BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Kevin de Le�n, Chair
SB 1357 (Wolk) - Physician Orders for Life Sustaining Treatment
form: statewide registry.
Amended: May 6, 2014 Policy Vote: Health 8-0, Judic.
5-1
Urgency: No Mandate: No
Hearing Date: May 19, 2014 Consultant: Brendan McCarthy
This bill meets the criteria for referral to the Suspense File.
Bill Summary: SB 1357 would require the Health and Human
Services Agency to create a statewide registry for Physician
Orders for Life Sustaining Treatment forms.
Fiscal Impact:
Start-up costs of about $2.5 million over the first three
years to develop the system (General Fund). The California
Health Care Foundation has commissioned a feasibility report
to examine the concept of a POLST registry. According to a
draft of the report, it will cost about $2.5 million to
develop the information technology system for an
online-accessible registry and set up the program.
Ongoing costs of about $1.3 million per year to maintain
the system, assist health care providers trying to access a
POLST form for a patient, and market the system (General
Fund).
Background: Under current law, a health care provider can
complete a Physician Orders for Life Sustaining Treatment
(POLST) form based on patient preferences and medical
indications. A POLST form must be signed by the patient and the
health care provider. The POLST form gives information to future
health care providers about the patient's wishes for medical
care at the end of life. The POLST form allows the patient to
specify the level of care that he or she wishes to be provided.
A POLST form is a more detailed set of instructions for health
care provides than a Do Not Resuscitate form.
Also authorized under current law, an individual may create and
advance care directive. An advance care directive is a legal
SB 1357 (Wolk)
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document through which an individual can appoint someone else to
make health care decisions, if the individual is not able to
make his or her own decisions. An advance care directive can
also give instructions for making health care decisions, for
example by giving instructions to family members about a
patient's wishes, should he or she be unable to make health care
decisions.
The Secretary of State's Office currently maintains an advance
care directive registry. That system is paper based and is not
widely marketed. There are only about 4,000 records in the
system and the Secretary's Office receives about 40 requests per
month for directives in the system. Because it is a paper-based
system with limited funding, requests can only be responded to
during normal business hours.
Proposed Law: SB 1357 would require the Health and Human
Services Agency to create a statewide registry for Physician
Orders for Life Sustaining Treatment forms.
Specific provisions of the bill would:
Require the Health and Human Services Agency to create a
statewide POLST registry, before January 1, 2016;
Require the registry to accept electronic submissions;
Require standards for verifying users and protecting
information in the registry;
Require other privacy and accuracy protections;
Require a health care provider who completes a POLST form
to include it in the patient's medical record;
Provide that a health care provider, acting in good faith
upon information in a POLST form, would be protected from
criminal or civil liability or other sanctions.
Related Legislation: AB 2452 (Pan) would require the Secretary
of State to develop an online registry for advance health care
directives. That bill is on the Assembly Appropriations
Committee's Suspense File.
Staff Comments: Under both the federal American Recovery and
Reinvestment Act and the Affordable Care Act, funding has been
made available to state governments and health care providers
for improvements to health-related information technology
systems. It is possible that the state may be able to secure
funding from the federal government under those bills or through
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the Medi-Cal program to offset some of the costs to develop the
system required under this bill.