Florida 2024 Regular Session

Florida House Bill H0219 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
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2	2
3	3	HB 219 2024
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5	5
6	6
7	7	CODING: Words stricken are deletions; words underlined are additions.
8	8	hb0219-00
9	9	Page 1 of 22
10	10	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
11	11
12	12
13	13
14	14	A bill to be entitled 1
15	15	An act relating to patient -directed doctor's orders; 2
16	16	amending ss. 395.1041, 400.142, and 400.487, F.S.; 3
17	17	authorizing specified personnel to withhold or 4
18	18	withdraw cardiopulmonary resuscitation if presented 5
19	19	with a patient-directed doctor's order (PDDO) form 6
20	20	that contains an order not to resuscitate; providing 7
21	21	such personnel with immunity from criminal prosecution 8
22	22	or civil liability for such actions; providing that 9
23	23	the absence of such form does not preclude physicians 10
24	24	or home health agency personnel from withhol ding or 11
25	25	withdrawing cardiopulmonary resuscitation under 12
26	26	certain conditions; amending s. 400.605, F.S.; 13
27	27	requiring the Agency for Health Care Administration to 14
28	28	adopt by rule procedures for the implementation of 15
29	29	PDDO forms in hospice care; amending s. 400.609 5, 16
30	30	F.S.; authorizing hospice care teams to withhold or 17
31	31	withdraw cardiopulmonary resuscitation if presented 18
32	32	with a PDDO form; providing hospice staff with 19
33	33	immunity from criminal prosecution or civil liability 20
34	34	for such actions; providing that the absence of such 21
35	35	form does not preclude physicians from withholding or 22
36	36	withdrawing cardiopulmonary resuscitation; amending s. 23
37	37	401.35, F.S.; requiring the Department of Health to 24
38	38	establish circumstances and procedures for honoring 25
39	39
40	40	HB 219 2024
41	41
42	42
43	43
44	44	CODING: Words stricken are deletions; words underlined are additions.
45	45	hb0219-00
46	46	Page 2 of 22
47	47	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
48	48
49	49
50	50
51	51	PDDO forms; amending s. 401.45, F.S.; authorizing 26
52	52	emergency medical personnel to withhold or withdraw 27
53	53	other forms of medical interventions if presented with 28
54	54	a PDDO form; prohibiting physician assistants from 29
55	55	signing such form; creating s. 401.451, F.S.; 30
56	56	establishing the Patient -directed Doctor's Order 31
57	57	(PDDO) Program within the department; providing 32
58	58	requirements for a PDDO form; providing duties of the 33
59	59	department; providing a restriction on the use of such 34
60	60	form; providing for the revocation of such form under 35
61	61	certain circumstances; specifying wh ich document takes 36
62	62	precedence when directives in such form conflict with 37
63	63	other advance directives; providing limited immunity 38
64	64	for legal representatives and specified health care 39
65	65	providers relying in good faith on such form; 40
66	66	requiring the review of such for m upon transfer of a 41
67	67	patient; prohibiting such form from being required as 42
68	68	a condition for treatment or admission to a health 43
69	69	care facility; providing that the presence or absence 44
70	70	of such form does not affect, impair, or modify 45
71	71	certain insurance contracts; declaring such form 46
72	72	invalid if executed in exchange for payment or other 47
73	73	remuneration; requiring the agency to create and 48
74	74	update a database for the storage, solely at the 49
75	75	option of the patient, of a PDDO form by the 50
76	76
77	77	HB 219 2024
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79	79
80	80
81	81	CODING: Words stricken are deletions; words underlined are additions.
82	82	hb0219-00
83	83	Page 3 of 22
84	84	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
85	85
86	86
87	87
88	88	department; providing construction; ame nding s. 51
89	89	429.255, F.S.; authorizing assisted living facility 52
90	90	personnel to withhold or withdraw cardiopulmonary 53
91	91	resuscitation or the use of an automated external 54
92	92	defibrillator if presented with a PDDO form; providing 55
93	93	facility staff and facilities with immun ity from 56
94	94	criminal prosecution or civil liability for such 57
95	95	actions; providing that the absence of such form does 58
96	96	not preclude physicians from withholding or 59
97	97	withdrawing cardiopulmonary resuscitation or the use 60
98	98	of an automated external defibrillator; amendin g s. 61
99	99	429.73, F.S.; requiring the agency to adopt rules for 62
100	100	the implementation of PDDO forms in adult family -care 63
101	101	homes; authorizing providers of such homes to withhold 64
102	102	or withdraw cardiopulmonary resuscitation if presented 65
103	103	with such form; providing such pr oviders with immunity 66
104	104	from criminal prosecution or civil liability for such 67
105	105	actions; amending s. 456.072, F.S.; authorizing 68
106	106	licensees to withhold or withdraw cardiopulmonary 69
107	107	resuscitation or the use of an automated external 70
108	108	defibrillator if presented with an order not to 71
109	109	resuscitate or a PDDO form; requiring the department 72
110	110	to adopt rules providing for the implementation of 73
111	111	such order and form; providing licensees with immunity 74
112	112	from criminal prosecution or civil liability for 75
113	113
114	114	HB 219 2024
115	115
116	116
117	117
118	118	CODING: Words stricken are deletions; words underlined are additions.
