MISSISSIPPI LEGISLATURE
2019 Regular Session
To: Public Health and Welfare
By: Senator(s) Burton
AN ACT ENTITLED THE "MISSISSIPPI EMERGENCY MEDICAL SERVICES DO NOT RESUSCITATE ORDER-BRACELET ACT"; TO PROVIDE DEFINITIONS; TO AUTHORIZE A TERMINAL PATIENT TO REQUEST HEALTH CARE PROVIDERS TO EXECUTE A "DO NOT RESUSCITATE ORDER FOR EMERGENCY SERVICES" AND TO PRESCRIBE CONDITIONS THEREON; TO PROVIDE FOR A "DO NOT RESUSCITATE" BRACELET; TO ALLOW A PARENT OR LEGAL GUARDIAN OF A PATIENT WHO IS A CHILD TO REQUEST AND REVOKE A "DO NOT RESUSCITATE ORDER" FOR EMERGENCY SERVICES FOR THE CHILD; TO PRESCRIBE THE DUTIES OF EMERGENCY MEDICAL SERVICES PERSONNEL WHEN PRESENTED WITH "DO NOT RESUSCITATE ORDERS"; TO PRESCRIBE THE REQUIRED FORM FOR THE ORDER; TO PROVIDE IMMUNITY FROM LIABILITY OF A HEALTH CARE PROVIDER OR EMERGENCY MEDICAL PERSONNEL REGARDING THE "DO NOT RESUSCITATE ORDER"; TO REQUIRE FULL RESUSCITATIVE MEASURES IN ABSENCE OF THE ORDER OR BRACELET; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. Short title. This act may be cited as the "Mississippi Emergency Medical Services Do Not Resuscitate Order-Bracelet Act."
SECTION 2. Definitions. As used in this act:
(a) "Child" means a person under the age of eighteen (18).
(b) "Do not resuscitate bracelet" or "bracelet" means a standardized identification bracelet that:
(i) Meets the specifications established under Section 3 of this act or that is approved by the State Department of Education under Section 3 of this act;
(ii) Bears the inscription "Do Not Resuscitate"; and
(iii) Signifies that the wearer is a patient who has obtained a do not resuscitate order which has not been revoked.
(c) "Do not resuscitate order for emergency services" means a document made pursuant to this act to prevent EMS personnel from employing resuscitative measures or any other medical process that would only extend the patient's suffering with no viable medical reason to perform the procedure.
(d) "EMS personnel" means emergency medical personnel certified by the State Department of Health, including first responders who have completed a State Department of Health approved medical first responder program.
(e) "Health care provider" means a person licensed to practice medicine or osteopathy pursuant to Section 73-25-1 et seq.
(f) "Palliative treatment" means the degree of treatment which must be provided to a patient in the routine delivery of emergency medical services, which assures the comfort and alleviation of pain and suffering to all extents possible, regardless of whether the patient has executed a document as provided for in this act.
(g) "Resuscitative treatment" means artificial stimulation of the cardiopulmonary systems of the human body, through either electrical, mechanical, or manual means including, but not limited to, cardiopulmonary resuscitation.
(h) "Terminal condition" means an incurable or irreversible condition that within reasonable medical judgment could cause death within a reasonably short period of time if life sustaining procedures are not used.
SECTION 3. Terminal patient may request health care provider to execute "do not resuscitate order for emergency services"; conditions; do not resuscitate bracelet. (1) An adult, married minor, or judicially emancipated minor patient who has a terminal condition, a surrogate for a patient with a terminal condition under the Adult Health Care Decisions Act, or an agent of a person with a terminal condition named by the patient in a Health Care Power of Attorney, or a parent or legal guardian of a patient who is a child with a terminal condition who is neither married nor judicially emancipated, may request a health care provider responsible for the care of the patient to execute a "do not resuscitate order for emergency services" if the:
(a) Patient has a terminal condition; and
(b) Terminal condition has been diagnosed by a health care provider and the health care provider's record establishes the time, date, and medical condition which gives rise to the diagnosis of a terminal condition.
(2) The health care provider who executes the do not resuscitate order shall make the order in writing on a form conforming to the requirements of Section 3 of this act, and either shall:
(a) Affix to the wrist of the patient a do not resuscitate bracelet that meets the specifications established under Section 3 of this act; or
(b) Provide the patient or his surrogate or agent, or the parent or legal guardian of a patient who is a child, with an order form, from a commercial vendor approved by the department pursuant to Section 3 of this act, to allow the patient to order a do not resuscitate bracelet from the commercial vendor.
SECTION 4. Duties of EMS personnel when presented with "do not resuscitate order." When called to render emergency medical services, EMS personnel must not use any resuscitative treatment if the patient has a "do not resuscitate order for emergency services" and the document is presented to the EMS personnel upon their arrival or if the patient is wearing a do not resuscitate bracelet. EMS personnel must provide that degree of palliative care called for under the circumstances which exist at the time treatment is rendered.
