Florida Senate - 2018                                     SB 474
       
       
        
       By Senator Brandes
       
       
       
       
       
       24-00549-18                                            2018474__
    1                        A bill to be entitled                      
    2         An act relating to physician orders for life
    3         sustaining treatment; creating s. 401.451, F.S.;
    4         establishing the Physician Orders for Life-Sustaining
    5         Treatment (POLST) Program within the Department of
    6         Health; defining terms; providing duties of the
    7         department; providing requirements for POLST forms;
    8         providing a restriction on the use of POLST forms;
    9         requiring periodic review of POLST forms; providing
   10         for the revocation of POLST forms under certain
   11         circumstances; authorizing expedited judicial
   12         intervention under certain circumstances; specifying
   13         which document takes precedence when directives in
   14         POLST forms conflict with other advance directives;
   15         providing limited immunity for legal representatives
   16         and specified health care providers acting in good
   17         faith in reliance on POLST forms; specifying
   18         additional requirements for POLST forms executed on
   19         behalf of minor patients under certain circumstances;
   20         requiring the review of a POLST form upon the transfer
   21         of a patient; prohibiting POLST forms from being
   22         required as a condition for treatment or admission to
   23         health care facilities; providing that the presence or
   24         absence of POLST forms does not affect, impair, or
   25         modify certain insurance contracts; declaring a POLST
   26         form invalid if it is executed in exchange for payment
   27         or other remuneration; providing construction;
   28         creating s. 408.064, F.S.; defining terms; requiring
   29         the Agency for Health Care Administration to establish
   30         and maintain a database of compassionate and
   31         palliative care plans by a specified date; providing
   32         duties of the agency; authorizing the agency to
   33         subscribe to or participate in a public or private
   34         clearinghouse in lieu of establishing and maintaining
   35         an independent database; amending ss. 400.142 and
   36         400.487, F.S.; authorizing specified personnel to
   37         withhold or withdraw cardiopulmonary resuscitation if
   38         presented with a POLST form that contains an order not
   39         to resuscitate the patient; providing immunity from
   40         criminal prosecution or civil liability to such
   41         personnel for such actions; providing that the absence
   42         of a POLST form does not preclude physicians or home
   43         health agency personnel from withholding or
   44         withdrawing cardiopulmonary resuscitation under
   45         certain conditions; amending s. 400.605, F.S.;
   46         requiring the Department of Elderly Affairs, in
   47         consultation with the agency, to adopt by rule
   48         procedures for the implementation of POLST forms in
   49         hospice care; amending s. 400.6095, F.S.; authorizing
   50         hospice care teams to withhold or withdraw
   51         cardiopulmonary resuscitation if presented with POLST
   52         forms that contain an order not to resuscitate;
   53         providing immunity from criminal prosecution or civil
   54         liability to hospice staff for such actions; providing
   55         that the absence of a POLST form does not preclude
   56         physicians from withholding or withdrawing
   57         cardiopulmonary resuscitation; amending s. 401.35,
   58         F.S.; requiring the Department of Health to establish
   59         circumstances and procedures for honoring certain
   60         POLST forms; amending s. 401.45, F.S.; authorizing
   61         emergency medical personnel to withhold or withdraw
   62         cardiopulmonary resuscitation or other medical
   63         interventions if presented with POLST forms that
   64         contain an order not to resuscitate; amending s.
