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PAG LIN 1 1 Section 1. NEW SECTION. 144D.1 SHORT TITLE. 1 2 This chapter may be cited as the "Resuscitation Status 1 3 Orders Act". 1 4 Sec. 2. NEW SECTION. 144D.2 DEFINITIONS. 1 5 As used in this chapter, unless the context otherwise 1 6 requires: 1 7 1. "Adult" means an individual eighteen years of age or 1 8 older. 1 9 2. "Attending physician" means a physician selected by, or 1 10 assigned to, a patient who has primary responsibility for the 1 11 treatment and care of the patient. 1 12 3. "Attorney in fact" means an individual who is 1 13 designated by a durable power of attorney for health care 1 14 pursuant to chapter 144B to make health care decisions for a 1 15 patient if the patient is unable, in the judgment of the 1 16 attending physician, to make health care decisions. 1 17 4. "Department" means the Iowa department of public 1 18 health. 1 19 5. "Durable power of attorney for health care" means a 1 20 document authorizing an attorney in fact to make health care 1 21 decisions for a patient if the patient is unable, in the 1 22 judgment of the attending physician, to make health care 1 23 decisions. 1 24 6. "Emergency medical care provider" or "EMS provider" 1 25 means an individual trained to provide emergency and 1 26 nonemergency medical care at the first-responder, EMT-basic, 1 27 EMT-intermediate, or EMT-paramedic level, or other 1 28 certification levels adopted by rule by the department, who 1 29 has been issued a certificate by the department. 1 30 7. "Emergency medical services" or "EMS" means an 1 31 integrated medical care delivery system to provide emergency 1 32 and nonemergency medical care at the scene or during out-of- 1 33 hospital patient transportation in an ambulance. 1 34 8. "Health care facility" means health care facility as 1 35 defined in section 135C.1. 2 1 9. "Health care provider" means a person who is licensed, 2 2 certified, or otherwise authorized or permitted by the law of 2 3 this state to administer health care in the ordinary course of 2 4 business or in the practice of a profession. "Heath care 2 5 provider" includes an EMS provider who provides emergency 2 6 medical services. 2 7 10. "Hospice program" means hospice program as defined in 2 8 section 135J.1. 2 9 11. "Life-sustaining intervention" means any medical 2 10 procedure, treatment, or intervention which utilizes 2 11 mechanical or artificial means to sustain, restore, or 2 12 supplant a spontaneous vital function, including but not 2 13 limited to, chest compressions, defibrillation, endotracheal 2 14 intubation, emergency drugs intended to stimulate cardiac 2 15 function or to otherwise sustain life, and other interventions 2 16 defined by rule of the department. 2 17 12. "Permanent unconsciousness" means a medical condition 2 18 characterized by loss of consciousness that has been diagnosed 2 19 in accordance with currently accepted medical standards and 2 20 from which, to a reasonable degree of medical certainty, there 2 21 can be no recovery. 2 22 13. "Physician" means a person licensed to practice 2 23 medicine and surgery, osteopathy, or osteopathic medicine and 2 24 surgery in this state. 2 25 14. "Resuscitation status order" means a physician's 2 26 written order issued with the consent of the patient or the 2 27 patient's authorized representative and consistent with this 2 28 chapter that directs the withholding or withdrawal of life- 2 29 sustaining interventions when the patient is in a health care 2 30 facility, hospice program, at home, or is otherwise outside a 2 31 hospital. Resuscitation status orders include affirmative 2 32 obligations to provide appropriate comfort care and pain 2 33 relief. 2 34 15. "Terminal condition" means an incurable or 2 35 irreversible condition that, without the administration of 3 1 life-sustaining intervention will, in the opinion of the 3 2 attending physician, result in death within a relatively short 3 3 period of time. 3 4 Sec. 3. NEW SECTION. 144D.3 RESUSCITATION STATUS ORDERS 3 5 SCOPE AND LIMITATION. 3 6 1. An attending physician may issue a resuscitation status 3 7 order under this chapter for an adult patient who is in a 3 8 terminal condition or a state of permanent unconsciousness. 3 9 2. A resuscitation status order may direct that life- 3 10 sustaining interventions shall be withheld or withdrawn. 