HB 1017

1	A bill to be entitled
2	An act relating to physician orders for life-sustaining
3	treatment; creating s. 765.3065, F.S.; requiring the
4	Department of Health to create a physician orders for
5	life-sustaining treatment (POLST) form; providing
6	definitions; requiring the form to be completed by a
7	licensed health care professional and signed by specified
8	parties; providing guidelines for use of the form;
9	requiring periodic review of the form; providing
10	requirements for the completion of a new form; providing
11	circumstances in which a form may be revoked; authorizing
12	certain future revisions to the form; requiring a
13	completed form to be part of a principal's medical record;
14	requiring the department to place the form on the
15	department's Internet website; amending s. 765.101, F.S.;
16	including the form in the definition of the term "advance
17	directive"; providing an effective date.
18
19	WHEREAS, seriously ill patients should be able to
20	communicate their wishes regarding medical treatment as they
21	move from one care setting to another, and
22	WHEREAS, the wishes expressed by an advance directive may
23	in some cases not be honored due to the unavailability of
24	completed forms or a health care professional's inability to
25	quickly translate the language of the document into orders for
26	treatment of specific medical conditions, and
27	WHEREAS, health care professionals caring for patients in
28	various settings may in good faith initiate or withhold
29	treatments contrary to the desires of the patient if the
30	patient's wishes are not readily available to the treating
31	health care professionals, and
32	WHEREAS, physician orders for life-sustaining treatment
33	(POLST) forms are designed to help health care professionals
34	honor the treatment wishes of their patients and are now
35	available in many states, and
36	WHEREAS, in order to document a patient's wishes for life-
37	sustaining treatment in the form of physicians' orders,
38	streamline the transfer of patient records between facilities,
39	clarify treatment intentions, and minimize confusion about
40	patient preferences, a standardized POLST form shall be
41	implemented in the state, NOW, THEREFORE,
42
43	Be It Enacted by the Legislature of the State of Florida:
44
45	Section 1.  Section 765.3065, Florida Statutes, is created
46	to read:
47	765.3065  Form for physician orders for life-sustaining
48	treatment.--
49	(1)  The Department of Health shall create, by rule, a
50	standardized, voluntary physician orders for life-sustaining
51	treatment (POLST) form similar to those being used in other
52	states. The department shall make any necessary changes to that
53	form to make it consistent with state law or department rules.
54	(2)  For purposes of this section:
55	(a)  "Licensed health care professional" means a physician
56	licensed under chapter 458, an osteopathic physician licensed
57	under chapter 459, a nurse licensed under part I of chapter 464,
58	a physician assistant licensed under chapter 458 or chapter 459,
59	or a dentist licensed under chapter 466.
60	(b)  "Physician" means a person licensed under chapter 458
61	or chapter 459.
62	(c)  "Principal" means a competent adult who has completed
63	a POLST form and on whose behalf health care decisions are to be
64	made.
65	(d) "Proxy" means a competent adult who has not been
66	expressly designated to make health care decisions for a
67	particular incapacitated individual, but who, nevertheless, is
68	authorized pursuant to s. 765.401 to make health care decisions
69	for such individual.
70	(e)  "Surrogate" means any competent adult expressly
71	designated by a principal to make health care decisions on
72	behalf of the principal upon the principal's incapacity.
73	(3)  The POLST form shall be completed by a licensed health
74	care professional based on the principal's preferences and
75	medical indications, but the POLST form must be signed by a
76	physician to be valid. Photocopies and facsimiles of signed
77	POLST forms are legal and valid; however, the department
78	strongly encourages the use of the original form.
79	(a)  Any section of the POLST form concerning the following
80	treatments that is not completed implies full treatment for that
81	section:
82	1.  Cardiopulmonary resuscitation;
83	2.  Medical interventions;
84	3.  Antibiotics; or
85	4.  Artificially administered nutrition.
86
87	Oral fluids and nutrition must always be offered if medically
88	feasible.
89	(b)  Intravenous fluids or medication may be administered
90	to a principal to enhance comfort if the principal has chosen
91	the category "Comfort Measures Only" on the POLST form for
92	authorized medical interventions.
93	(c)  The principal, if competent, or the surrogate or proxy
94	may revoke the POLST form at any time and request alternative
95	treatment.
96	(d)  A principal must sign the form if the principal has
97	the capacity and competence to sign the form in accordance with
98	chapter 765.
99	(e)  A principal is not required to sign the form if he or
100	she does not have the capacity or competence to sign the form.
101	The physician shall verify the signature of the principal, or
102	the signature of the surrogate or proxy if the principal is
103	incapacitated or incompetent, before the physician affixes his
104	or her signature to validate the POLST form.
105	(f)  The POLST form must be reviewed periodically. A new
106	POLST form must be completed when:
107	1.  The principal is transferred from one care setting or
108	care level to another;
109	2.  There is a substantial change in the health status of
110	the principal; or
111	3.  The treatment preferences of the principal change.
112
113	When a new POLST form is completed, the form must be signed by a
114	physician.
115	(g)  If an advance directive document with a more recent
116	execution date is provided to the facility where the principal
117	is located, the advance directive document is legally
118	controlling. The facility must revoke the POLST form submitted
119	before the advance directive and offer the principal, or the
120	surrogate or proxy, the opportunity to complete and sign a new
121	POLST form.
122	(4)  The Department of Health shall make any future changes
123	to the POLST form that are necessary to reflect changes in state
124	law or department rules or may otherwise modify the POLST form
125	in accordance with this section.
126	(5)  If a completed POLST form expresses a principal's
127	desires concerning life-sustaining procedures and has been
128	signed by a reviewing physician, that form shall be included in
129	the medical record of the principal.
130	(6)  The Department of Health shall make the POLST form
131	available on the department's Internet website.
132	Section 2.  Subsection (1) of section 765.101, Florida
133	Statutes, is amended to read:
134	765.101  Definitions.--As used in this chapter:
135	(1)  "Advance directive" means a witnessed written document
136	or oral statement in which instructions are given by a principal
137	or in which the principal's desires are expressed concerning any
138	aspect of the principal's health care, and includes, but is not
139	limited to, the designation of a health care surrogate, a living
140	will, a physician orders for life-sustaining treatment (POLST)
141	form, or an anatomical gift made pursuant to part X of chapter
142	732.
143	Section 3.  This act shall take effect July 1, 2006.

CODING: Words stricken are deletions; words underlined are additions.