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H. B. No. 241 As IntroducedAs Introduced
128th General Assembly | Regular Session | 2009-2010 |
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Cosponsors:
Representatives Lundy, Sayre, Williams, B., Luckie, Hackett, Skindell, Okey, Newcomb, Yuko, Hagan, Boyd, Letson, Harris, Evans, Heard
A BILL
To amend sections 2133.02, 2133.21, 2133.211, 2133.22
to 2133.26, and 3795.03 and to enact sections
2133.27 and
2133.30 to
2133.49
of the Revised
Code to require
the
Director of
Health to
prescribe a form to
document medical
orders for
life-sustaining
treatment and to make
changes to
the law
governing
DNR identification
and
orders.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 2133.02, 2133.21, 2133.211, 2133.22,
2133.23, 2133.24,
2133.25, 2133.26, and 3795.03 be amended and
sections
2133.27, 2133.30, 2133.31,
2133.32,
2133.33,
2133.34,
2133.35,
2133.36, 2133.37, 2133.38,
2133.39,
2133.40,
2133.41,
2133.42,
2133.43, 2133.44, 2133.45,
2133.46,
2133.47, 2133.48,
and 2133.49 of the
Revised Code be enacted to
read as
follows:
Sec. 2133.02. (A)(1) An adult who is of sound mind
voluntarily may execute at any time a declaration governing the
use or continuation, or the withholding or withdrawal, of
life-sustaining treatment. The declaration shall be signed at the
end
by the declarant or by another individual at the direction of
the
declarant, state the date of its execution, and either be
witnessed as described in division (B)(1) of this section or be
acknowledged by the declarant in accordance with division (B)(2)
of this section. The declaration may include a designation by
the
declarant of one or more persons who are to be notified by
the
declarant's attending physician at any time that
life-sustaining
treatment would be withheld or withdrawn pursuant
to the
declaration. The declaration may include a specific authorization
for the use or continuation or the withholding or withdrawal of
CPR, but the
failure to include a specific authorization for the
withholding or withdrawal
of CPR does not preclude the withholding
or withdrawal of
CPR in accordance with sections 2133.01 to
2133.15
or sections 2133.21 to 2133.26 2133.27 of the Revised
Code.
(2) Depending upon whether the declarant intends the
declaration to apply when the declarant is in a terminal
condition, in a
permanently unconscious state, or in either a
terminal condition
or a permanently unconscious state, the
declarant's
declaration shall use
either or both of the terms
"terminal condition" and "permanently
unconscious state" and shall
define or otherwise explain those
terms in a manner that is
substantially
consistent with the provisions of section 2133.01 of
the Revised
Code.
(3)(a) If a declarant who has authorized the withholding
or
withdrawal of life-sustaining treatment intends that the
declarant's attending physician withhold or withdraw nutrition or
hydration
when the declarant is in a permanently unconscious state
and
when the nutrition and hydration will not or no longer will
serve to
provide comfort to the declarant or alleviate
the
declarant's pain, then the declarant shall authorize
the
declarant's attending physician to withhold or withdraw
nutrition
or hydration when the declarant is in the
permanently unconscious
state by doing both of the following in the declaration:
(i) Including a statement in capital letters or other
conspicuous type,
including, but not limited to, a different font,
bigger type, or boldface
type,
that the
declarant's attending
physician may withhold or withdraw nutrition and
hydration if the
declarant is in a permanently unconscious
state and if the
declarant's attending physician and at
least one other physician
who has
examined the declarant determine, to a reasonable degree
of
medical
certainty and in accordance with reasonable medical
standards,
that nutrition or hydration will not or no longer will
serve to
provide comfort to the declarant or alleviate
the
declarant's pain, or checking or
otherwise marking a box or line
that is adjacent to a similar
statement on a printed form of a
declaration;
(ii) Placing the declarant's initials or signature
underneath
or
adjacent to the statement, check, or other mark
described in
division (A)(3)(a)(i) of this section.
(b) Division (A)(3)(a) of this section does not apply to the
extent that a
declaration authorizes the withholding or withdrawal
of
life-sustaining treatment when a declarant is in a terminal
condition. The provisions of division (E) of section 2133.12 of
the Revised Code pertaining to comfort care shall apply to a
declarant in a terminal condition.
(B)(1) If witnessed for purposes of division (A) of this
section, a declaration shall be witnessed by two individuals as
described in this division in whose presence the declarant, or
another individual at the direction of the declarant, signed the
declaration. The witnesses to a declaration shall be adults who
are not related to the declarant by blood, marriage, or adoption,
who are not the attending physician of the declarant, and who are
not the administrator of any nursing home in which the declarant
is receiving care. Each witness shall subscribe the
witness'
signature after the signature of the declarant or other
individual
at the direction 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 or other
individual at
the direction
of the declarant under division (A) of
this section
and of the
witnesses under this division are not required to
appear on the
same page of the declaration.
(2) If acknowledged for purposes of division (A) 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 appears to be of sound mind and not under or subject to
duress, fraud, or undue influence.
(C) An attending physician, or other health care personnel
acting under the direction of an attending physician, who is
furnished a copy of a declaration shall make it a part of the
declarant's medical record and, when section 2133.05 of the
Revised Code is applicable, also shall comply with that section.
(D)(1) Subject to division (D)(2) of this section, an
attending physician of a declarant or a health care facility in
which a declarant is confined may refuse to comply or allow
compliance with the declarant's declaration on the basis of a
matter of conscience or on another basis. An employee or agent
of
an attending physician of a declarant or of a health care
facility
in which a declarant is confined may refuse to comply
with the
declarant's declaration on the basis of a matter of
conscience.
(2) If an attending physician of a declarant or a health
care
facility in which a declarant is confined is not willing or
not
able to comply or allow compliance with the declarant's
declaration, the physician or facility promptly shall so advise
the declarant and comply with the provisions of section 2133.10
of
the Revised Code, or, if the declaration has become operative
as
described in division (A) of section 2133.03 of the Revised
Code,
shall comply with the provisions of section 2133.10 of the
Revised
Code.
(E) As used in this section, "CPR" has the
same meaning as
in
section 2133.21 of the Revised Code.
Sec. 2133.21. As used in this section and sections 2133.21
2133.211
to 2133.26 2133.27 of
the Revised Code,
unless the
context
clearly requires otherwise:
(A) "Attending
physician" means the physician to whom a
person, or the family
of a person, has assigned primary
responsibility for the
treatment or care of the person or, if the
person or the
person's family has not assigned that
responsibility, the
physician who has accepted that
responsibility.
(B) "CPR" means cardiopulmonary resuscitation or a component
of cardiopulmonary resuscitation, but it does not include clearing
a person's airway for a purpose other than as a component of CPR.
(C) "Declaration," "health care facility," "life-sustaining
treatment," "physician," "professional disciplinary action," and
"tort action"
have the same meanings as in section 2133.01 of the
Revised Code means a document executed in accordance with section
2133.02 of the Revised Code that includes a specific authorization
for the withholding or withdrawal of
CPR.
