BILL ANALYSIS �
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THIRD READING
Bill No: AB 2139
Author: Eggman (D), et al.
Amended: 8/18/14 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 6-2, 6/18/14
AYES: Hernandez, Beall, DeSaulnier, Evans, Monning, Wolk
NOES: Morrell, Nielsen
NO VOTE RECORDED: De Le�n
SENATE JUDICIARY COMMITTEE : 5-2, 6/24/14
AYES: Jackson, Corbett, Lara, Leno, Monning
NOES: Anderson, Vidak
ASSEMBLY FLOOR : 46-28, 5/29/14 - See last page for vote
SUBJECT : End-of-life care: patient notification
SOURCE : Author
DIGEST : This bill requires a health care provider to notify a
patient diagnosed with a terminal illness, or when applicable,
the other person authorized to make health care decisions for
the patient, of his/her right to comprehensive information and
counseling regarding legal end-of-life options.
Senate Floor Amendments of 8/18/14 make technical and clarifying
changes.
ANALYSIS :
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Existing law:
1. Establishes the Right to Know End of Life Act of 2008, which
requires, when a health care provider makes a diagnosis that
a patient has a terminal illness, the health care provider
to, upon the patient's request, provide the patient with
comprehensive information and counseling regarding legal
end-of-life care options.
2. Authorizes, when a terminally ill patient is in a health
facility, the health care provider, or medical director of
the health facility if the patient's health care provider is
not available, to refer the patient 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.
3. Requires, if the patient indicates a desire to receive
end-of-life care information and counseling, to include
specified comprehensive information.
4. Authorizes the information described in #3 above to be in
writing and health care providers to utilize information from
organizations specializing in end-of-life care that provide
information on factsheets and Internet Web sites to convey
the information.
5. Authorizes counseling to include, but not be limited to,
discussions about the outcomes for the patient and his/her
family, based on the interest of the patient, and to 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.
6. Authorizes the information and counseling sessions to
include a discussion of treatment options in a manner that
the patient and his/her family can easily understand.
Requires, if the patient requests information on the costs of
treatment options, including the availability of insurance
and eligibility of the patient for coverage, the patient to
be referred to the appropriate entity for that information.
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7. Requires, if a health care provider does not wish to comply
with his/her patient's request for information on end-of-life
options, the health care provider to refer or transfer a
patient to another health care provider that shall provide
the requested information, and provide the patient with
information on procedures to transfer to another health care
provider that shall provide the requested information.
8. Authorizes an adult having capacity to give an individual
oral or written health care instruction, which may be limited
to take effect only if a specified condition arises.
9. Defines advanced health care directive or advance directive
to mean either an individual health care instruction or a
power of attorney for health care. Establishes a process and
form for an individual to give instructions about health care
decision making and designating an agent to make decisions on
his/her behalf.
10.Defines health care decisions as a decision made by a
patient or patient's agent, conservator, or surrogate,
regarding a patient's health care, including the selection
and discharge of health care providers and institutions,
approval or disapproval of diagnostic tests, surgical
procedures, programs of medication, and directions to
provide, withhold, or withdraw artificial nutrition and
hydration and all other forms of health care, including
cardiopulmonary resuscitation.
This bill:
1. Requires a health care provider to notify a patient
diagnosed with a terminal illness of his/her right to, or
when applicable, the right of another person authorized to
make health care decisions for the patient, to comprehensive
information and counseling regarding legal end-of-life
options. Authorizes this notification to be provided at the
time of diagnosis or at a subsequent visit.
2. Authorizes the information and counseling sessions to
include a discussion of treatment options in a culturally
sensitive manner that the patient and his/her family, or
another person authorized to make health care decisions for
the patient, can easily understand.
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3. Clarifies that the notification in #1 above is not required
if the patient or other person authorized to make health care
decisions for the patient has already received the
notification.
4. Updates existing law to include another person authorized to
make health care decisions for the patient, as specified, as
a proxy for the patient with regard to end-of-life care
information and counseling.
5. Clarifies that these provisions do not interfere with the
clinical judgment of a health care provider.
