HLS 23RS-190 ORIGINAL
2023 Regular Session
HOUSE BILL NO. 599
BY REPRESENTATIVE DUSTIN MILLER
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
NURSES: Authorizes certain healthcare practitioners to complete documentation related
to illness and end of life treatment
1 AN ACT
2To amend and reenact R.S. 17:500(B)(1), 500.1(A), (B), and (C)(2),
3 500.2(A)(2)(introductory paragraph) and (c), (D)(1)(b), and E(1)(a), (2)(a) through
4 (c), and (e), 1201(A)(2) and (C)(1)(a), (b)(i) through (iii), and (v), 1202(A)(1)(b) and
5 (2)(introductory paragraph) and (d), (D)(1)(b), and (E)(1)(a) and (c), (2)(a) through
6 (c), and (3), 1206(A)(1), 1206.1(A)(1), (B), (C), and (D)(2), 1206.2(D)(1)(b),
7 (E)(1)(a) and (c), (2)(a) through (c), and (3), R.S. 40:1151(A)(3)(a),
8 1151.1(introductory paragraph), (1), (6), (10), and (11), 1151.2(B), (C)(1), and
9 (D)(2), 1151.3(A)(2)(b) and (3)(b) and (c) and (B), 1151.6(A) through (D),
10 1151.7(A) and (B), the heading of Subpart C of Part I of Subchapter A of Chapter
11 5-D of Title 40 of the Louisiana Revised Statutes of 1950, 1155.1(A)(3) and (4)(a)
12 and (B)(1) and (2), 1155.2(introductory paragraph), (1) through (3), and (8) and (9),
13 1155.3(A), (B)(5), and (D), 1155.4(A) through (C), and 1155.5(A)(1) and (2) and
14 to enact R.S. 17:1200(D) and R.S. 40:1155.3(B)(6), relative to signature authority
15 for healthcare providers; to provide for advanced practice registered nurse (APRN)
16 and physician assistant signature authority to issue certification of illness or
17 condition for the purposes of sick and extended sick leave for teachers, teaching
18 staff, and bus drivers; to provide for APRN signature authority for a declaration of
19 a "do not resuscitate" order; to provide for APRN signature authority for LaPOST;
20 to provide for definitions; and to provide for related matters.
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1Be it enacted by the Legislature of Louisiana:
2 Section 1. R.S. 17:500(B)(1), 500.1(A), (B), and (C)(2), 500.2(A)(2)(introductory
3paragraph) and (c), (D)(1)(b), and E(1)(a), (2)(a) through (c), and (e), 1201(A)(2) and
4(C)(1)(a), (b)(i) through (iii), and (v), 1202(A)(1)(b) and (2)(introductory paragraph) and (d),
5(D)(1)(b), and (E)(1)(a) and (c), (2)(a) through (c), and (3), 1206(A)(1), 1206.1(A)(1), (B),
6(C), and (D)(2), 1206.2(D)(1)(b), (E)(1)(a) and (c), (2)(a) through (c), and (3) are hereby
7amended and reenacted and R.S. 17:1200(D) is hereby enacted to read as follows:
8 §500. Sick leave for school bus operators; minimum pay for substitute
9 * * *
10 B.(1) All school bus operators employed by the parish and the city school
11 boards of this state shall be entitled to and shall be allowed a minimum of ten days
12 absence per school year because of personal illness or because of other emergencies
13 or special circumstances, without loss of pay. Such sick leave when not used in any
14 year shall be accumulated to the credit of the school bus operator without limitation.
15 When a school bus operator is absent for six or more consecutive days because of
16 personal illness, he shall be required to present a certificate from a provider
17 certifying such illness. As used in this Subpart "provider" means a physician,
18 physician assistant providing health care healthcare services in accordance with R.S.
19 37:1360.28, or nurse practitioner an advanced practice registered nurse providing
20 health care healthcare services in accordance with R.S. 37:913 certifying such
21 illness. The parish and city school boards are authorized to adopt such rules and
22 regulations as are necessary relative to the use of such sick leave, either current or
23 accumulated, for emergencies or special circumstances. The parish and city school
24 boards may grant additional sick leave, without loss of pay, or with such reduction
25 of pay as they may establish and fix.
26 * * *
27 §500.1. School bus operators; sick leave
28 A. A school bus operator as defined in R.S. 17:500 who is injured in his
29 official capacity as a result of physical assault and battery by any student or person
30 and is disabled as a result of such injury and cannot perform his functions as a school
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1 bus operator, shall receive sick leave without reduction in pay while disabled as a
2 result of such injury. If a school bus operator is absent for six or more consecutive
3 days as a result of such disability, he shall be required to present a certificate from
4 a physician provider certifying the disability. The sick leave authorized by this
5 Section shall be in addition to all other sick leave authorized by R.S. 17:500,
6 provided that additional sick leave for disability as a result of physical assault and
7 battery shall not be accumulated from year to year, nor shall such additional sick
8 leave be compensated for at death or retirement, or compensated for in any other
9 manner except as authorized in this Section.
