BILL ANALYSIS                                                                                                                                                                                                    Ó

          |SENATE RULES COMMITTEE            |                       ABX2 15|
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          |327-4478                          |                              |

                                   THIRD READING 

          Bill No:  ABX2 15
          Author:   Eggman (D), Alejo (D), and Mark Stone (D), et al.
          Amended:  9/3/15  
          Vote:     21  

           ASSEMBLY FLOOR:  44-35, 9/9/15 - See last page for vote

           SUBJECT:   End of life

          SOURCE:    Author

          DIGEST:   This bill permits a competent, qualified individual  
          who is an adult with a terminal disease to receive a  
          prescription for an aid-in-dying drug if certain conditions are  
          met, such as two oral requests, a minimum of 15 days apart, and  
          a written request signed by two witnesses, is provided to his or  
          her attending physician, the attending physician refers the  
          patient to a consulting physician to confirm diagnosis and  
          capacity to make medical decisions, and the attending physician  
          refers the patient to a mental health specialist, if indicated.   
          Sunsets these provisions on January 1, 2026.

          Existing law:

           1) Establishes requirements for health care providers when a  
             provider makes a diagnosis that a patient has a terminal  
             illness, including that the patient has a right to  
             comprehensive information and counseling regarding legal end  
             of life options, which includes information about hospice  
             care at home or in a health care setting, that he or she has  
             a right to comprehensive pain and symptom management at the  
             end of life, including, but not limited to, adequate pain  


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             medication, treatment of nausea, palliative chemotherapy,  
             relief from shortness of breath and fatigue, and other  
             clinical treatments useful when a patient is actively dying.

           2) Provides that a resident of a long term care facility lacks  
             capacity to make a decision regarding his or her health care  
             if the resident is unable to understand the nature and  
             consequences of the proposed medical intervention, including  
             its risks and benefits, or is unable to express a preference  
             regarding the intervention. Requires the physician, in making  
             the determination regarding capacity, to interview the  
             patient, review the patient's medical records, and consult  
             with facility staff, family members and friends of the  
             resident, if any have been identified.

           3) Makes it a felony to deliberately aid, or advise, or  
             encourage another to commit suicide.

          This bill:

           1) Permits an individual who is an adult with the capacity to  
             make medical decisions and with a terminal disease to request  
             and receive a prescription for an aid-in-dying drug if all of  
             the following conditions exist:  

              a)    The attending physician has diagnosed the individual  
                with a terminal disease;

              b)    The individual has voluntarily expressed the wish to  
                receive a prescription for an aid in dying drug;

              c)    The individual is a resident of California and is able  
                to establish residency, as specified; 

              d)    The individual documents his or her request for  
                aid-in-dying drug, as specified; and,

              e)    The individual has the physical and mental ability to  
                self-administer the aid-in-dying drug.

           2) Requires a request for a prescription for an aid-in-dying  
             drug to be made solely and directly by the individual  


                                                                    ABX2 15  
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             diagnosed with the terminal disease and prohibits it from  
             being made on behalf of the patient, including, but not  
             limited to, through a power of attorney, an advance health  
             care directive, or any other legally recognized health care  

           3) Requires a qualified individual wishing to receive a  
             prescription for an aid-in-dying drug to submit two oral  
             requests, a minimum of 15 days apart, and a witnessed written  
             request, as specified, to his or her attending physician.   
             Requires the attending physician to receive the three  
             requests, directly, and not through a designee.

           4) Requires at least two adult witnesses who attest that to the  
             best of their knowledge and belief the individual is known to  
             them or has provided proof of identity, voluntarily signed  
             the request in their presence, is of sound mind and not under  
             duress, fraud, or undue influence, and not an individual for  
             whom either is the attending physician, consulting physician,  
             or mental health specialist.  

           5) Permits one of the two witnesses to be related by blood,  
             marriage, or adoption; or be a person entitled to a portion  
             of the person's estate upon death.  Permits one of the two  
             witnesses to own, operate, or be employed at a health care  
             facility where the qualified individual is receiving medical  
             treatment or resides.  Prohibits the attending physician,  
             consulting physician, or mental health specialist from being  
             one of the witnesses.

