Honolulu, Hawaii



RE:    H.B. No. 2052

       H.D. 2

       S.D. 1




Honorable Donna Mercado Kim

President of the Senate

Twenty-Seventh State Legislature

Regular Session of 2014

State of Hawaii




     Your Committee on Health, to which was referred H.B. No. 2052, H.D. 2, entitled:




begs leave to report as follows:


     The purpose and intent of this measure is to:


     (1)  Increase access to provider orders for life-sustaining treatment by updating references from "physician orders for life-sustaining treatment" to "provider orders for life-sustaining treatment" throughout chapter 327K, Hawaii Revised Statutes;


     (2)  Expand health care provider signatory authority to include advanced practice registered nurses;


     (3)  Correct inconsistencies over terms used to describe who may sign a provider order for life-sustaining treatment form on behalf of a patient; and


     (4)  Require the Department of Health to adopt a sample form for provider orders for life-sustaining treatment.


     Your Committee received testimony in support of this measure from the Department of Health, Hawaii State Center for Nursing, Healthcare Association of Hawaii, Hospice Hawaii, Hawaii Island Family Residency, and four individuals.  Your Committee received testimony in opposition to this measure from the Executive Office on Aging and The Queen's Health Systems.  Your Committee received comments on this measure from Hawaii Pacific Health, Kokua Mau, Hawaii Medical Association, and one individual.


     Your Committee finds that the use of provider orders for life-sustaining treatment, commonly referred to as POLST, is a holistic method of planning for end-of-life care with a specific set of medical orders to ensure that patients' wishes are honored.  Your Committee further finds that expanding signatory authority to include advanced practice registered nurses will promote efficiency, assist with a timely completion of POLST forms for patients, and expand access to health care professionals who may sign POLST forms, which will be highly beneficial for individuals living in rural areas and neighbor islands.


     Your Committee has amended this measure by:


     (1)  Changing "legally authorized representative" to "legal representative";


     (2)  Adding an agent designated through a power of attorney for health care to the definition of a legal representative;


     (3)  Permitting a legal representative to execute a POLST form if the patient lacks capacity;


     (4)  Removing the requirement that a POLST form be signed by the patient's provider, in addition to the patient or the patient's legal representative;


     (5)  Removing the requirement that the Department of Health adopt a sample POLST form;


     (6)  Making the measure effective upon approval; and


     (7)  Making technical, nonsubstantive amendments for the purposes of clarity and consistency.


     As affirmed by the record of votes of the members of your Committee on Health that is attached to this report, your Committee is in accord with the intent and purpose of H.B. No. 2052, H.D. 2, as amended herein, and recommends that it pass Second Reading in the form attached hereto as H.B. No. 2052, H.D. 2, S.D. 1, and be referred to the Committee on Judiciary and Labor.


Respectfully submitted on behalf of the members of the Committee on Health,