Bill Text: NY A09647 | 2013-2014 | General Assembly | Amended
Bill Title: Relates to health care agents and proxies, decisions under the family health care decisions act and non-hospital orders not to resuscitate.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2014-06-18 - reported referred to rules [A09647 Detail]
Download: New_York-2013-A09647-Amended.html
S T A T E O F N E W Y O R K ________________________________________________________________________ 9647--A I N A S S E M B L Y May 14, 2014 ___________ Introduced by M. of A. CLARK, GOTTFRIED -- read once and referred to the Committee on Health -- reported and referred to the Committee on Codes -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the public health law, in relation to making technical, minor and coordinating amendments regarding health care agents and proxies, decisions under the family health care decisions act, and non-hospital orders not to resuscitate THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: 1 Section 1. Subdivisions 4 and 10 of section 2980 of the public health 2 law, subdivision 4 as added by chapter 752 of the laws of 1990, subdivi- 3 sion 10 as amended by chapter 23 of the laws of 1994, are amended to 4 read as follows: 5 4. "Health care" means any treatment, service or procedure to diagnose 6 or treat an individual's physical or mental condition. PROVIDING NUTRI- 7 TION OR HYDRATION ORALLY, WITHOUT RELIANCE ON MEDICAL TREATMENT, IS NOT 8 HEALTH CARE UNDER THIS ARTICLE AND IS NOT SUBJECT TO THIS ARTICLE. 9 10. "Mental hygiene facility" means a residential facility, excluding 10 family care homes, operated or licensed by the office of mental health 11 or the office [of mental retardation and] FOR PEOPLE WITH developmental 12 disabilities. 13 S 2. Paragraph (b) of subdivision 1 of section 2981 of the public 14 health law, as added by chapter 752 of the laws of 1990, is amended to 15 read as follows: 16 (b) For the purposes of this section, every adult shall be presumed 17 competent to appoint a health care agent unless such person has been 18 adjudged incompetent or otherwise adjudged not competent to appoint a 19 health care agent, or unless a [committee or] guardian of the person has 20 been appointed for the adult pursuant to article [seventy-eight] EIGHT- 21 Y-ONE of the mental hygiene law or article seventeen-A of the surro- 22 gate's court procedure act. EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD13618-03-4 A. 9647--A 2 1 S 3. Subdivision 2 of section 2982 of the public health law, as 2 amended by chapter 230 of the laws of 2004, is amended to read as 3 follows: 4 2. Decision-making standard. After consultation with a licensed physi- 5 cian, registered nurse, PHYSICIAN ASSISTANT, NURSE PRACTITIONER, 6 licensed psychologist, licensed master social worker, or a licensed 7 clinical social worker, the agent shall make health care decisions: (a) 8 in accordance with the principal's wishes, including the principal's 9 religious and moral beliefs; or (b) if the principal's wishes are not 10 reasonably known and cannot with reasonable diligence be ascertained, in 11 accordance with the principal's best interests; provided, however, that 12 if the principal's wishes regarding the administration of artificial 13 nutrition and hydration are not reasonably known and cannot with reason- 14 able diligence be ascertained, the agent shall not have the authority to 15 make decisions regarding these measures. 16 S 4. Subdivision 3 of section 2983 of the public health law, as added 17 by chapter 752 of the laws of 1990, is amended to read as follows: 18 3. Notice of determination. Notice of a determination that a principal 19 lacks capacity to make health care decisions shall promptly be given: 20 (a) to the principal, orally and in writing, where there is any indi- 21 cation of the principal's ability to comprehend such notice; (b) to the 22 agent; (c) if the principal is in or is transferred from a mental 23 hygiene facility, to the facility director; and (d) to the [conservator 24 for, or committee of, the principal] GUARDIAN, IF ANY. 25 S 5. Subdivision 2 of section 2991 of the public health law, as added 26 by chapter 752 of the laws of 1990, is amended to read as follows: 27 2. Such procedures shall be established in accordance with regulations 28 issued by the commissioners of health, mental health, and [mental retar- 29 dation and] developmental disabilities for facilities subject to their 30 respective regulatory authorities. 