senate Bill S7151A

2013-2014 Legislative Session

Relates to health care agents, decisions under the family care decisions act and non-hospital orders not to resuscitate

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  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Jun 16, 2014 print number 7151a
amend and recommit to health
May 01, 2014 referred to health

Bill Amendments

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Original
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S7151 - Bill Details

See Assembly Version of this Bill:
A9647A
Current Committee:
Law Section:
Public Health Law
Laws Affected:
Amd Pub Health L, generally

S7151 - Bill Texts

view summary

Relates to health care agents and proxies, decisions under the family health care decisions act and non-hospital orders not to resuscitate.

view sponsor memo
BILL NUMBER:S7151

TITLE OF BILL: 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 non-hospital orders not to resuscitate

PURPOSE OF GENERAL IDEA OF BILL:

This is one of a series of seven bills, informally referred to as the
"Surrogate Decision-Making Improvement Acts." The bills make
technical/minor and coordinating amendments and other improvements to
the laws that govern health care decisions, including life-sustaining
treatment decisions, for patients who lack decision-making capacity.
The SDMIAs address these topics:

*SDMIA 1 Technical, Minor and Coordinating Amendments

*SDMIA 2 Repeals PHL Art. 29-B Orders Not to Resuscitate for Patients
in Mental Hygiene Facilities

*SDMIA 3 Determining Patient Incapacity

*SDMIA 4 Decisions by a Health Care Agent About Artificial Nutrition
and Hydration

*SDMIA 5 Confirm the Primacy of a Patient's Clear Prior Decision

*SDMIA 6 Restore Medical Futility as a Basis for a DNR Order

*SDMIA 7 Life-Sustaining Treatment Decisions for Developmentally
Disabled Persons

This bill, SDMIA 1, makes technical, minor and coordinating amendments
to:

*NY PHL Art. 29-C Health Care Agents and Proxies;

*NY PHL Art. 29-CC Family Health Care Decisions; and

*NY PHL Art. 29-CCC Non-hospital Orders Not to Resuscitate.

SUMMARY OF SPECIFIC PROVISIONS:

Amendments to NY PHL Art. 29-C
Health Care Agents and Proxies

Section 1 amends PHL § 2980.4 and .10, and adds subdivision 8-a:

*to clarify that the provision of nutrition and hydration orally,
without reliance on medical treatment, is not "health care" within the
meaning of the article, as stated in the Family Health Care Decisions
Act (FHCDA),

*to provide a definition for "Health and social services
practitioner," based on the definition in the FHCDA and to add
"licensed master social worker" to the definition; and


*to substitute the name, "office for people with developmental
disabilities" (hereinafter OPWDD) for the former name, office of
mental retardation and developmental disabilities" (hereinafter,
OMRDD).

Section 2 amends PHL § 2981(b) to delete the outdated term "committee"
and to insert the correct reference to MHL Article 81.

Section 3 amends PHL § 2982.2 to add "physician assistant" to the list
of professionals, one of whom an agent must consult with before making
a decision.

Section 4 amends PHL § 2983.4 to eliminate outdated references to "the
conservator for, or committee of" a principal

Section 5 amends PHL § 2991 to substitute OPWDD for OMRDD.

Section 6 amends PHL § 2992 to replace outdated references to "the
conservator for, or committee of a principal with the correct
reference to "the guardian" of the principal.

Section 7 amends § 2993 to substitute OPWDD for OMRDD.

Amendments to PHL Article 29-CC
Family Health Care Decisions Act

Section 8 amends three subdivisions in PHL § 2994-a (Definitions):
Amends "Health or social services practitioner" to include licensed
master social worker." Substitutes OPWDD for OMRDD. Changes "the
hospital administrator" to "a hospital administrator."

Section 9 amends PHL § 2994-b(3)(a) to change "mental retardation or a
developmental disability" to "a developmental disability." Corrects a
spelling error.

Section 10 amends PHL § 2994-e to clarify that the obligation a
hospital has to notify the parents or guardian of an emancipated minor
is to make "diligent efforts" to notify such persons.

Section 11 amends PHL § 2994-m.4(b)(iv) to clarify that the obligation
an ethics committee has to notify certain persons is to make "diligent
efforts" to notify such persons. Section 20 amends PHL § 2994-t.2 to
substitute OPWDD for OMRDD.

Section 12 amends PHL § 2994-t to correct references to the
commissioners of OMH and OPWDD.

Section 13 amends PHL § 2994-u to direct the commissioner of health to
require that a copy of the statement of rights under this article be
furnished "to a patient or to the surrogate, or to the parent or
guardian of a minor patient, at or prior to admission to the hospital,
or within a reasonable time thereafter, and to any person on the
surrogate list who requests a copy of such statement from the
hospital. The statement shall also be made available to the hospital
clinical staff."


Section 14 directs the commissioner of health to revise the statement
of rights that hospitals are required to post (known as the Patient's
Bill of Rights) by replacing the clause regarding orders not to
resuscitate with a statement about a broader range health care
decision-making rights.

Amendments to PHL Article 29-CCC
Non-Hospital Orders Not to Resuscitate

Section 15 amends § 2994-aa subdivisions 12 and 13 and adds 14-a : to,
substitute OPWDD for OMRDD, to provide that a nonhospital order not to
resuscitate also applies to home care services agency personnel and
school health personnel, and to define "school health personnel.

