Bill Text: IN HB1182 | 2013 | Regular Session | Enrolled
Bill Title: Physician order for scope of treatment forms.
Spectrum: Slight Partisan Bill (Republican 2-1)
Status: (Passed) 2013-05-13 - Public Law 164 [HB1182 Detail]
Download: Indiana-2013-HB1182-Enrolled.html
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AN ACT to amend the Indiana Code concerning health.
(1) after the consenting party has had a full explanation of the abortion procedure to be performed, including disclosures and information required by IC 16-34-2-1.1; and
(2) as evidenced by the signature of the consenting party on a consent form prescribed by the state department of health.
(b) "Consent", for purposes of IC 16-36-6, has the meaning set forth in IC 16-36-6-1.
(b) "Declarant", for purposes of IC 16-36-6, has the meaning set forth in IC 16-36-6-2.
(1) An individual, a partnership, a corporation, a professional corporation, a facility, or an institution licensed or legally
authorized by this state to provide health care or professional
services as a licensed physician, a psychiatric hospital, a hospital,
a health facility, an emergency ambulance service (IC 16-31-3),
a dentist, a registered or licensed practical nurse, a midwife, an
optometrist, a pharmacist, a podiatrist, a chiropractor, a physical
therapist, a respiratory care practitioner, an occupational therapist,
a psychologist, a paramedic, an emergency medical technician, an
advanced emergency medical technician, or a person who is an
officer, employee, or agent of the individual, partnership,
corporation, professional corporation, facility, or institution acting
in the course and scope of the person's employment.
(2) A college, university, or junior college that provides health
care to a student, a faculty member, or an employee, and the
governing board or a person who is an officer, employee, or agent
of the college, university, or junior college acting in the course
and scope of the person's employment.
(3) A blood bank, community mental health center, community
mental retardation center, community health center, or migrant
health center.
(4) A home health agency (as defined in IC 16-27-1-2).
(5) A health maintenance organization (as defined in
IC 27-13-1-19).
(6) A health care organization whose members, shareholders, or
partners are health care providers under subdivision (1).
(7) A corporation, partnership, or professional corporation not
otherwise qualified under this subsection that:
(A) provides health care as one (1) of the corporation's,
partnership's, or professional corporation's functions;
(B) is organized or registered under state law; and
(C) is determined to be eligible for coverage as a health care
provider under IC 34-18 for the corporation's, partnership's, or
professional corporation's health care function.
Coverage for a health care provider qualified under this subdivision is
limited to the health care provider's health care functions and does not
extend to other causes of action.
(b) "Health care provider", for purposes of IC 16-35, has the
meaning set forth in subsection (a). However, for purposes of IC 16-35,
the term also includes a health facility (as defined in section 167 of this
chapter).
(c) "Health care provider", for purposes of IC 16-36-5 and
IC 16-36-6, means an individual licensed or authorized by this state to
provide health care or professional services as:
(1) a licensed physician;
(2) a registered nurse;
(3) a licensed practical nurse;
(4) an advanced practice nurse;
(5) a licensed nurse midwife;
(6) a paramedic;
(7) an emergency medical technician;
(8) an advanced emergency medical technician; or
(9) an emergency medical responder, as defined by section 109.8 of this chapter.
The term includes an individual who is an employee or agent of a health care provider acting in the course and scope of the individual's employment.
(d) "Health care provider", for purposes of IC 16-40-4, means any of the following:
(1) An individual, a partnership, a corporation, a professional corporation, a facility, or an institution licensed or authorized by the state to provide health care or professional services as a licensed physician, a psychiatric hospital, a hospital, a health facility, an emergency ambulance service (IC 16-31-3), an ambulatory outpatient surgical center, a dentist, an optometrist, a pharmacist, a podiatrist, a chiropractor, a psychologist, or a person who is an officer, employee, or agent of the individual, partnership, corporation, professional corporation, facility, or institution acting in the course and scope of the person's employment.
(2) A blood bank, laboratory, community mental health center, community mental retardation center, community health center, or migrant health center.
(3) A home health agency (as defined in IC 16-27-1-2).
