WEST virginia Legislature
2016 regular session
Senate Bill 433
By Senators Takubo, Stollings and Plymale
[Introduced January 29,
Referred to the Committee on Health and Human Resources.]
A BILL to amend and reenact §16-5-19 of the Code of West Virginia, 1931, as amended; and to amend and reenact §16-30-3 and §16-30-25 of said code, all relating to allowing advance practice registered nurses and physician assistants to complete physician orders for scope of treatment; allowing advance practice registered nurses and physician assistants to sign death certificates; and defining terms.
Be it enacted by the Legislature of West Virginia:
That §16-5-19 of the Code of West Virginia, 1931, as amended, be amended and reenacted; and that §16-30-3 and §16-30-25 of said code be amended and reenacted, all to read as follows:
ARTICLE 5. VITAL STATISTICS.
§16-5-19. Death registration.
(a) A certificate of death for each death which occurs in this state shall be filed with the section of vital statistics, or as otherwise directed by the State Registrar, within five days after death, and prior to final disposition, and shall be registered if it has been completed and filed in accordance with this section.
(1) If the place of death is unknown, but the dead body is found in this state, the place where the body was found shall be shown as the place of death.
(2) If the date of death is unknown, it shall be approximated. If the date cannot be approximated, the date found shall be shown as the date of death.
(3) If death occurs in a moving conveyance in the United States and the body is first removed from the conveyance in this state, the death shall be registered in this state and the place where it is first removed shall be considered the place of death.
(4) If death occurs in a moving conveyance while in international waters or air space or in a foreign country or its air space and the body is first removed from the conveyance in this state, the death shall be registered in this state but the certificate shall show the actual place of death insofar as can be determined.
(5) In all other cases, the place where death is pronounced shall be considered the place where death occurred.
(b) The funeral director or other person who assumes custody of the dead body shall:
(1) Obtain the personal data from the next of kin or the best qualified person or source available including the deceased person=s social security number or numbers, which shall be placed in the records relating to the death and recorded on the certificate of death;
(2) Within forty-eight hours after death, provide the certificate of death containing sufficient information to identify the decedent to the physician responsible for completing the medical certification as provided in subsection (c) of this section; and
(3) Upon receipt of the medical certification, file the certificate of death: Provided, That for implementation of electronic filing of death certificates, the person who certifies to cause of death will be responsible for filing the electronic certification of cause of death as directed by the State Registrar and in accordance with legislative rule.
(c) The medical certification shall be completed and signed within twenty-four hours after receipt of the certificate of death by the physician in charge of the patient's care for the illness or condition which resulted in death except when inquiry is required pursuant to chapter sixty-one, article twelve or other applicable provisions of this code.
(1) In the absence of the physician or with his or her approval, the certificate may be completed by his or her associate physician, any physician who has been placed in a position of responsibility for any medical coverage of the decedent, the chief medical officer of the institution in which death occurred, an advance practice registered nurse as defined in article seven, chapter thirty of this code or a physician assistant as defined in article three-e, chapter thirty of this code or the physician who performed an autopsy upon the decedent, provided inquiry is not required pursuant to chapter sixty-one, article twelve of this code.
(2) The person completing the cause of death shall attest to its accuracy either by signature or by an approved electronic process.
(d) When inquiry is required pursuant to article twelve, chapter sixty one, or other applicable provisions of this code, the state Medical Examiner or designee or county medical examiner or county coroner in the jurisdiction where the death occurred or where the body was found shall determine the cause of death and shall complete the medical certification within forty-eight hours after taking charge of the case.
(1) If the cause of death cannot be determined within forty-eight hours after taking charge of the case, the medical examiner shall complete the medical certification with a APending@ cause of death to be amended upon completion of medical investigation.
(2) After investigation of a report of death for which inquiry is required, if the state Medical Examiner or designee or county medical examiner or county coroner decline jurisdiction, the state Medical Examiner or designee or county medical examiner or county coroner may direct the decedent=s family physician or the physician who pronounces death to complete the certification of death: Provided, That the physician is not civilly liable for inaccuracy or other incorrect statement of death unless the physician willfully and knowingly provides information he or she knows to be false.
(e) When death occurs in an institution and the person responsible for the completion of the medical certification is not available to pronounce death, another physician may pronounce death. If there is no physician available to pronounce death, then a designated licensed health professional who views the body may pronounce death, attest to the pronouncement by signature or an approved electronic process, and, with the permission of the person responsible for the medical certification, release the body to the funeral director or other person for final disposition: Provided, That if the death occurs in an institution during court-ordered hospitalization, in a correctional facility or under custody of law-enforcement authorities, the death shall be reported directly to a medical examiner or coroner for investigation, pronouncement and certification.
(f) If the cause of death cannot be determined within the time prescribed, the medical certification shall be completed as provided by legislative rule. The attending physician or medical examiner, upon request, shall give the funeral director or other person assuming custody of the body notice of the reason for the delay, and final disposition of the body may not be made until authorized by the attending physician, medical examiner or other persons authorized by this article to certify the cause of death.
