S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 1719--A
                                                        Cal. No. 426

                       2009-2010 Regular Sessions

                          I N  A S S E M B L Y

                             January 9, 2009
                               ___________

Introduced  by M. of A. GOTTFRIED, CLARK, FIELDS, GUNTHER, HOYT, PAULIN,
  SCHIMMINGER -- Multi-Sponsored by -- M. of A.  CAHILL,  GALEF,  GLICK,
  JOHN, KELLNER, LAVINE, McENENY, PHEFFER, N. RIVERA, WEISENBERG -- read
  once  and referred to the Committee on Health -- reported from commit-
  tee, advanced to a  third  reading,  amended  and  ordered  reprinted,
  retaining its place on the order of third reading

AN  ACT to amend the public health law, in relation to authorizing nurse
  practitioners to execute orders not  to  resuscitate;  and  to  repeal
  subdivision  4  of  section  2977  of  such law relating to consent to
  nonhospital orders not to resuscitate

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section  1. Section 2960 of the public health law, as added by chapter
818 of the laws of 1987, is amended to read as follows:
  S 2960. Legislative findings and purpose. The legislature finds  that,
although  cardiopulmonary  resuscitation  has  proved  invaluable in the
prevention of sudden, unexpected death, it is appropriate for an attend-
ing physician OR ATTENDING NURSE PRACTITIONER, in certain circumstances,
to issue an order not to  attempt  cardiopulmonary  resuscitation  of  a
patient  where  appropriate  consent  has been obtained. The legislature
further finds that there is a need to clarify and establish  the  rights
and  obligations  of patients, their families, and health care providers
regarding cardiopulmonary resuscitation and the issuance of  orders  not
to resuscitate.
  S  2.  Subdivisions  2,  5 and 20 of section 2961 of the public health
law, subdivision 2 as amended by chapter 370 of the laws of 1991, subdi-
visions 5 and 20 as added by chapter 818 of the laws of  1987,  subdivi-
sion  20  as  renumbered by chapter 370 of the laws of 1991, are amended
and two new subdivisions 2-a and 16-a are added to read as follows:
  2. "Attending physician" means the physician selected by  or  assigned
to  a  patient  in  a  hospital or, for the purpose of provisions herein

