Bill Text: CA AB2139 | 2013-2014 | Regular Session | Amended

California Assembly Bill 2139 (Prior Session Legislation)

NOTE: There are more recent revisions of this legislation. Read Latest Draft

Bill Title: End-of-life care: patient notification.

Spectrum: Moderate Partisan Bill (Democrat 6-1)

Status: (Passed) 2014-09-25 - Chaptered by Secretary of State - Chapter 568, Statutes of 2014. [AB2139 Detail]

Download: California-2013-AB2139-Amended.html

BILL NUMBER: AB 2139	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  APRIL 2, 2014

INTRODUCED BY   Assembly Member Eggman

                        FEBRUARY 20, 2014

   An act to  add Section 442.4 to   amend
Sections 442, 442.5, and 442.7 of  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. 
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. 
   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.
    This   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  bill would
 additionally  require  a   the 
health care provider  , as defined,  to notify the
patient  or, when applicable, the agent  , 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.  The bill
would define the term "terminal illness" for these purposes. 
   Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

   SECTION 1.    Section 442 of the   Health
and Safety Code   is amended to read: 
   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. 
   (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.  
   (b) 
    (   c)  "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. 
   (c) 
    (   d)  "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. 
   (d) 
    (   e)  "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. 
   (e)
    (   f)  "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. 
   (f) 
    (   g)  "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. 
   (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. 
   SEC. 2.    Section 442.5 of the   Health and
Safety Code   is amended to read: 
   442.5.  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, or when applicable, 
 the agent of the patient's right to, comprehensive information
and counseling regarding legal end-of-life options and  , upon
the  patient's   patient or agent's 
request, provide the patient  or   agent  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  or
  agent  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  or agent  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)  The   If the patient has not appointed
an agent under a power of attorney for health care, the  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  , or, when applicable, the agent,  can easily
understand. If the patient  or agent  requests information
on the costs of treatment options, including the availability of
insurance and eligibility of the patient for coverage, the patient
 or agent  shall be referred to the appropriate entity for
that information.
   SEC. 3.    Section 442.7 of the   Health and
Safety Code   is amended to read: 
   442.7.  If a health care provider does not wish to comply with his
or her patient's request  or, when applicable, the agent's
request  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  or agent  with information on
procedures to transfer to another health care provider that shall
provide the requested information. 
  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.