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House
File
2262
-
Introduced
HOUSE
FILE
2262
BY
CROKEN
and
LEVIN
A
BILL
FOR
An
Act
creating
the
Iowa
our
care,
our
options
Act,
and
1
providing
penalties.
2
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
3
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Section
1.
NEW
SECTION
.
142E.1
Findings.
1
1.
The
state
of
Iowa
has
long
recognized
that
mentally
2
capable
adults
have
a
fundamental
right
to
determine
their
own
3
medical
treatment
options
in
accordance
with
their
own
values,
4
beliefs,
and
personal
preferences.
5
2.
The
state
of
Iowa
wants
to
uphold
both
the
highest
6
standard
of
medical
care
and
the
full
range
of
options
for
each
7
individual,
particularly
at
the
end
of
life.
8
3.
Terminally
ill
individuals
may
undergo
unremitting
9
pain,
agonizing
discomfort,
and
a
sudden,
continuing,
and
10
irreversible
reduction
in
their
quality
of
life
at
the
end
of
11
life.
12
4.
The
availability
of
medical
aid
in
dying
provides
13
an
additional
palliative
care
option
for
terminally
ill
14
individuals
who
seek
to
retain
their
autonomy
and
some
level
of
15
control
over
the
progression
of
the
illness
as
they
near
the
16
end
of
life
or
to
ease
unnecessary
pain
and
suffering.
17
5.
Integration
of
medical
aid
in
dying
into
standard
18
end-of-life
care
has
demonstrably
improved
the
quality
of
19
services
delivered
to
terminally
ill
individuals
by
enhancing
20
palliative
care
training
of
providers,
prompting
development
21
and
enhancement
of
palliative
care
service
delivery
systems,
22
and
promoting
more
in-depth
conversations
between
providers
23
and
terminally
ill
individuals
about
the
full
range
of
care
24
options
leading
to
more
appropriate
end-of-life
care
planning,
25
including
increased
hospice
use.
26
6.
The
state
of
Iowa
affirms
that
an
attending
provider
27
who
respects
and
honors
a
terminally
ill
patient’s
values
28
and
priorities
for
that
terminally
ill
patient’s
last
days
29
of
life
and
prescribes
or
dispenses
medication
for
any
such
30
qualified
patient
pursuant
to
this
chapter
is
practicing
lawful
31
patient-directed
care.
32
Sec.
2.
NEW
SECTION
.
142E.2
Short
title.
33
This
chapter
shall
be
known
and
may
be
cited
as
the
“Iowa
Our
34
Care,
Our
Options
Act”
.
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Sec.
3.
NEW
SECTION
.
142E.3
Definitions.
1
As
used
in
this
chapter,
unless
the
context
otherwise
2
requires:
3
1.
“Adult”
means
an
individual
eighteen
years
of
age
or
4
older.
5
2.
“Attending
provider”
means
a
health
care
provider
6
who
a
patient
determines
has
primary
responsibility
for
the
7
patient’s
health
care
and
treatment
of
the
patient’s
terminal
8
illness,
and
who
provides
medical
care
to
a
patient
with
a
9
terminal
illness
in
the
normal
course
of
the
provider’s
medical
10
practice.
11
3.
“Coercion
or
undue
influence”
means
the
willful
attempt,
12
whether
by
deception,
intimidation,
or
any
other
means,
to
13
cause
a
terminally
ill
patient
to
request,
or
a
qualified
14
patient
to
obtain
or
self-administer,
medication
pursuant
15
to
this
chapter
with
the
intent
to
cause
the
death
of
the
16
terminally
ill
patient
or
qualified
patient,
or
to
prevent
a
17
terminally
ill
patient
from
requesting,
or
a
qualified
patient
18
from
obtaining
or
self-administering,
medication
pursuant
to
19
this
chapter
against
the
wishes
of
the
terminally
ill
patient
20
or
qualified
patient.
21
4.
“Consulting
provider”
means
a
health
care
provider
who
22
is
qualified
by
specialty
or
experience
to
make
a
professional
23
diagnosis
and
prognosis
regarding
a
patient’s
terminal
illness.
24
5.
“Department”
means
the
department
of
health
and
human
25
services.
26
6.
“Health
care
facility”
means
a
hospital
licensed
pursuant
27
to
chapter
135B,
a
nursing
facility
licensed
pursuant
to
28
chapter
135C,
an
inpatient
hospice
program
as
defined
in
29
section
135J.1,
an
elder
group
home
as
defined
in
section
30
231B.1,
or
an
assisted
living
program
as
defined
in
section
31
231C.2.
“Health
care
facility”
does
not
include
the
location
of
32
an
individual
health
care
provider.
33
7.
“Health
care
provider”
means
a
person
who
is
licensed,
34
certified,
or
otherwise
authorized
or
permitted
by
the
laws
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of
this
state
to
administer
health
care,
diagnose
and
treat
1
medical
conditions,
and
prescribe
and
dispense
medications,
2
including
controlled
substances.
“Health
care
provider”
does
3
not
include
a
health
care
facility.
4
8.
“Informed
decision”
means
a
voluntary,
affirmative
5
decision
by
a
terminally
ill
patient
to
request
and
obtain
a
6
prescription
for
medication
pursuant
to
this
chapter
that
the
7
terminally
ill
patient
may
self-administer
to
bring
about
a
8
peaceful
death,
after
being
fully
informed
by
the
attending
9
provider
of
all
of
the
following:
10
a.
The
patient’s
medical
diagnosis.
11
b.
The
patient’s
prognosis.
12
c.
The
feasible
end-of-life
care
and
treatment
options
for
13
the
patient’s
terminal
illness,
including
but
not
limited
to
14
comfort
care,
palliative
care,
hospice
care,
and
pain
control,
15
and
the
risks
and
benefits
of
each
option.
16
d.
The
patient’s
right
to
withdraw
consent
at
any
time,
17
and
that
the
patient
is
not
under
any
obligation
to
continue
a
18
previously
chosen
option
for
end-of-life
care
or
treatment.
19
9.
“Licensed
mental
health
provider”
means
a
psychiatrist
20
licensed
pursuant
to
chapter
148,
a
psychologist
licensed
21
pursuant
to
chapter
154B,
or
an
independent
social
worker
22
licensed
pursuant
to
chapter
154C.
23
10.
“Medical
aid
in
dying”
means
the
medical
practice
24
authorized
under
this
chapter
and
established
standards
25
of
medical
care
to
determine
a
terminally
ill
patient’s
26
qualifications,
evaluate
a
terminally
ill
patient’s
request
27
for
medication,
and
provide
a
terminally
ill
patient
with
28
a
prescription
for
medication
or
dispense
the
prescribed
29
medication
to
bring
about
the
terminally
ill
patient’s
peaceful
30
death.
