Bill Text: OH SB347 | 2013-2014 | 130th General Assembly | Introduced

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Bill Title: To establish procedures for the use of medical orders for life-sustaining treatment and to make changes to the laws governing DNR identification and orders.

Spectrum: Partisan Bill (Republican 4-0)

Status: (Introduced - Dead) 2014-06-19 - To Civil Justice [SB347 Detail]

Download: Ohio-2013-SB347-Introduced.html

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As Introduced

130th General Assembly Regular Session 2013-2014

S. B. No. 347

Senator Lehner 

Cosponsors: Senators Jones, Seitz, Uecker 

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A BILL

To amend sections 2133.02, 2133.21, 2133.211,

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2133.23, 2133.24, 2133.25, 2133.26, 3795.03, and

2

4730.09; to amend, for the purpose of adopting new

3

section numbers as indicated in parentheses,

4

sections 2133.211 (2133.23), 2133.23 (2133.24),

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2133.24 (2133.25), 2133.25 (2133.26), and 2133.26

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(2133.27); to enact new section 2133.22 and

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sections 2133.28 to 2133.47; and to repeal section

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2133.22 of the Revised Code to establish

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procedures for the use of medical orders for

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life-sustaining treatment and to make changes to

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the laws governing DNR identification and orders.

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BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That sections 2133.02, 2133.21, 2133.211, 2133.23,	13
2133.24, 2133.25, 2133.26, 3795.03, and 4730.09 be amended;	14
sections 2133.211 (2133.23), 2133.23 (2133.24), 2133.24 (2133.25),	15
2133.25 (2133.26), and 2133.26 (2133.27) be amended for the	16
purpose of adopting new section numbers as indicated in	17
parentheses; and new section 2133.22 and sections 2133.28,	18
2133.29, 2133.30, 2133.31, 2133.32, 2133.33, 2133.34, 2133.35,	19
2133.36, 2133.37, 2133.38, 2133.39, 2133.40, 2133.41, 2133.42,	20
2133.43, 2133.44, 2133.45, 2133.46, and 2133.47 of the Revised	21
Code be enacted to read as follows:	22

Sec. 2133.02.  (A)(1) An adult who is of sound mind	23
voluntarily may execute at any time a declaration governing the	24
use or continuation, or the withholding or withdrawal, of	25
life-sustaining treatment. The declaration shall be signed at the	26
end by the declarant or by another individual at the direction of	27
the declarant, state the date of its execution, and either be	28
witnessed as described in division (B)(1) of this section or be	29
acknowledged by the declarant in accordance with division (B)(2)	30
of this section. The declaration may include a designation by the	31
declarant of one or more persons who are to be notified by the	32
declarant's attending physician at any time that life-sustaining	33
treatment would be withheld or withdrawn pursuant to the	34
declaration. The declaration may include a specific authorization	35
for the use or continuation or the withholding or withdrawal of	36
CPR, but the failure to include a specific authorization for the	37
withholding or withdrawal of CPR does not preclude the withholding	38
or withdrawal of CPR in accordance with sections 2133.01 to	39
2133.15 or sections 2133.21 to 2133.262133.29 of the Revised	40
Code.	41

(2) Depending upon whether the declarant intends the	42
declaration to apply when the declarant is in a terminal	43
condition, in a permanently unconscious state, or in either a	44
terminal condition or a permanently unconscious state, the	45
declarant's declaration shall use either or both of the terms	46
"terminal condition" and "permanently unconscious state" and shall	47
define or otherwise explain those terms in a manner that is	48
substantially consistent with the provisions of section 2133.01 of	49
the Revised Code.	50

(3)(a) If a declarant who has authorized the withholding or	51
withdrawal of life-sustaining treatment intends that the	52
declarant's attending physician withhold or withdraw nutrition or	53
hydration when the declarant is in a permanently unconscious state	54
and when the nutrition and hydration will not or no longer will	55
serve to provide comfort to the declarant or alleviate the	56
declarant's pain, then the declarant shall authorize the	57
declarant's attending physician to withhold or withdraw nutrition	58
or hydration when the declarant is in the permanently unconscious	59
state by doing both of the following in the declaration:	60

(i) Including a statement in capital letters or other	61
conspicuous type, including, but not limited to, a different font,	62
bigger type, or boldface type, that the declarant's attending	63
physician may withhold or withdraw nutrition and hydration if the	64
declarant is in a permanently unconscious state and if the	65
declarant's attending physician and at least one other physician	66
who has examined the declarant determine, to a reasonable degree	67
of medical certainty and in accordance with reasonable medical	68
standards, that nutrition or hydration will not or no longer will	69
serve to provide comfort to the declarant or alleviate the	70
declarant's pain, or checking or otherwise marking a box or line	71
that is adjacent to a similar statement on a printed form of a	72
declaration;	73

(ii) Placing the declarant's initials or signature underneath	74
or adjacent to the statement, check, or other mark described in	75
division (A)(3)(a)(i) of this section.	76

(b) Division (A)(3)(a) of this section does not apply to the	77
extent that a declaration authorizes the withholding or withdrawal	78
of life-sustaining treatment when a declarant is in a terminal	79
condition. The provisions of division (E) of section 2133.12 of	80
the Revised Code pertaining to comfort care shall apply to a	81
declarant in a terminal condition.	82

(B)(1) If witnessed for purposes of division (A) of this	83
section, a declaration shall be witnessed by two individuals as	84
described in this division in whose presence the declarant, or	85
another individual at the direction of the declarant, signed the	86
declaration. The witnesses to a declaration shall be adults who	87
are not related to the declarant by blood, marriage, or adoption,	88
who are not the attending physician of the declarant, and who are	89
not the administrator of any nursing home in which the declarant	90
is receiving care. Each witness shall subscribe the witness'	91
signature after the signature of the declarant or other individual	92
at the direction of the declarant and, by doing so, attest to the	93
witness' belief that the declarant appears to be of sound mind and	94
not under or subject to duress, fraud, or undue influence. The	95
signatures of the declarant or other individual at the direction	96
of the declarant under division (A) of this section and of the	97
witnesses under this division are not required to appear on the	98
same page of the declaration.	99

(2) If acknowledged for purposes of division (A) of this	100
section, a declaration shall be acknowledged before a notary	101
public, who shall make the certification described in section	102
147.53 of the Revised Code and also shall attest that the	103
declarant appears to be of sound mind and not under or subject to	104
duress, fraud, or undue influence.	105

(C) An attending physician, or other health care personnel	106
acting under the direction of an attending physician, who is	107
furnished a copy of a declaration shall make it a part of the	108
declarant's medical record and, when section 2133.05 of the	109
Revised Code is applicable, also shall comply with that section.	110