(C)(D) "DNR identification" means a
standardized
identification card, form, necklace, or bracelet that is of
uniform size and design, that has been approved by the
department
of health pursuant to section 2133.25 of the
Revised
Code, and
that signifies either
one of the following:
(1) That the person who is named on and possesses the card,
form,
necklace, or bracelet has executed a declaration
that
authorizes the
withholding or withdrawal of CPR and that has not
been
revoked pursuant to section 2133.04 of the Revised Code;
(2) That the attending physician of the person who is named
on and
possesses the card, form, necklace, or bracelet has issued
a current
do-not-resuscitate order, in accordance with the
do-not-resuscitate protocol
adopted by the department of health
pursuant to section 2133.25 of the Revised Code, for
that person
and has documented the
grounds for the order in that person's
medical record.;
(3) That an issuing practitioner has completed a MOLST form
that has not been revoked as described in section 2133.39 of the
Revised Code.
(D)(E) "Do-not-resuscitate order" means a directive issued by
a
physician
prior to the effective date of this amendment in
accordance with the do-not-resuscitate protocol that identifies a
person and specifies that CPR should not
be administered to the
person so identified.
(E)(F) "Do-not-resuscitate
protocol" means the standardized
method of procedure for the
withholding of CPR by physicians,
emergency medical service
personnel, and health care facilities
that is was
adopted in the rules
of the department of health
pursuant
to section 2133.25 of the
Revised Code as that section
existed prior to the effective date of this amendment.
(F)(G) "Emergency medical
services personnel" means paid or
volunteer firefighters, law
enforcement officers, first
responders, emergency medical
technicians-basic, emergency medical
technicians-intermediate, emergency medical technicians-paramedic,
medical technicians, or other emergency services personnel
acting
within the ordinary course of their profession.
(G) "CPR" means cardiopulmonary resuscitation or a
component
of cardiopulmonary resuscitation, but it does not include clearing
a
person's airway for a purpose other than as a component of CPR.
(H) "Health care facility," "life-sustaining treatment,"
"physician,"
"professional disciplinary action," and "tort
action" have the
same meanings as in section 2133.01 of the
Revised Code.
(I) "Issuing practitioner" has the same meaning as in section
2133.30 of the Revised Code.
(J) "MOLST form" means a form completed pursuant to division
(A) of section 2133.33 of the Revised Code that includes a
specific authorization for the
withholding or withdrawal of CPR.
Sec. 2133.211. A person who holds a certificate of authority
to practice
as a certified nurse practitioner or clinical nurse
specialist issued under
section 4723.42 of the Revised Code may
take any
action that may be taken by an attending physician under
sections 2133.21 2133.22 to
2133.26 2133.27 of the Revised Code
and has
the immunity provided by
section 2133.22 of the Revised
Code if
the action is taken
pursuant to a standard care
arrangement with a
collaborating physician.
Sec. 2133.22. (A)(1)(a) None of the following persons listed
in division (A)(1)(b) of this section are subject to
criminal
prosecution,
to liability in damages in a tort or other
civil
action for
injury, death, or loss to person or property, or
to
professional
disciplinary action arising out of or relating to
the
withholding or withdrawal of CPR from a person after
DNR
identification is
discovered in
the person's possession
and
reasonable efforts have been made to
determine that the person in
possession of the DNR identification
is the person named on the
DNR identification
any of the following:
(a)(i) An individual who has executed a declaration;
(ii) An individual for whom a do-not-resuscitate order has
been issued;
(iii) An individual for whom a MOLST form has been completed;
(iv) An individual who is in possession of DNR identification
if reasonable efforts have been made to determine that the
individual is the individual named on the DNR identification.
(b) Division (A)(1)(a) of this section applies only to the
following:
(i) A physician who causes the withholding or withdrawal
of
CPR from the person possessing the
DNR identification an
individual described in division (A)(1)(a) of this section;
(b)(ii) A person who
participates under the direction of or
with
the authorization of a
physician in the withholding or
withdrawal
of CPR from the person
possessing the DNR
identification an individual described in division (A)(1)(a) of
this section;
(c)(iii) Any emergency medical services personnel who cause
or
participate in the withholding or withdrawal of CPR from the
person possessing the
DNR identification an individual described
in division (A)(1)(a) of this section.
(2)(a) None of the following persons listed in division
(A)(2)(b) of this section are subject to criminal
prosecution,
to
liability in damages in a tort or other civil
action for
injury,
death, or loss to person or property, or to
professional
disciplinary action arising out of or relating to the
withholding
or withdrawal of
CPR from a person in a health care
facility
after
DNR
identification is discovered in the person's possession
and
reasonable efforts have been made to determine that the
person in
possession of the DNR identification is the person named
on the
DNR identification
or a do-not-resuscitate order is issued
for the
person
any of the following who is in a health care
facility:
(a)(i) An individual who has executed
a declaration;
(ii) An individual for whom a do-not-resuscitate order has
been issued;
(iii) An individual for whom a MOLST form has been completed;
(iv) An individual who is in possession of DNR identification
if reasonable efforts have been made to determine that the
individual is the individual named on the DNR identification.
(b) Division (A)(2)(a) of this section applies only to the
following:
(i) The health care facility or the administrator of the
health
care facility;
(b)(ii) A physician who causes the withholding or
withdrawal
of
CPR from the
person possessing the DNR
identification or for
whom the
do-not-resuscitate order has been
issued an individual
described in division (A)(2)(a) of this section;
(c)(iii) Any person who works for the
health care facility as
an
employee, contractor, or volunteer
and who participates under
the
direction of or with the
authorization of a physician in the
withholding or withdrawal of
CPR from the person possessing
the
DNR identification;
(d) Any person who works for the
health care facility as an
employee, contractor, or volunteer
and who participates under the
direction of or with the
authorization of a physician in the
withholding or withdrawal of
CPR from the person for whom
the
do-not-resuscitate order has been issued an individual described
in division (A)(2)(a) of this section;
(iv) Any emergency medical services personnel who cause or
participate in the withholding or withdrawal of CPR from an
individual described in division (A)(2)(a) of this section.
(3) If, after DNR identification is discovered in the
possession of a person it is determined that a person is an
individual described in division (A)(1)(a) or (2)(a) of this
section, the person makes an oral or written
request to
receive
CPR, any person who provides CPR pursuant to
the
request, any
health care facility in
which CPR is provided,
and the
administrator of any
health care facility in which CPR is
provided are not subject to
criminal prosecution as a result of
the provision of the CPR, are
not liable in damages in a tort or
other civil action for
injury, death, or loss to person or
property that arises out of or is related
to the provision of the
CPR, and are not subject
to professional disciplinary action as a
result of the provision
of the CPR.
(B) Divisions (A)(1), (A) and (2), and (C)
of this section
do
not
apply when CPR is withheld or withdrawn from a person who
possesses DNR identification or for
whom a do-not-resuscitate
order
has been issued an individual described in division
(A)(1)(a) or (2)(a) of this section unless the
withholding or
withdrawal is
in accordance with the
do-not-resuscitate protocol
instructions
regarding the withholding
or withdrawal of CPR in
the individual's
declaration, a do-not-resuscitate order that
names the individual, the individual's MOLST form, or in
instructions in any of the foregoing that is the basis of the
individual's DNR identification.
