AN ACT to amend the Indiana Code concerning health.
authorized by this state to provide health care or professional
services as a licensed physician, a psychiatric hospital, a hospital,
a health facility, an emergency ambulance service (IC 16-31-3),
a dentist, a registered or licensed practical nurse, a midwife, an
optometrist, a pharmacist, a podiatrist, a chiropractor, a physical
therapist, a respiratory care practitioner, an occupational therapist,
a psychologist, a paramedic, an emergency medical technician, an
advanced emergency medical technician, or a person who is an
officer, employee, or agent of the individual, partnership,
corporation, professional corporation, facility, or institution acting
in the course and scope of the person's employment.
(2) A college, university, or junior college that provides health care to a student, a faculty member, or an employee, and the governing board or a person who is an officer, employee, or agent of the college, university, or junior college acting in the course and scope of the person's employment.
(3) A blood bank, community mental health center, community mental retardation center, community health center, or migrant health center.
(4) A home health agency (as defined in IC 16-27-1-2).
(5) A health maintenance organization (as defined in IC 27-13-1-19).
(6) A health care organization whose members, shareholders, or partners are health care providers under subdivision (1).
(7) A corporation, partnership, or professional corporation not otherwise qualified under this subsection that:
(A) provides health care as one (1) of the corporation's, partnership's, or professional corporation's functions;
(B) is organized or registered under state law; and
(C) is determined to be eligible for coverage as a health care provider under IC 34-18 for the corporation's, partnership's, or professional corporation's health care function.
Coverage for a health care provider qualified under this subdivision is limited to the health care provider's health care functions and does not extend to other causes of action.
(b) "Health care provider", for purposes of IC 16-35, has the meaning set forth in subsection (a). However, for purposes of IC 16-35, the term also includes a health facility (as defined in section 167 of this chapter).
(c) "Health care provider", for purposes of IC 16-36-5 and IC 16-36-6, means an individual licensed or authorized by this state to provide health care or professional services as:
representative has been:
(i) appointed by the individual under IC 16-36-1-7 to serve as the individual's health care representative;
(ii) authorized to act under IC 30-5-5-16 and IC 30-5-5-17 as the individual's attorney in fact with authority to consent to or refuse health care for the individual; or
(iii) appointed by a court as the individual's guardian under IC 16-36-1-8.
(b) In order to complete a POST form, a person described in subsection (a) and the qualified person's treating physician or the physician's designee must do the following:
(1) Discuss the qualified person's goals and treatment options available to the qualified person based on the qualified person's health.
(2) Complete the POST form, to the extent possible, based on the qualified person's preferences determined during the discussion in subdivision (1).
(c) When completing a POST form on behalf of a qualified person, a representative shall act:
(1) in good faith; and
(A) accordance with the qualified person's express or implied intentions, if known; or
(B) the best interest of the qualified person, if the qualified person's express or implied intentions are not known.
(d) A copy of the executed POST form shall be maintained in the qualified person's medical file.
Sec. 8. (a) A POST form may be executed only by an individual's treating physician and only if:
(1) the treating physician has determined that:
(A) the individual is a qualified person; and
(B) the medical orders contained in the individual's POST form are reasonable and medically appropriate for the individual; and
(2) the qualified person or representative has completed the POST form in accordance with section 7 of this chapter.
(1) treating physician; and
(2) qualified person or representative;
must sign and date the POST form for the POST form to be effective.
original executed POST form. The POST form is considered the
personal property of the declarant. The treating physician who
executes the POST form shall maintain a copy of the POST form
in the declarant's medical records. If the POST form is executed at
a health care facility (as defined in IC 16-18-2-161), a copy of the
POST form shall be maintained in the health care facility's medical
(b) A health care provider or health care facility shall treat a facsimile, paper, or electronic copy of a valid POST form as an original document.
(c) A health care provider, a health care facility, or an entity acting in good faith may not be considered to have knowledge of a POST form solely on the basis of the POST form's entry into a medical record that can be accessed by a person described in this subsection.
Sec. 11. (a) A declarant or representative subject to subsection (b) may at any time revoke a POST form by any of the following:
(1) A signed and dated writing.
(2) Physical cancellation or destruction of the POST form by:
(A) the declarant;
(B) the representative; or
(C) another individual at the direction of the declarant or representative.
(3) An oral expression by the declarant or representative of an intent to revoke the POST form.
(b) A representative may revoke the POST form only if the declarant is incapable of making decisions regarding the declarant's health care.
(c) A revocation of a POST form under this section is effective upon communication of the revocation to a health care provider.
(d) Upon communication of the revocation of a POST form under this section, the health care provider shall immediately notify the declarant's treating physician, if known, of the revocation.
(e) Upon notification of the revocation of a POST form to the treating physician under subsection (d), the declarant's treating physician shall as soon as possible do the following:
(1) Add the revocation to the declarant's medical record with the following information:
(A) The time, date, and place of revocation of the POST form by the declarant, representative, or other individual at the direction of the declarant or representative.
withholding or withdrawal of care or treatment, that:
(1) is inconsistent with the declarant's known preferences; or
(2) in the absence of the declarant's known preferences, is not in the declarant's best interest;
the probate court may order any of the relief available under IC 16-36-1-8.
Sec. 14. A declarant's executed POST form has no effect during the declarant's pregnancy if the declarant is known to be pregnant.
