Florida Senate - 2018                        COMMITTEE AMENDMENT
       Bill No. SB 474
       
       
       
       
       
       
                                Ì156796_Î156796                         
       
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  02/14/2018           .                                
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       Appropriations Subcommittee on Health and Human Services
       (Brandes) recommended the following:
       
    1         Senate Amendment (with title amendment)
    2  
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Paragraph (l) of subsection (3) of section
    6  395.1041, Florida Statutes, is amended to read:
    7         395.1041 Access to emergency services and care.—
    8         (3) EMERGENCY SERVICES; DISCRIMINATION; LIABILITY OF
    9  FACILITY OR HEALTH CARE PERSONNEL.—
   10         (l) Hospital personnel may withhold or withdraw
   11  cardiopulmonary resuscitation if presented with an order not to
   12  resuscitate executed pursuant to s. 401.45 or a physician order
   13  for life-sustaining treatment (POLST) form executed pursuant to
   14  s. 401.451 which contains an order not to resuscitate. Facility
   15  staff and facilities are shall not be subject to criminal
   16  prosecution or civil liability, and are not nor be considered to
   17  have engaged in negligent or unprofessional conduct, for
   18  withholding or withdrawing cardiopulmonary resuscitation
   19  pursuant to such an order or POLST form. The absence of an order
   20  not to resuscitate executed pursuant to s. 401.45 or a POLST
   21  form executed pursuant to s. 401.451 which contains an order not
   22  to resuscitate does not preclude a physician from withholding or
   23  withdrawing cardiopulmonary resuscitation as otherwise
   24  authorized permitted by law.
   25         Section 2. Subsection (3) of section 400.142, Florida
   26  Statutes, is amended to read:
   27         400.142 Emergency medication kits; orders not to
   28  resuscitate.—
   29         (3) Facility staff may withhold or withdraw cardiopulmonary
   30  resuscitation if presented with an order not to resuscitate
   31  executed pursuant to s. 401.45 or a physician order for life
   32  sustaining treatment (POLST) form executed pursuant to s.
   33  401.451 that contains an order not to resuscitate. Facility
   34  staff and facilities are not subject to criminal prosecution or
   35  civil liability, or considered to have engaged in negligent or
   36  unprofessional conduct, for withholding or withdrawing
   37  cardiopulmonary resuscitation pursuant to such an order or POLST
   38  form. The absence of an order not to resuscitate executed
   39  pursuant to s. 401.45 or a POLST form executed pursuant to s.
   40  401.451 which contains an order not to resuscitate does not
   41  preclude a physician from withholding or withdrawing
   42  cardiopulmonary resuscitation as otherwise authorized permitted
   43  by law.
   44         Section 3. Subsection (7) of section 400.487, Florida
   45  Statutes, is amended to read:
   46         400.487 Home health service agreements; physician’s,
   47  physician assistant’s, and advanced registered nurse
   48  practitioner’s treatment orders; patient assessment;
   49  establishment and review of plan of care; provision of services;
   50  orders not to resuscitate; physician orders for life-sustaining
   51  treatment.—
   52         (7) Home health agency personnel may withhold or withdraw
   53  cardiopulmonary resuscitation if presented with an order not to
   54  resuscitate executed pursuant to s. 401.45 or a physician order
   55  for life-sustaining treatment (POLST) form executed pursuant to
   56  s. 401.451 which contains an order not to resuscitate. The
   57  agency shall adopt rules providing for the implementation of
   58  such orders. Home health personnel and agencies are shall not be
   59  subject to criminal prosecution or civil liability, and are not
   60  nor be considered to have engaged in negligent or unprofessional
   61  conduct, for withholding or withdrawing cardiopulmonary
   62  resuscitation pursuant to such an order or POLST form and rules
   63  adopted by the agency.
