2019 -- H 5555

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2019

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A N   A C T

RELATING TO HEALTH AND SAFETY- LILA MANFIELD SAPINSLEY

COMPASSIONATE CARE ACT

     

     Introduced By: Representatives Ajello, Knight, Kislak, Cassar, and Tanzi

     Date Introduced: February 27, 2019

     Referred To: House Health, Education & Welfare

     It is enacted by the General Assembly as follows:

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     SECTION 1. Title 23 of the General Laws entitled "HEALTH AND SAFETY" is hereby

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amended by adding thereto the following chapter:

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CHAPTER 4.13

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LILA MANFIELD SAPINSLEY COMPASSIONATE CARE ACT

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     23-4.13-1. Short title.

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     This chapter shall be known and may be cited as the "Lila Manfield Sapinsley

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Compassionate Care Act".

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     23-4.13-2. Definitions.

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     As used in this chapter:

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     (1) "Bona fide physician-patient relationship" means a treating or consulting relationship

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in the course of which a physician has completed a full assessment of the patient's medical history

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and current medical condition, including a personal physical examination.

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     (2) "Capable" means that a patient has the ability to make and communicate health care

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decisions to a physician, including communication through persons familiar with the patient's

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manner of communicating if those persons are available.

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     (3) "Health care facility" shall have the same meaning as in § 23-17-2.

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     (4) "Health care provider" means a person, partnership, corporation, facility, or

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institution, licensed or certified or authorized by law to administer health care or dispense

 

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medication in the ordinary course of business or practice of a profession.

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     (5) "Impaired judgment" means that a person does not sufficiently understand or

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appreciate the relevant facts necessary to make an informed decision.

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     (6) "Interested person" means:

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     (i) The patient's physician;

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     (ii) A person who knows that they are a relative of the patient by blood, civil marriage,

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civil union, or adoption;

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     (iii) A person who knows that they would be entitled, upon the patient's death, to any

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portion of the estate or assets of the patient under any will or trust, by operation of law, or by

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contract; or

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     (iv) An owner, operator, or employee of a health care facility, nursing home, or

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residential care facility where the patient is receiving medical treatment or is a resident.

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     (7) "Palliative care" shall have the same definition as in § 23-89-3.

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     (8) "Patient" means a person who is eighteen (18) years of age or older, a resident of

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Rhode Island, and under the care of a physician.

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     (9) "Physician" means an individual licensed to engage in the practice of medicine as

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defined in § 5-37-1.

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     (10) "Terminal condition" means an incurable and irreversible disease which would,

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within reasonable medical judgment, result in death within six (6) months or less.

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     23-4.13-3. Requirements for prescription and documentation - Immunity.

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     (a) A physician shall not be subject to any civil or criminal liability or professional

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disciplinary action if the physician prescribes to a patient with a terminal condition medication to

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be self-administered for the purpose of hastening the patient's death and the physician affirms by

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documenting in the patient's medical record that all of the following occurred:

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     (1) The patient made an oral request to the physician in the physician's physical presence

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to be prescribed medication to be self-administered for the purpose of hastening the patient's

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death.

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     (2) No fewer than fifteen (15) days after the first oral request, the patient made a second

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oral request to the physician in the physician's physical presence to be prescribed medication to

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be self-administered for the purpose of hastening the patient's death.

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     (3) At the time of the second oral request, the physician offered the patient an opportunity

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to rescind the request.

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     (4) The patient made a written request to be prescribed medication to be self-

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administered for the purpose of hastening the patient's death that was signed by the patient in the

 

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presence of two (2) or more subscribing witnesses at least one of whom is not an interested

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person as defined in § 23-4.13-2, who were at least eighteen (18) years of age, and who

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subscribed and attested that the patient appeared to understand the nature of the document and to

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be free from duress or undue influence at the time the request was signed.

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     (5) The physician determined that the patient:

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     (i) Was suffering a terminal condition, based on the physician's physical examination of

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the patient and the physician's review of the patient's relevant medical records;

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     (ii) Was capable;

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     (iii) Was making an informed decision;

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     (iv) Had made a voluntary request for medication to hasten their death; and

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     (v) Was a Rhode Island resident.

