Amended in Assembly September 4, 2015

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 add and repeal Section 4788 of the Probate Code, relating to resuscitative measures.

LEGISLATIVE COUNSEL’S DIGEST

SB 19, as amended, Wolk. Physician Orders for Life Sustaining Treatment form: electronic registry pilot.

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 POLST eRegistry Pilot Act. The bill would require the Emergency Medical Services Authority to establish a pilot project, in consultation with stakeholders, to operate an electronic registry system on a pilot basis, to be known as the California POLST eRegistry Pilot, for the purpose of collecting POLST information received from a physician or physician’s designee. 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. The bill would require the authority to implement these provisions only after it determines that sufficient nonstate funds are available for development of the POLST eRegistry Pilot, any related startup 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, a physician or physician’s designee who completes POLST information would be required to include the POLST information in the patient’s officialbegin delete electronic healthend deletebegin insert medicalend insert record and would be required to submit a copy of the form to, or to enter the information into, the POLST eRegistry Pilot, unless a patient or his or her health care decisionmaker chooses not to participate in the POLST eRegistry Pilot. The bill would require the authority to adopt guidelines for, among other things, the operation of the POLST eRegistry Pilot, including the means by which POLST information would be submitted electronically, modified, or withdrawn, 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 of POLST information received by the POLST eRegistry Pilot. The bill would require that any disclosure of POLST information in the POLST eRegistry Pilot 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 the POLST eRegistry Pilot, as specified. 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.

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 POLST eRegistry Pilot Act.

3

SEC. 2.  

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

4

4788.  

(a)    For purposes of this section:

5(1) “Authority” means the Emergency Medical Services
6Authority.

7(2) “Authorized user” means a person authorized by the
8 authority to submit information to, or to receive information from,
9the POLST eRegistry Pilot, including health carebegin delete providersend delete
10begin insert providers, as defined in Section 4781,end insert and their designees.

begin delete

11(3) “Health care provider” has the meaning provided in Section
124781.

end delete
begin delete

13(4)

end delete

14begin insert(3)end insert “POLST” means a Physician Orders for Life Sustaining
15Treatment that fulfills the requirements, in any format, of Section
164780.

begin delete

17(5)

end delete

18begin insert(4)end insert “POLST eRegistry Pilot” means the California POLST
19eRegistry Pilot Act established pursuant to this section to make
20electronic, in addition to other modes of submission and
21transmission, POLST information available to authorized users.

22(b) (1) The authority shall establish a pilot project, in
23consultation with stakeholders, to operate an electronic registry
24system on a pilot basis, to be known as the California POLST
25eRegistry Pilot, for the purpose of collecting a patient’s POLST
26information received from a physician or physician’s designee and
27disseminating the information to an authorized user.

28(2) The authority shall implement this section only after
29determining that sufficient nonstate funds are available to allow
30for the development of the POLST eRegistry Pilot, any related
31startup costs, and an evaluation of the POLST eRegistry Pilot.

32(3) The authority shall coordinate the POLST eRegistry Pilot,
33which shall be operated by, and as a part of, the health information
34exchange networks, or by an independent contractor, or by a
35combination thereof. The POLST eRegistry Pilot may operate in
P4    1a single geographic area or multiple geographic areas and may test
2various methods of making POLST information available
3electronically. The design of the POLST eRegistry Pilot shall be
4sufficiently robust, based on the success of the pilot, to inform the
5permanent, statewide operation of a POLST eRegistry.

6(4) The authority shall adopt guidelines necessary for the
7operation of the POLST eRegistry Pilot. In developing these
8guidelines, the authority shall seek input from interested parties
9and hold at least one public meeting. The adoption, amendment,
10or repeal of the guidelines authorized by this paragraph is hereby
11exempted from the Administrative Procedure Act (Chapter 3.5
12(commencing with Section 11340) of Part 1 of Division 3 of Title
132 of the Government Code). The guidelines shall include, but not
14be limited to, the following:

15(A) The means by which initial or subsequent POLST
16information may be submitted to, or withdrawn from, the POLST
17eRegistry Pilot, which shall include a method for electronic
18delivery of this information and the use of legally sufficient
19electronic signatures.

20(B) Appropriate and timely methods by which the information
21in the POLST eRegistry Pilot may be disseminated to an authorized
22user.

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

24(D) Procedures to ensure the accuracy of, and to appropriately
25protect the confidentiality of, POLST information submitted to
26the POLST eRegistry Pilot.

27(E) The requirement that a patient, or, when appropriate, his or
28her legally recognized health care decisionmaker, receive a
29confirmation or a receipt that the patient’s POLST information
30has been received by the POLST eRegistry Pilot.

31(F) The ability of a patient, or, when appropriate, his or her
32legally recognized health care decisionmaker, with his or her health
33care provider,begin insert as defined in Section 4621,end insert to modify or withdraw
34POLST information on the POLST eRegistry Pilot.

35(6) (A) Prior to implementation of the POLST eRegistry Pilot,
36the authority shall submit a detailed plan to the Legislature that
37explains how the POLST eRegistry Pilot will operate.

38(B) The plan to be submitted pursuant to subparagraph (A) shall
39be submitted in compliance with Section 9795 of the Government
40Code.

P5    1(c) The operation of the POLST eRegistry Pilot, for all users,
2shall comply with state and federal privacy and security laws and
3regulations, including, but not limited to, compliance with the
4Confidentiality of Medical Information Act (Part 2.6 (commencing
5with Section 56) of Division 1 of the Civil Code) and the
6regulations promulgated pursuant to the federal Health Insurance
7Portability and Accountability Act of 1996 (Public Law 104-191),
8found at Parts 160 and 164 of Title 45 of the Code of Federal
9Regulations.

10(d) When the POLST eRegistry Pilot is operable in the
11geographic area in which he or she practices or operates, a
12physician or physician’s designee who completes POLST
13information with a patient or his or her legally recognized health
14care decisionmaker shall include the POLST information in the
15patient’s officialbegin delete electronic healthend deletebegin insert medicalend insert record and shall submit
16a copy of the POLST form to, or enter the POLST information
17into, the POLST eRegistry Pilot, unless the patient or the legally
18recognized health care decisionmaker chooses not to participate
19in the POLST eRegistry Pilot.

20(e) When the POLST eRegistry Pilot is operable in the
21geographic area in which they practice or operate, physicians,
22hospitals, and health information exchange networks shall make
23electronic POLST information available, for use during
24emergencies, through the POLST eRegistry Pilot to health care
25begin delete providersend deletebegin insert providers, as defined in Section 4781,end insert that also practice
26or operate in a geographic area where the POLST eRegistry Pilot
27is operable, but that are outside of their health information
28exchange networks.

29(f) In accordance with Section 4782, a health carebegin delete providerend delete
30begin insert provider, as defined in Section 4781,end insert who honors a patient’s request
31regarding resuscitative measures obtained from the POLST
32eRegistry Pilot shall not be subject to criminal prosecution, civil
33liability, discipline for unprofessional conduct, administrative
34sanction, or any other sanction, if the health care provider (1)
35believes in good faith that the action or decision is consistent with
36this part, and (2) has no knowledge that the action or decision
37would be inconsistent with a health care decision that the individual
38signing the request would have made on his or her own behalf
39under like circumstances.

P6    1(g) An independent contractor approved by the authority shall
2perform an evaluation of the POLST eRegistry Pilot.

3(h) This section shall remain in effect only until January 1, 2020,
4and as of that date is repealed, unless a later enacted statute, that
5is enacted before January 1, 2020, deletes or extends that date.



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