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A07184 Summary:

A07184 Actions:

A07184 Committee Votes:

Committee:HEALTH   Chair:Paulin      
DATE:05/07/2024AYE/NAY:23/1  Action: Favorable         
Paulin
Aye
Jensen
Aye
Dinowitz
Aye
Byrnes
Excused
Gunther
Aye
Gandolfo
Aye
Rosenthal
Aye
Mikulin
Aye
Hevesi
Aye
Blumencranz
Aye
Steck
Excused
Bendett
Aye
Braunstein
Aye
Gray
Aye
Solages
Aye
McGowan
Nay
Bichotte Hermel
Aye
Sayegh
Aye
McDonald
Aye
Reyes
Aye
Gonzalez-Rojas
Aye
Rajkumar
Aye
Forrest
Aye
Kelles
Aye
Lucas
Aye
Meeks
Aye

A07184 Floor Votes:

A07184 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
 submitted in accordance with Assembly Rule III, Sec 1(f)



 
BILL NUMBER: A7184A
 
SPONSOR: Paulin

 
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 prox-
ies, decisions under the family health care decisions act, and nonhospi-
tal orders not to resuscitate
 
 
PURPOSE:
 
Makes technical, minor, and coordinating amendments regarding health
care agents and proxies, decisions under the family health care deci-
sions act, and nonhospital orders not to resuscitate
 
 
SUMMARY OF SPECIFIC PROVISIONS:

Section 1 amends paragraph (b) of subdivision 1 of section 2981 of the
public health law as it relates to health care agents and proxies and
non-hospital orders not to resuscitate. For the purpose of the section,
competent adults can appoint a healthcare agent unless a guardian has
been appointed for the adult in accordance with article eight-one of the
mental hygiene law.
 
Section 2 amends subdivision 2 of section 2982 of the public health law
as it relates to decision making standards for orders not to resusci-
tate. This section adds physician assistants and nurse practitioners to
the list of providers that health care proxies can consult for the deci-
sion making of do not resuscitate orders.
 
Section 3 amends subdivision 3 of section 2983 of the public health law
as it relates to notice of.determination. This section adds "guardian"
to the list of those who shall be promptly given notice of determination
that a principal lacks capacity to make health care decisions.

Section 4 amends the opening paragraph of section 2992 of the public
health law as it relates to special proceeding authorization. This
section gives new references of laws to define the health care provider
or a close friend of the principal for the commencement of special
proceedings.
 
Section 5 amends section 2993 of the public health law as it relates to
regulations. This section specifies the commissioner of health will
consult the commissioners of mental health and developmental disabili-
ties to establish regulations necessary to create and use proxies in
residential health care and mental hygiene facilities.
 
Section 6 amend subdivision 17 and 26 of section 2994-a of the public
health law as it relates to definitions. The definition of health or
social services practitioner will now include a licensed master social
worker.
 
Section 7 amends subdivision 3 of section 2994-e of the public health
law as it relates to decisions about life-sustaining treatment for minor
patients. This section gives the patient authority to decide about life-
sustaining treatment if an attending practitioner determines that the
patient is an emancipated minor patient with decision-making capacity
 
and documents the basis for such determination in the patient's medical
record.
 
Section 8 amends subparagraph (iv) of paragraph (b) of subdivision 4 of
section 2994-m of the public health law as it relates to procedures for
the ethics review committee. Following ethics review committee consider-
ation of a case concerning the withdrawal or withholding of life-sus-
taining treatment, such treatment shall not be withdrawn or withheld
until the hospital makes diligent efforts to inform the persons involved
in a patient's care and until they have been informed of the committee's
response to the case. The ethics committee must document such efforts in
the patient's medical record.
 
Section 9 amends section 2994-u of the public health law as it relates
to the right to publicize. The commissioner shall prepare a statement
summarizing the right, duties, and requirements of this article and 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 10 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 generally informing patients about their health care
decision-making rights.
 
Section 11 amends subdivision 12 and 13 of section 2994-aa of the public
health law as it relates to definitions. A mental hygiene facility will
no longer include facilities operated by the office for people with
developmental disabilities and non-hospital orders not to resuscitate
will now also apply to home care services agency personnel.

Section 12 amends subdivision 2 and 6 of section 2994-dd of the public
health law as it relateS to orders not to resuscitate; Patients now have
the option to wear a bracelet or another article to identify non-hospi-
tal order not to resuscitate status.
 
Section 13 amends section 2994-gg of the public health law as it relates
to immunity. Liability protections related to orders not to resuscitate
will now apply to this whole article and not just this section.
 
