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(125th General Assembly)
(Amended House Bill Number 72)
AN ACT
To amend sections 1337.11 and 1337.14 and to enact
sections 2135.01 to 2135.14 of the Revised
Code to
permit the execution of a Declaration for
Mental
Health Treatment.
Be it enacted by the General Assembly of the State of Ohio:
SECTION 1. That sections 1337.11 and 1337.14 be amended and
sections 2135.01, 2135.02, 2135.03, 2135.04,
2135.05, 2135.06,
2135.07, 2135.08, 2135.09, 2135.10, 2135.11, 2135.12, 2135.13,
and 2135.14
of the Revised Code be enacted to read as follows:
Sec. 1337.11. As used in sections 1337.11 to 1337.17 of
the
Revised Code: (A) "Adult" means a person who is eighteen years of age or
older. (B) "Attending physician" means the physician to whom a
principal or the family of a principal has assigned primary
responsibility for
the treatment or care of the principal or, if
the responsibility has not been
assigned, the physician
who has
accepted that responsibility. (C) "Comfort care" means any of the following: (1) Nutrition when administered to diminish the pain or
discomfort of a principal, but not to postpone death; (2) Hydration when administered to diminish the pain or
discomfort of a principal, but not to postpone death; (3) Any other medical or nursing procedure, treatment,
intervention, or other measure that is taken to diminish the pain
or discomfort of a principal, but not to postpone death. (D) "Consulting physician" means a physician who, in
conjunction with the attending physician of a principal, makes
one
or more determinations that are required to be made by the
attending physician, or to be made by the attending physician and
one other physician, by an applicable provision of sections
1337.11 to 1337.17 of the Revised Code, to a reasonable degree of
medical certainty and in accordance with reasonable medical
standards. (E)
"Declaration for mental health treatment" has the same
meaning as in section 2135.01 of the Revised Code. (F) "Guardian" means a person appointed by a probate court
pursuant to Chapter 2111. of the Revised Code to have the care
and
management of the person of an incompetent. (F)(G) "Health care" means any care, treatment, service, or
procedure to maintain, diagnose, or treat an individual's
physical
or mental condition
or physical or mental health.
(G)(H) "Health care decision" means informed consent,
refusal
to give informed consent, or withdrawal of informed
consent to
health care.
(H)(I) "Health care facility" means any of the following:
(1) A hospital; (2) A hospice care program or other institution that
specializes in comfort care of patients in a terminal condition
or
in a permanently unconscious state; (3) A nursing home; (4) A home health agency; (5) An intermediate care facility for the mentally
retarded; (6) A regulated community mental health organization. (I)(J) "Health care personnel" means physicians, nurses,
physician assistants, emergency medical
technicians-basic,
emergency medical
technicians-intermediate, emergency
medical
technicians-paramedic, medical technicians, dietitians,
other
authorized persons acting under the direction of an
attending
physician, and administrators of health care
facilities.
(J)(K) "Home health agency" has the same meaning as in
section
3701.88
5101.61 of the Revised Code.
(K)(L) "Hospice care program" has the same meaning as in
section 3712.01 of the Revised Code.
(L)(M) "Hospital" has the same meanings as in sections
2108.01,
3701.01, and 5122.01 of the Revised Code.
(M)(N) "Hydration" means fluids that are artificially or
technologically administered.
(N)(O) "Incompetent" has the same meaning as in section
2111.01
of the Revised Code.
(O)(P) "Intermediate care facility for the mentally
retarded"
has the same meaning as in section 5111.20 of the
Revised Code.
(P)(Q) "Life-sustaining treatment" means any medical
procedure,
treatment, intervention, or other measure that, when
administered
to a principal, will serve principally to prolong
the
process of
dying.
(Q)(R) "Medical claim" has the same meaning as in section
2305.11 2305.113 of the Revised Code.
(S) "Mental health treatment" has the same meaning as in
section 2135.01 of the Revised Code. (R)(T) "Nursing home" has the same meaning as in section
3721.01 of the Revised Code.
(S)(U) "Nutrition" means sustenance that is artificially or
technologically administered.
