House Bill 2429

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    Florida House of Representatives - 2000                HB 2429

        By the Committee on Elder Affairs & Long-Term Care and
    Representative Argenziano





  1                      A bill to be entitled

  2         An act relating to end-of-life care; amending

  3         s. 395.1041, F.S.; specifying conditions under

  4         which hospital personnel may withhold

  5         resuscitation; clarifying intent regarding

  6         orders not to resuscitate; amending ss.

  7         400.142, 400.4255, and 400.6095, F.S.;

  8         clarifying intent regarding orders not to

  9         resuscitate issued and acted upon by a

10         physician and staff in a nursing home, assisted

11         living facility, or hospice; amending s.

12         401.45, F.S., relating to emergency treatment;

13         requiring use of official form for a valid

14         do-not-resuscitate order; specifying required

15         signatures; specifying authorized substitute

16         signatures; amending s. 455.597, F.S., relating

17         to licensure renewal requirements for certain

18         health care professionals; providing for

19         substitution of continuing education programs

20         or courses on end-of-life care and palliative

21         health care for any authorized domestic

22         violence continuing education program or course

23         taken within a specified period; amending s.

24         765.102, F.S., relating to legislative findings

25         and intent; adding legislative intent to allow

26         a person to plan for future incapacity orally

27         or by executing a document; encouraging health

28         care professionals to rapidly increase their

29         understanding of end-of-life and palliative

30         health care; requiring a statewide, culturally

31         sensitive public education campaign on

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  1         end-of-life care; creating s. 765.1103, F.S.;

  2         requiring certain health care facilities,

  3         providers, and practitioners to provide

  4         patients with certain information and comply

  5         with patient requests for pain management and

  6         palliative care; amending s. 765.203, F.S.;

  7         revising the suggested form for designating a

  8         health care surrogate to include reference to

  9         anatomical gift declarations; amending s.

10         765.204, F.S.; revising the procedure for

11         determining a principal's capacity; providing

12         cross references; amending s. 765.205, F.S.;

13         providing responsibilities of a health care

14         surrogate with respect to medical records of

15         the principal; amending s. 765.303, F.S.;

16         revising the suggested form for a living will;

17         amending s. 765.305, F.S.; revising the

18         prerequisite circumstances on which a health

19         care surrogate must rely before authorizing

20         withholding or withdrawing of medical treatment

21         in the absence of a living will; amending s.

22         765.306, F.S., relating to determination of

23         patient condition; revising the factors that

24         must be evaluated for determining whether a

25         living will may take effect; amending s.

26         765.401, F.S.; revising conditions for a proxy

27         to make health care decisions on behalf of a

28         patient; deleting requirements that the proxy

29         act in accordance with a written declaration or

30         that the patient have certain specified medical

31         conditions before a proxy may consent to

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  1         withholding or withdrawing life-prolonging

  2         procedures; providing cross references;

  3         creating the End-of-Life Care Workgroup;

  4         providing membership and duties of the

  5         workgroup; requiring a report; providing an

  6         effective date.

  7

  8  Be It Enacted by the Legislature of the State of Florida:

  9

10         Section 1.  Paragraph (l) of subsection (3) of section

11  395.1041, Florida Statutes, is amended to read:

12         395.1041  Access to emergency services and care.--

13         (3)  EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF

14  FACILITY OR HEALTH CARE PERSONNEL.--

15         (l)  Hospital emergency services personnel may withhold

16  or withdraw cardiopulmonary resuscitation if presented with an

17  order not to resuscitate executed pursuant to s. 401.45.

18  Facility staff and facilities shall not be subject to criminal

19  prosecution or civil liability, nor be considered to have

20  engaged in negligent or unprofessional conduct, for

21  withholding or withdrawing cardiopulmonary resuscitation

22  pursuant to such an order. The absence of an order not to

23  resuscitate executed pursuant to s. 401.45 does not preclude a

24  physician from withholding or withdrawing cardiopulmonary

25  resuscitation as otherwise permitted by law.

26         Section 2.  Subsection (3) of section 400.142, Florida

27  Statutes, is amended to read:

28         400.142  Emergency medication kits; orders not to

29  resuscitate.--

30         (3)  Facility staff may withhold or withdraw

31  cardiopulmonary resuscitation if presented with an order not

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  1  to resuscitate executed pursuant to s. 401.45. The agency

  2  shall adopt rules providing for the implementation of such

  3  orders. Facility staff and facilities shall not be subject to

  4  criminal prosecution or civil liability, nor be considered to

  5  have engaged in negligent or unprofessional conduct, for

  6  withholding or withdrawing cardiopulmonary resuscitation

  7  pursuant to such an order and rules adopted by the agency. The

  8  absence of an order not to resuscitate executed pursuant to s.