   65         429.255, F.S.; authorizing assisted living facility
   66         personnel to withhold or withdraw cardiopulmonary
   67         resuscitation or the use of an automated external
   68         defibrillator if presented with POLST forms that
   69         contain an order not to resuscitate; providing
   70         immunity from criminal prosecution or civil liability
   71         to facility staff and facilities for such actions;
   72         providing that the absence of a POLST form does not
   73         preclude physicians from withholding or withdrawing
   74         cardiopulmonary resuscitation or the use of an
   75         automated external defibrillator; amending s. 429.73,
   76         F.S.; requiring the Department of Elderly Affairs to
   77         adopt rules for the implementation of POLST forms in
   78         adult family-care homes; authorizing providers of such
   79         homes to withhold or withdraw cardiopulmonary
   80         resuscitation if presented with POLST forms that
   81         contain an order not to resuscitate; providing
   82         immunity from criminal prosecution or civil liability
   83         to providers for such actions; amending s. 456.072,
   84         F.S.; authorizing certain licensees to withhold or
   85         withdraw cardiopulmonary resuscitation or the use of
   86         an automated external defibrillator if presented with
   87         orders not to resuscitate or POLST forms that contain
   88         an order not to resuscitate; requiring the Department
   89         of Health to adopt rules providing for the
   90         implementation of such orders; providing immunity from
   91         criminal prosecution or civil liability to licensees
   92         for withholding or withdrawing cardiopulmonary
   93         resuscitation or the use of an automated external
   94         defibrillator or for carrying out specified orders
   95         under certain circumstances; providing that the
   96         absence of a POLST form does not preclude a licensee
   97         from withholding or withdrawing cardiopulmonary
   98         resuscitation or the use of an automated external
   99         defibrillator under certain conditions; amending s.
  100         765.205, F.S.; requiring health care surrogates to
  101         provide written consent for POLST forms under certain
  102         circumstances; providing an effective date.
  103          
  104  Be It Enacted by the Legislature of the State of Florida:
  105  
  106         Section 1. Section 401.451, Florida Statutes, is created to
  107  read:
  108         401.451 Physician Orders for Life-Sustaining Treatment
  109  Program.—The Physician Orders for Life-Sustaining Treatment
  110  Program is established within the Department of Health to
  111  implement and administer the development and use of physician
  112  orders for life-sustaining treatment consistent with this
  113  section and to collaborate with the Agency for Health Care
  114  Administration in the implementation and operation of the
  115  Clearinghouse for Compassionate and Palliative Care Plans
  116  created under s. 408.064.
  117         (1)DEFINITIONS.—As used in this section, the term:
  118         (a) “Advance directive” has the same meaning as provided in
  119  s. 765.101.
  120         (b)“Agency” means the Agency for Health Care
  121  Administration.
  122         (c) “Clearinghouse for Compassionate and Palliative Care
  123  Plans” or “clearinghouse” has the same meaning as provided in s.
  124  408.064.
  125         (d) “End-stage condition” has the same meaning as provided
  126  in s. 765.101.
  127         (e) “Examining physician” means a physician who examines a
  128  patient who wishes, or whose legal representative wishes, to
  129  execute a POLST form; who attests to the ability of the patient
  130  or the patient’s legal representative to make and communicate
  131  health care decisions; who signs the POLST form; and who attests
  132  to the execution of the POLST form by the patient or by the
  133  patient’s legal representative.
  134         (f) “Health care provider” has the same meaning as provided
  135  in s. 408.07.
  136         (g) “Legal representative” means a patient’s legally
  137  authorized health care surrogate or proxy as provided in chapter
  138  765, a patient’s court-appointed guardian as provided in chapter
  139  744 who has been delegated authority to make health care
  140  decisions on behalf of the patient, an attorney in fact under a
  141  durable power of attorney as provided in chapter 709 who has
  142  been delegated authority to make health care decisions on behalf
  143  of the patient, or a patient’s parent if the patient is under 18
  144  years of age.
  145         (h) “Order not to resuscitate” means an order issued under
  146  s. 401.45(3).
  147         (i)“Physician order for life-sustaining treatment” or
  148  “POLST” means an order issued pursuant to this section which
  149  specifies a patient with an end-stage condition and provides
  150  directives for that patient’s medical treatment and care under
  151  certain conditions.
  152         (2) DUTIES OF THE DEPARTMENT.—The department shall:
  153         (a) Adopt rules to implement and administer the POLST
  154  program.
  155         (b) Prescribe a standardized POLST form.
  156         (c) Provide the POLST form in an electronic format on the
  157  department’s website and prominently state on the website the
  158  requirements for a POLST form as specified under paragraph
  159  (3)(a).
  160         (d) Consult with health care professional licensing groups,
  161  provider advocacy groups, medical ethicists, and other
  162  appropriate stakeholders on the development of rules and forms
  163  to implement and administer the POLST program.
  164         (e) Collaborate with the agency to develop and maintain the
  165  clearinghouse.
