Life-sustaining treatment for unemancipated minor patients provided.

A bill for an act

relating to health; providing life-sustaining treatment for unemancipated minor

patients; proposing coding for new law in Minnesota Statutes, chapter 144.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

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[144.609] LIFE-SUSTAINING TREATMENT FOR UNEMANCIPATED

MINORS.

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Subdivision 1.

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Short title.

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This section shall be known and may be cited as "Simon's

Law."

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Subd. 2.

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Definitions.

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(a) For purposes of this section, the following terms have the

meanings given.

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(b) "Order not to resuscitate" means a health care provider's order that resuscitation

measures shall not be provided to a person under a health care provider's care in the event

the person is found to have cardiopulmonary cessation. An order not to resuscitate shall

include but is not limited to orders written as "do not resuscitate" or "DNR"; "do not attempt

resuscitation" or "DNAR"; "allow natural death" or "AND"; or "do not allow resuscitative

measures."

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(c) "Reasonable medical judgment" means a health care provider's medical judgment

that is made by a reasonably prudent health care provider who is knowledgeable about a

patient's case and the treatment possibilities for the medical conditions involved.

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(d) "Unemancipated minor" means a minor who is not married or is not in active military

service, including a born alive infant from the moment of birth. Unemancipated minor does

not include a minor who has borne a child who is living apart from his or her parents and

managing his or her own financial affairs.

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Subd. 3.

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Order not to resuscitate; notice.

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(a) An order not to resuscitate, an order to

withhold artificial life-sustaining treatment, an order to withhold artificially administered

nutrition and hydration, and a similar health care provider order shall not be instituted, either

orally or in writing, unless at least one parent or legal guardian of an unemancipated minor

who is a patient or resident of a hospital or health care facility under whose care the

unemancipated minor has been admitted has first been notified of the health care provider's

intent to institute the order and reasonable attempts have been made to notify any other

parent or legal guardian, provided the other parent or legal guardian is reasonably available

and has custodial or visitation rights. The notification must be provided both orally and in

writing to at least one parent or legal guardian of the unemancipated minor patient unless,

in the health care provider's reasonable medical judgment, the urgency of the decision

requires reliance on only providing the information orally.

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(b) The notification must also include informing the parent or legal guardian of the

48-hour provision in subdivision 5. Unless the parent or legal guardian agrees with the

implementation of an order not to resuscitate, an order to withhold life-sustaining treatment,

an order to withhold artificial nutrition and hydration, or a similar health care provider's

order, the order shall not be instituted until at least 48 hours after oral and written notice

has been provided to at least one parent or legal guardian in accordance with this section.

The notification must be contemporaneously recorded in the patient's medical record,

specifying by whom and to whom the notification was given, the date and time of its

provision, and whether it was provided in writing as well. When only one parent or guardian

has been notified, the nature of reasonable attempts to inform the other parent or guardian,

or the reason why attempts were not made, must also be contemporaneously recorded in

the unemancipated minor patient's medical record.

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Subd. 4.

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Exception.

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The requirements of subdivision 3 do not apply if the health care

provider after 72 hours of diligent efforts is unable to contact and notify at least one known

parent or legal guardian of the unemancipated minor patient of the intent to implement an

order not to resuscitate, an order to withhold life-sustaining treatment, an order to withhold

artificial nutrition and hydration, or a similar health care provider's order.

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Subd. 5.

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Transfer process.

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(a) Within 48 hours of a notice of the intent to institute an

order not to resuscitate, an order to withhold life-sustaining treatment, an order to withhold

artificial nutrition and hydration, or a similar health care provider's order according to

subdivision 3, a parent or legal guardian may request a transfer of the unemancipated minor

patient or resident to another facility or to be discharged.

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(b) During the 72 hours of attempting to contact a parent or legal guardian, and the 48

hours in which a parent or legal guardian may consider whether or not to transfer a minor

patient, the hospital or health care facility under whose care the unemancipated minor patient

is admitted must continue to provide life-sustaining treatment and life-sustaining artificial

nutrition and hydration for a minimum of 15 days if a parent or legal guardian of the

unemancipated minor patient or resident requests a transfer and the notice requirements in

this section have been met. After the transfer request has been made, the hospital or health

care facility must make every reasonable effort to assist the requesting parent or legal

guardian in the transfer process.

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(c) The health care provider shall not interfere with the efforts of the parent or legal

guardian to obtain other medical opinions or a transfer of the unemancipated minor patient

to another health care provider selected by the parent or legal guardian. If requested by the

unemancipated minor patient's parent or legal guardian, the attending health care provider

shall provide immediate access to the unemancipated minor patient's medical records to the

licensed health care providers designated by the parent or legal guardian for that purpose.

The attending health care provider shall not hinder or delay the necessary measures,

mechanisms, or procedures for the unemancipated minor patient, including but not limited

to an immediate tracheotomy or gastronomy tube if required to facilitate a transfer to another

medical facility or long-term treatment facility.

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(d) The parent or legal guardian of the unemancipated minor patient shall not be hindered

or delayed by an attending health care provider, unless the unemancipated minor patient

has sustained irreversible circulatory and respiratory functions or all functions of the entire

brain, including the brain stem. There is a presumption that the continuation of life is in the

unemancipated minor patient's best interest.

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(e) If a transfer cannot be arranged and executed within 15 days from the parent's or

legal guardian's request to transfer, an order not to resuscitate, an order to withhold artificial

life-sustaining treatment, an order to withhold artificial nutrition and hydration, or a similar

health care provider's order may be instituted.

