HB195 — PHARMACISTS; PHYSICIAN ASSOCIATES

a psychologist or psychological associate licensed under AS 08.86;

or a social worker licensed under AS 08.95;

(B) a physician licensed in another state;

or (C) a member of a multidisciplinary care team who is licensed in another state;

* Sec.

3.

AS 08.02.130(j)(4) is amended to read:

(4) "member of a multidisciplinary care team" means an audiologist, speech-language pathologist, behavior analyst, professional counselor, dietitian, nutritionist, naturopath, marital and family therapist, podiatrist, osteopath, physician associate [ASSISTANT], nurse, pharmacist, physical therapist, occupational therapist, psychologist or psychological associate, advanced nurse practitioner, or social worker who is a member of a team coordinated by a physician licensed in another state who meets the requirements of (b)(3) of this section;

* Sec.

4.

AS 08.02 is amended by adding a new section to article 3 to read:

Sec.

08.02.150.

Regulation of collaborative practice agreements.

(a) The department or a board may not Enrolled HB 195 -2- (1) require a pharmacist to pay a fee to enter into, or provide patient care services under, a collaborative practice agreement;

(2) require department or board approval of a collaborative practice agreement;

(3) define the nature and scope of patient care services a pharmacist provides under a collaborative practice agreement;

or (4) otherwise regulate collaborative practice agreements.

(b) In this section, (1) "collaborative practice agreement" means a collaborative practice agreement authorized under AS 08.80.337(a);

and (2) "patient care services" has the meaning given in AS 08.80.337(d).

* Sec.

5.

AS 08.36.355(c) is amended by adding a new paragraph to read:

(4) "opioid overdose drug" has the meaning given in AS 17.20.085(g).

* Sec.

6.

AS 08.36.355 is amended by adding a new subsection to read:

(d) A licensee who issues a prescription for an opioid to a patient shall offer the patient a prescription for an opioid overdose drug if (1) the prescription is for an opioid that exceeds a three-day supply;

(2) the prescription is for a total daily opioid dosage representing a morphine milligram equivalent of 50 milligrams or more;

(3) the patient is concurrently prescribed a benzodiazepine;

or (4) the patient has a history of overdose or substance use disorder.

* Sec.

7.

AS 08.64.010 is amended to read:

Sec.

08.64.010.

Creation and membership of State Medical Board.

The governor shall appoint a board of medical examiners, to be known as the State Medical Board, consisting of five physicians licensed in the state and residing in as many separate geographical areas of the state as possible, one physician associate [ASSISTANT] licensed under AS 08.64.107, and two persons with no direct financial interest in the health care industry.

* Sec.

8.

AS 08.64.101(a) is amended to read:

(a) The board shall (1) except as provided in regulations adopted by the board under (b) of -3- Enrolled HB 195 this section, examine and issue licenses to applicants;

(2) develop written guidelines to ensure that licensing requirements are not unreasonably burdensome and the issuance of licenses is not unreasonably withheld or delayed;

(3) after a hearing, impose disciplinary sanctions on persons who violate this chapter or the regulations or orders of the board;

(4) adopt regulations ensuring that renewal of licenses is contingent on proof of continued competency on the part of the licensee;

(5) under regulations adopted by the board, contract with private professional organizations to establish an impaired medical professionals program to identify, confront, evaluate, and treat persons licensed under this chapter who abuse alcohol, other drugs, or other substances or are mentally ill or cognitively impaired;

(6) adopt regulations that establish guidelines for a physician or physician associate [ASSISTANT] who is rendering a diagnosis, providing treatment, or prescribing, dispensing, or administering a prescription drug to a person without conducting a physical examination under AS 08.64.364;

the guidelines must include a nationally recognized model policy for standards of care of a patient who is at a different location than the physician or physician associate [ASSISTANT];

(7) require that a licensee who has a federal Drug Enforcement Administration registration number register with the controlled substance prescription database under AS 17.30.200(n).

* Sec.

9.

AS 08.64.106 is amended to read:

Sec.

08.64.106.

Delegation of routine medical duties.

The board shall adopt regulations authorizing a physician, podiatrist, osteopath, or physician associate [ASSISTANT] licensed under this chapter to delegate routine medical duties to an agent of the physician, podiatrist, osteopath, or physician associate [ASSISTANT].

The regulations must (1) require that an agent who is not licensed under this chapter may perform duties delegated under this section only if the agent meets applicable standards established by the board;

(2) require that a physician, podiatrist, osteopath, or physician Enrolled HB 195 -4- associate [ASSISTANT] may not delegate duties related to pain management and opioid use and addiction;

and (3) define the phrase "routine medical duties." * Sec.

10.

AS 08.64.107 is amended to read:

Sec.

08.64.107.

Regulation of physician associates [ASSISTANTS].

The board shall adopt regulations regarding the licensure of physician associates [ASSISTANTS] and the medical services that they may perform, including the (1) educational and other qualifications, including education in pain management and opioid use and addiction;

(2) application and licensing procedures;

(3) scope of activities authorized;

and (4) responsibilities of the supervising or training physician.

* Sec.

11.

AS 08.64.170(a) is amended to read:

(a) A person may not practice medicine, podiatry, or osteopathy in the state unless the person is licensed under this chapter, except that (1) a physician associate [ASSISTANT] may examine, diagnose, or treat persons under the supervision, control, and responsibility of either a physician licensed under this chapter or a physician exempted from licensing under AS 08.64.370;

(2) a person who is licensed or authorized under another law of the state may engage in a practice that is authorized under that law;

and (3) a person may perform routine medical duties delegated under AS 08.64.106.

