2013 Indiana Code TITLE 16. HEALTH ARTICLE 36. MEDICAL CONSENT CHAPTER 6. PHYSICIAN ORDER FOR SCOPE OF TREATMENT (POST)
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IC 16-36-6
Chapter 6. Physician Order for Scope of Treatment (POST)
IC 16-36-6-1
"Consent"
Sec. 1. As used in this chapter, "consent" means authorization to
provide, withhold, or withdraw treatment.
As added by P.L.164-2013, SEC.8.
IC 16-36-6-2
"Declarant"
Sec. 2. As used in this chapter, "declarant" means a qualified
person:
(1) who has completed a POST form under section 7(a)(1) of
this chapter; or
(2) for whom a representative has completed a POST form
under section 7(a)(2) of this chapter;
and whose treating physician has executed a POST form under
section 8 of this chapter.
As added by P.L.164-2013, SEC.8.
IC 16-36-6-3
"Life prolonging procedure"
Sec. 3. (a) As used in this chapter, "life prolonging procedure"
means any medical procedure, treatment, or intervention that does
the following:
(1) Uses mechanical or other artificial means to sustain, restore,
or supplant a vital function.
(2) Serves to prolong the dying process.
(b) The term does not include the performance or provision of any
medical procedure or medication necessary to provide comfort care
or to alleviate pain.
As added by P.L.164-2013, SEC.8.
IC 16-36-6-4
"POST form"
Sec. 4. As used in this chapter, "POST form" refers to a physician
order for scope of treatment (POST) form developed by the state
department under section 9 of this chapter.
As added by P.L.164-2013, SEC.8.
IC 16-36-6-5
"Qualified person"
Sec. 5. As used in this chapter, "qualified person" refers to an
individual who has at least one (1) of the following:
(1) An advanced chronic progressive illness.
(2) An advanced chronic progressive frailty.
(3) A condition caused by injury, disease, or illness from which,
to a reasonable degree of medical certainty:
(A) there can be no recovery; and
(B) death will occur from the condition within a short period
without the provision of life prolonging procedures.
(4) A medical condition that, if the person were to suffer
cardiac or pulmonary failure, resuscitation would be
unsuccessful or within a short period the person would
experience repeated cardiac or pulmonary failure resulting in
death.
As added by P.L.164-2013, SEC.8.
IC 16-36-6-6
"Representative"
Sec. 6. As used in this chapter, "representative" means an
individual described in section 7(a)(2) of this chapter.
As added by P.L.164-2013, SEC.8.
IC 16-36-6-7
Individuals who may complete a POST form; requirements;
representative acting in good faith
Sec. 7. (a) The following individuals may complete a POST form:
(1) A qualified person who is:
(A) either:
(i) at least eighteen (18) years of age; or
(ii) less than eighteen (18) years of age but authorized to
consent under IC 16-36-1-3(a)(2); and
(B) of sound mind.
(2) A qualified person's representative, if the qualified person:
(A) is less than eighteen (18) years of age and is not
authorized to consent under IC 16-36-1-3(a)(2); or
(B) has been determined to be incapable of making decisions
about the qualified person's health care by a treating
physician acting in good faith and the representative has
been:
(i) appointed by the individual under IC 16-36-1-7 to serve
as the individual's health care representative;
(ii) authorized to act under IC 30-5-5-16 and IC 30-5-5-17
as the individual's attorney in fact with authority to
consent to or refuse health care for the individual; or
(iii) appointed by a court as the individual's guardian under
IC 16-36-1-8.
(b) In order to complete a POST form, a person described in
subsection (a) and the qualified person's treating physician or the
physician's designee must do the following:
(1) Discuss the qualified person's goals and treatment options
available to the qualified person based on the qualified person's
health.
(2) Complete the POST form, to the extent possible, based on
the qualified person's preferences determined during the
discussion in subdivision (1).
(c) When completing a POST form on behalf of a qualified
person, a representative shall act:
(1) in good faith; and
(2) in:
(A) accordance with the qualified person's express or
implied intentions, if known; or
(B) the best interest of the qualified person, if the qualified
person's express or implied intentions are not known.
(d) A copy of the executed POST form shall be maintained in the
qualified person's medical file.
As added by P.L.164-2013, SEC.8.