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
              

A                                                          LBD01106-03-9

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governing nonhospital orders not to resuscitate,  a  patient  not  in  a
hospital,  who  has primary responsibility for the treatment and care of
the patient. Where more than one  physician  AND/OR  NURSE  PRACTITIONER
shares such responsibility, any such physician OR NURSE PRACTITIONER may
act  as the attending physician OR ATTENDING NURSE PRACTITIONER pursuant
to this article.
  2-A. "ATTENDING  NURSE  PRACTITIONER"  MEANS  THE  NURSE  PRACTITIONER
SELECTED  BY  OR ASSIGNED TO A PATIENT IN A HOSPITAL OR, FOR THE PURPOSE
OF PROVISIONS HEREIN GOVERNING NONHOSPITAL ORDERS NOT TO RESUSCITATE,  A
PATIENT NOT IN A HOSPITAL, WHO HAS PRIMARY RESPONSIBILITY FOR THE TREAT-
MENT AND CARE OF THE PATIENT. WHERE MORE THAN ONE PHYSICIAN AND/OR NURSE
PRACTITIONER  SHARES  SUCH  RESPONSIBILITY,  ANY SUCH PHYSICIAN OR NURSE
PRACTITIONER MAY ACT AS THE ATTENDING PHYSICIAN OR ATTENDING NURSE PRAC-
TITIONER PURSUANT TO THIS ARTICLE.
  5. "Close friend" means any person, eighteen years of  age  or  older,
who  presents  an affidavit to an attending physician OR ATTENDING NURSE
PRACTITIONER stating that he OR SHE is a close friend of the patient and
that he OR SHE has maintained such regular contact with the  patient  as
to  be  familiar with the patient's activities, health, and religious or
moral beliefs and stating the facts and circumstances  that  demonstrate
such familiarity.
  16-A. "NURSE PRACTITIONER" MEANS A NURSE PRACTITIONER CERTIFIED PURSU-
ANT  TO  SECTION SIXTY-NINE HUNDRED TEN OF THE EDUCATION LAW, AND WHO IS
PRACTICING PURSUANT TO A WRITTEN PRACTICE AGREEMENT AND WRITTEN PRACTICE
PROTOCOLS ENTERED INTO WITH  HIS  OR  HER  COLLABORATING  PHYSICIAN,  IN
ACCORDANCE  WITH  SUBDIVISION THREE OF SECTION SIXTY-NINE HUNDRED TWO OF
THE EDUCATION LAW.
  20. "Reasonably available" means that a person to be contacted can  be
contacted  with  diligent  efforts  by an attending physician, ATTENDING
NURSE PRACTITIONER or another person acting on behalf of  the  attending
physician, THE ATTENDING NURSE PRACTITIONER or the hospital.
  S 3. Subdivisions 2 and 3 of section 2962 of the public health law, as
added  by  chapter  818  of  the  laws  of  1987, are amended to read as
follows:
  2. It shall be lawful for the attending physician OR  ATTENDING  NURSE
PRACTITIONER  to  issue  an order not to resuscitate a patient, provided
that the order has been issued pursuant  to  the  requirements  of  this
article.  The order shall be included in writing in the patient's chart.
An order not to resuscitate shall be effective upon issuance.
  3. Before obtaining, pursuant to this  article,  the  consent  of  the
patient, or of the surrogate of the patient, or parent or legal guardian
of  the  minor  patient,  to  an order not to resuscitate, the attending
physician OR ATTENDING NURSE PRACTITIONER shall provide  to  the  person
giving  consent information about the patient's diagnosis and prognosis,
the reasonably foreseeable risks and benefits of cardiopulmonary  resus-
citation for the patient, and the consequences of an order not to resus-
citate.
  S  4.  Paragraphs  (a) and (d) of subdivision 2 of section 2964 of the
public health law, as added by chapter 818 of  the  laws  of  1987,  are
amended to read as follows:
  (a) During hospitalization, an adult with capacity may express a deci-
sion consenting to an order not to resuscitate orally in the presence of
at  least two witnesses eighteen years of age or older, one of whom is a
physician OR ATTENDING NURSE PRACTITIONER affiliated with  the  hospital
in  which  the  patient  is  being treated.   Any such decision shall be
recorded in the patient's medical chart.

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  (d) Prior to issuing an order not to resuscitate  a  patient  who  has
expressed  a  decision  consenting  to an order not to resuscitate under
specified medical conditions, the attending physician OR ATTENDING NURSE
PRACTITIONER must make  a  determination,  to  a  reasonable  degree  of
medical  certainty, that such conditions exist, and include the determi-
nation in the patient's medical chart.
  S 5. The opening paragraph  of  paragraph  (c)  of  subdivision  2  of
section  2964  of  the public health law, as added by chapter 818 of the
laws of 1987, is amended to read as follows:
  An attending physician OR ATTENDING NURSE PRACTITIONER who is provided
with or informed of a decision pursuant to this subdivision shall record
or include the decision in the patient's medical chart if  the  decision
has not been recorded or included, and either:
  S  6.    The  opening  paragraph of paragraph (a) and paragraph (b) of
subdivision 3 of section 2964 of the public  health  law,  as  added  by
chapter 818 of the laws of 1987, are amended to read as follows:
  In  the  event that the attending physician OR ATTENDING NURSE PRACTI-
TIONER determines, in writing, that, to a reasonable degree  of  medical
certainty,  an adult patient who has capacity would suffer immediate and
severe injury from a discussion of  cardiopulmonary  resuscitation,  the
attending  physician  OR ATTENDING NURSE PRACTITIONER may issue an order
not to resuscitate without obtaining the  patient's  consent,  but  only
after:
  (b)  Where  the  provisions of this subdivision have been invoked, the
attending physician OR ATTENDING NURSE PRACTITIONER shall  reassess  the
patient's  risk  of injury from a discussion of cardiopulmonary resusci-
tation on a regular basis and shall consult the patient regarding resus-
citation as soon as the medical basis for not consulting the patient  no
longer exists.
  S  7.  The  opening  paragraph  of  paragraph  (c) of subdivision 3 of
section 2965 of the public health law, as added by chapter  818  of  the
laws  of 1987, such subdivision as renumbered by chapter 370 of the laws
of 1991, is amended to read as follows:
  A surrogate may consent to an order not to resuscitate on behalf of an
adult patient only if there has been a  determination  by  an  attending
physician OR ATTENDING NURSE PRACTITIONER with the concurrence of anoth-
er  physician  selected  by  a person authorized by the hospital to make
such selection, given after personal examination of the patient that, to
a reasonable degree of medical certainty:
  S 8. Paragraphs (a) and (b) of subdivision 4 of section  2965  of  the
public  health  law, paragraph (a) as amended by chapter 370 of the laws
of 1991 and paragraph (b) as added by chapter 818 of the laws  of  1987,
such  subdivision  as renumbered by chapter 370 of the laws of 1991, are
amended to read as follows:
  (a) A surrogate shall express a decision consenting to an order not to
resuscitate either (i) in writing, dated, and signed in the presence  of
one  witness eighteen years of age or older who shall sign the decision,
or (ii) orally, to two persons eighteen years of age or  older,  one  of
whom  is  a physician OR NURSE PRACTITIONER affiliated with the hospital
in which the patient is  being  treated.  Any  such  decision  shall  be
recorded in the patient's medical chart.
  (b)  The  attending  physician  OR ATTENDING NURSE PRACTITIONER who is
provided with the decision of a surrogate shall include the decision  in
the  patient's  medical chart and, if the surrogate has consented to the
issuance of an order not to resuscitate, shall either:

