SB739: Bill Text

SB739,9,25 Dated: ....

SB739,10,1 Witness Signature: ....

SB739,10,2 Dated: ....

SB739,10,5 156.13 Attending provider responsibilities. (1) The attending provider for an individual shall do all of the following with regard to requests for medication under this chapter:

SB739,10,7 (a) Determine whether the individual has a terminal disease with a prognosis of 6 months or less and is mentally capable.

SB739,10,11 (b) Confirm that the individual's request for medication under this chapter does not arise from coercion or undue influence by asking the individual about coercion and influence outside the presence of other persons, except for an interpreter if necessary.

SB739,10,12 (c) Inform the individual of all of the following:

SB739,10,13 1. The individual's diagnosis.

SB739,10,14 2. The individual's prognosis.

SB739,10,16 3. The potential risks, benefits, and probable result of self-administering the prescribed medication to bring about a peaceful death.

SB739,10,19 4. The potential benefits and risks of feasible alternatives, including concurrent or additional treatment options for the individual's terminal disease, palliative care, comfort care, hospice care, and pain control.

SB739,10,21 5. The individual's right to rescind the request for medication under this chapter at any time and in any manner.

SB739,10,23 (d) Inform the individual that there is no obligation to fill the prescription nor an obligation to self-administer the medication if it is obtained.

SB739,11,3 (e) Provide the individual with a referral for comfort care, palliative care, hospice care, pain control, or any other end-of-life treatment option as requested or as clinically indicated.

SB739,11,6 (f) Refer the individual to a consulting provider for medical confirmation that the individual requesting medication under this chapter both has a terminal disease with a prognosis of 6 months or less and is mentally capable.

SB739,11,8 (g) Include the consulting provider's written determination, as provided under s. 156.15, in the individual's medical record.

SB739,11,11 (h) Refer the individual to a licensed mental health care provider if the attending provider observes signs that the individual may not be capable of making an informed decision.

SB739,11,14 (i) Include the licensed mental health care provider's written determination, as provided under s. 156.17, in the individual's medical record if such determination was requested.

SB739,11,16 (j) Inform the individual of the benefits of notifying next of kin of the individual's decision to request medication under this chapter.

SB739,11,17 (k) Fulfill all medical record documentation requirements.

SB739,11,20 (L) Ensure that all procedures required in order to fulfill a request for medication under this chapter are followed before providing a prescription to a qualified individual for medication under this chapter, including all of the following:

SB739,11,22 1. Confirm that the individual has made an informed decision to obtain a prescription for medication under this chapter.

SB739,11,24 2. Offer the individual an opportunity to rescind the request for medication under this chapter.

SB739,12,5 3. Educate the individual on the recommended procedure for self-administering the medication to be prescribed; the safekeeping and proper disposal of unused medication in accordance with state and federal law; the importance of having another person present when the individual self-administers the medication to be prescribed; and not taking the medication in a public place.

SB739,12,14 (m) Deliver the prescription personally, by mail, or through an authorized electronic transmission to a licensed pharmacist who will dispense the medication, including any ancillary medications, to the attending provider, to the qualified individual, or to an individual expressly designated by the qualified individual in person or with a signature required on delivery, by mail service or by messenger service, or, if authorized by the federal drug enforcement agency, dispense the prescribed medication, including any ancillary medications, to the qualified individual or an individual expressly designated by the qualified individual in person.

SB739,12,19 (n) Document in the qualified individual's medical record the individual's diagnosis and prognosis, determination of mental capability, the date of the oral request or requests, a copy of the written request, a notation that the requirements under this chapter have been completed, and identification of the medication and ancillary medications prescribed to the qualified individual under this chapter.

SB739,12,21 (2) Notwithstanding any other provision of law, the attending provider may sign the individual's death certificate.

SB739,12,24 156.15 Consulting provider responsibilities. A consulting provider for an individual shall do all of the following with regard to requests for medication under this chapter:

SB739,12,25 (1) Evaluate the individual and the individual's relevant medical records.

SB739,13,2 (2) Confirm, in writing, to the individual's attending provider that all of the following are true:

SB739,13,3 (a) The individual has a terminal disease with prognosis of 6 months or less.

SB739,13,7 (b) The individual is mentally capable. If the consulting provider is unable to confirm that the individual is mentally capable, the consulting provider shall provide documentation that the consulting provider has referred the individual for further evaluation in accordance with s. 156.17.

SB739,13,8 (c) The individual is acting voluntarily, free from coercion or undue influence.

SB739,13,14 156.17 Referral for confirmation that the requesting individual is mentally capable. (1) If either an attending provider or a consulting provider is unable to confirm that an individual making a request for medication under this chapter is capable of making an informed decision, the attending provider or the consulting provider shall refer the individual to a licensed mental health care provider for determination regarding mental capability.

SB739,13,17 (2) The licensed mental health care provider who evaluates the individual under this section shall submit to the requesting attending provider or consulting provider a written determination of whether the individual is mentally capable.

SB739,13,21 (3) If the licensed mental health care provider determines that the individual is not mentally capable, the individual may not be deemed a qualified individual and the attending provider may not prescribe medication to the individual under this chapter.

