Amended in Assembly August 31, 2015

Amended in Assembly July 16, 2015

Amended in Senate June 2, 2015

Amended in Senate May 5, 2015

Amended in Senate March 25, 2015

Senate BillNo. 19


Introduced by Senator Wolk

(Coauthors: Senators Hancock, Monning, and Vidak)

(Coauthors: Assembly Members Bonilla, Dababneh, and Eggman)

December 1, 2014


An act to addbegin insert and repealend insert Section 4788begin delete toend deletebegin insert ofend insert the Probate Code, relating to resuscitative measures.

LEGISLATIVE COUNSEL’S DIGEST

SB 19, as amended, Wolk. Physician Orders for Life Sustaining Treatment form:begin delete statewide registry.end deletebegin insert electronic registry pilot.end insert

Existing law defines a request regarding resuscitative measures as a written document, signed by an individual with capacity, or a legally recognized health care decisionmaker, and the individual’s physician, directing a health care provider regarding resuscitative measures. Existing law defines a Physician Orders for Life Sustaining Treatment form, which is commonly referred to as a POLST form, and provides that a request regarding resuscitative measures includes a POLST form. Existing law requires that a POLST form and the medical intervention and procedures offered by the form be explained by a health care provider. Existing law distinguishes a request regarding resuscitative measures from an advance health care directive.

This bill would enact the California POLSTbegin delete Registryend deletebegin insert eRegistry Pilotend insert Act. The bill would require thebegin delete California Health and Human Services Agencyend deletebegin insert Emergency Medical Services Authorityend insert to establishbegin delete and operate a statewide registry system,end deletebegin insert a pilot project, in consultation with stakeholders, to operate an electronic registry system on a pilot basis,end insert to be known as the California POLSTbegin delete Registry,end deletebegin insert eRegistry Pilot,end insert for the purpose of collecting POLSTbegin delete formsend deletebegin insert informationend insert received from a physician or physician’s designee.begin insert The bill would require the authority to coordinate the POLST eRegistry Pilot, which would be operated by health information exchange networks, by an independent contractor, or by a combination thereof.end insert The bill would require thebegin delete agencyend deletebegin insert authorityend insert to implement these provisions only after it determines that sufficient nonstate fundsbegin delete have been receivedend deletebegin insert are availableend insert for development of thebegin delete registry andend deletebegin insert POLST eRegistry Pilot,end insert any related startupbegin delete costs. Aend deletebegin insert costs, and an evaluation of the POLST eRegistry Pilot. When the POLST eRegistry Pilot is operable in the geographic area in which he or she operates or practices, aend insert physician or physician’s designee who completesbegin delete aend delete POLSTbegin delete formend deletebegin insert informationend insert would be required to include the POLSTbegin delete formend deletebegin insert informationend insert in the patient’sbegin delete medicalend deletebegin insert official electronic healthend insert record and would be required to submitbegin delete the form to the registry,end deletebegin insert a copy of the form to, or to enter the information into, the POLST eRegistry Pilot,end insert unless a patient or his or her health care decisionmaker chooses not to participate in thebegin delete registry.end deletebegin delete The bill would require the agency to disseminate the information in the POLST form to an authorized user. The bill would define “authorized user” to include a health care provider.end deletebegin insert POLST eRegistry Pilot.end insert The bill would require thebegin delete agencyend deletebegin insert authorityend insert to adoptbegin delete rulesend deletebegin insert guidelinesend insert for, among other things, the operation of thebegin delete registry,end deletebegin insert POLST eRegistry Pilot,end insert including the means by which POLSTbegin delete formsend deletebegin insert informationend insert would be submitted electronically,begin delete revised, and revoked, the capability to check the POLST form for accuracy prior to it being made available,end deletebegin insert modified, or withdrawn,end insert the appropriate and timely methods for dissemination of POLST form information, the procedures for verifying the identity of an authorized user, and rules for maintaining the confidentiality ofbegin delete aend delete POLSTbegin delete formend deletebegin insert informationend insert received by thebegin delete registry.end deletebegin insert POLST eRegistry Pilot.end insert The bill would require that any disclosure of POLSTbegin delete formend delete information in thebegin delete registryend deletebegin insert POLST eRegistry Pilotend insert be made in accordance with applicable state and federal privacy and security laws and regulations. The bill would provide immunity from criminal prosecution, civil liability, discipline for unprofessional conduct, and any other sanction for a health care provider who honors a patient’s request regarding resuscitative measures obtained from thebegin delete registry,end deletebegin insert POLST eRegistry Pilot,end insert as specified.begin insert The bill would require an independent contractor approved by the authority to conduct an evaluation of the POLST eRegistry Pilot. The provisions of the bill would be operative until January 1, 2020.end insert

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

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

P3    1

SECTION 1.  

This act shall be known, and may be cited, as the
2California POLSTbegin delete Registryend deletebegin insert eRegistry Pilotend insert Act.

3

SEC. 2.  

Section 4788 is added to the Probate Code, to read:

4

4788.  

(a)    For purposes of this section:

begin delete

5(1) “Agency” means the California Health and Human Services
6Agency.

end delete
begin insert

7(1) “Authority” means the Emergency Medical Services
8Authority.

end insert

9(2) “Authorized user” means a person authorized by thebegin delete agencyend delete
10begin insert authorityend insert to submit information to, or to receive information from,
11the POLSTbegin delete registry,end deletebegin insert eRegistry Pilot,end insert including health care providers
12and their designees.

13(3) “Health care provider” has the meaning provided in Section
14begin delete 4621.end deletebegin insert 4781.end insert

15(4) begin delete“POLST form” end deletebegin insert“POLST” end insertmeans a Physician Orders for
16Life Sustaining Treatmentbegin delete formend delete that fulfills thebegin delete requirementsend delete
17begin insert requirements, in any format,end insert of Section 4780.

18(5) begin delete“Registry” end deletebegin insert“POLST eRegistry Pilot” end insertmeans the California
19POLSTbegin delete Registry established by the agencyend deletebegin insert eRegistry Pilot Act
20establishedend insert
pursuant to thisbegin delete section.end deletebegin insert section to make electronic, in
21addition to other modes of submission and transmission, POLST
22information available to authorized users.end insert

23(b) (1) begin deleteThe agency shall establish and operate a statewide
24registry system, to be known as the California POLST Registry, end delete

25begin insertThe authority shall establish a pilot project, in consultation with
26stakeholders, to operate an electronic registry system on a pilot
27basis, to be known as the California POLST eRegistry Pilot, end insert
for
28 the purpose of collecting abegin insert patient’send insert POLSTbegin delete formend deletebegin insert informationend insert
29 received from a physician or physician’s designee and
30disseminating the informationbegin delete in the formend delete to an authorized user.

P4    1(2) Thebegin delete agencyend deletebegin insert authorityend insert shall implement this section only after
2determining that sufficient nonstate fundsbegin delete have been receivedend deletebegin insert are
3availableend insert
to allow for the development of thebegin delete registry andend deletebegin insert POLST
4eRegistry Pilot,end insert
any related startupbegin delete costs.end deletebegin insert costs, and an evaluation
5of the POLST eRegistry Pilot.end insert

begin delete

6 (3) The registry may be operated and maintained by a contractor
7of the agency. The agency

end delete
begin insert

8(3) The authority shall coordinate the POLST eRegistry Pilot,
9which shall be operated by, and as a part of, the health information
10exchange networks, or by an independent contractor, or by a
11combination thereof. The POLST eRegistry Pilot may operate in
12a single geographic area or multiple geographic areas and may
13test various methods of making POLST information available
14electronically. The design of the POLST eRegistry Pilot shall be
15sufficiently robust, based on the success of the pilot, to inform the
16permanent, statewide operation of a POLST eRegistry.

end insert

17begin insert(4)end insertbegin insertend insertbegin insertThe authorityend insert shall adoptbegin delete all rulesend deletebegin insert guidelinesend insert necessary for
18the operation of the begin delete registry, whichend delete begin insert POLST eRegistry Pilot. In
19developing these guidelines, the authority shall seek input from
20interested parties and hold at least one public meeting. The
21adoption, amendment, or repeal of the guidelines authorized by
22this paragraph is hereby exempted from the Administrative
23Procedure Act (Chapter 3.5 (commencing with Section 11340) of
24Part 1 of Division 3 of Title 2 of the Government Code). The
25guidelinesend insert
shall include, but not be limited to, the following:

26(A) The means by whichbegin delete anend delete initial or subsequent POLSTbegin delete formend delete
27begin insert informationend insert may be submitted to, or withdrawn from, thebegin delete registry,end delete
28begin insert POLST eRegistry Pilot,end insert which shall include a method for electronic
29delivery of this information and the use of legally sufficient
30electronic signatures.

31(B) Appropriate and timely methods by which the information
32in thebegin delete registryend deletebegin insert POLST eRegistry Pilotend insert may be disseminated to an
33authorized user.

