BILL ANALYSIS Ó
AB 259
Page 1
Date of Hearing: April 9, 2013
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 259 (Logue) - As Amended: March 19, 2013
SUBJECT : Nursing: CPR in emergency situations.
SUMMARY : Makes it unprofessional conduct for a nurse to refuse
to administer cardiopulmonary resuscitation (CPR) in an
emergency situation, as specified. Provides that a policy that
prohibits a licensed professional nurse employed by a skilled
nursing facility (SNF), an intermediate care facility (ICF), or
a congregate living health facility from administering CPR is
void as against public policy. Specifically, this bill :
1)Makes it unprofessional conduct to refuse to administer CPR in
an emergency situation, provided that the nurse is able to
perform the resuscitation. Provides that this does not apply
if there is a "Do Not Resuscitate" (DNR) order in effect for
the person upon whom the resuscitation would otherwise be
performed.
2)Indicates that if a SNF, an ICF, or congregate living health
facility implements or enforces a policy that prohibits a
licensed professional nurse employed by the facility from
administering CPR, that policy is void as against public
policy.
EXISTING LAW :
1)Establishes the Nurse Practice Act (Act) to govern the
practice of nursing. Provides under the Act that
unprofessional conduct includes: incompetence; gross
negligence in carrying out usual certified or licensed nursing
functions; practicing medicine without a license; or,
obtaining or possessing prescribe controlled substances, as
specified.
2)Prohibits under the Act a nurse from being liable for any
civil damages, who in good faith renders emergency care at the
scene of an emergency which occurs outside both the place and
the course of that person's employment, as the result of acts
or omissions in rendering the emergency care. Excludes
immunity from civil damages when the nurse is grossly
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negligent.
3)Defines a SNF as a health facility that provides skilled
nursing care and supportive care to patients whose primary
need is for availability of skilled nursing care on an
extended basis.
4)Defines an ICF as a health facility that provides inpatient
care to ambulatory or nonambulatory patients who have
recurring need for skilled nursing supervision and need
supportive care, but who do not require availability of
continuous skilled nursing care.
5)Defines a congregate living health facility as a residential
home with a capacity of no more than 12 beds that provides
inpatient care, including these basic services: medical
supervision; 24-hour skilled nursing and supportive care;
pharmacy; dietary; social; and, recreational, as specified.
6)Defines a request regarding resuscitative measures as a
written document signed by an individual with capacity or
their legally recognized health care decisionmaker and the
individual's physician, that directs a health care provider
regarding resuscitative measures.
7)Requires a request for resuscitative measures to include one
or both of the following:
a) A prehospital DNR form as developed by the Emergency
Medical Services Authority (EMSA) or other substantially
similar form; and/or,
b) A Physician Orders for Life Sustaining Treatment (POLST)
form, as approved by EMSA.
8)Allows a request regarding resuscitative measures to also be
evidenced by a medallion engraved with the words "do not
resuscitate" or the letters "DNR," a patient identification
number, and a 24-hour toll-free telephone number, issued by a
person pursuant to an agreement with EMSA.
9)Allows an adult to specify an individual health care
instruction, which may be oral or written. Allows an adult,
having capacity, to execute a power of attorney for health
care. Provides that an advance health care directive is a
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legally binding form that allows an individual to designate an
agent to make health care decisions on that individual's
behalf. Specifies requirements for a written advance health
care directive and prescribes a statutory advance health care
directive form.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, "this bill is
in response to an incident that occurred on February 26, 2013.
At the Glenwood Gardens retirement community in Bakersfield,
an 87-year old woman collapsed, and was barely breathing.
During the course of a frantic 911 call, the nurse on the
phone indicated that she would not perform CPR on the woman
due to a policy of the facility that prevented that nurse or
any employee from performing life-saving procedures. The
woman eventually died before 911 services could arrive. This
situation is unacceptable if a qualified nurse is on staff for
him/her not to perform life-saving techniques on a resident
that was clearly in need. This bill aims to prevent such
policies in other facilities before someone else passes away
under unfortunate and unnecessary circumstances."
2)BACKGROUND . This bill arose out of an incident at the
Brookdale Senior Living/Glenwood Gardens retirement community
in Bakersfield, California where an individual who identified
herself as a nurse refused pleas from a 911 operator to
perform CPR on an elderly woman, who later died, saying that
nurse was following the facility's policy. According to news
reports, the facility director indicated in a written
statement that "In the event of a health emergency at this
independent living community our practice is to immediately
call emergency medical personnel for assistance and to wait
with the individual needing attention until such personnel
arrives."
Current law allows an individual to direct health care providers
regarding resuscitative measures. Requests for resuscitative
measures include a prehospital DNR form or a POLST form. Both
of these forms are written documents signed by an individual
with capacity or their legally recognized health care
decisionmaker and the individual's physician that directs
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their health care provider regarding resuscitative measures.
Request regarding resuscitative measures may also be evidenced
by a medallion engraved with the words "do not resuscitate" or
the letters "DNR," a patient identification number, and a
24-hour toll-free telephone number. Additionally, an advance
health care directive is a document that allows an individual
to designate an agent to make health care decisions on that
individual's behalf. The law specifies the requirements for
an advance health care directive and a sample form is also
prescribed.
3)SUPPORT . The California Advocates for Nursing Home Reform
states that this bill comports with long-term care consumers'
expectations that CPR will be performed when they are in
severe respiratory distress and they have no DNR order.
4)OPPOSITION . The California Nurses Association indicates that
healing arts boards, including the Board of Registered Nursing
currently have the authority to investigate the circumstances
involved in any situation in which a practitioner provides or
omits care for a patient in order to determine whether or not
unprofessional conduct has taken place. Modifying the Act, as
proposed by this bill, is erroneous and unnecessary.
5)PREVIOUS LEGISLATION . AB 3000 (Wolk), Chapter 266, Statutes
of 2008, establishes the POLST form which directs a health
care provider as to the resuscitative and life-sustaining
measures selected by a patient concerning the end of life, and
requires health care providers to treat individuals in
accordance with their POLST, across all health care settings.
6)DOUBLE-REFERRAL . This bill is double referred, should it pass
out of this Committee, it will be referred to the Assembly
Business, Professions & Consumer Protection Committee.
7)AUTHOR'S AMENDMENTS . Pursuant to the recommendation of the
Committee, the author has agreed to amend this bill to delete
provisions making it unprofessional conduct for a nurse to
refuse to perform CPR in an emergency situation.
8)SUGGESTED AMENDMENTS . Committee staff recommends that this
bill be amended to clarify the intent of the author, as
follows:
It is unlawful for a long-term health care facility,
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as defined in Section 1418, community care facility,
as defined in Section 1502, adult day health care
centers, as defined in Section 1570.7 or residential
care for the elderly as defined in Section 1569.2 to
have a policy that prohibits any employee from
administering cardiopulmonary resuscitation.
The policy specified in this section does not apply
if there is a "Do not resuscitate" or Physician
Orders for Life Sustaining Treatment forms, as
defined in Section 4780 of the Probate Code, or an
advance health care directive that prohibits
resuscitation, as specified in Section 4670 et seq.,
in effect for the person upon whom the resuscitation
would otherwise be performed.
REGISTERED SUPPORT / OPPOSITION :
Support
California Advocates for Nursing Home Reform
Opposition
California Nurses Association
Analysis Prepared by : Rosielyn Pulmano / HEALTH / (916)
319-2097