SB739,13,25 156.19 Safe disposal of unused medications. A person who has custody or control of medication prescribed under this chapter after a qualified individual's death shall dispose of the medication by lawful means in accordance with state and federal guidelines.

SB739,14,6 156.21 No duty to provide medical aid in dying. (1) A provider shall provide sufficient information to an individual with a terminal disease regarding available options, the alternatives, and the foreseeable risks and benefits of each option so that the individual is able to make informed decisions regarding his or her end-of-life health care, but a provider may choose whether or not to practice medical aid in dying under this chapter.

SB739,14,8 (2) If a provider is unable or unwilling to fulfill an individual's request for medication under this chapter, the provider shall do all of the following:

SB739,14,10 (a) Document the date of the individual's request in the individual's medical record.

SB739,14,12 (b) Upon the individual's request, transfer the individual's medical records to the new provider, consistent with federal and state law.

SB739,14,16 (3) A provider may not engage in false, misleading, or deceptive practices relating to the provider's willingness to qualify an individual or provide a prescription to a qualified individual under this chapter. Intentionally misleading an individual constitutes coercion or undue influence.

SB739,14,23 156.23 Health care facility permissible prohibitions and duties. (1) A health care facility may prohibit providers from qualifying, prescribing, or dispensing medication under this chapter while performing duties for the facility. A prohibiting facility must provide express advance notice in writing at the time of hiring, contracting with, or privileging providers and staff, and on a yearly basis thereafter. A health care facility that fails to provide advance notice in writing waives the right to enforce any prohibition.

SB739,15,4 (2) If an individual who is a patient at a prohibiting health care facility, as described under sub. (1), and who has made a request concerning medical aid in dying wishes to transfer care to another health care facility, the prohibiting facility shall coordinate a timely transfer, including transfer of the individual's medical records that include notation of the date the individual first made a request concerning medical aid in dying.

SB739,15,7 (3) No health care facility may prohibit a provider from doing any of the following in fulfilling the requirements of informed consent and meeting the medical of standard of care:

SB739,15,10 (a) Providing information to an individual regarding the individual's health status, including diagnosis, prognosis, recommended treatment, treatment alternatives, and any potential risks to the individual's health.

SB739,15,14 (b) Providing information about available services, including health care services available under this chapter, information about relevant community resources, and information about how to access those resources to obtain the care of the individual's choice.

SB739,15,17 (c) Prescribing medication under this chapter for a qualified individual outside the scope of the provider's employment or contract with the prohibiting facility and off the premises of the prohibiting facility.

SB739,15,21 (d) Being present when a qualified individual self-administers medication prescribed under this chapter or at the time of death, if requested by the qualified individual or his or her representative and if outside the scope of the provider's employment or contractual duties with the prohibiting facility.

SB739,16,6 (4) A health care facility may not engage in false, misleading, or deceptive practices relating to its policy regarding end-of-life care services, including whether it has a policy that prohibits affiliated providers from determining an individual's qualification for medical aid in dying or writing a prescription for a qualified individual under this chapter. A health care facility may not intentionally deny an individual access to medication under this chapter by failing to transfer an individual and the individual's medical records to another provider in a timely manner. Intentionally misleading an individual or deploying misinformation to obstruct access to services under this chapter constitutes coercion or undue influence.

SB739,16,11 (5) If any part of this chapter is found to be in conflict with federal requirements that are a prescribed condition for the receipt of federal funds, the conflicting part of this chapter is inoperative solely to the extent of the conflict with respect to the facility directly affected, and such finding or determination does not affect the operation of the remainder of the chapter.

SB739,16,16 156.25 Immunities for actions in good faith; prohibition against reprisals. (1) No person or health care facility shall be subject to civil or criminal liability or professional disciplinary action, including censure, suspension, loss of license, loss of privileges, loss of membership, or any other penalty, for engaging in good faith compliance with this chapter.

SB739,16,22 (2) No provider, health care facility, professional organization, or association shall subject a provider to discharge, demotion, censure, discipline, suspension, loss of license, loss of privileges, loss of membership, discrimination, or any other penalty for providing medical aid in dying in accordance with the medical standard of care and in good faith under this chapter, except if a provider acts in violation of a health care facility's valid prohibition or prohibitions under s. 156.23.

SB739,17,4 (3) No provider, health care facility, professional organization, or association shall subject a provider to discharge, demotion, censure, discipline, suspension, loss of license, loss of privileges, loss of membership, discrimination, or any other penalty for providing medical aid in dying in accordance with the medical standard of care and in good faith under this chapter while engaged in the outside practice of medicine and off the facility premises or for providing scientific and accurate information about medical aid in dying to an individual when discussing end-of-life care options.

SB739,17,11 (4) An individual is not subject to civil or criminal liability or professional discipline if, at the request of a qualified individual, the individual is present outside the scope of the individual's employment contract and off the facility premises when the qualified individual self-administers medication under this chapter or at the time of death. An individual who is present may, without civil or criminal liability, assist the qualified individual by preparing the medication prescribed under this chapter.