34(C) Procedures for verifying the identity of an authorized user.

35(D) Procedures to ensure the accuracy of, and to appropriately
36protect the confidentiality of, POLSTbegin delete formsend deletebegin insert informationend insert submitted
37to thebegin delete registry.end deletebegin insert POLST eRegistry Pilot.end insert

38(E) The requirement that a patient, or, when appropriate, his or
39her legally recognized health care decisionmaker, receive a
40confirmation or a receipt that the patient’s POLSTbegin delete formend delete
P5    1begin insert informationend insert has been received by thebegin delete registry.end deletebegin insert POLST eRegistry
2Pilot.end insert

begin delete

3(F) The ability of the physician who signed the POLST form,
4or his or her designee, and of a patient, or, when appropriate, his
5or her legally recognized health care decisionmaker, to review the
6information in the patient’s POLST form after it has been entered
7into the registry, and to confirm that it is accurate, prior to the
8information being available to an authorized user.

end delete
begin delete

9(G)

end delete

10begin insert(F)end insert The ability of a patient, or, when appropriate, his or her
11legally recognized health care decisionmaker,begin delete to withdraw a
12POLST form from the registry.end delete
begin insert with his or her health care
13provider, to modify or withdraw POLST information on the POLST
14eRegistry Pilot.end insert

begin insert

15(6) (A) Prior to implementation of the POLST eRegistry Pilot,
16the authority shall submit a detailed plan to the Legislature that
17explains how the POLST eRegistry Pilot will operate.

end insert
begin insert

18(B) The plan to be submitted pursuant to subparagraph (A) shall
19be submitted in compliance with Section 9795 of the Government
20Code.

end insert

21(c) The operation of thebegin delete registryend deletebegin insert POLST eRegistry Pilot, for all
22users,end insert
shall comply with state and federal privacy and security
23laws and regulations, including, but not limited to, compliance
24with the Confidentiality of Medical Information Act (Part 2.6
25(commencing with Section 56) of Division 1 of the Civil Code)
26and the regulations promulgated pursuant to the federal Health
27Insurance Portability and Accountability Act of 1996 (Public Law
28104-191), found at Parts 160 and 164 of Title 45 of the Code of
29Federal Regulations.

30(d) begin deleteA end deletebegin insertWhen the POLST eRegistry Pilot is operable in the
31geographic area in which he or she practices or operates, a end insert

32physician or physician’s designee who completesbegin delete a POLST formend delete
33begin insert POLST informationend insert with a patient or his or her legally recognized
34health care decisionmaker shall include the POLSTbegin delete formend delete
35begin insert informationend insert in the patient’s official begin delete medical record. The physician
36or physician’s designeeend delete
begin insert electronic health record andend insert shall submit
37a copy of the POLST formbegin delete to the registryend deletebegin insert to, or enter the POLST
38information into, the POLST eRegistry Pilot,end insert
unless the patient or
39the legally recognized health care decisionmaker chooses not to
40participate in thebegin delete registry.end deletebegin insert POLST eRegistry Pilot.end insert

begin insert

P6    1(e) When the POLST eRegistry Pilot is operable in the
2geographic area in which they practice or operate, physicians,
3hospitals, and health information exchange networks shall make
4electronic POLST information available, for use during
5emergencies, through the POLST eRegistry Pilot to health care
6providers that also practice or operate in a geographic area where
7the POLST eRegistry Pilot is operable, but that are outside of their
8health information exchange networks.

end insert
begin delete

9(e)

end delete

10begin insert(f)end insert In accordance with Section 4782, a health care provider who
11honors a patient’s request regarding resuscitative measures obtained
12from thebegin delete registryend deletebegin insert POLST eRegistry Pilotend insert shall not be subject to
13criminal prosecution, civil liability, discipline for unprofessional
14conduct, administrative sanction, or any other sanction, if the health
15care provider (1) believes in good faith that the action or decision
16is consistent with this part, and (2) has no knowledge that the action
17or decision would be inconsistent with a health care decision that
18the individual signing the request would have made on his or her
19own behalf under like circumstances.

begin insert

20(g) An independent contractor approved by the authority shall
21perform an evaluation of the POLST eRegistry Pilot.

end insert
begin insert

22(h) This section shall remain in effect only until January 1, 2020,
23and as of that date is repealed, unless a later enacted statute, that
24is enacted before January 1, 2020, deletes or extends that date.

end insert


O

    94