What's happening
This bill allows nurse practitioners and physician assistants, in addition to physicians, to execute and manage orders not to resuscitate and other life-sustaining treatment directives.
Why it matters
Expands access and flexibility for end-of-life care decisions. By allowing physician assistants (PAs) to issue and manage do-not-resuscitate (DNR) and life-sustaining treatment orders, the bill increases the pool of healthcare professionals who can respond to patient needs, which may reduce delays in critical decision-making, especially in hospitals and care facilities with limited physician or nurse practitioner availability.
Improves continuity and coordination of care. PAs often serve as primary providers or key members of care teams, particularly in underserved areas or at night and on weekends. Granting them this authority ensures patients’ wishes regarding resuscitation and life-sustaining treatments can be more consistently respected across shifts, settings, and transfers between facilities.
Addresses workforce and healthcare system realities. The change acknowledges the evolving role of PAs in modern healthcare, where they are increasingly relied upon for comprehensive patient management. This legal recognition can reduce administrative bottlenecks, improve workflow efficiency, and empower PAs to fully utilize their training and expertise in patient advocacy.
May impact patient, family, and surrogate experiences. Expanding who can execute these orders could make the process less stressful and more responsive for patients and families, who may have closer or more frequent contact with PAs than with physicians. It may also clarify roles and reduce confusion during emotionally charged situations, ultimately supporting patient autonomy and well-being.
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Who cares
Headline styles
Let Physician Assistants Sign DNRs
Plain English, a few words. Used as the page title.
Sponsors
1 Co-sponsor
History
- Substituted by S4841
- Ordered to third reading rules cal.235
- Rules report cal.235
- Reported
- Reported referred to rules
- Reported referred to codes
- Print number 1162a
- Amend and recommit to health
- Referred to health
Companion bill
The same bill in the other chamber. A bill becomes law when one version passes both houses and the governor signs it, so either number can carry it.
Let Physician Assistants Sign DNRs
Signed by Governor · Sponsor Gustavo Rivera
Full text
26 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
1162--A
2019-2020 Regular Sessions
IN ASSEMBLY
January 14, 2019
Introduced by M. of A. GOTTFRIED -- read once and referred to the Committee on Health -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee
AN ACT to amend the public health law, in relation to execution of orders not to resuscitate and orders pertaining to life sustaining treatments; and to repeal certain provisions of such law relating thereto
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Section 2960 of the public health law, as amended by chapter 430 of the laws of 2017, is amended to read as follows:
§ 2960. Legislative findings and purpose. The legislature finds that, although cardiopulmonary resuscitation has proved invaluable in the prevention of sudden, unexpected death, it is appropriate for an attending [physician or attending nurse] practitioner, in certain circumstances, to issue an order not to attempt cardiopulmonary resuscitation of a patient where appropriate consent has been obtained. The legislature further finds that there is a need to clarify and establish the rights and obligations of patients, their families, and health care providers regarding cardiopulmonary resuscitation and the issuance of orders not to resuscitate.
§ 2. Subdivisions 2, 5 and 20 of section 2961 of the public health law, as amended by chapter 430 of the laws of 2017, are amended to read as follows:
2. "Attending [physician] practitioner" means the physician, nurse practitioner, or physician assistant, licensed or certified pursuant to title eight of the education law, selected by or assigned to a patient in a hospital who has primary responsibility for the treatment and care of the patient. Where more than one physician [and/or], nurse practitioner, or physician assistant shares such responsibility, any such physician [or], nurse practitioner, or physician assistant may act as
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD03858-03-9
A. 1162--A 2
the attending [physician or attending nurse] practitioner pursuant to this article.
5. "Close friend" means any person, eighteen years of age or older, who is a close friend of the patient, or relative of the patient (other than a spouse, adult child, parent, brother or sister) who has maintained such regular contact with the patient as to be familiar with the patient's activities, health, and religious or moral beliefs and who presents a signed statement to that effect to the attending [physician or attending nurse] practitioner.
20. "Reasonably available" means that a person to be contacted can be contacted with diligent efforts by an attending [physician, attending nurse] practitioner or another person acting on behalf of the attending [physician, attending nurse] practitioner or the hospital.