A. 1719--A                          4

  (i) promptly issue an order not to resuscitate the patient and  inform
the hospital staff responsible for the patient's care of the order; or
  (ii)  promptly make the attending physician's OR ATTENDING NURSE PRAC-
TITIONER'S objection to the issuance of  such  an  order  known  to  the
surrogate  and  either  make  all  reasonable efforts to arrange for the
transfer of the patient to another physician, if necessary, or  promptly
refer the matter to the dispute mediation system.
  S  9. Subdivision 1 of section 2966 of the public health law, as added
by chapter 818 of the laws of 1987, is amended to read as follows:
  1. If no surrogate is reasonably available, willing to make a decision
regarding issuance of an order not to resuscitate, and competent to make
a decision regarding issuance of an order not to resuscitate  on  behalf
of  an  adult  patient  who  lacks  capacity  and who had not previously
expressed a decision regarding cardiopulmonary resuscitation, an attend-
ing physician OR ATTENDING NURSE PRACTITIONER (a) may issue an order not
to resuscitate the patient, provided that  the  attending  physician  OR
ATTENDING  NURSE PRACTITIONER determines, in writing, that, to a reason-
able degree of  medical  certainty,  resuscitation  would  be  medically
futile,  and  another  physician  selected by a person authorized by the
hospital to make such  selection,  after  personal  examination  of  the
patient, reviews and concurs in writing with such determination, or, (b)
shall  issue  an  order  not  to resuscitate the patient, provided that,
pursuant to subdivision one of section twenty-nine  hundred  seventy-six
of  this  article, a court has granted a judgment directing the issuance
of such an order.
  S 10. Subdivisions 1, 3 and 4 of section 2967  of  the  public  health
law,  subdivisions  1 and 4 as added by chapter 818 of the laws of 1987,
and subdivision 3 and paragraphs (a) and (b) of subdivision 4 as amended
by chapter 370 of the laws of 1991, are amended to read as follows:
  1. An attending physician OR ATTENDING NURSE PRACTITIONER, in  consul-
tation  with a minor's parent or legal guardian, shall determine whether
a minor has the capacity to make a decision regarding resuscitation.
  3. A parent or legal guardian may consent to an order not to  resusci-
tate on behalf of a minor only if there has been a written determination
by  the  attending  physician  OR ATTENDING NURSE PRACTITIONER, with the
written concurrence of another physician selected by a person authorized
by the hospital to make such selections given after personal examination
of the patient, that, to a reasonable degree of medical  certainty,  the
minor  suffers from one of the medical conditions set forth in paragraph
(c) of subdivision three of section twenty-nine  hundred  sixty-five  of
this  article.  Each  determination  shall  be included in the patient's
medical chart.
  4. (a) A parent or legal guardian of a minor,  in  making  a  decision
regarding   cardiopulmonary  resuscitation,  shall  consider  the  minor
patient's wishes, including a consideration of the minor patient's reli-
gious and moral beliefs, and shall  express  a  decision  consenting  to
issuance of an order not to resuscitate either (i) in writing, dated and
signed in the presence of one witness eighteen years of age or older who
shall  sign  the decision, or (ii) orally, to two persons eighteen years
of age or older, one of whom is a physician OR NURSE PRACTITIONER affil-
iated with the hospital in which the patient is being treated. Any  such
decision shall be recorded in the patient's medical chart.
  (b)  The  attending  physician  OR ATTENDING NURSE PRACTITIONER who is
provided with the decision  of  a  minor's  parent  or  legal  guardian,
expressed  pursuant  to  this subdivision, and of the minor if the minor
has capacity, shall include such decision or decisions  in  the  minor's