31
11.
“Medical
confirmation”
means
the
medical
opinion
of
the
32
attending
provider
has
been
confirmed
by
a
consulting
provider
33
who
has
examined
the
patient
and
the
patient’s
relevant
medical
34
records.
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12.
“Mentally
capable”
means
that
in
the
opinion
of
the
1
attending
provider,
a
consulting
provider,
and
a
licensed
2
mental
health
care
provider,
as
applicable,
the
patient
3
requesting
medical
aid
in
dying
has
the
ability
to
make
and
4
communicate
an
informed
decision.
5
13.
“Patient”
means
an
adult
who
is
under
the
care
of
a
6
health
care
provider.
7
14.
“Patient-directed
care”
means
patient-centered
care
that
8
is
not
only
respectful
of
and
responsive
to
individual
patient
9
preferences,
needs,
and
values,
but
also
ensures
that
patient
10
values
guide
all
clinical
decisions
and
that
patients
are
fully
11
informed
of
and
able
to
access
all
legal
end-of-life
care
and
12
treatment
options.
13
15.
“Prognosis
of
six
months
or
less”
with
reference
to
14
a
terminal
illness
means
the
terminal
illness
will,
within
15
reasonable
medical
judgment,
result
in
a
patient’s
death
within
16
six
months.
17
16.
“Qualified
patient”
means
a
mentally
capable,
terminally
18
ill
patient,
who
is
a
resident
of
Iowa
and
has
satisfied
19
the
requirements
of
this
chapter
in
order
to
obtain
and
20
self-administer
a
prescription
for
medication
to
bring
about
21
the
terminally
ill
patient’s
peaceful
death.
22
17.
“Self-administer”
or
“self-administration”
means
a
23
qualified
patient’s
affirmative,
conscious,
voluntary
act
to
24
ingest
medication
prescribed
pursuant
to
this
chapter
to
bring
25
about
the
patient’s
own
peaceful
death.
“Self-administer”
26
or
“self-administration”
does
not
include
administration
of
27
medication
via
injection
or
intravenous
infusion.
28
18.
“Terminal
illness”
or
“terminally
ill”
means
an
29
incurable
illness
with
a
prognosis
of
six
months
or
less.
30
19.
“Terminally
ill
patient”
means
a
patient
who
has
been
31
certified
by
a
health
care
provider
to
be
terminally
ill.
32
Sec.
4.
NEW
SECTION
.
142E.4
Process
for
requesting
33
medication
for
medical
aid
in
dying.
34
1.
A
patient
who
is
mentally
capable,
is
a
resident
of
this
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state,
and
has
been
certified
by
a
health
care
provider
to
be
1
terminally
ill,
may
request
medication
that
the
patient
may
2
self-administer
to
end
the
patient’s
life
as
follows:
3
a.
By
making
two
oral
requests
to
the
terminally
4
ill
patient’s
attending
provider
separated
by
a
5
fifteen-calendar-day
waiting
period,
beginning
from
the
6
day
the
first
request
is
made.
7
b.
By
providing
one
written
request
to
the
terminally
ill
8
patient’s
attending
provider.
9
2.
A
written
request
made
under
this
section
shall
be
in
10
substantially
the
form
described
in
section
142E.5,
shall
be
11
signed
and
dated,
or
attested
to,
by
the
terminally
ill
patient
12
requesting
medical
aid
in
dying,
and
shall
be
signed
and
dated,
13
or
attested
to,
by
one
witness.
14
3.
Oral
and
written
requests
made
under
this
section
must
be
15
made
by
the
terminally
ill
patient
and
shall
not
be
made
by
any
16
other
individual
including
the
terminally
ill
patient’s
agent
17
under
a
power
of
attorney
executed
pursuant
to
chapter
633B,
an
18
attorney
in
fact
under
a
durable
power
of
attorney
for
health
19
care
pursuant
to
chapter
144B,
or
via
a
declaration
relating
to
20
use
of
life-sustaining
procedures
pursuant
to
chapter
144A.
21
4.
A
patient
shall
not
qualify
to
make
a
request
under
this
22
section
solely
based
on
age
or
disability.
23
5.
Notwithstanding
subsection
1,
if
a
terminally
ill
24
patient’s
attending
provider
attests
that
the
terminally
ill
25
patient
will,
within
reasonable
medical
judgment,
die
within
26
fifteen
days
after
the
terminally
ill
patient’s
initial
oral
27
request
is
made
under
this
section,
the
terminally
ill
patient
28
may
reiterate
the
oral
request
to
the
attending
provider
at
any
29
time
after
making
the
initial
oral
request
and
the
fifteen-day
30
waiting
period
shall
be
waived.
31
Sec.
5.
NEW
SECTION
.
142E.5
Form
of
written
request
——
32
requirements.
33
1.
A
written
request
for
medication
that
a
terminally
ill
34
patient
may
self-administer
to
end
the
terminally
ill
patient’s
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life
as
authorized
by
this
chapter
shall
be
in
substantially
1
the
following
form:
2
Request
for
Medication
3
to
End
My
Life
in
4
a
Peaceful
Manner
5
I,
___________________________________
am
an
adult
of
sound
6
mind.
I
have
been
diagnosed
with
7
_______________________________________________,
and
given
a
8
prognosis
of
six
months
or
less
to
live.
9
I
have
been
fully
informed
of
the
feasible
alternatives,
10
and
the
concurrent
or
additional
care
and
treatment
options
11
for
my
terminal
illness,
including
but
not
limited
to
comfort
12
care,
palliative
care,
hospice
care,
and
pain
control,
and
the
13
potential
risks
and
benefits
of
each.
I
have
been
offered
or
14
received
resources
or
referrals
to
pursue
these
alternative
15
and
concurrent
or
additional
care
and
treatment
options
for
my
16
terminal
illness.
17
I
have
been
fully
informed
of
the
nature
of
the
medication
to
18
be
prescribed,
the
risks
and
benefits,
and
the
probable
result
19
of
self-administering
the
medication,
should
I
decide
to
do
20
so.
I
understand
that
I
can
rescind
this
request
at
any
time,
21
and
that
I
am
under
no
obligation
to
fill
the
prescription
once
22
provided
nor
to
self-administer
the
medication
if
I
obtain
the
23
medication.
24
I
request
that
my
attending
provider
furnish
a
prescription
25
for
medication
that
will
end
my
life
in
a
peaceful
manner
if
26
I
choose
to
self-administer
it,
and
I
authorize
my
attending
27
provider
to
contact
a
pharmacist
to
dispense
the
prescription
28
at
a
time
of
my
choosing.
