Amended in Senate June 1, 2015

Amended in Senate June 1, 2015

Amended in Senate April 14, 2015

Amended in Senate March 17, 2015

Senate Bill No. 128

Introduced by Senators Wolk and Monning

(Principal coauthors: Senators Jackson and Leno)

(Principal coauthors: Assembly Members Alejo and Eggman)

(Coauthors: Senators Block, Hall, Hancock, Hernandez, Hill, McGuire, and Wieckowski)

(Coauthors: Assembly Members Chu, Cooper, Frazier, Cristina Garcia, Low, Quirk, Rendon, and Mark Stone)

January 20, 2015

An act to add Part 1.85 (commencing with Section 443) to Division 1 of the Health and Safety Code, relating to end of life.

LEGISLATIVE COUNSEL’S DIGEST

SB 128, as amended, Wolk. End of life.

Existing law authorizes an adult to give an individual health care instruction and to appoint an attorney to make health care decisions for that individual in the event of his or her incapacity pursuant to a power of attorney for health care.

This bill would enact the End of Life Option Act authorizing an adult who meets certain qualifications, and who has been determined by his or her attending physician to be suffering from a terminal disease, as defined, to make a request for a drug prescribed pursuant to these provisions for the purpose of ending his or her life. The bill would establish the procedures for making these requests. The bill would also establish the forms to request an aid-in-dying drug and, under specified circumstances, an interpreter declaration to be signed subject to penalty of perjury, thereby imposing a crime and state-mandated local program. This bill would require specified information to be documented in the individual’s medical record, including, among other things, all oral and written requests for an aid-in-dying drug.

This bill would prohibit a provision in a contract, will, or other agreement from being conditioned upon or affected by a person making or rescinding a request for the above-described drug. The bill would prohibit the sale, procurement, or issuance of any life, health, or accident insurance or annuity policy, health care service plan, contract, or health benefit plan, or the rate charged for any policy or plan contract, from being conditioned upon or affected by the request. The bill would prohibit an insurance carrier from providing any information in communications made to an individual about the availability of an aid-in-dying drug absent a request by the individual, his or her attending physician at the behest of the individual, or the individual’s designee. The bill would also prohibit any communication from containing both the denial of treatment and information as to the availability of aid-in-dying drug coverage.

This bill would provide immunity from civil, criminal, administrative, employment, or contractual liability or professional disciplinary action for participating in good faith compliance with the act, and would specify that the immunities and prohibitions on sanctions of a health care provider are solely reserved for conduct provided for by the bill. The bill would begin delete provide that end delete begin insert make end insert participation in activities authorized pursuant to begin delete this bill shall be voluntary. end delete begin insert its provisions voluntary, and would make health care providers immune from liability for refusing to participate in activities authorized pursuant to its provisions. end insert The bill would authorize a health care provider to prohibit its employees, independent contractors, or other persons or entities, including other health care providers, from participating in activities under this act while on the premises owned or under the management or direct control of that prohibiting health care provider, or while acting within the course and scope of any employment by, or contract with, the prohibiting health care provider.

This bill would make it a felony to knowingly alter or forge a request for drugs to end an individual’s life without his or her authorization or to conceal or destroy a withdrawal or rescission of a request for a drug, if it is done with the intent or effect of causing the individual’s death. The bill would make it a felony to knowingly coerce or exert undue influence on an individual to request a drug for the purpose of ending his or her life or to destroy a withdrawal or rescission of a request. By creating a new crime, the bill would impose a state-mandated local program. The bill would provide that nothing in its provisions is to be construed to authorize ending a patient’s life by lethal injection, mercy killing, or active euthanasia, and would provide that action taken in accordance with the act shall not constitute, among other things, suicide or homicide.

This bill would require the State Public Health Officer to adopt regulations establishing additional reporting requirements for physicians and pharmacists to determine the use of, and compliance with, the act, and would require the State Public Health Officer to annually review a sample of certain records and the State Department of Public Health to make a statistical report of the information collected.

Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.

This bill would make legislative findings to that effect.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

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

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

SECTION 1.  

Part 1.85 (commencing with Section 443) is
added to Division 1 of the Health and Safety Code, to read:

 

PART 1.85.  End of Life Option Act

 

443.  

This part shall be known and may be cited as the End of
Life Option Act.

443.1.  

As used in this part, the following definitions shall apply:

(a) “Adult” means an individual 18 years of age or older.

