Legislature(2021 - 2022)BUTROVICH 205
05/05/2022 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SB191 | |
| HB392 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 242 | TELECONFERENCED | |
| += | HB 392 | TELECONFERENCED | |
| += | SB 191 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 392-EXPAND ADV PRC REG NURSE, PHYS ASSIS AUTH
1:49:24 PM
CHAIR WILSON reconvened the meeting and announced the
consideration of CS FOR HOUSE BILL NO. 392(HSS) am "An Act
relating to advanced practice registered nurses and physician
assistants; and relating to death certificates, do not
resuscitate orders, and life sustaining treatment."
CHAIR WILSON asked the sponsor if she had any comments before
the committee considered amendments.
1:50:03 PM
REPRESENTATIVE LIZ SNYDER, Alaska State Legislature, Juneau,
Alaska, sponsor of HB 392, stated that during the initial
hearing the committee focused on the DNR order in Section 5 that
requires written consent of the patient or the parent or
guardian of a minor patient. Section 10 did not receive much
attention but it explicitly states that a patient that is
capable has the right to make their own health decisions,
including revoking a DNR order that may be made by a physician.
If the bill were to pass, this would also include an advanced
practice registered nurse (APRN) or physician's assistant (PA).
She noted that the health care professional who testified during
the first hearing was referencing this protection that is
already in statute.
REPRESENTATIVE SNYDER explained that AS 13.52.065(b) directs the
department to adopt a protocol for DNR orders, which is subject
to approval by the State Medical Board. That protocol is laid
out in 7 AAC 16.010. When an individual comes in to a health
care facility, the first step is for the health care provider to
determine the patient's identity by one of the following means:
the patient could communicate their identity; the patient's
hospital or institutional arm band; the patient is known to the
health care provider; the patient's driver's license; another
person identified the patient; or with a medical necklace,
bracelet, or information card the patient is wearing. Once the
identity has been determined, the provider must examine the
patient, review patient records, and look to see if there is a
medical bracelet, necklace, or card that identifies the
individual's DNR status. The patient can provide their DNR
status if they're awake, and the provider could look to see if a
Physician Orders for Life Sustaining Treatment (POLST) form is
on file. This is a form that is filled out in consultation
between the patient and health care provider documenting what
the individual wants to do if a DNR is in question. She
confirmed that the patient's signature on the POLST form is
voluntary and that there was good reason. Some people are
physically unable to sign, but the form is filled out in
consultation with their physician. She acknowledged that absent
a POLST or any clear direction from the patient about their DNR
wishes, an attending physician can assess the patient and make a
determination about whether a DNR order is appropriate.
REPRESENTATIVE SNYDER highlighted that that according to the DNR
protocol that is in regulation, CPR must be administered until
items 1 and 2 have been worked through and confirmed. That is
the current issue. As currently written, Section 5, requires the
written consent no matter what. This ensures the patient, their
surrogate, or guardian is making an informed decision on a DNR
order, but it's made it impossible for medical professionals to
respond in other acute instances where the consent process is
not possible. Medical professionals have voiced concern that
physicians in an emergency department would have to perform CPR
in situations where it was not in the best interest of the
patient.
REPRESENTATIVE SNYDER urged the committee to find a way to
ensure that consent when possible is obtained and documented,
and when it's not possible to rely on the DNR protocol that's in
regulation.
1:57:38 PM
SENATOR HUGHES asked what items 1 and 2 are in the protocol for
an attending physician to assess the patient and make a
determination about whether issuing a DNR order is appropriate.
REPRESENTATIVE SNYDER answered that those are the steps to first
identify the patient and second to determine whether there is or
is not a documented DNR order or completed POLST form. In the
absence of these things, regulation authorizes a physician to
make the determination about whether issuing a DNR order is
appropriate in the particular situation.
1:58:45 PM
SENATOR HUGHES expressed concern that just one physician could
make this decision after going through steps 1 and 2 and
assessing the immediate situation. Her preference would be to
have several physicians in consultation come to agreement on
whether it was appropriate to issue a DNR order. She
acknowledged that this was beyond the scope of the bill, but
suggested that the issue probably needed to be revisited because
it was too much power and responsibility to be vested in just
one physician.
