Senate
Study
Bill
3043
-
Introduced
SENATE
FILE
_____
BY
(PROPOSED
COMMITTEE
ON
HUMAN
RESOURCES
BILL
BY
CHAIRPERSON
RAGAN)
A
BILL
FOR
An
Act
relating
to
physician
orders
for
scope
of
treatment.
1
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
2
TLSB
5365XC
(8)
84
pf/nh
S.F.
_____
Section
1.
LEGISLATIVE
FINDINGS.
The
general
assembly
1
recognizes
the
importance
of
encouraging
individuals
to
discuss
2
and
make
health
care
decisions
before
a
situation
necessitates
3
an
actual
decision.
The
general
assembly
also
recognizes
4
that
health
care
planning
is
a
process,
rather
than
a
single
5
decision,
based
upon
the
individual’s
values
and
personal
6
health
status.
Advance
directives
provide
the
opportunity
for
7
an
individual
to
enunciate
and
document
the
individual’s
wishes
8
and
to
identify
the
person
authorized
to
make
decisions
for
9
the
individual
if
the
individual
is
unable
to
make
decisions.
10
The
general
assembly
recognizes
that
the
physician
order
for
11
scope
of
treatment
form,
modeled
after
the
national
physician
12
orders
for
life-sustaining
treatment
paradigm
initiative,
13
complements
advance
directives
by
converting
individual
wishes
14
contained
in
advance
directives
into
medical
orders
that
are
15
actionable
across
medical
settings,
thereby
enhancing
the
16
ability
of
medical
providers
to
understand
and
honor
patients’
17
wishes.
An
Iowa
physician
order
for
scope
of
treatment
form
is
18
intended
for
individuals
who
are
frail
and
elderly
or
who
have
19
a
chronic,
critical
medical
condition
or
a
terminal
illness.
20
Sec.
2.
NEW
SECTION
.
144D.1
Physician
orders
for
scope
of
21
treatment.
22
As
used
in
this
chapter,
unless
the
context
otherwise
23
requires:
24
1.
“Advanced
registered
nurse
practitioner”
means
an
advanced
25
registered
nurse
practitioner
licensed
pursuant
to
chapter
152
26
or
152E.
27
2.
“Department”
means
the
department
of
public
health.
28
3.
“Emergency
medical
care
provider”
means
emergency
medical
29
care
provider
as
defined
in
section
147A.1.
30
4.
“Health
care
facility”
means
health
care
facility
as
31
defined
in
section
135C.1,
a
hospice
program
as
defined
in
32
section
135J.1,
an
elder
group
home
as
defined
in
section
33
231B.1,
and
an
assisted
living
program
as
defined
in
section
34
231C.2.
35
-1-
LSB
5365XC
(8)
84
pf/nh
1/
8
S.F.
_____
5.
“Health
care
provider”
means
an
individual,
including
1
an
emergency
medical
care
provider
and
an
individual
providing
2
home
and
community-based
services,
who
is
licensed,
certified,
3
or
otherwise
authorized
or
permitted
by
the
law
of
this
state
4
to
administer
health
care
in
the
ordinary
course
of
business
or
5
in
the
practice
of
a
profession.
6
6.
“Hospital”
means
hospital
as
defined
in
section
135B.1.
7
7.
“Physician”
means
a
person
licensed
to
practice
medicine
8
and
surgery
or
osteopathic
medicine
and
surgery
in
this
state.
9
8.
“Physician
assistant”
means
a
person
licensed
as
a
10
physician
assistant
under
chapter
148C.
11
9.
“Physician
orders
for
scope
of
treatment
form”
or
“POST
12
form”
means
a
document
containing
medical
orders
actionable
13
across
medical
settings
that
consolidates
and
summarizes
14
an
individual’s
preferences
for
life-sustaining
treatments
15
and
interventions
and
acts
as
a
complement
to
and
does
not
16
supersede
any
valid
advance
directive.
17
Sec.
3.
NEW
SECTION
.
144D.2
Physician
orders
for
scope
of
18
treatment
(POST)
form.
19
1.
The
POST
form
shall
be
a
uniform
form
based
upon
the
20
national
physician
orders
for
life-sustaining
treatment
21
paradigm
form.
The
form
shall
have
all
of
the
following
22
characteristics:
23
a.
The
form
shall
include
the
patient’s
name
and
date
of
24
birth.
25
b.
The
form
shall
be
signed
by
the
patient
or
the
patient’s
26
legal
representative.
