Florida Senate - 2019                                     SB 206
       
       
        
       By Senator Brandes
       
       
       
       
       
       24-00501-19                                            2019206__
    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 for specified purposes; defining terms;
    7         providing duties of the department; providing
    8         requirements for POLST forms; providing a restriction
    9         on the use of POLST forms; requiring periodic review
   10         of POLST forms; providing for the revocation of POLST
   11         forms under certain circumstances; authorizing
   12         expedited judicial intervention under certain
   13         circumstances; specifying which document takes
   14         precedence when directives in POLST forms conflict
   15         with other advance directives; providing limited
   16         immunity for legal representatives and specified
   17         health care providers acting in good faith in reliance
   18         on POLST forms; specifying additional requirements for
   19         POLST forms executed on behalf of minor patients under
   20         certain circumstances; requiring the review of a POLST
   21         form upon the transfer of a patient; prohibiting
   22         health care facilities and providers from requiring
   23         that a patient have in effect or modify a POLST form
   24         as a prerequisite to treatment or admission; providing
   25         that the presence or absence of a POLST form does not
   26         affect, impair, or modify certain insurance contracts
   27         or annuities, or the issuance thereof, or increase or
   28         decrease premiums; providing that a POLST form is
   29         invalid if it is executed in exchange for payment or
   30         other remuneration; providing construction; creating
   31         s. 408.064, F.S.; defining terms; requiring the Agency
   32         for Health Care Administration, by a specified date,
   33         to establish and maintain a clearinghouse for
   34         compassionate and palliative care plans consisting of
   35         a database accessible to health care providers and
   36         facilities and other authorized individuals; providing
   37         a requirement for the database; providing related
   38         duties of the agency; authorizing the agency to
   39         subscribe to or participate in a public or private
   40         database in lieu of establishing and maintaining the
   41         clearinghouse; amending ss. 400.142 and 400.487, F.S.;
   42         authorizing specified personnel to withhold or
   43         withdraw cardiopulmonary resuscitation if presented
   44         with a POLST form that contains an order not to
   45         resuscitate the patient; providing that the absence of
   46         a POLST form does not preclude physicians or home
   47         health agency personnel from withholding or
   48         withdrawing cardiopulmonary resuscitation under
   49         certain conditions; providing immunity from criminal
   50         prosecution or civil liability to such personnel for
   51         such actions; amending s. 400.605, F.S.; requiring the
   52         Department of Elderly Affairs, in consultation with
   53         the agency, to adopt by rule procedures for the
   54         implementation of POLST forms in hospice care;
   55         amending s. 400.6095, F.S.; authorizing hospice care
   56         teams to withhold or withdraw cardiopulmonary
   57         resuscitation if presented with POLST forms that
   58         contain an order not to resuscitate; providing
   59         immunity from criminal prosecution or civil liability
   60         to hospice staff for such actions; providing that the
   61         absence of a POLST form does not preclude physicians
   62         from withholding or withdrawing cardiopulmonary
   63         resuscitation; amending s. 401.35, F.S.; requiring the
   64         Department of Health to establish circumstances and
   65         procedures for honoring certain POLST forms; amending
   66         s. 401.45, F.S.; authorizing emergency medical
   67         personnel to withhold or withdraw forms of medical
   68         intervention, in addition to cardiopulmonary
   69         resuscitation, under certain circumstances; providing
   70         that a specified form is valid if signed by a minor’s
   71         parent or legal guardian; conforming provisions to
   72         changes made by the act; amending s. 429.255, F.S.;
   73         authorizing assisted living facility personnel to
   74         withhold or withdraw cardiopulmonary resuscitation or
   75         the use of an automated external defibrillator if
   76         presented with POLST forms that contain an order not
   77         to resuscitate; providing immunity from criminal
   78         prosecution or civil liability to facility staff and
   79         facilities for such actions; providing that the
   80         absence of a POLST form does not preclude physicians
   81         from withholding or withdrawing cardiopulmonary
   82         resuscitation or the use of an automated external
   83         defibrillator; amending s. 429.73, F.S.; requiring the
   84         Department of Elderly Affairs to adopt rules for the
   85         implementation of POLST forms in adult family-care
   86         homes; authorizing providers of such homes to withhold
   87         or withdraw cardiopulmonary resuscitation if presented
   88         with POLST forms that contain an order not to
   89         resuscitate; providing immunity from criminal
   90         prosecution or civil liability to providers for such
   91         actions; amending s. 456.072, F.S.; authorizing
   92         certain licensees to withhold or withdraw
   93         cardiopulmonary resuscitation or the use of an
   94         automated external defibrillator if presented with
   95         orders not to resuscitate or POLST forms that contain
   96         an order not to resuscitate; requiring the Department
   97         of Health to adopt rules providing for the
   98         implementation of such orders; providing immunity from
   99         criminal prosecution or civil liability to licensees
  100         for the withholding or withdrawing of cardiopulmonary
  101         resuscitation or use of an automated external
  102         defibrillator or for carrying out specified orders
  103         under certain circumstances; providing that the
  104         absence of a POLST form does not preclude a licensee
  105         from withholding or withdrawing cardiopulmonary
  106         resuscitation or the use of an automated external
  107         defibrillator under certain conditions; amending s.