29
I
make
this
request
voluntarily,
free
from
coercion
and
30
undue
influence,
and
I
accept
full
responsibility
for
my
31
actions.
32
________________________________________
_____________
33
Requestor
Signature
Date
34
________________________________________
_____________
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Witness
Signature
Date
1
2.
A
witness
shall
not
be
any
of
the
following:
2
a.
A
relative
of
the
terminally
ill
patient
by
blood,
3
marriage,
or
adoption.
4
b.
A
person
who
at
the
time
the
request
is
signed
would
5
be
entitled
to
any
portion
of
the
estate
of
the
terminally
6
ill
patient
upon
death
under
any
will,
trust,
or
other
legal
7
instrument,
or
by
operation
of
law.
8
Sec.
6.
NEW
SECTION
.
142E.6
Attending
provider
duties.
9
An
attending
provider
shall
do
all
of
the
following:
10
1.
Provide
care
that
conforms
to
accepted
medical
11
standards.
12
2.
After
confirming
that
a
patient
is
terminally
ill,
13
determine
whether
the
patient
requesting
medical
aid
in
dying
14
meets
all
of
the
following
criteria:
15
a.
Is
mentally
capable.
16
b.
Has
made
the
request
for
medication
voluntarily
and
free
17
from
coercion
or
undue
influence.
18
c.
Is
a
resident
of
the
state.
19
3.
In
confirming
that
the
terminally
ill
patient’s
request
20
does
not
arise
from
coercion
or
undue
influence
by
another
21
person,
discuss
with
the
terminally
ill
patient,
outside
the
22
presence
of
other
persons
with
the
exception
of
an
interpreter
23
if
necessary,
whether
the
terminally
ill
patient
feels
coerced
24
or
unduly
influenced
by
another
person.
25
4.
Thoroughly
educate
the
terminally
ill
patient
about
all
26
of
the
following:
27
a.
The
feasible
alternatives
and
concurrent
or
additional
28
care
and
treatment
options
for
the
patient’s
terminal
illness,
29
including
but
not
limited
to
comfort
care,
palliative
care,
30
hospice
care,
or
pain
control,
and
the
potential
risks
and
31
benefits
of
each.
32
b.
The
potential
risks,
benefits,
and
probable
result
of
33
self-administering
the
medication
to
be
prescribed
to
bring
34
about
a
peaceful
death.
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c.
The
choices
available
to
the
terminally
ill
patient
1
that
reflect
the
terminally
ill
patient’s
self-determination,
2
including
that
the
terminally
ill
patient
is
under
no
3
obligation
to
fill
the
prescription
once
provided
nor
to
4
self-administer
the
medication
if
the
medication
is
obtained.
5
d.
The
terminally
ill
patient’s
right
to
rescind
the
request
6
for
medication
pursuant
to
this
chapter
at
any
time
and
in
any
7
manner.
8
e.
The
benefits
of
notifying
family
of
the
terminally
ill
9
patient’s
decision
to
request
medication
pursuant
to
this
10
chapter
as
an
end-of-life
care
option.
11
f.
The
recommended
methods
for
self-administering
the
12
medication
to
be
prescribed.
13
g.
The
safekeeping
and
proper
disposal
of
any
unused
14
medication
in
accordance
with
federal
and
state
law.
15
h.
The
importance
of
having
another
individual
present
when
16
the
terminally
ill
patient
self-administers
the
medication
to
17
be
prescribed.
18
i.
The
importance
of
not
taking
the
medication
in
a
public
19
place.
20
5.
Provide
the
terminally
ill
patient
with
a
referral
for
21
comfort
care,
palliative
care,
hospice
care,
pain
control,
or
22
other
end-of-life
care
and
treatment
options
as
requested
or
23
as
clinically
indicated.
24
6.
a.
Refer
the
terminally
ill
patient
to
a
consulting
25
provider
for
medical
confirmation
that
the
patient
requesting
26
medication
pursuant
to
this
chapter
is
eligible.
27
b.
The
attending
provider
shall
add
the
medical
confirmation
28
provided
under
paragraph
“a”
to
the
terminally
ill
patient’s
29
medical
record.
30
7.
Refer
the
terminally
ill
patient
to
a
licensed
mental
31
health
provider
for
evaluation
in
accordance
with
section
32
142E.8
if
the
attending
provider
observes
signs
that
the
33
terminally
ill
patient
may
not
be
mentally
capable
of
making
34
an
informed
decision,
and
add
the
licensed
mental
health
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provider’s
written
determination
to
the
terminally
ill
1
patient’s
medical
record.
2
8.
Ensure
that
all
appropriate
steps
are
carried
out
in
3
accordance
with
this
chapter
before
providing
a
prescription
4
for
medication
pursuant
to
this
chapter
to
a
terminally
ill
5
patient.
6
9.
Once
the
terminally
ill
patient
is
determined
to
be
a
7
qualified
patient,
do
either
of
the
following:
8
a.
Deliver
the
prescription
for
the
requested
medication
9
personally,
by
mail,
or
through
an
authorized
electronic
10
transmission
to
a
licensed
pharmacist
who
will
dispense
11
the
medication,
including
ancillary
medications
intended
12
to
minimize
the
qualified
patient’s
discomfort,
to
the
13
attending
provider,
to
the
qualified
patient,
or
to
a
person
14
expressly
designated
by
the
qualified
patient,
in
person
or
15
with
a
signature
required
on
delivery,
by
mail
service,
or
by
16
messenger
service.
17
b.
Dispense
the
prescribed
requested
medication,
including
18
ancillary
medications
intended
to
minimize
the
qualified
19
patient’s
discomfort,
to
the
qualified
patient
or
to
a
person
20
expressly
designated
by
the
qualified
patient
in
person,
21
if
the
attending
provider
has
a
current
drug
enforcement
22
administration
number
if
required
under
chapter
124.
23
10.
Document
in
the
qualified
patient’s
medical
record
the
24
qualified
patient’s
diagnosis
and
prognosis,
determination
of
25
mental
capability,
the
dates
of
the
qualified
patient’s
oral
26
requests,
a
copy
of
the
written
request,
and
a
notation
that
27
all
the
requirements
under
this
chapter
have
been
completed
28
including
a
description
of
the
medication
and
ancillary
29
medications
prescribed
to
the
qualified
patient
pursuant
to
30
this
chapter.
31
Sec.
7.
NEW
SECTION
.
142E.7
Consulting
provider
duties.
32
1.
A
terminally
ill
patient
requesting
medical
aid
in
dying
33
under
this
chapter
shall
receive
medical
confirmation
from
a
34
consulting
provider
prior
to
being
deemed
a
qualified
patient.
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2.
A
consulting
provider
shall
do
all
of
the
following:
1
a.