  9  401.45 does not preclude a physician from issuing an order not

10  to resuscitate as otherwise permitted by law.

11         Section 3.  Subsection (3) of section 400.4255, Florida

12  Statutes, is amended to read:

13         400.4255  Use of personnel; emergency care.--

14         (3)  Facility staff may withhold or withdraw

15  cardiopulmonary resuscitation if presented with an order not

16  to resuscitate executed pursuant to s. 401.45. The department

17  shall adopt rules providing for the implementation of such

18  orders. Facility staff and facilities shall not be subject to

19  criminal prosecution or civil liability, nor be considered to

20  have engaged in negligent or unprofessional conduct, for

21  withholding or withdrawing cardiopulmonary resuscitation

22  pursuant to such an order and rules adopted by the department.

23  The absence of an order not to resuscitate executed pursuant

24  to s. 401.45 does not preclude a physician from issuing an

25  order not to resuscitate as otherwise permitted by law.

26         Section 4.  Subsection (8) of section 400.6095, Florida

27  Statutes, is amended to read:

28         400.6095  Patient admission; assessment; plan of care;

29  discharge; death.--

30         (8)  The hospice care team may withhold or withdraw

31  cardiopulmonary resuscitation if presented with an order not

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  1  to resuscitate executed pursuant to s. 401.45. The department

  2  shall adopt rules providing for the implementation of such

  3  orders. Hospice staff shall not be subject to criminal

  4  prosecution or civil liability, nor be considered to have

  5  engaged in negligent or unprofessional conduct, for

  6  withholding or withdrawing cardiopulmonary resuscitation

  7  pursuant to such an order and rules adopted by the department.

  8  The absence of an order not to resuscitate executed pursuant

  9  to s. 401.45 does not preclude a physician from issuing an

10  order not to resuscitate as otherwise permitted by law.

11         Section 5.  Paragraph (a) of subsection (3) of section

12  401.45, Florida Statutes, is amended to read:

13         401.45  Denial of emergency treatment; civil

14  liability.--

15         (3)(a)  Resuscitation may be withheld or withdrawn from

16  a patient by an emergency medical technician or paramedic if

17  evidence of an order not to resuscitate by the patient's

18  physician is presented to the emergency medical technician or

19  paramedic. An order not to resuscitate, to be valid, must be

20  on the form adopted by rule of the department. The form must

21  be signed by the patient's physician and by the patient or, if

22  the patient is incapacitated, the patient's health care

23  surrogate or proxy as provided in chapter 765, court-appointed

24  guardian as provided in chapter 744, or attorney in fact under

25  a durable power of attorney as provided in chapter 709. The

26  court-appointed guardian or attorney in fact must have been

27  delegated authority to make health care decisions on behalf of

28  the patient.

29         Section 6.  Section 455.597, Florida Statutes, is

30  amended to read:

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  1         455.597  Requirement for instruction on domestic

  2  violence.--

  3         (1)(a)  The appropriate board shall require each person

  4  licensed or certified under chapter 458, chapter 459, chapter

  5  464, chapter 466, chapter 467, chapter 490, or chapter 491 to

  6  complete a 1-hour continuing education course, approved by the

  7  board, on domestic violence, as defined in s. 741.28, as part

  8  of biennial relicensure or recertification.  The course shall

  9  consist of information on the number of patients in that

10  professional's practice who are likely to be victims of

11  domestic violence and the number who are likely to be

12  perpetrators of domestic violence, screening procedures for

13  determining whether a patient has any history of being either

14  a victim or a perpetrator of domestic violence, and

15  instruction on how to provide such patients with information

16  on, or how to refer such patients to, resources in the local

17  community, such as domestic violence centers and other

18  advocacy groups, that provide legal aid, shelter, victim

19  counseling, batterer counseling, or child protection services.

20         (b)  Each such licensee or certificateholder shall

21  submit confirmation of having completed such course, on a form

22  provided by the board, when submitting fees for each biennial

23  renewal.

24         (c)  The board may approve additional equivalent

25  courses that may be used to satisfy the requirements of

26  paragraph (a).  Each licensing board that requires a licensee

27  to complete an educational course pursuant to this subsection

28  may include the hour required for completion of the course in

29  the total hours of continuing education required by law for

30  such profession unless the continuing education requirements

31  for such profession consist of fewer than 30 hours biennially.