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     (6) The physician informed the patient in person, both verbally and in writing, of all the

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following:

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     (i) The patient's medical diagnosis;

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     (ii) The patient's prognosis, including an acknowledgement that the physician's prediction

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of the patient's life expectancy was an estimate based on the physician's best medical judgment

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and was not a guarantee of the actual time remaining in the patient's life, and that the patient

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could live longer than the time predicted;

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     (iii) The range of treatment options appropriate for the patient and the patient's diagnosis;

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     (iv) If the patient was not enrolled or participating in hospice care, all feasible end-of-life

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services, including palliative care, comfort care, hospice care, and pain control;

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     (v) The range of possible results, including potential risks associated with taking the

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medication to be prescribed; and

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     (vi) The probable result of taking the medication to be prescribed.

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     (7) The physician referred the patient to a second physician for medical confirmation of

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the diagnosis, prognosis, and a determination that the patient was capable, was acting voluntarily,

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and had made an informed decision.

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     (8) The physician either verified that the patient did not have impaired judgment or

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referred the patient for an evaluation by a psychiatrist, psychologist, or clinical social worker,

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licensed in Rhode Island, for confirmation that the patient was capable and did not have impaired

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judgment.

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     (9) If applicable, the physician consulted with the patient's primary care physician with

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the patient's consent.

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     (10) The physician informed the patient that the patient may rescind the request at any

 

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time and in any manner and offered the patient an opportunity to rescind after the patient's second

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oral request.

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     (11) The physician ensured that all required steps were carried out in accordance with this

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section and confirmed, immediately prior to writing the prescription for medication, that the

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patient was making an informed decision.

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     (12) The physician wrote the prescription no fewer than forty-eight (48) hours after the

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last to occur of the following events:

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     (i) The patient's written request for medication to hasten their death;

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     (ii) The patient's second oral request; or

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     (iii) The physician's offering the patient an opportunity to rescind the request.

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     (13) The physician either:

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     (i) Dispensed the medication directly, provided that at the time the physician dispensed

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the medication, they were licensed to dispense medication in Rhode Island, had a current Drug

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Enforcement Administration certificate, and complied with any applicable administrative rules; or

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     (ii) With the patient's written consent:

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     (A) Contacted a pharmacist and informed the pharmacist of the prescription; and

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     (B) Delivered the written prescription personally or by mail or electronically to the

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pharmacist, who dispensed the medication to the patient, the physician, or an expressly identified

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agent of the patient.

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     (14) The physician recorded and filed the following in the patient's medical record:

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     (i) The date, time and detailed description of all oral requests of the patient for

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medication to hasten their death;

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     (ii) All written requests by the patient for medication to hasten their death;

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     (iii) The physician's diagnosis, prognosis, and basis for the determination that the patient

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was capable, was acting voluntarily, and had made an informed decision;

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     (iv) The second physician's diagnosis, prognosis, and verification that the patient was

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capable, was acting voluntarily, and had made an informed decision;

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     (v) The physician's attestation that the patient was enrolled in hospice care at the time of

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the patient's oral and written requests for medication to hasten their death or that the physician

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informed the patient of all feasible end-of-life services;

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     (vi) The physician's verification that the patient either did not have impaired judgment or

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that the physician referred the patient for an evaluation and the person conducting the evaluation

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has determined that the patient did not have impaired judgment;

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     (vii) A report of the outcome and determinations made during any evaluation which the

 

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patient may have received;

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     (viii) The date, time, and detailed description of the physician's offer to the patient to

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rescind the request for medication at the time of the patient's second oral request; and

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     (ix) A note by the physician indicating that all requirements under this section were

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satisfied and describing all of the steps taken to carry out the request, including a notation of the

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medication prescribed.

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     (15) After writing the prescription, the physician promptly filed a report with the

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department of health documenting completion of all of the requirements under this section.

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     (b) This section shall not be construed to limit civil or criminal liability for gross

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negligence, recklessness, or intentional misconduct.

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     23-4.13-4. No duty to aid.