(b) “Aid-in-dying drug” means a drug determined and prescribed
by a physician for a qualified individual, which the qualified
individual may choose to self-administer to bring about his or her
death due to a terminal disease.

(c) “Attending physician” means the physician who has primary
responsibility for the health care of an individual and treatment of
the individual’s terminal disease.

(d) “Capacity to make medical decisions” means that, in the
opinion of an individual’s attending physician, consulting
physician, psychiatrist, or psychologist, pursuant to Section 4609
of the Probate Code, the individual has the ability to understand
the nature and consequences of a health care decision, the ability
to understand its significant benefits, risks, and alternatives, and
the ability to make and communicate an informed decision to health
care providers, including communication through a person familiar
with the individual’s manner of communicating, if that person is
available.

(e) “Consulting physician” means a physician who is
independent from the attending physician and who is qualified by
specialty or experience to make a professional diagnosis and
prognosis regarding an individual’s terminal disease.

(f) “Department” means the State Department of Public Health.

(g) “End of Life Option Act Checklist” means a checklist
identifying each and every requirement that must be fulfilled by
a health care provider to be in good faith compliance with the End
of Life Option Act should the health care provider choose to
participate.

(h) “Health care provider” or “provider of health care” means
any person licensed or certified pursuant to Division 2
(commencing with Section 500) of the Business and Professions
Code; any person licensed pursuant to the Osteopathic Initiative
Act or the Chiropractic Initiative Act; any person certified pursuant
to Division 2.5 (commencing with Section 1797) of this code; and
any clinic, health dispensary, or health facility licensed pursuant
to Division 2 (commencing with Section 1200) of this code.

(i) “Informed decision” means a decision by an individual with
a terminal disease to request and obtain a prescription for a drug
that the individual may self-administer to end the individual’s life,
that is based on an understanding and acknowledgment of the
relevant facts, and that is made after being fully informed by the
attending physician of all of the following:

(1) The individual’s medical diagnosis and prognosis.

(2) The potential risks associated with taking the drug to be
prescribed.

(3) The probable result of taking the drug to be prescribed.

(4) The possibility that the individual may choose not to obtain
the drug or may obtain the drug but may decide not to ingest it.

(5) The feasible alternatives or additional treatment
opportunities, including, but not limited to, comfort care, hospice
care, palliative care, and pain control.

(j) “Medically confirmed” means the medical diagnosis and
prognosis of the attending physician has been confirmed by a
consulting physician who has examined the individual and the
individual’s relevant medical records.

(k) “Mental health specialist assessment” means one or more
consultations between an individual and a mental health specialist
for the purpose of determining that the individual has the capacity
to make medical decisions and is not suffering from impaired
judgment due to a mental disorder.

(l) “Mental health specialist” means a psychiatrist or a licensed
psychologist.

(m) “Physician” means a doctor of medicine or osteopathy
currently licensed to practice medicine in this state.

(n) “Public place” means any street, alley, park, public building,
any place of business or assembly open to or frequented by the
public, and any other place that is open to the public view, or to
which the public has access.

(o) “Qualified individual” means an adult who has the capacity
to make medical decisions and is a resident of California and has
satisfied the requirements of this part in order to obtain a
prescription for a drug to end his or her life.

(p) “Self-administer” means a qualified individual’s affirmative,
conscious, and physical act of begin insert administering and end insert ingesting the
aid-in-dying drug to bring about his or her own death.

(q) “Terminal disease” means an incurable and irreversible
disease that has been medically confirmed and will, within
reasonable medical judgment, result in death within six months.

443.2.  

(a) A qualified individual who is an adult with the
capacity to make medical decisions and with a terminal disease
may make a request to receive a prescription for an aid-in-dying
drug if all of the following conditions are satisfied:

(1) The individual’s attending physician has diagnosed the
individual with a terminal disease.

(2) The individual has voluntarily expressed the wish to receive
a prescription for an aid-in-dying drug.

(3) The individual is a resident of California and is able to
establish residency through any of the following means:

(A) Possession of a California driver license or other
identification issued by the State of California.

(B) Registration to vote in California.

(C) Evidence that the person owns or leases property in
California.

(D) Filing of a California tax return for the most recent tax year.

(4) The individual documents his or her request pursuant to the
requirements set forth in Section 443.3.

