Florida Senate - 2024 SB 390



By Senator Gruters





22-00439-24 2024390__
1 A bill to be entitled
2 An act relating to patient-directed doctor’s orders;
3 amending ss. 395.1041, 400.142, and 400.487, F.S.;
4 authorizing specified personnel of hospitals, nursing
5 homes, and home health agencies, respectively, to
6 withhold or withdraw cardiopulmonary resuscitation if
7 presented with a patient-directed doctor’s order
8 (PDDO) form that contains an order not to resuscitate;
9 providing such personnel and their employing
10 facilities and agencies with immunity from criminal
11 prosecution or civil liability for such actions;
12 revising construction; amending s. 400.605, F.S.;
13 requiring the Agency for Health Care Administration to
14 adopt by rule procedures for the implementation of
15 PDDO forms in hospice care; amending s. 400.6095,
16 F.S.; authorizing hospice care teams to withhold or
17 withdraw cardiopulmonary resuscitation if presented
18 with a PDDO form that contains an order not to
19 resuscitate; providing hospice staff with immunity
20 from criminal prosecution or civil liability for such
21 actions; revising construction; amending s. 401.35,
22 F.S.; requiring the Department of Health to establish
23 by rule circumstances and procedures under which
24 emergency medical technicians and paramedics may honor
25 PDDO forms; amending s. 401.45, F.S.; authorizing
26 emergency medical personnel and other health care
27 professionals to withhold or withdraw cardiopulmonary
28 resuscitation or other forms of medical interventions
29 if presented with a PDDO form that contains an order
30 not to resuscitate; conforming provisions to changes
31 made by the act; prohibiting physician assistants from
32 signing PDDO forms under certain circumstances;
33 creating s. 401.451, F.S.; requiring a patient
34 directed doctor’s order to be on a form adopted by
35 department rule; specifying requirements for the form;
36 authorizing a legal representative to revoke a PDDO
37 form on behalf of a patient, with an exception;
38 providing legal representatives with immunity from
39 criminal and civil liability for, in good faith,
40 executing a PDDO form on behalf of a patient;
41 providing for expedited judicial intervention under
42 certain circumstances; providing duties of the
43 department; providing for the recognition of PDDO
44 forms executed by a provider from a different health
45 care facility or from another state under certain
46 circumstances; providing specified health care
47 professionals immunity from criminal or civil
48 liability for acting in good faith to comply with a
49 PDDO; requiring health care facilities that receive a
50 patient transfer to review the patient’s PDDO form, if
51 any; specifying which document takes precedence when
52 directives in PDDO forms conflict with other advance
53 directives; prohibiting health care facilities and
54 health care providers from requiring execution,
55 revision, or revocation of a PDDO form to receive
56 medical services or for admission to the facility;
57 providing for the revocation of PDDO forms under
58 certain circumstances; providing that the presence or
59 absence of PDDO forms does not affect, impair, or
60 modify certain insurance contracts and may not be the
61 basis for delaying issuance of or refusing to issue
62 certain insurance policies or for modifying premiums;
63 specifying that PDDO forms are invalid if executed in
64 exchange for payment or other remuneration; requiring
65 the agency to create and maintain a database for the
66 optional storage of PDDO forms by the department;
67 providing construction; amending s. 429.255, F.S.;
68 authorizing assisted living facility personnel to
69 withhold or withdraw cardiopulmonary resuscitation or
70 the use of an automated external defibrillator if
71 presented with a PDDO form that contains an order not
72 to resuscitate; providing facility staff and
73 facilities with immunity from criminal prosecution or
74 civil liability for such actions; providing that the
75 absence of a PDDO form does not preclude physicians
76 from withholding or withdrawing cardiopulmonary
77 resuscitation or the use of an automated external
78 defibrillator; amending s. 429.73, F.S.; requiring the
79 agency to adopt rules for the implementation of PDDO
80 forms in adult family-care homes; authorizing
81 providers of such homes to withhold or withdraw
82 cardiopulmonary resuscitation if presented with a PDDO
83 form that contains an order not to resuscitate;
84 providing such providers with immunity from criminal
85 prosecution or civil liability for such actions;
86 amending s. 456.072, F.S.; authorizing licensees to
87 withhold or withdraw cardiopulmonary resuscitation or
88 the use of an automated external defibrillator if
89 presented with orders not to resuscitate or a PDDO
90 form that contains an order not to resuscitate;
91 requiring the department to adopt rules providing for
92 the implementation of such orders or forms; providing
93 licensees with immunity from criminal prosecution or
94 civil liability for withholding or withdrawing
95 cardiopulmonary resuscitation or the use of an
96 automated external defibrillator if presented with
97 such orders or forms; providing that the absence of
98 such orders or forms does not preclude licensees from
99 withholding or withdrawing cardiopulmonary
100 resuscitation or the use of an automated external
101 defibrillator; amending s. 765.205, F.S.; requiring
102 health care surrogates to provide written consent for
103 PDDO forms under certain circumstances; providing an
104 effective date.