(T)(V) "Permanently unconscious state" means a state of
permanent unconsciousness in a principal that, to a reasonable
degree of medical certainty as determined in accordance with
reasonable medical standards by the principal's attending
physician and one other physician who has examined the principal,
is characterized by both of the following:
(1) Irreversible unawareness of
one's being and
environment. (2) Total loss of cerebral cortical
functioning, resulting
in the principal having no capacity to
experience pain or
suffering. (U)(W) "Person" has the same meaning as in section 1.59 of
the
Revised Code and additionally includes political subdivisions
and
governmental agencies, boards, commissions, departments,
institutions, offices, and other instrumentalities.
(V)(X) "Physician" means a person who is authorized under
Chapter 4731. of the Revised Code to practice medicine and surgery
or osteopathic medicine and surgery.
(W)(Y) "Political subdivision" and "state" have the same
meanings as in section 2744.01 of the Revised Code.
(X)(Z) "Professional disciplinary action" means action taken
by
the board or other entity that regulates the professional
conduct
of health care personnel, including the state medical
board and
the board of nursing.
(Y)(AA) "Regulated community mental health organization" means a residential facility as defined and licensed under section 5119.22 of the Revised Code or a community mental health agency as defined in section 5122.01 of the Revised Code.
(BB) "Terminal condition" means an irreversible,
incurable,
and untreatable condition caused by disease, illness,
or injury
from which, to a reasonable degree of medical certainty
as
determined in accordance with reasonable medical standards by a
principal's attending physician and one other physician who has
examined the principal, both of the following apply: (1) There can be no recovery. (2) Death is likely to occur within a relatively short
time
if life-sustaining treatment is not administered. (Z)(CC) "Tort action" means a civil action for damages for
injury, death, or loss to person or property, other than a civil
action for damages for a breach of contract or another agreement
between persons.
Sec. 1337.14. (A) A principal who creates a valid durable
power of attorney for health care may revoke that instrument or
the designation of the attorney in fact under it. The principal may so revoke at any time and in any manner.
The revocation
shall be effective when the principal expresses
his
an intention
to so revoke, except that, if the principal
made
his
the
principal's attending physician aware of the durable
power of
attorney
for health care, the revocation shall be effective upon
its
communication to the attending physician by the principal
himself, a witness to the revocation, or other health care
personnel to whom the revocation is communicated by such a
witness. Absent actual knowledge to the contrary, the attending
physician of the principal and other health care personnel who
are
informed of the revocation of a durable power of attorney for
health care by an alleged witness may rely on the information and
act in accordance with the revocation. (B) Upon the communication as described in division (A) of
this section to the attending physician of a principal of the
fact
that
his
the principal's durable power of attorney for
health care
has been
revoked, the attending physician or other health care
personnel
acting under the direction of the attending physician
shall make
the fact a part of the principal's medical record. (C) Unless the instrument provides otherwise, a valid
durable power of attorney for health care revokes a prior, valid
durable power of attorney for health care.
(D) Regardless of when the declaration is drafted, the
execution of a declaration for mental health treatment does not
revoke a valid durable power of attorney for health care. A
declaration for mental health treatment executed in accordance
with Chapter 2135. of the Revised Code supersedes a valid durable
power of attorney for health care with regard to mental health
treatment and the designation of a proxy to make decisions
regarding mental health treatment.
Sec. 2135.01. As used in sections 2135.01 to 2135.14 of the
Revised Code: (A) "Adult" means a person who is eighteen years of
age or older. (B) "Capacity to consent to mental health treatment
decisions" means the functional ability to understand information
about the risks of,
benefits of, and alternatives to the proposed
mental health treatment, to rationally use that information, to
appreciate how that information applies to the declarant, and to
express a choice about the proposed treatment. (C)
"Declarant" means an adult who has executed a
declaration
for mental health treatment in accordance with this chapter. (D) "Declaration for mental health treatment" or
"declaration" means a written document declaring preferences or
instructions regarding mental health treatment executed in
accordance with this chapter.
(E) "Designated physician" means the physician the
declarant has named in a declaration for mental health treatment
and has assigned the primary responsibility for the declarant's
mental health treatment or, if the declarant has not so named a
physician, the physician who has accepted that responsibility. (F) "Guardian" means a person appointed by a probate court
pursuant to Chapter 2111. of the Revised Code to have the care and
management of the person of an incompetent.
