Oklahoma 2022 Regular Session

Oklahoma Senate Bill SB1596 Compare Versions

Version 1 (Old)

Version 2 (New)

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4		-	An Act
5		-	ENROLLED SENATE
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	29	+	HOUSE OF REPRESENTATIVES - FLOOR VERSION
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	31	+	STATE OF OKLAHOMA
	32	+
	33	+	2nd Session of the 58th Legislature (2022)
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	35	+	ENGROSSED SENATE
6	36		BILL NO. 1596 By: Howard of the Senate
7	37
8	38		and
9	39
10	40		Stinson of the House
11	41
12	42
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15	45		An Act relating to health care power of attor ney;
16	46		creating the Oklahoma Health Care Ag ent Act;
17	47		providing short title; defining terms; authorizing
18	48		execution of power of attorney for health care;
19	49		establishing requirements for execution of power of
20	50		attorney for health care; specifying when power of
21	51		attorney for health care is effective; es tablishing
22	52		requirements for revocation of p ower of attorney for
23	53		health care; creating optional form for execution of
24	54		power of attorney for health care; requiring certain
25	55		communication by health care provider; requiring
26	56		record of certain information; requiring ce rtain
27	57		compliance by health care provider; providing
28	58		exceptions; requiring notice of certain
29	59		noncompliance; authorizing access to certain
30	60		information; establishing immu nity from liability for
31	61		certain actions; creating certain presumption;
32	62		stating effectiveness of copy; construing provisions;
33	63		providing for judicial relief; requiring retroactive
34	64		application of provisions to certain documents;
35	65		amending 63 O.S. 2021, Sections 1-1973, 3102.4,
36	66		3105.2, 3105.4, 3131.3 , and 3131.5, which relate to
37	67		the Home Care Act, the Oklahoma Advance Directive
38	68		Act, the Physician Orders for Life -Sustaining
39	69		Treatment Act, and the Oklahoma Do -Not-Resuscitate
40	70		Act; updating statutory references; provid ing for
41	71		codification; and declaring a n emergency.
42	72
43	73
44	74
45		-	SUBJECT: Health care power of attorney
46		-
47		-
48		-	ENR. S. B. NO. 1596 Page 2
49	75		BE IT ENACTED BY THE PEO PLE OF THE STATE OF OKLAHOMA:
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51	103		SECTION 1. NEW LAW A new section of law to be codified
52	104		in the Oklahoma Statutes as Section 3111.1 of Title 63, unless there
53	105		is created a duplication in numb ering, reads as follows:
54		-
55	106		This act shall be known and may be cited as the “Oklahoma Health
56	107		Care Agent Act”.
57		-
58	108		SECTION 2. NEW LAW A new section of law to be codified
59	109		in the Oklahoma Statutes as Se ction 3111.2 of Title 63, unless there
60	110		is created a duplication in numbering, reads as follows:
61		-
62	111		As used in the Oklahoma Health Care Agent Act:
63		-
64	112		1. “Advance directive for health care” means any writing
65	113		executed in accordance with the requirements of Section 3101.4 of
66	114		Title 63 of the Oklahoma Statutes;
67		-
68	115		2. “Agent” means an individual designated in a power of
69	116		attorney for health care to make a health care decision for the
70	117		individual granting the power ;
71		-
72	118		3. “Attending physician” means the physician who has primary
73	119		responsibility for the treatment and care of a patient;
74		-
75	120		4. “Capacity” means an individual’s ability to understand and
76	121		appreciate the nature and impli cations of a health care decision, to
77	122		make an informed choice regar ding the alternatives presented
78	123		including understanding and appreciat ing the significant benefits
79	124		and risks, and to make and communicate a health care decision in an
80	125		unambiguous manner;
81	126
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82	153		5. “Health care” means any care, treatment, service, or
83	154		procedure to maintain, diagnose, or otherwise affect an individual ’s
84	155		physical or mental condition;
85		-
86	156		6. “Health care decision” means a decision made by an
87	157		individual or the individual’s agent regarding the individual’s
88	158		health care including:
89		-
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91		-	ENR. S. B. NO. 1596 Page 3
92	159		a. selection and discharge of health care providers and
93	160		facilities,
94		-
95	161		b. consent to or refusal of any care, treat ment, service,
96	162		or procedure to maintai n, diagnose, or otherwise
97	163		affect a physical or mental co ndition, and
98		-
99	164		c. signing a do-not-resuscitate consent in accordance
100	165		with the provisions of the Oklahoma Do -Not-Resuscitate
101	166		Act, Section 3131.1 et se q. of Title 63 of the
102	167		Oklahoma Statutes.
103		-
104	168		Health care decision shall not include the ability of the a gent to
105	169		make decisions about the withholding or withdrawal of nutrition or
106	170		hydration;
107		-
108	171		7. “Health care facility” means any public or private
109	172		organization, corporation, authority, partnership, sole
110	173		proprietorship, association, agency, network, joint venture , or
111	174		other entity that is established and appropriately licensed in this
112	175		state to administer or provid e health care services . Health care
113	176		facility includes but is not l imited to hospitals, medical centers,
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114	204		ambulatory surgery centers, physicians’ offices, clinics, nursing
115	205		homes, rehabilitation centers, home care agencies, hospices, and
116	206		long-term care agencies;
117		-
118	207		8. “Health care provider” means a person who is licensed,
119	208		certified, or otherwise authorized by the laws of this state to
120	209		administer health care in the o rdinary course of business or
121	210		practice of a profession ;
122		-
123	211		9. “Individual instruction ” means an individual’s direction
124	212		concerning a health care decision for the individual;
125		-
126	213		10. “Person” means a person eighteen (18) years of age or older
127	214		or a minor who may consent to have s ervices provided by health
128	215		professionals pursuant to Section 2602 of Title 63 of the Oklahoma
129	216		Statutes;
130		-
131	217		11. “Physician” means an individual authorized to practice
132	218		medicine or osteopathy pursuant to Chapter 11 or Chapter 14 of Title
133	219		59 of the Oklahoma Stat utes;
134		-
135		-	ENR. S. B. NO. 1596 Page 4
136		-
137	220		12. “Power of attorney for health care ” means the designation
138	221		of an agent to make health care decisions for the individual
139	222		granting the power;
140		-
141	223		13. “Reasonably available” means readily able to be contacted
142	224		without undue effort and willing and able to act in a timely manner
143	225		considering the urgency of the patient’s health care needs; and
144	226
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145	253		14. “State” means a state of the United States, the District of
146	254		Columbia, the Commonwealth of Puerto Rico, or a territory or insular
147	255		possession subject to the jurisdi ction of the United States.
148		-
149	256		SECTION 3. NEW LAW A new secti on of law to be codified
150	257		in the Oklahoma Statutes as Section 3111.3 of Title 63, unless there
151	258		is created a duplication in numbering, reads as follows:
152		-
153	259		A. A person with capacity may give an oral or written
154	260		individual instruction. The instruction may be li mited to take
155	261		effect only if a specified condition arises.
156		-
157	262		B. A person with capacity may execute a power of attorney for
158	263		health care, which may authorize the agent to make a ny health care
159	264		decision the principal could have made while having capacity other
160	265		than the withholding or withdrawal of life -sustaining treatment,
161	266		nutrition, or hydration, which may only b e authorized in compliance
162	267		with the Oklahoma Ad vance Directive Act; provided, however, the
163	268		power of attorney for health care may authorize the agent to sign a
164	269		do-not-resuscitate consent in accordance with the provisions of the
165	270		Oklahoma Do-Not-Resuscitate Act, Section 3131.1 et seq. of Title 63
166	271		of the Oklahoma Statutes . The power shall be in writing and signed
167	272		by the principal. The power remains in effect notwithstanding the
168	273		principal’s later incapacity and may include indi vidual
169	274		instructions. Unless rela ted to the principal by blood, marriage,
170	275		or adoption, an agent may n ot be an owner, operator, or employee of
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171	303		a residential long-term health care institution at which the
172	304		principal is receiving care.
173		-
174	305		C. Unless otherwise spe cified in a power of attorney for health
175	306		care, the authority of an agent becomes effective only upon a
176	307		determination that the principal lacks capacity and ceases to be
177		-
178		-	ENR. S. B. NO. 1596 Page 5
179	308		effective upon a determination that the principal has recovered
180	309		capacity.
181		-
182	310		D. Unless otherwise specified in a power of attorney for health
183	311		care, a determination that an individual lacks or has recovered
184	312		capacity, or that another condition exists that affects an
185	313		individual instruction or the authority of an agent, shall be made
186	314		by the attending physician.
