California Legislature—2015–16 Second Extraordinary Session

Assembly BillNo. 15


Introduced by Assembly Members Eggman, Alejo, and Mark Stone

(Principal coauthor: Assembly Member Bonta)

(Principal coauthors: Senators Monning and Wolk)

(Coauthors: Assembly Members Burke, Chiu, Chu, Cooper, Frazier, Cristina Garcia, Jones-Sawyer, Low, McCarty, Quirk, and Rendon)

(Coauthors: Senators Allen, Block, De León, Hall, Hancock, Hernandez, Hertzberg, Hill, Jackson, Leno, McGuire, Mitchell, and Wieckowski)

August 17, 2015


An act to add Part 1.85 (commencing with Section 443) to Division 1 of the Health and Safety Code, relating to end of life.

LEGISLATIVE COUNSEL’S DIGEST

AB 15, as introduced, Eggman. End of life.

Existing law authorizes an adult to give an individual health care instruction and to appoint an attorney 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.

This bill would enact the End of Life Option Act authorizing an adult who meets certain qualifications, and who has been determined by his or her attending physician to be suffering from a terminal disease, as defined, to make a request for a drug prescribed pursuant to these provisions for the purpose of ending his or her life. The bill would establish the procedures for making these requests. The bill would also establish the forms to request an aid-in-dying drug and, under specified circumstances, an interpreter declaration to be signed subject to penalty of perjury, thereby creating a crime and imposing state-mandated local program. This bill would require specified information to be documented in the individual’s medical record, including, among other things, all oral and written requests for an aid-in-dying drug.

This bill would prohibit a provision in a contract, will, or other agreement from being conditioned upon or affected by a person making or rescinding a request for the above-described drug. The bill would prohibit the sale, procurement, or issuance of any life, health, or annuity policy, health care service plan, contract, or health benefit plan, or the rate charged for any policy or plan contract, from being conditioned upon or affected by the request. The bill would prohibit an insurance carrier from providing any information in communications made to an individual about the availability of an aid-in-dying drug absent a request by the individual or his or her attending physician at the behest of the individual. The bill would also prohibit any communication from containing both the denial of treatment and information as to the availability of aid-in-dying drug coverage.

This bill would provide immunity from civil, criminal, administrative, employment, or contractual liability or professional disciplinary action for participating in good faith compliance with the act, and would specify that the immunities and prohibitions on sanctions of a health care provider are solely reserved for conduct provided for by the bill. The bill would make participation in activities authorized pursuant to its provisions voluntary, and would make health care providers immune from liability for refusing to engage in activities authorized pursuant to its provisions. The bill would authorize a health care provider to prohibit its employees, independent contractors, or other persons or entities, including other health care providers, from participating in activities under the act while on the premises owned or under the management or direct control of that prohibiting health care provider, or while acting within the course and scope of any employment by, or contract with, the prohibiting health care provider.

This bill would make it a felony to knowingly alter or forge a request for drugs to end an individual’s life without his or her authorization or to conceal or destroy a withdrawal or rescission of a request for a drug, if it is done with the intent or effect of causing the individual’s death. The bill would make it a felony to knowingly coerce or exert undue influence on an individual to request a drug for the purpose of ending his or her life or to destroy a withdrawal or rescission of a request. By creating a new crime, the bill would impose a state-mandated local program. The bill would provide that nothing in its provisions is to be construed to authorize ending a patient’s life by lethal injection, mercy killing, or active euthanasia, and would provide that action taken in accordance with the act shall not constitute, among other things, suicide or homicide.

This bill would require physicians to submit specified forms and information to the State Department of Public Health after writing a prescription for an aid-in-dying drug and after the death of an individual who requested an aid-in-dying drug. The bill would require the Medical Board of California to update those forms on or before January 1, 2019, and the State Department of Public Health to publish the forms on its Internet Web site. The bill would require the department to annually review a sample of certain information and records and to make a statistical report of the information collected.

Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.

This bill would make legislative findings to that effect.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

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

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

P3    1

SECTION 1.  

Part 1.85 (commencing with Section 443) is
2added to Division 1 of the Health and Safety Code, to read:

3 

4PART 1.85.  End of Life Option Act

5

 

6

443.  

This part shall be known and may be cited as the End of
7Life Option Act.

8

443.1.  

As used in this part, the following definitions shall apply:

9(a) “Adult” means an individual 18 years of age or older.

10(b) “Aid-in-dying drug” means a drug determined and prescribed
11by a physician for a qualified individual, which the qualified
P4    1individual may choose to self-administer to bring about his or her
2death due to a terminal disease.

3(c) “Attending physician” means the physician who has primary
4responsibility for the health care of an individual and treatment of
5the individual’s terminal disease.

