AB 199 — Revises provisions relating to end-of-life care. (BDR 40-813)

(ReprintedAssembly withBill amendmentsNo. adopted on April 24, 2017) FIRST REPRINT A.B.

199199–Assemblywomen AWoodbury SSEMBLYand BILLTitus NOJoint .Sponsor:

199–ASSEMBLYWOMENSenator WHardy OODBURYCHAPTER.......... AND T ITUS PREFILED F EBRUARY 13, 2017 ____________ JOINT SPONSOR :

ENATOR H ARDY ____________ Referred to Committee on Commerce and Labor SUMMARY—Revises provisions relating to end-of-life care.

(BDR 40-813) FISCAL NOTE:

Effect on Local Government:

Increases or Newly Provides for Term of Imprisonment in County or City Jail or Detention Facility.

Effect on the State:

Yes.

~ EXPLANATION – Matter in bolded italics is new;

matter between brackets [omitted material] is material to be omitted.

Life-Sustaining Treatment form (POLST form), a document which records therdertheOrder for wishes of a patient and directs any provider of health care regarding the provision of life-resuscitating treatment and life-sustaining treatment.

Under existing law, if a patient is at least 18 years of age and incompetent, certain legal representatives of the patient are authorized to execute and revoke a POLST form on behalf of the patient.

(NRS 449.6942, 449.6944) Sections 2-5, 7-17 and 21-25m21-25 of this bill authorize a physician assistant or advanced practice registered nurse to make certain determinations related to a POLST form and to execute a POLSTPOLSTed nurse to form for a patient.

(1) provides that, under certain circumstances, a surrogate who is not a legal representative of the patient, including, without limitation, certain family members of the patient or any othernt,other - *AB199_R1* – 2 – adult who has exhibited special care or concern for the patient, is familiar with the values of the patient and willing and able to make health care decisions for the patient,revises isthe authorizedstandard for determining whether a patient has the capacity to requestrequest) and execute a POLST formform. for the patient;

andSection (2)10 andrevises the standard for determining whether a patient has the capacity to revoke a POLST form so that the standard matches the standard set forth in section 9 for determining whether the patient has the capacity to execute a POLST form.

SectionExisting 10law revisescontains theprovisions standard for determiningoresolving requestpotential whetherconflicts abetween patient has the capacity to revoke a POLST form soand thatanother thetype standardof matchesinstrument thegoverning standard set forth in section 9 for determining whether the patientwithholding hasor thewithdrawal capacityof tolife-resuscitating executetreatment aand POLSTlife-sustaining form.treatment.

Existing(NRS lawdirection containsor provisionsorder forset resolvingforth potentialin conflictsa betweenPOLST aform withdrawalto ofprovide life-resuscitating treatment andif life-sustainingthe treatment.declaration, direction or order is executed after a do-not-resuscitate identification was issued to the patient.

(NRS- 449.6946)79th SectionSession 11(2017) requires– a2 provider– ofEXPLANATION health– careMatter to honor a declaration, direction or order set forth in abolded POLSTitalics form to provide life-resuscitating treatment if the declaration, direction or order is executednew; after a do-not-resuscitate identification was issued to the patient.

matter between brackets [omitted material] is material to be omitted.

449.693 [“Physician] “Provider Order for Life-Sustaining Treatment form” or “POLST form” means the form prescribed pursuantpur1.antRecords tothe NRSwishes 449.694of that:the patient;

1.and 2.

Records the wishes of the patient;

and - *AB199_R1* – 3 – 2.

- 79th Session (2017) – 3 – 3.

Is intended to be honored by any provider of health care who treats the patient in any health-care setting, including, without limitation, the patient’s residence, a health care facility or the scene of a medical emergency;

3.physician assistant or advanced practice registered nurse shall complete the POLST form based on the preferences and medical indications of the patient [.] , upon the request of:

[Upon(a) If the requestpatient is 18 years of theage patient,or the]older Theand physicianthe ,physician, physician assistant or advanced practice registered nurse shalldetermines completethat the POLSTpatient formhas basedthe oncapacity theto preferencesmake anddecisions medicalregarding indicationshis ofor her wishes for the patientprovision [.]of ,life-resuscitating upontreatment theand requestlife-sustaining of:treatment, the patient.

(a) If the patient is 18 years of age or older and the physician, physician assistant or advanced practice registered nurse determines that the patient has the capacity to make decisions - *AB199_R1* – 4 – regarding his or her wishes for the provision of life-resuscitating treatment and life-sustaining treatment, the patient.

or - 79th Session (2017) – 4 – (2) If no person is a representative of the patient and a valid POLST form has not been executed by the patient or the representative of the patient, a surrogate of the patient who has the capacity to make decisions regarding the provision of life- resuscitatingpatient.ating treatment and life-sustaining treatment for the (c) If the patient is less than 18 years of age, the patient and a parent or legal guardian of the patient.

(c) If the patient is less than 18 years of age, the patient and a parent or legal guardian of the patient.

(c)parent Ifor thelegal patientguardian isof lessthe thanpatient.ars 18 years of age, [the patient and] a parent5. or legal guardian of the patient.

5.If, pursuant to subsection 3, a valid POLST form has been executed by a representative or surrogate of the patient and a provider of health care or the representative or surrogate of the patient believes that the patient has regained the capacity to make decisions regarding his or her wishes for the provision of life- resuscitating treatment and life-sustaining treatment, a physician, physician assistant or advanced practice registered nurse must examine the patient and inform the patient of the execution of the POLST form.

If,If pursuant to subsection 3, a valid POLST form has been executed by a representative or surrogate of the patientphysician, andphysician aassistant provider of health care or theadvanced representativepractice orregistered surrogatenurse ofdetermines the patient believes that the patient has regained the capacity to make decisions regarding his or her wishes for the provision of life-life-resuscitating resuscitating treatment and life-sustaining treatment, athe physician,patient physicianmay assistantapprove orthe advancedexecution practiceof registeredthe nursePOLST must - *AB199_R1*79th Session (2017) – 5 – examineform or, pursuant to NRS 449.6944, revoke the patientPOLST andform informexecuted for the patient ofby thehis executionor ofher therepresentative POLSTor form.surrogate.

If the physician,patient physicianapproves assistant or advanced practice registered nurse determines that the patientexecution regainedof the capacityPOLST toform makeexecuted decisionsby regarding his or her wishesrepresentative foror thesurrogate, provisionsuch ofapproval life-resuscitatingmust treatmentbe and life-sustaining treatment, the patient may approve the execution of the POLST form or,is pursuantdeemed to NRSbe 449.6944,valid. revoke the POLST form executed for the patient by his or her representative or surrogate.

If the patient approves the execution of the POLST form executed by his or her representative or surrogate, such approval must be made a part of the medical record of the patient and the POLST form is deemed to be valid.

(1) The spouse of the patient;

or - *AB199_R1* – 6 – (6) An adult who has exhibited special care or concern for the patient, is familiar with the values of the patient and willing and able to make health care decisions for the patient.

- 79th Session (2017) – 6 – Sec.

(a) The patient who executed it [,] or for whom a representative or surrogate executed it pursuant to NRS 449.6942, if [competent,][competent,]e the patient is 18 years of age or older and the physician, physician assistant or advanced practice registered nurse determines that the patient has the capacity to make decisions regarding his or her wishes for the provision of life-resuscitating treatment and life- sustaining treatment;