The purpose of this subchapter is to affirm the right of all competent adults to control decisions relating to their own health care and to have their rights and intentions in health care matters respected and implemented by others if they become incapable of making or communicating decisions for themselves.
§ 21–2202. Definitions.
For the purposes of this subchapter, the term:
(1) “Attorney in fact” means the person who receives the power of attorney for health-care decisions pursuant to the provisions of this subchapter.
(1A) “Close friend” means any adult who has exhibited significant care and concern for the patient, and has maintained regular contact with the patient so as to be familiar with his or her activities, health, and religious and moral beliefs.
(2) “District” means the District of Columbia.
(2A) “Domestic partner” means an adult person living with, but not married to, another adult person in a committed, intimate relationship. The term “domestic partner” shall include any adult who has registered as a domestic partner under the Health Care Benefits Expansion Act of 1992, effective June 11, 1992 (D.C. Law 9-114; D.C. Official Code § 32-701 et seq.), as well as any adult who has registered as a domestic partner in a substantially equivalent program administered by another jurisdiction.
(2B) “Domestic partnership” means 2 adult persons living together, but not married, in a committed, intimate relationship. The term “domestic partnership” shall include any relationship registered under § 32-701(4), as well as any relationship in another jurisdiction that includes a substantially equivalent registration requirement, including those relationships recognized under § 32-702(i).
(3) “Durable power of attorney for health care” means a legally enforceable document that:
(A) Is executed in the District in a manner consistent with this subchapter or validly executed in another jurisdiction pursuant to similar provisions of the law of that jurisdiction; and
(B) Creates a power of attorney for health-care decisions, which is effective upon, and only during incapacitation and is unaffected by the subsequent disability or incapacity of the principal as defined in this subchapter.
(4) “Health-care provider” means any person or organizational entity, including health care facilities as defined in § 44-501, licensed or otherwise authorized to provide health-care services in the District.
(5) “Incapacitated individual” means an adult individual who lacks sufficient mental capacity to appreciate the nature and implications of a health-care decision, make a choice regarding the alternatives presented or communicate that choice in an unambiguous manner.
(5A) “Member of a religious order or diocesan priest” means an unmarried adult who, by vow or other bond of commitment, voluntarily undertakes a style of living under the rule and direction of a religious order or community that has been established for religious purposes and has been recognized and approved as a religious order or community by a church.
(6) “Principal” means a person who is competent to make health-care decisions for his or her own benefit or on his or her own account.
(6A) “Qualified psychologist” means a person who is licensed pursuant to § 3-1205.01 and has:
(A) One year of formal training within a hospital setting; or
(B) Two years of supervised clinical experience in an organized health-care setting, one year of which must be post-doctoral.
(7) “Religious superior” means a bishop or a member of a religious order who, under the approved constitution, laws, statutes, bylaws, or rules of the religious order or community, exercises authority over the particular community or unit of the religious order to which the member of the religious order or community belongs.
§ 21–2203. Presumption of capacity.
An individual shall be presumed capable of making health-care decisions unless certified otherwise under § 21-2204. Mental incapacity to make a health-care decision shall not be inferred from the fact that an individual:
(1) Has been voluntarily or involuntarily hospitalized for mental illness pursuant to § 21-501 et seq.;
(2) Has a diagnosis of an intellectual disability or has been determined by a court to be incompetent to refuse commitment under § 7-1301.01 et seq.; or
(3) Has a conservator or guardian appointed pursuant to § 21-1501 et seq. [repealed] or § 21-2001 et seq.
§ 21–2204. Certification of incapacity.
(a) Mental incapacity to make a health-care decision shall be certified by 2 professionals who are licensed to practice in the District and qualified to make a determination of mental incapacity. One of the 2 certifying professionals shall be a physician and one shall be a qualified psychologist or psychiatrist. At least 1 of the 2 certifying professionals shall examine the individual in question within 1 day preceding certification. Both certifying professionals shall give an opinion regarding the cause and nature of the mental incapacity as well as its extent and probable duration.
(b) All professional findings and opinions forming the basis of certification under subsection (a) of this section shall be expressed in writing, included in the patient-care records of the individual, and provide clear evidence that the person is incapable of understanding the health-care choice, making a decision concerning the particular treatment or services in question, or communicating a decision even if capable of making it.
(c) Certification of incapacity under this section shall be limited in its effect to the capacity to make health-care decisions and shall not be construed as a finding of incompetency for any other purpose.