119	119	hb0219-00
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121	121	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
122	122
123	123
124	124
125	125	withholding or withdrawing cardi opulmonary 76
126	126	resuscitation or the use of an automated external 77
127	127	defibrillator if presented with such order or form; 78
128	128	providing that the absence of such order or form does 79
129	129	not preclude licensees from withholding or withdrawing 80
130	130	cardiopulmonary resuscitation or t he use of an 81
131	131	automated external defibrillator; amending s. 765.205, 82
132	132	F.S.; requiring health care surrogates to provide 83
133	133	written consent for a PDDO form under certain 84
134	134	circumstances; providing an effective date. 85
135	135	86
136	136	Be It Enacted by the Legislature of the Sta te of Florida: 87
137	137	88
138	138	Section 1. Paragraph (l) of subsection (3) of section 89
139	139	395.1041, Florida Statutes, is amended to read: 90
140	140	395.1041 Access to and ensurance of emergency services; 91
141	141	transfers; patient rights; diversion programs; reports of 92
142	142	controlled substance overdoses.— 93
143	143	(3) EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF 94
144	144	FACILITY OR HEALTH CARE PERSONNEL. — 95
145	145	(l) Hospital personnel may withhold or withdraw 96
146	146	cardiopulmonary resuscitation if presented with an order not to 97
147	147	resuscitate executed pursuant to s. 401.45 or a patient-directed 98
148	148	doctor's order (PDDO) form executed pursuant to s. 401.451 that 99
149	149	contains an order not to resuscitate . Facility staff and 100
150	150
151	151	HB 219 2024
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153	153
154	154
155	155	CODING: Words stricken are deletions; words underlined are additions.
156	156	hb0219-00
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158	158	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
159	159
160	160
161	161
162	162	facilities are shall not be subject to criminal prosecution or 101
163	163	civil liability, and are not nor be considered to have engaged 102
164	164	in negligent or unprofessional conduct, for withholding or 103
165	165	withdrawing cardiopulmonary resuscitation pursuant to such an 104
166	166	order or PDDO form. The absence of an order not to resuscitate 105
167	167	executed pursuant to s. 401.45 or a PDDO form execut ed pursuant 106
168	168	to s. 401.451 that contains an order not to resuscitate does not 107
169	169	preclude a physician from withholding or withdrawing 108
170	170	cardiopulmonary resuscitation as otherwise authorized permitted 109
171	171	by law. 110
172	172	Section 2. Subsection (3) of section 400.142, Flor ida 111
173	173	Statutes, is amended to read: 112
174	174	400.142 Emergency medication kits; orders not to 113
175	175	resuscitate.— 114
176	176	(3) Facility staff may withhold or withdraw 115
177	177	cardiopulmonary resuscitation if presented with an order not to 116
178	178	resuscitate executed pursuant to s. 401.45 or a patient-directed 117
179	179	doctor's order (PDDO) form executed pursuant to s. 401.451 that 118
180	180	contains an order not to resuscitate . Facility staff and 119
181	181	facilities are not subject to criminal prosecution or civil 120
182	182	liability, or considered to have engaged in negligent or 121
183	183	unprofessional conduct, for withholding or withdrawing 122
184	184	cardiopulmonary resuscitation pursuant to such an order or PDDO 123
185	185	form. The absence of an order not to resuscitate executed 124
186	186	pursuant to s. 401.45 or a PDDO form executed pursuant to s. 125
187	187
188	188	HB 219 2024
189	189
190	190
191	191
192	192	CODING: Words stricken are deletions; words underlined are additions.