10 B. At any time during the period of certified disability, if the school board
11 questions the validity of the physician provider certification, the board may require
12 the school bus operator to be examined by a physician provider selected by the
13 board. In such a case, the board shall pay all costs of the examination and any tests
14 determined to be necessary. If the physician provider selected by the board certifies
15 the disability, the leave shall be granted or continued as appropriate. If the physician
16 provider selected by the board disagrees with the certification of the physician
17 provider selected by the school bus operator, the board may require the school bus
18 operator to be examined by a third physician provider whose name appears next in
19 the rotation of physicians provider on a list established by the local or state medical
20 society for such purpose and maintained by the board. All costs of an examination
21 and any tests required by a third physician providers shall be paid by the board. The
22 opinion of the third physician provider shall be determinative of the issue.
23 C.
24 * * *
25 (2) If the school bus operator's physician provider determines that he is able
26 to return to active service as a school bus operator with restrictions and the board
27 does not allow the school bus operator to return to active service as a school bus
28 operator subject to those restrictions, then the school bus operator's leave shall be
29 granted or continued, as appropriate, as provided in this Section.
30 * * *
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1 §500.2. School bus operators; extended sick leave
2 A.
3 * * *
4 (2) As used in this Section, the following terms shall have the following
5 meanings:
6 * * *
7 (c) "Medical necessity" means the result of catastrophic illness or injury, a
8 life threatening condition, a chronic condition, or an incapacitating condition, as
9 certified by a physician provider, of a school bus operator or an immediate family
10 member.
11 * * *
12 D.(1) No school bus operator may undertake additional gainful employment
13 while on extended sick leave, unless all of the following conditions are met:
14 * * *
15 (b) The physician provider who certifies the medical necessity of the leave
16 indicates that such part-time work does not impair the purpose for which the
17 extended leave is required.
18 * * *
19 E.(1)(a) On every occasion that a school bus operator uses extended sick
20 leave, a statement from a licensed physician provider certifying that it is a medical
21 necessity for the school bus operator to be absent for at least ten consecutive work
22 days shall be presented prior to the extension of such leave.
23 (2)(a) If the board or superintendent, upon review of the application,
24 questions the validity or accuracy of the certification, the board or superintendent,
25 as the case may be, referred to in this Paragraph as the "challenging party", may
26 require the school bus operator or the immediate family member, as a condition for
27 continued extended leave, to be examined by a licensed physician provider selected
28 by the challenging party. In such a case, the employer shall pay all costs of the
29 examination and any tests determined to be necessary. If the physician provider
30 selected by the challenging party finds medical necessity, the leave shall be granted.
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1 (b) If the physician provider selected by the challenging party disagrees with
2 the certification of the physician provider selected by the school bus operator, then
3 the challenging party may require the school bus operator or the immediate family
4 member, as a condition for continued extension of sick leave, to be examined by a
5 third licensed appropriate physician provider whose name appears next in the
6 rotation of physicians providers on a list established by the local medical society for
7 such purpose and maintained by the challenging party. All costs of an examination
8 and any required tests by a third doctor shall be paid by the employer. The opinion
9 of the third physician provider shall be determinative of the issue.
10 (c) The opinion of all physicians providers consulted as provided in this
11 Paragraph shall be submitted to the challenging party in the form of a sworn
12 statement which shall be subject to the provisions of R.S. 14:125.
13 * * *
14 (e) All information contained in any statement from a physician provider
15 shall be confidential and shall not be subject to the public records law.
16 * * *
17 §1200. Definitions
18 * * *
19 D. As used in this Subpart, "provider" means a licensed physician, physician
20 assistant providing healthcare services in accordance with R.S. 37:1360.28, or an
21 advanced practice registered nurse providing healthcare services in accordance with
22 R.S. 37:913.
23 §1201. Amount of sick leave; reimbursement; injury on the job
24 A.
25 * * *
26 (2) When a member of the teaching staff is absent for six or more
27 consecutive days because of personal illness, he shall be required to present a
28 certificate from a provider physician, physician assistant providing health care
29 services in accordance with R.S. 37:1360.28, or nurse practitioner providing health
30 care services in accordance with R.S. 37:913 certifying such illness. Each parish and
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1 city school board may adopt such rules and regulations as are necessary relative to
2 the use of such sick leave, either current or accumulated, for emergencies or special
3 circumstances. The parish and city school boards may grant additional sick leave,
4 without loss of pay, or with such reduction of pay as they may establish and fix.
