BILL ANALYSIS Ó AB 637 Page 1 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 AB 637 Page 2 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. AB 637 Page 3 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 AB 637 Page 4 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 AB 637 Page 5