187		-
188	315		E. An agent shall make health care decisions in accordance with
189	316		the principal’s individual instructions, if any, and other wishes to
190	317		the extent known to the agent. Otherwise, the agent shall make the
191	318		decision in accordance with the agent ’s determination of the
192	319		principal’s best interest. In determining the principal ’s best
193	320		interest, the agent shall consider the principal’s personal values
194	321		to the extent known to the agent.
195		-
196	322		F. A health care decision made by an agent for a principal is
197	323		effective without judicial approval.
198		-
199	324		G. A power of attorney for health care shall be signed by the
200	325		principal and witnessed by two (2) individuals who are at least
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201	353		eighteen (18) years of age and who are not legatees, devise es, or
202	354		heirs at law of the principal.
203		-
204	355		H. A power of attorney for health care is valid for purposes of
205	356		this act if it is in substantial compliance with this act,
206	357		regardless of when o r where executed or c ommunicated.
207		-
208	358		SECTION 4. NEW LAW A n ew section of law to be codified
209	359		in the Oklahoma Statutes as Section 3111.4 of Title 63, unless there
210	360		is created a duplication in numbering, reads as follows:
211		-
212	361		A. An individual may revoke the designation of an agent by a
213	362		signed writing or by personally inf orming the health care provider
214	363		at any time and in any manner that c ommunicates an intent to revoke .
215		-
216	364		B. A health care provider or agent who is informed of a
217	365		revocation shall promptly communicate the fact of the revocation to
218	366		the attending physician and to any health care facility at which the
219	367		patient is receiving care.
220		-
221		-
222		-	ENR. S. B. NO. 1596 Page 6
223	368		C. A decree of annulment, divorce, dissolution of marriage, or
224	369		legal separation revokes a previous designatio n of a spouse as agent
225	370		unless otherwise specified in the decree or specifically enumerated
226	371		in a power of attorney for health care.
227		-
228	372		D. A power of attorney for health care that conflicts with an
229	373		earlier power of attorney for health care revokes the earlier power
230	374		of attorney to the extent of the conflict.
231	375
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232	402		SECTION 5. NEW LAW A new section of law to be codified
233	403		in the Oklahoma Statutes as Section 3111.5 of Title 63, unless there
234	404		is created a duplication in numbering, reads as follows:
235		-
236	405		The following form may, but need not, be used to create a power
237	406		of attorney for health care. The other sections of t his act govern
238	407		the effect of this form or any other writing used to create a power
239	408		of attorney for health care. An individual may complete o r modify
240	409		all or any part of the following form to the extent consistent with
241	410		subsection B of Section 3 of this act:
242		-
243	411		HEALTH CARE POWER OF ATTORNEY
244		-
245	412		You have the right to give instructions about your own health
246	413		care. You also have the right to name someone else to make health
247	414		care decisions for you. Thi s form lets you do either or both of
248	415		these things. If you use this form, you may complete or modify all
249	416		or any part of it. You are free to use a different form.
250		-
251	417		This form is a power of attorney for health care that lets you
252	418		name another individual as agent to make health care decisions for
253	419		you if you become incapable of making your own decisions or if y ou
254	420		want someone else to make those deci sions for you now even though
255	421		you are still capable. You may also name an alternate agent to act
256	422		for you if your first choice is not wil ling, able, or reasonably
257	423		available to make dec isions for you. Unless related t o you, your
258	424		agent may not be an owner, operator, or employee of a residential
259	425		long-term health care institution at which you are receiving care.
260	426
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261	453		Unless the form you sign limits the authority of your agent,
262	454		your agent may make all health care decisions for you. This form
263	455		has a place for you to limit the authority of your a gent. You need
264	456		not limit the authority of your agent if you wish to rely on your
265		-
266		-	ENR. S. B. NO. 1596 Page 7
267	457		agent for all health care decisions that may have to be made. If
268	458		you choose not to limit the authority of your agent, your agent will
269	459		have the right to:
270		-
271	460		1. Consent or refuse consent to any care, treatment, service,
272	461		or procedure to maintain, diagnose, or o therwise affect a physica l
273	462		or mental condition;
274		-
275	463		2. Select or discharge health care providers and facilities;
276	464		and
277		-
278	465		3. Sign a do-not-resuscitate consent.
279		-
280	466		This form does not authorize the agent to make any decisions
281	467		directing the withholding or withdrawal of life-sustaining
282	468		treatment, nutrition, or hydration, which may only be authorized in
283	469		compliance with the Oklahoma Advance Directive Act, except that this
284	470		form may authorize the agent to sign a do-not-resuscitate consent.
285		-
286	471		After completing this form, sign and date the form at the end.
287	472		It is required that two other individuals sign as witnesses. These
288	473		witnesses must be at least 18 years old and not related to you or
289	474		named to inherit from you. Give a copy of the signed and completed
290	475		form to your physician, to any o ther health care providers you may
291	476		have, to any health care facility at which you are receiving care,
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292	504		and to any health care agents you have name d. You should talk t o
293	505		the person you have named as agent to make sur e that he or she
294	506		understands your wishe s and is willing to take the responsibility.
295		-
296	507		You have the right to r evoke this power of attorney for health
297	508		care or replace this form at any time.
298		-
299	509		POWER OF ATTORNEY FOR HEALTH CARE
300		-
301	510		1. DESIGNATION OF AGENT: I designate the following individual
302	511		as my agent to make health care decisions for me:
303		-
304	512		__________________________________________ _________________________
305		-
306	513		(name of individual you choose as agent)
307		-
308	514		_____________________ ______________________________________________
309		-
310		-	ENR. S. B. NO. 1596 Page 8
311		-
312	515		(address) (city) (state) (zip code)
313		-
314	516		___________________________________________________________________
315		-
316	517		(home phone) (work phone)
317		-
318	518		OPTIONAL: If I revo ke my agent’s authority or if my agent is
319	519		not willing, able, or reasonably availa ble to make a health care
320	520		decision for me, I designate as my first alternate agent:
321		-
322	521		___________________________________________________________________
323		-
324	522		(name of individual you choose as first alternate agent)
325		-
326	523		_____________________________________________ ______________________
327	524		(address) (city) (state) (zip cod e)
328		-
329	525		___________________________________________________________________
330		-
331	526		(home phone) (work phone)
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332	553
333	554		OPTIONAL: If I revoke the authority of my agent and first
334	555		alternate agent or if neither is willing, able, or reasonably
335	556		available to make a health care decision for me, I designate as my
336	557		second alternate agent:
337		-
338	558		_________________________________________________________ __________
339		-
340	559		(name of individual you choose as second alternate agent)
341		-
342	560		___________________________________________________ ________________
343	561		(address) (city) (state) (zip code)
344		-
345	562		__________________________________________________ _________________
346		-
347	563		(home phone) (work phone)
348		-
349	564		2. AGENT’S AUTHORITY: My agent is authorized to make all
350	565		health care decisions (not to include the withholding or withdrawal
351	566		of life-sustaining treatment, nutrition, or hydration, other than
352		-
353		-	ENR. S. B. NO. 1596 Page 9
354	567		signing a do-not-resuscitate consent) for me that I could make if I
355	568		were able, except as I state here:
356		-
357	569		______________________________ _____________________________________
358		-
359	570		___________________________________________________________________
360		-
361	571		______________________________ _____________________________________
362		-
363	572		(Add additional sheets if needed.)
364		-
365	573		3. WHEN AGENT’S AUTHORITY BECOMES EFFECTIVE: My agent’s
366	574		authority becomes effective when my attending physician determines
367	575		that I am unable to make my own health care decisions unless I mark
368	576		the following box. If I mark this box [ ] , my agent’s authority
369	577		to make health care decisions for me takes effect immediately.
370	578
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371	605		_____________
372		-
373	606		(Initials)
374		-
375	607		4. AGENT’S OBLIGATION: My agent shall make health care
376	608		decisions for me in accordance with this power of att orney for
377	609		health care and my other wishes to the extent known to my agent. To
378	610		the extent my wishes a re unknown, my agent shall make health care
379	611		decisions for me in accordance with what my agent determines to be
380	612		in my best interest. In determining my best interest, my agent
381	613		shall consider the decisions I would have made myself to the extent
382	614		known to my agent.
383		-
384	615		_____________
385		-
386	616		(Initials)
387		-
388	617		5. RELIEF FROM PAIN: Except a s I state in the following space,
389	618		I direct that treatment for alleviation of pain or discomfort be
390	619		provided at all times, even i f it hastens my death:
391		-
392	620		________________________________________________________________
393		-
394	621		________________________________________ ________________________
395		-
396		-
397		-	ENR. S. B. NO. 1596 Page 10
398	622		6. OTHER WISHES: (If you do not agree with any of the optional
399	623		choices above and wish to write your o wn, or if you wish to add to
400	624		the instructions you have given above, you may do so here.) I
401	625		direct that:
402		-
403	626		___________________________________________________________________
404		-
405	627		___________________________________________________________________
406		-
407	628		(Add additional sheets if needed.)