5 * * *
6 C.(1)(a) Any member of the teaching staff of the public schools who is
7 injured or disabled while acting in his official capacity as a result of assault or
8 battery by any student or person shall receive sick leave without reduction in pay and
9 without reduction in accrued sick leave days while disabled as a result of such assault
10 or battery. However, such member of the teaching staff shall be required to present
11 a certificate from a physician provider certifying such injury and disability. If the
12 member of the teaching staff who is receiving sick leave without reduction as
13 provided in this Section begins to draw his benefit from the Teachers' Retirement
14 System of Louisiana, the leave shall cease.
15 (b)(i) A member of the teaching staff of the public schools who while acting
16 in his official capacity is disabled as a result of physical contact with a student while
17 providing physical assistance to a student to prevent danger or risk of injury to the
18 student shall receive sick leave for a period up to one calendar year without reduction
19 in pay and without reduction in accrued sick leave days while disabled as a result of
20 rendering such assistance. Such member of the teaching staff shall be required to
21 present a certificate from a physician provider selected by the teaching staff member
22 certifying the disability. Nothing in this Subsection shall prohibit a city, parish, or
23 other local public school board from extending this period beyond one calendar year.
24 (ii) At any time during the period of certified disability, if the school board
25 questions the validity of the physician provider certification provided for in this
26 Section, the board may require the teaching staff member to be examined by a
27 physician provider selected by the board. In such a case, the board shall pay all costs
28 of the examination and any tests determined to be necessary. If the physician
29 provider selected by the board certifies the disability, the leave shall be granted or
30 continued as appropriate. If the physician provider selected by the board disagrees
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1 with the certificate of the physician provider selected by the staff member, then the
2 board may require the staff member to be examined by a third physician provider
3 whose name appears next in the rotation of physicians providers on a list established
4 by the local or state medical society for such purpose and maintained by the board.
5 All costs of an examination and any tests required by a third physician provider shall
6 be paid by the board. The opinion of the third physician provider shall be
7 determinative of the issue.
8 (iii) The opinion of each physician provider consulted as provided in this
9 Subparagraph shall be submitted to the school board in the form of a sworn statement
10 that shall be subject to the provisions of R.S. 14:125.
11 * * *
12 (v) If the member of the teaching staff's physician provider determines that
13 the member is able to return to active service as a member of the teaching staff with
14 restrictions and the board does not allow the member to return to active service as
15 a member of the teaching staff subject to those restrictions, then the member's leave
16 shall be granted or continued as provided in this Subsection.
17 * * *
18 § 1202. Teachers; extended sick leave
19 A.(1) Every city, parish, and other local public school board shall permit:
20 * * *
21 (b) Each teacher granted maternity or adoptive leave in accordance with the
22 provisions of R.S. 17:48 or 1211 and who has no remaining sick leave balance
23 available to take in the manner provided in this Section up to thirty days of additional
24 extended sick leave in each six-year period of employment for personal illness
25 relating to pregnancy, illness of an infant, or for required medical visits certified by
26 a physician provider as relating to infant or maternal health.
27 (2) As used in this Section the following terms shall have the following
28 meanings:
29 * * *
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1 (d) "Medical necessity" means the result of catastrophic illness or injury, a
2 life threatening condition, a chronic condition, or an incapacitating condition, as
3 certified by a physician provider, of a teacher or an immediate family member.
4 * * *
5 D.(1) No teacher may undertake additional gainful employment while on
6 extended sick leave, unless all of the following conditions are met:
7 * * *
8 (b) The physician provider who certifies the medical necessity of the leave
9 indicates that such part-time work does not impair the purpose for which the
10 extended leave is required.
11 * * *
12 E.(1)(a) On every occasion that a teacher uses extended sick leave, a
13 statement from a licensed physician provider certifying that it is for personal illness
14 relating to pregnancy, illness of an infant, or for required medical visits related to
15 infant or maternal health or that it is a medical necessity shall be presented prior to
16 the extension of such leave.
17 (c) The physician provider statement required by this Paragraph may be
18 presented and the extended sick leave may be requested subsequent to the teacher's
19 return to service. In such a case, the extended leave shall be granted for all days for
20 which such leave is requested and the required documentation is presented provided
21 the leave is requested and the required documentation is presented within three days
22 after the teacher returns to service.
23 (2)(a) If the board or superintendent, upon review of the application,
24 questions the validity or accuracy of the certification, the board or superintendent,
25 as the case may be, referred to in this Paragraph as the "challenging party", may
26 require the teacher or the immediate family member, as a condition for continued
27 extended leave, to be examined by a licensed physician provider selected by the
28 challenging party. In such a case, the employer shall pay all costs of the examination
29 and any tests determined to be necessary. If the physician selected by the
30 challenging party finds medical necessity, the leave shall be granted.