27
c.
The
form
shall
be
signed
by
the
patient’s
physician,
28
advanced
registered
nurse
practitioner,
or
physician
assistant.
29
d.
If
preparation
of
the
form
was
facilitated
by
another
30
individual,
the
facilitator
shall
also
sign
the
form.
31
e.
The
form
shall
include
the
patient’s
wishes
regarding
the
32
care
of
the
patient,
including
but
not
limited
to
all
of
the
33
following:
34
(1)
The
administration
of
cardiopulmonary
resuscitation.
35
-2-
LSB
5365XC
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pf/nh
2/
8
S.F.
_____
(2)
The
level
of
medical
interventions
in
the
event
of
a
1
medical
emergency.
2
(3)
The
use
of
medically
administered
nutrition
by
tube.
3
(4)
The
rationale
for
the
orders.
4
f.
The
form
shall
be
easily
distinguishable
to
facilitate
5
recognition
by
health
care
providers,
hospitals,
and
health
6
care
facilities.
7
g.
An
incomplete
section
on
the
form
shall
imply
the
8
patient’s
wishes
for
full
treatment
for
the
type
of
treatment
9
addressed
in
that
section.
10
2.
The
department
shall
post
the
form
on
the
department’s
11
website
for
public
availability.
12
Sec.
4.
NEW
SECTION
.
144D.3
Compliance
with
POST
form.
13
1.
A
POST
form
executed
in
this
state
or
another
state
14
or
jurisdiction
in
compliance
with
the
law
of
that
state
or
15
jurisdiction
shall
be
deemed
valid
and
enforceable
in
this
16
state
to
the
extent
the
form
is
consistent
with
the
laws
of
17
this
state,
and
may
be
accepted
by
a
health
care
provider,
18
hospital,
or
health
care
facility.
19
2.
A
health
care
provider,
hospital,
or
health
care
facility
20
may
comply
with
an
executed
POST
form,
notwithstanding
that
the
21
physician,
advanced
registered
nurse
practitioner,
or
physician
22
assistant
who
signed
the
POST
form
does
not
have
admitting
23
privileges
at
the
hospital
or
health
care
facility
providing
24
health
care
or
treatment.
25
3.
In
the
absence
of
actual
notice
of
the
revocation
of
26
a
POST
form,
a
health
care
provider,
hospital,
health
care
27
facility,
or
any
other
person
who
complies
with
a
POST
form
28
shall
not
be
subject
to
civil
or
criminal
liability
for
29
actions
taken
under
this
chapter
which
are
in
accordance
30
with
reasonable
medical
standards.
A
health
care
provider,
31
hospital,
health
care
facility,
or
other
person
against
whom
32
criminal
or
civil
liability
is
asserted
because
of
conduct
in
33
compliance
with
this
chapter
may
interpose
the
restriction
on
34
liability
in
this
paragraph
as
an
absolute
defense.
35
-3-
LSB
5365XC
(8)
84
pf/nh
3/
8
S.F.
_____
4.
A
health
care
provider,
hospital,
or
health
care
facility
1
that
is
unwilling
to
comply
with
an
executed
POST
form
shall
2
take
all
reasonable
steps
to
transfer
the
patient
to
another
3
health
care
provider,
hospital,
or
health
care
facility.
4
Sec.
5.
NEW
SECTION
.
144D.4
General
provisions.
5
1.
If
an
individual
is
a
qualified
patient
as
defined
in
6
section
144A.2,
the
individual’s
declaration
executed
under
7
chapter
144A
shall
control
health
care
decision
making
for
the
8
individual
in
accordance
with
chapter
144A.
If
an
individual
9
has
not
executed
a
declaration
pursuant
to
chapter
144A,
health
10
care
decision
making
relating
to
life-sustaining
procedures
for
11
the
individual
shall
be
governed
by
section
144A.7.
A
POST
12
form
shall
not
supersede
a
declaration
executed
pursuant
to
13
chapter
144A.
14
2.
If
an
individual
has
executed
a
durable
power
of
attorney
15
for
health
care
pursuant
to
chapter
144B,
the
individual’s
16
durable
power
of
attorney
for
health
care
shall
control
health
17
care
decision
making
for
the
individual
in
accordance
with
18
chapter
144B.
A
POST
form
shall
not
supersede
a
durable
power
19
of
attorney
for
health
care
executed
pursuant
to
chapter
144B.
20
3.
