BILL ANALYSIS �
AB 2452
Page 1
Date of Hearing: April 29, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 2452 (Pan) - As Amended: April 8, 2014
SUBJECT : Advance health care directive registry.
SUMMARY : Requires the Secretary of State (SoS) to establish an
electronic process for submittal and retrieval of advance health
care directives (AHCD). Specifically, this bill :
1)Requires the SoS to establish an electronic process for the
registry of AHDCs to allow downloading of electronic
reproductions of AHDC s.
2)Requires the SoS to post this information on a secure portion of
the office's Website and to allow downloading and retrieving a
copy of the electronic reproduction.
3)Requires the new electronic registry to merge with the existing
registry.
4)Requires a person to submit specified information to the SoS to
have the AHDC registered and lists acceptable documents that
can be submitted for registration.
5)Provides the steps the SoS must take to register an AHDC,
including assigning a registration number and password and
issuing a registration card with pertinent information for
accessing the electronic retrieval system. .
6)Directs the SoS to limit access to the registry except when the
password and registration are supplied, a court orders access
or when the SoS determines that providing access is in the
best interest of the registrant.
7)Requires the SoS to establish procedures for administering the
registry, including how to register replacement AHDCs and
other documents, removal of AHDCs that have been revised or
revoked.
8)Requires the SoS to the extent practical to work with any entity
licensed as a health care facility to develop a process for
retrieving documents and information related to AHDCs from a
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statewide health information exchange system.
9)Mandates the SoS make the electronic registry and system
available January 1, 2016.
EXISTING LAW :
1)Enacts the Health Care Decisions Law, which governs health care
for adults deprived of decision-making capacity. Codifies a
statutory form for AHDCs.
2)Provides a surrogate can make a health care decision in
accordance with the patient's individual health care
instructions to the extent known to the surrogate.
3)Requires the SoS to establish a registry for people who have a
written AHDC.
4)Requires SoS to issue a registrant an AHDC registry
identification card indicating that an AHDC, or information
regarding an AHDC, has been deposited with the registry.
Costs associated with issuance of the card shall be offset by
the fee charged by the SoS to receive and register information
at the registry.
5)Requires SoS to provide the information about the AHDC to any
health care provider, the public guardian or legal
representative of the person who registered by the close of
the next business day.
6)Requires hospitals within 24 hours to contact a person who can
make health care decision for a patient, who is unconscious or
otherwise incapable of communication. Establishes a hospital
has met its duty if it attempts specified actions including
contacting the SoS to determine if the patient has registered
an AHDC with SoS.
FISCAL EFFECT : This bill has not been analyzed yet by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill is
needed because the current Advanced Healthcare Directive
database is outdated and impractical for use by doctors and
other health care providers in a timely manner. The current
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system relies on hardcopies and faxing to provide requesting
medical professionals with information. Because patients are
often in critical condition or incapacitated when these
decisions must be made, doctors require immediate notification
about the AHDCs of their patients. The author argues
modernizing the system to primarily operate as an online
portal where all AHDCs are available quickly will allow
doctors to know more about their patients in emergency
situations and better understand their patients' desires.
2)BACKGROUND . An AHDC is a set of written instructions that a
person gives that specifies what actions should be taken for
their health, if they are no longer able to make decisions
because of illness or incapacity. The document can take many
forms, including a living will, personal directive, advance
directive, or advance decision. California does not provide
for a living will in law, only an AHDC.
The California Probate Code defines AHDC as an individual
health care instruction or a power of attorney for health
care. Current law codifies a statutory AHDC form that
includes an explanation of each part, an explanation of the
duties of a designated agent, and instructions for signing the
form, including an explanation of witnessing requirements or
notarization requirements. The use of this form is optional,
and does not preclude the use of additional or different
forms.
The demand and need for AHDCs in partly in response to the
increasing sophistication and prevalence of medical
technology. The improvements in health care have led to
significant changes in the death experience of many Americans.
Of U.S. deaths, 50%-75% occur in health care facilities.
People are more likely to die of a chronic condition with
their deterioration and eventual death occurring after a
prolonged period rather than the result of a sudden incident,
such as a fatal heart attack or accident. Researchers have
documented that medical care for the dying can be
unnecessarily prolonged, painful, expensive, and emotionally
burdensome to both patients and their families.
AHDCs gained widespread usage among health care professionals
when it appeared in the Patient Self-Determination Act (PSDA),
a federal statute enacted as part of the federal Omnibus
Budget Reconciliation Act of 1990. The PSDA required health
care facilities receiving Medicare funding to provide each
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patient with information about AHDCs.
3)REGISTRY EXPERIENCE . The SoS has received very few AHDCs for
registration, approximately 4300. They said they get about
450 new AHDCs annually. Because there are so few registered
AHDCs, the registry is rarely used and many physicians are
unaware of its existence. California is not the only state
facing difficulties establishing a registry. The State of
Washington ended its living well registry in 2011. Only 2500
people had registered and the fees could not support the
program operations.
4)SUPPORT . The American Federation of State, County and
Municipal Employees argues this bill allows those with access
to view, download and print copies of AHDCs, which contain
information such as whether or not the registrant approves of
certain end of life treatments and procedures, CPR and organ
donation. They state this bill would make the current AHDC
registry more convenient and accessible, especially in
emergencies. The American College of Emergency Physicians
supports this bill because it will provide greater
availability of documents; ensuring patients' wishes are
honored regarding medical treatment towards the end of life.
The California Medical Association supports the bill because
allowing timely and secure access to all health care decision
documents in one database will greatly improve patient care,
especially in emergency circumstances.
5)RELATED LEGISLATION . SB 1357 (Wolk) develops an online
database for the POLST form only. SB 1357 is set for hearing
April 29 in the Senate Judiciary Committee.
6)PREVIOUS LEGISLATION . AB 2445 (Canciamilla), Chapter 882,
Statutes of 2004, authorized issuing an identification card
and allowed the SoS to charge a fee for the AHDC registry.
AB 891 (Alquist), Chapter 658, Statutes of 1999, established the
Health Care Decisions Law, which also governs AHDCs, including
establishing the program at the SoS.
7)AMENDMENTS . The author may want to consider amendments to
clarify which documents must be submitted as part of the
application process and which AHDCs can be submitted for the
registry for posting online. Other technical and correcting
amendments to correct drafting errors are also needed.
AB 2452
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REGISTERED SUPPORT / OPPOSITION :
Support
California Chapter of the American College of Emergency
Physicians
American Federation of State County and Municipal Employees
California Medical Association
Opposition
None on file.
Analysis Prepared by : Roger Dunstan / HEALTH / (916) 319-2097