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1 (b) If the physician provider selected by the challenging party disagrees with
2 the certification of the physician selected by the teacher or the immediate family
3 member, then the challenging party may require the teacher or the immediate family
4 member, as a condition for continued extension of sick leave, to be examined by a
5 third licensed appropriate physician provider whose name appears next in the
6 rotation of physicians providers on a list established by the local medical society for
7 such purpose and maintained by the challenging party. All costs of an examination
8 and any required tests by a third doctor provider shall be paid by the employer. The
9 opinion of the third physician provider shall be determinative of the issue.
10 (c) The opinion of all physicians providers consulted as provided in this
11 Paragraph shall be submitted to the challenging party in the form of a sworn
12 statement which shall be subject to the provisions of R.S. 14:125.
13 * * *
14 (3) All information contained in any statement from a physician provider
15 shall be confidential and shall not be subject to the public records law.
16 * * *
17 §1206. Ten days sick leave for employees; cumulation of unused sick leave
18 A.(1) All such employees, as defined in R.S. 17:1205, shall be entitled to and
19 shall be allowed a minimum of ten days leave of absence as sick leave or in case of
20 other emergencies or special circumstances, per school year, without loss of pay.
21 Any portion of such sick leave not used in any year shall be accumulated to the credit
22 of the employee without limitation. When such employee is absent for six or more
23 consecutive days because of personal illness, he shall be required to present a
24 certificate from a provider. physician, physician assistant providing health care
25 services in accordance with R.S. 37:1360.28, or nurse practitioner providing health
26 care services in accordance with R.S. 37:913 certifying such illness. Each parish and
27 city school board may adopt such rules and regulations as are necessary relative to
28 the use of such sick leave, either current or accumulated, for emergencies or special
29 circumstances. The parish and city school boards may grant additional sick leave,
30 without loss of pay, or with such reduction of pay as they may establish and fix.
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1 * * *
2 §1206.1. School employees; sick leave
3 A.(1) An employee of a city, parish, or other local public school board, as
4 the word "employee" is defined in R.S. 17:1205, who is disabled while acting in his
5 official capacity as a result of assault or battery by any student or person, shall
6 receive sick leave without reduction in pay and without reduction in accrued sick
7 leave days while disabled as a result of such assault or battery; however, if the
8 employee is absent for six or more consecutive days as a result of such disability, he
9 shall be required to present a certificate from a physician provider certifying the
10 disability. If the employee who is receiving sick leave without reduction as
11 described in this Section begins to draw his benefit from the Teachers' Retirement
12 System of Louisiana or the Louisiana School Employees' Retirement System, the
13 leave shall cease.
14 * * *
15 B. An employee of the parish or city school boards of this state, as the word
16 "employee" is defined in R.S. 17:1205, who is disabled while acting in his official
17 capacity as a result of physical contact with a student while providing physical
18 assistance to a student to prevent danger or risk of injury to the student, shall receive
19 sick leave for a period up to ninety days without reduction in pay and without
20 reduction in accrued sick leave days while disabled as a result of rendering such
21 assistance. Such employee shall be required to present a certificate from a physician
22 provider certifying the disability. Nothing in this Section shall prohibit a city or
23 parish school board from extending this period beyond ninety days.
24 C. At any time during the period of certified disability, if the school board
25 questions the validity or accuracy of the physician provider certification, the board
26 may require the employee to be examined by a physician provider selected by the
27 board. In such a case, the board shall pay all costs of the examination and any tests
28 determined to be necessary. If the physician provider selected by the board certifies
29 the disability, the leave shall be granted or continued as appropriate. If the physician
30 selected by the board disagrees with the certification of the physician provider
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1 selected by the employee, the board may require the employee to be examined by a
2 third physician provider whose name appears next in the rotation of physicians
3 providers on a list established by the local or state medical society for such purpose
4 and maintained by the board. All costs of an examination and any tests required by
5 a third provider shall be paid by the board. The opinion of the third physician
6 provider shall be determinative of the issue.
7 D.
8 * * *
9 (2) If the employee's physician provider determines that he is able to return
10 to active service as a school employee with restrictions and the board does not allow
11 the employee to return to active service as a school employee subject to those
12 restrictions, then the employee's leave shall be granted or continued, as appropriate,
13 as provided in this Section.
14 §1206.2. Employees; extended sick leave
15 * * *
16 D.(1) No employee may undertake additional gainful employment while on
17 extended sick leave, unless all of the following conditions are met:
18 * * *
19 (b) The physician provider who certifies the medical necessity of the leave
20 indicates that such part-time work does not impair the purpose for which the
21 extended leave is required.
22 * * *
23 E.(1)(a) On every occasion when an employee uses extended sick leave, a
24 statement from a licensed physician provider certifying that it is a medical necessity
25 for the employee to be absent for at least ten consecutive work days shall be
26 presented prior to the extension of such leave.