31 S 6. The opening paragraph of section 2992 of the public health law, 32 as added by chapter 752 of the laws of 1990, is amended to read as 33 follows: 34 The health care provider, the [conservator for, or committee] GUARDIAN 35 of the principal UNDER ARTICLE EIGHTY-ONE OF THE MENTAL HYGIENE LAW OR 36 ARTICLE SEVENTEEN-A OF THE SURROGATE'S COURT PROCEDURE ACT, members of 37 the principal's family, a close friend of the principal as defined in 38 subdivision [five] FOUR of section [two thousand nine] TWENTY-NINE 39 hundred [sixty-one] NINETY-FOUR-A of this chapter, or the commissioner 40 [of health], THE COMMISSIONER OF mental health, or [mental retardation 41 and] THE COMMISSIONER OF developmental disabilities may commence a 42 special proceeding pursuant to article four of the civil practice law 43 and rules, in a court of competent jurisdiction, with respect to any 44 dispute arising under this article, including, but not limited to, a 45 proceeding to: 46 S 7. Section 2993 of the public health law, as added by chapter 752 of 47 the laws of 1990, is amended to read as follows: 48 S 2993. Regulations. The commissioner [of health], in consultation 49 with the commissioners of [the office of] mental health and [the office 50 of mental retardation and] developmental disabilities, shall establish 51 such regulations as may be necessary for the implementation of this 52 article, subject to the provisions of subdivision two of section [two 53 thousand nine] TWENTY-NINE hundred ninety-one of this article. 54 S 8. Subdivisions 17, 20 and 26 of section 2994-a of the public health 55 law, as added by chapter 8 of the laws of 2010, are amended to read as 56 follows: A. 9647--A 3 1 17. "Health or social [service] SERVICES practitioner" means a regis- 2 tered professional nurse, nurse practitioner, physician, physician 3 assistant, psychologist, LICENSED MASTER SOCIAL WORKER or licensed clin- 4 ical social worker, licensed or certified pursuant to the education law 5 acting within his or her scope of practice. 6 20. "Mental hygiene facility" means a facility operated or licensed by 7 the office of mental health or the office [of mental retardation and] 8 FOR PEOPLE WITH developmental disabilities as defined in subdivision six 9 of section 1.03 of the mental hygiene law. 10 26. "Person connected with the case" means the patient, any person on 11 the surrogate list, a parent or guardian of a minor patient, [the] A 12 hospital administrator, an attending physician, any other health or 13 social services practitioner who is or has been directly involved in the 14 patient's care, and any duly authorized state agency, including the 15 facility director or regional director for a patient transferred from a 16 mental hygiene facility and the facility director for a patient trans- 17 ferred from a correctional facility. 18 S 9. The opening paragraph and paragraph (a) of subdivision 3 of 19 section 2994-b of the public health law, as added by chapter 8 of the 20 laws of 2010, are amended to read as follows: 21 Prior to seeking or relying upon a health care decision by a surrogate 22 for a patient under this article, if the attending physician has reason 23 to believe that the patient has a history of receiving services for 24 [mental retardation or] a developmental disability; it reasonably 25 appears to the attending physician that the patient has [mental retarda- 26 tion or] a developmental disability; or the attending physician has 27 reason to believe that the patient has been transferred from a mental 28 hygiene facility operated or licensed by the office of mental health, 29 then such physician shall make reasonable efforts to determine whether 30 paragraphs (a), (b) or (c) of this subdivision are applicable: 31 (a) If the patient has a guardian appointed by a court pursuant to 32 article seventeen-A of the surrogate's court procedure act, health care 33 decisions for the patient shall be governed by section seventeen hundred 34 fifty-b of the surrogate's court [proceedure] PROCEDURE act and not by 35 this article. 