   64         Section 4. Paragraph (e) of subsection (1) of section
   65  400.605, Florida Statutes, is amended to read:
   66         400.605 Administration; forms; fees; rules; inspections;
   67  fines.—
   68         (1) The agency, in consultation with the department, may
   69  adopt rules to administer the requirements of part II of chapter
   70  408. The department, in consultation with the agency, shall by
   71  rule establish minimum standards and procedures for a hospice
   72  pursuant to this part. The rules must include:
   73         (e) Procedures relating to the implementation of advance
   74  advanced directives; physician order for life-sustaining
   75  treatment (POLST) forms executed pursuant to s. 401.451 which
   76  contain orders not to resuscitate; and orders not to resuscitate
   77  do-not-resuscitate orders.
   78         Section 5. Subsection (8) of section 400.6095, Florida
   79  Statutes, is amended to read:
   80         400.6095 Patient admission; assessment; plan of care;
   81  discharge; death.—
   82         (8) The hospice care team may withhold or withdraw
   83  cardiopulmonary resuscitation if presented with an order not to
   84  resuscitate executed pursuant to s. 401.45 or a physician order
   85  for life-sustaining treatment (POLST) form executed pursuant to
   86  s. 401.451 which contains an order not to resuscitate. The
   87  department shall adopt rules providing for the implementation of
   88  such orders. Hospice staff are shall not be subject to criminal
   89  prosecution or civil liability, and are not nor be considered to
   90  have engaged in negligent or unprofessional conduct, for
   91  withholding or withdrawing cardiopulmonary resuscitation
   92  pursuant to such an order or POLST form and applicable rules.
   93  The absence of an order to resuscitate executed pursuant to s.
   94  401.45 or a POLST form executed pursuant to s. 401.451 which
   95  contains an order not to resuscitate does not preclude a
   96  physician from withholding or withdrawing cardiopulmonary
   97  resuscitation as otherwise authorized permitted by law.
   98         Section 6. Subsection (4) of section 401.35, Florida
   99  Statutes, is amended to read:
  100         401.35 Rules.—The department shall adopt rules, including
  101  definitions of terms, necessary to carry out the purposes of
  102  this part.
  103         (4) The rules must establish circumstances and procedures
  104  under which emergency medical technicians and paramedics may
  105  honor orders by the patient’s physician not to resuscitate
  106  executed pursuant to s. 401.45 or physician order for life
  107  sustaining treatment (POLST) forms executed pursuant to s.
  108  401.451 that contain orders not to resuscitate and the
  109  documentation and reporting requirements for handling such
  110  requests.
  111         Section 7. Paragraph (a) of subsection (3) of section
  112  401.45, Florida Statutes, is amended to read:
  113         401.45 Denial of emergency treatment; civil liability.—
  114         (3)(a) Resuscitation or other forms of medical intervention
  115  may be withheld or withdrawn from a patient by an emergency
  116  medical technician, or paramedic, or other health care
  117  professional if evidence of an order not to resuscitate by the
  118  patient’s physician or a physician order for life-sustaining
  119  treatment (POLST) form executed pursuant to s. 401.451 which
  120  contains an order not to resuscitate is presented to the
  121  emergency medical technician, or paramedic, or other health care
  122  professional. To be valid, an order not to resuscitate or not to
  123  perform other medical intervention, to be valid, must be on the
  124  form adopted by rule of the department. The form must be signed
  125  by the patient’s physician and by the patient or, if the patient
  126  is incapacitated, the patient’s health care surrogate or proxy
  127  as provided in chapter 765, court-appointed guardian as provided
  128  in chapter 744, or attorney in fact under a durable power of
  129  attorney as provided in chapter 709 or, if the patient is a
  130  minor, the patient’s parent or legal guardian. The court
  131  appointed guardian or attorney in fact must have been delegated
  132  authority to make health care decisions on behalf of the
  133  patient.