193	193	hb0219-00
194	194	Page 6 of 22
195	195	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
196	196
197	197
198	198
199	199	401.451 that contains an order not to resuscitate does not 126
200	200	preclude a physician from withholding or withdrawing 127
201	201	cardiopulmonary resuscitation as otherwise authorized permitted 128
202	202	by law. 129
203	203	Section 3. Subsection (7) of section 400.487, Florida 130
204	204	Statutes, is amended to read: 131
205	205	400.487 Home health service agreements; physician's, 132
206	206	physician assistant's, and advanced practice registered nurse's 133
207	207	treatment orders; patient assessment; establishment and review 134
208	208	of plan of care; provision of services; orders not to 135
209	209	resuscitate; patient-directed doctor's orders for life -136
210	210	sustaining treatment .— 137
211	211	(7) Home health agency personnel may withhold or withdraw 138
212	212	cardiopulmonary resuscitation if presented with an order not to 139
213	213	resuscitate executed pursuant to s. 401.45 or a patient-directed 140
214	214	doctor's order (PDDO) form executed pursuant to s. 401.451 that 141
215	215	contains an order not to resuscitate . The agency shall adopt 142
216	216	rules providing for the implementation of such orders. Home 143
217	217	health personnel and agencies are shall not be subject to 144
218	218	criminal prosecution or civil liability, and are not nor be 145
219	219	considered to have engaged in negligent or unprofessional 146
220	220	conduct, for withholding or withdrawing cardiopulmonary 147
221	221	resuscitation pursuant to such an order or PDDO form and rules 148
222	222	adopted by the agency. 149
223	223	Section 4. Paragraph (e) of subsection (1) of section 150
224	224
225	225	HB 219 2024
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227	227
228	228
229	229	CODING: Words stricken are deletions; words underlined are additions.
230	230	hb0219-00
231	231	Page 7 of 22
232	232	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
233	233
234	234
235	235
236	236	400.605, Florida Statutes, is amended to read: 151
237	237	400.605 Administration; forms; fees; rules; inspections; 152
238	238	fines.— 153
239	239	(1) The agency shall by rule establish minimum standards 154
240	240	and procedures for a hospice pursuant to this part. The rules 155
241	241	must include: 156
242	242	(e) Procedures relating to the implementation of advance 157
243	243	advanced directives; patient-directed doctor's order (PDDO) 158
244	244	forms executed pursuant to s. 401.451 that contain orders not to 159
245	245	resuscitate; and orders not to resuscitate do-not-resuscitate 160
246	246	orders. 161
247	247	Section 5. Subsection (8) of section 400.6095, Florida 162
248	248	Statutes, is amended to read: 163
249	249	400.6095 Patient admission; assessment; plan of care; 164
250	250	discharge; death.— 165
251	251	(8) The hospice care team may withhold or withdraw 166
252	252	cardiopulmonary resuscitation if presented with an order not to 167
253	253	resuscitate executed pursuant to s. 401.45 or a patient-directed 168
254	254	doctor's order (PDDO) form executed pursuant to s. 401.451 that 169
255	255	contains an order not to resusci tate. The agency shall adopt 170
256	256	rules providing for the implementation of such orders. Hospice 171
257	257	staff are shall not be subject to criminal prosecution or civil 172
258	258	liability, and are not nor be considered to have engaged in 173
259	259	negligent or unprofessional conduct, for withholding or 174
260	260	withdrawing cardiopulmonary resuscitation pursuant to such an 175
261	261
262	262	HB 219 2024
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264	264
265	265
266	266	CODING: Words stricken are deletions; words underlined are additions.
267	267	hb0219-00
268	268	Page 8 of 22
269	269	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
270	270
271	271
272	272
273	273	order or PDDO form and applicable rules. The absence of an order 176
274	274	to resuscitate executed pursuant to s. 401.45 or a PDDO form 177
275	275	executed pursuant to s. 401.451 that contains an ord er not to 178
276	276	resuscitate does not preclude a physician from withholding or 179
277	277	withdrawing cardiopulmonary resuscitation as otherwise 180
278	278	authorized permitted by law. 181
279	279	Section 6. Subsection (4) of section 401.35, Florida 182
280	280	Statutes, is amended to read: 183
281	281	401.35 Rules.—The department shall adopt rules, including 184
282	282	definitions of terms, necessary to carry out the purposes of 185
283	283	this part. 186
284	284	(4) The rules must establish circumstances and procedures 187
285	285	under which emergency medical technicians and paramedics may 188
286	286	honor orders by the patient's physician not to resuscitate 189
287	287	executed pursuant to s. 401.45 or patient -directed doctor's 190
288	288	order (PDDO) forms executed pursuant to s. 401.451 that contain 191
289	289	orders not to resuscitate and the documentation and reporting 192
290	290	requirements for handling s uch requests. 193
291	291	Section 7. Paragraph (a) of subsection (3) of section 194
292	292	401.45, Florida Statutes, is amended to read: 195
293	293	401.45 Denial of emergency treatment; civil liability. — 196
294	294	(3)(a) Resuscitation or other forms of medical 197
295	295	intervention may be withheld or withdrawn from a patient by an 198
296	296	emergency medical technician , a or paramedic, or another health 199
297	297	care professional if evidence of an order not to resuscitate by 200
298	298
299	299	HB 219 2024
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301	301
302	302
303	303	CODING: Words stricken are deletions; words underlined are additions.