3 11 3. A resuscitation status order shall not be interpreted 3 12 to limit or pertain to professional obligations to provide 3 13 comfort care and pain relief. Health care providers shall 3 14 continue to provide appropriate comfort care and pain relief 3 15 to a patient under a resuscitation status order. 3 16 4. A resuscitation status order shall be valid 3 17 indefinitely from the date of issuance, unless the order 3 18 includes an expiration date or has been revoked. 3 19 5. A health care provider may honor a resuscitation status 3 20 order for a person in need of emergency medical services due 3 21 to a sudden accident or injury resulting from a motor vehicle 3 22 collision, fire, mass casualty, or other cause of sudden 3 23 accident or injury which is outside the scope of the patient's 3 24 usual care and treatment. 3 25 Sec. 4. NEW SECTION. 144D.4 RESUSCITATION STATUS ORDERS 3 26 AUTHORIZATION. 3 27 1. A resuscitation status order may be issued with the 3 28 consent of a competent, adult patient. 3 29 2. A resuscitation status order may be issued for a 3 30 patient who is comatose, incompetent, or otherwise incapable 3 31 of making the patient's own health care decisions with the 3 32 consent of any of the following individuals, in the following 3 33 order of priority, if no individual in a prior class is 3 34 reasonably available, willing, and competent to act: 3 35 a. The attorney in fact designated to make treatment 4 1 decisions for the patient pursuant to a durable power of 4 2 attorney for health care. 4 3 b. The guardian of the patient, if a guardian has been 4 4 appointed. 4 5 c. The patient's spouse. 4 6 d. An adult child of the patient, or, if the patient has 4 7 more than one adult child, a majority of the adult children 4 8 who are reasonably available. 4 9 e. A parent of the patient, or the parents of the patient 4 10 if both are reasonably available. 4 11 f. An adult sibling of the patient. 4 12 3. An individual authorized to consent on the patient's 4 13 behalf shall be guided by the express or implied intentions of 4 14 the patient, including, but not limited to, the patient's 4 15 advance directive, if any, and the patient's previously 4 16 expressed statements and values. 4 17 4. This chapter does not authorize a resuscitation status 4 18 order without the consent of the patient or an individual 4 19 authorized to act on the patient's behalf. However, this 4 20 chapter shall not be interpreted to restrict the existing 4 21 ability of a physician to exercise independent medical 4 22 judgment and issue medical orders for the patient. 4 23 5. This chapter shall not be interpreted to limit or 4 24 pertain to a health care provider's rights and duties under 4 25 circumstances not governed by this chapter. 4 26 6. Resuscitation status orders are valid only if signed by 4 27 a physician in accordance with the requirements of this 4 28 chapter, and shall be based upon communication between the 4 29 attending physician and the patient, if capable, or an 4 30 individual authorized to act on the patient's behalf. 4 31 Sec. 5. NEW SECTION. 144D.5 RESUSCITATION STATUS ORDERS 4 32 IMPLEMENTATION. 4 33 1. The department, in collaboration with the Iowa medical 4 34 society and other interested parties, shall prescribe uniform 4 35 resuscitation status order forms. The uniform forms shall be 5 1 used statewide. 5 2 2. The resuscitation status order form shall include the 5 3 name of the patient, the name of the individual authorized to 5 4 act on the patient's behalf, if applicable, the physician's 5 5 signature, the date signed, a clear statement of the nature 5 6 and scope of the order, and other information as necessary to 5 7 provide clear and reliable instructions to health care 5 8 providers and families. 5 9 3. The attending physician shall document the patient's 5 10 resuscitation status order, include a copy of the order in the 5 11 patient's medical record, and provide a copy of the order to 5 12 the patient or an individual authorized to act on the 5 13 patient's behalf. 5 14 4. If uncertainty regarding the validity of a 5 15 resuscitation status order exists, a health care provider 5 16 shall provide necessary and appropriate life-sustaining 5 17 intervention. 5 18 5. The personal wishes of family members or other 5 19 individuals not authorized pursuant to section 144D.4 to act 5 20 on the patient's behalf shall not supersede the patient's 5 21 wishes as expressed in a valid resuscitation status order. 