BILL ANALYSIS �
AB 2452
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ASSEMBLY THIRD READING
AB 2452 (Pan)
As Amended May 23, 2014
Majority vote
HEALTH 18-0 APPROPRIATIONS 16-0
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|Ayes:|Pan, Maienschein, |Ayes:|Gatto, Bigelow, |
| |Ammiano, Chau, Bonta, | |Bocanegra, Bradford, Ian |
| |Ch�vez, Chesbro, Gomez, | |Calderon, Campos, Eggman, |
| |Gonzalez, Roger | |Gomez, Holden, Jones, |
| |Hern�ndez, Lowenthal, | |Linder, Pan, Quirk, |
| |Waldron, Nazarian, | |Ridley-Thomas, Wagner, |
| |Nestande, Patterson, | |Weber |
| |Ridley-Thomas, Wagner, | | |
| |Wieckowski | | |
| | | | |
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SUMMARY : Requires the Secretary of State (SOS) to establish an
electronic process for submittal and retrieval of advance health
care directives (AHCDs). Specifically, this bill :
1)Requires the SOS to establish an electronic process for the
registry of AHCDs to allow downloading of electronic
reproductions of AHCDs and requires the SOS to post this
information on a secure portion of the office's Web site and
to allow downloading and retrieving a copy of the electronic
reproduction. Requires the new electronic registry to merge
with the existing (paper based) registry.
2)Requires a person to submit specified information to the SOS to
have the AHCD registered and lists acceptable documents that
can be submitted for registration, including, a values
statement or other document that supplements the AHCD, a power
of attorney form, and a physician orders for life-sustaining
treatment form, among others.
3)Provides the steps the SOS must take to register an AHCD or other
acceptable document, including assigning a registration number
and password and issuing a registration card with pertinent
information for accessing the electronic retrieval system.
4)Directs the SOS to limit access to the registry except when the
password and registration are supplied, a court orders access
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or when the SOS determines that providing access is in the
best interest of the registrant.
5)Requires the SOS to establish procedures for administering the
registry, including how to register replacement AHCDs and
other documents, as well as removal of AHCDs that have been
revised or revoked, and 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 AHCDs from a statewide health
information exchange system.
6)Mandates the SOS make the electronic registry and system
available January 1, 2016, and requires the registry to be
fully supported by fees by January 1, 2020.
7)Requires the SOS to develop and submit a financial sustainability
plan to the Legislature by January 1, 2018 which details the
amount of revenue generated by the fees charged, the estimated
costs of maintaining the registry, the number of participants
in the registry and projected future participation, and, a
plan for ensuring that the fee revenue will support the
ongoing costs of maintaining the registry.
FISCAL EFFECT : According to the Assembly Appropriations
Committee estimated one-time costs of $2.5 million General Fund
(GF/fee revenue, for information technology planning and
development, regulations, and secure storage of records and
unknown ongoing staff costs to SOS to maintain and operate the
system, likely under $1 million annually (GF/fee revenue).
After 2020, the program must be fully supported by fee revenue.
Current law allows the SOS to charge a fee to each registrant in
an amount such that, when all fees charged to registrants are
aggregated, the aggregated fees do not exceed the actual cost of
establishing and maintaining the registry. The SOS currently
charges a fee of $10 per registration. Fee revenue is currently
minor, as there are only about 5,000 registrants and only a few
hundred new registrants annually. To the extent the new system
was more efficient and effective, fee revenue would likely
increase.
COMMENTS : 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. The current system relies on hardcopies and faxing
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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 AHCDs of their patients. The
author argues modernizing the system to primarily operate as an
online portal where all AHCDs are available quickly will allow
doctors to know more about their patients in emergency
situations and better understand their patients' desires.
An AHCD 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 AHCD. The California Probate Code Section 4605 defines
AHCD as an individual health care instruction or a power of
attorney for health care. Current law codifies a statutory AHCD
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 AHCDs is partly in response to the
increasing sophistication and prevalence of medical technology.
Improvements in health care have led to significant changes in
the death experience of many Americans. Of United States
deaths, 50% to 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.
Analysis Prepared by : Lara Flynn / HEALTH / (916) 319-2097
FN: 0003778
AB 2452
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