SECTION 5. Required form for "do not resuscitate order"; revocation procedure; do not resuscitate bracelet. (1) A document purporting to be a "do not resuscitate order" for EMS purposes must be in substantially the following form:
NOTICE TO EMS PERSONNEL
This notice is to inform all emergency medical personnel who may be called to render assistance to __________________ he/she has a terminal condition which has been diagnosed by me and has specifically requested that no resuscitative efforts including artificial stimulation of the cardiopulmonary system by electrical, mechanical, or manual means be made in the event of cardiopulmonary arrest.
REVOCATION PROCEDURE
THIS FORM MAY BE REVOKED BY AN ORAL STATEMENT BY THE PATIENT, OR THE PARENT OR LEGAL GUARDIAN OF A PATIENT WHO IS A CHILD, TO EMS PERSONNEL OR BY MUTILATING, OBLITERATING, OR DESTROYING THE DOCUMENT IN ANY MANNER.
Date:______________________________________
___________________________________________
Patient's signature (or surrogate or agent)
___________________________________________
Physician's signature
___________________________________________
Physician's address
___________________________________________
Physician's telephone number
(2) The State Department of Health may approve a do not resuscitate bracelet developed and distributed by a commercial vendor if the bracelet contains an emblem that displays an internationally recognized medical symbol on the front and the words "Mississippi Do Not Resuscitate EMS" and the patient's first name and last name on the back. The department may not approve a do not resuscitate bracelet developed and distributed by a commercial vendor if the vendor does not require a health care provider's order for the bracelet before distributing it to a patient.
(3) The cost of obtaining a bracelet must be borne by the patient, or the parent or legal guardian of a patient who is a child, and may not be provided by the department at the expense of the department.
(4) The vendor approved by the department shall not fulfill a request for a do not resuscitate bracelet without receiving a health care provider's order for the bracelet with the request.
SECTION 6. Liability of health care provider or EMS personnel regarding "do not resuscitate order." No health care provider or EMS personnel is liable for damages, may be the subject of disciplinary proceedings, or may be subject to civil or criminal liability due to:
(a) Issuing a "do not resuscitate order for emergency medical services" or a "do not resuscitate bracelet";
(b) Good faith reliance on a "do not resuscitate order for emergency medical services" or a "do not resuscitate bracelet" resulting in:
(i) The withholding of resuscitative treatment; or
(ii) The withholding of resuscitative treatment already in progress once a duly executed "do not resuscitate order for emergency medical services" is identified;
(c) Initiating resuscitative treatment on a "do not resuscitate patient" if EMS personnel were unaware of the existence of the order or bracelet or if EMS personnel reasonably and in good faith believed the "do not resuscitate order" had been cancelled or revoked or, where applicable, if the do not resuscitate bracelet has been tampered with or removed; or
(d) Initiating resuscitative treatment on a "do not resuscitate patient" where in the best medical judgment of EMS personnel, the care was necessary to relieve pain or suffering or to provide comfort care to the patient.
SECTION 7. Full resuscitative measures required in absence of order or bracelet. In the absence of a "do not resuscitate order for emergency medical services" or a "do not resuscitate bracelet," EMS personnel shall give full resuscitative measures as are medically indicated in all cases.
SECTION 8. Health care provider or EMS personnel must honor order or bracelet; exceptions; transfer care of patient. A health care provider and an EMS personnel shall follow the request of the patient, or the parent or legal guardian of a patient who is a child, and must not provide resuscitative measures when the patient has a "do not resuscitate order for emergency medical services" or is wearing a "do not resuscitate bracelet," except where the:
(a) Order is revoked pursuant to Section 10 of this act; or
(b) Bracelet, when applicable, appears to have been tampered with or removed.
SECTION 9. Act not condonation of mercy killing; minors ineligible for "do not resuscitate orders"; compliance with act not suicide. (1) Nothing in this act may be construed to condone, authorize, or approve mercy killing or euthanasia or to permit any affirmative action or deliberate act to end life other than to allow the natural process of dying.
(2) The withholding of resuscitative measures pursuant to this act does not constitute suicide for any purpose.
SECTION 10. Means of revocation of "do not resuscitate order for emergency services." A patient, or a parent or legal guardian of a patient who is a child, may revoke a "do not resuscitate order for emergency services" by:
(a) Mutilating, obliterating, or destroying the "do not resuscitate order for emergency medical services" document in any manner;
(b) Orally expressing to an emergency medical technician, first responder, or to a person who serves as a member of an emergency health care facility's personnel, the desire to be resuscitated, after which the emergency medical technician, first responder, or the member of the emergency health care facility shall disregard the "do not resuscitate order for emergency medical services" document and, if applicable, promptly remove the bracelet;
(c) Defacing, burning, cutting, or otherwise destroying the bracelet, if applicable; or
(d) Removing the bracelet or asking another person to remove the bracelet.
SECTION 11. Regulations to provide direction to emergency personnel in identifying patients having "do not resuscitate orders." The Mississippi State Department of Health shall promulgate regulations necessary to provide direction to emergency personnel in identifying patients who have a "do not resuscitate order for emergency services."
SECTION 12. This act shall take effect and be in force from and after July 1, 2019.