Connecticut Seal

General Assembly

File No. 615

    January Session, 2017

Substitute Senate Bill No. 938

Senate, April 13, 2017

The Committee on Public Health reported through SEN. GERRATANA of the 6th Dist. and SEN. SOMERS of the 18th Dist., Chairpersons of the Committee on the part of the Senate, that the substitute bill ought to pass.

AN ACT CONCERNING THE DEPARTMENT OF PUBLIC HEALTH'S RECOMMENDATIONS FOR THE STATE-WIDE ADOPTION OF THE MEDICAL ORDERS FOR LIFE-SUSTAINING TREATMENT PROGRAM.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. (NEW) (Effective October 1, 2017) (a) As used in this section:

(1) "Medical order for life-sustaining treatment" means a written medical order by a physician, advanced practice registered nurse or physician assistant to effectuate a patient's request for life-sustaining treatment when the patient has been determined by a physician or advanced practice registered nurse to be approaching the end stage of a serious, life-limiting illness or is in a condition of advanced, chronic progressive frailty;

(2) "Health care provider" means any person, corporation, limited liability company, facility or institution operated, owned or licensed by this state to provide health care or professional medical services, or an officer, employee or agent thereof acting in the course and scope of his or her employment; and

(3) "Legally authorized representative" means a minor patient's parent, guardian appointed by the Probate Court or a health care representative appointed in accordance with sections 19a-576 and 19a-577 of the general statutes.

(b) The Commissioner of Public Health shall establish a state-wide program to implement the use of medical orders for life-sustaining treatment by health care providers. Patient participation in the program shall be voluntary. An agreement to participate in the program shall be documented by the signature of the patient or the patient's legally authorized representative on the medical order for life sustaining treatment form and verified by the signature of a witness.

(c) Notwithstanding the provisions of sections 19a-495 and 19a-580d of the general statutes and the regulations adopted thereunder, the Commissioner of Public Health may adopt regulations, in accordance with the provisions of chapter 54 of the general statutes, for the program established in accordance with this section to ensure that: (1) Medical orders for life-sustaining treatment are transferrable among, and recognized by, various types of health care institutions; (2) any procedures and forms developed for recording medical orders for life-sustaining treatment require the signature of the patient or the patient's legally authorized representative and a witness on the medical order for life-sustaining treatment and the patient or the patient's legally authorized representative is given the original order immediately after signing such order and a copy of such order is immediately placed in the patient's medical record; (3) prior to requesting the signature of the patient or the patient's legally authorized representative on such order, the physician, advanced practice registered nurse or physician assistant writing the medical order discusses with the patient or the patient's legally authorized representative the patient's goals for care and treatment and the benefits and risks of various methods for documenting the patient's wishes for end-of-life treatment, including medical orders for life-sustaining treatment; and (4) each physician, advanced practice registered nurse or physician assistant that intends to write a medical order for life-sustaining treatment receives training concerning: (A) The importance of talking with patients about their personal treatment goals; (B) methods for presenting choices for end-of-life care that elicit information concerning patients' preferences and respects those preferences without directing patients toward a particular option for end-of-life care; (C) the importance of fully informing patients about the benefits and risks of an immediately effective medical order for life-sustaining treatment; (D) awareness of factors that may affect the use of medical orders for life-sustaining treatment, including, but not limited to, race, ethnicity, age, gender, socioeconomic position, immigrant status, sexual minority status, language, disability, homelessness, mental illness and geographic area of residence; and (E) procedures for properly completing and effectuating medical orders for life-sustaining treatment.

(d) Nothing in this section shall be construed to limit the authority of the Commissioner of Developmental Services under subsection (g) of section 17a-238 of the general statutes concerning orders applied to persons receiving services under the direction of said commissioner.

(e) The Commissioner of Public Health may implement policies and procedures necessary to administer the provisions of this section until such time as regulations are adopted pursuant to subsection (c) of this section.

Sec. 2. (NEW) (Effective October 1, 2017) There is established, within available appropriations, a medical orders for life-sustaining treatment advisory council. The advisory council shall consist of health care providers, public health professionals and consumer advocates and shall make recommendations to the Commissioner of Public Health concerning the requirements prescribed in section 1 of this act. The advisory council shall consist of the following members, who shall be appointed by the commissioner not later than January 1, 2018: (1) A public health practitioner; (2) two physicians, one of whom shall be an emergency department physician; (3) an advanced practice registered nurse; (4) a physician assistant; (5) an emergency medical service provider; (6) two patient advocates, one of whom shall be an advocate for persons with disabilities; (7) a hospital representative; (8) a long-term care facility representative; and (9) any person or a representative from any other organization who, as determined by the commissioner, possesses familiarity with the issues concerning medical orders for life-sustaining treatment. The advisory council shall meet at least annually to be updated on the status of the program and advise the department on matters related to improving the program established pursuant to section 1 of this act.

This act shall take effect as follows and shall amend the following sections:

Section 1

October 1, 2017

New section

Sec. 2

October 1, 2017

New section

Statement of Legislative Commissioners:

In Section 1, former Subsecs. (b) to (d), inclusive, of Sec. 2 were redesignated as Subsecs. (c) to (e), inclusive, of Sec. 1 for clarity; and in Section 2, "advisory group shall meet" was changed to "advisory council shall meet" for internal consistency; this "section" was changed to "section 1 of this act" for clarity; and "established pursuant to section 1 of this act" was inserted after "program" for clarity.

PH

Joint Favorable Subst.

 

The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of the General Assembly, solely for purposes of information, summarization and explanation and do not represent the intent of the General Assembly or either chamber thereof for any purpose. In general, fiscal impacts are based upon a variety of informational sources, including the analyst's professional knowledge. Whenever applicable, agency data is consulted as part of the analysis, however final products do not necessarily reflect an assessment from any specific department.


OFA Fiscal Note

State Impact: None

Municipal Impact: None

Explanation

This bill, which requires the Department of Public Health (DPH) to establish a statewide Medical Orders for Life-Sustaining Treatment (MOLST) program, does not result in a fiscal impact to the agency or municipalities. DPH launched its MOLST program on 4/16/15. As of 3/20/17, a total of 127 patients and 13 providers have participated in the program. As members of the MOLST advisory council, established under the bill, are anticipated to participate on a voluntary basis, there is no fiscal impact to DPH is anticipated from this provision.

The Out Years

State Impact: None

Municipal Impact: None

Sources:

Public Hearing Testimony, 3/20/17

OLR Bill Analysis

sSB 938

AN ACT CONCERNING THE DEPARTMENT OF PUBLIC HEALTH'S RECOMMENDATIONS FOR THE STATE-WIDE ADOPTION OF THE MEDICAL ORDERS FOR LIFE-SUSTAINING TREATMENT PROGRAM.

SUMMARY

Currently, the Department of Public Health (DPH) is operating a “medical orders for life-sustaining treatment” (MOLST) pilot program, scheduled to end in October 2017.

This bill requires DPH to establish a statewide MOLST program. As under the pilot program, patient participation must be voluntary. The bill authorizes the commissioner to adopt regulations on various matters to implement the program, such as ensuring that (1) MOLST orders are transferrable and recognized by various types of health care institutions and (2) authorized providers intending to write these orders receive training on specified matters.

The bill also establishes, within available appropriations, a MOLST advisory council to make recommendations to the DPH commissioner.

Under the bill, a MOLST is a medical order written by a physician, advanced practice registered nurse (APRN), or physician assistant (PA) to effectuate a patient's request for life-sustaining treatment when a physician or APRN has determined the patient is approaching the end stage of a serious, life-limiting illness or is in a condition of advanced, chronic progressive frailty.

EFFECTIVE DATE: October 1, 2017

STATEWIDE MOLST PROGRAM

The bill requires the DPH commissioner to establish a statewide program to implement the use of MOLST by health care providers (including their employees or agents). To agree to participate, the patient or the patient's legally authorized representative must sign the MOLST form, and a witness must sign it as well. A “legally authorized representative” is a minor patient's parent, a guardian appointed by the probate court, or a health care representative appointed under law.

Regulations

The bill allows the DPH commissioner to adopt regulations for the MOLST program to ensure that:

In addition, the bill allows regulations to ensure that each physician, APRN, or PA who intends to write a MOLST receives training on:

The bill allows the DPH commissioner to implement policies and procedures needed to administer the bill until regulations are adopted.

Department of Developmental Services

The bill specifies that its provisions do not limit the existing authority of the Department of Developmental Services (DDS) commissioner as to certain medical orders for individuals receiving services under his direction. This law provides that the DDS commissioner (1) can make treatment decisions for such individuals only in limited circumstances and (2) may not seek to impede a properly executed medical order to withhold cardiopulmonary resuscitation under specified conditions (CGS 17a-238(g)).

2 — MOLST ADVISORY COUNCIL

The bill establishes a MOLST advisory council, within available appropriations, to advise the DPH commissioner on the program. The council must meet at least once a year to receive updates on the status of the program and advise DPH on possible ways to improve it.

The DPH commissioner must appoint the council's members by January 1, 2018. The membership must include:

COMMITTEE ACTION

Public Health Committee

Joint Favorable Substitute

Yea

26

Nay

0

(03/24/2017)

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