  108         765.205, F.S.; requiring health care surrogates to
  109         provide written consent for POLST forms under certain
  110         circumstances; providing an effective date.
  111          
  112  Be It Enacted by the Legislature of the State of Florida:
  113  
  114         Section 1. Section 401.451, Florida Statutes, is created to
  115  read:
  116         401.451 Physician Orders for Life-Sustaining Treatment
  117  Program.—The Physician Orders for Life-Sustaining Treatment
  118  Program is established within the Department of Health to
  119  implement and administer the development and use of physician
  120  orders for life-sustaining treatment consistent with this
  121  section and to collaborate with the Agency for Health Care
  122  Administration in the implementation and operation of the
  123  Clearinghouse for Compassionate and Palliative Care Plans
  124  created under s. 408.064.
  125         (1)DEFINITIONS.—As used in this section, the term:
  126         (a) “Advance directive” has the same meaning as in s.
  127  765.101.
  128         (b)“Agency” means the Agency for Health Care
  129  Administration.
  130         (c) “Clearinghouse for Compassionate and Palliative Care
  131  Plans” or “clearinghouse” has the same meaning as in s. 408.064.
  132         (d) “End-stage condition” has the same meaning as in s.
  133  765.101.
  134         (e) “Examining physician” means a physician who examines a
  135  patient who wishes, or whose legal representative wishes, to
  136  execute a POLST form; who attests to the ability of the patient
  137  or the patient’s legal representative to make and communicate
  138  health care decisions; who signs the POLST form; and who attests
  139  to the execution of the POLST form by the patient or by the
  140  patient’s legal representative.
  141         (f) “Health care provider” has the same meaning as in s.
  142  408.07.
  143         (g) “Legal representative” means a patient’s legally
  144  authorized health care surrogate or proxy as provided in chapter
  145  765; a patient’s court-appointed guardian, as provided in
  146  chapter 744, who has been delegated authority to make health
  147  care decisions on behalf of the patient; an attorney in fact,
  148  acting under a durable power of attorney as provided in chapter
  149  709, who has been delegated authority to make health care
  150  decisions on behalf of the patient; or a patient’s parent if the
  151  patient is under 18 years of age.
  152         (h) “Order not to resuscitate” means an order issued under
  153  s. 401.45(3).
  154         (i)“Physician order for life-sustaining treatment” or
  155  “POLST” means an order issued pursuant to this section which
  156  identifies a patient with an end-stage condition and provides
  157  directives for that patient’s medical treatment and care in
  158  certain circumstances.
  159         (2) DUTIES OF THE DEPARTMENT.—The department shall:
  160         (a) Adopt rules to implement and administer the POLST
  161  Program.
  162         (b) Prescribe a standardized POLST form.
  163         (c) Provide the POLST form in an electronic format on the
  164  department’s website and prominently state on the website the
  165  requirements for a POLST form as specified in paragraph (3)(a).