Evaluate
the
terminally
ill
patient
and
the
terminally
2
ill
patient’s
relevant
medical
records.
3
b.
Confirm,
in
writing,
all
of
the
following
to
the
4
attending
provider:
5
(1)
That
the
patient
has
a
terminal
illness.
6
(2)
That
the
terminally
ill
patient
has
made
the
request
7
for
medical
aid
in
dying
voluntarily
and
free
from
coercion
or
8
undue
influence.
9
(3)
That
the
terminally
ill
patient
is
mentally
capable,
or
10
provide
documentation
that
the
consulting
provider
has
referred
11
the
terminally
ill
patient
to
a
licensed
mental
health
provider
12
for
further
evaluation
in
accordance
with
section
142E.8.
13
Sec.
8.
NEW
SECTION
.
142E.8
Confirmation
——
determination
14
of
mental
capability
——
referral
to
licensed
mental
health
15
provider.
16
1.
If
either
the
attending
provider
or
the
consulting
17
provider
is
unable
to
confirm
that
the
terminally
ill
patient
18
requesting
medication
for
medical
aid
in
dying
under
this
19
chapter
is
mentally
capable,
the
attending
provider
or
20
consulting
provider
shall
refer
the
terminally
ill
patient
to
a
21
licensed
mental
health
provider
for
a
determination
of
mental
22
capability.
23
2.
A
licensed
mental
health
provider
who
evaluates
a
24
terminally
ill
patient
under
this
section
shall
communicate
in
25
writing
to
the
attending
provider
or
consulting
provider
who
26
requested
the
evaluation
the
licensed
mental
health
provider’s
27
conclusions
about
whether
the
terminally
ill
patient
is
28
mentally
capable.
29
3.
If
the
licensed
mental
health
provider
determines
30
that
the
terminally
ill
patient
is
not
currently
mentally
31
capable,
the
licensed
mental
health
provider
shall
not
deem
the
32
terminally
ill
patient
to
be
mentally
capable
and
the
attending
33
provider
shall
not
determine
the
terminally
ill
patient
to
be
a
34
qualified
patient
and
prescribe
medication
to
the
terminally
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ill
patient
under
this
chapter.
1
Sec.
9.
NEW
SECTION
.
142E.9
Reporting
requirements.
2
1.
The
department
shall
create
and
make
available
to
all
3
attending
providers
a
prescribing
provider
checklist
form
4
and
prescribing
provider
follow-up
form
for
the
purposes
of
5
reporting
the
information
as
specified
under
this
section
to
6
the
department.
7
2.
Within
thirty
calendar
days
of
providing
a
prescription
8
to
a
qualified
patient
for
medication
pursuant
to
this
chapter,
9
the
attending
provider
shall
submit
to
the
department
a
10
completed
prescribing
provider
checklist
form
with
all
of
the
11
following
information
regarding
a
qualified
patient:
12
a.
The
qualified
patient’s
name
and
date
of
birth.
13
b.
The
qualified
patient’s
terminal
diagnosis
and
prognosis.
14
c.
A
notation
that
all
the
requirements
under
this
chapter
15
have
been
completed.
16
d.
A
notation
that
medication
has
been
prescribed
pursuant
17
to
this
chapter.
18
3.
Within
sixty
calendar
days
of
notification
of
a
qualified
19
patient’s
death
from
self-administration
of
medication
20
prescribed
pursuant
to
this
chapter,
the
attending
provider
21
shall
submit
to
the
department
a
completed
prescribing
provider
22
follow-up
form
with
all
of
the
following
information:
23
a.
The
qualified
patient’s
name,
date
of
birth,
age
at
24
death,
education
level,
race,
sex,
type
of
insurance,
if
any,
25
and
underlying
illness.
26
b.
The
date
of
the
qualified
patient’s
death.
27
c.
A
notation
of
whether
or
not
the
qualified
patient
was
28
enrolled
in
and
receiving
hospice
services
at
the
time
of
the
29
qualified
patient’s
death.
30
4.
The
department
shall
annually
review
a
sample
of
records
31
maintained
pursuant
to
this
section
to
ensure
compliance
32
and
shall
generate
and
make
available
to
the
public
a
33
statistical
report
of
nonidentifying
information
collected.
34
The
statistical
report
shall
be
limited
to
the
following
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information:
1
a.
The
number
of
prescriptions
for
medication
written
2
pursuant
to
this
chapter.
3
b.
The
number
of
attending
providers
who
wrote
prescriptions
4
for
medication
pursuant
to
this
chapter.
5
c.
The
number
of
qualified
patients
who
died
following
6
self-administration
of
medication
prescribed
and
dispensed
7
pursuant
to
this
chapter.
8
5.
Except
as
otherwise
required
by
law,
the
information
9
collected
by
the
department
shall
not
be
a
public
record
and
10
shall
not
be
made
available
for
public
inspection.
11
Sec.
10.
NEW
SECTION
.
142E.10
Safe
disposal
of
unused
12
medications.
13
A
person
who
has
custody
or
control
of
medication
prescribed
14
and
dispensed
pursuant
to
this
chapter
that
remains
unused
15
after
a
qualified
patient’s
death
shall
dispose
of
the
16
medication
by
lawful
means
in
accordance
with
state
and
federal
17
guidelines.
18
Sec.
11.
NEW
SECTION
.
142E.11
Use
of
interpreters.
19
1.
An
interpreter
whose
services
are
provided
to
a
patient
20
requesting
information
or
services
under
this
chapter
shall
21
meet
the
standards
promulgated
by
the
Iowa
interpreters
and
22
translators
association
or
the
national
board
of
certification
23
for
medical
interpreters,
or
other
standard
deemed
acceptable
24
by
the
department.
25
2.
An
interpreter
providing
services
pursuant
to
this
26
chapter
shall
not
be
related
to
a
qualified
patient
by
blood,
27
marriage,
or
adoption,
or
be
entitled
to
a
portion
of
the
28
qualified
patient’s
estate
by
will,
trust,
or
other
legal
29
instrument,
or
by
operation
of
law
upon
the
qualified
patient’s
30
death.
31
Sec.
12.
NEW
SECTION
.
142E.12
Effect
on
construction
of
32
wills,
contracts,
and
statutes.
33
1.
A
provision
in
a
contract,
will,
or
other
agreement,
34
whether
written
or
oral,
to
the
extent
the
provision
would
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affect
whether
a
patient
may
make
or
rescind
a
request
for
1
medication
pursuant
to
this
chapter,
shall
not
be
valid.
2
2.
An
obligation
owing
under
any
currently
existing
3
contract
shall
not
be
conditioned
upon
or
affected
by
the
4
making
or
rescinding
of
a
request
by
a
patient
for
medication
5
pursuant
to
this
chapter.
