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

                                 2947--A

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                              March 6, 2009
                               ___________

Introduced by Sens. HANNON, MONTGOMERY, HASSELL-THOMPSON, OPPENHEIMER --
  read  twice  and  ordered printed, and when printed to be committed to
  the Committee on Health -- committee discharged, bill amended, ordered
  reprinted as amended and recommitted to said committee

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
governing  nonhospital  orders  not  to  resuscitate, a patient not in a
hospital, who has primary responsibility for the treatment and  care  of

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD01106-02-9
              

S. 2947--A                          2

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.
  (d)  Prior  to  issuing  an order not to resuscitate a patient who has
expressed a decision consenting to an order  not  to  resuscitate  under

S. 2947--A                          3

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:
  (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

S. 2947--A                          4

  (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
medical  chart  and shall comply with the provisions of paragraph (b) of

S. 2947--A                          5

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;
  (b) for an outpatient whose order  not  to  resuscitate  is  effective
while  the  patient receives care in a hospital, each time the attending

S. 2947--A                          6

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:
  2. The dispute mediation system shall be  authorized  to  mediate  any
dispute, including disputes regarding the determination of the patient's

S. 2947--A                          7

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
hospital  may  commence a special proceeding pursuant to article four of
the civil practice law and rules, in a court of competent  jurisdiction,

S. 2947--A                          8

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.
  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

S. 2947--A                          9

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.