(C) Any emergency medical services personnel who comply with
a
do-not-resuscitate
order issued by a physician and any
individuals who work for a health
care facility as employees,
contractors, or volunteers and who comply with a
do-not-resuscitate order issued by a physician are not subject to
liability in
damages in a civil action for injury, death, or loss
to person or
property that arises out of or is related to
compliance with
the order, are not subject to criminal prosecution
as
a result of compliance with the order, and are not subject to
professional disciplinary action as a result of compliance with
the order.
In an emergency situation, emergency medical services
personnel and emergency department personnel are not required to
search a
person to
determine if
the person possesses DNR
identification is an individual described in division (A)(1)(a) or
(2)(a) of this section. If a person possesses
DNR identification
is an individual described in division (A)(1)(a) or (2)(a) of this
section, if
emergency medical services personnel or
emergency
department
personnel provide CPR to the person in an
emergency
situation,
and
if, at that time, the personnel do not know and
do
not have
reasonable cause to believe that the person possesses
DNR
identification is an individual described in division
(A)(1)(a) or (2)(a) of this section, the
emergency medical
services personnel and
emergency department personnel are
not
subject to criminal
prosecution as a result of the provision of
the CPR, are not
liable
in damages in a tort or other civil
action for injury,
death, or loss to person or property that
arises out of or
is
related to the provision of the CPR, and
are
not subject to
professional disciplinary action as a result
of
the provision of
the CPR.
(D) Nothing in sections 2133.21 to 2133.26 2133.27 of the
Revised
Code or the do-not-resuscitate protocol grants immunity to
a
physician
for issuing a do-not-resuscitate order that is
contrary to reasonable medical
standards or that the physician
knows or has reason to know is
contrary to the
wishes of the
patient or of a person who is
lawfully authorized to make
informed medical decisions on the
patient's behalf.
Sec. 2133.23. (A) If emergency medical
services personnel,
other than physicians, are presented with
DNR identification
possessed by
a person or are presented with a written
do-not-resuscitate
order for a person or if a physician directly
issues to
emergency medical services personnel, other than
physicians, an
oral do-not-resuscitate order for a person a
written do-not-resuscitate order that has been issued for the
person or a MOLST form that has been completed for the person, the
emergency medical services personnel shall
comply with the
do-not-resuscitate protocol for the person. If an
oral
do-not-resuscitate
order is issued by a
physician who is not
present at the scene, the emergency medical
services personnel
shall verify the physician's identity instructions regarding the
withholding or withdrawal of CPR in the relevant document or as
signified by the DNR identification.
(B) If a person possesses DNR identification and if the
person's attending physician or the health care
facility in which
the person is located is unwilling or unable
to comply with the
do-not-resuscitate protocol for the
person instructions regarding
the withholding or withdrawal of CPR in the person's declaration,
the written do-not-resuscitate order that has been
issued for the
person, or the
MOLST form that has been completed
for the
person, any of which is the basis of the person's DNR
identification, the attending
physician or the health care
facility
shall not prevent or attempt
to prevent, or unreasonably
delay or attempt to
delay, the
transfer of the person to a
different physician who will follow
the protocol instructions or
to a
different health care facility
in which the protocol
instructions will be
followed.
(C) If a person who being transferred from one health care
facility to another
possesses DNR identification or
for whom
a
current, has executed a declaration, is the subject of a written
do-not-resuscitate order that has been issued is
being transferred
from one health care
facility to
another,
before or at the time
of the transfer, or is the subject of a MOLST form that has been
completed, the
transferring
health
care facility shall notify
the receiving
health care
facility
and the persons transporting
the person of
the existence
of the
DNR identification or the
order,
declaration, do-not-resuscitate order, or MOLST form. The
notice shall be given before or at the time of the transfer. If a
current
do-not-resuscitate
order was issued orally, it shall be
reduced to
writing before the
time of the transfer. The DNR
identification or
the order, declaration, do-not-resuscitate
order, or MOLST
form
shall
accompany the person to the receiving
health care
facility
and
shall, subject to section 2133.41 of
the Revised Code, remain
in effect unless it is revoked or
unless, in the
case of a
do-not-resuscitate order, the order no
longer is
current any of
the following circumstances apply:
(1) In the case of a DNR identification, it has been revoked
in accordance with rules adopted by the department of health
pursuant to section 2133.25 of the Revised Code.
(2) In the case of a declaration, it has been revoked as
described in section 2133.04 of the Revised Code.
(3) In the case of a written do-not-resuscitate order, it is
no longer current.
(4) In the case of a MOLST form, it has been revoked as
described in section 2133.39 of the Revised Code.
Sec. 2133.24. (A) The death of a person resulting from the
withholding or withdrawal of CPR for the person pursuant to the
do-not-resuscitate
protocol instructions regarding the withholding
or withdrawal of CPR in a declaration executed by the person, a
written do-not-resuscitate order that has been issued for the
person, a MOLST form that
has been completed for the person or
pursuant to instructions in any of the foregoing that is the basis
of the person's DNR identification
and in the circumstances
described in section 2133.22
of the
Revised Code or in accordance
with
division (A) of section
2133.23
of the Revised Code does not
constitute for
any purpose a
suicide, aggravated murder, murder,
or any other
homicide.
(B)(1) If a person has executed a declaration, a written
do-not-resuscitate order has been issued for the person, a MOLST
form has been
completed for the person, or the
person possesses
DNR
identification or if
a current
do-not-resuscitate order has
been
issued for a person, the
existence of the declaration,
written
do-not-resuscitate order, or MOLST form, or the
possession or
order of
the DNR identification, shall not do
either of the
following:
(a) Affect in any manner the sale,
procurement, issuance, or
renewal of a policy of life
insurance or annuity, notwithstanding
any term of a policy or
annuity to the contrary;
(b) Be deemed to modify in any manner
or invalidate the terms
of any policy of life insurance or
annuity that is in effect on
the effective date of this section.
(2) Notwithstanding any term of a policy of life
insurance
or
annuity to the contrary, the withholding or
withdrawal of CPR
from
a person who is
insured or covered under the policy or
annuity and
who possesses
DNR identification or for whom a
current
do-not-resuscitate order has
been issued, in accordance
with
sections 2133.21 to 2133.26 of the
Revised
Code, who has
executed
a declaration, for whom a written do-not-resuscitate
order has
been issued, or for whom a MOLST form
has been
completed shall
not impair or
invalidate any policy of
life
insurance or annuity.
(3) Notwithstanding any term of a policy or plan to the
contrary, neither of the following shall impair or invalidate any
policy of
health insurance or other health care benefit plan:
(a) The withholding or withdrawal in accordance with sections
2133.21 to 2133.26 2133.27 of the Revised Code of CPR from a
person who is
insured or
covered under the
policy or plan and who
possesses
DNR
identification or for whom a current
do-not-resuscitate order
has
been issued, who has executed a
declaration, for whom a written
do-not-resuscitate order has
been issued, or for whom a MOLST form has been completed;
(b) The provision in accordance with sections 2133.21 to
2133.26
2133.27 of the Revised Code of CPR to a person of the
nature
described in division
(B)(3)(a) of this section.
