Bill Text: IA SF2125 | 2011-2012 | 84th General Assembly | Introduced
Bill Title: A bill for an act relating to physician orders for scope of treatment. (Formerly SSB 3043.)
Spectrum: Committee Bill
Status: (Introduced - Dead) 2012-02-22 - Withdrawn. S.J. 315. [SF2125 Detail]
Download: Iowa-2011-SF2125-Introduced.html
Senate
File
2125
-
Introduced
SENATE
FILE
2125
BY
COMMITTEE
ON
HUMAN
RESOURCES
(SUCCESSOR
TO
SSB
3043)
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
5365SV
(2)
84
pf/nh
S.F.
2125
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
the
9
individual
if
the
individual
is
unable
to
make
decisions.
The
10
general
assembly
recognizes
that
the
physician
order
for
scope
11
of
treatment
form,
modeled
after
the
national
physician
orders
12
for
life-sustaining
treatment
paradigm
initiative,
complements
13
advance
directives
by
converting
individual
wishes
contained
14
in
advance
directives,
or
as
otherwise
expressed,
into
medical
15
orders
that
may
be
recognized
and
acted
upon
across
medical
16
settings,
thereby
enhancing
the
ability
of
medical
providers
to
17
understand
and
honor
patients’
wishes.
An
Iowa
physician
order
18
for
scope
of
treatment
form
is
intended
for
individuals
who
19
are
frail
and
elderly
or
who
have
a
chronic,
critical
medical
20
condition
or
a
terminal
illness.
21
Sec.
2.
NEW
SECTION
.
144D.1
Physician
orders
for
scope
of
22
treatment.
23
As
used
in
this
chapter,
unless
the
context
otherwise
24
requires:
25
1.
“Advanced
registered
nurse
practitioner”
means
an
advanced
26
registered
nurse
practitioner
licensed
pursuant
to
chapter
152
27
or
152E.
28
2.
“Department”
means
the
department
of
public
health.
29
3.
“Emergency
medical
care
provider”
means
emergency
medical
30
care
provider
as
defined
in
section
147A.1.
31
4.
“Health
care
facility”
means
health
care
facility
as
32
defined
in
section
135C.1,
a
hospice
program
as
defined
in
33
section
135J.1,
an
elder
group
home
as
defined
in
section
34
231B.1,
and
an
assisted
living
program
as
defined
in
section
35
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2125
231C.2.
1
5.
“Health
care
provider”
means
an
individual,
including
2
an
emergency
medical
care
provider
and
an
individual
providing
3
home
and
community-based
services,
and
including
a
home
4
health
agency,
licensed,
certified,
or
otherwise
authorized
or
5
permitted
by
the
law
of
this
state
to
administer
health
care
6
in
the
ordinary
course
of
business
or
in
the
practice
of
a
7
profession.
8
6.
“Home
health
agency”
means
home
health
agency
as
defined
9
in
42
C.F.R.
pt.
484.
10
7.
“Hospital”
means
hospital
as
defined
in
section
135B.1.
11
8.
“Legal
representative”
means
an
individual
authorized
to
12
execute
a
POST
form
on
behalf
of
a
patient
who
is
not
competent
13
to
do
so,
in
the
order
of
priority
set
out
in
section
144A.7,
14
subsection
1,
and
guided
by
the
express
or
implied
intentions
15
of
the
patient
or,
if
such
intentions
are
unknown,
by
the
16
patient’s
best
interests
given
the
patient’s
overall
medical
17
condition
and
prognosis.
18
9.
“Patient”
means
an
individual
who
is
frail
and
elderly
19
or
who
has
a
chronic,
critical
medical
condition
or
a
terminal
20
illness
and
for
which
a
physician
order
for
scope
of
treatment
21
is
consistent
with
the
individual’s
goals
of
care.
22
10.
“Physician”
means
a
person
licensed
to
practice
medicine
23
and
surgery
or
osteopathic
medicine
and
surgery
in
this
state.
24
11.
“Physician
assistant”
means
a
person
licensed
as
a
25
physician
assistant
under
chapter
148C.
26
12.
“Physician
orders
for
scope
of
treatment
form”
or
“POST
27
form”
means
a
document
containing
medical
orders
which
may
28
be
relied
upon
across
medical
settings
that
consolidates
29
and
summarizes
a
patient’s
preferences
for
life-sustaining
30
treatments
and
interventions
and
acts
as
a
complement
to
and
31
does
not
supersede
any
valid
advance
directive.
32
Sec.
3.
NEW
SECTION
.
144D.2
Physician
orders
for
scope
of
33
treatment
(POST)
form.
34
1.
