Referred to Committee on Health and Human Services
SUMMARY--Establishes procedure that authorizes qualified patient to choose not to be resuscitated in event of cardiac or respiratory arrest. (BDR 40-144)
FISCAL NOTE: Effect on Local Government: Yes.
Effect on the State or on Industrial Insurance: No.
EXPLANATION - Matter in italics is new; matter in brackets [ ] is material to be omitted.
AN ACT relating to health care; establishing a procedure that authorizes a qualified patient to direct that he not be resuscitated in the event of a cardiac or respiratory arrest; prohibiting certain acts that may interfere with the carrying out of such a direction; providing immunity for certain persons who comply with the procedure for not resuscitating a qualified patient who has chosen not to be resuscitated; providing a penalty; and providing other matters properly relating thereto.
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
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Section 1 Chapter 449 of NRS is hereby amended by adding thereto the provisions set forth as sections 2 to 21, inclusive, of this act.
Sec. 2. As used in sections 2 to 21, inclusive, of this act, unless the context otherwise requires, the words and terms defined in sections 3 to 9, inclusive, of this act have the meanings ascribed to them in those sections.
Sec. 3. "Do-not-resuscitate identification bracelet" means a bracelet of uniform size and design, approved by the health division, which signifies that:
1. A person is a qualified patient who wishes not to be resuscitated in the event of cardiac or respiratory arrest; or
2. The patient's attending physician has:
(a) Issued a do-not-resuscitate order for the patient;
(b) Obtained the approval of the patient concerning the order; and
(c) Documented the grounds for the order in the patient's medical record.
Sec. 4. "Do-not-resuscitate order" means an oral or written directive issued by a physician licensed in this state that emergency life-resuscitating treatment must not be administered to a qualified patient.
Sec. 5. "Do-not-resuscitate protocol" means a procedure established by the health division for the withholding of emergency life-resuscitating treatment in compliance with a do-not-resuscitate order or a do-not-resuscitate identification bracelet.
Sec. 6. "Health care facility" has the meaning ascribed to it in NRS 449.800.
Sec. 7. "Life-resuscitating treatment" means cardiopulmonary resuscitation or a component of cardiopulmonary resuscitation.
Sec. 8. "Person who administers emergency medical services" means a paid or volunteer fire fighter, law enforcement officer, emergency medical technician, or other person employed to provide emergency medical services within the ordinary course of his profession.
Sec. 9. "Qualified patient" has the meaning ascribed to it in NRS 449.585.
Sec. 10. The provisions of sections 2 to 21, inclusive, of this act, apply only to emergency medical services administered to a qualified patient before he is admitted to a medical facility.
Sec. 11. The health division shall adopt regulations to carry out the provisions of sections 2 to 21, inclusive, of this act. The regulations must establish:
1. A do-not-resuscitate protocol.
2. The procedure to apply for a do-not-resuscitate identification bracelet.
3. The price to obtain a do-not-resuscitate identification bracelet. The price must not exceed the cost to manufacture the bracelet, plus the cost to obtain the bracelet from the manufacturer, including the cost of shipping and handling.
Sec. 12 Each do-not-resuscitate identification bracelet must include, without limitation:
1. An identification number that is unique to the qualified patient to whom the bracelet is issued;
2. The name and date of birth of the patient; and
3. The name of the attending physician of the patient.
Sec. 13. 1. A physician licensed in this state may issue an oral or written do-not-resuscitate order only to a qualified patient.
2. The order is effective only if the patient has agreed to its terms, orally or in writing, while he is capable of making an informed decision.
3. A physician who issues a do-not-resuscitate order shall apply, on behalf of the patient, to the health division for a do-not-resuscitate identification bracelet for that patient.
Sec. 14. 1. A qualified patient may apply to the health division for a do-not-resuscitate identification bracelet by submitting an application on a form provided by the health division. To obtain a do-not-resuscitate identification bracelet, the patient must comply with the requirements prescribed by the health division and sign a form which states that he has informed each member of his family within the first degree of consanguinity or affinity, whose whereabouts are known to him, or if no such members are living, his legal guardian, if any, of his decision to apply for a bracelet.
2. An application must include, without limitation:
(a) Certification by the patient's attending physician that the patient suffers from a terminal condition;
(b) Certification by the patient's attending physician that the patient:
(1) Is capable of making an informed decision; or
(2) When he was capable of making an informed decision, executed:
(I) A written directive that life-resuscitating treatment be withheld under certain circumstances; or
(II) A durable power of attorney for health care pursuant to NRS 449.800 to 449.860, inclusive;
(c) A statement that the patient does not wish that life-resuscitating treatment be undertaken in the event of a cardiac or respiratory arrest;
(d) The name, signature and telephone number of the patient's attending physician; and
(e) The name and signature of the patient or the attorney in fact who is authorized to make health care decisions on the patient's behalf pursuant to a durable power of attorney for health care.