§ 3. Subdivision 2-a of section 2961 of the public health law is REPEALED.
§ 4. Subdivisions 2 and 3 of section 2962 of the public health law, as amended by chapter 430 of the laws of 2017, are amended to read as follows:
2. It shall be lawful for the attending [physician or attending nurse] practitioner to issue an order not to resuscitate a patient, provided that the order has been issued pursuant to the requirements of this article. The order shall be included in writing in the patient's chart. An order not to resuscitate shall be effective upon issuance.
3. Before obtaining, pursuant to this article, the consent of the patient, or of the surrogate of the patient, or parent or legal guardian of the minor patient, to an order not to resuscitate, the attending [physician or attending nurse] practitioner shall provide to the person giving consent information about the patient's diagnosis and prognosis, the reasonably foreseeable risks and benefits of cardiopulmonary resuscitation for the patient, and the consequences of an order not to resuscitate.
§ 5. Section 2963 of the public health law, as amended by chapter 430 of the laws of 2017, is amended to read as follows:
§ 2963. Determination of capacity to make a decision regarding cardiopulmonary resuscitation. 1. Every adult shall be presumed to have the capacity to make a decision regarding cardiopulmonary resuscitation unless determined otherwise pursuant to this section or pursuant to a court order or unless a guardian is authorized to decide about health care for the adult pursuant to article eighty-one of the mental hygiene law or article seventeen-A of the surrogate's court procedure act. The attending [physician or attending nurse] practitioner shall not rely on the presumption stated in this subdivision if clinical indicia of incapacity are present.
2. A determination that an adult patient lacks capacity shall be made by the attending [physician or attending nurse] practitioner to a reasonable degree of medical certainty. The determination shall be made in writing and shall contain such attending [physician's or attending nurse] practitioner's opinion regarding the cause and nature of the patient's incapacity as well as its extent and probable duration. The determination shall be included in the patient's medical chart.
3. (a) At least one other physician, selected by a person authorized by the hospital to make such selection, must concur in the determination that an adult lacks capacity. The concurring determination shall be made in writing after personal examination of the patient and shall contain the physician's opinion regarding the cause and nature of the patient's
A. 1162--A 3
incapacity as well as its extent and probable duration. Each concurring determination shall be included in the patient's medical chart.
(b) If the attending [physician or attending nurse] practitioner determines that a patient lacks capacity because of mental illness, the concurring determination required by paragraph (a) of this subdivision shall be provided by a physician licensed to practice medicine in New York state, who is a diplomate or eligible to be certified by the American Board of Psychiatry and Neurology or who is certified by the American Osteopathic Board of Neurology and Psychiatry or is eligible to be certified by that board.
(c) If the attending [physician or attending nurse] practitioner determines that a patient lacks capacity because of a developmental disability, the concurring determination required by paragraph (a) of this subdivision shall be provided by a physician or psychologist employed by a developmental disabilities services office named in section 13.17 of the mental hygiene law, or who has been employed for a minimum of two years to render care and service in a facility operated or licensed by the office for people with developmental disabilities, or who has been approved by the commissioner of developmental disabilities in accordance with regulations promulgated by such commissioner. Such regulations shall require that a physician or psychologist possess specialized training or three years experience in treating developmental disabilities.
4. Notice of a determination that the patient lacks capacity shall promptly be given (a) to the patient, where there is any indication of the patient's ability to comprehend such notice, together with a copy of a statement prepared in accordance with section twenty-nine hundred seventy-eight of this article, and (b) to the person on the surrogate list highest in order of priority listed, when persons in prior subparagraphs are not reasonably available. Nothing in this subdivision shall preclude or require notice to more than one person on the surrogate list.
5. A determination that a patient lacks capacity to make a decision regarding an order not to resuscitate pursuant to this section shall not be construed as a finding that the patient lacks capacity for any other purpose.