(D)(1) Subject to division (D)(2) of this section, an	111
attending physician of a declarant or a health care facility in	112
which a declarant is confined may refuse to comply or allow	113
compliance with the declarant's declaration on the basis of a	114
matter of conscience or on another basis. An employee or agent of	115
an attending physician of a declarant or of a health care facility	116
in which a declarant is confined may refuse to comply with the	117
declarant's declaration on the basis of a matter of conscience.	118

(2) If an attending physician of a declarant or a health care	119
facility in which a declarant is confined is not willing or not	120
able to comply or allow compliance with the declarant's	121
declaration, the physician or facility promptly shall so advise	122
the declarant and comply with the provisions of section 2133.10 of	123
the Revised Code, or, if the declaration has become operative as	124
described in division (A) of section 2133.03 of the Revised Code,	125
shall comply with the provisions of section 2133.10 of the Revised	126
Code.	127

(E) As used in this section, "CPR" has the same meaning as in	128
section 2133.21 of the Revised Code.	129

Sec. 2133.21.  As used in this section and sections 2133.21	130
2133.211 to 2133.262133.29 of the Revised Code, unless the	131
context clearly requires otherwise:	132

(A) "Attending physician" means the physician to whom a	133
person, or the family of a person, has assigned primary	134
responsibility for the treatment or care of the person or, if the	135
person or the person's family has not assigned that	136
responsibility, the physician who has accepted that	137
responsibility.	138

(B) "CPR" means cardiopulmonary resuscitation or a component	139
of cardiopulmonary resuscitation, but it does not include clearing	140
a person's airway for a purpose other than as a component of CPR.	141

(C) "Declaration," "health care facility," "life-sustaining	142
treatment," "physician," "professional disciplinary action," and	143
"tort action" have the same meanings as in section 2133.01 of the	144
Revised Codemeans a document executed in accordance with section	145
2133.02 of the Revised Code.	146

(C)(D) "DNR identification" means a standardized	147
identification card, form, necklace, or bracelet that is of	148
uniform size and design, that has been approved by the department	149
of health pursuant to former section 2133.25 of the Revised Code,	150
and that signifies eitherat least one of the following:	151

(1) That the person who is named on and possesses the card,	152
form, necklace, or bracelet has executed a declaration that	153
authorizes the withholding or withdrawal of CPR and that has not	154
been revoked pursuant to section 2133.04 of the Revised Code;	155

(2) That the attending physician of the person who is named	156
on and possesses the card, form, necklace, or bracelet has issued	157
a current do-not-resuscitate order, in accordance with the	158
do-not-resuscitate protocol adopted by the department of health	159
pursuant to section 2133.25 of the Revised Code, for that person	160
and has documented the grounds for the order in that person's	161
medical record.;	162

(3) That an issuing practitioner has completed a MOLST form	163
that has not been revoked as described in section 2133.38 of the	164
Revised Code.	165

(D)(E) "Do-not-resuscitate order" means a written directive	166
issued by a physician prior to or not later than six months after	167
the effective date of this amendment in accordance with the	168
do-not-resuscitate protocol that identifies a person and specifies	169
that CPR should not be administered to the person so identified.	170

(E)(F) "Do-not-resuscitate protocol" means the standardized	171
method of procedure for the withholding of CPR by physicians,	172
emergency medical serviceservices personnel, and health care	173
facilities that iswas adopted in the rules of the department of	174
health pursuant to former section 2133.25 of the Revised Code.	175

(F)(G) "Emergency medical services personnel" means paid or	176
volunteer firefighters,; law enforcement officers,; medical	177
technicians; any of the following, as defined in section 4765.01	178
of the Revised Code: first responders, emergency medical	179
technicians-basic, emergency medical technicians-intermediate, or	180
emergency medical technicians-paramedic, medical technicians,; or	181
other emergency services personnel acting within the ordinary	182
course of their profession.	183

(G) "CPR" means cardiopulmonary resuscitation or a component	184
of cardiopulmonary resuscitation, but it does not include clearing	185
a person's airway for a purpose other than as a component of CPR.	186

(H) "Health care facility," "life-sustaining treatment,"	187
"physician," "professional disciplinary action," and "tort action"	188
have the same meanings as in section 2133.01 of the Revised Code.	189

(I) "Issuing practitioner" has the same meaning as in section	190
2133.30 of the Revised Code.	191

(J) "MOLST form" means the form specified in section 2133.31	192
of the Revised Code.	193

Sec. 2133.22.  Nothing in sections 2133.23 to 2133.29 of the	194
Revised Code condones, authorizes, or approves of mercy killing,	195
assisted suicide, or euthanasia.	196

Sec. 2133.211.        Sec. 2133.23.  A person who holds a certificate of	197
authority to practice as a certified nurse practitioner or,	198
clinical nurse specialist issued under section 4723.42 of the	199
Revised Code, or physician assistant may take any action that may	200
be taken by an attending physician under sections 2133.212133.22	201
to 2133.262133.29 of the Revised Code and has the immunity	202
provided by section 2133.222133.29 of the Revised Code if, as	203
applicable, the action is taken pursuant to a standard care	204
arrangement with a collaborating physician, a physician	205
supervisory plan approved under section 4730.17 of the Revised	206
Code, or the policies of the health care facility in which the	207
physician assistant is practicing.	208

Sec. 2133.23.        Sec. 2133.24.  (A) If emergency medical services	209
personnel, other than physicians, are presented with DNR	210
identification possessed by a person or are presented with a	211
written do-not-resuscitate order for a person or if a physician	212
directly issues to emergency medical services personnel, other	213
than physicians, an oral do-not-resuscitate order for a person,	214
the emergency medical services personnel shall comply with the	215
do-not-resuscitate protocol for the person. If an oral	216
do-not-resuscitate order is issued by a physician who is not	217
present at the scene, the emergency medical services personnel	218
shall verify the physician's identityinstructions signified by	219
the DNR identification or in the do-not-resuscitate order.	220

(B) If a person possesses DNR identification and if the	221
person's attending physician or the health care facility in which	222
the person is located is unwilling or unable to comply with the	223
do-not-resuscitate protocol for the personinstructions signified	224
by the person's DNR identification or in the do-not-resuscitate	225
order, the attending physician or the health care facility shall	226
not prevent or attempt to prevent, or unreasonably delay or	227
attempt to delay, the transfer of the person to a different	228
physician who will follow the protocolinstructions or to a	229
different health care facility in which the protocol	230
instructions will be followed.	231