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(f) Nothing in this section shall be construed to limit the health care bill of rights pursuant

to section 144.651.

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Subd. 6.

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Revocation of prior consent; court authority.

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(a) Consent to an order not to

resuscitate or a similar order previously given under subdivision 3 may be revoked orally

or in writing by the parent or legal guardian of the unemancipated minor patient or resident

who granted the original permission. The revocation of prior consent shall take precedence

over any prior consent to implement a do-not-resuscitate or do-not-attempt-to-resuscitate,

an order to allow natural death, or an order that states do not allow resuscitation measures,

or a physician order intended to halt treatment or similar physician's order shall be

immediately recorded in the unemancipated minor patient's or resident's medical record,

specifying who provided the information, to whom the information was provided, which

parent or legal guardian revoked consent, who the witnesses were, and the date and time

the revocation was obtained.

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(b) A court of law or equity shall not have the authority to require the withdraw of

life-sustaining procedures from an unemancipated minor patient over the objection of the

parent or legal guardian unless there is destruction of the circulatory and respiratory systems

and the entire brain, including the brain stem of the child.

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(c) For a child under juvenile court jurisdiction, a juvenile or family court may not issue

a medical decision order to withhold treatment, if that order would be reasonably expected

to result in the death of the child, without first appointing a guardian ad litem to act in the

best interest of the child. The Department of Children, Youth, and Families shall not be

appointed as guardian for a child to make medical decisions to withhold treatment that

would result in the death of the child, including orders not to resuscitate, an order not to

attempt to resuscitate, an order to allow natural death, or an order that states to not allow

resuscitative measures, or similar orders. In the event a child under the jurisdiction of a

juvenile or family court is returned to the custody of the legal guardian or parent, the legal

guardian or parent may revoke the consent for medical decisions or similar physician's

orders ordered by the court, including do-not-resuscitate orders for the patient. Revocation

of consent may be orally or in writing and shall be immediately recorded in the patient's

medical records, specifying who provided the information, to whom the information was

provided, which parent or legal guardian revoked consent, who the witnesses were, and the

date and time the revocation was obtained.

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(d) For the purposes of this section, a relative caregiver shall have the same authority

given to a parent or legal guardian of an unemancipated minor patient or resident under 18

years of age, provided that such a patient or resident is not under juvenile or family court

jurisdiction.

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Subd. 7.

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Cause of action.

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Any parent, guardian, relative caregiver, sibling, or grandparent

of an unemancipated minor patient who dies or is injured as a result of a do-not-resuscitate

order in which the parent, legal guardian, or relative caregiver whose rights under the

provisions of this section were violated or delayed may maintain an action for death of or

injury to the unemancipated minor patient, including a born alive infant, against the person

whose responsibility it was to notify the parent, guardian, or relative caregiver.

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Subd. 8.

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Mandatory reporting of violations.

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(a) A health care practitioner or any

employee of a hospital, a health care facility, a residential facility, a physician's office, or

an abortion facility who has knowledge of a failure to comply with the requirements of

subdivision 3 shall immediately report the failure to an appropriate state law enforcement

agency.

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(b) Any responsible medical personnel that does not take all reasonable measures

consistent with the provisions of this section may be subject to the suspension or revocation

of that person's professional license by the professional board with authority over that person.

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(c) Nothing in this subdivision shall be construed to hold a parent or legal guardian

criminally or civilly liable for the actions of a physician, nurse, or other licensed health care

provider in violation of this section to which the parent or legal guardian did not give consent.

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Subd. 9.

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Limitations on treatment.

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(a) Nothing in this section shall be construed to

require any health care facility, nursing home, physician, nurse, or medical staff to provide

or continue any treatment, including resuscitative efforts, food, medication, oxygen,

intravenous fluids, or nutrition, that would be medically inappropriate because, in the medical

professional's reasonable medical judgment, providing such treatment would:

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(1) create a greater risk of causing or hastening the death of the patient; or

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(2) be potentially harmful or cause unnecessary pain, suffering, or injury to the patient.

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(b) Nothing in this section shall require health care providers to continue cardiopulmonary

resuscitation or manual ventilation beyond a time in which, in the health care provider's

reasonable medical judgment, there is no further benefit to the patient or likely recovery of

the patient.

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Subd. 10.

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Policy disclosures.

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Upon the request of a parent or legal guardian of an

unemancipated minor patient or resident or a prospective patient or resident, a health care

provider shall disclose verbally and in writing any policies involving resuscitation or

life-sustaining measures, including any policies relating to measures deemed not beneficial,

ineffective, futile, or inappropriate. Nothing in this section shall be construed to require a

provider to have a written policy relating to resuscitation, life-sustaining measures, or

measures deemed not beneficial, ineffective, futile, or inappropriate for patients or residents.

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Subd. 11.

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Severability.

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If any one or more provision, subdivision, sentence, clause,

phrase, or word of this section or the application thereof, to any person or circumstance is

found to be unconstitutional, the same is declared to be severable and the balance of this

section shall remain in effect not withstanding the unconstitutional part. The legislature

declares that it would have passed this section, and each provision, subdivision, sentence,

clause, phrase, or word thereof, irrespective of the fact that any one or more provision,

section, subdivision, sentence, clause, phrase, or word is declared unconstitutional.

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