Section 16 amends PHL § 2994-bb.1(a) to make the nonhospital DNR
provisions applicable to school health personnel.

Section 17 amends § 2994-dd.2 to delete a reference to the
commissioner's obligation to develop a standard DNR bracelet, and to
refer to a standard bracelet "or other article", and amends
2994-dd.6 to allow alternate forms for nonhospital DNR orders in
developmental disability services offices.

Section 18 amends PHL § 2994-gg to substitute the word "article" for
the word "section" in two places.

Effective Date

Section 19 is the effective date.

JUSTIFICATION:

By enacting Chapter 8 of the Laws of 2010, including the Family Health
Care Decisions Act, the Legislature significantly improved the laws in
New York relating to decision-making for patients who lack capacity
and who do not have a health care agent. Specifically, the FHCDA
clarified the authority of a close family member or close friend to
consent to treatment for such patients, and allowed such person to
direct the withdrawal or withholding of life-sustaining treatment in
limited and clearly defined circumstances, based on sound standards.

This bill draws upon growing experience with the FHCDA, and its
interaction with other health care decision-making laws. It makes
technical, minor and coordinating amendments to those laws.

PRIOR LEGISLATIVE HISTORY:

S.5321 (Sen. Hannon) (2013)/ A.7371 (M. of A. Gottfried)(2013)
included all of these provisions, as well as other provisions.

FISCAL IMPLICATIONS:

None.

EFFECTIVE DATE:


This act shall take effect ninety days after the date on which this
act shall have become a law. The amendments to article 29-C of the
public health law shall apply to decisions made pursuant to health
care proxies created prior to this act becoming law as well as those
created thereafter.

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

                                  7151

                            I N  S E N A T E

                               May 1, 2014
                               ___________

Introduced  by  Sen.  HANNON -- read twice and ordered printed, and when
  printed to be committed to the Committee on Health

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
  non-hospital orders not to resuscitate

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

  Section 1. Subdivisions 4 and 10 of section 2980 of the public  health
law, subdivision 4 as added by chapter 752 of the laws of 1990, subdivi-
sion  10 as amended by chapter 23 of the laws of 1994, are amended and a
new subdivision 8-a is added to read as follows:
  4. "Health care" means any treatment, service or procedure to diagnose
or treat an individual's physical or mental condition. PROVIDING  NUTRI-
TION  OR HYDRATION ORALLY, WITHOUT RELIANCE ON MEDICAL TREATMENT, IS NOT
HEALTH CARE UNDER THIS ARTICLE AND IS NOT SUBJECT TO THIS ARTICLE.
  8-A. "HEALTH OR  SOCIAL  SERVICES  PRACTITIONER"  MEANS  A  REGISTERED
PROFESSIONAL  NURSE, NURSE PRACTITIONER, PHYSICIAN, PHYSICIAN ASSISTANT,
PSYCHOLOGIST, LICENSED MASTER SOCIAL WORKER OR LICENSED CLINICAL  SOCIAL
WORKER, LICENSED OR CERTIFIED PURSUANT TO THE EDUCATION LAW ACTING WITH-
IN HIS OR HER SCOPE OF PRACTICE.
  10.  "Mental hygiene facility" means a residential facility, excluding
family care homes, operated or licensed by the office of  mental  health
or  the office [of mental retardation and] FOR PEOPLE WITH developmental
disabilities.
  S 2. Paragraph (b) of subdivision 1 of  section  2981  of  the  public
health  law,  as added by chapter 752 of the laws of 1990, is amended to
read as follows:
  (b) For the purposes of this section, every adult  shall  be  presumed
competent  to  appoint  a  health care agent unless such person has been
adjudged incompetent or otherwise adjudged not competent  to  appoint  a
health care agent, or unless a [committee or] guardian of the person has
been  appointed for the adult pursuant to article [seventy-eight] EIGHT-

