Bill Text: IA SSB3043 | 2013-2014 | 85th General Assembly | Introduced

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Bill Title: A study bill for an act relating to a physician assistant's or advanced registered nurse practitioner's authority in regard to life=sustaining procedures.

Spectrum: Unknown

Status: (N/A - Dead) 2014-01-22 - In Human Resources [SSB3043 Detail]

Download: Iowa-2013-SSB3043-Introduced.html

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Senate Study Bill 3043 - Introduced
SENATE FILE _____
BY (PROPOSED COMMITTEE ON
HUMAN RESOURCES BILL BY
CHAIRPERSON RAGAN)
A BILL FOR
An Act relating to a physician assistant’s or advanced
registered nurse practitioner’s authority in regard to
life-sustaining procedures.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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Section 1. Section 144A.2, Code 2014, is amended by adding
the following new subsections:
NEW SUBSECTION . 1A. “Advanced registered nurse practitioner”
means an advanced registered nurse practitioner licensed
pursuant to chapter 152 or 152E.
NEW SUBSECTION . 1B. “Attending advanced registered nurse
practitioner” means the advanced registered nurse practitioner
selected by, or assigned to, the patient who has primary
responsibility for the treatment and care of the patient.
NEW SUBSECTION . 2A. “Attending physician assistant” means
the physician assistant selected by, or assigned to, the
patient who has primary responsibility for the treatment and
care of the patient.
NEW SUBSECTION . 10A. “Physician assistant” means a person
licensed under chapter 148C.
Sec. 2. Section 144A.2, subsections 9, 11, and 13, Code
2014, are amended to read as follows:
9. “Out-of-hospital do-not-resuscitate order” means a written
order signed by a physician , physician assistant, or advanced
registered nurse practitioner , executed in accordance with the
requirements of section 144A.7A and issued consistent with
this chapter , that directs the withholding or withdrawal of
resuscitation when an adult patient in a terminal condition is
outside the hospital.
11. “Qualified patient” means a patient who has executed
a declaration or an out-of-hospital do-not-resuscitate order
in accordance with this chapter and who has been determined
by the attending physician , attending physician assistant, or
attending advanced registered nurse practitioner to be in a
terminal condition.
13. “Terminal condition” means an incurable or irreversible
condition that, without the administration of life-sustaining
procedures, will, in the opinion of the attending physician ,
attending physician assistant, or attending advanced registered
nurse practitioner , result in death within a relatively short
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period of time or a state of permanent unconsciousness from
which, to a reasonable degree of medical certainty, there can
be no recovery.
Sec. 3. Section 144A.3, subsections 3 and 5, Code 2014, are
amended to read as follows:
3. It is the responsibility of the declarant to provide the
declarant’s attending physician , attending physician assistant,
attending advanced registered nurse practitioner, or health
care provider with the declaration. An attending physician ,
attending physician assistant, attending advanced registered
nurse practitioner, or health care provider may presume, in the
absence of actual notice to the contrary, that the declaration
complies with this chapter and is valid.
5. A declaration executed pursuant to this chapter may, but
need not, be in the following form:
DECLARATION
If I should have an incurable or irreversible condition that
will result either in death within a relatively short period
of time or a state of permanent unconsciousness from which,
to a reasonable degree of medical certainty, there can be no
recovery, it is my desire that my life not be prolonged by
the administration of life-sustaining procedures. If I am
unable to participate in my health care decisions, I direct
my attending physician , attending physician assistant, or
attending advanced registered nurse practitioner to withhold
or withdraw life-sustaining procedures that merely prolong the
dying process and are not necessary to my comfort or freedom
from pain.
Sec. 4. Section 144A.4, Code 2014, is amended to read as
follows:
144A.4 Revocation of declaration.
1. A declaration may be revoked at any time and in any
manner by which the declarant is able to communicate the
declarant’s intent to revoke, without regard to mental or
physical condition. A revocation is only effective as to
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the attending physician , attending physician assistant,
or attending advanced registered nurse practitioner upon
communication to such physician , physician assistant, or
advanced registered nurse practitioner by the declarant or by
another to whom the revocation was communicated.
2. The attending physician , attending physician assistant,
or attending advanced registered nurse practitioner shall make
the revocation a part of the declarant’s medical record.
Sec. 5. Section 144A.5, Code 2014, is amended to read as
follows:
144A.5 Determination of terminal condition.
When an attending physician , an attending physician
assistant, or attending advanced registered nurse practitioner
who has been provided with a declaration determines that
the declarant is in a terminal condition, this decision
must be confirmed by another physician , physician assistant,
or advanced registered nurse practitioner . The attending
physician , attending physician assistant, or attending advanced
registered nurse practitioner must record that determination in
the declarant’s medical record.
Sec. 6. Section 144A.6, subsection 2, Code 2014, is amended
to read as follows:
2. The declaration of a qualified patient known to
the attending physician , attending physician assistant,
or attending advanced registered nurse practitioner to be
pregnant shall not be in effect as long as the fetus could
develop to the point of live birth with continued application
of life-sustaining procedures. However, the provisions
of this subsection do not impair any existing rights or
responsibilities that any person may have in regard to the
withholding or withdrawal of life-sustaining procedures.
Sec. 7. Section 144A.7, subsection 1, unnumbered paragraph
1, Code 2014, is amended to read as follows:
Life-sustaining procedures may be withheld or withdrawn from