27 (c) The physician provider statement required by this Paragraph may be
28 presented and the extended sick leave may be requested subsequent to the employee's
29 return to service. In such a case, the extended leave shall be granted for all days for
30 which such leave is requested and the required documentation is presented provided
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1 the leave is requested and the required documentation is presented within three days
2 after the employee returns to service.
3 (2)(a) If the board or superintendent, upon review of the application,
4 questions the validity or accuracy of the certification, the board or superintendent,
5 as the case may be, referred to in this Paragraph as the "challenging party", may
6 require the employee or the immediate family member, as a condition for continued
7 extended leave, to be examined by a licensed physician provider selected by the
8 challenging party. In such a case, the employer shall pay all costs of the examination
9 and any tests determined to be necessary. If the physician provider selected by the
10 challenging party finds medical necessity, the leave shall be granted.
11 (b) If the physician provider selected by the challenging party disagrees with
12 the certification of the physician provider selected by the employee or the immediate
13 family member, then the challenging party may require the employee or the
14 immediate family member, as a condition for continued extension of sick leave, to
15 be examined by a third licensed appropriate physician provider whose name appears
16 next in the rotation of physicians providers on a list established by the local medical
17 society for such purpose and maintained by the challenging party. All costs of an
18 examination and any required tests by a third doctor shall be paid by the employer.
19 The opinion of the third physician provider shall be determinative of the issue.
20 (c) The opinion of all physicians providers consulted as provided in this
21 Paragraph shall be submitted to the challenging party in the form of a sworn
22 statement which shall be subject to the provisions of R.S. 14:125.
23 * * *
24 (3) All information contained in any statement from a physician provider
25 shall be confidential and shall not be subject to the public records law.
26 * * *
27 Section 2. R.S. 40:1151(A)(3)(a), 1151.1(introductory paragraph), (1), (6), (10), and
28(11), 1151.2(B), (C)(1), and (D)(2), 1151.3(A)(2)(b) and (3)(b) and (c) and (B), 1151.6(A)
29through (D), 1151.7(A) and (B), the heading of Subpart C of Part I of Subchapter A of
30Chapter 5-D of Title 40 of the Louisiana Revised Statutes of 1950, 1155.1(A)(3) and (4)(a)
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1and (B)(1) and (2), 1155.2(introductory paragraph), (1) through (3), and (8) and (9),
21155.3(A), (B)(5), and (D), 1155.4(A) through (C), and 1155.5(A)(1) and (2) are hereby
3amended and reenacted and R.S. 1155.3(B)(6) is hereby enacted to read as follows:
4 §1151. Legislative purpose, findings and intent
5 A.
6 * * *
7 (3) In order that the rights of such persons may be respected even after they
8 are no longer able to participate actively in decisions concerning themselves, the
9 legislature hereby declares that the laws of the state of Louisiana shall recognize:
10 (a) The right of such a person to make a declaration instructing his physician
11 provider to withhold or withdraw life-sustaining procedures or designating another
12 to make the treatment decision and make such a declaration for him, in the event he
13 is diagnosed as having a terminal and irreversible condition.; and
14 * * *
15 §1151.1. Definitions
16 As used in this Subpart, the following words shall have the meanings
17 ascribed to them unless the context clearly states otherwise:
18 (1) "Attending physician provider" means the physician provider who has
19 primary responsibility for the treatment and care of the patient.
20 * * *
21 (6) "Health care provider Healthcare facility" means any health maintenance
22 organization, home health agency, hospice, hospital, or nursing facility.
23 * * *
24 (10) "Physician" "Provider" means either of the following:
25 (a) a A physician or surgeon licensed by the Louisiana State Board of
26 Medical Examiners or by the official licensing authority of another state.
27 (b) An advanced practice registered nurse in accordance with R.S. 37:913
28 licensed by the Louisiana State Board of Nursing.
29 (11) "Qualified patient" means a patient diagnosed and certified in writing
30 as having a terminal and irreversible condition by two physicians providers who have
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1 personally examined the patient, one of whom shall be the attending physician
2 provider.
3 * * *
4 §1151.2. Making of declaration; notification; illustrative form; registry; issuance of
5 do-not-resuscitate identification bracelets
6 * * *
7 B.(1) It shall be the responsibility of the declarant to notify his attending
8 physician provider that a declaration has been made.
9 (2) In the event the declarant is comatose, incompetent, or otherwise
10 mentally or physically incapable of communication, any other person may notify the
11 physician provider of the existence of the declaration. In addition, the attending
12 physician provider or health care healthcare facility may directly contact the registry
13 to determine the existence of any such declaration.
14 (3) Any attending physician provider who is so notified, or who determines
15 directly or is advised by the health care healthcare facility that a declaration is
16 registered, shall promptly make the declaration or a copy of the declaration, if
17 written, or a notation of the existence of a registered declaration, a part of the
18 declarant's medical record.