105
106 Be It Enacted by the Legislature of the State of Florida:
107
108 Section 1. Paragraph (l) of subsection (3) of section
109 395.1041, Florida Statutes, is amended to read:
110 395.1041 Access to and ensurance of emergency services;
111 transfers; patient rights; diversion programs; reports of
112 controlled substance overdoses.—
113 (3) EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
114 FACILITY OR HEALTH CARE PERSONNEL.—
115 (l) Hospital personnel may withhold or withdraw
116 cardiopulmonary resuscitation if presented with an order not to
117 resuscitate executed pursuant to s. 401.45 or a patient-directed
118 doctor’s order (PDDO) form executed pursuant to s. 401.451 which
119 contains an order not to resuscitate. Facility staff and
120 facilities are shall not be subject to criminal prosecution or
121 civil liability, and are not nor be considered to have engaged
122 in negligent or unprofessional conduct, for withholding or
123 withdrawing cardiopulmonary resuscitation pursuant to such an
124 order or PDDO form. The absence of an order not to resuscitate
125 executed pursuant to s. 401.45 or a PDDO form executed pursuant
126 to s. 401.451 which contains an order not to resuscitate does
127 not preclude a physician from withholding or withdrawing
128 cardiopulmonary resuscitation as otherwise authorized permitted
129 by law.
130 Section 2. Subsection (3) of section 400.142, Florida
131 Statutes, is amended to read:
132 400.142 Emergency medication kits; orders not to
133 resuscitate.—
134 (3) Facility staff may withhold or withdraw cardiopulmonary
135 resuscitation if presented with an order not to resuscitate
136 executed pursuant to s. 401.45 or a patient-directed doctor’s
137 order (PDDO) form executed pursuant to s. 401.451 which contains
138 an order not to resuscitate. Facility staff and facilities are
139 not subject to criminal prosecution or civil liability, or
140 considered to have engaged in negligent or unprofessional
141 conduct, for withholding or withdrawing cardiopulmonary
142 resuscitation pursuant to such an order or PDDO form. The
143 absence of an order not to resuscitate executed pursuant to s.
144 401.45 or a PDDO form executed pursuant to s. 401.451 which
145 contains an order not to resuscitate does not preclude a
146 physician from withholding or withdrawing cardiopulmonary
147 resuscitation as otherwise authorized permitted by law.
148 Section 3. Subsection (7) of section 400.487, Florida
149 Statutes, is amended to read:
150 400.487 Home health service agreements; physician’s,
151 physician assistant’s, and advanced practice registered nurse’s
152 treatment orders; patient assessment; establishment and review
153 of plan of care; provision of services; orders not to
154 resuscitate; patient-directed doctor’s orders for life
155 sustaining treatment.—
156 (7) Home health agency personnel may withhold or withdraw
157 cardiopulmonary resuscitation if presented with an order not to
158 resuscitate executed pursuant to s. 401.45 or a patient-directed
159 doctor’s order (PDDO) form executed pursuant to s. 401.451 which
160 contains an order not to resuscitate. The agency shall adopt
161 rules providing for the implementation of such orders. Home
162 health personnel and agencies are shall not be subject to
163 criminal prosecution or civil liability, and are not nor be
164 considered to have engaged in negligent or unprofessional
165 conduct, for withholding or withdrawing cardiopulmonary
166 resuscitation pursuant to such an order or PDDO form and rules
167 adopted by the agency.
168 Section 4. Paragraph (e) of subsection (1) of section
169 400.605, Florida Statutes, is amended to read:
170 400.605 Administration; forms; fees; rules; inspections;
171 fines.—
172 (1) The agency shall by rule establish minimum standards
173 and procedures for a hospice pursuant to this part. The rules
174 must include:
175 (e) Procedures relating to the implementation of advance
176 advanced directives; patient-directed doctor’s order (PDDO)
177 forms executed pursuant to s. 401.451 which contain orders not
178 to resuscitate; and orders not to resuscitate do-not-resuscitate
179 orders.
180 Section 5. Subsection (8) of section 400.6095, Florida
181 Statutes, is amended to read:
182 400.6095 Patient admission; assessment; plan of care;
183 discharge; death.—
184 (8) The hospice care team may withhold or withdraw
185 cardiopulmonary resuscitation if presented with an order not to
186 resuscitate executed pursuant to s. 401.45 or a patient-directed
187 doctor’s order (PDDO) form executed pursuant to s. 401.451 which
188 contains an order not to resuscitate. The agency shall adopt
189 rules providing for the implementation of such orders. Hospice
190 staff are shall not be subject to criminal prosecution or civil
191 liability, and are not nor be considered to have engaged in
192 negligent or unprofessional conduct, for withholding or
193 withdrawing cardiopulmonary resuscitation pursuant to such an
194 order or PDDO form and applicable rules. The absence of an order
195 to resuscitate executed pursuant to s. 401.45 or a PDDO form
196 executed pursuant to s. 401.451 which contains an order not to
197 resuscitate does not preclude a physician from withholding or
198 withdrawing cardiopulmonary resuscitation as otherwise
199 authorized permitted by law.
