HF 627

as introduced - 84th Legislature (2005 - 2006) Posted on 12/15/2009 12:00am

A bill for an act
relating to health; providing for do not
resuscitate/do not intubate orders; providing
liability protection for certain health professionals;
proposing coding for new law as Minnesota Statutes,
chapter 145D.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

new text begin [145D.01] DEFINITIONS.
new text end

new text begin Subdivision 1. new text end

new text begin Scope. new text end

new text begin The definitions in this section
apply to this chapter.
new text end

new text begin Subd. 2. new text end

new text begin Attending physician. new text end

new text begin "Attending physician"
means a physician selected by or assigned to the principal who
has primary responsibility for treatment or care of the
principal and who is licensed under chapter 147. If more than
one physician shares that responsibility, any of those
physicians may act as the attending physician under the
provisions of this chapter.
new text end

new text begin Subd. 3. new text end

new text begin Cardiopulmonary resuscitation. new text end

new text begin "Cardiopulmonary
resuscitation" means those measures used to restore or support
cardiac or respiratory function in the event of a cardiac or
respiratory arrest.
new text end

new text begin Subd. 4. new text end

new text begin Commissioner. new text end

new text begin "Commissioner" means the
commissioner of health.
new text end

new text begin Subd. 5. new text end

new text begin Decision-making capacity. new text end

new text begin "Decision-making
capacity" means the ability to understand the significant
benefits, risks, and alternatives to proposed health care and to
make and communicate a health care decision.
new text end

new text begin Subd. 6. new text end [DNR/DNI] new text begin "DNR/DNI" means do not resuscitate and
do not intubate.
new text end

new text begin Subd. 7. new text end

new text begin Dnr/dni identification. new text end

new text begin "DNR/DNI identification"
means a standardized identification necklace, bracelet, or card,
as provided under section 145D.11, that signifies that a DNR/DNI
order has been issued for the possessor.
new text end

new text begin Subd. 8. new text end

new text begin Dnr/dni order. new text end

new text begin "DNR/DNI order" means an order
issued by an attending physician that cardiopulmonary
resuscitation or intubation should not be administered to a
principal.
new text end

new text begin Subd. 9. new text end

new text begin Ems personnel. new text end

new text begin "EMS personnel" means emergency
medical services personnel, including paid or volunteer
firefighters, law-enforcement officers, emergency medical
technicians, paramedics, first responders, or other emergency
services personnel, providers, or entities acting within the
usual course of their professions.
new text end

new text begin Subd. 10. new text end

new text begin Health care decision. new text end

new text begin "Health care decision"
means a decision to give, withhold, or withdraw informed consent
to any type of health care, including, but not limited to,
medical and surgical treatments, including life-prolonging
interventions; nursing care; hospitalization; treatment in a
nursing home or other extended care facility; home health care;
and the gift or donation of a body organ or tissue.
new text end

new text begin Subd. 11. new text end

new text begin Health care facility. new text end

new text begin "Health care facility"
means a hospital or other entity licensed under sections 144.50
to 144.58, a nursing home licensed to serve adults under section
144A.02, a home care provider licensed under sections 144A.43 to
144A.47, or a hospice provider licensed under sections 144A.75
to 144A.755.
new text end

new text begin Subd. 12. new text end

new text begin Health care provider. new text end

new text begin "Health care provider"
means a person, health care facility, organization, or
corporation licensed, certified, or otherwise authorized or
permitted by the laws of this state to administer health care
directly or through an arrangement with other health care
providers, including health maintenance organizations licensed
under chapter 62D.
new text end

new text begin Subd. 13. new text end

new text begin Home. new text end

new text begin "Home" means any place of residence
other than a health care facility and includes residential board
and care homes and personal care homes.
new text end

new text begin Subd. 14. new text end

new text begin Principal. new text end

new text begin "Principal" means an individual age
18 or older who is the subject of a DNR/DNI order.
new text end

new text begin Subd. 15. new text end

new text begin Qualified physician. new text end

new text begin "Qualified physician"
means a physician licensed under chapter 147 who has personally
examined the principal.
new text end

new text begin Subd. 16. new text end

new text begin Health care agent or agent. new text end

new text begin "Health care agent"
or "agent" means an individual age 18 or older who is appointed
by a principal in a health care power of attorney to make health
care decisions on behalf of the principal.
new text end

new text begin Subd. 17. new text end

new text begin Trauma. new text end

new text begin "Trauma" means blunt or penetrating
bodily injuries from impact that occur in situations, including,
but not limited to, motor vehicle collisions, mass casualty
incidents, and industrial accidents.
new text end