* Sec.

12.

AS 08.64.360 is amended to read:

Sec.

08.64.360.

Penalty for practicing without a license or in violation of law.

Except for a physician associate [ASSISTANT] or a person licensed or authorized under another law of the state who engages in practices for which that person is licensed or authorized under that law, a person practicing medicine or osteopathy in the state without a valid license or permit is guilty of a class A misdemeanor.

Each day of illegal practice is a separate offense.

* Sec.

13.

AS 08.64.363(c) is amended by adding a new paragraph to read:

-5- Enrolled HB 195 (4) "opioid overdose drug" has the meaning given in AS 17.20.085(g).

* Sec.

14.

AS 08.64.363 is amended by adding a new subsection to read:

(d) A licensee who issues a prescription for an opioid to a patient shall offer the patient a prescription for an opioid overdose drug if (1) the prescription is for an opioid that exceeds a three-day supply;

(2) the prescription is for a total daily opioid dosage representing a morphine milligram equivalent of 50 milligrams or more;

(3) the patient is concurrently prescribed a benzodiazepine;

or (4) the patient has a history of overdose or substance use disorder.

* Sec.

15.

AS 08.64.364(a) is amended to read:

(a) The board may not impose disciplinary sanctions on a physician or physician associate [ASSISTANT] for rendering a diagnosis, providing treatment, or prescribing, dispensing, or administering a prescription drug that is not a controlled substance to a person without conducting a physical examination if (1) the physician, physician associate [ASSISTANT], or another licensed health care provider in the medical practice is available to provide follow-up care;

and (2) the physician or physician associate [ASSISTANT] requests that the person consent to sending a copy of all records of the encounter to the person's primary care provider if the prescribing physician or physician associate [ASSISTANT] is not the person's primary care provider and, if the person consents, the physician or physician associate [ASSISTANT] sends the records to the person's primary care provider.

* Sec.

16.

AS 08.64.364(b) is amended to read:

(b) The board may not impose disciplinary sanctions on a physician or physician associate [ASSISTANT] for prescribing, dispensing, or administering a prescription drug that is a controlled substance if the requirements under (a) of this section and AS 08.64.363 are met.

* Sec.

17.

AS 08.64.364(c) is amended to read:

(c) Notwithstanding (a) and (b) of this section, (1) a physician may not prescribe, dispense, or administer an abortion- Enrolled HB 195 -6- inducing drug under (a) of this section unless the physician complies with AS 18.16.010;

and (2) a physician or physician associate [ASSISTANT] may not prescribe, dispense, or administer a prescription drug in response to an Internet questionnaire or electronic mail message to a person with whom the physician or physician associate [ASSISTANT] does not have a prior physician-patient relationship.

* Sec.

18.

AS 08.64.369(d) is amended to read:

(d) In this section, "health care professional" includes an emergency medical technician certified under AS 18.08, health aide, physician, nurse, mobile intensive care paramedic licensed under AS 18.08, and physician associate [ASSISTANT], but does not include a practitioner of religious healing.

* Sec.

19.

AS 08.65.140 is amended to read:

Sec.

08.65.140.

Required practices.

The board shall adopt regulations regarding the practice of direct-entry midwifery.

At a minimum, the regulations must require that a certified direct-entry midwife (1) recommend, before care or delivery of a client, that the client undergo a physical examination performed by a physician, physician associate [ASSISTANT], or advanced practice registered nurse who is licensed in this state;

(2) obtain informed consent from a client before onset of labor;

(3) comply with AS 18.15.150 regarding taking of blood samples, AS 18.15.200 regarding screening of phenylketonuria (PKU), AS 18.50.160 regarding birth registration, AS 18.50.230 regarding registration of deaths, AS 18.50.240 regarding fetal death registration, and regulations adopted by the Department of Health concerning prophylactic treatment of the eyes of newborn infants;

(4) not knowingly deliver a woman with certain types of health conditions, prior history, or complications as specified by the board.

* Sec.

20.

AS 08.68.265 is amended to read:

Sec.

08.68.265.

Supervision of practical nurses.

A practical nurse shall work under the supervision of a licensed registered or advanced practice registered nurse, a licensed physician, a licensed physician associate [ASSISTANT], or a licensed -7- Enrolled HB 195 dentist.

* Sec.

21.

AS 08.68.700(a) is amended to read:

(a) A registered nurse licensed under this chapter may make a determination and pronouncement of death of a person under the following circumstances:

(1) an attending physician, an attending advanced practice registered nurse, or an attending physician associate [ASSISTANT] has documented in the person's medical or clinical record that the person's death is anticipated due to illness, infirmity, or disease;

this prognosis is valid for purposes of this section for not more than 120 days from the date of the documentation;

(2) at the time of documentation under (1) of this subsection, the physician, the advanced practice registered nurse, or the physician associate [ASSISTANT] authorized in writing a specific registered nurse or nurses to make a determination and pronouncement of the person's death;

however, if the person is in a health care facility and the health care facility has complied with (d) of this section, the physician, the advanced practice registered nurse, or the physician associate [ASSISTANT] may authorize all nurses employed by the facility to make a determination and pronouncement of the person's death.

* Sec.

22.