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD13618-01-4

S. 7151                             2

Y-ONE of the mental hygiene law or article  seventeen-A  of  the  surro-
gate's court procedure act.
  S  3.  Subdivision  2  of  section  2982  of the public health law, as
amended by chapter 230 of the laws  of  2004,  is  amended  to  read  as
follows:
  2. Decision-making standard. After consultation with a licensed physi-
cian,  registered  nurse,  PHYSICIAN  ASSISTANT,  licensed psychologist,
licensed master social worker, or a licensed clinical social worker, the
agent shall make health care decisions: (a) in accordance with the prin-
cipal's wishes, including the principal's religious and  moral  beliefs;
or  (b)  if  the  principal's wishes are not reasonably known and cannot
with reasonable diligence be ascertained, in accordance with the princi-
pal's best interests; provided, however, that if the principal's  wishes
regarding  the  administration of artificial nutrition and hydration are
not reasonably known and cannot  with  reasonable  diligence  be  ascer-
tained, the agent shall not have the authority to make decisions regard-
ing these measures.
  S  4. Subdivision 3 of section 2983 of the public health law, as added
by chapter 752 of the laws of 1990, is amended to read as follows:
  3. Notice of determination. Notice of a determination that a principal
lacks capacity to make health care decisions shall  promptly  be  given:
(a)  to  the  principal, orally and in writing, where there is any indi-
cation of the principal's ability to comprehend such notice; (b) to  the
agent;  AND  (c)  if the principal is in or is transferred from a mental
hygiene facility, to the facility director[; and (d) to the  conservator
for, or committee of, the principal].
  S  5. Subdivision 2 of section 2991 of the public health law, as added
by chapter 752 of the laws of 1990, is amended to read as follows:
  2. Such procedures shall be established in accordance with regulations
issued by the commissioners of health, mental health, and [mental retar-
dation and] developmental disabilities for facilities subject  to  their
respective regulatory authorities.
  S  6.  The opening paragraph of section 2992 of the public health law,
as added by chapter 752 of the laws of  1990,  is  amended  to  read  as
follows:
  The health care provider, the [conservator for, or committee] GUARDIAN
of  the  principal UNDER ARTICLE EIGHTY-ONE OF THE MENTAL HYGIENE LAW OR
ARTICLE SEVENTEEN-A OF THE SURROGATE'S COURT PROCEDURE ACT,  members  of
the  principal's  family,  a close friend of the principal as defined in
subdivision [five] FOUR  of  section  [two  thousand  nine]  TWENTY-NINE
hundred  [sixty-one]  NINETY-FOUR-A of this chapter, or the commissioner
[of health], THE COMMISSIONER OF mental health, or  [mental  retardation
and]  THE  COMMISSIONER  OF  developmental  disabilities  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, including, but  not  limited  to,  a
proceeding to:
  S 7. Section 2993 of the public health law, as added by chapter 752 of
the laws of 1990, is amended to read as follows:
  S  2993.  Regulations.  The  commissioner [of health], in consultation
with the commissioners of [the office of] mental health and [the  office
of  mental  retardation and] developmental disabilities, shall establish
such regulations as may be necessary  for  the  implementation  of  this
article,  subject  to  the provisions of subdivision two of section [two
thousand nine] TWENTY-NINE hundred ninety-one of this article.

S. 7151                             3

  S 8. Subdivisions 17, 20 and 26 of section 2994-a of the public health
law, as added by chapter 8 of the laws of 2010, are amended to  read  as
follows:
  17.  "Health or social [service] SERVICES practitioner" means a regis-
tered  professional  nurse,  nurse  practitioner,  physician,  physician
assistant, psychologist, LICENSED MASTER SOCIAL WORKER or licensed clin-
ical  social worker, licensed or certified pursuant to the education law
acting within his or her scope of practice.
  20. "Mental hygiene facility" means a facility operated or licensed by
the office of mental health or the office [of  mental  retardation  and]
FOR PEOPLE WITH developmental disabilities as defined in subdivision six
of section 1.03 of the mental hygiene law.
  26.  "Person connected with the case" means the patient, any person on
the surrogate list, a parent or guardian of a  minor  patient,  [the]  A
hospital  administrator,  an  attending  physician,  any other health or
social services practitioner who is or has been directly involved in the
patient's care, and any duly  authorized  state  agency,  including  the
facility  director or regional director for a patient transferred from a
mental hygiene facility and the facility director for a  patient  trans-
ferred from a correctional facility.
  S  9.  The  opening  paragraph  and  paragraph (a) of subdivision 3 of
section 2994-b of the public health law, as added by chapter  8  of  the
laws of 2010, are amended to read as follows:
  Prior to seeking or relying upon a health care decision by a surrogate
for  a patient under this article, if the attending physician has reason
to believe that the patient has a  history  of  receiving  services  for
[mental  retardation  or]  a  developmental  disability;  it  reasonably
appears to the attending physician that the patient has [mental retarda-
tion or] a developmental disability;  or  the  attending  physician  has
reason  to  believe  that the patient has been transferred from a mental
hygiene facility operated or licensed by the office  of  mental  health,
then  such  physician shall make reasonable efforts to determine whether
paragraphs (a), (b) or (c) of this subdivision are applicable:
  (a) If the patient has a guardian appointed by  a  court  pursuant  to
article  seventeen-A of the surrogate's court procedure act, health care
decisions for the patient shall be governed by section seventeen hundred
fifty-b of the surrogate's court [proceedure] PROCEDURE act and  not  by
this article.
  S  10.  Paragraph (b) of subdivision 3 of section 2994-e of the public
health law, as added by chapter 8 of the laws of  2010,  is  amended  to
read as follows:
  (b) If the hospital can with reasonable efforts ascertain the identity
of the parents or guardian of an emancipated minor patient, the hospital
shall  MAKE DILIGENT EFFORTS TO notify such persons prior to withholding
or withdrawing life-sustaining treatment pursuant to this subdivision.
  S 11. Subparagraph (iv) of paragraph (b) of subdivision 4  of  section
2994-m  of  the  public health law, as added by chapter 8 of the laws of
2010, is amended to read as follows:
  (iv)  Following  ethics  review  committee  consideration  of  a  case
concerning  the  withdrawal or withholding of life-sustaining treatment,
treatment shall not be withdrawn or withheld until  THE  HOSPITAL  MAKES
DILIGENT  EFFORTS TO INFORM the persons identified in subparagraph (iii)
of this paragraph [have been informed] of the  committee's  response  to
the case.
  S  12.  Subdivision  2  of section 2994-t of the public health law, as
added by chapter 8 of the laws of 2010, is amended to read as follows:

S. 7151                             4

  2. The commissioner, in consultation with the  commissioners  of  [the
office  of]  mental  health  and  [the office of mental retardation and]
developmental disabilities, shall promulgate regulations identifying the
credentials of health care professionals qualified to provide  an  inde-
pendent  determination, pursuant to subdivision three of section twenty-
nine hundred ninety-four-c of this article, that a patient  lacks  deci-
sion-making   capacity   because  of  mental  illness  or  developmental
disability.
  S 13. Section 2994-u of the public health law, as added by  chapter  8
of the laws of 2010, is amended to read as follows:
  S  2994-u.  Rights  to be publicized. The commissioner shall prepare a
statement summarizing the rights, duties, and requirements of this arti-
cle and shall require that a copy of  such  statement  be  furnished  to
[patients] A PATIENT or to [persons on] the surrogate [list known to the
hospital],  or  to  the  [parents  or guardians] PARENT OR GUARDIAN of A
minor [patients] PATIENT, at or prior to admission to the  hospital,  or
within  a  reasonable time thereafter, and to [each member of the hospi-
tal's staff directly involved with  patient  care]  ANY  PERSON  ON  THE
SURROGATE  LIST WHO REQUESTS A COPY OF SUCH STATEMENT FROM THE HOSPITAL.
THE STATEMENT SHALL ALSO BE MADE  AVAILABLE  TO  THE  HOSPITAL  CLINICAL
STAFF.
  S  14. The commissioner of health shall revise the statement of rights
that hospitals are required to post (known  as  the  Patient's  Bill  of
Rights)  pursuant  to  paragraph (g) of subdivision 1 of section 2803 of
the public health law, by replacing the clause regarding orders  not  to
resuscitate  with  a  statement  that more generally informs patients of
their right to receive  from  the  hospital  upon  admission,  and  upon
request,  a  more  complete  statement  of  their rights with respect to
deciding about health care, including appointing a  health  care  agent,
consenting to do-not-resuscitate orders and making other life-sustaining
treatment  decisions. The clause should also state in substance that the
hospital will also provide such statement upon  request  to  any  family
member or friend of a patient who lacks decision-making capacity.
  S  15.  Subdivisions 12 and 13 of section 2994-aa of the public health
law, subdivision 12 as added by chapter 8 of the laws of 2010 and subdi-
vision 13 as amended  by chapter 167 of the laws of  2011,  are  amended
and a new subdivision 14-a is added to read as follows:
  12. "Mental hygiene facility" means a residential facility operated or
licensed  by the office of mental health [or the office of mental retar-
dation and developmental disabilities].
  13. "Nonhospital order not to resuscitate" means an order that directs
emergency medical  services  personnel,  hospice  personnel,  HOME  CARE
SERVICES  AGENCY  PERSONNEL, SCHOOL HEALTH PERSONNEL, and hospital emer-
gency services personnel not to attempt cardiopulmonary resuscitation in
the event a patient suffers cardiac or respiratory arrest.
  14-A. "SCHOOL HEALTH PERSONNEL" MEANS A SCHOOL-BASED PHYSICIAN, NURSE,
PHYSICIAN ASSISTANT OR NURSE PRACTITIONER.
  S 16. Paragraph (a) of subdivision 1 of section 2994-bb of the  public
health  law,  as  added  by chapter 8 of the laws of 2010, is amended to
read as follows:
  (a) Emergency medical services personnel, home  care  services  agency
personnel,  hospice  personnel,  SCHOOL  HEALTH  PERSONNEL, and hospital
emergency services personnel  shall  honor  nonhospital  orders  not  to
resuscitate,  except  as provided in section twenty-nine hundred ninety-
four-ee of this article.

S. 7151                             5

  S 17. Subdivisions 2 and 6 of section 2994-dd  of  the  public  health
law,  subdivision 2 as added by chapter 8 of the laws of 2010 and subdi-
vision 6 as amended by section 10 of part J of chapter 56 of the laws of
2012, are amended to read as follows:
  2. A nonhospital order not to resuscitate shall be issued upon a stan-
dard  form  prescribed by the commissioner. [The commissioner shall also
develop a] A standard bracelet [that] OR OTHER ARTICLE may be worn by  a
patient  with  a  nonhospital  order not to resuscitate to identify that
status; provided, however, that no person may require a patient to  wear
such  a  bracelet  OR  OTHER  ARTICLE  and  that no person may require a
patient to wear such a bracelet OR OTHER  ARTICLE  as  a  condition  for
honoring  a nonhospital order not to resuscitate or for providing health
care services.
  6. The commissioner may authorize the use of one or  more  alternative
forms  for  issuing  a nonhospital order not to resuscitate (in place of
the standard form prescribed by the commissioner under  subdivision  two
of  this  section).  Such  alternative form or forms may also be used to
issue a non-hospital do not intubate order. Any such  alternative  forms
intended  for use for persons with developmental disabilities or persons
with mental illness who are incapable of making their  own  health  care
decisions  or  who  have  a guardian of the person appointed pursuant to
article eighty-one of the mental hygiene law or article  seventeen-A  of
the surrogate's court procedure act must also be approved by the commis-
sioner  of  developmental  disabilities  or  the  commissioner of mental
health, as appropriate. An alternative form under this subdivision shall
otherwise conform with applicable federal and state law.  This  subdivi-
sion  does  not limit, restrict or impair the use of an alternative form
for issuing an order not to resuscitate in a general hospital  or  resi-
dential  health care facility under article twenty-eight of this chapter
or a hospital under subdivision  ten  of  section  1.03  of  the  mental
hygiene  law  OR  A  DEVELOPMENTAL  DISABILITIES  SERVICES  OFFICE UNDER
SECTION 13.17 OF THE MENTAL HYGIENE LAW.
  S 18. Section 2994-gg of the public health law, as added by chapter  8
of the laws of 2010, is amended to read as follows:
  S  2994-gg.  Immunity. No person shall be subjected to criminal prose-
cution or civil liability, or be deemed to  have  engaged  in  unprofes-
sional  conduct,  for  honoring reasonably and in good faith pursuant to
this [section] ARTICLE a  nonhospital  order  not  to  resuscitate,  for
disregarding a nonhospital order pursuant to section twenty-nine hundred
ninety-four-ee  of  this  article, or for other actions taken reasonably
and in good faith pursuant to this [section] ARTICLE.
  S 19. This act shall take effect on the ninetieth day after  it  shall
have  become  a law, provided that the amendments to article 29-C of the
public health law shall apply to decisions made pursuant to health  care
proxies created prior to the effective date of this act as well as those
created thereafter.