6
Sec.
13.
NEW
SECTION
.
142E.13
Insurance
or
annuity
7
policies.
8
1.
The
sale,
procurement,
or
issuance
of
a
life,
health,
9
or
accident
insurance
or
annuity
policy,
or
the
rate
charged
10
for
any
such
policy
shall
not
be
conditioned
upon
or
affected
11
by
the
making
or
rescinding
of
a
request
by
a
patient
for
12
medication
pursuant
to
this
chapter.
13
2.
A
qualified
patient’s
act
of
self-administering
14
medication
pursuant
to
this
chapter
shall
not
have
an
effect
on
15
or
invalidate
any
part
of
a
life,
health,
or
accident
insurance
16
or
annuity
policy.
17
3.
A
terminally
ill
patient
who
is
a
covered
beneficiary
18
of
a
health
insurance
policy
shall
not
be
subject
to
denial
19
or
alteration
of
such
benefits
based
on
the
availability
of
20
medical
aid
in
dying
or
the
patient’s
request
or
absence
of
a
21
request
for
medication
pursuant
to
this
chapter.
22
4.
A
terminally
ill
patient
who
is
a
recipient
of
Medicaid
23
coverage
shall
not
be
subject
to
denial
or
alteration
of
such
24
benefits
based
on
the
availability
of
medical
aid
in
dying
or
25
the
patient’s
request
or
absence
of
request
for
medication
26
pursuant
to
this
chapter.
27
Sec.
14.
NEW
SECTION
.
142E.14
Death
certificate.
28
1.
Unless
otherwise
prohibited
by
law,
the
attending
29
provider
or
the
hospice
medical
director
shall
sign
the
30
death
certificate
of
a
qualified
patient
who
obtained
and
31
self-administered
a
prescription
for
medication
pursuant
to
32
this
chapter.
33
2.
When
a
death
has
occurred
in
accordance
with
this
34
chapter:
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a.
The
manner
of
death
of
the
qualified
patient
on
a
death
1
certificate
shall
not
be
listed
as
suicide
or
homicide.
2
b.
The
cause
of
death
of
a
qualified
patient
on
a
death
3
certificate
shall
be
listed
as
the
qualified
patient’s
4
underlying
terminal
illness.
5
c.
The
qualified
patient’s
act
of
self-administering
6
medication
prescribed
pursuant
to
this
chapter
shall
not
be
7
indicated
on
the
death
certificate.
8
3.
A
death
that
occurs
in
accordance
with
this
chapter
does
9
not
alone
constitute
a
person’s
death
that
affects
the
public
10
interest
as
described
pursuant
to
section
331.802.
11
a.
If
a
death
that
occurs
in
accordance
with
this
chapter
12
is
referred
to
the
state
medical
examiner
or
a
county
medical
13
examiner,
a
preliminary
investigation
may
be
conducted
to
14
determine
whether
the
person
received
a
prescription
for
15
medication
under
this
chapter.
16
b.
Any
inquiry
or
investigation
conducted
by
the
state
17
medical
examiner
or
a
county
medical
examiner
relating
to
18
deaths
that
occur
pursuant
to
this
chapter
shall
not
require
19
the
state
medical
examiner
or
a
county
medical
examiner
to
20
sign
the
death
certificate
if
the
state
medical
examiner
or
a
21
county
medical
examiner
identifies
the
attending
provider
that
22
prescribed
the
qualified
patient
medication
pursuant
to
this
23
chapter.
24
Sec.
15.
NEW
SECTION
.
142E.15
Construction
of
chapter.
25
1.
This
chapter
shall
not
be
interpreted
to
lessen
the
26
applicable
standard
of
care,
including
the
standard
of
care
for
27
the
treatment
of
terminally
ill
patients
and
medical
aid
in
28
dying,
for
an
attending
provider,
consulting
provider,
licensed
29
mental
health
provider,
or
any
other
health
care
provider
30
acting
under
this
chapter.
31
2.
This
chapter
shall
not
be
construed
to
do
any
of
the
32
following:
33
a.
Limit
the
information
or
counseling
a
health
care
34
provider
must
provide
to
a
patient
in
order
to
comply
with
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informed
consent
laws
and
requirements
to
meet
a
medical
1
standard
of
care.
2
b.
Authorize
a
health
care
provider
or
any
other
person
to
3
end
an
individual’s
life
by
infusion,
intravenous
injection,
4
mercy
killing,
or
euthanasia.
Actions
taken
in
accordance
5
and
compliance
with
this
chapter
shall
not,
for
any
purposes,
6
constitute
suicide,
assisted
suicide,
euthanasia,
mercy
7
killing,
homicide,
or
elder
abuse
under
the
law.
8
3.
A
request
by
a
patient
for
and
the
provision
of
9
medication
pursuant
to
this
chapter
do
not
solely
constitute
10
neglect
or
elder
abuse
for
any
purpose
of
law,
or
provide
the
11
sole
basis
for
the
appointment
of
a
guardian
or
conservator.
12
Sec.
16.
NEW
SECTION
.
142E.16
No
duty
to
provide
medical
13
aid
in
dying.
14
1.
A
health
care
provider
shall
provide
sufficient
15
information
to
a
terminally
ill
patient
regarding
available
16
options,
alternatives,
and
the
foreseeable
risks
and
benefits
17
of
each
option
or
alternative,
so
that
the
patient
is
able
18
to
make
a
fully
informed,
voluntary,
affirmative
decision
19
regarding
the
patient’s
end-of-life
care
and
treatment.
20
2.
A
health
care
provider
may
choose
whether
or
not
to
21
practice
medical
aid
in
dying
pursuant
to
this
chapter
and
22
shall
not
be
under
any
duty,
whether
by
contract,
statute,
or
23
any
other
legal
requirement,
to
participate
in
the
practice
of
24
medical
aid
in
dying
or
to
provide
a
qualified
patient
with
25
medication
pursuant
to
this
chapter.
26
3.
If
an
attending
provider
is
unable
or
unwilling
to
27
determine
a
terminally
ill
patient’s
qualification
for
medical
28
aid
in
dying,
evaluate
a
terminally
ill
patient’s
request
for
29
medication,
or
provide
a
qualified
patient
with
a
prescription
30
for
medication
or
dispense
prescribed
medication
to
a
qualified
31
patient
pursuant
to
this
chapter,
the
attending
provider
shall
32
do
all
of
the
following:
33
a.
Accurately
document
the
terminally
ill
patient’s
request
34
in
the
terminally
ill
patient’s
medical
record.
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b.