304	304	hb0219-00
305	305	Page 9 of 22
306	306	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
307	307
308	308
309	309
310	310	the patient's physician or physician assistant or a patient-201
311	311	directed doctor's order (PDDO) form executed pursuant to s. 202
312	312	401.451 that contains an order not to resuscitate is presented 203
313	313	to the emergency medical technician , or paramedic, or other 204
314	314	health care professional . To be valid, an order not to 205
315	315	resuscitate or not to perform other medical interventi on, to be 206
316	316	valid, must be on the form adopted by rule of the department. 207
317	317	The form must be signed by the patient's physician or physician 208
318	318	assistant and by the patient or, if the patient is 209
319	319	incapacitated, the patient's health care surrogate or proxy as 210
320	320	provided in chapter 765, court -appointed guardian as provided in 211
321	321	chapter 744, or attorney in fact under a durable power of 212
322	322	attorney as provided in chapter 709 ; however, a physician 213
323	323	assistant may not sign a patient -directed doctor's order form 214
324	324	executed pursuant to s. 401.451 that contains an order not to 215
325	325	resuscitate. The court-appointed guardian or attorney in fact 216
326	326	must have been delegated authority to make health care decisions 217
327	327	on behalf of the patient. 218
328	328	Section 8. Section 401.451, Florida Statutes, is created 219
329	329	to read: 220
330	330	401.451 Patient-directed Doctor's Order Program. — 221
331	331	(1) PATIENT-DIRECTED DOCTOR'S ORDER FORM. —A patient-222
332	332	directed doctor's order (PDDO) must be on a form adopted by rule 223
333	333	of the department which must include the statutory requirements 224
334	334	specified in this section and must be executed as required by 225
335	335
336	336	HB 219 2024
337	337
338	338
339	339
340	340	CODING: Words stricken are deletions; words underlined are additions.
341	341	hb0219-00
342	342	Page 10 of 22
343	343	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
344	344
345	345
346	346
347	347	this section. 226
348	348	(a) A PDDO form may only be completed by or for a patient 227
349	349	determined by the patient's physician to have an end -stage 228
350	350	condition as defined in s. 765.101 or a patient who, in the good 229
351	351	faith clinical judgment of his or her physician, is suffering 230
352	352	from at least one terminal medical condition that will likely 231
353	353	result in the death of the patient within 1 year. 232
354	354	(b) A PDDO form must be signed by the patient's physician. 233
355	355	The form must contain a cert ification by the physician signing 234
356	356	the PDDO form that the physician consulted with the patient 235
357	357	signing the form or, if the patient is incapable of making 236
358	358	health care decisions for himself or herself or is 237
359	359	incapacitated, the patient's health care surrogate, proxy, 238
360	360	court-appointed guardian, or attorney in fact permitted to 239
361	361	execute a PDDO form on behalf of the patient as provided in 240
362	362	paragraph (c) and include information about the patient's care 241
363	363	goals and preferences selected as reflected on the PDDO form, 242
364	364	specifically relating to the use of and the effect of removal or 243
365	365	refusal of life-sustaining medical treatment. The physician 244
366	366	signing the PDDO form must further indicate the medical 245
367	367	circumstance justifying the execution of the PDDO. 246
368	368	(c) A PDDO form must also be signed by the patient or, if 247
369	369	the patient is incapable of making health care decisions for 248
370	370	himself or herself or is incapacitated, the patient's health 249
371	371	care surrogate or proxy as provided in chapter 765, court -250
372	372
373	373	HB 219 2024
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375	375
376	376
377	377	CODING: Words stricken are deletions; words underlined are additions.
