BILL NUMBER: AB 3000	CHAPTERED
	BILL TEXT

	CHAPTER  266
	FILED WITH SECRETARY OF STATE  AUGUST 4, 2008
	APPROVED BY GOVERNOR  AUGUST 4, 2008
	PASSED THE SENATE  JULY 10, 2008
	PASSED THE ASSEMBLY  JULY 15, 2008
	AMENDED IN SENATE  JULY 2, 2008
	AMENDED IN SENATE  JUNE 19, 2008
	AMENDED IN SENATE  MAY 20, 2008

INTRODUCED BY   Assembly Member Wolk
   (Principal coauthor: Assembly Member Berg)
   (Coauthors: Assembly Members Huffman and Krekorian)
   (Coauthor: Senator Kuehl)

                        FEBRUARY 22, 2008

   An act to amend Sections 4780, 4782, 4783, 4784, and 4785 of, to
amend the heading of Part 4 (commencing with Section 4780) of
Division 4.7 of, and to add Sections 4781.2, 4781.4, and 4781.5 to,
the Probate Code, relating to health care decisions.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 3000, Wolk. Health care decisions: life-sustaining treatment.
   Existing law defines a "request to forgo resuscitative measures"
as a written document, signed by an individual, or a legally
recognized surrogate health care decisionmaker, and a physician, that
directs a health care provider to forgo resuscitative measures for
the individual. Existing law provides that a health care provider who
honors a request to forgo resuscitative measures is not subject to
criminal prosecution, civil liability, discipline for unprofessional
conduct, administrative sanction, or any other sanction, as a result
of his or her reliance on the request, provided that he or she meets
certain requirements.
   This bill would make findings and declarations regarding health
care planning. The bill would redefine a request to forgo
resuscitative measures as a "request regarding resuscitative
measures," which would be a written document, signed by an individual
with capacity, or a legally recognized health care decisionmaker,
and that individual's physician, that directs a health care provider
regarding resuscitative measures. The bill would include within this
definition a Physician Orders for Life Sustaining Treatment (POLST)
form, as specified. The bill would authorize a legally recognized
health care decisionmaker to execute the POLST form only if the
individual lacks capacity, or the individual has designated that the
decisionmaker's authority is effective, and would require a health
care provider to explain the form, as specified. The bill would allow
an individual having capacity to revoke a POLST form, as specified.
The bill would require a health care provider to treat an individual
in accordance with a POLST form, except as specified, and would
permit a physician to conduct an evaluation of the individual and
issue a new order consistent with the most current information
available about the individual's health status and goals of care. The
bill would require the legally recognized health care decisionmaker
of an individual without capacity to consult with the individual's
treating physician prior to making a request to modify that
individual's POLST form, and would provide that an individual with
capacity may at any time request alternative treatment to that
treatment that was ordered on the form. The bill would provide that
if the orders in an individual's request regarding resuscitative
measures directly conflict with his or her individual health care
instruction, the most recent order or instruction is effective. The
bill would also make conforming changes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  The Legislature finds and declares all of the
following:
   (a) It is important for people to make health care decisions
before it is necessary.
   (b) Health care planning is a process, rather than a single
decision, that helps individuals think about the kind of care they
would want if they become seriously ill or incapacitated, and
encourages them to talk with their loved ones and physicians.
   (c) Advance directives give individuals the ability to put their
wishes in writing and to identify the person who would speak for them
should they become unable to speak for themselves.
   (d) The Physician Orders for Life Sustaining Treatment (POLST)
form complements an advance directive by taking the individual's
wishes regarding life-sustaining treatment, such as those set forth
in the advance directive, and converting those wishes into a medical
order.
   (e) The hallmarks of a POLST form are (1) immediately actionable,
signed medical orders on a standardized form, (2) orders that address
a range of life-sustaining interventions as well as the patient's
preferred intensity of treatment for each intervention, (3) a
brightly colored, clearly identifiable form, and (4) a form that is
recognized, adopted, and honored across treatment settings.
   (f) A POLST is particularly useful for individuals who are frail
and elderly or who have a compromised medical condition, a prognosis
of one year of life, or a terminal illness.
  SEC. 2.  The heading of Part 4 (commencing with Section 4780) of
Division 4.7 of the Probate Code is amended to read:

      PART 4.  REQUEST REGARDING RESUSCITATIVE MEASURES


  SEC. 3.  Section 4780 of the Probate Code is amended to read:
   4780.  (a) As used in this part:
   (1) "Request regarding resuscitative measures" means a written
document, signed by (A) an individual with capacity, or a legally
recognized health care decisionmaker, and (B) the individual's
physician, that directs a health care provider regarding
resuscitative measures. A request regarding resuscitative measures is
not an advance health care directive.
   (2) "Request regarding resuscitative measures" includes one, or
both of, the following:
    (A) A prehospital "do not resuscitate" form as developed by the
Emergency Medical Services Authority or other substantially similar
form.
   (B) A Physician Orders for Life Sustaining Treatment form, as
approved by the Emergency Medical Services Authority.
   (3) "Physician Orders for Life Sustaining Treatment form" means a
request regarding resuscitative measures that directs a health care
provider regarding resuscitative and life-sustaining measures.
   (b) A legally recognized health care decisionmaker may execute the
Physician Orders for Life Sustaining Treatment form only if the
individual lacks capacity, or the individual has designated that the
decisionmaker's authority is effective pursuant to Section 4682.
   (c) The Physician Orders for Life Sustaining Treatment form and
medical intervention and procedures offered by the form shall be
explained by a health care provider, as defined in Section 4621. The
form shall be completed by a health care provider based on patient
preferences and medical indications, and signed by a physician and
the patient or his or her legally recognized health care
decisionmaker. The health care provider, during the process of
completing the Physician Orders for Life Sustaining Treatment form,
should inform the patient about the difference between an advance
health care directive and the Physician Orders for Life Sustaining
Treatment form.
   (d) An individual having capacity may revoke a Physician Orders
for Life Sustaining Treatment form at any time and in any manner that
communicates an intent to revoke, consistent with Section 4695.
   (e) A request regarding resuscitative measures may also be
evidenced by a medallion engraved with the words "do not resuscitate"
or the letters "DNR," a patient identification number, and a 24-hour
toll-free telephone number, issued by a person pursuant to an
agreement with the Emergency Medical Services Authority.
  SEC. 4.  Section 4781.2 is added to the Probate Code, to read:
   4781.2.  (a) A health care provider shall treat an individual in
accordance with a Physician Orders for Life Sustaining Treatment
form.
   (b) Subdivision (a) does not apply if the Physician Orders for
Life Sustaining Treatment form requires medically ineffective health
care or health care contrary to generally accepted health care
standards applicable to the health care provider or institution.
   (c) A physician may conduct an evaluation of the individual and,
if possible, in consultation with the individual, or the individual's
legally recognized health care decisionmaker, issue a new order
consistent with the most current information available about the
individual's health status and goals of care.
   (d) The legally recognized health care decisionmaker of an
individual without capacity shall consult with the physician who is,
at that time, the individual's treating physician prior to making a
request to modify that individual's Physician Orders for Life
Sustaining Treatment form.
   (e) An individual with capacity may, at any time, request
alternative treatment to that treatment that was ordered on the form.

   SEC. 5.  Section 4781.4 is added to the Probate Code, to read:
   4781.4.  If the orders in an individual's request regarding
resuscitative measures directly conflict with his or her individual
health care instruction, as defined in Section 4623, then, to the
extent of the conflict, the most recent order or instruction is
effective.
  SEC. 6.  Section 4781.5 is added to the Probate Code, to read:
   4781.5.  The legally recognized health care decisionmaker shall
make health care decisions pursuant to this part in accordance with
Sections 4684 and 4714.
  SEC. 7.  Section 4782 of the Probate Code is amended to read:
   4782.  A health care provider who honors a request regarding
resuscitative measures is not subject to criminal prosecution, civil
liability, discipline for unprofessional conduct, administrative
sanction, or any other sanction, as a result of his or her reliance
on the request, if the health care provider (a) believes in good
faith that the action or decision is consistent with this part, and
(b) has no knowledge that the action or decision would be
inconsistent with a health care decision that the individual signing
the request would have made on his or her own behalf under like
circumstances.
  SEC. 8.  Section 4783 of the Probate Code is amended to read:
   4783.  (a) Forms for requests regarding resuscitative measures
printed after January 1, 1995, shall contain the following:

"By signing this form, the legally recognized health care
decisionmaker acknowledges that this request regarding resuscitative
measures is consistent with the known desires of, and with the best
interest of, the individual who is the subject of the form."

   (b) A printed form substantially similar to that described in
subparagraph (A) of paragraph (2) of subdivision (a) of Section 4780
is valid and enforceable if all of the following conditions are met:
   (1) The form is signed by the individual, or the individual's
legally recognized health care decisionmaker, and a physician.
   (2) The form directs health care providers regarding resuscitative
measures.
   (3) The form contains all other information required by this
section.
  SEC. 9.  Section 4784 of the Probate Code is amended to read:
   4784.  In the absence of knowledge to the contrary, a health care
provider may presume that a request regarding resuscitative measures
is valid and unrevoked.
  SEC. 10.  Section 4785 of the Probate Code is amended to read:
   4785.  This part applies regardless of whether the individual
executing a request regarding resuscitative measures is within or
outside a hospital or other health care institution.