(G) "Health care" means any care, treatment, service, or
procedure to maintain, diagnose, or treat an individual's physical
or mental
condition or physical or mental health. (H) "Health care facility" has the same meaning as in
section 1337.11 of the Revised Code.
(I) "Incompetent" has the same meaning as in section
2111.01 of the Revised Code.
(J) "Informed consent" means consent voluntarily given by a
person after a sufficient explanation and disclosure of the
subject matter involved to enable that person to have a general
understanding of the nature, purpose, and goal of the treatment or
procedures, including the substantial risks and hazards inherent
in the proposed treatment or procedures and any alternative
treatment or procedures, and to make a knowing health care
decision without coercion or undue influence.
(K) "Medical record" means any document or combination of documents that pertains to a declarant's medical history, diagnosis, prognosis, or medical condition and that is generated and maintained in the process of the declarant's health care.
(L)
"Mental health treatment" means any care, treatment,
service, or procedure to maintain, diagnose, or treat an
individual's mental condition or mental health, including, but not
limited to,
electroconvulsive or other convulsive treatment,
treatment of
mental illness with medication, and admission to and
retention in
a health care facility. (M) "Mental health treatment decision" means informed
consent, refusal to give informed consent, or withdrawal of
informed consent to mental health treatment.
(N) "Mental health treatment provider" means physicians,
physician assistants, psychologists, licensed independent
social
workers, licensed professional clinical counselors, and
psychiatric nurses.
(O) "Physician" means a person who is authorized under
Chapter 4731. of the Revised Code to practice medicine and surgery
or osteopathic medicine and surgery.
(P) "Professional disciplinary action" means action taken
by the board or other entity that regulates the professional
conduct of health care personnel, including, but not limited to,
the state medical board, the state board of psychology, and the state board of
nursing. (Q) "Proxy" means an adult designated to make mental health
treatment decisions for a declarant under a valid declaration for
mental health treatment.
(R) "Psychiatric nurse" means a registered nurse who holds
a master's degree or doctorate in nursing with a specialization in
psychiatric nursing.
(S) "Psychiatrist" has the same meaning as in section
5122.01 of the Revised Code.
(T) "Psychologist" has the same meaning as in section
4732.01 of the Revised Code.
(U) "Registered nurse" has the same meaning as in section
4723.01 of the Revised Code. (V) "Tort action" means a civil action for damages for
injury, death, or loss to person or property, other than a civil
action for damages for a breach of contract or another agreement
between persons.
Sec. 2135.02. (A) An adult who has the capacity to consent
to mental health treatment decisions voluntarily
may execute at
any time a declaration governing the use or
continuation, or the
withholding or withdrawal, of mental health
treatment. The
declaration shall be signed at the end by the
declarant, state the
date of its execution, and either be
witnessed or
be acknowledged
in accordance with
section 2135.06 of the Revised
Code. The
declaration may include
a designation by the
declarant of a person
to act as a
proxy to make decisions
regarding mental health
treatment pursuant
to the declaration, and, if the declaration
includes a designation of a proxy, the declaration shall be signed
at the end by the designated proxy. The
declarant may also
specifically designate in the declaration an
alternate proxy to
act in that role if the original proxy is
unable or unwilling to
act at any time,
and, if the declaration includes a
designation of an alternate proxy, the declaration shall be signed
at the end by the designated alternate proxy. The declarant may
name in the declaration a physician and assign the physician the
primary responsibility for the declarant's mental health
treatment. The declaration may
include a specific
authorization
for the use or continuation, or
the withholding or
withdrawal, of
mental health treatment. (B) A mental health treatment provider or a health care facility providing services to a declarant shall
continue to
obtain the declarant's informed consent to all mental
health
treatment decisions if the declarant has the capacity to consent
to mental health treatment decisions.
