BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
SB 128 (Wolk) - End of life
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|Version: April 14, 2015 |Policy Vote: HEALTH 6 - 2, JUD. |
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|Urgency: No |Mandate: Yes |
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|Hearing Date: May 28, 2015 |Consultant: Brendan McCarthy |
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SUSPENSE FILE. AS AMENDED.
Bill
Summary: SB 128 would allow a terminally ill individual to
request a prescription for aid-in-dying medication, if certain
conditions are met and certain procedures are followed.
Fiscal Impact (as approved on May 28,
2015):
One-time costs of $265,000 over two years for the development
of regulations by the Department of Public Health (General
Fund).
One-time costs of $90,000 and ongoing costs of $10,000 per
year for the Department of Public Health to develop and
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operate a secure computer system for tracking patients who
have received an aid-in-dying prescription (General Fund).
Ongoing costs of $235,000 per year for Department of Public
Health staff to collect data, follow up on prescriptions with
prescribing physicians, and prepare the required annual report
(General Fund).
Ongoing costs of $275,000 per year for Department of Public
Health staff to review a sample of the medical records of
participating patients, to ensure compliance with the
requirements of the bill (General Fund).
One-time costs of $600,000 over two year for the Department of
Managed Health Care to develop policies, adopt regulations,
and respond to public record requests (Managed Care Fund). The
bill does not mandate coverage for aid-in-dying medication by
health plans. However, because current law mandates coverage
for pain management drugs, the Department expects to develop
regulations to clarify the responsibilities of health plans in
this area.
Minor costs to the Medical Board. The Medical Board would not
need to amend or adopt any regulations. The Medical Board
estimates that any additional enforcement actions due to the
bill would result in minor costs.
Minor costs to the Board of Pharmacy. The Board of Pharmacy
would not need to amend or adopt any regulations. The Board of
Pharmacy estimates that any additional enforcement actions due
to the bill would result in minor costs.
Minor potential reduction in statewide health care spending
(various funds). (See below.)
Background: Under current law, when a health care provider makes a
diagnosis that a patient has a terminal illness, the health care
provider is required to give certain information to the patient,
including information about hospice care, the patient's rights
to continue to receive care or to refuse care, the right to give
future health care instructions through advanced care directives
and other means, and other information.
SB 128 (Wolk) Page 2 of
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Proposed Law:
SB 128 would allow a terminally ill individual to request a
prescription for aid-in-dying medication, if certain conditions
and procedures are met.
Specific provisions of the bill would:
Permit a competent individual who is terminally ill to make a
request for aid-in-dying medication if specified conditions
are met;
Specify the manner of making the request;
Specify the duties and responsibilities of the attending
physician to whom the request is made, including requirements
for referral to a consulting physician, and verification that
the patient is not under duress;
Specify the procedures for delivering the medication to the
patient;
Specify the documentation requirements on the attending
physician;
Provide specified patient protections;
Provide protections for physicians and pharmacists from
professional censure;
Make participation by health care providers voluntary;
Make it a felony to forge a request or coerce a patient to
participate;
Require the Department of Health Care Services to review
records from participating patients' medical records;
Require the Department of Public Health to adopt regulations
for reporting by physicians and pharmacists;
Provide for protection of patient confidentiality.
Related
Legislation:
SB 19 (Wolk) would establish a statewide registry for
Physician Orders for Life Sustaining Treatment. That bill will
be heard in this committee.
SB 149 (Stone) would make investigational drugs available to
patients with a terminal illness. That bill will be heard in
this committee.
Staff
Comments: Under the bill, a terminally ill patient could use
aid-in-dying medication to hasten his or her death. In those
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cases, there may be some avoided health care costs. However,
experience with a similar program in Oregon indicates that a
relatively small number of individuals is likely to make use of
the program (less than 1,000 people per year, extrapolating from
experience in Oregon). Of the participating individuals in
Oregon, 90% were enrolled in hospice care at the time of their
death. While hospice care does not always preclude the continued
use of curative medical interventions, in practice, most hospice
patients are no longer using intensive medical services (such as
inpatient hospital services). Therefore, avoided health care
expenditures are not likely to be significant.
The only costs that may be incurred by a local agency relate to
crimes and infractions. Under the California Constitution, such
costs are not reimbursable by the state.
Author's amendments (as adopted May 28, 2015): make a variety of
changes to the requirements on physicians, make changes to
patient protection requirements, and make technical changes.
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