SB739,17,14 (5) A request by an individual for and the provision of medication under this chapter alone does not constitute neglect or elder abuse for any purpose of law, nor shall it be the sole basis for appointment of a guardian or conservator.

SB739,17,16 (6) This chapter does not limit civil liability for intentional or negligent misconduct.

SB739,17,20 156.27 Reporting requirements. (1) The department shall create a checklist form and a follow-up form for attending providers to facilitate collection of the information described in this chapter and post these forms to the department's Internet site.

SB739,17,23 (2) Within 30 calendar days of providing a prescription for medication under this chapter, an attending provider shall submit to the department a completed checklist form, as provided under sub. (1), with all of the following information:

SB739,17,24 (a) The qualified individual's name and date of birth.

SB739,17,25 (b) The qualified individual's terminal diagnosis and prognosis.

SB739,18,1 (c) Notice that the requirements under this chapter have been completed.

SB739,18,2 (d) Notice that medication has been prescribed under this chapter.

SB739,18,6 (3) Within 60 calendar days of notification of a qualified individual's death from self-administration of medication prescribed under this chapter, the attending provider shall submit to the department a follow up form, as provided under sub. (1), with all of the following information:

SB739,18,7 (a) The qualified individual's name and date of birth.

SB739,18,8 (b) The date of the qualified individual's death.

SB739,18,10 (c) A notation of whether or not the qualified individual was enrolled in hospice services at the time of the qualified individual's death.

SB739,18,14 (4) The department shall annually review a sample of records related to requests under this chapter to ensure compliance and issue a public statistical report. The report shall not include any identifying information and shall be limited to the following statistical information:

SB739,18,15 (a) The number of prescriptions for medication written under this chapter.

SB739,18,17 (b) The number of providers who wrote prescriptions for medication under this chapter.

SB739,18,19 (c) The number of qualified individuals who died following self-administration of medication prescribed and dispensed under this chapter.

SB739,18,22 (5) Except as otherwise required by law, the information collected by the department that is related to requests under this chapter is not a public record and is not available for public inspection under s. 19.35.

SB739,18,24 (6) Willful failure or refusal to timely submit records required under this chapter nullifies protections under s. 156.25.

SB739,19,4 156.29 Effect on construction of will, contracts, and statutes. (1) No provision in a contract, will, or other agreement, whether written or oral, that would determine whether an individual may make or rescind a request under this chapter is valid.

SB739,19,6 (2) No obligation owing under any existing contract may be conditioned or affected by an individual's act of making or rescinding a request under this chapter.

SB739,19,10 (3) It is unlawful for an insurer to deny or alter health care benefits otherwise available to an individual with a terminal disease based on the availability of medical aid in dying or to otherwise attempt to coerce an individual with a terminal disease to make a request for medical aid-in-dying medication.

SB739,19,14 156.31 Insurance or annuity policies. (1) Neither the sale, procurement, or issuance of a life, health, or accident insurance policy or an annuity policy nor the rate charged for such a policy may be conditioned upon or affected by an individual's act of making or rescinding a request for medication under this chapter.

SB739,19,17 (2) A qualified individual's act of self-administering medication under this chapter does not invalidate any part of a life, health, or accident insurance policy or an annuity policy.

SB739,19,23 (3) An insurance plan, including the Medical Assistance program under subch. IV of ch. 49, may not deny or alter benefits to an individual with a terminal disease who is a covered beneficiary of an insurance plan based on the availability of medical aid in dying, the individual's request for medication under this chapter, or the absence of a request for medication under this chapter. Failure to meet this requirement shall constitute a violation of the insurance code of this state.

SB739,20,2 156.33 Death certificate. (1) Unless otherwise prohibited by law, an attending provider or a hospice medical director may sign the death certificate of a qualified individual who obtained and self-administered a prescription for medication under this chapter.

SB739,20,4 (2) When a death has occurred in accordance with this chapter, the death shall be attributed to the underlying terminal disease.

SB739,20,6 (3) A death following self-administering medication under this chapter does not alone constitute grounds for post-mortem inquiry.

SB739,20,8 (4) A death in accordance with this chapter may not be designated as suicide or homicide.

SB739,20,10 (5) A qualified individual's act of self-administering medication prescribed under this chapter may not be indicated on the individual's death certificate.

SB739,20,12 (6) A coroner may conduct a preliminary investigation to determine whether an individual received a prescription for medication under this chapter.

SB739,20,16 156.35 Liabilities and penalties . (1) Intentionally or knowingly altering or forging an individual's request for medication under this chapter or concealing or destroying a rescission of a request for medication under this chapter is a Class F felony.

SB739,20,19 (2) Intentionally or knowingly exercising coercion or undue influence on an individual with a terminal disease to request or use medication under this chapter is a Class F felony.

SB739,20,22 (3) Nothing in this chapter limits civil liability nor damages arising from negligent conduct or intentional misconduct, including failure to obtain informed consent by any person, provider, or health care facility.

SB739,20,24 (4) The penalties specified in this chapter do not preclude criminal penalties applicable under other laws for conduct inconsistent with this chapter.