Death
resulting
from
the
withholding
or
withdrawal
of
21
life-sustaining
procedures
pursuant
to
an
executed
POST
form
22
and
in
accordance
with
this
chapter
does
not,
for
any
purpose,
23
constitute
a
suicide,
homicide,
or
dependent
adult
abuse.
24
4.
The
executing
of
a
POST
form
does
not
affect
in
any
25
manner
the
sale,
procurement,
or
issuance
of
any
policy
of
26
life
insurance,
nor
shall
it
be
deemed
to
modify
the
terms
27
of
an
existing
policy
of
life
insurance.
A
policy
of
life
28
insurance
is
not
legally
impaired
or
invalidated
in
any
manner
29
by
the
withholding
or
withdrawal
of
life-sustaining
procedures
30
pursuant
to
this
chapter
notwithstanding
any
term
of
the
policy
31
to
the
contrary.
32
5.
A
health
care
provider,
hospital,
health
care
facility,
33
health
care
service
plan,
insurer
issuing
disability
insurance,
34
self-insured
employee
welfare
benefit
plan,
or
nonprofit
35
-4-
LSB
5365XC
(8)
84
pf/nh
4/
8
S.F.
_____
hospital
plan
shall
not
require
any
person
to
execute
a
POST
1
form
as
a
condition
of
being
insured
for,
or
receiving,
health
2
care
services.
3
6.
This
chapter
does
not
create
a
presumption
concerning
4
the
intention
of
an
individual
who
has
not
executed
a
POST
5
form
with
respect
to
the
use,
withholding,
or
withdrawal
6
of
life-sustaining
procedures
in
the
event
of
a
terminal
7
condition.
8
7.
This
chapter
shall
not
be
interpreted
to
affect
the
right
9
of
a
patient
to
make
decisions
regarding
use
of
life-sustaining
10
procedures
as
long
as
the
patient
is
able
to
do
so,
nor
to
11
impair
or
supersede
any
right
or
responsibility
that
any
person
12
has
to
effect
the
withholding
or
withdrawal
of
medical
care
in
13
any
lawful
manner.
In
that
respect,
the
provisions
of
this
14
chapter
are
cumulative.
15
8.
This
chapter
shall
not
be
construed
to
condone,
16
authorize,
or
approve
mercy
killing
or
euthanasia,
or
to
permit
17
any
affirmative
or
deliberate
act
or
omission
to
end
life
other
18
than
to
permit
the
natural
process
of
dying.
19
EXPLANATION
20
This
bill
provides
for
the
use
of
physician
orders
for
scope
21
of
treatment
(POST).
22
The
bill
provides
legislative
findings
that
provide
that
23
the
general
assembly
recognizes
the
importance
of
encouraging
24
individuals
to
discuss
and
make
health
care
decisions
before
an
25
actual
decision
is
necessary;
that
health
care
planning
is
a
26
process
based
upon
the
individual’s
values
and
personal
health
27
status;
and
that
advance
directives
provide
the
opportunity
28
for
an
individual
to
enunciate
and
document
their
wishes
and
29
to
identify
the
person
authorized
to
make
decisions
for
the
30
individual.
The
general
assembly
also
recognizes
that
the
31
POST
form,
modeled
after
the
national
physician
orders
for
32
life-sustaining
treatment
paradigm
initiative,
complements
33
advance
directives
by
converting
individual
wishes
contained
34
in
advance
directives
into
medical
orders
that
are
actionable
35
-5-
LSB
5365XC
(8)
84
pf/nh
5/
8
S.F.
_____
across
medical
settings,
thereby
enhancing
the
ability
of
1
medical
providers
to
understand
and
honor
patients’
wishes.
2
The
POST
form
is
intended
for
individuals
who
are
frail
and
3
elderly
or
who
have
a
chronic,
critical
medical
condition
or
a
4
terminal
illness.
5
The
bill
provides
definitions
used
in
Code
chapter
144D,
6
including
the
physician
order
for
scope
of
treatment
POST
form,
7
which
means
a
document
containing
medical
orders
actionable
8
across
medical
settings
that
consolidates
and
summarizes
9
an
individual’s
preferences
for
life-sustaining
treatments
10
and
interventions
and
acts
as
a
complement
to
but
does
not
11
supersede
any
valid
advance
directive.
12
The
bill
specifies
the
content
of
the
POST
form
and
that
13
the
department
of
public
health
is
to
post
the
form
on
the
14
department’s
website
for
public
availability.
15
The
bill
specifies
compliance
requirements
for
the
POST
16
form.