  166         (d) Consult with health care professional licensing groups,
  167  provider advocacy groups, medical ethicists, and other
  168  appropriate stakeholders on the development of rules and forms
  169  to implement and administer the POLST Program.
  170         (e) Collaborate with the agency to develop and maintain the
  171  clearinghouse.
  172         (f) Ensure that department staff receive ongoing training
  173  on the POLST Program and are aware of the availability of POLST
  174  forms.
  175         (g) Recommend a statewide, uniform process for identifying
  176  a patient who has, or whose legal representative has, executed a
  177  POLST form and for providing the contact information for the
  178  examining physician to the health care providers currently
  179  treating the patient.
  180         (h) Adopt POLST-related continuing education requirements
  181  for health care providers licensed by the department.
  182         (i) Develop a process for collecting feedback from health
  183  care providers to facilitate the periodic redesign of the POLST
  184  form in accordance with current health care best practices.
  185         (3) POLST FORMS.—
  186         (a) Requirements.—A POLST form may not include a directive
  187  regarding hydration or the preselection of any decision or
  188  directive. A POLST form must be voluntarily executed by the
  189  patient or, if the patient is incapacitated or a minor, the
  190  patient’s legal representative, and all directives included in
  191  the form must be made by the patient or, if the patient is
  192  incapacitated or a minor, the patient’s legal representative at
  193  the time of signing the form. A POLST form is not valid and may
  194  not be included in a patient’s medical records or submitted to
  195  the clearinghouse unless the form:
  196         1.Is clearly printed on one or both sides of a single
  197  piece of paper as determined by department rule;
  198         2.Includes the signatures of the patient and the patient’s
  199  examining physician or, if the patient is incapacitated or a
  200  minor, the patient’s legal representative and the patient’s
  201  examining physician. The POLST form may be executed only after
  202  the examining physician consults with the patient or the
  203  patient’s legal representative, as appropriate;
  204         3. Prominently states that completion of a POLST form is
  205  voluntary, that the execution or use of a POLST form may not be
  206  required as a condition for medical treatment, and that a POLST
  207  form may not be given effect if the patient is conscious and
  208  competent to make health care decisions;
  209         4. Prominently provides in a conspicuous location on the
  210  form a space for the patient’s examining physician to attest
  211  that, in his or her clinical judgment and with good faith, at
  212  the time the POLST form is completed and signed, the patient has
  213  the ability to make and communicate health care decisions or, if
  214  the patient is incapacitated or a minor, that the patient’s
  215  legal representative has such ability;
  216         5. Includes an expiration date, provided by the patient’s
  217  examining physician, which is within 1 year after the patient or
  218  the patient’s legal representative signs the form or which is
  219  contingent on completion of the course of treatment addressed in
  220  the POLST form, whichever occurs first; and
  221         6. Identifies the medical condition or conditions, provided
  222  by the patient’s examining physician, which necessitate the
  223  POLST form.
  224         (b) Restriction on use.A POLST form may be completed only
  225  by or for a patient determined by the patient’s examining
  226  physician to have an end-stage condition or a patient who, in
  227  the good faith clinical judgment of the examining physician, is
  228  suffering from a life-limiting medical condition that will
  229  likely result in the death of the patient within 1 year after
  230  the execution of the form.
  231         (c) Periodic review.At a minimum, the patient’s examining
  232  physician must review the patient’s POLST form with the patient
  233  or the patient’s legal representative, as appropriate, when the
  234  patient:
  235         1. Is transferred from one health care facility or level of
  236  care to another in accordance with subsection (6);
  237         2. Is discharged from a health care facility to return home
  238  before the expiration of the POLST form;
  239         3. Experiences a substantial change in his or her condition
  240  as determined by the patient’s examining physician, in which
  241  case the review must occur within 24 hours after the substantial
  242  change; or
  243         4. Expresses an intent to change his or her medical
  244  treatment preferences.
  245         (d) Revocation.
  246         1. A POLST form may be revoked at any time by the patient;
  247  if the patient is a minor, by the patient’s legal
  248  representative; or, if the patient is incapacitated and has
  249  granted the authority to revoke a POLST form to such person, by
  250  his or her legal representative.