6(d) “Attending physician checklist and compliance form” means
7a form, as described in Section 443.22, identifying each and every
8requirement that must be fulfilled by an attending physician to be
9in good faith compliance with this part should the attending
10physician choose to participate.

11(e) “Capacity to make medical decisions” means that, in the
12opinion of an individual’s attending physician, consulting
13physician, psychiatrist, or psychologist, pursuant to Section 4609
14of the Probate Code, the individual has the ability to understand
15the nature and consequences of a health care decision, the ability
16to understand its significant benefits, risks, and alternatives, and
17the ability to make and communicate an informed decision to health
18care providers, including communication through a person familiar
19with the individual’s manner of communicating, if that person is
20available.

21(f) “Consulting physician” means a physician who is
22independent from the attending physician and who is qualified by
23specialty or experience to make a professional diagnosis and
24prognosis regarding an individual’s terminal disease.

25(g) “Department” means the State Department of Public Health.

26(h) “Health care provider” or “provider of health care” means
27any person licensed or certified pursuant to Division 2
28(commencing with Section 500) of the Business and Professions
29Code; any person licensed pursuant to the Osteopathic Initiative
30Act or the Chiropractic Initiative Act; any person certified pursuant
31to Division 2.5 (commencing with Section 1797) of this code; and
32any clinic, health dispensary, or health facility licensed pursuant
33to Division 2 (commencing with Section 1200) of this code.

34(i) “Informed decision” means a decision by an individual with
35a terminal disease to request and obtain a prescription for a drug
36that the individual may self-administer to end the individual’s life,
37that is based on an understanding and acknowledgment of the
38relevant facts, and that is made after being fully informed by the
39attending physician of all of the following:

40(1) The individual’s medical diagnosis and prognosis.

P5    1(2) The potential risks associated with taking the drug to be
2prescribed.

3(3) The probable result of taking the drug to be prescribed.

4(4) The possibility that the individual may choose not to obtain
5the drug or may obtain the drug but may decide not to ingest it.

6(5) The feasible alternatives or additional treatment
7opportunities, including, but not limited to, comfort care, hospice
8care, palliative care, and pain control.

9(j) “Medically confirmed” means the medical diagnosis and
10prognosis of the attending physician has been confirmed by a
11consulting physician who has examined the individual and the
12individual’s relevant medical records.

13(k) “Mental health specialist assessment” means one or more
14consultations between an individual and a mental health specialist
15for the purpose of determining that the individual has the capacity
16to make medical decisions and is not suffering from impaired
17judgment due to a mental disorder.

18(l) “Mental health specialist” means a psychiatrist or a licensed
19psychologist.

20(m) “Physician” means a doctor of medicine or osteopathy
21currently licensed to practice medicine in this state.

22(n) “Public place” means any street, alley, park, public building,
23any place of business or assembly open to or frequented by the
24public, and any other place that is open to the public view, or to
25which the public has access.

26(o) “Qualified individual” means an adult who has the capacity
27to make medical decisions, is a resident of California, and has
28satisfied the requirements of this part in order to obtain a
29prescription for a drug to end his or her life.

30(p) “Self-administer” means a qualified individual’s affirmative,
31conscious, and physical act of administering and ingesting the
32aid-in-dying drug to bring about his or her own death.

33(q) “Terminal disease” means an incurable and irreversible
34disease that has been medically confirmed and will, within
35reasonable medical judgment, result in death within six months.

36

443.2.  

(a) An individual who is an adult with the capacity to
37make medical decisions and with a terminal disease may make a
38request to receive a prescription for an aid-in-dying drug if all of
39the following conditions are satisfied:

P6    1(1) The individual’s attending physician has diagnosed the
2individual with a terminal disease.

3(2) The individual has voluntarily expressed the wish to receive
4a prescription for an aid-in-dying drug.

5(3) The individual is a resident of California and is able to
6establish residency through any of the following means:

7(A) Possession of a California driver license or other
8identification issued by the State of California.

9(B) Registration to vote in California.

10(C) Evidence that the person owns or leases property in
11California.

12(D) Filing of a California tax return for the most recent tax year.

13(4) The individual documents his or her request pursuant to the
14requirements set forth in Section 443.3.

15(5) The individual has the physical and mental ability to
16self-administer the aid-in-dying drug.

17(b) A person shall not be considered a “qualified individual”
18under the provisions of this part solely because of age or disability.

19(c) A request for a prescription for an aid-in-dying drug under
20this part shall be made solely and directly by the individual
21diagnosed with the terminal disease and shall not be made on behalf
22of the patient, including, but not limited to, through a power of
23attorney, an advance health care directive, a conservator, health
24care agent, surrogate, or any other legally recognized health care
25decisionmaker.

