Amended in Assembly May 13, 2014

Amended in Assembly April 2, 2014

California Legislature—2013–14 Regular Session

Assembly Bill No. 2139

Introduced by Assembly Member Eggman

February 20, 2014

An act to amend Sections begin delete 442, 442.5, end delete begin insert 442.5 end insert and 442.7 of the Health and Safety Code, relating to terminal illness.

LEGISLATIVE COUNSEL’S DIGEST

AB 2139, as amended, Eggman. End-of-life care: patient notification.

Under existing law, the State Department of Public Health licenses and regulates health facilities, including hospice facilities, and the provision of hospice services. Existing law establishes the Medical Practice Act, which provides for the regulation and licensure of physicians and surgeons by the Medical Board of California. begin delete Existing law authorizes an adult to give an individual, known as an agent, authority to make health care decisions for that individual in the event of his or her incapacity pursuant to a power of attorney for health care. end delete

When a health care provider, as defined, makes a diagnosis that a patient has a terminal illness, existing law requires the health care provider to provide the patient, upon the patient’s request, with comprehensive information and counseling regarding legal end-of-life options, as specified, and provide for the referral or transfer of a patient, as provided, if the patient’s health care provider does not wish to comply with the patient’s request for information on end-of-life options.

This bill would apply these provisions to begin delete an agent under a power of attorney for health care end delete begin insert another person authorized to make health care decisions, as defined, end insert for a patient with a terminal illness diagnosis. The bill would additionally require the health care provider to notify begin insert , except as specified, end insert the patient or, when applicable, the begin delete agent, end delete begin insert other person authorized to make health care decisions, end insert when the health care provider makes a diagnosis that a patient has a terminal illness, of the patient’s begin insert and the other authorized person’s end insert right to comprehensive information and counseling regarding legal end-of-life care options. begin delete The bill would define the term “terminal illness” for these purposes. end delete

Vote: majority. Appropriation: no. Fiscal committee: no. State-mandated local program: no.

The people of the State of California do enact as follows:

begin delete

SECTION 1.  

Section 442 of the Health and Safety Code is
amended to read:

442.  

For the purposes of this part, the following definitions
shall apply:

(a) “Actively dying” means the phase of terminal illness when
death is imminent.

(b) “Agent” means an individual designated in a power of
attorney for health care, as provided in Article 1 (commencing
with Section 4670) and Article 2 (commencing with Section 4680)
of Chapter 1 of Part 2 of Division 4.7 of the Probate Code, to make
a health care decision for the patient who has been diagnosed with
a terminal illness, regardless of whether the person is known as
an agent or attorney in fact, or by some other term.

(c) “Disease-targeted treatment” means treatment directed at
the underlying disease or condition that is intended to alter its
natural history or progression, irrespective of whether or not a cure
is a possibility.

(d) “Health care provider” means an attending physician and
surgeon. It also means a nurse practitioner or physician assistant
practicing in accordance with standardized procedures or protocols
developed and approved by the supervising physician and surgeon
and the nurse practitioner or physician assistant.

(e) “Hospice” means a specialized form of interdisciplinary
health care that is designed to provide palliative care, alleviate the
physical, emotional, social, and spiritual discomforts of an
individual who is experiencing the last phases of life due to the
existence of a terminal disease, and provide supportive care to the
primary caregiver and the family of the hospice patient, and that
meets all of the criteria specified in subdivision (b) of Section
1746.

(f) “Palliative care” means medical treatment, interdisciplinary
care, or consultation provided to a patient or family members, or
both, that has as its primary purpose the prevention of, or relief
from, suffering and the enhancement of the quality of life, rather
than treatment aimed at investigation and intervention for the
purpose of cure or prolongation of life as described in subdivision
(b) of Section 1339.31. In some cases, disease-targeted treatment
may be used in palliative care.

(g) “Refusal or withdrawal of life-sustaining treatment” means
forgoing treatment or medical procedures that replace or support
an essential bodily function, including, but not limited to,
cardiopulmonary resuscitation, mechanical ventilation, artificial
nutrition and hydration, dialysis, and any other treatment or
discontinuing any or all of those treatments after they have been
used for a reasonable time.