(4) No physician, health care facility, other health
care
provider, person authorized to engage in the business of
insurance
in this state under Title XXXIX of the
Revised Code,
health
insuring corporation, other
health care benefit plan, legal entity
that is self-insured and provides
benefits to its employees or
members, or other person shall
require an individual to possess
DNR identification, execute a declaration, or have a written
do-not-resuscitate order issued, or have a MOLST form completed,
or shall require
an individual to
revoke or refrain from
possessing
DNR identification, as a
condition of being insured or
of receiving health care benefits
or
services.
(C)(1) Sections 2133.21 to 2133.26 2133.27 of the Revised
Code do not
create any
presumption concerning the intent of an
individual who
does not
possess
DNR identification with respect
to the use,
withholding, or withdrawal of CPR.
(2) Sections 2133.21 to 2133.26 2133.27 of the
Revised Code
do not
affect the right of
a person to make informed decisions
regarding
the use,
withholding, or withdrawal of CPR for the
person as long
as the person is able to make those decisions.
(3) Sections 2133.21 to 2133.26 2133.27 of the
Revised Code
are in
addition to and
independent of, and do not limit, impair,
or
supersede, any
right or responsibility that a person has to
effect
the
withholding or withdrawal of life-sustaining treatment
to
another pursuant to
sections 2133.01 to 2133.15 or sections
2133.30 to 2133.47 of the
Revised Code or in any other lawful
manner.
(D) Nothing in sections
2133.21 to 2133.26 2133.27 of the
Revised
Code condones, authorizes, or
approves of mercy killing,
assisted
suicide, or euthanasia.
Sec. 2133.25. (A) The department of
health, by rule adopted
pursuant to Chapter 119. of the
Revised
Code, shall adopt a
standardized method of procedure for the
withholding of CPR by
physicians, emergency medical services
personnel, and health care
facilities in accordance with sections 2133.21 to
2133.26 of the
Revised Code. The standardized method shall specify criteria
for
determining
when a do-not-resuscitate order issued by a physician
is current. The
standardized method so adopted shall be the
"do-not-resuscitate protocol" for
purposes of sections 2133.21 to
2133.26 of the Revised Code. The department
also of health, by
rule adopted pursuant to Chapter 119. of the Revised Code,
shall
approve one
or more standard forms of
DNR identification to be
used
throughout
this state and shall specify one or more
procedures for revoking the forms of identification.
(B) The department of health shall adopt rules in accordance
with
Chapter 119. of the Revised Code for the
administration of
sections 2133.21 to 2133.26 of the
Revised Code The
do-not-resuscitate protocol adopted by the department of health in
rules adopted pursuant to this section as this section existed
prior to the effective date of this amendment and the standard
forms of
DNR identification approved by the department pursuant
to this
section as this section existed prior to the effective
date of this amendment are effective only for do-not-resuscitate
orders issued
before the effective date of this amendment.
The
criteria for
determining when a do-not-resuscitate order is
current apply only
to orders issued before that date.
(C) The department of health shall appoint an advisory
committee
to advise the department in the development of rules
under this section. The
advisory committee shall include, but
shall not be limited to, representatives
of each of the following
organizations:
(1) The association for hospitals and health systems (OHA);
(2) The Ohio state medical association;
(3) The Ohio chapter of the American college of
emergency
physicians;
(4) The Ohio hospice organization;
(5) The Ohio council for home care;
(6) The Ohio health care association;
(7) The Ohio ambulance association;
(8) The Ohio medical directors association;
(9) The Ohio association of emergency medical services;
(10) The bioethics network of Ohio;
(11) The Ohio nurses association;
(12) The Ohio academy of nursing homes;
(13) The Ohio association of professional firefighters;
(14) The department of mental retardation and developmental
disabilities;
(15) The Ohio osteopathic association;
(16) The association of Ohio philanthropic homes, housing and
services for the aging;
(17) The catholic conference of Ohio;
(18) The department of aging;
(19) The department of mental health;
(20) The Ohio private residential association;
(21) The northern Ohio fire fighters association.
Sec. 2133.26. (A)(1) No physician shall
purposely prevent or
attempt to prevent, or delay or unreasonably attempt to
delay, the
transfer of a patient in violation of division
(B) of section
2133.23 of the
Revised Code.
(2) No person shall purposely conceal, cancel, deface, or
obliterate the DNR identification of another person without the
consent of the other
person.
(3) No person shall purposely falsify or forge a revocation
of a
declaration or MOLST form that is
the basis of the
DNR
identification of another person
or purposely falsify or forge an
order of a physician or an instruction in a MOLST form that
purports to
supersede a
do-not-resuscitate order issued, or an
instruction in a MOLST form completed, for
another person.
(4) No person shall purposely falsify or forge the
DNR
identification of another person
with the intent to cause the use,
withholding, or withdrawal of
CPR for the other person.
(5) No person who has personal knowledge that another
person
has revoked a declaration that is the basis of the
other person's
DNR
identification or personal knowledge that a physician has
issued
an order that supersedes a do-not-resuscitate order that
the
physician issued for another person None of the following
shall purposely conceal or
withhold that personal knowledge with
the intent to cause the use,
withholding, or withdrawal of CPR for
the other person:
(a) A person who has personal knowledge that another person
has revoked a declaration that is the basis of the other person's
DNR identification;
(b) A person who has personal knowledge that a physician has
issued an order that supersedes a do-not-resuscitate order that
the physician issued for
another person;
(c) A person who has personal knowledge that another person
has revoked a MOLST form or superseded an instruction in a MOLST
form that is the basis of the
other person's DNR identification.
(B)(1) Whoever violates division (A)(1)
or (5) of this
section is guilty of a misdemeanor of the third
degree.
(2) Whoever violates division (A)(2), (3), or (4) of this
section
is guilty of a misdemeanor of the first degree.
Sec. 2133.27. Nothing in sections 2133.21 to 2133.26 of the
Revised Code prohibits a physician from issuing a directive on or
after the effective date of this section that identifies a person
and specifies that CPR should not be administered to the person so
identified but any such directive shall be issued in accordance
with reasonable and prevailing standards of care.
Sec. 2133.30. As used in this section and sections 2133.31
to 2133.47 of the Revised Code:
(A) "Advanced practice nurse" means a registered nurse who
holds a valid certificate that authorizes the practice of nursing
as a certified nurse practitioner or a clinical nurse specialist
in accordance with section 4723.43 of the Revised Code.
(B) "Attending physician" means the physician to whom a
patient or patient's family has assigned primary responsibility
for the medical treatment or care of the patient 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 pain or
discomfort, but not to postpone death;
(2) Hydration when administered to diminish pain or
discomfort, but not to postpone death;
(3) Any other medical or nursing procedure, treatment,
intervention, or other measure that is taken to diminish pain or
discomfort, but not to postpone death.
(D) "CPR" has the same meaning as in section 2133.21 of the
Revised Code.
(E)
"Declaration" means a document executed in accordance
with section 2133.02 of the Revised Code.
(F) "DNR identification" and "do-not-resuscitate order" have
the same meanings as in
section 2133.21 of the Revised Code.
(G) "Durable power of attorney for health care" means a
document created pursuant to sections 1337.11 to 1337.17 of the
Revised Code.
