01/30/2012 01:30 PM Senate HEALTH & SOCIAL SERVICES

                                                                                                                                
        SB 172-CARE DIRECTIVES/DO NOT RESUSCITATE ORDERS                                                                    
                                                                                                                                
1:32:43 PM                                                                                                                    
CHAIR DAVIS  announced that the  first order of business  to come                                                               
before the committee was SB 172, of which she is a co-sponsor.                                                                  
                                                                                                                                
SENATOR FRED DYSON,  primary sponsor, stated that  the purpose of                                                               
SB  172  is  to  correct   possible  ambiguities  in  end-of-life                                                               
decisions currently in statute and  ensure that the intent of the                                                               
legislature is followed. It also  protects patient rights and do-                                                               
not-resuscitate (DNR)  orders. He  emphasized that  the patient's                                                               
wishes should always  predominate. In the case  of an incompetent                                                               
patient,  the  responsibility would  fall  to  family members  or                                                               
authorized surrogates.                                                                                                          
                                                                                                                                
SENATOR DYSON related  that the Health Care  Decisions Act, which                                                               
was  passed  in  2004,  changed provisions  in  AS  13.52.120  by                                                               
establishing  a presumption  in favor  of life.  When there  is a                                                               
question as to what should  be done medically, the presumption is                                                               
to preserve  the life of  the patient.  He said he  believed that                                                               
when the  statute is read in  its entirety, it can  and should be                                                               
interpreted   to  allow   the   patient,   or  their   authorized                                                               
representative, to prevent a physician  from issuing a DNR order.                                                               
This  legislation would  clarify the  authority of  DNR decisions                                                               
with respect to the patient  and physicians, and amend the Alaska                                                               
Care Directive form  to allow patients to accept  or refuse life-                                                               
sustaining procedures.  He reported no  opposition to SB  172 and                                                               
noted  that it  has also  been referred  to the  Senate Judiciary                                                               
Standing Committee.                                                                                                             
                                                                                                                                
1:35:56 PM                                                                                                                    
CHUCK  KOPP,  staff to  Senator  Dyson,  presented the  sectional                                                               
analysis:                                                                                                                       
                                                                                                                                
     Section  1 amends  AS 13.52.045  to  prohibit a  health                                                                    
     care  institution  or  facility from  interpreting  the                                                                    
     issuance of a DNR order  as preventing the providing of                                                                    
     life-sustaining procedures to the patient.                                                                                 
                                                                                                                                
     Section 2  amends AS 13.52.060(e) to  prohibit a health                                                                    
     care   provider   from   declining,  for   reasons   of                                                                    
     conscience,  to  comply  with   a  DNR  order  that  is                                                                    
     consistent with  this chapter. It also  states that the                                                                    
     subsection  does  not  allow a  health  care  provider,                                                                    
     institution, or  facility to decline to  comply with an                                                                    
     individual instruction  or a health care  decision that                                                                    
     requests  that cardiopulmonary  resuscitation (CPR)  or                                                                    
     other resuscitative measures be provided.                                                                                  
                                                                                                                                
     Section  3 amends  AS 13.52.060(f)  to  state that  the                                                                    
     subsection  does  not  allow a  health  care  provider,                                                                    
     institution, or  facility to decline to  comply with an                                                                    
     advance  health   care  directive  or  a   health  care                                                                    
     decision that  is consistent with the  chapter and that                                                                    
     requests that  CPR or  other resuscitative  measures be                                                                    
     provided. The subsection  addresses declining to comply                                                                    
     with an individual instruction  or health care decision                                                                    
     that  requires  medically  ineffective health  care  or                                                                    
     health care contrary to  generally accepted health care                                                                    
     standards.                                                                                                                 
                                                                                                                                
MR. KOPP noted a drafting error  on page 2, line 13; "declined to                                                               
comply with an advanced health  care directive" should be changed                                                               
to "declined  to comply with  an individual instruction"  to make                                                               
it consistent with line 9.                                                                                                      
                                                                                                                                
CHAIR DAVIS commented that Terry Bannister was available to                                                                     
answer questions.                                                                                                               
                                                                                                                                
MR. KOPP continued:                                                                                                             
                                                                                                                                
     Section   4  amends   AS   13.52.065(a)   to  limit   a                                                                    
     physician's  right  to  issue   a  DNR  order  only  as                                                                    
     provided in AS 13.52.065.                                                                                                  
                                                                                                                                
     Section 5  amends AS 13.52.065(b)  to require  that the                                                                    
     protocol adopted by the  department for withholding CPR                                                                    
     comply with AS 13.52.065.                                                                                                  
                                                                                                                                
     Section 6  adds new  subsections (g-j).  Subsection (g)                                                                    
     prohibits a  physician from issuing  a DNR order  for a                                                                    
     patient without  the express  consent described  in the                                                                    
     subsection, except  as provided in (h).  Subsection (h)                                                                    
     states that  a physician  may issue a  DNR order  for a                                                                    
     patient without  the expressed consent required  by (g)                                                                    
     if  the  patient does  not  have  capacity, no  one  is                                                                    
     authorized  to  make  health care  decisions,  and  the                                                                    
     patient  has an  advanced  health  care directive  that                                                                    
     indicates  the  patient  wants  a  DNR  order,  or  the                                                                    
     directive is silent  about the issuance of  a DNR order                                                                    
     and another physician concurs in the decision.                                                                             
                                                                                                                                