36 S 10. Paragraphs (a) and (b) of subdivision 3 of section 2994-e of the 37 public health law, as added by chapter 8 of the laws of 2010, are 38 amended to read as follows: 39 (a) If an attending physician determines that a patient is an emanci- 40 pated minor patient with decision-making capacity AND DOCUMENTS THE 41 BASIS FOR SUCH DETERMINATION IN THE PATIENT'S MEDICAL RECORD, the 42 patient shall have the authority to decide about life-sustaining treat- 43 ment. Such authority shall include a decision to withhold or withdraw 44 life-sustaining treatment if an attending physician and the ethics 45 review committee determine that the decision accords with the standards 46 for surrogate decisions for adults, and the ethics review committee 47 approves the decision. 48 (b) If the hospital can with reasonable efforts ascertain the identity 49 of the parents or guardian of an emancipated minor patient, the hospital 50 shall MAKE DILIGENT EFFORTS TO notify such persons, AND DOCUMENT SUCH 51 DILIGENT EFFORTS IN THE PATIENT'S MEDICAL RECORD, prior to withholding 52 or withdrawing life-sustaining treatment pursuant to this subdivision. 53 S 11. Subparagraph (iv) of paragraph (b) of subdivision 4 of section 54 2994-m of the public health law, as added by chapter 8 of the laws of 55 2010, is amended to read as follows: A. 9647--A 4 1 (iv) Following ethics review committee consideration of a case 2 concerning the withdrawal or withholding of life-sustaining treatment, 3 treatment shall not be withdrawn or withheld until THE HOSPITAL MAKES 4 DILIGENT EFFORTS TO INFORM the persons identified in subparagraph (iii) 5 of this paragraph [have been informed] of the committee's response to 6 the case AND DOCUMENTS SUCH DILIGENT EFFORTS IN THE PATIENT'S MEDICAL 7 RECORD. 8 S 12. Subdivision 2 of section 2994-t of the public health law, as 9 added by chapter 8 of the laws of 2010, is amended to read as follows: 10 2. The commissioner, in consultation with the commissioners of [the 11 office of] mental health and [the office of mental retardation and] 12 developmental disabilities, shall promulgate regulations identifying the 13 credentials of health care professionals qualified to provide an inde- 14 pendent determination, pursuant to subdivision three of section twenty- 15 nine hundred ninety-four-c of this article, that a patient lacks deci- 16 sion-making capacity because of mental illness or developmental 17 disability. 18 S 13. Section 2994-u of the public health law, as added by chapter 8 19 of the laws of 2010, is amended to read as follows: 20 S 2994-u. Rights to be publicized. The commissioner shall prepare a 21 statement summarizing the rights, duties, and requirements of this arti- 22 cle and shall require that a copy of such statement be furnished to 23 [patients] A PATIENT or to [persons on] the surrogate [list known to the 24 hospital], or to the [parents or guardians] PARENT OR GUARDIAN of A 25 minor [patients] PATIENT, at or prior to admission to the hospital, or 26 within a reasonable time thereafter, and to [each member of the hospi- 27 tal's staff directly involved with patient care] ANY PERSON ON THE 28 SURROGATE LIST WHO REQUESTS A COPY OF SUCH STATEMENT FROM THE HOSPITAL. 29 THE STATEMENT SHALL ALSO BE MADE AVAILABLE TO THE HOSPITAL CLINICAL 30 STAFF. 31 S 14. The commissioner of health shall revise the statement of rights 32 that hospitals are required to post (known as the Patient's Bill of 33 Rights) pursuant to paragraph (g) of subdivision 1 of section 2803 of 34 the public health law, by replacing the clause regarding orders not to 35 resuscitate with a statement that more generally informs patients of 36 their right to receive from the hospital upon admission, and upon 37 request, a more complete statement of their rights with respect to 38 deciding about health care, including appointing a health care agent, 39 consenting to do-not-resuscitate orders and making other life-sustaining 40 treatment decisions. The clause should also state in substance that the 41 hospital will also provide such statement upon request to any family 42 member or friend of a patient who lacks decision-making capacity. 