BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 19|
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UNFINISHED BUSINESS
Bill No: SB 19
Author: Wolk (D), et al.
Amended: 9/4/15
Vote: 21
SENATE HEALTH COMMITTEE: 9-0, 4/8/15
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth, Wolk
SENATE JUDICIARY COMMITTEE: 6-0, 4/28/15
AYES: Jackson, Anderson, Hertzberg, Leno, Monning, Wieckowski
NO VOTE RECORDED: Moorlach
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/28/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
SENATE FLOOR: 40-0, 6/3/15
AYES: Allen, Anderson, Bates, Beall, Berryhill, Block,
Cannella, De León, Fuller, Gaines, Galgiani, Glazer, Hall,
Hancock, Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson,
Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell, Monning,
Moorlach, Morrell, Nguyen, Nielsen, Pan, Pavley, Roth, Runner,
Stone, Vidak, Wieckowski, Wolk
ASSEMBLY FLOOR: 64-11, 9/8/15 - See last page for vote
SUBJECT: Physician Orders for Life Sustaining Treatment form:
electronic registry pilot.
SOURCE: Coalition for Compassionate Care of California
DIGEST: This bill establishes a Physician Orders for Life
Sustaining Treatment (POLST) eRegistry Pilot operated by the
California Emergency Medical Services Authority for the purpose
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of collecting a POLST form received from a physician, or his or
her designee, and disseminating the information in the form to
authorized persons.
Assembly Amendments (1) make this bill a pilot project at the
Emergency Medical Services Authority (EMSA); (2) require EMSA to
coordinate the registry pilot operated by, and as part of,
health information exchange networks, or by an independent
contractor, or a combination thereof; (3) adopt guidelines
necessary for operation of the pilot exempt from the
Administrative Procedures Act, but after seeking input from
interested parties and holding at least one public meeting; (4)
delete the ability of the physician who signed the POLST form
and the patient to review the form after it has been entered
into the registry; (5) require EMSA to submit a detailed plan to
the Legislature prior to implementation; (6) modify the
liability protections with regard to resuscitative measures; (7)
limit the health care provider types who can modify or withdraw
POLST information on the POLST eRegistry Pilot; (8) require an
independent contractor approved by EMSA to perform an
evaluation, and (9) sunset the bill on January 1, 2020.
ANALYSIS:
Existing law:
1) Requires the Secretary of State to establish a registry
system through which a person who has executed a written
advance health care directive may register information
regarding the advance directive, making that information
available upon request to any health care provider, the
public guardian, or the legal representative of the
registrant. Defines advance health care directive or
directive to mean either an individual health care
instruction or a power of attorney for health care.
2) Establishes the POLST form and medical intervention and
procedures, and requires that POLST is explained by a health
care provider, as defined.
3) Requires POLST to be completed by a health care provider
based on patient preferences and medical indications, and
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signed by a physician and the patient or his or her legally
recognized health care decision maker. Requires the health
care provider, during the process of completing form, to
inform the patient about the difference between an advance
health care directive and the POLST form.
4) Defines "health care provider" for the purposes of health
care decisions, as an individual licensed, certified, or
otherwise authorized or permitted by the law of this state to
provide health care in the ordinary course of business or
practice of a profession. Defines "health care provider" for
purposes of request for resuscitative measures as persons
described in the preceding sentence, and emergency response
employees, including, but not limited to, firefighters, law
enforcement officers, emergency medical technicians I and II,
paramedics, and employees and volunteer members of legally
organized and recognized volunteer organizations, as
specified.
This bill:
1) Establishes the California POLST eRegistry Pilot Act, and
requires EMSA to make electronic, in addition to other modes
of submission and transmission, POLST information available
to authorized users, and establish a pilot to operate an
electronic registry system on a pilot basis for the purpose
of collecting a POLST form received from a physician or
physician designee and disseminating the information in the
form to an authorized user.
2) Requires EMSA to implement this bill only after determining
that sufficient non-state funds are available to allow for
the development of the pilot and any related start-up costs
and evaluation.
3) Requires EMSA to coordinate the pilot, operated by, and as
part of, health information exchange networks, or by an
independent contractor, or by a combination thereof. Permits
the pilot to operate in a single geographic area or multiple
geographic areas and may test various methods of making POLST
information available electronically.