  134         Section 8. Section 401.451, Florida Statutes, is created to
  135  read:
  136         401.451Physician Order for Life-Sustaining Treatment
  137  Program.—
  138         (1)POLST FORM.—A physician order for life-sustaining
  139  treatment (POLST) must be on the form adopted by rule of the
  140  department which must include the requirements specified in this
  141  section and must be executed as required by this section.
  142         (a)A POLST form may only be completed by or for a patient
  143  determined by the patient’s physician to have an end-stage
  144  condition as defined in s. 765.101(4) or a patient who, in the
  145  good faith clinical judgment of her or his physician, is
  146  suffering from at least one terminal medical condition that will
  147  likely result in the death of the patient within 1 year.
  148         (b)A POLST form must be signed by the patient’s physician.
  149  The form must contain a certification by the physician signing
  150  the POLST form that the physician consulted with the patient
  151  signing the form, or if the patient is incapable of making
  152  health care decisions for herself or himself or is
  153  incapacitated, with the patient’s health care surrogate, proxy,
  154  court-appointed guardian or attorney-in-fact authorized to
  155  execute a POLST form on behalf of the patient as provided in
  156  paragraph (c), and must include information about the patient’s
  157  care goals and preferences as reflected on the POLST form,
  158  specifically including the use of and the effect of removal or
  159  refusal of life-sustaining medical treatment. The physician
  160  signing the POLST form must further indicate the medical
  161  circumstance justifying the execution of the POLST.
  162         (c)A POLST form must also be signed by the patient, or if
  163  the patient is incapable of making health care decisions for
  164  herself or himself or is incapacitated, by the patient’s health
  165  care surrogate or proxy as provided in chapter 765, or if none
  166  exists, by the patient’s court-appointed guardian if the
  167  guardian has such authority as provided in chapter 744, or if
  168  none exists, by the patient’s attorney-in-fact if the patient
  169  has delegated the power to make all health care decisions to the
  170  attorney-in-fact as provided in chapter 709. If a POLST form is
  171  signed by a health care surrogate, proxy, court-appointed
  172  guardian, or attorney-in-fact, the patient’s physician must
  173  certify the basis for the authority of the appropriate
  174  individual to execute the POLST form on behalf of the patient
  175  including compliance with chapter 765, chapter 744, or chapter
  176  709.
  177         (d)The execution of a POLST form by the patient
  178  automatically revokes all POLST forms previously executed by the
  179  patient.
  180         (e)A patient’s health care surrogate, proxy, court
  181  appointed guardian, or attorney-in-fact authorized to execute a
  182  POLST form on behalf of the patient as provided in paragraph (c)
  183  may subsequently revoke a POLST form for a patient, unless a
  184  valid advance directive or prior POLST form executed by the
  185  patient expressly forbids changes by a surrogate, proxy,
  186  guardian, or attorney-in-fact.
  187         (f)An individual acting in good faith as a surrogate,
  188  proxy, court-appointed guardian, or attorney-in-fact who
  189  executes a POLST form on behalf of an incapacitated patient or a
  190  minor patient in accordance with this section and rules adopted
  191  by the department is not subject to criminal prosecution or
  192  civil liability for executing the POLST form.