(H) "Emergency medical services worker" means a paid or
volunteer firefighter, law enforcement officer, first responder,
emergency medical technician-basic, emergency medical
technician-intermediate, emergency medical technician-paramedic,
medical technician, or other emergency services worker acting
within the ordinary course of the emergency services profession.
(I) "Form preparer" means the issuing practitioner who
completes a medical orders for life-sustaining treatment form or
the individual who completes the form pursuant to the
practitioner's delegation.
(J) "Health care facility" has the same meaning as in section
1337.11 of the Revised Code.
(K) "Issuing practitioner" means a physician, physician
assistant, or advanced practice nurse who issues medical orders
for life-sustaining treatment for a patient by signing as the
issuing practitioner the medical orders for life-sustaining
treatment form for the patient.
(L) "Life-sustaining treatment" means any medical procedure,
treatment, intervention, or other measure that, when administered
to a patient, is intended to serve principally to prolong the
process of dying.
(M) "Medical orders for life-sustaining treatment" means
instructions, issued by a physician, physician assistant, or
advanced practice nurse, regarding how a patient should be treated
with respect to hospitalization, administration or withdrawal of
life-sustaining treatment and comfort care, administration of CPR,
and other treatment
the director of health has specified in rules
adopted under
section 2133.31 of the Revised Code.
(N) "Medical orders for life-sustaining treatment form,"
"MOLST form," or "form" means the form prescribed by the director
of health pursuant to rules adopted under section 2133.31 of the
Revised Code that when completed documents an issuing
practitioner's medical orders for life-sustaining treatment.
(O) "Nutrition" means sustenance that is artificially or
technologically administered.
(P) "Physician" means an individual authorized under Chapter
4731. of the Revised Code to practice medicine and surgery or
osteopathic medicine and surgery.
(Q) "Physician assistant" means an individual who holds a
valid certificate to practice as a physician assistant issued
under Chapter 4730. of the Revised Code.
Sec. 2133.31. (A) Subject to division (D) of this section,
the director of health shall adopt rules in accordance with
Chapter 119. of the Revised Code to do all of the following:
(1) Specify the treatment, in addition to hospitalization,
administration or withdrawal of life-sustaining treatment and
comfort care, and administration of CPR, that may be included in
instructions that constitute
medical orders for life-sustaining
treatment under section 2133.30
of the Revised Code;
(2) Subject to divisions (B) and (C) of this section,
prescribe a
medical orders for life-sustaining treatment (MOLST)
form;
(3) Specify procedures for a MOLST form to be amended or
revoked;
(4) Specify what constitutes full treatment relative to
treatment covered by each section of a MOLST form, for purposes of
section 2133.42 of the Revised Code;
(5) Specify the requirements an individual must meet to be
authorized to complete a MOLST form when this responsibility is
delegated by an issuing practitioner;
(6) Specify the extent to which MOLST forms, physician orders
for
life-sustaining treatment forms, or physician orders for
scope of
treatment forms executed under the laws or regulations
of other
states are valid
for purposes of sections 2133.31 to
2133.48 of
the Revised Code;
(7) Specify the individual or class of individuals who are
authorized to
sign and date a MOLST form if all of the individuals
or classes
of individuals in divisions (B)(2)(a) to (f) of
section 2133.34 of
the Revised Code are incapacitated, are not
willing to
participate, or are not
available within a reasonable
period of
time to participate in the
completion of a MOLST form;
(8) Address any other matters necessary or appropriate to
implement or clarify sections 2133.31 to 2133.48 of the Revised
Code.
(B) The rules the director adopts under division (A)(2) of
this section shall, at minimum, address all of the following:
(1) The color of the MOLST form if it is on paper;
(2) The logo that identifies a form, whether in paper or
electronic format, as an official MOLST form;
(3) The inclusion of a space designated for the patient's
name;
(4)
The inclusion of spaces designated for the names,
telephone numbers,
signatures, and dates of signature of all of
the following:
(a) The issuing practitioner;
(c) The patient, the patient's attorney in fact under the
patient's durable power of attorney for health care, the
individual or class of individuals
specified in division (B)(2)
of section 2133.34 of the Revised
Code
who participate in the
form's completion, or the individual authorized pursuant to
division (D) of section 2133.35 of the Revised Code to complete a
new form;
(d) The parent, guardian, or custodian of the patient, to be
used only if the patient is under eighteen years of age.
(5) The inclusion of boxes for the form preparer to indicate
whether a physician or advanced practice nurse
has issued a
do-not-resuscitate order for the patient and whether
the patient
has executed a
declaration or a durable power of attorney for
health care.
(6) The inclusion of boxes corresponding to a range of
preferences the patient, the patient's parent, guardian, or legal
custodian, or any other individual or class of individuals
described in division (B)(4)(c) of this section
who
participate
in a form's
completion can select regarding
various
medical
treatments and
when such treatments should be
administered,
including, but not
limited to, CPR, antibiotics,
artificially or
technologically
administered nutrition and
hydration, and other
medical
interventions and the inclusion of
spaces
next to the
boxes for
the names of the patient,
individual,
or
individuals
who make
the selections;
(7) The inclusion of a box for the form preparer to indicate
whether the patient, the patient's parent, guardian, or legal
custodian, or the other individual or class of individuals
described in division (B)(4)(c) of this section who participate in
the form's completion
authorize
the temporary
administration of
medical
treatments that
may be
contrary to
the selections made
under
division (B)(6) of
this
section if
the patient has an
advanced
chronic progressive
illness and the
medical treatment
would be
administered for a
different injury
or illness.
(8) The inclusion of a space where the form preparer can
indicate the name and telephone number of an individual the
patient has authorized pursuant to division (D) of section 2133.35
of the Revised Code to do
both of the following:
(a) Make all medical decisions on the patient's behalf,
including those regarding the administration of CPR and other
life-sustaining treatment;
(b) Revoke the form at any time in accordance with the
procedure prescribed in rules adopted under section 2133.31 of the
Revised Code and complete a new form on the patient's behalf.
(9) The inclusion of a space for the form preparer to list
the name and contact information for
the patient's next of kin if
the patient does not have a legally effective durable power of
attorney for health care.
(10) The inclusion of a space for the form preparer to
indicate the date that the form was completed and signed in
accordance with sections 2133.34 and 2133.35 of the Revised Code;
(11) The inclusion of spaces designated for the names of
individuals who review the form after it is completed, the dates
on which reviews are completed, and the reviewer to indicate the
review's outcome;
(12) The inclusion of the following advisory statements, in
boldface type:
(a) "There is no requirement that a patient, a patient's
parent, guardian, or legal custodian, or a patient's
representative execute a MOLST form. You are not required to sign
this form for the patient to receive treatment."
This statement shall appear in the space immediately above
the space designated for the signature of the patient, the
patient's attorney in fact under the patient's durable power of
attorney for health care, or any of the other individuals or class
of individuals described in division (B)(4)(c) of this section who
participate in a form's
completion.
(b) "The instructions in this form may supersede an
inconsistent instruction in a declaration (living will), durable
power of attorney for health care, general consent to treatment
form, or a DNR order as
described in section 2133.41 of the Ohio
Revised Code."