  251         2. The execution of a POLST form under this section by a
  252  patient and the patient’s examining physician or, if the patient
  253  is incapacitated or a minor, by the patient’s legal
  254  representative and the patient’s examining physician
  255  automatically revokes all POLST forms previously executed by the
  256  patient.
  257         (e) Review of a legal representative’s decision.—If a
  258  family member of the patient, the health care facility providing
  259  services to the patient, or the patient’s physician who may
  260  reasonably be expected to be affected by the patient’s POLST
  261  form directives believes that directives executed by the
  262  patient’s legal representative are in conflict with the
  263  patient’s prior expressed desires regarding end-of-life care,
  264  the family member, facility, or physician may seek expedited
  265  judicial intervention pursuant to the Florida Probate Rules.
  266         (f) Conflicting advance directives.—To the extent that a
  267  directive made on a patient’s POLST form conflicts with another
  268  advance directive of the patient which addresses a substantially
  269  similar health care condition or treatment, the document most
  270  recently signed by the patient takes precedence. Such directives
  271  may include, but are not limited to:
  272         1. A living will.
  273         2. A health care power of attorney.
  274         3. A POLST form for the specific medical condition or
  275  treatment.
  276         4. An order not to resuscitate.
  277         (4) ACTING IN GOOD FAITH; LIMITED IMMUNITY.—
  278         (a) An individual acting in good faith as a legal
  279  representative who executes, in accordance with this section and
  280  rules adopted by the department, a POLST form on behalf of an
  281  incapacitated patient or a minor patient is not subject to
  282  criminal prosecution or civil liability for such execution.
  283         (b) A licensee, a physician, a medical director, an
  284  emergency medical technician, a paramedic, or a registered nurse
  285  who in good faith complies with a POLST form is not subject to
  286  criminal prosecution or civil liability for such compliance and
  287  does not engage in negligent or unprofessional conduct by virtue
  288  of compliance with a POLST form executed in accordance with this
  289  section and rules adopted by the department.
  290         (5)POLST FORM FOR A MINOR PATIENT.—If a medical order on a
  291  POLST form executed for a minor patient directs that life
  292  sustaining treatment may be withheld from the minor patient, the
  293  order must include certifications by the patient’s examining
  294  physician and a health care provider other than the examining
  295  physician stating that, in their clinical judgment, an order to
  296  withhold medical treatment is in the best interest of the minor
  297  patient. A POLST form for a minor patient must be signed by the
  298  minor patient’s legal representative. The minor patient’s
  299  examining physician shall certify the basis for the authority of
  300  the minor patient’s legal representative to execute the POLST
  301  form on behalf of the minor patient, including the legal
  302  representative’s compliance with the relevant provisions of
  303  chapter 744 or chapter 765.
  304         (6) PATIENT TRANSFER; POLST FORM REVIEW REQUIRED.—If a
  305  patient whose goals and preferences for care have been
  306  documented in a valid POLST form is transferred from one health
  307  care facility or level of care to another, the health care
  308  facility or level of care initiating the transfer must
  309  communicate the existence of the POLST form to the receiving
  310  facility or level of care before the transfer. Upon the
  311  patient’s transfer, the treating health care provider at the
  312  receiving facility or level of care must review the POLST form
  313  with the patient or, if the patient is incapacitated or a minor,
  314  the patient’s legal representative.
  315         (7) POLST FORM NOT A PREREQUISITE.—A health care facility
  316  or provider may not require that a patient have in effect a
  317  POLST form as a prerequisite to receiving medical services or
  318  admission. A health care facility or health care provider may
  319  not require a person to complete, revise, or revoke a POLST form
  320  as a condition of receiving medical services or treatment or as
  321  a condition of admission. Any decision regarding the execution,
  322  revision, or revocation of a POLST form must be voluntary on the
  323  part of the patient or, if the patient is incapacitated or a
  324  minor, the patient’s legal representative.
  325         (8) INSURANCE NOT AFFECTED.—The presence or absence of a
  326  POLST form does not affect, impair, or modify a contract of life
  327  or health insurance or an annuity to which an individual is a
  328  party and may not serve as the basis for a delay in issuing or
  329  refusing to issue a policy of life or health insurance or an
  330  annuity or for an increase or decrease in premiums charged to
  331  the individual.