	629	+
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408	655
409	656		7. EFFECT OF COPY: A cop y of this form has the same effect as
410	657		the original.
411		-
412	658		8. SIGNATURES: Sign and date the form here:
413		-
414	659		_______________________________ ______________________________
415		-
416	660		(date) (sign your name)
417		-
418	661		_____________________________ __ ___________ ___________________
419		-
420	662		(address) (print your name)
421		-
422	663		_______________________ ________
423		-
424	664		(city) (state)
425		-
426	665		SIGNATURES OF WITNESSES:
427		-
428	666		First witness Second witness
429		-
430	667		____________________________ __ _______________________________
431		-
432	668		(print name) (print name)
433		-
434	669		_____________________ _________ _______________________________
435		-
436	670		(address) (address)
437		-
438	671		______________________________ ___ ___________________________
439	672		(city) (state) (city) (state)
440		-
441		-	ENR. S. B. NO. 1596 Page 11
442		-
443	673		______________________________ ______________________________
444	674		(signature of witness) (signature of witness)
445		-
446	675		______________________ ________ _______________________ _______
447		-
448	676		(date) (date)
449		-
450	677		SECTION 6. NEW LAW A new section of law to be codified
451	678		in the Oklahoma Statutes as Section 3111.6 of Title 63, unless there
452	679		is created a duplication in numbering, reads as follows:
	680	+
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453	706
454	707		A. Before implementing a health care decision made for a
455	708		patient, the attending physician , if possible, shall promptly
456	709		communicate to the patient the decision made and the identit y of the
457	710		person making the decision.
458		-
459	711		B. An attending physician who knows of the existence of a power
460	712		of attorney for health c are or a revocation of a power of attorney
461	713		for health care shall promptly record its existence in the patient’s
462	714		medical record and, if it is in writing, shall request a copy and if
463	715		one is furnished shall arrange for its maintenance in the medical
464	716		record. An attending physician who makes or is informed of a
465	717		determination that a patient lacks or has recovered capacity shall
466	718		promptly record the determination in the patient’s medical record
467	719		and communicate the determination to the patient, if possible, and
468	720		to any person then authorized to make health care decisions for the
469	721		patient.
470		-
471	722		C. Except as provided in subsections D and E of this section, a
472	723		health care provider or facility providing care to a patient shall:
473		-
474	724		1. Comply with an individual instruction of the patient and
475	725		with a reasonable interpretation of t hat instruction made by a
476	726		person then authorized to make health care decisions for the
477	727		patient; and
478		-
479	728		2. Comply with a health care decision for the patient made by a
480	729		person then authorized to make health care decisions for the patient
	730	+
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481	757		to the same extent as if the decision had been made by th e patient
482	758		while having capacity.
483		-
484		-
485		-	ENR. S. B. NO. 1596 Page 12
486	759		D. An attending physician or health care provider may decline
487	760		to comply with an individual instruction or health care decision for
488	761		reasons of conscience. A health care facility may decline to comply
489	762		with an individual instruction or health care decision if the
490	763		instruction or decision is contrary to a policy of the facility
491	764		which is expressly based on reasons of conscience and if the policy
492	765		was timely communicated to the patient or to a person then
493	766		authorized to make health care decisions for the patient.
494		-
495	767		E. A health care provider or facility may decline to comply
496	768		with an individual instruction or health care decision that requires
497	769		medically ineffective or non-beneficial health care or health care
498	770		contrary to generally accepted health care standards applicable to
499	771		the health care provider or facility.
500		-
501	772		F. A health care provider or facility that declines to comply
502	773		with an individual instruction or health care decision shall:
503		-
504	774		1. Promptly so inform the patie nt, if possible, and any person
505	775		then authorized to make health care decisions for the patient;
506		-
507	776		2. Provide continuing care t o the patient until a transfer can
508	777		be effected; and
509		-
510	778		3. Unless the patient or person then authorized to make health
511	779		care decisions for the patient refus es assistance, immediately make
512	780		all reasonable efforts to assist in the transfer of the patient to
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513	808		another health care provider or facility that is willing to comply
514	809		with the instruction or decision.
515		-
516	810		G. A health care provider or facility may not require or
517	811		prohibit the execution or revocation of an a dvance health care
518	812		directive as a condition for providing health care.
519		-
520	813		H. The provisions of this section shall not be constru ed to
521	814		supersede or authorize noncompliance with the requirements of the
522	815		Oklahoma Advance Directive Act as provided in Section 3101 .9 of
523	816		Title 63 of the Oklahoma Statutes.
524		-
525	817		SECTION 7. NEW LAW A new section of law to be codified
526	818		in the Oklahoma Statutes as Section 3111.7 of Title 63, unless there
527	819		is created a duplication i n numbering, reads as follows:
528		-
529		-	ENR. S. B. NO. 1596 Page 13
530		-
531	820		Unless otherwise specified in a power of attorney for health
532	821		care, a person then authorized to make health care decisions for a
533	822		patient has the same rights as the patient to request, receiv e,
534	823		examine, copy, and consent to the disc losure of medical or any other
535	824		health care information.
536		-
537	825		SECTION 8. NEW LAW A new section of law to be codified
538	826		in the Oklahoma Statutes as Section 3111.8 of Title 63, unless there
539	827		is created a duplication in numbering, reads as follows:
540		-
541	828		A. A health care provider or facility acting in good faith and
542	829		in accordance with gener ally accepted health care standards
543	830		applicable to the health care provider or facility shall not be
	831	+
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544	858		subject to civil or cri minal liability or to discipline f or
545	859		unprofessional conduct for:
546		-
547	860		1. Complying with a health care decision of a person apparently
548	861		having authority to make a health care decision for a patient;
549		-
550	862		2. Declining to comply with a he alth care decision of a person
551	863		based on a belief that the person then lacked authority; or
552		-
553	864		3. Complying with a power of attorney for health care and
554	865		assuming that the designation was valid when made and has not been
555	866		revoked or terminated.
556		-
557	867		B. An individual acting as agent under this act shall not be
558	868		subject to civil or criminal liability or to discipline fo r
559	869		unprofessional conduct for health care decisions made in good faith.
560		-
561	870		SECTION 9. NEW LAW A new section of law to be codified
562	871		in the Oklahoma Statutes as Sect ion 3111.9 of Title 63, unless there
563	872		is created a duplication in numb ering, reads as follows:
564		-
565	873		A. This act shall not be construed to affect the right of an
566	874		individual to make health care decisions while having capacity to do
567	875		so.
568		-
569	876		B. An individual is presumed to have capacity to make a health
570	877		care decision and to give or revoke powers of attorney for health
571	878		care.
572		-
573		-	ENR. S. B. NO. 1596 Page 14
574		-
575	879		SECTION 10. NEW LAW A n ew section of law to be codified
576	880		in the Oklahoma Statutes as Section 3111.10 of Title 63, unless
577	881		there is created a duplication in numbering, reads as follows:
578	882
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	908	+
579	909		A copy of a written power of attorney for health care or
580	910		revocation of a power of attorney for health care has the same
581	911		effect as the original.
582		-
583	912		SECTION 11. NEW LAW A new section of law to be codified
584	913		in the Oklahoma Statutes as Section 3111.11 of Title 63, unless
585	914		there is created a duplication in numb ering, reads as follows:
586		-
587	915		A. This act shall not be construed to create a presumption
588	916		concerning the intention of an indiv idual who has not made or who
589	917		has revoked a power of attorney for health care .
590		-
591	918		B. This act shall not be construed to authorize or require a
592	919		health care provider or facility to provide health care contrary to
593	920		generally accepted health care standards applicable to the health
594	921		care provider or facility; provided, this provision shall not be
595	922		construed to supersede or authorize noncompliance with the
596	923		requirements of the Oklaho ma Advance Directive Act as provided in
597	924		Section 3101.9 of Title 63 of the O klahoma Statutes.
598		-
599	925		C. This act shall not be construed to authorize an agent to
600	926		consent to the admission of an indiv idual to a mental health care
601	927		facility unless the individual’s written directive expressly so
602	928		provides.
603		-
604	929		D. This act shall not affect other statutes of this state
605	930		governing treatment for mental illness of an individual
606	931		involuntarily committed to a mental h ealth care facility under
607	932		Chapter 1 of Title 43A of the Oklahoma Statutes.
