F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 219 2024
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 to withhold or
5 withdraw cardiopulmonary resuscitation if presented
6 with a patient-directed doctor's order (PDDO) form
7 that contains an order not to resuscitate; providing
8 such personnel with immunity from criminal prosecution
9 or civil liability for such actions; providing that
10 the absence of such form does not preclude physicians
11 or home health agency personnel from withholding or
12 withdrawing cardiopulmonary resuscitation under
13 certain conditions; amending s. 400.605, F.S.;
14 requiring the Agency for Health Care Administration to
15 adopt by rule procedures for the implementation of
16 PDDO forms in hospice care; amending s. 400.6095,
17 F.S.; authorizing hospice care teams to withhold or
18 withdraw cardiopulmonary resuscitation if presented
19 with a PDDO form; providing hospice staff with
20 immunity from criminal prosecution or civil liability
21 for such actions; providing that the absence of such
22 form does not preclude physicians from withholding or
23 withdrawing cardiopulmonary resuscitation; amending s.
24 401.35, F.S.; requiring the Department of Health to
25 establish circumstances and procedures for honoring
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26 PDDO forms; amending s. 401.45, F.S.; authorizing
27 emergency medical personnel to withhold or withdraw
28 other forms of medical interventions if presented with
29 a PDDO form; prohibiting physician assistants from
30 signing such form; creating s. 401.451, F.S.;
31 establishing the Patient-directed Doctor's Order
32 (PDDO) Program within the department; providing
33 requirements for a PDDO form; providing duties of the
34 department; providing a restriction on the use of such
35 form; providing for the revocation of such form under
36 certain circumstances; specifying which document takes
37 precedence when directives in such form conflict with
38 other advance directives; providing limited immunity
39 for legal representatives and specified health care
40 providers relying in good faith on such form;
41 requiring the review of such form upon transfer of a
42 patient; prohibiting such form from being required as
43 a condition for treatment or admission to a health
44 care facility; providing that the presence or absence
45 of such form does not affect, impair, or modify
46 certain insurance contracts; declaring such form
47 invalid if executed in exchange for payment or other
48 remuneration; requiring the agency to create and
49 update a database for the storage, solely at the
50 option of the patient, of a PDDO form by the
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51 department; providing construction; amending s.
52 429.255, F.S.; authorizing assisted living facility
53 personnel to withhold or withdraw cardiopulmonary
54 resuscitation or the use of an automated external
55 defibrillator if presented with a PDDO form; providing
56 facility staff and facilities with immunity from
57 criminal prosecution or civil liability for such
58 actions; providing that the absence of such form does
59 not preclude physicians from withholding or
60 withdrawing cardiopulmonary resuscitation or the use
61 of an automated external defibrillator; amending s.
62 429.73, F.S.; requiring the agency to adopt rules for
63 the implementation of PDDO forms in adult family-care
64 homes; authorizing providers of such homes to withhold
65 or withdraw cardiopulmonary resuscitation if presented
66 with such form; providing such providers with immunity
67 from criminal prosecution or civil liability for such
68 actions; amending s. 456.072, F.S.; authorizing
69 licensees to withhold or withdraw cardiopulmonary
70 resuscitation or the use of an automated external
71 defibrillator if presented with an order not to
72 resuscitate or a PDDO form; requiring the department
73 to adopt rules providing for the implementation of
74 such order and form; providing licensees with immunity
75 from criminal prosecution or civil liability for
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76 withholding or withdrawing cardiopulmonary
77 resuscitation or the use of an automated external
78 defibrillator if presented with such order or form;
79 providing that the absence of such order or form does
80 not preclude licensees from withholding or withdrawing
81 cardiopulmonary resuscitation or the use of an
82 automated external defibrillator; amending s. 765.205,
83 F.S.; requiring health care surrogates to provide
84 written consent for a PDDO form under certain
85 circumstances; providing an effective date.
86
87 Be It Enacted by the Legislature of the State of Florida:
88
89 Section 1. Paragraph (l) of subsection (3) of section
90 395.1041, Florida Statutes, is amended to read:
91 395.1041 Access to and ensurance of emergency services;
92 transfers; patient rights; diversion programs; reports of
93 controlled substance overdoses.—
94 (3) EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
95 FACILITY OR HEALTH CARE PERSONNEL.—
96 (l) Hospital personnel may withhold or withdraw
97 cardiopulmonary resuscitation if presented with an order not to
98 resuscitate executed pursuant to s. 401.45 or a patient-directed
99 doctor's order (PDDO) form executed pursuant to s. 401.451 that
100 contains an order not to resuscitate. Facility staff and
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101 facilities are shall not be subject to criminal prosecution or
102 civil liability, and are not nor be considered to have engaged
103 in negligent or unprofessional conduct, for withholding or
104 withdrawing cardiopulmonary resuscitation pursuant to such an
105 order or PDDO form. The absence of an order not to resuscitate
106 executed pursuant to s. 401.45 or a PDDO form executed pursuant
107 to s. 401.451 that contains an order not to resuscitate does not
108 preclude a physician from withholding or withdrawing
109 cardiopulmonary resuscitation as otherwise authorized permitted
110 by law.