  332         (9) INVALIDITY.—A POLST form is invalid if payment or other
  333  remuneration was offered or made in exchange for execution of
  334  the form.
  335         (10) CONSTRUCTION.—The Legislature intends that this act
  336  not be construed as authorizing an affirmative or deliberate act
  337  to end a person’s life, except to allow the natural process of
  338  dying. To that end, this section may not be construed to
  339  condone, authorize, or approve mercy killing or euthanasia.
  340         Section 2. Section 408.064, Florida Statutes, is created to
  341  read:
  342         408.064 Clearinghouse for compassionate and palliative care
  343  plans.—
  344         (1)DEFINITIONS.—As used in this section, the term:
  345         (a) “Advance directive” has the same meaning as in s.
  346  765.101.
  347         (b) “Clearinghouse” means an electronic database of
  348  compassionate and palliative care plans established by the
  349  agency under subsection (2) or an alternative database made
  350  available pursuant to subsection (3).
  351         (c) “Compassionate and palliative care plan” or “plan”
  352  means an end-of-life document or medical directive document,
  353  including, but not limited to, an advance directive, an order
  354  not to resuscitate, a physician order for life-sustaining
  355  treatment, or a health care surrogate designation, which is
  356  recognized by this state and executed by a resident of this
  357  state.
  358         (d)“Department” means the Department of Health.
  359         (e) “End-stage condition” has the same meaning as in s.
  360  765.101.
  361         (f) “Order not to resuscitate” means an order issued
  362  pursuant to s. 401.45(3).
  363         (g)“Physician order for life-sustaining treatment” or
  364  “POLST” means an order issued pursuant to s. 401.451 which
  365  identifies a patient with an end-stage condition and provides
  366  directions for that patient’s medical treatment and care in
  367  certain circumstances.
  368         (2) ELECTRONIC DATABASE.—Unless a like database is made
  369  available under subsection (3), the agency shall:
  370         (a) By January 1, 2020, establish and maintain a
  371  clearinghouse for compassionate and palliative care plans
  372  consisting of such plans submitted by residents of this state
  373  which is accessible to health care providers, health care
  374  facilities, and other authorized individuals through a secure
  375  electronic portal. The clearinghouse must allow the electronic
  376  submission, storage, indexing, and retrieval of such plans and
  377  allow access to them by the treating health care providers of
  378  the patients.
  379         (b) Develop and maintain a validation system that confirms
  380  the identity of the health care facility, health care provider,
  381  or other authorized individual seeking the retrieval of a plan
  382  and provides privacy protections that meet all state and federal
  383  privacy and security standards for the release of a patient’s
  384  personal and medical information to a third party.
  385         (c) Consult with compassionate and palliative care
  386  providers, health care facilities, and residents of this state
  387  as necessary and appropriate to facilitate the development and
  388  implementation of the clearinghouse.
  389         (d) Publish and disseminate to residents of this state
  390  information regarding the clearinghouse.
  391         (e) In collaboration with the department, develop and
  392  maintain a process for the submission of compassionate and
  393  palliative care plans by residents of this state or by health
  394  care providers on behalf of, and at the direction of, their
  395  patients, or the patients’ legal representatives as defined in
  396  s. 401.451, for inclusion in the clearinghouse.
  397         (f) Provide training to health care providers and health
  398  care facilities in this state as to how to access plans in the
  399  clearinghouse.
  400         (3) ALTERNATIVE IMPLEMENTATION.—In lieu of establishing and
  401  maintaining a clearinghouse as provided in subsection (2), the
  402  agency may subscribe to or otherwise participate in a database
  403  operated by a public or private entity which meets the
  404  requirements of this section. The alternative database must
  405  operate on at least a statewide basis and may operate on a
  406  nationwide or regionwide basis.
  407         Section 3. Subsection (3) of section 400.142, Florida
  408  Statutes, is amended to read:
  409         400.142 Emergency medication kits; orders not to
  410  resuscitate.—
  411         (3) Facility staff may withhold or withdraw cardiopulmonary
  412  resuscitation if presented with an order not to resuscitate
  413  executed pursuant to s. 401.45 or a physician order for life
  414  sustaining treatment (POLST) form executed pursuant to s.