(C) If a person whobeing transferred from one health care	232
facility to another possesses DNR identification or for whom a	233
current, has executed a declaration, or is the subject of a	234
do-not-resuscitate order that has been issued is being transferred	235
from one health care facility to another, before or at the time of	236
the transfer, the transferring health care facility shall notify	237
the receiving health care facility and the persons transporting	238
the person of the existence of the DNR identification or the	239
order, declaration, or do-not-resuscitate order. The notice shall	240
be given before or at the time of the transfer. If a current	241
do-not-resuscitate order was issued orally, it shall be reduced to	242
writing before the time of the transfer. The DNR identification or	243
the order, declaration, or do-not-resuscitate order shall	244
accompany the person to the receiving health care facility and	245
shall remain in effect unless it is revoked or unless, in the case	246
of a do-not-resuscitate order, the order no longer is current.	247

(D) If emergency medical services personnel, a physician, or	248
a health care facility is aware that a person's DNR identification	249
signifies that the person is the subject of a MOLST form, the	250
emergency medical services personnel, physician, or health care	251
facility shall comply with sections 2133.30 to 2133.47 of the	252
Revised Code.	253

Sec. 2133.24.        Sec. 2133.25.  (A) The death of a person resulting	254
from the withholding or withdrawal of CPR forfrom the person	255
pursuant to the do-not-resuscitate protocol and in the	256
circumstances described in section 2133.22 of the Revised Code or	257
in accordance with division (A) of section 2133.23 of the Revised	258
Codeinstructions in a declaration executed by the person, a	259
do-not-resuscitate order that has been issued for the person, or	260
pursuant to instructions that form the basis of the person's DNR	261
identification does not constitute for any purpose a suicide,	262
aggravated murder, murder, or any other homicide.	263

(B)(1) If a person has executed a declaration, a	264
do-not-resuscitate order has been issued for the person, or the	265
person possesses DNR identification or if a current	266
do-not-resuscitate order has been issued for a person, the	267
existence of the declaration, do-not-resuscitate order, or the	268
possession or orderof the DNR identification shall not do either	269
of the following:	270

(a) Affect in any manner the sale, procurement, issuance, or	271
renewal of a policy of life insurance or annuity, notwithstanding	272
any term of a policy or annuity to the contrary;	273

(b) Be deemed to modify in any manner or invalidate the terms	274
of any policy of life insurance or annuity that is in effect on	275
the effective date of this section.	276

(2) Notwithstanding any term of a policy of life insurance or	277
annuity to the contrary, the withholding or withdrawal of CPR from	278
a person who is insured or covered under the policy or annuity and	279
who possesses DNR identification or for whom a current	280
do-not-resuscitate order has been issued, in accordance with	281
sections 2133.21 to 2133.26 of the Revised Code, who has executed	282
a declaration, or for whom a do-not-resuscitate order has been	283
issued shall not impair or invalidate any policy of life insurance	284
or annuity.	285

(3) Notwithstanding any term of a policy or plan to the	286
contrary, neither of the following shall impair or invalidate any	287
policy of health insurance or other health care benefit plan:	288

(a) The withholding or withdrawal in accordance with sections	289
2133.21 to 2133.262133.29 of the Revised Code of CPR from a	290
person who is insured or covered under the policy or plan and who	291
possesses DNR identification or for whom a current	292
do-not-resuscitate order has been issued, who has executed a	293
declaration, or for whom a do-not-resuscitate order has been	294
issued;	295

(b) The provision in accordance with sections 2133.21 to	296
2133.262133.29 of the Revised Code of CPR to a person of the	297
nature described in division (B)(3)(a) of this section.	298

(4) No physician, health care facility, other health care	299
provider, person authorized to engage in the business of insurance	300
in this state under Title XXXIX of the Revised Code, health	301
insuring corporation, other health care benefit plan, legal entity	302
that is self-insured and provides benefits to its employees or	303
members, or other person shall require an individual to possess	304
DNR identification, execute a declaration, or have a	305
do-not-resuscitate order issued, or shall require an individual to	306
revoke or refrain from possessing DNR identification, as a	307
condition of being insured or of receiving health care benefits or	308
services.	309

(C)(1) Sections 2133.21 to 2133.262133.29 of the Revised	310
Code do not create any presumption concerning the intent of an	311
individual who does not possess DNR identification with respect to	312
the use, continuation, withholding, or withdrawal of CPR.	313

(2) Sections 2133.21 to 2133.262133.29 of the Revised Code	314
do not affect the right of a person to make informed decisions	315
regarding the use, continuation, withholding, or withdrawal of CPR	316
for the person as long as the person is able to make those	317
decisions.	318

(3) Sections 2133.21 to 2133.262133.29 of the Revised Code	319
are in addition to and independent of, and do not limit, impair,	320
or supersede, any right or responsibility that a person has to	321
effect the withholding or withdrawal of life-sustaining treatment	322
to another pursuant to sections 2133.01 to 2133.15 or sections	323
2133.30 to 2133.47 of the Revised Code or in any other lawful	324
manner.	325

(D) Nothing in sections 2133.21 to 2133.26 of the Revised	326
Code condones, authorizes, or approves of mercy killing, assisted	327
suicide, or euthanasia.	328

Sec. 2133.25.        Sec. 2133.26.  (A) The department of health, by rule	329
adopted pursuant to Chapter 119. of the Revised Code, shall adopt	330
a standardized method of procedure for the withholding of CPR by	331
physicians, emergency medical services personnel, and health care	332
facilities in accordance with sections 2133.21 to 2133.26 of the	333
Revised Code. The standardized method shall specify criteria for	334
determining when a do-not-resuscitate order issued by a physician	335
is current. The standardized method so adopted shall be the	336
"do-not-resuscitate protocol" for purposes of sections 2133.21 to	337
2133.26 of the Revised Code. The department also shall approve one	338
or more standard forms of DNR identification to be used throughout	339
this state and shall specify one or more procedures for revoking	340
the forms of identification.	341

(B) The department of health shall adopt rules in accordance	342
with Chapter 119. of the Revised Code for the administration of	343
sections 2133.21 to 2133.26 of the Revised CodeThe	344
do-not-resuscitate protocol adopted by the department in rules	345
adopted under former section 2133.25 of the Revised Code are	346
effective only for do-not-resuscitate orders issued on a date that	347
is not later than six months after the effective date of this	348
amendment. The criteria for determining when a do-not-resuscitate	349
order is current apply only to orders issued before that date.	350

(C) The department of health shall appoint an advisory	351
committee to advise the department in the development of rules	352
under this section. The advisory committee shall include, but	353
shall not be limited to, representatives of each of the following	354
organizations:	355

(1) The association for hospitals and health systems (OHA);

356

(2) The Ohio state medical association;

357

(3) The Ohio chapter of the American college of emergency	358
physicians;	359

(4) The Ohio hospice organization;

360

(5) The Ohio council for home care;

361

(6) The Ohio health care association;

362

(7) The Ohio ambulance association;

363

(8) The Ohio medical directors association;

364

(9) The Ohio association of emergency medical services;

365

(10) The bioethics network of Ohio;

366

(11) The Ohio nurses association;

367

(12) The Ohio academy of nursing homes;

368

(13) The Ohio association of professional firefighters;

369

(14) The department of developmental disabilities;

370

(15) The Ohio osteopathic association;

371

(16) The association of Ohio philanthropic homes, housing and	372
services for the aging;	373

(17) The catholic conference of Ohio;

374

(18) The department of aging;

375

(19) The department of mental health and addiction services;

376

(20) The Ohio private residential association;

377

(21) The northern Ohio fire fighters association.