IC 16-36-6-8
Execution by treating physician; signature
Sec. 8. (a) A POST form may be executed only by an individual's
treating physician and only if:
(1) the treating physician has determined that:
(A) the individual is a qualified person; and
(B) the medical orders contained in the individual's POST
form are reasonable and medically appropriate for the
individual; and
(2) the qualified person or representative has completed the
POST form in accordance with section 7 of this chapter.
(b) The:
(1) treating physician; and
(2) qualified person or representative;
must sign and date the POST form for the POST form to be effective.
As added by P.L.164-2013, SEC.8.
IC 16-36-6-9
State department development of POST form; requirements;
Internet; not liable
Sec. 9. (a) The state department shall develop a standardized
POST form and distribute the POST form.
(b) The POST form developed under this section must include the
following:
(1) A medical order specifying whether cardiopulmonary
resuscitation (CPR) should be performed if the qualified person
is in cardiopulmonary arrest.
(2) A medical order concerning the level of medical
intervention that should be provided to the qualified person,
including the following:
(A) Comfort measures.
(B) Limited additional interventions.
(C) Full intervention.
(3) A medical order specifying whether antibiotics should be
provided to the qualified person.
(4) A medical order specifying whether artificially administered
nutrition should be provided to the qualified person.
(5) A signature line for the treating physician, including the
following information:
(A) The physician's printed name.
(B) The physician's telephone number.
(C) The physician's medical license number.
(D) The date of the physician's signature.
As used in this subdivision, "signature" includes an electronic
or physician controlled stamp signature.
(6) A signature line for the qualified person or representative,
including the following information:
(A) The qualified person's or representative's printed name.
(B) The relationship of the representative signing the POST
form to the qualified person covered by the POST form.
(C) The date of the signature.
(7) A section presenting the option to allow a declarant to
appoint an individual under IC 16-36-1-7 to serve as the
declarant's health care representative.
(c) The state department shall place the POST form on its Internet
web site.
(d) The state department is not liable for any use or misuse of the
POST form.
As added by P.L.164-2013, SEC.8.
IC 16-36-6-10
Original kept by declarant; copy in medical file
Sec. 10. (a) The declarant or representative shall keep the original
executed POST form. The POST form is considered the personal
property of the declarant. The treating physician who executes the
POST form shall maintain a copy of the POST form in the declarant's
medical records. If the POST form is executed at a health care
facility (as defined in IC 16-18-2-161), a copy of the POST form
shall be maintained in the health care facility's medical records.
(b) A health care provider or health care facility shall treat a
facsimile, paper, or electronic copy of a valid POST form as an
original document.
(c) A health care provider, a health care facility, or an entity
acting in good faith may not be considered to have knowledge of a
POST form solely on the basis of the POST form's entry into a
medical record that can be accessed by a person described in this
subsection.
As added by P.L.164-2013, SEC.8.
IC 16-36-6-11
Revocation of POST form; effectiveness; notification
Sec. 11. (a) A declarant or representative subject to subsection (b)
may at any time revoke a POST form by any of the following:
(1) A signed and dated writing.
(2) Physical cancellation or destruction of the POST form by:
(A) the declarant;
(B) the representative; or
(C) another individual at the direction of the declarant or
representative.
(3) An oral expression by the declarant or representative of an
intent to revoke the POST form.
(b) A representative may revoke the POST form only if the
declarant is incapable of making decisions regarding the declarant's
health care.
(c) A revocation of a POST form under this section is effective
upon communication of the revocation to a health care provider.
(d) Upon communication of the revocation of a POST form under
this section, the health care provider shall immediately notify the
declarant's treating physician, if known, of the revocation.
(e) Upon notification of the revocation of a POST form to the
treating physician under subsection (d), the declarant's treating
physician shall as soon as possible do the following:
(1) Add the revocation to the declarant's medical record with
the following information:
(A) The time, date, and place of revocation of the POST
form by the declarant, representative, or other individual at
the direction of the declarant or representative.
(B) The time, date, and place the treating physician was
notified of the revocation of the POST form.
(2) Cancel the POST form that is being revoked by
conspicuously noting in the declarant's medical records that the
declarant's POST form has been voided.
(3) Notify any health care personnel responsible for the care of
the declarant of the revocation of the POST form.
(4) Notify the physician who signed the POST form of the
revocation through the contact information for the physician
indicated on the form.
As added by P.L.164-2013, SEC.8.