(g) Upon receipt of autopsy results, additional scientific study, or where further inquiry or investigation provides additional information that would change the information on the certificate of death from that originally reported, the certifier, or any State Medical Examiner who provides such inquiry under authority of article twelve, chapter sixty-one of this code shall immediately file a supplemental report of cause of death or other information with the section of vital statistics to amend the record, but only for purposes of accuracy.
(h) When death is presumed to have occurred within this state but the body cannot be located, a certificate of death may be prepared by the State Registrar only upon receipt of an order of a court of competent jurisdiction which shall include the finding of facts required to complete the certificate of death. The certificate of death will be marked APresumptive@ and will show on its face the date of death as determined by the court and the date of registration, and shall identify the court and the date of the order.
(i) The local registrar shall transmit each month to the county clerk of his or her county a copy of the certificates of all deaths occurring in the county, and if any person dies in a county other than the county within the state in which the person last resided prior to death, then the State Registrar shall furnish a copy of the death certificate to the clerk of the county commission of the county where the person last resided, from which copies the clerk shall compile a register of deaths, in a form prescribed by the State Registrar. The register shall be a public record.
ARTICLE 30. WEST VIRGINIA HEALTH CARE DECISIONS ACT.
For the purposes of this article:
(a) "Actual knowledge" means the possession of information of the person=s wishes communicated to the health care provider orally or in writing by the person, the person=s medical power of attorney representative, the person=s health care surrogate or other individuals resulting in the health care provider=s personal cognizance of these wishes. Constructive notice and other forms of imputed knowledge are not actual knowledge.
(b) "Adult" means a person who is eighteen years of age or older, an emancipated minor who has been established as such pursuant to the provisions of section twenty-seven, article seven, chapter forty-nine of this code or a mature minor.
practitioner" means a registered nurse with substantial theoretical
knowledge in a specialized area of nursing practice and proficient clinical
utilization of the knowledge in implementing the nursing process, and who has
met the further requirements of title 19, legislative rules for West Virginia
board of examiners for registered professional nurses, series 7 , who has a
mutually agreed upon association in writing with a physician and has been
selected by or assigned to the person and has primary responsibility for
treatment and care of the person. “Advance practice registered nurse”
means the same as that term is defined in section one, article seven, chapter
thirty of this code.
(d) "Attending physician" means the physician selected by or assigned to the person who has primary responsibility for treatment and care of the person and who is a licensed physician. If more than one physician shares that responsibility, any of those physicians may act as the attending physician under this article.
(e) "Capable adult" means an adult who is physically and mentally capable of making health care decisions and who is not considered a protected person pursuant to the provisions of chapter forty-four-a of this code.
(f) "Close friend" means any adult who has exhibited significant care and concern for an incapacitated person who is willing and able to become involved in the incapacitated person's health care and who has maintained regular contact with the incapacitated person so as to be familiar with his or her activities, health and religious and moral beliefs.
(g) "Death" means a finding made in accordance with accepted medical standards of either: (1) The irreversible cessation of circulatory and respiratory functions; or (2) the irreversible cessation of all functions of the entire brain, including the brain stem.
(h) "Guardian" means a person appointed by a court pursuant to the provisions of chapter forty-four-a of this code who is responsible for the personal affairs of a protected person and includes a limited guardian or a temporary guardian.
(i) "Health care decision" means a decision to give, withhold or withdraw informed consent to any type of health care, including, but not limited to, medical and surgical treatments, including life-prolonging interventions, psychiatric treatment, nursing care, hospitalization, treatment in a nursing home or other facility, home health care and organ or tissue donation.
(j) "Health care facility" means a facility commonly known by a wide variety of titles, including, but not limited to, hospital, psychiatric hospital, medical center, ambulatory health care facility, physicians' office and clinic, extended care facility operated in connection with a hospital, nursing home, a hospital extended care facility operated in connection with a rehabilitation center, hospice, home health care and other facility established to administer health care in its ordinary course of business or practice.
(k) "Health care provider" means any licensed physician, dentist, nurse, physician's assistant, paramedic, psychologist or other person providing medical, dental, nursing, psychological or other health care services of any kind.
(l) "Incapacity" means the inability because of physical or mental impairment to appreciate the nature and implications of a health care decision, to make an informed choice regarding the alternatives presented and to communicate that choice in an unambiguous manner.
(m) "Life-prolonging intervention" means any medical procedure or intervention that, when applied to a person, would serve to artificially prolong the dying process or to maintain the person in a persistent vegetative state. Life-prolonging intervention includes, among other things, nutrition and hydration administered intravenously or through a feeding tube. The term "life-prolonging intervention" does not include the administration of medication or the performance of any other medical procedure considered necessary to provide comfort or to alleviate pain.