378	378	hb0219-00
379	379	Page 11 of 22
380	380	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
381	381
382	382
383	383
384	384	appointed guardian as provided in chapter 74 4, or attorney in 251
385	385	fact as provided in chapter 709. If a PDDO form is signed by a 252
386	386	health care surrogate, proxy, court -appointed guardian, or 253
387	387	attorney in fact, the patient's physician must certify the basis 254
388	388	for the authority of the appropriate individual to execute the 255
389	389	PDDO form on behalf of the patient, including compliance with 256
390	390	chapter 765, chapter 744, or chapter 709. 257
391	391	(d) The execution of a PDDO form by the patient 258
392	392	automatically revokes all PDDO forms previously executed by the 259
393	393	patient. 260
394	394	(e) A patient's health care surrogate, proxy, court -261
395	395	appointed guardian, or attorney in fact permitted to execute a 262
396	396	PDDO form on behalf of a patient as provided in paragraph (c) 263
397	397	may subsequently revoke a PDDO form for a patient, unless a 264
398	398	valid advance directive or prior P DDO form executed by the 265
399	399	patient expressly forbids changes by a surrogate, proxy, 266
400	400	guardian, or attorney in fact. 267
401	401	(f) An individual acting in good faith as a surrogate, 268
402	402	proxy, court-appointed guardian, or attorney in fact who 269
403	403	executes a PDDO form on behal f of an incapacitated patient in 270
404	404	accordance with this section and rules adopted by the department 271
405	405	is not subject to criminal prosecution or civil liability for 272
406	406	executing the PDDO form. 273
407	407	(g) If a family member of the patient, the health care 274
408	408	facility providing services to the patient, or the patient's 275
409	409
410	410	HB 219 2024
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414	414	CODING: Words stricken are deletions; words underlined are additions.
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417	417	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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419	419
420	420
421	421	physician who may reasonably be expected to be affected by the 276
422	422	patient's PDDO form directives believes that directives executed 277
423	423	by the patient's legal representative are in conflict with the 278
424	424	patient's prior expressed desires regarding end -of-life care, 279
425	425	the family member, facility, or physician may seek expedited 280
426	426	judicial intervention pursuant to the Florida Probate Rules if: 281
427	427	1. The PDDO form regarding the patient's wishes regarding 282
428	428	life-sustaining treatment i s ambiguous or the patient has 283
429	429	changed his or her mind after execution of the advance directive 284
430	430	or PDDO form; 285
431	431	2. The PDDO form was executed by a surrogate, proxy, 286
432	432	court-appointed guardian, or attorney in fact permitted to 287
433	433	execute a PDDO form on behalf of a patient as provided in 288
434	434	paragraph (c) and the PDDO form is not in accord with the 289
435	435	patient's known desires or chapter 765, chapter 744, or chapter 290
436	436	709; 291
437	437	3. The PDDO form was executed by a surrogate, proxy, 292
438	438	court-appointed guardian, or attorney in fact on behalf of a 293
439	439	patient as provided in paragraph (c) and the surrogate, proxy, 294
440	440	court-appointed guardian, or attorney in fact was improperly 295
441	441	designated or appointed, or the designation of the surrogate, 296
442	442	proxy, court-appointed guardian, or attorney in fact is n o 297
443	443	longer effective or has been removed; 298
444	444	4. The surrogate, proxy, court -appointed guardian, or 299
445	445	attorney in fact who executed the PDDO form on behalf of the 300
446	446
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449	449
450	450
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454	454	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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456	456
457	457
458	458	patient as provided in paragraph (c) has failed to discharge his 301
459	459	or her duties, or incapacity or il lness renders him or her 302
460	460	incapable of discharging those duties; 303
461	461	5. The PDDO was executed by a surrogate, proxy, court -304
462	462	appointed guardian, or attorney in fact permitted to execute a 305
463	463	PDDO form on behalf of a patient as provided in paragraph (c) 306
464	464	who has abused his or her powers; or 307
465	465	6. The patient has sufficient capacity to make his or her 308
466	466	own health care decisions. 309
467	467	(h) A PDDO form may not include a directive regarding 310
468	468	hydration or the preselection of any decision or directive. A 311
469	469	PDDO form must be voluntarily executed by the patient or, if the 312
470	470	patient is incapacitated, the patient's legal representative, 313
471	471	and all directives included in the form must be made by the 314
472	472	patient or, if the patient is incapacitated, the patient's legal 315
473	473	representative at the time of signing the form. A PDDO form is 316
474	474	not valid and may not be included in a patient's medical records 317
475	475	or submitted to the database as provided in subsection (10) 318
476	476	unless the form: 319
477	477	1. Is clearly printed on one or both sides of a single 320
478	478	piece of paper as determined by department rule; 321
479	479	2. Includes the signatures of the patient and the 322
480	480	patient's examining physician or, if the patient is 323
481	481	incapacitated, the patient's legal representative and the 324
482	482	patient's examining physician. The PDDO form may be executed 325
483	483
484	484	HB 219 2024
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488	488	CODING: Words stricken are deletions; words underlined are additions.