200 Section 6. Subsection (4) of section 401.35, Florida
201 Statutes, is amended to read:
202 401.35 Rules.—The department shall adopt rules, including
203 definitions of terms, necessary to carry out the purposes of
204 this part.
205 (4) The rules must establish circumstances and procedures
206 under which emergency medical technicians and paramedics may
207 honor orders by the patient’s physician not to resuscitate
208 executed pursuant to s. 401.45 or patient-directed doctor’s
209 order (PDDO) forms executed pursuant to s. 401.451 which contain
210 orders not to resuscitate and the documentation and reporting
211 requirements for handling such requests.
212 Section 7. Paragraph (a) of subsection (3) of section
213 401.45, Florida Statutes, is amended to read:
214 401.45 Denial of emergency treatment; civil liability.—
215 (3)(a) Resuscitation or other forms of medical intervention
216 may be withheld or withdrawn from a patient by an emergency
217 medical technician, a or paramedic, or another health care
218 professional if evidence of an order not to resuscitate by the
219 patient’s physician or physician assistant or a patient-directed
220 doctor’s order (PDDO) form executed pursuant to s. 401.451 which
221 contains an order not to resuscitate is presented to the
222 emergency medical technician, or paramedic, or other health care
223 professional. To be valid, an order not to resuscitate or not to
224 perform other medical intervention, to be valid, must be on the
225 form adopted by rule of the department. The form must be signed
226 by the patient’s physician or physician assistant and by the
227 patient or, if the patient is incapacitated, the patient’s
228 health care surrogate or proxy as provided in chapter 765,
229 court-appointed guardian as provided in chapter 744, or attorney
230 in fact under a durable power of attorney as provided in chapter
231 709; however, a physician assistant may not sign a patient
232 directed doctor’s order form executed pursuant to s. 401.451
233 which contains an order not to resuscitate. The court-appointed
234 guardian or attorney in fact must have been delegated authority
235 to make health care decisions on behalf of the patient.
236 Section 8. Section 401.451, Florida Statutes, is created to
237 read:
238 401.451 Patient-Directed Doctor’s Order Program.—
239 (1) PATIENT-DIRECTED DOCTOR’S ORDER FORM.—A patient
240 directed doctor’s order (PDDO) must be on a form adopted by
241 department rule which must include the statutory requirements
242 specified in this section and must be executed as required by
243 this section.
244 (a) A PDDO form may be completed only by or for a patient
245 determined by the patient’s physician to have an end-stage
246 condition as defined in s. 765.101 or a patient who, in the good
247 faith clinical judgment of his or her physician, is suffering
248 from at least one terminal medical condition that will likely
249 result in the death of the patient within 1 year.
250 (b) A PDDO form must be signed by the patient’s physician.
251 The form must contain a certification by the physician signing
252 the PDDO form that the physician consulted with the patient
253 signing the form or, if the patient is incapable of making
254 health care decisions for himself or herself or is
255 incapacitated, consulted with the patient’s health care
256 surrogate, proxy, court-appointed guardian, or attorney in fact
257 authorized to execute a PDDO form on behalf of the patient as
258 provided in paragraph (c). The form must also include
259 information about the patient’s care goals and preferences
260 selected as reflected on the PDDO form, specifically relating to
261 the use of and the effect of removal or refusal of life
262 sustaining medical treatment. The physician signing the PDDO
263 form must further indicate the medical circumstance justifying
264 the execution of the PDDO.
265 (c) A PDDO form must also be signed by the patient or, if
266 the patient is incapable of making health care decisions for
267 himself or herself or is incapacitated, the patient’s health
268 care surrogate or proxy as provided in chapter 765, court
269 appointed guardian as provided in chapter 744, or attorney in
270 fact as provided in chapter 709. If a PDDO form is signed by a
271 health care surrogate, proxy, court-appointed guardian, or
272 attorney in fact, the patient’s physician must certify the basis
273 for the authority of the appropriate individual to execute the
274 PDDO form on behalf of the patient, including compliance with
275 chapter 765, chapter 744, or chapter 709.
276 (d) The execution of a PDDO form by the patient
277 automatically revokes any PDDO forms previously executed by the
278 patient.
279 (e) A patient’s health care surrogate, proxy, court
280 appointed guardian, or attorney in fact authorized to execute a
281 PDDO form on behalf of a patient as provided in paragraph (c)
282 may subsequently revoke a PDDO form for a patient, unless a
283 valid advance directive or prior PDDO form executed by the
284 patient expressly forbids changes by a s