302.1 A health care provider, including a health care professional, shall not be required, by contract or otherwise, to dispense or prescribe covered medication.
302.2 If a health care provider, including a health care professional, is unable or unwilling to participate in the Program, and the patient transfers his or her care to a new health care provider, the prior health care provider shall, upon the patient's request, transfer a copy of the patient's medical record to the new health care provider.
302.3 A health care provider may prohibit any health care provider it employs or contracts with from participating in the Program on the prohibiting health care provider's premises or within the scope of the health care provider's duties for the prohibiting health care provider, provided that the prohibiting health care provider has notified the employee or contractor of this policy before the employee or contractor has provided the covered medication.
302.4 An attending physician who is licensed in the District, and who is not prohibited from participation under this section, may participate in the Program after completing the training module approved by the Director.
302.5 After completing the training module and receiving a written request for covered medication, an attending physician shall:
(a) Determine that the patient: (1) Has a terminal disease;(3) Has made the request voluntarily; and(4) Is a resident of the District;(b) Inform the patient of:(1) The patient's medical diagnosis;(2) The patient's prognosis;(3) The potential risks associated with taking a covered medication;(4) The probable result of taking a covered medication;(5) The feasible alternatives to taking a covered medication, including comfort care, hospice care, and pain control; and(6) The availability of supportive counseling to address the range of possible psychological and emotional stress involved with the end stages of life;(c) Refer the patient to a consulting physician;(d) Refer the patient for counseling if the attending physician believes the patient may have a psychiatric or psychological disorder or depression that impairs the patient's judgment;(e) Recommend that the patient notify next of kin, friends, an d a spiritual advisor, if applicable, of the decision to request covered medication;(f) Counsel the patient about the importance of having another person present when the patient ingests covered medication, and of not taking covered medication in a public place;(g) Inform the patient that the patient may rescind a request for covered medication at any time and in any manner; and(h) Verify, immediately before dispensing a covered medication or delivering a prescription for a covered medication, that th e patient is making an informed decision.302.6 The attending physician shall document, file in the patient's medical record, and make available to the Department for compliance review:
(a) The date of each patient oral request for covered medication;(b) The date of receipt of the written request for covered medication;(c) The attending physician's: (1) Diagnosis and prognosis of the patient;(2) Determination that the patient is a District resident and the documentation the patient supplied to support the determination;(3) Determination that the patient is capable, is acting voluntarily, and has made an informed decision to request covered medication;(4) Offer to the patient to rescind the request for covered medication before the second oral request;(5) Notation on the form provided by the Director that all requirements of the Act have been met;(6) Notation on the form provided by the Director of all steps taken to carry out the patient's request for covered medication, including the medication dispensed or prescribed;(d) The consulting physician's: (1) Diagnosis and prognosis of the patient;(2) Verification that the patient is capable, acting voluntarily, and has made an informed decision to request covered medication;(e) The report by the psychiatrist or psychologist of the outcome and determinations of counseling, if applicable; and(f) For a patient who died after using a covered medication; (1) The patient's age at death;(2) The patient's education level, if known;(3) The patient's race or ethnicity;(5) The patient's type of insurance, if known;(6) The patient's terminal disease; and(7) Whether the patient died due to using a covered medication.302.7 When a patient has been referred to a consulting physician, as required by § 302.5(c), the consulting physician shall:
(a) Examine the patient and the patient's medical records to confirm, in writing, the attending physician's diagnosis and prognosis that the patient has a terminal disease;(b) Verify, in writing, to the attending physician that the patient: (1) Is capable, including that patient does not suffer from a psychiatric or psychological disorder or depression that impairs the patient's judgment;(2) Is acting voluntarily; and(3) Has made an informed decision;(c) Complete the consult form provided by the Director and immediately submit the completed form to the attending physician; and(d) Refer the patient for counseling if the consulting physician believes the patient may have a psychiatric or psychological disorder or depression that impairs the patient's judgment.302.8 The attending physician shall not dispense or prescribe covered medication to a patient who has been referred for counseling until the patient receives counseling and the psychologist or psychiatrist who counseled the patient determines and reports to the attending physician that the patient does not have a psychiatric or psychological disorder or depression that causes impaired judgment. The attending physician shall document the results of the psychological or psychiatric evaluation on the form to be submitted to the Department.
302.9 After the attending physician has completed all the requirements of §§ 302.5 and 302.6, and after the attending physician offers the patient another opportunity to rescind the patient's request, the attending physician may dispense directly to the patient, or prescribe, covered medication, including ancillary medication intended to minimize patient discomfort.
302.10 If the attending physician prescribes covered medication rather than dispensing it directly to the patient, the attending physician first shall offer the patient another opportunity to rescind the patient's request and then shall:
(a) Contact a pharmacist who is licensed in the District and authorized to participate in the Program, and inform the pharmacist of the prescription;(b) Deliver the written prescription to the pharmacist personally, by telephone, by facsimile, or electronically; and(c) Record the date the prescription was delivered in the patient's medical record.302.11 If the attending physician dispenses the medication, the attending physician shall immediately notify the Department on a form provided by the Director that covered medication has been dispensed. The Department shall provide the notification form, or information contained therein, to the OCME.
302.12 Within thirty (30) days after a patient dies from ingesting a covered medication, or as soon as practicable after the health care provider is made aware of a patient's death resulting from ingesting the covered medication, the health care provider shall notify the Department of the patient's death.
D.C. Mun. Regs. tit. 22, r. 22-D302
Final Rulemaking published at 64 DCR 12077 (11/24/2017)