Bill Text: NY A05973 | 2019-2020 | General Assembly | Amended
Bill Title: Makes technical, minor and coordinating amendments regarding health care agents and proxies, decisions under the family health care decisions act, and nonhospital orders not to resuscitate.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2020-01-08 - referred to codes [A05973 Detail]
Download: New_York-2019-A05973-Amended.html
STATE OF NEW YORK ________________________________________________________________________ 5973--A 2019-2020 Regular Sessions IN ASSEMBLY February 22, 2019 ___________ Introduced by M. of A. GOTTFRIED -- read once and referred to the Committee on Health -- reported and referred to the Committee on Codes -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the public health law, in relation to making technical, minor and coordinating amendments regarding health care agents and proxies, decisions under the family health care decisions act, and nonhospital orders not to resuscitate The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Subdivision 10 of section 2980 of the public health law, as 2 amended by chapter 23 of the laws of 1994, is amended to read as 3 follows: 4 10. "Mental hygiene facility" means a residential facility, excluding 5 family care homes, operated or licensed by the office of mental health 6 or the office [of mental retardation and] for people with developmental 7 disabilities. 8 § 2. Paragraph (b) of subdivision 1 of section 2981 of the public 9 health law, as added by chapter 752 of the laws of 1990, is amended to 10 read as follows: 11 (b) For the purposes of this section, every adult shall be presumed 12 competent to appoint a health care agent unless such person has been 13 adjudged incompetent or otherwise adjudged not competent to appoint a 14 health care agent, or unless a [committee or] guardian of the person has 15 been appointed for the adult pursuant to article [seventy-eight] eight- 16 y-one of the mental hygiene law or article seventeen-A of the surro- 17 gate's court procedure act. 18 § 3. Subdivision 2 of section 2982 of the public health law, as 19 amended by chapter 230 of the laws of 2004, is amended to read as 20 follows: EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD09564-02-9A. 5973--A 2 1 2. Decision-making standard. After consultation with a licensed physi- 2 cian, registered nurse, physician assistant, nurse practitioner, 3 licensed psychologist, licensed master social worker, or a licensed 4 clinical social worker, the agent shall make health care decisions: (a) 5 in accordance with the principal's wishes, including the principal's 6 religious and moral beliefs; or (b) if the principal's wishes are not 7 reasonably known and cannot with reasonable diligence be ascertained, in 8 accordance with the principal's best interests; provided, however, that 9 if the principal's wishes regarding the administration of artificial 10 nutrition and hydration are not reasonably known and cannot with reason- 11 able diligence be ascertained, the agent shall not have the authority to 12 make decisions regarding these measures. 13 § 4. Subdivision 3 of section 2983 of the public health law, as 14 amended by chapter 342 of the laws of 2018, is amended to read as 15 follows: 16 3. Notice of determination. Notice of a determination that a principal 17 lacks capacity to make health care decisions shall promptly be given: 18 (a) to the principal, orally and in writing, where there is any indi- 19 cation of the principal's ability to comprehend such notice; (b) to the 20 agent; (c) if the principal is in or is transferred from a mental 21 hygiene facility, to the facility director; and (d) to the [conservator22for, or committee of, the principal] guardian, if any. 23 § 5. Subdivision 2 of section 2991 of the public health law, as added 24 by chapter 752 of the laws of 1990, is amended to read as follows: 25 2. Such procedures shall be established in accordance with regulations 26 issued by the commissioners of health, mental health, and [mental retar-27dation and] developmental disabilities for facilities subject to their 28 respective regulatory authorities. 29 § 6. The opening paragraph of section 2992 of the public health law, 30 as amended by chapter 93 of the laws of 2014, is amended to read as 31 follows: 32 The health care provider[, the conservator for, or committee] of the 33 principal under article eighty-one of the mental hygiene law or article 34 seventeen-A of the surrogate's court procedure act, members of the prin- 35 cipal's family, a close friend of the principal as defined in subdivi- 36 sion [five] four of section [two thousand nine] twenty-nine hundred 37 [sixty-one] ninety-four-a of this chapter, or the commissioner [of38health], the commissioner of mental health, or the commissioner of 39 developmental disabilities may commence a special proceeding pursuant to 40 article four of the civil practice law and rules, in a court of compe- 41 tent jurisdiction, with respect to any dispute arising under this arti- 42 cle, including, but not limited to, a proceeding to: 43 § 7. Section 2993 of the public health law, as added by chapter 752 of 44 the laws of 1990, is amended to read as follows: 45 § 2993. Regulations. The commissioner [of health], in consultation 46 with the commissioners of [the office of] mental health and [the office47of mental retardation and] developmental disabilities, shall establish 48 such regulations as may be necessary for the implementation of this 49 article, subject to the provisions of subdivision two of section [two50thousand nine] twenty-nine hundred ninety-one of this article. 