26

443.3.  

(a) An individual seeking to obtain a prescription for
27an aid-in-dying drug pursuant to this part shall submit two oral
28requests, a minimum of 15 days apart, and a written request to his
29or her attending physician. The attending physician shall directly,
30and not through a designee, receive all three requests required
31pursuant to this section.

32(b) A valid written request for an aid-in-dying drug under
33subdivision (a) shall meet all of the following conditions:

34(1) The request shall be in the form described in Section 443.11.

35(2) The request shall be signed and dated, in the presence of
36two witnesses, by the individual seeking the aid-in-dying drug.

37(3) The request shall be witnessed by at least two other adult
38persons who, in the presence of the individual, shall attest that to
39the best of their knowledge and belief the individual is all of the
40following:

P7    1(A) An individual who is personally known to them or has
2provided proof of identity.

3(B) An individual who voluntarily signed this request in their
4presence.

5(C) An individual whom they believe to be of sound mind and
6not under duress, fraud, or undue influence.

7(D) Not an individual for whom either of them is the attending
8physician, consulting physician, or mental health specialist.

9(c) Only one of the two witnesses at the time the written request
10is signed may:

11(1) Be related to the qualified individual by blood, marriage,
12registered domestic partnership, or adoption or be entitled to a
13portion of the individual’s estate upon death.

14(2) Own, operate, or be employed at a health care facility where
15the individual is receiving medical treatment or resides.

16(d) The attending physician, consulting physician, or mental
17health specialist of the individual shall not be one of the witnesses
18required pursuant to paragraph (3) of subdivision (b).

19

443.4.  

(a) An individual may at any time withdraw or rescind
20his or her request for an aid-in-dying drug, or decide not to ingest
21an aid-in-dying drug, without regard to the individual’s mental
22state.

23(b) A prescription for an aid-in-dying drug provided under this
24part may not be written without the attending physician directly,
25and not through a designee, offering the individual an opportunity
26to withdraw or rescind the request.

27

443.5.  

(a) Before prescribing an aid-in-dying drug, the
28attending physician shall do all of the following:

29(1) Make the initial determination of all of the following:

30(A) (i) Whether the requesting adult has the capacity to make
31medical decisions.

32(ii) If there are indications of a mental disorder, the physician
33shall refer the individual for a mental health specialist assessment.

34(iii) If a mental health specialist assessment referral is made,
35no aid-in-dying drugs shall be prescribed until the mental health
36specialist determines that the individual has the capacity to make
37medical decisions and is not suffering from impaired judgment
38due to a mental disorder.

39(B) Whether the requesting adult has a terminal disease.

P8    1(C) Whether the requesting adult has voluntarily made the
2request for an aid-in-dying drug pursuant to Sections 443.2 and
3443.3.

4(D) Whether the requesting adult is a qualified individual
5pursuant to subdivision (o) of Section 443.1.

6(2) Confirm that the individual is making an informed decision
7by discussing with him or her all of the following:

8(A) His or her medical diagnosis and prognosis.

9(B) The potential risks associated with ingesting the requested
10aid-in-dying drug.

11(C) The probable result of ingesting the aid-in-dying drug.

12(D) The possibility that he or she may choose to obtain the
13aid-in-dying drug but not take it.

14(E) The feasible alternatives or additional treatment options,
15including, but not limited to, comfort care, hospice care, palliative
16care, and pain control.

17(3) Refer the individual to a consulting physician for medical
18confirmation of the diagnosis and prognosis, and for a
19determination that the individual has the capacity to make medical
20decisions and has complied with the provisions of this part.

21 (4) Confirm that the qualified individual’s request does not arise
22from coercion or undue influence by another person by discussing
23with the qualified individual, outside of the presence of any other
24persons, except for an interpreter as required pursuant to this part,
25whether or not the qualified individual is feeling coerced or unduly
26influenced by another person.

27(5) Counsel the qualified individual about the importance of all
28of the following:

29(A) Having another person present when he or she ingests the
30aid-in-dying drug prescribed pursuant to this part.

31(B) Not ingesting the aid-in-dying drug in a public place.

32(C) Notifying the next of kin of his or her request for an
33aid-in-dying drug. A qualified individual who declines or is unable
34to notify next of kin shall not have his or her request denied for
35that reason.

36(D) Participating in a hospice program.

37(E) Maintaining the aid-in-dying drug in a safe and secure
38location until the time that the qualified individual will ingest it.

39(6) Inform the individual that he or she may withdraw or rescind
40the request for an aid-in-dying drug at any time and in any manner.

P9    1(7) Offer the individual an opportunity to withdraw or rescind
2the request for an aid-in-dying drug before prescribing the
3aid-in-dying drug.

