Download 1073 - PA General Assembly

PRIOR PRINTER'S NO. 81
PRINTER'S NO.
1073
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No. 96
Session of
2001
INTRODUCED BY FLEAGLE, NICKOL, MUNDY, CLARK, MANDERINO, VANCE,
JOSEPHS, L. I. COHEN, BELFANTI, T. STEVENSON, BEBKO-JONES,
MARSICO, FRANKEL, B. SMITH, BELARDI, RUBLEY, MAITLAND, DALEY,
HERSHEY, CAPPABIANCA, GEIST, HALUSKA, M. BAKER, STERN,
CORRIGAN, TIGUE, SCRIMENTI, SHANER, MAYERNIK, BARRAR,
BASTIAN, BENNINGHOFF, CLYMER, DAILEY, FAIRCHILD, HENNESSEY,
JADLOWIEC, R. MILLER, S. MILLER, NAILOR, PHILLIPS, SATHER,
SOLOBAY, STABACK, WILT, ZUG, BROWNE, SEMMEL, STEELMAN, McCALL
AND BOYES, JANUARY 23, 2001
AS REPORTED FROM COMMITTEE ON JUDICIARY, HOUSE OF
REPRESENTATIVES, AS AMENDED, MARCH 13, 2001
AN ACT
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Amending Title 20 (Decedents, Estates and Fiduciaries) of the
Pennsylvania Consolidated Statutes, further providing for
advance directives for health care definitions and emergency
medical services; and providing for out-of-hospital
nonresuscitation.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1.
Title 20 of the Pennsylvania Consolidated Statutes is amended to
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read:
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§ 5403.
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The definition of "declarant" in section 5403 of
Definitions.
The following words and phrases when used in this chapter
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shall have the meanings given to them in this section unless the
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context clearly indicates otherwise:
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* * *
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"Declarant."
A person who makes a declaration in accordance
with this chapter. The
_______________________________________
term includes an emancipated minor.
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* * *
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Section 2.
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§ 5413.
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[(a)
Section 5413 of Title 20 is amended to read:
Emergency medical services.
Care given prior to declaration taking effect.--Nothing
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in this chapter shall be construed to make the provisions of a
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declaration apply to care given to a patient by emergency
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medical services personnel prior to the declaration's becoming
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operative under sections 5405 (relating to when declaration
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becomes operative) and 5408 (relating to duty of physician to
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confirm terminal condition).
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(b)
Care given after declaration takes effect.--The
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provisions of a declaration shall apply to care given to a
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patient by emergency medical services personnel after the
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declaration becomes operative under sections 5405 and 5408 only
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if:
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(1)
an original declaration, signed by the declarant or
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other authorized person, is presented to the emergency
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medical services personnel. The emergency medical services
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personnel must immediately notify the medical command
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physician of the presence of the declaration; or
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(2)
the medical command physician, based on prior
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notification by the attending physician or other health care
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provider that a valid and operative declaration exists,
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directs the emergency medical service personnel according to
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the provisions of the declaration.
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(c)
Uncertainty regarding validity of declaration.--
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Emergency medical services personnel confronted with any
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conflicting information regarding the patient's wishes for life-
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sustaining treatment shall act according to the accepted
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treatment protocols and standards appropriate to their level of
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certification.]
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__________________________________________________________
(a)
General rule.--An emergency medical services provider
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_____________________________________________________________
shall,
in the course of providing care to a declarant, at all
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___________________________________________________________
times
comply with the instructions of an authorized medical
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____________________________________________________________
command
physician to withhold or discontinue cardiopulmonary
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______________
resuscitation.
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_____________________________________________________________
(b)
Applicability.--This section is applicable only in those
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_____________________________________________________________
instances
where an out-of-hospital DNR order is not in effect
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__________________________________________________________
under
section 5404-A(a) (relating to orders, bracelets and
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___________
necklaces).
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Section 3.
Title 20 is amended by adding a chapter to read:
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CHAPTER 54-A
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OUT-OF-HOSPITAL NONRESUSCITATION
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Sec.