Sec. 2.

new text begin [145D.02] APPLICABILITY.
new text end

new text begin This chapter applies to all persons regardless of whether
they have completed a living will under chapter 145B, a health
care directive under chapter 145C, or a health care power of
attorney under chapter 145C. For the purposes of direction to
EMS personnel, a DNR/DNI order does not apply to treatment
rendered at the site where trauma has occurred to a principal
who experiences a cardiac or respiratory arrest as the result of
severe trauma.
new text end

Sec. 3.

new text begin [145D.03] PRESUMED CONSENT TO CARDIOPULMONARY
RESUSCITATION AND INTUBATION.
new text end

new text begin (a) An individual is presumed to consent to the
administration of cardiopulmonary resuscitation and intubation
in the event of cardiac or respiratory arrest, unless one or
more of the following conditions, of which the health care
provider has actual knowledge, apply:
new text end

new text begin (1) a DNR/DNI order has been issued for the individual
according to this chapter;
new text end

new text begin (2) a completed health care directive for the individual is
in effect according to chapter 145C, or a completed living will
for the individual is in effect according to chapter 145B, and
the individual is in a terminal condition or a persistent
vegetative state; or
new text end

new text begin (3) a completed health care power of attorney for the
individual is in effect according to chapter 145C, in which the
individual indicated that the individual does not wish to
receive cardiopulmonary resuscitation or intubation or the
individual's health care agent has determined that the
individual would not wish to receive cardiopulmonary
resuscitation or intubation.
new text end

new text begin (b) Nothing in this section requires a nursing home,
personal care home, hospice, or extended care facility operated
in connection with hospitals to institute or maintain the
ability to provide cardiopulmonary resuscitation or intubation
or to expand its existing equipment, facilities, or personnel to
provide cardiopulmonary resuscitation or intubation. If a
health care facility does not provide cardiopulmonary
resuscitation or intubation, this policy must be communicated in
writing to the principal or health care agent prior to admission.
new text end

Sec. 4.

new text begin [145D.04] ISSUANCE OF DNR/DNI ORDER.
new text end

new text begin Subdivision 1. new text end

new text begin Issuance. new text end

new text begin An attending physician may
issue a DNR/DNI order for a principal who is present in or
residing at home or in a health care facility if the principal
or health care agent has consented to the order. A DNR/DNI
order must be issued in writing in the form described in this
section for a principal not present or residing in a health care
facility. For principals present in health care facilities, a
DNR/DNI order must be issued according to the policies and
procedures of the health care facility or according to this
section.
new text end

new text begin Subd. 2. new text end

new text begin Who may consent. new text end

new text begin (a) Principals may request
their physicians to issue DNR/DNI orders for them.
new text end

new text begin (b) A health care agent may consent to a DNR/DNI order for
a principal who lacks decision-making capacity. A DNR/DNI order
written by a physician, with the consent of the health care
agent, for a principal who lacks decision-making capacity is
valid and must be respected by health care providers.
new text end

new text begin (c) A parent or guardian may consent to a DNR/DNI order for
a minor child, if a second physician who has examined the child
concurs with the opinion of the attending physician that the
provision of cardiopulmonary resuscitation or intubation would
be contrary to accepted medical standards. If the minor is
between the ages of 16 and 18 and, in the opinion of the
attending physician, is of sufficient maturity to understand the
nature and effect of a DNR/DNI order, then the order must be
signed by the minor and a parent or guardian of the minor. In
the event of a conflict between the wishes of the parents or
guardians and the wishes of the mature minor, the wishes of the
mature minor must take precedence. For purposes of this
section, a minor less than 16 years of age is not considered
mature. Nothing in this section shall be interpreted to
conflict with the provisions of the federal Child Abuse
Prevention and Treatment Act and implementing regulations under
Code of Federal Regulations, title 45, section 1340. In the
event conflict is unavoidable, federal law and regulation
governs.
new text end

