PCMS_Philadelphia_Medicine_Spring2018 - 25

p h i l a m e d s o c  .o rg

House of Representatives
Session of 2017 - 2018 Regular Session
Posted: February 1, 2017 09:40 AM
From: Representative Bryan Cutler
and Rep. David S. Hickernell
To: All House members
Subject: Codification of PA Orders for
Life-Sustaining Treatment (POLST)

Introduced as HB1196

My legislation will codify a POLST form
that may be used by individuals wishing to
designate end-of-life wishes and discontinue
the use of OOH-DNR orders following the
effective date of my legislation.
The first part of our legislation will
update Chapter 54 of Title 20 to include
the recognition of POLST orders. The
majority of our legislation creates new
Subchapter F known as the Pennsylvania
Order for Life-Sustaining Treatment Act.
New Subchapter F will:

* Make clear that POLST forms are not
In the near future, we plan on introducing
legislation that would amend Title 20 to be used to advance or support euthanasia,
(Decedents, Estates and Fiduciaries) of the suicide or health care practitioner-assisted
Pennsylvania Consolidated Statutes to update suicide.
and revise Pennsylvania law to include the
* Health insurer prohibitions: Prohibit
codification of Pennsylvania Orders for Lifeinsurers from certain actions regarding
Sustaining Treatment (POLST) to be used
POLST orders, including requiring an
by medical professionals across all health
individual to consent to a POLST order
care settings for patients who voluntarily
or to have a POLST order as a condition
wish to execute a POLST order. POLST
for being insured, prohibit insurers from
orders are different from advance directives
charging an individual a different rate
in that POLST orders convert an individual's
whether the individual consents to a POLST
wishes regarding health care into a medical
order or has a POLST order, and prohibit an
order that is immediately actionable and
insurer from requiring a health care provider
applicable across all health care settings.
to have a policy to offer a POLST order to
In contrast, advance directives often only
any individual.
name a surrogate decision-maker to make
health care decisions for the individual or
* Health care provider restrictions:
often lack specificity as to the individual's
Prohibit health care providers from
goals and preferences for a medical condition
adopting policies that require individuals
that subsequently develops because it was
to have a POLST order as a condition
not foreseen by the individual.
for treatment or admission to a facility.
In 2006, Title 20 was amended by Act
169 to update the procedures for living
wills, health care powers of attorney and
out-of-hospital do not resuscitate (OOHDNR) orders. In addition, Act 169 created
a committee to assist the Department
of Health (DOH) in determining the
advisability of using a standardized form
containing orders by qualified physicians
that detail the scope of medical treatment
for patients' life-sustaining wishes. However,
Act 169 did not mandate the use of a POLST
form as a medical order.

* DOH responsibilities: Create a POLST
Advisory Committee headed by the
Secretary of Health to advise DOH on
POLST-related matters, including but
not limited to the format and content
of the POLST form and education
about POLST orders. DOH would be
required to adopt and update a POLST
form as needed; develop and update
basic education materials on POLST
orders; and make the POLST form and
its educational materials available and
accessible through the Internet.

* Requirements for a valid POLST
order: Require specific information be
provided on the POLST form, including:
completion of the medical order section
regarding CPR, the individual and
health care practitioner's signatures, and
procedures when a verbal POLST order
shall be accepted as a valid POLST order.
* Portability and transfer requirements:
Ensure that POLST orders are valid
anywhere within the Commonwealth,
including health care facilities, the
individual's residence, vehicle transits
from one health care facility to another
and other care settings outside of a health
care facility.
* My bill will also require a health care
facility that transfers an individual to
another health care facility to provide a
copy of the POLST order to the receiving
health care facility.
* Emergency medical services: Set forth
requirements for EMS providers in
complying with POLST orders.
* Immunity: Provide immunity for health
care providers and other persons for
complying with a POLST order based
upon a good faith assumption that the
order was valid.
This legislation was drafted by a
committee of stakeholders that met and
addressed many issues that were of concern to
each stakeholder group. If you wish to know
more about the makeup of the committee or
the meetings that were held, please contact
Representative Cutler's Harrisburg staff.
Individuals should have the right to
dictate end-of-life decisions in a manner that
is sensitive to the situation at hand while
also providing clear direction to medical
professionals making treatment decisions
on behalf of the individual.
Please join us in support of this
legislation. *
Spring 2018 : Philadelphia Medicine 25


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