§ 21–2205. Durable power of attorney for health care.
(a) A competent adult may designate, in writing, an individual who shall be empowered to make health-care decisions on behalf of the competent adult, if the competent adult becomes incapable, by reason of mental disability, of making or communicating a choice regarding a particular health-care decision.
(b) A durable power of attorney for health care shall include language which clearly communicates that the principal intends the attorney in fact to have the authority to make health-care decisions on behalf of the principal and shall include language identical or substantially similar to the following:
(1) “This power of attorney shall not be affected by the subsequent incapacity of the principal.” ; or
(2) “This power of attorney becomes effective upon the incapacity of the principal.”
(c) A durable power of attorney for health care shall be dated and signed by the principal and 2 adult witnesses who affirm that the principal was of sound mind and free from duress at the time of signing. The 2 adult witnesses shall not include the principal, the health-care provider of the principal or an employee of the health-care provider of the principal.
(d) Of the 2 adult witnesses referred to in subsection (c) of this section, at least 1 shall not be related to the principal by blood, marriage or adoption and shall not be entitled to any part of the estate of the principal by a current will or operation of law.
(e) Any durable power of attorney for health care executed prior to March 16, 1989, and specifically written to include health-care decision making after incompetency shall be effective, if the execution of the prior document meets the requirements of this subchapter.
§ 21–2206. Rights and duties of attorney in fact.
(a) Subject to any express limitations in the durable power of attorney for health care, an attorney in fact shall have all the rights, powers and authority related to health-care decisions that the principal would have under District and federal law. This authority shall include, at a minimum:
(1) The authority to grant, refuse or withdraw consent to the provision of any health-care service, treatment, or procedure;
(2) The right to review the health care records of the principal;
(3) The right to be provided with all information necessary to make informed health-care decisions;
(4) The authority to select and discharge health-care professionals; and
(5) The authority to make decisions regarding admission to or discharge from health-care facilities and to take any lawful actions that may be necessary to carry out these decisions.
(b)(1) Except as provided in paragraph (2) of this subsection and unless a durable power of attorney for health care provides otherwise, the designated attorney in fact, if known to a health-care provider to be available and willing to make a particular health-care decision, shall have priority over any other person to act for the principal in all matters regarding health care.
(2) A designated attorney in fact shall not have the authority to make a particular health-care decision, if the principal is able to give or withhold informed consent with respect to that decision.
(c) In exercising authority under a durable power of attorney for health care, the attorney in fact shall have a duty to act in accordance with:
(1) The wishes of the principal as expressed in the durable power of attorney for health care; or
(2) The good faith belief of the attorney in fact as to the best interests of the principal, if the wishes of the principal are unknown and cannot be ascertained.
(d) Nothing in this subchapter shall affect any right that an attorney in fact may have, independent of the designation in a durable power of attorney for health care, to make or otherwise participate in health-care decisions on behalf of the principal.
§ 21–2207. Forms for creating a durable power of attorney for health care.
Any written form meeting the requirements of § 21-2205 may be used to create a durable power of attorney for health care. The following is offered as a sample form only and its inclusion in this section shall not be construed to preclude the use of alternative language:
INFORMATION ABOUT THIS DOCUMENT
“THIS IS AN IMPORTANT LEGAL DOCUMENT. BEFORE SIGNING THIS DOCUMENT, IT IS VITAL FOR YOU TO KNOW AND UNDERSTAND THESE FACTS:
“THIS DOCUMENT GIVES THE PERSON YOU NAME AS YOUR ATTORNEY IN FACT THE POWER TO MAKE HEALTH-CARE DECISIONS FOR YOU IF YOU CANNOT MAKE THE DECISIONS FOR YOURSELF.
“AFTER YOU HAVE SIGNED THIS DOCUMENT, YOU HAVE THE RIGHT TO MAKE HEALTH-CARE DECISIONS FOR YOURSELF IF YOU ARE MENTALLY COMPETENT TO DO SO. IN ADDITION, AFTER YOU HAVE SIGNED THIS DOCUMENT, NO TREATMENT MAY BE GIVEN TO YOU OR STOPPED OVER YOUR OBJECTION IF YOU ARE MENTALLY COMPETENT TO MAKE THAT DECISION.
“YOU MAY STATE IN THIS DOCUMENT ANY TYPE OF TREATMENT THAT YOU DO NOT DESIRE AND ANY THAT YOU WANT TO MAKE SURE YOU RECEIVE.
