Bill Text: FL S0206 | 2019 | Regular Session | Introduced
Bill Title: Physician Orders for Life-sustaining Treatment
Spectrum: Partisan Bill (Republican 1-0)
Status: (Failed) 2019-05-03 - Died in Health Policy [S0206 Detail]
Download: Florida-2019-S0206-Introduced.html
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 authorizedpermittedby 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) IfWhenrequired bythe provisions ofchapter 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) IfWhennursing 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 areshallnotbesubject to criminal prosecution or 487 civil liability, and are notnorbeconsidered to have engaged 488 in negligent or unprofessional conduct, for withholding or 489 withdrawing cardiopulmonary resuscitation pursuant to such 490 ordersan orderand 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 501advanceddirectives; physician orders for life-sustaining 502 treatment forms executed pursuant to s. 401.451; and orders not 503 to resuscitatedo-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 areshallnotbesubject to criminal 515 prosecution or civil liability, and are notnorbeconsidered to 516 have engaged in negligent or unprofessional conduct, for 517 withholding or withdrawing cardiopulmonary resuscitation 518 pursuant to such ordersan orderand 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 authorizedpermitted523 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,orparamedic, 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 applicableis presented to the550emergency medical technician or paramedic. To be valid, an order 551 not to resuscitate or not to perform other medical intervention,552to 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 areshallnotbesubject to criminal prosecution 573 or civil liability, and are notnorbeconsidered 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 authorizedpermittedby 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 isshallnotbesubject to criminal 596 prosecution or civil liability, and is notnorbeconsidered to 597 have engaged in negligent or unprofessional conduct, for 598 withholding or withdrawing cardiopulmonary resuscitation 599 pursuant to such ordersan orderand 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.