           6) Permits an individual at any time to withdraw or rescind his  
             or her request for an aid-in-dying drug or decide not to  
             ingest an aid-in-dying drug, without regard to the  
             individual's mental state.

           7) Requires before prescribing an aid-in-dying drug the  
             attending physician to:

              a)    Make the initial determination whether the requesting  
                adult has the capacity to make medical decisions; if there  
                are indications of a mental disorder the physician is  
                required to refer the individual for a mental health  


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                assessment and cannot prescribe the aid-in-dying drug  
                until the mental health specialist determines that the  
                individual has the capacity to make medical decisions and  
                is not suffering from impaired judgment; has a terminal  
                disease, has voluntarily made the request, and is a  
                qualified individual.

              b)    Confirm the individual is making an informed decision  
                by discussing with him or her the medical diagnosis and  
                prognosis, potential risks with taking the drug, the  
                probable result of taking the drug, the possibility that  
                he or she may choose to obtain the drug but not take it,  
                and the feasible alternatives or additional treatment  
                opportunities including, but not limited to, comfort care,  
                hospice care, palliative care, and pain control.

              c)    Refer the individual to a consulting physician,  
                (defined as a physician who is independent from the  
                attending physician and is qualified by specialty or  
                experience to make a professional diagnosis and prognosis  
                regarding the individual's terminal disease), for medical  
                confirmation of the diagnosis, prognosis, and for a  
                determination that the individual has the capacity to make  
                medical decisions and has complied with this bill.

              d)    Refer the individual for a mental health specialist,  
                if there are indications of a mental disorder.  Defines  
                counseling as one or more consultations, as necessary,  
                between an individual and a California licensed  
                psychiatrist or psychologist for the purpose of  
                determining that the individual is competent and is not  
                suffering from a psychiatric or psychological disorder or  
                depression causing impaired judgment.

              e)    Confirm the qualified individual's request does not  
                arise from coercion or undue influence by another person  
                by discussing with the qualified individual, outside of  
                the presence of any other persons, except for an  
                interpreter as required by this bill, whether or not the  
                qualified individual is feeling coerced or unduly  
                influenced by another person.


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              f)    Counsel the individual about the importance of having  
                another person present when he or she takes the drug and  
                not taking the drug in a public place, notifying next of  
                kin, participating in a hospice program, and maintaining  
                the aid-in-dying drug in a safe and secure location until  
                the time it will be ingested.

              g)    Inform the individual that he or she may rescind the  
                request at any time and in any manner. 

              h)    Offer the individual an opportunity to withdraw or  
                rescind the request before prescribing the drug.

              i)    Verify, immediately prior to writing the prescription  
                for medication, that the individual is making an informed  

              j)    Fulfill the record documentation, as specified.

              aa)   Complete the attending physician checklist and  
                compliance form, established in this bill, include it and  
                the consulting physician compliance form, established in  
                this bill, in the individual's medical record, and submit  
                both forms to the Department of Public Health (DPH).

              bb)   Give the qualified individual the final attestation  
                form, with the instruction that the form be filled out and  
                executed by the qualified individual within 48 hours prior  
                to the qualified individual choosing to self-administer  
                the aid-in-dying drug.

           8) Requires, prior to a qualified individual obtaining aid in  
             dying medication from the attending physician, the consulting  
             physician to perform all of the following:

              a)    Examine the individual and his or her relevant medical  

              b)    Confirm in writing the diagnosis and prognosis;

              c)    Determine that the individual has the capacity to make  


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                medical decisions, is acting voluntarily, and has made an  
                informed decision; 

              d)    If there are indications of a mental disorder, refer  
                the individual for a mental health specialist assessment;

              e)    Fulfill the record documentation requirement, as  
                established in this bill; and,

              f)    Submit the compliance form to the attending physician.

           9) Requires the mental health specialist, upon referral from  
             the attending or consulting physician, to examine the  
             qualified individual and his or her relevant medical records;  
             determine that the individual has the mental capacity to make  
             medical decisions, act voluntarily, and make an informed  
             decision; determine that the individual is not suffering from  
             impaired judgment due to a mental disorder; and fulfill the  
             record documentation requirements established by this bill.