Make
reasonable
efforts
to
accommodate
the
terminally
1
ill
patient’s
request
including
by
transferring
the
care
and
2
medical
records
of
the
terminally
ill
patient
to
another
3
attending
provider
upon
the
terminally
ill
patient’s
request
4
so
that
the
terminally
ill
patient
is
able
to
make
a
voluntary
5
affirmative
decision
regarding
the
terminally
ill
patient’s
6
end-of-life
care
and
treatment.
7
4.
Failure
to
inform
a
terminally
ill
patient
who
requests
8
information
about
available
end-of-life
options
including
9
medical
aid
in
dying,
or
failure
to
refer
the
terminally
ill
10
patient
to
another
attending
provider
who
can
provide
the
11
information,
is
considered
a
failure
to
obtain
informed
consent
12
for
subsequent
medical
treatments.
13
5.
An
attending
provider
shall
not
engage
in
false,
14
misleading,
or
deceptive
practices
relating
to
the
attending
15
provider’s
willingness
to
determine
the
qualification
of
a
16
terminally
ill
patient
for
medical
aid
in
dying,
to
evaluate
17
a
terminally
ill
patient’s
request
for
medication,
or
to
18
provide
a
prescription
for
medication
to
a
qualified
patient
19
or
dispense
a
prescribed
medication
to
a
qualified
patient
20
pursuant
to
this
chapter.
21
Sec.
17.
NEW
SECTION
.
142E.17
Health
care
facility
——
22
permissible
prohibitions
and
duties.
23
1.
A
health
care
facility
that
has
adopted
a
policy
24
prohibiting
health
care
providers
in
the
course
of
performing
25
duties
for
the
health
care
facility
from
determining
the
26
qualification
of
a
terminally
ill
patient
for
medical
aid
27
in
dying,
evaluating
a
terminally
ill
patient’s
request
28
for
medication,
or
providing
a
qualified
patient
with
a
29
prescription
for
medication
or
dispensing
prescribed
medication
30
to
a
qualified
patient,
shall
provide
advance
notice
in
31
writing
to
the
health
care
facility’s
patients
and
health
care
32
providers
that
the
health
care
facility
is
a
nonparticipating
33
health
care
facility
under
this
chapter.
34
2.
A
nonparticipating
health
care
facility
that
fails
to
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provide
explicit,
advance
notice
in
writing
to
the
health
care
1
facility’s
patients
and
health
care
providers
shall
not
enforce
2
such
a
policy.
3
3.
If
a
terminally
ill
patient
wishes
to
transfer
the
4
patient’s
care
from
a
nonparticipating
health
care
facility
to
5
another
health
care
facility,
the
nonparticipating
health
care
6
facility
shall
coordinate
a
timely
transfer,
including
transfer
7
of
the
terminally
ill
patient’s
medical
records
that
include
8
notation
of
the
date
the
terminally
ill
patient
first
requested
9
medical
aid
in
dying.
10
4.
A
nonparticipating
health
care
facility
shall
not
11
prohibit
a
health
care
provider
from
providing
services
12
consistent
with
the
applicable
standard
of
medical
care
13
including
all
of
the
following:
14
a.
Providing
information
to
a
patient
about
the
availability
15
of
medical
aid
in
dying
pursuant
to
this
chapter.
16
b.
Prescribing
medication
pursuant
to
this
chapter
for
17
a
qualified
patient
outside
the
scope
of
the
health
care
18
provider’s
employment
or
contract
with
the
nonparticipating
19
health
care
facility
and
off
the
premises
of
the
20
nonparticipating
health
care
facility.
21
c.
Being
present
at
the
time
a
qualified
patient
22
self-administers
medication
prescribed
pursuant
to
this
chapter
23
or
at
the
time
of
the
patient’s
death,
if
requested
by
the
24
qualified
patient
or
the
qualified
patient’s
representative
25
outside
the
scope
of
the
health
care
provider’s
employment
or
26
contractual
duties.
27
5.
A
health
care
facility
shall
not
engage
in
false,
28
misleading,
or
deceptive
practices
relating
to
the
health
care
29
facility’s
policy
regarding
end-of-life
care
and
treatment
30
services,
including
whether
the
health
care
facility
has
a
31
policy
which
prohibits
affiliated
health
care
providers
from
32
determining
a
terminally
ill
patient’s
qualification
for
33
medical
aid
in
dying,
evaluating
a
terminally
ill
patient’s
34
request
for
medication,
or
providing
a
prescription
for
or
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dispensing
medication
to
a
qualified
patient
pursuant
to
this
1
chapter;
or
intentionally
denying
a
terminally
ill
patient
2
access
to
medication
pursuant
to
this
chapter
by
failing
to
3
transfer
a
terminally
ill
patient
and
the
terminally
ill
4
patient’s
medical
records
to
another
health
care
facility
in
a
5
timely
manner.
6
Sec.
18.
NEW
SECTION
.
142E.18
Immunities
for
actions
in
7
good
faith
——
prohibition
against
reprisals.
8
1.
A
health
care
provider
or
health
care
facility
shall
9
not
be
subject
to
civil
or
criminal
liability,
professional
10
disciplinary
action,
or
any
other
penalty
for
engaging
in
11
the
practice
of
medical
aid
in
dying
in
accordance
with
12
the
standard
of
care
and
in
good
faith
compliance
with
this
13
chapter.
14
2.
A
health
care
provider,
health
care
facility,
or
15
professional
organization
or
association
shall
not
subject
16
a
health
care
provider
or
health
care
facility
to
censure,
17
discipline,
the
denial,
suspension,
or
revocation
of
licensure,
18
loss
of
privileges,
loss
of
membership,
or
any
other
penalty
19
for
providing
medical
aid
in
dying
in
accordance
with
the
20
standard
of
care
and
in
good
faith
compliance
with
this
21
chapter
or
for
providing
scientific
and
accurate
information
22
about
medical
aid
in
dying
to
a
terminally
ill
patient
when
23
discussing
end-of-life
care
and
treatment
options.
24
3.
A
health
care
provider
shall
not
be
subject
to
civil
25
or
criminal
liability
or
professional
discipline
if,
with
the
26
consent
of
the
qualified
patient
or
the
qualified
patient’s
27
representative,
the
health
care
provider
is
present
outside
the
28
scope
of
the
health
care
provider’s
professional
duties
when
29
the
qualified
patient
self-administers
medication
prescribed
30
pursuant
to
this
chapter
or
at
the
time
of
the
qualified
31
patient’s
death.
32
4.
This
section
shall
not
be
interpreted
to
limit
civil
or
33
criminal
liability
of
a
health
care
provider
who
intentionally
34
or
knowingly
fails
or
refuses
to
timely
submit
records
required
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pursuant
to
section
142E.9.
1
5.
