Citations Affected: IC 16-18-2; IC 16-36-6; IC 27-1-12-45;
IC 34-30-2-75.5.
Synopsis: Physician order for scope of treatment forms. Establishes a
process for the execution of a physician order for scope of treatment
(POST) form by an individual, or the individual's representative, and
the individual's treating physician to indicate treatment the individual
would like to have or have withheld under specified circumstances.
Requires the state department of health to: (1) develop and distribute
the POST form; and (2) report to the health finance commission,
concerning the POST form. Specifies provisions that must be included
in the POST form. Allows for the modification or revocation of the
POST form. Specifies that the existence of an executed POST form
cannot affect life insurance policies or premiums. Provides civil and
criminal immunity for certain actions taken by a health care provider
or its employees under an executed POST form.
Effective: July 1, 2013.
January 10, 2013, read first time and referred to Committee on Public Health.
A BILL FOR AN ACT to amend the Indiana Code concerning
health.
SECTION 11, IS AMENDED TO READ AS FOLLOWS [EFFECTIVE
JULY 1, 2013]: Sec. 163. (a) "Health care provider", for purposes of
IC 16-21 and IC 16-41, means any of the following:
(1) An individual, a partnership, a corporation, a professional
corporation, a facility, or an institution licensed or legally
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:
(1) a licensed physician;
(2) a registered nurse;
(3) a licensed practical nurse;
(4) an advanced practice nurse;
(5) a licensed nurse midwife;
(6) a paramedic;
(7) an emergency medical technician;
(8) an advanced emergency medical technician; or
(9) an emergency medical responder, as defined by section 109.8
of this chapter.
The term includes an individual who is an employee or agent of a
health care provider acting in the course and scope of the individual's
employment.
(d) "Health care provider", for purposes of IC 16-40-4, means any
of the following:
(1) An individual, a partnership, a corporation, a professional
corporation, a facility, or an institution licensed or authorized by
the 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), an
ambulatory outpatient surgical center, a dentist, an optometrist, a
pharmacist, a podiatrist, a chiropractor, a psychologist, 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 blood bank, laboratory, community mental health center,
community mental retardation center, community health center,
or migrant health center.
(3) A home health agency (as defined in IC 16-27-1-2).
(4) A health maintenance organization (as defined in
IC 27-13-1-19).
(5) A health care organization whose members, shareholders, or
partners are health care providers under subdivision (1).
(6) A corporation, partnership, or professional corporation not
otherwise specified in 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.
(7) A person that is designated to maintain the records of a person
described in subdivisions (1) through (6).
(e) "Health care provider", for purposes of IC 16-45-4, has the
meaning set forth in 47 CFR 54.601(a).
this chapter; or
(2) for whom a representative has completed a POST form
under section 7(a)(2) of this chapter;
and whose treating physician has executed a POST form under
section 8 of this chapter.
Sec. 3. (a) As used in this chapter, "life prolonging procedure"
means any medical procedure, treatment, or intervention that does
the following:
(1) Uses mechanical or other artificial means to sustain,
restore, or supplant a vital function.
(2) Serves to prolong the dying process.
(b) The term does not include the performance or provision of
any medical procedure or medication necessary to provide comfort
care or to alleviate pain.
Sec. 4. As used in this chapter, "POST form" refers to a
physician order for scope of treatment (POST) form developed by
the state department under section 9 of this chapter.
Sec. 5. As used in this chapter, "qualified person" refers to an
individual who has at least one (1) of the following:
(1) An advanced chronic progressive illness.
(2) An advanced chronic progressive frailty.
(3) A condition caused by injury, disease, or illness from
which, to a reasonable degree of medical certainty:
(A) there can be no recovery; and
(B) death will occur from the condition within a short
period without the provision of life prolonging procedures.
(4) A medical condition that, if the person were to suffer
cardiac or pulmonary failure, resuscitation would be
unsuccessful or within a short period the person would
experience repeated cardiac or pulmonary failure resulting in
death.
Sec. 6. As used in this chapter, "representative" means an
individual described in section 7(a)(2) of this chapter.
Sec. 7. (a) The following individuals may complete a POST
form:
(1) A qualified person who is:
(A) either:
(i) at least eighteen (18) years of age; or
(ii) less than eighteen (18) years of age but authorized to
consent under IC 16-36-1-3(a)(2); and
(B) of sound mind.