(5) The individual has the physical and mental ability to
self-administer the aid-in-dying drug.

(b) A person shall not be considered a “qualified individual”
under the provisions of this part solely because of age or disability.

(c) A request for a prescription for an aid-in-dying drug under
this part shall be made solely and directly by the individual
diagnosed with the terminal disease and shall not be made on behalf
of the patient, including, but not limited to, through a power of
attorney, an advance health care directive, a conservator, health
care agent, surrogate, or any other legally recognized health care
decisionmaker.

443.3.  

(a) An individual seeking to obtain a prescription for
an aid-in-dying drug pursuant to this part shall submit two oral
requests, a minimum of 15 days apart, and a written request to his
or her attending physician. The attending physician shall directly,
and not through a designee, receive all three requests required
pursuant to this section.

(b) A valid written request for an aid-in-dying drug under
subdivision (a) shall meet all of the following conditions:

(1) The request shall be in substantially the form described in
Section begin delete 443.9. end delete begin insert 443.10. end insert

(2) The request shall be signed and dated, in the presence of
two witnesses in accordance with paragraph (3), by the individual
seeking the aid-in-dying drug.

(3) The request shall be witnessed by at least two other adult
persons who, in the presence of the individual, shall attest that to
the best of their knowledge and belief that the individual is all of
the following:

(A) A person who has the capacity to make medical decisions.

(B) Acting voluntarily.

(C) Not being coerced to make or sign the request.

(c) Only one of the two witnesses at the time the written request
is signed may:

(1) Be related to the qualified individual by blood, marriage,
registered domestic partnership, or adoption or be entitled to a
portion of the individual’s estate upon death.

(2) Own, operate, or be employed at a health care facility where
the individual is receiving medical treatment or resides.

(d) The attending physician, consulting physician, or mental
health specialist of the individual shall not be one of the witnesses
required pursuant to paragraph (3) of subdivision (b).

443.4.  

(a) An individual may at any time withdraw or rescind
his or her request for an aid-in-dying drug, or decide not to ingest
an aid-in dying drug, without regard to the individual’s mental
state.

(b) A prescription for an aid-in-dying drug provided under this
part may not be written without the attending physician directly,
and not through a designee, offering the individual an opportunity
to withdraw or rescind the request.

443.5.  

(a) Before prescribing an aid-in-dying drug, the
attending physician shall do all of the following:

(1) Make the initial determination of all of the following:

(A) (i) Whether the requesting adult has the capacity to make
medical decisions.

(ii) If there are indications of a mental disorder, the physician
shall refer the individual for a mental health specialist assessment.

(iii) If a mental health specialist assessment referral is made,
no aid-in-dying drugs shall be prescribed until the mental health
specialist determines that the individual has the capacity to make
medical decisions and is not suffering from impaired judgment
due to a mental disorder.

(B) Whether the requesting adult has a terminal disease.

(C) Whether the requesting adult has voluntarily made the
request for an aid-in-dying drug pursuant to Sections 443.2 and
443.3.

(D) Whether the requesting adult is a qualified individual
pursuant to subdivision (m) of Section 443.1.

(2) Confirm that the individual is making an informed decision
by discussing with him or her all of the following:

(A) His or her medical diagnosis and prognosis.

(B) The potential risks associated with ingesting the requested
aid-in-dying drug.

(C) The probable result of ingesting the aid-in-dying drug.

(D) The possibility that he or she may choose to obtain the
aid-in-dying drug but not take it.

(E) The feasible alternatives or additional treatment options,
including, but not limited to, comfort care, hospice care, palliative
care, and pain control.

(3) Refer the individual to a consulting physician for medical
confirmation of the diagnosis and prognosis, and for a
determination that the individual has the capacity to make medical
decisions and has complied with the provisions of this part.

(4) Confirm that the qualified individual’s request does not arise
from coercion or undue influence by another person by discussing
with the qualified individual, outside of the presence of any other
persons, begin insert except for an interpreter as required pursuant to this part, end insert
whether or not the qualified individual is feeling coerced or unduly
influenced by another person.

(5) Counsel the qualified individual about the importance of all
of the following:

(A) Having another person present when he or she ingests the
aid-in-dying drug prescribed pursuant to this part.

(B) Not ingesting the aid-in-dying drug in a public place.

(C) Notifying the next of kin of his or her request for an
aid-in-dying drug. A qualified individual who declines or is unable
to notify next of kin shall not have his or her request denied for
that reason.