  415  401.451 which contains an order not to resuscitate. Facility
  416  staff and facilities are not subject to criminal prosecution or
  417  civil liability, or considered to have engaged in negligent or
  418  unprofessional conduct, for withholding or withdrawing
  419  cardiopulmonary resuscitation pursuant to such an order or a
  420  POLST form. The absence of an order not to resuscitate executed
  421  pursuant to s. 401.45 or a POLST form executed pursuant to s.
  422  401.451 does not preclude a physician from withholding or
  423  withdrawing cardiopulmonary resuscitation as otherwise
  424  authorized permitted by law.
  425         Section 4. Section 400.487, Florida Statutes, is amended to
  426  read:
  427         400.487 Home health service agreements; physician’s,
  428  physician assistant’s, and advanced practice registered nurse’s
  429  treatment orders; patient assessment; establishment and review
  430  of plan of care; provision of services; orders not to
  431  resuscitate; physician orders for life-sustaining treatment
  432  (POLST).—
  433         (1) Services provided by a home health agency must be
  434  covered by an agreement between the home health agency and the
  435  patient or the patient’s legal representative specifying the
  436  home health services to be provided, the rates or charges for
  437  services paid with private funds, and the sources of payment,
  438  which may include Medicare, Medicaid, private insurance,
  439  personal funds, or a combination thereof. A home health agency
  440  providing skilled care must make an assessment of the patient’s
  441  needs within 48 hours after the start of services.
  442         (2) If When required by the provisions of chapter 464; part
  443  I, part III, or part V of chapter 468; or chapter 486, the
  444  attending physician, physician assistant, or advanced practice
  445  registered nurse, acting within his or her respective scope of
  446  practice, shall establish treatment orders for a patient who is
  447  to receive skilled care. The treatment orders must be signed by
  448  the physician, physician assistant, or advanced practice
  449  registered nurse before a claim for payment for the skilled
  450  services is submitted by the home health agency. If the claim is
  451  submitted to a managed care organization, the treatment orders
  452  must be signed within the time allowed under the provider
  453  agreement. The treatment orders shall be reviewed, as frequently
  454  as the patient’s illness requires, by the physician, physician
  455  assistant, or advanced practice registered nurse in consultation
  456  with the home health agency.
  457         (3) A home health agency shall arrange for supervisory
  458  visits by a registered nurse to the home of a patient receiving
  459  home health aide services in accordance with the patient’s
  460  direction, approval, and agreement to pay the charge for the
  461  visits.
  462         (4) Each patient has the right to be informed of and to
  463  participate in the planning of his or her care. Each patient
  464  must be provided, upon request, a copy of the plan of care
  465  established and maintained for that patient by the home health
  466  agency.
  467         (5) If When nursing services are ordered, the home health
  468  agency to which a patient has been admitted for care must
  469  provide the initial admission visit, all service evaluation
  470  visits, and the discharge visit by a direct employee. Services
  471  provided by others under contractual arrangements to a home
  472  health agency must be monitored and managed by the admitting
  473  home health agency. The admitting home health agency is fully
  474  responsible for ensuring that all care provided through its
  475  employees or contract staff is delivered in accordance with this
  476  part and applicable rules.
  477         (6) The skilled care services provided by a home health
  478  agency, directly or under contract, must be supervised and
  479  coordinated in accordance with the plan of care.
  480         (7) Home health agency personnel may withhold or withdraw
  481  cardiopulmonary resuscitation if presented with an order not to
  482  resuscitate executed pursuant to s. 401.45 or a POLST form
  483  executed pursuant to s. 401.451 which contains an order not to
  484  resuscitate. The agency shall adopt rules providing for the
  485  implementation of such orders. Home health personnel and
  486  agencies are shall not be subject to criminal prosecution or
  487  civil liability, and are not nor be considered to have engaged
  488  in negligent or unprofessional conduct, for withholding or
  489  withdrawing cardiopulmonary resuscitation pursuant to such
  490  orders an order and rules adopted by the agency.