           10)Requires within 30 calendar days of writing a prescription  
             for aid-in-dying drug, the attending physician to submit to  
             DPH a copy of the qualifying patient's written request, the  
             attending physician checklist and compliance form, and the  
             consulting physician compliance form.  Requires within 30  
             calendar days following the qualified individual's death from  
             ingestion of the aid-in-dying drug, or any cause, the  
             attending physician to submit the attending physician  
             follow-up form to DPH.

           11)Establishes a format for the aid-in-dying drug request and  
             requires that a request be in substantially the same form,  
             and translated, as specified. Requires the interpreter to be  
             qualified, as specified, and not related to the qualified  
             individual by blood, marriage, or adoption or be entitled to  
             a portion of the person's estate upon death.

           12)Establishes the format of the final attestation form given  
             by the attending physician to the qualified individual at the  
             time the attending physician writes the prescription.   
             Requires the individual to complete the form within 48 hours  
             prior to the individual self-administering the aid-in-dying  


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             drug.  Requires if aid-in-dying medication is not returned or  
             relinquished upon the patient's death, as required by this  
             bill, the completed form to be delivered by the individual's  
             health care provider, family member, or other representative  
             to the attending physician to be included in the patient's  
             medical record.  Requires upon receiving the final  
             attestation form, the attending physician to add this form to  
             the medical records of the qualified individual.

           13)Makes a provision in a contract, will, or other agreement,  
             executed on or after January 1, 2016, whether written or  
             oral, affecting whether a person may make, withdraw or  
             rescind a request for aid-in-dying drug, invalid.  Prohibits  
             an obligation owing under any contract in effect on or after  
             January 1, 2016, from being conditioned upon or affected by a  
             person making or rescinding a request for an aid-in-dying  

           14)States that a death resulting from the self-administering of  
             an aid-in-dying drug is not suicide and therefore prohibits  
             health and insurance coverage from being exempted on that  

           15)Provides, notwithstanding any other law, that a qualified  
             individual's act of self-administering aid-in-dying drug may  
             not have an effect upon a life, health, or accident insurance  
             or annuity policy other than that of a natural death from the  
             underlying illness.

           16)Prohibits an insurance carrier from providing any  
             information in communications made about the availability of  
             aid-in-dying drug absent a request by the individual or the  
             individual's attending physician at his or her behest.   
             Prohibits any communication from including both the denial of  
             treatment and information as to the availability of  
             aid-in-dying drug coverage.  

           17)Prohibits a person from being subject to civil or criminal  
             liability solely because the person was present when the  
             qualified individual self-administers the prescribed  
             aid-in-dying drug.  Permits, without civil or criminal  
             liability, a person who is present to assist the qualified  


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             individual by preparing the aid-in-dying drug so long as the  
             person does not assist the qualified person in ingesting the  

           18)Prohibits a health care provider or professional  
             organization or association from censoring, disciplining,  
             suspending, or revoking licensure, privileges, membership, or  
             administering other penalty to an individual for  
             participating or refusing to participate in good faith  
             compliance with this bill.

           19)Provides that a request by a qualified individual to an  
             attending physician to provide aid-in-dying drug in good  
             faith compliance with the provisions of this bill shall not  
             provide the sole basis for the appointment of a guardian or  

           20)Provides, notwithstanding any other law, a health care  
             provider shall not be subject to civil, criminal,  
             administrative, disciplinary, employment, credentialing,  
             professional discipline, contractual liability, or medical  
             staff action, sanction, or penalty or other liability for  
             participating in this bill, as specified.  States that  
             nothing in this provision shall be construed to limit the  
             application of, or provide immunity from 30)-34) below.

           21)Permits a health care provider to prohibit its employees,  
             independent contractors, or other persons from participating  
             in activities under this bill while on premises owned or  
             under the management or direct control of that prohibiting  
             health care provider, as specified.  Indicates that nothing  
             shall be construed to prevent, or to allow a prohibiting  
             health care provider to prohibit its employees or contractors  
             from participating in activities under this bill outside the  
             scope of the employee or contractor's duties, or while on  
             premises not owned by the prohibiting employer, as specified.