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4) Requires EMSA to adopt guidelines necessary for the
operation of pilot, and seek input from interested parties
and hold at least one public meeting. Exempts EMSA from the
Administrative Procedures Act in adopting these guidelines.
5) Requires the guidelines include the means to submit initial
or subsequent POLST information, or withdraw a form, from the
pilot, including a method for electronic delivery and the use
of legally sufficient electronic signatures.
6) Requires the operation of the pilot to comply with state and
federal privacy and security laws and regulations including
the federal Health Insurance Portability and Accountability
Act of 1996.
7) Requires EMSA to submit a detailed plan to the Legislature
that explains how the pilot will operate prior to
implementation, and the plan to be submitted in compliance
with the law, as specified.
8) Protects a health care provider who honors a patient's
request regarding resuscitative measures obtained from the
eRegistry from criminal prosecution, civil liability,
discipline for unprofessional conduct, administrative
sanction, or any other sanction, if the health care provider
believes in good faith that the action or decision is
consistent with this part, and has no knowledge that the
action or decision would be inconsistent with a health care
decision that the individual signing the request would have
made on his or her own behalf under like circumstances.
9) Requires an independent contractor approved by EMSA perform
an evaluation of the pilot.
10)Sunsets this bill on January 1, 2020.
Comments
1)Author's statement. According to the author, POLST is a form
that contains a doctor's orders to ensure that a patient's
wishes are honored regarding medical treatment towards the end
of life. Currently, the POLST form is a paper document, and as
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such, is oftentimes a key barrier to its effectiveness given
that it can be misplaced. Furthermore, there isn't a central
database or registry that first responders can access in an
emergency situation. An electronic POLST registry in
California would help ensure immediate access to vital medical
orders by emergency medical personnel. In an era of
ever-increasing technology and federal funding available to
specifically support electronic health records. Several states
are developing and a few states have already completed a
statewide registry to access POLST forms more effectively.
2)What is POLST? POLST is neither an advance directive nor a
replacement for advance directives. However, both documents
are helpful for communicating patient wishes when
appropriately used. An advance directive is a form in which an
individual appoints a person or persons to make health care
decisions for the individual if and when the individual loses
capacity to make health care decisions (health care power of
attorney); and/or provides guidance or instructions for making
health care decisions (living will). An advance directive is
from the patient, not a medical order. POLST consists of a
set of medical orders that applies to a limited population of
patients and addresses a limited number of critical medical
decisions. POLST is a complement to advance directives in that
it serves as a translation tool and a continuity of care
assurance.
3)POLST in California. According to Dr. Neil Wenger of UCLA
Health Ethics Center at a December 3, 2014 briefing on POLST
in California, based on an evaluation by UCLA, POLST is widely
used in California but there are challenges with completing
the form and making sure it travels with the patient.
Additional problems include incomplete or inaccurate
information and for emergency medical responders the documents
are not always available. Dr. Wenger suggests a registry is
one solution to these challenges.
4)California pilot project. In October of 2014, the California
HealthCare Foundation (CHCF) issued a request for information
to learn about the technical, infrastructure, and cost
requirements for developing a POLST registry in a single
California community. CHCF was looking for information from
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vendors around the technology, operational, and support
services necessary to establish a POLST registry and estimates
of corresponding costs. The ideal technical solution(s) should
receive the POLST information for patients from varied
sources, communicate POLST records to emergency responders and
other medical professionals, and maintain data accuracy by
interfacing with medical and public health information systems
(such as the California death registry). CHCF also requested
letters of interest from California communities with the
ability to convene acute care hospitals, medical groups,
nursing homes, hospices, and emergency medical services to
test a registry platform that would make POLST records
available to authorized providers telephonically,
electronically, or both. The ideal provider community would be
able to modify clinical workflows to use the pilot POLST
registry, integrate the POLST form into electronic health
record systems, and explore a sustainable financing model. A
decision by CHCF to move forward with a pilot is not expected
until September.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Assembly Appropriations Committee, costs likely
exceeding $1 million per year for two years (non-state funds)
for system development. CHCF has commissioned a feasibility
report to examine the concept of a POLST registry. According to
a draft of the report, it would cost about $2.5 million to
develop a statewide information technology system for an
online-accessible registry and set up the program; costs in the
hundreds of thousands of dollars per year to staff, maintain,
and market the registry pilot for the course of the pilot
(General Fund or other unknown fund source); and, unknown
potential cost savings due to avoided unwanted medical care
(various fund sources).