(c) "This form may be revoked in accordance with section
2133.39 of the Ohio Revised Code."
(C) When prescribing a medical orders for life-sustaining
treatment form pursuant to division (A)(2) of this section, the
director shall consider the design and content of forms used in
other states to document medical or physician orders for
life-sustaining treatment.
(D)
The director shall adopt the initial rules required by
this section not later than twelve months after the effective date
of
this section. In adopting the rules, the director shall
consider the physician orders for life-sustaining treatment
(POLST) paradigm program requirements established by the national
POLST paradigm initiative task force.
Sec. 2133.32. The MOLST form prescribed in rules adopted
under section 2133.31 of the Revised Code shall be made available
on the department of health's web site in a format that can be
downloaded free of charge and reproduced.
Sec. 2133.33. (A) Except as provided in division (C) of this
section, a physician, physician assistant, or advanced practice
nurse may at any time issue medical orders for life-sustaining
treatment for a patient by completing a MOLST form. Once completed
and signed in accordance with sections 2133.34 and 2133.35 of the
Revised Code,
the MOLST form is valid and, except as provided in
division (B) of
this section, the instructions in it become
operative and govern
how the patient who is the subject of the
form is to be treated
with respect to hospitalization,
administration or withdrawal of
life-sustaining treatment and
comfort care, administration of CPR, and other treatment
the
director of health has
specified in rules adopted under
section
2133.31 of the Revised
Code.
(B) The instructions in a MOLST form are not operative and do
not govern how a patient is to be treated when the instructions
are
superseded as described in section 2133.41 or 2133.43 of the
Revised Code or the form is
revoked as described in section
2133.39 of the Revised Code.
(C) A physician, physician assistant, or advanced practice
nurse shall not have a MOLST form completed for a patient if,
subject to division (D) of this section, any of the following
makes known to the physician, physician assistant, or advanced
practice nurse that completion of a MOLST form is not desired:
(1) If the patient is at least eighteen years of age and not
incapacitated, the patient;
(2) If the patient is not at least eighteen years of age, the
patient's parent, guardian, or legal custodian;
(3) If the patient is at least eighteen years of age,
incapacitated, has a legally effective durable power of
attorney
for health care, and the circumstances in division (E) of this
section do not apply, the patient's attorney in fact under the
durable power of attorney for health care;
(4) If the patient is at least eighteen years of age,
incapacitated, does not have a legally effective durable power
of
attorney for health care, and the circumstances in division (E) of
this section do not apply, the individual or class of
individuals
determined according to the order of priority in
division (B)(2)
of section 2133.34 of the Revised Code.
(D) Any disagreement within a class of individuals determined
according to the order of priority in division (B)(2) of section
2133.34 of the Revised Code as to
whether a MOLST form should be
completed shall be resolved in
accordance with section 2133.36 of
the Revised Code.
(E) If the patient, pursuant to division (D) of section
2133.35 of the Revised Code, authorized another individual to make
all medical decisions and to revoke a MOLST form on the patient's
behalf, that individual may make known to the physician, physician
assistant, or advanced practice nurse that completion of a new
MOLST form is not desired.
Sec. 2133.34. (A) A MOLST form is valid only if all of the
following participate in completion of the form:
(1) The issuing practitioner, who shall sign and date the
form
in the space designated for the practitioner's signature and
who
may complete the form or delegate the responsibility of the
form's
completion to an individual who meets the requirements
established
in rules adopted under section 2133.31 of the Revised
Code;
(2) If the issuing practitioner is not the form preparer, the
form preparer, who shall sign and date the form in the space
designated for the form preparer's signature;
(3) Except as provided in division (B) of this section or
when the patient has, pursuant to division (D) of section 2133.35
of the Revised Code, authorized another individual to make all
medical decisions and to revoke a MOLST form and complete a new
form on the patient's behalf, the
patient, who shall sign and
date the form in the space designated
for the patient's
signature.
(B)(1) If the patient is at least eighteen years of age,
incapacitated, has a legally effective durable power of attorney
for health care, and is not already the subject of a valid MOLST
form, the patient's attorney in fact under the patient's durable
power of attorney for health care shall sign and date the form in
the space designated for such signature and indicate the person's
status as the patient's attorney in fact.
(2) If the patient is at least eighteen years of age,
incapacitated, does not have a legally effective durable power of
attorney for health care, and is not the subject of a valid MOLST
form, the individual or class of individuals determined in the
following order of priority and subject to divisions (D) and (E)
of this section and section 2133.36 of the Revised Code shall sign
and date the form in the space designated for such signature or
signatures and indicate the relationship to the patient:
(a) The patient's guardian;
(b) The patient's spouse;
(c) An adult child of the patient or, if there is more than
one adult child, all of the patient's adult children;
(d) The patient's parents;
(e) An adult sibling of the patient or, if there is more than
one adult sibling, all of the adult siblings;
(f) The adult not described in divisions (B)(2)(a) to (e) of
this section who is most closely related to the patient by blood
or adoption;
(g) The individual or class of individuals specified by the
director of health in rules adopted under section 2133.31 of the
Revised Code.
(3) If the patient is under eighteen years of age, the
parent, guardian, or legal custodian of the patient shall sign and
date the form in the space designated for such signature and
indicate the relationship to the patient.
(C) Division (B)(2)(a) of this section shall not be construed
as permitting or requiring the appointment of a guardian for the
patient.
(D) If an appropriate individual entitled to participate
under (B)(2) of this section in a MOLST form's completion is not
available within a reasonable period of time to participate in the
form's completion, is incapacitated, or declines to participate,
the next priority individual or class of individuals specified in
that division is authorized to participate.
(E) If at least one individual in a class of individuals
entitled to participate under division (B)(2) of this section in a
MOLST form's completion is incapacitated, is not willing to
participate, or is not available within a reasonable period of
time, participation shall be limited to the individual or
individuals in the class who are not incapacitated and are willing
to participate and available within a reasonable period of time.
Sec. 2133.35. (A)(1) When completing a MOLST form, the form
preparer shall, except as provided in division (A)(2) of this
section, discuss the instructions in the form with one of
the
following:
(a) If the patient is at least eighteen years of age and not
incapacitated, the patient;
(b) If the patient is not at least eighteen years of age, the
patient's parent, guardian, or legal custodian;
(c) If the patient is at least eighteen years of age,
incapacitated, and has a legally effective durable power of
attorney for health care, the patient's attorney in fact under the
durable power of attorney for health care;
(d) If the patient is at least eighteen years of age,
incapacitated, and does not have a legally effective durable power
of attorney for health care, the individual or class of
individuals determined according to the order of priority in
division (B)(2) of section 2133.34 of the Revised Code.
(2) If the MOLST form is a new form completed by an
individual authorized pursuant to division (D) of this section to
make all medical decisions and to complete a new form on the
patient's behalf, the form preparer shall discuss the instructions
in the form with that individual.
(B) The instructions the form preparer lists on the form
shall reflect the desires of the appropriate person or persons
determined in accordance with division (A) of this section as
expressed during the discussion.
(C) A declaration or durable power of attorney for health
care, or both, if a copy of one or both documents is furnished to
the form preparer, may guide the discussion between the form
preparer and the appropriate person or persons determined in
accordance with division (A) of this section.