The
POST
form
shall
be
a
uniform
form
based
upon
the
35
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2125
national
physician
orders
for
life-sustaining
treatment
1
paradigm
form.
The
form
shall
have
all
of
the
following
2
characteristics:
3
a.
The
form
shall
include
the
patient’s
name
and
date
of
4
birth.
5
b.
The
form
shall
be
signed
and
dated
by
the
patient
or
the
6
patient’s
legal
representative.
7
c.
The
form
shall
be
signed
and
dated
by
the
patient’s
8
physician,
advanced
registered
nurse
practitioner,
or
physician
9
assistant.
10
d.
If
preparation
of
the
form
was
facilitated
by
an
11
individual
other
than
the
patient’s
physician,
advanced
12
registered
nurse
practitioner,
or
physician
assistant,
the
13
facilitator
shall
also
sign
and
date
the
form.
14
e.
The
form
shall
include
the
patient’s
wishes
regarding
the
15
care
of
the
patient,
including
but
not
limited
to
all
of
the
16
following:
17
(1)
The
administration
of
cardiopulmonary
resuscitation.
18
(2)
The
level
of
medical
interventions
in
the
event
of
a
19
medical
emergency.
20
(3)
The
use
of
medically
administered
nutrition
by
tube.
21
(4)
The
rationale
for
the
orders.
22
f.
The
form
shall
be
easily
distinguishable
to
facilitate
23
recognition
by
health
care
providers,
hospitals,
and
health
24
care
facilities.
25
g.
An
incomplete
section
on
the
form
shall
imply
the
26
patient’s
wishes
for
full
treatment
for
the
type
of
treatment
27
addressed
in
that
section.
28
2.
The
department
shall
prescribe
the
uniform
POST
form
29
and
shall
post
the
form
on
the
department’s
website
for
public
30
availability.
31
Sec.
4.
NEW
SECTION
.
144D.3
Compliance
with
POST
form.
32
1.
A
POST
form
executed
in
this
state
or
another
state
33
or
jurisdiction
in
compliance
with
the
law
of
that
state
or
34
jurisdiction
shall
be
deemed
valid
and
enforceable
in
this
35
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state
to
the
extent
the
form
is
consistent
with
the
laws
of
1
this
state,
and
may
be
accepted
by
a
health
care
provider,
2
hospital,
or
health
care
facility.
3
2.
A
health
care
provider,
hospital,
or
health
care
facility
4
may
comply
with
an
executed
POST
form,
notwithstanding
that
the
5
physician,
advanced
registered
nurse
practitioner,
or
physician
6
assistant
who
signed
the
POST
form
does
not
have
admitting
7
privileges
at
the
hospital
or
health
care
facility
providing
8
health
care
or
treatment.
9
3.
A
POST
form
may
be
revoked
at
any
time
and
in
any
manner
10
by
which
the
patient
or
a
patient’s
legal
representative
is
11
able
to
communicate
the
patient’s
intent
to
revoke,
without
12
regard
to
the
patient’s
mental
or
physical
condition.
A
13
revocation
is
only
effective
as
to
the
health
care
provider,
14
hospital,
or
health
care
facility
upon
communication
to
the
15
health
care
provider,
hospital,
or
health
care
facility
by
the
16
patient,
the
patient’s
legal
representative,
or
by
another
to
17
whom
the
revocation
was
communicated.
18
4.
In
the
absence
of
actual
notice
of
the
revocation
19
of
a
POST
form,
a
health
care
provider,
hospital,
health
20
care
facility,
or
any
other
person
who
complies
with
a
POST
21
form
shall
not
be
subject
to
civil
or
criminal
liability
or
22
professional
disciplinary
action
for
actions
taken
under
23
this
chapter
which
are
in
accordance
with
reasonable
medical
24
standards.
A
health
care
provider,
hospital,
health
care
25
facility,
or
other
person
against
whom
criminal
or
civil
26
liability
is
asserted
because
of
conduct
in
compliance
with
27
this
chapter
may
interpose
the
restriction
on
liability
in
this
28
paragraph
as
an
absolute
defense.
29
5.
A
health
care
provider,
hospital,
or
health
care
facility
30
that
is
unwilling
to
comply
with
an
executed
POST
form
based
on
31
policy,
religious
beliefs,
or
moral
convictions
shall
take
all
32
reasonable
steps
to
transfer
the
patient
to
another
health
care
33
provider,
hospital,
or
health
care
facility.
34
Sec.
5.
NEW
SECTION
.
144D.4
General
provisions.
35
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1.
