2012 -- H 7312

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LC00782

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STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2012

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A N A C T

RELATING TO HEALTH AND SAFETY - HEALTH CARE POWER OF ATTORNEY

     Introduced By: Representative Arthur Handy

     Date Introduced: February 01, 2012

     Referred To: House Judiciary

It is enacted by the General Assembly as follows:

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     SECTION 1. Sections 23-4.10-1, 23-4.10-1.1 and 23-4.10-2 of the General Laws in

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Chapter 23-4.10 entitled "Health Care Power of Attorney" are hereby amended to read as follows:

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     23-4.10-1. Purpose. -- (a) The legislature finds that adult persons have the fundamental

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right to control the decisions relating to the rendering of their own medical care.

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      (b) In order that the rights of patients may be respected even after they are no longer able

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to participate actively in decisions about themselves, the legislature declares that the laws of the

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state shall recognize the right of an adult person to make a written durable power of attorney

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regarding all health care decisions which might include instructing his or her physician on issues

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concerning behavioral health treatment and/or to withhold or withdraw life-sustaining procedures

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in the event of a terminal condition.

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     23-4.10-1.1. Definitions. -- The following definitions govern the construction of this

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chapter:

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      (1) "Advance directive protocol" means a standardized, state-wide method developed for

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emergency service personnel by the department of health and approved by the ambulance service

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advisory board, of providing palliative care to, and withholding life-sustaining procedures from, a

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qualified patient.

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      (2) "Artificial feeding" means the provision of nutrition or hydration by parenteral,

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nasogastric, gastric, or any means other than through per oral voluntary sustenance.

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      (3) "Attending physician" means the physician who has primary responsibility for the

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treatment and care of the patient.

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      (4) "Director" means the director of health.

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      (5) "Durable power of attorney" means a witnessed document executed in accordance

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with the requirements of section 23-4.10-2.

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      (6) "Emergency medical services personnel" means paid or volunteer firefighters, law

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enforcement officers, first responders, emergency medical technicians, or other emergency

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services personnel acting within the ordinary course of their professions.

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      (7) "Health-care provider" means a person who is licensed, certified, or otherwise

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authorized by the law of this state to administer health care in the ordinary course of business or

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practice of a profession.

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      (8) "Life-sustaining procedure" means any medical procedure or intervention that, when

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administered to a patient, will serve only to prolong the dying process. "Life-sustaining

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procedure" shall not include any medical procedure or intervention considered necessary by the

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attending physician or emergency service personnel to provide comfort, care, or alleviate pain.

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     (9) "Behavioral health treatment" means treatment of psychiatric or substance abuse

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issues.

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     (9)(10) "Person" means an individual, corporation, business trust, estate, trust,

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partnership, association, government, governmental subdivision or agency, or any other legal

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entity.

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      (10)(11) "Physician and/or doctor" means an individual licensed to practice medicine in

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this state.

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      (11)(12) "Terminal condition" means an incurable or irreversible condition that, without

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the administration of life-sustaining procedures, will, in the opinion of the attending physician,

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result in death.

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     (13) "Psychotropic medication" means medications used in the ordinary course of

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treatment of mental illness, addictions, and other illnesses of the brain, including, but not limited

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to, antipsychotic medications, antidepressant medications, anticonvulsant medication and mood

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stabilizers, anti-Alzheimer's-disease agents, and anxiolytics.

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     23-4.10-2. Statutory form of durable power of attorney. -- The statutory form of

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durable power of attorney is as follows:

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     STATUTORY FORM DURABLE POWER OF ATTORNEY FOR HEALTH CARE

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WARNING TO PERSON EXECUTING THIS DOCUMENT

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     This is an important legal document which is authorized by the general laws of this state.

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Before executing this document, you should know these important facts:

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     You must be at least eighteen (18) years of age and a resident of the state for this

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document to be legally valid and binding.

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     This document gives the person you designate as your agent (the attorney in fact) the

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power to make health care decisions for you. Your agent must act consistently with your desires

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as stated in this document or otherwise made known.

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     Except as you otherwise specify in this document, this document gives your agent the

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power to consent to your doctor not giving treatment or stopping treatment necessary to keep you

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alive.

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     Notwithstanding this document, you have the right to make medical, behavioral health

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and other health care decisions for yourself so long as you can give informed consent with respect

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to the particular decision. In addition, no treatment may be given to you over your objection at the

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time, and health care necessary to keep you alive may not be stopped or withheld if you object at

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the time. This document gives your agent authority to consent, to refuse to consent, or to

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withdraw consent to any care, treatment, service, or procedure to maintain, diagnose, or treat a

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physical or mental condition including admission to a facility as defined in subdivision 40.1-5-

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2(5), as well as treatment with psychotropic medication. This power is subject to any statement of

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your desires and any limitation that you include in this document. You may state in this document

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any types of treatment that you do not desire. In addition, a court can take away the power of your

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agent to make health care decisions for you if your agent:

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     (1) Authorizes anything that is illegal,

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     (2) Acts contrary to your known desires, or

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     (3) Where your desires are not known, does anything that is clearly contrary to your best

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interests.