           22)Prohibits a health care provider from being sanctioned for:  
             making an initial determination that an individual has a  
             terminal illness and informing him or her of the medical  
             prognosis; providing information about the End of Life Option  
             Act to a patient upon the request of the individual;  


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             providing an individual, upon request, with a referral to  
             another physician; or, contracting with an individual to act  
             outside the course and scope of the provider's capacity as an  
             employee or independent contractor of a health care provider  
             that prohibits activities under this bill.

           23)States that notwithstanding any contrary provision in this  
             bill, the immunities and prohibitions on sanctions of a  
             health care provider are solely reserved for actions of a  
             health care provider taken pursuant to this bill.   
             Additionally, health care providers may be sanctioned by  
             their licensing board or agency for conduct and actions  
             unprofessional conduct, including failure to comply in good  
             faith with this bill. 

           24)Makes it a felony to knowingly alter or forge a request for  
             aid-in-dying drug to end an individual's life without his or  
             her authorization or concealing or destroying a withdrawal or  
             rescission of a request for an aid-in-dying drug if the act  
             is done with the intent or effect of causing the individual's  

           25)Makes it a felony to knowingly coerce or exert undue  
             influence on an individual to request or ingest an  
             aid-in-dying drug for the purpose of ending his or her life  
             or to destroy a withdrawal or rescission of a request, or to  
             administer an aid-in-dying drug to an individual without his  
             or her knowledge or consent.

           26)Indicates that 24) and 25) above shall not be construed to  
             limit civil liability, and do not preclude criminal penalties  
             applicable under any law for conduct inconsistent with the  
             provisions of this bill.

           27)Provides that nothing in this bill may be construed to  
             authorize a physician or any other person to end an  
             individual's life by lethal injection, mercy killing, or  
             active euthanasia.  Provides that actions taken in accordance  
             with this bill shall not, for any purpose, constitute  
             suicide, assisted suicide, mercy killing, homicide, or elder  
             abuse under the law.


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           28)Requires DPH to collect and review the specified information  
             and to be collected in a manner that protects the privacy of  
             the patient, the patient's family, and any medical provider  
             or pharmacist involved with the patient under this bill.   
             Requires a report annually beginning on or before July 1,  
             2017, to be posted on the department's website.

           29)Requires a person who has custody or control of any unused  
             aid in dying medication to personally deliver the unused  
             medication to the nearest qualified facility that properly  
             disposes of controlled substances, or if none is available,  
             dispose of it by lawful means.

           30)Sunsets this bill on January 1, 2026.

          1)Author's statement.  According to the author, ABX2 15, the End  
            of Life Option Act allows an adult in California with a  
            terminal disease that has the capacity to make medical  
            decisions and who has been given a prognosis of less than six  
            months to live, to make end of life decisions. By giving these  
            patients the legal right to ask for and receive an  
            aid-in-dying prescription from his/her physician, ABX2 15  
            provides one more option to the number of options one has when  
            faced with the end of their life. This bill includes strong  
            provisions to safeguard patients from coercion and to allow  
            voluntary participation by physicians, pharmacists and health  
            care facilities. This medical practice is already recognized  
            in five other states. There is substantial evidence from those  
            states that prove this law can be used safely and effectively.  
            Californians that are faced with a terminal disease should not  
            have to leave the state in order to have a peaceful death. In  
            the end, how each of us spends the end of our lives is a  
            deeply personal decision. That decision should remain with the  
            individual, as a matter of personal freedom and liberty,  
            without criminalizing those who help to honor our wishes and  
            ease our suffering.

          2)Other States.  According to the National Conference of State  
            Legislatures, four states currently allow a person to request  


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            a drug to end one's life, including:  Montana, Oregon,  
            Vermont, and Washington.  Montana's authorization was  
            determined in the 2008 case of Baxter v. State of Montana.   
            New Mexico's authorization was determined in 2014 Morris v.  
            New Mexico, however the New Mexico Attorney General appealed  
            the district court's ruling.  According to the Albuquerque  
            Journal News, a divided New Mexico Court of Appeals reversed  
            the 2014 ruling in August 2015 but virtually guaranteed the  
            issue to be revisited by the New Mexico Supreme Court.   
            Oregon, Vermont, and Washington have authorized the practice  
            in statute, by voter initiative in Oregon (passed in 1994 and  
            enacted in 1997) and Washington (in 2008).  In 2013, Vermont  
            passed legislation to authorize physician aid in dying.   
            Arkansas and Idaho have enacted laws which specifically  
            prohibit physician aid in dying.  

