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.