§ 6. Subdivision 2 of section 2964 of the public health law, as amended by chapter 430 of the laws of 2017, is amended to read as follows:
2. (a) During hospitalization, an adult with capacity may express a decision consenting to an order not to resuscitate orally in the presence of at least two witnesses eighteen years of age or older, one of whom is a physician [or], nurse practitioner, or physician assistant affiliated with the hospital in which the patient is being treated. Any such decision shall be recorded in the patient's medical chart.
(b) Prior to or during hospitalization, an adult with capacity may express a decision consenting to an order not to resuscitate in writing, dated and signed in the presence of at least two witnesses eighteen years of age or older who shall sign the decision.
(c) An attending [physician or attending nurse] practitioner who is provided with or informed of a decision pursuant to this subdivision shall record or include the decision in the patient's medical chart if the decision has not been recorded or included, and either:
(i) promptly issue an order not to resuscitate the patient or issue an order at such time as the conditions, if any, specified in the decision
A. 1162--A 4
are met, and inform the hospital staff responsible for the patient's care of the order; or
(ii) promptly make his or her objection to the issuance of such an order and the reasons therefor known to the patient and either make all reasonable efforts to arrange for the transfer of the patient to another physician [or], nurse practitioner or physician assistant, if necessary, or promptly submit the matter to the dispute mediation system.
(d) Prior to issuing an order not to resuscitate a patient who has expressed a decision consenting to an order not to resuscitate under specified medical conditions, the attending [physician or attending nurse] practitioner must make a determination, to a reasonable degree of medical certainty, that such conditions exist, and include the determination in the patient's medical chart.
§ 7. Subdivisions 3 and 4 of section 2965 of the public health law, as amended by chapter 430 of the laws of 2017, are amended to read as follows:
3. (a) The surrogate shall make a decision regarding cardiopulmonary resuscitation on the basis of the adult patient's wishes including a consideration of the patient's religious and moral beliefs, or, if the patient's wishes are unknown and cannot be ascertained, on the basis of the patient's best interests.
(b) Notwithstanding any law to the contrary, the surrogate shall have the same right as the patient to receive medical information and medical records.
(c) A surrogate may consent to an order not to resuscitate on behalf of an adult patient only if there has been a determination by an attending [physician or attending nurse] practitioner with the concurrence of another physician [or], nurse practitioner or physician assistant selected by a person authorized by the hospital to make such selection, given after personal examination of the patient that, to a reasonable degree of medical certainty:
(i) the patient has a terminal condition; or
(ii) the patient is permanently unconscious; or
(iii) resuscitation would be medically futile; or
(iv) resuscitation would impose an extraordinary burden on the patient in light of the patient's medical condition and the expected outcome of resuscitation for the patient.
Each determination shall be included in the patient's medical chart.
4. (a) A surrogate shall express a decision consenting to an order not to resuscitate either (i) in writing, dated, and signed in the presence of one witness eighteen years of age or older who shall sign the decision, or (ii) orally, to two persons eighteen years of age or older, one of whom is a physician [or], nurse practitioner or physician assistant affiliated with the hospital in which the patient is being treated. Any such decision shall be recorded in the patient's medical chart.
(b) The attending [physician or attending nurse] practitioner who is provided with the decision of a surrogate shall include the decision in the patient's medical chart and, if the surrogate has consented to the issuance of an order not to resuscitate, shall either:
(i) promptly issue an order not to resuscitate the patient and inform the hospital staff responsible for the patient's care of the order; or
(ii) promptly make the attending [physician's or attending nurse] practitioner's objection to the issuance of such an order known to the surrogate and either make all reasonable efforts to arrange for the transfer of the patient to another physician [or], nurse practitioner or
A. 1162--A 5
physician assistant, if necessary, or promptly refer the matter to the dispute mediation system.
(c) If the attending [physician or attending nurse] practitioner has actual notice of opposition to a surrogate's consent to an order not to resuscitate by any person on the surrogate list, the physician [or], nurse practitioner or physician assistant shall submit the matter to the dispute mediation system and such order shall not be issued or shall be revoked in accordance with the provisions of subdivision three of section twenty-nine hundred seventy-two of this article.
§ 8. Section 2966 of the public health law, as amended by chapter 430 of the laws of 2017, is amended to read as follows:
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
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