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5401-A.
Short title of chapter.
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5402-A.
Legislative findings and intent.
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5403-A.
Definitions.
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5404-A.
Orders, bracelets and necklaces.
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5405-A.
Revocation.
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5406-A.
Liability.
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5407-A.
Effect on suicide and life insurance.
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5408-A.
Order optional.
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5409-A.
Preservation of existing rights.
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5410-A.
Emergency medical services.
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5411-A.
Pregnancy.
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5412-A.
Penalties.
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5413-A.
Severability.
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§ 5401-A.
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Short title of chapter.
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This chapter shall be known and may be cited as the Do-Not-
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Resuscitate Act.
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§ 5402-A.
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Legislative findings and intent.
The General Assembly finds and declares as follows:
(1)
Although cardiopulmonary resuscitation has saved the
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lives of individuals about to experience sudden, unexpected
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death, present medical data indicates that cardiopulmonary
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resuscitation rarely leads to prolonged survival in
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individuals with terminal illnesses in whom death is
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expected.
(2)
In many circumstances, the performance of
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cardiopulmonary resuscitation may cause infliction of
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unwanted and unnecessary pain and suffering.
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(3)
Existing emergency medical services protocols may
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require emergency medical services personnel to proceed to
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cardiopulmonary resuscitation when an individual is found in
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a cardiac or respiratory arrest even if the individual has
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completed a living will or advance directive indicating that
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the individual does not wish to receive cardiopulmonary
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resuscitation.
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(4)
The administration of cardiopulmonary resuscitation
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by emergency medical services personnel to an individual with
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an out-of-hospital do-not-resuscitate order offends the
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dignity of the individual and conflicts with standards of
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accepted medical practice.
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(5)
This chapter provides clear direction to emergency
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medical services personnel and other health care providers in
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regard to the performance of cardiopulmonary resuscitation.
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(6)
Nothing in this chapter is intended to condone,
authorize or approve mercy killing, euthanasia or aided
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suicide or to permit any affirmative or deliberate act or
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omission to end life other than as defined in this chapter.
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§ 5403-A.
Definitions.
The following words and phrases when used in this chapter
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shall have the meanings given to them in this section unless the
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context clearly indicates otherwise:
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"Attending physician."
The physician who has primary
responsibility for the treatment and care of the patient.
"Bracelet."
An out-of-hospital do-not-resuscitate bracelet.
"Cardiopulmonary resuscitation."
Cardiac compression,
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invasive airway techniques, artificial ventilation,
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defibrillation and other related procedures.
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"Declarant."
As defined in section 5403 (relating to
definitions).
"Declaration."
As defined in section 5403 (relating to
definitions).
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"Department."
The Department of Health of the Commonwealth.
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"DNR."
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"Emergency medical services provider."
Do not resuscitate.
A health care
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provider recognized under the act of July 3, 1985 (P.L.164,
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No.45), known as the Emergency Medical Services Act. The term
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includes those individuals recognized under 42 Pa.C.S. § 8331.2
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(relating to good Samaritan civil immunity for use of automated
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external defibrillator).
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"EMS."
Emergency medical services.
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"Health care provider."
A person who is licensed or
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certified by the laws of this Commonwealth to administer health
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care in the ordinary course of business or practice of a
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profession. The term includes personnel recognized under the act
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of July 3, 1985 (P.L.164, No.45), known as the Emergency Medical
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Services Act. The term includes those individuals recognized
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under 42 Pa.C.S. § 8331.2 (relating to good Samaritan civil
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immunity for use of automated external defibrillator).
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"Incompetent."
The lack of sufficient capacity for a person
to make or communicate decisions concerning himself.
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"Invasive airway technique."
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including endotracheal intubation.
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"Life-sustaining treatment."
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Any advanced airway technique,
Any medical procedure or
intervention that, when administered to a patient, will serve
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only to prolong the process of dying or to maintain the patient
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in a state of permanent unconsciousness. Life-sustaining
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treatment shall include nutrition and hydration administered by
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gastric tube or intravenously or any other artificial or
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invasive means if the order of the patient so specifically
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provides.