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491	491	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
492	492
493	493
494	494
495	495	only after the examining physician consults with the patient or 326
496	496	the patient's legal representative, as appropriate; 327
497	497	3. Prominently states that completion of a PDDO form is 328
498	498	voluntary, that the execution or use of a PDDO form may not be 329
499	499	required as a condition for medical treatment, and that a PDDO 330
500	500	form may not be given effect if the patient is conscious and 331
501	501	competent to make health care decisions; 332
502	502	4. Prominently provides in a conspicuous location on the 333
503	503	form a space for the patient's examining physician to attest 334
504	504	that, in his or her clinical judgment and with good faith, at 335
505	505	the time the PDDO form is completed and signed, the patient has 336
506	506	the ability to make and communicate health care decisions or, if 337
507	507	the patient is incapacitated, that the patient's legal 338
508	508	representative has such ability; 339
509	509	5. Includes an expiration date, provided by the patient's 340
510	510	examining physician, that is within 1 year after the patient or 341
511	511	the patient's legal representative signs the form or that is 342
512	512	contingent on completion of the course of treatment addressed in 343
513	513	the PDDO form, whichever occurs first; and 344
514	514	6. Identifies the medical condition or conditions, 345
515	515	provided by the patient's examining physician, that necessitate 346
516	516	the PDDO form. 347
517	517	(2) DUTIES OF THE DEPARTMENT. —The department shall: 348
518	518	(a) Adopt rules to implement and administer the PDDO 349
519	519	program. 350
520	520
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528	528	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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530	530
531	531
532	532	(b) Prescribe a standardized PDDO form. 351
533	533	(c) Provide the PDDO form in an electronic format on the 352
534	534	department's website and prominently state on the website the 353
535	535	requirements for a PDDO form as specified under paragraph 354
536	536	(3)(a). 355
537	537	(d) Consult with health care professional licensing 356
538	538	groups, provider advocacy groups, medical ethicists, and other 357
539	539	appropriate stakeholders on the development of rules and forms 358
540	540	to implement and administer the PDDO pr ogram. 359
541	541	(e) Recommend a uniform method of identifying persons who 360
542	542	have executed a PDDO form and providing health care providers 361
543	543	with contact information regarding the person's primary health 362
544	544	care provider. 363
545	545	(f) Oversee the education of health care provid ers 364
546	546	licensed by the department regarding implementation of the PDDO 365
547	547	program. 366
548	548	(g) Develop a process for collecting provider feedback to 367
549	549	enable periodic redesign of the PDDO form in accordance with 368
550	550	current health care best practices. 369
551	551	(3) DUTY TO COMPLY W ITH PDDO; OUT-OF-STATE PDDO; LIMITED 370
552	552	IMMUNITY.— 371
553	553	(a) Emergency medical service personnel, health care 372
554	554	providers, physicians, and health care facilities, absent actual 373
555	555	notice of revocation or termination of a PDDO form, may comply 374
556	556	with the orders on a pers on's PDDO form, without regard to 375
557	557
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565	565	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
566	566
567	567
568	568
569	569	whether the PDDO ordering provider is on the medical staff of 376
570	570	the treating health care facility. If the PDDO ordering provider 377
571	571	is not on the medical staff of the treating health care 378
572	572	facility, the PDDO form shall be review ed by the treating health 379
573	573	care professional at the receiving facility with the patient or 380
574	574	the patient's health care surrogate, proxy, court -appointed 381
575	575	guardian, or attorney in fact permitted to execute a PDDO form 382
576	576	on behalf of a patient as provided in parag raph (1)(c) and made 383
577	577	into a medical order at the receiving facility, unless the PDDO 384
578	578	form is replaced or voided as provided in this act. 385
579	579	(b) A PDDO form from another state, absent actual notice 386
580	580	of revocation or termination, shall be presumed valid and sh all 387
581	581	be effective in this state and shall be complied with to the 388
582	582	same extent as a PDDO form executed in this state. 389
583	583	(c) Any licensee, physician, medical director, or 390
584	584	emergency medical technician or paramedic who acts in good faith 391
585	585	on a PDDO is not subjec t to criminal prosecution or civil 392
586	586	liability, and has not engaged in negligent or unprofessional 393
587	587	conduct, as a result of carrying out the directives of the PDDO 394
588	588	made in accordance with this section and rules adopted by the 395
589	589	department. 396
590	590	(4) PATIENT TRANSFE R; PDDO FORM REVIEW REQUIRED. —If a 397
591	591	patient whose goals and preferences for care have been entered 398
592	592	in a valid PDDO form is transferred from one health care 399
593	593	facility or level of care to another, the health care facility 400
594	594
