BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 1002
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|AUTHOR: |Monning |
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|VERSION: |February 10, 2016 |
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|HEARING DATE: |March 30, 2016 | | |
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|CONSULTANT: |Teri Boughton |
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SUBJECT : End of Life Option Act: telephone number
SUMMARY : Requires the Department of Public Health to establish and
maintain a toll-free telephone number for the purpose of
receiving and responding to inquiries regarding the End of Life
Option Act.
Existing law:
1)Permits, under the End of Life Option Act, a competent,
qualified individual who is an adult with a terminal disease
to receive a prescription for an aid-in-dying drug if certain
conditions are met, such as two oral requests, a minimum of 15
days apart, and a written request signed by two witnesses, is
provided to his or her attending physician, the attending
physician refers the patient to a consulting physician to
confirm diagnosis and capacity to make medical decisions, and
the attending physician refers the patient to a mental health
specialist, if indicated.
2)Requires within 30 calendar days of writing a prescription for
aid-in-dying drug, the attending physician to submit to the
Department of Public Health (DPH) a copy of the qualifying
patient's written request, the attending physician checklist
and compliance form, and the consulting physician compliance
form. Requires within 30 calendar days following the
qualified individual's death from ingestion of the
aid-in-dying drug, or any cause, the attending physician to
submit the attending physician follow-up form to DPH.
3)Requires DPH to collect and review the information described
in 2) above and to be collected in a manner that protects the
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privacy of the patient, the patient's family, and any medical
provider or pharmacist involved with the patient under the End
of Life Option Act.
4)Requires a report beginning on or before July 1, 2017, to be
annually posted on DPH's website that includes, but is not
limited to, the number of people for whom an aid-in-dying
prescription was written, and, the number of known people who
died each year for whom an aid-in-dying prescription was
written, and the cause of death of those individuals.
5)Prohibits an insurance carrier from providing any information
in communications made about the availability of aid-in-dying
drug absent a request by the individual or the individual's
attending physician at his or her behest. Prohibits any
communication from including both the denial of treatment and
information as to the availability of aid-in-dying drug
coverage.
6)Requires participation in activities authorized pursuant to
the End of Life Option Act to be voluntary, and states that
notwithstanding existing law, a person or entity that elects,
for reasons of conscience, morality, or ethics, not to engage
in activities authorized pursuant to the End of Life Option
Act, is not required to take any action in support of an
individual's decision under the Act.
7)Sunsets these provisions on January 1, 2026.
8)Permits the Medical Board of California to update the
attending physician checklist and compliance form, the
consulting physician compliance form, and the attending
physician follow-up form, as specified, and requires, upon
completion, DPH to publish the updated forms on its Internet
Web site.
9)Requires, under existing law that is not the End of Life
Option Act, a health care provider when making a diagnosis
that a patient has a terminal illness, to notify the patient
of his or her right, or, when applicable, the right of another
person authorized to make health care decisions for the
patient, to comprehensive information and counseling regarding
SB 1002 (Monning) Page 3 of ?
legal end-of-life options, and upon request, provide the
patient or other authorized person with comprehensive
information and counseling regarding legal end-of-life care
options, as specified.
10)Requires, if a health care provider does not wish to provide
information on end-of-life options, the health care provider
to refer or transfer a patient to another health care provider
that will provide the requested information, and provide
information on procedures to transfer to another health care
provider that shall provide the requested information.
This bill:
1)Requires DPH to establish and maintain a toll-free telephone
number for the purpose of receiving and responding to
inquiries regarding the End of Life Option Act.
2)Requires DPH to post the telephone number on its Internet Web
site.
3)Requires the telephone number to operate during DPH's regular
business hours and be available to the public.
FISCAL
EFFECT : This bill has not been analyzed yet by a fiscal
committee.
COMMENTS :
1)Author's statement. According to the author, since the provisions
included in the End of Life Option Act that was signed into law in
2015 made participation in the Act completely voluntary, including
the sharing of information about the Act, it is necessary to have
a central location for individuals in California to seek
information about the law when they have inquiries.
2)Other Toll Free Information Lines for Consumers. The Office of
the Patient Advocate (OPA) maintains a list of toll free telephone
lines for people to use who need help with health care problems.
OPA indicates that patients should contact the government agency
that oversees the specific program for fastest assistance. If the
program information is not known, OPA recommends contacting the
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California Consumer Assistance Program which is maintained by the
Department of Managed Health Care. There are multiple existing
toll-free information lines to assist consumers with issues and
respond to inquiries specific to certain agencies and programs
such as at the Department of Insurance, U.S. Department of Labor,
CalMediConnect, Covered California, Medi-Cal Managed Care,
Medi-Cal Mental Health, Medi-Cal Access Program, Medicare, Major
Risk Medical Insurance Program, U.S. Department of Veterans
Affairs, and the Medical Board of California. DPH has a toll-free
consumer assistance line associated with its licensing and
certification program, which licenses, regulates and inspects
certain health care facilities. DPH also has toll-free consumer
assistance telephone lines at 15 regional offices.
