BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                       AB 637


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          ASSEMBLY THIRD READING


          AB  
          637 (Campos)


          As Introduced  February 24, 2015


          Majority vote


           ----------------------------------------------------------------- 
          |Committee       |Votes |Ayes                |Noes                |
          |----------------+------+--------------------+--------------------|
          |Judiciary       |10-0  |Mark Stone, Wagner, |                    |
          |                |      |Alejo, Chau, Chiu,  |                    |
          |                |      |Gallagher, Cristina |                    |
          |                |      |Garcia, Holden,     |                    |
          |                |      |Maienschein,        |                    |
          |                |      |O'Donnell           |                    |
           ----------------------------------------------------------------- 


          SUMMARY:  Expands the ability to sign a Physician Order for Life  
          Sustaining Treatment (POLST) form to nurse practitioners (NP) and  
          physician assistants (PA).  Specifically, this bill:  


          1)Authorizes a NP or a PA to sign a POLST form, completed by a  
            health care provider based on patient preferences and medical  
            indications, with either the patient, or the patient's legally  
            recognized health care decision maker under specified  
            circumstances.


          2)Requires that the NP or PA who signs such a form to be acting  
            under the supervision of the physician and within the scope of  








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            practice authorized by law.


          EXISTING LAW:  


          1)Provides that an advanced health care directive is either a  
            document containing a) individual health care instruction or b)  
            a power of attorney for health care.  Further establishes a  
            process and form for an individual to give instructions about  
            health care decision making and designating an agent to make  
            decisions on his or her behalf.  


          2)Requires a request regarding resuscitative orders to be a  
            pre-hospital "Do Not Resuscitate" form, as specified, or an  
            Emergency Medical Services Authority (EMSA) approved POLST form.  
             


          3)Establishes the POLST form and requires the form to be completed  
            by a health care provider based on patient preferences and  
            medical indications, and signed by a physician and the patient  
            or his or her legally recognized health care decision maker.  


          4)Requires the health care provider, during the process of  
            completing the form, to inform the patient about the difference  
            between an advance health care directive and the POLST form.  


          5)Protects a health care provider from liability regarding a  
            resuscitative measures if the health care provider a) believes  
            in good faith that his or her action is consistent with the  
            applicable law, and b) has no knowledge that the action or  
            decision would be inconsistent with a health care decision that  
            the individual would have made on his or her own behalf under  
            like circumstances.  









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          FISCAL EFFECT:  None



          COMMENTS:  The POLST Paradigm is a clinical process designed to  
          facilitate communication between health care professionals and  
          patients (or their authorized surrogates in cases where the  
          patients themselves do not have the capacity to make health care  
          decisions) who are very ill or very frail.  The process encourages  
          patients and their families to participate in planned, shared, and  
          informed medical decision-making that respects the patients' goals  
          for care in regard to the use of cardiopulmonary resuscitation and  
          other medical interventions.  The POLST paradigm promotes the use  
          of a highly visible, portable medical form, known as a POLST form,  
          which transfers from one setting to another with the patient.  It  
          functions as a Do Not Resuscitate order and provides treatment  
          direction for multiple health situations.  The form itself is  
          outcome neutral.  Its options range from full treatment to comfort  
          care only.    


          As of January 1, 2014, 24 states offered POLST programs.  In the  
          majority of those states (14 of 24), RNs and PAs were allowed to  
          sign a POLST form.  California is one of only nine states that  
          allow only physicians to sign POLST forms.  (New Jersey allows a  
          physician or "Advanced Practice Nurse" to sign the form.   
          (2H-134(b)(3).)


          In a statewide survey of California nursing homes, 59% of  
          responding nursing homes reported having a formal policy on POLST.  
           Two-thirds had admitted a resident with a POLST and 15% of newly  
          admitted residents over the past month had a POLST.  Few nursing  
          homes reported difficulty following POLST orders, but 38% noted  
          difficulty involving physicians in POLST completion.  

          In support of the bill, the California Medical Association writes  
          that the POLST improves communication between patients and health  








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          care providers:


               POLST also helps patients talk with their healthcare  
               team and loved ones about their choices. In this way,  
               POLST can help reduce patient and family suffering by  
               making sure that patient wishes are known and honored.  
               While patients discuss POLST with other members of the  
               healthcare team, NPs and PAs, in addition to their  
               physician, currently the POLST does not become  
               actionable until signed by both the patient or their  
               health care decision maker and their physician.  
               Therefore, to help increase POLST utilization and  
               availability, this bill allows NPs and PAs under a  
               physician's supervision to also sign POLST forms.



          The California Right to Life Committee criticizes the bill for  
          "not only replac[ing] the physician with a lower level of  
          medically trained health care decision maker but even further  
          remov[ing] the patient himself from the decision making process by  
          assigning the title of "legally recognized health care decision  
          maker" to nurse practitioners and nursing assistants who will  
          determine when or if this person's life is no longer to be  
          considered worthy of restorative health care treatment."  




          Analysis Prepared by:                                               
                          Alison Merrilees / JUD. / (916) 319-2334  FN:  
          0000116














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