AS 08.68.700(b) is amended to read:

(b) A registered nurse who has determined and pronounced death under this section shall document the clinical criteria for the determination and pronouncement in the person's medical or clinical record and notify the physician, the advanced practice registered nurse, or the physician associate [ASSISTANT] who determined that the prognosis for the patient was for an anticipated death.

The registered nurse shall sign the death certificate, which must include the (1) name of the deceased;

(2) presence of a contagious disease, if known;

and (3) date and time of death.

* Sec.

23.

AS 08.68.700(c) is amended to read:

(c) Except as otherwise provided under AS 18.50.230, a physician or physician associate [ASSISTANT] licensed under AS 08.64 or an advanced practice registered nurse licensed under this chapter shall certify a death determined under (b) Enrolled HB 195 -8- of this section within 24 hours after the pronouncement by the registered nurse.

* Sec.

24.

AS 08.68.700(d) is amended to read:

(d) In a health care facility in which a physician, an advanced practice registered nurse, or a physician associate [ASSISTANT] chooses to proceed under (a) of this section, written policies and procedures shall be adopted that provide for the determination and pronouncement of death by a registered nurse authorized by a physician, an advanced practice registered nurse, or a physician associate [ASSISTANT] under this section.

A registered nurse employed by a health care facility and authorized by a physician, an advanced practice registered nurse, or a physician associate [ASSISTANT] to make a determination and pronouncement of death under this section may not make the determination or pronouncement unless the facility has written policies and procedures implementing and ensuring compliance with this section.

* Sec.

25.

AS 08.68.705(d) is amended by adding a new paragraph to read:

(4) "opioid overdose drug" has the meaning given in AS 17.20.085(g).

* Sec.

26.

AS 08.68.705 is amended by adding a new subsection to read:

(e) An advanced practice registered nurse who issues a prescription for an opioid to a patient shall offer the patient a prescription for an opioid overdose drug if (1) the prescription is for an opioid that exceeds a three-day supply;

(2) the prescription is for a total daily opioid dosage representing a morphine milligram equivalent of 50 milligrams or more;

(3) the patient is concurrently prescribed a benzodiazepine;

or (4) the patient has a history of overdose or substance use disorder.

* Sec.

27.

AS 08.72.276 is amended by adding new subsections to read:

(c) A licensee who issues a prescription for an opioid to a patient shall offer the patient a prescription for an opioid overdose drug if (1) the prescription is for an opioid that exceeds a three-day supply;

(2) the prescription is for a total daily opioid dosage representing a morphine milligram equivalent of 50 milligrams or more;

(3) the patient is concurrently prescribed a benzodiazepine;

or (4) the patient has a history of overdose or substance use disorder.

-9- Enrolled HB 195 (d) In this section, "opioid overdose drug" has the meaning given in AS 17.20.085(g).

* Sec.

28.

HB0195a -1- HB 195 New Text Underlined [DELETED TEXT BRACKETED] 34-LS0909\A (4) adopt regulations to carry out the purposes of this chapter;

(11) establish and maintain a controlled substance prescription Enrolled HB 195 -10- database as provided in AS 17.30.200;

(14) require that a licensed pharmacist who prescribes, administers, or dispenses a schedule IA, IIA, IIIA, IVA, or VA controlled substance under state law or schedule II, III, [OR] IV, or VIV controlled substance under federal law to a person in the state register with the controlled substance prescription database under HB 195 -2- HB0195a New Text Underlined [DELETED TEXT BRACKETED] 34-LS0909\A AS 17.30.200(n);

2.29.

-11- Enrolled HB 195 (4) have completed internship training or another program that has been approved by the board or demonstrated to the board's satisfaction that the applicant has experience in the practice of pharmacy that meets or exceeds the minimum internship requirements of the board;

3.30.

If another jurisdiction allows HB0195a -3- HB 195 New Text Underlined [DELETED TEXT BRACKETED] 34-LS0909\A licensure in that jurisdiction of a pharmacist licensed in this state under conditions similar to those in this section, the board may license as a pharmacist in this state a person licensed as a pharmacist in the other jurisdiction if the person (1) submits a written application to the board on a form required by the board;

4.31.

AS 08.80.157(j) is amended to read:

Enrolled HB 195 -12- (j) This section does not apply to the offices of physicians, osteopaths, podiatrists, physician associates [ASSISTANTS], advanced nurse practitioners, dentists, veterinarians, dispensing opticians, or optometrists.

* Sec.

32.

The continuing education requirements must include at least two hours of education in pain management and opioid use and addiction induring the twoconcluding yearslicensing precedingperiod. an application for renewal of a license.

or (2) the licensee does not currently hold a valid federal Drug HB 195 -4- HB0195a New Text Underlined [DELETED TEXT BRACKETED] 34-LS0909\A Enforcement Administration registration number.

5.33.

The collaborative practice agreement must define the nature and scope of patient care services the pharmacist may provide under the agreement.

6.34.

AS 08.80.337(b) is amended to read:

(b) A pharmacist may independently provide patient care services for (1) general health and wellness;

(2) disease prevention;

or (3) a condition that (A) is minor and generally self limiting;

(B) does not require a new diagnosis;

(C) requires a new diagnosis only if (i) the pharmacist uses [(B) HAS] a test [THAT IS USED] to guide the pharmacist's diagnosis or clinical decision- -13- Enrolled HB 195 making;

and (ii) the test is waived under 42 U.S.C.

263a (Clinical Laboratory Improvement Amendments of 1988);

or (D) [(C)] falls under a statewide standing order from the chief medical officer in the Department of Health.

* Sec.

35.