  193         (g)If a family member of the patient, the health care
  194  facility providing services to the patient, or the patient’s
  195  physician, who may reasonably be expected to be affected by the
  196  patient’s POLST form directives, believes that directives
  197  executed by the patient’s legal representative are in conflict
  198  with the patient’s prior expressed desires regarding end-of-life
  199  care, the family member, facility, or physician may seek
  200  expedited judicial intervention pursuant to the Florida Probate
  201  Rules if that person believes:
  202         1.The POLST form regarding the patient's wishes regarding
  203  life-sustaining treatment is ambiguous or the patient has
  204  changed her or his mind after execution of the advance directive
  205  or POLST form;
  206         2.The POLST form was executed by a surrogate, proxy,
  207  court-appointed guardian, or attorney-in-fact authorized to
  208  execute a POLST form on behalf of a patient as provided in
  209  paragraph (c) and the POLST form is not in accord with the
  210  patient’s known desires or chapter 765, chapter 744, or chapter
  211  709;
  212         3.The POLST was executed by a surrogate, proxy, court
  213  appointed guardian, or attorney-in-fact on behalf of a patient
  214  as provided in paragraph (c) and the surrogate, proxy, court
  215  appointed guardian, or attorney-in-fact was improperly
  216  designated or appointed, or the designation of the surrogate,
  217  proxy, court-appointed guardian, or attorney-in-fact is no
  218  longer effective or has been removed;
  219         4.The surrogate, proxy, court-appointed guardian, or
  220  attorney-in-fact who executed the POLST form on behalf of the
  221  patient as provided in paragraph (c) has failed to discharge her
  222  or his duties, or incapacity or illness renders her or him
  223  incapable of discharging those duties;
  224         5.The POLST was executed by surrogate, proxy, court
  225  appointed guardian, or attorney-in-fact authorized to execute a
  226  POLST form on behalf of a patient as provided in paragraph (c)
  227  who has abused her or his powers; or
  228         6.The patient has sufficient capacity to make her or his
  229  own health care decisions.
  230         (h)A POLST form may not include a directive regarding
  231  hydration or the preselection of any decision or directive. A
  232  POLST form must be voluntarily executed by the patient or, if
  233  the patient is incapacitated or a minor, the patient’s legal
  234  representative, and all directives included in the form must be
  235  made by the patient or, if the patient is incapacitated or a
  236  minor, the patient’s legal representative, at the time of
  237  signing the form. A POLST form is not valid and may not be
  238  included in a patient’s medical records or submitted to the
  239  clearinghouse unless the form:
  240         1.Is clearly printed on one or both sides of a single
  241  piece of paper as determined by department rule;
  242         2.Includes the signatures of the patient and the patient’s
  243  examining physician or, if the patient is incapacitated or a
  244  minor, the signatures of the patient’s legal representative and
  245  the patient’s examining physician. The POLST form may be
  246  executed only after the examining physician consults with the
  247  patient or the patient’s legal representative, as appropriate;
  248         3.Prominently states that completion of a POLST form is
  249  voluntary, that the execution or use of a POLST form may not be
  250  required as a condition for medical treatment, and that a POLST
  251  form may not be given effect if the patient is conscious and
  252  competent to make health care decisions;
  253         4.Prominently provides in a conspicuous location on the
  254  form a space for the patient’s examining physician to attest
  255  that, in her or his clinical judgment and with good faith at the
  256  time the POLST form is completed and signed, the patient has the
  257  ability to make and communicate health care decisions or, if the
  258  patient is incapacitated or a minor, that the patient’s legal
  259  representative has such ability;
  260         5.Includes an expiration date, provided by the patient’s
  261  examining physician, that is within 1 year after the patient or
  262  the patient’s legal representative signs the form or that is
  263  contingent on completion of the course of treatment addressed in
  264  the POLST form, whichever occurs first; and
  265         6.Identifies the medical condition or conditions, provided
  266  by the patient’s examining physician, that necessitate the POLST
  267  form.
  268         (2)DUTIES OF THE DEPARTMENT.—The department shall:
  269         (a)Adopt rules to implement and administer the POLST
  270  program.
  271         (b)Prescribe a standardized POLST form.
  272         (c)Provide the POLST form in an electronic format on the
  273  department’s website and prominently state on the website the
  274  requirements for a POLST form as specified in this section.
  275         (d)Consult with health care professional licensing groups,
  276  provider advocacy groups, medical ethicists, and other
  277  appropriate stakeholders on the development of rules and forms
  278  to implement and administer the POLST program.
  279         (e)Recommend a uniform method of identifying persons who
  280  have executed a POLST form and provide health care providers
  281  with contact information regarding a patient's primary health
  282  care provider.
  283         (f)Oversee the education of health care providers licensed
  284  by the department regarding implementation of the POLST program.