(D) Participating in a hospice program.

(E) Maintaining the aid-in-dying drug in a safe and secure
location until the time that the qualified individual will ingest it.

(6) Inform the individual that he or she may withdraw or rescind
the request for an aid-in-dying drug at any time and in any manner.

(7) Offer the individual an opportunity to withdraw or rescind
the request for an aid-in-dying drug before prescribing the
aid-in-dying drug.

(8) Verify, immediately prior to writing the prescription for
aid-in-dying drug, that the qualified individual is making an
informed decision.

(9) Confirm that all requirements are met and all appropriate
steps are carried out in accordance with this part before writing a
prescription for an aid-in-dying drug.

(10) Fulfill the record documentation required under Sections
443.7 and begin delete 443.17. end delete begin insert 443.18. end insert

(11) Complete the End of Life Option Act Checklist and include
it in the individual’s medical record.

(b) If the conditions set forth in subdivision (a) are satisfied,
the attending physician may deliver the aid-in-dying drug in any
of the following ways:

(1) Dispensing the aid-in-dying drug directly, including ancillary
medication intended to minimize the qualified individual’s
discomfort, if the attending physician meets all of the following
criteria:

(A) Is authorized to dispense medicine under California law.

(B) Has a current United States Drug Enforcement
Administration (USDEA) certificate.

(C) Complies with any applicable administrative rule or
regulation.

(2) With the qualified individual’s written consent, contacting
a pharmacist, informing the pharmacist of the prescriptions, and
delivering the written prescriptions personally, by mail, or
electronically to the pharmacist, who may dispense the drug to the
qualified individual, the attending physician, or a person expressly
designated by the qualified individual and with the designation
delivered to the pharmacist in writing or verbally.

(c) Delivery of the dispensed drug to the qualified individual,
the attending physician, or a person expressly designated by the
qualified individual may be made by personal delivery, or, with a
signature required on delivery, by United Parcel Service, United
States Postal Service, Federal Express, or by messenger service.

443.6.  

Prior to a qualified individual obtaining an aid-in-dying
drug from the attending physician, the consulting physician shall
perform all of the following:

(a) Examine the individual and his or her relevant medical
records.

(b) Confirm in writing the attending physician’s diagnosis and
prognosis.

(c) Determine that the individual has capacity to make medical
decisions, is acting voluntarily, and has made an informed decision.

(d) If there are indications of a mental disorder, the consulting
physician shall refer the individual for a mental health specialist
assessment.

(e) Fulfill the record documentation required under this part.

begin insert

begin insert 443.7. end insert   

Upon referral from the attending or consulting physician
pursuant to this part, the mental health specialist shall:

(a) Examine the qualified individual and his or her relevant
medical records.

(b) Determine that the individual has the mental capacity to
make medical decisions, act voluntarily, and make an informed
decision.

(c) Determine that the individual is not suffering from impaired
judgment due to a mental disorder.

(d) Fulfill the record documentation requirements of this part.

end insert

begin delete 443.7. end delete
begin insert 443.8. end insert   

All of the following shall be documented in the
individual’s medical record:

(a) All oral requests for aid-in-dying drugs.

(b) All written requests for aid-in-dying drugs.

(c) The attending physician’s diagnosis and prognosis, and the
determination that a qualified individual has the capacity to make
medical decisions, is acting voluntarily, and has made an informed
decision, or that the attending physician has determined that the
individual is not a qualified individual.

(d) The consulting physician’s diagnosis and prognosis, and
verification that the qualified individual has the capacity to make
medical decisions, is acting voluntarily, and has made an informed
decision, or that the consulting physician has determined that the
individual is not a qualified individual.

(e) A report of the outcome and determinations made during a
mental health specialist’s assessment, if performed.

(f) The attending physician’s offer to the qualified individual
to withdraw or rescind his or her request at the time of the
individual’s second oral request.