new text begin Subd. 3. new text end

new text begin Documentation. new text end

new text begin (a) For a principal not present
or residing in a health care facility, the DNR/DNI order must be
noted in the following form on a card suitable for carrying on
the person:
new text end

new text begin DNR/DNI ORDER
new text end

new text begin Physician Signature
new text end new text begin new text end

new text begin Address
new text end new text begin new text end

new text begin Principal Signature
new text end new text begin new text end

new text begin Address
new text end new text begin new text end

new text begin Health Care Agent Signature
new text end new text begin new text end

new text begin Address
new text end new text begin new text end

new text begin (b) For a principal residing in a health care facility, the
DNR/DNI order must be preserved in at least one of the following
forms:
new text end

new text begin (1) forms required by the policies and procedures of the
health care facility; or
new text end

new text begin (2) a DNR/DNI card according to paragraph (a).
new text end

Sec. 5.

new text begin [145D.05] COMPLIANCE.
new text end

new text begin (a) Health care providers must comply with the DNR/DNI
order when presented with one of the following:
new text end

new text begin (1) a DNR/DNI order completed by a physician on a form as
specified in section 145D.04;
new text end

new text begin (2) a DNR/DNI identification as provided under section
145D.11; or
new text end

new text begin (3) a DNR/DNI order for a principal present or residing in
a health care facility issued according to the health care
facility's policies and procedures.
new text end

new text begin (b) Health care providers must respect DNR/DNI orders for a
principal in health care facilities, ambulances, homes, and
communities.
new text end

Sec. 6.

new text begin [145D.06] REVOCATION OF DNR/DNI ORDER.
new text end

new text begin (a) At any time in a health care facility, a DNR/DNI order
may be revoked by the principal by making either a written,
oral, or other act of communication to a physician or other
professional health staff of the health care facility.
new text end

new text begin (b) At any time, a principal residing at home may revoke a
DNR/DNI order by destroying the order and removing any DNR/DNI
identification on the person. The principal is responsible for
notifying the principal's physician of the revocation.
new text end

new text begin (c) At any time, a health care agent may revoke consent to
a DNR/DNI order for a principal in a health care facility who
lacks decision-making capacity by:
new text end

new text begin (1) notifying a physician or other professional staff of
the health care facility of the revocation of consent in
writing; or
new text end

new text begin (2) by orally notifying the attending physician in the
presence of a witness 18 years of age or older.
new text end

new text begin (d) At any time, a health care agent may revoke the agent's
consent to a DNR/DNI order for a principal residing at home who
lacks decision-making capacity by destroying the order and
removing the DNR/DNI identification from the principal. The
health care agent is responsible for notifying the principal's
physician of the revocation.
new text end

new text begin (e) The attending physician who is informed of, or provided
with, a revocation of consent according to this section must
immediately cancel the DNR/DNI order if the principal is in a
health care facility and notify the professional health staff of
the health care facility responsible for the principal's care of
the revocation and cancellation. Any professional health staff
of the health care facility who is informed of or provided with
a revocation of consent according to this section must
immediately notify the attending physician of the revocation.
new text end

new text begin (f) Only a licensed physician may cancel the issuance of a
DNR/DNI order.
new text end

Sec. 7.