378

Sec. 2133.26.        Sec. 2133.27.  (A)(1) No physician shall purposely	379
prevent or attempt to prevent, or delay or unreasonably attempt to	380
delay, the transfer of a patient in violation of division (B) of	381
section 2133.232133.24 of the Revised Code.	382

(2) No person shall purposely conceal, cancel, deface, or	383
obliterate the DNR identification of another person without the	384
consent of the other person.	385

(3) No person shall purposely falsify or forge a revocation	386
of a declaration that is the basis of the DNR identification of	387
another person or purposely falsify or forge an order of a	388
physician that purports to supersede a do-not-resuscitate order	389
issued for another person.	390

(4) No person shall purposely falsify or forge the DNR	391
identification of another person with the intent to cause the use,	392
withholding, or withdrawal of CPR for the other person.	393

(5) No person who has personal knowledge that another person	394
has revoked a declaration that is the basis of the other person's	395
DNR identification or personal knowledge that a physician has	396
issued an order that supersedes a do-not-resuscitate order that	397
the physician issued for another personNeither of the following	398
shall purposely conceal or withhold that personal knowledge with	399
the intent to cause the use, withholding, or withdrawal of CPR for	400
the other person:	401

(a) A person who has personal knowledge that another person	402
has revoked a declaration that is the basis of the other person's	403
DNR identification;	404

(b) A person who has personal knowledge that a physician has	405
issued an order that supersedes a do-not-resuscitate order that	406
the physician issued for another person.	407

(B)(1) Whoever violates division (A)(1) or (5) of this	408
section is guilty of a misdemeanor of the third degree.	409

(2) Whoever violates division (A)(2), (3), or (4) of this	410
section is guilty of a misdemeanor of the first degree.	411

Sec. 2133.28. (A) None of the following shall be subject to	412
criminal prosecution, liability in damages in a tort or other	413
civil action for injury, death, or loss to person or property, or	414
professional disciplinary action arising out of or relating to the	415
withholding or withdrawal of CPR from a person after DNR	416
identification is discovered in the person's possession and	417
reasonable efforts have been made to determine that the person in	418
possession of the DNR identification is the person named on the	419
identification, if the withholding or withdrawal is in accordance	420
with the instructions signified by the DNR identification:	421

(1) The health care facility in which the person is present,	422
the administrator of that facility, and any person who works for	423
the facility as an employee or contractor, or who volunteers at	424
the health care facility, and who participates under the direction	425
of or with the authorization of a physician in the withholding or	426
withdrawal of CPR from the person possessing the DNR	427
identification;	428

(2) A physician who causes the withholding or withdrawal of	429
CPR from a person who possesses DNR identification;	430

(3) Any emergency medical services personnel who cause or	431
participate in the withholding or withdrawal of CPR from the	432
person possessing the DNR identification.	433

(B) If, after DNR identification is discovered in the	434
possession of a person, the person makes an oral or written	435
request to receive CPR, any person who provides CPR pursuant to	436
the request, any health care facility in which CPR is provided,	437
and the administrator of any health care facility in which CPR is	438
provided are not subject to criminal prosecution as a result of	439
the provision of CPR, are not liable in damages in tort or other	440
civil action for injury, death, or loss to person or property that	441
arises out of or is related to the provision of CPR, and are not	442
subject to professional disciplinary action as a result of the	443
provision of CPR.	444

Sec. 2133.29. (A) In an emergency situation, emergency	445
medical services personnel are not required to search a person to	446
determine if the person possesses DNR identification. If emergency	447
medical services personnel or emergency department personnel	448
provide CPR to a person in possession of DNR identification in an	449
emergency situation, and if, at that time, the personnel do not	450
know and do not have reasonable cause to believe that the person	451
possesses DNR identification, the emergency medical services	452
personnel and emergency department personnel are not subject to	453
criminal prosecution as a result of the provision of the CPR, are	454
not liable in damages in tort or other civil action for injury,	455
death, or loss to person or property that arises out of or is	456
related to the provision of CPR, and are not subject to	457
professional disciplinary action as a result of the provision of	458
CPR.	459

(B) Nothing in this section or sections 2133.21 to 2133.29 of	460
the Revised Code grants immunity to a physician for issuing a	461
do-not-resuscitate order that is contrary to reasonable medical	462
standards or that the physician knows or has reason to know is	463
contrary to the wishes of the patient or of a person who is	464
authorized to make informed medical decisions on the patient's	465
behalf.	466

Sec. 2133.30. As used in this section and sections 2133.31 to	467
2133.47 of the Revised Code:	468

(A) "Attending physician" means the physician to whom a	469
patient or patient's family has assigned primary responsibility	470
for the medical treatment or care of the patient or, if the	471
responsibility has not been assigned, the physician who has	472
accepted that responsibility.	473

(B) "Certified nurse practitioner" and "clinical nurse	474
specialist" have the same meanings as in section 4723.01 of the	475
Revised Code.	476

(C) "Comfort care" means any of the following:

477

(1) Nutrition when administered to diminish pain or	478
discomfort, but not to postpone death;	479

(2) Hydration when administered to diminish pain or	480
discomfort, but not to postpone death;	481

(3) Any other medical or nursing procedure, treatment,	482
intervention, or other measure that is taken to diminish pain or	483
discomfort, but not to postpone death.	484

(D) "CPR" has the same meaning as in section 2133.21 of the	485
Revised Code.	486

(E) "Declaration" means a document executed in accordance	487
with section 2133.02 of the Revised Code.	488

(F) "DNR identification" and "do-not-resuscitate order" have	489
the same meanings as in section 2133.21 of the Revised Code.	490

(G) "Durable power of attorney for health care" means a	491
document created pursuant to sections 1337.11 to 1337.17 of the	492
Revised Code.	493

(H) "Emergency medical services person" is the singular of	494
"emergency medical services personnel," as defined in section	495
2133.21 of the Revised Code.	496

(I) "Form preparer" means the issuing practitioner who	497
completes and signs a medical orders for life-sustaining treatment	498
form or the individual who completes the form pursuant to the	499
practitioner's delegation and for the practitioner's signature.	500

(J) "Guardian" has the same meaning as in section 2133.01 of	501
the Revised Code.	502

(K) "Health care facility" means any of the following:

503

(1) A health care facility, as defined in section 1337.11 of	504
the Revised Code;	505

(2) An ambulatory surgical facility, as defined in section	506
3702.30 of the Revised Code;	507

(3) A residential care facility, as defined in section	508
3721.01 of the Revised Code;	509

(4) A freestanding dialysis center.