(g) A note by the attending physician indicating that all
requirements under Sections 443.5 and 443.6 have been met and
indicating the steps taken to carry out the request, including a
notation of the aid-in-dying drug prescribed.

begin delete 443.8. end delete
begin insert 443.9. end insert   

A qualified individual may not receive a prescription
for an aid-in-dying drug pursuant to this part unless he or she has
made an informed decision. Immediately before writing a
prescription for an aid-in-dying drug under this part, the attending
physician shall verify that the individual is making an informed
decision.

begin delete 443.9. end delete
begin insert 443.10. end insert   

(a) A request for an aid-in-dying drug as authorized
by this part shall be in substantially the following form:

 

REQUEST FOR AN AID-IN-DYING DRUG TO END MY LIFE IN A HUMANE AND DIGNIFIED MANNER I, ......................................................, am an adult of sound mind and a resident of the State of California.

I am suffering from ................, which my attending physician has determined is in its terminal phase and which has been medically confirmed.

I have been fully informed of my diagnosis and prognosis, the nature of the aid-in-dying drug to be prescribed and potential associated risks, the expected result, and the feasible alternatives or additional treatment options, including comfort care, hospice care, palliative care, and pain control.

I request that my attending physician prescribe an aid-in-dying drug that will end my life in a humane and dignified manner if I choose to take it, and I authorize my attending physician to contact any pharmacist about my request.

INITIAL ONE:

............ I have informed one or more members of my family of my decision and taken their opinions into consideration.

............ I have decided not to inform my family of my decision.

............ I have no family to inform of my decision.

I understand that I have the right to withdraw or rescind this request at any time.

I understand the full import of this request and I expect to die if I take the aid-in-dying drug to be prescribed. My attending physician has counseled me about the possibility that my death may not be immediately upon the consumption of the drug.

I make this request voluntarily, without reservation, and without being coerced.

Signed:..............................................

Dated:...............................................

DECLARATION OF WITNESSES

We declare that the person signing this request:

(a) is personally known to us or has provided proof of identity;

(b) signed this request in our presence;

(c) is an individual whom we believe to be of sound mind and not under duress, fraud, or undue influence; and

(d) is not an individual for whom either of us is the attending physician, consulting physician, or mental health specialist.

............................Witness 1/Date

............................Witness 2/Date

NOTE: Only one of the two witnesses may be a relative (by blood, marriage, registered domestic partnership, or adoption) of the person signing this request or be entitled to a portion of the person’s estate upon death. Only one of the two witnesses may own, operate, or be employed at a health care facility where the person is a patient or resident.

 

(b) (1) The written language of the request shall be written in
the same translated language as any conversations, consultations,
or interpreted conversations or consultations between a patient and
his or her attending or consulting physicians.

(2) Notwithstanding paragraph (1), the written request may be
prepared in English even when the conversations or consultations
or interpreted conversations or consultations were conducted in a
language other than English if the English language form includes
an attached interpreter’s declaration that is signed under penalty
of perjury. The interpreter’s declaration shall state words to the
effect that:

 

I (INSERT NAME OF INTERPRETER), am fluent in English and (INSERT TARGET LANGUAGE).

On (insert date) at approximately (insert time), I read the “Request for an Aid-In-Dying Drug to End My Life” to (insert name of individual/patient) in (insert target language).

Mr./Ms. (insert name of patient/qualified individual) affirmed to me that he/she understood the content of this form and affirmed his/her desire to sign this form under his/her own power and volition and that the request to sign the form followed consultations with an attending and consulting physician.

I declare that I am fluent in English and (insert target language) and further declare under penalty of perjury that the foregoing is true and correct.

Executed at (insert city, county, and state) on this (insert day of month) of (insert month), (insert year).

X______Interpreter signature

X______Interpreter printed name

X______Interpreter address

 

(3) An interpreter whose services are provided pursuant to
paragraph (2) shall not be related to the qualified individual by
blood, marriage, registered domestic partnership, or adoption or
be entitled to a portion of the person’s estate upon death. An
interpreter whose services are provided pursuant to paragraph (2)
shall meet the standards promulgated by the California Healthcare
Interpreting Association or the National Council on Interpreting
in Health Care or other standards deemed acceptable by the
department for health care providers in California.

begin delete 443.10. end delete
begin insert 443.11. end insert   

(a) A provision in a contract, will, or other agreement
executed on or after January 1, 2016, whether written or oral, to
the extent the provision would affect whether a person may make,
withdraw, or rescind a request for an aid-in-dying drug is not valid.