(4) A health maintenance organization (as defined in IC 27-13-1-19).
(5) A health care organization whose members, shareholders, or partners are health care providers under subdivision (1).
(6) A corporation, partnership, or professional corporation not otherwise specified in this subsection that:
(A) provides health care as one (1) of the corporation's, partnership's, or professional corporation's functions;
(B) is organized or registered under state law; and
(C) is determined to be eligible for coverage as a health care provider under IC 34-18 for the corporation's, partnership's, or professional corporation's health care function.
(7) A person that is designated to maintain the records of a person described in subdivisions (1) through (6).
(e) "Health care provider", for purposes of IC 16-45-4, has the meaning set forth in 47 CFR 54.601(a).
(b) "Life prolonging procedure", for purposes of IC 16-36-6, has the meaning set forth in IC 16-36-6-3.
(b) "Qualified person", for purposes of IC 16-36-6, has the meaning set forth in IC 16-36-6-5.
(b) "Representative", for purposes of IC 16-36-5, has the meaning set forth in IC 16-36-5-9.
(c) "Representative", for purposes of IC 16-36-6, has the meaning set forth in IC 16-36-6-6.
Chapter 6. Physician Order for Scope of Treatment (POST)
Sec. 1. As used in this chapter, "consent" means authorization to provide, withhold, or withdraw treatment.
Sec. 2. As used in this chapter, "declarant" means a qualified person:
(1) who has completed a POST form under section 7(a)(1) of this chapter; or
(2) for whom a representative has completed a POST form under section 7(a)(2) of this chapter;
and whose treating physician has executed a POST form under section 8 of this chapter.
Sec. 3. (a) As used in this chapter, "life prolonging procedure" means any medical procedure, treatment, or intervention that does the following:
(1) Uses mechanical or other artificial means to sustain, restore, or supplant a vital function.
(2) Serves to prolong the dying process.
(b) The term does not include the performance or provision of any medical procedure or medication necessary to provide comfort care or to alleviate pain.
Sec. 4. As used in this chapter, "POST form" refers to a physician order for scope of treatment (POST) form developed by the state department under section 9 of this chapter.
Sec. 5. As used in this chapter, "qualified person" refers to an individual who has at least one (1) of the following:
(1) An advanced chronic progressive illness.
(2) An advanced chronic progressive frailty.
(3) A condition caused by injury, disease, or illness from which, to a reasonable degree of medical certainty:
(A) there can be no recovery; and
(B) death will occur from the condition within a short period without the provision of life prolonging procedures.
(4) A medical condition that, if the person were to suffer cardiac or pulmonary failure, resuscitation would be unsuccessful or within a short period the person would experience repeated cardiac or pulmonary failure resulting in death.
Sec. 6. As used in this chapter, "representative" means an individual described in section 7(a)(2) of this chapter.
Sec. 7. (a) The following individuals may complete a POST form:
(1) A qualified person who is:
(A) either:
(i) at least eighteen (18) years of age; or
(ii) less than eighteen (18) years of age but authorized to consent under IC 16-36-1-3(a)(2); and
(B) of sound mind.
(2) A qualified person's representative, if the qualified person:
(A) is less than eighteen (18) years of age and is not authorized to consent under IC 16-36-1-3(a)(2); or
(B) has been determined to be incapable of making decisions about the qualified person's health care by a treating physician acting in good faith and the
representative has been:
(i) appointed by the individual under IC 16-36-1-7 to
serve as the individual's health care representative;
(ii) authorized to act under IC 30-5-5-16 and
IC 30-5-5-17 as the individual's attorney in fact with
authority to consent to or refuse health care for the
individual; or
(iii) appointed by a court as the individual's guardian
under IC 16-36-1-8.
(b) In order to complete a POST form, a person described in
subsection (a) and the qualified person's treating physician or the
physician's designee must do the following:
(1) Discuss the qualified person's goals and treatment options
available to the qualified person based on the qualified
person's health.
(2) Complete the POST form, to the extent possible, based on
the qualified person's preferences determined during the
discussion in subdivision (1).
