§ 23-4.11-3.1. Medical orders for life sustaining treatment.
(a) The department of health shall establish rules and regulations, consistent with the
provisions of this section, for the establishment of Medical Orders for Life Sustaining
Treatment and the structure and content of Medical Orders for Life Sustaining Treatment
forms.
(b)(1) A declaration by a qualified patient may be recorded as a medical order for life-sustaining
treatment provided that:
(i) The medical orders for life-sustaining treatment and medical intervention and procedures
are explained by a MOLST qualified healthcare provider to the qualified patient or
healthcare decision maker. The MOLST qualified healthcare provider shall further inform
the patient of the difference between an advance healthcare directive and MOLST medical
order;
(ii) A MOLST qualified healthcare provider has conducted an evaluation of the qualified
patient; and
(iii) A MOLST form documenting the declaration has been completed by a MOLST qualified healthcare
provider based on qualified patient preferences and medical appropriateness, and has
been signed by a MOLST qualified healthcare provider and the qualified patient or
his or her recognized healthcare decision maker.
(2) A healthcare decision maker may execute the MOLST form if the qualified patient lacks
capacity, or if the qualified patient has designated that the healthcare decision
maker's authority is valid.
(3) A request regarding resuscitative measures may also be evidenced by the words "do
not resuscitate� or the letters "DNR,� in a qualified patient's medical record and/or
through a mechanism established by the department of health consistent with the provisions
of chapter 23-4.11.
(c)(1) A healthcare provider shall treat a qualified patient in accordance with the qualified
patient's MOLST, subject to the provisions of this chapter.
(2) A MOLST qualified healthcare provider may conduct an evaluation of the qualified patient
and if necessary, in consultation with the qualified patient or recognized healthcare
decision maker, issue a new MOLST consistent with the most current information available
about the qualified patient's health status and care preferences.
(3) The recognized healthcare decision maker of a qualified patient who is without capacity
shall consult with the MOLST qualified healthcare provider prior to making a request
to modify the qualified patient's MOLST.
(d)(1) MOLST Form. A MOLST shall be documented on an easily identifiable form approved by the director.
The director shall promulgate rules and regulations for the implementation of this
section.
(2) The MOLST form shall be signed by the qualified patient, or the qualified patient's
recognized healthcare decision maker, and a MOLST qualified healthcare provider.
(3) The MOLST form shall contain all other information as required by this section.
(e)(1) A MOLST shall apply regardless of whether the qualified patient executes the MOLST
form within or outside a hospital or other healthcare setting.
(2) The MOLST form is valid within or outside a hospital or other healthcare setting.
(f)(1) Revocation. A qualified patient or his/her recognized healthcare decision maker may, at any time,
revoke in any manner that communicates an intent to revoke his/her declaration by
informing the MOLST qualified healthcare providers, other healthcare providers, or
any member of the medical or nursing staff of the revocation of the declaration concerning
life-sustaining or resuscitative measures.
(2) Any member of the medical or nursing staff informed of a revocation shall immediately
notify a MOLST qualified healthcare provider of the revocation.
(3) The MOLST qualified healthcare provider informed of a revocation of MOLST made pursuant
to this section shall immediately:
(i) Record the revocation in the qualified patient's medical record;
(ii) Cancel any orders implementing the decision to withhold or withdraw treatment; and
(iii) Notify the healthcare providers and staff directly responsible for the qualified patient's
care of the revocation and any cancellations.
(4) If a decision to withhold or withdraw life-sustaining treatment has been made by a
recognized healthcare decision maker pursuant to this section, and the MOLST qualified
healthcare provider determines at any time that the decision is no longer appropriate
or authorized because the qualified patient has regained decision-making capacity
or because the qualified patient's condition has otherwise improved, the MOLST qualified
healthcare provider shall immediately:
(i) Include such determination in the qualified patient's medical record;
(ii) Cancel any orders or plans of care implementing the decision to withhold or withdraw
life-sustaining treatment;
(iii) Notify the healthcare decision maker who made the decision to withhold or withdraw
treatment; and
(iv) Notify the other healthcare providers, including the medical and nursing staff directly
responsible for the qualified patient's care, of any cancelled MOLST orders or plans
of care.
(g) If a qualified patient with a MOLST order is transferred from a hospital, a licensed
health facility, or the community, the MOLST order or plan shall remain effective
until a MOLST qualified healthcare provider first examines the transferred qualified
patient, whereupon a MOLST qualified healthcare provider shall issue appropriate orders
to continue the prior order or plan. Such orders may be issued without obtaining another
consent to withhold or withdraw life-sustaining treatment pursuant to this chapter.
(h) The MOLST is a voluntary option for qualified patients. No patient is required to elect a MOLST.