(b) An obligation owing under any contract executed on or after
January 1, 2016, may not be conditioned or affected by a qualified
individual making, withdrawing, or rescinding a request for an
aid-in-dying drug.

begin delete 443.11. end delete
begin insert 443.12. end insert   

(a) The sale, procurement, or issuance of a life, health,
or accident insurance or annuity policy, health care service plan
contract, or health benefit plan, or the rate charged for a policy or
plan contract may not be conditioned upon or affected by a person
making or rescinding a request for an aid-in-dying drug.

(b) Notwithstanding any other law, a qualified individual’s act
of self-administering an aid-in-dying drug may not have an effect
upon a life, health, or accident insurance or annuity policy other
than that of a natural death from the underlying disease.

(c) An insurance carrier shall not provide any information in
communications made to an individual about the availability of
an aid-in-dying drug absent a request by the begin delete individual, his or her
attending physician at the behest of the individual, or the
individual’s designee. end delete begin insert individual or his or her attending physician
at the behest of the individual. end insert Any communication shall not
include both the denial of treatment and information as to the
availability of aid-in-dying drug coverage. For the purposes of this
subdivision, “insurance carrier” means a health care service plan
as defined in Section 1345 of this code or a carrier of health
insurance as defined in Section 106 of the Insurance Code.

begin delete 443.12. end delete
begin insert 443.13. end insert   

(a) Notwithstanding any other law, a person shall not
be subject to civil, criminal, administrative, employment, or
contractual liability or professional disciplinary action for
participating in good faith compliance with this part, including an
individual who is present when a qualified individual
self-administers the prescribed aid-in-dying drug.

(b) A health care provider or professional organization or
association shall not subject an individual to censure, discipline,
suspension, loss of license, loss of privileges, loss of membership,
or other penalty for participating in good faith compliance with
this part or for refusing to participate in accordance with
subdivision (e).

(c) Notwithstanding any other law, a health care provider shall
not be subject to civil, criminal, administrative, disciplinary,
employment, credentialing, professional discipline, contractual
liability, or medical staff action, sanction, or penalty or other
liability for participating in this part, including, but not limited to,
determining the diagnosis or prognosis of an individual,
determining the capacity of an individual for purposes of qualifying
for the act, providing information to an individual regarding this
part, and providing a referral to a physician who participates in
this part.

(d) (1) A request by a qualified individual to an attending
physician to provide an aid-in-dying drug in good faith compliance
with the provisions of this part shall not provide the sole basis for
the appointment of a guardian or conservator.

(2) No actions taken in compliance with the provisions of this
part shall constitute or provide the basis for any claim of neglect
or elder abuse for any purpose of law.

(e) (1) Participation in activities authorized pursuant to this
part shall be voluntary. begin delete A person or entity that elects, for reasons
of conscience, morality, or ethics, not to engage in activities
authorized pursuant to this part is not required to take any action
in support of a patient’s decision under this part, except as required
by Sections 442 to 442.7, inclusive. end delete begin insert Notwithstanding Sections 442
to 442.7, inclusive, a person or entity that elects, for reasons of
conscience, morality, or ethics, not to engage in activities
authorized pursuant to this part is not required to take any action
in support of an individual’s decision under this part. end insert

begin insert

(2) Notwithstanding any other law, a health care provider is
not subject to civil, criminal, administrative, disciplinary,
employment, credentialing, professional discipline, contractual
liability, or medical staff action, sanction, or penalty or other
liability for refusing to participate in activities authorized under
the End of Life Option Act, including, but not limited to, refusing
to inform a patient regarding his or her rights under the End of
Life Option Act and not referring an individual to a physician who
participates in activities authorized under the End of Life Option
Act.

end insert begin delete

(2)

end delete

begin insert (3) end insert  If a health care provider is unable or unwilling to carry out
a qualified individual’s request under this part and the qualified
individual transfers care to a new health care provider, the
individual may request a copy of his or her medical records
pursuant to law.

begin delete 443.13. end delete
begin insert 443.14. end insert   

(a) Subject to subdivision (b), notwithstanding any
other law, a health care provider may prohibit its employees,
independent contractors, or other persons or entities, including
other health care providers, from participating in activities under
this part while on premises owned or under the management or
direct control of that prohibiting health care provider or while
acting within the course and scope of any employment by, or
contract with, the prohibiting health care provider.

(b) A health care provider that elects to prohibit its employees,
independent contractors, or other persons or entities, including
health care providers, from participating in activities under this
part, as described in subdivision (a), shall first give notice of the
policy prohibiting participation under this part to the individual or
entity. A health care provider that fails to provide notice to an
individual or entity in compliance with this subdivision shall not
be entitled to enforce such a policy against that individual or entity.