4(8) Verify, immediately before writing the prescription for an
5aid-in-dying drug, that the qualified individual is making an
6informed decision.

7 (9) Confirm that all requirements are met and all appropriate
8steps are carried out in accordance with this part before writing a
9prescription for an aid-in-dying drug.

10(10) Fulfill the record documentation required under Sections
11443.8 and 443.19.

12(11) Complete the attending physician checklist and compliance
13form, as described in Section 443.22, include it in the individual’s
14medical record, and submit it to the State Department of Public
15Health.

16(b) If the conditions set forth in subdivision (a) are satisfied,
17the attending physician may deliver the aid-in-dying drug in any
18of the following ways:

19(1) Dispensing the aid-in-dying drug directly, including ancillary
20medication intended to minimize the qualified individual’s
21discomfort, if the attending physician meets all of the following
22 criteria:

23(A) Is authorized to dispense medicine under California law.

24(B) Has a current United States Drug Enforcement
25Administration (USDEA) certificate.

26(C) Complies with any applicable administrative rule or
27regulation.

28(2) With the qualified individual’s written consent, contacting
29a pharmacist, informing the pharmacist of the prescriptions, and
30delivering the written prescriptions personally, by mail, or
31electronically to the pharmacist, who may dispense the drug to the
32qualified individual, the attending physician, or a person expressly
33designated by the qualified individual and with the designation
34delivered to the pharmacist in writing or verbally.

35(c) Delivery of the dispensed drug to the qualified individual,
36the attending physician, or a person expressly designated by the
37qualified individual may be made by personal delivery, or, with a
38signature required on delivery, by United Parcel Service, United
39States Postal Service, Federal Express, or by messenger service.

P10   1

443.6.  

Before a qualified individual obtains an aid-in-dying
2drug from the attending physician, the consulting physician shall
3perform all of the following:

4(a) Examine the individual and his or her relevant medical
5records.

6(b) Confirm in writing the attending physician’s diagnosis and
7prognosis.

8(c) Determine that the individual has the capacity to make
9medical decisions, is acting voluntarily, and has made an informed
10decision.

11(d) If there are indications of a mental disorder, refer the
12individual for a mental health specialist assessment.

13(e) Fulfill the record documentation required under this part.

14

443.7.  

Upon referral from the attending or consulting physician
15pursuant to this part, the mental health specialist shall:

16(a) Examine the qualified individual and his or her relevant
17medical records.

18(b) Determine that the individual has the mental capacity to
19make medical decisions, act voluntarily, and make an informed
20decision.

21(c) Determine that the individual is not suffering from impaired
22judgment due to a mental disorder.

23(d) Fulfill the record documentation requirements of this part.

24

443.8.  

All of the following shall be documented in the
25individual’s medical record:

26(a) All oral requests for aid-in-dying drugs.

27(b) All written requests for aid-in-dying drugs.

28(c) The attending physician’s diagnosis and prognosis, and the
29determination that a qualified individual has the capacity to make
30medical decisions, is acting voluntarily, and has made an informed
31decision, or that the attending physician has determined that the
32individual is not a qualified individual.

33(d) The consulting physician’s diagnosis and prognosis, and
34verification that the qualified individual has the capacity to make
35medical decisions, is acting voluntarily, and has made an informed
36decision, or that the consulting physician has determined that the
37individual is not a qualified individual.

38(e) A report of the outcome and determinations made during a
39mental health specialist’s assessment, if performed.

P11   1(f) The attending physician’s offer to the qualified individual
2to withdraw or rescind his or her request at the time of the
3individual’s second oral request.

4(g) A note by the attending physician indicating that all
5requirements under Sections 443.5 and 443.6 have been met and
6indicating the steps taken to carry out the request, including a
7notation of the aid-in-dying drug prescribed.

8

443.9.  

(a) Within 30 calendar days of writing a prescription
9for an aid-in-dying drug, the attending physician shall submit to
10the State Department of Public Health a copy of the qualifying
11patient’s written request, the attending physician compliance form,
12and the consulting physician compliance form.

13(b) Within 30 calendar days following the qualified individual’s
14death from ingesting the aid-in-dying drug, or any other cause, the
15attending physician shall submit the attending physician followup
16form to the State Department of Public Health.

17

443.10.  

A qualified individual may not receive a prescription
18for an aid-in-dying drug pursuant to this part unless he or she has
19made an informed decision. Immediately before writing a
20prescription for an aid-in-dying drug under this part, the attending
21physician shall verify that the individual is making an informed
22decision.

23

443.11.  