(D) If a patient participates in the form's completion, the
patient may instruct the form preparer to document in the
appropriate space on the form that the patient authorizes another
individual to do both of the following:
(1) Make all medical decisions on the patient's behalf,
including those regarding the administration of CPR and other
life-sustaining treatment;
(2) Revoke the form at any time in accordance with the
procedure prescribed in rules adopted under section 2133.31 of the
Revised Code and, if desired, complete a new form on the patient's
behalf.
Sec. 2133.36. (A) Subject to division (B) of this section,
if individuals in a class of individuals determined in accordance
with division (B)(2) of section 2133.34 of the Revised Code
disagree
on any decision that must be made with regard to the
completion of
the form, the opinion of the majority of
individuals who are not
incapacitated and are
available within a
reasonable period of
time and
willing to participate shall
prevail.
(B) If a majority of individuals cannot reach a decision
under division (A) of this section, a physician who is not the
issuing practitioner but who has reviewed the patient's medical
record shall make the decision that the physician believes is most
consistent with reasonable and prevailing medical standards.
Sec. 2133.37. A completed MOLST form shall be placed in a
conspicuous location in the paper or electronic medical record of
the patient to whom it pertains. Whether maintained as part of a
paper or electronic medical record, the form shall be readily
available and retrievable.
Sec. 2133.38. (A) If a patient with a MOLST form is
transferred
from one health care facility to another, the health
care facility
initiating the transfer shall communicate the
existence of, and
send a copy of, the form to the receiving
facility prior to the
transfer. The copy may be sent via regular
mail or by facsimile or
other electronic means, but if maintained
in paper format, shall
be
placed on the color of paper
specified in rules adopted under
section 2133.31 of the Revised
Code on receipt by the receiving
facility. A copy of the form is
the same as the original.
(B)(1) Consistent with section 2133.37 of the Revised Code,
the
copy of the MOLST form shall be placed in a conspicuous
location
in the patient medical record immediately on receipt by
the
receiving facility. After admission, the attending physician
shall
review the MOLST form and, except as provided in division
(B)(2) of this section, discuss with one of the following
whether
the form should be amended or revoked and whether a new
form
should be issued:
(a) If the patient is at least eighteen years of age and not
incapacitated, the patient;
(b) If the patient is not at least eighteen years of age, the
patient's parent, guardian, or legal custodian;
(c) If the patient is at least eighteen years of age,
incapacitated, and has a legally effective durable power of
attorney for health care, the patient's attorney in fact under the
durable power of attorney for health care;
(d) If the patient is at least eighteen years of age,
incapacitated, and does not have a legally effective durable power
of attorney for health care, the individual or class of
individuals determined according to the order of priority in
division (B)(2) of section 2133.34 of the Revised Code.
(2) If the patient has authorized, pursuant to division (D)
of section 2133.35 of the Revised Code, another individual to make
all medical decisions and to revoke a MOLST form on the patient's
behalf, the attending physician, after the physician's review of
the form, shall discuss with that individual whether the form
should be amended or revoked and whether a new form should be
issued.
(C) If a decision is made to amend the form, the attending
physician shall proceed with the amendment consistent with the
amendment procedure prescribed in rules adopted under section
2133.31 of the Revised Code. If a decision is made to revoke the
form, whether or not there is an intention to issue a new form,
the revocation shall be done in accordance with section 2133.39 of
the Revised Code.
Sec. 2133.39. (A) A patient, an individual the patient has
authorized pursuant to division (D) of section 2133.35 of the
Revised Code to make all medical decisions and to revoke a MOLST
form on the patient's behalf, or, if the patient is under
eighteen years of age, the patient's parent, guardian, or legal
custodian, may revoke a MOLST form at any
time in accordance with
the procedure specified in rules adopted
under section 2133.31 of
the Revised Code.
(B) If a patient is at least eighteen years of age,
incapacitated, and has not authorized an individual pursuant to
division (D) of section 2133.35 of the Revised Code to make all
medical decisions and to revoke the patient's MOLST form, the
patient's attorney in fact under a durable
power of attorney for
health care or, if the patient does not have
a legally effective
durable power of attorney for health care, the
individual or
class of
individuals determined
in accordance with
division
(B)(2) of
section
2133.34 of the
Revised Code, may
revoke a
form in
accordance with
the procedure
specified in
rules
adopted under
section 2133.31 of
the Revised
Code if the
attending physician
determines that at
least one of
the
following is the case:
(1) There has been a change in the physical condition of the
patient that significantly decreases the benefit of the
instructions in the MOLST form to the patient.
(2) The instructions in the MOLST form are no longer
significantly effective in achieving the purposes for which
consent to their use was given by the
patient, the patient's
attorney in fact under a durable power of attorney for health
care, or the individual or class of individuals determined in
accordance with division (B)(2) of section 2133.34 of the Revised
Code.
Sec. 2133.40. Unless revoked in accordance with section
2133.39 of the Revised Code, a MOLST form does not expire.
Sec. 2133.41. Except as provided in section 2133.43 of the
Revised Code, both of the following apply with respect to
determining which instruction supersedes when an instruction is
inconsistent in different documents:
(A) An instruction in a MOLST form that is
inconsistent with
an instruction in a do-not-resuscitate order
always supersedes
the inconsistent instruction in the
do-not-resuscitate order.
(B)
An instruction in a MOLST form that is
inconsistent with
an instruction in a general consent to treatment
form signed by
or on behalf of the patient, a declaration, or a
durable power of
attorney for health care
supersedes the inconsistent instruction
in any of those documents
unless both of the following conditions
are met:
(1) The document was executed after the MOLST form, as
evidenced by the date on the document.
(2) The attending physician is made aware of the document and
furnished a copy of it.
Sec. 2133.42. Except as provided in section 2133.43 of the
Revised Code, if a section of a MOLST form has not been
completed, a health care professional may proceed with the
understanding that full treatment relative to treatment covered by
that section of the form, as specified in rules adopted by the
director of health pursuant to section 2133.31 of the Revised
Code, is to
be considered unless the form
indicates that the
patient has
authorized another individual to
make all medical
decisions on
the patient's behalf as described in
division (D)
of section
2133.35 of the Revised Code.
Sec. 2133.43. If an emergency medical services worker
determines in an emergency situation that either of the following
applies, the emergency medical services worker shall proceed to
treat the patient as directed, verbally or in writing, by a
physician or the cooperating physician advisory board of the
emergency medical service organization with which the emergency
medical services worker is affiliated:
(A) An instruction in the patient's MOLST form is
inconsistent with an instruction in any of the following:
(1) A do-not-resuscitate order that applies to the patient;
(2) A general consent to treatment form signed by or on
behalf of the patient;
(3) A declaration executed by the patient;
(4) A durable power of attorney for health care executed by
the patient.
(B) The section of the MOLST form that relates to the
patient's treatment in that emergency situation has not been
completed.