A. 1719--A                          5

medical  chart  and shall comply with the provisions of paragraph (b) of
subdivision four of section twenty-nine hundred sixty-five of this arti-
cle.
  (c)  If  the  attending  physician OR ATTENDING NURSE PRACTITIONER has
actual notice of the opposition of a parent or non-custodial  parent  to
consent  by  another  parent to an order not to resuscitate a minor, the
physician OR NURSE PRACTITIONER shall submit the matter to  the  dispute
mediation  system and such order shall not be issued or shall be revoked
in accordance with the provisions of subdivision three of section  twen-
ty-nine hundred seventy-two of this article.
  S  11.  Paragraph  (b)  of subdivision 2 of section 2967 of the public
health law, as amended by chapter 370 of the laws of 1991, is amended to
read as follows:
  (b) Where the attending physician OR ATTENDING NURSE PRACTITIONER  has
reason to believe that there is another parent or a non-custodial parent
who  has not been informed of a decision to issue an order not to resus-
citate the minor, the attending physician OR ATTENDING NURSE PRACTITION-
ER, or someone acting on behalf of the attending physician OR  ATTENDING
NURSE  PRACTITIONER,  shall  make reasonable efforts to determine if the
uninformed parent or non-custodial parent has maintained substantial and
continuous contact with the  minor  and,  if  so,  shall  make  diligent
efforts  to  notify  that parent or non-custodial parent of the decision
prior to issuing the order.
  S 12. Subdivisions 2 and 3 of section 2969 of the public  health  law,
subdivision 2 as amended by chapter 370 of the laws of 1991 and subdivi-
sion  3 as added by chapter 818 of the laws of 1987, are amended to read
as follows:
  2. Any surrogate, parent, or legal guardian may at any time revoke his
or her consent to an order not to resuscitate a patient by (a) notifying
a physician or member of the nursing staff of the revocation of  consent
in  writing,  dated  and  signed,  or (b) orally notifying the attending
physician OR ATTENDING NURSE PRACTITIONER in the presence of  a  witness
eighteen years of age or older.
  3.  Any physician OR NURSE PRACTITIONER who is informed of or provided
with a revocation of consent pursuant to this section shall  immediately
include  the  revocation  in  the patient's chart, cancel the order, and
notify the hospital staff responsible for  the  patient's  care  of  the
revocation and cancellation. Any member of the nursing staff, OTHER THAN
A  NURSE  PRACTITIONER, who is informed of or provided with a revocation
of consent pursuant to this section shall immediately notify a physician
OR NURSE PRACTITIONER of such revocation.
  S 13. Section 2970 of the public health law, as added by  chapter  818
of the laws of 1987, subdivision 1 and paragraph (b) of subdivision 2 as
amended  by  chapter  370  of  the  laws  of 1991, is amended to read as
follows:
  S 2970. Physician AND NURSE PRACTITIONER review of the  order  not  to
resuscitate.  1.  For  each patient for whom an order not to resuscitate
has been issued, the attending physician OR ATTENDING NURSE PRACTITIONER
shall review the patient's chart to determine  if  the  order  is  still
appropriate  in  light  of the patient's condition and shall indicate on
the patient's chart that the order has been reviewed:
  (a) for a patient, excluding outpatients described in paragraph (b) of
this subdivision and alternate level of care patients,  in  a  hospital,
other  than  a  residential  health  care facility, at least every seven
days;

