BILL NUMBER: AB 2139 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MAY 13, 2014
AMENDED IN ASSEMBLY APRIL 2, 2014
INTRODUCED BY Assembly Member Eggman
FEBRUARY 20, 2014
An act to amend Sections 442, 442.5, 442.5
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.
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.
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 an agent under
a power of attorney for health care another person
authorized to make health care decisions, as defined, for a
patient with a terminal illness diagnosis. The bill would
additionally require the health care provider to notify , except
as specified, the patient or, when applicable, the
agent, other person authorized to make health care
decisions, when the health care provider makes a diagnosis that
a patient has a terminal illness, of the patient's and the
other authorized person's right to comprehensive information
and counseling regarding legal end-of-life care options. The
bill would define the term "terminal illness" for these purposes.
Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
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.
SEC. 2. SECTION 1. Section 442.5 of
the Health and Safety Code is amended to read:
442.5. (a) When a health care provider
makes a diagnosis that a patient has a terminal illness, the health
care provider shall notify do both of the
following:
(1) Notify the patient of his or
her right to, or when applicable, the 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 right of another person
authorized to make health care decisions for the patient to, co
mprehensive 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.
(2) 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 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
agent other authorized person 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.
(a)
(b) If the patient or agent indicates a desire
to receive the information and counseling,
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), 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) If the patient has not appointed an agent under a
power of attorney for health care, the The
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.
(b)
(c) The information described in subdivision
(a) (b) 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 (a).
(b).
(c)
(d) 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 (a), (b), 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.
(d)
(e) The information and counseling sessions may include
a discussion of treatment options in a culturally sensitive
manner that the patient and his or her family, or, when
applicable, the agent, another person
authorized to make health care decisions for the patient, can
easily understand. If the patient or agent
other authorized person requests information on the costs of
treatment options, including the availability of insurance and
eligibility of the patient for coverage, the patient or
agent other authorized person shall be referred
to the appropriate entity for that information.
(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.
(g) For purposes of this section, "health care decisions" has the
meaning set fourth in Section 4617 of the Probate Code.
SEC. 3. SEC. 2. 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 agent's
request of another person authorized to make health
care decisions, as defined in Section 4617 of the Probate Code, for
the patient 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 agent other
person authorized to make health care decisions for the patient
with information on procedures to transfer to another health care
provider that shall provide the requested information.