608	933
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609	960		SECTION 12. NEW LAW A new section of law to be codified
610	961		in the Oklahoma Statutes as Section 3111.12 of Title 63, unless
611	962		there is created a duplication in numbering, reads as follows:
612		-
613	963		On petition of a patient, the patient’s agent, or a health care
614	964		provider or facility involved with the patient’s care, the court may
615	965		enjoin or direct a health care decision or order other equitable
616		-
617		-	ENR. S. B. NO. 1596 Page 15
618	966		relief. A proceeding under this section shall be governed by Title
619	967		12 of the Oklahoma Statutes.
620		-
621	968		SECTION 13. NEW LAW A new section of law to be codifie d
622	969		in the Oklahoma Statutes as Section 3111.13 of Title 63, unless
623	970		there is created a duplication in numbering, reads as follows:
624		-
625	971		Any document made in substantial compliance with the
626	972		requirements of the Oklahoma Health Care Agen t Act shall have full
627	973		force and effect including such documents made prior to the
628	974		effective date of this act .
629		-
630	975		SECTION 14. AMENDATORY 63 O.S. 2021, Section 1-1973, is
631	976		amended to read as follows:
632		-
633	977		Section 1-1973. A. Patients who are capabl e of self-
634	978		administering their own medications without assistance shall be
635	979		encouraged and allowed to do so. How ever, a certified nurse aide
636	980		may assist a patient whose condition is medically stable with the
637	981		self-administration of routine, regularly schedule d medications that
638	982		are intended to be self -administered, if the following conditions
639	983		are met:
640	984
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641	1011		1. For an oral medication, the medication shall have been
642	1012		placed in a medication planner by a registered n urse, a relative of
643	1013		the patient or nursing staff of an Oklahoma licensed home health or
644	1014		hospice agency that is currently serving the patient; and
645		-
646	1015		2. For all other fo rms, the certified nurse aide shall assist
647	1016		with self-administration consistent with a disp ensed prescription’s
648	1017		label or the package directions of an over-the-counter medication.
649		-
650	1018		B. For purposes of this section, self -administered medications
651	1019		include both legend and over-the-counter oral dosage forms, topical
652	1020		dosage forms and topical ophthalmic, otic and nasal dosage forms,
653	1021		including solutions, susp ensions, sprays and inhalers.
654		-
655	1022		C. Assistance with self -administration of medication by a
656	1023		certified nurse aide m ay occur only upon a documented request by,
657	1024		and the written informed consent of, a patient or the patient’s
658	1025		surrogate, guardian or attorney -in-fact.
659		-
660		-
661		-	ENR. S. B. NO. 1596 Page 16
662	1026		D. For purposes of this section, assistance with self -
663	1027		administration of medication includes:
664		-
665	1028		1. Taking an oral medication out of a pill planner and bringing
666	1029		it to the patient;
667		-
668	1030		2. Placing an oral dosage in the patient’s hand or placing the
669	1031		dosage in another container and helping the patient by lifting the
670	1032		container to his or her mouth;
671		-
672	1033		3. If ordered by a phy sician, placing an oral medication in
673	1034		food before the patient self-administers;
674	1035
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675	1062		4. Crushing an oral medication pursuant to orders given by a
676	1063		physician or health care professional;
677		-
678	1064		5. Applying topical medications; and
679		-
680	1065		6. Keeping a record of when a patien t receives assistance with
681	1066		self-administration pursuant to this section.
682		-
683	1067		E. For purposes of this section, assistance with self-
684	1068		administration of medication does not include:
685		-
686	1069		1. Removing oral medication from any container other than a
687	1070		pill planner;
688		-
689	1071		2. Mixing, compounding, converting or calculating medication
690	1072		doses;
691		-
692	1073		3. The preparation of syri nges for injection or the
693	1074		administration of medications by any injectable route;
694		-
695	1075		4. Administration of medications through intermittent positive
696	1076		pressure breathing ma chines;
697		-
698	1077		5. Administration of medications by way of a tube inserted in a
699	1078		cavity of the body;
700		-
701	1079		6. Administration of parenteral preparations;
702		-
703		-
704		-	ENR. S. B. NO. 1596 Page 17
705	1080		7. Irrigations or debriding agents used in the treatment of a
706	1081		skin condition;
707		-
708	1082		8. Rectal, urethral, or vaginal prep arations;
709		-
710	1083		9. Medications ordered by the physician or health care
711	1084		professional with prescr iptive authority to be given “as needed”,
712	1085		unless the order is written with specific parameters that preclude
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713	1113		independent judgment on the part of the certified nurse a ide, and at
714	1114		the request of a competent patient;
715		-
716	1115		10. Medications for which the time of adm inistration, the
717	1116		amount, the strength of dosage, the me thod of administration or the
718	1117		reason for administration requires judgment or discretion on the
719	1118		part of the certified nurse aide; or
720		-
721	1119		11. Assistance with the self-administration of medication by a
722	1120		certified nurse aide in an assisted living center through ho me care
723	1121		services as provided for in Section 1 -890.8 of Title 63 of the
724	1122		Oklahoma Statutes.
725		-
726	1123		F. Assistance with t he self-administration of medication by a
727	1124		certified nurse aide as described in this sectio n does not
728	1125		constitute administration as defined in Sect ion 353.1 of Title 59 of
729	1126		the Oklahoma Statutes.
730		-
731	1127		G. The State Commissioner of Health may by rule establish
732	1128		procedures and interpret terms as necessary to implement the
733	1129		provisions of this section.
734		-
735	1130		H. For purposes of this section:
736		-
737	1131		1. “Informed consent” means advising the patient, or the
738	1132		patient’s surrogate, guardian or attorney -in-fact, that the patient
739	1133		may be receiving assistance with self-administration of medication
740	1134		from a certified nurse aide; and
741		-
742	1135		2. “Attorney-in-fact” means an attorney-in-fact authorized to
743	1136		act pursuant to the Uniform Durable Power of Attorney Act, Sections
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744	1164		1071 through 1077 of Title 58 of the Oklahoma Statutes Oklahoma
745	1165		Health Care Agent Act, with authority to act regarding the pat ient’s
746	1166		health and medical care decisions, subject to th e limitations under
747		-
748		-	ENR. S. B. NO. 1596 Page 18
749	1167		paragraph 1 of subsection B of Section 1072.1 of Title 58 of the
750	1168		Oklahoma Statutes the Oklahoma Health Care Agent Act.
751		-
752	1169		SECTION 15. AMENDATORY 63 O.S. 2021, Se ction 3102.4, is
753	1170		amended to read as follows:
754		-
755	1171		Section 3102.4. A. When an adult patient or a person under
756	1172		eighteen (18) years of age who may consent to have service s provided
757	1173		by health professionals under Section 2602 of this title is
758	1174		persistently unconsci ous, incompetent or otherwise mentally or
759	1175		physically incapable of communicating, a person who is reasonably
760	1176		available and willing in the following classes, in the o rder of
761	1177		priority set forth in this subsection, shall be authorized to make
762	1178		health care decisions for the patient under the same standard as
763	1179		that applicable to making life-sustaining treatment decisions under
764	1180		Section 3101.16 of this title, excluding any per son who is
765	1181		disqualified from exercising such authority by Section 3102.5 of
766	1182		this title. If those within a class disagree, a majority within the
767	1183		class may make a health care decision for the patient. However, a
768	1184		provider of health care to the patient or an y member or members of
769	1185		any of the following classes may petition a court that would have
770	1186		jurisdiction over a guardianship proceeding concerning t he patient
771	1187		under Section 1-115 of Title 30 of the Oklahoma Statutes to seek an
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772	1215		order directing a different heal th care decision on the ground that
773	1216		the health care decision or decisions made violate the s tandard
774	1217		required by this section, granting another me mber or other members
775	1218		from among the following classes (notwithstanding the statutory
776	1219		order of priority) superv ening authority to make health care
777	1220		decisions for the patient on the ground that clear and c onvincing
778	1221		evidence demonstrates they are more likely to adhere to that
779	1222		standard, or both. Upon motion by any party, the court shall issue
780	1223		an order requiring that p ending its decision on the merits and the
781	1224		resolution of any appeal the patient be provided w ith health care of
782	1225		which denial, in reasonable medica l judgment, would be likely to
783	1226		result in or hasten the death of the patient, unless its provision
784	1227		would require denial of the same health care to another patient.