19 (4) If the declaration is oral or nonverbal, the physician provider shall
20 promptly make a recitation of the reasons the declarant could not make a written
21 declaration and make the recitation a part of the patient's medical records.
22 C.(1) The declaration may, but need not, be in the following illustrative form
23 and may include other specific directions including but not limited to a designation
24 of another person to make the treatment decision for the declarant should he be
25 diagnosed as having a terminal and irreversible condition and be comatose,
26 incompetent, or otherwise mentally or physically incapable of communications:
27 "DECLARATION
28 Declaration made this _______________ day of __________ (month, year).
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1 I, _______________________, being of sound mind, willfully and voluntarily make
2known my desire that my dying shall not be artificially prolonged under the circumstances
3set forth below and do hereby declare:
4 If at any time I should have an incurable injury, disease or illness, or be in a continual
5profound comatose state with no reasonable chance of recovery, certified to be a terminal
6and irreversible condition by two physicians providers who have personally examined me,
7one of whom shall be my attending physician provider, and the physicians providers have
8determined that my death will occur whether or not life-sustaining procedures are utilized
9and where the application of life-sustaining procedure would serve only to prolong
10artificially the dying process, I direct (initial one only):
11 ___That all life-sustaining procedures, including nutrition and hydration, be withheld
12or withdrawn so that food and water will not be administered invasively.
13 ___That life-sustaining procedures, except nutrition and hydration, be withheld or
14withdrawn so that food and water can be administered invasively.
15 I further direct that I be permitted to die naturally with only the administration of
16medication or the performance of any medical procedure deemed necessary to provide me
17with comfort care.
18 In the absence of my ability to give directions regarding the use of such life-
19sustaining procedures, it is my intention that this declaration shall be honored by my family
20and physician(s) provider(s) as the final expression of my legal right to refuse medical or
21surgical treatment and accept the consequences from such refusal.
22 I understand the full import of this declaration and I am emotionally and mentally
23competent to make this declaration.
24 Signed ____________________
25 City, Parish, and State of Residence ____________________
26 The declarant has been personally known to me and I believe him or her to be of
27sound mind.
28 Witness ____________________
29 Witness ____________________"
30 * * *
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1 D.
2 * * *
3 (2) Any attending physician provider or health care healthcare facility may,
4 orally or in writing, request the secretary of state to confirm immediately the
5 existence of a declaration and to disclose the contents thereof for any patient
6 believed to be a resident of Louisiana. A copy of the declaration or a facsimile
7 thereof transmitted from the office of the secretary of state shall be deemed
8 authentic. However, nothing herein in this Paragraph requires a physician provider
9 or health care healthcare facility to confirm the existence of such declaration or
10 obtain a copy thereof prior to the withholding or withdrawal of medical treatment or
11 life-sustaining procedures.
12 * * *
13 §1151.3. Revocation of declaration
14 A. A declaration may be revoked at any time by the declarant without regard
15 to his or her mental state or competency by any of the following methods:
16 * * *
17 (2)
18 * * *
19 (b) The attending physician provider shall record in the patient's medical
20 record the time and date when notification of the written revocation was received.
21 (3)
22 * * *
23 (b) Such revocation by any method enumerated in this Section shall become
24 effective upon communication to the attending physician provider.
25 (c) The attending physician provider shall record in the patient's medical
26 records the time and date when notification of the revocation was received.
27 B. A declaration registered with the secretary of state's office may be
28 revoked by the filing of a written notice of revocation in that office. The secretary
29 of state shall indicate on the declaration the date and time the notice of revocation
30 was received in his office. Until the notation has been indicated on the declaration,
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1 any physician provider or health care healthcare facility acting in good faith may rely
2 upon the validity of the declaration.
3 * * *
4 §1151.6. Physician, health care provider Provider, healthcare facility, and licensed
5 emergency medical services practitioner responsibility
6 A. Any attending physician provider who has been notified of the existence
7 of a declaration made under pursuant to this Subpart or at the request of the proper
8 person as provided in R.S. 40:1151.4 or R.S. 40:1151.5 upon diagnosis of a terminal
9 and irreversible condition of the patient, or who on his own determines the existence
10 of a declaration on file in the registry, shall take necessary steps to provide for
11 written certification of the patient's terminal and irreversible condition, so that the
12 patient may be deemed to be a qualified patient as defined in R.S. 40:1151.1.
13 B. Any attending physician provider who refuses to comply with the
14 declaration of a qualified patient or declaration otherwise made pursuant to this
15 Subpart shall make a reasonable effort to transfer the patient to another physician
16 provider.
17 C. No provision of this Subpart imposes a duty upon the physician provider
18 or health care healthcare facility to make a search of the registry for the existence of
19 a declaration.