Sec. 2133.44. (A) Subject to division (B) of this section, no
health care facility, health care professional, emergency
services worker, or other individual who works for a health care
facility as an employee, contractor, or volunteer and who works
under the direction of or with the authorization of a physician or
advanced practice nurse shall be subject to criminal prosecution,
liable
in damages in tort or other civil action, or subject to
professional disciplinary action for acting in accordance with, or
otherwise being in compliance with, a valid MOLST form or sections
2133.31 to 2133.48 of the Revised Code.
(B) Division (A) of this section does not grant an immunity
from criminal or civil liability or from professional disciplinary
action to health care personnel for actions that are outside their
scope of authority.
Sec. 2133.45. The death of an individual that occurs as a
result of actions taken consistent with instructions in a MOLST
form does not constitute for any purpose a suicide, aggravated
murder, murder, or any other homicide.
Sec. 2133.46. The issuance of a MOLST form shall not do any
of the following:
(A) Affect in any manner the sale, procurement, issuance, or
renewal of a policy of life insurance or annuity, notwithstanding
any term of a policy or annuity to the contrary;
(B) Modify in any manner or invalidate the terms of a policy
of life insurance or annuity that is in effect on the effective
date of this section;
(C) Impair or invalidate a policy of life insurance or
annuity or any health benefit plan.
Sec. 2133.47. No physician, health care facility, other
health care provider, person authorized to engage in the business
of insurance in this state under Title XXXIX of the Revised Code,
health insuring corporation, other health care benefit plan, legal
entity that is self-insured and provides benefits to its employees
or members, governmental entity, or other person shall require
that an individual be the subject of a MOLST form, or require an
individual to revoke or refrain from being the subject of a MOLST
form, as a condition of being insured or of receiving health care
benefits or services.
Sec. 2133.48. In the absence of actual knowledge to the
contrary and if acting in good faith, an attending physician,
other health care professional, emergency services worker, or
health care facility may assume that a MOLST form complies with
sections 2133.31 to 2133.47 of the Revised Code and is valid.
Sec. 2133.49. (A) There is hereby created the medical orders
for
life-sustaining treatment advisory council. The council shall
consist of the following thirty-one members:
(1) An employee of the department of aging, appointed by the
director of aging;
(2) An employee of the department of mental health, appointed
by the director of mental health;
(3) An employee of the department of mental retardation and
developmental disabilities, appointed by the director of mental
retardation and developmental disabilities;
(4) The executive director of the Ohio medical transportation
board;
(5) The executive director of the state board of emergency
medical services;
(6) The state long-term care ombudsperson;
(7)
One representative from each of the following
organizations, appointed by the president or chief administrative
officer of the organization:
(a) The Ohio hospital association;
(b) The Ohio state medical association;
(c) The Ohio chapter of the American college of emergency
physicians;
(d) The Ohio hospice and palliative care organization;
(e) The Ohio health care association;
(f) The Ohio ambulance and medical transportation
Association;
(g) The Ohio medical directors association;
(h) The Ohio association of emergency medical services;
(i) The bioethics network of Ohio;
(j) The Ohio nurses association;
(k) The Ohio academy of nursing homes;
(l) The Ohio association of professional firefighters;
(m) The Ohio osteopathic association;
(n) The association of Ohio philanthropic homes, housing and
services for the aging;
(o) The catholic conference of Ohio;
(p) The Ohio private residential association;
(q) The northern Ohio fire fighters association;
(r) The Ohio assisted living association;
(s) The Ohio council for home care;
(u) The Ohio state bar association;
(v) The Ohio association of advanced practice nurses;
(w) The Ohio fire chiefs association;
(x) The Ohio state firefighters association;
(y) Agudath Israel of America.
(B) The council shall meet at the call of the director of
health. The department of health shall provide meeting space,
staff services, and technical assistance required by the council
in carrying out its duties.
(C) The council shall advise the director of health regarding
the rules the director must adopt under section 2133.31 of the
Revised Code and, at such times that the rules are subject to
review pursuant to section 119.032 of the Revised Code, whether
and to
what extent the rules should be continued without change,
amended,
or rescinded.
Each member of the council has one vote. A majority
of the
members present at a meeting constitutes a quorum, and the
affirmative vote of a majority of the members present is necessary
for the council to make an official recommendation to the director
on a particular rule.
The director may assign other duties to the
council,
as the
director considers appropriate.
(D) Members of the council shall serve without compensation,
except to the extent that serving on the council is considered
part of their regular duties of employment.
(E) Sections 101.82 to 101.87 of the Revised Code do not
apply to the council.
Sec. 3795.03. Nothing in section 3795.01 or 3795.02 of the
Revised Code
shall do any of the following:
(A) Prohibit or preclude a physician, certified nurse
practitioner, certified nurse-midwife, or clinical nurse
specialist who carries out
the responsibility to provide comfort
care to a patient in good
faith and while acting within the scope
of the physician's or nurse's authority from
prescribing,
dispensing, administering,
or causing to be
administered any
particular medical procedure,
treatment,
intervention, or other
measure to the patient,
including, but not
limited to,
prescribing, personally furnishing,
administering, or causing to
be administered by judicious
titration or in another manner any
form of medication, for the
purpose of diminishing the patient's
pain or discomfort and not for the purpose of postponing or
causing the patient's death, even
though the
medical
procedure,
treatment,
intervention, or other
measure may appear to hasten or
increase
the risk of the patient's
death;
(B) Prohibit or preclude health care personnel acting
under
the
direction of a person authorized to prescribe a patient's
treatment and who carry out the responsibility to
provide comfort
care to the patient in good faith and while
acting
within the
scope of their authority from dispensing,
administering, or
causing to be administered any particular
medical procedure,
treatment, intervention, or other measure to
the patient,
including, but not limited to, personally furnishing,
administering, or causing to be administered by judicious
titration or in another manner any form of medication, for the
purpose of diminishing the patient's
pain or
discomfort and
not
for the
purpose of postponing or
causing the patient's
death, even
though the medical procedure, treatment, intervention, or other
measure may
appear to hasten or increase the risk of the patient's
death;
(C) Prohibit or affect the use or continuation, or the
withholding or withdrawal, of life-sustaining treatment, CPR, or
comfort
care under Chapter 2133. of the Revised Code;
(D) Prohibit or affect the provision or withholding of health
care, life-sustaining treatment, or comfort care to a principal
under a durable power of attorney for health care or any other
health care decision made by an attorney in fact under sections
1337.11 to 1337.17 of the Revised Code;
(E) Affect or limit the authority of a physician, a health
care facility, a person employed by or under contract with a
health care facility, or emergency service personnel to provide or
withhold health care to a person in accordance with
reasonable
medical standards applicable in an emergency situation;
(F) Affect or limit the authority of a person to refuse to
give informed consent to health care, including through the
execution of a durable power of attorney for health care under
sections 1337.11 to 1337.17 of the Revised Code, the execution of
a declaration under sections 2133.01 to 2133.15 of the Revised
Code, the completion of a MOLST form under sections 2133.30 to
2133.48 of the Revised Code, or authorizing the withholding or
withdrawal of CPR under
sections 2133.21 to 2133.26 2133.27 of the
Revised Code.
Section 2. That existing sections 2133.02, 2133.21, 2133.211,
2133.22, 2133.23,
2133.24, 2133.25, 2133.26, and 3795.03 of the
Revised Code are
hereby repealed.
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