785	1228		The classes are as follows:
786		-
787	1229		1. A general guardian of the person appointed pursuant to
788	1230		subsection A of Section 3-112 of Title 30 of the Oklahoma Statutes
789	1231		or a limited guardian of the person appointed pur suant to subsection
790	1232		B of Section 3-112 of Title 30 of the Oklahoma Statutes with
791		-
792		-	ENR. S. B. NO. 1596 Page 19
793	1233		authority to make personal medical decisions as determined under
794	1234		paragraph 5 of subsection B of Section 3 -113 of Title 30 of the
795	1235		Oklahoma Statutes;
796		-
797	1236		2. A health care proxy, or alternate health care proxy,
798	1237		designated by the patient, as defined in paragraph 6 of Sectio n
799	1238		3101.3 of Title 63 of the Oklahoma Statutes;
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800	1265
801	1266		3. An attorney-in-fact authorized to act pursuant to the
802	1267		Uniform Durable Power of Attorney Act, Sections 1071 throu gh 1077 of
803	1268		Title 58 of the Oklahoma Statutes Oklahoma Health Care Agent Act,
804	1269		with authority to act regarding the patient’s health and medical
805	1270		care decisions, subject to the limitations under paragraph 1 of
806	1271		subsection B of Section 1072.1 of Title 58 of the Oklahoma Statutes
807	1272		the Oklahoma Health Care Agent Act;
808		-
809	1273		4. The patient’s spouse;
810		-
811	1274		5. Adult children of the patient;
812		-
813	1275		6. Parents of the patient;
814		-
815	1276		7. Adult siblings;
816		-
817	1277		8. Other adult relatives of the patient in order of kinship; or
818		-
819	1278		9. Close friends of the pat ient who have maintained regular
820	1279		contact with the patient sufficient to be familiar with the
821	1280		patient’s personal values. Execution of an affidavit stating
822	1281		specific facts and circumstances documenting such contact
823	1282		constitutes prima facie evidence of close f riendship.
824		-
825	1283		B. Prior to making a health care decision for a patient
826	1284		pursuant to subsection A of this section, a person shall provide to
827	1285		the health care provider or hea lth care entity a signed copy of the
828	1286		following statement to be entered into the patient ’s medical record:
829		-
830	1287		“I hereby certify that:
831		-
832	1288		I have not been convicted of, pleaded guilty to or p leaded no
833	1289		contest to the crimes of abuse, verbal abus e, neglect or financi al
	1290	+
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834	1317		exploitation by a caregiver; exploitation of an elderly person or
835		-
836		-	ENR. S. B. NO. 1596 Page 20
837	1318		disabled adult; or a buse, neglect, exploitation or sexual abuse of a
838	1319		child;
839		-
840	1320		I have not been found to have committ ed abuse, verbal abuse or
841	1321		exploitation by a final inv estigative finding of the State
842	1322		Department of Health or Department of Human Services or by a finding
843	1323		of an administrative law judge, unless it was overturned on appeal;
844	1324		and
845		-
846	1325		I have not been criminally cha rged as a person responsible for
847	1326		the care of a vulner able adult with a cri me resulting in the death
848	1327		or near death of a vulnerable adult. ”
849		-
850	1328		SECTION 16. AMENDATORY 63 O.S. 2021, Section 3105.2, is
851	1329		amended to read as follows:
852		-
853	1330		Section 3105.2. As used in the Physician Orders for Life -
854	1331		Sustaining Treatment Act:
855		-
856	1332		1. “Attorney-in-fact” means an attorney-in-fact authorized to
857	1333		act pursuant to the Uniform Durable Power of Attorney Act, Sections
858	1334		1071 through 1077 of Title 58 o f the Oklahoma Statutes Oklahoma
859	1335		Health Care Agent Act, with authority to act regarding the patient ’s
860	1336		health and medical care decisions, subject to the limit ations under
861	1337		paragraph 1 of subsection B of Section 1072.1 of Title 58 of the
862	1338		Oklahoma Statutes the Oklahoma Health C are Agent Act;
863		-
864	1339		2. “Guardian” means a general guardian of the person appointed
865	1340		pursuant to subsection A of Section 3 -112 of Title 30 of the
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	1367	+
866	1368		Oklahoma Statutes or a l imited guardian of the person appointed
867	1369		pursuant to subsection B of Section 3 -112 of Title 30 of the
868	1370		Oklahoma Statutes with the authority to make personal medical
869	1371		decisions as determined under paragraph 5 of subsection B of Section
870	1372		3-113 of Title 30 of the Oklahoma Statutes;
871		-
872	1373		3. “Health care provider” means a person who is licensed,
873	1374		certified or otherwise authorized by the laws of this state t o
874	1375		administer health care in the ordinary course of business or
875	1376		practice of a profession;
876		-
877	1377		4. “Health care proxy” means a health care proxy (or alternate
878	1378		health care proxy) authorized to act pursuant to the Oklahoma
879		-
880		-	ENR. S. B. NO. 1596 Page 21
881	1379		Advance Directive Act, Sections 3101.1 through 3101.16 of Title 63
882	1380		of the Oklahoma Statutes this title, as defined in paragraph 6 of
883	1381		Section 3101.3 of Title 63 of the Oklahoma Statutes this title; and
884		-
885	1382		5. “Other legally authoriz ed person” means a person, other than
886	1383		a minor’s custodial parent or guardian, the patient or the patient ’s
887	1384		attorney-in-fact, guardian or health care proxy, who has authority
888	1385		to make health care decisions for the patient under common law.
889		-
890	1386		SECTION 17. AMENDATORY 63 O.S. 2021, Section 3 105.4, is
891	1387		amended to read as follows:
892		-
893	1388		Section 3105.4. 1. At the top of the first page of the
894	1389		standardized format Oklahoma physician orders for life-sustaining
895	1390		treatment form the following wording in al l capitals shall appear
896	1391		against a contrasting color b ackground: “FORM SHALL ACCOMPANY
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	1418	+
897	1419		PERSON WHEN TRANSFERRED OR DISCHARGED”; at the bottom of the first
898	1420		page the following wording in all capitals shall appear against a
899	1421		contrasting color background: “HIPAA PERMITS DISCLOSURE TO HEALTH
900	1422		CARE PROFESSIONALS AND PROXY DECISION MAKERS AS NECESSARY FOR
901	1423		TREATMENT”.
902		-
903	1424		2. There shall be an introductory section, the left block of
904	1425		which shall contain the name “Oklahoma Physician Orders for Life-
905	1426		Sustaining Treatment (POL ST)” followed by the words, “This Physician
906	1427		Order set is based on the patient’s current medical condition and
907	1428		wishes and is to be reviewed for potential replacemen t in the case
908	1429		of a substantial change in either, as well as in other cases listed
909	1430		under F. Any section not completed indicates full treatment for
910	1431		that section. Photocopy or fax copy of this form is lega l and
911	1432		valid.” and the right block of which shall con tain lines for the
912	1433		patient’s name, the patient’s date of birth and the effective date
913	1434		of the form followed by the statement, “Form must be reviewe d at
914	1435		least annually.”
915		-
916	1436		3. In Section A of the form, the le ft block shall contain, in
917	1437		bold font, “A. Check One”, and the right block shall be headed, in
918	1438		bold font, “Cardiopulmonary Resuscitation (CPR): Person has no
919	1439		pulse and is not breathing. ” below which there shall be a checkbox
920	1440		followed by “Attempt Resuscitation (CPR)”, then a checkbox followed
921	1441		by “Do Not Attempt Resuscitation (DNR/ no CPR)”, and below which
922	1442
923		-	ENR. S. B. NO. 1596 Page 22
	1443	+	SB1596 HFLR Page 29
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	1468	+
924	1469		shall be the words, “When not in cardiopul monary arrest, follow
925	1470		orders in B, C and D below. ”
926		-
927	1471		4. In Section B of the form, the left block shall contain, in
928	1472		bold, “B. Check One”, and the right block shall be headed, in bold,
929	1473		“Medical Interventions: Person has pulse and/or is breathing. ”
930	1474		Below this there shall be a checkbox followed by, in bold, “Full
931	1475		Treatment” followed by, “Includes the use of intubatio n, advanced
932	1476		airway interventions, mechanical ventila tion, defibrillation or
933	1477		cardio version as indicated, medical treatment, intravenous fluids,
934	1478		and cardiac monitor as indicated. Transfer to hospita l if
935	1479		indicated. Include intensive care. Includes treatme nt listed under
936	1480		“Limited Interventions ” and “Comfort Measures”, followed by, in
937	1481		bold, “Treatment Goal: Attempt to preserve life by all medically
938	1482		effective means.”
939		-
940	1483		Below this there shall be a checkb ox followed by, in bold,
941	1484		“Limited Interventions ” followed by, “Includes the use of medical
942	1485		treatment, oral and intravenous medications, intravenous fluids,
943	1486		cardiac monitoring as indicated, noninvasive bi -level positive
944	1487		airway pressure, a bag valve mask or other advanced airway
945	1488		interventions. Includes treatment l isted under “Comfort Measures”,
946	1489		followed by, “Do not use intubation or mechanical ventilation.
947	1490		Transfer to hospital if indicated. Avoid intensi ve care.” followed
948	1491		by, in bold, “Treatment Goal: Att empt to preserve life by basic
949	1492		medical treatments.”
