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S1069.................................................by HEALTH AND WELFARE
VITAL STATISTICS - Amends and adds to existing law relating to vital
statistics to permit physician assistants and advanced practice
professional nurses to certify cause of death and to sign certificates of
stillbirth; to provide reference to the coroner when death is due to
natural causes and an authorized person is not available or is physically
incapable of signing and for circumstances of stillbirths.
01/30 Senate intro - 1st rdg - to printing
01/31 Rpt prt - to Health/Wel
02/06 Rpt out - rec d/p - to 2nd rdg
02/07 2nd rdg - to 3rd rdg
02/09 3rd rdg - PASSED - 32-0-3
AYES -- Andreason, Bair, Bastian, Bilyeu, Broadsword, Burkett,
Cameron, Corder, Darrington, Fulcher, Gannon, Geddes, Goedde,
Hammond, Heinrich, Hill, Jorgenson, Kelly, Keough, Langhorst, Little,
Lodge, McGee, McKague, McKenzie, Pearce, Richardson, Schroeder,
Siddoway, Stegner, Stennett, Werk
NAYS -- None
Absent and excused -- Coiner, Davis, Malepeai
Floor Sponsor - Lodge
Title apvd - to House
02/12 House intro - 1st rdg - to Health/Wel
03/09 Rpt out - rec d/p - to 2nd rdg
03/12 2nd rdg - to 3rd rdg
03/19 3rd rdg - PASSED - 68-0-2
AYES -- Anderson, Andrus, Barrett, Bayer, Bedke, Bell, Bilbao, Black,
Block, Bock, Boe, Bolz, Brackett, Bradford, Chadderdon, Chavez, Chew,
Clark, Collins, Crane, Durst, Edmunson, Eskridge, Hagedorn, Hart,
Henbest, Henderson, Jaquet, Killen, King, Kren, Labrador, Lake,
LeFavour, Loertscher, Luker, Marriott, Mathews, McGeachin, Mortimer,
Moyle, Nielsen, Nonini, Pasley-Stuart, Patrick, Pence, Raybould,
Ring, Ringo, Roberts, Ruchti, Rusche, Sayler, Schaefer, Shepherd(2),
Shepherd(8), Shirley, Shively, Smith(30), Snodgrass, Stevenson,
Thayn, Trail, Vander Woude, Wills, Wood(27), Wood(35), Mr. Speaker
NAYS -- None
Absent and excused -- Harwood, Smith(24)
Floor Sponsor - Bilbao
Title apvd - to Senate
03/20 To enrol
03/21 Rpt enrol - Pres signed - Sp signed
03/22 To Governor
03/28 Governor signed
Session Law Chapter 244
Effective: 07/01/07
]]]] LEGISLATURE OF THE STATE OF IDAHO ]]]]
