Text: SF02154 Text: SF02156 Text: SF02100 - SF02199 Text: SF Index Bills and Amendments: General Index Bill History: General Index
PAG LIN 1 1 SENATE FILE 2155 1 2 1 3 AN ACT 1 4 PROVIDING FOR THE ISSUANCE OF OUT-OF-HOSPITAL DO-NOT- 1 5 RESUSCITATE ORDERS AND MAKING PENALTIES APPLICABLE. 1 6 1 7 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 1 8 1 9 Section 1. Section 144A.2, Code 2001, is amended to read 1 10 as follows: 1 11 144A.2 DEFINITIONS. 1 12 Except as otherwise provided, as used in this chapter: 1 13 1. "Adult" means an individual eighteen years of age or 1 14 older. 1 15 2. "Attending physician" means the physician selected by, 1 16 or assigned to, the patient who has primary responsibility for 1 17 the treatment and care of the patient. 1 18 3. "Declaration" means a document executed in accordance 1 19 with the requirements of section 144A.3. 1 20 4. "Department" means the Iowa department of public 1 21 health. 1 22 5. "Emergency medical care provider" means emergency 1 23 medical care provider as defined in section 147A.1. 1 244.6. "Health care provider" means a person, including an 1 25 emergency medical care provider, who is licensed, certified, 1 26 or otherwise authorized or permitted by the law of this state 1 27 to administer health care in the ordinary course of business 1 28 or in the practice of a profession. 1 29 7. "Hospital" means hospital as defined in section 135B.1. 1 305.8. "Life-sustaining procedure" means any medical 1 31 procedure, treatment, or intervention, including 1 32 resuscitation, which meets both of the following requirements: 1 33 a. Utilizes mechanical or artificial means to sustain, 1 34 restore, or supplant a spontaneous vital function. 1 35 b. When applied to a patient in a terminal condition, 2 1 would serve only to prolong the dying process. 2 2 "Life-sustaining procedure" does not include the provision 2 3 of nutrition or hydration except when required to be provided 2 4 parenterally or through intubation or the administration of 2 5 medication or performance of any medical procedure deemed 2 6 necessary to provide comfort care or to alleviate pain. 2 7 9. "Out-of-hospital do-not-resuscitate order" means a 2 8 written order signed by a physician, executed in accordance 2 9 with the requirements of section 144A.7A and issued consistent 2 10 with this chapter, that directs the withholding or withdrawal 2 11 of resuscitation when an adult patient in a terminal condition 2 12 is outside the hospital. 2 136.10. "Physician" means a person licensed to practice 2 14 medicine and surgery, osteopathy or osteopathic medicine and 2 15 surgery in this state. 2 167.11. "Qualified patient" means a patient who has 2 17 executed a declaration or an out-of-hospital do-not- 2 18 resuscitate order in accordance with this chapter and who has 2 19 been determined by the attending physician to be in a terminal 2 20 condition. 2 21 12. "Resuscitation" means any medical intervention that 2 22 utilizes mechanical or artificial means to sustain, restore, 2 23 or supplant a spontaneous vital function, including but not 2 24 limited to chest compression, defibrillation, intubation, and 2 25 emergency drugs intended to alter cardiac function or 2 26 otherwise to sustain life. 2 278.13. "Terminal condition" means an incurable or 2 28 irreversible condition that, without the administration of 2 29 life-sustaining procedures, will, in the opinion of the 2 30 attending physician, result in death within a relatively short 2 31 period of time or a state of permanent unconsciousness from 2 32 which, to a reasonable degree of medical certainty, there can 2 33 be no recovery. 2 34 Sec. 2. Section 144A.3, subsection 2, unnumbered paragraph 2 35 1, Code 2001, is amended to read as follows: 3 1 The declaration must be signed by the declarant or another 3 2 person acting on behalf of the declarant at the direction of 3 3 the declarant, must contain the date ofitsthe declaration's 3 4 execution, and must be witnessed or acknowledged by one of the 3 5 following methods: 3 6 Sec. 3. Section 144A.3, subsection 2, paragraph a, 3 7 subparagraphs (1) and (2), Code 2001, are amended to read as 3 8 follows: 3 9 (1) A health care provider attending the declarant on the 3 10 date of execution of the declaration. 3 11 (2) An employee of a health care provider attending the 3 12 declarant on the date of execution of the declaration. 3 13 Sec. 4. Section 144A.7, subsection 1, paragraph a, Code 3 14 2001, is amended to read as follows: 3 15 a. The attorney in fact designated to make treatment 3 16 decisions for the patient should such person be diagnosed as 3 17 suffering from a terminal condition, if the designation is in 3 18 writing and complies with chapter 144B or section 633.705. 