§ 9709. Obligations of health care providers, health care facilities, residential care facilities,
and health insurers regarding protocols and nondiscrimination
(a) As used in this section, “DNR/COLST” shall mean do-not-resuscitate orders (DNR) and
clinician orders for life sustaining treatment (COLST) as defined in section 9701 of this title.
(b) Every health care provider, health care facility, and residential care facility shall
develop protocols:
(1) to ensure that a principal’s advance directive, including any amendment, suspension,
or revocation thereof, and DNR/COLST order, if any, are promptly available when services
are to be provided, including that the existence of the advance directive, amendment,
suspension, revocation, or DNR/COLST order is prominently noted on any file jacket
or folder, and that a note is entered into any electronic database of the provider
or facility;
(2) for maintaining advance directives received from individuals who anticipate future
care but are not yet patients of that provider or facility;
(3) to ensure that the provider or facility checks the registry at the time any individual
without capacity is admitted or provided services to determine whether the individual
has an advance directive;
(4)(A) to ensure that, unless otherwise specified in an advance directive or guardianship
order, an agent or guardian shall have the same rights a principal with capacity would
have to:
(i) request, review, receive, and copy any oral or written information regarding the principal’s
physical or mental health, including medical and hospital records;
(ii) participate in any meetings, discussions, or conferences concerning health care decisions
related to the principal;
(iii) consent to the disclosure of health care information; and
(iv) file a complaint on behalf of the principal regarding a health care provider, health
care facility, or residential care facility;
(B) the exercise of rights under this subdivision shall not be construed to waive any
privilege provided by law;
(5) to ensure that the provider or facility complies with its obligations under the Patient
Self-Determination Act, 42 U.S.C. § 1395cc(a), and the regulations issued thereunder.
(c) Every health care facility and residential care facility shall develop written protocols
to ensure that:
(1) A patient is asked if the patient has an advance directive:
(A) prior to an anticipated admission, when possible;
(B) if not possible prior to admission, as soon thereafter as possible; and
(C) periodically while at the facility.
(2)(A) A patient’s advance directive is reviewed to determine whether the facility would
decline to follow any of the advance directive’s instructions pursuant to subsection 9707(b) of this title, in which case the facility shall comply with the requirements of subsection 9707(c)
or subdivision 9707(b)(3) of this title.
(B) The review of a patient’s advance directive required by this subdivision shall occur:
(i) prior to an anticipated admission, when possible;
(ii) if not possible prior to an anticipated admission, as soon thereafter as possible;
and
(iii) when a patient executes an advance directive or an amendment to an advance directive.
(3) A patient with an advance directive is encouraged and helped to submit the advance
directive or a notice of the advance directive to the registry.
(4) DNR/COLST orders are issued, revoked, and handled pursuant to the same process and
standards that are used for each patient receiving health care.
(5) Upon transfer or discharge to another facility, a copy of any advance directive, DNR
order, or COLST order shall be transmitted with the principal or patient. If the transfer
is to a health care facility or residential care facility, any advance directive,
DNR order, or COLST order shall be promptly transmitted to the subsequent facility,
unless the sending facility has confirmed that the receiving facility has a copy of
the advance directive, DNR order, or COLST order.
(6) For a patient for whom DNR/COLST orders are documented in a facility-specific manner,
any DNR/COLST orders to be continued upon discharge, during transport, or in another
setting shall be documented on the Vermont DNR/COLST form issued pursuant to subsection 9708(b) of this title or on the form as prescribed by the patient’s state of residence.
(d)(1) Each nursing home and residential care facility that chooses to use volunteers to
explain to residents the nature and effect of an advance directive as required by
subsection 9703(d) of this title shall ensure that the volunteers have received appropriate training regarding the
explanation of advance directives.
(2) Every hospital shall designate an adequate number of individuals to explain the nature
and effect of an advance directive to patients as required by subsection 9703(e) of this title.
(e) No health care provider, health care facility, residential care facility, health insurer
as defined in section 9402 of this title, insurer issuing disability insurance, or self-insured employee welfare benefit plan
shall charge an individual a different rate or require any individual to execute an
advance directive or to obtain a DNR/COLST order or DNR identification as a condition
of admission to a facility or as a condition of being insured for or receiving health
care or residential care. No health care shall be refused except as provided in this
subchapter because an individual is known to have executed an advance directive. (Added 2005, No. 55, § 1, eff. Sept. 1, 2005; amended 2011, No. 60, § 12, eff. June 1, 2011; 2017, No. 121 (Adj. Sess.), § 4, eff. May 3, 2018; 2023, No. 6, § 245, eff. July 1, 2023.)