act on the patient's behalf. 3 19 2. The department, in collaboration with interested 3 20 parties, shall prescribe uniform out-of-hospital do-not- 3 21 resuscitate order forms and uniform personal identifiers, and 3 22 shall adopt administrative rules necessary to implement this 3 23 section. The uniform forms and personal identifiers shall be 3 24 used statewide. 3 25 3. The out-of-hospital do-not-resuscitate order form shall 3 26 include all of the following: 3 27 a. The patient's name. 3 28 b. The patient's date of birth. 3 29 c. The name of the individual authorized to act on the 3 30 patient's behalf, if applicable. 3 31 d. A statement that the patient is in a terminal 3 32 condition. 3 33 e. The physician's signature. 3 34 f. The date the form is signed. 3 35 g. A concise statement of the nature and scope of the 4 1 order. 4 2 h. Any other information necessary to provide clear and 4 3 reliable instructions to a health care provider. 4 4 4. A health care provider may withhold or withdraw 4 5 resuscitation outside a hospital consistent with an out-of- 4 6 hospital do-not-resuscitate order issued under this section 4 7 and the rules or protocols adopted by the department. 4 8 5. In fulfilling the instructions of an out-of-hospital 4 9 do-not-resuscitate order under this chapter, a health care 4 10 provider shall continue to provide appropriate comfort care 4 11 and pain relief to the patient. 4 12 6. An out-of-hospital do-not-resuscitate order shall not 4 13 apply when a patient is in need of emergency medical services 4 14 due to a sudden accident or injury resulting from a motor 4 15 vehicle collision, fire, mass casualty, or other cause of a 4 16 sudden accident or injury which is outside the scope of the 4 17 patient's terminal condition. 4 18 7. An out-of-hospital do-not-resuscitate order is deemed 4 19 revoked at any time that a patient, or an individual 4 20 authorized to act on the patient's behalf as designated on the 4 21 out-of-hospital do-not-resuscitate order, is able to 4 22 communicate in any manner the intent that the order be 4 23 revoked, without regard to the mental or physical condition of 4 24 the patient. A revocation is only effective as to the health 4 25 care provider upon communication to that provider by the 4 26 patient, an individual authorized to act on the patient's 4 27 behalf as designated in the order, or by another person to 4 28 whom the revocation is communicated. 4 29 8. The personal wishes of family members or other 4 30 individuals who are not authorized in the order to act on the 4 31 patient's behalf shall not supersede a valid out-of-hospital 4 32 do-not-resuscitate order. 4 33 9. If uncertainty regarding the validity or applicability 4 34 of an out-of-hospital do-not-resuscitate order exists, a 4 35 health care provider shall provide necessary and appropriate 5 1 resuscitation. 5 2 10. A health care provider shall document compliance or 5 3 noncompliance with an out-of-hospital do-not-resuscitate order 5 4 and the reasons for not complying with the order, including 5 5 evidence that the order was revoked or uncertainty regarding 5 6 the validity or applicability of the order. 5 7 11. This section shall not preclude a hospital licensed 5 8 under chapter 135B from honoring an out-of-hospital do-not- 5 9 resuscitate order entered in accordance with this section and 5 10 in compliance with established hospital policies and 5 11 protocols. 5 12 Sec. 6. Section 144A.8, Code 2001, is amended to read as 5 13 follows: 5 14 144A.8 TRANSFER OF PATIENTS. 5 15 1. An attending physician who is unwilling to comply with 5 16 the requirements of section 144A.5, or who is unwilling to 5 17 comply with the declaration of a qualified patient in 5 18 accordance with section 144A.6 or an out-of-hospital do-not- 5 19 resuscitate order pursuant to section 144A.7A, or who is 5 20 unwilling to comply with the provisions of section 144A.7 or 5 21 144A.7A shall take all reasonable steps to effect the transfer 5 22 of the patient to another physician. 5 23 2. If the policies of a health care provider preclude 5 24 compliance with the declaration or out-of-hospital do-not- 5 25 resuscitate order of a qualified patient under this chapter or 5 26 preclude compliance with the provisions of section 144A.7 or 5 27 144A.7A, the provider shall take all reasonable steps to 5 28 effect the transfer of the patient to a facility in which the 5 29 provisions of this chapter can be carried out. 5 30 Sec. 7. Section 144A.9, subsection 1, unnumbered paragraph 5 31 1, Code 2001, is amended to read as follows: 5 32 In the absence of actual notice of the revocation of a 5 33 declaration or of an out-of-hospital do-not-resuscitate order, 5 34 the following, while acting in accordance with the 5 35 requirements of this chapter, are not subject to civil or 6 1 criminal liability or guilty of unprofessional conduct: 6 2 Sec. 8. Section 144A.9, Code 2001, is amended by adding 6 3 the following new subsection: 6 4 NEW SUBSECTION. 4. In the absence of actual notice of the 6 5 revocation of an out-of-hospital do-not-resuscitate order, a 6 6 health care provider who complies with this chapter is not 6 7 subject to civil or criminal liability or guilty of 6 8 unprofessional conduct in entering, executing, or otherwise 6 9 participating in an out-of-hospital do-not-resuscitate order. 