IC 16-36-6-12
Alternative treatment request allowed
Sec. 12. (a) A declarant, or, subject to subsection (b), a
representative, may, at any time, request alternative treatment to the
treatment specified on the POST form.
(b) A representative may request alternative treatment only if the
declarant is incapable of making decisions concerning the declarant's
health care.
(c) A health care provider to whom a request for alternative
treatment is communicated shall, as soon as possible, notify the
declarant's treating physician, if known, of the request.
(d) The treating physician who is notified under subsection (c) of
a request for alternative treatment shall do the following as soon as
possible:
(1) Include a written, signed note of the request in the
declarant's medical records with the following information:
(A) The time, date, and place of the request by the declarant
or representative.
(B) The time, date, and place that the treating physician was
notified of the request.
(2) Review the POST form with the declarant or representative
and execute a new POST form, if needed.
As added by P.L.164-2013, SEC.8.
IC 16-36-6-13
Petition for relief; court authority
Sec. 13. (a) A health care provider, a health care facility, or an
interested individual that believes that following the medical orders
set forth in the POST form will result in care or treatment, or the
withholding of care or treatment, that:
(1) is inconsistent with the declarant's known preferences; or
(2) in the absence of the declarant's known preferences, is not
in the declarant's best interest;
may seek relief under IC 16-36-1-8 by petitioning the probate court
in the county where the declarant is located.
(b) If, in a proceeding sought under subsection (a), a probate court
determines that following the medical orders in the declarant's POST
form will result in care or treatment, or the withholding or
withdrawal of care or treatment, that:
(1) is inconsistent with the declarant's known preferences; or
(2) in the absence of the declarant's known preferences, is not
in the declarant's best interest;
the probate court may order any of the relief available under
IC 16-36-1-8.
As added by P.L.164-2013, SEC.8.
IC 16-36-6-14
POST form not effective during pregnancy
Sec. 14. A declarant's executed POST form has no effect during
the declarant's pregnancy if the declarant is known to be pregnant.
As added by P.L.164-2013, SEC.8.
IC 16-36-6-15
Medical orders in POST form effective in all settings;
noncompliance; contrary care not required; discussion of order
requirement; transfer of care
Sec. 15. (a) Except as otherwise provided in this chapter, the
medical orders included in a POST form executed under this chapter
are effective in all settings. A health care provider shall comply with
a declarant's POST form that is apparent and immediately available
to the provider unless the provider:
(1) believes the POST form was not validly executed under this
chapter;
(2) believes in good faith that the declarant, the representative,
or another individual at the request of the declarant or
representative has revoked the POST form as provided in
section 11 of this chapter;
(3) believes in good faith that the declarant or representative has
made a request for alternative treatment as provided in section
12 of this chapter;
(4) believes it would be medically inappropriate to provide the
intervention included in the declarant's POST form; or
(5) has religious or moral beliefs that conflict with the POST
form.
(b) A health care provider is not required to provide medical
treatment that is contrary to a declarant's POST form that has been
executed in accordance with this chapter.
(c) If a declarant is capable of making health care decisions, the
declarant's treating physician, before carrying out or implementing
a medical order indicated in the declarant's POST form, shall discuss
the order with the declarant to reaffirm or amend the order on the
POST form. For purposes of this subsection, a minor who is not
authorized to consent to health care under IC 16-36-1-3(a)(2) is not
capable of consenting to health care. This subsection applies
regardless of whether the POST form was signed by the declarant or
representative.
(d) A health care provider who is unable to implement or carry out
the orders of a POST form shall transfer care of the declarant to
another health care provider who is able to implement or carry out
the orders. However, a health care provider who refuses to
implement the medical orders included in an executed POST form is
not required to transfer care of the declarant if any of the
circumstances in subsection (a)(1) through (a)(4) have occurred.
(e) The treating physician is responsible for coordinating the
transfer of care of a declarant in the circumstances in subsection (d).
If the treating physician, after a reasonable attempt, is unable to find
a physician willing to implement or carry out the medical orders
included in the declarant's POST form, the treating physician may
decline to implement or carry out the medical orders.
(f) If, under this section, the treating physician does not transfer
a declarant or implement the medical orders included in the
declarant's POST form and the declarant is competent, the treating
physician shall attempt to ascertain the declarant's preferences for
medical care by discussing the preferences with the declarant. If the
declarant is incompetent to act, the treating physician shall attempt
to ascertain the declarant's preferences for medical care by consulting
with the following individuals:
(1) The treating physician shall consult with any representative
who is available, willing, and competent to act.