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     A patient with a terminal condition who self-administers a lethal dose of medication shall

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not be considered to be a person exposed to grave physical harm under § 11-56-1, and no person

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shall be subject to civil or criminal liability solely for being present when a patient with a

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terminal condition self-administers a lethal dose of medication pursuant to this chapter, or for not

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acting to prevent the patient from self-administering a lethal dose of medication pursuant to this

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chapter, or for not rendering aid to a patient who has self-administered medication pursuant to

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this chapter.

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     23-4.13-5. Limitations on actions.

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     (a) A physician, nurse, pharmacist, or other person shall not be under any duty, by law or

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contract, to participate in the provision of a lethal dose of medication to a patient.

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     (b) A health care facility or health care provider shall not subject a physician, nurse,

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pharmacist, or other person to discipline, suspension, loss of license, loss of privileges, or other

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penalty for actions taken in good faith reliance on the provisions of this chapter or refusals to act

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under this chapter.

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     (c) Except as otherwise provided in this chapter herein, nothing in this chapter shall be

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construed to limit liability for civil damages resulting from negligent conduct or intentional

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misconduct by any person.

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     23-4.13-6. Health care facility exception.

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     A health care facility may prohibit a physician from writing a prescription for a dose of

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medication intended to be lethal for a patient who is a resident in its facility and intends to use the

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medication on the facility's premises, provided the facility has notified the physician in writing of

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its policy with regard to the said prescriptions. Notwithstanding the provisions of § 23-4.13-5(b),

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any physician who violates a policy established by a health care facility under this section may be

 

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subject to sanctions otherwise allowable under law or contract.

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     23-4.13-7. Insurance policies; prohibitions.

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     (a) A person and their beneficiaries shall not be denied benefits under any life insurance

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policy, as defined in § 27-4-0.1, for actions taken in accordance with this chapter.

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     (b) The sale, procurement, or issue of any medical malpractice insurance policy or the

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rate charged for the policy shall not be conditioned upon or affected by whether the physician is

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willing or unwilling to participate in the provisions of this chapter.

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     23-4.13-8. No effect on palliative sedation.

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     This chapter shall not limit or otherwise affect the provision, administration, or receipt of

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palliative sedation consistent with accepted medical standards.

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     23-4.13-9. Protection of patient choice at end-of-life.

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     A physician with a bona fide physician-patient relationship with a patient with a terminal

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condition shall not be considered to have engaged in unprofessional conduct under § 5-37-5.1 if:

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     (1) The physician determines that the patient is capable and does not have impaired

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judgment; and

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     (2) The physician informs the patient of all feasible end-of-life services, including

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palliative care, comfort care, hospice care, and pain control; and

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     (3) The physician prescribes a dose of medication that may be lethal to the patient; and

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     (4) The physician advises the patient of all foreseeable risks related to the prescription;

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and

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     (5) The patient makes an independent decision to self-administer a lethal dose of the

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medication.

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     23-4.13-10. Immunity for physicians.

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     A physician shall be immune from any civil or criminal liability or professional

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disciplinary action for actions performed in good faith compliance with the provisions of this

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chapter.

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     23-4.13-11. Safe disposal of unused medications.

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     The department of health shall adopt rules providing for the safe disposal of unused

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medications prescribed under this chapter.

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     23-4.13-12. Statutory construction.

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     Nothing in this chapter shall be construed to authorize a physician or any other person to

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end a patient's life by lethal injection, mercy killing, or active euthanasia. Action taken in

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accordance with this chapter shall not be construed for any purpose to constitute suicide, assisted

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suicide, mercy killing, or homicide under the law. This section shall not be construed to conflict

 

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with section 1553 of the Patient Protection and Affordable Care Act, Pub.L. No. 111-148, as

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amended by the Health Care and Education Reconciliation Act of 2010, Pub.L. No. 111-152.

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     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO HEALTH AND SAFETY- LILA MANFIELD SAPINSLEY

COMPASSIONATE CARE ACT

***

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     This act would create the Lila Manfield Sapinsley Compassionate Care Act, to provide a

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legal mechanism whereby a terminally ill patient may choose to end their life using drugs

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prescribed by a physician.

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     This act would take effect upon passage.

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