Sec. 15. A qualified patient wearing a do-not-resuscitate identification bracelet may revoke his authorization to withhold life-resuscitating treatment by removing or requesting the removal of his bracelet or otherwise indicating to a person that he wishes to have his bracelet removed.
Sec. 16. 1. A person is not guilty of unprofessional conduct or subject to civil or criminal liability if he:
(a) Is a physician who causes the withholding of life-resuscitating treatment from a qualified patient wearing a do-not-resuscitate identification bracelet in accordance with the do-not-resuscitate protocol;
(b) Pursuant to the direction of or with the authorization of a physician, participates in the withholding of life-resuscitating treatment from a qualified patient wearing a do-not-resuscitate identification bracelet in accordance with the do-not-resuscitate protocol; or
(c) Administers emergency medical services and causes or participates in the withholding of life-resuscitating treatment from a qualified patient wearing a do-not-resuscitate identification bracelet or carries out a do-not-resuscitate order that has been issued in accordance with the do-not-resuscitate protocol.
2. A health care facility that employs a person described in subsection 1 is not guilty of unprofessional conduct or subject to civil or criminal liability for the acts or omissions of the employee carried out in accordance with the provisions of subsection 1.
3. A physician, a person pursuant to the direction or authorization of a physician, a health care facility or a person administering emergency medical services who provides life-resuscitating treatment pursuant to:
(a) An oral or written request made by a qualified patient who possesses a do-not-resuscitate identification bracelet; or
(b) An observation that a qualified patient has removed or requested the removal of his bracelet or otherwise indicated that he wished to have his bracelet removed,
is not guilty of unprofessional conduct or subject to civil or criminal liability.
Sec. 17. 1. Except as otherwise provided in subsection 2, a person who administers emergency medical services shall comply with do-not-resuscitate protocol when he:
(a) Observes a do-not-resuscitate identification bracelet; or
(b) Is given an oral or written do-not-resuscitate order by a physician.
2. A person who administers emergency medical services and who is unwilling or unable to comply with the do-not-resuscitate protocol shall take all reasonable measures to transfer a qualified patient who possesses a do-not-resuscitate identification bracelet to a physician or health care facility in which the do-not-resuscitate protocol may be followed.
Sec. 18. 1. Unless he has knowledge to the contrary, a physician, any other provider of health care or any person who administers emergency medical services may assume that a do-not-resuscitate identification bracelet complies with the provisions of sections 2 to 21, inclusive, of this act and is valid.
2. The provisions of sections 2 to 21, inclusive, of this act do not create a presumption concerning the intention of a:
(a) Qualified patient who has revoked his authorization to withhold life-resuscitating treatment; or
(b) Person who has not obtained a do-not-resuscitate identification bracelet,
concerning the use or withholding of life-resuscitating treatment in a life-threatening emergency.
Sec. 19. 1. Death that results when life-resuscitating treatment has been withheld pursuant to the do-not-resuscitate protocol and in accordance with the provisions of sections 2 to 21, inclusive, of this act does not constitute a suicide or homicide.
2. The possession of a do-not-resuscitate identification bracelet does not affect the sale, procurement or issuance of a policy of life insurance or an annuity or impair or modify the terms of a policy of life insurance or an annuity. A policy of life insurance or an annuity is not legally impaired or invalidated if life-resuscitating treatment has been withheld from an insured who possesses a do-not-resuscitate identification bracelet, notwithstanding any term in the policy or annuity to the contrary.
3. A person may not prohibit or require the possession of a do-not-resuscitate identification bracelet as a condition of being insured for, or receiving, health care. Sec. 20. 1. It is unlawful for:
(a) A person who administers emergency medical services to fail willfully to transfer a qualified patient in accordance with the provisions of section 17 of this act.
(b) A person purposely to conceal, cancel, deface or obliterate a do-not-resuscitate identification bracelet of a qualified patient.
(c) A person to falsify or forge the do-not-resuscitate identification bracelet of a qualified patient or purposely to conceal or withhold personal knowledge of the revocation of a do-not-resuscitate identification bracelet with the intent to cause the use, withholding or withdrawal of life-resuscitating treatment.
2. A person who violates any of the provisions of this section is guilty of a misdemeanor.
Sec. 21. The provisions of sections 2 to 21, inclusive, of this act do not:
1. Require a physician or other provider of health care to take action contrary to reasonable medical standards;
2. Condone, authorize or approve mercy killing or euthanasia;
3. Substitute for any other legally authorized procedure by which a person may direct that he not be resuscitated in the event of a cardiac or respiratory arrest;
4. Affect or impair any right created pursuant to the provisions of NRS 449.535 to 449.690, inclusive; or
5. Affect the right of a qualified patient to make decisions concerning the use of life-resuscitating treatment, if he is able to do so, or impair or supersede a right or responsibility of a person to affect the withholding of medical care in a lawful manner.
Sec. 22. The provisions of subsection 1 of NRS 354.599 do not apply to any additional expenses of a local government that are related to the provisions of this act.
Sec. 23. The provisions of this act do not apply to offenses that are committed before October 1, 1997.