          3)Other Countries.  Belgium, the Netherlands, Luxembourg,  
            Switzerland and, beginning next year, Canada, allow physician  
                             aid in dying.  The Netherlands and Belgium also allow  
            euthanasia (administered by a physician).  Belgium extended  
            its law in 2014 to include children of any age living with  
            terminal illness.  In the Netherlands, the law is not  
            available to children under 12 years old and for teenagers,  
            the law requires parental consent.

          4)Oregon Data.  According to the Oregon Public Health Division  
            2013 report, from 1998 to 2013, 1,173 were prescribed aid with  
            dying medication and 752 deaths occurred as a result of  
            ingesting prescribed medications.  From 1998 to 2013, the  
            gender break down of those who died from ingesting a lethal  
            dose of medication was 52 percent male and 48 percent female.   
            Less than 32 percent of the individuals who ingested the  
            medication were between ages 18-64.  Almost 70 percent were  
            over aged 65. The race breakdown was white (97 percent),  
            African American (.1 percent), American Indian (.3 percent),  
            Asian (1.1 percent), Pacific Islander (.1 percent), other (.1  
            percent), two or more races (.3 percent), and Hispanic (.7  
            percent).  Over 46 percent of those who ingested the  
            medication were married and the remaining 64 percent were  
            widowed, never married, divorced, or status was unknown (three  
            individuals).  Less than 28 percent of those who ingested the  
            medication had a high school education or less and 72 percent  


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            had some college or higher education levels (five individuals  
            had unknown status).  Ninety percent of those who ingested the  
            medication were enrolled in hospice.  Sixty-three percent had  
            private insurance, 35 percent had Medicare, Medicaid or other  
            governmental insurance, and less than two percent were  
            uninsured (35 individuals had unknown status).  Almost 80  
            percent of those who ingested the medication had malignant  
            neoplasms, seven percent had Amyotrophic lateral sclerosis,  
            five percent had chronic lower respiratory disease, two  
            percent had heart disease, one percent had HIV/AIDS and six  
            percent had other illnesses.  Six percent of those who  
            ingested the medication were referred for psychiatric  
            evaluation.  Ninety-four informed their family of their  
            decision.  Ninety-five percent died at home, four percent died  
            in long-term care, and .1 percent died in the hospital.   
            Ninety-one percent of those who ingested the medication were  
            concerned about loss of autonomy, 89 percent were concerned  
            about being less able to engage in activities that make life  
            enjoyable, 81 percent were concerned about loss of dignity, 50  
            percent were concerned about losing bodily function, 40  
            percent were concerned about being a burden on family, friends  
            or caregivers, 23 percent were concerned about inadequate pain  
            control, and three percent were concerned about financial  
            implications of treatment.  There were 22 complications of  
            regurgitation reported and six individuals regained  
            consciousness after ingesting the medications.  A range of  
            between 15 and 1,009 days elapsed from the first request for  
            medication and death. 

          5)Brittany Maynard.  According to Compassion and Choices, a  
            nonprofit that works to expand end of life choices, Brittany  
            Maynard was a California native with a terminal brain cancer  
            diagnosis who moved to Oregon to access its death with dignity  
            law.  Brittany Maynard died in Oregon after taking  
            aid-in-dying drug on November 1, 2014.  In the final weeks of  
            her life, Ms. Maynard partnered with Compassion and Choices to  
            launch a campaign to make aid in dying an open and accessible  
            medical practice in California and throughout the country.   
            According to Brittany Maynard, as published on CNN Opinion  
            Tuesday, October 7, 2014, "Because the rest of my body is  
            young and healthy, I am likely to physically hang on for a  
            long time even though cancer is eating my mind.  I probably  


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            would have suffered in hospice care for weeks or even months.   
            And my family would have had to watch that."  After moving to  
            Oregon with her family, establishing the residency  
            requirements, and finding new physicians, Ms. Maynard obtained  
            aid-in-dying drug. "Now that I've had the prescription filled  
            and it's in my possession, I have experienced a tremendous  
            sense of relief.  And if I decide to change my mind about  
            taking the medication, I will not take it?..When my suffering  
            becomes too great, I can say to all those I love, I love you;  
            come be by my side, and come say goodbye as I pass into  
            whatever's next." 

