Chapter 199
2012 -- S 2361 SUBSTITUTE B
Enacted 06/11/12
A N A C T
RELATING TO
HEALTH AND SAFETY
Introduced By: Senators Perry, Miller, DeVall, Nesselbush, and Sosnowski
Date Introduced: February 14, 2012
It is enacted by the General
Assembly as follows:
SECTION 1. Section 23-4.11-2 of the General Laws in Chapter
23-4.11 entitled "Rights
of the Terminally Ill Act" is hereby amended to
read as follows:
23-4.11-2.
Definitions. -- The following definitions govern
the construction of this
chapter:
(1) "Advance
directive protocol" means a standardized, state-wide method developed for
emergency medical services personnel by the department of
health and approved by the
ambulance service advisory board, of providing palliative care
to, and withholding life-sustaining
procedures from, a qualified patient.
(2) "Artificial
feeding" means the provision of nutrition or hydration by parenteral,
nasogastric, gastric or any means other than through per oral
voluntary sustenance.
(3) "Attending
physician" means the physician who has primary responsibility for the
treatment and care of the patient.
(4)
"Declaration" means a witnessed document executed in accordance with
the
requirements of section sections 23-4.11-3 or
23-4.11-3.1.
(5) "Director"
means the director of health.
(6) "Emergency
medical services personnel" means paid or volunteer firefighters, law
enforcement officers, first responders, emergency medical
technicians, or other emergency
services personnel acting within the ordinary course of their
professions.
(7) “Health care
decision maker” means a person authorized by law or by the qualified
patient to make health care decisions for the qualified
patient. The qualified patient may revoke at
any time and in any manner the appointment of a health
care decision maker.
(7)(8)
"Health care provider" means a person who is licensed, certified, or
otherwise
authorized by the law of this state to administer health care in
the ordinary course of business or
practice of a profession.
(8)(9)
"Life sustaining procedure" means any medical procedure or
intervention that,
when administered to a qualified patient, will serve only
to prolong the dying process. "Life
sustaining procedure" shall not include any medical
procedure or intervention considered
necessary by the attending physician to provide comfort and
care or alleviate pain.
(10) “Medical orders
for life sustaining treatment” or “MOLST” means a voluntary
request that directs a health care provider regarding
resuscitative and life-sustaining measures.
(11) “Medical orders
for life sustaining treatment form” or “MOLST Form” means a
document which directs health care providers regarding
resuscitative and life-sustaining
measures.
(12) “MOLST qualified
health care provider” means the physician, registered nurse
practitioner, or physician assistant who is authorized by the
patient to sign a MOLST form.
(13) “Physician
assistant” shall mean a person licensed as a physician assistant under
Rhode Island general laws, chapter 5-54.
(9)(14)
"Person" means an individual, corporation, business trust, estate,
trust,
partnership, association, government, governmental subdivision or
agency, or any other legal
entity.
(10)(15)
"Physician" means an individual licensed to practice medicine in
this state under
subdivision 5-37-1(13).
(11)(16)
"Qualified patient" means a patient who has executed a declaration in
accordance with this chapter and who has been determined by the
attending physician to be in a
terminal condition.
(17) “Registered
nurse practitioner” shall mean a person licensed as such under Rhode
Island general laws, chapter 5-34.
(12)(18)
"Reliable documentation" means a standardized, state-wide form of
identification such as a nontransferable necklace or bracelet of
uniform design, adopted by the
director of health, with consultation from the local community
emergency medical services
agencies and licensed hospice and home health agencies, that
signifies and certifies that a valid
and current declaration is on file and that the
individual is a qualified patient.
(19) “Request
regarding resuscitative and life sustaining measures” means a written
document, signed by: (i) A qualified
patient with capacity, or a recognized health care decision
maker; and
(ii) The MOLST
qualified health care provider, which directs a health care provider
regarding resuscitative and life sustaining measures. Such a
request regarding resuscitative and
life sustaining measures is a medical order.
(13)(20)
"Terminal condition" means an incurable or irreversible condition
that, without
the administration of life sustaining procedures, will, in
the opinion of the attending physician,
result in death.
SECTION 2. Chapter 23-4.11 of the General Laws entitled
“Rights of the Terminally Ill
Act” is hereby amended by
adding thereto the following section:
23-4.11-3.1.
Medical Orders for Life Sustaining Treatment. -- (a)
The department of
health shall establish rules and regulations, consistent
with the provisions of this section, for the
establishment of Medical Orders for Life Sustaining Treatment and
the structure and content of
Medical Orders for Life
Sustaining Treatment forms.
(b)(1) A declaration
by a qualified patient may be recorded as a medical order for life-
sustaining treatment provided that:
(i)
The medical orders for life-sustaining treatment and medical intervention and
procedures are explained by a MOLST qualified health care
provider to the qualified patient or
health care decision maker. The MOLST qualified health care
provider shall further inform the
patient of the difference between an advance health care
directive and MOLST medical order;
(ii) A MOLST
qualified health care provider has conducted an evaluation of the qualified
patient; and
(iii) A MOLST form
documenting the declaration has been completed by a MOLST
qualified health care provider based on qualified patient
preferences and medical appropriateness,
and has been signed by a MOLST qualified health care
provider and the qualified patient or his or
her recognized health care decision maker.
(2) A health care
decision maker may execute the MOLST form if the qualified patient
lacks capacity, or if the qualified patient has designated
that the health care decision maker’s
authority is valid.
(3) A request
regarding resuscitative measures may also be evidenced by the words “do
not resuscitate” or the letters “DNR,” in a qualified
patient’s medical record and/or through a
mechanism established by the department of health consistent
with the provisions of chapter 23-
4.11.
(c)(1) A health care
provider shall treat a qualified patient in accordance with the
qualified patient’s MOLST, subject to the provisions of this
chapter.
(2) A MOLST qualified
health care provider may conduct an evaluation of the qualified
patient and if necessary, in consultation with the qualified
patient or recognized health care
decision maker, issue a new MOLST consistent with the most
current information available about
the qualified patient’s health status and care preferences.
(3) The recognized
health care decision maker of a qualified patient who is without
capacity shall consult with the MOLST qualified health care
provider prior to making a request to
modify that a qualified patient’s MOLST.
(d)(1) MOLST Form. A
MOLST shall be documented on an easily identifiable form
approved by the director. The director shall promulgate rules
and regulations for the
implementation of this section.
(2) The MOLST form shall
be signed by the qualified patient, or the qualified patient’s
recognized health care decision maker, and a MOLST qualified
health care provider.
(3) The MOLST form
shall contain all other information as required by this section.
(e)(1) A MOLST shall
apply regardless of whether the qualified patient executes the
MOLST form within or outside a
hospital or other health care setting.
(2) The MOLST form is
valid within or outside a hospital or other health care setting.
(f)(1) Revocation. A
qualified patient or his/her recognized health care decision maker
may, at any time, revoke in any manner that communicates
an intent to revoke his/her declaration
by informing the MOLST qualified health care providers,
other health care providers, or any
member of the medical or nursing staff of the revocation of
the declaration concerning life-
sustaining or resuscitative measures.
(2) Any member of the
medical or nursing staff informed of a revocation shall
immediately notify a MOLST qualified health care provider of the
revocation.
(3) The MOLST
qualified health care provider informed of a revocation of MOLST made
pursuant to this section shall immediately:
(i) Record the revocation in the qualified patient's
medical record;
(ii) Cancel any
orders implementing the decision to withhold or withdraw treatment; and
(iii) Notify the
health care providers and staff directly responsible for the qualified
patient's care of the revocation and any cancellations.
(4) If a decision to
withhold or withdraw life-sustaining treatment has been made by a
recognized health care decision maker pursuant to this section,
and the MOLST qualified health
care provider determines at any time that the decision is
no longer appropriate or authorized
because the qualified patient has regained decision-making
capacity or because the qualified
patient’s condition has otherwise improved, the MOLST qualified
health care provider shall
immediately:
(i)
Include such determination in the qualified patient's medical record;
(ii) Cancel any
orders or plans of care implementing the decision to withhold or withdraw
life-sustaining treatment;
(iii) Notify the
health care decision maker who made the decision to withhold or
withdraw treatment; and
(iv)
Notify the other health care providers, including the medical and
nursing staff
directly responsible for the qualified patient’s care, of any
cancelled MOLST orders or plans of
care.
(g) If a qualified patient
with a MOLST order is transferred from a hospital, a licensed
health facility, or the community, the MOLST order or plan
shall remain effective until a MOLST
qualified health care provider first examines the transferred
qualified patient, whereupon a
MOLST qualified health care provider shall issue
appropriate orders to continue the prior order or
plan. Such orders may be issued without obtaining another consent to withhold or withdraw life-
sustaining treatment pursuant to this chapter.
(h) The MOLST is a
voluntary option for qualified patients. No patient is required to
elect a MOLST.
SECTION 3. This act shall take effect upon passage.
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LC01287/SUB B/2
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