  285         (g)Develop a process for collecting provider feedback to
  286  enable periodic redesign of the POLST form in accordance with
  287  current health care best practices.
  288         (3)DUTY TO COMPLY WITH POLST; OUT-OF-STATE POLST; LIMITED
  289  IMMUNITY.—
  290         (a)Emergency medical service personnel, health care
  291  providers, physicians, and health care facilities, absent actual
  292  notice of revocation or termination of a POLST form, may comply
  293  with the orders on a person’s POLST form without regard to
  294  whether the POLST-ordering provider is on the medical staff of
  295  the treating health care facility. If the POLST-ordering
  296  provider is not on the medical staff of the treating health care
  297  facility, the POLST form must be reviewed by the treating health
  298  care professional at the receiving facility with the patient, or
  299  the patient’s health care surrogate, proxy, court-appointed
  300  guardian, or attorney-in-fact authorized to execute a POLST form
  301  on behalf of a patient as provided in paragraph (1)(c), and
  302  shall be made into a medical order at the receiving facility,
  303  unless the POLST form is replaced or voided as provided in this
  304  section.
  305         (b)A POLST form from another state, absent actual notice
  306  of revocation or termination, shall be presumed to be valid and
  307  shall be effective in this state and shall have the same burden
  308  of compliance as a POLST form executed in this state.
  309         (c)Any licensee, physician, medical director, or emergency
  310  medical technician or paramedic who acts in good faith on a
  311  POLST is not subject to criminal prosecution or civil liability
  312  and has not engaged in negligent or unprofessional conduct as a
  313  result of carrying out the directives of the POLST made in
  314  accordance with this section and rules adopted by the
  315  department.
  316         (4)PATIENT TRANSFER; POLST FORM REVIEW REQUIRED.—If a
  317  patient whose goals and preferences for care have been entered
  318  in a valid POLST form is transferred from one health care
  319  facility or level of care to another, the health care facility
  320  initiating the transfer must communicate the existence of the
  321  POLST form to the receiving facility before the transfer. Upon
  322  the patient’s transfer, the treating health care provider at the
  323  receiving facility must review the POLST form with the patient
  324  or, if the patient is incapacitated or a minor, the patient’s
  325  health care surrogate, proxy, court-appointed guardian, or
  326  attorney-in-fact.
  327         (5)CONFLICTS WITH ADVANCE DIRECTIVES.—To the extent that a
  328  directive made on a patient’s POLST form conflicts with another
  329  advance directive of the patient which addresses a substantially
  330  similar health care condition or treatment, the document most
  331  recently signed by the patient takes precedence. Such directives
  332  may include, but are not limited to:
  333         (a)A living will.
  334         (b)A health care power of attorney.
  335         (c)A POLST form for the specific medical condition or
  336  treatment.
  337         (d)An order not to resuscitate.
  338         (6)POLST FORM FOR A MINOR PATIENT.—If a medical order on a
  339  POLST form executed for a minor patient directs that life
  340  sustaining treatment may be withheld from the minor patient, the
  341  order must include certifications by the patient’s examining
  342  physician and a health care provider other than the examining
  343  physician stating that, in their clinical judgment, an order to
  344  withhold medical treatment is in the best interest of the minor
  345  patient. A POLST form for a minor patient must be signed by the
  346  minor patient’s legal representative. The minor patient’s
  347  examining physician must certify the basis for the authority of
  348  the minor patient’s legal representative to execute the POLST
  349  form on behalf of the minor patient, including the legal
  350  representative’s compliance with the relevant provisions of
  351  chapter 744 or chapter 765.
  352         (7)POLST FORM NOT A PREREQUISITE.—A POLST form may not be
  353  a prerequisite for receiving medical services or for admission
  354  to a health care facility. A health care facility or health care
  355  provider may not require an individual to complete, revise, or
  356  revoke a POLST form as a condition of receiving medical services
  357  or treatment or as a condition of admission. The execution,
  358  revision, or revocation of a POLST form must be a voluntary
  359  decision of the patient or, if the patient is incapacitated or a
  360  minor, the patient’s legal representative.