This
section
shall
not
be
interpreted
to
limit
civil
or
2
criminal
liability
for
intentional
violations
of
this
chapter.
3
Sec.
19.
NEW
SECTION
.
142E.19
Liabilities
and
penalties.
4
1.
A
person
who
without
authorization
of
a
patient
5
intentionally
or
knowingly
alters
or
forges
a
request
for
6
medication
pursuant
to
this
chapter
with
the
intent
or
effect
7
of
causing
the
patient’s
death,
or
conceals
or
destroys
a
8
patient’s
rescission
of
a
request
for
medication
pursuant
to
9
this
chapter,
is
guilty
of
a
class
“A”
felony.
10
2.
A
person
who
coerces
or
exerts
undue
influence
over
11
a
patient
to
request
or
utilize
medication
pursuant
to
this
12
chapter,
with
the
intent
or
effect
of
causing
the
patient’s
13
death,
is
guilty
of
a
class
“A”
felony.
14
3.
A
person
who
intentionally
or
knowingly
coerces
or
15
exerts
undue
influence
over
a
terminally
ill
patient
to
forgo
a
16
request
for
or
to
obtain
medication
pursuant
to
this
chapter,
17
or
who
intentionally
or
knowingly
denies
a
qualified
patient
18
access
to
medication
under
this
chapter
as
an
end-of-life
care
19
and
treatment
option
is
guilty
of
a
serious
misdemeanor.
20
4.
Nothing
in
this
section
shall
be
interpreted
to
limit
21
liability
for
civil
damages
resulting
from
negligent
conduct
or
22
intentional
misconduct
applicable
under
other
law
for
conduct
23
which
is
inconsistent
with
the
provisions
of
this
chapter.
24
5.
The
penalties
specified
in
this
chapter
shall
not
25
preclude
application
of
criminal
penalties
applicable
under
26
other
law
for
conduct
which
is
inconsistent
with
this
chapter.
27
Sec.
20.
NEW
SECTION
.
142E.20
Claims
by
governmental
entity
28
for
costs
incurred.
29
A
governmental
entity
that
incurs
costs
resulting
from
a
30
qualified
patient
self-administering
medication
prescribed
31
pursuant
to
this
chapter
in
a
public
place
shall
have
a
claim
32
against
the
estate
of
the
qualified
patient
to
recover
such
33
costs
and
reasonable
attorney
fees
related
to
enforcing
the
34
claim.
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EXPLANATION
1
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
2
the
explanation’s
substance
by
the
members
of
the
general
assembly.
3
This
bill
creates
the
Iowa
our
care,
our
options
Act.
4
The
bill
includes
findings
relating
to
end-of-life
care
and
5
treatment
options
and
provides
definitions
of
terms
used
in
the
6
bill.
7
The
bill
provides
a
process
for
an
adult
patient
who
is
8
mentally
capable,
is
a
resident
of
the
state,
and
has
been
9
determined
by
the
patient’s
attending
provider
and
consulting
10
provider
to
be
terminally
ill,
to
request
medication
that
the
11
patient
may
self-administer
to
end
the
patient’s
life.
Such
12
patient
must
make
two
oral
requests
to
the
patient’s
attending
13
provider,
followed
by
one
written
request
to
the
patient’s
14
attending
provider
to
request
the
medication.
15
The
bill
provides
the
form
in
which
the
written
request
16
must
be
substantially
made,
and
requires
that
oral
and
written
17
requests
must
be
made
by
the
terminally
ill
patient.
Under
18
the
bill,
a
patient
shall
not
qualify
to
make
a
request
solely
19
based
on
age
or
disability.
The
bill
also
provides
that
20
notwithstanding
other
provisions
of
the
bill,
if
a
terminally
21
ill
patient’s
attending
provider
attests
that
the
terminally
22
ill
patient
will,
within
reasonable
medical
judgment,
die
23
within
15
days
after
making
the
initial
oral
request,
the
24
terminally
ill
patient
may
reiterate
the
oral
request
to
the
25
attending
provider
at
any
time
after
making
the
initial
oral
26
request
and
the
15-day
waiting
period
shall
be
waived.
27
The
bill
specifies
the
duties
of
the
attending
provider
and
28
the
consulting
provider,
and
provides
for
the
referral
of
a
29
terminally
ill
patient
by
either
an
attending
provider
or
a
30
consulting
provider
to
a
licensed
mental
health
provider
to
31
confirm
that
the
terminally
ill
patient
requesting
medication
32
for
medical
aid
in
dying
is
mentally
capable.
33
The
bill
requires
the
department
of
health
and
human
34
services
(HHS)
to
create
and
make
available
to
all
attending
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providers
a
prescribing
provider
checklist
form
and
prescribing
1
provider
follow-up
form
for
the
purposes
of
reporting
the
2
information
specified
under
the
bill
to
HHS.
The
department
3
of
health
and
human
services
is
required
to
annually
review
4
a
sample
of
records
to
ensure
compliance
and
shall
generate
5
and
make
available
to
the
public
a
statistical
report
of
6
nonidentifying
information
collected.
7
The
bill
provides
for
the
safe
disposal
of
unused
8
medications
and
the
use
of
interpreters
by
patients.
9
The
bill
provides
for
the
effect
of
a
request
for
medication
10
to
end
a
patient’s
life
on
the
construction
of
wills,
11
contracts,
and
statutes,
as
well
as
on
insurance
and
annuity
12
policies.
13
The
bill
provides
that
unless
otherwise
prohibited
by
14
law,
the
attending
provider
or
the
hospice
medical
director
15
shall
sign
the
death
certificate
of
a
qualified
patient
who
16
obtained
and
self-administered
a
prescription
for
medication;
17
and
provides
specific
requirements
relative
to
a
qualified
18
patient’s
death
certificate
and
the
role
of
medical
examiner
19
investigations
and
actions.
20
The
bill
specifies
how
the
bill
is
to
be
interpreted
relative
21
to
applicable
standards
of
care.
The
bill
provides
that
it
is
22
not
to
be
construed
to
waive
informed
consent
requirements
nor
23
provide
authorization
to
a
health
care
provider
or
any
other
24
person
to
end
an
individual’s
life
by
infusion,
intravenous
25
injection,
mercy
killing,
or
euthanasia.
The
bill
provides
26
actions
taken
in
accordance
and
compliance
with
the
bill
shall
27
not,
for
any
purposes,
constitute
suicide,
assisted
suicide,
28
euthanasia,
mercy
killing,
homicide,
or
elder
abuse
under
the
29
law.
The
bill
provides
that
a
request
by
a
patient
for
and
the
30
provision
of
medication
pursuant
to
the
bill
does
not
solely
31
constitute
neglect
or
elder
abuse
for
any
purpose
of
law,
or
32
provide
the
sole
basis
for
the
appointment
of
a
guardian
or
33
conservator.
