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.