  361         (8)REVOCATION OF A POLST FORM.—
  362         (a)A POLST form may be revoked at any time by a patient
  363  deemed to have capacity by means of:
  364         1.A signed, dated writing;
  365         2.The physical cancellation or destruction of the POLST
  366  form by the patient or by another in the patient’s presence and
  367  at the patient’s direction;
  368         3.An oral expression of intent to revoke; or
  369         4.A subsequently executed POLST form or advance directive
  370  that is materially different from a previously executed POLST
  371  form or advance directive.
  372         (b)A surrogate, proxy, court-appointed guardian, or
  373  attorney-in-fact permitted to execute a POLST form on behalf of
  374  a patient as provided in paragraph (1)(c) who created a POLST
  375  form for a patient may revoke a POLST form at any time in a
  376  writing signed by such surrogate, proxy, court-appointed
  377  guardian, or attorney-in-fact.
  378         (c)Any revocation of a POLST form shall be promptly
  379  communicated to the patient’s primary health care provider,
  380  primary physician, and any health care facility at which the
  381  patient is receiving care. Further, a health care professional,
  382  surrogate, proxy, court-appointed guardian, or attorney-in-fact
  383  who is informed of the revocation of a POLST form shall promptly
  384  communicate the fact of the revocation to the patient’s primary
  385  care physician, the current supervising health care
  386  professional, and any health care facility at which the patient
  387  is receiving care, to the extent known to the surrogate, proxy,
  388  court-appointed guardian, or attorney-in-fact.
  389         (d)Upon revocation, a POLST form shall be void. A POLST
  390  form may only be revoked in its entirety. A partial revocation
  391  of a POLST form renders the entirety of the POLST form void.
  392         (9)INSURANCE NOT AFFECTED.—The presence or absence of a
  393  POLST form does not affect, impair, or modify a contract of life
  394  or health insurance or an annuity to which an individual is a
  395  party, and may not serve as the basis for a delay in issuing or
  396  refusing to issue a policy of life or health insurance or an
  397  annuity or for an increase or decrease in premiums charged to
  398  the individual.
  399         (10)INVALIDITY.—A POLST form is invalid if payment or
  400  other remuneration was offered or made in exchange for execution
  401  of the form.
  402         (11)CONSTRUCTION.—This section may not be construed to
  403  condone, authorize, or approve mercy killing or euthanasia. The
  404  Legislature does not intend that this act be construed as
  405  authorizing an affirmative or deliberate act to end an
  406  individual’s life, except to allow the natural process of dying.
  407         Section 9. Subsection (4) of section 429.255, Florida
  408  Statutes, is amended to read:
  409         429.255 Use of personnel; emergency care.—
  410         (4) Facility staff may withhold or withdraw cardiopulmonary
  411  resuscitation or the use of an automated external defibrillator
  412  if presented with an order not to resuscitate executed pursuant
  413  to s. 401.45 or a physician order for life-sustaining treatment
  414  (POLST) form executed pursuant to s. 401.451 that contains an
  415  order not to resuscitate. The department shall adopt rules
  416  providing for the implementation of such an order or POLST form
  417  orders. Facility staff and facilities are shall not be subject
  418  to criminal prosecution or civil liability, and are not nor be
  419  considered to have engaged in negligent or unprofessional
  420  conduct, for withholding or withdrawing cardiopulmonary
  421  resuscitation or the use of an automated external defibrillator
  422  pursuant to such an order or POLST form and rules adopted by the
  423  department. The absence of an order not to resuscitate executed
  424  pursuant to s. 401.45 or a POLST form executed pursuant to s.
