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Daily Court Reporter - News Voluntary, non-opioid directive in medical treatment proposed


Voluntary, non-opioid directive in medical treatment proposed

KEITH ARNOLD, Daily Reporter Staff Writer

Shortly before adjourning for summer recess, lawmakers in the House of Representatives heard testimony in support of a plan to implement use of a voluntary, non-opioid directive in medical treatment of Ohioans.

House Bill 618 was proposed as a preventative measure to stave off further opioid addiction, especially among at-risk populations, Canton Democrat Rep. Thomas West told members of the Health Committee.

"HB 618 will require the Department of Mental Health and Addiction Services to develop a non-opioid directive form," West said. "This form will be made available to the public free of charge and is to be added to the patient's medical record per their request.

"The form states that the patient chooses not to be treated with an opioid analgesic."

The lawmaker said that his legislation would ensure that people who have completed treatment with a community addiction services provider are offered the form at their time of discharge.

Additionally, forms would be made available to individuals who have served a prison term for a drug offense.

According to analysis of the bill by the Ohio Legislative Service Commission, such a directive does not become effective until the form is signed by the patient, or by that patient's representative and placed in the patient's paper or electronic medical record.

In cases of minor patients, a patient's parent, guardian or legal custodian is the patient's representative.

As the directive is voluntary, a patient or representative may revoke a non-opioid directive at any time and in any manner that communicates the intent to revoke.

HB 618 would require creation of a policy to notify the State Board of Pharmacy of all non-opioid directives.

The legislation grants immunity to only those pharmacists and pharmacy interns who abide by the directive.

In instances in which the pharmacist or intern knowingly fails to comply with a patient's non-opioid directive, he is no longer immune from criminal prosecution, civil liability and professional discipline.

To be eligible for immunity from civil liability and professional discipline, a pharmacist or intern cannot fail to comply with a non-opioid directive in a manner that constitutes willful or wanton misconduct.

"When a valid prescription for an opioid analgesic is presented to a pharmacist or pharmacy intern for dispensing, neither the pharmacist nor intern is required under the bill to inquire about the existence of a non-opioid directive for the patient or to determine if the patient is the subject of a directive," Elizabeth Molnar wrote in the commission's analysis.

Similarly, emergency medical services personnel are not required to inquire about the existence of such a directive for a patient or to determine if a patient is the subject of a non-opioid directive.

The bill grants immunity from criminal prosecution, civil liability and professional discipline to emergency services personnel who administer or otherwise provide in the course of an emergency situation an opioid analgesic to a patient who is the subject of a non-opioid directive.

Eligibility for immunity is based on the emergency medical services personnel not knowing the patient is the subject of such a directive and he must believe, based on professional judgment, that the patient's chances of recovery will be substantially improved by an opioid analgesic.

West said the measure is intended to get the Buckeye State one step closer toward a solution.

HB 618 also includes provisions that address the impact of non-opioid directives on insurance - first, specifying that the existence or nonexistence of a non-opioid directive for a patient does not affect in any manner the sale, procurement, issuance or renewal of a policy of life insurance or annuity, notwithstanding any term of a policy or annuity to the contrary; modify or invalidate the terms of a policy of life insurance or annuity that is in effect on the bill's effective date; or impair or invalidate a policy of life insurance or annuity or any health benefit plan.

"Second, the bill prohibits a person authorized to engage in the business of insurance under Ohio law, a health insuring corporation, other health benefit plan or a legal entity that is self-insured and provides benefits to employees or members from requiring an individual, as a condition of being insured or receiving benefits, to be the subject of a non-opioid directive or to revoke or refrain from being the subject of a non-opioid directive," Molnar noted.

Health care facilities, like insurers may not require an individual, as a condition of receiving services, to be the subject of a non-opioid directive or to revoke or refrain from being the subject of one.

Date Published: August 17, 2018


Copyright © 2018 The Daily Reporter - All Rights Reserved


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