“YOU HAVE THE RIGHT TO TAKE AWAY THE AUTHORITY OF YOUR ATTORNEY IN FACT, UNLESS YOU HAVE BEEN ADJUDICATED INCOMPETENT, BY NOTIFYING YOUR ATTORNEY IN FACT OR HEALTH-CARE PROVIDER EITHER ORALLY OR IN WRITING. SHOULD YOU REVOKE THE AUTHORITY OF YOUR ATTORNEY IN FACT, IT IS ADVISABLE TO REVOKE IN WRITING AND TO PLACE COPIES OF THE REVOCATION WHEREVER THIS DOCUMENT IS LOCATED.
“IF THERE IS ANYTHING IN THIS DOCUMENT THAT YOU DO NOT UNDERSTAND, YOU SHOULD ASK A SOCIAL WORKER, LAWYER, OR OTHER PERSON TO EXPLAIN IT TO YOU.
* * * * *
“YOU SHOULD KEEP A COPY OF THIS DOCUMENT AFTER YOU HAVE SIGNED IT. GIVE A COPY TO THE PERSON YOU NAME AS YOUR ATTORNEY IN FACT. IF YOU ARE IN A HEALTH-CARE FACILITY, A COPY OF THIS DOCUMENT SHOULD BE INCLUDED IN YOUR MEDICAL RECORD.
POWER OF ATTORNEY FOR HEALTH CARE
“I, _________________________, hereby appoint:
_______________
name home address
_______________
home telephone number
_______________
work telephone number
as my attorney in fact to make health-care decisions for me if I become unable to make my own health-care decisions. This gives my attorney in fact the power to grant, refuse, or withdraw consent on my behalf for any health-care service, treatment or procedure. My attorney in fact also has the authority to talk to health-care personnel, get information and sign forms necessary to carry out these decisions.
“If the person named as my attorney in fact is not available or is unable to act as my attorney in fact, I appoint the following person to serve in the order listed below:
1. _______________
name home address
_______________
home telephone number
_______________
work telephone number
2. _______________
name home address
_______________
home telephone number
_______________
work telephone number
“With this document, I intend to create a power of attorney for health care, which shall take effect if I become incapable of making my own health-care decisions and shall continue during that incapacity.
“My attorney in fact shall make health-care decisions as I direct below or as I make known to my attorney in fact in some other way.
“(a) STATEMENT OF DIRECTIVES CONCERNING LIFE-PROLONGING CARE, TREATMENT, SERVICES, AND PROCEDURES:
“(b) SPECIAL PROVISIONS AND LIMITATIONS:
“BY MY SIGNATURE I INDICATE THAT I UNDERSTAND THE PURPOSE AND EFFECT OF THIS DOCUMENT.
“I sign my name to this form on
(date)
at:
(address).
(Signature)
WITNESSES
“I declare that the person who signed or acknowledged this document is personally known to me, that the person signed or acknowledged this durable power of attorney for health care in my presence, and that the person appears to be of sound mind and under no duress, fraud, or undue influence. I am not the person appointed as the attorney in fact by this document, nor am I the health-care provider of the principal or an employee of the health-care provider of the principal.
First Witness
Signature:
Home Address:
Print Name:
Date:
Second Witness
Signature:
Home Address:
Print Name:
Date:
(AT LEAST 1 OF THE WITNESSES LISTED ABOVE SHALL ALSO SIGN THE FOLLOWING DECLARATION.)
“I further declare that I am not related to the principal by blood, marriage or adoption, and, to the best of my knowledge, I am not entitled to any part of the estate of the principal under a currently existing will or by operation of law.
Signature: ________________
Signature: ________________.”
§ 21–2208. Revocation.
(a) At any time that the principal has the capacity to create a durable power of attorney for health care, the principal may:
(1) Revoke the appointment of the attorney in fact under a durable power of attorney for health care by notifying the attorney in fact orally or in writing; or
(2) Revoke the authority to make health-care decisions granted to the attorney in fact under a durable power of attorney for health care by notifying the health-care provider orally or in writing.
(b) If a health-care provider is notified of a revocation pursuant to subsection (a)(2) of this section, the health-care provider shall document this fact in the patient-care records of the principal and make a reasonable effort to notify the attorney in fact of the revocation.
(c) There shall be a rebuttable presumption, affecting the burden of proof, that a principal has the capacity to revoke a durable power of attorney for health care.
(d) Unless it expressly provides otherwise, a valid durable power of attorney for health care revokes any prior durable power of attorney for health-care decisions only.