Section 14 gives the effective date.
 
 
JUSTIFICATION:
 
This bill helps health care agents and proxies with the decision making
process of do not resuscitate orders by amending the Family Health Care
Decisions Act (Ch.8, Laws of 2010) (FHCDA).
 
 
BILL HISTORY:
 
2019:A5973 Health Reported to Codes /Senate Health
 
2020:A5973 Health Reported to Codes /Senate Health
 
2021:A175 - Health Reported to Codes /Senate 3rd Reading Calendar
 
2022:A175 - Referred to Codes /SenateHealth
 
FISCAL IMPLICATIONS:
 
None.
 
 
EFFECTIVE DATE:
This act shall take effect on the ninetieth day after it shall become a
law.

A07184 Text:

 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         7184--A
 
                               2023-2024 Regular Sessions
 
                   IN ASSEMBLY
 
                                      May 12, 2023
                                       ___________
 
        Introduced by M. of A. PAULIN -- read once and referred to the Committee
          on Health -- recommitted to the Committee on Health in accordance with
          Assembly Rule 3, sec. 2 -- committee discharged, bill amended, ordered
          reprinted as amended and recommitted to said committee
 
        AN  ACT to amend the public health law, in relation to making technical,
          minor and coordinating amendments regarding  health  care  agents  and
          proxies,  decisions  under  the  family health care decisions act, and
          nonhospital orders not to resuscitate
 
          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
 
     1    Section  1.  Paragraph  (b)  of  subdivision  1 of section 2981 of the
     2  public health law, as added by chapter 752  of  the  laws  of  1990,  is
     3  amended to read as follows:
     4    (b)  For  the  purposes of this section, every adult shall be presumed
     5  competent to appoint a health care agent unless  such  person  has  been
     6  adjudged  incompetent  or  otherwise adjudged not competent to appoint a
     7  health care agent, or unless a [committee or] guardian of the person has
     8  been appointed for the adult pursuant to article [seventy-eight]  eight-
     9  y-one  of  the  mental  hygiene law or article seventeen-A of the surro-
    10  gate's court procedure act.
    11    § 2. Subdivision 2 of section  2982  of  the  public  health  law,  as
    12  amended  by  chapter  230  of  the  laws  of 2004, is amended to read as
    13  follows:
    14    2. Decision-making standard. After consultation with a licensed physi-
    15  cian,  registered  nurse,  physician  assistant,   nurse   practitioner,
    16  licensed  psychologist,  licensed  master  social  worker, or a licensed
    17  clinical social worker, the agent shall make health care decisions:  (a)
    18  in  accordance  with  the  principal's wishes, including the principal's
    19  religious and moral beliefs; or (b) if the principal's  wishes  are  not
    20  reasonably known and cannot with reasonable diligence be ascertained, in
    21  accordance  with the principal's best interests; provided, however, that
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD05270-04-4
        A. 7184--A                          2
 