51 § 8. Subdivisions 17, 20 and 26 of section 2994-a of the public health 52 law, as added by chapter 8 of the laws of 2010, are amended to read as 53 follows: 54 17. "Health or social [service] services practitioner" means a regis- 55 tered professional nurse, nurse practitioner, physician, physician 56 assistant, psychologist, licensed master social worker or licensed clin-A. 5973--A 3 1 ical social worker, licensed or certified pursuant to the education law 2 acting within his or her scope of practice. 3 20. "Mental hygiene facility" means a facility operated or licensed by 4 the office of mental health or the office [of mental retardation and] 5 for people with developmental disabilities as defined in subdivision six 6 of section 1.03 of the mental hygiene law. 7 26. "Person connected with the case" means the patient, any person on 8 the surrogate list, a parent or guardian of a minor patient, [the] a 9 hospital administrator, an attending physician, any other health or 10 social services practitioner who is or has been directly involved in the 11 patient's care, and any duly authorized state agency, including the 12 facility director or regional director for a patient transferred from a 13 mental hygiene facility and the facility director for a patient trans- 14 ferred from a correctional facility. 15 § 9. The opening paragraph of subdivision 3 of section 2994-b of the 16 public health law, as amended by chapter 430 of the laws of 2017, is 17 amended to read as follows: 18 Prior to seeking or relying upon a health care decision by a surrogate 19 for a patient under this article, if the attending physician or attend- 20 ing nurse practitioner has reason to believe that the patient has a 21 history of receiving services for [mental retardation or] a develop- 22 mental disability; it reasonably appears to the attending physician or 23 attending nurse practitioner that the patient has [mental retardation24or] a developmental disability; or the attending physician or attending 25 nurse practitioner has reason to believe that the patient has been 26 transferred from a mental hygiene facility operated or licensed by the 27 office of mental health, then such physician or nurse practitioner shall 28 make reasonable efforts to determine whether paragraphs (a), (b) or (c) 29 of this subdivision are applicable: 30 § 10. Subdivision 3 of section 2994-e of the public health law, as 31 amended by chapter 430 of the laws of 2017, is amended to read as 32 follows: 33 3. Decision-making standards and procedures for emancipated minor 34 patient. (a) If an attending physician or attending nurse practitioner 35 determines that a patient is an emancipated minor patient with deci- 36 sion-making capacity and documents the basis for such determination in 37 the patient's medical record, the patient shall have the authority to 38 decide about life-sustaining treatment. Such authority shall include a 39 decision to withhold or withdraw life-sustaining treatment if an attend- 40 ing physician or attending nurse practitioner and the ethics review 41 committee determine that the decision accords with the standards for 42 surrogate decisions for adults, and the ethics review committee approves 43 the decision. 44 (b) If the hospital can with reasonable efforts ascertain the identity 45 of the parents or guardian of an emancipated minor patient, the hospital 46 shall make diligent efforts to notify such persons, and document such 47 diligent efforts in the patient's medical record, prior to withholding 48 or withdrawing life-sustaining treatment pursuant to this subdivision. 49 § 11. Subparagraph (iv) of paragraph (b) of subdivision 4 of section 50 2994-m of the public health law, as amended by chapter 430 of the laws 51 of 2017, is amended to read as follows: 52 (iv) Following ethics review committee consideration of a case 53 concerning the withdrawal or withholding of life-sustaining treatment, 54 treatment shall not be withdrawn or withheld until the hospital makes 55 diligent efforts to inform the persons identified in subparagraph (iii) 56 of this paragraph [have been informed] of the committee's response toA. 5973--A 4 1 the case and documents such diligent efforts in the patient's medical 2 record. 3 § 12. Subdivision 2 of section 2994-t of the public health law, as 4 added by chapter 8 of the laws of 2010, is amended to read as follows: 5 2. The commissioner, in consultation with the commissioners of [the6office of] mental health and [the office of mental retardation and] 7 developmental disabilities, shall promulgate regulations identifying the 8 credentials of health care professionals qualified to provide an inde- 9 pendent determination, pursuant to subdivision three of section twenty- 10 nine hundred ninety-four-c of this article, that a patient lacks deci- 11 sion-making capacity because of mental illness or developmental 12 disability. 