Fifty-ninth Legislature First Regular Session - 2007
IN THE SENATE
SENATE BILL NO. 1069
BY HEALTH AND WELFARE COMMITTEE
1 AN ACT
2 RELATING TO VITAL STATISTICS; AMENDING SECTION 39-260, IDAHO CODE, TO PERMIT
3 PHYSICIAN ASSISTANTS AND ADVANCED PRACTICE PROFESSIONAL NURSES TO CERTIFY
4 CAUSE OF DEATH, TO PROVIDE FOR REFERENCE TO THE CORONER WHEN DEATH IS DUE
5 TO NATURAL CAUSES AND AN AUTHORIZED PERSON IS NOT AVAILABLE OR IS PHYSI-
6 CALLY INCAPABLE OF SIGNING, TO PERMIT PHYSICIAN ASSISTANTS AND ADVANCED
7 PRACTICE PROFESSIONAL NURSES TO SIGN CERTIFICATES OF STILLBIRTH, TO PRO-
8 VIDE FOR CIRCUMSTANCES FOR REFERENCE OF STILLBIRTHS TO THE CORONER AND TO
9 MAKE TECHNICAL CORRECTIONS; AND AMENDING SECTION 39-268, IDAHO CODE, TO
10 PERMIT PHYSICIAN ASSISTANTS AND ADVANCED PRACTICE PROFESSIONAL NURSES TO
11 AUTHORIZE FINAL DISPOSITION OF DEATHS AND STILLBIRTHS, TO REVISE CODE REF-
12 ERENCES AND TO MAKE TECHNICAL CORRECTIONS.
13 Be It Enacted by the Legislature of the State of Idaho:
14 SECTION 1. That Section 39-260, Idaho Code, be, and the same is hereby
15 amended to read as follows:
16 39-260. REGISTRATION OF DEATHS AND STILLBIRTHS. (a1) A certificate of
17 each death which occurs in this state shall be filed with the local registrar
18 of the district in which the death occurs, or as otherwise directed by the
19 state registrar, within five (5) days after the occurrence. However, the board
20 shall, by rule and upon such conditions as it may prescribe to assure compli-
21 ance with the purposes of the vital statistics act, provide for the filing of
22 death certificates without medical certifications of cause of death in cases
23 in which compliance with the applicable prescribed period would result in
24 undue hardship; but provided, however, that medical certifications of cause of
25 death shall be provided by the certifying physician, physician assistant,
26 advanced practice professional nurse or coroner to the vital statistics unit
27 within fifteen (15) days from the filing of the death certificate. No certifi-
28 cate shall be deemed complete until every item of information required shall
29 have been provided or its omission satisfactorily accounted for. When death
30 occurs in a moving conveyance in the United States and the body is first
31 removed from the conveyance in this state, the death shall be registered in
32 this state and the place where the body is first removed shall be considered
33 the place of death. When a death occurs on a moving conveyance while in inter-
34 national air space airspace or in a foreign country or its air space airspace
35 and the body is first removed from the conveyance in this state, the death
36 shall be registered in this state but the certificate shall show the actual
37 place of death insofar as can be determined. If the place of death is unknown
38 but the dead body is found in this state, the certificate of death shall be
39 completed and filed in accordance with this section. The place where the body
40 is found shall be shown as the place of death. If the date of death is
41 unknown, it shall be determined by approximation.
42 The person in charge of interment or of removal of the body from the dis-
43 trict shall be responsible for obtaining and filing the certificate. Said per-
2
1 son shall obtain the required information from the following persons, over
2 their respective signatures:
3 (1a) Personal data shall be supplied by the person best qualified to sup-
4 ply them; and
5 (2b) Except as otherwise provided, medical data shall be supplied by the
6 physician, physician assistant or advanced practice professional nurse who
7 attended the deceased during the last illness, who shall certify to the
8 cause of death according to his best knowledge, information and belief
9 within seventy-two (72) hours from time of death. In the absence of the
10 attending physician, physician assistant or advanced practice professional
11 nurse or with said physician's person's approval the certificate may be
12 completed and signed by said physician's person's associate, physician who
13 must be a physician, physician assistant or advanced practice professional
14 nurse, the chief medical officer of the institution in which death
15 occurred, or the physician who performed an autopsy upon the decedent,
16 provided such individual has access to the medical history of the case,
17 views the deceased at or after death, and death is due to natural causes.
18 (b2) The person in charge of interment or of removal of the body from the
19 district shall refer the following cases to the coroner who shall make an
20 immediate investigation, supply the necessary medical data, and certify to the
21 cause of death:
22 (1a) When no physician, physician assistant or advanced practice profes-
23 sional nurse was in attendance during the last illness of the deceased; or
24 (2b) When the circumstances suggest that the death occurred as a result
25 of other than natural causes; or
26 (c) When death is due to natural causes and the physician, physician
27 assistant or advanced practice professional nurse who attended the
28 deceased during the last illness or said person's designated associate who
29 must be a physician, physician assistant or advanced practice professional
30 nurse, is not available or is physically incapable of signing.
31 (c3) When a death is presumed to have occurred within this state but the
32 body cannot be located, a death certificate may be prepared by the state reg-
33 istrar upon receipt of an order of a court of record of this state, which
34 shall include the finding of facts required to complete the death certificate.
35 Such a death certificate shall be marked "presumptive" and shall show on its
36 face the date of registration and shall identify the court and the date of
37 decree.
38 (d4) Each stillbirth, defined as a spontaneous fetal death of twenty (20)
39 completed weeks gestation or more, based on a clinical estimate of gestation,
40 or a weight of three hundred fifty (350) grams (twelve and thirty-five hun-
41 dredths (12.35) ounces) or more, which occurs in this state shall be regis-
42 tered on a certificate of stillbirth within five (5) days after delivery with
43 the local registrar of the district in which the stillbirth occurred. All
44 induced terminations of pregnancy shall be reported in the manner prescribed
45 in section 39-261, Idaho Code, and shall not be reported as stillbirths. No
46 certificate shall be deemed complete until every item of information required
47 shall have been provided or its omission satisfactorily accounted for.