(d) In this section, "patient care services" (1) means medical care services, including the prescription or administration of a drug or device to a patient, that are given in exchange for compensation and intended to achieve outcomes related to the cure or prevention of a disease, elimination or reduction of a patient's symptoms, or arresting or slowing of a disease process.process;

(2) does not include the prescription or administration of the following drugs unless the drug is being used for the treatment of an opioid use disorder in a clinic:

(A) a schedule IA or IIA controlled substance under state law or a schedule II controlled substance under federal law;

(B) a drug that may only be prescribed or administered after completing a certified education program required by (i) the manufacturer;

or (ii) the United States Food and Drug Administration, including by a risk evaluation and mitigation strategy;

or (C) a drug that is not generally available at pharmacies and may only be dispensed at a pharmacy that (i) is authorized by the manufacturer to dispense the drug;

or (ii) meets a requirement to dispense the drug under federal law.

7.36.

(e) A pharmacist prescribing or administering a drug or device under this Enrolled HB 195 -14- section shall recognize the limits of the pharmacist's education, training, and experience and consult with and refer to other practitioners as appropriate.

8.37.

AS 08.80.400 is amended to read:

Sec.

08.80.400.

Other licensees not affected.

This chapter does not affect the practice of medicine by a licensed medical doctor and does not limit a licensed medical doctor, osteopath, podiatrist, physician associate [ASSISTANT], advanced practice registered nurse, dentist, veterinarian, dispensing optician, or optometrist in supplying a patient with any medicinal preparation or article within the scope of the person's license.

* Sec.

38.

9.39.

10.40.

AS 09.55.560(2) is amended to read:

(2) "health care provider" means an acupuncturist licensed under AS 08.06;

an audiologist or speech-language pathologist licensed under AS 08.11;

a chiropractor licensed under AS 08.20;

a dental hygienist licensed under AS 08.32;

a dentist licensed under AS 08.36;

a nurse licensed under AS 08.68;

a dispensing optician licensed under AS 08.71;

a naturopath licensed under AS 08.45;

an optometrist licensed under AS 08.72;

a pharmacist licensed under AS 08.80;

a -15- Enrolled HB 195 physical therapist or occupational therapist licensed under AS 08.84;

a physician or physician associate [ASSISTANT] licensed under AS 08.64;

a podiatrist;

a psychologist and a psychological associate licensed under AS 08.86;

a hospital as defined in AS 47.32.900, including a governmentally owned or operated hospital;

an employee of a health care provider acting within the course and scope of employment;

an ambulatory surgical facility and other organizations whose primary purpose is the delivery of health care, including a health maintenance organization, individual practice association, integrated delivery system, preferred provider organization or arrangement, and a physical hospital organization;

* Sec.

41.

AS 09.65.300(c)(1) is amended to read:

(1) "health care provider" means a physician, physician associate [ASSISTANT], dentist, dental hygienist, osteopath, optometrist, chiropractor, registered nurse, practical nurse, advanced practice registered nurse, naturopath, physical therapist, occupational therapist, marital and family therapist, psychologist, psychological associate, behavior analyst, assistant behavior analyst, licensed clinical social worker, athletic trainer, certified direct-entry midwife, licensed professional counselor, or licensed associate counselor;

* Sec.

42.

AS 09.65.340(d)(1) is amended to read:

(1) "health care provider" means a licensed physician, osteopath, dentist, advanced nurse practitioner, physician associate [ASSISTANT], nurse, village health aide, or pharmacist operating within the scope of the health care provider's authority;

* Sec.

43.

AS 09.68.120 is amended to read:

Sec.

09.68.120.

Definition of death.

An individual is considered dead if, in the opinion of a physician licensed or exempt from licensing under AS 08.64 or a registered nurse authorized to pronounce death under AS 08.68.700, based on acceptable medical standards, or in the opinion of a mobile intensive care paramedic, physician associate [ASSISTANT], or emergency medical technician authorized to pronounce death based on the medical standards in AS 18.08.089, the individual has sustained irreversible cessation of circulatory and respiratory functions, or irreversible cessation of all functions of the entire brain, including the brain stem.

Death may be Enrolled HB 195 -16- pronounced in this circumstance before artificial means of maintaining respiratory and cardiac function are terminated.

* Sec.

44.

AS 11.41.470(1) is amended to read:

(1) "health care worker" includes a person who is or purports to be an acupuncturist, advanced practice registered nurse, anesthesiologist, certified direct- entry midwife, chiropractor, dentist, health aide, hypnotist, massage therapist, mental health counselor, midwife, nurse, occupational therapist, occupational therapy assistant, osteopath, naturopath, physical therapist, physical therapist assistant, physician, physician associate [ASSISTANT], psychiatrist, psychological associate, psychologist, radiologist, religious healing practitioner, surgeon, x-ray technician, or a substantially similar position;

* Sec.

45.

AS 11.71.900(20) is amended to read:

(20) "practitioner" means (A) a physician, dentist, advanced practice registered nurse, optometrist, veterinarian, scientific investigator, or other person licensed, registered, or otherwise permitted to distribute, dispense, conduct research with respect to, or to administer or use in teaching or chemical analysis a controlled substance in the course of professional practice or research in the state;

(B) a pharmacist prescribing or administering a controlled substance in the course of professional practice in the state;

or (C) [(B)] a pharmacy, hospital, or other institution licensed, registered, or otherwise permitted to distribute, dispense, conduct research with respect to, or to administer a controlled substance in the course of professional practice or research in the state;

* Sec.