  491         Section 5. Paragraph (e) of subsection (1) of section
  492  400.605, Florida Statutes, is amended to read:
  493         400.605 Administration; forms; fees; rules; inspections;
  494  fines.—
  495         (1) The agency, in consultation with the department, may
  496  adopt rules to administer the requirements of part II of chapter
  497  408. The department, in consultation with the agency, shall by
  498  rule establish minimum standards and procedures for a hospice
  499  pursuant to this part. The rules must include:
  500         (e) Procedures relating to the implementation of advance
  501  advanced directives; physician orders for life-sustaining
  502  treatment forms executed pursuant to s. 401.451; and orders not
  503  to resuscitate do-not-resuscitate orders.
  504         Section 6. Subsection (8) of section 400.6095, Florida
  505  Statutes, is amended to read:
  506         400.6095 Patient admission; assessment; plan of care;
  507  discharge; death.—
  508         (8) The hospice care team may withhold or withdraw
  509  cardiopulmonary resuscitation if presented with an order not to
  510  resuscitate executed pursuant to s. 401.45 or a physician order
  511  for life-sustaining treatment (POLST) form executed pursuant to
  512  s. 401.451 which contains an order not to resuscitate. The
  513  department shall adopt rules providing for the implementation of
  514  such orders. Hospice staff are shall not be subject to criminal
  515  prosecution or civil liability, and are not nor be considered to
  516  have engaged in negligent or unprofessional conduct, for
  517  withholding or withdrawing cardiopulmonary resuscitation
  518  pursuant to such orders an order and applicable rules. The
  519  absence of an order to resuscitate executed pursuant to s.
  520  401.45 or a POLST form executed pursuant to s. 401.451 does not
  521  preclude a physician from withholding or withdrawing
  522  cardiopulmonary resuscitation as otherwise authorized permitted
  523  by law.
  524         Section 7. Subsection (4) of section 401.35, Florida
  525  Statutes, is amended to read:
  526         401.35 Rules.—The department shall adopt rules, including
  527  definitions of terms, necessary to carry out the purposes of
  528  this part.
  529         (4) The rules must establish circumstances and procedures
  530  under which emergency medical technicians and paramedics may
  531  honor orders by the patient’s physician not to resuscitate
  532  executed pursuant to s. 401.45, or under a physician order for
  533  life-sustaining treatment form executed pursuant to s. 401.451
  534  which contains an order not to resuscitate, or honor orders to
  535  withhold or withdraw other forms of medical intervention, and
  536  the documentation and reporting requirements for handling such
  537  requests.
  538         Section 8. Paragraph (a) of subsection (3) of section
  539  401.45, Florida Statutes, is amended to read:
  540         401.45 Denial of emergency treatment; civil liability.—
  541         (3)(a) Resuscitation or other forms of medical intervention
  542  may be withheld or withdrawn from a patient by an emergency
  543  medical technician, or paramedic, or other health care
  544  professional if the technician, paramedic, or other professional
  545  is presented with evidence of an order not to resuscitate by the
  546  patient’s physician or evidence of a physician order for life
  547  sustaining treatment form executed pursuant to s. 401.451 which
  548  contains an order not to resuscitate or an order not to perform
  549  other medical intervention, as applicable is presented to the
  550  emergency medical technician or paramedic. To be valid, an order
  551  not to resuscitate or not to perform other medical intervention,
  552  to be valid, must be on the form adopted by rule of the
  553  department. The form must be signed by the patient’s physician
  554  and by the patient or, if the patient is incapacitated, the
  555  patient’s health care surrogate or proxy as provided in chapter
  556  765, court-appointed guardian as provided in chapter 744, or
  557  attorney in fact under a durable power of attorney as provided
  558  in chapter 709 or, if the patient is a minor, the patient’s
  559  parent or legal guardian. The court-appointed guardian or
  560  attorney in fact must have been delegated authority to make
  561  health care decisions on behalf of the patient.