(c) When completing a POST form on behalf of a qualified
person, a representative shall act:
(1) in good faith; and
(2) in:
(A) accordance with the qualified person's express or
implied intentions, if known; or
(B) the best interest of the qualified person, if the qualified
person's express or implied intentions are not known.
(d) A copy of the executed POST form shall be maintained in the
qualified person's medical file.
Sec. 8. (a) A POST form may be executed only by an individual's
treating physician and only if:
(1) the treating physician has determined that:
(A) the individual is a qualified person; and
(B) the medical orders contained in the individual's POST
form are reasonable and medically appropriate for the
individual; and
(2) the qualified person or representative has completed the
POST form in accordance with section 7 of this chapter.
(b) The:
(1) treating physician; and
(2) qualified person or representative;
must sign and date the POST form for the POST form to be
effective.
Sec. 9. (a) The state department shall develop a standardized POST form and distribute the POST form.
(b) The POST form developed under this section must include the following:
(1) A medical order specifying whether cardiopulmonary resuscitation (CPR) should be performed if the qualified person is in cardiopulmonary arrest.
(2) A medical order concerning the level of medical intervention that should be provided to the qualified person, including the following:
(A) Comfort measures.
(B) Limited additional interventions.
(C) Full intervention.
(3) A medical order specifying whether antibiotics should be provided to the qualified person.
(4) A medical order specifying whether artificially administered nutrition should be provided to the qualified person.
(5) A signature line for the treating physician, including the following information:
(A) The physician's printed name.
(B) The physician's telephone number.
(C) The physician's medical license number.
(D) The date of the physician's signature.
As used in this subdivision, "signature" includes an electronic or physician controlled stamp signature.
(6) A signature line for the qualified person or representative, including the following information:
(A) The qualified person's or representative's printed name.
(B) The relationship of the representative signing the POST form to the qualified person covered by the POST form.
(C) The date of the signature.
(7) A section presenting the option to allow a declarant to appoint an individual under IC 16-36-1-7 to serve as the declarant's health care representative.
(c) The state department shall place the POST form on its Internet web site.
(d) The state department is not liable for any use or misuse of the POST form.
Sec. 10. (a) The declarant or representative shall keep the
original executed POST form. The POST form is considered the
personal property of the declarant. The treating physician who
executes the POST form shall maintain a copy of the POST form
in the declarant's medical records. If the POST form is executed at
a health care facility (as defined in IC 16-18-2-161), a copy of the
POST form shall be maintained in the health care facility's medical
records.
(b) A health care provider or health care facility shall treat a
facsimile, paper, or electronic copy of a valid POST form as an
original document.
(c) A health care provider, a health care facility, or an entity
acting in good faith may not be considered to have knowledge of a
POST form solely on the basis of the POST form's entry into a
medical record that can be accessed by a person described in this
subsection.
Sec. 11. (a) A declarant or representative subject to subsection
(b) may at any time revoke a POST form by any of the following:
(1) A signed and dated writing.
(2) Physical cancellation or destruction of the POST form by:
(A) the declarant;
(B) the representative; or
(C) another individual at the direction of the declarant or
representative.
(3) An oral expression by the declarant or representative of an
intent to revoke the POST form.
(b) A representative may revoke the POST form only if the
declarant is incapable of making decisions regarding the
declarant's health care.
(c) A revocation of a POST form under this section is effective
upon communication of the revocation to a health care provider.
(d) Upon communication of the revocation of a POST form
under this section, the health care provider shall immediately
notify the declarant's treating physician, if known, of the
revocation.
(e) Upon notification of the revocation of a POST form to the
treating physician under subsection (d), the declarant's treating
physician shall as soon as possible do the following:
(1) Add the revocation to the declarant's medical record with
the following information:
(A) The time, date, and place of revocation of the POST
form by the declarant, representative, or other individual
at the direction of the declarant or representative.
(B) The time, date, and place the treating physician was notified of the revocation of the POST form.
(2) Cancel the POST form that is being revoked by conspicuously noting in the declarant's medical records that the declarant's POST form has been voided.