(e) Unless a durable power of attorney for health care expressly provides otherwise, and after its execution the marriage or domestic partnership of the principal is dissolved, annulled, or terminated in accordance with § 32-702(d), or § 16-904(e), the dissolution, annulment, or termination shall automatically revoke a designation of the former spouse or domestic partner as an attorney in fact to make health-care decisions for the principal. If a designation is revoked solely on account of this subsection, it shall be revived by the remarriage of the principal to the former spouse, or the reentry of the domestic partnership of the principal to the domestic partner, but may be subsequently revoked by an act of the principal.
§ 21–2209. Health-care provider limitation.
(a) No health-care provider may require an individual to execute a durable power of attorney for health care as a condition for the provision of health-care services or admission to a health-care facility, as defined in § 44-501.
(b) After an individual has spent at least 48 hours in a health care facility, a health care provider may request the individual to execute a durable power of attorney for health care subject to the limitations set forth in this subchapter. The health care provider may not be named as the attorney in fact.
§ 21–2210. Substituted consent.
(a) In the absence of a durable power of attorney for health care and provided that the incapacity of the principal has been certified in accordance with § 21-2204, the following individuals, in the order of priority set forth below, shall be authorized to grant, refuse or withdraw consent on behalf of the patient with respect to the provision of any health-care service, treatment, or procedure:
(1) A court-appointed guardian or conservator of the patient, if the consent is within the scope of the guardianship or conservatorship;
(1A) A court-appointed intellectual disability advocate of the patient, if the ability to grant, refuse, or withdraw consent is within the scope of the advocate’s appointment under section 7-1304.13.
(2) The spouse or domestic partner of the patient;
(3) An adult child of the patient;
(4) A parent of the patient;
(5) An adult sibling of the patient;
(5A) A religious superior of the patient, if the patient is a member of a religious order or a diocesan priest;
(5B) A close friend of the patient; or
(6) The nearest living relative of the patient.
(b) A decision to grant, refuse or withdraw consent made pursuant to subsection (a) of this section shall be based on the known wishes of the patient or, if the wishes of the patient are unknown and cannot be ascertained, on a good faith belief as to the best interests of the patient.
(c) There shall be at least 1 witness present whenever a person specified in subsection (a)(2) through (6) of this section grants, refuses or withdraws consent on behalf of the patient.
(d) If no individual in a prior class is reasonably available, mentally capable and willing to act, responsibility for decisionmaking shall rest with the next reasonably available, mentally capable, and willing person on the priority list.
(e) Any person listed in subsection (a) of this section shall have legal standing to challenge in the Superior Court of the District of Columbia any decision made by a person of higher priority as listed within that subsection.
(f) The order of priority established in subsection (a) of this section creates a presumption that may be rebutted if a person of lower priority is found to have better knowledge of the wishes of the patient, or, if the wishes of the patient are unknown and cannot be ascertained, is better able to demonstrate a good-faith belief as to the interests of the patient.
(g) An individual identified in subsection (a)(5B) of this section shall not be authorized to grant, refuse, or withdraw consent on behalf of the patient with respect to a decision regarding a health-care service, treatment, or procedure if the individual is:
(1) A health-care provider who is treating or providing services to the incapacitated patient at the time of the health-care decision; or
(2) An owner, operator, administrator, or employee of, or a person with decision-making authority for, a health-care provider treating or providing services to the incapacitated patient at the time of the health-care decision.
(h) If no person listed in subsection (a) of this section is reasonably available, mentally capable, and willing to act, the health-care provider, or the District of Columbia, for those persons committed to receive habilitation or other services pursuant to Chapter 13 of Title 7, or any interested person may petition the Superior Court of the District of Columbia for appointment of a guardian pursuant to section 21-2044 or section 21-2046.
(i) The health-care provider who is treating or providing services to the incapacitated patient at the time of the health-care decision shall accept the decision of the individual authorized under this section to grant, refuse, or withdraw consent on behalf of the patient as the decision of the principal.
§ 21–2211. Limitations.
No person authorized to act pursuant to § 21-2210 shall have the power:
(1) To consent to an abortion, sterilization or psycho-surgery, unless authorized by a court; or
(2) To consent to convulsive therapy or behavior modification programs involving aversive stimuli, unless authorized by a court.
§ 21–2212. Effect of subchapter.