  166         (f) Ensure that department staff receive ongoing training
  167  on the POLST program and are aware of the availability of POLST
  168  forms.
  169         (g) Recommend a statewide, uniform process for identifying
  170  a patient who has, or whose legal representative has, executed a
  171  POLST form and for providing the contact information for the
  172  examining physician to the health care providers currently
  173  treating the patient.
  174         (h) Adopt POLST-related continuing education requirements
  175  for health care providers licensed by the department.
  176         (i) Develop a process for collecting feedback from health
  177  care providers to facilitate the periodic redesign of the POLST
  178  form in accordance with current health care best practices.
  179         (3) POLST FORM.—
  180         (a) Requirements.—A POLST form may not include a directive
  181  regarding hydration or the preselection of any decision or
  182  directive. A POLST form must be voluntarily executed by the
  183  patient or, if the patient is incapacitated or a minor, the
  184  patient’s legal representative, and all directives included in
  185  the form must be made by the patient or, if the patient is
  186  incapacitated or a minor, the patient’s legal representative at
  187  the time of signing the form. A POLST form is not valid and may
  188  not be included in a patient’s medical records or submitted to
  189  the clearinghouse unless the form:
  190         1.Is clearly printed on one or both sides of a single
  191  piece of paper as determined by department rule;
  192         2.Includes the signatures of the patient and the patient’s
  193  examining physician or, if the patient is incapacitated or a
  194  minor, the patient’s legal representative and the patient’s
  195  examining physician. The POLST form may be executed only after
  196  the examining physician consults with the patient or the
  197  patient’s legal representative, as appropriate;
  198         3. Prominently states that completion of a POLST form is
  199  voluntary, that the execution or use of a POLST form may not be
  200  required as a condition for medical treatment, and that a POLST
  201  form may not be given effect if the patient is conscious and
  202  competent to make health care decisions;
  203         4. Prominently provides in a conspicuous location on the
  204  form a space for the patient’s examining physician to attest
  205  that, in his or her clinical judgment and with good faith, at
  206  the time the POLST form is completed and signed, the patient has
  207  the ability to make and communicate health care decisions or, if
  208  the patient is incapacitated or a minor, that the patient’s
  209  legal representative has such ability;
  210         5. Includes an expiration date, provided by the patient’s
  211  examining physician, that is within 1 year after the patient or
  212  the patient’s legal representative signs the form or that is
  213  contingent on completion of the course of treatment addressed in
  214  the POLST form, whichever occurs first; and
  215         6. Identifies the medical condition or conditions, provided
  216  by the patient’s examining physician, that necessitate the POLST
  217  form.
  218         (b) Restriction on the use of a POLST form.—A POLST form
  219  may be completed only by or for a patient determined by the
  220  patient’s examining physician to have an end-stage condition or
  221  a patient who, in the good faith clinical judgment of the
  222  examining physician, is suffering from a life-limiting medical
  223  condition that will likely result in the death of the patient
  224  within 1 year after the execution of the form.
  225         (c) Periodic review of a POLST form.—At a minimum, the
  226  patient’s examining physician must review the patient’s POLST
  227  form with the patient or the patient’s legal representative, as
  228  appropriate, when the patient:
  229         1. Is transferred from one health care facility or level of
  230  care to another in accordance with subsection (6);
  231         2. Is discharged from a health care facility to return home
  232  before the expiration of the POLST form;
  233         3. Experiences a substantial change in his or her condition
  234  as determined by the patient’s examining physician, in which
  235  case the review must occur within 24 hours after the substantial
  236  change; or
  237         4. Expresses an intent to change his or her medical
  238  treatment preferences.
  239         (d) Revocation of a POLST form.—
  240         1. A POLST form may be revoked at any time by the patient
  241  or the patient’s legal representative if the patient is a minor
  242  or if the patient is incapacitated and has granted the authority
  243  to revoke a POLST form to his or her legal representative.
  244         2. The execution of a POLST form by a patient and the
  245  patient’s examining physician or, if the patient is
  246  incapacitated or a minor, by the patient’s legal representative
  247  and the patient’s examining physician under this section
  248  automatically revokes all POLST forms previously executed by the
  249  patient.