46.

AS 12.55.135(k)(3) is amended to read:

(3) "medical professional" means a person who is an advanced practice registered nurse, anesthesiologist, chiropractor, dental hygienist, dentist, health aide, nurse, nurse aide, mental health counselor, osteopath, physician, physician associate [ASSISTANT], psychiatrist, psychological associate, psychologist, radiologist, surgeon, or x-ray technician, or who holds a substantially similar position.

* Sec.

47.

AS 13.52.065(a) is amended to read:

-17- Enrolled HB 195 (a) A physician, an advanced practice registered nurse, or a physician associate [ASSISTANT] may issue a do not resuscitate order for a patient of the physician, the advanced practice registered nurse, or the physician associate [ASSISTANT] with the consent of the patient or the parent or guardian of the patient if the patient is under 18 years of age.

The physician, the advanced practice registered nurse, or the physician associate [ASSISTANT] shall document the grounds for the order in the patient's medical file.

* Sec.

48.

AS 13.52.065(c) is amended to read:

(c) The department shall develop standardized designs and symbols for do not resuscitate identification cards, forms, necklaces, and bracelets that signify, when carried or worn, that the carrier or wearer is an individual for whom a physician, an advanced practice registered nurse, or a physician associate [ASSISTANT] has issued a do not resuscitate order.

* Sec.

49.

AS 13.52.065(d) is amended to read:

(d) A health care provider other than a physician, an advanced practice registered nurse, or a physician associate [ASSISTANT] shall comply with the protocol adopted under (b) of this section for do not resuscitate orders when the health care provider is presented with a do not resuscitate identification, an oral do not resuscitate order issued directly by a physician, an advanced practice registered nurse, or a physician associate [ASSISTANT] if the applicable hospital allows oral do not resuscitate orders, or a written do not resuscitate order entered on and as required by a form prescribed by the department.

* Sec.

50.

AS 13.52.065(f) is amended to read:

(f) A do not resuscitate order may not be made ineffective unless a physician, an advanced practice registered nurse, or a physician associate [ASSISTANT] revokes the do not resuscitate order, a patient for whom the order is written and who has capacity requests that the do not resuscitate order be revoked, or the patient for whom the order is written is under 18 years of age and the parent or guardian of the patient requests that the do not resuscitate order be revoked.

Any physician, advanced practice registered nurse, or physician associate [ASSISTANT] of a patient for whom a do not resuscitate order is written may revoke the do not resuscitate order if the person for Enrolled HB 195 -18- whom the order is written requests that the physician, the advanced practice registered nurse, or the physician associate [ASSISTANT] revoke the do not resuscitate order.

* Sec.

51.

AS 13.52.080(a) is amended to read:

(a) A health care provider or health care institution that acts in good faith and in accordance with generally accepted health care standards applicable to the health care provider or institution is not subject to civil or criminal liability or to discipline for unprofessional conduct for (1) providing health care information in good faith under AS 13.52.070;

(2) complying with a health care decision of a person based on a good faith belief that the person has authority to make a health care decision for a patient, including a decision to withhold or withdraw health care;

(3) declining to comply with a health care decision of a person based on a good faith belief that the person then lacked authority;

(4) complying with an advance health care directive and assuming in good faith that the directive was valid when made and has not been revoked or terminated;

(5) participating in the withholding or withdrawal of cardiopulmonary resuscitation under the direction or with the authorization of a physician, an advanced practice registered nurse, or a physician associate [ASSISTANT] or upon discovery of do not resuscitate identification on [UPON] an individual;

(6) causing or participating in providing cardiopulmonary resuscitation or other life-sustaining procedures (A) under AS 13.52.065(e) when an individual has made an anatomical gift;

(B) because an individual has made a do not resuscitate order ineffective under AS 13.52.065(f) or another provision of this chapter;

or (C) because the patient is a woman of childbearing age and AS 13.52.055 applies;

or (7) acting in good faith under the terms of this chapter or the law of another state relating to anatomical gifts.

-19- Enrolled HB 195 * Sec.

52.

AS 13.52.100(c) is amended to read:

(c) An individual who is a qualified patient, including an individual for whom a physician, an advanced practice registered nurse, or a physician associate [ASSISTANT] has issued a do not resuscitate order, has the right to make a decision regarding the use of cardiopulmonary resuscitation and other life-sustaining procedures as long as the individual is able to make the decision.

If an individual who is a qualified patient, including an individual for whom a physician, advanced practice registered nurse, or physician associate [ASSISTANT] has issued a do not resuscitate order, is not able to make the decision, the protocol adopted under AS 13.52.065 for do not resuscitate orders governs a decision regarding the use of cardiopulmonary resuscitation and other life-sustaining procedures.

* Sec.

53.

AS 13.52.300 is amended to read:

Sec.

13.52.300.

Optional form.

The following sample form may be used to create an advance health care directive.

The other sections of this chapter govern the effect of this or any other writing used to create an advance health care directive.

This form may be duplicated.

This form may be modified to suit the needs of the person, or a different form that complies with this chapter may be used, including the mandatory witnessing requirements:

ADVANCE HEALTH CARE DIRECTIVE Explanation You have the right to give instructions about your own health care to the extent allowed by law.

You also have the right to name someone else to make health care decisions for you to the extent allowed by law.

This form lets you do either or both of these things.

It also lets you express your wishes regarding the designation of your health care provider.

If you use this form, you may complete or modify all or any part of it.