3 19 Sec. 5. NEW SECTION. 144A.7A OUT-OF-HOSPITAL DO-NOT- 3 20 RESUSCITATE ORDERS. 3 21 1. If an attending physician issues an out-of-hospital do- 3 22 not-resuscitate order for an adult patient under this section, 3 23 the physician shall use the form prescribed pursuant to 3 24 subsection 2, include a copy of the order in the patient's 3 25 medical record, and provide a copy to the patient or an 3 26 individual authorized to act on the patient's behalf. 3 27 2. The department, in collaboration with interested 3 28 parties, shall prescribe uniform out-of-hospital do-not- 3 29 resuscitate order forms and uniform personal identifiers, and 3 30 shall adopt administrative rules necessary to implement this 3 31 section. The uniform forms and personal identifiers shall be 3 32 used statewide. 3 33 3. The out-of-hospital do-not-resuscitate order form shall 3 34 include all of the following: 3 35 a. The patient's name. 4 1 b. The patient's date of birth. 4 2 c. The name of the individual authorized to act on the 4 3 patient's behalf, if applicable. 4 4 d. A statement that the patient is in a terminal 4 5 condition. 4 6 e. The physician's signature. 4 7 f. The date the form is signed. 4 8 g. A concise statement of the nature and scope of the 4 9 order. 4 10 h. Any other information necessary to provide clear and 4 11 reliable instructions to a health care provider. 4 12 4. A health care provider may withhold or withdraw 4 13 resuscitation outside a hospital consistent with an out-of- 4 14 hospital do-not-resuscitate order issued under this section 4 15 and the rules or protocols adopted by the department. 4 16 5. In fulfilling the instructions of an out-of-hospital 4 17 do-not-resuscitate order under this chapter, a health care 4 18 provider shall continue to provide appropriate comfort care 4 19 and pain relief to the patient. 4 20 6. An out-of-hospital do-not-resuscitate order shall not 4 21 apply when a patient is in need of emergency medical services 4 22 due to a sudden accident or injury resulting from a motor 4 23 vehicle collision, fire, mass casualty, or other cause of a 4 24 sudden accident or injury which is outside the scope of the 4 25 patient's terminal condition. 4 26 7. An out-of-hospital do-not-resuscitate order is deemed 4 27 revoked at any time that a patient, or an individual 4 28 authorized to act on the patient's behalf as designated on the 4 29 out-of-hospital do-not-resuscitate order, is able to 4 30 communicate in any manner the intent that the order be 4 31 revoked, without regard to the mental or physical condition of 4 32 the patient. A revocation is only effective as to the health 4 33 care provider upon communication to that provider by the 4 34 patient, an individual authorized to act on the patient's 4 35 behalf as designated in the order, or by another person to 5 1 whom the revocation is communicated. 5 2 8. The personal wishes of family members or other 5 3 individuals who are not authorized in the order to act on the 5 4 patient's behalf shall not supersede a valid out-of-hospital 5 5 do-not-resuscitate order. 5 6 9. If uncertainty regarding the validity or applicability 5 7 of an out-of-hospital do-not-resuscitate order exists, a 5 8 health care provider shall provide necessary and appropriate 5 9 resuscitation. 5 10 10. A health care provider shall document compliance or 5 11 noncompliance with an out-of-hospital do-not-resuscitate order 5 12 and the reasons for not complying with the order, including 5 13 evidence that the order was revoked or uncertainty regarding 5 14 the validity or applicability of the order. 5 15 11. This section shall not preclude a hospital licensed 5 16 under chapter 135B from honoring an out-of-hospital do-not- 5 17 resuscitate order entered in accordance with this section and 5 18 in compliance with established hospital policies and 5 19 protocols. 5 20 Sec. 6. Section 144A.8, Code 2001, is amended to read as 5 21 follows: 5 22 144A.8 TRANSFER OF PATIENTS. 5 23 1. An attending physician who is unwilling to comply with 5 24 the requirements of section 144A.5, or who is unwilling to 5 25 comply with the declaration of a qualified patient in 5 26 accordance with section 144A.6 or an out-of-hospital do-not- 5 27 resuscitate order pursuant to section 144A.7A, or who is 5 28 unwilling to comply with the provisions of section 144A.7 or 5 29 144A.7A shall take all reasonable steps to effect the transfer 5 30 of the patient to another physician. 5 31 2. If the policies of a health care provider preclude 5 32 compliance with the declaration or out-of-hospital do-not- 5 33 resuscitate order of a qualified patient under this chapter or 5 34 preclude compliance with the provisions of section 144A.7 or 5 35 144A.7A, the provider shall take all reasonable steps to 6 1 effect the transfer of the patient to a facility in which the 6 2 provisions of this chapter can be carried out. 6 3 Sec. 7. Section 144A.9, subsection 1, unnumbered paragraph 6 4 1, Code 2001, is amended to read as follows: 6 5 In the absence of actual notice of the revocation of a 6 6 declaration or of an out-of-hospital do-not-resuscitate order, 6 7 the following, while acting in accordance with the 6 8 requirements of this chapter, are not subject to civil or 6 9 criminal liability or guilty of unprofessional conduct: 6 10 Sec. 8. Section 144A.9, Code 2001, is amended by adding 6 11 the following new subsection: 6 12 NEW SUBSECTION. 4. In the absence of actual notice of the 6 13 revocation of an out-of-hospital do-not-resuscitate order, a 6 14 health care provider who complies with this chapter is not 6 15 subject to civil or criminal liability or guilty of 6 16 unprofessional conduct in entering, executing, or otherwise 6 17 participating in an out-of-hospital do-not-resuscitate order. 6 18 Sec. 9. Section 144A.10, Code 2001, is amended to read as 6 19 follows: 6 20 144A.10 PENALTIES. 6 21 1. Any person who willfully conceals, withholds, cancels, 6 22 destroys, alters, defaces, or obliterates the declaration, 6 23 out-of-hospital do-not-resuscitate order, or out-of-hospital 6 24 do-not-resuscitate identifier of another without the 6 25 declarant's or patient's consent or who falsifies or forges a 6 26 revocation of the declaration or out-of-hospital do-not- 6 27 resuscitate order of another is guilty of a serious 6 28 misdemeanor. 6 29 2. Any person who falsifies or forges the declaration or 6 30 out-of-hospital do-not-resuscitate order of another, or 6 31 willfully conceals or withholds personal knowledge of or 6 32 delivery of a revocation as provided in section 144A.4 or 6 33 144A.7A, with the intent to cause a withholding or withdrawal 6 34 of life-sustaining procedures, is guilty of a serious 6 35 misdemeanor. 7 1 Sec. 10. Section 144A.11, subsections 1, 2, 3, and 4, Code 7 2 2001, are amended to read as follows: 7 3 1. Death resulting from the withholding or withdrawal of 7 4 life-sustaining procedures pursuant to a declaration or out- 7 5 of-hospital do-not-resuscitate order and in accordance with 7 6 this chapter does not, for any purpose, constitute a suicide, 7 7orhomicide, or dependent adult abuse. 7 8 2. Themakingexecuting of a declaration pursuant to 7 9 section 144A.3 or an out-of-hospital do-not-resuscitate order 7 10 pursuant to section 144A.7A does not affect in any manner the 7 11 sale, procurement, or issuance of any policy of life 7 12 insurance, nor shall it be deemed to modify the terms of an 7 13 existing policy of life insurance. No policy of life 7 14 insurance is legally impaired or invalidated in any manner by 7 15 the withholding or withdrawal of life-sustaining procedures 7 16 pursuant to this chapter, notwithstanding any term of the 7 17 policy to the contrary. 7 18 3. A physician, health care provider, health care service 7 19 plan, insurer issuing disability insurance, self-insured 7 20 employee welfare benefit plan, or nonprofit hospital plan 7 21 shall not require any person to execute a declaration or an 7 22 out-of-hospital do-not-resuscitate order as a condition for 7 23 being insured for, or receiving, health care services. 7 24 4. This chapter creates no presumption concerning the 7 25 intention of an individual who has not executed a declaration 7 26 or an out-of-hospital do-not-resuscitate order with respect to 7 27 the use, withholding, or withdrawal of life-sustaining 7 28 procedures in the event of a terminal condition. 7 29 Sec. 11. APPLICATION TO EXISTING ORDERS. An out-of- 7 30 hospital do-not-resuscitate order or similar order executed 7 31 prior to July 1, 2002, is valid and shall be honored in 7 32 accordance with the then-applicable provisions of law. 7 33 7 34 7 35 8 1 MARY E. KRAMER 8 2 President of the Senate 8 3 8 4 8 5 8 6 BRENT SIEGRIST 8 7 Speaker of the House 8 8 8 9 I hereby certify that this bill originated in the Senate and 8 10 is known as Senate File 2155, Seventy-ninth General Assembly. 8 11 8 12 8 13 8 14 MICHAEL E. MARSHALL 8 15 Secretary of the Senate 8 16 Approved , 2002 8 17 8 18 8 19 8 20 THOMAS J. VILSACK 8 21 Governor
Text: SF02154 Text: SF02156 Text: SF02100 - SF02199 Text: SF Index Bills and Amendments: General Index Bill History: General Index
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