(a) A request for an aid-in-dying drug as authorized
24by this part shall be in the following form:


25

 

REQUEST FOR AN AID-IN-DYING DRUG TO END MY LIFE IN A HUMANE AND DIGNIFIED MANNER I, ......................................................, am an adult of sound mind and a resident of the State of California.
I am suffering from ................, which my attending physician has determined is in its terminal phase and which has been medically confirmed.
I have been fully informed of my diagnosis and prognosis, the nature of the aid-in-dying drug to be prescribed and potential associated risks, the expected result, and the feasible alternatives or additional treatment options, including comfort care, hospice care, palliative care, and pain control.
I request that my attending physician prescribe an aid-in-dying drug that will end my life in a humane and dignified manner if I choose to take it, and I authorize my attending physician to contact any pharmacist about my request.
INITIAL ONE:
............ I have informed one or more members of my family of my decision and taken their opinions into consideration.
............ I have decided not to inform my family of my decision.
............ I have no family to inform of my decision.
I understand that I have the right to withdraw or rescind this request at any time.
I understand the full import of this request and I expect to die if I take the aid-in-dying drug to be prescribed. My attending physician has counseled me about the possibility that my death may not be immediately upon the consumption of the drug.
I make this request voluntarily, without reservation, and without being coerced.
 
Signed:..............................................
Dated:...............................................
 
 
DECLARATION OF WITNESSES
We declare that the person signing this request:
(a) is personally known to us or has provided proof of identity;
(b) voluntarily signed this request in our presence;
(c) is an individual whom we believe to be of sound mind and not under duress, fraud, or undue influence; and
(d) is not an individual for whom either of us is the attending physician, consulting physician, or mental health specialist.
............................Witness 1/Date
............................Witness 2/Date
NOTE: Only one of the two witnesses may be a relative (by blood, marriage, registered domestic partnership, or adoption) of the person signing this request or be entitled to a portion of the person’s estate upon death. Only one of the two witnesses may own, operate, or be employed at a health care facility where the person is a patient or resident.
P12  303P12  20

 

31(b) (1) The written language of the request shall be written in
32the same translated language as any conversations, consultations,
33or interpreted conversations or consultations between a patient and
34his or her attending or consulting physicians.

35(2) Notwithstanding paragraph (1), the written request may be
36prepared in English even when the conversations or consultations
37or interpreted conversations or consultations were conducted in a
38language other than English if the English language form includes
39an attached interpreter’s declaration that is signed under penalty
P13   1of perjury. The interpreter’s declaration shall state words to the
2effect that:

 

I, (INSERT NAME OF INTERPRETER), am fluent in English and (INSERT TARGET LANGUAGE).

On (insert date) at approximately (insert time), I read the “Request for an Aid-In-Dying Drug to End My Life” to (insert name of individual/patient) in (insert target language).

Mr./Ms. (insert name of patient/qualified individual) affirmed to me that he/she understood the content of this form and affirmed his/her desire to sign this form under his/her own power and volition and that the request to sign the form followed consultations with an attending and consulting physician.

I declare that I am fluent in English and (insert target language) and further declare under penalty of perjury that the foregoing is true and correct.

Executed at (insert city, county, and state) on this (insert day of month) of (insert month), (insert year).

X______Interpreter signature

X______Interpreter printed name

X______Interpreter address

P12  20

 

21(3) An interpreter whose services are provided pursuant to
22paragraph (2) shall not be related to the qualified individual by
23blood, marriage, registered domestic partnership, or adoption or
24be entitled to a portion of the person’s estate upon death. An
25interpreter whose services are provided pursuant to paragraph (2)
26shall meet the standards promulgated by the California Healthcare
27Interpreting Association or the National Council on Interpreting
28in Health Care or other standards deemed acceptable by the
29department for health care providers in California.

30

443.12.  

(a) A provision in a contract, will, or other agreement
31executed on or after January 1, 2016, whether written or oral, to
32the extent the provision would affect whether a person may make,
33withdraw, or rescind a request for an aid-in-dying drug is not valid.

34(b) An obligation owing under any contract executed on or after
35January 1, 2016, may not be conditioned or affected by a qualified
36individual making, withdrawing, or rescinding a request for an
37aid-in-dying drug.

38

443.13.  

(a) (1) The sale, procurement, or issuance of a life,
39health, or annuity policy, health care service plan contract, or health
40benefit plan, or the rate charged for a policy or plan contract may
P14   1not be conditioned upon or affected by a person making or
2rescinding a request for an aid-in-dying drug.

3(2) Pursuant to Section 443.18, death resulting from the
4self-administration of an aid-in-dying drug is not suicide, and
5therefore health and insurance coverage shall not be exempted on
6that basis.

7(b) Notwithstanding any other law, a qualified individual’s act
8of self-administering an aid-in-dying drug shall not have an effect
9upon a life, health, or annuity policy other than that of a natural
10death from the underlying disease.