5 22 6. When following a patient's resuscitation status order, 5 23 a health care provider shall continue to provide appropriate 5 24 comfort care and pain relief. 5 25 7. Health care providers shall document compliance or 5 26 noncompliance with a resuscitation status order, and the 5 27 reasons for not complying with an order, including evidence 5 28 that the order has been revoked. 5 29 Sec. 6. NEW SECTION. 144D.6 PATIENT IDENTIFIERS. 5 30 The department, in collaboration with the Iowa medical 5 31 society and other interested parties, shall prescribe uniform 5 32 identifiers and a mechanism for timely verification. The 5 33 uniform identifiers and mechanism for timely verification 5 34 shall be used statewide. 5 35 Sec. 7. NEW SECTION. 144D.7 REVOCATION. 6 1 1. A patient may revoke a resuscitation status order by 6 2 any means that evidences an intent to revoke the order, 6 3 regardless of the patient's mental or physical condition. 6 4 2. The attorney in fact or an individual authorized by 6 5 this chapter to act on the patient's behalf, who consents to a 6 6 resuscitation status order for a patient who is comatose, 6 7 incompetent, or otherwise incapable of making the patient's 6 8 own health care decisions, may revoke a resuscitation status 6 9 order by any means that evidences an intent to revoke the 6 10 order. 6 11 3. A revocation is only effective as to a health care 6 12 provider upon actual communication of the revocation to that 6 13 health care provider. To be effective, a revocation must be 6 14 communicated to the health care provider by the patient, an 6 15 individual authorized by this chapter to revoke a 6 16 resuscitation status order, or by another individual to whom 6 17 the revocation has been communicated by the patient or an 6 18 individual authorized by this chapter to revoke the order. 6 19 Sec. 8. NEW SECTION. 144D.8 IMMUNITIES. 6 20 1. A health care provider acting pursuant to a valid 6 21 resuscitation status order is presumed to be acting in good 6 22 faith and in the best interest of the patient, absent clear 6 23 and convincing evidence to the contrary. 6 24 2. A health care provider who acts in good faith to comply 6 25 with this chapter is immune from civil and criminal liability 6 26 and from professional disciplinary action for those acts of 6 27 compliance. 6 28 3. An individual authorized by this chapter to consent to 6 29 or revoke a resuscitation status order for a patient who is 6 30 comatose, incompetent, or otherwise incapable of making the 6 31 patient's own health care decisions, who acts in good faith to 6 32 honor the patient's wishes in compliance with this chapter, is 6 33 immune from civil and criminal liability for those acts of 6 34 compliance. 6 35 Sec. 9. NEW SECTION. 144D.9 ORDERS FROM OTHER STATES. 7 1 A health care provider may honor a resuscitation status 7 2 order or out-of-hospital do-not-resuscitate order executed in 7 3 another state or jurisdiction in compliance with the law of 7 4 that state or jurisdiction, to the extent that the order is 7 5 consistent with the laws of this state. 7 6 Sec. 10. NEW SECTION. 144D.10 RULES AND IMPLEMENTATION. 7 7 1. The department, in cooperation with the department of 7 8 inspections and appeals, shall adopt rules pursuant to chapter 7 9 17A to administer this chapter. 7 10 2. The rules adopted may direct health care facilities to 7 11 adopt policies as necessary to honor a patient's resuscitation 7 12 status order, including a policy that a health care provider 7 13 is not required to call an EMS provider or to transfer the 7 14 patient to a hospital when contrary to the wishes of the 7 15 patient or an individual authorized to act on the patient's 7 16 behalf. 7 17 3. The department, in cooperation with the department of 7 18 inspections and appeals, shall monitor and evaluate the 7 19 implementation and effectiveness of this chapter. The 7 20 department shall submit a report regarding the evaluation, 7 21 including any recommendations for changes, to the general 7 22 assembly no later than July 1, 2006. 7 23 Sec. 11. NEW SECTION. 144D.11 PENALTIES. 7 24 1. A person who willfully conceals, withholds, cancels, 7 25 destroys, alters, defaces, or obliterates a resuscitation 7 26 status order without the patient's consent, or who falsifies 7 27 or forges a revocation of an order for resuscitation status of 7 28 another, is guilty of a serious misdemeanor. 