(h) “Terminal illness” means a medical condition resulting in
a prognosis of a life expectancy of one year or less, if the disease
follows its normal course.

end delete

begin delete SEC. 2. end delete
begin insert SECTION 1. end insert   

Section 442.5 of the Health and Safety Code is
amended to read:

442.5.  

begin insert (a) end insert begin insert   end insert When a health care provider makes a diagnosis that
a patient has a terminal illness, the health care provider shall begin delete notify end delete
begin insert do both of the following: end insert

begin insert (1) end insert begin insert   end insert begin insert Notify end insert the patient of his or her right to, or when applicable,
the begin delete agent of the patient’s right to, comprehensive information and
counseling regarding legal end-of-life options and, upon the patient
or agent’s request, provide the patient or agent end delete begin insert right of another
person authorized to make health care decisions for the patient
to, comprehensive information and counseling regarding legal
end-of-life options. This notification maybe provided at the time
of diagnosis or at a subsequent visit in which the provider discusses
treatment options with the patient or the other authorized person. end insert

begin insert (2) end insert begin insert   end insert begin insert Upon the request of the patient or another person authorized
to make health care decisions for the patient, provide the patient
or other authorized person end insert with comprehensive information and
counseling regarding legal end-of-life care options pursuant to this
section. When a terminally ill patient is in a health facility, as
defined in Section 1250, the health care provider, or medical
director of the health facility if the patient’s health care provider
is not available, may refer the patient or begin delete agent end delete begin insert other authorized
person end insert to a hospice provider or private or public agencies and
community-based organizations that specialize in end-of-life care
case management and consultation to receive comprehensive
information and counseling regarding legal end-of-life care options.

begin delete

(a)

end delete

begin insert (b) end insert  If begin delete the patient or agent indicates a desire to receive the
information and counseling, end delete begin insert a patient or another person authorized
to make health care decisions for the patient, requests information
and counseling pursuant to paragraph (2) of subdivision (a), end insert the
comprehensive information shall include, but not be limited to,
the following:

(1) Hospice care at home or in a health care setting.

(2) A prognosis with and without the continuation of
disease-targeted treatment.

(3) The patient’s right to refusal of or withdrawal from
life-sustaining treatment.

(4) The patient’s right to continue to pursue disease-targeted
treatment, with or without concurrent palliative care.

(5) The patient’s right to comprehensive pain and symptom
management at the end of life, including, but not limited to,
adequate pain medication, treatment of nausea, palliative
chemotherapy, relief of shortness of breath and fatigue, and other
clinical treatments useful when a patient is actively dying.

(6)  begin delete If the patient has not appointed an agent under a power of
attorney for health care, the end delete begin insert The end insert patient’s right to give individual
health care instruction pursuant to Section 4670 of the Probate
Code, which provides the means by which a patient may provide
written health care instruction, such as an advance health care
directive, and the patient’s right to appoint a legally recognized
health care decisionmaker.

begin delete

(b)

end delete

begin insert (c) end insert  The information described in subdivision begin delete (a) end delete begin insert (b) end insert may, but
is not required to, be in writing. Health care providers may utilize
information from organizations specializing in end-of-life care
that provide information on factsheets and Internet Web sites to
convey the information described in subdivision begin delete (a). end delete begin insert (b). end insert

begin delete

(c)

end delete

begin insert (d) end insert  Counseling may include, but is not limited to, discussions
about the outcomes for the patient and his or her family, based on
the interest of the patient. Information and counseling, as described
in subdivision begin delete (a), end delete begin insert (b), end insert may occur over a series of meetings with
the health care provider or others who may be providing the
information and counseling based on the patient’s needs.

begin delete

(d)

end delete

begin insert (e) end insert  The information and counseling sessions may include a
discussion of treatment options in a begin insert culturally sensitive end insert manner
that the patient and his or her family, or, when applicable, begin delete the
agent, end delete begin insert another person authorized to make health care decisions
for the patient, end insert can easily understand. If the patient or begin delete agent end delete begin insert other
authorized person end insert requests information on the costs of treatment
options, including the availability of insurance and eligibility of
the patient for coverage, the patient or begin delete agent end delete begin insert other authorized
person end insert shall be referred to the appropriate entity for that
information.

begin insert

(f) The notification in paragraph (1) of subdivision (a) shall not
be required if the patient or other person authorized to make health
care decisions, as defined in Section 4617 of the Probate Code,
for the patient has already received the notification.

end insert begin insert

(g) For purposes of this section, “health care decisions” has
the meaning set fourth in Section 4617 of the Probate Code.

end insert

begin delete SEC. 3. end delete
begin insert SEC. 2. end insert   

Section 442.7 of the Health and Safety Code is
amended to read:

442.7.  

If a health care provider does not wish to comply with
his or her patient’s request or, when applicable, the begin delete agent’s end delete request
begin insert of another person authorized to make health care decisions, as
defined in Section 4617 of the Probate Code, for the patient end insert for
information on end-of-life options, the health care provider shall
do both of the following:

(a) Refer or transfer a patient to another health care provider
that shall provide the requested information.

(b) Provide the patient or begin delete agent end delete begin insert other person authorized to make
health care decisions for the patient end insert with information on
procedures to transfer to another health care provider that shall
provide the requested information.