11(c) An insurance carrier shall not provide any information in
12communications made to an individual about the availability of
13an aid-in-dying drug absent a request by the individual or his or
14her attending physician at the behest of the individual. Any
15communication shall not include both the denial of treatment and
16information as to the availability of aid-in-dying drug coverage.
17For the purposes of this subdivision, “insurance carrier” means a
18health care service plan as defined in Section 1345 of this code or
19a carrier of health insurance as defined in Section 106 of the
20Insurance Code.

21

443.14.  

(a) Notwithstanding any other law, a person shall not
22be subject to civil, criminal, administrative, employment, or
23contractual liability or professional disciplinary action for
24participating in good faith compliance with this part, including an
25individual who is present when a qualified individual
26self-administers the prescribed aid-in-dying drug.

27(b) A health care provider or professional organization or
28association shall not subject an individual to censure, discipline,
29suspension, loss of license, loss of privileges, loss of membership,
30or other penalty for participating in good faith compliance with
31this part or for refusing to participate in accordance with
32subdivision (e).

33(c) Notwithstanding any other law, a health care provider shall
34not be subject to civil, criminal, administrative, disciplinary,
35employment, credentialing, professional discipline, contractual
36liability, or medical staff action, sanction, or penalty or other
37liability for participating in this part, including, but not limited to,
38determining the diagnosis or prognosis of an individual,
39determining the capacity of an individual for purposes of qualifying
40for the act, providing information to an individual regarding this
P15   1part, and providing a referral to a physician who participates in
2this part.

3(d) (1) A request by a qualified individual to an attending
4physician to provide an aid-in-dying drug in good faith compliance
5with the provisions of this part shall not provide the sole basis for
6the appointment of a guardian or conservator.

7(2) No actions taken in compliance with the provisions of this
8part shall constitute or provide the basis for any claim of neglect
9or elder abuse for any purpose of law.

10(e) (1) Participation in activities authorized pursuant to this
11part shall be voluntary. Notwithstanding Sections 442 to 442.7,
12inclusive, a person or entity that elects, for reasons of conscience,
13morality, or ethics, not to engage in activities authorized pursuant
14to this part is not required to take any action in support of an
15individual’s decision under this part.

16(2) Notwithstanding any other law, a health care provider is not
17subject to civil, criminal, administrative, disciplinary, employment,
18credentialing, professional discipline, contractual liability, or
19medical staff action, sanction, or penalty or other liability for
20refusing to participate in activities authorized under this part,
21 including, but not limited to, refusing to inform a patient regarding
22his or her rights under this part, and not referring an individual to
23a physician who participates in activities authorized under this
24part.

25(3) If a health care provider is unable or unwilling to carry out
26a qualified individual’s request under this part and the qualified
27individual transfers care to a new health care provider, the
28individual may request a copy of his or her medical records
29pursuant to law.

30

443.15.  

(a) Subject to subdivision (b), notwithstanding any
31other law, a health care provider may prohibit its employees,
32independent contractors, or other persons or entities, including
33other health care providers, from participating in activities under
34this part while on premises owned or under the management or
35direct control of that prohibiting health care provider or while
36acting within the course and scope of any employment by, or
37contract with, the prohibiting health care provider.

38(b) A health care provider that elects to prohibit its employees,
39independent contractors, or other persons or entities, including
40health care providers, from participating in activities under this
P16   1part, as described in subdivision (a), shall first give notice of the
2 policy prohibiting participation under this part to the individual or
3entity. A health care provider that fails to provide notice to an
4individual or entity in compliance with this subdivision shall not
5be entitled to enforce such a policy against that individual or entity.

6(c) Subject to compliance with subdivision (b), the prohibiting
7health care provider may take action, including, but not limited
8to, the following, as applicable, against any individual or entity
9that violates this policy:

10(1) Loss of privileges, loss of membership, or other action
11authorized by the bylaws or rules and regulations of the medical
12staff.

13(2) Suspension, loss of employment, or other action authorized
14by the policies and practices of the prohibiting health care provider.

15(3) Termination of any lease or other contract between the
16prohibiting health care provider and the individual or entity that
17violates the policy.

18(4) Imposition of any other nonmonetary remedy provided for
19in any lease or contract between the prohibiting health care provider
20and the individual or entity in violation of the policy.

21(d) Nothing in this section shall be construed to prevent, or to
22allow a prohibiting health care provider to prohibit, any other
23health care provider, employee, independent contractor, or other
24person or entity from any of the following:

25(1) Participating, or entering into an agreement to participate,
26in activities under this part, while on premises that are not owned
27or under the management or direct control of the prohibiting
28provider or while acting outside the course and scope of the
29participant’s duties as an employee of, or an independent contractor
30for, the prohibiting health care provider.