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"Medical command physician."
A licensed physician who is
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authorized to give medical command under the act of July 3, 1985
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(P.L.164, No.45), known as the Emergency Medical Services Act.
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"Necklace."
An out-of-hospital do-not-resuscitate necklace.
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"Order."
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"Out-of-hospital do-not-resuscitate bracelet."
An out-of-hospital do-not-resuscitate order.
A bracelet in
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the standard format set forth in section 5404-A (relating to
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orders, bracelets and necklaces), supplied by the department and
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issued by the attending physician, which may be worn, at the
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patient's option, to notify emergency medical services providers
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of the presence of an order.
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"Out-of-hospital do-not-resuscitate necklace."
A necklace in
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the standard format set forth in section 5404-A (relating to
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orders, bracelets and necklaces), supplied by the department and
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issued by the attending physician, which may be worn, at the
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patient's option, to notify emergency medical services providers
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of the presence of an order.
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"Out-of-hospital do-not-resuscitate order."
An order in the
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standard format set forth in section 5404-A (relating to orders,
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bracelets and necklaces), supplied by the department and issued
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by the attending physician, directing emergency medical services
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providers to withhold cardiopulmonary resuscitation from the
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patient in the event of respiratory or cardiac arrest.
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"Out-of-hospital do-not-resuscitate patient."
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following:
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(1)
Any of the
An individual:
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(i)
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(ii)
who is in a terminal condition; and
who, pursuant to section 5404-A(a) (relating to
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orders, bracelets and necklaces), possesses and in any
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manner displays or causes to be displayed for emergency
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medical services providers an apparently valid order,
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bracelet or necklace.
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(2)
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A declarant:
(i)
whose declaration has become operative under
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section 5405(2) (relating to when declaration becomes
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operative); and
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(ii)
who, pursuant to section 5404-A(a), possesses
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and in any manner displays or causes to be displayed for
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emergency medical services providers an apparently valid
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order, bracelet or necklace.
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"Patient."
An out-of-hospital do-not-resuscitate patient.
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"Permanently unconscious."
A medical condition that has been
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diagnosed in accordance with currently accepted medical
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standards and with reasonable medical certainty as total and
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irreversible loss of consciousness and capacity for interaction
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with the environment. The term includes, without limitation, a
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persistent vegetative state or irreversible coma.
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"Person."
An individual, corporation, partnership,
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association or Federal, State or local government or
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governmental agency.
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"Terminal condition."
An incurable and irreversible medical
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condition in an advanced state caused by injury, disease or
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physical illness which will, in the opinion of the attending
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physician, to a reasonable degree of medical certainty, result
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in death regardless of the continued application of life-
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sustaining treatment.
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§ 5404-A.
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(a)
Orders, bracelets and necklaces.
Issuance.--An attending physician, upon the request of
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an individual who is at least 18 years of age, has graduated
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from high school or has married, or the individual's surrogate
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if the surrogate is so authorized, shall issue to the individual
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an order, and may issue at the request of the patient or the
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patient's surrogate a bracelet or necklace supplied by the
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department. The patient may, at the patient's option, wear the
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bracelet or display the order or necklace to notify emergency
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medical services providers of the patient's do-not-resuscitate
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status.
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(b)
Format of order.--The department shall, with the advice
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of the Pennsylvania Emergency Health Services Council and with
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the assistance of the regional emergency medical services
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councils, make available within 180 days of the effective date
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of this subsection standard orders for issuance to patients by
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attending physicians of this Commonwealth. The form of the order
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shall contain, but not be limited to, the following:
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PENNSYLVANIA OUT-OF-HOSPITAL
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DO-NOT-RESUSCITATE ORDER
Patient's full legal name:
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I, the undersigned, state that I am the attending
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physician of the patient named above. The above-named
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patient has requested this order and I have made the
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determination that this patient is in a terminal
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condition and eligible for an order.