          6)Concerns.  Allstate Insurance Company is concerned that the  
            language contained in Section 443.13 (a) and (b) could be  
            interpreted to constrain a life insurer's ability to conduct  
            its traditional underwriting practice, including the  
            consideration of the underlying terminal illness.

          Related Legislation

          SB 128 (Wolk and Monning) permits a qualified adult with  
          capacity to make medical decisions, who has been diagnosed with  
          a terminal disease to receive a prescription for an aid in dying  
          drug if certain conditions are met, such as two oral requests, a  
          minimum of 15 days apart and a signed written request witnessed  
          by two individuals is provided to his or her attending  
          physician, the attending physician refers the patient to an  
          independent, consulting physician to confirm diagnosis and  
          capacity of the patient to make medical decisions, and the  
          attending physician refers the patient for a mental health  
          specialist assessment if there are indications of a mental  
          disorder.  SB 128 is pending in the Assembly Health Committee.

          FISCAL EFFECT:   Appropriation:    No          Fiscal  
          Com.:YesLocal:   Yes

          According to the Assembly Committee on Finance:

          Department of Health Care Services
          Potential minor costs and savings in Medi-Cal based on the  
          Medi-Cal program choosing to cover this end-of-life option  


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          (General Fund (GF)).

          Department of Public Health
          One-time GF costs of $90,000 for information technology  
          services, and ongoing GF costs in the range of $250,000.  DPH  
          anticipates that a secure drive with password protection would  
          be needed to store the confidential data collected pursuant to  
          this bill, and would require an SQL database to perform data  
          collection and storage.  DPH states that a database could be  
          developed with one-time development costs of approximately  
          $88,000, and ongoing yearly maintenance by Information  
          Technology Services Division of approximately $10,000 per year,  
          as shown in the chart below.
           |Database Development Task                |Hours    |Cost        |
           |Application Development                  |         |            |
           |            Requirements Specifications |267      |$16,000     |
           |            Design/Test Plan            |133      |$8,000      |
           |            System Development / Code & |800      |$48,000     |
           |       Test                              |         |            |
           |            Acceptance Testing/User     |133      |$8,000      |
           |       Training                          |         |            |
           |            Initial Internet/SQL DBA    |133      |$8,000      |
           |       setup                             |         |            |
           |                                         |         |            |
           |Total One-Time Cost                      |1466     |$88,000     |
           |Ongoing yearly maintenance ($845 x 12)   |14/mo    |$10,140     |
           |                                         |         |            |

          Additionally, once the database is established, DPH estimates  


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          that two full-time positions would be required to perform  
          confidential program and reporting duties outlined in this bill,  
          with duties including:  

                 Collect data, enter reports received, collect forms,  
               track program utilization and associated deaths;

                 Follow-up with providers that submit incomplete reports;

                 Perform data analysis, cross-check decedent deaths with  
               list of prescribed participants, and draft annual reports;

                 Prepare the annual report mandated by the bill;

                 Maintain program information on the public website, and  
               respond to inquiries regarding program policy; and

                 Update website as needed, and make reporting forms  
               available for download online.

          Summary of Total Cost to DPH
          |     Total Budget Year Cost     |Total Cost Budget Year + 1 |
          |            $323,087            |$245,227                   |
          |                                |                           |

          Department of Managed Health Care
          Due to the sensitive and controversial nature of aid-in-dying  
          medication, the Department of Managed Health Care (DMHC)  
          anticipates a high level of public interest, which will result  
          in Public Records Act (PRA) or Information Practices Act (IPA)  
          requests during the first three years.  The Office of Legal  
          Services (OLS) anticipates PRA/IPA requests regarding which  
          health plans that cover aid-in-dying medications and under what  
          terms the medications are covered, as well as information on  
          relevant policy decisions, enforcement policies, and consumer  
          grievances. OLS estimates that these tasks will have no cost in  
          the current fiscal year, $276,000 (Managed Care Fund (MCF)) and  


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          2.0 positions in the 2015-16 fiscal year, and $244,000 MCF and  
          2.0 positions each in the 2016-17 and 2017-18 fiscal years.  OLS  
          does not anticipate ongoing costs after the 2017-18 fiscal year.