Sec. 2135.03. (A) Except as otherwise provided in this division and subject to division (C) of this section, a declaration for mental health treatment
remains valid and effective for three years after its
execution unless it is properly revoked. A declaration for mental health treatment may become operative as provided in section 2135.04 of the Revised Code. If the declaration
becomes operative, the authority of a proxy named in the
declaration continues in effect as long as the declaration
designating the proxy is in effect or until the proxy has
withdrawn. If a declaration for mental health treatment has
become operative and is in effect at the expiration of three years
after its execution, the declaration remains effective until the
declarant has the capacity to consent to mental health treatment
decisions. If a declaration
for mental health treatment has not
become operative at the
expiration of three years after its
execution, the declaration
may be renewed as provided in division (C)(1) of this section or remains effective as provided in division (C)(2) of this section. (B) A valid declaration may be revoked in accordance with
section 2135.09 of the Revised Code or renewed in accordance with
division (C) (1) of this section, but it shall not otherwise be
altered
or amended after it has been executed. A properly
executed
declaration is not revoked or invalidated by an
alteration of or
amendment to the declaration. Any alteration of
or amendment to
the declaration is not a part of the declaration.
(C) (1) A declarant may renew a declaration once, extending the
validity of the document for an additional three-year period from
the date of the renewal, by repeating the procedures set
forth in section 2135.06 of the Revised Code, if the declarant has included in the declaration a specific authorization for the use or continuation, or the withholding or withdrawal, of mental health treatment, and the declarant makes no change with respect to that authorization. A declarant shall
not make any changes to any term or provision of the declaration
when renewing under division (C)(1) of this section.
(2) A declaration for mental health treatment that has not become operative at the expiration of three years after its execution remains effective if both of the following apply:
(a) The declaration designates a proxy or an alternate proxy.
(b) The declarant does not include in the declaration a specific authorization for the use or continuation, or the witholding or withdrawal, of mental health treatment.
Sec. 2135.04. (A) A declaration becomes operative when both
of the following apply: (1) The declaration is communicated to a mental health
treatment provider of the declarant. (2) The designated physician or a psychiatrist, and one
other
mental health treatment
provider, who examine the declarant
determine that
the declarant does not have the capacity to consent
to mental health treatment decisions. At least one of the two
persons who make this determination shall not currently be
involved in the declarant's treatment at the time of the
determination. If a designated physician is named in the
declaration and is not one of the two persons who make this
determination, then the psychiatrist who makes the determination
in lieu of the designated physician shall make a good faith effort
to consult with the designated physician as soon as practicable. (B) A mental health treatment
provider for a declarant or a health care facility providing services to a declarant shall
make a declaration part of the declarant's medical record and
shall note in that record when the declaration is operative. (C) A mental health treatment provider for a
declarant or a health care facility providing services to a declarant shall
act in accordance with an operative declaration of
the declarant
consistent with
reasonable medical practice, the availability of
treatments
requested, and applicable law. The mental health
treatment provider or the health care facility shall continue to act in accordance with an
operative declaration until the declarant has the capacity to
consent to mental health treatment decisions. (D) An operative declaration of a declarant
supersedes any
general consent to treatment form signed by the
declarant prior
to, upon, or after the declarant's
admission to a
health care
facility to the extent there is a
conflict between the
declaration
and the form, even if the declarant signs the form after the
execution of the declaration. To the extent that
the provisions
of a declarant's declaration and a general consent to treatment
form signed by the declarant do not conflict, both
documents shall
govern the use or continuation, or the withholding
or withdrawal,
of mental health treatment for the declarant. This
division does
not apply if a declarant revokes a declaration after
the declarant
signs a general consent to treatment form.
Sec. 2135.05. (A) A declaration may designate an adult to
act as a proxy to make decisions about the mental health treatment
of the declarant and may designate an adult as an alternate proxy
as described in section 2135.02 of the Revised Code. A proxy
designated to make decisions about
mental health treatment may
make decisions about mental health
treatment on behalf of the
declarant only when the declaration has
become operative. The
decisions of the proxy regarding the mental
health treatment of
the declarant must be consistent with desires
the declarant has
expressed in the declaration. (B) The following persons may not serve as a proxy for a
declarant: (1) The declarant's mental health treatment
provider, or an
employee
of the declarant's mental
health treatment
provider; (2) The owner, operator, or employee of a health care
facility in which the declarant is a patient receiving its services or a resident. (C) Divisions (B)(1) and (2) of this section do not apply if
the declarant and proxy are related by blood, marriage, or
adoption.