a patient who is in a terminal condition and who is comatose,
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incompetent, or otherwise physically or mentally incapable of
communication and has not made a declaration in accordance with
this chapter if there is consultation and written agreement for
the withholding or the withdrawal of life-sustaining procedures
between the attending physician , attending physician assistant,
or attending advanced registered nurse practitioner and any of
the following individuals, who shall be guided by the express
or implied intentions of the patient, in the following order
of priority if no individual in a prior class is reasonably
available, willing, and competent to act:
Sec. 8. Section 144A.7, subsection 3, Code 2014, is amended
to read as follows:
3. Subsections 1 and 2 shall not be in effect for a patient
who is known to the attending physician , attending physician
assistant, or attending advanced registered nurse practitioner
to be pregnant with a fetus that could develop to the point
of live birth with continued application of life-sustaining
procedures. However, the provisions of this subsection do
not impair any existing rights or responsibilities that any
person may have in regard to the withholding or withdrawal of
life-sustaining procedures.
Sec. 9. Section 144A.7A, subsection 1, Code 2014, is amended
to read as follows:
1. If an attending physician , attending physician
assistant, or attending advanced registered nurse practitioner
issues an out-of-hospital do-not-resuscitate order for an adult
patient under this section , the physician , physician assistant,
or advanced registered nurse practitioner shall use the form
prescribed pursuant to subsection 2 , include a copy of the
order in the patient’s medical record, and provide a copy to
the patient or an individual authorized to act on the patient’s
behalf.
Sec. 10. Section 144A.7A, subsection 3, paragraph e, Code
2014, is amended to read as follows:
e. The physician’s , physician assistant’s, or advanced
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registered nurse practitioner’s signature.
Sec. 11. Section 144A.8, subsection 1, Code 2014, is amended
to read as follows:
1. An attending physician , attending physician assistant,
or attending advanced registered nurse practitioner who is
unwilling to comply with the requirements of section 144A.5 , or
who is unwilling to comply with the declaration of a qualified
patient in accordance with section 144A.6 or an out-of-hospital
do-not-resuscitate order pursuant to section 144A.7A , or who is
unwilling to comply with the provisions of section 144A.7 or
144A.7A shall take all reasonable steps to effect the transfer
of the patient to another physician , physician assistant, or
advanced registered nurse practitioner .
Sec. 12. Section 144A.9, subsection 1, paragraphs a and c,
Code 2014, are amended to read as follows:
a. A physician , physician assistant, or advanced registered
nurse practitioner who causes the withholding or withdrawal of
life-sustaining procedures from a qualified patient.
c. A person who participates in the withholding or
withdrawal of life-sustaining procedures under the direction of
or with the authorization of a physician , physician assistant,
or advanced registered nurse practitioner .
Sec. 13. Section 144A.9, subsection 2, Code 2014, is amended
to read as follows:
2. A physician , physician assistant, or advanced registered
nurse practitioner is not subject to civil or criminal
liability for actions under this chapter which are in accord
with reasonable medical standards.
Sec. 14. Section 144A.11, subsection 3, Code 2014, is
amended to read as follows:
3. A physician, physician assistant, advanced registered
nurse practitioner, health care provider, health care service
plan, insurer issuing disability insurance, self-insured
employee welfare benefit plan, or nonprofit hospital plan
shall not require any person to execute a declaration or an
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out-of-hospital do-not-resuscitate order as a condition for
being insured for, or receiving, health care services.
Sec. 15. Section 144D.4, subsection 3, Code 2014, is amended
to read as follows:
3. If the individual’s physician , physician assistant,
or advanced registered nurse practitioner has issued an
out-of-hospital do-not-resuscitate order pursuant to section
144A.7A , the POST form shall not supersede the out-of-hospital
do-not-resuscitate order.
Sec. 16. Section 235B.2, subsection 5, paragraph b,
subparagraph (3), Code 2014, is amended to read as follows:
(3) The withholding or withdrawing of health care from
a dependent adult who is terminally ill in the opinion of a
licensed physician , physician assistant, or advanced registered
nurse practitioner , when the withholding or withdrawing of
health care is done at the request of the dependent adult or at
the request of the dependent adult’s next of kin, attorney in
fact, or guardian pursuant to the applicable procedures under
chapter 125 , 144A , 144B , 222 , 229 , or 633 .
Sec. 17. Section 235E.1, subsection 5, paragraph b,
subparagraph (3), Code 2014, is amended to read as follows:
(3) The withholding or withdrawing of health care from
a dependent adult who is terminally ill in the opinion of a
licensed physician , physician assistant, or advanced registered
nurse practitioner , when the withholding or withdrawing of
health care is done at the request of the dependent adult or at
the request of the dependent adult’s next of kin, attorney in
fact, or guardian pursuant to the applicable procedures under
chapter 125 , 144A , 144B , 222 , 229 , or 633 .
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
This bill relates to a physician assistant’s or advanced
registered nurse practitioner’s authority in regard to
life-sustaining procedures. The bill grants a physician
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assistant and an advanced registered nurse practitioner the
same authority as a physician to issue an out-of-hospital
do-not-resuscitate order for an adult patient pursuant to
Code chapter 144A, to withhold life-sustaining procedures in
accordance with the Code chapter, to consult and be party to a
written agreement for withholding life-sustaining procedures
pursuant to the Code chapter, and to determine that a patient
has a terminal condition.
The bill makes conforming changes.
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