  250         (e) Review of a legal representative’s decision on a POLST
  251  form.—If a family member of the patient, the health care
  252  facility providing services to the patient, or the patient’s
  253  physician who may reasonably be expected to be affected by the
  254  patient’s POLST form directives believes that directives
  255  executed by the patient’s legal representative are in conflict
  256  with the patient’s prior expressed desires regarding end-of-life
  257  care, the family member, facility, or physician may seek
  258  expedited judicial intervention pursuant to the Florida Probate
  259  Rules.
  260         (f) Conflicting advance directives.—To the extent that a
  261  directive made on a patient’s POLST form conflicts with another
  262  advance directive of the patient which addresses a substantially
  263  similar health care condition or treatment, the document most
  264  recently signed by the patient takes precedence. Such directives
  265  may include, but are not limited to:
  266         1. A living will.
  267         2. A health care power of attorney.
  268         3. A POLST form for the specific medical condition or
  269  treatment.
  270         4. An order not to resuscitate.
  271         (4) ACTING IN GOOD FAITH; LIMITED IMMUNITY.—
  272         (a) An individual acting in good faith as a legal
  273  representative who executes a POLST form on behalf of an
  274  incapacitated patient or a minor patient in accordance with this
  275  section and rules adopted by the department is not subject to
  276  criminal prosecution or civil liability for executing the POLST
  277  form.
  278         (b) A licensee, physician, medical director, emergency
  279  medical technician, paramedic, or registered nurse who in good
  280  faith complies with a POLST form is not subject to criminal
  281  prosecution or civil liability for complying with the POLST
  282  form, and has not engaged in negligent or unprofessional conduct
  283  as a result of carrying out the directives of a POLST form
  284  executed in accordance with this section and rules adopted by
  285  the department.
  286         (5)POLST FORM FOR A MINOR PATIENT.—If a medical order on a
  287  POLST form executed for a minor patient directs that life
  288  sustaining treatment may be withheld from the minor patient, the
  289  order must include certifications by the patient’s examining
  290  physician and a health care provider other than the examining
  291  physician stating that, in their clinical judgment, an order to
  292  withhold medical treatment is in the best interest of the minor
  293  patient. A POLST form for a minor patient must be signed by the
  294  minor patient’s legal representative. The minor patient’s
  295  examining physician must certify the basis for the authority of
  296  the minor patient’s legal representative to execute the POLST
  297  form on behalf of the minor patient, including the legal
  298  representative’s compliance with the relevant provisions of
  299  chapter 744 or chapter 765.
  300         (6) PATIENT TRANSFER; POLST FORM REVIEW REQUIRED.—If a
  301  patient whose goals and preferences for care have been entered
  302  in a valid POLST form is transferred from one health care
  303  facility or level of care to another, the health care facility
  304  or level of care initiating the transfer must communicate the
  305  existence of the POLST form to the receiving facility or level
  306  of care before the transfer. Upon the patient’s transfer, the
  307  treating health care provider at the receiving facility or level
  308  of care must review the POLST form with the patient or, if the
  309  patient is incapacitated or a minor, the patient’s legal
  310  representative.
  311         (7) POLST FORM NOT A PREREQUISITE.—A POLST form may not be
  312  a prerequisite for receiving medical services or for admission
  313  to a health care facility. A health care facility or health care
  314  provider may not require a person to complete, revise, or revoke
  315  a POLST form as a condition of receiving medical services or
  316  treatment or as a condition of admission. The execution,
  317  revision, or revocation of a POLST form must be a voluntary
  318  decision of the patient or, if the patient is incapacitated or a
  319  minor, the patient’s legal representative.
  320         (8) INSURANCE NOT AFFECTED.—The presence or absence of a
  321  POLST form does not affect, impair, or modify a contract of life
  322  or health insurance or annuity to which an individual is a party
  323  and may not serve as the basis for a delay in issuing or
  324  refusing to issue a policy of life or health insurance or an
  325  annuity or for an increase or decrease in premiums charged to
  326  the individual.