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  1         (d)  Any person holding two or more licenses subject to

  2  the provisions of this subsection shall be permitted to show

  3  proof of having taken one board-approved course on domestic

  4  violence, for purposes of relicensure or recertification for

  5  additional licenses.

  6         (e)  Failure to comply with the requirements of this

  7  subsection shall constitute grounds for disciplinary action

  8  under each respective practice act and under s. 455.624(1)(k).

  9  In addition to discipline by the board, the licensee shall be

10  required to complete such course.

11         (2)  The board shall also require, as a condition of

12  granting a license under any chapter specified in paragraph

13  (1)(a), that each applicant for initial licensure under the

14  appropriate chapter complete an educational course acceptable

15  to the board on domestic violence which is substantially

16  equivalent to the course required in subsection (1).  An

17  applicant who has not taken such course at the time of

18  licensure shall, upon submission of an affidavit showing good

19  cause, be allowed 6 months to complete such requirement.

20         (3)  In lieu of completing a course as required in

21  subsection (1), a licensee or certificateholder may complete a

22  course in end-of-life care and palliative health care, if the

23  licensee or certificateholder has completed an approved

24  domestic violence course in the immediately preceding

25  biennium.

26         (4)(3)  Each board may adopt rules to carry out the

27  provisions of this section.

28         (5)(4)  Each board shall report to the President of the

29  Senate, the Speaker of the House of Representatives, and the

30  chairs of the appropriate substantive committees of the

31

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  1  Legislature by March 1 of each year as to the implementation

  2  of and compliance with the requirements of this section.

  3         Section 7.  Section 765.102, Florida Statutes, is

  4  amended to read:

  5         765.102  Legislative findings and intent.--

  6         (1)  The Legislature finds that every competent adult

  7  has the fundamental right of self-determination regarding

  8  decisions pertaining to his or her own health, including the

  9  right to choose or refuse medical treatment. This right is

10  subject to certain interests of society, such as the

11  protection of human life and the preservation of ethical

12  standards in the medical profession.

13         (2)  To ensure that such right is not lost or

14  diminished by virtue of later physical or mental incapacity,

15  the Legislature intends that a procedure be established to

16  allow a person to plan for incapacity by executing a document

17  or orally designating another person to direct the course of

18  his or her medical treatment upon his or her incapacity. Such

19  procedure should be less expensive and less restrictive than

20  guardianship and permit a previously incapacitated person to

21  exercise his or her full right to make health care decisions

22  as soon as the capacity to make such decisions has been

23  regained.

24         (3)  The Legislature recognizes that for some the

25  administration of life-prolonging medical procedures may

26  result in only a precarious and burdensome existence. In order

27  to ensure that the rights and intentions of a person may be

28  respected even after he or she is no longer able to

29  participate actively in decisions concerning himself or

30  herself, and to encourage communication among such patient,

31  his or her family, and his or her physician, the Legislature

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  1  declares that the laws of this state recognize the right of a

  2  competent adult to make an advance directive instructing his

  3  or her physician to provide, withhold, or withdraw

  4  life-prolonging procedures, or to designate another to make

  5  the treatment decision for him or her in the event that such

  6  person should become incapacitated and unable to personally

  7  direct his or her medical care.

  8         (4)  The Legislature recognizes the need for all health

  9  care professionals to rapidly increase their understanding of

10  end-of-life and palliative health care. Therefore, the

11  Legislature encourages the professional regulatory boards to

12  adopt appropriate standards and guidelines regarding

13  end-of-life care and pain management and encourages

14  educational institutions established to train health care

15  professionals and allied health professionals to implement

16  curricula to train such professionals to provide end-of-life

17  care, including pain management and palliative care.

18         (5)  The Department of Elderly Affairs, the Agency for

19  Health Care Administration, and the Department of Health shall

20  jointly create a campaign on end-of-life care for purposes of

21  educating the public. This campaign shall include culturally

22  sensitive programs to improve understanding of end-of-life

23  care issues in minority communities.

24         Section 8.  Section 765.1103, Florida Statutes, is

25  created to read:

26         765.1103  Pain management and palliative care.--

27         (1)  A patient shall be given information concerning

28  pain management and palliative care when he or she discusses

29  with the attending or treating physician, or such physician's

30  designee, the diagnosis, planned course of treatment,

31  alternatives, risks, or prognosis for his or her illness. If

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  1  the patient is incapacitated, the information shall be given

  2  to the patient's health care surrogate or proxy as provided in

  3  chapter 765, court-appointed guardian as provided in chapter

  4  744, or attorney in fact under a durable power of attorney as

  5  provided in chapter 709. The court-appointed guardian or

  6  attorney in fact must have been delegated authority to make

  7  health care decisions on behalf of the patient.

