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ARIZONA STATE SENATE
Fifty-Fourth Legislature, First Regular Session
AMENDED
do-not-resuscitate orders; minors; parental consent
Purpose
Prohibits providers from implementing do‑not‑resuscitate (DNR) orders for minors without the consent of the patient's parents or legal guardian (guardian).
Background
Healthcare institutions are prohibited from permitting the performance of any surgical procedure on a minor without having received a prior written consent from a parent or guardian of the minor. If an emergency has been determined by a physician, and if necessary, a physician is permitted to perform surgical procedures: 1) for the treatment of a serious disease; 2) for injury or drug abuse; 3) to save the life of the patient; or 4) when a parent or guardian cannot be located or contacted after reasonably diligent efforts (A.R.S. § 36-2271).
Statute allows
an individual to execute a prehospital medical care directive that, in the
event of cardiac or respiratory arrest, directs emergency medical system
personnel, hospital emergency department personnel and direct care staff to
withhold cardiopulmonary resuscitation. Cardiopulmonary resuscitation
includes: 1) cardiac compression; 2) endotracheal intubation;
3) artificial ventilation; 4) defibration; 5) administration of advanced
cardiac life support drugs; and 6) any other advanced airway management (A.R.S.
§ 36-3251).
There is no anticipated fiscal impact to the state General Fund associated with this legislation.
Provisions
1. Prohibits a provider from implementing a DNR for an unemancipated minor (minor) without communicating with at least one of the minor's parents or the minor's guardian.
2. Establishes that the communication between a provider and a minor's parents or guardian must include a discussion of:
a) the minor's care plan, including implementing a DNR and what the DNR means for the minor; and
b) the right to request that the minor be transferred to another facility.
3. Requires the communication between a provider and a minor's parents or guardian to include a witness, other than the parents or guardian, who is willing to confirm that the communication took place.
4. Directs a provider to immediately document and record the communication in the minor's medical record indicating:
a) whom the communication was with;
b) who witnessed the communication; and
c) date and time of the communication.
5. Directs a provider to ask the minor's parents or guardian to sign a written acknowledgement of the communication.
6. Specifies that the communication requirements do not apply if a provider makes a reasonably diligent and documented effort to contact the minor's parent or guardian without success for at least 48 hours.
7. Requires a provider who in unable to contact a minor's parent or guardian for at least 48 hours to document the reason for a minor's DNR in the minor's medical record.
8. Specifies that a provider is not required to provide or continue resuscitative measures on a minor if such measures would be medically inappropriate because providing the treatment, in the provider's medical judgement, would either:
a) create a greater risk of causing or hastening the minor's death; or
b) be potentially harmful or cause unnecessary pain, suffering or injury to the minor because there is no further benefit to the minor in performing resuscitative measures.
9. Establishes, at any point during the communication process, that a parent or guardian has a right to request that a minor be transferred to another facility.
10. Requires a provider, if a transfer request is made and before implementing a DNR, to provide reasonable time for a parent or guardian to find another facility and provider that will accept the minor.
11. Directs a provider, if a transfer request is made, to provide the minor's medical records to any accredited facility that is willing to care for the minor.
12. Directs a provider to facilitate the transfer of a minor patient if an accredited facility is willing to accept the minor.
13. Permits a parent to petition the appropriate superior court for an order enjoining a violation or threatened violation of prescribed requirements or to resolve a conflict between the parents.
14. Requires the superior court, upon receipt of a petition, to issue an order fixing the date, time and place of a hearing regarding a petition and order that notice be provided to all interested parties.
15. Allows a preliminary hearing to be held without notice if the superior court determines that holding the hearing is necessary to prevent imminent danger to the minor's life.
16. Grants the court discretion to conduct a preliminary hearing in a courtroom, healthcare facility or other suitable place.
17. Precludes a DNR from being implemented pending the final determination of the superior court proceedings, including any appeals.
18. Requires a provider, to disclose, upon request, any policies relating to a patient, resident or services that may be received involving resuscitation or life-sustaining measures, including policies related to treatments that are deemed nonbeneficial, ineffective, futile or inappropriate.
19. Specifies that a provider is not required to have a written policy relating to or involving resuscitation, life-sustaining measures or nonbeneficial treatment for unemancipated minor patients, adult patients or residents.
19. Defines DNR and provider.
20. Cites this legislation as Simon's Law.
21. Becomes effective on the general effective date.
Amendments Adopted by Committee
1. Eliminates proposed language regarding the conditions under which specified healthcare institutions and professionals are permitted to implement a DNR for a minor.
2. Prohibits a provider from implementing a DNR for an unemancipated minor without communicating with at least one parent or guardian and outlines communication requirements.
3. Exempts a provider who makes a diligent and documented effort to contact the child's parents or guardian without success for 48 hours from communication requirements.
4. Establishes the right of a parent or guardian to request the transfer of the minor to another facility and outlines transfer procedures.
5. Defines relevant terms.
6. Makes technical and conforming changes.
House Action Senate Action
HHS 2/14/19 DPA 8-0-1-0 HHS 3/28/19 DPA 8-0-0
3rd Read 3/4/19 58-0-2
Prepared by Senate Research
April 1, 2019
CRS/AG/kja