If
an
individual
is
a
qualified
patient
as
defined
in
1
section
144A.2,
the
individual’s
declaration
executed
under
2
chapter
144A
shall
control
health
care
decision
making
for
the
3
individual
in
accordance
with
chapter
144A.
If
an
individual
4
has
not
executed
a
declaration
pursuant
to
chapter
144A,
health
5
care
decision
making
relating
to
life-sustaining
procedures
for
6
the
individual
shall
be
governed
by
section
144A.7.
A
POST
7
form
shall
not
supersede
a
declaration
executed
pursuant
to
8
chapter
144A.
9
2.
If
an
individual
has
executed
a
durable
power
of
attorney
10
for
health
care
pursuant
to
chapter
144B,
the
individual’s
11
durable
power
of
attorney
for
health
care
shall
control
health
12
care
decision
making
for
the
individual
in
accordance
with
13
chapter
144B.
A
POST
form
shall
not
supersede
a
durable
power
14
of
attorney
for
health
care
executed
pursuant
to
chapter
144B.
15
3.
If
the
individual’s
physician
has
issued
an
16
out-of-hospital
do-not-resuscitate
order
pursuant
to
section
17
144A.7A,
the
POST
form
shall
not
supersede
the
out-of-hospital
18
do-not-resuscitate
order.
19
4.
Death
resulting
from
the
withholding
or
withdrawal
of
20
life-sustaining
procedures
pursuant
to
an
executed
POST
form
21
and
in
accordance
with
this
chapter
does
not,
for
any
purpose,
22
constitute
a
suicide,
homicide,
or
dependent
adult
abuse.
23
5.
The
executing
of
a
POST
form
does
not
affect
in
any
24
manner
the
sale,
procurement,
or
issuance
of
any
policy
of
25
life
insurance,
nor
shall
it
be
deemed
to
modify
the
terms
26
of
an
existing
policy
of
life
insurance.
A
policy
of
life
27
insurance
is
not
legally
impaired
or
invalidated
in
any
manner
28
by
the
withholding
or
withdrawal
of
life-sustaining
procedures
29
pursuant
to
this
chapter
notwithstanding
any
term
of
the
policy
30
to
the
contrary.
31
6.
A
health
care
provider,
hospital,
health
care
facility,
32
health
care
service
plan,
insurer
issuing
disability
insurance,
33
self-insured
employee
welfare
benefit
plan,
or
nonprofit
34
hospital
plan
shall
not
require
any
person
to
execute
a
POST
35
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form
as
a
condition
of
being
insured
for,
or
receiving,
health
1
care
services.
2
7.
This
chapter
does
not
create
a
presumption
concerning
3
the
intention
of
an
individual
who
has
not
executed
a
POST
4
form
with
respect
to
the
use,
withholding,
or
withdrawal
5
of
life-sustaining
procedures
in
the
event
of
a
terminal
6
condition.
7
8.
This
chapter
shall
not
be
interpreted
to
affect
the
8
right
of
an
individual
to
make
decisions
regarding
use
of
9
life-sustaining
procedures
as
long
as
the
individual
is
able
to
10
do
so,
nor
to
impair
or
supersede
any
right
or
responsibility
11
that
any
person
has
to
effect
the
withholding
or
withdrawal
12
of
medical
care
in
any
lawful
manner.
In
that
respect,
the
13
provisions
of
this
chapter
are
cumulative.
14
9.
This
chapter
shall
not
be
construed
to
condone,
15
authorize,
or
approve
mercy
killing
or
euthanasia,
or
to
permit
16
any
affirmative
or
deliberate
act
or
omission
to
end
life
other
17
than
to
permit
the
natural
process
of
dying.
18
EXPLANATION
19
This
bill
provides
for
the
use
of
physician
orders
for
scope
20
of
treatment
(POST).
21
The
bill
provides
legislative
findings
that
provide
that
22
the
general
assembly
recognizes
the
importance
of
encouraging
23
individuals
to
discuss
and
make
health
care
decisions
before
an
24
actual
decision
is
necessary;
that
health
care
planning
is
a
25
process
based
upon
the
individual’s
values
and
personal
health
26
status;
and
that
advance
directives
provide
the
opportunity
27
for
an
individual
to
enunciate
and
document
their
wishes
and
28
to
identify
the
person
authorized
to
make
decisions
for
the
29
individual.
The
general
assembly
also
recognizes
that
the
30
POST
form,
modeled
after
the
national
physician
orders
for
31
life-sustaining
treatment
paradigm
initiative,
complements
32
advance
directives
by
converting
individual
wishes
contained
33
in
advance
directives,
or
as
otherwise
expressed,
into
medical
34
orders
that
may
be
recognized
and
acted
upon
across
medical
35
-6-
LSB
5365SV
(2)
84
pf/nh
6/
9
S.F.
