Amended in Assembly April 2, 2014

California Legislature—2013–14 Regular Session

Assembly Bill No. 2139

Introduced by Assembly Member Eggman

February 20, 2014

An act to begin delete add Section 442.4 to end delete begin insert amend Sections 442, 442.5, and 442.7 of end insert the Health and Safety Code, relating to terminal illness.

LEGISLATIVE COUNSEL’S DIGEST

AB 2139, as amended, Eggman. End-of-life care: patient notification.

Under existing law, the State Department of Public Health licenses and regulates health facilities, including hospice facilities, and the provision of hospice services. Existing law establishes the Medical Practice Act, which provides for the regulation and licensure of physicians and surgeons by the Medical Board of California. begin insert Existing law authorizes an adult to give an individual, known as an agent, authority 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. end insert

When a health care provider, as defined, makes a diagnosis that a patient has a terminal illness, existing law requires the health care provider to provide the patient, upon the patient’s request, with comprehensive information and counseling regarding legal end-of-life options, as specified, and provide for the referral or transfer of a patient, as provided, if the patient’s health care provider does not wish to comply with the patient’s request for information on end-of-life options.

begin delete This end delete begin insert This bill would apply these provisions to an agent under a power of attorney for health care for a patient with a terminal illness diagnosis. The end insert bill would begin insert additionally end insert require begin delete a end delete begin insert the end insert health care provider begin delete , as defined, end delete to notify the patient begin insert or, when applicable, the agent end insert , when the health care provider makes a diagnosis that a patient has a terminal illness, of the patient’s right to comprehensive information and counseling regarding legal end-of-life care options. begin insert The bill would define the term “terminal illness” for these purposes. end insert

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

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

begin insert

begin insert SECTION 1. end insert   

end insert

begin insert Section 442 of the end insert begin insert Health and Safety Code end insert begin insert is
amended to read: end insert

442.  

For the purposes of this part, the following definitions
shall apply:

(a) “Actively dying” means the phase of terminal illness when
death is imminent.

begin insert

(b) “Agent” means an individual designated in a power of
attorney for health care, as provided in Article 1 (commencing
with Section 4670) and Article 2 (commencing with Section 4680)
of Chapter 1 of Part 2 of Division 4.7 of the Probate Code, to make
a health care decision for the patient who has been diagnosed with
a terminal illness, regardless of whether the person is known as
an agent or attorney in fact, or by some other term.

end insert begin delete

(b)

end delete

begin insert ( end insert begin insert c) end insert  “Disease-targeted treatment” means treatment directed at
the underlying disease or condition that is intended to alter its
natural history or progression, irrespective of whether or not a cure
is a possibility.

begin delete

(c)

end delete

begin insert ( end insert begin insert d) end insert  “Health care provider” means an attending physician and
surgeon. It also means a nurse practitioner or physician assistant
practicing in accordance with standardized procedures or protocols
developed and approved by the supervising physician and surgeon
and the nurse practitioner or physician assistant.

begin delete

(d)

end delete

begin insert ( end insert begin insert e) end insert  “Hospice” means a specialized form of interdisciplinary
health care that is designed to provide palliative care, alleviate the
physical, emotional, social, and spiritual discomforts of an
individual who is experiencing the last phases of life due to the
existence of a terminal disease, and provide supportive care to the
primary caregiver and the family of the hospice patient, and that
meets all of the criteria specified in subdivision (b) of Section
1746.

begin delete

(e)

end delete

begin insert ( end insert begin insert f) end insert  “Palliative care” means medical treatment, interdisciplinary
care, or consultation provided to a patient or family members, or
both, that has as its primary purpose the prevention of, or relief
from, suffering and the enhancement of the quality of life, rather
than treatment aimed at investigation and intervention for the
purpose of cure or prolongation of life as described in subdivision
(b) of Section 1339.31. In some cases, disease-targeted treatment
may be used in palliative care.

begin delete

(f)

end delete

begin insert ( end insert begin insert g) end insert  “Refusal or withdrawal of life-sustaining treatment” means
forgoing treatment or medical procedures that replace or support
an essential bodily function, including, but not limited to,
cardiopulmonary resuscitation, mechanical ventilation, artificial
nutrition and hydration, dialysis, and any other treatment or
discontinuing any or all of those treatments after they have been
used for a reasonable time.

begin insert

(h) “Terminal illness” means a medical condition resulting in
a prognosis of a life expectancy of one year or less, if the disease
follows its normal course.

end insert

begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Section 442.5 of the end insert begin insert Health and Safety Code end insert begin insert is amended
to read: end insert

442.5.  