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  (b) for an outpatient whose order  not  to  resuscitate  is  effective
while  the  patient receives care in a hospital, each time the attending
physician OR ATTENDING NURSE PRACTITIONER examines the patient,  whether
in  the  hospital  or elsewhere, provided that the review need not occur
more than once every seven days; and
  (c)  for  a patient in a residential health care facility or an alter-
nate level of care patient in a  hospital,  each  time  the  patient  is
required  to  be  seen by a physician OR NURSE PRACTITIONER but at least
every sixty days.
  Failure to comply with this subdivision shall not render an order  not
to resuscitate ineffective.
  2.  (a)  If  the  attending  physician OR ATTENDING NURSE PRACTITIONER
determines at any time that an order not to  resuscitate  is  no  longer
appropriate  because  the  patient's medical condition has improved, the
physician OR NURSE PRACTITIONER shall immediately notify the person  who
consented  to  the  order.  Except  as provided in paragraph (b) of this
subdivision, if such person declines to revoke consent to the order, the
physician OR NURSE  PRACTITIONER  shall  promptly  (i)  make  reasonable
efforts  to arrange for the transfer of the patient to another physician
or (ii) submit the matter to the dispute mediation system.
  (b) If the order not to resuscitate was entered upon the consent of  a
surrogate,  parent,  or  legal  guardian  and the attending physician OR
ATTENDING NURSE PRACTITIONER who issued the order, or,  if  unavailable,
another  attending physician OR ATTENDING NURSE PRACTITIONER at any time
determines that the patient does not suffer  from  one  of  the  medical
conditions  set  forth  in paragraph (c) of subdivision three of section
twenty-nine hundred sixty-five of this article, the attending  physician
OR  ATTENDING NURSE PRACTITIONER shall immediately include such determi-
nation in the patient's chart, cancel the order, and notify  the  person
who  consented  to  the order and all hospital staff responsible for the
patient's care of the cancellation.
  (c) If an order not to resuscitate was entered upon the consent  of  a
surrogate  and  the  patient  at any time gains or regains capacity, the
attending physician OR  ATTENDING  NURSE  PRACTITIONER  who  issued  the
order,  or,  if  unavailable,  another  attending physician OR ATTENDING
NURSE PRACTITIONER shall immediately cancel the  order  and  notify  the
person  who  consented  to  the  order  and  all hospital staff directly
responsible for the patient's care of the cancellation.
  S 14. The opening paragraph and subdivision 2 of section 2971  of  the
public  health  law,  as amended by chapter 370 of the laws of 1991, are
amended to read as follows:
  If a patient for whom an order not to resuscitate has been  issued  is
transferred  from  a  hospital  to  a different hospital the order shall
remain effective, unless revoked pursuant to  this  article,  until  the
attending  physician  OR ATTENDING NURSE PRACTITIONER first examines the
transferred patient, whereupon  the  attending  physician  OR  ATTENDING
NURSE PRACTITIONER must either:
  2.  Cancel the order not to resuscitate, provided the attending physi-
cian OR ATTENDING NURSE PRACTITIONER immediately notifies the person who
consented to the order and the hospital staff directly  responsible  for
the  patient's  care  of  the  cancellation.  Such cancellation does not
preclude the entry of a new order pursuant to this article.
  S 15. Subdivisions 2 and 4 of section 2972 of the public  health  law,
subdivision 2 as amended by chapter 370 of the laws of 1991 and subdivi-
sion  4 as added by chapter 818 of the laws of 1987, are amended to read
as follows:

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  2. The dispute mediation system shall be  authorized  to  mediate  any
dispute, including disputes regarding the determination of the patient's
capacity,  arising under this article between the patient and an attend-
ing physician, ATTENDING NURSE PRACTITIONER  or  the  hospital  that  is
caring  for  the  patient  and, if the patient is a minor, the patient's
parent, or among an attending physician, AN ATTENDING NURSE  PRACTITION-
ER,  a  parent,  non-custodial  parent,  or  legal  guardian  of a minor
patient, any person on the surrogate list, the hospital that  is  caring
for  the  patient and, where the dispute involves a patient who is in or
is transferred from a mental hygiene facility, the facility director.
  4. If a dispute between a patient who expressed a  decision  rejecting
cardiopulmonary  resuscitation  and  an  attending  physician, ATTENDING
NURSE PRACTITIONER or the hospital that is caring  for  the  patient  is
submitted to the dispute mediation system, and either:
  (a)  the dispute mediation system has concluded its efforts to resolve
the dispute, or
  (b) seventy-two hours have elapsed from the time of submission without
resolution of the dispute, whichever shall occur  first,  the  attending
physician  OR  ATTENDING  NURSE  PRACTITIONER shall either: (i) promptly
issue an order not to resuscitate the patient or issue the order at such
time as the conditions, if any, specified in the decision are  met,  and
inform  the  hospital  staff  responsible  for the patient's care of the
order; or (ii) promptly arrange for  the  transfer  of  the  patient  to
another physician or hospital.
  S  16.  Subdivision  1  of  section  2973 of the public health law, as
amended by chapter 577 of the laws  of  1993,  is  amended  to  read  as
follows:
  1. The patient, an attending physician, AN ATTENDING NURSE PRACTITION-
ER,  a  parent,  non-custodial  parent,  or  legal  guardian  of a minor
patient, any person on the surrogate list, the hospital that  is  caring
for  the  patient  and,  in disputes involving a patient who is in or is
transferred from a mental hygiene or correctional facility, the facility
director, may commence a special proceeding pursuant to article four  of
the  civil practice law and rules, in a court of competent jurisdiction,
with respect to any dispute arising under this article, except that  the
decision  of  a  patient  not  to consent to issuance of an order not to
resuscitate may not be subjected to judicial review. In  any  proceeding
brought  pursuant  to  this subdivision challenging a decision regarding
issuance of an order not to resuscitate on the ground that the  decision
is  contrary  to  the  patient's wishes or best interests, the person or
entity challenging the decision  must  show,  by  clear  and  convincing
evidence,  that the decision is contrary to the patient's wishes includ-
ing consideration of the patient's religious and moral beliefs,  or,  in
the  absence  of  evidence of the patient's wishes, that the decision is
contrary to the  patient's  best  interests.  In  any  other  proceeding
brought  pursuant to this subdivision, the court shall make its determi-
nation based upon the applicable substantive  standards  and  procedures
set forth in this article.
  S 17. Subdivision 1 of section 2976 of the public health law, as added
by chapter 818 of the laws of 1987, is amended to read as follows:
  1. If no surrogate is reasonably available, willing to make a decision
regarding issuance of an order not to resuscitate, and competent to make
a  decision  regarding issuance of an order not to resuscitate on behalf
of an adult patient who  lacks  capacity  and  who  had  not  previously
expressed a decision regarding cardiopulmonary resuscitation pursuant to
this  article,  an  attending physician, ATTENDING NURSE PRACTITIONER or

