What's happening
This bill expands authority for do-not-resuscitate (DNR) and life-sustaining treatment orders to include nurse practitioners and physician assistants, not just physicians.
Why it matters
Increases access to end-of-life medical decisions. By allowing nurse practitioners and physician assistants to issue and manage DNR and life-sustaining treatment orders, patients—especially in underserved or rural areas—may get more timely and accessible care, as these providers are often more available than physicians.
Modernizes scope of practice and care teams. The bill recognizes the evolving roles of nurse practitioners and physician assistants in healthcare, aligning legal authority with current clinical practice and advanced training, which may improve team-based care and patient outcomes.
Could reduce delays in critical decision-making. Expanding authority to more providers can help avoid bureaucratic or logistical delays in implementing DNR or life-sustaining treatment orders, potentially respecting patient wishes more efficiently during emergencies or hospital transfers.
May impact institutional policies and training. Hospitals and care facilities will need to update protocols, documentation, and training to ensure nurse practitioners and physician assistants are integrated into these sensitive processes, possibly requiring new education for staff and changes in how disputes are mediated or orders reviewed.
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Who cares
Headline styles
Let Physician Assistants Sign DNRs
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Signed chap.708
- Delivered to governor
- Returned to senate
- Passed assembly
- Ordered to third reading rules cal.235
- Substituted for A1162A
- Referred to codes
- Delivered to assembly
- Passed senateVote 55–6
- Advanced to third reading
- 2nd report cal.
- 1st report cal.541
Show 1 earlier action
- 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
Assembly Floor Calendar · Sponsor Richard Gottfried
Full text
26 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
4841
2019-2020 Regular Sessions
IN SENATE
March 27, 2019
Introduced by Sen. RIVERA -- read twice and ordered printed, and when printed to be committed to the Committee on Health
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.
LBD03858-04-9
S. 4841 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
S. 4841 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
S. 4841 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
S. 4841 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.
Sponsor's memo
Title of bill
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
Purpose
This bill would add physician assistants to the list of health care professionals authorized to act in relation to orders pertaining to life sustaining treatments and orders not to resuscitate and to make capacity determinations for purposes of witnessing and implementing health care proxies.
Summary of provisions
The bill amends the Public Health Law to authorize a physician assistant to act in relation to orders pertaining to life sustaining treatments and orders not to resuscitate, as well as to make capacity determi- nations for purposes of witnessing and implementing health care proxies, in cases when the physician assistant has primary responsibility for the treatment and care of the patient and is acting within his or her scope of practice. Rather than repeating each of the three provider types (physician, nurse practitioner, and physician assistant) throughout the law, the bill creates a definition of "attending practitioner" that covers the physician, NP, or PA with such responsibility. This bill will take effect 180 days after it becomes law.
Read the full memo (721 words)
Existing law
Prior to 2017, only attending physicians were authorized to take actions in relation to orders pertaining to life sustaining treatments and orders not to resuscitate on behalf of patients and families. Chapter 430 of 2017 added attending nurse practitioners to existing references to physicians.
Prior to 2018, only attending physicians were involved in making deter- minations of capacity for purposes of executing health care proxies. Chapter 342 of 2018 added attending nurse practitioners to existing references to physicians.
Justification
New York law has extensive provisions for health care decision-making for patients who do not have decision-making capacity. An adult who has capacity can sign a "health care proxy" form to designate a "health care agent" to make health care decisions if and when the person loses capac- ity. Where a patient without capacity has not designated a health care agent, the law provides a mechanism for a family member to make deci- sions. The law provides guidelines, especially relating to withdrawal of life-sustaining treatment or a do-not-resuscitate order. These laws provide for various findings and actions to be made by the patient's attending physician.
Chapter 430 of 2017 added attending nurse practitioners to those author- ized to act under those laws. "Attending nurse practitioner" is defined as a nurse practitioner "selected by or assigned to a patient in a hospital who have primary responsibility for the treatment and care of the patient." The 2017 law reflected recognition that nurse practition- ers possess the knowledge, training and legal scope of practice neces- sary to competently act in relation to these orders. NPs and PAs often serve as the patient's primary treatment provider, so an NP or PA rather than the physician may be the provider with the strongest trusting relationship with a patient and his or her family.
Chapter 342 of 2018 then built on the 2017 chapter, recognizing that professionals taking actions relating to life-sustaining treatments and orders not to resuscitate should similarly be authorized to make deter- minations of capacity relating to health care proxies.
For nearly half a century under New York Law, PAs have had the legal authority to perform any clinical service a physician may, when acting under a physician's supervision. They possess the knowledge, training, and patient relationships to act in relation to these orders for the benefit of patients. Like NPs, they are increasingly serving patients as primary providers and often spend more time with patients and their families than physicians. This is especially true in rural communities and longterm care settings.
Patients and their families should not be limited in making decisions relating to life sustaining treatment or DNR orders on the basis of whether they primarily use a physician, NP, or PA. Given the deeply personal nature of the decision to refuse possible life-sustaining treatment, it is imperative that patients and their families have the opportunity to make these decisions in consultation with their trusted health care provider of choice.
Legislative history
New Bill
Fiscal implications
None
Local fiscal implications
None
Effective date
180 days after it shall have become a law
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.