Bill Text: NY S07507 | 2023-2024 | General Assembly | Introduced
Bill Title: Relates to orders not to resuscitate for and the applicability of the family health care decisions act to residents of mental hygiene facilities; relates to do not resuscitate orders and decisions regarding life-sustaining treatment and hospice care in in-patient psychiatric hospitals.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Engrossed) 2024-03-14 - ADVANCED TO THIRD READING [S07507 Detail]
Download: New_York-2023-S07507-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 7507 2023-2024 Regular Sessions IN SENATE June 2, 2023 ___________ Introduced by Sen. BROUK -- (at request of the Office of Mental Health) -- read twice and ordered printed, and when printed to be committed to the Committee on Rules AN ACT to amend the public health law and the surrogate's court proce- dure act, in relation to orders not to resuscitate for and decisions regarding life-sustaining treatment and hospice care; and to repeal article 29-B, subdivision 12 of section 2994-aa and subdivision 5 of section 2994-cc of such law relating thereto The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Article 29-B of the public health law is REPEALED. 2 § 2. Subdivision 18 of section 2994-a of the public health law, as 3 amended by chapter 167 of the laws of 2011, is amended to read as 4 follows: 5 18. "Hospital" means a general hospital, a hospital as defined in 6 subdivision ten of section 1.03 of the mental hygiene law, a residential 7 health care facility, or hospice. 8 § 3. The opening paragraph and paragraph (c) of subdivision 3 of 9 section 2994-b of the public health law, the opening paragraph as 10 amended by chapter 479 of the laws of 2022 and paragraph (c) as amended 11 by chapter 708 of the laws of 2019, are amended to read as follows: 12 Prior to seeking or relying upon a health care decision by a surrogate 13 for a patient under this article, if the attending practitioner has 14 reason to believe that the patient has a history of receiving services 15 for [a] an intellectual or developmental disability; the patient is in a 16 hospital as defined in subdivision ten of section 1.03 of the mental 17 hygiene law; it reasonably appears to the attending practitioner that 18 the patient has [a] an intellectual or developmental disability; or the 19 practitioner in a general hospital has reason to believe that the 20 patient has been temporarily transferred from a mental hygiene facility 21 operated or licensed by the office of mental health or the office for EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD07353-01-3S. 7507 2 1 people with developmental disabilities, then such physician, nurse prac- 2 titioner or physician assistant shall make reasonable efforts to deter- 3 mine whether [paragraphs] paragraph (a), (b) or (c) of this subdivision 4 [are] is applicable: 5 (c) If a health care decision for a patient cannot be made under para- 6 graphs (a) or (b) of this subdivision, but consent for [the] a routine 7 or major medical treatment decision may be provided pursuant to the 8 mental hygiene law or regulations of the office of mental health or the 9 office for people with developmental disabilities, then the decision 10 shall be governed by such statute or regulations and not by this arti- 11 cle. 12 § 4. Subparagraphs (ii) and (iii) of paragraph (b) of subdivision 3 of 13 section 2994-c of the public health law, as amended by chapter 708 of 14 the laws of 2019, are amended to read as follows: 15 (ii) In a general hospital or hospital as defined in subdivision ten 16 of section 1.03 of the mental hygiene law, a health or social services 17 practitioner employed by or otherwise formally affiliated with the 18 facility must independently determine whether an adult patient lacks 19 decision-making capacity if the surrogate's decision concerns the with- 20 drawal or withholding of life-sustaining treatment. 21 (iii) With respect to decisions regarding hospice care for a patient 22 in a general hospital, hospital as defined in subdivision ten of section 23 1.03 of the mental hygiene law, or residential health care facility, the 24 health or social services practitioner must be employed by or otherwise 25 formally affiliated with the general hospital, hospital as defined in 26 subdivision ten of section 1.03 of the mental hygiene law, or residen- 27 tial health care facility. 