new text begin [145D.07] LIABILITY PROTECTION.
new text end

new text begin (a) A health care provider, EMS personnel, health care
facility, or individual employed by, acting as the agent of, or
under contract with any of the foregoing is immune from criminal
or civil liability for carrying out in good faith a DNR/DNI
order authorized by this chapter on behalf of a principal as
instructed by the principal or health care agent.
new text end

new text begin (b) A health care provider, EMS personnel, health care
facility, individual employed by, acting as agent of, or under
contract with any of the foregoing, or other individual who
witnesses a cardiac or respiratory arrest is immune from
criminal or civil liability for providing cardiopulmonary
resuscitation or intubation to a principal for whom a DNR/DNI
order has been issued, if the health care provider or individual
reasonably and in good faith:
new text end

new text begin (1) was unaware of the issuance of a DNR/DNI order; or
new text end

new text begin (2) believed that consent to the DNR/DNI order had been
revoked or canceled.
new text end

new text begin (c) Any physician who refuses to issue a DNR/DNI order at a
principal's request or to comply with a DNR/DNI order entered
according to this chapter must take reasonable steps to promptly
advise the principal or health care agent of the principal that
the physician is unwilling to effectuate the order. The
attending physician must thereafter at the election of the
principal or health care agent permit the principal or health
care agent to obtain another physician.
new text end

Sec. 8.

new text begin [145D.08] INSURANCE.
new text end

new text begin (a) No policy of life insurance is legally impaired,
modified, or invalidated in any manner by the issuance of a
DNR/DNI order, notwithstanding any term of the policy to the
contrary.
new text end

new text begin (b) A person may not prohibit or require the issuance of a
DNR/DNI order for an individual as a condition of the individual
being insured or receiving health care services.
new text end

Sec. 9.

new text begin [145D.09] INTERINSTITUTIONAL TRANSFERS.
new text end

new text begin If a principal with a DNR/DNI order is transferred from one
health care facility to another health care facility, the health
care facility initiating the transfer must communicate the
existence of a DNR/DNI order to the receiving facility prior to
the transfer. The written DNR/DNI order, or the DNR/DNI card
described in section 145D.04, must accompany the principal to
the health care facility receiving the principal and remains
effective until a physician at the receiving facility issues
admission orders. The DNR/DNI card must be kept as the first
page in the principal's transfer records.
new text end

Sec. 10.

new text begin [145D.10] PRESERVATION OF EXISTING RIGHTS.
new text end

new text begin (a) Nothing in this chapter supersedes any legal right or
legal responsibility that any person may have to effect the
withholding of cardiopulmonary resuscitation or intubation in
any lawful manner. In this respect, the provisions of this
chapter are cumulative.
new text end

new text begin (b) Nothing in this chapter shall be construed to preclude
a court of competent jurisdiction from approving the issuance of
a DNR/DNI order under circumstances other than those under which
such an order may be issued according to this chapter.
new text end

Sec. 11.

new text begin [145D.11] FORMAT; DISTRIBUTION.
new text end

new text begin (a) The commissioner must implement the statewide
distribution of standardized DNR/DNI forms as described in
section 145D.04, subdivision 3.
new text end

new text begin (b) DNR/DNI identification may consist of either a medical
condition bracelet or necklace with an inscription of the
patient's name, date of birth in numerical form, and "MN
DNR/DNI." The commissioner must issue the DNR/DNI
identification only upon presentation of a properly executed
DNR/DNI order form as described in section 145D.04, subdivision
3, or a DNR/DNI order properly executed according to a health
care facility's written policy and procedure.
new text end

new text begin (c) The commissioner must establish a system for the
distribution of DNR/DNI identification. The commissioner must
develop and implement a statewide educational effort to inform
the public of the right to accept or refuse cardiopulmonary
resuscitation or intubation and to request a physician to write
a DNR/DNI order.
new text end

Sec. 12.

new text begin [145D.12] CERTAIN PRACTICES NOT CONDONED.
new text end

new text begin Withholding cardiopulmonary resuscitation or intubation
from a principal according to this chapter does not, for any
purpose, constitute suicide or murder. Withholding
cardiopulmonary resuscitation from a principal according to this
chapter, however, does not relieve an individual of
responsibility for any criminal acts that may have caused the
principal's condition. Nothing in this chapter legalizes,
condones, authorizes, or approves mercy killing or assisted
suicide.
new text end