Bill Text: VA HB286 | 2022 | Regular Session | Prefiled
Bill Title: Nurse practitioners; authorized to declare death and determine cause of death.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Passed) 2022-04-07 - Governor: Acts of Assembly Chapter text (CHAP0184) [HB286 Detail]
Download: Virginia-2022-HB286-Prefiled.html
Be it enacted by the General Assembly of Virginia:
1. That §§32.1-263 and 54.1-2972 of the Code of Virginia are amended and reenacted as follows:
§32.1-263. Filing death certificates; medical certification; investigation by Office of the Chief Medical Examiner.
A. A death certificate, including, if known, the social security number or control number issued by the Department of Motor Vehicles pursuant to §46.2-342 of the deceased, shall be filed for each death that occurs in the Commonwealth. Non-electronically filed death certificates shall be filed with the registrar of any district in the Commonwealth within three days after such death and prior to final disposition or removal of the body from the Commonwealth. Electronically filed death certificates shall be filed with the State Registrar of Vital Records through the Electronic Death Registration System within three days after such death and prior to final disposition or removal of the body from the Commonwealth. Any death certificate shall be registered by such registrar if it has been completed and filed in accordance with the following requirements:
1. If the place of death is unknown, but the dead body is found in the Commonwealth, the death shall be registered in the Commonwealth and the place where the dead body is found shall be shown as the place of death. If the date of death is unknown, it shall be determined by approximation, taking into consideration all relevant information, including information provided by the immediate family regarding the date and time that the deceased was last seen alive, if the individual died in his home; and
2. When death occurs in a moving conveyance, in the United States of America and the body is first removed from the conveyance in the Commonwealth, the death shall be registered in the Commonwealth and the place where it is first removed shall be considered the place of death. When a death occurs on a moving conveyance while in international waters or air space or in a foreign country or its air space and the body is first removed from the conveyance in the Commonwealth, the death shall be registered in the Commonwealth but the certificate shall show the actual place of death insofar as can be determined.
B. The licensed funeral director, funeral service licensee, office of the state anatomical program, or next of kin as defined in § 54.1-2800 who first assumes custody of a dead body shall complete the certificate of death. He shall obtain personal data of the deceased necessary to complete the certificate of death, including the social security number of the deceased or control number issued to the deceased by the Department of Motor Vehicles pursuant to §46.2-342, from the best qualified person or source available and obtain the medical certification from the person responsible therefor.
If a licensed funeral director, funeral service licensee, or representative of the office of the state anatomical program completes the certificate of death, he shall file the certificate of death with the State Registrar of Vital Records electronically using the Electronic Death Registration System and in accordance with the requirements of subsection A. If a member of the next of kin of the deceased completes the certificate of death, he shall file the certificate of death in accordance with the requirements of subsection A but shall not be required to file the certificate of death electronically.
C. The medical certification shall be completed and filed
electronically with the State Registrar of Vital Records using the Electronic
Death Registration System within 24 hours after death by the physician or autonomous nurse
practitioner in charge of the patient's care for the
illness or condition which that resulted in death except
when inquiry or investigation by the Office of the Chief Medical Examiner is
required by §32.1-283 or 32.1-285.1, or by the physician that or autonomous nurse
practitioner who pronounces death pursuant
to §54.1-2972. If the death occurred while under the care of a hospice
provider, the medical certification shall be completed by the decedent's health
care provider and filed electronically with the State Registrar of Vital
Records using the Electronic Death Registration System for completion of the
death certificate.
In the absence of such physician or autonomous nurse practitioner or with his approval, the certificate may be completed and filed by the following: (i) another physician or autonomous nurse practitioner employed or engaged by the same professional practice; (ii) a physician assistant supervised by such physician; (iii) a nurse practitioner who is not an autonomous nurse practitioner practicing in accordance with the provisions of §54.1-2957; (iv) the chief medical officer or medical director, or his designee, of the institution, hospice, or nursing home in which death occurred; (v) a physician or autonomous nurse practitioner specializing in the delivery of health care to hospitalized or emergency department patients who is employed by or engaged by the facility where the death occurred; (vi) the physician who performed an autopsy upon the decedent; (vii) an individual to whom the physician or autonomous nurse practitioner has delegated authority to complete and file the certificate, if such individual has access to the medical history of the case and death is due to natural causes; or (viii) a physician who is not licensed by the Board of Medicine who was in charge of the patient's care for the illness or condition that resulted in death. A physician described in clause (viii) who completes a certificate in accordance with this subsection shall not be required to register with the Electronic Death Registration System or complete the certificate electronically.
As used in this subsection, "autonomous nurse practitioner" has the same meaning as provided in §54.1-2972.
D. When inquiry or investigation by the Office of the Chief Medical Examiner is required by §32.1-283 or 32.1-285.1, the Chief Medical Examiner shall cause an investigation of the cause of death to be made and the medical certification portion of the death certificate to be completed and filed within 24 hours after being notified of the death. If the Office of the Chief Medical Examiner refuses jurisdiction, the physician last furnishing medical care to the deceased shall prepare and file the medical certification portion of the death certificate.