950	1493
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951	1520		Below this there shall be a checkbox followed by, in bold,
952	1521		“Comfort Measures only” followed by, “Includes keeping the patient
953	1522		clean, warm and dry; use of medication by any route; positioning,
954	1523		wound care and other measures to relieve pain and suffering. Use
955	1524		oxygen, suction and manual treatment of airway obstructi on as needed
956	1525		for comfort. Transfer from current location to intermediate
957	1526		facility only if needed and adequate to meet comfort needs and to
958	1527		hospital only if comfort needs cannot otherwise be met in the
959	1528		patient’s current location (e.g., hip fracture; if int ravenous route
960	1529		of comfort measures is required).”
961		-
962	1530		Below this there shall be, in italics, “Additional Orders:”
963	1531		followed by an underlined space for other instructions.
964		-
965		-
966		-	ENR. S. B. NO. 1596 Page 23
967	1532		5. In Section C of the form, the left block shall contain, in
968	1533		bold, “C. Check One” and the right block shall be headed, in bold,
969	1534		“Antibiotics”.
970		-
971	1535		Below this there shall be a checkbox followed by, in bold, “Use
972	1536		antibiotics to preserve li fe.”
973		-
974	1537		Below this there shall be a checkbox followed by, in bold,
975	1538		“Trial period of antibiotics if and when infec tion occurs.” After
976	1539		this there shall be, in italics, “*Include goals below in E. ”
977		-
978	1540		Below this there shall be a checkbox followed by, in bold,
979	1541		“Initially, use antibiotics only to relieve pain and discomfor t.”
980	1542		After this there shall be, in italics, “+Contact patient or
981	1543		patient’s representative for further direction.”
982	1544
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983	1571		Below this there shall be, in it alics, “Additional Orders:”
984	1572		followed by an underlined space for other instructions.
985		-
986	1573		6. In Section D of the for m, the left block shall contain, in
987	1574		bold, “D. Check One in Each Column”, and the right block shall be
988	1575		headed in bold, “Assisted Nutrition and Hy dration”, below which
989	1576		shall be “Administer oral fluid s and nutrition, if necessary by
990	1577		spoon feeding, if physica lly possible.” Below these the right block
991	1578		shall be divided into three columns.
992		-
993	1579		The leftmost column shall be headed, “TPN (Total Parenteral
994	1580		Nutrition-provision of nutrition into blood vessels). ” Below this
995	1581		there shall be a checkbox followed by, in bold, “TPN long-term”
996	1582		followed by “if needed”. Below this there shall be a checkbox
997	1583		followed by, in bold, “TPN for a trial period* ”. Below this there
998	1584		shall be a checkbox followed by, in bold, “Initially, no TPN+”.
999		-
1000	1585		The middle column shall be headed “Tube Feeding”. Below this
1001	1586		there shall be a checkbox followed b y, in bold, “Long-term feeding
1002	1587		tube” followed by “if needed”. Below this there shall be a ch eckbox
1003	1588		followed by, in bold, “Feeding tube for a tria l period*”. Below
1004	1589		this there shall be a checkbox followed by, in bold, “Initially, no
1005	1590		feeding tube”.
1006		-
1007	1591		The rightmost column shall be headed, “Intravenous (IV) Fluids
1008	1592		for Hydration”. Below this there shal l be a checkbox followed by,
1009		-
1010		-	ENR. S. B. NO. 1596 Page 24
1011	1593		in bold, “Long-term IV fluids” followed by “if needed”. Below this
1012	1594		there shall be a checkbox followed by, in bold, “IV fluids for a
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1013	1622		trial period*”. Below this there shall be a checkbox followed by,
1014	1623		in bold, “Initially, no IV fluids+”.
1015		-
1016	1624		Running below all the columns there shall b e, in italics,
1017	1625		“Additional Orders:” followed by an underli ned space for other
1018	1626		instructions, followed by, in it alics, “*Include goals below in E.
1019	1627		+Contact patient or patient’s representative for further d irection.”
1020		-
1021	1628		7. In Section E of the form, the left blo ck shall contain, in
1022	1629		bold, “E. Check all that apply ” and the right block shall be
1023	1630		headed, in bold, “Patient Preferences as a Basis for this POLST
1024	1631		Form” shall include the following:
1025		-
1026	1632		a. below the heading there shall be a box including the
1027	1633		words, in bold, “Patient Goals/Medical Condition:”
1028	1634		followed by an adequate s pace for such information,
1029		-
1030	1635		b. below this there shall be a checkbox followed by, “The
1031	1636		patient has an advance directive for health care in
1032	1637		accordance with Sections 3101.4 or 3101.14 of Title 63
1033	1638		of the Oklahoma Statutes.” Below that there shall be
1034	1639		a checkbox followed by, “The patient has a durable
1035	1640		power of attorney for health care decisions in
1036	1641		accordance with paragraph 1 of subsection B of Section
1037	1642		1072.1 of Title 58 of the Oklahoma Statutes the
1038	1643		Oklahoma Health Care Agent Act.” Below that shall be
1039	1644		the indented words, “Date of execution” followed by an
1040	1645		underlined space. Below that shall be the words, “If
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1041	1673		POLST not being executed by patient: We certify that
1042	1674		this POLST is in accordance with the patient ’s advance
1043	1675		directive.” Below this there shall be a n underlined
1044	1676		space underneath which shall be positioned the wo rds,
1045	1677		“Name and Position (print) Signature” and “Signature
1046	1678		of Physician”,
1047		-
1048	1679		c. below these shall be the words, “Directions given by:”
1049	1680		and below that a checkbox followed by “Patient”, a
1050	1681		checkbox followed by “Minor’s custodial parent or
1051	1682		guardian”, a checkbox followed by “Attorney-in-fact”,
1052	1683		a checkbox followed by “Health care proxy”, and a
1053		-
1054		-	ENR. S. B. NO. 1596 Page 25
1055	1684		checkbox followed by “Other legally authorized
1056	1685		person:” followed by an underlined space. Beneath or
1057	1686		beside the checkbox and “Other legally authorized
1058	1687		person:” and the underlined space shall be the words
1059	1688		“Basis of Authority:” followed by an underlined space,
1060	1689		and
1061		-
1062	1690		d. below these shall be a four-column table with four
1063	1691		rows. In the top row the first column shall be blank ;
1064	1692		the second column shall have the words, “Printed
1065	1693		Name”; the third column shall have the word,
1066	1694		“Signature”, and the fourth column shall have the
1067	1695		word, “Date”. In the remaining rows the second
1068	1696		through fourth columns shall be blank. In the first
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1069	1724		column of these rows, in the second row shall be the
1070	1725		words, “Attending physician”; in the third row shall
1071	1726		be the words, “Patient or other individual checked
1072	1727		above (patient’s representative)”; and in the fourth
1073	1728		row shall be the words, “Health care professional
1074	1729		preparing form (besides doctor).”
1075		-
1076	1730		8. Section F of the form, which shall have the heading, in
1077	1731		bold, “Information for Patient or Representative of Patient Named on
1078	1732		this Form”, shall include the following language, appearing in bold
1079	1733		on the form:
1080		-
1081	1734		“The POLST form is always voluntary and is usually for persons
1082	1735		with advanced illness. Before providing information for or signing
1083	1736		it, carefully read “Information for Patie nts and Their Families -
1084	1737		Your Medical Treatment Right s Under Oklahoma Law”, which the health
1085	1738		care provider must give you. It is especially important to read the
1086	1739		sections on CPR and food and fluids, which have summaries of
1087	1740		Oklahoma laws that may control th e directions you may give. POLST
1088	1741		records your wishes for medical treatment in your current state of
1089	1742		health. Once initial medical treatment is begun and the risks and
1090	1743		benefits of further therapy are clear, your treatment wishes may
1091	1744		change. Your medical c are and this form can be changed to reflect
1092	1745		your new wishes at any time. However, no form can addres s all the
1093	1746		medical treatment decisions that may need to be made . An advance
1094	1747		health care directive is recommended, regardless of your health
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1095	1775		status. An advance directive allows you to document in detail your
1096		-
1097		-	ENR. S. B. NO. 1596 Page 26
1098	1776		future health care instructions and/or name a he alth care agent to
1099	1777		speak for you if you are unable to speak fo r yourself.
1100		-
1101	1778		The State of Oklahoma affirms that the lives of all are of equal
1102	1779		dignity regardless of age or disability and emphasizes that no one
1103	1780		should ever feel pressured to agree to forego life -preserving
1104	1781		medical treatment because of age, disability or fear of being
1105	1782		regarded as a burden.