(c) Subject to compliance with subdivision (b), the prohibiting
health care provider may take action, including, but not limited
to, the following, as applicable, against any individual or entity
that violates this policy:

(1) Loss of privileges, loss of membership, or other action
authorized by the bylaws or rules and regulations of the medical
staff.

(2) Suspension, loss of employment, or other action authorized
by the policies and practices of the prohibiting health care provider.

(3) Termination of any lease or other contract between the
prohibiting health care provider and the individual or entity that
violates the policy.

(4) Imposition of any other nonmonetary remedy provided for
in any lease or contract between the prohibiting health care provider
and the individual or entity in violation of the policy.

(d) Nothing in this section shall be construed to prevent, or to
allow a prohibiting health care provider to prohibit any other health
care provider, employee, independent contractor, or other person
or entity from any of the following:

(1) Participating, or entering into an agreement to participate,
in activities under this part, while on premises that are not owned
or under the management or direct control of the prohibiting
provider or while acting outside the course and scope of the
participant’s duties as an employee of, or an independent contractor
for, the prohibiting health care provider.

(2) Participating, or entering into an agreement to participate,
in activities under this part as an attending physician or consulting
physician while on premises that are not owned or under the
management or direct control of the prohibiting provider.

(e) In taking actions pursuant to subdivision (c), a health care
provider shall comply with all procedures required by law, its own
policies or procedures, and any contract with the individual or
entity in violation of the policy, as applicable.

(f) For purposes of this section:

(1) “Notice” means a separate statement in writing advising of
the prohibiting health care provider policy with respect to
participating in activities under this part.

(2) “Participating, or entering into an agreement to participate,
in activities under this part” means doing or entering into an
agreement to do any one or more of the following:

(A) Performing the duties of an attending physician as specified
in Section 443.5.

(B) Performing the duties of a consulting physician as specified
in Section 443.6.

(C) Performing the duties of a mental health specialist, in the
circumstance that a referral to one is made.

(D) Delivering the prescription for, dispensing, or delivering
the dispensed aid-in-dying drug pursuant to paragraph (2) of
subdivision (b) of, and subdivision (c) of, Section 443.5.

(E) Being present when the qualified individual takes the
aid-in-dying drug prescribed pursuant to this part.

(3) “Participating, or entering into an agreement to participate,
in activities under this part” does not include doing, or entering
into an agreement to do, any of the following:

(A) Diagnosing whether a patient has a terminal disease,
informing the patient of the medical prognosis, or determining
whether a patient has the capacity to make decisions.

(B) Providing information to a patient about this part.

(C) Providing a patient, upon the patient’s request, with a referral
to another health care provider for the purposes of participating in
the activities authorized by this part.

(g) Any action taken by a prohibiting provider pursuant to this
section shall not be reportable under Sections 800 to 809.9,
inclusive, of the Business and Professions Code. The fact that a
health care provider participates in activities under this part shall
not be the sole basis for a complaint or report by another health
care provider of unprofessional or dishonorable conduct under
Sections 800 to 809.9, inclusive, of the Business and Professions
Code.

(h) Nothing in this part shall prevent a health care provider from
providing an individual with health care services that do not
constitute participation in this part.

begin delete 443.14. end delete
begin insert 443.15. end insert   

(a) A health care provider may not be sanctioned for
any of the following:

(1) Making an initial determination pursuant to the standard of
care that an individual has a terminal disease and informing him
or her of the medical prognosis.

(2) Providing information about the End of Life Option Act to
a patient upon the request of the individual.

(3) Providing an individual, upon request, with a referral to
another physician.

(b) A health care provider that prohibits activities under this
part in accordance with Section begin delete 443.13 end delete begin insert 443.14 end insert shall not sanction
an individual health care provider for contracting with a qualified
individual to engage in activities authorized by this part if the
individual health care provider is acting outside of the course and
scope of his or her capacity as an employee or independent
contractor of the prohibiting health care provider.