(a) Nothing in this subchapter shall be construed to condone, authorize, or approve mercy-killing or to permit any affirmative or deliberate act to end a human life other than to permit the natural dying process.
(b) Nothing in this subchapter shall be construed to conflict with or supersede, the Emergency Medical Treatment and Labor Act, approved April 17, 1986 (100 Stat. 164; 42 U.S.C. § 1395dd).
(c) Emergency health care may be provided without consent to a patient who is certified incapacitated under § 21-2204, if no authorized person is reasonably available or if, in the reasonable medical judgment of the attending physician, attempting to locate an authorized person would cause:
(1) A substantial risk of death;
(2) The health of the incapacitated individual to be placed in serious jeopardy;
(3) Serious impairment to the incapacitated individual’s bodily functions; or
(4) Serious dysfunction of any bodily organ or part of the incapacitated individual.
§ 21–2213. Construction.
This subchapter shall be liberally construed and applied to promote its underlying purposes and policies.
(1) "Advanced life support" means endotracheal intubation, defibrillation, or administration of cardiopulmonary resuscitation medications.
(2) "Advanced practice nurse" means a licensed registered nurse engaged in the practice of advanced practice registered nursing, as defined in § 3-1201.02(2)[].
(3) "Authorized representative" means a person who is authorized to make a health-care decision on behalf of an incapacitated individual or minor in accordance with § 21-2205 and § 21-2210.
(4) "Authorized health care professional" means a licensed physician or advanced practice nurse who has responsibility for the medical care of a patient.
(5) "Cardiopulmonary resuscitation" means chest compression or artificial ventilation.
(6) "DOH" means the Department of Health.
(7) "Emergency medical service" or "EMS" means a medical service provided in response to a person's need for immediate medical care and is intended to prevent loss of life, the aggravation of a physiological illness or injury, or the aggravation of a psychological illness. The term "emergency medical service" or "EMS" includes any service recognized in the District as first response, basic life support, advanced life support, specialized life support, patient transportation, medical control, or rescue.
(8) "EMS agency" means a government department or agency, person, firm, corporation, or organization authorized to provide emergency medical service.
(9) "EMS personnel" means an emergency medical responder, emergency medical technician, emergency medical technician/intermediate, advanced emergency medical technician, or paramedic who is certified to provide emergency medical services in the District.
(10) "Health care institution" means a hospital, maternity center, nursing home, community residence facility, group home for persons with intellectual disabilities, hospice, home care agency, ambulatory surgical facility, or renal dialysis facility, as those terms are defined in § 44-501, or an acute care hospital, skilled nursing facility, or long term care facility.
(11) "Health care professional" means a person who has graduated from an accredited program for physicians, registered nurses, advanced practice nurses, physician assistants, clinical social workers, clinical psychologists, or professional counselors, and is licensed to practice in the District.
(12) "Incapacitated individual" shall have the same meaning as provided in § 21-2202(5).
(13) "Minor" means a person who is less than 18 years of age.
(14) "Medical Orders for Scope of Treatment Form" or "MOST Form" means a set of portable, medical orders on a form issued by DOH that results from a patient's or a patient's authorized representative's informed decision-making with a health care professional.
(15) "Patient" means a person who has been determined by an authorized health care professional to be approaching the end stage of a serious, life-limiting illness or frailty such that the person's life expectancy is 12 months or less.
(16) "Resuscitate" means the administration of cardiopulmonary resuscitation or advanced life support.
§ 21–2221.02. Creation of a MOST Form.
(a)(1) Within 9 months after February 27, 2016, DOH shall develop, and make available online, a MOST Form and instructions for health care institutions, health care professionals, and patients and authorized representatives completing and using the MOST Form.
(2) DOH shall evaluate the design and use of a MOST Form, including compliance or non-compliance with a MOST Form by EMS personnel and health care professionals, at least every 3 years.
(b)(1) DOH shall require, and provide for, ongoing training of health care professionals and EMS personnel about best practices regarding the use of a MOST Form.
(2) The training shall include, at a minimum:
(A) The importance of talking to each patient or the patient's authorized representative about the patient's prognosis, the likely course of illness, and personal goals of care;
(B) Methods for presenting choices for care that elicit information concerning each patient's preferences and respecting those preferences without directing patients toward a particular care option;
(C) The importance of fully informing patients about the benefits and risks of an immediately effective MOST Form;
(D) Awareness of factors that may affect the use of a MOST Form, including race, ethnicity, age, gender, socioeconomic position, immigrant status, sexual orientation, language disability, homelessness, mental illness, and geographic area of residence; and
(E) Procedures for properly completing and effectuating a MOST Form.
§ 21–2221.03. MOST Advisory Committee.
(a)(1) DOH shall establish the MOST Advisory Committee.
(2) DOH shall appoint the 11 members of the MOST Advisory Committee. Except as provided in paragraph (3) of this subsection, members of the advisory committee shall be appointed for terms of 6 years.
(3) Of the members initially appointed under this section, 3 shall be appointed for a term of 2 years, 4 shall be appointed for a term of 4 years, and 4 shall be appointed for a term of 6 years. The terms of the members first appointed shall begin on the date that a majority of the first members are sworn in, which shall become the anniversary date for all subsequent appointments.
(4) The MOST Advisory Committee shall include:
(A) One representative from an EMS agency;
(B) One commercial EMS representative;
(C) One pediatric health care professional;
(D) Two physicians, advanced practice nurses, or other health care professionals involved in treating patients;
(E) One representative of a long-term care facility;
(F) One representative of a skilled nursing facility;
(G) One representative of an acute care hospital;
(H) Two representatives of a disability advocacy group; and
(I) One representative of a patient advocacy group.
(b) The MOST Advisory Committee shall:
(1) Assist DOH in the development and periodic review of the MOST Form;
(2) Promote public awareness about the option to complete a MOST Form;
(3) Provide recommendations to DOH for ongoing training of health care professionals and EMS personnel about best practices regarding the use of a MOST Form and the nature and development of related medical protocols; and
(4) Develop an electronic MOST Form pursuant to § 21-2221.14a.
§ 21–2221.04. MOST Form.
(a) The MOST Form shall be designed to provide the following information regarding the patient's care and medical condition:
(1) The orders of an authorized health care professional regarding cardiopulmonary resuscitation and level of medical intervention in accordance with the choices, goals, and preferences of a patient or the patient's authorized representative;
(2) The signature of the authorized health care professional;
(3) Whether the patient has an authorized representative;
(4) The signature of the patient or the authorized representative acknowledging agreement with the orders of the authorized health care professional; and
(5) The date and location of the initial authorization of the MOST Form and the date, location, and outcome of any subsequent revisions to the MOST Form.
(b) Upon execution, a hard copy of a patient's operative MOST Form shall be provided to the patient or the patient's authorized representative.
(c) An executed MOST Form shall be kept in a prominent manner in a patient's printed and electronic medical records in a health care institution or private medical practice, and a copy shall be transferred with the patient whenever the patient is transferred to another health care institution or private medical practice, or to the patient's residence.
(d) A copy of a MOST Form shall be as effective as an original.
§ 21–2221.05. Completion and execution of the MOST Form.
(a) A patient shall be given the option to complete a MOST Form, but no patient shall be required to complete or execute a MOST Form.
(b)(1) Only an authorized health care professional treating a patient may complete a MOST Form for that patient.
(2) The authorized health care professional shall complete the MOST Form in accordance with the instructions of the patient or the patient's authorized representative.
(c)(1) Only the following persons may execute a MOST Form:
(A) Any patient who is 18 years of age or older, on behalf of himself or herself; or
(B) An authorized representative.
(2) Execution of a MOST Form shall be evidenced by the patient's or the authorized representative's signature.
(d) The MOST Form shall be reviewed by an authorized health care professional with the patient or with the patient's authorized representative at least once per year and:
(1) Whenever the patient's condition changes significantly; or
(2) At the patient's or the patient's authorized representative's request.
(e)(1) If a patient with a MOST Form is transferred from one health care institution to another, the health care institution transferring the patient shall communicate the existence of the MOST Form to the receiving health care institution before the transfer.
(2) The MOST Form shall accompany the patient to the receiving health care institution and remain in effect.
(3) Within 72 hours after a patient is transferred, the MOST Form shall be reviewed by an authorized health care professional and the patient, provided that the patient is not incapacitated, or the patient's authorized representative, if present.
§ 21–2221.06. Revocation of a MOST Form.
(a) A patient or the patient's authorized representative may revoke a MOST Form at any time by:
(1) Directing the authorized health care professional who issued the MOST Form to cancel the MOST Form; or
(2) Communicating the patient's or the patient's authorized representative's intent to revoke the MOST Form to the treating EMS personnel or health care professional.
(b) If a patient or the patient's authorized representative revokes a MOST Form pursuant to subsection (a)(2) of this section, the treating EMS personnel or health care professional shall record the circumstances in which the MOST Form was revoked.