E. If the death is a natural death and a death certificate is being prepared pursuant to §54.1-2972 and the physician, nurse practitioner, or physician assistant is uncertain about the cause of death, he shall use his best medical judgment to certify a reasonable cause of death or contact the health district physician director in the district where the death occurred to obtain guidance in reaching a determination as to a cause of death and document the same.
If the cause of death cannot be determined within 24 hours after death, the medical certification shall be completed as provided by regulations of the Board. The attending physician or autonomous nurse practitioner, as defined in §54.1-2972, or the Chief Medical Examiner, an Assistant Chief Medical Examiner, or a medical examiner appointed pursuant to §32.1-282 shall give the funeral director or person acting as such notice of the reason for the delay, and final disposition of the body shall not be made until authorized by the attending physician, autonomous nurse practitioner, the Chief Medical Examiner, an Assistant Chief Medical Examiner, or a medical examiner appointed pursuant to §32.1-282.
F. A physician, nurse practitioner, physician assistant, or individual delegated authority to complete and file a certificate of death by a physician who, in good faith, files a certificate of death or determines the cause of death shall be immune from civil liability, only for such filing and determination of causes of death on such certificate, absent gross negligence or willful misconduct.
§54.1-2972. When person deemed medically and legally dead; determination of death; nurses', physician assistants', or nurse practitioners' authority to pronounce death under certain circumstances.
A. As used in this subsection, "autonomous nurse practitioner" means a nurse practitioner who is authorized to practice without a practice agreement pursuant to subsection I of §54.1-2957.
B. A person shall be medically and legally dead if:
1. In the opinion of a physician duly authorized to practice medicine in the Commonwealth or autonomous nurse practitioner, based on the ordinary standards of medical practice, there is the absence of spontaneous respiratory and spontaneous cardiac functions and, because of the disease or condition that directly or indirectly caused these functions to cease, or because of the passage of time since these functions ceased, attempts at resuscitation would not, in the opinion of such physician or autonomous nurse practitioner, be successful in restoring spontaneous life-sustaining functions, and, in such event, death shall be deemed to have occurred at the time these functions ceased; or
2. In the opinion of a physician, who shall be duly licensed to practice medicine in the Commonwealth and board-eligible or board-certified in the field of neurology, neurosurgery, or critical care medicine, when based on the ordinary standards of medical practice, there is irreversible cessation of all functions of the entire brain, including the brain stem, and, in the opinion of such physician, based on the ordinary standards of medical practice and considering the irreversible cessation of all functions of the entire brain, including the brain stem, and the patient's medical record, further attempts at resuscitation or continued supportive maintenance would not be successful in restoring such functions, and, in such event, death shall be deemed to have occurred at the time when all such functions have ceased.
B. A registered nurse or a, physician assistant, or nurse practitioner who
is not an autonomous nurse practitioner
may pronounce death if the following criteria are satisfied: (i) the nurse is
employed by or the physician assistant or autonomous
nurse practitioner works at (a)
a home care organization as defined in §32.1-162.7, (b) a hospice as defined
in §32.1-162.1, (c) a hospital or nursing home as defined in §32.1-123,
including state-operated hospitals for the purposes of this section, (d) the
Department of Corrections, or (e) a continuing care retirement community registered
with the State Corporation Commission pursuant to Chapter 49 (§38.2-4900 et
seq.) of Title 38.2; (ii) the nurse or, physician assistant, or nurse practitioner
who is not an autonomous nurse practitioner is directly involved
in the care of the patient; (iii) the patient's death has occurred; (iv) the
patient is under the care of a physician or autonomous nurse
practitioner when his death occurs; (v) the patient's death
has been anticipated; and
(vi) the physician autonomous nurse
practitioner is unable to be present within a reasonable
period of time to determine death; and (vii) there is
a valid Do Not Resuscitate Order pursuant to §54.1-2987.1 for the patient who
has died. The nurse or, physician assistant, or nurse practitioner
who is not an autonomous nurse practitioner
shall inform the patient's attending and consulting
physicians physician or autonomous
nurse practitioner of the
patient's death as soon as practicable.
The nurse or, physician assistant, or nurse practitioner
who is not an autonomous nurse practitioner
shall have the authority to pronounce death in accordance with such procedural
regulations, if any, as may be promulgated by the Board of Medicine; however,
if the circumstances of the death are not anticipated or the death requires an
investigation by the Office of the Chief Medical Examiner,
the such
nurse or,
physician assistant, or nurse practitioner shall
notify the Office of the Chief Medical Examiner of the death and the body shall
not be released to the funeral director.
This subsection shall not authorize a nurse or,
physician assistant, or nurse
practitioner who is not an autonomous nurse practitioner
to determine the cause of death. Determination of cause of death shall continue
to be the responsibility of the attending physician or
autonomous nurse practitioner,
except as provided in §32.1-263. Further, this subsection shall not be
construed to impose any obligation to carry out the functions of this
subsection.
This subsection shall not relieve any registered nurse or,
physician assistant, or nurse
practitioner who is not an autonomous nurse
practitioner from any civil or criminal liability
that might otherwise be incurred for failure to follow statutes or Board of
Nursing or Board of Medicine regulations.
C. The alternative definitions of death provided in subdivisions A 1 and 2 may be utilized for all purposes in the Commonwealth, including the trial of civil and criminal cases.