(3) Notify any health care personnel responsible for the care of the declarant of the revocation of the POST form.
(4) Notify the physician who signed the POST form of the revocation through the contact information for the physician indicated on the form.
Sec. 12. (a) A declarant, or, subject to subsection (b), a representative, may, at any time, request alternative treatment to the treatment specified on the POST form.
(b) A representative may request alternative treatment only if the declarant is incapable of making decisions concerning the declarant's health care.
(c) A health care provider to whom a request for alternative treatment is communicated shall, as soon as possible, notify the declarant's treating physician, if known, of the request.
(d) The treating physician who is notified under subsection (c) of a request for alternative treatment shall do the following as soon as possible:
(1) Include a written, signed note of the request in the declarant's medical records with the following information:
(A) The time, date, and place of the request by the declarant or representative.
(B) The time, date, and place that the treating physician was notified of the request.
(2) Review the POST form with the declarant or representative and execute a new POST form, if needed.
Sec. 13. (a) A health care provider, a health care facility, or an interested individual that believes that following the medical orders set forth in the POST form will result in care or treatment, or the withholding of care or treatment, that:
(1) is inconsistent with the declarant's known preferences; or
(2) in the absence of the declarant's known preferences, is not in the declarant's best interest;
may seek relief under IC 16-36-1-8 by petitioning the probate court in the county where the declarant is located.
(b) If, in a proceeding sought under subsection (a), a probate court determines that following the medical orders in the declarant's POST form will result in care or treatment, or the
withholding or withdrawal of care or treatment, that:
(1) is inconsistent with the declarant's known preferences; or
(2) in the absence of the declarant's known preferences, is not
in the declarant's best interest;
the probate court may order any of the relief available under
IC 16-36-1-8.
Sec. 14. A declarant's executed POST form has no effect during
the declarant's pregnancy if the declarant is known to be pregnant.
Sec. 15. (a) Except as otherwise provided in this chapter, the
medical orders included in a POST form executed under this
chapter are effective in all settings. A health care provider shall
comply with a declarant's POST form that is apparent and
immediately available to the provider unless the provider:
(1) believes the POST form was not validly executed under
this chapter;
(2) believes in good faith that the declarant, the
representative, or another individual at the request of the
declarant or representative has revoked the POST form as
provided in section 11 of this chapter;
(3) believes in good faith that the declarant or representative
has made a request for alternative treatment as provided in
section 12 of this chapter;
(4) believes it would be medically inappropriate to provide the
intervention included in the declarant's POST form; or
(5) has religious or moral beliefs that conflict with the POST
form.
(b) A health care provider is not required to provide medical
treatment that is contrary to a declarant's POST form that has
been executed in accordance with this chapter.
(c) If a declarant is capable of making health care decisions, the
declarant's treating physician, before carrying out or
implementing a medical order indicated in the declarant's POST
form, shall discuss the order with the declarant to reaffirm or
amend the order on the POST form. For purposes of this
subsection, a minor who is not authorized to consent to health care
under IC 16-36-1-3(a)(2) is not capable of consenting to health
care. This subsection applies regardless of whether the POST form
was signed by the declarant or representative.
(d) A health care provider who is unable to implement or carry
out the orders of a POST form shall transfer care of the declarant
to another health care provider who is able to implement or carry
out the orders. However, a health care provider who refuses to
implement the medical orders included in an executed POST form
is not required to transfer care of the declarant if any of the
circumstances in subsection (a)(1) through (a)(4) have occurred.
(e) The treating physician is responsible for coordinating the
transfer of care of a declarant in the circumstances in subsection
(d). If the treating physician, after a reasonable attempt, is unable
to find a physician willing to implement or carry out the medical
orders included in the declarant's POST form, the treating
physician may decline to implement or carry out the medical
orders.
(f) If, under this section, the treating physician does not transfer
a declarant or implement the medical orders included in the
declarant's POST form and the declarant is competent, the treating
physician shall attempt to ascertain the declarant's preferences for
medical care by discussing the preferences with the declarant. If
the declarant is incompetent to act, the treating physician shall
attempt to ascertain the declarant's preferences for medical care
by consulting with the following individuals:
(1) The treating physician shall consult with any
representative who is available, willing, and competent to act.