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I direct any and all emergency medical services
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personnel, commencing on the effective date of this
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order, to withhold cardiopulmonary resuscitation (cardiac
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compression, invasive airway techniques, artificial
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ventilation, defibrillation and other related procedures)
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from the patient in the event of the patient's
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respiratory or cardiac arrest. I further direct such
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personnel to provide to the patient other medical
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interventions, such as intravenous fluids, oxygen or
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other therapies necessary to provide comfort care or to
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alleviate pain, unless directed otherwise by the patient
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or the emergency medical services provider's authorized
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medical command physician.
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Signature of attending physician:
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Printed name of attending physician:
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Dated:
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Attending physician's emergency telephone number:
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Signature of patient (if capable of making informed
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decisions):
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I, the undersigned, hereby direct that in the event
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of my cardiac and/or respiratory arrest, efforts at
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cardiopulmonary resuscitation not be initiated. I
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understand that I may revoke these directions at any time
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by giving verbal instructions to the emergency medical
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services providers, by physical cancellation or
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destruction of this form or my bracelet or necklace, or
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by simply not displaying this form or the bracelet or
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necklace for my EMS caregivers.
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Signature of surrogate (if patient is incapable of
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making informed decisions):
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I, the undersigned, hereby certify that I am
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authorized to execute this order on the patient's behalf
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by virtue of having been designated as the patient's
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surrogate and/or by virtue of my relationship to the
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patient (specify relationship: _________________). I
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hereby direct that in the event of the patient's cardiac
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and/or respiratory arrest, efforts at cardiopulmonary
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resuscitation not be initiated.
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(c)
Format of bracelet.--The department shall, with the
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advice of the Pennsylvania Emergency Health Services Council and
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with the assistance of the regional emergency medical services
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councils, make available within 180 days of the effective date
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of this subsection standard bracelets for issuance to patients
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by attending physicians. The bracelets shall be uniform in
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design and shall, at a minimum, on the face clearly indicate
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OUT-OF-HOSPITAL DNR and the name of the patient and attending
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physician, as well as the dated signature of the attending
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physician.
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(d)
Format of necklace.--The department shall, with the
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advice of the Pennsylvania Emergency Health Services Council and
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with the assistance of the regional emergency medical services
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councils, make available within 180 days of the effective date
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of this subsection standard necklaces for issuance to patients
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by attending physicians. The necklaces shall be uniform in
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design and shall, at a minimum, on the face clearly indicate
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OUT-OF-HOSPITAL DNR and the name of the patient and attending
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physician, as well as the dated signature of the attending
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physician.
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§ 5405-A.
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(a)
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Revocation.
Patient.--If a patient has obtained an order, only the
patient may revoke the patient's DNR status.
(b)
Surrogate.--If a surrogate has obtained an order, the
patient or the surrogate may revoke the patient's status.
(c)
Manner.--Revocation under this section may be done at
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any time without regard to the patient's physical or mental
13
condition and in any manner, including verbally or by destroying
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or not displaying the order, bracelet or necklace.
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§ 5406-A.
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(a)
Liability.
General rule.--No physician, emergency medical services
17
provider or other health care provider who, consistent with this
18
chapter, causes or participates in the initiating, continuing,
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withholding or withdrawal of life-sustaining treatment or
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cardiopulmonary resuscitation from a patient shall, as a result
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of such action, be subject to criminal or civil liability or be
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found to have committed an act of unprofessional conduct if the
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attending physician, health care provider or emergency medical
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services provider has followed the patient's EXPRESSED wishes as
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expressed earlier by the patient in the form of a declaration
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or, order OR REVOCATION, executed pursuant to this chapter.
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(b)
Absence of order, bracelet or necklace.--The absence of
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an order, bracelet or necklace by a patient shall not give rise
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to any presumption as to the intent of the patient to consent to
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or to refuse the initiation, continuation or termination of
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<
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life-sustaining treatment.
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§ 5407-A.
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(a)
Effect on suicide and life insurance.
Criminal effect.--The withholding or withdrawal of life-
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sustaining treatment from a patient in accordance with the
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provisions of this chapter shall not, for any purpose,
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constitute suicide or homicide.
