BILL ANALYSIS                                                                                                                                                                                                    

                             Senator Ricardo Lara, Chair
                            2015 - 2016  Regular  Session

          SB 19 (Wolk) - Physician Orders for Life Sustaining Treatment  
          form:  statewide registry
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          |Version: May 5, 2015            |Policy Vote: HEALTH 9 - 0, JUD. |
          |                                |          6 - 0                 |
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          |Urgency: No                     |Mandate: No                     |
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          |Hearing Date: May 18, 2015      |Consultant: Brendan McCarthy    |
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          This bill meets the criteria for referral to the Suspense File.


          Summary:  SB 19 would require the Health and Human Services  
          Agency to create a statewide registry for Physician Orders for  
          Life Sustaining Treatment forms.

              Start-up costs of about $2.5 million over the first three  
              years to develop the system (General Fund or other unknown  
              fund source). The California Health Care Foundation has  
              commissioned a feasibility report to examine the concept of  
              a POLST registry. According to a draft of the report, it  
              will cost about $2.5 million to develop the information  
              technology system for an online-accessible registry and set  


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              up the program.

              Ongoing costs of about $1.3 million per year to maintain  
              the system, assist health care providers trying to access a  
              POLST form for a patient, and market the system (General  
              Fund or other unknown fund source).

              Unknown potential cost savings due to avoided unwanted  
              medical care (various fund sources). The primary purpose of  
              a POLST and the POLST registry proposed in this bill is to  
              ensure that individuals do not receive medical care they do  
              not wish to receive. By creating a registry of POLST forms,  
              the bill will improve access to POLST forms by emergency  
              medical services and hospitals. In turn, this will lead to  
              fewer emergency health care services for individuals who do  
              not want those services. The size of this impact is unknown.

          Background:  Under current law, a physician can complete a Physician Orders  
          for Life Sustaining Treatment (POLST) form based on patient  
          preferences and medical indications. A POLST form must be signed  
          by the patient and the physician. The POLST form gives  
          information to other health care providers about the patient's  
          wishes for medical care at the end of life. The POLST form  
          allows the patient to specify the level of care that he or she  
          wishes to be provided (across a wide range of treatment  
          options). A POLST form is a more detailed set of instructions  
          for health care providers than a Do Not Resuscitate form.  
          Importantly, because a POLST form is signed by a physician,  
          other health care providers can use the POLST form as a  
          physician's order, allowing them to provide or withhold  
          treatment based on the direction of the form.

          Also authorized under current law, an individual may create an  
          advance care directive. An advance care directive is a legal  
          document through which an individual can appoint someone else to  
          make health care decisions, if the individual is not able to  
          make his or her own decisions. An advance care directive can  
          also give instructions for making health care decisions, for  
          example by giving instructions to family members about a  
          patient's wishes, should he or she be unable to make health care  

          The Secretary of State's Office currently maintains an advance  


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          care directive registry. That system is paper based and is not  
          widely marketed. There are only about 4,000 records in the  
          system and the Secretary's Office receives about 40 requests per  
          month for directives in the system. Because it is a paper-based  
          system with limited funding, requests can only be responded to  
          during normal business hours.

          Proposed Law:  
            SB 19 would require the Health and Human Services Agency to  
          create a statewide registry for Physician Orders for Life  
          Sustaining Treatment (POLST)  forms.

          Specific provisions of the bill would:
              Require the Health and Human Services Agency to establish a  
              statewide POLST registry;
              Require the registry to accept electronic submissions;
              Require standards for verifying users and protecting  
              information in the registry;
              Require other privacy and accuracy protections;
              Require a health care provider who completes a POLST form  
              to include it in the patient's medical record;
              Provide that a health care provider, acting in good faith  
              upon information in a POLST form, would be protected from  
              criminal or civil liability or other sanctions.

              SB 128 (Wolk and Monning)  would permit a competent  
              individual who has been diagnosed with a terminal illness to  
              request a prescription for aid in dying medication. That  
              bill is on this committee's Suspense File.
              SB 1357 (Wolk, 2014) was substantially similar to this  
              bill. That bill was held on this committee's Suspense File.
              AB 2452 (Pan, 2014) would have required the Secretary of  
              State to develop an online registry for advance health care  
              directives. That bill was held in the Senate Judiciary  

          Comments:  Under both the federal American Recovery and Reinvestment Act  
          and the Affordable Care Act, funding has been made available to  


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          state governments and health care providers for improvements to  
          health-related information technology systems. Based on  
          information provided by the Health and Human Services Agency, it  
          does not seem likely that such federal funding would be  
          available to provide significant funding for the POLST registry  
          proposed in this bill. For example, federal Medicaid funding for  
          information technology systems authorized in the Affordable Care  
          Act is limited to the adoption and/or meaningful use of  
          electronic health records for Medicaid programs. While some  
          users of the proposed POLST system will certainly be Medi-Cal  
          beneficiaries, the Agency indicates that this connection to the  
          Medi-Cal program is likely not strong enough to secure federal  
          funds. Similarly, funding available under the American Recovery  
          and Reinvestment Act is available to advance health information  
          exchange efforts that are already under way. 

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