31(2) Participating, or entering into an agreement to participate,
32in activities under this part as an attending physician or consulting
33physician while on premises that are not owned or under the
34management or direct control of the prohibiting provider.

35(e) In taking actions pursuant to subdivision (c), a health care
36provider shall comply with all procedures required by law, its own
37policies or procedures, and any contract with the individual or
38entity in violation of the policy, as applicable.

39(f) For purposes of this section:

P17   1(1) “Notice” means a separate statement in writing advising of
2the prohibiting health care provider policy with respect to
3participating in activities under this part.

4(2) “Participating, or entering into an agreement to participate,
5in activities under this part” means doing or entering into an
6agreement to do any one or more of the following:

7(A) Performing the duties of an attending physician as specified
8in Section 443.5.

9(B) Performing the duties of a consulting physician as specified
10in Section 443.6.

11(C) Performing the duties of a mental health specialist, in the
12circumstance that a referral to one is made.

13(D) Delivering the prescription for, dispensing, or delivering
14the dispensed aid-in-dying drug pursuant to paragraph (2) of
15subdivision (b) of, and subdivision (c) of, Section 443.5.

16(E) Being present when the qualified individual takes the
17aid-in-dying drug prescribed pursuant to this part.

18(3) “Participating, or entering into an agreement to participate,
19in activities under this part” does not include doing, or entering
20into an agreement to do, any of the following:

21(A) Diagnosing whether a patient has a terminal disease,
22informing the patient of the medical prognosis, or determining
23whether a patient has the capacity to make decisions.

24(B) Providing information to a patient about this part.

25(C) Providing a patient, upon the patient’s request, with a referral
26to another health care provider for the purposes of participating in
27the activities authorized by this part.

28(g) Any action taken by a prohibiting provider pursuant to this
29section shall not be reportable under Sections 800 to 809.9,
30inclusive, of the Business and Professions Code. The fact that a
31health care provider participates in activities under this part shall
32not be the sole basis for a complaint or report by another health
33care provider of unprofessional or dishonorable conduct under
34Sections 800 to 809.9, inclusive, of the Business and Professions
35Code.

36(h) Nothing in this part shall prevent a health care provider from
37providing an individual with health care services that do not
38constitute participation in this part.

39

443.16.  

(a) A health care provider may not be sanctioned for
40any of the following:

P18   1(1) Making an initial determination pursuant to the standard of
2care that an individual has a terminal disease and informing him
3or her of the medical prognosis.

4(2) Providing information about the End of Life Option Act to
5a patient upon the request of the individual.

6(3) Providing an individual, upon request, with a referral to
7another physician.

8(b) A health care provider that prohibits activities under this
9part in accordance with Section 443.15 shall not sanction an
10 individual health care provider for contracting with a qualified
11individual to engage in activities authorized by this part if the
12individual health care provider is acting outside of the course and
13scope of his or her capacity as an employee or independent
14contractor of the prohibiting health care provider.

15(c) Notwithstanding any contrary provision in this section, the
16immunities and prohibitions on sanctions of a health care provider
17are solely reserved for actions taken pursuant to this part, and those
18health care providers may be sanctioned for conduct and actions
19not included and provided for in this part if the conduct and actions
20do not comply with the standards and practices set forth by the
21Medical Board of California.

22

443.17.  

(a) Knowingly altering or forging a request for an
23aid-in-dying drug to end an individual’s life without his or her
24authorization or concealing or destroying a withdrawal or rescission
25of a request for an aid-in-dying drug is punishable as a felony if
26the act is done with the intent or effect of causing the individual’s
27death.

28(b) Knowingly coercing or exerting undue influence on an
29individual to request an aid-in-dying drug for the purpose of ending
30his or her life or to destroy a withdrawal or rescission of a request
31is punishable as a felony.

32(c) For purposes of this section, “knowingly” has the meaning
33provided in Section 7 of the Penal Code.

34(d) Nothing in this section shall be construed to limit civil
35liability.

36(e) The penalties in this section do not preclude criminal
37penalties applicable under any law for conduct inconsistent with
38the provisions of this section.

39

443.18.  

Nothing in this part may be construed to authorize a
40physician or any other person to end an individual’s life by lethal
P19   1injection, mercy killing, or active euthanasia. Actions taken in
2accordance with this part shall not, for any purposes, constitute
3suicide, assisted suicide, homicide, or elder abuse under the law.

4

443.19.  

(a) The State Department of Public Health shall collect
5and review the information submitted pursuant to Section 443.9.
6The information collected shall be confidential and shall be
7collected in a manner that protects the privacy of the patient, the
8patient’s family, and any medical provider or pharmacist involved
9with the patient under the provisions of this part. The information
10shall not be disclosed, discoverable, or compelled to be produced
11in any civil, criminal, administrative, or other proceeding.

