Committee hears bill to let interdisciplinary teams consent for incapacitated patients when no decisionmaker exists

The House Human Services Committee held a hearing on Senate Bill 2,297, a proposal to let a neutral interdisciplinary team provide informed consent for non‑emergency but urgent medical care when a patient lacks capacity and no authorized decisionmaker can be identified.

Sponsor Senator Kirsten Rohrs, District 27, told the committee the bill responds to a growing number of hospitalized patients who lack family or other decisionmakers and can become ‘‘stuck’’ in hospitals while clinicians wait to find someone to sign consent forms. Rohrs said hospitals sometimes absorb or write off large costs when patients remain hospitalized solely for lack of a decisionmaker.

The bill would add a last‑resort option: a team made up of at least three health care professionals, none of whom are on the treating clinicians’ care team, to make a decision in the patient’s best interest for care that is urgent but not immediately life‑threatening. Rohrs said the draft separates rules for minors and incapacitated adults to make priorities and authorities clearer.

Representatives of the state Department of Health and Human Services, hospitals and hospital ethics committees described how the bill would work in practice. Jonathan Ulm, chief legal officer for the Department of Health and Human Services, described a proposed amendment to include psychologists alongside attending physicians in parts of the bill because psychologists are authorized elsewhere in state law to make capacity determinations.

Melissa Howard, general counsel for the North Dakota Hospital Association, said hospitals support the bill and the department’s amendment. Howard said the interdisciplinary team provision was amended in the Senate to require three independent professionals (up from two) to provide additional neutrality and expertise.

Dr. Stephen Mitchell, retired neuroradiologist and emeritus ethics‑committee chair at Sanford Medical Center Fargo, described clinical scenarios hospitals encounter, including a patient with an infected bone requiring possible partial amputation whose condition is not yet emergent. He said some states allow a ‘‘two‑physician rule’’ but many ethicists prefer an interdisciplinary team that is not directly involved in a patient’s day‑to‑day care.

Testifiers and committee members discussed practical details: who would serve on teams, whether team members must be from the same facility, whether a primary care physician could provide background information, and how the team’s decision would yield to a higher‑priority surrogate if one is later located. Dr. Mitchell and other witnesses said hospitals would continue making good‑faith efforts to locate higher priority decisionmakers and that teams would be used only as a last resort.

No committee vote was taken during the hearing. Supporters asked the committee to hold the bill pending finalising technical amendments that were discussed on the record.

Ending: Committee staff and several proponents said they would provide the committee with the technical amendments discussed during testimony; the committee recessed the hearing without taking formal action during the session recorded in the transcript.