S7151A (ACTIVE) - Bill Details

See Assembly Version of this Bill:
A9647A
Current Committee:
Law Section:
Public Health Law
Laws Affected:
Amd Pub Health L, generally

S7151A (ACTIVE) - Bill Texts

view summary

Relates to health care agents and proxies, decisions under the family health care decisions act and non-hospital orders not to resuscitate.

view sponsor memo
BILL NUMBER:S7151A

TITLE OF BILL: 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 deci-
sions act, and non-hospital orders not to resuscitate

PURPOSE OF GENERAL IDEA OF BILL: This is one of a series of seven bills,
informally referred to as the "Surrogate Decision-Making Improvement
Acts." The bills make technical/minor, clarifying and coordinating
amendments and other improvements to the Family Health Care Decisions
Act (FHCDA) (Ch. 8, Laws of 2010) and other laws that govern health care
decisions, including life-sustaining treatment decisions, for patients
who lack decision-making capacity. This bill makes technical changes to
the FHCDA and other laws.

SUMMARY OF SPECIFIC PROVISIONS:

Section 1 amends PHL § 2980, subdivs. 4 and 10: to clarify that the
provision of nutrition and hydration orally, without reliance on medical
treatment, is not "health care" within the meaning of the article, as
stated in the Family Health Care Decisions Act (FHCDA); and to substi-
tute the name, "office for people with developmental disabilities"
(hereinafter OPWDD) for the former name, office of mental retardation
and developmental disabilities" (hereinafter, OMRDD).

Section 2 amends PHL § 2981(b) to delete the outdated term "committee"
and to insert the correct reference to MHL Article 81.

Section 3 amends PHL § 2982(2) to add "physician assistant and nurse
practitioner" to the list of professionals, one of whom an agent must
consult with before making a decision.

Section 4 amends PHL § 2983(4) to replace outdated references to "the
conservator for, or committee of" a principal with a reference to "the
guardian, if any, for the principal."

Section 5 amends PHL § 2991 to substitute OPWDD for OMRDD.

Section 6 amends PHL § 2992 to replace outdated references to "the
conservator for, or committee of a principal with the correct reference
to "the guardian" of the principal

Section 7 amends § 2993 to substitute OPWDD for OMRDD.

Section 8 amends three subdivisions in PHL § 2994-a (Definitions):
Amends "Health or social services practitioner" to include "licensed
master social worker." Substitutes OPWDD for OMRDD. Changes "the hospi-
tal administrator" to "a hospital administrator "

Section 9 amends PHL § 2994-b(3)(a) to change "mental retardation or a
developmental disability" to "a developmental disability." Corrects a
spelling error.

Section 10 amends PHL § 2994-e to clarify that the obligation a hospital
has to notify the parents or guardian of an emancipated minor is to make
"diligent efforts" to notify such persons, and to require documentation
of the basis for the determination of emancipation and capacity, and
thof the diligent efforts.

Section 11 amends PHL § 2994-m(4)(b)(iv) to clarify that the obligation
an ethics committee has to notify certain persons is to make "diligent
efforts" to notify such persons, and to document such efforts, Section
20 amends PHL § 2994-t(2) to substitute OPWDD for OMRDD.

Section 12 amends PHL § 2994-t to correct references to the commission-
ers of OMH and OPWDD.

Section 13 amends PHL § 2994-u to direct the commissioner of health to
require that a copy of the statement of rights under this article be
furnished "to a patient or to the surrogate, or to the parent or guardi-
an of a minor patient, at or prior to admission to the hospital, or
within a reasonable time thereafter, and to any person on the surrogate
list who requests a copy of such statement from the hospital. The state-
ment shall also be made available to the hospital clinical staff."

Section 14 directs the commissioner of health to revise the statement of
rights that hospitals are required to post (known as the Patient's Bill
of Rights) by replacing the clause regarding orders not to resuscitate
with a statement about a broader range health care decision-making
rights.

Section 15 amends § 2994-aa subdivisions 12 and 13 and adds 14-a to,
substitute OPWDD for OMRDD, to provide that a nonhospital order not to
resuscitate also applies to home care services agency personnel and
school health personnel, and to define "school health personnel.

Section 16 amends PHL § 2994-bb(1)(a) to make the nonhospital DNR
provisions applicable to school health personnel .

