2014 Louisiana Laws
Revised Statutes
TITLE 40 - Public Health and Safety
RS 40:1299.64.2 - Definitions

§1299.64.2. Definitions

As used in this Part, the following terms shall have the meanings ascribed to them unless the context clearly states otherwise:

(1) "Attending physician" means the physician who has primary responsibility for the treatment and care of the patient.

(2) "Licensed emergency medical services practitioner" means a licensed emergency medical services practitioner as defined in R.S. 40:1231.

(3) Repealed by Acts 2012, 789, §3, eff. June 13, 2012.

(4) "Health care provider" means any home health agency, hospice, hospital, or nursing facility.

(5) "LaPOST" means Louisiana Physician Order for Scope of Treatment.

(6) "Life-limiting and irreversible condition" means a continual profound comatose state with no reasonable chance of recovery or a condition caused by injury, disease, or illness which within reasonable medical judgment would usually produce death within six months, for which the application of life-sustaining procedures would serve only to postpone the moment of death and for which the life-sustaining procedures would be a burden and not a benefit to the qualified patient, except as provided in the definition of "life-sustaining procedure" herein.

(7) "Life-sustaining procedure" means any medical procedure or intervention which, within reasonable medical judgment, would serve only to prolong the dying process of a qualified patient, including such procedures as the invasive administration of nutrition and hydration and the administration of cardiopulmonary resuscitation when the benefits of the procedure do not outweigh the burdens thereof. A "life-sustaining procedure" shall not include any measure deemed as comfort care. Notwithstanding any other provision of this Part, the administration of nutrition and hydration, whether orally or by invasive means, shall always occur except in the event another condition arises which is life-limiting and irreversible and in which nutrition and hydration by any means becomes a greater burden than benefit to the qualified patient.

(8) "Louisiana Physician Order for Scope of Treatment" means a form which documents the wishes of a qualified patient in a physician order. The following statements shall appear at the bottom of each page of the form: "Send form with person whenever transferred or discharged. Use of original form is strongly encouraged. Photocopies and faxes of signed LaPOST forms are legal and valid". The form shall include certain fields which provide information, instructions, and areas to record information. The fields shall include but not be limited to the following:

(a) A field stating "HIPAA permits disclosure of LaPOST to other health care providers as necessary".

(b) A field identifying the form as "Louisiana Physician Orders for Scope of Treatment".

(c) A field providing an instruction which reads: "First follow these orders, then contact physician. This is a physician order sheet based on the person's medical condition and wishes. Any section not completed implies full treatment for that section. Everyone shall be treated with dignity and respect. Please see www.La-POST.org for information regarding "what my cultural/religious heritage tells me about end of life care"".

(d) Fields for recording the last name, first name, middle initial, and date of birth of a qualified patient.

(e) A field titled "Patient's diagnosis of life-limiting disease and irreversible condition" with an area below to record information.

(f) A field titled "A. Cardiopulmonary resuscitation (CPR): person has no pulse and is not breathing". This field shall provide an instruction which reads "check one" and shall further provide two options for selection. The two options shall be labeled as follows:

(i) "CPR / attempt resuscitation (requires full treatment in section B)".

(ii) "DNR / do not attempt resuscitation (allow natural death)".

(g) A field titled "B. Medical interventions: person has pulse or is breathing". This field shall provide an instruction which reads "check one" and shall further provide three options for selection and one area to record additional orders. The four items shall be labeled as follows:

(i) "Comfort measures only: Use medication by any route, positioning, wound care and other measures to relieve pain and suffering. Use oxygen, oral suction and manual treatment of airway obstruction as needed for comfort. Patient prefers no transfer: EMS contact medical control to determine if transport indicated".

(ii) "Limited additional interventions: Includes care described above. Use medical treatment, IV fluids and cardiac monitor as indicated. Do not use intubations, advanced airway interventions, or mechanical ventilation. Transfer to hospital if indicated. Avoid intensive care unit if possible".

(iii) "Full treatment: Includes care described above. Use intubation, advanced airway interventions, mechanical ventilation. Transfer to hospital if indicated, includes intensive care unit".

(iv) "Additional orders (e.g. dialysis, etc.)"

(h) A field titled "C. Antibiotics". This field shall provide an instruction which reads "check one" and shall further provide three options for selection and one area to record additional orders. The four items shall be labeled as follows:

(i) "No antibiotics. Use other measures to relieve symptoms".

(ii) "Use antibiotics if life can be prolonged".

(iii) "Determine use or limitation of antibiotics when infection occurs, with comfort as goal. (Benefit of treatment should outweigh burden of treatment)".

(iv) "Additional orders:"

(i) A field titled "D. Artificially administered fluids and nutrition: (Always offer food / fluids by mouth as tolerated)". This field shall contain the statement "The administration of nutrition and hydration, whether orally or by invasive means, shall always occur except in the event another condition arises, which is life-limiting or irreversible in which the nutrition or hydration becomes a greater burden than benefit to patient". This field shall provide an instruction which reads "check one in each column" and shall further provide a column listing three options for selection, a column listing two options for selection, and one area to record additional orders. The six items shall be labeled as follows and contain the following text, respectively:

(i) A column shall list:

(aa) "No artificial nutrition by tube".