Sec. 15. (a) Except as otherwise provided in this chapter, the medical orders included in a POST form executed under this chapter are effective in all settings. A health care provider shall comply with a declarant's POST form that is apparent and immediately available to the provider unless the provider:
(1) believes the POST form was not validly executed under this chapter;
(2) believes in good faith that the declarant, the representative, or another individual at the request of the declarant or representative has revoked the POST form as provided in section 11 of this chapter;
(3) believes in good faith that the declarant or representative has made a request for alternative treatment as provided in section 12 of this chapter;
(4) believes it would be medically inappropriate to provide the intervention included in the declarant's POST form; or
(5) has religious or moral beliefs that conflict with the POST form.
(b) A health care provider is not required to provide medical treatment that is contrary to a declarant's POST form that has been executed in accordance with this chapter.
(c) If a declarant is capable of making health care decisions, the declarant's treating physician, before carrying out or implementing a medical order indicated in the declarant's POST form, shall discuss the order with the declarant to reaffirm or amend the order on the POST form. For purposes of this subsection, a minor who is not authorized to consent to health care under IC 16-36-1-3(a)(2) is not capable of consenting to health care. This subsection applies regardless of whether the POST form was signed by the declarant or representative.
(d) A health care provider who is unable to implement or carry out the orders of a POST form shall transfer care of the declarant to another health care provider who is able to implement or carry out the orders. However, a health care provider who refuses to
implement the medical orders included in an executed POST form
is not required to transfer care of the declarant if any of the
circumstances in subsection (a)(1) through (a)(4) have occurred.
(e) The treating physician is responsible for coordinating the transfer of care of a declarant in the circumstances in subsection (d). If the treating physician, after a reasonable attempt, is unable to find a physician willing to implement or carry out the medical orders included in the declarant's POST form, the treating physician may decline to implement or carry out the medical orders.
(f) If, under this section, the treating physician does not transfer a declarant or implement the medical orders included in the declarant's POST form and the declarant is competent, the treating physician shall attempt to ascertain the declarant's preferences for medical care by discussing the preferences with the declarant. If the declarant is incompetent to act, the treating physician shall attempt to ascertain the declarant's preferences for medical care by consulting with the following individuals:
(1) The treating physician shall consult with any representative who is available, willing, and competent to act.
(2) If the declarant does not have a representative or if a representative is not available, willing, and competent to act, the treating physician shall consult with any of the following individuals who are available, willing, and competent to act:
(A) The declarant's spouse.
(B) An adult child of the declarant, or, if the declarant has more than one (1) adult child, a majority of the children who are reasonably available for consultation.
(C) A parent of the declarant.
(D) An adult sibling of the declarant, or, if the declarant has more than one (1) adult sibling, a majority of the siblings who are reasonably available for consultation.
(E) An individual with firsthand knowledge of the declarant's intentions.
(g) An individual described in subsection (f) shall act according to the declarant's intentions, if known, or in the best interest of the declarant.
(h) The physician shall list the names of the individuals described in subsection (f) who were consulted and the information received by the individuals in the declarant's medical record.
Sec. 16. (a) A:
(1) health care provider;
(2) health care facility; or
(3) health entity;
or an employee under the direction of a person described in subdivisions (1) through (3) that acts in good faith and in accordance with reasonable medical standards to carry out the orders on a POST form, including a medical order for the withholding or withdrawal of life prolonging procedures, is not subject to criminal or civil liability and may not be found to have committed an act of unprofessional conduct.
(b) A health care provider may presume in the absence of actual notice or evidence to the contrary that a POST form executed in compliance with this chapter is valid and enforceable.
Sec. 17. (a) This chapter may not be construed to modify or alter any applicable laws, ethics, standards, or protocols for the practice of medicine or nursing, including section 19 of this chapter concerning euthanasia.
(b) A POST form may not be construed to compel or authorize a health care provider or health care facility to administer medical treatment that is medically inappropriate or prohibited by state or federal law.
Sec. 18. (a) A death as a result of the withholding or withdrawal of life prolonging procedures in accordance with a declarant's POST form does not constitute a suicide.
(b) A person may not require an individual to complete a POST form as a condition of receiving health care services.
(c) This chapter does not impair or supersede any legal right or legal responsibility that an individual may have to effect the provision, withholding, or withdrawing of care or treatment, including the withholding or withdrawal of life prolonging procedures, in a lawful manner.
(d) Use of a POST form is voluntary. If an individual refuses to complete a POST form, a person described in section 16(a) of this chapter shall document the refusal in the individual's medical records and may not ask the individual again to complete a POST form unless:
(1) required to do so by:
(A) state or federal law or regulation; or
(B) national accrediting entity standards; or
(2) a significant change in condition that is documented in the individual's medical record has occurred.
Sec. 19. This chapter does not authorize euthanasia or any affirmative or deliberate act or omission to end life other than to
permit the natural process of dying.
Sec. 20. The execution or revocation of a POST form by or for a qualified person does not revoke or impair the validity of any of the following:
(1) A power of attorney that is executed by a qualified person when the qualified person is competent.
(2) Health care powers that are granted to an attorney in fact under IC 30-5-5-16 or IC 30-5-5-17.
(3) An appointment of a health care representative that is executed by a qualified person, except to the extent that the POST form contains a superseding appointment of a new health care representative under section 9(b)(7) of this chapter.
(4) The authority of a health care representative under IC 16-36-1 to consent to health care on behalf of the qualified patient.
(5) The authority of an attorney in fact holding health care powers under IC 30-5-5-16 or IC 30-5-5-17 to issue and enforce instructions under IC 30-5-7 concerning the qualified person's health care.
orders of a physician order for scope of treatment form).