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(b)
Life insurance.--The making of or failure to make an
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order in accordance with this chapter shall not affect in any
9
manner the sale, procurement or issuance of any policy of life
10
insurance nor shall it be deemed to modify the terms of an
11
existing policy of life insurance. No policy of life insurance
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shall be legally impaired or invalidated in any manner by the
13
withholding or withdrawal of life-sustaining treatment from an
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insured patient, notwithstanding any term of the policy to the
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contrary.
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§ 5408-A.
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Order optional.
No physician or other health care provider and no health care
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service plan, health maintenance organization, insurer issuing
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disability insurance, self-insured employee welfare benefit
20
plan, nonprofit hospital plan or Federal, State or local
21
government sponsored or operated program may:
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(1)
require any person to execute an order as a
23
condition for being insured for or receiving health care
24
services; or
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(2)
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charge any person a different rate or fee whether or
not the person executes or has executed an order.
§ 5409-A.
Preservation of existing rights.
The provisions of this chapter shall not impair or supersede
29
any existing rights or responsibilities not addressed in this
30
chapter.
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§ 5410-A.
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(a)
Emergency medical services.
Medical command instructions.--Notwithstanding the
3
absence of an order, bracelet or necklace pursuant to this
4
section, emergency medical services providers shall at all times
5
comply with the instructions of an authorized medical command
6
physician to withhold or discontinue resuscitation.
7
(b)
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Effect of order, bracelet or necklace.-(1)
Emergency medical services providers are authorized
to, and shall, comply with an order if made aware of the
10
order by examining a bracelet, a necklace or the order
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itself.
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(2)
Emergency medical services providers shall provide
13
other medical interventions necessary and appropriate to
14
provide comfort and alleviate pain, including intravenous
15
fluids, medications, oxygen and any other intervention
16
appropriate to the level of the certification of the
17
provider, unless otherwise directed by the patient or the
18
emergency medical services provider's authorized medical
19
command physician.
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(3)
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As used in this subsection, the term "comply" means:
(i)
to withhold cardiopulmonary resuscitation from
22
the patient in the event of respiratory or cardiac
23
arrest; or
24
(ii)
to discontinue and cease cardiopulmonary
25
resuscitation in the event the emergency medical services
26
provider is presented with an order or discovers a
27
necklace or bracelet after initiating cardiopulmonary
28
resuscitation.
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(c)
Uncertainty regarding validity or applicability of
order, bracelet or necklace.--
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(1)
Emergency medical services providers who in good
2
faith are uncertain about the validity or applicability of an
3
order, bracelet or necklace shall render care in accordance
4
with their level of certification.
5
(2)
Emergency medical services providers who act under
6
paragraph (1) shall not be subject to civil or criminal
7
liability or administrative sanction for failure to comply
8
with an order under this section.
9
(d)
Recognition of other states' orders.--Emergency medical
10
services or out-of-hospital DNR orders, bracelets or necklaces
11
valid in states other than this Commonwealth shall be recognized
12
in this Commonwealth to the extent that these orders, bracelets
13
or necklaces are consistent with the laws of this Commonwealth.
14
Emergency medical services providers shall act in accordance
15
with the provisions of this section when encountering a patient
16
with an apparently valid EMS or out-of-hospital DNR form,
17
bracelet or necklace issued by another state. Emergency medical
18
services providers acting in good faith under this section shall
19
be entitled to the same immunities and protections that would
20
otherwise be applicable.
21
§ 5411-A.
22
(a)
Pregnancy.
General rule.--Notwithstanding the existence of an order
23
or direction to the contrary, life-sustaining treatment,
24
cardiopulmonary resuscitation, nutrition and hydration must be
25
provided to a pregnant patient unless, to a reasonable degree of
26
medical certainty as certified on the patient's medical record
27
by the attending physician and an obstetrician who has examined
28
the patient, life-sustaining treatment, nutrition and hydration:
29
30
(1)
will not maintain the pregnant patient in such a way
as to permit the continuing development and live birth of the
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unborn child;
2
3
(2)
will be physically harmful to the pregnant patient;
(3)
would cause pain to the pregnant patient which
or
4
5
cannot be alleviated by medication.