28 § 5. Paragraph (c) of subdivision 4 of section 2994-c of the public 29 health law, as added by chapter 8 of the laws of 2010, is amended to 30 read as follows: 31 (c) if the patient is in a hospital as defined in subdivision ten of 32 section 1.03 of the mental hygiene law or was transferred from a mental 33 hygiene facility, to the director of the mental hygiene facility and to 34 the mental hygiene legal service under article forty-seven of the mental 35 hygiene law. 36 § 6. Subparagraph (ii) of paragraph (a) and paragraph (c) of subdivi- 37 sion 5 of section 2994-d of the public health law, as amended by chapter 38 708 of the laws of 2019, are amended to read as follows: 39 (ii) The provision of treatment would involve such pain, suffering or 40 other burden that it would reasonably be deemed inhumane or extraor- 41 dinarily burdensome under the circumstances and the patient has an irre- 42 versible or incurable condition other than mental illness or a develop- 43 mental disability, as determined by an attending practitioner with the 44 independent concurrence of another physician, nurse practitioner or 45 physician assistant to a reasonable degree of medical certainty and in 46 accord with accepted medical standards. 47 (c) In a general hospital or hospital as defined in subdivision ten of 48 section 1.03 of the mental hygiene law, if the attending practitioner 49 objects to a surrogate's decision, under subparagraph (ii) of paragraph 50 (a) of this subdivision, to withdraw or withhold nutrition and hydration 51 provided by means of medical treatment, the decision shall not be imple- 52 mented until the ethics review committee, including at least one physi- 53 cian, nurse practitioner or physician assistant who is not directly 54 responsible for the patient's care, or a court of competent jurisdic- 55 tion, reviews the decision and determines that it meets the standards 56 set forth in this subdivision and subdivision four of this section.S. 7507 3 1 § 7. Subparagraph (iii) of paragraph (b) of subdivision 5-a of section 2 2994-g of the public health law, as amended by chapter 708 of the laws 3 of 2019, is amended to read as follows: 4 (iii) in settings other than a general hospital or residential health 5 care facility, the medical director of the hospice or hospital as 6 defined in subdivision ten of section 1.03 of the mental hygiene law, or 7 a physician designated by the medical director, must independently 8 determine that he or she concurs that the recommendation is medically 9 appropriate and consistent with such standards for surrogate decisions; 10 provided that if the medical director is the patient's attending physi- 11 cian, a different physician designated by the hospice or hospital as 12 defined in subdivision ten of section 1.03 of the mental hygiene law, 13 must make this independent determination; and 14 § 8. Paragraph (c) of subdivision 5-a of section 2994-g of the public 15 health law, as separately amended by chapters 622 and 708 of the laws of 16 2019, is amended to read as follows: 17 (c) The ethics review committee of the general hospital, hospital as 18 defined in subdivision ten of section 1.03 of the mental hygiene law, 19 residential health care facility or hospice, as applicable, including at 20 least one physician, nurse practitioner or physician assistant who is 21 not the patient's attending practitioner, or a court of competent juris- 22 diction, must review the decision and determine that it is consistent 23 with such standards for surrogate decisions. This requirement shall not 24 apply to decisions about routine medical treatment. Such decisions shall 25 be governed by subdivision three of this section. 26 § 9. Section 2994-l of the public health law, as amended by chapter 27 708 of the laws of 2019, is amended to read as follows: 28 § 2994-l. Interinstitutional transfers. 1. If a patient with an order 29 to withhold or withdraw life-sustaining treatment is transferred from a 30 mental hygiene facility to a hospital or from a hospital to a different 31 hospital, any such order or plan shall remain effective until an attend- 32 ing practitioner first examines the transferred patient, whereupon an 33 attending practitioner must either: 34 [1.](a) Issue appropriate orders to continue the prior order or plan. 35 Such orders may be issued without obtaining another consent to withhold 36 or withdraw life-sustaining treatment pursuant to this article; or 37 [2.](b) Cancel such order, if the attending practitioner determines 38 that the order is no longer appropriate or authorized. Before canceling 39 the order the attending practitioner shall make reasonable efforts to 40 notify the person who made the decision to withhold or withdraw treat- 41 ment and the hospital staff directly responsible for the patient's care 42 of any such cancellation. If such notice cannot reasonably be made prior 43 to canceling the order or plan, the attending practitioner shall make 44 such notice as soon as reasonably practicable after cancellation. 45 2. Orders to withhold or withdraw life-sustaining treatment shall 46 remain effective and no affirmative action by a general hospital shall 47 be required pursuant to this section where a patient is transferred 48 within a general hospital between a medical unit and a ward, wing, unit 49 or other part of the general hospital which is operated for the purpose 50 of providing services for persons with mental illness pursuant to an 51 operating certificate issued by the commissioner of mental health. 