     1  if the principal's wishes regarding  the  administration  of  artificial
     2  nutrition and hydration are not reasonably known and cannot with reason-
     3  able diligence be ascertained, the agent shall not have the authority to
     4  make decisions regarding these measures.
     5    §  3.  Subdivision  3  of  section  2983  of the public health law, as
     6  amended by chapter 342 of the laws  of  2018,  is  amended  to  read  as
     7  follows:
     8    3. Notice of determination. Notice of a determination that a principal
     9  lacks  capacity  to  make health care decisions shall promptly be given:
    10  (a) to the principal, orally and in writing, where there  is  any  indi-
    11  cation  of the principal's ability to comprehend such notice; (b) to the
    12  agent; (c) if the principal is  in  or  is  transferred  from  a  mental
    13  hygiene  facility, to the facility director; and (d) to the [conservator
    14  for, or committee of, the principal] guardian of the principal, if any.
    15    § 4. The opening paragraph of section 2992 of the public  health  law,
    16  as  amended  by  chapter  93  of the laws of 2014, is amended to read as
    17  follows:
    18    The health care provider[, the conservator for, or committee]  of  the
    19  principal  under article eighty-one of the mental hygiene law or article
    20  seventeen-A of the surrogate's court procedure act, members of the prin-
    21  cipal's family, a close friend of the principal as defined  in  subdivi-
    22  sion  [five]  four  of  section  [two thousand nine] twenty-nine hundred
    23  [sixty-one] ninety-four-a of  this  chapter,  or  the  commissioner  [of
    24  health],  the  commissioner  of  mental  health,  or the commissioner of
    25  developmental disabilities may commence a special proceeding pursuant to
    26  article four of the civil practice law and rules, in a court  of  compe-
    27  tent  jurisdiction, with respect to any dispute arising under this arti-
    28  cle, including, but not limited to, a proceeding to:
    29    § 5. Section 2993 of the public health law, as amended by chapter  672
    30  of the laws of 2019, is amended to read as follows:
    31    §  2993.  Regulations.  The  commissioner [of health], in consultation
    32  with the commissioners of the office of mental health and the office for
    33  people with developmental disabilities, shall establish such regulations
    34  as may be necessary for the implementation of this article,  subject  to
    35  the  provisions  of subdivision two of section [two thousand nine] twen-
    36  ty-nine hundred ninety-one of this article.
    37    § 6. Subdivisions 17 and 26 of section 2994-a  of  the  public  health
    38  law,  as  added by chapter 8 of the laws of 2010, are amended to read as
    39  follows:
    40    17. "Health or social [service] services practitioner" means a  regis-
    41  tered  professional  nurse,  nurse  practitioner,  physician,  physician
    42  assistant, psychologist, licensed  master  social  worker,  or  licensed
    43  clinical  social  worker,  licensed  [or],  certified  [pursuant  to] or
    44  authorized under the education law  acting  within  [his  or  her]  such
    45  health or social services practitioner's scope of practice.
    46    26.  "Person connected with the case" means the patient, any person on
    47  the surrogate list, a parent or guardian of a minor patient, the  hospi-
    48  tal  administrator,  an  attending  [physician]  practitioner, any other
    49  health or social services practitioner  who  is  or  has  been  directly
    50  involved  in  the  patient's care, and any duly authorized state agency,
    51  including the facility director  or  regional  director  for  a  patient
    52  transferred from a mental hygiene facility and the facility director for
    53  a patient transferred from a correctional facility.
    54    §  7.  Subdivision  3  of  section 2994-e of the public health law, as
    55  amended by chapter 708 of the laws  of  2019,  is  amended  to  read  as
    56  follows:
        A. 7184--A                          3
 
     1    3.  Decision-making  standards  and  procedures  for emancipated minor
     2  patient. (a) If an attending practitioner determines that a  patient  is
     3  an emancipated minor patient with decision-making capacity and documents
     4  the  basis  for  that determination in the patient's medical record, the
     5  patient  shall have the authority to decide about life-sustaining treat-
     6  ment. [Such] That authority shall include  a  decision  to  withhold  or
     7  withdraw  life-sustaining treatment if an attending practitioner and the
     8  ethics review committee determine that the  decision  accords  with  the
     9  standards  for  surrogate  decisions  for  adults, and the ethics review
    10  committee approves the decision.
    11    (b) If the hospital can with reasonable efforts ascertain the identity
    12  of the parents or guardian of an emancipated minor patient, the hospital
    13  shall make diligent efforts to notify such persons, and  documents  such
    14  diligent  efforts  in the patient's medical record, prior to withholding
    15  or withdrawing life-sustaining treatment pursuant to this subdivision.
    16    § 8. Subparagraph (iv) of paragraph (b) of subdivision  4  of  section
    17  2994-m  of  the public health law, as amended by chapter 708 of the laws
    18  of 2019, is amended to read as follows:
    19    (iv)  Following  ethics  review  committee  consideration  of  a  case
    20  concerning  the  withdrawal or withholding of life-sustaining treatment,
    21  treatment shall not be withdrawn or withheld until  the  hospital  makes
    22  diligent  efforts to inform the persons identified in subparagraph (iii)
    23  of this paragraph have been informed of the committee's response to  the
    24  case and documents the diligent efforts in the patient's medical record.
    25    § 9. Section 2994-u of the public health law, as added by chapter 8 of
    26  the laws of 2010, is amended to read as follows:
    27    §  2994-u.  Rights  to be publicized. The commissioner shall prepare a
    28  statement summarizing the rights, duties, and requirements of this arti-
    29  cle and shall require that a copy of  such  statement  be  furnished  to
    30  [patients]  a  patient  or to [persons on] the patient's surrogate [list
    31  known to the hospital], or to the [parents or guardians] parent or guar-
    32  dian of a minor [patients] patient, at or  prior  to  admission  to  the
    33  hospital, or within a reasonable time thereafter, and to [each member of
    34  the  hospital's staff directly involved with patient care] any person on
    35  the surrogate list who requests a copy of the statement from the  hospi-
    36  tal. The statement shall also be made available to the hospital clinical
    37  staff.
    38    §  10. The commissioner of health shall revise the statement of rights
    39  that hospitals are required to post (known  as  the  Patient's  Bill  of
    40  Rights)  under  paragraph  (g)  of  subdivision 1 of section 2803 of the
    41  public health law, by replacing  the  clause  regarding  orders  not  to
    42  resuscitate  with  a  statement  that more generally informs patients of
    43  their right to receive  from  the  hospital  upon  admission,  and  upon
    44  request,  a  more  complete  statement  of  their rights with respect to
    45  deciding about health care, including appointing a  health  care  agent,
    46  consenting to do-not-resuscitate orders and making other life-sustaining
    47  treatment  decisions. The clause should also state in substance that the
    48  hospital will also provide such statement upon  request  to  any  family
    49  member or friend of a patient who lacks decision-making capacity.
    50    §  11.  Subdivisions 12 and 13 of section 2994-aa of the public health
    51  law, subdivision 12 as amended by chapter 672 of the laws  of  2019  and
    52  subdivision  13  as  amended    by  chapter 167 of the laws of 2011, are
    53  amended to read as follows:
    54    12. "Mental hygiene facility" means a residential facility operated or
    55  licensed by the office of mental health [or the office for  people  with
    56  developmental disabilities].
        A. 7184--A                          4
 