  8         (2)  Health care providers and practitioners regulated

  9  under chapter 458, chapter 459, or chapter 464 must, as

10  appropriate, comply with a request for pain management or

11  palliative care from a patient under their care or, for an

12  incapacitated patient under their care, from a surrogate,

13  proxy, guardian, or other representative permitted to make

14  health care decisions for the incapacitated patient.

15  Facilities regulated under chapter 400 or chapter 395 must

16  comply with the pain management or palliative care measures

17  ordered by the patient's physician.

18         Section 9.  Section 765.203, Florida Statutes, is

19  amended to read:

20         765.203  Suggested form of designation.--A written

21  designation of a health care surrogate executed pursuant to

22  this chapter may, but need not be, in the following form:

23

24               DESIGNATION OF HEALTH CARE SURROGATE

25

26  Name:....(Last)....(First)....(Middle Initial)....

27         In the event that I have been determined to be

28  incapacitated to provide informed consent for medical

29  treatment and surgical and diagnostic procedures, I wish to

30  designate as my surrogate for health care decisions:

31

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  1  Name:.........................................................

  2  Address:......................................................

  3  .................................................. Zip Code:....

  4  Phone:................

  5         If my surrogate is unwilling or unable to perform his

  6  or her duties, I wish to designate as my alternate surrogate:

  7  Name:.........................................................

  8  Address:......................................................

  9  .................................................. Zip Code:....

10  Phone:................

11         I fully understand that this designation will permit my

12  designee to make health care decisions, except for anatomical

13  gifts, unless I have executed an anatomical gift declaration

14  pursuant to law, and to provide, withhold, or withdraw consent

15  on my behalf; to apply for public benefits to defray the cost

16  of health care; and to authorize my admission to or transfer

17  from a health care facility.

18  Additional instructions (optional):...........................

19  ..............................................................

20  ..............................................................

21  ..............................................................

22         I further affirm that this designation is not being

23  made as a condition of treatment or admission to a health care

24  facility.  I will notify and send a copy of this document to

25  the following persons other than my surrogate, so they may

26  know who my surrogate is.

27  Name:.........................................................

28  Name:.........................................................

29  ..............................................................

30  ..............................................................

31  Signed:.......................................................

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  1  Date:.........................................................

  2  Witnesses: 1.................................................

  3             2.................................................

  4         Section 10.  Subsection (2) of section 765.204, Florida

  5  Statutes, is amended to read:

  6         765.204  Capacity of principal; procedure.--

  7         (2)  If a principal's capacity to make health care

  8  decisions for herself or himself or provide informed consent

  9  is in question, the attending physician shall evaluate the

10  principal's capacity and, if the physician concludes that the

11  principal lacks capacity, enter that evaluation in the

12  principal's medical record. If the attending physician has a

13  question as to whether the principal lacks capacity, another

14  physician shall also evaluate the principal's capacity, and.

15  if the second physician agrees that the principal lacks the

16  capacity to make health care decisions or provide informed

17  consent, the health care facility shall enter both physicians'

18  physician's evaluations in the principal's medical clinical

19  record. and, If the principal has designated a health care

20  surrogate or has delegated authority to make health care

21  decisions to an attorney in fact under a durable power of

22  attorney, the facility, shall notify such surrogate or

23  attorney in fact in writing that her or his authority under

24  the instrument has commenced, as provided in s. 765.203 or

25  chapter 709, respectively.

26         Section 11.  Section 765.205, Florida Statutes, is

27  amended to read:

28         765.205  Responsibility of the surrogate.--

29         (1)  The surrogate, in accordance with the principal's

30  instructions, unless such authority has been expressly limited

31  by the principal, shall:

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  1         (a)  Have authority to act for the principal and to

  2  make all health care decisions for the principal during the

  3  principal's incapacity, in accordance with the principal's

  4  instructions, unless such authority has been expressly limited

  5  by the principal.

  6         (b)  Consult expeditiously with appropriate health care

  7  providers to provide informed consent, and make only health

  8  care decisions for the principal which he or she believes the

  9  principal would have made under the circumstances if the

10  principal were capable of making such decisions.

11         (c)  Provide written consent using an appropriate form

12  whenever consent is required, including a physician's order

13  not to resuscitate.

14         (d)  Be provided access to the appropriate medical

15  clinical records of the principal.

16         (e)  Apply for public benefits, such as Medicare and

17  Medicaid, for the principal and have access to information

18  regarding the principal's income and assets and banking and

19  financial records to the extent required to make application.

20  A health care provider or facility may not, however, make such

21  application a condition of continued care if the principal, if

22  capable, would have refused to apply.

23         (2)  The surrogate may authorize the release of

24  information and medical clinical records to appropriate

25  persons to ensure the continuity of the principal's health

26  care and may authorize the admission, discharge, or transfer

27  of the principal to or from a health care facility or other

28  facility or program licensed under chapter 400.

29         (3)  If, after the appointment of a surrogate, a court

30  appoints a guardian, the surrogate shall continue to make

31  health care decisions for the principal, unless the court has

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  1  modified or revoked the authority of the surrogate pursuant to

  2  s. 744.3115. The surrogate may be directed by the court to

  3  report the principal's health care status to the guardian.

  4         Section 12.  Subsection (1) of section 765.303, Florida

  5  Statutes, is amended to read:

  6         765.303  Suggested form of a living will.--

  7         (1)  A living will may, BUT NEED NOT, be in the

  8  following form:

  9                           Living Will

10         Declaration made this .... day of ...., ...(year)...,

11  I, ........, willfully and voluntarily make known my desire

12  that my dying not be artificially prolonged under the

13  circumstances set forth below, and I do hereby declare that,

14  if at any time I am both mentally and physically incapacitated

15  and

16         ...(initial)... and I have a terminal condition

17         or ...(initial)... and I have an end-stage end-state

18  condition

19         or ...(initial)... and I am in a persistent vegetative

20  state

21

22  and if my attending or treating physician and another

23  consulting physician have determined that there is no

24  reasonable medical probability of my recovery from such

25  condition, I direct that life-prolonging procedures be

26  withheld or withdrawn when the application of such procedures

27  would serve only to prolong artificially the process of dying,

28  and that I be permitted to die naturally with only the

29  administration of medication or the performance of any medical

30  procedure deemed necessary to provide me with comfort care or

31  to alleviate pain.

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  1         It is my intention that this declaration be honored by

  2  my family and physician as the final expression of my legal

  3  right to refuse medical or surgical treatment and to accept

  4  the consequences for such refusal.

  5         In the event that I have been determined to be unable

  6  to provide express and informed consent regarding the

  7  withholding, withdrawal, or continuation of life-prolonging

  8  procedures, I wish to designate, as my surrogate to carry out

  9  the provisions of this declaration:

10

11  Name:.........................................................

12  Address:......................................................

13  .................................................. Zip Code:....

14  Phone:................

15         I understand the full import of this declaration, and I

16  am emotionally and mentally competent to make this

17  declaration.

18  Additional Instructions (optional):

19  ..............................................................

20  ..............................................................

21  ..............................................................

22                         ....(Signed)....

23                         ....Witness....

24                         ....Address....

25                          ....Phone....

26                         ....Witness....

27                         ....Address....

28                          ....Phone....

29         Section 13.  Subsection (2) of section 765.305, Florida

30  Statutes, is amended to read:

31         765.305  Procedure in absence of a living will.--

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  1         (2)  Before exercising the incompetent patient's right

  2  to forego treatment, the surrogate must be satisfied that:

  3         (a)  The patient does not have a reasonable medical

  4  probability of recovering capacity so that the right could be

  5  exercised by the patient; and.

  6         (b)  The patient is both mentally and physically

  7  incapacitated with no reasonable medical probability of

  8  recovery, The patient has an end-stage condition, the patient

  9  is in a persistent vegetative state, or the patient's physical

10  condition is terminal.

11         Section 14.  Section 765.306, Florida Statutes, is

12  amended to read:

13         765.306  Determination of patient condition.--In

14  determining whether the patient has a terminal condition, has

15  an end-stage condition, or is in a persistent vegetative state

16  or may recover mental and physical capacity, or whether a

17  medical condition or limitation referred to in an advance

18  directive exists, the patient's attending or treating

19  physician and at least one other consulting physician must

20  separately examine the patient. The findings of each such

21  examination must be documented in the patient's medical record

22  and signed by each examining physician before life-prolonging

23  procedures may be withheld or withdrawn.