20 D. If the policies of a health care provider healthcare facility preclude
21 compliance with the declaration of a qualified patient under pursuant to this Subpart
22 or preclude compliance with the provisions pertaining to a representative acting on
23 behalf of a qualified patient, then the provider shall take all reasonable steps to
24 transfer the patient to a provider with which the provisions of this Subpart can be
25 effectuated.
26 * * *
27 §1151.7. Immunity from liability
28 A.(1) Any health care healthcare facility, physician provider, or other person
29 acting under the direction of a physician provider shall not be subject to criminal
30 prosecution or civil liability or be deemed to have engaged in unprofessional conduct
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1 as a result of the withholding or the withdrawal of life-sustaining procedures from
2 a qualified patient who has made a declaration or is wearing a do-not-resuscitate
3 identification bracelet in accordance with the provisions of this Subpart.
4 (2) Any person, health care healthcare facility, physician provider, or other
5 person acting under the direction of a physician provider who authorizes the
6 withholding or withdrawal of life-sustaining procedures in accordance with a
7 qualified patient's declaration or do-not-resuscitate identification bracelet, or as
8 otherwise provided in this Subpart shall not be subject to criminal prosecution or
9 civil liability for such action.
10 B. In instances where a patient diagnosed as having a terminal and
11 irreversible condition or his representative utilized means other than those in
12 accordance with the provisions of this Subpart to document or manifest the patient's
13 intention and desire that medical treatment or life-sustaining procedures be withheld
14 or withdrawn, any health care healthcare facility, physician provider, or other person
15 acting under the direction of a physician provider shall not be subject to criminal
16 prosecution or civil liability or be deemed to have engaged in unprofessional conduct
17 as a result of the withholding or withdrawal of life-sustaining procedures when the
18 health care healthcare facility, physician provider, or other person acting under the
19 direction of a physician provider has acted in good faith reliance on the patient's or
20 his representative's manifestations that medical treatment or life-sustaining
21 procedures be withheld or withdrawn and the continued utilization of life-sustaining
22 procedures would, within reasonable medical judgment, serve only to prolong the
23 dying process.
24 * * *
25 SUBPART C. LOUISIANA PHYSICIAN PROVIDER ORDER FOR SCOPE OF
26 TREATMENT
27 §1155.1. Legislative purpose, findings, and intent
28 A. The legislature finds and declares all of the following:
29 * * *
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1 (3) The Louisiana Physician Provider Order for Scope of Treatment
2 "LaPOST" form documents the wishes of a qualified patient in a physician provider
3 order.
4 (4) The hallmarks of the LaPOST form are the following:
5 (a) Immediately actionable, signed physician provider orders on a
6 standardized form.
7 * * *
8 B.(1) The legislature intends that the provisions of this Subpart are
9 permissive and voluntary. The legislature further intends that the completion of the
10 Louisiana Physician Provider Order for Scope of Treatment form merely illustrates
11 a means of documenting a decision of a patient relative to withholding or withdrawal
12 of medical treatment or life-sustaining procedures.
13 (2) It is the intent of the legislature that nothing in this Subpart shall be
14 construed to require the completion of a Louisiana Physician Provider Order for
15 Scope of Treatment form pursuant to this Subpart.
16 * * *
17 §1155.2. Definitions
18 As used in this Subpart, the following terms shall have the meanings ascribed
19 to them unless the context clearly states otherwise:
20 (1) "Attending physician provider" means the physician provider who has
21 primary responsibility for the treatment and care of the patient.
22 (2) "Health care provider" "Healthcare facility" means any home health
23 agency, hospice, hospital, or nursing facility.
24 (3) "LaPOST" means Louisiana Physician Provider Order for Scope of
25 Treatment as provided in R.S. 40:1155.2.1.
26 * * *
27 (8) "Physician" "Provider" means any of the following:
28 (a) a A physician or surgeon licensed by the Louisiana State Board of
29 Medical Examiners or by the official licensing authority of another state.
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1 (b) An advanced practice registered nurse as defined in R.S. 37:913 licensed
2 by the Louisiana State Board of Nursing.
3 (9) "Qualified patient" means a patient diagnosed and certified in writing as
4 having a life-limiting and irreversible condition by the attending physician provider
5 or personal physician provider of the patient.
6 * * *
7 §1155.3. Louisiana Physician Provider Order for Scope of Treatment
8 A. The secretary of the Louisiana Department of Health is hereby authorized
9 and directed to promulgate and publish rules, regulations, and standards, in
10 accordance with the Administrative Procedure Act, to provide for the Louisiana
11 Physician Provider Order for Scope of Treatment "LaPOST" program.
12 B. The rules and regulations shall include the following:
13 * * *
14 (5) Requirements for periodic review of the LaPOST form by the patient and
15 his physician provider.
16 (6) Procedures for a qualified patient and a provider to sign the LaPOST
17 form physically and electronically.