     Subsection  (i) requires  a physician  to revoke  a DNR                                                                    
     order  for  a  patient  if  the  issuance  of  the  DNR                                                                    
     violates (g), if the patient  has capacity and requests                                                                    
     that the DNR order be  revoked, if the patient does not                                                                    
     want  a DNR  order, or  if  the patient  does not  have                                                                    
     capacity  and  does not  have  an  advance health  care                                                                    
     directive that indicates that the  patient wants a DNR,                                                                    
     and a  person authorized to make  health care decisions                                                                    
     for  the  patient  requests  or  does  not  oppose  the                                                                    
     revocation  of the  DNR order.  A physician  shall also                                                                    
     revoke a DNR order if the  patient is under 18 years of                                                                    
     age and the parent or  guardian of the patient requests                                                                    
     that the DNR order be revoked.                                                                                             
                                                                                                                                
     Subsection (j) says a physician  may revoke a DNR order                                                                    
     issued  by  another  physician for  a  patient  if  the                                                                    
     physician  has a  physician-patient  relationship or  a                                                                    
     health care obligation to the patient.                                                                                     
                                                                                                                                
     Section  7,   amends  AS  13.52.080(a)  to   replace  a                                                                    
     citation  to  a subsection  that  is  repealed by  this                                                                    
     bill.                                                                                                                      
                                                                                                                                
     Section 8  amends AS 13.52.080(c)  to provide  that its                                                                    
     immunity provisions do not apply  if a DNR order relied                                                                    
     on  by  the  health   care  provider,  institution,  or                                                                    
     facility was issued in violation of AS 13.52.065.                                                                          
                                                                                                                                
     Section  9 amends  AS 13.52.120(b)  to  clarify that  a                                                                    
     violation of  the new provisions added  by bill section                                                                    
     6, does not, in the  context of the provisions required                                                                    
     consistency  with the  chapter, constitute  a homicide.                                                                    
     It also  adds a cross  reference to  the new (h)  as an                                                                    
     exception  for applying  the  subsection's approach  to                                                                    
     suicide or homicide.                                                                                                       
                                                                                                                                
     Section  10  adds AS  13.52.120(h)  to  state that  the                                                                    
     provisions  in (b)  about homicide  and suicide  do not                                                                    
     apply to a person who  orders or causes the withholding                                                                    
     or  withdrawal of  life-sustaining procedures  and acts                                                                    
     intentionally,  recklessly,  with criminal  negligence,                                                                    
     or with gross negligence.                                                                                                  
                                                                                                                                
     Section 11 amends the optional  form in AS 13.52.300 to                                                                    
     add  a section  regarding a  patient's wishes  on life-                                                                    
     sustaining  procedures. He  directed attention  to page                                                                    
     13 of the bill.                                                                                                            
                                                                                                                                
     Section   12  Amends   AS  13.52.390,   the  definition                                                                    
     section,  to  change  the definition  of  "health  care                                                                    
     decision" to  state that the term  includes a direction                                                                    
     about receiving CPR or other resuscitative measures.                                                                       
                                                                                                                                
     Section  13 repeals  AS  13.52.065(f), which  currently                                                                    
     addresses how DNR orders are made ineffective.                                                                             
                                                                                                                                
     Section 14 adds a provision  to indicate how DNR orders                                                                    
     made  before  the  bill's  effective  date  are  to  be                                                                    
     treated in light of the bill.                                                                                              
                                                                                                                                
TERRY BANNISTER, Attorney, Legislative Legal and Research                                                                       
Services, Legislative Affairs Agency, agreed that the previously                                                                
suggested correction would parallel previous language.                                                                          
                                                                                                                                
1:47:49 PM                                                                                                                    
WARD  HURLBURT,   M.D.,  Director  and  Chief   Medical  Officer,                                                               
Division  of  Public  Health, Department  of  Health  and  Social                                                               
Services (DHSS), stated  that SB 172 matched his  experience as a                                                               
doctor and hospital  administrator. He agreed with  the intent of                                                               
the bill to  honor the patient's wishes and to  prolong life when                                                               
there  is a  question  about what  is to  be  done medically.  He                                                               
called the  bill reasonable and  appropriate. He stated  that the                                                               
bill would not require additional funding.                                                                                      
                                                                                                                                
CHAIR DAVIS  thanked the sponsor  for addressing health  care DNR                                                               
decisions.  She  said the  bill  has  been  sent to  the  Medical                                                               
Association  and  has  been  referred  to  the  Senate  Judiciary                                                               
Standing Committee.                                                                                                             
                                                                                                                                
SENATOR   DYSON  commented   that   the  bill   was  written   in                                                               
collaboration  with  one  of  the   major  health  providers.  He                                                               
preferred to move the bill.                                                                                                     
                                                                                                                                
CHAIR DAVIS said she had no problem moving the bill.                                                                            
                                                                                                                                
1:51:48 PM                                                                                                                    
SENATOR  EGAN  moved  to  report   SB  172  from  committee  with                                                               
individual recommendations and attached zero fiscal note.                                                                       
                                                                                                                                
CHAIR DAVIS announced  that without objection, SB  172 moved from                                                               
the Senate Health and Social Services Committee.