Comments
According to the author's office, this bill ensures that
patients diagnosed with a terminal illness or their
decision-makers are notified of their right to comprehensive
information and counseling regarding their legal end-of-life
options. This bill modifies existing law by requiring the
healthcare provider to notify terminally ill patients or their
decision makers of their right to comprehensive information and
counseling at the time of diagnosis or at a subsequent
appointment at which treatment options are discussed. As is the
case under existing law - healthcare providers who do not wish
to comply with a patient's request for information can refer or
transfer a patient to a provider who can convey this
information.
End-of-life cancer care in California . According to an August
2013 report by the CHCF, compared to the country as a whole, in
2010 California's patients with advanced cancer were more likely
to die in the hospital, spend time in an intensive care unit
(ICU), receive life-support procedures in the last month of
life, and receive chemotherapy in the last two weeks of life.
Some regions saw a steep increase in the percentage of patients
receiving life-sustaining procedures in the last month of life,
while others saw no change or a decrease. In 2010, nearly
one-third of Californians with poor-prognosis cancer spent their
last days in hospitals and ICUs, a decline of 7% compared with
2003-07 but still 20% higher than the national average. More
than 10% of Californians with poor-prognosis cancer who were in
the last month of life received advanced life-support procedures
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in 2010. About 6% of cancer patients were given chemotherapy in
the last two weeks of life in 2010; in some regions of the state
and in some hospitals, the rate exceeded 10%. The percentage of
dying cancer patients in California who received hospice care
increased slightly between 2003-07 and 2010, but remained below
the national average. In some California hospitals, referral to
hospice care occurred so close to the day of death that it was
unlikely to have provided much assistance or comfort to
patients.
Prior Legislation
AB 2747 (Berg, Chapter 683, Statutes of 2008) seeks to
facilitate meaningful end-of-life care communication between
doctors and their patients by enacting the California Right to
Know End-of-Life Act of 2008 to ensure that health care
providers provide critically-needed information in
carefully-circumscribed instances.
AB 891 (Alquist, Chapter 658, Statutes of 1999) streamlined and
updated the provisions governing health care decisions for
adults without decision-making capacity. Specifically, the bill
repealed the provisions governing durable powers of attorney for
health care and the Natural Death Act, and revised and recast
these provisions as part of a new Health Care Decisions Law.
FISCAL EFFECT : Appropriation: No Fiscal Com.: No Local:
No
SUPPORT : (Verified 8/19/14)
Alzheimer's Foundation of America
American Cancer Society Cancer Action Network
California Advocates for Nursing Home Reform
California Commission on Aging
California Hospice and Palliative Care Association
Compassion and Choices, Northern California
National Association of Social Workers, California Chapter
OPPOSITION : (Verified 8/19/14)
California Right to Life Committee
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ASSEMBLY FLOOR : 46-28, 5/29/14
AYES: Achadjian, Alejo, Ammiano, Bloom, Bocanegra, Bonilla,
Bonta, Bradford, Brown, Ian Calderon, Campos, Chau, Chesbro,
Cooley, Dahle, Daly, Dickinson, Eggman, Fong, Fox, Frazier,
Garcia, Gomez, Gordon, Hall, Roger Hern�ndez, Jones-Sawyer,
Levine, Lowenthal, Mullin, Muratsuchi, Nazarian, Olsen, Pan,
Perea, John A. P�rez, Quirk, Quirk-Silva, Rendon,
Ridley-Thomas, Salas, Skinner, Stone, Wieckowski, Yamada,
Atkins
NOES: Allen, Bigelow, Ch�vez, Conway, Dababneh, Donnelly, Beth
Gaines, Gatto, Gorell, Gray, Grove, Hagman, Harkey, Holden,
Jones, Linder, Logue, Maienschein, Mansoor, Medina, Melendez,
Nestande, Patterson, V. Manuel
P�rez, Ting, Wagner, Waldron, Wilk
NO VOTE RECORDED: Buchanan, Gonzalez, Rodriguez, Weber,
Williams, Vacancy
JL:k 8/19/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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