(2) If the declarant does not have a representative or if a
representative is not available, willing, and competent to act,
the treating physician shall consult with any of the following
individuals who are available, willing, and competent to act:
(A) The declarant's spouse.
(B) An adult child of the declarant, or, if the declarant has
more than one (1) adult child, a majority of the children
who are reasonably available for consultation.
(C) A parent of the declarant.
(D) An adult sibling of the declarant, or, if the declarant
has more than one (1) adult sibling, a majority of the
siblings who are reasonably available for consultation.
(E) An individual with firsthand knowledge of the
declarant's intentions.
(g) An individual described in subsection (f) shall act according
to the declarant's intentions, if known, or in the best interest of the
declarant.
(h) The physician shall list the names of the individuals
described in subsection (f) who were consulted and the information
received by the individuals in the declarant's medical record.
Sec. 16. (a) A:
(1) health care provider;
(2) health care facility; or
(3) health entity;
or an employee under the direction of a person described in
subdivisions (1) through (3) that acts in good faith and in
accordance with reasonable medical standards to carry out the
orders on a POST form, including a medical order for the
withholding or withdrawal of life prolonging procedures, is not
subject to criminal or civil liability and may not be found to have
committed an act of unprofessional conduct.
(b) A health care provider may presume in the absence of actual
notice or evidence to the contrary that a POST form executed in
compliance with this chapter is valid and enforceable.
Sec. 17. (a) This chapter may not be construed to modify or alter
any applicable laws, ethics, standards, or protocols for the practice
of medicine or nursing, including section 19 of this chapter
concerning euthanasia.
(b) A POST form may not be construed to compel or authorize
a health care provider or health care facility to administer medical
treatment that is medically inappropriate or prohibited by state or
federal law.
Sec. 18. (a) A death as a result of the withholding or withdrawal
of life prolonging procedures in accordance with a declarant's
POST form does not constitute a suicide.
(b) A person may not require an individual to complete a POST
form as a condition of receiving health care services.
(c) This chapter does not impair or supersede any legal right or
legal responsibility that an individual may have to effect the
provision, withholding, or withdrawing of care or treatment,
including the withholding or withdrawal of life prolonging
procedures, in a lawful manner.
(d) Use of a POST form is voluntary. If an individual refuses to
complete a POST form, a person described in section 16(a) of this
chapter shall document the refusal in the individual's medical
records and may not ask the individual again to complete a POST
form unless:
(1) required to do so by:
(A) state or federal law or regulation; or
(B) national accrediting entity standards; or
(2) a significant change in condition that is documented in the
individual's medical record has occurred.
Sec. 19. This chapter does not authorize euthanasia or any
affirmative or deliberate act or omission to end life other than to
permit the natural process of dying.
Sec. 20. The execution or revocation of a POST form by or for
a qualified person does not revoke or impair the validity of any of
the following:
(1) A power of attorney that is executed by a qualified person
when the qualified person is competent.
(2) Health care powers that are granted to an attorney in fact
under IC 30-5-5-16 or IC 30-5-5-17.
(3) An appointment of a health care representative that is
executed by a qualified person, except to the extent that the
POST form contains a superseding appointment of a new
health care representative under section 9(b)(7) of this
chapter.
(4) The authority of a health care representative under
IC 16-36-1 to consent to health care on behalf of the qualified
patient.
(5) The authority of an attorney in fact holding health care
powers under IC 30-5-5-16 or IC 30-5-5-17 to issue and
enforce instructions under IC 30-5-7 concerning the qualified
person's health care.
(b) A policy of life insurance is not legally impaired or invalidated by the execution of a POST form, including the withholding or withdrawal of life prolonging procedures from an insured under the medical orders included in the POST form.
(c) A POST form may not be considered in the establishment of insurance premiums for an individual.
(d) A person may not require an individual to complete a POST form as a condition for being insured for health care services.
orders of a physician order for scope of treatment form).
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