7 29 2. A person who falsifies or forges a resuscitation status 7 30 order, or willfully conceals or withholds personal knowledge 7 31 of or delivery of a revocation with the intent to cause 7 32 withholding or withdrawal of life-sustaining interventions, is 7 33 guilty of a serious misdemeanor. 7 34 Sec. 12. NEW SECTION. 144D.12 GENERAL PROVISIONS. 7 35 1. A death resulting from the withholding or withdrawal of 8 1 life-sustaining interventions pursuant to a resuscitation 8 2 status order and in accordance with this chapter, does not, 8 3 for any purpose, constitute a suicide or homicide. 8 4 2. A resuscitation status order shall not affect in any 8 5 manner the sale, procurement, or issuance of any policy of 8 6 health or life insurance, and shall not be deemed to modify 8 7 the terms of an existing policy of health or life insurance. 8 8 A policy of health or life insurance is not legally impaired 8 9 or invalidated in any manner by the withholding or withdrawal 8 10 of life-sustaining interventions pursuant to a resuscitation 8 11 status order and this chapter, notwithstanding any terms of 8 12 the policy to the contrary. 8 13 3. A physician, health care provider, hospital, health 8 14 care service plan, insurer issuing disability insurance, self- 8 15 insured employee welfare benefit plan, or nonprofit hospital 8 16 plan, or any other entity subject to the insurance laws of the 8 17 state providing a plan of health insurance, federal benefits, 8 18 or health services shall not require any person to execute or 8 19 consent to a resuscitation status order as a condition of 8 20 being insured for, or receiving health care insurance benefits 8 21 services. 8 22 4. This chapter does not create a presumption concerning 8 23 the intention of a patient who does not have a resuscitation 8 24 status order, and does not create any presumption concerning 8 25 resuscitation status orders in a hospital. 8 26 5. This chapter shall not be interpreted to affect the 8 27 right of a competent patient or an individual authorized to 8 28 make decisions on a patient's behalf to make decisions 8 29 regarding use of life-sustaining interventions, or to impair 8 30 or supersede any right or responsibility that any person has 8 31 to effect the withholding or withdrawal of medical care in any 8 32 lawful manner. In that respect, the provisions of this 8 33 chapter are cumulative. 8 34 6. This chapter shall not be construed to condone, 8 35 authorize, or approve mercy killing or euthanasia, or to 9 1 permit any affirmative or deliberate act or omission to end 9 2 life other than to permit the natural process of dying. 9 3 Sec. 13. APPLICATION TO EXISTING ORDERS. A resuscitation 9 4 status order, an out-of-hospital do-not-resuscitate order, or 9 5 a similar order executed prior to July 1, 2001, is valid and 9 6 shall be honored in accordance with the then-applicable 9 7 provisions of law. 9 8 EXPLANATION 9 9 This bill establishes Code chapter 144D, the "Resuscitation 9 10 Status Orders Act". The bill provides definitions including 9 11 the definition of a "resuscitation status order" which is a 9 12 physician's written order issued with the consent of the 9 13 patient or the patient's authorized representative that 9 14 directs the withholding or withdrawal or life-sustaining 9 15 interventions when the patient is outside a hospital. 9 16 The bill establishes the scope and limitations of a 9 17 resuscitation status order, specifies who may consent to the 9 18 establishment of an order, directs the Iowa department of 9 19 public health to prescribe the form of the order, the 9 20 information to be included in an order, uniform identifiers, 9 21 and a mechanism for timely verification of an order, and to 9 22 adopt rules necessary to implement the chapter. 9 23 The bill specifies provisions for revocation of a 9 24 resuscitation status order, provides immunity for persons 9 25 acting in good faith compliance with the chapter, provides for 9 26 the honoring of an order executed in another state, provides 9 27 penalties for violations of the chapter, and provides general 9 28 provisions relating to the orders. 9 29 The bill also provides that existing resuscitation status 9 30 orders or similar orders existing prior to July 1, 2001, are 9 31 valid and are to be honored in accordance with the laws that 9 32 were applicable at that time. 9 33 LSB 2053SV 79 9 34 pf/pj/5
Text: SF00263 Text: SF00265 Text: SF00200 - SF00299 Text: SF Index Bills and Amendments: General Index Bill History: General Index
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