Effective - 28 Aug 2019
191.250. Citation of law — definitions — DNR orders, requirements — revocation of consent — appointment of guardian, when — continuation of treatment not required, when. — 1. This section shall be known and may be cited as "Simon's Law".
2. As used in this section, the following terms shall mean:
(1) "End-of-life medical decision order", a decision issued by a juvenile or family court pertaining to life-sustaining treatment, including do-not-resuscitate orders, provided on behalf of and in the best interests of a child under juvenile or family court jurisdiction under section 211.031;
(2) "Reasonable medical judgment", a medical judgment that would be made by a reasonably prudent health care provider who is knowledgeable about the case and the treatment possibilities with respect to the medical conditions involved.
3. For a child who is not under juvenile or family court jurisdiction under section 211.031, no health care facility, nursing home, physician, nurse, or medical staff shall institute a do-not-resuscitate order or similar physician's order, either orally or in writing, without the written or oral consent of at least one parent or legal guardian of the patient or resident under eighteen years of age who is not emancipated. If consent to implement a do-not-resuscitate order or similar physician's order is granted orally, two witnesses other than the parent, legal guardian, or physician shall be present and willing to attest to the consent given by at least one parent or the legal guardian of the patient or resident. The provision of such consent shall be immediately recorded in the patient's or resident's medical record, specifying who provided the information, to whom the information was provided, which parent or legal guardian gave the consent, who the witnesses were, and the date and time the consent was obtained.
4. The requirements of subsection 3 of this section shall not apply if a reasonably diligent effort of at least forty-eight hours without success has been made to contact and inform each known parent or legal guardian of the intent to implement a do-not-resuscitate order or similar physician's order.
5. Consent previously given under subsection 3 of this section may be revoked orally or in writing by the parent or legal guardian of the patient or resident who granted the original permission. Such revocation of prior consent shall take precedence over any prior consent to implement a do-not-resuscitate order or similar physician's order and shall be immediately recorded in the patient's or resident's medical record, specifying who provided the information, to whom the information was provided, which parent or legal guardian revoked consent, who the witnesses were, and the date and time the revocation was obtained.
6. For a child under juvenile court jurisdiction under section 211.031, a juvenile or family court may issue an end-of-life medical decision order, a physician's order, or any other medical decision order, or may appoint a guardian for the child for that purpose. The children's division shall not be appointed as guardian for a child to make an end-of-life medical decision*, including a do-not-resuscitate order*. In the event a child under the jurisdiction of a juvenile or family court under section 211.031 is returned to the custody of the parent or legal guardian, the parent or legal guardian may revoke the consent for the end-of-life medical decision* or similar physician's orders ordered by the court, including a do-not-resuscitate order* for the child. Revocation may be orally or in writing and shall be immediately recorded in the patient's or resident's medical records, specifying who provided the information, to whom the information was provided, which parent or legal guardian revoked consent, who the witnesses were, and the date and time the revocation was obtained.
7. For the purposes of this section, a relative caregiver under the provisions of section 431.058 shall have the same authority given to a parent or legal guardian of a nonemancipated patient or resident under eighteen years of age, provided that such a patient or resident is not under juvenile or family court jurisdiction under section 211.031.
8. Nothing in this section shall be construed to require any health care facility, nursing home, physician, nurse, or medical staff to provide or continue any treatment, including resuscitative efforts, food, medication, oxygen, intravenous fluids, or nutrition, that would be:
(1) Medically inappropriate because, in their reasonable medical judgment, providing such treatment would create a greater risk of causing or hastening the death of the patient or resident; or
(2) Medically inappropriate because, in their reasonable medical judgment, providing such treatment would be potentially harmful or cause unnecessary pain, suffering, or injury to the patient or resident.
9. Nothing in this section shall require health care providers to continue cardiopulmonary resuscitation or manual ventilation beyond a time in which, in their reasonable medical judgment, there is no further benefit to the patient or resident or likely recovery of the patient or resident.
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(L. 2019 H.B. 138 merged with H.B. 397)
*The plural form of these words appear in original rolls of H.B. 138, 2019.
Structure Missouri Revised Statutes
Title XII - Public Health and Welfare
Chapter 191 - Health and Welfare
Section 191.005 - Information exchange between departments, rulemaking authority.
Section 191.025 - Health care compact.
Section 191.127 - Land may be leased for farming or grazing — procedure.
Section 191.150 - Purchase of food limited to use of institution inmates.
Section 191.160 - Board and living quarters for employees of institutions.
Section 191.170 - Mistreatment of inmates — penalty.
Section 191.180 - Furnishing unfit food to institution — penalty.
Section 191.190 - Accessory to mistreatment of inmates or furnishing of unwholesome food — penalty.
Section 191.210 - Attendance of patient by private physician.