2125
settings,
thereby
enhancing
the
ability
of
medical
providers
1
to
understand
and
honor
patients’
wishes.
The
POST
form
is
2
intended
for
individuals
who
are
frail
and
elderly
or
who
have
3
a
chronic,
critical
medical
condition
or
a
terminal
illness.
4
The
bill
provides
definitions
used
in
Code
chapter
144D,
5
including
the
physician
orders
for
scope
of
treatment
(POST)
6
form,
which
means
a
document
containing
medical
orders
which
7
may
be
relied
upon
across
medical
settings
that
consolidates
8
and
summarizes
an
individual’s
preferences
for
life-sustaining
9
treatments
and
interventions
and
acts
as
a
complement
to
but
10
does
not
supersede
any
valid
advance
directive.
11
The
bill
specifies
the
content
of
the
POST
form
and
that
the
12
department
of
public
health
is
to
prescribe
the
uniform
POST
13
form
and
post
the
form
on
the
department’s
website
for
public
14
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
or
28
professional
disciplinary
action
for
a
health
care
provider,
29
hospital,
health
care
facility,
or
any
other
person
who
30
complies
with
a
POST
form
if
the
actions
are
in
accordance
with
31
reasonable
medical
standards.
The
bill
requires
a
health
care
32
provider,
hospital,
or
health
care
facility
that
is
unwilling
33
to
comply
with
an
executed
POST
form
due
to
policy,
religious
34
beliefs,
or
moral
convictions
to
take
all
reasonable
steps
to
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transfer
the
patient
to
another
health
care
provider,
hospital,
1
or
health
care
facility.
2
The
bill
provides
for
the
relation
of
an
executed
POST
3
form
to
a
declaration
under
the
life-sustaining
procedures
4
Act,
a
durable
power
of
attorney
for
health
care,
and
an
5
out-of-hospital
do-not-resuscitate
order.
In
all
cases,
6
the
declaration,
the
durable
power
of
attorney,
and
the
7
out-of-hospital
do-not-resuscitate
order
control
health
care
8
decision
making
and
the
POST
form
does
not
supersede
them.
9
The
bill
provides
that
death
resulting
from
the
withholding
10
or
withdrawal
of
life-sustaining
procedures
pursuant
to
an
11
executed
POST
form
and
in
accordance
with
the
bill
does
not
12
constitute
a
suicide,
homicide,
or
dependent
adult
abuse
and
13
that
executing
a
POST
form
does
not
affect
in
any
manner
14
the
sale,
procurement,
or
issuance
of
any
policy
of
life
15
insurance;
modify
the
terms
of
an
existing
policy
of
life
16
insurance;
or
legally
impair
or
invalidate
the
policy.
The
17
bill
prohibits
the
execution
of
a
POST
form
as
a
condition
for
18
being
insured
or
receiving
health
care
services
and
provides
19
that
not
executing
a
POST
form
does
not
create
a
presumption
20
concerning
the
intention
of
an
individual
with
respect
to
the
21
use,
withholding,
or
withdrawal
of
life-sustaining
procedures
22
in
the
event
of
a
terminal
condition.
23
The
bill
is
not
to
be
interpreted
to
affect
the
right
of
an
24
individual
to
make
decisions
regarding
use
of
life-sustaining
25
procedures
as
long
as
the
individual
is
able
to
do
so,
nor
to
26
impair
or
supersede
any
right
or
responsibility
that
any
person
27
has
to
effect
the
withholding
or
withdrawal
of
medical
care
in
28
any
lawful
manner.
The
bill
is
not
to
be
construed
to
condone,
29
authorize,
or
approve
mercy
killing
or
euthanasia,
or
to
permit
30
any
affirmative
or
deliberate
act
or
omission
to
end
life
other
31
than
to
permit
the
natural
process
of
dying.
32
The
general
assembly
in
2008
Iowa
Acts,
chapter
1188,
33
section
36,
established
a
two-year
pilot
project
in
Linn
county
34
and
in
2010
Iowa
Acts,
chapter
1192,
section
58,
expanded
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the
pilot
project
to
Jones
county
and
extended
the
duration
1
until
June
30,
2012,
to
pilot
the
use
of
the
POST
form.
The
2
legislation
also
directed
the
department
to
convene
an
advisory
3
council
for
the
pilot
project
and
directed
the
advisory
council
4
to
report
its
findings
and
recommendations
to
the
general
5
assembly
by
January
1,
2012.
The
advisory
council
recommended
6
expanding
the
adoption
of
the
POST
form
statewide.
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