Bill Text: HI SB2867 | 2014 | Regular Session | Introduced
Bill Title: Physician Orders for Life-Sustaining Treatment
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2014-01-23 - Referred to HTH, JDL. [SB2867 Detail]
Download: Hawaii-2014-SB2867-Introduced.html
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THE SENATE |
S.B. NO. |
2867 |
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TWENTY-SEVENTH LEGISLATURE, 2014 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
RELATING TO PHYSICIAN ORDERS FOR LIFE-SUSTAINING TREATMENT.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The Hawaii Physician Orders for Life-sustaining Treatment law, chapter 327K, Hawaii Revised Statutes, enables individuals or their legal representatives to complete a physician orders for life-sustaining treatment form. These orders are portable and recognized statewide. The national standard for authorized healthcare provider signatories include licensed physicians and advanced practice registered nurses.
The legislature finds that Hawaii's law is limited to only licensed physicians, creating a barrier to timely completion of a physician orders for life-sustaining treatment form. This occurs in rural areas where an advanced practice registered nurse is the only prescribing provider an individual may see. It also occurs in long-term care settings where the advanced practice registered nurse is the primary provider and physician's visits are several weeks apart. Additionally, given the ability of advanced practice registered nurses in Hawaii to practice independently, bottlenecks occur in a variety of other settings as they are unable to complete a physician orders for life-sustaining treatment form directly with patients and families.
Physician Orders for Life-sustaining Treatment is beneficial to people with serious illness, including people with dementia, and their decision makers as it specifies the types of treatments that a patient wishes to receive towards the end of life. Completing a physician orders for life-sustaining treatment form encourages communication between healthcare providers and patients, enabling patients to make more informed decisions. The physician orders for life-sustaining treatment form documents those decisions in a clear manner and can be quickly understood by all providers, including first responders and emergency medical services personnel. As a result, the patient's wishes can be honored across all settings of care. If the patient no longer has the capacity to make decisions for the patient’s self, the patient's legally recognized representatives can complete physician orders for life-sustaining treatment on the patient's behalf.
Additionally, the current law uses wording to describe a legally authorized healthcare decision maker that is inconsistent with chapter 327E, Hawaii Revised Statutes, the Uniform Health Care Decisions Act. This Act will correct those inconsistencies.
The purpose of this Act is to expand signature authorization to include advanced practice registered nurses and make technical corrections to the Hawaii Physician Orders for Life-sustaining Treatment law.
SECTION 2. Section 327K-1, Hawaii Revised Statutes, is amended to read as follows:
"[[]§327K-1[]]
Definitions. As used in this chapter, unless the context otherwise
requires:
"Advanced practice registered nurse" means a registered nurse who has met the qualifications for advanced practice registered nurse set forth in chapter 457 and through rules of the board, which shall include educational requirements as defined in section 457-2.
"Department" means the department of health.
"Form" means a physician orders for life-sustaining treatment form adopted by the department.
"Health care provider" means an individual licensed, certified, or otherwise authorized or permitted by law to provide health care in the ordinary course of the individual's business or profession.
"Legal representative" shall have the same meaning as a person who is empowered to make decisions on behalf of another person as allowed for in chapter 327E.
"Patient's physician" means a physician licensed pursuant to chapter 453 who has examined the patient.
"Physician orders for life-sustaining
treatment form" means a form signed by a patient, or if incapacitated, by
the patient's [surrogate] legal representative and the patient's
physician[;] or advanced practice registered nurse that records
the patient's wishes and that directs a health care provider regarding the
provision of resuscitative and life-sustaining measures. A physician orders
for life-sustaining treatment form is not an advance health-care directive.
["Surrogate" shall have the same
meaning as in section 327E-2.]"
SECTION 3. Section 327K-2, Hawaii Revised Statutes, is amended to read as follows:
"[[]§327K-2[]] Physician
orders for life-sustaining treatment form; execution; explanation; compliance;
revocation.
(a) The following may execute a form:
(1) The patient;
(2) The patient's physician[;] or advanced
practice registered nurse; and
(3) The [surrogate,] legal representative,
but only if the patient:
(A) Lacks capacity; or
B) Has designated that the [surrogate]
legal representative is authorized to execute the form.
The patient's physician or advanced practice
registered nurse may medically evaluate the patient and, based upon the
evaluation, may recommend new orders consistent with the most current
information available about the individual's health status and goals of
care. The patient's physician or advanced practice registered nurse
shall consult with the patient or the patient's [surrogate] legal
representative before issuing any new orders on a form. The patient
or the patient's [surrogate] legal representative may choose to
execute or not execute any new form. If a patient is incapacitated, the
patient's [surrogate] legal representative shall consult with the
patient's physician or advanced practice registered nurse before
requesting the patient's physician or advanced practice registered nurse
to modify treatment orders on the form. To be valid, a form shall be
signed by the patient's physician or advanced practice registered nurse
and the patient, or the patient's physician or advanced practice registered
nurse and the patient's [surrogate] legal representative. At
any time, a patient, or, if incapacitated, the patient's [surrogate] legal
representative, may request alternative treatment that differs from the
treatment indicated on the form.
(b) The patient's physician or advanced practice registered nurse or a health care provider shall explain to the patient the nature and content of the form, including any medical intervention or procedures, and shall also explain the difference between an advance health-care directive and the form. The form shall be prepared by the patient's physician or advanced practice registered nurse or a health care provider based on the patient's preferences and medical indications.
(c) Any health care provider, including the
patient's physician[,] or advanced practice registered nurse,
emergency medical services personnel, and emergency physicians shall comply
with a properly executed and signed form and treat the patient according to the
orders on the form; provided that compliance shall not be required if the
orders on the form request medically ineffective health care or health care
that is contrary to generally accepted health care standards.
(d) A patient having capacity, or, if the
patient is incapacitated, the patient's [surrogate,] legal
representative, may revoke a form at any time and in any manner that communicates
intent to revoke."
SECTION 4. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 5. This Act shall take effect upon its approval.
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INTRODUCED BY: |
_____________________________ |
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BY REQUEST |
Report Title:
Physician Orders for Life-Sustaining Treatment
Description:
Expands signature authorization to include advanced practice registered nurses. Makes technical corrections to the Hawaii physician orders for life-sustaining treatments law.
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