          The Help Center, Office of Administrative Services, Office of  
          Technology and Innovation, Office of Enforcement, Office of Plan  
          Licensing, Division of Plan Surveys, and Office of Financial  
          Review anticipate absorbable workload that will have no  
          significant fiscal impact on those programs.

          Medical Board of California
          Minor costs to the Medical Board to update several of the forms  
          required by this bill as deemed necessary (Contingent Fund of  
          the Medical Board of California).

          Board of Pharmacy
          Minor costs to the Board of Pharmacy.  The Board would not need  
          to amend or adopt any regulations. The Board estimates that any  
          additional enforcement actions due to this bill would result in  
          minor costs (Pharmacy Fund).

          SUPPORT:   (Verified9/10/15)

          Advisory Council of the Central Coast Commission for Senior  
          AIDS Healthcare Foundation
          AIDS Project Los Angeles
          American Nurses Association\California
          California Association for Nurse Practitioners 
          California Association of Marriage and Family Therapists
          California Chapter of the National Association of Social Workers
          California Church IMPACT
          California Commission on Aging
          California Democratic Party
          California Primary Care Association
          California Psychological Association
          California Senior Legislature
          Cardinal Point at Mariner Square Residents' Association
          Church Council of West Hollywood United Church of Christ
          City of Cathedral City


                                                                    ABX2 15  
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          City of Santa Barbara
          Coastside Democrats
          Compassion and Choices California
          Conference of California Bar Associations
          Democratic Party of Orange County
          Democratic Party of Santa Barbara County
          Democratic Service Club of Santa Barbara County
          Desert Ministries United Church of Christ
          Desert Stonewall Democrats
          Ethical Culture Society of Silicon Valley
          Five Counties Central Labor Council
          Full Circle Living and Dying Collective
          GLMA: Health Professionals Advancing LGBT Equality
          Gray Panthers of Long Beach
          Humanist Society of Santa Barbara
          Humboldt and Del Norte Counties Central Labor Council
          Laguna Woods Democratic Club
          Lompoc Valley Democratic Club
          Los Angeles LGBT Center
          Mar Vista Community Council
          Potrero Hill Democratic Club
          Progressive Christians Uniting 
          Sacramento Central Labor Council, AFL-CIO
          San Benito County Democratic Central Committee
          San Francisco AIDS Foundation
          San Mateo County Democracy for America
          San Mateo County Democratic Party
          San Mateo County Medical Association
          Santa Barbara County Board of Supervisors
          Santa Cruz City Council
          Sierra County Democratic Central Committee
          South Orange County Democratic Club
          Tehachapi Mountain Democratic Club
          Unitarian Universalist Church of the Verdugo Hills
          Ventura County Board of Supervisors
          Visalia Democratic Club

          OPPOSITION:   (Verified9/10/15)

          Agudath Israel of California


                                                                    ABX2 15  
                                                                    Page  18

          Alliance of Catholic Health Care
          Association of Northern California Oncologists
          California Catholic Conference
          California Disability Alliance
          California Foundation for Independent Living Centers
          Coalition of Concerned Medical Professionals
          Communities Actively Living Independent and Free
          Communities United in Defense of Olmstead
          Dignity Health
          Disability Action Center
          Disability Rights California
          Disability Rights Education and Defense Fund
          FREED Center for Independent Living
          Independent Living Center of Southern California
          Independent Living Resource Center of San Francisco
          Medical Oncology Association of Southern California
          Patients Rights Action Fund
          Placer Independent Resource Services
          Rabbinical Council of California
          Silicon Valley Independent Living Center
          The Arc of California