18 * * *
19 D. The Louisiana Physician Provider Order for Scope of Treatment or
20 LaPOST form is not a declaration concerning life-sustaining procedures and
21 therefore shall not have to comply with the provisions of R.S. 40:1151 through
22 1151.9 in order to be valid and enforceable.
23 §1155.4. Physician, health care provider Provider, healthcare facility, and licensed
24 emergency medical services practitioner responsibility
25 A. Any attending physician provider who refuses to comply with the
26 provisions of a duly executed LaPOST form executed pursuant to this Subpart shall
27 make a reasonable effort to transfer the patient to another physician provider.
28 B. No provision of this Subpart imposes a duty upon the physician provider
29 or health care provider healthcare facility to make a search of whether a patient has
30 executed a LaPOST form.
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1 C. If the policies of a health care provider healthcare facility preclude
2 compliance with the LaPOST form executed under pursuant to this Subpart or
3 preclude compliance with the provisions pertaining to a representative acting on
4 behalf of a patient, then the health care provider healthcare facility shall take all
5 reasonable steps to transfer the patient to a health care provider healthcare facility
6 with which the provisions of this Subpart can be effectuated.
7 * * *
8 §1155.5. Immunity from liability
9 A.(1) Any health care provider healthcare facility, physician provider, or
10 other person acting under the direction of a physician provider shall not be subject
11 to criminal prosecution or civil liability or be deemed to have engaged in
12 unprofessional conduct as a result of the withholding or withdrawal of life-sustaining
13 procedures from a patient who has duly executed a LaPOST form in accordance with
14 the provisions of this Subpart, or as a result of transferring a patient to a provider
15 with which the provisions of this Subpart can be effectuated.
16 (2) Any person, health care provider healthcare facility, physician provider,
17 or other person acting under the direction of a physician provider who authorizes the
18 withholding or withdrawal of life-sustaining procedures in accordance with a duly
19 executed LaPOST form, or as otherwise provided in this Subpart, shall not be subject
20 to criminal prosecution or civil liability for such action.
21 * * *
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
HB 599 Original 2023 Regular Session Dustin Miller
Abstract: Grants advanced practice registered nurses (APRN) and physician assistants
(PA) the authority to certify illness and disability of teachers, teaching staff, and bus
drivers, and grants APRNs the authority to execute documents pertaining to patients'
wishes with respect to end of life care.
Present law requires the authorization of a physician in the following:
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(1) Certifying an illness or disability of school bus operators and teaching staff for the
purpose of sick leave, extended sick leave, and disputes arising out of the use of sick
leave and extended sick leave.
(2) Certifying an illness or disability of teachers for the purpose of extended sick leave,
disputes arising out of the use of sick leave and extended, sick leave, and sick leave
as a result of disability that resulted from an assault or battery by a student.
(3) Confirming, identifying, and revoking do-not-resuscitate (DNR) declarations and
matters related to DNR declarations.
(4) Documenting the wishes of a qualified patient with respect to the scope of treatment
in the event of life-limiting and irreversible conditions via use of the La. Physician
Order for Scope of Treatment (LaPOST) form.
Proposed law extends the authority of a "physician" as described in present law to PAs and
APRNs under the new term "provider" with respect to school employee sick leave.
Proposed law extends the authority of "physician" as described in present law to APRNs
under the term "provider" with respect to DNR forms and LaPOST.
Present law confers immunity from liability to physicians for certain actions with respect to
DNR decelerations and LaPOST.
Proposed law extends present law immunity to "providers" as defined in proposed law.
(Amends R.S. 17:500(B)(1), 500.1(A), (B), and (C)(2), 500.2(A)(2)(intro. para.) and (c),
(D)(1)(b), and E(1)(a), (2)(a)-(c), and (e), 1201(A)(2) and (C)(1)(a), (b)(i)-(iii), and (v),
1202(A)(1)(b) and (2)(intro. para.) and (d), (D)(1)(b), and (E)(1)(a) and (c), (2)(a)-(c), and
(3), 1206(A)(1), 1206.1(A)(1), (B), (C), and (D)(2), 1206.2(D)(1)(b), (E)(1)(a) and (c),
(2)(a)-(c), and (3), R.S. 40:1151.1(intro. para.), (1), (6), (10), and (11), 1151.2(B), (C)(1),
and (D)(2), 1151.3(A)(2)(b) and (3)(b) and (c) and (B), 1151.6(A)-(D), 1151.7(A) and (B),
the heading of Subpart C of Part I of Subchapter A of Chapter 5-D of Title 40 of the La.
Revised Statutes of 1950, 1155.1(A)(3) and (4)(a) and (B)(1) and (2), 1155.2(intro. para.),
(1)-(3), and (8) and (9), 1155.3(A), (B)(5), and (D), 1155.4(A)-(C), and 1155.5(A)(1) and
(2); Adds R.S. 17:1200(D) and R.S. 40:1155.3(B)(6))
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