  327         (9) INVALIDITY.—A POLST form is invalid if payment or other
  328  remuneration was offered or made in exchange for execution of
  329  the form.
  330         (10) CONSTRUCTION.—This section may not be construed to
  331  condone, authorize, or approve mercy killing or euthanasia. The
  332  Legislature does not intend that this act be construed as
  333  authorizing an affirmative or deliberate act to end a person’s
  334  life, except to allow the natural process of dying.
  335         Section 2. Section 408.064, Florida Statutes, is created to
  336  read:
  337         408.064 Clearinghouse for Compassionate and Palliative Care
  338  Plans.—
  339         (1)DEFINITIONS.—As used in this section, the term:
  340         (a) “Advance directive” has the same meaning as provided in
  341  s. 765.101.
  342         (b) “Clearinghouse for Compassionate and Palliative Care
  343  Plans” or “clearinghouse” means the state’s electronic database
  344  of compassionate and palliative care plans submitted by
  345  residents of this state and managed by the agency pursuant to
  346  this section.
  347         (c) “Compassionate and palliative care plan” or “plan”
  348  means an end-of-life document or medical directive document
  349  recognized by this state and executed by a resident of this
  350  state, including, but not limited to, an advance directive, an
  351  order not to resuscitate, a physician order for life-sustaining
  352  treatment, or a health care surrogate designation.
  353         (d)“Department” means the Department of Health.
  354         (e) “End-stage condition” has the same meaning as provided
  355  in s. 765.101.
  356         (f) “Order not to resuscitate” means an order issued
  357  pursuant to s. 401.45(3).
  358         (g)“Physician order for life-sustaining treatment” or
  359  “POLST” means an order issued pursuant to s. 401.451 which
  360  specifies a patient with an end-stage condition and provides
  361  directions for that patient’s medical treatment and care under
  362  certain conditions.
  363         (2) ELECTRONIC DATABASE.—The Agency for Health Care
  364  Administration shall:
  365         (a) By January 1, 2019, establish and maintain the
  366  Clearinghouse for Compassionate and Palliative Care Plans, a
  367  reliable and secure database consisting of compassionate and
  368  palliative care plans submitted by residents of this state which
  369  is accessible to health care providers, health care facilities,
  370  and other authorized individuals through a secure electronic
  371  portal. The clearinghouse must allow the electronic submission,
  372  storage, indexing, and retrieval of such plans and allow access
  373  to them by the treating health care providers of the patients.
  374         (b) Develop and maintain a validation system that confirms
  375  the identity of the health care facility, health care provider,
  376  or other authorized individual seeking the retrieval of a plan
  377  and provides privacy protections that meet all state and federal
  378  privacy and security standards for the release of a patient’s
  379  personal and medical information to a third party.
  380         (c) Consult with compassionate and palliative care
  381  providers, health care facilities, and residents of this state
  382  as necessary and appropriate to facilitate the development and
  383  implementation of the clearinghouse.
  384         (d) Publish and disseminate to residents of this state
  385  information regarding the clearinghouse.
  386         (e) In collaboration with the department, develop and
  387  maintain a process for the submission of compassionate and
  388  palliative care plans by residents of this state or by health
  389  care providers on behalf of, and at the direction of, their
  390  patients, or the patients’ legal representatives as defined in
  391  s. 401.451, for inclusion in the clearinghouse.
  392         (f) Provide training to health care providers and health
  393  care facilities in this state on how to access plans in the
  394  clearinghouse.
  395         (3) ALTERNATIVE IMPLEMENTATION.—In lieu of establishing and
  396  maintaining the clearinghouse, the agency may subscribe to or
  397  otherwise participate in a database operated by a public or
  398  private entity if that database meets the requirements of this
  399  section. The alternative database must operate on a statewide
  400  basis in this state, and may operate on a nationwide or
  401  regionwide basis.
  402         Section 3. Subsection (3) of section 400.142, Florida
  403  Statutes, is amended to read:
  404         400.142 Emergency medication kits; orders not to
  405  resuscitate.—
  406         (3) Facility staff may withhold or withdraw cardiopulmonary
  407  resuscitation if presented with an order not to resuscitate
  408  executed pursuant to s. 401.45 or a physician order for life
  409  sustaining treatment (POLST) form executed pursuant to s.