(n) "Living will" means a written, witnessed advance directive governing the withholding or withdrawing of life-prolonging intervention, voluntarily executed by a person in accordance with the requirements of section four of this article.
(o) "Mature minor" means a person less than eighteen years of age who has been determined by a qualified physician, a qualified psychologist or an advanced nurse practitioner to have the capacity to make health care decisions.
(p) "Medical information" or "medical records" means and includes without restriction any information recorded in any form of medium that is created or received by a health care provider, health care facility, health plan, public health authority, employer, life insurer, school or university or health care clearinghouse that relates to the past, present or future physical or mental health of the person, the provision of health care to the person, or the past, present or future payment for the provision of health care to the person.
(q) "Medical power of attorney representative" or "representative" means a person eighteen years of age or older appointed by another person to make health care decisions pursuant to the provisions of section six of this article or similar act of another state and recognized as valid under the laws of this state.
(r) "Parent" means a person who is another person's natural or adoptive mother or father or who has been granted parental rights by valid court order and whose parental rights have not been terminated by a court of law.
(s) "Persistent vegetative state" means an irreversible state as diagnosed by the attending physician or a qualified physician in which the person has intact brain stem function but no higher cortical function and has neither self-awareness or awareness of the surroundings in a learned manner.
(t) "Person" means an individual, a corporation, a business trust, a trust, a partnership, an association, a government, a governmental subdivision or agency or any other legal entity.
(u) “Physician assistant” means a person defined and licensed as set forth in article three-e, chapter thirty of this code.
(u) (v) APhysician orders for
scope of treatment (POST) form@ means a standardized
form containing orders by a qualified physician that details a person=s life-sustaining wishes as provided by section
twenty-five of this article. (v) (w) "Principal" means a person who
has executed a living will or medical power of attorney. (w) (x) "Protected person" means an
adult who, pursuant to the provisions of chapter forty-four-a of this code, has
been found by a court, because of mental impairment, to be unable to receive
and evaluate information effectively or to respond to people, events and
environments to an extent that the individual lacks the capacity to: (1) Meet
the essential requirements for his or her health, care, safety, habilitation or
therapeutic needs without the assistance or protection of a guardian; or (2)
manage property or financial affairs to provide for his or her support or for
the support of legal dependents without the assistance or protection of a
conservator. (x) (y) "Qualified physician" means a
physician licensed to practice medicine who has personally examined the person. (y) (z) "Qualified psychologist" means a
psychologist licensed to practice psychology who has personally examined the
person. (z) (aa) "Surrogate decisionmaker" or
"surrogate" means an individual eighteen years of age or older who is
reasonably available, is willing to make health care decisions on behalf of an
incapacitated person, possesses the capacity to make health care decisions and
is identified or selected by the attending physician or advanced nurse
practitioner in accordance with the provisions of this article as the person
who is to make those decisions in accordance with the provisions of this
article. (aa) (bb) "Terminal condition" means an
incurable or irreversible condition as diagnosed by the attending physician or
a qualified physician for which the administration of life-prolonging
intervention will serve only to prolong the dying process
§16-30-25. Physician orders for scope of treatment form.
(a) No later than July 1, 2003, the secretary of the Department of Health and Human Resources shall implement the statewide distribution of standardized physician orders for scope of treatment (POST) forms.
(b) Physician orders for scope of treatment forms shall be standardized forms used to reflect orders by a qualified physician or an advance practice registered nurse or physician assistant as defined in this article for medical treatment of a person in accordance with that person=s wishes or, if that person=s wishes are not reasonably known and cannot with reasonable diligence be ascertained, in accordance with that person=s best interest. The form shall be bright pink in color to facilitate recognition by emergency medical services personnel and other health care providers and shall be designed to provide for information regarding the care of the patient, including, but not limited to, the following:
(1) The orders of a qualified physician or an advance practice registered nurse or physician assistant as defined in this article regarding cardiopulmonary resuscitation, level of medical intervention in the event of a medical emergency, use of antibiotics and use of medically administered fluids and nutrition and the basis for the orders;
(2) The signature of the qualified physician or an advance practice registered nurse or physician assistant as defined in this article;
(3) Whether the person has completed an advance directive or had a guardian, medical power of attorney representative or surrogate appointed;
(4) The signature of the person or his or her guardian, medical power of attorney representative, or surrogate acknowledging agreement with the orders of the qualified physician; and
(5) The date, location and outcome of any review of the physician orders for scope of treatment form.
(c) The physician advance practice registered nurse or physician assistant orders for scope of treatment form shall be kept as the first page in a person=s medical record in a health care facility unless otherwise specified in the health care facility=s policies and procedures and shall be transferred with the person from one health care facility to another.
NOTE: The purpose of this bill is to allow advance practice registered nurses and physician assistants to complete orders for physician orders for scope of treatment forms and to pronounce death and sign a death certificate.
Strike-throughs indicate language that would be stricken from a heading or the present law and underscoring indicates new language that would be added.