6 10 Sec. 9. Section 144A.10, Code 2001, is amended to read as 6 11 follows: 6 12 144A.10 PENALTIES. 6 13 1. Any person who willfully conceals, withholds, cancels, 6 14 destroys, alters, defaces, or obliterates the declaration, 6 15 out-of-hospital do-not-resuscitate order, or out-of-hospital 6 16 do-not-resuscitate identifier of another without the 6 17 declarant's or patient's consent or who falsifies or forges a 6 18 revocation of the declaration or out-of-hospital do-not- 6 19 resuscitate order of another is guilty of a serious 6 20 misdemeanor. 6 21 2. Any person who falsifies or forges the declaration or 6 22 out-of-hospital do-not-resuscitate order of another, or 6 23 willfully conceals or withholds personal knowledge of or 6 24 delivery of a revocation as provided in section 144A.4 or 6 25 144A.7A, with the intent to cause a withholding or withdrawal 6 26 of life-sustaining procedures, is guilty of a serious 6 27 misdemeanor. 6 28 Sec. 10. Section 144A.11, subsections 1, 2, 3, and 4, Code 6 29 2001, are amended to read as follows: 6 30 1. Death resulting from the withholding or withdrawal of 6 31 life-sustaining procedures pursuant to a declaration or out- 6 32 of-hospital do-not-resuscitate order and in accordance with 6 33 this chapter does not, for any purpose, constitute a suicide, 6 34orhomicide, or dependent adult abuse. 6 35 2. Themakingexecuting of a declaration pursuant to 7 1 section 144A.3 or an out-of-hospital do-not-resuscitate order 7 2 pursuant to section 144A.7A does not affect in any manner the 7 3 sale, procurement, or issuance of any policy of life 7 4 insurance, nor shall it be deemed to modify the terms of an 7 5 existing policy of life insurance. No policy of life 7 6 insurance is legally impaired or invalidated in any manner by 7 7 the withholding or withdrawal of life-sustaining procedures 7 8 pursuant to this chapter, notwithstanding any term of the 7 9 policy to the contrary. 7 10 3. A physician, health care provider, health care service 7 11 plan, insurer issuing disability insurance, self-insured 7 12 employee welfare benefit plan, or nonprofit hospital plan 7 13 shall not require any person to execute a declaration or an 7 14 out-of-hospital do-not-resuscitate order as a condition for 7 15 being insured for, or receiving, health care services. 7 16 4. This chapter creates no presumption concerning the 7 17 intention of an individual who has not executed a declaration 7 18 or an out-of-hospital do-not-resuscitate order with respect to 7 19 the use, withholding, or withdrawal of life-sustaining 7 20 procedures in the event of a terminal condition. 7 21 Sec. 11. APPLICATION TO EXISTING ORDERS. An out-of- 7 22 hospital do-not-resuscitate order or similar order executed 7 23 prior to July 1, 2002, is valid and shall be honored in 7 24 accordance with the then-applicable provisions of law. 7 25 EXPLANATION 7 26 This bill provides for the development and use of out-of- 7 27 hospital do-not-resuscitate orders. The bill provides 7 28 definitions, including definitions of "emergency medical care 7 29 provider", "out-of-hospital do-not-resuscitate order", and 7 30 "resuscitation". The bill also provides the process for 7 31 issuing an out-of-hospital do-not-resuscitate order, directs 7 32 the Iowa department of public health to develop a uniform form 7 33 and personal identifier for the orders, specifies the contents 7 34 of the form, and establishes the scope and limitations of the 7 35 order. The bill specifies provisions for the revocation of an 8 1 order, provides immunity for persons acting in compliance in 8 2 entering, executing, or otherwise participating in an order, 8 3 and provides for the application of penalties and general 8 4 provisions relating to the orders. With regard to penalties, 8 5 the bill provides that any person who willfully conceals, 8 6 withholds, cancels, destroys, alters, defaces, or obliterates 8 7 an out-of-hospital do-not-resuscitate order, or out-of- 8 8 hospital do-not-resuscitate identifier of a patient without 8 9 the patient's consent, or who falsifies or forges a revocation 8 10 of an out-of-hospital do-not-resuscitate order of another, is 8 11 guilty of a serious misdemeanor. Additionally, any person who 8 12 falsifies or forges an out-of-hospital do-not-resuscitate 8 13 order of another, or willfully conceals or withholds personal 8 14 knowledge of or delivery of a revocation with the intent to 8 15 cause a withholding or withdrawal of life-sustaining 8 16 procedures, is guilty of a serious misdemeanor. A serious 8 17 misdemeanor is punishable by confinement for no more than one 8 18 year and a fine of at least $250 but not more than $1,500. 8 19 The bill also provides that existing orders or similar 8 20 orders existing prior to July 1, 2002, are valid and are to be 8 21 honored in accordance with the laws that were applicable at 8 22 the time of execution of the order. 8 23 LSB 6053HC 79 8 24 pf/pj/5
Text: HSB00622 Text: HSB00624 Text: HSB00600 - HSB00699 Text: HSB Index Bills and Amendments: General Index Bill History: General Index
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