6
(b)
Pregnancy test.--Nothing in this section shall require a
7
physician to perform a pregnancy test unless the physician has
8
reason to believe that the patient may be pregnant.
9
10
(c)
Payment of expenses by Commonwealth.-(1)
In the event that treatment, cardiopulmonary
11
resuscitation, nutrition or hydration are provided to a
12
pregnant patient, notwithstanding the existence of an order
13
or direction to the contrary, the Commonwealth shall pay all
14
usual, customary and reasonable expenses directly and
15
indirectly incurred by the pregnant patient to whom such
16
treatment, nutrition and hydration are provided.
17
(2)
The Commonwealth shall have the right of subrogation
18
against all moneys paid by any third-party health insurer on
19
behalf of the pregnant patient.
20
(3)
The expenditures incurred on behalf of the pregnant
21
patient shall constitute a grant and no lien shall be placed
22
upon the property of the pregnant patient, her estate or her
23
heirs.
24
§ 5412-A.
25
Penalties.
Any person who intentionally conceals, cancels, defaces,
26
obliterates or damages the order, bracelet or necklace of
27
another without the consent of the patient commits a felony of
28
the third degree. Any person who falsifies or forges the order,
29
bracelet or necklace of another, or conceals or withholds
30
personal knowledge of a revocation as provided in section 5405-A
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(relating to revocation), with the intent to cause a withholding
2
or withdrawal of life-sustaining treatment contrary to the
3
wishes of the patient and, because of such an act, directly
4
causes life-sustaining treatment to be withheld or withdrawn and
5
death to be hastened shall be subject to prosecution for
6
criminal homicide as provided in 18 Pa.C.S. Ch. 25 (relating to
7
criminal homicide). Any person who intentionally, by undue
8
influence, fraud or duress, causes a person to execute an order
9
pursuant to this chapter commits a felony of the third degree.
10
§ 5413-A.
Severability.
11
The provisions of this chapter are severable, and, if any
12
word, phrase, clause, sentence, section or provision of this
13
chapter is for any reason held to be unconstitutional, the
14
decision of the court shall not affect or impair any of the
15
remaining provisions of this chapter. It is hereby declared as
16
the legislative intent that this chapter would have been adopted
17
had such unconstitutional word, phrase, clause, sentence,
18
section or provision thereof not been included herein.
19
Section 4.
The Department of Health shall, with the advice
20
of the Pennsylvania Emergency Health Services Council and with
21
the assistance of the regional emergency medical services
22
councils, develop and make available to health care providers
23
recognized under the act of July 3, 1985 (P.L.164, No.45), known
24
as the Emergency Medical Services Act, including those
25
individuals recognized under 42 Pa.C.S. § 8331.2, within 180
26
days of the effective date of this act, educational materials
27
relating to the implementation of the provisions of this act.
28
The department shall also cause the requirements of this act to
29
be included as part of the curricula for health care providers
30
recognized under the Emergency Medical Services Act.
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Section 5.
The Department of Health may contract with any
2
public or private entity to facilitate all or part of its
3
responsibilities under 20 Pa.C.S. Ch. 54 or 54-A.
4
Section 6.
The Department of Health, upon the conclusion of
5
at least one public hearing, shall publish interim regulations
6
in the Pennsylvania Bulletin within 120 days of the effective
7
date of this act. The interim regulations shall not be subject
8
to the act of July 31, 1968 (P.L.769, No.240), referred to as
9
the Commonwealth Documents Law, or to the act of June 25, 1982
10
(P.L.633, No.181), known as the Regulatory Review Act. The
11
interim regulations shall be effective until final regulations
12
are promulgated by the department. Final regulations shall be
13
promulgated no later than 18 months following the effective date
14
of this act.
15
Section 7.
This act shall take effect in 60 days.
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