510

(L) "Issuing practitioner" means a physician, physician	511
assistant, certified nurse practitioner, or clinical nurse	512
specialist who issues medical orders for life-sustaining treatment	513
for a patient by signing as the issuing practitioner the medical	514
orders for life-sustaining treatment form for the patient.	515

(M) "Life-sustaining treatment" means any medical procedure,	516
treatment, intervention, or other measure that, when administered	517
to a patient, is intended to serve principally to prolong the	518
process of dying.	519

(N) "Medical orders for life-sustaining treatment" means	520
instructions, issued by a physician, physician assistant,	521
certified nurse practitioner, or clinical nurse specialist,	522
regarding how a patient should be treated with respect to	523
hospitalization, administration or withdrawal of life-sustaining	524
treatment and comfort care, administration of CPR, and other	525
treatment prescribed by the Revised Code.	526

(O) "Medical orders for life-sustaining treatment form,"	527
"MOLST form," or "form" means the form specified in section	528
2133.31 of the Revised Code.	529

(P) "Medically administered hydration" means fluids that are	530
technologically administered.	531

(Q) "Medically administered nutrition" means sustenance that	532
is technologically administered.	533

(R) "Physician" means an individual authorized under Chapter	534
4731. of the Revised Code to practice medicine and surgery or	535
osteopathic medicine and surgery.	536

(S) "Physician assistant" means an individual who holds a	537
valid certificate to practice as a physician assistant issued	538
under Chapter 4730. of the Revised Code.	539

Sec. 2133.31. A medical orders for life-sustaining treatment	540
form shall be substantially in the following form. It is	541
recommended that the patient's name and date of birth, as shown	542
below with the form's title, appear on a page separate from the	543
remaining pages of the form.	544

MEDICAL ORDERS FOR LIFE-SUSTAINING TREATMENT FORM	545

("MOLST FORM")	546

Patient's Name (printed): .....................................	547

Patient's Date of Birth: ......................................	548

There is no requirement that a patient or the patient's parent,	549
guardian, legal custodian, or representative execute a medical	550
orders for life-sustaining treatment form (MOLST form).	551

These medical orders are based on the patient's medical condition	552
and advance directives or preferences at the time the orders were	553
issued. An incomplete section does not invalidate the form and	554
implies full treatment for that section.	555

Each patient shall be treated with dignity and respect and	556
attention shall be given to the patient's needs. The duty of	557
medicine is to care for the patient even when the patient cannot	558
be cured. Moral judgments about the use of technology to maintain	559
life shall reflect the inherent dignity of human life and the duty	560
of medical care.	561

The instructions in this form shall be followed in accordance with	562
Ohio law, including restrictions in Ohio Revised Code section	563
2133.09 governing the removal of life-sustaining treatment from an	564
adult who currently is, and for at least the immediately preceding	565
twelve months has been, in a permanently unconscious state.	566

This form may be revoked at any time and in any manner that	567
communicates the intent to revoke.	568

When signed, this form supersedes all previously signed MOLST	569
forms.	570

A. CARDIOPULMONARY RESUSCITATION (CPR): Individual has no pulse	571
and is not breathing. Check only one:	572

[ ] Attempt resuscitation/CPR. With full treatment and	573
intervention including intubation, advanced airway interventions,	574
mechanical ventilation, defibrillation, and cardioversion as	575
indicated. Transfer to intensive care if indicated.	576

[ ] Do NOT attempt resuscitation/DNR (no CPR).	577

When patient is not in cardiopulmonary arrest, follow the orders	578
in sections B, C, and D.	579

B. MEDICAL INTERVENTIONS: Patient has a pulse, is breathing, or	580
both. Check only one:	581

[ ] Full intervention. Includes all care described in this	582
subsection. Use intubation, advanced airway interventions,	583
mechanical ventilation, and cardioversion as indicated. Transfer	584
to intensive care if indicated.	585

Additional order/instructions: ...............................	586

..............................................................	587

[ ] Limited additional interventions. Includes all care described	588
in this subsection. Use medical treatment, intravenous fluids, and	589
cardiac monitor as indicated. Do not use intubation, advanced	590
airway interventions, or mechanical ventilation. May consider	591
airway support (e.g., CPAP, BiPAP). Avoid intensive care.	592

Additional order/instructions: ...............................	593

..............................................................	594

[ ] Comfort measures only. Use medication by any route,	595
positioning, wound care, and other measures to relieve pain and	596
suffering. Use oxygen, suction, and manual treatment of airway	597
obstruction as needed for comfort. Do not transfer to higher level	598
of care for life-sustaining treatment.	599

Additional order/instructions: ...............................	600

..............................................................	601

C. ANTIBIOTICS. Check only one:	602

[ ] Use antibiotics if medically indicated.	603

[ ] Determine use or limitation of antibiotics when infection	604
occurs.	605

[ ] Do not use antibiotics. Use other measures to relieve	606
symptoms.	607

Additional order/instructions: ...............................	608

..............................................................	609

D. MEDICALLY ADMINISTERED NUTRITION/HYDRATION	610

The administration of nutrition or hydration, or both, whether	611
orally or by invasive means, shall occur except in the event that	612
another condition arises which is life-limiting or irreversible in	613
which the nutrition or hydration becomes a greater burden than	614
benefit to the patient.	615

Always offer by mouth, if feasible. Check only one in each column:	616

	[ ] Long-term medically administered nutrition by tube		[ ] Long-term IV fluids, if indicated			617
	[ ] Medically administered nutrition by tube for a defined trial period		[ ] IV fluids for a defined trial period			618
	[ ] No medically administered nutrition by tube		[ ] No IV fluids			619

Additional order/instructions: ...............................	620

..............................................................	621

E. AUTHORIZATION BY PATIENT OR DECISION MAKER	622

Patient possesses the following prior to execution of this form:	623

[ ] Declaration (living will) – Attach copy if available	624

[ ] Durable power of attorney for health care – Attach copy if	625
available	626

Authorization name and signature belongs to (check only one):	627

[ ] Patient	628

[ ] Guardian appointed by a probate court pursuant to Ohio Revised	629
Code Chapter 2111.	630