          ARGUMENTS IN SUPPORT:     Compassion and Choices writes that  
          this bill will improve the quality of end-of-life care for  
          terminally ill Californians and their families, while protecting  
          physicians who care for them. According to Compassion and  
          Choices less than one percent of dying Californians would take  
          the medication, but many people would benefit from the peace of  
          mind of having access to it if they need and want it.  Simply  
          knowing the option is available can provide a palliative effect  
          for dying people. The Advisory Council of the Central Coast  
          Commission for Senior Citizens, Area Agency on Aging based their  
          support on the thorough efforts in the proposed legislation to  
          provide safeguards to individuals. The AIDS Healthcare  
          Foundation writes that this bill contains explicit protections  
          against manipulation of the law for inappropriate purposes.   
          These provisions ensure a balance between meeting the critical  
          goal of the bill and protecting against acts by people who do  
          not have the patients' best interests in mind. The Conference of  
          California Bar Associations indicates that this bill includes  
          numerous safeguards to ensure that the medication is provided  


                                                                    ABX2 15  
                                                                    Page  19

          only to terminally ill individuals according to their own choice  
          and knowing, well-considered decision after consideration of  
          feasible alternatives and additional treatment opportunities.  
          Proponents indicate that 20 years of data collected in Oregon  
          demonstrate that this law works as intended, with no  
          substantiated reports of abuse or coercion and it resulted in  
          improved end-of-life pain management and increased use of  
          hospice for all dying patients.

          ARGUMENTS IN OPPOSITION:     A coalition of physicians and other  
          health care providers, organizations dedicated to the rights of  
          people with disabilities, and faith-based organizations write in  
          opposition that while protections for health care providers are  
          present, it is the patient who remains without adequate  
          protections. The coalition writes that physician suicide is bad  
          for Californians, particularly those with low incomes who may  
          lack adequate access to health care, including mental health  
          services. The coalition writes that this bill does not require a  
          psychiatrist to evaluate a patient before he/she decides to end  
          their life; does not require anyone to be present when the  
          patient takes his/her lethal prescription; allows the patient,  
          or designated agent, to pick up their lethal prescription at the  
          local pharmacy.  In addition, the opponents believe this bill  
          will have a devastating impact on the treatment of terminally  
          ill and disabled patients because it will quickly become another  
          treatment option, always being the cheapest.  Disability Rights  
          California writes that there is no oversight of the fatal dose  
          once it has been dispensed and no way to know if the patient has  
          changed her mind but is given the dose anyway.  The Medical  
          Oncology Association of Southern California, Inc, believes no  
          matter how many parameters are placed around the practice,  
          legalizing a form of suicide will have spillover effects in  
          society at large.  One physician writes that the "good faith"  
          legal standard in this bill that protects physicians is found  
          nowhere else in medical practice, where physicians are required  
          to practice according to the higher "medical standard of care."

          ASSEMBLY FLOOR:  44-35, 9/9/15
          AYES:  Alejo, Baker, Bloom, Bonilla, Bonta, Burke, Calderon,  
            Campos, Chau, Chiu, Chu, Cooley, Cooper, Dababneh, Dodd,  
            Eggman, Frazier, Cristina Garcia, Eduardo Garcia, Gatto,  


                                                                    ABX2 15  
                                                                    Page  20

            Gomez, Gordon, Gray, Hadley, Holden, Irwin, Jones-Sawyer,  
            Levine, Low, Maienschein, McCarty, Medina, Mullin, Nazarian,  
            Perea, Quirk, Rendon, Salas, Mark Stone, Thurmond, Ting,  
            Weber, Wood, Atkins
          NOES:  Achadjian, Travis Allen, Bigelow, Brough, Brown, Chang,  
            Chávez, Dahle, Beth Gaines, Gallagher, Gipson, Gonzalez,  
            Grove, Harper, Roger Hernández, Jones, Kim, Lackey, Linder,  
            Lopez, Mathis, Mayes, Melendez, Obernolte, O'Donnell, Olsen,  
            Patterson, Ridley-Thomas, Rodriguez, Santiago, Steinorth,  
            Wagner, Waldron, Wilk, Williams
          NO VOTE RECORDED:  Daly

          Prepared by:Teri Boughton / HEALTH / 
          9/10/15 23:36:14

                                   ****  END  ****