(bb) "Trial period of artificial nutrition by tube (Goal:__________)".

(cc) "Long-term artificial nutrition by tube (if needed)".

(ii) A column shall list:

(aa) "IV fluids (Goal:__________)".

(bb) "No IV fluids".

(iii) "Additional orders:"

(j) A field titled "E. Other instructions: (May include additional guidelines for starting or stopping treatments in sections above or other directions not addressed elsewhere)".

(k) A field titled "F. Summary of goals" which shall comprise the following two parts:

(i) An area providing an instruction which reads "check one" and further providing the text "Discussed with" and the following two options for selection:

(aa) "Patient".

(bb) "Personal health care representative".

(ii) An area providing an instruction which reads "check all that apply" and further providing the text "The basis for these orders is:" and the following four items for selection:

(aa) "Patient's declaration (can be oral or nonverbal)".

(bb) "Patient's personal health care representative (qualified patient without capacity)."

(cc) "Patient's advance directive, if indicated, patient has completed an additional document that provides guidance for treatment measures if he/she loses medical decision-making capacity".

(dd) "Resuscitation would be medically non-beneficial".

(l) Fields for recording the name, signature, and phone number of a physician.

(m) Fields, labeled "Mandatory," for recording the signature of the patient or personal health care representative and the date of such signature.

(n) A field stating "If personal health care representative, state relationship and authority to act on behalf of patient".

(o) A field titled "Directions for health care professionals" which shall consist of three sections, labeled as follows, and state the following information, respectively:

(i) A section labeled "Completing LaPOST" which shall state the following:

(aa) "Must be completed by a physician based on patient preferences and medical indications".

(bb) "LaPOST must be signed by a physician to be valid. Verbal physician orders are acceptable with follow-up signature by physician in accordance with Louisiana law".

(cc) "Use of original form is strongly encouraged. Photocopies and faxes of signed LaPOST are legal and valid".

(ii) A section labeled "Using LaPOST" which shall state the following:

(aa) "Any section of LaPOST not completed implies full treatment for that section".

(bb) "A semi-automatic external defibrillator (AED) should not be used on a person who has chosen "do not attempt resuscitation"".

(cc) "Even if a patient chooses "no artificial nutrition by tube" or "no IV fluids" or "trial period of artificial nutrition by tube," the administration of nutrition and hydration, whether orally or by invasive means, shall always occur except in the event another condition arises which is life-limiting and irreversible in which nutrition and hydration by any means becomes a greater burden than benefit to patient".

(dd) "When comfort cannot be achieved in the current setting, the person, including someone with "comfort measures only," should be transferred to a setting able to provide comfort (e.g. pinning of a hip fracture)".

(ee) "A person who chooses either "comfort measures only" or "limited additional interventions" should not be entered into a Level I trauma system".

(ff) "A parenteral (IV/Subcutaneous) medication to enhance comfort may be appropriate for a person who has chosen "comfort measures only"".

(gg) "Treatment of dehydration is a measure which may prolong life. A person who desires IV fluids should indicate "limited interventions" or "full treatment"".

(hh) "A person with capacity or the personal representative (if the patient lacks capacity) can revoke the LaPOST at any time and request alternative treatment based on the known desires of the individual; or, if unknown, the individual's best interests".

(ii) "Please see links on www.La-POST.org for "what my cultural/religious heritage tells me about end of life care"".

(jj) "The duty of medicine is to care for patients even when they cannot be cured. Physicians and their patients must evaluate the use of technology available for their personal medical situation. Moral judgments about the use of technology to maintain life must reflect the inherent dignity of human life and the purpose of medical care".

(iii) A section labeled "Reviewing LaPOST" which shall provide the following:

(aa) The statement: "This LaPOST should be reviewed periodically such as when the person is transferred from one care setting or care level to another, or there is a substantial change in the person’s health status. A new LaPOST should be completed if the patient wishes to make a substantive change to their treatment goal (e.g. reversal of prior directive). When completing a new form, the old form must be properly voided and retained in the medical chart. To void the LaPOST form, draw a line through "Physician Orders" and write "void" in large letters. This should be signed and dated".

(bb) A chart titled "Review of this LaPOST form" consisting of four columns which are titled as follows:

(I) "Review date and time".

(II) "Reviewer".

(III) "Location of review".

(IV) "Review outcome". Each row in this column shall contain the following two options for selection:

(aaa) "No change".

(bbb) "Form voided and new form completed".

(9) "Personal health care representative" means a person who has authority in accordance with Louisiana law to act on behalf of an individual who is an adult or an emancipated minor in making decisions related to health care because of incapacity.

(10) "Physician" means a physician or surgeon licensed by the Louisiana State Board of Medical Examiners or by the official licensing authority of another state.

(11) "Qualified patient" means a patient diagnosed and certified in writing as having a life-limiting and irreversible condition by the attending physician or personal physician of the patient.

Acts 2010, No. 954, §1; Acts 2012, No. 789, §§2,3, eff. June 13, 2012.