34
The
bill
provides
that
a
health
care
provider
shall
provide
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sufficient
information
to
a
terminally
ill
patient
regarding
1
available
options,
the
alternatives,
and
the
foreseeable
2
risks
and
benefits
of
each
option
or
alternative,
so
that
3
the
terminally
ill
patient
is
able
to
make
a
fully
informed,
4
voluntary,
affirmative
decision
regarding
the
patient’s
5
end-of-life
care
and
treatment.
The
bill
further
provides
6
that
a
health
care
provider
may
choose
whether
or
not
to
7
practice
medical
aid
in
dying
and
shall
not
be
under
any
duty,
8
whether
by
contract,
statute,
or
any
other
legal
requirement,
9
to
participate
in
the
practice
of
medical
aid
in
dying
or
to
10
provide
a
qualified
patient
with
medication
pursuant
to
the
11
bill.
The
bill
requires
an
attending
provider
who
is
unable
or
12
unwilling
to
determine
a
terminally
ill
patient’s
qualification
13
for
medical
aid
in
dying
to
evaluate
a
terminally
ill
patient’s
14
request
for
medication,
or
to
prescribe
or
dispense
medication
15
to
a
qualified
patient
under
the
bill
to
otherwise
accommodate
16
the
terminally
ill
or
qualified
patient.
17
Failure
to
inform
a
terminally
ill
patient
who
requests
18
information
about
available
end-of-life
treatments
including
19
medical
aid
in
dying,
or
failure
to
refer
a
terminally
ill
20
patient
to
another
attending
provider
who
can
provide
the
21
information,
is
considered
a
failure
to
obtain
informed
consent
22
for
subsequent
medical
treatments.
The
bill
prohibits
an
23
attending
provider
from
engaging
in
false,
misleading,
or
24
deceptive
practices
relating
to
the
health
care
provider’s
25
willingness
to
determine
the
qualification
of
a
terminally
ill
26
patient
for
medical
aid
in
dying,
to
evaluate
a
terminally
ill
27
patient’s
request
for
medication,
or
to
provide
a
prescription
28
for
or
dispense
medication
to
a
qualified
patient
under
the
29
bill.
30
The
bill
specifies
permissible
prohibitions
and
duties
of
31
a
health
care
facility
that
has
adopted
a
policy
prohibiting
32
health
care
providers
from
determining
the
qualification
of
a
33
patient
for
medical
aid
in
dying,
evaluating
a
terminally
ill
34
patient’s
request
for
medication,
or
prescribing
or
dispensing
35
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24
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2262
prescribed
medication
pursuant
to
the
bill
in
the
course
of
1
the
health
care
provider
performing
duties
for
the
health
care
2
facility.
3
The
bill
provides
immunities
for
actions
taken
in
good
4
faith
by
a
health
care
provider
or
health
care
facility.
The
5
bill
prohibits
a
health
care
provider,
health
care
facility,
6
or
professional
organization
or
association
from
subjecting
7
a
health
care
provider
or
health
care
facility
to
censure,
8
discipline,
denial,
suspension
or
revocation
of
licensure,
9
loss
of
privileges,
loss
of
membership,
or
any
other
penalty
10
for
providing
medical
aid
in
dying
in
accordance
with
the
11
standard
of
care
and
in
good
faith
compliance
with
the
12
bill,
or
for
providing
scientific
and
accurate
information
13
about
medical
aid
in
dying
to
a
terminally
ill
patient
when
14
discussing
end-of-life
care
and
treatment
options.
The
bill
15
also
prohibits
a
health
care
provider
from
being
subject
to
16
civil
or
criminal
liability
or
professional
discipline
if,
17
with
the
consent
of
the
qualified
patient
or
the
qualified
18
patient’s
agent,
the
health
care
provider
is
present
outside
19
the
scope
of
their
professional
duties
when
the
qualified
20
patient
self-administers
medication
prescribed
pursuant
to
21
the
bill
or
at
the
time
of
the
qualified
patient’s
death.
22
Civil
and
criminal
liability
is
not
limited
for
a
health
care
23
provider
who
intentionally
or
knowingly
fails
or
refuses
to
24
timely
submit
records
required
to
be
submitted
to
HHS
or
for
25
intentional
violations
of
the
bill.
26
The
bill
provides
for
liability
and
criminal
penalties
to
27
be
imposed
on
persons
who
violate
the
bill.
A
person
who
28
without
authorization
of
a
patient
intentionally
or
knowingly
29
alters
or
forges
a
request
for
medication
with
the
intent
or
30
effect
of
causing
the
patient’s
death,
or
conceals
or
destroys
31
a
patient’s
rescission
of
a
request
for
medication
is
guilty
32
of
a
class
“A”
felony.
A
person
who
coerces
or
exerts
undue
33
influence
over
a
patient
to
request
or
utilize
medication
under
34
the
bill,
with
the
intent
or
effect
of
causing
the
patient’s
35
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death,
is
guilty
of
a
class
“A”
felony.
A
class
“A”
felony
1
is
punishable
by
confinement
for
life
without
possibility
of
2
parole.
3
A
person
who
intentionally
or
knowingly
coerces
or
exerts
4
undue
influence
over
a
terminally
ill
patient
to
forgo
a
5
request
for
or
to
obtain
medication
pursuant
to
the
bill,
or
6
intentionally
or
knowingly
denies
a
qualified
patient
access
7
to
medication
under
the
bill
as
an
end-of-life
care
option,
8
is
guilty
of
a
serious
misdemeanor.
A
serious
misdemeanor
is
9
punishable
by
confinement
for
no
more
than
one
year
and
a
fine
10
of
at
least
$430
but
not
more
than
$2,560.
11
The
liability
and
penalty
provisions
under
the
bill
are
12
not
to
be
interpreted
to
limit
liability
for
civil
damages
13
resulting
from
negligent
conduct
or
intentional
misconduct
14
applicable
under
other
law
for
conduct
which
is
inconsistent
15
with
the
provisions
of
this
chapter,
and
penalties
specified
in
16
the
bill
shall
not
preclude
application
of
criminal
penalties
17
applicable
under
other
law
for
conduct
which
is
inconsistent
18
with
the
bill.
19
The
bill
also
provides
that
a
governmental
entity
20
that
incurs
costs
resulting
from
a
qualified
patient
21
self-administering
medication
prescribed
under
the
bill
in
22
a
public
place
shall
have
a
claim
against
the
estate
of
the
23
patient
to
recover
such
costs
and
reasonable
attorney
fees
24
related
to
the
enforcement
of
the
claim.
25
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24