You are free to use a different form if the form complies with the requirements of AS 13.52.

Part 1 of this form is a durable power of attorney for health care.

A "durable power of attorney for health care" means the designation of an agent to make health care decisions for you.

Part 1 Enrolled HB 195 -20- lets you name another individual as an agent to make health care decisions for you if you do not have the capacity to make your own decisions or if you want someone else to make those decisions for you now even though you still have the capacity to make those decisions.

You may name an alternate agent to act for you if your first choice is not willing, able, or reasonably available to make decisions for you.

Unless related to you, your agent may not be an owner, operator, or employee of a health care institution where you are receiving care.

Unless the form you sign limits the authority of your agent, your agent may make all health care decisions for you that you could legally make for yourself.

This form has a place for you to limit the authority of your agent.

You do not have to limit the authority of your agent if you wish to rely on your agent for all health care decisions that may have to be made.

If you choose not to limit the authority of your agent, your agent will have the right, to the extent allowed by law, to (a) consent or refuse consent to any care, treatment, service, or procedure to maintain, diagnose, or otherwise affect a physical or mental condition, including the administration or discontinuation of psychotropic medication;

(b) select or discharge health care providers and institutions;

(c) approve or disapprove proposed diagnostic tests, surgical procedures, and programs of medication;

(d) direct the provision, withholding, or withdrawal of artificial nutrition and hydration and all other forms of health care;

and (e) make an anatomical gift following your death.

Part 2 of this form lets you give specific instructions for any aspect of your health care to the extent allowed by law, except you may not authorize mercy killing, assisted suicide, or euthanasia.

Choices are provided for you to express your wishes regarding the provision, withholding, or withdrawal of treatment to keep you alive, including the provision of artificial nutrition and hydration, as well as the -21- Enrolled HB 195 provision of pain relief medication.

Space is provided for you to add to the choices you have made or for you to write out any additional wishes.

Part 3 of this form lets you express an intention to make an anatomical gift following your death.

Part 4 of this form lets you make decisions in advance about certain types of mental health treatment.

Part 5 of this form lets you designate a physician to have primary responsibility for your health care.

After completing this form, sign and date the form at the end and have the form witnessed by one of the two alternative methods listed below.

Give a copy of the signed and completed form to your physician, to any other health care providers you may have, to any health care institution at which you are receiving care, and to any health care agents you have named.

You should talk to the person you have named as your agent to make sure that the person understands your wishes and is willing to take the responsibility.

You have the right to revoke this advance health care directive or replace this form at any time, except that you may not revoke this declaration when you are determined not to be competent by a court, by two physicians, at least one of whom shall be a psychiatrist, or by both a physician and a professional mental health clinician.

In this advance health care directive, "competent" means that you have the capacity (1) to assimilate relevant facts and to appreciate and understand your situation with regard to those facts;

and (2) to participate in treatment decisions by means of a rational thought process.

PART 1 DURABLE POWER OF ATTORNEY FOR HEALTH CARE DECISIONS (1) DESIGNATION OF AGENT.

I designate the Enrolled HB 195 -22- following individual as my agent to make health care decisions for me:

_________________________________________________________ (name of individual you choose as agent) _________________________________________________________ (address) (city) (state) (zip code) _________________________________________________________ (home telephone) (work telephone) OPTIONAL:

If I revoke my agent's authority or if my agent is not willing, able, or reasonably available to make a health care decision for me, I designate as my first alternate agent _________________________________________________________ (name of individual you choose as first alternate agent) _________________________________________________________ (address) (city) (state) (zip code) _________________________________________________________ (home telephone) (work telephone) OPTIONAL:

If I revoke the authority of my agent and first alternate agent or if neither is willing, able, or reasonably available to make a health care decision for me, I designate as my second alternate agent _________________________________________________________ (name of individual you choose as second alternate agent) _________________________________________________________ (address) (city) (state) (zip code) _________________________________________________________ (home telephone) (work telephone) (2) AGENT'S AUTHORITY.

My agent is authorized and directed to follow my individual instructions and my other wishes to the extent known to the agent in making all health care decisions for me.

If these are not known, my agent is authorized to make these decisions in accordance with my best interest, including decisions to -23- Enrolled HB 195 provide, withhold, or withdraw artificial hydration and nutrition and other forms of health care to keep me alive, except as I state here:

_________________________________________________________ _________________________________________________________ _________________________________________________________ (Add additional sheets if needed.) Under this authority, "best interest" means that the benefits to you resulting from a treatment outweigh the burdens to you resulting from that treatment after assessing (A) the effect of the treatment on your physical, emotional, and cognitive functions;

(B) the degree of physical pain or discomfort caused to you by the treatment or the withholding or withdrawal of the treatment;

(C) the degree to which your medical condition, the treatment, or the withholding or withdrawal of treatment, results in a severe and continuing impairment;

(D) the effect of the treatment on your life expectancy;

(E) your prognosis for recovery, with and without the treatment;

(F) the risks, side effects, and benefits of the treatment or the withholding of treatment;

and (G) your religious beliefs and basic values, to the extent that these may assist in determining benefits and burdens.

(3) WHEN AGENT'S AUTHORITY BECOMES EFFECTIVE.

Except in the case of mental illness, my agent's authority becomes effective when my primary physician determines that I am unable to make my own health care decisions unless I mark the following box.

In the case of mental illness, unless I mark the Enrolled HB 195 -24- following box, my agent's authority becomes effective when a court determines I am unable to make my own decisions, or, in an emergency, if my primary physician or another health care provider determines I am unable to make my own decisions.