§ 21–2221.07. Compliance with a MOST Form.
(a)(1) If an EMS personnel or health care professional encounters a person who is in possession of a MOST Form, the EMS personnel or health care professional shall determine whether the person is the subject of the MOST Form and whether the MOST Form has been revoked.
(2) If there is uncertainty as to whether the MOST Form has been revoked, the EMS personnel or health care professional shall act as if there were no MOST Form and resuscitate the patient.
(b) If an EMS personnel or health care professional encounters a patient in an emergency medical circumstance with a MOST Form that is unreadable, the EMS personnel or health care professional shall proceed as if there were no MOST Form.
(c) If the EMS personnel does not resuscitate the patient on the basis of applicable treatment instructions on a MOST Form, EMS personnel shall record the do-not-resuscitate response in the run report and report the do-not-resuscitate response to DOH within 5 business days after the incident.
(d) On a biannual basis, DOH shall provide the Mayor with data on do-not-resuscitate responses.
§ 21–2221.08. Comfort care.
Regardless of the treatment orders on the MOST Form, EMS personnel and other health care professionals may provide the following interventions, as needed, to a patient for comfort or to alleviate pain:
(1) Clear the airway, without the use of artificial ventilation, esophageal obturator airway, or endotracheal intubation;
(2) Administer suction;
(3) Provide oxygen, without the use of artificial ventilation, esophageal obturator airway, or endotracheal intubation;
(4) Provide pain medication;
(5) Control bleeding; or
(6) Make any other necessary adjustments.
§ 21–2221.09. Reciprocity.
EMS personnel and other health care professionals shall recognize a MOST Form or similar instrument executed in another state as if the instrument were executed in accordance with the laws of that state.
§ 21–2221.10. Relationship with other legal documents.
If a patient has a durable power of attorney for health care under subchapter I [of the chapter], or a comparable statute in any other jurisdiction, or another legal document with a substantially equivalent purpose to a durable power of attorney or a MOST Form, the most recent document to have been executed shall govern if any conflict exists between the directives in that legal document and the directives in the patient's MOST Form.
§ 21–2221.11. Liability.
This subchapter shall not be construed to create a private right of action, including a private right of action based on the failure [to] act in accordance with a MOST Form if the failure to act is based solely on religious beliefs.
§ 21–2221.12. Penalties.
(a) A person who, without authorization by the patient or the patient's authorized representative, willfully alters, forges, conceals, or destroys a MOST Form, an amendment or revocation of a MOST Form, or any other evidence or document reflecting the patient's desires and interests, with the intent or effect of causing a withholding or withdrawal of life-sustaining procedures or of artificially administered nutrition and hydration that hastens the death of the patient commits a Class A felony.
(b) Except as provided in subsection (a) of this section, a person who, without authorization by the patient or the patient's authorized representative, willfully alters, forges, conceals, or destroys a MOST Form, an amendment or revocation of a MOST Form, or any other evidence or document reflecting the patient's desires and interests, with the intent or effect of impacting any decision regarding the provision of a health care service, treatment, or procedure shall be fined not more than the amount set forth in § 22-3571.01, or imprisoned for not more than 180 days, or both.
§ 21–2221.13. Insurance.
(a) The execution of a MOST Form shall not alter an insurance policy or annuity contract, unless the insurance policy or contract states otherwise.
(b) Adherence to the medical orders in a MOST form shall not constitute suicide or assisted suicide.
(c) The execution of a MOST form cannot be used as a condition for being insured, receiving health care services, or receiving other employment benefits.
§ 21–2221.14. Study of electronic registry. [Repealed]
[Repealed].
§ 21–2221.14a. Establishment of an electronic medical orders for scope of treatment registry.
(a) To facilitate the use of cloud-based technology for electronic Medical Orders for Scope of Treatment ("MOST") Forms, the DOH shall issue a request for proposals from and contract with an electronic MOST service or multiple electronic MOST services to connect with health care providers at the point of care through the State-designated health information exchange.
(b) A MOST registry shall:
(1) Be approved by the MOST Advisory Committee established pursuant to [§ 21-2221.03];
(2) Meet the technology, security, and privacy standards set by the MOST Advisory Committee; and
(3) Allow for the authentication of a declarant's identify for a MOST form that is not witnessed.
(c) DOH shall carry out appropriate education and outreach efforts to increase public awareness of an electronic MOST service.