  425  401.451 which contains an order not to resuscitate does not
  426  preclude a physician from withholding or withdrawing
  427  cardiopulmonary resuscitation or the use of an automated
  428  external defibrillator as otherwise authorized permitted by law.
  429         Section 10. Subsection (3) of section 429.73, Florida
  430  Statutes, is amended to read:
  431         429.73 Rules and standards relating to adult family-care
  432  homes.—
  433         (3) The department shall adopt rules providing for the
  434  implementation of orders not to resuscitate and physician order
  435  for life-sustaining treatment (POLST) forms executed pursuant to
  436  s. 401.451 which contain orders not to resuscitate. The provider
  437  may withhold or withdraw cardiopulmonary resuscitation if
  438  presented with an order not to resuscitate executed pursuant to
  439  s. 401.45 or a POLST form executed pursuant to s. 401.451 which
  440  contains an order not to resuscitate. The provider is shall not
  441  be subject to criminal prosecution or civil liability, and is
  442  not nor be considered to have engaged in negligent or
  443  unprofessional conduct, for withholding or withdrawing
  444  cardiopulmonary resuscitation pursuant to such an order or POLST
  445  form and applicable rules.
  446         Section 11. Subsections (7) and (8) of section 456.072,
  447  Florida Statutes, are renumbered as subsections (8) and (9),
  448  respectively, and a new subsection (7) is added to that section
  449  to read:
  450         456.072 Grounds for discipline; penalties; enforcement.—
  451         (7)A licensee may withhold or withdraw cardiopulmonary
  452  resuscitation or the use of an automated external defibrillator
  453  if presented with an order not to resuscitate executed pursuant
  454  to s. 401.45 or a physician order for life-sustaining treatment
  455  (POLST) form executed pursuant to s. 401.451 which contains an
  456  order not to resuscitate. The department shall adopt rules
  457  providing for the implementation of such an order or POLST form.
  458  A licensee is not subject to criminal prosecution or civil
  459  liability and is not considered to have engaged in negligent or
  460  unprofessional conduct for withholding or withdrawing
  461  cardiopulmonary resuscitation or the use of an automated
  462  external defibrillator if presented with such an order or POLST
  463  form. The absence of such an order or POLST form does not
  464  preclude a licensee from withholding or withdrawing
  465  cardiopulmonary resuscitation or the use of an automated
  466  external defibrillator as otherwise authorized by law.
  467         Section 12. Paragraph (c) of subsection (1) of section
  468  765.205, Florida Statutes, is amended to read:
  469         765.205 Responsibility of the surrogate.—
  470         (1) The surrogate, in accordance with the principal’s
  471  instructions, unless such authority has been expressly limited
  472  by the principal, shall:
  473         (c) Provide written consent using an appropriate form
  474  whenever consent is required, including a physician’s order not
  475  to resuscitate or a physician order for life-sustaining
  476  treatment (POLST) form executed pursuant to s. 401.451 which
  477  contains an order not to resuscitate.
  478         Section 13. This act shall take effect July 1, 2018.
  479  
  480  ================= T I T L E  A M E N D M E N T ================
  481  And the title is amended as follows:
  482         Delete everything before the enacting clause
  483  and insert:
  484                        A bill to be entitled                      
  485         An act relating to physician orders for life
  486         sustaining treatment; amending ss. 395.1041, 400.142,
  487         and 400.487, F.S.; authorizing specified personnel to
  488         withhold or withdraw cardiopulmonary resuscitation if
  489         presented with orders not to resuscitate or POLST
  490         forms that contain orders not to resuscitate;
  491         providing such personnel with immunity from criminal
  492         prosecution or civil liability for such actions;
  493         providing that the absence of such orders or forms
  494         does not preclude physicians or home health agency
  495         personnel from withholding or withdrawing
  496         cardiopulmonary resuscitation under certain
  497         conditions; amending s. 400.605, F.S.; requiring the
  498         Department of Elderly Affairs, in consultation with
  499         the Agency for Health Care Administration, to adopt by
  500         rule procedures for the implementation of POLST forms
  501         in hospice care; amending s. 400.6095, F.S.;
  502         authorizing hospice care teams to withhold or withdraw
  503         cardiopulmonary resuscitation if presented with POLST
  504         forms that contain orders not to resuscitate;
  505         providing hospice staff with immunity from criminal
  506         prosecution or civil liability for such actions;
  507         providing that the absence of a POLST form does not
  508         preclude physicians from withholding or withdrawing
  509         cardiopulmonary resuscitation; amending s. 401.35,
  510         F.S.; requiring the Department of Health to establish
  511         circumstances and procedures for honoring POLST forms;
  512         amending s. 401.45, F.S.; authorizing emergency
  513         medical personnel to withhold or withdraw
  514         cardiopulmonary resuscitation or other medical
  515         interventions if presented with POLST forms that
  516         contain orders not to resuscitate; creating s.
