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SECOND REGULAR SESSION
HOUSE BILL NO. 2464
103RD GENERAL ASSEMBL Y
INTRODUCED BY REPRESENT A TIVE AMA TO .
4731H.01I JOSEPH ENGLER, Chief Clerk
AN ACT
T o amend chapter 197, RSMo, by adding thereto seven new sections relating to the care of
terminally ill patients in hospitals, with a delayed ef fective date and penalty
provisions.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Chapter 197, RSMo, is amended by adding thereto seven new sections, to
2 be known as sections 197.1060, 197.1063, 197.1066, 197.1069, 197.1072, 197.1075, and
3 197.1078, to read as follows:
197.1060. Sections 197.1060 to 197.1078 shall be known and may be cited as the
2 "Missouri T erminally Ill Patient Dignity and Car e Act".
197.1063. As used in sections 197.1060 to 197.1078, the following terms mean:
2 (1) "Hospital", any institution licensed under this chapter that pr ovides
3 inpatient car e;
4 (2) "Neglect":
5 (a) Failur e of a hospital or its staff to pr ovide timely , appr opriate, and adequate
6 car e necessary to rel ieve pain or other distr essing symptoms;
7 (b) Failur e to res pond within a medically appr opriate period to a patient's or
8 family's call for assistance or r elief of suffering; or
9 (c) Abandonment of a patient without reas onable oversight while the patient is
10 in pain or distr ess;
11 (3) "T erminally ill patient", a patient who has a condition that reas onably can be
12 expected to res ult in death within six months as certified in writing by a licensed
13 physician.
EXPLANA TION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is
intended to be omitted from the law . Matter in bold-face type in the above bill is proposed language.
197.1066. 1. Each hospital shall adopt and enfor ce care pr otocols specific to
2 terminally ill patients that ensure that:
3 (1) Pain and symptom management ar e initiated and evaluated at intervals
4 consistent with best practice standards for palliative care;
5 (2) A res ponse to a patient's r equest for assistance, including via call light, nurse
6 r eferral, or a family advocate, occurs within a reas onable time frame not to exceed
7 thirty minutes unless clinically justified;
8 (3) No patient is left unattended without adequate supervision or monitoring
9 while experiencing pain or distr ess; and
10 (4) Each patient or his or her designated repr esentative is informed of the car e
11 pr otocols requ ired under this subsection, is offered the opportunity to designate a family
12 member or advocate to monitor and raise concerns about care, and has access to clear
13 instructions on how to file a complaint of neglect.
14 2. Hospitals shall maintain documentation for each terminally ill patient of:
15 (1) The physician's certification of terminal illness;
16 (2) The interventions for pain and symptom r elief provi ded and the time
17 intervals at which the rel ief is pr ovided;
18 (3) The time between a patient's or family's req uest for assistance, or call-light
19 activation, and staff r esponse; and
20 (4) Any complaints of neglect or delay in car e and the investigation and
21 r esolution of any such complaints.
197.1069. 1. Each hospital shall designate a terminal car e ombudsman
2 r esponsible for:
3 (1) Receiving and reviewi ng all complaints fro m terminally ill patients or their
4 families concerning neglect or delay in car e;
5 (2) T racking res ponse times and compliance with the care pr otocols requ ired in
6 section 197.1066; and
7 (3) Reporting annually to the department of health and senior services on the
8 hospital's compliance statistics for terminally ill patient care.
9 2. A hospital may designate an employee in an existing job position as the
10 terminal car e ombudsman.
11 3. The terminal care ombudsman shall have access to care records and res ponse-
12 time logs and shall have authority to rec ommend internal corr ective actions.
197.1072. 1. The department of health and senior services shall pr omulgate
2 rules to implement sections 197.1060 to 197.1078. Any rule or portion of a rule, as that
3 term is defined in section 536.010, that is creat ed under the authority delegated in this
4 section shall become effective only if it complies with and is subject to all of the
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5 pr ovisions of chapter 536 and, if applicable, section 536.028. This section and chapter
6 536 are nonseverable and if any of the powers vested with the general assembly
7 pursuant to chapter 536 to revi ew , to delay the effective date, or to disappr ove and annul
8 a rule are subsequently held unconstitutional, then the grant of rulemaking authority
9 and any rule pr oposed or adopted after the effective date of this section shall be invalid
10 and void.
11 2. The department of health and senior services may investigate verified
12 complaints of neglect alleging violations of the requ irem ents of sections 197.1060 to
13 197.1078. Upon finding a substantial violation by a hospital, the department of health
14 and senior services may impose administrative sanctions including, but not limited to:
15 (1) Corr ective orders re quiring compliance by the hospital within a defined time
16 frame;
17 (2) Civil penalties of up to five thousand dollars for each violation; and
18 (3) Suspension or revoc ation of the hospital's license.
19 3. The department of health and senior services shall make publicly available on
20 its website the annual r eports filed by each hospital under section 197.1069, along with
21 the aggreg ate data on res ponse times and complaints, in a manner that pr otects patient
22 confidentiality .
197.1075. 1. A hospital shall not ret aliate against an employee of the hospital
2 who, in good faith, reports neglect or a delay of care affecting a terminally ill patient in
3 violation of the r equir ements of sections 197.1060 to 197.1078.
4 2. A hospital that violates this section is liable to the employee for all of the
5 following:
6 (1) Reinstatement to the employee's position without loss of seniority;
7 (2) T wo times the amount of lost back pay; and
8 (3) Interest on the back pay at the rate of one per cent over the prime rate.
197.1078. 1. A terminally ill patient or his or her designated repr esentative shall
2 have the right to:
3 (1) Be informed in a timely manner of the patient's rights under sections
4 191.1060 to 191.1078;
5 (2) Make a complaint to the hospital's terminal care ombudsman and to the
6 department of health and senior services without fear of r eprisal; and
7 (3) Have a designated family member or advocate pr esent or available to
8 intervene on behalf of the patient's comfort and care.
9 2. A hospital shall post in each inpatient unit a notice of rights under sections
10 191.1060 to 191.1078 that includes contact information for the terminal care
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11 ombudsman and a description of complaint proced ures of the department of health and
12 senior services.
Section B. The enactment of sections 197.1060, 197.1063, 197.1066, 197.1069,
2 197.1072, 197.1075, and 197.1078 of this act shall become ef fective on January 1, 2027.
✔
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