  410  401.451 which contains an order not to resuscitate. Facility
  411  staff and facilities are not subject to criminal prosecution or
  412  civil liability, or considered to have engaged in negligent or
  413  unprofessional conduct, for withholding or withdrawing
  414  cardiopulmonary resuscitation pursuant to such an order or a
  415  POLST form. The absence of an order not to resuscitate executed
  416  pursuant to s. 401.45 or a POLST form executed pursuant to s.
  417  401.451 does not preclude a physician from withholding or
  418  withdrawing cardiopulmonary resuscitation as otherwise
  419  authorized permitted by law.
  420         Section 4. Section 400.487, Florida Statutes, is amended to
  421  read:
  422         400.487 Home health service agreements; physician’s,
  423  physician assistant’s, and advanced registered nurse
  424  practitioner’s treatment orders; patient assessment;
  425  establishment and review of plan of care; provision of services;
  426  orders not to resuscitate; physician orders for life-sustaining
  427  treatment.—
  428         (1) Services provided by a home health agency must be
  429  covered by an agreement between the home health agency and the
  430  patient or the patient’s legal representative specifying the
  431  home health services to be provided, the rates or charges for
  432  services paid with private funds, and the sources of payment,
  433  which may include Medicare, Medicaid, private insurance,
  434  personal funds, or a combination thereof. A home health agency
  435  providing skilled care must make an assessment of the patient’s
  436  needs within 48 hours after the start of services.
  437         (2) If When required by the provisions of chapter 464; part
  438  I, part III, or part V of chapter 468; or chapter 486, the
  439  attending physician, physician assistant, or advanced registered
  440  nurse practitioner, acting within his or her respective scope of
  441  practice, shall establish treatment orders for a patient who is
  442  to receive skilled care. The treatment orders must be signed by
  443  the physician, physician assistant, or advanced registered nurse
  444  practitioner before a claim for payment for the skilled services
  445  is submitted by the home health agency. If the claim is
  446  submitted to a managed care organization, the treatment orders
  447  must be signed within the time allowed under the provider
  448  agreement. The treatment orders shall be reviewed, as frequently
  449  as the patient’s illness requires, by the physician, physician
  450  assistant, or advanced registered nurse practitioner in
  451  consultation with the home health agency.
  452         (3) A home health agency shall arrange for supervisory
  453  visits by a registered nurse to the home of a patient receiving
  454  home health aide services in accordance with the patient’s
  455  direction, approval, and agreement to pay the charge for the
  456  visits.
  457         (4) Each patient has the right to be informed of and to
  458  participate in the planning of his or her care. Each patient
  459  must be provided, upon request, a copy of the plan of care
  460  established and maintained for that patient by the home health
  461  agency.
  462         (5) If When nursing services are ordered, the home health
  463  agency to which a patient has been admitted for care must
  464  provide the initial admission visit, all service evaluation
  465  visits, and the discharge visit by a direct employee. Services
  466  provided by others under contractual arrangements to a home
  467  health agency must be monitored and managed by the admitting
  468  home health agency. The admitting home health agency is fully
  469  responsible for ensuring that all care provided through its
  470  employees or contract staff is delivered in accordance with this
  471  part and applicable rules.
  472         (6) The skilled care services provided by a home health
  473  agency, directly or under contract, must be supervised and
  474  coordinated in accordance with the plan of care.
  475         (7) Home health agency personnel may withhold or withdraw
  476  cardiopulmonary resuscitation if presented with an order not to
  477  resuscitate executed pursuant to s. 401.45 or a physician order
  478  for life-sustaining treatment (POLST) form executed pursuant to
  479  s. 401.451 which contains an order not to resuscitate. The
  480  agency shall adopt rules providing for the implementation of
  481  such orders. Home health personnel and agencies are shall not be
  482  subject to criminal prosecution or civil liability, and are not
  483  nor be considered to have engaged in negligent or unprofessional
  484  conduct, for withholding or withdrawing cardiopulmonary
  485  resuscitation pursuant to such orders an order and rules adopted
  486  by the agency.