12(b) On or before July 1, 2017, and each year thereafter, based
13on the information collected in the previous year, the department
14shall report the information collected from the attending physician
15follow-up form. The report shall include, but not be limited to, all
16of the following based on the information that is provided to the
17department and on the department’s access to vital statistics:

18(1) The number of people for whom an aid-in-dying prescription
19was written.

20(2) The number of known individuals who died each year for
21whom aid-in-dying prescriptions were written, and the cause of
22death of those individuals.

23(3) For the period commencing January 1, 2016, to and including
24the previous year, cumulatively, the total number of aid-in-dying
25prescriptions written, the number of people who died due to use
26of aid-in-dying drugs, and the number of those people who died
27who were enrolled in hospice or other palliative care programs at
28the time of death.

29(4) The number of known deaths in California from using
30aid-in-dying drugs per 10,000 deaths in California.

31(5) The number of physicians who wrote prescriptions for
32aid-in-dying drugs.

33(6) Of people who died due to using an aid-in-dying drug,
34demographic percentages organized by the following
35characteristics:

36(A) Age at death.

37(B) Education level.

38(C) Race.

39(D) Sex.

P20   1(E) Type of insurance, including whether or not they had
2insurance.

3(F) Underlying illness.

4(c) The State Department of Public Health shall make available
5the attending physician checklist and compliance form, the
6consulting physician compliance form, and the attending physician
7followup form, as described in Section 443.22, by posting them
8on its Internet Web site.

9

443.20.  

A person who has custody or control of any unused
10aid-in-dying drugs prescribed pursuant to this part after the death
11of the patient shall personally deliver the unused aid-in-dying drugs
12for disposal by delivering it to the nearest qualified facility that
13properly disposes of controlled substances, or if none is available,
14shall dispose of it by lawful means in accordance with guidelines
15promulgated by the California State Board of Pharmacy or a federal
16Drug Enforcement Administration approved take-back program.

17

443.21.  

Any governmental entity that incurs costs resulting
18from a qualified individual terminating his or her life pursuant to
19the provisions of this part in a public place shall have a claim
20against the estate of the qualified individual to recover those costs
21and reasonable attorney fees related to enforcing the claim.

22

443.22.  

(a) On or before January 1, 2019, the Medical Board
23of California shall develop, revise, and update an attending
24physician checklist and compliance form, a consulting physician
25compliance form, and an attending physician followup form, based
26on those provided in subdivision (b). Upon completion, the State
27Department of Public Health shall publish the updated forms on
28its Internet Web Site.

29(b) Until the Medical Board of California develops and revises
30forms pursuant to subdivision (a), or January 1, 2019, whichever
31is later, the attending physician checklist and compliance form,
32the consulting physician compliance form, and the attending
33physician followup form shall be in the following form:

P21   1PRINTER PLEASE NOTE: TIP-IN MATERIAL TO BE
2INSERTED

[8 pages]

P29   1

SEC. 2.  

The Legislature finds and declares that Section 1 of
2this act, which adds Section 443.19 to the Health and Safety Code,
3imposes a limitation on the public’s right of access to the meetings
4of public bodies or the writings of public officials and agencies
5within the meaning of Section 3 of Article I of the California
6Constitution. Pursuant to that constitutional provision, the
7Legislature makes the following findings to demonstrate the interest
8protected by this limitation and the need for protecting that interest:

9(a) Any limitation to public access to personally identifiable
10patient data collected pursuant to Section 443.19 of the Health and
11Safety Code as proposed to be added by this act is necessary to
12protect the privacy rights of the patient and his or her family.

13(b) The interests in protecting the privacy rights of the patient
14and his or her family in this situation strongly outweigh the public
15interest in having access to personally identifiable data relating to
16services.

17(c) The statistical report to be made available to the public
18pursuant to subdivision (b) of Section 443.19 of the Health and
19Safety Code is sufficient to satisfy the public’s right to access.

20

SEC. 3.  

The provisions of this part are severable. If any
21provision of this part or its application is held invalid, that
22invalidity shall not affect other provisions or applications that can
23be given effect without the invalid provision or application.

24

SEC. 4.  

No reimbursement is required by this act pursuant to
25Section 6 of Article XIII B of the California Constitution because
26the only costs that may be incurred by a local agency or school
27district will be incurred because this act creates a new crime or
28infraction, eliminates a crime or infraction, or changes the penalty
29for a crime or infraction, within the meaning of Section 17556 of
30the Government Code, or changes the definition of a crime within
31the meaning of Section 6 of Article XIII B of the California
32Constitution.



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