SUPPORT: (Verified9/8/15)
Coalition for Compassionate Care of California (source)
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AARP
Alliance of Catholic Health Care
Arc and United Cerebral Palsy California Collaboration
Blue Shield of California
California Accountable Physician Groups
California American College of Emergency Physicians
California Assisted Living Association
California Association of Physician Groups
California Chapter American College of Emergency Physicians
California Commission on Aging
California Hospital Association
Care Like A Daughter, LLC
Long Term Care Ombudsman Services of San Luis Obispo County
Mission Hospital, Laguna Beach
Mission Hospital, Mission Viejo
Petaluma Valley Hospital
Providence Health & Services Southern California
Queen of the Valley Medical Center, Napa
Redwood Memorial Hospital, Fortuna
Riverside Family Physicians
Santa Rosa Memorial Hospital
St. Mary Medical Center, Apple Valley
St. Joseph Hospital, Orange
St. Jude Medical Center, Fullerton
Vynca
OPPOSITION: (Verified9/8/15)
California Advocates for Nursing Home Reform
California Right to Life Committee
ARGUMENTS IN SUPPORT: According to this bill's sponsor,
Coalition for Compassionate Care of California (CCCC), POLST has
been widely adopted in California, almost 95% of California
hospitals have admitted a patient with a POLST and 87% have
blank forms available; 69% of nursing homes had reported
admitting a resident with a POLST form and 81% report a staff
member had completed a POLST with a resident; and after hearing
a description of POLST almost two-thirds of Californians say
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they would definitely or probably want to complete a POLST form
if they were seriously ill. CCCC states that gaining access to
a patient's POLST during a medical crisis is a critical factor
in honoring patients' wishes and a statewide registry will
eliminate delays in care and confusion. Hospitals have written
that POLST is an important care planning tool, but it does
little good if the information is not easily available in a time
of crisis. POLST forms sometimes get lost when patients
transition from care settings and a statewide registry would
eliminate this problem. Others write that POLST facilitates
free and informed consent required for medical treatments and
procedures for persons who are frail and elderly or who have a
compromised medical condition. There are common roadblocks to
effective use of POLST but the registry can be a solution.
ARGUMENTS IN OPPOSITION: The California Right to Life
Committee, Inc. opposes this bill because the organization
believes the goals of this bill are directly tied to SB 128.
The California Right to Life Committee, Inc. believes this bill
is another interjection of the state into the medical field and
will result in an authorization of the death industry to heavily
pressure ill, elderly or disabled, especially low-income
citizens to succumb to their sales pitch and seek to end their
own lives. The California Advocates for Nursing Home Reform
(CANHR) believes using state resources to create a POLST
registry without including advance health care directives
represents a significant missed opportunity and threatens to
further relegate advance health care directives to second class
status compared to POLST. CANHR believes the POLST promotion
has exacerbated some of the form's problems, namely the form
does not need to be signed by patients and can sometimes be used
to override their actual wishes. CANHR writes that advance
health care directives are generally superior to POLSTs for
advance care planning, but under this bill, advance health care
directives will continue to languish in a registry system that
is ancient, unused, and virtually useless.
ASSEMBLY FLOOR: 64-11, 9/8/15
AYES: Achadjian, Alejo, Baker, Bloom, Bonilla, Bonta, Brown,
Burke, Campos, Chang, Chau, Chiu, Chu, Cooley, Cooper,
Dababneh, Daly, Dodd, Frazier, Gallagher, Cristina Garcia,
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Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray,
Hadley, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer,
Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis,
McCarty, Medina, Mullin, Nazarian, Obernolte, O'Donnell,
Olsen, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas,
Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner,
Weber, Williams, Wood, Atkins
NOES: Travis Allen, Bigelow, Brough, Dahle, Beth Gaines,
Harper, Mayes, Melendez, Patterson, Waldron, Wilk
NO VOTE RECORDED: Calderon, Chávez, Eggman, Grove, Kim
Prepared by:Teri Boughton / HEALTH /
9/8/15 20:56:40
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