BILL ANALYSIS Ó
AB 637
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ASSEMBLY THIRD READING
AB
637 (Campos)
As Introduced February 24, 2015
Majority vote
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|Committee |Votes |Ayes |Noes |
|----------------+------+--------------------+--------------------|
|Judiciary |10-0 |Mark Stone, Wagner, | |
| | |Alejo, Chau, Chiu, | |
| | |Gallagher, Cristina | |
| | |Garcia, Holden, | |
| | |Maienschein, | |
| | |O'Donnell | |
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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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