  562         Section 9. Subsection (4) of section 429.255, Florida
  563  Statutes, is amended to read:
  564         429.255 Use of personnel; emergency care.—
  565         (4) Facility staff may withhold or withdraw cardiopulmonary
  566  resuscitation or the use of an automated external defibrillator
  567  if presented with an order not to resuscitate executed pursuant
  568  to s. 401.45 or a physician order for life-sustaining treatment
  569  (POLST) form executed pursuant to s. 401.451 which contains an
  570  order not to resuscitate. The department shall adopt rules
  571  providing for the implementation of such orders. Facility staff
  572  and facilities are shall not be subject to criminal prosecution
  573  or civil liability, and are not nor be considered to have
  574  engaged in negligent or unprofessional conduct, for withholding
  575  or withdrawing cardiopulmonary resuscitation or the use of an
  576  automated external defibrillator pursuant to such an order or a
  577  POLST form that contains an order not to resuscitate and rules
  578  adopted by the department. The absence of an order not to
  579  resuscitate executed pursuant to s. 401.45 or a POLST form
  580  executed pursuant to s. 401.451 does not preclude a physician
  581  from withholding or withdrawing cardiopulmonary resuscitation or
  582  the use of an automated external defibrillator as otherwise
  583  authorized permitted by law.
  584         Section 10. Subsection (3) of section 429.73, Florida
  585  Statutes, is amended to read:
  586         429.73 Rules and standards relating to adult family-care
  587  homes.—
  588         (3) The department shall adopt rules providing for the
  589  implementation of orders not to resuscitate and physician orders
  590  for life-sustaining treatment (POLST) forms executed pursuant to
  591  s. 401.451. The provider may withhold or withdraw
  592  cardiopulmonary resuscitation if presented with an order not to
  593  resuscitate executed pursuant to s. 401.45 or a POLST form
  594  executed pursuant to s. 401.451 which contains an order not to
  595  resuscitate. The provider is shall not be subject to criminal
  596  prosecution or civil liability, and is not nor be considered to
  597  have engaged in negligent or unprofessional conduct, for
  598  withholding or withdrawing cardiopulmonary resuscitation
  599  pursuant to such orders an order and applicable rules.
  600         Section 11. Present subsections (7) and (8) of section
  601  456.072, Florida Statutes, are redesignated as subsections (8)
  602  and (9), respectively, and a new subsection (7) is added to that
  603  section, to read:
  604         456.072 Grounds for discipline; penalties; enforcement.—
  605         (7) A licensee may withhold or withdraw cardiopulmonary
  606  resuscitation or the use of an automated external defibrillator
  607  if presented with an order not to resuscitate executed pursuant
  608  to s. 401.45 or a physician order for life-sustaining treatment
  609  (POLST) form executed pursuant to s. 401.451 which contains an
  610  order not to resuscitate. The department shall adopt rules
  611  providing for the implementation of such orders. A licensee is
  612  not subject to criminal prosecution or civil liability, and is
  613  not considered to have engaged in negligent or unprofessional
  614  conduct, for withholding or withdrawing cardiopulmonary
  615  resuscitation or the use of an automated external defibrillator,
  616  or otherwise complying with an order not to resuscitate executed
  617  pursuant to s. 401.45 or a POLST form executed pursuant to s.
  618  401.451 and department rule. The absence of an order not to
  619  resuscitate executed pursuant to s. 401.45 or a POLST form
  620  executed pursuant to s. 401.451 does not preclude a licensee
  621  from withholding or withdrawing cardiopulmonary resuscitation or
  622  the use of an automated external defibrillator or otherwise
  623  carrying out a medical order authorized by law.
  624         Section 12. Paragraph (c) of subsection (1) of section
  625  765.205, Florida Statutes, is amended to read:
  626         765.205 Responsibility of the surrogate.—
  627         (1) The surrogate, in accordance with the principal’s
  628  instructions, unless such authority has been expressly limited
  629  by the principal, shall:
  630         (c) Provide written consent using an appropriate form
  631  whenever consent is required, including a physician’s order not
  632  to resuscitate or a physician order for life-sustaining
  633  treatment form executed pursuant to s. 401.451.
  634         Section 13. This act shall take effect July 1, 2019.