2:00:18 PM
SENATOR REINBOLD said it's an important point, particularly in
light of the COVID-19 mandates that blocked patient advocacy.
CHAIR WILSON noted that Senator Costello had an amendment for
the committee to consider.
2:01:27 PM
At ease.
2:02:35 PM
CHAIR WILSON reconvened the meeting and solicited a motion.
2:02:38 PM
SENATOR COSTELLO moved to adopt Amendment 1.
AMENDMENT 1
Page 3, line 5:
Delete "written"
2:02:40 PM
CHAIR WILSON objected for purposes of discussion.
2:02:41 PM
SENATOR COSTELLO stated that Amendment 1 removes the word
"written" because the physician's order for life sustaining
treatment (POLST) form, which is filled out in consultation with
the patient and placed in a national database, does not require
the patient's signature. The patient's signature is voluntary
and it can be witnessed. As currently written, the bill negates
all existing POLST forms that do not have a patient signature.
The amendment does not remove the requirement in Section 5 for
consent from the patient [or the parent or guardian of a minor
patient]. The amendment only removes the requirement for the
consent to be in writing.
2:05:24 PM
SENATOR HUGHES summarized her understanding that a POLST form
would be filled out in consultation between an individual and
their physician, it may or may not be signed, the form would be
filed in a national database, and it would remain valid until
the individual opted to change it. She asked if that was an
accurate characterization.
2:06:16 PM
At ease.
2:10:00 PM
CHAIR WILSON reconvened the meeting.
2:10:03 PM
SENATOR BEGICH read the following about POLST forms, noting that
46 states have these forms:
Health care providers should complete this form only
after a conversation with the patient or the patient's
representative. A POLST decision-making process is for
patients who are at risk for a life-threatening
clinical event because they have a serious life-
limiting medical condition, which may include advanced
frailty.
The POLST form is a medical order, which means that
the POLST form is always signed by a medical
professional and, depending upon the state, the person
stated on the form can sign as well.
SENATOR BEGICH highlighted that in Alaska the patient's
signature on the POLST form is optional. He continued to read:
A pragmatic rule for initiating a POLST can be if the
clinician would not be surprised if the individual
were to die within one year.
One difference between the POLST form and an advanced
directive is that the POLST form is designated to be
actionable throughout an entire community. It is
immediately recognizable and can be used by doctors
and first responders, including paramedics, fire
departments, police, emergency rooms, hospitals and
nursing homes.
2:11:37 PM
SENATOR COSTELLO summarized that a POLST is a medical order that
allows the individual to convey their wishes about receiving
CPR, including mechanical ventilation, defibrillation and
cardioversion should they be incapacitated.
SENATOR HUGHES also pointed out that a POLST form allows for a
patient to designate a representative if they so desire.
2:12:39 PM
CHAIR WILSON removed his objection; he found no further
objection, and Amendment 1 was adopted.
SENATOR HUGHES commented that she was very impressed that both
PAs and APRNs have assumed greater responsibility and helped to
improve access to more affordable health care in the state. The
training they receive has become more comparable to the training
physicians receive so it makes sense to give them this added
authority.
2:13:58 PM
SENATOR HUGHES moved to report HB 392, work order 32-LS1561\B.A,
as amended, from committee with individual recommendations and
attached fiscal note(s).
2:14:14 PM
CHAIR WILSON found no objection and SCS CSHB 392(HSS) was
reported from the Senate Health and Social Services Standing
Committee.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 191 Ammendment 5.5.22.pdf |
SHSS 5/5/2022 1:30:00 PM |
SB 191 |
| HB 392 Testimony 5.5.22.pdf |
SHSS 5/5/2022 1:30:00 PM |
HB 392 |
| HB 392 Ammendment 1 5.5.22.pdf |
SHSS 5/5/2022 1:30:00 PM |
HB 392 |
| HB 392 AK POLST Form.pdf |
SHSS 5/5/2022 1:30:00 PM |
HB 392 |