Section 17 amends § 2994-dd(2) to delete a reference to the commission-
er's obligation to develop a standard DNR bracelet, and to refer to a
standard bracelet "or other article", and amends § 2994-dd.6 to allow
alternate forms for nonhospital DNR orders in developmental disability
services offices.

Section 18 amends PHL § 2994-gg to substitute the word "article" for the
word "section" in two places. Section 19 is the effective date ninety
days after it becomes a law.

JUSTIFICATION:

This bill amends the Family Health Care Decisions Act (Ch 8. Laws of
2010) (FHCDA). It makes technical, minor and coordinating amendments to
related laws.

PRIOR LEGISLATIVE HISTORY: 2013: A.7371 reported referred to codes

FISCAL IMPLICATIONS: None.

EFFECTIVE DATE: This act shall take effect ninety days after the date on
which this act shall have become a law. The amendments to article 29-C
of the public health law shall apply to decisions made pursuant to
health care proxies created prior to this act becoming law as well as
those created thereafter.

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

                                 7151--A

                            I N  S E N A T E

                               May 1, 2014
                               ___________

Introduced  by  Sen.  HANNON -- 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 making technical,
  minor and coordinating amendments regarding  health  care  agents  and
  proxies,  decisions  under  the  family health care decisions act, and
  non-hospital orders not to resuscitate

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

  Section  1. Subdivisions 4 and 10 of section 2980 of the public health
law, subdivision 4 as added by chapter 752 of the laws of 1990, subdivi-
sion 10 as amended by chapter 23 of the laws of  1994,  are  amended  to
read as follows:
  4. "Health care" means any treatment, service or procedure to diagnose
or  treat an individual's physical or mental condition. PROVIDING NUTRI-
TION OR HYDRATION ORALLY, WITHOUT RELIANCE ON MEDICAL TREATMENT, IS  NOT
HEALTH CARE UNDER THIS ARTICLE AND IS NOT SUBJECT TO THIS ARTICLE.
  10.  "Mental hygiene facility" means a residential facility, excluding
family care homes, operated or licensed by the office of  mental  health
or  the office [of mental retardation and] FOR PEOPLE WITH developmental
disabilities.
  S 2. Paragraph (b) of subdivision 1 of  section  2981  of  the  public
health  law,  as added by chapter 752 of the laws of 1990, is amended to
read as follows:
  (b) For the purposes of this section, every adult  shall  be  presumed
competent  to  appoint  a  health care agent unless such person has been
adjudged incompetent or otherwise adjudged not competent  to  appoint  a
health care agent, or unless a [committee or] guardian of the person has
been  appointed for the adult pursuant to article [seventy-eight] EIGHT-
Y-ONE of the mental hygiene law or article  seventeen-A  of  the  surro-
gate's court procedure act.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD13618-04-4

S. 7151--A                          2

  S  3.  Subdivision  2  of  section  2982  of the public health law, as
amended by chapter 230 of the laws  of  2004,  is  amended  to  read  as
follows:
  2. Decision-making standard. After consultation with a licensed physi-
cian,   registered   nurse,  PHYSICIAN  ASSISTANT,  NURSE  PRACTITIONER,
licensed psychologist, licensed master  social  worker,  or  a  licensed
clinical  social worker, the agent shall make health care decisions: (a)
in accordance with the principal's  wishes,  including  the  principal's
religious  and  moral  beliefs; or (b) if the principal's wishes are not
reasonably known and cannot with reasonable diligence be ascertained, in
accordance with the principal's best interests; provided, however,  that
if  the  principal's  wishes  regarding the administration of artificial
nutrition and hydration are not reasonably known and cannot with reason-
able diligence be ascertained, the agent shall not have the authority to
make decisions regarding these measures.
  S 4. Subdivision 3 of section 2983 of the public health law, as  added
by chapter 752 of the laws of 1990, is amended to read as follows:
  3. Notice of determination. Notice of a determination that a principal
lacks  capacity  to  make health care decisions shall promptly be given:
(a) to the principal, orally and in writing, where there  is  any  indi-
cation  of the principal's ability to comprehend such notice; (b) to the
agent; (c) if the principal is  in  or  is  transferred  from  a  mental
hygiene  facility, to the facility director; and (d) to the [conservator
for, or committee of, the principal] GUARDIAN, IF ANY.
  S 5. Subdivision 2 of section 2991 of the public health law, as  added
by chapter 752 of the laws of 1990, is amended to read as follows:
  2. Such procedures shall be established in accordance with regulations
issued by the commissioners of health, mental health, and [mental retar-
dation  and]  developmental disabilities for facilities subject to their
respective regulatory authorities.
  S 6. The opening paragraph of section 2992 of the public  health  law,
as  added  by  chapter  752  of  the laws of 1990, is amended to read as
follows:
  The health care provider, the [conservator for, or committee] GUARDIAN
of the principal UNDER ARTICLE EIGHTY-ONE OF THE MENTAL HYGIENE  LAW  OR
ARTICLE  SEVENTEEN-A  OF THE SURROGATE'S COURT PROCEDURE ACT, members of
the principal's family, a close friend of the principal  as  defined  in
subdivision  [five]  FOUR  of  section  [two  thousand nine] TWENTY-NINE
hundred [sixty-one] NINETY-FOUR-A of this chapter, or  the  commissioner
[of  health],  THE COMMISSIONER OF mental health, or [mental retardation
and] THE COMMISSIONER  OF  developmental  disabilities  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, including, but not limited to, a
proceeding to:
  S 7. Section 2993 of the public health law, as added by chapter 752 of
the laws of 1990, is amended to read as follows:
  S 2993. Regulations. The commissioner  [of  health],  in  consultation
with  the commissioners of [the office of] mental health and [the office
of mental retardation and] developmental disabilities,  shall  establish
such  regulations  as  may  be  necessary for the implementation of this
article, subject to the provisions of subdivision two  of  section  [two
thousand nine] TWENTY-NINE hundred ninety-one of this article.
  S 8. Subdivisions 17, 20 and 26 of section 2994-a of the public health
law,  as  added by chapter 8 of the laws of 2010, are amended to read as
follows:

S. 7151--A                          3

  17. "Health or social [service] SERVICES practitioner" means a  regis-
tered  professional  nurse,  nurse  practitioner,  physician,  physician
assistant, psychologist, LICENSED MASTER SOCIAL WORKER or licensed clin-
ical social worker, licensed or certified pursuant to the education  law
acting within his or her scope of practice.
  20. "Mental hygiene facility" means a facility operated or licensed by
the  office  of  mental health or the office [of mental retardation and]
FOR PEOPLE WITH developmental disabilities as defined in subdivision six
of section 1.03 of the mental hygiene law.
  26. "Person connected with the case" means the patient, any person  on
the  surrogate  list,  a  parent or guardian of a minor patient, [the] A
hospital administrator, an attending  physician,  any  other  health  or
social services practitioner who is or has been directly involved in the
patient's  care,  and  any  duly  authorized state agency, including the
facility director or regional director for a patient transferred from  a
mental  hygiene  facility and the facility director for a patient trans-
ferred from a correctional facility.
  S 9. The opening paragraph and  paragraph  (a)  of  subdivision  3  of
section  2994-b  of  the public health law, as added by chapter 8 of the
laws of 2010, are amended to read as follows:
  Prior to seeking or relying upon a health care decision by a surrogate
for a patient under this article, if the attending physician has  reason
to  believe  that  the  patient  has a history of receiving services for
[mental  retardation  or]  a  developmental  disability;  it  reasonably
appears to the attending physician that the patient has [mental retarda-
tion  or]  a  developmental  disability;  or the attending physician has
reason to believe that the patient has been transferred  from  a  mental
hygiene  facility  operated  or licensed by the office of mental health,
then such physician shall make reasonable efforts to  determine  whether
paragraphs (a), (b) or (c) of this subdivision are applicable:
  (a)  If  the  patient  has a guardian appointed by a court pursuant to
article seventeen-A of the surrogate's court procedure act, health  care
decisions for the patient shall be governed by section seventeen hundred
fifty-b  of  the surrogate's court [proceedure] PROCEDURE act and not by
this article.
  S 10. Paragraphs (a) and (b) of subdivision 3 of section 2994-e of the
public health law, as added by chapter  8  of  the  laws  of  2010,  are
amended to read as follows:
  (a)  If an attending physician determines that a patient is an emanci-
pated minor patient with  decision-making  capacity  AND  DOCUMENTS  THE
BASIS  FOR  SUCH  DETERMINATION  IN  THE  PATIENT'S  MEDICAL RECORD, the
patient shall have the authority to decide about life-sustaining  treat-
ment.  Such  authority  shall include a decision to withhold or withdraw
life-sustaining treatment if  an  attending  physician  and  the  ethics
review  committee determine that the decision accords with the standards
for surrogate decisions for adults,  and  the  ethics  review  committee
approves the decision.
  (b) If the hospital can with reasonable efforts ascertain the identity
of the parents or guardian of an emancipated minor patient, the hospital
shall  MAKE  DILIGENT  EFFORTS TO notify such persons, AND DOCUMENT SUCH
DILIGENT EFFORTS IN THE PATIENT'S MEDICAL RECORD, prior  to  withholding
or withdrawing life-sustaining treatment pursuant to this subdivision.
  S  11.  Subparagraph (iv) of paragraph (b) of subdivision 4 of section
2994-m of the public health law, as added by chapter 8 of  the  laws  of
2010, is amended to read as follows:

S. 7151--A                          4

  (iv)  Following  ethics  review  committee  consideration  of  a  case
concerning the withdrawal or withholding of  life-sustaining  treatment,
treatment  shall  not  be withdrawn or withheld until THE HOSPITAL MAKES
DILIGENT EFFORTS TO INFORM the persons identified in subparagraph  (iii)
of  this  paragraph  [have been informed] of the committee's response to
the case AND DOCUMENTS SUCH DILIGENT EFFORTS IN  THE  PATIENT'S  MEDICAL
RECORD.
  S  12.  Subdivision  2  of section 2994-t of the public health law, as
added by chapter 8 of the laws of 2010, is amended to read as follows:
  2. The commissioner, in consultation with the  commissioners  of  [the
office  of]  mental  health  and  [the office of mental retardation and]
developmental disabilities, shall promulgate regulations identifying the
credentials of health care professionals qualified to provide  an  inde-
pendent  determination, pursuant to subdivision three of section twenty-
nine hundred ninety-four-c of this article, that a patient  lacks  deci-
sion-making   capacity   because  of  mental  illness  or  developmental
disability.
  S 13. Section 2994-u of the public health law, as added by  chapter  8
of the laws of 2010, is amended to read as follows:
  S  2994-u.  Rights  to be publicized. The commissioner shall prepare a
statement summarizing the rights, duties, and requirements of this arti-
cle and shall require that a copy of  such  statement  be  furnished  to
[patients] A PATIENT or to [persons on] the surrogate [list known to the
hospital],  or  to  the  [parents  or guardians] PARENT OR GUARDIAN of A
minor [patients] PATIENT, at or prior to admission to the  hospital,  or
within  a  reasonable time thereafter, and to [each member of the hospi-
tal's staff directly involved with  patient  care]  ANY  PERSON  ON  THE
SURROGATE  LIST WHO REQUESTS A COPY OF SUCH STATEMENT FROM THE HOSPITAL.
THE STATEMENT SHALL ALSO BE MADE  AVAILABLE  TO  THE  HOSPITAL  CLINICAL
STAFF.
  S  14. The commissioner of health shall revise the statement of rights
that hospitals are required to post (known  as  the  Patient's  Bill  of
Rights)  pursuant  to  paragraph (g) of subdivision 1 of section 2803 of
the public health law, by replacing the clause regarding orders  not  to
resuscitate  with  a  statement  that more generally informs patients of
their right to receive  from  the  hospital  upon  admission,  and  upon
request,  a  more  complete  statement  of  their rights with respect to
deciding about health care, including appointing a  health  care  agent,
consenting to do-not-resuscitate orders and making other life-sustaining
treatment  decisions. The clause should also state in substance that the
hospital will also provide such statement upon  request  to  any  family
member or friend of a patient who lacks decision-making capacity.
  S  15.  Subdivisions 12 and 13 of section 2994-aa of the public health
law, subdivision 12 as added by chapter 8 of the laws of 2010 and subdi-
vision 13 as amended  by chapter 167 of the laws of 2011, are amended to
read as follows:
  12. "Mental hygiene facility" means a residential facility operated or
licensed by the office of mental health [or the office of mental  retar-
dation and developmental disabilities].
  13. "Nonhospital order not to resuscitate" means an order that directs
emergency  medical  services  personnel,  hospice  personnel,  HOME CARE
SERVICES AGENCY PERSONNEL and hospital emergency services personnel  not
to  attempt cardiopulmonary resuscitation in the event a patient suffers
cardiac or respiratory arrest.
  S 16. Subdivisions 2 and 6 of section 2994-dd  of  the  public  health
law,  subdivision 2 as added by chapter 8 of the laws of 2010 and subdi-

S. 7151--A                          5

vision 6 as amended by section 10 of part J of chapter 56 of the laws of
2012, are amended to read as follows:
  2. A nonhospital order not to resuscitate shall be issued upon a stan-
dard  form  prescribed by the commissioner. [The commissioner shall also
develop a] A standard bracelet [that] OR OTHER ARTICLE may be worn by  a
patient  with  a  nonhospital  order not to resuscitate to identify that
status; provided, however, that no person may require a patient to  wear
such  a  bracelet  OR  OTHER  ARTICLE  and  that no person may require a
patient to wear such a bracelet OR OTHER  ARTICLE  as  a  condition  for
honoring  a nonhospital order not to resuscitate or for providing health
care services.
  6. The commissioner may authorize the use of one or  more  alternative
forms  for  issuing  a nonhospital order not to resuscitate (in place of
the standard form prescribed by the commissioner under  subdivision  two
of  this  section).  Such  alternative form or forms may also be used to
issue a non-hospital do not intubate order. Any such  alternative  forms
intended  for use for persons with developmental disabilities or persons
with mental illness who are incapable of making their  own  health  care
decisions  or  who  have  a guardian of the person appointed pursuant to
article eighty-one of the mental hygiene law or article  seventeen-A  of
the surrogate's court procedure act must also be approved by the commis-
sioner  of  developmental  disabilities  or  the  commissioner of mental
health, as appropriate. An alternative form under this subdivision shall
otherwise conform with applicable federal and state law.  This  subdivi-
sion  does  not limit, restrict or impair the use of an alternative form
for issuing an order not to resuscitate in a general hospital  or  resi-
dential  health care facility under article twenty-eight of this chapter
or a hospital under subdivision  ten  of  section  1.03  of  the  mental
hygiene  law  OR  A  DEVELOPMENTAL  DISABILITIES  SERVICES  OFFICE UNDER
SECTION 13.17 OF THE MENTAL HYGIENE LAW.
  S 17. Section 2994-gg of the public health law, as added by chapter  8
of the laws of 2010, is amended to read as follows:
  S  2994-gg.  Immunity. No person shall be subjected to criminal prose-
cution or civil liability, or be deemed to  have  engaged  in  unprofes-
sional  conduct,  for  honoring reasonably and in good faith pursuant to
this [section] ARTICLE a  nonhospital  order  not  to  resuscitate,  for
disregarding a nonhospital order pursuant to section twenty-nine hundred
ninety-four-ee  of  this  article, or for other actions taken reasonably
and in good faith pursuant to this [section] ARTICLE.
  S 18. This act shall take effect on the ninetieth day after  it  shall
have  become  a law, provided that the amendments to article 29-C of the
public health law shall apply to decisions made pursuant to health  care
proxies created prior to the effective date of this act as well as those
created thereafter.

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