Amended in Senate August 18, 2014

Amended in Assembly May 13, 2014

Amended in Assembly April 2, 2014

California Legislature—2013–14 Regular Session

Assembly BillNo. 2139


Introduced by Assembly Member Eggman

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(Principal coauthor: Senator Leno)

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(Coauthors: Assembly Members Ammiano, Olsen, and Wieckowski)

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(Coauthors: Senators Monning and Wolk)

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February 20, 2014


An act to amend Sections 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.

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 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 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.

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

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

P2    1

SECTION 1.  

Section 442.5 of the Health and Safety Code is
2amended to read:

3

442.5.  

(a) When a health care provider makes a diagnosis that
4a patient has a terminal illness, the health care provider shall do
5both of the following:

6(1) Notify the patient of his or herbegin delete right to,end deletebegin insert right,end insert or when
7applicable, the right of another person authorized to make health
8care decisions for thebegin delete patient to,end deletebegin insert patient, toend insert comprehensive
9information and counseling regarding legal end-of-life options.
10This notificationbegin delete maybeend deletebegin insert may beend insert provided at the time of diagnosis
11or at a subsequent visit in which the provider discusses treatment
12options with the patient or the other authorized person.

13(2) Upon the request of the patient or another person authorized
14to make health care decisions for the patient, provide the patient
15or other authorized person with comprehensive information and
16counseling regarding legal end-of-life care options pursuant to this
17section. When a terminally ill patient is in a health facility, as
18defined in Section 1250, the health care provider, or medical
19director of the health facility if the patient’s health care provider
20is not available, may refer the patient or other authorized person
21to a hospice provider or private or public agencies and
22community-based organizations that specialize in end-of-life care
23case management and consultation to receive comprehensive
24information and counseling regarding legal end-of-life care options.

25(b) If a patient or another person authorized to make health care
26decisions for the patient, requests information and counseling
P3    1pursuant to paragraph (2) of subdivision (a), the comprehensive
2information shall include, but not be limited to, the following:

3(1) Hospice care at home or in a health care setting.

4(2) A prognosis with and without the continuation of
5disease-targeted treatment.

6(3) The patient’s right to refusal of or withdrawal from
7life-sustaining treatment.

8(4) The patient’s right to continue to pursue disease-targeted
9treatment, with or without concurrent palliative care.

10(5) The patient’s right to comprehensive pain and symptom
11management at the end of life, including, but not limited to,
12adequate pain medication, treatment of nausea, palliative
13chemotherapy, relief of shortness of breath and fatigue, and other
14clinical treatments useful when a patient is actively dying.

15(6) The patient’s right to give individual health care instruction
16pursuant to Section 4670 of the Probate Code, which provides the
17means by which a patient may provide written health care
18instruction, such as an advance health care directive, and the
19patient’s right to appoint a legally recognized health care
20decisionmaker.

21(c) The information described in subdivision (b) may, but is not
22required to, be in writing. Health care providers may utilize
23information from organizations specializing in end-of-life care
24that provide information on factsheets and Internet Web sites to
25convey the information described in subdivision (b).

26(d) Counseling may include, but is not limited to, discussions
27about the outcomes for the patient and his or her family, based on
28the interest of the patient. Information and counseling, as described
29in subdivision (b), may occur over a series of meetings with the
30health care provider or others who may be providing the
31information and counseling based on the patient’s needs.

32(e) The information and counseling sessions may include a
33discussion of treatment options in a culturally sensitive manner
34that the patient and his or her family, or, when applicable, another
35person authorized to make health care decisions for the patient,
36can easily understand. If the patient or other authorized person
37requests information on the costs of treatment options, including
38the availability of insurance and eligibility of the patient for
39coverage, the patient or other authorized person shall be referred
40to the appropriate entity for that information.

P4    1(f) The notificationbegin delete inend deletebegin insert made pursuant toend insert paragraph (1) of
2subdivision (a) shall not be required if the patient or other person
3authorized to make health care decisions, as defined in Section
44617 of the Probate Code, for the patient has already received the
5notification.

6(g) For purposes of this section, “health care decisions” has the
7meaning set fourth in Section 4617 of the Probate Code.

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8(h) This section shall not be construed to interfere with the
9clinical judgment of a health care provider in recommending the
10course of treatment.

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11

SEC. 2.  

Section 442.7 of the Health and Safety Code is
12amended to read:

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442.7.  

If a health care provider does not wish to comply with
14his or her patient’s request or, when applicable, the request of
15another person authorized to make health care decisions, as defined
16in Section 4617 of the Probate Code, for the patient for information
17on end-of-life options, the health care provider shall do both of
18the following:

19(a) Refer or transfer a patient to another health care provider
20that shall provide the requested information.

21(b) Provide the patient or other person authorized to make health
22care decisions for the patient with information on procedures to
23transfer to another health care provider that shall provide the
24requested information.



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