When a health care provider makes a diagnosis that a
patient has a terminal illness, the health care provider shall begin insert notify
the patient of his or her right to, or when applicable, end insert begin insert the agent of
the patient’s right to, comprehensive information and counseling
regarding legal end-of-life options and end insert , upon the begin delete patient’s end delete begin insert patient
or agent’s end insert request, provide the patient begin insert or end insert begin insert agent end insert with comprehensive
information and counseling regarding legal end-of-life care options
pursuant to this section. When a terminally ill patient is in a health
facility, as defined in Section 1250, the health care provider, or
medical director of the health facility if the patient’s health care
provider is not available, may refer the patient begin insert or end insert begin insert agent end insert to a hospice
provider or private or public agencies and community-based
organizations that specialize in end-of-life care case management
and consultation to receive comprehensive information and
counseling regarding legal end-of-life care options.

(a) If the patient begin insert or agent end insert indicates a desire to receive the
information and counseling, the comprehensive information shall
include, but not be limited to, the following:

(1) Hospice care at home or in a health care setting.

(2) A prognosis with and without the continuation of
disease-targeted treatment.

(3) The patient’s right to refusal of or withdrawal from
life-sustaining treatment.

(4) The patient’s right to continue to pursue disease-targeted
treatment, with or without concurrent palliative care.

(5) The patient’s right to comprehensive pain and symptom
management at the end of life, including, but not limited to,
adequate pain medication, treatment of nausea, palliative
chemotherapy, relief of shortness of breath and fatigue, and other
clinical treatments useful when a patient is actively dying.

(6)  begin delete The end delete begin insert If the patient has not appointed an agent under a power
of attorney for health care, the end insert patient’s right to give individual
health care instruction pursuant to Section 4670 of the Probate
Code, which provides the means by which a patient may provide
written health care instruction, such as an advance health care
directive, and the patient’s right to appoint a legally recognized
health care decisionmaker.

(b) The information described in subdivision (a) may, but is not
required to, be in writing. Health care providers may utilize
information from organizations specializing in end-of-life care
that provide information on factsheets and Internet Web sites to
convey the information described in subdivision (a).

(c) Counseling may include, but is not limited to, discussions
about the outcomes for the patient and his or her family, based on
the interest of the patient. Information and counseling, as described
in subdivision (a), may occur over a series of meetings with the
health care provider or others who may be providing the
information and counseling based on the patient’s needs.

(d) The information and counseling sessions may include a
discussion of treatment options in a manner that the patient and
his or her family begin insert , or, when applicable, the agent, end insert can easily
understand. If the patient begin insert or agent end insert requests information on the
costs of treatment options, including the availability of insurance
and eligibility of the patient for coverage, the patient begin insert or agent end insert shall
be referred to the appropriate entity for that information.

begin insert

begin insert SEC. 3. end insert   

end insert

begin insert Section 442.7 of the end insert begin insert Health and Safety Code end insert begin insert is amended
to read: end insert

442.7.  

If a health care provider does not wish to comply with
his or her patient’s request begin insert or, when applicable, the agent’s request end insert
for information on end-of-life options, the health care provider
shall do both of the following:

(a) Refer or transfer a patient to another health care provider
that shall provide the requested information.

(b) Provide the patient begin insert or agent end insert with information on procedures
to transfer to another health care provider that shall provide the
requested information.

begin delete

SECTION 1.  

Section 442.4 is added to the Health and Safety
Code, to read:

442.4.  

When a health care provider makes a diagnosis that a
patient has a terminal illness, the health care provider shall notify
the patient of his or her right to comprehensive information and
counseling regarding legal end-of-life options pursuant to Section
442.5.

end delete