13 § 13. Section 2994-u of the public health law, as added by chapter 8 14 of the laws of 2010, is amended to read as follows: 15 § 2994-u. Rights to be publicized. The commissioner shall prepare a 16 statement summarizing the rights, duties, and requirements of this arti- 17 cle and shall require that a copy of such statement be furnished to 18 [patients] a patient or to [persons on] the surrogate [list known to the19hospital], or to the [parents or guardians] parent or guardian of a 20 minor [patients] patient, at or prior to admission to the hospital, or 21 within a reasonable time thereafter, and to [each member of the hospi-22tal's staff directly involved with patient care] any person on the 23 surrogate list who requests a copy of such statement from the hospital. 24 The statement shall also be made available to the hospital clinical 25 staff. 26 § 14. The commissioner of health shall revise the statement of rights 27 that hospitals are required to post (known as the Patient's Bill of 28 Rights) pursuant to paragraph (g) of subdivision 1 of section 2803 of 29 the public health law, by replacing the clause regarding orders not to 30 resuscitate with a statement that more generally informs patients of 31 their right to receive from the hospital upon admission, and upon 32 request, a more complete statement of their rights with respect to 33 deciding about health care, including appointing a health care agent, 34 consenting to do-not-resuscitate orders and making other life-sustaining 35 treatment decisions. The clause should also state in substance that the 36 hospital will also provide such statement upon request to any family 37 member or friend of a patient who lacks decision-making capacity. 38 § 15. Subdivisions 12 and 13 of section 2994-aa of the public health 39 law, subdivision 12 as added by chapter 8 of the laws of 2010 and subdi- 40 vision 13 as amended by chapter 167 of the laws of 2011, are amended to 41 read as follows: 42 12. "Mental hygiene facility" means a residential facility operated or 43 licensed by the office of mental health [or the office of mental retar-44dation and developmental disabilities]. 45 13. "Nonhospital order not to resuscitate" means an order that directs 46 emergency medical services personnel, hospice personnel, home care 47 services agency personnel and hospital emergency services personnel not 48 to attempt cardiopulmonary resuscitation in the event a patient suffers 49 cardiac or respiratory arrest. 50 § 16. Subdivisions 2 and 6 of section 2994-dd of the public health 51 law, as amended by chapter 430 of the laws of 2017, are amended to read 52 as follows: 53 2. A nonhospital order not to resuscitate shall be issued upon a stan- 54 dard form prescribed by the commissioner. [The commissioner shall also55develop a] A standard bracelet [that] or other article may be worn by a 56 patient with a nonhospital order not to resuscitate to identify thatA. 5973--A 5 1 status; provided, however, that no person may require a patient to wear 2 such a bracelet or other article and that no person may require a 3 patient to wear such a bracelet as a condition for honoring a nonhospi- 4 tal order not to resuscitate or for providing health care services. 5 6. The commissioner may authorize the use of one or more alternative 6 forms for issuing a nonhospital order not to resuscitate (in place of 7 the standard form prescribed by the commissioner under subdivision two 8 of this section). Such alternative form or forms may also be used to 9 issue a non-hospital do not intubate order. Any such alternative forms 10 intended for use for persons with developmental disabilities or persons 11 with mental illness who are incapable of making their own health care 12 decisions or who have a guardian of the person appointed pursuant to 13 article eighty-one of the mental hygiene law or article seventeen-A of 14 the surrogate's court procedure act must also be approved by the commis- 15 sioner of developmental disabilities or the commissioner of mental 16 health, as appropriate. An alternative form under this subdivision shall 17 otherwise conform with applicable federal and state law. This subdivi- 18 sion does not limit, restrict or impair the use of an alternative form 19 for issuing an order not to resuscitate in a general hospital or resi- 20 dential health care facility under article twenty-eight of this chapter 21 or a hospital under subdivision ten of section 1.03 of the mental 22 hygiene law or a developmental disabilities services office under 23 section 13.17 of the mental hygiene law. 24 § 17. Section 2994-gg of the public health law, as added by chapter 8 25 of the laws of 2010, is amended to read as follows: 26 § 2994-gg. Immunity. No person shall be subjected to criminal prose- 27 cution or civil liability, or be deemed to have engaged in unprofes- 28 sional conduct, for honoring reasonably and in good faith pursuant to 29 this [section] article a nonhospital order not to resuscitate, for 30 disregarding a nonhospital order pursuant to section twenty-nine hundred 31 ninety-four-ee of this article, or for other actions taken reasonably 32 and in good faith pursuant to this [section] article. 33 § 18. This act shall take effect on the ninetieth day after it shall 34 have become a law, provided that the amendments to article 29-C of the 35 public health law shall apply to decisions made pursuant to health care 36 proxies created prior to the effective date of this act as well as those 37 created thereafter.