24         Section 15.  Subsection (3) of section 765.401, Florida

25  Statutes, is amended to read:

26         765.401  The proxy.--

27         (3)  Before exercising the incapacitated patient's

28  rights to select or decline health care, the proxy must comply

29  with the pertinent provisions of ss. 765.205 and 765.305

30  applicable to surrogates under this chapter, except that a

31

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  1  proxy's decision to withhold or withdraw life-prolonging

  2  procedures must either:

  3         (a)  Be supported by a written declaration; or

  4         (b)  If there is no written declaration, the patient

  5  must have a terminal condition, have an end-stage condition,

  6  or be in a persistent vegetative state, and the proxy's

  7  decision must be supported by clear and convincing evidence

  8  that the decision would have been the one the patient would

  9  have chosen had the patient been competent.

10         Section 16.  End-of-Life Care Workgroup.--

11         (1)  There is created within the Department of Elderly

12  Affairs the End-of-Life Care Workgroup. The workgroup shall:

13         (a)  Examine reimbursement methodologies for

14  end-of-life care.

15         (b)  Identify end-of-life care standards that will

16  enable all health care providers along the health-care

17  continuum to participate in an excellent system of delivering

18  end-of-life care.

19         (c)  Develop recommendations for incentives for

20  appropriate end-of-life care.

21         (2)  The workgroup is composed of the Secretary of

22  Elderly Affairs or his or her designee; the Secretary of

23  Health or his or her designee; the Director of Health Care

24  Administration or his or her designee; a member of the Senate,

25  appointed by the President of the Senate; a member of the

26  House of Representatives, appointed by the Speaker of the

27  House of Representatives; and one representative from each of

28  the following organizations: the Florida Hospital Association,

29  the Florida Medical Association, the Florida Osteopathic

30  Medical Association, the Florida Nurses Association, the

31  Florida Acupuncture Association, the Florida Pharmacy

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    Florida House of Representatives - 2000                HB 2429

    173-975-00






  1  Association, Florida Hospices and Palliative Care, Inc., the

  2  Florida Health Care Association, the Florida Assisted Living

  3  Association, the Florida Association of Homes for the Aging,

  4  the Florida Life Care Residents Association, the Florida

  5  Association of Insurance and Financial Advisors, and the

  6  Florida Association of Health Maintenance Organizations.

  7         (3)  The workgroup shall exist for 1 year and shall

  8  meet as often as necessary to carry out its duties and

  9  responsibilities. Within existing resources, the Department of

10  Elderly Affairs shall provide support services to the

11  workgroup. Workgroup members shall serve without compensation.

12         (4)  The workgroup shall submit a report of its

13  findings and recommendations to the Governor, the President of

14  the Senate, and the Speaker of the House of Representatives by

15  December 31, 2000.

16         (5)  This section expires May 1, 2001.

17         Section 17.  This act shall take effect upon becoming a

18  law.

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    Florida House of Representatives - 2000                HB 2429

    173-975-00






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  2                          HOUSE SUMMARY

  3
      Specifies conditions under which hospital personnel may
  4    withhold resuscitation. Clarifies intent regarding
      do-not-resuscitate orders in hospitals, nursing homes,
  5    assisted living facilities, and hospices. Requires use of
      an official form for a valid do-not-resuscitate order in
  6    emergency treatment. Provides for substitution of
      continuing education on end-of-life and palliative care
  7    for domestic violence continuing education, for certain
      health care professionals. Requires a statewide,
  8    culturally sensitive public education campaign on
      end-of-life care. Requires certain health care
  9    facilities, providers, and practitioners to provide
      patients with information about, and comply with patient
10    requests for, pain management and palliative care.
      Revises the suggested form for designation of a health
11    care surrogate to include reference to anatomical gift
      declarations. Revises procedure for determining a
12    principal's capacity. Provides responsibilities of a
      health care surrogate regarding the principal's medical
13    records. Revises the suggested form for a living will.
      Revises prerequisite circumstances for a health care
14    surrogate to authorize withholding or withdrawing medical
      treatment in the absence of a living will. Revises
15    factors that must be evaluated for determining whether a
      living will may take effect. Revises conditions for a
16    proxy to make health care decisions on behalf of a
      patient. Removes requirements that a proxy act in
17    accordance with a written declaration or that the patient
      have certain specified medical conditions before a proxy
18    may consent to withholding or withdrawing life-prolonging
      procedures. Creates the End-of-Life Care Workgroup,
19    provides membership and duties, and requires a report to
      the Governor and Legislature. See bill for details.
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