If I mark this box [ ], my agent's authority to make health care decisions for me takes effect immediately.

(4) AGENT'S OBLIGATION.

My agent shall make health care decisions for me in accordance with this durable power of attorney for health care, any instructions I give in Part 2 of this form, and my other wishes to the extent known to my agent.

To the extent my wishes are unknown, my agent shall make health care decisions for me in accordance with what my agent determines to be in my best interest.

In determining my best interest, my agent shall consider my personal values to the extent known to my agent.

(5) NOMINATION OF GUARDIAN.

If a guardian of my person needs to be appointed for me by a court, I nominate the agent designated in this form.

If that agent is not willing, able, or reasonably available to act as guardian, I nominate the alternate agents whom I have named under (1) above, in the order designated.

PART 2 INSTRUCTIONS FOR HEALTH CARE If you are satisfied to allow your agent to determine what is best for you in making health care decisions, you do not need to fill out this part of the form.

If you do fill out this part of the form, you may strike any wording you do not want.

There is a state protocol that governs the use of do not resuscitate orders by physicians, advanced practice registered nurses, physician associates [ASSISTANTS], and other health care providers.

You may obtain a copy of the protocol from the Alaska Department of Health.

A "do not resuscitate order" means a directive from a licensed physician, advanced practice registered nurse, or physician associate [ASSISTANT] that emergency cardiopulmonary -25- Enrolled HB 195 resuscitation should not be administered to you.

(6) END-OF-LIFE DECISIONS.

Except to the extent prohibited by law, I direct that my health care providers and others involved in my care provide, withhold, or withdraw treatment in accordance with the choice I have marked below:

(Check only one box.) [ ] (A) Choice To Prolong Life I want my life to be prolonged as long as possible within the limits of generally accepted health care standards;

OR [ ] (B) Choice Not To Prolong Life I want comfort care only and I do not want my life to be prolonged with medical treatment if, in the judgment of my physician, I have (check all choices that represent your wishes) [ ] (i) a condition of permanent unconsciousness:

a condition that, to a high degree of medical certainty, will last permanently without improvement;

in which, to a high degree of medical certainty, thought, sensation, purposeful action, social interaction, and awareness of myself and the environment are absent;

and for which, to a high degree of medical certainty, initiating or continuing life- sustaining procedures for me, in light of my medical outcome, will provide only minimal medical benefit for me;

or [ ] (ii) a terminal condition:

an incurable or irreversible illness or injury that without the administration of life-sustaining procedures will result in my death in a short period of time, for which there is no reasonable prospect of cure or recovery, that imposes Enrolled HB 195 -26- severe pain or otherwise imposes an inhumane burden on me, and for which, in light of my medical condition, initiating or continuing life-sustaining procedures will provide only minimal medical benefit;

[ ] Additional instructions:

________________ ___________________________________________________ (C) Artificial Nutrition and Hydration.

If I am unable to safely take nutrition, fluids, or nutrition and fluids (check your choices or write your instructions), [ ] I wish to receive artificial nutrition and hydration indefinitely;

[ ] I wish to receive artificial nutrition and hydration indefinitely, unless it clearly increases my suffering and is no longer in my best interest;

[ ] I wish to receive artificial nutrition and hydration on a limited trial basis to see if I can improve;

[ ] In accordance with my choices in (6)(B) above, I do not wish to receive artificial nutrition and hydration.

[ ] Other instructions:_____________________ ___________________________________________________ (D) Relief from Pain.

[ ] I direct that adequate treatment be provided at all times for the sole purpose of the alleviation of pain or discomfort;

or [ ] I give these instructions:

_____________________________________________ _____________________________________________ (E) Should I become unconscious and I am pregnant, I direct that ________________________ _____________________________________________ _____________________________________________ -27- Enrolled HB 195 (7) OTHER WISHES.

(If you do not agree with any of the optional choices above and wish to write your own, or if you wish to add to the instructions you have given above, you may do so here.) I direct that _________________________________________________________ _________________________________________________________ Conditions or limitations:

______________________________ _________________________________________________________.

(Add additional sheets if needed.) PART 3 ANATOMICAL GIFT AT DEATH (OPTIONAL) If you are satisfied to allow your agent to determine whether to make an anatomical gift at your death, you do not need to fill out this part of the form.

(8) Upon my death:

(mark applicable box) [ ] (A) I give any needed organs, tissues, or other body parts, OR [ ] (B) I give the following organs, tissues, or other body parts only ________________________________ __________________________________________________ [ ] (C) My gift is for the following purposes (mark any of the following you want):

[ ] (i) transplant;

[ ] (ii) therapy;

[ ] (iii) research;

[ ] (iv) education.

[ ] (D) I refuse to make an anatomical gift.

PART 4 MENTAL HEALTH TREATMENT This part of the declaration allows you to make decisions in Enrolled HB 195 -28- advance about mental health treatmentThe instructions that you include in this declaration will be followed only if a court, two physicians that include a psychiatrist, or a physician and a professional mental health clinician believe that you are not competent and cannot make treatment decisions.

Otherwise, you will be considered to be competent and to have the capacity to give or withhold consent for the treatments.

If you are satisfied to allow your agent to determine what is best for you in making these mental health decisions, you do not need to fill out this part of the form.

If you do fill out this part of the form, you may strike any wording you do not want.

(9) PSYCHOTROPIC MEDICATIONS.