(c) Notwithstanding any contrary provision in this section, the
immunities and prohibitions on sanctions of a health care provider
are solely reserved for actions taken pursuant to this part, and those
health care providers may be sanctioned for conduct and actions
not included and provided for in this part if the conduct and actions
do not comply with the standards and practices set forth by the
Medical Board of California.

begin delete 443.15. end delete
begin insert 443.16. end insert   

(a) Knowingly altering or forging a request for an
aid-in-dying drug to end an individual’s life without his or her
authorization or concealing or destroying a withdrawal or rescission
of a request for an aid-in-dying drug is punishable as a felony if
the act is done with the intent or effect of causing the individual’s
death.

(b) Knowingly coercing or exerting undue influence on an
individual to request an aid-in-dying drug for the purpose of ending
his or her life or to destroy a withdrawal or rescission of a request
is punishable as a felony.

(c) For purposes of this section, “knowingly” has the meaning
provided in Section 7 of the Penal Code.

(d) Nothing in this section shall be construed to limit civil
liability.

(e) The penalties in this section do not preclude criminal
penalties applicable under any law for conduct inconsistent with
the provisions of this section.

begin delete 443.16. end delete
begin insert 443.17. end insert   

Nothing in this part may be construed to authorize a
physician or any other person to end an individual’s life by lethal
injection, mercy killing, or active euthanasia. Actions taken in
accordance with this part shall not, for any purposes, constitute
suicide, assisted suicide, homicide, or elder abuse under the law.

begin delete 443.17. end delete
begin insert 443.18. end insert   

(a) The State Public Health Officer shall annually
review a sample of records maintained pursuant to Section begin delete 443.7 end delete
begin insert 443.8 end insert and shall adopt regulations establishing additional reporting
requirements for physicians and pharmacists pursuant to this part.

(b) The reporting requirements shall be designed to collect
information to determine utilization and compliance with this part.
The information collected shall be confidential and shall be
collected in a manner that protects the privacy of the patient, the
patient’s family, and any medical provider or pharmacist involved
with the patient under the provisions of this part.

(c) Based on the information collected, the department shall
provide an annual compliance and utilization statistical report
aggregated by age, gender, race, ethnicity, and primary language
spoken at home and other data the department may determine
relevant. The department shall make the report public within 30
days of completion of each annual report.

(d) The State Public Health Officer shall make available to
health care providers the End of Life Option Act Checklist by
posting it on its Internet Web site.

begin delete 443.18. end delete
begin insert 443.19. end insert   

A person who has custody or control of any unused
aid-in-dying drugs prescribed pursuant to this part after the death
of the patient shall personally deliver the unused aid-in-dying drugs
for disposal by delivering it to the nearest qualified facility that
properly disposes of controlled substances, or if none is available,
shall dispose of it by lawful means in accordance with guidelines
promulgated by the California State Board of Pharmacy or a federal
Drug Enforcement Administration approved take back program.

begin delete 443.19. end delete
begin insert 443.20. end insert   

Any governmental entity that incurs costs resulting
from a qualified individual terminating his or her life pursuant to
the provisions of this part in a public place shall have a claim
against the estate of the qualified individual to recover those costs
and reasonable attorney fees related to enforcing the claim.

SEC. 2.  

The Legislature finds and declares that Section 1 of
this act, which adds Section begin delete 443.17 end delete begin insert 443.18 end insert to the Health and Safety
Code, imposes a limitation on the public’s right of access to the
meetings of public bodies or the writings of public officials and
agencies within the meaning of Section 3 of Article I of the
California Constitution. Pursuant to that constitutional provision,
the Legislature makes the following findings to demonstrate the
interest protected by this limitation and the need for protecting
that interest:

(a) Any limitation to public access to personally identifiable
patient data collected pursuant to Section begin delete 443.17 end delete begin insert 443.18 end insert of the
Health and Safety Code as proposed to be added by this act is
necessary to protect the privacy rights of the patient and his or her
family.

(b) The interests in protecting the privacy rights of the patient
and his or her family in this situation strongly outweigh the public
interest in having access to personally identifiable data relating to
services.

(c) The statistical report to be made available to the public
pursuant to subdivision (c) of Section begin delete 443.17 end delete begin insert 443.18 end insert of the Health
and Safety Code is sufficient to satisfy the public’s right to access.

SEC. 3.  

The provisions of this part are severable. If any
provision of this part or its application is held invalid, that
invalidity shall not affect other provisions or applications that can
be given effect without the invalid provision or application.

SEC. 4.  

No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of
the Government Code, or changes the definition of a crime within
the meaning of Section 6 of Article XIII B of the California
Constitution.