[ ] Attorney in fact under patient's durable power of attorney for	631
health care	632

[ ] Next of kin as specified in Ohio Revised Code section	633
2133.08(B)(2) – (6)	634

[ ] Parent, guardian, or legal custodian of a minor	635

[ ] Other representative (print name and relationship to patient):	636
..............................................	637

Name (printed): ..............................................	638

Phone Contact: ...............................................	639

Signature (mandatory): .......................................	640

Date Signed: .................................................	641

F. SIGNATURE OF PRACTITIONER	642

My signature in this section indicates, to the best of my	643
knowledge, that these orders are consistent with the patient's	644
current medical condition and preferences as indicated by the	645
patient's advance directive, previous discussions with the person	646
identified in Section E, above, or both.	647

Name of Physician, Physician Assistant, Certified Nurse	648
Practitioner, or Clinical Nurse Specialist:	649

.....................................................................	650

Signature of Physician, Physician Assistant, Certified Nurse	651
Practitioner, or Clinical Nurse Specialist (mandatory):	652

.....................................................................	653

Date Signed: .....................................................	654

G. REVIEW OF MOLST FORM	655

This form should be reviewed periodically, such as when the	656
patient is transferred from one care setting or care level to	657
another or there is a substantial change in the patient's health	658
status. A new MOLST form should be completed if the patient wishes	659
to make a substantive change to his or her treatment goal (e.g.,	660
reversal of a prior directive). When completing a new form, the	661
old form must be properly revoked and retained in the medical	662
chart.	663

To revoke the MOLST form, draw a line through the heading of this	664
form, MEDICAL ORDERS FOR LIFE-SUSTAINING TREATMENT FORM ("MOLST	665
FORM") and write "VOID" next to it in large letters. The "VOID"	666
designation should be signed and dated.	667

Review of This MOLST Form	668

Review date and time		Reviewer's name (printed)		Location of review		Review Outcome			669
						[ ] No change			670
						[ ] Form revoked and new form completed			671
						[ ] No change			672
						[ ] Form revoked and new form completed			673
						[ ] No change			674
						[ ] Form revoked and new form completed			675
						[ ] No change			676
						[ ] Form revoked and new form completed			677
						[ ] No change			678
						[ ] Form revoked and new form completed			679

SEND FORM WITH PATIENT WHENEVER PATIENT IS TRANSFERRED OR	680
DISCHARGED	681

Use of original form is strongly encouraged. Photocopies and faxes	682
of signed MOLST forms are legal and valid.	683

Sec. 2133.32.  The department of health shall make a version	684
of the MOLST form available on the department's internet web site.	685
The form shall be made available in a format that can be	686
downloaded free of charge and reproduced.	687

Sec. 2133.33.  A physician, physician assistant, certified	688
nurse practitioner, or clinical nurse specialist may at any time	689
issue medical orders for life-sustaining treatment for a patient	690
by completing a MOLST form. Patients for whom medical orders for	691
life-sustaining treatment are suggested, but not required, include	692
those who are suffering from an illness that is in its advanced	693
stages.	694

Once completed and signed in accordance with sections 2133.34	695
and 2133.35 of the Revised Code, a MOLST form is valid and the	696
instructions in it become operative and govern how the patient who	697
is the subject of the form is to be treated with respect to	698
hospitalization, administration or withdrawal of life-sustaining	699
treatment and comfort care, administration of CPR, and any other	700
medical treatment specified on the form.	701

At all times, the issuance of medical orders for	702
life-sustaining treatment shall be guided by prudent medical	703
practice and standards.	704

Sec. 2133.34.  (A) Both of the following persons shall	705
participate in completion of a MOLST form:	706

(1) The issuing practitioner, who shall sign and date the	707
form in the space designated for the practitioner's signature and	708
who may complete the form or delegate to another person the	709
responsibility of the form's completion other than signing the	710
form;	711

(2) The patient, who shall sign and date the form in the	712
space designated for the patient's signature, unless either of the	713
following is the case:	714

(a) A circumstance described in division (B) applies;

715

(b) The patient, in a separate written document, has	716
authorized a representative, including an attorney in fact under	717
the patient's durable power of attorney for health care, to revoke	718
a MOLST form and complete a new form on the patient's behalf.	719

(B)(1) If the patient is at least eighteen years of age,	720
incapacitated, has a legally effective durable power of attorney	721
for health care, and is not already the subject of a valid MOLST	722
form, the patient's attorney in fact under the patient's durable	723
power of attorney for health care shall sign and date the form in	724
the space designated for such signature and indicate the person's	725
status as the patient's attorney in fact.	726

(2) If the patient is at least eighteen years of age,	727
incapacitated, does not have a legally effective durable power of	728
attorney for health care, and is not the subject of a valid MOLST	729
form, the individual or class of individuals specified in the	730
descending order of priority in division (B) of section 2133.08 of	731
the Revised Code, subject to division (C) of that section, shall	732
sign and date the form in the space designated for such signature	733
or signatures and indicate the relationship to the patient.	734

(3) If the patient is under eighteen years of age, the	735
parent, guardian, or legal custodian of the patient shall sign and	736
date the form in the space designated for such signature and	737
indicate the relationship to the patient.	738

Sec. 2133.35. (A) When completing a MOLST form, the form	739
preparer shall discuss the instructions in the form with the	740
patient or the individual or class of individuals who participate	741
in the form's completion on the patient's behalf in accordance	742
with division (A)(2) or (B) of section 2133.34 of the Revised	743
Code. The instructions the form preparer lists on the form shall	744
be consistent with the desires of that person or persons, except	745
that if the patient is under eighteen years of age, the patient's	746
parent, guardian, or legal custodian may not indicate instructions	747
that would result in the withholding of medically indicated	748
treatment, as defined in section 14 of the "Child Abuse	749
Prevention, Adoption, and Family Services Act of 1988," 102 Stat.	750
117 (1988), 42 U.S.C. 5106g, as amended.	751

(B) A declaration or durable power of attorney for health	752
care, or both, if a copy of one or both documents is furnished to	753
the form preparer, may guide the discussion between the form	754
preparer and the patient or other person or persons who	755
participate in the form's completion.	756

Sec. 2133.36.  A completed MOLST form shall be placed in the	757
paper or electronic medical record of the patient to whom it	758
pertains. Whether maintained as part of a paper or electronic	759
medical record, the form shall be readily available and	760
retrievable.	761