48 (1a) When a stillbirth occurs in an institution, the person in charge of
49 the institution or a designated representative shall prepare the certifi-
50 cate, obtain the signature of the physician, physician assistant or
51 advanced practice professional nurse in attendance, (except as otherwise
52 provided in subsection 39-260(e), Idaho Code) (5) of this section, who
53 shall provide the medical data, and forward the certificate to the morti-
54 cian or person acting as such. In the absence of the attending physician,
55 physician assistant or advanced practice professional nurse or with said
3
1 physician's person's approval the certificate may be completed and signed
2 by said physician's person's associate, physician who must be a physician,
3 physician assistant or advanced practice professional nurse, the chief
4 medical officer of the institution in which the stillbirth occurred, or
5 the physician who performed an autopsy on the stillborn fetus, provided
6 such individual has access to the medical history of the case and views
7 the fetus at or after stillbirth. The mortician or person acting as such
8 shall provide the disposition information and file the certificate with
9 the local registrar.
10 (2b) When a stillbirth occurs outside an institution, the mortician or
11 person acting as such shall complete the certificate, obtain the medical
12 data from and signature of the attendant at the stillbirth, (except as
13 otherwise provided in subsection 39-260(e), Idaho Code) (5) of this sec-
14 tion, and file the certificate. If the attendant at or immediately after
15 the stillbirth is not a physician, physician assistant or advanced prac-
16 tice professional nurse, the coroner shall investigate and sign the cer-
17 tificate of stillbirth.
18 (3c) When a stillbirth occurs in a moving conveyance in the United States
19 and the stillborn fetus is first removed from the conveyance in this
20 state, the stillbirth shall be registered in this state and the place
21 where the stillborn fetus is first removed shall be considered the place
22 of stillbirth. When a stillbirth occurs in a moving conveyance while in
23 international air space airspace or in a foreign country or its air space
24 airspace and the stillborn fetus is first removed from the conveyance in
25 this state, the stillbirth shall be registered in this state but the cer-
26 tificate shall show the actual place of stillbirth insofar as can be
27 determined.
28 (4d) When a stillborn fetus is found in this state and the place of
29 stillbirth is unknown, it shall be reported in this state. The place where
30 the stillborn fetus was found shall be considered the place of stillbirth.
31 (5e) The name of the father shall be entered on the certificate of still-
32 birth as provided by section 39-255, Idaho Code.
33 (5) The person responsible for the preparation or completion of the
34 stillbirth certificate as stated in subsections (4)(a) and (b) of this section
35 shall refer the following cases to the coroner who shall make an immediate
36 investigation, supply the necessary medical data and certify to the cause of
37 stillbirth:
38 (ea) When the circumstances suggest that the stillbirth occurred as a
39 result of other than natural causes, (excepting legally induced abortions,
40 as defined by section 39-241, Idaho Code), the local registrar shall refer
41 the case to the coroner in the county where the stillbirth occurred. Said
42 coroner shall make an immediate investigation, supply the necessary medi-
43 cal data, and certify to the cause of stillbirth; or
44 (b) When death is due to natural causes and the physician, physician
45 assistant or advanced practice professional nurse in attendance at or
46 immediately after the stillbirth or said person's designated associate is
47 not available or is physically incapable of signing.
48 SECTION 2. That Section 39-268, Idaho Code, be, and the same is hereby
49 amended to read as follows:
50 39-268. AUTHORIZATION FOR FINAL DISPOSITION. (a1) The mortician or per-
51 son acting as such who first assumes possession of a dead body or stillborn
52 fetus shall make a written report to the registrar of the district in which
53 death or stillbirth occurred or in which the body or stillborn fetus was found
4
1 within twenty-four (24) hours after taking possession of the body or stillborn
2 fetus, on a form prescribed and furnished by the state registrar and in accor-
3 dance with regulations rules promulgated by the board. Except as specified in
4 subsection (b2) of this section, the written report shall serve as permit to
5 transport, bury or entomb the body or stillborn fetus within this state, pro-
6 vided that the mortician or person acting as such shall certify that the phy-
7 sician, physician assistant or advanced practice professional nurse in charge
8 of the patient's care for the illness or condition which resulted in death or
9 stillbirth has been contacted and has affirmatively stated that said
10 physician, physician assistant or advanced practice professional nurse or the
11 physician's designated associate according to section 39-260(a1)(2b) or
12 (d4)(1a), Idaho Code, will sign the certificate of death or stillbirth.