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     Unless you specify a specific period, this power will exist until you revoke it. Your

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agent's power and authority ceases upon your death except to inform your family or next of kin of

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your desire, if any, to be an organ and tissue owner.

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     You have the right to revoke the authority of your agent by notifying your agent or your

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treating doctor, hospital, or other health care provider orally or in writing of the revocation.

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     Your agent has the right to examine your medical records and to consent to their

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disclosure unless you limit this right in this document.

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     This document revokes any prior durable power of attorney for health care.

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     You should carefully read and follow the witnessing procedure described at the end of

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this form. This document will not be valid unless you comply with the witnessing procedure.

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     If there is anything in this document that you do not understand, you should ask a lawyer

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to explain it to you.

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     Your agent may need this document immediately in case of an emergency that requires a

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decision concerning your health care. Either keep this document where it is immediately available

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to your agent and alternate agents or give each of them an executed copy of this document. You

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may also want to give your doctor an executed copy of this document.

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     (1) DESIGNATION OF HEALTH CARE AGENT. I,

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     (insert your name and address)

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     do hereby designate and appoint:

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     (insert name, address, and telephone number of one individual only as your agent to make

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health care decisions for you. None of the following may be designated as your agent: (1) your

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treating health care provider, (2) a nonrelative employee of your treating health care provider, (3)

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an operator of a community care facility, or (4) a nonrelative employee of an operator of a

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community care facility.) as my attorney in fact (agent) to make health care decisions for me as

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authorized in this document. For the purposes of this document, "health care decision" means

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consent, refusal of consent, or withdrawal of consent to any care, treatment, service, or procedure

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to maintain, diagnose, or treat an individual's physical or mental condition.

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     (2) CREATION OF DURABLE POWER OF ATTORNEY FOR HEALTH CARE. By

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this document I intend to create a durable power of attorney for health care.

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     (3) GENERAL STATEMENT OF AUTHORITY GRANTED. Subject to any limitations

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in this document, I hereby grant to my agent full power and authority to make medical and

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behavioral health care decisions for me to the same extent that I could make such decisions for

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myself if I had the capacity to do so. In exercising this authority, my agent shall make health care

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decisions that are consistent with my desires as stated in this document or otherwise made known

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to my agent, including, but not limited to, my desires concerning obtaining or refusing or

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withdrawing life-prolonging care, treatment, services, and procedures and informing my family or

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next of kin of my desire, if any, to be an organ or tissue donor.

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     (If you want to limit the authority of your agent to make health care decisions for you,

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you can state the limitations in paragraph (4) ("Statement of Desires, Special Provisions, and

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Limitations") below. You can indicate your desires by including a statement of your desires in the

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same paragraph.)

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     (4) STATEMENT OF DESIRES, SPECIAL PROVISIONS, AND LIMITATIONS.

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(Your agent must make health care decisions that are consistent with your known desires. You

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can, but are not required to, state your desires in the space provided below. You should consider

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whether you want to include a statement of your desires concerning life-prolonging care,

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treatment, services, and procedures. You can also include a statement of your desires concerning

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other matters relating to your health care. You can also make your desires known to your agent by

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discussing your desires with your agent or by some other means. If there are any types of

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treatment that you do not want to be used, you should state them in the space below. If you want

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to limit in any other way the authority given your agent by this document, you should state the

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limits in the space below. If you do not state any limits, your agent will have broad powers to

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make health care decisions for you, except to the extent that there are limits provided by law.)

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     In exercising the authority under this durable power of attorney for health care, my agent

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shall act consistently with my desires as stated below and is subject to the special provisions and

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limitations stated below:

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     (a) Statement of desires concerning life-prolonging care, treatment, services, and

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procedures:

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     (b) Additional statement of desires, special provisions, and limitations regarding health

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care decisions:

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     (c) Statement of desire regarding organ and tissue donation:

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     Initial if applicable:

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     [ ] In the event of my death, I request that my agent inform my family next of kin of my

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desire to be an organ and tissue donor, if possible.

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     (You may attach additional pages if you need more space to complete your statement. If

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you attach additional pages, you must date and sign EACH of the additional pages at the same

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time you date and sign this document.)

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     (5) INSPECTION AND DISCLOSURE OF INFORMATION RELATING TO MY

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PHYSICAL OR MENTAL HEALTH. Subject to any limitations in this document, my agent has

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the power and authority to do all of the following:

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     (a) Request, review, and receive any information, verbal or written, regarding my

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physical or mental health, including, but not limited to, medical and hospital records.

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     (b) Execute on my behalf any releases or other documents that may be required in order

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to obtain this information.

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     (c) Consent to the disclosure of this information.