(2) If the declarant does not have a representative or if a
representative is not available, willing, and competent to act,
the treating physician shall consult with any of the following
individuals who are available, willing, and competent to act:
(A) The declarant's spouse.
(B) An adult child of the declarant, or, if the declarant has
more than one (1) adult child, a majority of the children who
are reasonably available for consultation.
(C) A parent of the declarant.
(D) An adult sibling of the declarant, or, if the declarant has
more than one (1) adult sibling, a majority of the siblings
who are reasonably available for consultation.
(E) An individual with firsthand knowledge of the
declarant's intentions.
(g) An individual described in subsection (f) shall act according
to the declarant's intentions, if known, or in the best interest of the
declarant.
(h) The physician shall list the names of the individuals described
in subsection (f) who were consulted and the information received by
the individuals in the declarant's medical record.
As added by P.L.164-2013, SEC.8.
IC 16-36-6-16
Good faith and medical standards; immunity from civil and
criminal liability; presumption of compliance
Sec. 16. (a) A:
(1) health care provider;
(2) health care facility; or
(3) health entity;
or an employee under the direction of a person described in
subdivisions (1) through (3) that acts in good faith and in accordance
with reasonable medical standards to carry out the orders on a POST
form, including a medical order for the withholding or withdrawal of
life prolonging procedures, is not subject to criminal or civil liability
and may not be found to have committed an act of unprofessional
conduct.
(b) A health care provider may presume in the absence of actual
notice or evidence to the contrary that a POST form executed in
compliance with this chapter is valid and enforceable.
As added by P.L.164-2013, SEC.8.
IC 16-36-6-17
No modification or alteration of practice of medicine or nursing;
prohibition on medically inappropriate treatment
Sec. 17. (a) This chapter may not be construed to modify or alter
any applicable laws, ethics, standards, or protocols for the practice
of medicine or nursing, including section 19 of this chapter
concerning euthanasia.
(b) A POST form may not be construed to compel or authorize a
health care provider or health care facility to administer medical
treatment that is medically inappropriate or prohibited by state or
federal law.
As added by P.L.164-2013, SEC.8.
IC 16-36-6-18
Death not considered suicide; prohibition on compelling
completion of POST form; legal rights not superseded; POST form
voluntary
Sec. 18. (a) A death as a result of the withholding or withdrawal
of life prolonging procedures in accordance with a declarant's POST
form does not constitute a suicide.
(b) A person may not require an individual to complete a POST
form as a condition of receiving health care services.
(c) This chapter does not impair or supersede any legal right or
legal responsibility that an individual may have to effect the
provision, withholding, or withdrawing of care or treatment,
including the withholding or withdrawal of life prolonging
procedures, in a lawful manner.
(d) Use of a POST form is voluntary. If an individual refuses to
complete a POST form, a person described in section 16(a) of this
chapter shall document the refusal in the individual's medical records
and may not ask the individual again to complete a POST form
unless:
(1) required to do so by:
(A) state or federal law or regulation; or
(B) national accrediting entity standards; or
(2) a significant change in condition that is documented in the
individual's medical record has occurred.
As added by P.L.164-2013, SEC.8.
IC 16-36-6-19
No authorization of euthanasia
Sec. 19. This chapter does not authorize euthanasia or any
affirmative or deliberate act or omission to end life other than to
permit the natural process of dying.
As added by P.L.164-2013, SEC.8.
IC 16-36-6-20
Execution or revocation of POST form does not affect other legal
documents or authority
Sec. 20. The execution or revocation of a POST form by or for a
qualified person does not revoke or impair the validity of any of the
following:
(1) A power of attorney that is executed by a qualified person
when the qualified person is competent.
(2) Health care powers that are granted to an attorney in fact
under IC 30-5-5-16 or IC 30-5-5-17.
(3) An appointment of a health care representative that is
executed by a qualified person, except to the extent that the
POST form contains a superseding appointment of a new health
care representative under section 9(b)(7) of this chapter.
(4) The authority of a health care representative under
IC 16-36-1 to consent to health care on behalf of the qualified
patient.
(5) The authority of an attorney in fact holding health care
powers under IC 30-5-5-16 or IC 30-5-5-17 to issue and enforce
instructions under IC 30-5-7 concerning the qualified person's
health care.
As added by P.L.164-2013, SEC.8.
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