BILL ANALYSIS                                                                                                                                                                                                    Ó




                   Senate Appropriations Committee Fiscal Summary
                            Senator Kevin de León, Chair


          SB 1357 (Wolk) - Physician Orders for Life Sustaining Treatment  
          form: statewide registry.
          
          Amended: May 6, 2014            Policy Vote: Health 8-0, Judic.  
          5-1
          Urgency: No                     Mandate: No
          Hearing Date: May 19, 2014      Consultant: Brendan McCarthy
          
          This bill meets the criteria for referral to the Suspense File.
          
          
          Bill Summary: SB 1357 would require the Health and Human  
          Services Agency to create a statewide registry for Physician  
          Orders for Life Sustaining Treatment forms.

          Fiscal Impact: 
              Start-up costs of about $2.5 million over the first three  
              years to develop the system (General Fund). The California  
              Health Care Foundation has commissioned a feasibility report  
              to examine the concept of a POLST registry. According to a  
              draft of the report, it will cost about $2.5 million to  
              develop the information technology system for an  
              online-accessible registry and set up the program.

              Ongoing costs of about $1.3 million per year to maintain  
              the system, assist health care providers trying to access a  
              POLST form for a patient, and market the system (General  
              Fund).

          Background: Under current law, a health care provider can  
          complete a Physician Orders for Life Sustaining Treatment  
          (POLST) form based on patient preferences and medical  
          indications. A POLST form must be signed by the patient and the  
          health care provider. The POLST form gives information to future  
          health care providers about the patient's wishes for medical  
          care at the end of life. The POLST form allows the patient to  
          specify the level of care that he or she wishes to be provided.  
          A POLST form is a more detailed set of instructions for health  
          care provides than a Do Not Resuscitate form.

          Also authorized under current law, an individual may create and  
          advance care directive. An advance care directive is a legal  








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          document through which an individual can appoint someone else to  
          make health care decisions, if the individual is not able to  
          make his or her own decisions. An advance care directive can  
          also give instructions for making health care decisions, for  
          example by giving instructions to family members about a  
          patient's wishes, should he or she be unable to make health care  
          decisions.

          The Secretary of State's Office currently maintains an advance  
          care directive registry. That system is paper based and is not  
          widely marketed. There are only about 4,000 records in the  
          system and the Secretary's Office receives about 40 requests per  
          month for directives in the system. Because it is a paper-based  
          system with limited funding, requests can only be responded to  
          during normal business hours.

          Proposed Law: SB 1357 would require the Health and Human  
          Services Agency to create a statewide registry for Physician  
          Orders for Life Sustaining Treatment forms.

          Specific provisions of the bill would:
              Require the Health and Human Services Agency to create a  
              statewide POLST registry, before January 1, 2016;
              Require the registry to accept electronic submissions;
              Require standards for verifying users and protecting  
              information in the registry;
              Require other privacy and accuracy protections;
              Require a health care provider who completes a POLST form  
              to include it in the patient's medical record;
              Provide that a health care provider, acting in good faith  
              upon information in a POLST form, would be protected from  
              criminal or civil liability or other sanctions.

          Related Legislation: AB 2452 (Pan) would require the Secretary  
          of State to develop an online registry for advance health care  
          directives. That bill is on the Assembly Appropriations  
          Committee's Suspense File.

          Staff Comments: Under both the federal American Recovery and  
          Reinvestment Act and the Affordable Care Act, funding has been  
          made available to state governments and health care providers  
          for improvements to health-related information technology  
          systems. It is possible that the state may be able to secure  
          funding from the federal government under those bills or through  








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          the Medi-Cal program to offset some of the costs to develop the  
          system required under this bill.