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602	602	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
603	603
604	604
605	605
606	606	or level of care initiating the transf er must communicate the 401
607	607	existence of the PDDO form to the receiving facility or level of 402
608	608	care before the transfer. Upon the patient's transfer, the 403
609	609	treating health care provider at the receiving facility or level 404
610	610	of care must review the PDDO form with the patient or, if the 405
611	611	patient is incapacitated, the patient's health care surrogate, 406
612	612	proxy, court-appointed guardian, or attorney in fact . 407
613	613	(5) CONFLICTS WITH ADVANCE DIRECTIVES. —To the extent that 408
614	614	a directive made on a patient's PDDO form conflicts with ano ther 409
615	615	advance directive of the patient which addresses a substantially 410
616	616	similar health care condition or treatment, the document most 411
617	617	recently signed by the patient takes precedence. Such directives 412
618	618	may include, but are not limited to: 413
619	619	(a) A living will. 414
620	620	(b) A health care power of attorney. 415
621	621	(c) A PDDO form for the specific medical condition or 416
622	622	treatment. 417
623	623	(d) An order not to resuscitate. 418
624	624	(6) PDDO FORM NOT A PREREQUISITE. —A PDDO form may not be a 419
625	625	prerequisite for receiving medical services or for admi ssion to 420
626	626	a health care facility. A health care facility or health care 421
627	627	provider may not require an individual to complete, revise, or 422
628	628	revoke a PDDO form as a condition of receiving medical services 423
629	629	or treatment or as a condition of admission. The execution , 424
630	630	revision, or revocation of a PDDO form must be a voluntary 425
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639	639	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
640	640
641	641
642	642
643	643	decision of the patient or, if the patient is incapacitated, the 426
644	644	patient's legal representative. 427
645	645	(7) REVOCATION OF A PDDO FORM. — 428
646	646	(a) A PDDO form may be revoked at any time by a patient 429
647	647	deemed to have capacity by means of: 430
648	648	1. A signed, dated writing; 431
649	649	2. The physical cancellation or destruction of the PDDO 432
650	650	form by the patient or by another in the patient's presence and 433
651	651	at the patient's direction; 434
652	652	3. An oral expression of intent to revoke; or 435
653	653	4. A subsequently executed PDDO form or advance directive 436
654	654	that is materially different from a previously executed PDDO 437
655	655	form or advance directive. 438
656	656	(b) A surrogate, proxy, court -appointed guardian, or 439
657	657	attorney in fact permitted to execute a PDDO form on behalf of a 440
658	658	patient as provided in paragraph (1)(c) who created a PDDO form 441
659	659	for a patient may revoke a PDDO form at any time in a writing 442
660	660	signed by such surrogate, proxy, court -appointed guardian, or 443
661	661	attorney in fact. 444
662	662	(c) Any revocation of a PDDO form shall be promptly 445
663	663	communicated to the patient's primary health care provider, 446
664	664	primary physician, any health care facility at which the patient 447
665	665	is receiving care, and the Agency for Health Care Administration 448
666	666	for purposes of updating the database. Further, a health care 449
667	667	professional, surrogate, proxy, court -appointed guardian, or 450
668	668
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676	676	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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678	678
679	679
680	680	attorney in fact who is informed of the revocation of a PDDO 451
681	681	form shall promptly communicate the fact of the revocation to 452
682	682	the patient's primary care physician, the current supervi sing 453
683	683	health care professional, and any health care facility at which 454
684	684	the patient is receiving care, to the extent known to the 455
685	685	surrogate, proxy, court -appointed guardian, or attorney in fact. 456
686	686	(d) Upon revocation, a PDDO form shall be void. A PDDO 457
687	687	form may only be revoked in its entirety. A partial revocation 458
688	688	of a PDDO form renders the entirety of the PDDO form void. 459
689	689	(8) INSURANCE NOT AFFECTED. —The presence or absence of a 460
690	690	PDDO form does not affect, impair, or modify a contract of life 461
691	691	or health insurance or an annuity to which an individual is a 462
692	692	party and may not serve as the basis for a delay in issuing or 463
693	693	refusing to issue a policy of life or health insurance or an 464
694	694	annuity or for an increase or decrease in premiums charged to 465
695	695	the individual. 466
696	696	(9) INVALIDITY.—A PDDO form is invalid if payment or other 467
697	697	remuneration was offered or made in exchange for execution of 468
698	698	the form. 469
699	699	(10) DATABASE.—The Agency for Health Care Administration 470
700	700	shall create and update a database for the storage of PDDO 471
701	701	forms, which shall be stored solely at the option of the patient 472
702	702	in electronic form by the department. 473
703	703	(11) CONSTRUCTION.—This section may not be construed to 474
704	704	condone, authorize, or approve mercy killing or euthanasia. The 475
705	705