111 Section 2. Subsection (3) of section 400.142, Flor ida
112 Statutes, is amended to read:
113 400.142 Emergency medication kits; orders not to
114 resuscitate.—
115 (3) Facility staff 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 that
119 contains an order not to resuscitate. Facility staff and
120 facilities are not subject to criminal prosecution or civil
121 liability, or considered to have engaged in negligent or
122 unprofessional conduct, for withholding or withdrawing
123 cardiopulmonary resuscitation pursuant to such an order or PDDO
124 form. The absence of an order not to resuscitate executed
125 pursuant to s. 401.45 or a PDDO form executed pursuant to s.
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126 401.451 that contains an order not to resuscitate does not
127 preclude a physician from withholding or withdrawing
128 cardiopulmonary resuscitation as otherwise authorized permitted
129 by law.
130 Section 3. Subsection (7) of section 400.487, Florida
131 Statutes, is amended to read:
132 400.487 Home health service agreements; physician's,
133 physician assistant's, and advanced practice registered nurse's
134 treatment orders; patient assessment; establishment and review
135 of plan of care; provision of services; orders not to
136 resuscitate; patient-directed doctor's orders for life-
137 sustaining treatment.—
138 (7) Home health agency personnel may withhold or withdraw
139 cardiopulmonary resuscitation if presented with an order not to
140 resuscitate executed pursuant to s. 401.45 or a patient-directed
141 doctor's order (PDDO) form executed pursuant to s. 401.451 that
142 contains an order not to resuscitate. The agency shall adopt
143 rules providing for the implementation of such orders. Home
144 health personnel and agencies are shall not be subject to
145 criminal prosecution or civil liability, and are not nor be
146 considered to have engaged in negligent or unprofessional
147 conduct, for withholding or withdrawing cardiopulmonary
148 resuscitation pursuant to such an order or PDDO form and rules
149 adopted by the agency.
150 Section 4. Paragraph (e) of subsection (1) of section
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151 400.605, Florida Statutes, is amended to read:
152 400.605 Administration; forms; fees; rules; inspections;
153 fines.—
154 (1) The agency shall by rule establish minimum standards
155 and procedures for a hospice pursuant to this part. The rules
156 must include:
157 (e) Procedures relating to the implementation of advance
158 advanced directives; patient-directed doctor's order (PDDO)
159 forms executed pursuant to s. 401.451 that contain orders not to
160 resuscitate; and orders not to resuscitate do-not-resuscitate
161 orders.
162 Section 5. Subsection (8) of section 400.6095, Florida
163 Statutes, is amended to read:
164 400.6095 Patient admission; assessment; plan of care;
165 discharge; death.—
166 (8) The hospice care team may withhold or withdraw
167 cardiopulmonary resuscitation if presented with an order not to
168 resuscitate executed pursuant to s. 401.45 or a patient-directed
169 doctor's order (PDDO) form executed pursuant to s. 401.451 that
170 contains an order not to resuscitate. The agency shall adopt
171 rules providing for the implementation of such orders. Hospice
172 staff are shall not be subject to criminal prosecution or civil
173 liability, and are not nor be considered to have engaged in
174 negligent or unprofessional conduct, for withholding or
175 withdrawing cardiopulmonary resuscitation pursuant to such an
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176 order or PDDO form and applicable rules. The absence of an order
177 to resuscitate executed pursuant to s. 401.45 or a PDDO form
178 executed pursuant to s. 401.451 that contains an order not to
179 resuscitate does not preclude a physician from withholding or
180 withdrawing cardiopulmonary resuscitation as otherwise
181 authorized permitted by law.
182 Section 6. Subsection (4) of section 401.35, Florida
183 Statutes, is amended to read:
184 401.35 Rules.—The department shall adopt rules, including
185 definitions of terms, necessary to carry out the purposes of
186 this part.
187 (4) The rules must establish circumstances and procedures
188 under which emergency medical technicians and paramedics may
189 honor orders by the patient's physician not to resuscitate
190 executed pursuant to s. 401.45 or patient-directed doctor's
191 order (PDDO) forms executed pursuant to s. 401.451 that contain
192 orders not to resuscitate and the documentation and reporting
193 requirements for handling such requests.
194 Section 7. Paragraph (a) of subsection (3) of section
195 401.45, Florida Statutes, is amended to read:
196 401.45 Denial of emergency treatment; civil liability. —
197 (3)(a) Resuscitation or other forms of medical
198 intervention may be withheld or withdrawn from a patient by an
199 emergency medical technician, a or paramedic, or another health
200 care professional if evidence of an order not to resuscitate by
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201 the patient's physician or physician assistant or a patient-
202 directed doctor's order (PDDO) form executed pursuant to s.
203 401.451 that contains an order not to resuscitate is presented
204 to the emergency medical technician, or paramedic, or other
205 health care professional. To be valid, an order not to
206 resuscitate or not to perform other medical intervention, to be
207 valid, must be on the form adopted by rule of the department.
208 The form must be signed by the patient's physician or physician
209 assistant and by the patient or, if the patient is
210 incapacitated, the patient's health care surrogate or proxy as
211 provided in chapter 765, court-appointed guardian as provided in
212 chapter 744, or attorney in fact under a durable power of
213 attorney as provided in chapter 709; however, a physician