(D)
A proxy may withdraw from a declaration prior to the
declaration becoming operative by giving notice to the declarant.
If the declaration is operative, a proxy may withdraw by giving
written notice to the declarant's mental health
treatment
provider or the health care facility providing services to the declarant. The mental health
treatment provider or the health care facility shall note the
withdrawal of a proxy as part
of the declarant's medical record.
Sec. 2135.06. (A) A declaration for mental health treatment
is valid only if it is signed by the declarant,
states the date
of
its execution, and is either witnessed by two
adults or
acknowledged before a notary public.
If a proxy, or a proxy and an alternate proxy, have been
designated in the declaration, then each proxy also shall sign the
declaration, and the signature of each proxy shall be either
witnessed by two adults or acknowledged before a notary public,
except that, notwithstanding these requirements, both of the
following apply:
(1) No declaration shall be invalid or be held invalid
because a proxy has not signed the declaration.
(2) If a proxy has not signed the declaration, or if the
signature of a proxy named in a valid declaration is not either
witnessed by two adults or acknowledged before a notary public,
then the designation of the proxy is invalid, but the declaration
is not invalid because of the absence of a witnessed or
acknowledged signature of a proxy. (B) If witnessed for purposes of this section, a declaration
shall be witnessed by two individuals as described in this
division in whose presence the declarant and each designated proxy
signs the
declaration. Each witness shall
subscribe the witness'
signature
after the signature of the
declarant
and, by doing so,
attest to
the witness' belief that the declarant
appears to be of
sound mind and
not under or subject to duress, fraud, or
undue
influence. The
signatures of the
declarant and any proxy under
this
section and
of the witnesses
under this division are not
required
to appear on
the same page of
the declaration. (C) If acknowledged for purposes of this section, a
declaration shall be acknowledged before a notary public, who
shall make the certification described in section 147.53 of the
Revised Code and also shall attest that the declarant and each
designated proxy appear to be of sound mind and not under or
subject to duress, fraud, or undue influence. (D) The following may not serve as a witness to the signing
of a declarant's declaration: (1) The declarant's mental health
treatment provider or a
relative or employee of the declarant's
mental health treatment
provider; (2) The owner, the operator, or a relative or employee of an
owner or operator
of a health care facility in which the declarant
is a patient receiving its services or
a resident; (3) A person related to the declarant by blood, marriage, or
adoption; (4) A person named as a proxy in the declarant's declaration.
Sec. 2135.07. (A) If a mental health treatment
provider of a declarant or a
health care facility providing services to a declarant is unwilling at any time to
comply with
the declarant's declaration, the mental health
treatment provider or health care facility promptly shall notify
the declarant and any
proxy and document the notification in the
declarant's medical
record. The mental health treatment provider
or health care facility that is unwilling to comply with the
declarant's declaration shall not prevent or attempt to prevent,
or unreasonably delay or attempt to unreasonably delay, the
transfer of the declarant to the care of a mental health treatment
provider or a health care facility that is willing and able to
comply or allow compliance with the declarant's declaration. (B) The mental health treatment provider of a
declarant or a health care facility providing services to a declarant may
subject the declarant to treatment in a manner
contrary to the
declarant's expressed wishes only if either of the
following
applies: (1) The declarant has been committed as a patient under
Chapter 2945. or 5122. of the Revised Code, and, if the court
knows of the declaration, the committing court acknowledges the
existence of the declaration and specifically orders
treatment in
a manner contrary to the declaration. (2) An emergency situation endangers the life or health of
the declarant or others.
Sec. 2135.08. (A) The proxy under a declaration is not, as a
result of acting in that capacity, personally liable for the cost
of treatment provided to the declarant. Except to the extent the
right is limited by the declaration or any federal law, a proxy
has the same right as the declarant to receive information
regarding the proposed mental health treatment of the declarant
and to receive, review, and consent to disclosure of the
declarant's medical records relating to that treatment. This
right of access does not waive any evidentiary privilege. (B) In exercising authority under a declaration, the proxy
has a duty to act consistently with the desires of the declarant
as expressed in the declaration. If the declarant's desires are
not expressed in the declaration, the proxy has a duty to act in
what the proxy in good faith believes to be the best interests of
the declarant. (C) A proxy is not subject to criminal prosecution, tort or
other civil liability for injury, death, or loss to person or
property, or professional disciplinary action for an action taken
in good faith under a declaration for mental health treatment.