1106		-
1107	1783		If this form is for a minor for whom you are authorized to make
1108	1784		health care decisions, you may not direct denial of medical
1109	1785		treatment in a manner that would vio late the child abuse and neglect
1110	1786		laws of Oklahoma. In particu lar, you may not direct the withholding
1111	1787		of medically indicated treatment from a disabled infa nt with life-
1112	1788		threatening conditions, as those terms a re defined in 42 U.S.C.,
1113	1789		Section 5106g or regulations implementing it and 42 U.S.C., Section
1114	1790		5106a.”
1115		-
1116	1791		9. Section G of the form, which shall have the heading, in
1117	1792		bold, “Directions for Completing and Imple menting Form”, shall
1118	1793		include the following three subdivisions:
1119		-
1120	1794		a. the first subdivision, entitled “COMPLETING POLST”,
1121	1795		shall have the following language with the wo rds, “The
1122	1796		signature of the patient or the patient’s
1123	1797		representative is required ” appearing in bold on the
1124	1798		form:
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1125	1825
1126	1826		“POLST must be reviewed and prepare d in consultation
1127	1827		with the patient or the patien t’s representative after
1128	1828		that person has been given a copy of “Information for
1129	1829		Patients and Their Families - Your Medical Treatment
1130	1830		Rights Under Oklahoma L aw”. POLST must be reviewed
1131	1831		and signed by a physicia n to be valid. Be sure to
1132	1832		document the basis fo r concluding the patient had or
1133	1833		lacked capacity at the time of execution of the form
1134	1834		in the patient’s medical record. If the patient lacks
1135	1835		capacity, any current advance directive form must be
1136	1836		reviewed and the patient’s representative and
1137	1837		physician must both certify that POLST complies with
1138	1838		it. The signature of the patient or the patient’s
1139	1839		representative is required; however, if the patient ’s
1140		-
1141		-	ENR. S. B. NO. 1596 Page 27
1142	1840		representative is not reasonably available to sign the
1143	1841		original form, a copy of the completed form with the
1144	1842		signature of the patient’s representative must be
1145	1843		placed in the medical record as soon as practicable
1146	1844		and “on file” must be written on the appropriate
1147	1845		signature line on this form.”,
1148		-
1149	1846		b. the second subdivision, entitl ed “IMPLEMENTING POLST”,
1150	1847		shall have the followin g language:
1151		-
1152	1848		“If a minor protests a directive to deny the minor
1153	1849		life-preserving medical treatment, the denial of
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1154	1877		treatment may not be implemented pending is suance of a
1155	1878		judicial order resolving the conflict. A health care
1156	1879		provider unwilling to comply with P OLST must comply
1157	1880		with the transfer and treatment pending trans fer
1158	1881		requirements of Section 3101.9 of Title 63 of the
1159	1882		Oklahoma Statutes as well as those of t he
1160	1883		Nondiscrimination in Treatment Act, Sections 3090. 2
1161	1884		and 3090.3 of Title 63 of the Oklahoma Statute s”, and
1162		-
1163	1885		c. the third subdivision, entitled “REVIEWING POLST”,
1164	1886		shall have the following language:
1165		-
1166	1887		“This POLST must be reviewed at least annually or
1167	1888		earlier if:
1168		-
1169	1889		The patient is admitted to or discharged from a
1170	1890		medical care facility; there is substantial chang e in
1171	1891		the patient’s health status; or the treatment
1172	1892		preferences of the patient or patient’s representative
1173	1893		change.”
1174		-
1175	1894		The same requirements for participation of the patient or
1176	1895		patient’s representative, and signa ture by both a physician and the
1177	1896		patient or the patient’s representative, that are described under
1178	1897		“COMPLETING POLST” shall also apply when POLST is reviewed, and must
1179	1898		be documented in Section I.
1180	1899
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1181	1926		10. Section H of the form, which shall have the heading, in
1182	1927		bold, “REVOCATION OF POLST”, shall have the fol lowing language, with
1183	1928		the words specified below appearing in b old on the form:
1184		-
1185		-	ENR. S. B. NO. 1596 Page 28
1186		-
1187	1929		“If POLST is revised or becomes invalid, write in bold the word
1188	1930		“VOID” in large letters on the front of the form. After voiding the
1189	1931		form a new form may be completed. A patient with capacity or the
1190	1932		individual or individuals authorized to sign on behalf of the
1191	1933		patient in Section E of this form may void this form. If no new
1192	1934		form is completed, full treatment and resuscitation is to b e
1193	1935		provided, except as otherwise authorized by Ok lahoma law.”
1194		-
1195	1936		11. Section I of the form, which shall have the heading, in
1196	1937		bold, “REVIEW SECTION”, followed by: “Periodic review confirms
1197	1938		current form or may require completion of new form,” shall include
1198	1939		the following columns and a number of rows determine d by the Office
1199	1940		of the Attorney General:
1200		-
1201	1941		a. Date of Review,
1202		-
1203	1942		b. Location of Review,
1204		-
1205	1943		c. Patient or Representative Signature,
1206		-
1207	1944		d. Physician Signature, and
1208		-
1209	1945		e. Outcome of Review.
1210		-
1211	1946		Each row in column (5) shall includ e a checkbox followed by,
1212	1947		“FORM CONFIRMED - No Change”, below which there shall be a checkbox
1213	1948		followed by, “FORM VOIDED, see updated form.”, below which there
1214	1949		shall be a checkbox followed by, “FORM VOIDED, no new form.”
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1215	1976
1216	1977		A final section of the form, which s hall have the heading, in
1217	1978		bold, “Contact Information:”, shall include two rows of four
1218	1979		columns. In the first column, the first row shall include
1219	1980		“Patient/Representative” followed by an adequate space fo r such
1220	1981		information, and the second column shall inclu de “Health Care
1221	1982		Professional Preparing Form ” followed by an adequate space for such
1222	1983		information. In the secon d column both rows shall include
1223	1984		“Relationship” followed by an adequate space for such inform ation;
1224	1985		in the third column both rows shall include “Phone Number” followed
1225	1986		by an adequate space for s uch information; and in the fourth column
1226	1987		both rows shall incl ude “Email Address” followed by an adequate
1227	1988		space for such information.
1228		-
1229		-	ENR. S. B. NO. 1596 Page 29
1230		-
1231	1989		SECTION 18. AMENDATORY 63 O.S. 2021, Section 3131 .3, is
1232	1990		amended to read as follows:
1233		-
1234	1991		Section 3131.3. As used in the Oklahoma Do -Not-Resuscitate Act:
1235		-
1236	1992		1. “Attending physician” means a licensed physician who has
1237	1993		primary responsibility for treatment or care of the person. If more
1238	1994		than one physician s hares that responsibility, any of those
1239	1995		physicians may act as the attending physician under the provisions
1240	1996		of the Oklahoma Do-Not-Resuscitate Act;
1241		-
1242	1997		2. “Cardiopulmonary resuscitation” means those measures used to
1243	1998		restore or support cardiac or respiratory fu nction in the event of a
1244	1999		cardiac or respiratory arrest;
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1245	2026
1246	2027		3. “Do-not-resuscitate identification ” means a standardized
1247	2028		identification necklace, bracelet, or card as set forth in the
1248	2029		Oklahoma Do-Not-Resuscitate Act that signifies that a do-not-
1249	2030		resuscitate consent or order has been executed for the possessor;
1250		-
1251	2031		4. “Do-not-resuscitate order” means an order issued by a
1252	2032		licensed physician that cardiopulmonary resuscitation should not be
1253	2033		administered to a particul ar person;
1254		-
1255	2034		5. “Emergency medical services personnel ” means firefighters,
1256	2035		law enforcement officers, emergency medical technicians, paramedics,
1257	2036		or other emergency service s personnel, providers, or entities,
1258	2037		acting within the usual course of their profession s;
1259		-
1260	2038		6. “Health care decision” means a decision to giv e, withhold,
1261	2039		or withdraw informed consent to any type of health care including,
1262	2040		but not limited to, medical and surg ical treatments including life-
1263	2041		prolonging interventions, nursing care, hospitalization, treatment
1264	2042		in a nursing home or other extended care f acility, home health care,
1265	2043		and the gift or donation of a body organ or tissue;
1266		-
1267	2044		7. “Health care agency” means an agency established to
1268	2045		administer or provide health care services and which is commonly
1269	2046		known by a wide variety of titles including, but not lim ited to,
1270	2047		hospitals, medical cen ters, ambulatory health care facilities,
1271	2048		physicians’ offices and clinics, extended ca re facilities operated
1272		-
1273		-	ENR. S. B. NO. 1596 Page 30
1274	2049		in connection with hospitals, nursing homes, extended care
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1275	2077		facilities operated in connection with rehabilitation cent ers, home
1276	2078		care agencies and hos pices;
1277		-
1278	2079		8. “Health care provider ” means any physician, dentist, nurse,
1279	2080		paramedic, psychologist, or other person providing medical, dental,
1280	2081		nursing, psychological, hospice, or other health care services of
1281	2082		any kind;
1282		-
1283	2083		9. “Incapacity” means the inability, bec ause of physical or
1284	2084		mental impairment, to appreciate the nature and implications of a
1285	2085		health care decision, to make an informed choice regarding the
1286	2086		alternatives presented, and to communicate that choice in an
1287	2087		unambiguous manner; and
1288		-
1289	2088		10. “Representative” means an attorney-in-fact for health care
1290	2089		decisions acting pursuant to the Uniform Durable Power of Attorney
1291	2090		Act Oklahoma Health Care Agent Act, a health care proxy acting
1292	2091		pursuant to the Oklahoma Rights of the Terminally Ill or
1293	2092		Persistently Unconscious Advance Directive Act, or a guardian of the
1294	2093		person appointed under the Oklahoma Guardianship a nd Conservatorship
1295	2094		Act.