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713	713	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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715	715
716	716
717	717	Legislature does not intend that this act be c onstrued as 476
718	718	authorizing an affirmative or deliberate act to end an 477
719	719	individual's life, except to allow the natural process of dying. 478
720	720	Section 9. Subsection (4) of section 429.255, Florida 479
721	721	Statutes, is amended to read: 480
722	722	429.255 Use of personnel; emergenc y care.— 481
723	723	(4) Facility staff may withhold or withdraw 482
724	724	cardiopulmonary resuscitation or the use of an automated 483
725	725	external defibrillator if presented with an order not to 484
726	726	resuscitate executed pursuant to s. 401.45 or a patient-directed 485
727	727	doctor's order (PDDO) form executed pursuant to s. 401.451 that 486
728	728	contains an order not to resuscitate . The agency shall adopt 487
729	729	rules providing for the implementation of such an order or PDDO 488
730	730	form orders. Facility staff and facilities are may not be 489
731	731	subject to criminal prosecution or civil liability, and are not 490
732	732	nor be considered to have engaged in negligent or unprofessional 491
733	733	conduct, for withholding or withdrawing cardiopulmonary 492
734	734	resuscitation or the use of an automated external defibrillator 493
735	735	pursuant to such an order or PDDO form and rules adopted by the 494
736	736	agency. The absence of an order not to resuscitate executed 495
737	737	pursuant to s. 401.45 or a PDDO form executed pursuant to s. 496
738	738	401.451 that contains an order not to resuscitate does not 497
739	739	preclude a physician from withholding or withdrawi ng 498
740	740	cardiopulmonary resuscitation or the use of an automated 499
741	741	external defibrillator as otherwise authorized permitted by law. 500
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750	750	F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
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753	753
754	754	Section 10. Subsection (3) of section 429.73, Florida 501
755	755	Statutes, is amended to read: 502
756	756	429.73 Rules and standards relating to ad ult family-care 503
757	757	homes.— 504
758	758	(3) The agency shall adopt rules providing for the 505
759	759	implementation of orders not to resuscitate and patient-directed 506
760	760	doctor's order (PDDO) forms executed pursuant to s. 401.451 that 507
761	761	contain orders not to resuscitate . The provider may withhold or 508
762	762	withdraw cardiopulmonary resuscitation if presented with an 509
763	763	order not to resuscitate executed pursuant to s. 401.45 or a 510
764	764	PDDO form executed pursuant to s. 401.451 that contains an order 511
765	765	not to resuscitate. The provider is shall not be subject to 512
766	766	criminal prosecution or civil liability, and is not nor be 513
767	767	considered to have engaged in negligent or unprofessional 514
768	768	conduct, for withholding or withdrawing cardiopulmonary 515
769	769	resuscitation pursuant to such an order or PDDO form and 516
770	770	applicable rules. 517
771	771	Section 11. Subsections (7) and (8) of section 456.072, 518
772	772	Florida Statutes, are renumbered as subsections (8) and (9), 519
773	773	respectively, and a new subsection (7) is added to that section 520
774	774	to read: 521
775	775	456.072 Grounds for discipline; penalties; enforcement. — 522
776	776	(7) A licensee may withhold or withdraw cardiopulmonary 523
777	777	resuscitation or the use of an automated external defibrillator 524
778	778	if presented with an order not to resuscitate executed pursuant 525
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790	790
791	791	to s. 401.45 or a patient -directed doctor's order (PDDO) form 526
792	792	executed pursuant to s. 401.451 that contains an order not to 527
793	793	resuscitate. The department shall adopt rules providing for the 528
794	794	implementation of such order or form. A licensee is not subject 529
795	795	to criminal prosecution or civil liability, and is not 530
796	796	considered to have engaged in negligent or unprofessional 531
797	797	conduct, for withholding or withdrawing cardiopulmonary 532
798	798	resuscitation or the use of an automated external defibrillator 533
799	799	if presented with such an order or PDDO form. The absence of 534
800	800	such an order or PDDO form does not preclude a licensee from 535
801	801	withholding or withdrawing cardiopulmonary resuscitation or the 536
802	802	use of an automated external defibrillator as otherwise 537
803	803	authorized by law. 538
804	804	Section 12. Paragraph (c) of subsection (1) of section 539
805	805	765.205, Florida Statutes, is am ended to read: 540
806	806	765.205 Responsibility of the surrogate. — 541
807	807	(1) The surrogate, in accordance with the principal's 542
808	808	instructions, unless such authority has been expressly limited 543
809	809	by the principal, shall: 544
810	810	(c) Provide written consent using an appropriate fo rm 545
811	811	whenever consent is required, including a physician's order not 546
812	812	to resuscitate or a patient-directed doctor's order (PDDO) form 547
813	813	executed pursuant to s. 401.451 that contains an order not to 548
814	814	resuscitate. 549
815	815	Section 13. This act shall take effect July 1, 2024. 550