52 § 10. Paragraph (a) of subdivision 4 of section 2994-m of the public 53 health law, as amended by chapter 708 of the laws of 2019, is amended to 54 read as follows: 55 (a) These procedures are required only when: (i) the ethics review 56 committee is convened to review a decision by a surrogate to withhold orS. 7507 4 1 withdraw life-sustaining treatment for: (A) a patient in a residential 2 health care facility pursuant to paragraph (b) of subdivision five of 3 section twenty-nine hundred ninety-four-d of this article; (B) a patient 4 in a general hospital or hospital as defined in subdivision ten of 5 section 1.03 of the mental hygiene law, pursuant to paragraph (c) of 6 subdivision five of section twenty-nine hundred ninety-four-d of this 7 article; or (C) an emancipated minor patient pursuant to subdivision 8 three of section twenty-nine hundred ninety-four-e of this article; or 9 (ii) when a person connected with the case requests the ethics review 10 committee to provide assistance in resolving a dispute about proposed 11 care. Nothing in this section shall bar health care providers from first 12 striving to resolve disputes through less formal means, including the 13 informal solicitation of ethical advice from any source. 14 § 11. Paragraph (c) of subdivision 4 of section 2994-m of the public 15 health law, as amended by chapter 708 of the laws of 2019, is amended to 16 read as follows: 17 (c) When an ethics review committee is convened to review decisions 18 regarding hospice care for a patient in a general hospital, hospital as 19 defined in subdivision ten of section 1.03 of the mental hygiene law, or 20 residential health care facility, the responsibilities of this section 21 shall be carried out by the ethics review committee of the general 22 hospital, hospital as defined in subdivision ten of section 1.03 of the 23 mental hygiene law, or residential health care facility, provided that 24 such committee shall invite a representative from hospice to partic- 25 ipate. 26 § 12. Subdivision 12 of section 2994-aa of the public health law is 27 REPEALED and subdivisions 13 and 13-a are renumbered subdivisions 12 and 28 13. 29 § 13. Subdivision 5 of section 2994-cc of the public health law is 30 REPEALED. 31 § 14. Section 2994-ff of the public health law, as added by chapter 8 32 of the laws of 2010, is amended to read as follows: 33 § 2994-ff. Interinstitutional transfer. If a patient with a nonhospi- 34 tal order not to resuscitate is admitted to a hospital, the order shall 35 be treated as an order not to resuscitate for a patient transferred from 36 another hospital, and shall be governed by article twenty-nine-CC of 37 this chapter[, except that any such order for a patient admitted to a38mental hygiene facility shall be governed by article twenty-nine-B of39this chapter]. 40 § 15. Subparagraph (i) of paragraph (b) of subdivision 4 of section 41 1750-b of the surrogate's court procedure act, as amended by chapter 198 42 of the laws of 2016, is amended as follows: 43 (i) the person who is intellectually disabled has a medical condition 44 as follows: 45 A. a terminal condition, [as defined in subdivision twenty-three of46section twenty-nine hundred sixty-one of the public health law] which 47 for the purpose of this section means an illness or injury from which 48 there is no recovery, and which reasonably can be expected to cause 49 death within one year; or 50 B. permanent unconsciousness; or 51 C. a medical condition other than such person's intellectual disabili- 52 ty which requires life-sustaining treatment, is irreversible and which 53 will continue indefinitely; and 54 § 16. Paragraph (d) of subdivision 5 of section 1750-b of the surro- 55 gate's court procedure act, as amended by chapter 198 of the laws of 56 2016, is amended as follows:S. 7507 5 1 (d) Dispute mediation. In the event of an objection pursuant to this 2 subdivision, at the request of the objecting party or person or entity 3 authorized to act as a guardian under this section, except a surrogate 4 decision making committee established pursuant to article eighty of the 5 mental hygiene law, such objection shall be referred to a [dispute medi-6ation system] ethics review committee, established pursuant to section 7 two thousand nine hundred [seventy-two] ninety-four-m of the public 8 health law or similar entity for mediating disputes in a hospice, such 9 as a patient's advocate's office, hospital chaplain's office or ethics 10 committee, as described in writing and adopted by the governing authori- 11 ty of such hospice, for non-binding mediation. In the event that such 12 dispute cannot be resolved within seventy-two hours or no such mediation 13 entity exists or is reasonably available for mediation of a dispute, the 14 objection shall proceed to judicial review pursuant to this subdivision. 15 The party requesting mediation shall provide notification to those 16 parties entitled to notice pursuant to paragraph (a) of this subdivi- 17 sion. 18 § 17. This act shall take effect December 31, 2023.