43 S 15. Subdivisions 12 and 13 of section 2994-aa of the public health 44 law, subdivision 12 as added by chapter 8 of the laws of 2010 and subdi- 45 vision 13 as amended by chapter 167 of the laws of 2011, are amended to 46 read as follows: 47 12. "Mental hygiene facility" means a residential facility operated or 48 licensed by the office of mental health [or the office of mental retar- 49 dation and developmental disabilities]. 50 13. "Nonhospital order not to resuscitate" means an order that directs 51 emergency medical services personnel, hospice personnel, HOME CARE 52 SERVICES AGENCY PERSONNEL and hospital emergency services personnel not 53 to attempt cardiopulmonary resuscitation in the event a patient suffers 54 cardiac or respiratory arrest. 55 S 16. Subdivisions 2 and 6 of section 2994-dd of the public health 56 law, subdivision 2 as added by chapter 8 of the laws of 2010 and subdi- A. 9647--A 5 1 vision 6 as amended by section 10 of part J of chapter 56 of the laws of 2 2012, are amended to read as follows: 3 2. A nonhospital order not to resuscitate shall be issued upon a stan- 4 dard form prescribed by the commissioner. [The commissioner shall also 5 develop a] A standard bracelet [that] OR OTHER ARTICLE may be worn by a 6 patient with a nonhospital order not to resuscitate to identify that 7 status; provided, however, that no person may require a patient to wear 8 such a bracelet OR OTHER ARTICLE and that no person may require a 9 patient to wear such a bracelet OR OTHER ARTICLE as a condition for 10 honoring a nonhospital order not to resuscitate or for providing health 11 care services. 12 6. The commissioner may authorize the use of one or more alternative 13 forms for issuing a nonhospital order not to resuscitate (in place of 14 the standard form prescribed by the commissioner under subdivision two 15 of this section). Such alternative form or forms may also be used to 16 issue a non-hospital do not intubate order. Any such alternative forms 17 intended for use for persons with developmental disabilities or persons 18 with mental illness who are incapable of making their own health care 19 decisions or who have a guardian of the person appointed pursuant to 20 article eighty-one of the mental hygiene law or article seventeen-A of 21 the surrogate's court procedure act must also be approved by the commis- 22 sioner of developmental disabilities or the commissioner of mental 23 health, as appropriate. An alternative form under this subdivision shall 24 otherwise conform with applicable federal and state law. This subdivi- 25 sion does not limit, restrict or impair the use of an alternative form 26 for issuing an order not to resuscitate in a general hospital or resi- 27 dential health care facility under article twenty-eight of this chapter 28 or a hospital under subdivision ten of section 1.03 of the mental 29 hygiene law OR A DEVELOPMENTAL DISABILITIES SERVICES OFFICE UNDER 30 SECTION 13.17 OF THE MENTAL HYGIENE LAW. 31 S 17. Section 2994-gg of the public health law, as added by chapter 8 32 of the laws of 2010, is amended to read as follows: 33 S 2994-gg. Immunity. No person shall be subjected to criminal prose- 34 cution or civil liability, or be deemed to have engaged in unprofes- 35 sional conduct, for honoring reasonably and in good faith pursuant to 36 this [section] ARTICLE a nonhospital order not to resuscitate, for 37 disregarding a nonhospital order pursuant to section twenty-nine hundred 38 ninety-four-ee of this article, or for other actions taken reasonably 39 and in good faith pursuant to this [section] ARTICLE. 40 S 18. This act shall take effect on the ninetieth day after it shall 41 have become a law, provided that the amendments to article 29-C of the 42 public health law shall apply to decisions made pursuant to health care 43 proxies created prior to the effective date of this act as well as those 44 created thereafter.