HCS HB 182 -- OUTSIDE THE HOSPITAL DO-NOT-RESUSCITATE ACT

SPONSOR:  Cooper, 155 (Bruns)

COMMITTEE ACTION:  Voted "do pass" by the Committee on Health
Care Policy by a vote of 9 to 1.

This substitute establishes the Outside the Hospital
Do-not-resuscitate Act which requires that a copy of this order
must be included as the first page of a patient's medical record.
A patient or patient's representative and the patient's attending
physician may execute an outside the hospital do-not-resuscitate
order.  The Department of Health and Senior Services must develop
and approve uniform forms and personal identifiers.  The
identifiers must alert any emergency medical technician,
paramedic, first responder, or other health care provider of the
existence of this order for the patient.

The substitute specifies that the outside the hospital
do-not-resuscitate order will only be effective when the patient
has not been admitted to or is not being treated within a
hospital.  These orders and protocols will not authorize the
withholding or withdrawal of other medical interventions such as
intravenous fluids, oxygen, or therapies other than
cardiopulmonary resuscitation.  An outside the hospital
do-not-resuscitate order will not be effective when a patient is
pregnant or when believing in good faith that a patient is
pregnant.

Emergency medical technicians, paramedics, first responders, and
other health care providers are required to comply with an
outside the hospital do-not-resuscitate order or identifier
unless the patient or patient's representative expresses to the
personnel in any manner, before or after the onset of a cardiac
or respiratory arrest, the desire to be resuscitated.  A
physician or a health care facility other than a hospital that is
unwilling or unable to comply with this order must take all
reasonable steps to transfer the patient to another physician or
facility where the order will be followed.

The substitute specifies individuals and entities that are exempt
from civil or criminal liability for withholding or withdrawing
resuscitation pursuant to an order or identifier as long as the
actions were performed in good faith and without gross
negligence.  Anyone who knowingly conceals, cancels, defaces, or
obliterates an order or identifier without the individual's
consent or knowingly falsifies or forges a revocation will be
guilty of a class A misdemeanor.  Anyone who knowingly executes,
falsifies, or forges an order without the individual's consent or
knowingly conceals or withholds the knowledge of a revocation of
an order will be guilty of a class D felony.

FISCAL NOTE:  No impact on state funds in FY 2008, FY 2009, and
FY 2010.

PROPONENTS:  Supporters say that the bill establishes a process
for prehospitalization do-not-resuscitate orders, provides
consistency and clarity with do-not-resuscitate orders, and helps
people who wish to die with dignity.  The bill does not prevent
treatment for trauma or pain relief and allows patients to change
their mind regarding do-not-resuscitate orders.

Testifying for the bill were Representative Page; Missouri
Ambulance Association; Ralph Hellebusch, Warren County Ambulance
District; Frank Foster, EMS Legal Services; Metropolitan
Ambulance Services Trust; AARP; Missouri Chapter, National
Academy of Elder Law Attorneys; Charles Landsbaum; Campaign Life
Missouri; Missouri Catholic Conference; Denise Swenson, Missouri
River Hospice; University of Missouri-Columbia School of Social
Work; Silver Haired Legislature; and Missouri State Council of
Firefighters.

OPPONENTS:  There was no opposition voiced to the committee.

OTHERS:  Others testifying on the bill say that it satisfies the
Missouri Right to Life concerns.

Testifying on the bill was Missouri Right to Life.

Missouri House of Representatives
94th General Assembly, 1st Regular Session
Last Updated July 25, 2007 at 11:18 am