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hospital may commence a special proceeding pursuant to article  four  of
the  civil practice law and rules, in a court of competent jurisdiction,
for a judgment directing the physician OR NURSE PRACTITIONER to issue an
order  not to resuscitate where the patient has a terminal condition, is
permanently unconscious, or resuscitation would impose an  extraordinary
burden  on  the  patient in light of the patient's medical condition and
the expected outcome of resuscitation for the patient, and  issuance  of
an  order  not  to  resuscitate  is consistent with the patient's wishes
including a consideration of the patient's religious and  moral  beliefs
or,  in  the  absence of evidence of the patient's wishes, the patient's
best interests.
  S 18. Subdivisions 4, 5, 7, 8 and 9 of  section  2977  of  the  public
health  law, subdivision 4 as amended by chapter 577 of the laws of 1993
and subdivisions 5, 7, 8 and 9 as added by chapter 370 of  the  laws  of
1991, are amended to read as follows:
  4.  (a)  Consent  to  a  nonhospital order not to resuscitate shall be
governed by sections twenty-nine hundred sixty-four through  twenty-nine
hundred  sixty-seven  of  this article, provided, however, that an adult
with capacity, whether or not hospitalized or a health care  agent,  may
also  consent  to  a  nonhospital order not to resuscitate orally to the
attending physician OR ATTENDING NURSE PRACTITIONER.
  (b) When the concurrence of a second physician is  sought  to  fulfill
the  requirements  for  the  issuance of an order not to resuscitate for
patients in a correctional facility,  such  second  physician  shall  be
selected  by  the chief medical officer of the department of corrections
or his or her designee.
  This paragraph shall not apply to the issuance  of  an  order  not  to
resuscitate  pursuant to section [two thousand nine] TWENTY-NINE hundred
sixty-six of this article.
  (C) WHEN THE CONCURRENCE OF A SECOND PHYSICIAN IS  SOUGHT  TO  FULFILL
THE  REQUIREMENTS  FOR  THE  ISSUANCE OF AN ORDER NOT TO RESUSCITATE FOR
HOSPICE AND HOME CARE PATIENTS, SUCH SECOND PHYSICIAN SHALL BE  SELECTED
BY  THE HOSPICE MEDICAL DIRECTOR OR HOSPICE NURSE COORDINATOR DESIGNATED
BY THE MEDICAL DIRECTOR OR BY THE HOME CARE SERVICES AGENCY DIRECTOR  OF
PATIENT CARE SERVICES, AS APPROPRIATE TO THE PATIENT.
  5. The  attending  physician  OR  ATTENDING  NURSE  PRACTITIONER shall
record the issuance of a nonhospital order not  to  resuscitate  in  the
patient's medical chart.
  7. An  attending  physician  OR  ATTENDING  NURSE PRACTITIONER who has
issued a nonhospital order not to resuscitate, and who transfers care of
the patient to another physician, shall  inform  the  physician  of  the
order.
  8.  For  each  patient for whom a nonhospital order not to resuscitate
has been issued, the attending physician OR ATTENDING NURSE PRACTITIONER
shall review whether the order is still  appropriate  in  light  of  the
patient's condition each time he or she examines the patient, whether in
the hospital or elsewhere, but at least every ninety days, provided that
the  review need not occur more than once every seven days.  The attend-
ing physician OR ATTENDING NURSE PRACTITIONER shall record the review in
the patient's medical chart record provided, however, that a  registered
nurse  who  provides direct care to the patient may record the review in
the chart record at the direction of the physician.  In such  case,  the
attending  physician  shall  include a confirmation of the review in the
patient's medical chart within fourteen days of such review. Failure  to
comply with this subdivision shall not render a nonhospital order not to
resuscitate ineffective.

A. 1719--A                          9

  9.  A  person who has consented to a nonhospital order not to resusci-
tate may at any time revoke his or her consent to the order by  any  act
evidencing  a  specific  intent  to revoke such consent. Any health care
professional informed of a revocation of consent to a nonhospital  order
not  to  resuscitate  shall  notify the attending physician OR ATTENDING
NURSE PRACTITIONER of the revocation. An attending physician OR  ATTEND-
ING  NURSE  PRACTITIONER who is informed that a nonhospital order not to
resuscitate  has  been  revoked  shall  record  the  revocation  in  the
patient's  medical  chart, cancel the order and make diligent efforts to
retrieve the form issuing the order, and the standard bracelet, if any.
  S 19. Subdivision 4 of section 2977  of  the  public  health  law,  as
amended by chapter 308 of the laws of 1993, is REPEALED.
  S  20.  This  act  shall  take effect on the one hundred eightieth day
after it shall have become a law, provided  that  effective  immediately
any  rules and regulations necessary to implement the provisions of this
act are authorized and directed to be amended, repealed  and/or  promul-
gated on or before such date.