(1) "After-care" means any type of assistance that is not regulated under Chapter 12 of Title 3, or similar law, and that is provided by a lay caregiver to a patient after the patient's discharge and is limited to the patient's condition at the time of discharge.
(2) "Authorized representative" means a person who is authorized to make a health-care decision on behalf of an incapacitated individual or minor in accordance with §§ 21-2205 and 21-2210.
(3) "Discharge" means a patient's exit and release from a hospital to the patient's residence following an inpatient admission.
(4) "Hospital" shall have the same meaning as provided in § 44-501(a)(1).
(5) "Lay caregiver" means an individual who is designated by the patient or authorized representative to provide after-care to the patient at the patient's residence and accepts the role as the patient's lay caregiver.
(6) "Residence" means a dwelling that the patient considers to be the patient's home and does not include a rehabilitation facility, hospital, nursing home, assisted living facility, or group home licensed by the Department of Health.
§ 21–2231.02. Lay caregiver designation.
(a) A hospital shall provide each patient or authorized representative an opportunity to designate a lay caregiver as soon as practicable following the patient's inpatient admission into a hospital and before the patient's discharge.
(b)(1) If the patient or authorized representative designates an individual as a lay caregiver, the hospital shall:
(A) Provide notice to the lay caregiver as soon as practicable following the designation and before the patient's discharge;
(B) Promptly request the written consent of the patient or authorized representative to release medical information to the patient's lay caregiver in accordance with the hospital's procedures for releasing personal health information and in compliance with all federal and District laws, including the Health Insurance Portability and Accountability Act of 1996, approved August 21, 1996 (Pub. L. No. 104-191; 110 Stat. 1936);
(C) Record the patient's or authorized representative's designation of the lay caregiver, the relationship of the lay caregiver to the patient, and the name, telephone number, and address of the lay caregiver in the patient's medical record; and
(D) Notify the lay caregiver of the patient's discharge to the patient's residence as soon as practicable; provided, that if the hospital is unable to contact the lay caregiver, the hospital shall document that in the patient's medical record as soon as practicable.
(2) If a patient or authorized representative fails to authorize the release of medical information to the lay caregiver under paragraph (1)(B) of this subsection, the hospital is deemed to have met the requirements of the subchapter and no further action is needed.
(3) A patient or authorized representative may elect to change the designation of a lay caregiver at any time before the patient's discharge; provided, that if a change is made, the hospital shall record that change in the patient's medical record as soon as practicable.
(4) The designation of a lay caregiver by the patient or authorized representative does not obligate the lay caregiver to accept the designation or provide after-care.
(5) A hospital is not obligated to determine the ability of a lay caregiver to understand or perform after-care tasks.
§ 21–2231.03. Hospital discharge plan.
(a) As soon as practicable before the patient's discharge, the hospital shall:
(1) Consult with the lay caregiver and the patient or authorized representative regarding the lay caregiver's capabilities and limitations;
(2) Provide a copy of the discharge plan to the lay caregiver;
(3) Consult with, and provide instruction to, the lay caregiver regarding the patient's discharge plan; and
(4) Provide contact information for any health care, community resources, and long-term care services and supports necessary to carry out the patient's discharge plan.
(b) At a minimum, the discharge plan described in subsection (a) of this section shall include:
(1) The name and contact information of the lay caregiver;
(2) A description of all after-care tasks necessary to maintain the patient's ability to reside in the patient's residence; and
(3) Contact information for any health care, community resources, and long-term care services and supports necessary to carry out the patient's discharge plan.
(c)(1) At a minimum, the instruction to the lay caregiver described in subsection (a) of this section shall include:
(A) An opportunity for a demonstration at the hospital of the after-care tasks; and
(B) An opportunity for the lay caregiver and the patient to ask questions and receive answers to questions about the after-care tasks; and
(2) The instruction provided shall be documented in the patient's medical record and shall include, at minimum, the date, time, and contents of the instruction.
§ 21–2231.04. Construction.
(a) Nothing in this subchapter shall be construed to delay the discharge of a patient or the transfer of a patient from a hospital to another facility, including the inability of the hospital to contact a designated lay caregiver;
(b) Nothing in this subchapter shall be construed to create a private right of action not otherwise existing in the law for compliance or non-compliance with this subchapter.
§ 21–2231.05. Rules.
The Mayor, pursuant to subchapter 1 of Chapter 5 of Title 2, may issue rules to implement the provisions of this subchapter.