Sec. 2135.09. (A) A declarant may revoke a declaration at any
time the declarant has the capacity to consent to mental health
treatment decisions. Any revocation of a declaration by a
declarant shall be in writing, signed by the declarant, and dated.
The revocation shall be effective upon its
communication to the
mental health
treatment provider of the declarant or the health care facility providing services to the declarant. If the
declaration is operative, then the declarant may revoke the
declaration after a designated physician or a psychiatrist, and
one other mental health treatment provider, who examine the
declarant determine that the declarant has the capacity to consent
to mental health treatment decisions. (B) Upon the declarant's revocation of a declaration, the
mental health treatment provider or the health care facility shall make the revocation a part
of the declarant's medical record. (C) A valid declaration for mental health treatment revokes a
prior, valid declaration for mental health treatment. (D) The probate judge of the county in which the declarant is
located may revoke a declaration if the judge appoints a guardian
for the declarant and specifically orders the revocation of the
declaration.
Sec. 2135.10. A mental health treatment provider
of a
declarant, a health care facility providing services to a declarant, or other authorized persons acting under the direction
of either a mental health treatment provider of a declarant or a health care facility providing services to a declarant who
administer or do not administer mental
health
treatment according
to and in good faith reliance upon the
validity of the declarant's
declaration are not subject to criminal
prosecution, are not
liable in tort or other civil damages for
injury, death, or loss
to person or property, and are not subject
to professional
disciplinary action resulting from a subsequent
finding of a
declaration's invalidity.
Sec. 2135.11. No person shall require an individual to
execute or to refrain from executing a declaration as a criterion
for insurance, as a condition for receiving mental health
treatment or health care, or as a condition of admission to or
discharge from a health care facility.
Sec. 2135.12. (A) A declaration executed in accordance with this
chapter shall not supersede a valid
declaration governing the use or continuation, or the withholding
or withdrawal, of life-sustaining treatment executed under Chapter
2133. of the Revised Code. (B) A declaration executed in accordance with this chapter
does not revoke a valid durable power of attorney for health care
created under Chapter 1337. of the Revised Code, but a declaration
so executed
shall supersede the designation of an attorney in fact
made in a
valid health care power of attorney under Chapter 1337.
of the
Revised Code with respect to the mental health treatment of
the
declarant. The designation of an attorney in fact in a valid
health care power of attorney under Chapter 1337. of the Revised
Code shall remain effective in all other respects.
Sec. 2135.13. (A)
A person who opposes any decision arising
under this chapter may make an application opposing the decision
to the probate division of the court of common pleas of the county
in which the declarant is located or in which the declaration was
either witnessed or acknowledged as described in this chapter. (B) If a declarant has not named any proxies in the
declaration, or if all the named proxies have withdrawn or are
unable or unwilling to act at a time when the declaration has
become operative, then the physician who has the primary
responsibility for treating the declarant may petition the probate
division of the court of common pleas of the county in which the
declarant is located to appoint a person to act as a proxy. If
the judge of the probate division of the court of common pleas
finds it to be in the best interest of the declarant, then the
court shall appoint a person to serve as a proxy for the declarant
while the declaration is effective. The person so appointed shall
be a person who is eligible to serve as a proxy as determined
under section 2135.05 of the Revised Code.
Sec. 2135.14. A printed form of a declaration may be sold or
otherwise distributed in this state for use by adults who are not
advised by an attorney. By use of a printed form of that nature, a
declarant may consent or refuse to consent to mental health
treatment and may designate a proxy to make mental health
treatment decisions in accordance with this chapter. The printed
form shall not be used as an instrument for granting any other
type of authority or for making any other type of designation,
including those declarations that may be made under Chapter 2133.
of the Revised Code or designations made under Chapter 1337. of
the Revised Code.
SECTION 2. That existing sections 1337.11 and 1337.14 of the
Revised Code are hereby repealed.
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