Sec. 2133.37. (A) If a patient with a MOLST form is	762
transferred from one health care facility to another health care	763
facility, the health care facility initiating the transfer shall	764
communicate the existence of, and send a copy of, the form to the	765
receiving facility prior to the transfer. The copy may be sent by	766
regular mail or by facsimile or other electronic means. A copy of	767
the form is the same as the original.	768

(B) Consistent with section 2133.36 of the Revised Code, the	769
copy of the MOLST form shall be placed in the patient's medical	770
record immediately on receipt by the receiving facility. After	771
admission, the attending physician shall review the MOLST form.	772

Sec. 2133.38.  The patient, the patient's authorized	773
representative described in division (A)(2) or (B) of section	774
2133.34 of the Revised Code, or, if the patient is under eighteen	775
years of age, the patient's parent, guardian, or legal custodian,	776
may revoke a MOLST form at any time and in any manner that	777
communicates the intent to revoke. A revoked MOLST form shall be	778
retained in the patient's medical record.	779

Sec. 2133.39.  Unless revoked in accordance with section	780
2133.38 of the Revised Code, a MOLST form does not expire.	781

Sec. 2133.40. If an emergency medical services person	782
determines in an emergency situation that either of the following	783
applies, the emergency medical services person shall proceed to	784
treat the patient as directed, verbally or in writing, by a	785
physician, or, if applicable, the cooperating physician advisory	786
board of the emergency medical service organization with which the	787
emergency medical services person is affiliated:	788

(A) An instruction in the patient's MOLST form is	789
inconsistent with an instruction in any of the following:	790

(1) A do-not-resuscitate order that applies to the patient;

791

(2) A general consent to treatment form signed by or on	792
behalf of the patient;	793

(3) A declaration executed by the patient;

794

(4) A durable power of attorney for health care executed by	795
the patient.	796

(B) The section of the MOLST form that relates to the	797
patient's treatment in that emergency situation has not been	798
completed.	799

Sec. 2133.41. (A) Subject to division (B) of this section, no	800
health care facility, health care professional, emergency medical	801
services person, or other individual who works for or volunteers	802
at a health care facility as an employee, contractor, or volunteer	803
and who is or who works or volunteers under the direction of or	804
with the authorization of a physician, physician assistant,	805
certified nurse practitioner, or clinical nurse specialist shall	806
be subject to criminal prosecution, liable in damages in tort or	807
other civil action, or subject to professional disciplinary action	808
for acting in good faith and in accordance with, or otherwise	809
being in compliance with, a valid MOLST form or sections 2133.31	810
to 2133.47 of the Revised Code.	811

(B) Division (A) of this section does not grant immunity from	812
criminal or civil liability or from professional disciplinary	813
action to a health care professional or emergency medical service	814
person for actions that are outside the professional's or person's	815
scope of authority.	816

Sec. 2133.42.  The death of an individual that occurs as a	817
result of actions taken consistent with instructions in a MOLST	818
form does not constitute for any purpose a suicide, aggravated	819
murder, murder, or any other homicide.	820

Sec. 2133.43.  The issuance or non-issuance of a MOLST form	821
shall not do any of the following:	822

(A) Affect in any manner the sale, procurement, issuance, or	823
renewal of a policy of life insurance or annuity, notwithstanding	824
any term of a policy or annuity to the contrary;	825

(B) Modify in any manner or invalidate the terms of a policy	826
of life insurance or annuity that is in effect on the effective	827
date of this section;	828

(C) Impair or invalidate a policy of life insurance or	829
annuity or any health benefit plan.	830

Sec. 2133.44.  No physician, health care facility, other	831
health care provider, person authorized to engage in the business	832
of insurance in this state under Title XXXIX of the Revised Code,	833
health insuring corporation, other health care benefit plan, legal	834
entity that is self-insured and provides benefits to its employees	835
or members, governmental entity, or other person shall require	836
that an individual be the subject of a MOLST form, or require an	837
individual to revoke or refrain from being the subject of a MOLST	838
form, as a condition of being insured or of receiving health care	839
benefits or services.	840

Sec. 2133.45.  (A) Subject to divisions (B) and (C) of this	841
section, an attending physician of a patient or a health care	842
facility in which a patient is located may refuse to comply or	843
allow compliance with one or more instructions in a MOLST form on	844
the basis of conscience or on another basis. An employee of an	845
attending physician or of a health care facility in which a	846
patient is located may refuse to comply with one or more	847
instructions in a MOLST form on the basis of a matter of	848
conscience.	849

(B) An attending physician of a patient who, or a health care	850
facility in which a patient is confined that, is not willing or	851
not able to comply or allow compliance with one or more	852
instructions in a MOLST form shall immediately notify the patient	853
or person who has signed the MOLST form on the patient's behalf	854
under section 2133.34 of the Revised Code, and shall not prevent	855
or attempt to prevent, or unreasonably delay or attempt to	856
unreasonably delay, the transfer of the patient to the care of a	857
physician who, or a health care facility that, is willing and able	858
to so comply or allow compliance.	859

Sec. 2133.46. In the absence of actual knowledge to the	860
contrary and if acting in good faith, an attending physician,	861
other health care professional, emergency medical services person,	862
or health care facility may assume that a MOLST form complies with	863
sections 2133.31 to 2133.45 of the Revised Code and is valid.	864

Sec. 2133.47. Not later than sixty months after the effective	865
date of this section, the director of health shall appoint a MOLST	866
task force to perform a five-year review of medical orders for	867
life-sustaining treatment and the MOLST form. Task force members	868
shall be, or represent, persons or government entities that have	869
experience with medical orders for life-sustaining treatment or	870
the MOLST form. Not later than seventy-two months after the	871
effective date of this section, the task force shall submit a	872
report of its findings to the general assembly in accordance with	873
section 101.68 of the Revised Code.	874

Members of the task force shall serve without compensation,	875
but may be reimbursed for necessary expenses.	876

Sec. 3795.03. Nothing in section 3795.01 or 3795.02 of the	877
Revised Code shall do any of the following:	878

(A) Prohibit or preclude a physician, certified nurse	879
practitioner, certified nurse-midwife, or clinical nurse	880
specialist who carries out the responsibility to provide comfort	881
care to a patient in good faith and while acting within the scope	882
of the physician's or nurse's authority from prescribing,	883
dispensing, administering, or causing to be administered any	884
particular medical procedure, treatment, intervention, or other	885
measure to the patient, including, but not limited to,	886
prescribing, personally furnishing, administering, or causing to	887
be administered by judicious titration or in another manner any	888
form of medication, for the purpose of diminishing the patient's	889
pain or discomfort and not for the purpose of postponing or	890
causing the patient's death, even though the medical procedure,	891
treatment, intervention, or other measure may appear to hasten or	892
increase the risk of the patient's death;	893