Section 191.211 - Funding of certain programs.
Section 191.213 - Additional funding sources for certain programs.
Section 191.228 - Physician and pharmacist not subject to discipline for cooperation.
Section 191.300 - Definitions.
Section 191.315 - Genetics program to be established by department — rules authorized — procedure.
Section 191.335 - Hemophilia program established — state assistance, when.
Section 191.362 - Appropriately trained employees to have completed course in dialysis techniques.
Section 191.365 - Sickle cell anemia — purposes of program — financial assistance, when.
Section 191.375 - Cystic fibrosis, program for care and treatment — financial assistance, when.
Section 191.380 - Cystic fibrosis, duties of department.
Section 191.500 - Definitions.
Section 191.510 - Contracts for loans to include terms.
Section 191.515 - Requirements for application.
Section 191.520 - Maximum amount of loans — source of funds.
Section 191.525 - Number of loans available — to whom — length of loans.
Section 191.530 - Interest on loans — repayment terms — temporary deferral.
Section 191.535 - Termination of course of study, effect.
Section 191.540 - Repayment schedules — breach of contract.
Section 191.545 - Recovery — actions for.
Section 191.550 - Approval of contracts.
Section 191.603 - Definitions.
Section 191.605 - Department to designate as areas of need — factors to be considered.
Section 191.607 - Qualifications for eligibility established by department.
Section 191.609 - Contract for repayment of loans, contents.
Section 191.615 - Application for federal funds — insufficient funds, effect.
Section 191.630 - Definitions.
Section 191.650 - Definitions.
Section 191.653 - HIV testing performed by whom, how — consultation with subject required, when.
Section 191.665 - Discrimination prohibited, exceptions.
Section 191.680 - Maintaining a nuisance, abatement to be ordered, when.
Section 191.683 - Reports to general assembly by department of health and senior services.
Section 191.692 - Premarital HIV testing, rulemaking authorized, when.
Section 191.695 - Rulemaking authority, department of health and senior services — procedure.
Section 191.710 - MO HealthNet program and SCHIPS to focus on premature infant health care.
Section 191.711 - Education publications to be prepared, contents — distribution.
Section 191.748 - Shaken baby syndrome video, required viewing, when.
Section 191.755 - Department to post resources on website, content.
Section 191.756 - Grants awarded by board of health and senior services — eligibility criteria.
Section 191.758 - Information to be made available by physician to pregnant women, when.
Section 191.765 - Definitions.
Section 191.769 - Areas not considered public places.
Section 191.771 - Person in control of public places or public meetings, duties.
Section 191.773 - Violators, guilty of infraction.
Section 191.800 - Definitions.
Section 191.803 - Boards of education to establish breakfast program — rules — waiver, procedure.
Section 191.805 - Hardship grant program, distribution of, rules.
Section 191.815 - Administrative rules, procedure.
Section 191.828 - Evaluations, effect of initiatives.
Section 191.839 - Education programs for persons with no or inadequate health insurance.
Section 191.843 - Authorizes grants for regional research consortia in a distressed community.
Section 191.900 - Definitions.
Section 191.907 - Original source of information to receive a portion of any recovery.
Section 191.908 - Whistleblower protections — violations, penalty.
Section 191.914 - False report or claim, penalty.
Section 191.915 - Breast-feeding information provided, when, by whom.
Section 191.931 - Early intervention services available — report, content.
Section 191.937 - Rulemaking authority, procedure.
Section 191.990 - Diabetes goals and benchmarks — report, contents.
Section 191.1050 - Definitions.
Section 191.1056 - Fund created, use of moneys.
Section 191.1075 - Definitions.
Section 191.1080 - Council created, purpose, members, terms, duties — report — expiration date.
Section 191.1085 - Program established, purpose — website information — rulemaking authority.
Section 191.1100 - Citation of law — definitions.
Section 191.1102 - Additional licensure not required, when — inapplicability.
Section 191.1104 - Display of license or certificate, how satisfied.
Section 191.1140 - Treatment of chronic, common, and complex diseases, program authorized, purpose.
Section 191.1145 - Definitions — telehealth services authorized, when.
Section 191.1146 - Physician-patient relationship required, how established.
Section 191.1150 - Citation of law — definitions — designation of caregiver, when — requirements.
Section 191.1164 - Citation of law — definitions.
Section 191.1167 - Contracts, policies, or procedures in violation of act deemed null and void.
Section 191.1168 - Severability clause.
Section 191.1601 - Citation of law.
Section 191.1603 - Definitions.
Section 191.1604 - Long-term dignity savings account, use, requirements.
Section 191.1606 - Reporting, forms — rulemaking authority.
Section 191.1607 - Financial institutions, requirements — no responsibility or liability, when.