If I do not have the capacity to give or withhold informed consent for mental health treatment, my wishes regarding psychotropic medications are as follows:

________ I consent to the administration of the following medications:

______________________________________________ ________ I do not consent to the administration of the following medications:

______________________________________ Conditions or limitations:_______________________________ _________________________________________________________.

(10) ELECTROCONVULSIVE TREATMENT.

If I do not have the capacity to give or withhold informed consent for mental health treatment, my wishes regarding electroconvulsive treatment are as follows:

________ I consent to the administration of electroconvulsive treatment.

________ I do not consent to the administration of electroconvulsive treatment.

Conditions or limitations:

______________________________ _________________________________________________________.

-29- Enrolled HB 195 (11) ADMISSION TO AND RETENTION IN FACILITY.

If I do not have the capacity to give or withhold informed consent for mental health treatment, my wishes regarding admission to and retention in a mental health facility for mental health treatment are as follows:

________ I consent to being admitted to a mental health facility for mental health treatment for up to ________ days.

(The number of days not to exceed 17.) ________ I do not consent to being admitted to a mental health facility for mental health treatment.

Conditions or limitations:

______________________________ _________________________________________________________.

OTHER WISHES OR INSTRUCTIONS _________________________________________________________ _________________________________________________________ _________________________________________________________ Conditions or limitations:

______________________________ _________________________________________________________.

PART 5 PRIMARY PHYSICIAN (OPTIONAL) (12) I designate the following physician as my primary physician:

_________________________________________________________ (name of physician) _________________________________________________________ (address) (city) (state) (zip code) _________________________________________________________ (telephone) OPTIONAL:

If the physician I have designated above is not willing, able, or reasonably available to act as my primary Enrolled HB 195 -30- physician, I designate the following physician as my primary physician:

_________________________________________________________ (name of physician) _________________________________________________________ (address) (city) (state) (zip code) _________________________________________________________ (telephone) (13) EFFECT OF COPY.

A copy of this form has the same effect as the original.

(14) SIGNATURES.

Sign and date the form here:

_________________________________________________________ (date) (sign your name) _________________________________________________________ (print your name) _________________________________________________________ (address) (city) (state) (zip code) (15) WITNESSES.

This advance care health directive will not be valid for making health care decisions unless it is (A) signed by two qualified adult witnesses who are personally known to you and who are present when you sign or acknowledge your signature;

the witnesses may not be a health care provider employed at the health care institution or health care facility where you are receiving health care, an employee of the health care provider who is providing health care to you, an employee of the health care institution or health care facility where you are receiving health care, or the person appointed as your agent by this document;

at least one of the two witnesses may not be related to you by blood, marriage, or adoption or entitled to a portion of your estate upon your death under your will or codicil;

or (B) acknowledged before a notary public in the -31- Enrolled HB 195 state.

ALTERNATIVE NO.

1 Witness Who is Not Related to or a Devisee of the Principal I swear under penalty of perjury under AS 11.56.200 that the principal is personally known to me, that the principal signed or acknowledged this durable power of attorney for health care in my presence, that the principal appears to be of sound mind and under no duress, fraud, or undue influence, and that I am not (1) a health care provider employed at the health care institution or health care facility where the principal is receiving health care;

(2) an employee of the health care provider providing health care to the principal;

(3) an employee of the health care institution or health care facility where the principal is receiving health care;

(4) the person appointed as agent by this document;

(5) related to the principal by blood, marriage, or adoption;

or (6) entitled to a portion of the principal's estate upon the principal's death under a will or codicil.

________________________________________________________ (date) (signature of witness) ________________________________________________________ (printed name of witness) ________________________________________________________ (address) (city) (state) (zip code) Witness Who May be Related to or a Devisee of the Principal I swear under penalty of perjury under AS 11.56.200 that the principal is personally known to me, that the principal signed or acknowledged this durable power of attorney for health care in my presence, that the principal appears to be of sound mind and under no Enrolled HB 195 -32- duress, fraud, or undue influence, and that I am not (1) a health care provider employed at the health care institution or health care facility where the principal is receiving health care;

(2) an employee of the health care provider who is providing health care to the principal;

(3) an employee of the health care institution or health care facility where the principal is receiving health care;

or (4) the person appointed as agent by this document.

_______________________________________________________ (date) (signature of witness) _______________________________________________________ (printed name of witness) _______________________________________________________ (address) (city) (state) (zip code) ALTERNATIVE NO.

2 State of Alaska ________________ Judicial District On this ____ day of ___________________, in the year ______________, before me, _______________________________ (insert name of notary public) appeared _______________________________, personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed to this instrument, and acknowledged that the person executed it.

Notary Seal ___________________________ (signature of notary public) * Sec.

54.

AS 13.52.390(13) is amended to read:

(13) "do not resuscitate order" means a directive from a licensed physician, advanced practice registered nurse, or physician associate [ASSISTANT] -33- Enrolled HB 195 that emergency cardiopulmonary resuscitation should not be administered to a qualified patient;

* Sec.

55.

AS 13.52.390(24) is amended to read:

(24) "life-sustaining procedures" means any medical treatment, procedure, or intervention that, in the judgment of the primary physician, advanced practice registered nurse, or physician associate [ASSISTANT], when applied to a patient with a qualifying condition, would not be effective to remove the qualifying condition, would serve only to prolong the dying process, or, when administered to a patient with a condition of permanent unconsciousness, may keep the patient alive but is not expected to restore consciousness;