A
POST
form
executed
in
this
state
or
another
state
17
or
jurisdiction
in
compliance
with
the
law
of
the
applicable
18
state
or
jurisdiction
shall
be
deemed
valid
and
enforceable
in
19
this
state
to
the
extent
the
form
is
consistent
with
the
laws
20
of
this
state,
and
may
be
accepted
by
a
health
care
provider,
21
hospital,
or
health
care
facility.
A
health
care
provider,
22
hospital,
or
health
care
facility
may
comply
with
an
executed
23
POST
form,
even
if
the
physician,
advanced
registered
nurse
24
practitioner,
or
physician
assistant
who
signed
the
POST
form
25
does
not
have
admitting
privileges
at
the
hospital
or
health
26
care
facility
providing
health
care
or
treatment.
The
bill
27
provides
an
absolute
defense
to
civil
or
criminal
liability
28
for
a
health
care
provider,
hospital,
health
care
facility,
or
29
any
other
person
who
complies
with
a
POST
form
if
the
actions
30
are
in
accordance
with
reasonable
medical
standards.
The
bill
31
requires
a
health
care
provider,
hospital,
or
health
care
32
facility
that
is
unwilling
to
comply
with
an
executed
POST
form
33
to
take
all
reasonable
steps
to
transfer
the
patient
to
another
34
health
care
provider,
hospital,
or
health
care
facility.
35
-6-
LSB
5365XC
(8)
84
pf/nh
6/
8
S.F.
_____
The
bill
provides
for
the
relation
of
an
executed
POST
form
1
to
a
declaration
under
the
life-sustaining
procedures
Act
and
a
2
durable
power
of
attorney
for
health
care.
In
both
cases,
the
3
declaration
and
the
durable
power
of
attorney
control
health
4
care
decision
making
and
the
POST
form
does
not
supersede
them.
5
The
bill
provides
that
death
resulting
from
the
withholding
6
or
withdrawal
of
life-sustaining
procedures
pursuant
to
an
7
executed
POST
form
and
in
accordance
with
the
bill
does
not
8
constitute
a
suicide,
homicide,
or
dependent
adult
abuse
and
9
that
executing
a
POST
form
does
not
affect
in
any
manner
10
the
sale,
procurement,
or
issuance
of
any
policy
of
life
11
insurance;
modify
the
terms
of
an
existing
policy
of
life
12
insurance;
or
legally
impair
or
invalidate
the
policy.
The
13
bill
prohibits
the
execution
of
a
POST
form
as
a
condition
for
14
being
insured
or
receiving
health
care
services
and
provides
15
that
not
executing
a
POST
form
does
not
create
a
presumption
16
concerning
the
intention
of
an
individual
with
respect
to
the
17
use,
withholding,
or
withdrawal
of
life-sustaining
procedures
18
in
the
event
of
a
terminal
condition.
19
The
bill
is
not
to
be
interpreted
to
affect
the
right
of
20
a
patient
to
make
decisions
regarding
use
of
life-sustaining
21
procedures
as
long
as
the
patient
is
able
to
do
so,
nor
to
22
impair
or
supersede
any
right
or
responsibility
that
any
person
23
has
to
effect
the
withholding
or
withdrawal
of
medical
care
in
24
any
lawful
manner.
The
bill
is
not
to
be
construed
to
condone,
25
authorize,
or
approve
mercy
killing
or
euthanasia,
or
to
permit
26
any
affirmative
or
deliberate
act
or
omission
to
end
life
other
27
than
to
permit
the
natural
process
of
dying.
28
The
general
assembly
in
2008
Iowa
Acts,
chapter
1188,
29
section
36,
established
a
two-year
pilot
project
in
Linn
county
30
and
in
2010
Iowa
Acts,
chapter
1192,
section
58,
expanded
31
the
pilot
project
to
Jones
county
and
extended
the
duration
32
until
June
30,
2012,
to
pilot
the
use
of
the
POST
form.
The
33
legislation
also
directed
the
department
to
convene
an
advisory
34
council
for
the
pilot
project
and
directed
the
advisory
council
35
-7-
LSB
5365XC
(8)
84
pf/nh
7/
8
S.F.
_____
to
report
its
findings
and
recommendations
to
the
general
1
assembly
by
January
1,
2012.
The
advisory
council
recommended
2
expanding
the
adoption
of
the
POST
form
statewide.
3
-8-
LSB
5365XC
(8)
84
pf/nh
8/
8