13 (b2) The written report as specified in subsection (a1) of this section
14 shall not serve as a permit to:
15 (1a) Remove a body or stillborn fetus from this state;
16 (2b) Cremate the body or stillborn fetus; or
17 (3c) Make disposal or disposition of any body or stillborn fetus in any
18 manner when inquiry is required under chapter 43, title 19, Idaho Code, or
19 section 39-260(b2) or (e5), Idaho Code.
20 (c3) In accordance with the provisions of subsection (b2) of this sec-
21 tion, the mortician or person acting as such who first assumes possession of a
22 dead body or stillborn fetus shall obtain an authorization for final disposi-
23 tion prior to final disposal or removal from the state of the body or still-
24 born fetus. The physician, physician assistant, advanced practice professional
25 nurse or coroner responsible for signing the death or stillbirth certificate
26 shall authorize final disposition of the body or stillborn fetus, on a form
27 prescribed and furnished by the state registrar. If the body is to be cre-
28 mated, the coroner must also give additional authorization. In the case of
29 stillbirths, the hospital may dispose of the stillborn fetus if the parent(s)
30 so requests; authorization from the coroner is not necessary unless the coro-
31 ner is responsible for signing the certificate of stillbirth.
32 (d4) When a dead body or stillborn fetus is transported into the state, a
33 permit issued in accordance with the law of the state in which the death or
34 stillbirth occurred or in which the body or stillborn fetus was found shall
35 authorize the transportation and final disposition within the state of Idaho.
36 (e5) A permit for disposal shall not be required in the case of a dead
37 fetus of less than twenty (20) weeks gestation and less than three hundred
38 fifty (350) grams or twelve and thirty-five hundredths (12.35) ounces where
39 disposal of the fetal remains is made within the institution where the deliv-
40 ery of the dead fetus occurred.
STATEMENT OF PURPOSE
RS 16540
Section 39-260, Idaho Code, spells out which health care professionals
(physicians and county coroners) can certify a death or a stillbirth
certificate and Section 39-268, Idaho Code, allows only certain health
care professionals (physicians and county coroners) to give
authorization for final disposition or removal of dead bodies and
stillborn fetuses. Section 54-1102, Idaho Code, was changed in 2004
to allow advanced practice professional nurses to work with no
physician supervision. Since then, the Bureau of Health Policy and
Vital Statistics has received certificates signed by advanced practice
professional nurses that had to be rejected because they are not
authorized to certify death or stillbirth certificates according to
section 39-260, Idaho Code. This legislation would allow advanced
practice professional nurses to sign death and stillbirth certificates
and to authorize final disposition or removal of dead bodies and
stillborn fetuses.
Additionally, physician assistants cannot certify death and stillbirth
certificates or authorize final disposition or removal of dead bodies
and stillborn fetuses. In some areas of the state, physicians are not
available to sign these certificates and only the county coroner can
sign the certificates or authorize final disposition. The Bureau of
Health Policy and Vital Statistics has received certificates signed by
physician assistants that had to be rejected because they are not
authorized to certify death or stillbirth certificates according to
section 39-260, Idaho Code. This legislation would allow physician
assistants who are providing health care to sign the certificates and
to give authorization for final disposition or removal of dead bodies
and stillborn fetuses.
In some circumstances, where the person in attendance is not available
to sign the certificates, the certificates cannot be completed until
the person is available again, often after the time frame for
submission of the certificates has passed. This legislation would
allow coroners to sign certificates in these circumstances so that
families are not being inconvenienced while waiting for the person in
attendance to return.
This legislation requires the definitions in section 39-241 that are
being proposed.
FISCAL NOTE
No fiscal impact.
CONTACT
Name: Greg Heitman
Agency: Health and Welfare
Phone: 208-334-5986
STATEMENT OF PURPOSE/FISCAL NOTE S 1069