1296		-
1297	2095		SECTION 19. AMENDATORY 63 O.S. 2021, Section 3131.5, is
1298	2096		amended to read as follows:
1299		-
1300	2097		Section 3131.5. A. For persons under the care of a health care
1301	2098		agency, a do-not-resuscitate order shall, if issued, be in
1302	2099		accordance with the policies and procedures of the health care
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1303	2127		agency as long as not in conflict with the provisions of the
1304	2128		Oklahoma Do-Not-Resuscitate Act.
1305		-
1306	2129		B. The do-not-resuscitate consent form shall be in
1307	2130		substantially the following form:
1308		-
1309	2131		FRONT PAGE
1310		-
1311	2132		OKLAHOMA DO-NOT-RESUSCITATE (DNR) CONSENT FORM
1312		-
1313	2133		I, _________________________, request limited health care as
1314	2134		described in this document. If my heart stops beating or if I stop
1315	2135		breathing, no medical procedure to restore breathing or heart
1316		-
1317		-	ENR. S. B. NO. 1596 Page 31
1318	2136		function will be instituted by any health care provider including,
1319	2137		but not limited to, emergency medical services (EMS) personnel.
1320		-
1321	2138		I understand that this decision will not prevent me from
1322	2139		receiving other health care such as the Heimlich maneuver or oxygen
1323	2140		and other comfort care measures.
1324		-
1325	2141		I understand that I may revoke this consent at any time in one
1326	2142		of the following ways:
1327		-
1328	2143		1. If I am under the care of a health care agency, by making an
1329	2144		oral, written, or other act of communication to a physician or other
1330	2145		health care provider o f a health care agency;
1331		-
1332	2146		2. If I am not under the care of a health care agency, by
1333	2147		destroying my do-not-resuscitate form, removing all do-not-
1334	2148		resuscitate identification from my person, and notifying my
1335	2149		attending physician of the revocation;
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1336	2176
1337	2177		3. If I am incapacitated and under the care of a health care
1338	2178		agency, my representative may revoke the do-not-resuscitate consent
1339	2179		by written notification to a physician or other health care provider
1340	2180		of the health care agency or by oral notification to my attending
1341	2181		physician; or
1342		-
1343	2182		4. If I am incapacitated and not under the care of a health
1344	2183		care agency, my representative may revoke the do-not-resuscitate
1345	2184		consent by destroying the do -not-resuscitate form, removing all do -
1346	2185		not-resuscitate identification from my person, and noti fying my
1347	2186		attending physician of the revocation.
1348		-
1349	2187		I give permission for this information to be given to EMS
1350	2188		personnel, doctors, nurses, and other health care providers. I
1351	2189		hereby state that I am making an informed decision and agree to a
1352	2190		do-not-resuscitate order.
1353		-
1354	2191		____________________ OR ________________________________
1355		-
1356	2192		Signature of Person Signature of Representative
1357		-
1358	2193		(Limited to an attorney-in-fact for
1359	2194		health care decisions acting under the
1360		-
1361		-	ENR. S. B. NO. 1596 Page 32
1362	2195		Durable Power of Attorney Act Oklahoma
1363	2196		Health Care Agent Act, a health care
1364	2197		proxy acting under the Oklahoma Advance
1365	2198		Directive Act or a guardian of the
1366	2199		person appointed under the Oklahoma
1367	2200		Guardianship and Conservatorship Act.)
1368	2201
	2202	+	SB1596 HFLR Page 44
	2203	+	BOLD FACE denotes Committee Amendments. 1
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1369	2228		This DNR consent form was signed in my
1370	2229		presence.
1371		-
1372	2230		______________ ______________________ ____________ _
1373		-
1374	2231		Date Signature of Witness Address
1375		-
1376	2232		______________________ _____________
1377		-
1378	2233		Signature of Witness Address
1379		-
1380	2234		BACK OF PAGE
1381		-
1382	2235		CERTIFICATION OF PHYSICIAN
1383		-
1384	2236		(This form is to be used by an attending physician only to
1385	2237		certify that an incapacitated person without a representative would
1386	2238		not have consented to the administration of cardiopulmonary
1387	2239		resuscitation in the event of cardiac or respiratory arrest. An
1388	2240		attending physician of an incapacitated person without a
1389	2241		representative must know by clear and convincing e vidence that the
1390	2242		incapacitated person, when competent, decided on the basis of
1391	2243		information sufficient to constitute informed consent that such
1392	2244		person would not have consented to the administration of
1393	2245		cardiopulmonary resuscitation in the event of cardiac or respiratory
1394	2246		arrest. Clear and convincing evidence for this purpose shall
1395	2247		include oral, written, or other acts of communication between the
1396	2248		patient, when competent, and family members, health care providers,
1397	2249		or others close to the patient with knowledge o f the patient’s
1398	2250		desires.)
1399	2251
	2252	+	SB1596 HFLR Page 45
	2253	+	BOLD FACE denotes Committee Amendments. 1
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1400	2278		I hereby certify, based on clear and convincing evidence
1401	2279		presented to me, that I believe that ___________________________
1402		-
1403	2280		Name of Incapacitated Person
1404		-
1405		-	ENR. S. B. NO. 1596 Page 33
1406		-
1407	2281		would not have consented to the administration of cardiopulmonary
1408	2282		resuscitation in the event of cardiac or respiratory arrest.
1409	2283		Therefore, in the event of cardiac or respiratory arrest, no chest
1410	2284		compressions, artificial ventilation, intubations, defibrillation,
1411	2285		or emergency cardiac medications are to be initiated.
1412		-
1413	2286		__________________________ _____________________________
1414		-
1415	2287		Physician’s Signature/Date Physician’s Name (PRINT)
1416		-
1417	2288		________________________________________________________________
1418		-
1419	2289		Physician’s Address/Phone
1420		-
1421	2290		C. Witnesses must be individuals who are eighteen (18) years of
1422	2291		age or older who are not legatees, devisees or heirs at law.
1423		-
1424	2292		D. It is the intention of the Legislature that the preferred,
1425	2293		but not required, do-not-resuscitate form in Oklahoma shall be the
1426	2294		form set out in subsection B of this section.
1427		-
1428	2295		SECTION 20. It being immediately necessary for the preservation
1429	2296		of the public peace, health or safety, an emergency is hereby
1430	2297		declared to exist, by reason whereof this act shall take effect and
1431	2298		be in full force from and after its passage an d approval.
1432	2299
1433		-
1434		-	ENR. S. B. NO. 1596 Page 34
1435		-	Passed the Senate the 15th day of March, 2022.
1436		-
1437		-
1438		-
1439		-	Presiding Officer of the Senate
1440		-
1441		-
1442		-	Passed the House of Representatives the 26th day of April, 2022.
1443		-
1444		-
1445		-
1446		-	Presiding Officer of the House
1447		-	of Representatives
1448		-
1449		-	OFFICE OF THE GOVERNOR
1450		-	Received by the Office of the Governor this _______ _____________
1451		-	day of ___________________, 20_______, at _______ o'clock _______ M.
1452		-	By: _______________________________ __
1453		-	Approved by the Governor of the State of Oklahoma this _____ ____
1454		-	day of _________________ __, 20_______, at _______ o'clock _______ M.
1455		-
1456		-	_________________________ ________
1457		-	Governor of the State of Oklahoma
1458		-
1459		-
1460		-	OFFICE OF THE SECRETARY OF STATE
1461		-	Received by the Office of the Secretary of State this _______ ___
1462		-	day of __________________, 20 _______, at _______ o'clock _______ M.
1463		-	By: _______________________________ __
	2300	+	COMMITTEE REPORT BY: COMMITTEE ON RULES, dated 04/18/2022 - DO PASS.