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     (If you want to limit the authority of your agent to receive and disclose information

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relating to your health, you must state the limitations in paragraph (4) ("Statement of desires,

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special provisions, and limitations") above.)

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     (6) SIGNING DOCUMENTS, WAIVERS, AND RELEASES. Where necessary to

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implement the health care decisions that my agent is authorized by this document to make, my

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agent has the power and authority to execute on my behalf all of the following:

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     (a) Documents titled or purporting to be a "Refusal to Permit Treatment" and "Leaving

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Hospital Against Medical Advice."

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     (b) Any necessary waiver or release from liability required by a hospital or physician.

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     (7) DURATION. (Unless you specify a shorter period in the space below, this power of

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attorney will exist until it is revoked.)

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     This durable power of attorney for health care expires on

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     (Fill in this space ONLY if you want the authority of your agent to end on a specific

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date.)

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     (8) DESIGNATION OF ALTERNATE AGENTS. (You are not required to designate any

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alternate agents but you may do so. Any alternate agent you designate will be able to make the

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same health care decisions as the agent you designated in paragraph (1), above, in the event that

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agent is unable or ineligible to act as your agent. If the agent you designated is your spouse, he or

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she becomes ineligible to act as your agent if your marriage is dissolved.)

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     If the person designated as my agent in paragraph (1) is not available or becomes

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ineligible to act as my agent to make a health care decision for me or loses the mental capacity to

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make health care decisions for me, or if I revoke that person's appointment or authority to act as

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my agent to make health care decisions for me, then I designate and appoint the following

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persons to serve as my agent to make health care decisions for me as authorized in this document,

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such persons to serve in the order listed below:

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     (A) First Alternate Agent:

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     (Insert name, address, and telephone number of first alternate agent.)

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     (B) Second Alternate Agent:

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     (Insert name, address, and telephone number of second alternate agent.)

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     (9) PRIOR DESIGNATIONS REVOKED. I revoke any prior durable power of attorney

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for health care.

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     DATE AND SIGNATURE OF PRINCIPAL

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     (YOU MUST DATE AND SIGN THIS POWER OF ATTORNEY)

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     I sign my name to this Statutory Form Durable Power of Attorney for Health Care on

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______________ at (Date) (City)

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     ______________________________

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     (State) ______________________________

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     (You sign here)

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     (THIS POWER OF ATTORNEY WILL NOT BE VALID UNLESS IT IS SIGNED BY

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ONE NOTARY PUBLIC OR TWO (2) QUALIFIED WITNESSES WHO ARE PRESENT

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WHEN YOU SIGN OR ACKNOWLEDGE YOUR SIGNATURE. IF YOU HAVE ATTACHED

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ANY ADDITIONAL PAGES TO THIS FORM, YOU MUST DATE AND SIGN EACH OF

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THE ADDITIONAL PAGES AT THE SAME TIME YOU DATE AND SIGN THIS POWER

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OF ATTORNEY.)

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     STATEMENT OF WITNESSES

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     (This document must be witnessed by two (2) qualified adult witnesses or one (1) notary

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public. None of the following may be used as a witness:

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     (1) A person you designate as your agent or alternate agent,

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     (2) A health care provider,

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     (3) An employee of a health care provider,

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     (4) The operator of a community care facility,

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     (5) An employee of an operator of a community care facility.

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     I declare under penalty of perjury that the person who signed or acknowledged this

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document is personally known to me to be the principal, that the principal signed or

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acknowledged this durable power of attorney in my presence, that the principal appears to be of

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sound mind and under no duress, fraud, or undue influence, that I am not the person appointed as

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attorney in fact by this document, and that I am not a health care provider, an employee of a

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health care provider, the operator of a community care facility, nor an employee of an operator of

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a community care facility.

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     Option 1 - Two (2) Qualified Witnesses:

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     Signature: ________________ Residence Address:

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     Print Name: ______________

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     Date: ________________________

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     Signature: ________________ Residence Address:

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     Print Name: ______________

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     Date: ________________________

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     Option 2 - One Notary Public

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     Signature: ________________________________________ , Notary Public

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     Print Name: ________________________________________

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     Date: ______________________________

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     My commission expires on: ______________________________

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     (AT LEAST ONE OF THE ABOVE WITNESSES OR THE NOTARY PUBLIC MUST

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ALSO SIGN THE FOLLOWING DECLARATION.)

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     I further declare under penalty of perjury that I am not related to the principal by blood,

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marriage, or adoption, and, to the best of my knowledge, I am not entitled to any part of the estate

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of the principal upon the death of the principal under a will now existing or by operation of law.

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Signature:

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     Print Name:

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     SECTION 2. This act shall take effect upon passage.

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LC00782

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO HEALTH AND SAFETY - HEALTH CARE POWER OF ATTORNEY

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     This act would amend the statutory health care power of attorney form to clarify that the

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power of attorney applies to behavioral health treatment as well as medical treatment.

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     This act would take effect upon passage.

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LC00782

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