  487         Section 5. Paragraph (e) of subsection (1) of section
  488  400.605, Florida Statutes, is amended to read:
  489         400.605 Administration; forms; fees; rules; inspections;
  490  fines.—
  491         (1) The agency, in consultation with the department, may
  492  adopt rules to administer the requirements of part II of chapter
  493  408. The department, in consultation with the agency, shall by
  494  rule establish minimum standards and procedures for a hospice
  495  pursuant to this part. The rules must include:
  496         (e) Procedures relating to the implementation of advance
  497  advanced directives; physician orders for life-sustaining
  498  treatment (POLST) forms executed pursuant to s. 401.451; and
  499  orders not to resuscitate do-not-resuscitate orders.
  500         Section 6. Subsection (8) of section 400.6095, Florida
  501  Statutes, is amended to read:
  502         400.6095 Patient admission; assessment; plan of care;
  503  discharge; death.—
  504         (8) The hospice care team may withhold or withdraw
  505  cardiopulmonary resuscitation if presented with an order not to
  506  resuscitate executed pursuant to s. 401.45 or a physician order
  507  for life-sustaining treatment (POLST) form executed pursuant to
  508  s. 401.451 which contains an order not to resuscitate. The
  509  department shall adopt rules providing for the implementation of
  510  such orders. Hospice staff are shall not be subject to criminal
  511  prosecution or civil liability, and are not nor be considered to
  512  have engaged in negligent or unprofessional conduct, for
  513  withholding or withdrawing cardiopulmonary resuscitation
  514  pursuant to such orders an order and applicable rules. The
  515  absence of an order to resuscitate executed pursuant to s.
  516  401.45 or a POLST form executed pursuant to s. 401.451 does not
  517  preclude a physician from withholding or withdrawing
  518  cardiopulmonary resuscitation as otherwise authorized permitted
  519  by law.
  520         Section 7. Subsection (4) of section 401.35, Florida
  521  Statutes, is amended to read:
  522         401.35 Rules.—The department shall adopt rules, including
  523  definitions of terms, necessary to carry out the purposes of
  524  this part.
  525         (4) The rules must establish circumstances and procedures
  526  under which emergency medical technicians and paramedics may
  527  honor orders by the patient’s physician not to resuscitate
  528  executed pursuant to s. 401.45, or under a physician order for
  529  life-sustaining treatment (POLST) form executed pursuant to s.
  530  401.451 which contains an order not to resuscitate, or honor
  531  orders to withhold or withdraw other forms of medical
  532  intervention, and the documentation and reporting requirements
  533  for handling such requests.
  534         Section 8. Paragraph (a) of subsection (3) of section
  535  401.45, Florida Statutes, is amended to read:
  536         401.45 Denial of emergency treatment; civil liability.—
  537         (3)(a) Resuscitation or other forms of medical intervention
  538  may be withheld or withdrawn from a patient by an emergency
  539  medical technician, or paramedic, or other health care
  540  professional if the technician, paramedic, or professional is
  541  presented with evidence of an order not to resuscitate by the
  542  patient’s physician or evidence of a physician order for life
  543  sustaining treatment (POLST) form executed pursuant to s.
  544  401.451 which contains an order not to resuscitate or an order
  545  not to perform other medical intervention, as applicable is
  546  presented to the emergency medical technician or paramedic. To
  547  be valid, an order not to resuscitate or not to perform other
  548  medical intervention, to be valid, must be on the form adopted
  549  by rule of the department. The form must be signed by the
  550  patient’s physician and by the patient or, if the patient is
  551  incapacitated, the patient’s health care surrogate or proxy as
  552  provided in chapter 765, court-appointed guardian as provided in
  553  chapter 744, or attorney in fact under a durable power of
  554  attorney as provided in chapter 709 or, if the patient is a
  555  minor, the patient’s parent or legal guardian. The court
  556  appointed guardian or attorney in fact must have been delegated
  557  authority to make health care decisions on behalf of the
  558  patient.
