Relating to end-of-life care for qualified minors; to amend Section 22-8A-7, Code of Alabama 1975; to add Section 22-8A-18 to the Code of Alabama 1975; to prohibit any health care facility or health care professional from instituting a do not attempt resuscitation order, or similar physician's order, without the written or oral consent of at least one parent or legal guardian of a qualified minor patient or resident unless certain conditions apply.
Section 22-8A-7, Code of Alabama 1975, is amended to read as follows: "§22-8A-7. "(a) A competent adult may make decisions regarding life-sustaining treatment and artificially provided nutrition and hydration so long as that individual is able to do so. The desires of an individual shall at all times supersede the effect of an advance directive for health care. "(b) If the individual is not competent at the time of the decision to provide, withhold, or withdraw life-sustaining treatment or artificially provided nutrition and hydration, a living will executed in accordance with Section 22-8A-4(a) or a proxy designation executed in accordance with Section 22-8A-4(b) is presumed to be valid. For the purpose of this chapter, a health care provider may presume in the absence of actual notice to the contrary that an individual who executed an advance directive for health care was competent when it was executed. The fact of an individual's having executed an advance directive for health care shall not be considered as an indication of a declarant's mental incompetency. Advanced age of itself shall not be a bar to a determination of competency. "(c) No physician, licensed health care professional, medical care facility, other health care provider, or any employee thereof who in good faith and pursuant to reasonable medical standards issues or follows a portable physician DNAR order entered in the medical record pursuant to this chapter or causes or participates in the providing, withholding, or withdrawing of life-sustaining treatment or artificially provided nutrition and hydration from a patient pursuant to a living will or designated proxy made in accordance with this chapter or pursuant to the directions of a duly designated surrogate appointed in accordance with this chapter, in the absence of actual knowledge of the revocation thereof, shall, as a result thereof, be subject to criminal or civil liability, or be found to have committed an act of unprofessional conduct. "(d) Any health care provider or health care facility acting within the applicable standard of care who is signing, executing, ordering, or attempting to follow the directives of an Order for PPEL Care, or an order issued under Section 22-8A-18, either of which is in compliance with this chapter shall not be subject to criminal or civil liability and shall not be found to have committed an act of unprofessional conduct. Nothing in this chapter shall be construed to establish a standard of care for physicians or otherwise modify, amend, or supersede any provision of the Alabama Medical Liability Act of 1987, the Alabama Medical Liability Act of 1996, or any amendment or judicial interpretation thereof. A health care provider or health care facility that does not know, or could not reasonably know, that a physician's Order for PPEL Care, or an order issued under Section 22-8A-18, exists may not be civilly or criminally liable for actions taken to assist a qualified minor subject to a physician's Order for PPEL Care or an order issued under Section 22-8A-18."
Section 22-8A-18 is added to the Code of Alabama 1975, to read as follows: §22-8A-18 (a) This section shall be known and may be cited as Simon's Law. (b)(1) Unless an Order for Pediatric Palliative and End of Life (PPEL) Care has been executed by the representative of a qualified minor and entered into the record by the attending physician of the qualified minor in accordance with this chapter, a Do Not Attempt Resuscitation (DNAR) Order, or similar physician's order, shall not be instituted, either orally or in writing, for a qualified minor until both of the following occur: a. At least one parent or legal guardian of the qualified minor is first informed of the physician's intent to institute the order. b. A reasonable attempt is made to inform the other parent if the other parent is reasonably available and has custodial or visitation rights. (2) A physician, hospital, facility, or the designee of any of the aforementioned shall provide information regarding the intent to institute a DNAR order, or similar physician's order, pursuant to this subsection both orally and in writing unless, in the physician's reasonable medical judgment, the urgency of the decision requires reliance on only providing the information orally. The physician, hospital, facility, or the designee of any of the aforementioned shall contemporaneously record the provision of information in the patient's medical record, and specify by whom and to whom the information was given. When only one parent has been informed, the physician, hospital, facility or a designee of any of the aforementioned shall contemporaneously record, within the patient's medical record, the attempts to inform the other parent or the reason why such attempts were not made. (c) Either parent of a qualified minor or the qualified minor's guardian may refuse consent for a DNAR order or similar physician's order for the qualified minor, either in writing or orally. Any refusal of consent shall be contemporaneously recorded in the patient's medical record. No DNAR order, or similar physician's order, shall be instituted either orally or in writing if there has been a timely refusal of consent except in accordance with a court order issued pursuant to subsection (d). (d) If the parents or guardian of a qualified minor patient are unable to agree on whether to institute or revoke a DNAR order or similar physician's order, either a parent or guardian may institute a proceeding under subsection (e) to resolve the conflict based on a presumption in favor of the provision of cardiopulmonary resuscitation. Pending the final determination of the proceedings, including any appeals, a DNAR order or similar physician's order shall not be implemented. (e) A parent, guardian, physician, hospital or other facility may petition a circuit court of the county in which the patient resides, or in which the patient is receiving treatment, for an order enjoining a violation or threatened violation of this section or to resolve a conflict or perceived conflict. Upon receiving the petition, the circuit court shall issue an order fixing the date, time, and place of a hearing on the petition and ordering that notice of the hearing shall be provided. A preliminary hearing may be held without notice if the court determines that holding that hearing without notice is necessary to prevent imminent danger to the life of the qualified minor. In the court's discretion, a hearing may be conducted in a courtroom, a treatment facility, or at some other suitable place. (f) Upon the request of a patient, resident, prospective patient, or prospective resident, a health care facility, nursing home, or physician shall disclose in writing any policies relating to a patient or resident or the services a patient or resident may receive involving resuscitation or life-sustaining measures, including any policies related to treatments deemed non-beneficial, ineffective, futile, or inappropriate, within the health care facility or nursing home. Nothing in this section shall require a health care facility, nursing home, or physician to have a written policy relating to or involving resuscitation, life-sustaining treatment, or non-beneficial treatment for qualified minor patients or adult patients, residents, or wards. (g) Nothing in this act shall affect the rights of individuals or obligations of providers under the Federal Patient Self Determination Act, 42 U.S.C. §§ 1395cc(f); 1396a(w).
This act shall become effective on the first day of the third month following its passage and approval by the Governor, or its otherwise becoming law. Senate Read for the first time and referred to the Senate committee on Healthcare........................... 0.6-FEB-20Read for the second time and placed on the calen- dar 1 amendment.................................. 2.0-FEB-20Read for the third time and passed as amended .... 2.0-FEB-20 Patrick Harris, Secretary.
|March 10, 2020||H||Read for the first time and referred to the House of Representatives committee on Health|
|March 5, 2020||S||Engrossed|
|March 5, 2020||S||Motion to Read a Third Time and Pass adopted Roll Call 315|
|March 5, 2020||S||Livingston motion to Adopt adopted Roll Call 314|
|March 5, 2020||S||Healthcare Amendment Offered|
|March 5, 2020||S||Third Reading Passed|
|February 20, 2020||S||Read for the second time and placed on the calendar 1 amendment|
|February 6, 2020||S||Read for the first time and referred to the Senate committee on Healthcare|