3)Pending Budget Requests.
a) DPH. According to the Senate Budget Subcommittee
analysis of the Governor's 2016-17 proposed budget, DPH
is requesting $323,000 from the Health Statistics Special
Fund in 2016-17, $245,000 in 2017-18 and annually
thereafter, and two permanent positions to meet the new
mandate to establish the End of Life Option Act program
as specified in AB X2 15 (Eggman), Chapter 1, Statutes of
2015. This funding will enable DPH to create a secure
database to implement and administer the program and
provide staffing for the required confidential program
management and reporting duties. DPH requests two
permanent positions to perform confidential program and
reporting duties, including (1) collect forms and data,
enter reports received, and track program utilization and
associated deaths; (2) follow-up with providers regarding
incomplete or missing forms; (3) perform data analysis,
crosscheck decedent deaths with the list of prescribed
participants, and draft various statistical reports; (4)
prepare the annual report mandated by the bill; (5)
maintain program information on the public website and
respond to inquiries regarding program policy; and (6)
update the website as needed, and make reporting forms
available for download from the site. Although the number
of aid-in-dying cases is projected to be small, special
protections for the data will be required because of the
sensitivity of this information. One-time development
costs for the secure database are estimated to be
approximately $88,000, and ongoing yearly maintenance
costs are expected to be $10,000.
SB 1002 (Monning) Page 5 of ?
b) DMHC. According to the Senate Budget Subcommittee
analysis of the Governor's 2016-17 proposed budget, DMHC
is requesting two-year limited-term expenditure authority
of $244,000 for 2016-17 and 2017-18 to meet DMHC's
operational needs in order to address the short-term
workload resulting from the implementation of the End of
Life Option Act. AB X2 15 does not specify whether
health plans are required to cover aid-in-dying
medication or how a health plan may decline to cover
aid-in-dying medication. Due to the sensitive and
controversial nature of aid-in-dying medication, DMHC
expects a high level of public interest which, over the
next two years, will result in its Office of Legal
Service (OLS) conducting legal research, producing legal
opinions, and promulgating one regulation package to
clarify the issue of coverage. To address this new
workload, OLS requests limited-term expenditure authority
so OLS may hire temporary help to perform short-term
workload from July 1, 2016 through June 30, 2018. An
Attorney I to review and process legal questions related
to AB X2 15. The review of legal questions encompasses
all tasks necessary to compose the final determination
and present to impacted or requesting divisions. In
addition, this position will be responsible for the
promulgation of regulations pertaining to AB X2 15, which
includes conducting stakeholder meetings, researching and
analyzing policy concerns, drafting regulations, holding
public hearings, and drafting the final rulemaking
documents. A Staff Services Analyst will provide support
and assist the Attorney I with tasks associated with AB
X2 15, such as promulgation of regulations and the
drafting/filing of legal memoranda.
4)Related legislation. SB 128 (Wolk and Monning) is similar to
ABX2 15. SB 128 is pending in the Assembly Health Committee.
5)Prior legislation. ABX2 15 (Eggman), Chapter 1, Statutes of
2015, Second Extraordinary Session, established the End of
Life Option Act, which will take effect on June 9, 2016.
6)Support. Proponents write that people at the end of their
lives may have difficulty negotiating the various steps of the
law. A hotline at DPH for terminally ill patients and others
to access information about the law would be helpful. Since
participation by physicians and health care facilities is
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voluntary, some proponents request that the information
include access to information where a person could receive
compassionate care. Proponents also indicate that people have
many questions about the law and it is important that people
have clear, accessible, and accurate information about the
law.
7)Opposition. Opponents write that this bill would create a
"how to" number for elder abuse and coercion. Any interested
party, including impatient heirs, could inquire about
obtaining, preparing and aiding another person in using the
deadly prescription. SB 1002 presents a confused double-minded
government policy that would accept both anti-suicide and
pro-suicide hot lines. Opponents believe this bill is an
expansion of the assisted suicide law that was supposed to be
a private matter solely between doctor and patient. Now the
state would play a role in the law's promotion. Opponents
raise concerns that there is no way to limit callers to people
who are terminally ill and that anyone could call, including
people who are depressed, and people eager to end the life of
a family member. Opponents ask if the state will refer callers
to organizations who will assist these callers, including
suicide hotlines.
8)Amendments. The author requests amendments be adopted by the
Committee to allow for the toll-free line to be available in
multiple languages.
SUPPORT AND OPPOSITION :
Support: California Commission on Aging
California Primary Care Association
Death with Dignity National Center
Hemlock Society of San Diego
National Association of Social Workers, CA Chapter
West Hollywood United Church of Christ
100+ Individuals
Oppose: Alliance of Catholic Health Care
California Catholic Conference, Inc.
California Nurses for Ethical Standards
California Right to Life committee, Inc.
Crusade for Life, Inc.
Disability Rights Education & Defense Fund
Life Legal Defense Foundation
Silicon Valley Independent Living Center
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100+ Individuals
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