  517         401.451, F.S.; establishing the Physician Order for
  518         Life-Sustaining Treatment (POLST) Program within the
  519         Department of Health; providing requirements for POLST
  520         forms; providing duties of the department; providing a
  521         restriction on the use of POLST forms; providing for
  522         the revocation of POLST forms under certain
  523         circumstances; specifying which document takes
  524         precedence when directives in POLST forms conflict
  525         with other advance directives; providing limited
  526         immunity for legal representatives and specified
  527         health care providers relying in good faith on POLST
  528         forms; specifying additional requirements for POLST
  529         forms executed on behalf of minor patients under
  530         certain circumstances; requiring the review of POLST
  531         forms upon the transfer of a patient; prohibiting
  532         POLST forms from being required as a condition for
  533         treatment or admission to health care facilities;
  534         providing for the revocation of POLST forms under
  535         certain circumstances; providing that the presence or
  536         absence of POLST forms does not affect, impair, or
  537         modify certain insurance contracts; declaring POLST
  538         forms invalid if they are executed in exchange for
  539         payment or other remuneration; providing construction;
  540         amending s. 429.255, F.S.; authorizing assisted living
  541         facility personnel to withhold or withdraw
  542         cardiopulmonary resuscitation or the use of an
  543         automated external defibrillator if presented with
  544         POLST forms that contain orders not to resuscitate;
  545         providing facility staff and facilities with immunity
  546         from criminal prosecution or civil liability for such
  547         actions; providing that the absence of a POLST form
  548         does not preclude physicians from withholding or
  549         withdrawing cardiopulmonary resuscitation or the use
  550         of an automated external defibrillator; amending s.
  551         429.73, F.S.; requiring the Department of Elderly
  552         Affairs to adopt rules for the implementation of POLST
  553         forms in adult family-care homes; authorizing
  554         providers of such homes to withhold or withdraw
  555         cardiopulmonary resuscitation if presented with a
  556         POLST form that contains orders not to resuscitate;
  557         providing such providers with immunity from criminal
  558         prosecution or civil liability for such actions;
  559         amending s. 456.072, F.S.; authorizing licensees to
  560         withhold or withdraw cardiopulmonary resuscitation or
  561         the use of an automated external defibrillator if
  562         presented with orders not to resuscitate or POLST
  563         forms that contain orders not to resuscitate;
  564         requiring the Department of Health to adopt rules
  565         providing for the implementation of such orders or
  566         forms; providing licensees with immunity from criminal
  567         prosecution or civil liability for withholding or
  568         withdrawing cardiopulmonary resuscitation or the use
  569         of an automated external defibrillator if presented
  570         with such orders or forms; providing that the absence
  571         of such orders or forms does not preclude licensees
  572         from withholding or withdrawing cardiopulmonary
  573         resuscitation or the use of an automated external
  574         defibrillator; amending s. 765.205, F.S.; requiring
  575         health care surrogates to provide written consent for
  576         POLST forms under certain circumstances; providing an
  577         effective date.