(REPRINTED WITH ADOPTED AMENDMENTS) SECOND REPRINT
Assembly Bill No. 29-Assemblywoman Segerblom
Prefiled on January 16, 1997
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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 450B 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" means:
1. A form of identification approved by the health authority, which signifies that:
(a) A person is a qualified patient who wishes not to be resuscitated in the event of cardiac or respiratory arrest; or
(b) The patient's attending physician has:
(1) Issued a do-not-resuscitate order for the patient;
(2) Obtained the approval of the patient concerning the order; and
(3) Documented the grounds for the order in the patient's medical record.
2. The term also includes a valid do-not-resuscitate identification issued under the laws of another state.
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. The term also includes a valid do-not-resuscitate order issued under the laws of another state.
Sec. 5. "Do-not-resuscitate protocol" means the standardized procedure and guidelines established by the health authority for the withholding of emergency life-resuscitating treatment in compliance with a do-not-resuscitate order or a do-not-resuscitate identification.
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, including chest compressions, defibrillation, cardioversion, assisted ventilation, airway intubation or administration of cardiotonic drugs.
Sec. 8. "Person who administers emergency medical services" means a paid or volunteer fire fighter, law enforcement officer, emergency medical technician, ambulance attendant or other person trained to provide emergency medical services.
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. 1. The health authority shall adopt regulations to carry out the provisions of sections 2 to 21, inclusive, of this act. The regulations must establish:
(a) A do-not-resuscitate protocol.
(b) The procedure to apply for a do-not-resuscitate identification.
(c) The price to obtain a do-not-resuscitate identification. The price must not exceed the actual cost to the health authority in manufacturing or obtaining the identification from a manufacturer, including the cost of shipping and handling.
2. In the case of a county or district board of health, such regulations take effect immediately upon approval by the state board of health.
Sec. 12 Each do-not-resuscitate identification issued by the health authority must include, without limitation:
1. An identification number that is unique to the qualified patient to whom the identification 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 may apply, on behalf of the patient, to the health authority for a do-not-resuscitate identification for that patient.
Sec. 14. 1. A qualified patient may apply to the health authority for a do-not-resuscitate identification by submitting an application on a form provided by the health authority. To obtain a do-not-resuscitate identification, the patient must comply with the requirements prescribed by the health authority 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, or if he has no such members living and has no legal guardian, his caretaker, if any, of his decision to apply for an identification.
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 who possesses a do-not-resuscitate identification may revoke his authorization to withhold life-resuscitating treatment by removing or destroying or requesting the removal or destruction of his identification or otherwise indicating to a person that he wishes to have his identification removed or destroyed.
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 who possesses a do-not-resuscitate identification 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 who possesses a do-not-resuscitate identification 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
who possesses a do-not-resuscitate identification 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, ambulance service or fire fighting agency 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; or
(b) An observation that a qualified patient has removed or destroyed or requested the removal or destruction of his do-not-resuscitate identification or otherwise indicated that he wished to have his identification removed or destroyed,
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; 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 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 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,
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 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, 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 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 of a qualified patient, unless it is done in compliance with the request of the qualified patient to remove or destroy his do-not-resuscitate identification.
(c) A person to falsify or forge the do-not-resuscitate identification of a qualified patient or purposely to conceal or withhold personal knowledge of the revocation of a do-not-resuscitate identification 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.