  559         Section 9. Subsection (4) of section 429.255, Florida
  560  Statutes, is amended to read:
  561         429.255 Use of personnel; emergency care.—
  562         (4) Facility staff may withhold or withdraw cardiopulmonary
  563  resuscitation or the use of an automated external defibrillator
  564  if presented with an order not to resuscitate executed pursuant
  565  to s. 401.45 or a physician order for life-sustaining treatment
  566  (POLST) form executed pursuant to s. 401.451 which contains an
  567  order not to resuscitate. The department shall adopt rules
  568  providing for the implementation of such orders. Facility staff
  569  and facilities are shall not be subject to criminal prosecution
  570  or civil liability, and are not nor be considered to have
  571  engaged in negligent or unprofessional conduct, for withholding
  572  or withdrawing cardiopulmonary resuscitation or the use of an
  573  automated external defibrillator pursuant to such an order or a
  574  POLST form which contains an order not to resuscitate and rules
  575  adopted by the department. The absence of an order not to
  576  resuscitate executed pursuant to s. 401.45 or a POLST form
  577  executed pursuant to s. 401.451 does not preclude a physician
  578  from withholding or withdrawing cardiopulmonary resuscitation or
  579  the use of an automated external defibrillator as otherwise
  580  authorized permitted by law.
  581         Section 10. Subsection (3) of section 429.73, Florida
  582  Statutes, is amended to read:
  583         429.73 Rules and standards relating to adult family-care
  584  homes.—
  585         (3) The department shall adopt rules providing for the
  586  implementation of orders not to resuscitate and physician orders
  587  for life-sustaining treatment (POLST) forms executed pursuant to
  588  s. 401.451. The provider may withhold or withdraw
  589  cardiopulmonary resuscitation if presented with an order not to
  590  resuscitate executed pursuant to s. 401.45 or a POLST form
  591  executed pursuant to s. 401.451 which contains an order not to
  592  resuscitate. The provider is shall not be subject to criminal
  593  prosecution or civil liability, and is not nor be considered to
  594  have engaged in negligent or unprofessional conduct, for
  595  withholding or withdrawing cardiopulmonary resuscitation
  596  pursuant to such orders an order and applicable rules.
  597         Section 11. Present subsections (7) and (8) of section
  598  456.072, Florida Statutes, are redesignated as subsections (8)
  599  and (9), respectively, and a new subsection (7) is added to that
  600  section, to read:
  601         456.072 Grounds for discipline; penalties; enforcement.—
  602         (7) A licensee may withhold or withdraw cardiopulmonary
  603  resuscitation or the use of an automated external defibrillator
  604  if presented with an order not to resuscitate executed pursuant
  605  to s. 401.45 or a physician order for life-sustaining treatment
  606  (POLST) form executed pursuant to s. 401.451 which contains an
  607  order not to resuscitate. The department shall adopt rules
  608  providing for the implementation of such orders. A licensee is
  609  not subject to criminal prosecution or civil liability, and is
  610  not considered to have engaged in negligent or unprofessional
  611  conduct, for withholding or withdrawing cardiopulmonary
  612  resuscitation or the use of an automated external defibrillator,
  613  or otherwise carrying out an order in an order not to
  614  resuscitate executed pursuant to s. 401.45 or a POLST form
  615  executed pursuant to s. 401.451, pursuant to the order not to
  616  resuscitate or the POLST form and pursuant to rules adopted by
  617  the department. The absence of an order not to resuscitate
  618  executed pursuant to s. 401.45 or a POLST form executed pursuant
  619  to s. 401.451 does not preclude a licensee from withholding or
  620  withdrawing cardiopulmonary resuscitation or the use of an
  621  automated external defibrillator or otherwise carrying out a
  622  medical order authorized by law.
  623         Section 12. Paragraph (c) of subsection (1) of section
  624  765.205, Florida Statutes, is amended to read:
  625         765.205 Responsibility of the surrogate.—
  626         (1) The surrogate, in accordance with the principal’s
  627  instructions, unless such authority has been expressly limited
  628  by the principal, shall:
  629         (c) Provide written consent using an appropriate form
  630  whenever consent is required, including a physician’s order not
  631  to resuscitate or a physician order for life-sustaining
  632  treatment (POLST) form executed pursuant to s. 401.451.
  633         Section 13. This act shall take effect July 1, 2018.