(B) Prohibit or preclude health care personnel acting under	894
the direction of a person authorized to prescribe a patient's	895
treatment and who carry out the responsibility to provide comfort	896
care to the patient in good faith and while acting within the	897
scope of their authority from dispensing, administering, or	898
causing to be administered any particular medical procedure,	899
treatment, intervention, or other measure to the patient,	900
including, but not limited to, personally furnishing,	901
administering, or causing to be administered by judicious	902
titration or in another manner any form of medication, for the	903
purpose of diminishing the patient's pain or discomfort and not	904
for the purpose of postponing or causing the patient's death, even	905
though the medical procedure, treatment, intervention, or other	906
measure may appear to hasten or increase the risk of the patient's	907
death;	908

(C) Prohibit or affect the use or continuation, or the	909
withholding or withdrawal, of life-sustaining treatment, CPR, or	910
comfort care under Chapter 2133. of the Revised Code;	911

(D) Prohibit or affect the provision or withholding of health	912
care, life-sustaining treatment, or comfort care to a principal	913
under a durable power of attorney for health care or any other	914
health care decision made by an attorney in fact under sections	915
1337.11 to 1337.17 of the Revised Code;	916

(E) Affect or limit the authority of a physician, a health	917
care facility, a person employed by or under contract with a	918
health care facility, or emergency servicemedical services	919
personnel to provide or withhold health care to a person in	920
accordance with reasonable medical standards applicable in an	921
emergency situation;	922

(F) Affect or limit the authority of a person to refuse to	923
give informed consent to health care, including through the	924
execution of a durable power of attorney for health care under	925
sections 1337.11 to 1337.17 of the Revised Code, the execution of	926
a declaration under sections 2133.01 to 2133.15 of the Revised	927
Code, the completion of a MOLST form under sections 2133.30 to	928
2133.47 of the Revised Code, or authorizing the withholding or	929
withdrawal of CPR under sections 2133.21 to 2133.262133.29 of the	930
Revised Code.	931

Sec. 4730.09. (A) Under a physician supervisory plan approved	932
under section 4730.17 of the Revised Code, a physician assistant	933
may provide any or all of the following services without approval	934
by the state medical board as special services:	935

(1) Obtaining comprehensive patient histories;

936

(2) Performing physical examinations, including audiometry	937
screening, routine visual screening, and pelvic, rectal, and	938
genital-urinary examinations, when indicated;	939

(3) Ordering, performing, or ordering and performing routine	940
diagnostic procedures, as indicated;	941

(4) Identifying normal and abnormal findings on histories,	942
physical examinations, and commonly performed diagnostic studies;	943

(5) Assessing patients and developing and implementing	944
treatment plans for patients;	945

(6) Monitoring the effectiveness of therapeutic	946
interventions;	947

(7) Exercising physician-delegated prescriptive authority	948
pursuant to a certificate to prescribe issued under this chapter;	949

(8) Carrying out or relaying the supervising physician's	950
orders for the administration of medication, to the extent	951
permitted by law;	952

(9) Providing patient education;

953

(10) Instituting and changing orders on patient charts;

954

(11) Performing developmental screening examinations on	955
children with regard to neurological, motor, and mental functions;	956

(12) Performing wound care management, suturing minor	957
lacerations and removing the sutures, and incision and drainage of	958
uncomplicated superficial abscesses;	959

(13) Removing superficial foreign bodies;

960

(14) Administering intravenous fluids;

961

(15) Inserting a foley or cudae catheter into the urinary	962
bladder and removing the catheter;	963

(16) Performing biopsies of superficial lesions;

964

(17) Making appropriate referrals as directed by the	965
supervising physician;	966

(18) Performing penile duplex ultrasound;

967

(19) Changing of a tracheostomy;

968

(20) Performing bone marrow aspirations from the posterior	969
iliac crest;	970

(21) Performing bone marrow biopsies from the posterior iliac	971
crest;	972

(22) Performing cystograms;

973

(23) Performing nephrostograms after physician placement of	974
nephrostomy tubes;	975

(24) Fitting, inserting, or removing birth control devices;

976

(25) Removing cervical polyps;

977

(26) Performing nerve conduction testing;

978

(27) Performing endometrial biopsies;

979

(28) Inserting filiform and follower catheters;

980

(29) Performing arthrocentesis of the knee;

981

(30) Performing knee joint injections;

982

(31) Performing endotracheal intubation with successful	983
completion of an advanced cardiac life support course;	984

(32) Performing lumbar punctures;

985

(33) In accordance with rules adopted by the board, using	986
light-based medical devices for the purpose of hair removal;	987

(34) Administering, monitoring, or maintaining local	988
anesthesia, as defined in section 4730.091 of the Revised Code;	989

(35) Applying or removing a cast or splint;

990

(36) Inserting or removing chest tubes;

991

(37) Prescribing physical therapy or referring a patient to a	992
physical therapist for the purpose of receiving physical therapy;	993

(38) Ordering occupational therapy or referring a patient to	994
an occupational therapist for the purpose of receiving	995
occupational therapy;	996

(39) Taking any action that may be taken by an attending	997
physician under sections 2133.21 to 2133.262133.29 of the Revised	998
Code, as specified in section 2133.2112133.23 of the Revised	999
Code;	1000

(40) Determining and pronouncing death in accordance with	1001
section 4730.092 of the Revised Code;	1002

(41) Admitting patients to hospitals in accordance with	1003
section 3727.06 of the Revised Code;	1004

(42) Performing other services that are within the	1005
supervising physician's normal course of practice and expertise,	1006
if the services are included in any model physician supervisory	1007
plan approved under section 4730.06 of the Revised Code or the	1008
services are designated by the board by rule or other means as	1009
services that are not subject to approval as special services.	1010

(B) Under the policies of a health care facility, the	1011
services a physician assistant may provide are limited to the	1012
services the facility has authorized the physician assistant to	1013
provide for the facility. The services a health care facility may	1014
authorize a physician assistant to provide for the facility	1015
include the following:	1016

(1) Any or all of the services specified in division (A) of	1017
this section;	1018

(2) Assisting in surgery in the health care facility;

1019

(3) Any other services permitted by the policies of the	1020
health care facility, except that the facility may not authorize a	1021
physician assistant to perform a service that is prohibited by	1022
this chapter.	1023

Section 2. That existing sections 2133.02, 2133.21, 2133.211,	1024
2133.23, 2133.24, 2133.25, 2133.26, 3795.03, and 4730.09 and	1025
section 2133.22 of the Revised Code are hereby repealed.	1026