(2) A qualified person's representative, if the qualified person
has been determined to be incapable of making decisions
about the qualified person's health care by a treating
physician acting in good faith and the representative has
been:
(A) authorized to act under IC 16-36-1; or
(B) authorized under IC 30-5-5-16 and IC 30-5-5-17 as the
qualified person's attorney in fact with authority to
consent to or refuse health care for the qualified person.
(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
(2) in:
(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.
(b) The:
(1) treating physician; and
(2) qualified person or representative;
must sign and date the POST form for the POST form to be
effective.
Sec. 9. (a) The state department shall develop a standardized
POST form and distribute the POST form.
(b) The POST form developed under this section must include
the following:
(1) A medical order specifying whether cardiopulmonary
resuscitation (CPR) should be performed if the qualified
person is in cardiopulmonary arrest.
(2) A medical order concerning the level of medical
intervention that should be provided to the qualified person,
including the following:
(A) Comfort measures.
(B) Limited additional interventions.
(C) Full intervention.
(3) A medical order specifying whether antibiotics should be
provided to the qualified person.
(4) A medical order specifying whether artificially
administered nutrition should be provided to the qualified
person.
(5) A signature line for the treating physician, including the
following information:
(A) The physician's printed name.
(B) The physician's telephone number.
(C) The physician's medical license number.
(D) The date of the physician's signature.
As used in this subdivision, "signature" includes an electronic
or physician controlled stamp signature.
(6) A signature line for the qualified person or representative,
including the following information:
(A) The qualified person's or representative's printed
name.
(B) The relationship of the representative signing the
POST form to the qualified person covered by the POST
form.
(C) The date of the signature.
(7) A section presenting the option to allow a declarant to
appoint an individual under IC 16-36-1-7 to serve as the
declarant's health care representative.
(c) The state department:
(1) shall adopt rules under IC 4-22-2 concerning the use and
distribution of the POST form; and
(2) may adopt rules under IC 4-22-2 necessary to carry out
this chapter.
Sec. 10. (a) The declarant or representative shall keep the
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
records.
(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
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.
(B) The time, date, and place the treating physician was
notified of the revocation of the POST form.
(2) Cancel the POST form that is being revoked by
conspicuously noting in the declarant's medical records that
the declarant's POST form has been voided.
(3) Notify any health care personnel responsible for the care
of the declarant of the revocation of the POST order.
(4) Notify the physician who signed the POST form of the
revocation through the contact information for the physician
indicated on the form.
Sec. 12. (a) A declarant, or subject to subsection (b), a
representative, may, at any time, request alternative treatment to
the treatment specified on the POST form.
(b) A representative may request alternative treatment only if
the declarant is incapable of making decisions concerning the
declarant's health care.
(c) A health care provider to whom a request for alternative
treatment is communicated shall, as soon as possible, notify the
declarant's treating physician, if known, of the request.
(d) The treating physician who is notified under subsection (c)
of a request for alternative treatment shall do the following as soon
as possible:
(1) Include a written, signed note of the request in the
declarant's medical records with the following information:
(A) The time, date, and place of the request by the
declarant or representative.
(B) The time, date, and place that the treating physician
was notified of the request.
(2) Review the POST form with the declarant or
representative and execute a new POST form, if needed.
Sec. 13. (a) A health care provider, a health care facility, or an
interested individual who believes that following the medical
orders set forth in the POST form will result in care or treatment,
or the withholding 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;
may seek relief under IC 16-36-1-8 by petitioning the probate court
in the county where the declarant is located.
(b) If, in a proceeding sought under subsection (a), a probate
court determines that following the medical orders in the
declarant's POST form will result in care or treatment, or the
withholding or withdrawal of care or treatment, that:
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 any of the following individuals who are
available, willing, and competent to act:
(1) The judicially appointed guardian of the declarant. This
subdivision does not require the appointment of a guardian
for a treatment decision to be made under this subsection.
(2) The declarant's representative.
(3) The declarant's spouse.
(4) An adult child of the declarant, or, if the declarant has
more than one (1) adult child, by a majority of the children
who are reasonably available for consultation.
(5) A parent of the declarant.
(6) An adult sibling of the declarant, or, if the declarant has
more than one (1) adult sibling, by a majority of the siblings
who are reasonably available for consultation.
(7) 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;