Governor Parson Signs Measures Recognizing TPOPP/POLST as Equivalent to Missouri Out of Hospital Do Not Resuscitate Order

Legislative gavel and books.

After more than a decade, the Missouri Assembly approved legislation recognizing the TPOPP/POLST medical order set equivalent to the state’s Out of Hospital Do Not Resuscitate (OHDNR) Order known as the “Purple Form.” 

 The Legislation addresses both adults and pediatric populations and will go into effect on August 28, 2023. 

 Governor Parson, on July 6, 2023, signed two measures SB 45 and HB 402, both granting recognition to TPOPP/POLST in Missouri, along with other state POLST forms, including Kansas, as long as those orders meet the provisions of the existing Missouri OHDNR statute. 


A Team Effort

 Retired Center for Practical Bioethics President and CEO, John Carney, who has been working with members of the TPOPP/POLST Steering Committee for more than a decade, expressed his appreciation to Jason White, a long- time Emergency Response professional, and Daren Pfeifer, Access Center Service Line Director for HCA Midwest Health, who led efforts at monitoring and supporting the recognition of TPOPP/POLST as more comprehensive and dynamic expressions of treatment for those at the most vulnerable times in their lives. 

 “There is not a better friend for Missourians who live with advanced disease and frailty than Jason White,” Carney said. “He has been a patient, persistent, and compassionate leader dedicated to serving those of every age regardless of what setting they live in or what kind of care they seek.” 

 Benefits for Patients and Providers

 The primary benefit of state of Missouri equivalency recognition allows individuals and their physician providers to execute a more comprehensive set of specific medical orders for persons living with advanced illness and medical frailty who wish to detail specific treatments that they do or don’t want and to share those across settings.

Stack of TPOPP forms.The form is designed to be updated as the patient’s condition changes and also provides immediate access to other critical information to the care of the individual, such as the intensity of services to be provided, treatments regarding medically administered nutrition, and information about hospice election and contact information. Responding providers will also receive immunity protections as afforded those responding to the state’s “Purple” form.   

 New Training Coming

 The Center for Practical Bioethics has served as sponsoring organization of the TPOPP/POLST initiative in Kansas and Missouri since 2008. As a result of the recognition, new training is under development and will be made available statewide in Missouri to providers in all settings within the next few months. Special programs will target hospital, long term care, EMS and home care and hospice.

For more information contact the President and CEO of the Center, James Stowe, at 816-979-1353 or

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