     1    13. "Nonhospital order not to resuscitate" means an order that directs
     2  emergency  medical  services  personnel,  hospice  personnel,  home care
     3  services agency personnel and hospital emergency services personnel  not
     4  to  attempt cardiopulmonary resuscitation in the event a patient suffers
     5  cardiac or respiratory arrest.
     6    §  12.  Subdivisions  2  and 6 of section 2994-dd of the public health
     7  law, as amended by chapter 708 of the laws of 2019, are amended to  read
     8  as follows:
     9    2. A nonhospital order not to resuscitate shall be issued upon a stan-
    10  dard  form  prescribed by the commissioner. [The commissioner shall also
    11  develop a] A standard bracelet or other article that may be  worn  by  a
    12  patient  with  a  nonhospital  order not to resuscitate to identify that
    13  status; provided, however, that no person may require a patient to  wear
    14  such  a bracelet and that no person may require a patient to wear such a
    15  bracelet as a condition for honoring a nonhospital order not to resusci-
    16  tate or for providing health care services.
    17    6. The commissioner may authorize the use of one or  more  alternative
    18  forms  for  issuing  a nonhospital order not to resuscitate (in place of
    19  the standard form prescribed by the commissioner under  subdivision  two
    20  of  this  section).  Such  alternative form or forms may also be used to
    21  issue a non-hospital do not intubate order. Any such  alternative  forms
    22  intended  for use for persons with developmental disabilities or persons
    23  with mental illness who are incapable of making their  own  health  care
    24  decisions  or  who  have  a guardian of the person appointed pursuant to
    25  article eighty-one of the mental hygiene law or article  seventeen-A  of
    26  the surrogate's court procedure act must also be approved by the commis-
    27  sioner  of  developmental  disabilities  or  the  commissioner of mental
    28  health, as appropriate. An alternative form under this subdivision shall
    29  otherwise conform with applicable federal and state law.  This  subdivi-
    30  sion  does  not limit, restrict or impair the use of an alternative form
    31  for issuing an order not to resuscitate in a general hospital  or  resi-
    32  dential  health care facility under article twenty-eight of this chapter
    33  or a hospital under subdivision  ten  of  section  1.03  of  the  mental
    34  hygiene  law  or  a  developmental  disabilities  services  office under
    35  section 13.17 of the mental hygiene law.
    36    § 13. Section 2994-gg of the public health law, as added by chapter  8
    37  of the laws of 2010, is amended to read as follows:
    38    §  2994-gg.  Immunity. No person shall be subjected to criminal prose-
    39  cution or civil liability, or be deemed to  have  engaged  in  unprofes-
    40  sional  conduct,  for  honoring reasonably and in good faith pursuant to
    41  this [section] article a  nonhospital  order  not  to  resuscitate,  for
    42  disregarding a nonhospital order pursuant to section twenty-nine hundred
    43  ninety-four-ee  of  this  article, or for other actions taken reasonably
    44  and in good faith pursuant to this [section] article.
    45    § 14. This act shall take effect on the ninetieth day after  it  shall
    46  have  become  a law, provided that the amendments to article 29-C of the
    47  public health law shall apply to decisions made pursuant to health  care
    48  proxies created prior to the effective date of this act as well as those
    49  created thereafter.

A07184 LFIN:

 
NO LFIN

A07184 Chamber Video/Transcript: