Bill Text: CA SB1196 | 2023-2024 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: End of Life Option Act.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced) 2024-04-18 - April 22 set for first hearing canceled at the request of author. [SB1196 Detail]

Download: California-2023-SB1196-Amended.html

Amended  IN  Senate  March 19, 2024

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Senate Bill
No. 1196


Introduced by Senator Blakespear

February 14, 2024


An act relating to end of life. to amend Sections 443.1, 443.2, 443.4, 443.5, 443.9, 443.11, 443.14, 443.15, 443.16, 443.17, and 443.19 of, to repeal Section 443.215 of, and to repeal and add Section 443.22 of, the Health and Safety Code, relating to end of life.


LEGISLATIVE COUNSEL'S DIGEST


SB 1196, as amended, Blakespear. End of Life Option Act.
Existing law, the End of Life Option Act, until January 1, 2031, authorizes an adult who meets certain qualifications, including, among other things, being a resident of the State of California, and who has been determined by their attending physician to be suffering from a terminal disease, as defined, to make a request for an aid-in-dying drug for the purpose of ending their life. Existing law establishes the procedures for making these requests, including that 2 oral requests be made a minimum of 48 hours apart and that a specified form to request an aid-in-dying drug be submitted, under specified circumstances. Existing law requires specified information to be documented in the individual’s medical record, including, among other things, all oral and written requests for an aid-in-dying drug. Existing law prescribes specified forms that attending and consulting physicians are required to submit to the State Department of Public Health and authorizes the Medical Board of California to update these forms.
This bill would delete the California residency requirement described above. The bill would replace the term “terminal disease” for purposes of the act with “grievous and irremediable medical condition,” defined as a medical condition that (1) is a serious and incurable illness or disease, (2) has placed the individual in a state of irreversible decline in capability, (3) is causing the individual to endure physical or psychological suffering due to the illness, disease, or state of decline that is intolerable to the individual and cannot be relieved in a manner the individual deems acceptable, and (4) after taking into account all of the individual’s medical circumstances, it is reasonably foreseeable that the condition will become the individual’s natural cause of death, as specified. The bill would, for purposes of the act, include a diagnosis of early to mid-stage dementia while the individual still has the capacity to make medical decisions in the definition of a “grievous and irremediable medical condition.” The bill would also expand the definition of “mental health specialist” to include neurologists.
The bill would additionally authorize the self-administration of an aid-in-dying drug through intravenous injection. The bill would repeal the January 1, 2031, expiration date of the act, thereby imposing a state-mandated local program by extending the operation of crimes for specified violations of the act. The bill would make certain technical, nonsubstantive changes to these provisions.
The bill would delete the prescribed forms described above and instead require the Medical Board of California to develop and update an attending physician compliance form, a consulting physician form, and an attending physician followup form that meet certain requirements and include specified information.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law, the End of Life Option Act, until January 1, 2031, authorizes an adult who meets certain qualifications, and who has been determined by their attending physician to be suffering from a terminal disease, as defined, to make a request for an aid-in-dying drug for the purpose of ending their life. Existing law makes participation in activities authorized pursuant to the act voluntary, and makes individual health care providers immune from liability for refusing to engage in activities authorized pursuant to its provisions, including providing information about the act or referring an individual to a provider who prescribes aid-in-dying medication.

This bill would express the intent of the Legislature to enact legislation to expand the provisions of the act.

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: NOYES   Local Program: NOYES  

The people of the State of California do enact as follows:


SECTION 1.

 Section 443.1 of the Health and Safety Code is amended to read:

443.1.
 As used in this part, the following definitions shall apply:
(a) “Adult” means an individual 18 years of age or older.
(b) “Aid-in-dying drug” means a drug determined and prescribed by a physician for a qualified individual, which the qualified individual may choose to self-administer to bring about their death due to a terminal disease. grievous and irremediable medical condition.
(c) “Attending physician” means the physician who has primary responsibility for the health care of an individual and treatment of the individual’s terminal disease. grievous and irremediable medical condition.
(d) “Attending physician checklist and compliance form” means a form, as described in Section 443.22, identifying each and every requirement that must be fulfilled by an attending physician to be in good faith compliance with this part should the attending physician choose to participate.
(e) “Capacity to make medical decisions” means that, in the opinion of an individual’s attending physician, consulting physician, psychiatrist, neurologist, or psychologist, pursuant to Section 4609 of the Probate Code, the individual has the ability to understand the nature and consequences of a health care decision, the ability to understand its significant benefits, risks, and alternatives, and the ability to make and communicate an informed decision to health care providers.
(f) “Consulting physician” means a physician who is independent from the attending physician and who is qualified by specialty or experience to make a professional diagnosis and prognosis regarding an individual’s terminal disease. grievous and irremediable medical condition.
(g) “Department” means the State Department of Public Health.
(h) (1) “Grievous and irremediable medical condition” means a medical condition that meets all the following criteria:
(A) The condition is a serious and incurable illness or disease.
(B) The condition has placed the individual in a state of irreversible decline in capability.
(C) The condition is causing the individual to endure physical or psychological suffering due to the illness, disease, or state of decline that is intolerable to the individual and cannot be relieved in a manner the individual deems acceptable.
(D) After taking into account all of the individual’s medical circumstances, it is reasonably foreseeable that the condition will become the individual’s natural cause of death. A specific prognosis as to the length of time the person has left to live shall not be required to meet this criteria.
(2) For purposes of this part, a “grievous and irremediable medical condition” includes a diagnosis of early to mid-stage dementia while the individual still has the capacity to make medical decisions.

(h)

(i) “Health care provider” or “provider of health care” means any person licensed or certified pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code; Code, including nurse practitioners, physician assistants, and registered nurses, any person licensed pursuant to the Osteopathic Initiative Act or the Chiropractic Initiative Act; Act, and any person certified pursuant to Division 2.5 (commencing with Section 1797) of this code.

(i)

(j) “Health care entity” means any clinic, health dispensary, or health facility licensed pursuant to Division 2 (commencing with Section 1200), including a general hospital, medical clinic, nursing home or hospice facility. A health care entity does not include individuals described in subdivision (h). (i).

(j)

(k) “Informed decision” means a decision by an individual with a terminal disease grievous and irremediable medical condition to request and obtain a prescription for a drug that the individual may self-administer to end the individual’s life, that is based on an understanding and acknowledgment of the relevant facts, and that is made after being fully informed by the attending physician of all of the following:
(1) The individual’s medical diagnosis and prognosis.
(2) The potential risks associated with taking utilizing the drug to be prescribed.
(3) The probable result of taking utilizing the drug to be prescribed.
(4) The possibility that the individual may choose not to obtain the drug or may obtain the drug but may decide not to ingest utilize it.
(5) The feasible alternatives or additional treatment opportunities, including, but not limited to, comfort care, hospice care, palliative care, and pain control.

(k)

(l) “Medically confirmed” means the medical diagnosis and prognosis of the attending physician has been confirmed by a consulting physician who has examined the individual and the individual’s relevant medical records.

(l)

(m) “Mental health specialist assessment” means one or more consultations between an individual and a mental health specialist for the purpose of determining that the individual has the capacity to make medical decisions and is not suffering from impaired judgment due to a mental disorder.

(m)

(n) “Mental health specialist” means a psychiatrist psychiatrist, neurologist, or a licensed psychologist.

(n)

(o) “Physician” means a doctor of medicine or osteopathy currently licensed to practice medicine in this state.

(o)

(p) “Public place” means any street, alley, park, public building, any place of business or assembly open to or frequented by the public, and any other place that is open to the public view, or to which the public has access. “Public place” does not include a health care entity.

(p)

(q) “Qualified individual” means an adult who has the capacity to make medical decisions, is a resident of California, decisions and has satisfied the requirements of this part in order to obtain a prescription for a drug to end their life.

(q)

(r) “Self-administer” means a qualified individual’s affirmative, conscious, and physical act of administering and ingesting administering the aid-in-dying drug to bring about their own death. death through ingestion, or through an intravenous pathway after a health care provider places an intravenous catheter if one was not already placed, to bring about the qualified individual’s own death.

(r)“Terminal disease” means an incurable and irreversible disease that has been medically confirmed and will, within reasonable medical judgment, result in death within six months.

SEC. 2.

 Section 443.2 of the Health and Safety Code is amended to read:

443.2.
 (a) An individual who is an adult with the capacity to make medical decisions and with a terminal disease grievous and irremediable medical condition may make a request to receive a prescription for an aid-in-dying drug if all of the following conditions are satisfied:
(1) The individual’s attending physician has diagnosed the individual with a terminal disease. grievous and irremediable medical condition.
(2) The individual has voluntarily expressed the wish to receive a prescription for an aid-in-dying drug.

(3)The individual is a resident of California and is able to establish residency through any of the following means:

(A)Possession of a California driver’s license or other identification issued by the State of California.

(B)Registration to vote in California.

(C)Evidence that the person owns or leases property in California.

(D)Filing of a California tax return for the most recent tax year.

(4)

(3) The individual documents his or her their request pursuant to the requirements set forth in Section 443.3.

(5)

(4) The individual has the physical and mental ability to self-administer the aid-in-dying drug.
(b) A person shall not be considered a “qualified individual” qualified individual under the provisions of this part solely because of age or disability.
(c) A request for a prescription for an aid-in-dying drug under this part shall be made solely and directly by the individual diagnosed with the terminal disease grievous and irremediable medical condition and shall not be made on behalf of the patient, including, but not limited to, through a power of attorney, an advance health care directive, a conservator, health care agent, surrogate, or any other legally recognized health care decisionmaker.

SEC. 3.

 Section 443.4 of the Health and Safety Code is amended to read:

443.4.
 (a) An individual may at any time withdraw or rescind their request for an aid-in-dying drug, or decide not to ingest utilize an aid-in-dying drug, without regard to the individual’s mental state.
(b) A prescription for an aid-in-dying drug provided under this part may not be written without the attending physician directly, and not through a designee, offering the individual an opportunity to withdraw or rescind the request.
(c) If the individual decides to transfer care to another physician, upon request of the individual the physician shall transfer all relevant medical records records, including written documentation including that contain the dates of the individual’s oral and written requests seeking to obtain a prescription for an aid-in-dying drug.

SEC. 4.

 Section 443.5 of the Health and Safety Code is amended to read:

443.5.
 (a) Before prescribing an aid-in-dying drug, the attending physician shall do all of the following:
(1) Make the initial determination of all of the following:
(A) (i) Whether the requesting adult has the capacity to make medical decisions.
(ii) If there are indications of a mental disorder, the physician shall refer the individual for a mental health specialist assessment.
(iii) If a mental health specialist assessment referral is made, no aid-in-dying drugs shall not be prescribed until the mental health specialist determines that the individual has the capacity to make medical decisions and is not suffering from impaired judgment due to a mental disorder.
(B) Whether the requesting adult has a terminal disease. grievous and irremediable medical condition.
(C) Whether the requesting adult has voluntarily made the request for an aid-in-dying drug pursuant to Sections 443.2 and 443.3.
(D) Whether the requesting adult is a qualified individual pursuant to subdivision (q) of Section 443.1.
(2) Confirm that the individual is making an informed decision by discussing with them all of the following:
(A) Their medical diagnosis and prognosis.
(B) The potential risks associated with ingesting utilizing the requested aid-in-dying drug.
(C) The probable result of ingesting utilizing the aid-in-dying drug.
(D) The possibility that they may choose to obtain the aid-in-dying drug but not take it.
(E) The feasible alternatives or additional treatment options, including, but not limited to, comfort care, hospice care, palliative care, and pain control.
(3) Refer the individual to a consulting physician for medical confirmation of the diagnosis and prognosis, and for a determination that the individual has the capacity to make medical decisions and has complied with the provisions of this part.
(4) Confirm that the qualified individual’s request does not arise from coercion or undue influence by another person by discussing with the qualified individual, outside of the presence of any other persons, except for an interpreter as required pursuant to this part, whether or not the qualified individual is feeling coerced or unduly influenced by another person.
(5) Counsel the qualified individual about the importance of all of the following:
(A) Having another person present when they ingest utilize the aid-in-dying drug prescribed pursuant to this part.
(B) Not ingesting utilizing the aid-in-dying drug in a public place.
(C) Notifying the next of kin of their request for an aid-in-dying drug. A qualified individual who declines or is unable to notify next of kin shall not have their request denied for that reason.
(D) Participating in a hospice program.
(E) Maintaining the aid-in-dying drug in a safe and secure location until the time that the qualified individual will ingest utilize it.
(6) Inform the individual that they may withdraw or rescind the request for an aid-in-dying drug at any time and in any manner.
(7) Offer the individual an opportunity to withdraw or rescind the request for an aid-in-dying drug before prescribing the aid-in-dying drug.
(8) Verify, immediately before writing the prescription for an aid-in-dying drug, that the qualified individual is making an informed decision.
(9) Confirm that all requirements are met and all appropriate steps are carried out in accordance with this part before writing a prescription for an aid-in-dying drug.
(10) Fulfill the record documentation required under Sections 443.8 and 443.19.
(11) Complete the attending physician checklist and compliance form, as described in Section 443.22, include it and the consulting physician compliance form in the individual’s medical record, and submit both forms to the State Department of Public Health. department.
(b) If the conditions set forth in subdivision (a) are satisfied, the attending physician may deliver the aid-in-dying drug in any of the following ways:
(1) Dispensing the aid-in-dying drug directly, including ancillary medication intended to minimize the qualified individual’s discomfort, if the attending physician meets all of the following criteria:
(A) Is authorized to dispense medicine under California law.
(B) Has a current United States Drug Enforcement Administration (USDEA) certificate.
(C) Complies with any applicable administrative rule or regulation.
(2) With the qualified individual’s written consent, contacting a pharmacist, informing the pharmacist of the prescriptions, and delivering the written prescriptions personally, by mail, or electronically to the pharmacist, who may dispense the drug to the qualified individual, the attending physician, or a person expressly designated by the qualified individual and with the designation delivered to the pharmacist in writing or verbally.
(c) Delivery of the dispensed drug to the qualified individual, the attending physician, or a person expressly designated by the qualified individual may be made by personal delivery, or, with a signature required on delivery, by United Parcel Service, United States Postal Service, FedEx, or by messenger service.

SEC. 5.

 Section 443.9 of the Health and Safety Code is amended to read:

443.9.
 (a) Within 30 calendar days of writing a prescription for an aid-in-dying drug, the attending physician shall submit to the State Department of Public Health department a copy of the qualifying patient’s written request, the attending physician checklist and compliance form, and the consulting physician compliance form.
(b) Within 30 calendar days following the qualified individual’s death from ingesting utilizing the aid-in-dying drug, or any other cause, the attending physician shall submit the attending physician followup form to the State Department of Public Health. department.

SEC. 6.

 Section 443.11 of the Health and Safety Code is amended to read:

443.11.
 (a) A request for an aid-in-dying drug as authorized by this part shall be in the following form:
REQUEST FOR AN AID-IN-DYING DRUG TO END MY LIFE IN A HUMANE AND DIGNIFIED MANNER I, ......................................................, am an adult of sound mind and a resident of the State of California. mind.
I am suffering from ................, which my attending physician has determined is in its terminal phase to be grievous and irremediable medical condition and which has been medically confirmed.
I have been fully informed of my diagnosis and prognosis, the nature of the aid-in-dying drug to be prescribed and potential associated risks, the expected result, and the feasible alternatives or additional treatment options, including comfort care, hospice care, palliative care, and pain control.
I request that my attending physician prescribe an aid-in-dying drug that will end my life in a humane and dignified manner if I choose to take utilize it, and I authorize my attending physician to contact any pharmacist about my request.
INITIAL ONE:
............ I have informed one or more members of my family of my decision and taken their opinions into consideration.
............ I have decided not to inform my family of my decision.
............ I have no family to inform of my decision.
I understand that I have the right to withdraw or rescind this request at any time.
I understand the full import of this request and I expect to die if I take utilize the aid-in-dying drug to be prescribed. My attending physician has counseled me about the possibility that my death may not be immediately upon the consumption of the drug. occur immediately upon utilization of the drug.
I make this request voluntarily, without reservation, and without being coerced.
Signed:..............................................
Dated:...............................................
DECLARATION OF WITNESSES
We declare that the person signing this request:
(a) is personally known to us or has provided proof of identity;
(b) voluntarily signed this request in our presence;
(c) is an individual whom we believe to be of sound mind and not under duress, fraud, or undue influence; and
(d) is not an individual for whom either of us is the attending physician, consulting physician, or mental health specialist.
............................Witness 1/Date
............................Witness 2/Date
NOTE: Only one of the two witnesses may be a relative (by blood, marriage, registered domestic partnership, or adoption) of the person signing this request or be entitled to a portion of the person’s estate upon death. Only one of the two witnesses may own, operate, or be employed at a health care entity where the person is a patient or resident.
(b) (1) The written language of the request shall be written in the same translated language as any conversations, consultations, or interpreted conversations or consultations between a patient and their attending or consulting physicians.
(2) Notwithstanding paragraph (1), the written request may be prepared in English even when the conversations or consultations or interpreted conversations or consultations were conducted in a language other than English if the English language form includes an attached interpreter’s declaration that is signed under penalty of perjury. The interpreter’s declaration shall state words to the effect that:
I, (INSERT NAME OF INTERPRETER), am fluent in English and (INSERT TARGET LANGUAGE).
On (insert date) at approximately (insert time), I read the “Request for an Aid-In-Dying Drug to End My Life” to (insert name of individual/patient) in (insert target language).
Mr./Ms./Mx. (insert name of patient/qualified individual) affirmed to me that they understood the content of this form and affirmed their desire to sign this form under their own power and volition and that the request to sign the form followed consultations with an attending and consulting physician.
I declare that I am fluent in English and (insert target language) and further declare under penalty of perjury that the foregoing is true and correct.
Executed at (insert city, county, and state) on this (insert day of month) of (insert month), (insert year).
X______Interpreter signature
X______Interpreter printed name
X______Interpreter address
(3) An interpreter whose services are provided pursuant to paragraph (2) shall not be related to the qualified individual by blood, marriage, registered domestic partnership, or adoption or nor be entitled to a portion of the person’s estate upon death. An interpreter whose services are provided pursuant to paragraph (2) shall meet the standards promulgated by the California Healthcare Interpreting Association or the National Council on Interpreting in Health Care or other standards deemed acceptable by the department for health care providers in California.

SEC. 7.

 Section 443.14 of the Health and Safety Code is amended to read:

443.14.
 (a) Notwithstanding any other law, a person shall not be subject to civil or criminal liability solely because the person was present when the qualified individual self-administers the prescribed aid-in-dying drug. A person who is present may, without civil or criminal liability, assist the qualified individual by preparing the aid-in-dying drug so long as the person does not assist the qualified person in ingesting utilizing the aid-in-dying drug. For purposes of this section, “assisting the qualified individual by preparing the aid-in-dying drug” includes a health care provider placing an intravenous catheter, so long as the health care provider does not assist the qualified individual in introducing the aid-in-dying drug into the qualified individual’s vein.
(b) A health care provider, health care entity, or professional organization or association shall not subject an individual to censure, discipline, suspension, loss of license, loss of privileges, loss of membership, or other penalty for participating in good faith compliance with this part or for refusing to participate in accordance with subdivision (e).
(c) Notwithstanding any other law, a health care provider or a health care entity shall not be subject to civil, criminal, administrative, disciplinary, employment, credentialing, professional discipline, contractual liability, or medical staff action, sanction, or penalty or other liability for participating in this part. This subdivision does not limit the application of, or provide immunity from, Section 443.15, 443.16, or 443.17.
(d) (1) A request by a qualified individual to an attending physician to provide an aid-in-dying drug in good faith compliance with the provisions of this part shall not provide the sole basis for the appointment of a guardian or conservator.
(2) Actions taken in compliance with the provisions of this part shall not constitute or provide the basis for any claim of neglect or elder abuse for any purpose of law.
(e) (1) Participation under this part shall be voluntary. Notwithstanding Sections 442 to 442.7, inclusive, a person or entity that elects, for reasons of conscience, morality, or ethics, not to participate is not required to participate under this part. This subdivision does not limit the application of, or excuse noncompliance with, paragraphs (2), (4), and (5) of this subdivision or subdivision (b), (i), or (j) of Section 443.15, as applicable.
(2) A health care provider who objects for reasons of conscience, morality, or ethics to participate under this part shall not be required to participate. If a health care provider is unable or unwilling to participate under this part, as defined in subdivision (f) of Section 443.15, the provider shall, at a minimum, inform the individual that they do not participate in the End of Life Option Act, document the individual’s date of request and provider’s notice to the individual of their objection in the medical record, and transfer the individual’s relevant medical record upon request.
(3) A health care provider or health care entity is not subject to civil, criminal, administrative, disciplinary, employment, credentialing, professional discipline, contractual liability, or medical staff action, sanction, or penalty or other liability for refusing to participate under this part, as defined in paragraph (2) of subdivision (f) of Section 443.15.
(4) If a health care provider is unable or unwilling to carry out a qualified individual’s request under this part and the qualified individual transfers care to a new health care provider or health care entity, the individual’s relevant medical records shall be provided to the individual and, upon the individual’s request, timely transferred with documentation of the date of the individual’s request for a prescription for aid-in-dying drug in the medical record, pursuant to law.
(5) A health care provider or a health care entity shall not engage in false, misleading, or deceptive practices relating to a willingness to qualify an individual or provide a prescription to a qualified individual under this part.

SEC. 8.

 Section 443.15 of the Health and Safety Code is amended to read:

443.15.
 (a) Subject to subdivision (b), notwithstanding any other law, a health care entity may prohibit its employees, independent contractors, or other persons or entities, including health care providers, from participating under this part while on premises owned or under the management or direct control of that health care entity or while acting within the course and scope of any employment by, or contract with, the entity.
(b) A health care entity shall first give notice upon employment or other affiliation and thereafter annual notice of the policy concerning this part to the individual or entity. An entity that fails to provide notice to an individual or entity in compliance with this subdivision shall not be entitled to enforce such a policy against that individual or entity. For purposes of this subdivision, posting on the entity’s public internet website the entity’s current policy governing medical aid in dying shall satisfy the annual notice requirement.
(c) Subject to compliance with subdivision (b), the health care entity may take action, including, but not limited to, the following, as applicable, against any individual or entity that violates this policy:
(1) Loss of privileges, loss of membership, or other action authorized by the bylaws or rules and regulations of the medical staff.
(2) Suspension, loss of employment, or other action authorized by the policies and practices of the health care entity.
(3) Termination of any lease or other contract between the health care entity and the individual or entity that violates the policy.
(4) Imposition of any other nonmonetary remedy provided for in any lease or contract between the health care entity and the individual or entity in violation of the policy.
(d) This section does not prevent, or allow a health care entity to prohibit, any health care provider, employee, independent contractor, or other person or entity from any of the following:
(1) Participating, or entering into an agreement to participate, under this part, while on premises that are not owned or under the management or direct control of the health care entity or while acting outside the course and scope of the participant’s duties as an employee of, or an independent contractor for, the health care entity.
(2) Participating, or entering into an agreement to participate, under this part as an attending physician or consulting physician while on premises that are not owned or under the management or direct control of the health care entity.
(e) In taking actions pursuant to subdivision (c), a health care entity shall comply with all procedures required by law, its own policies or procedures, and any contract with the individual or entity in violation of the policy, as applicable.
(f) For purposes of this part:
(1) “Notice” means a separate statement in writing advising of the health care entity policy with respect to participating under this part.
(2) “Participating, or entering into an agreement to participate, under this part” means doing or entering into an agreement to do any one or more of the following:
(A) Performing the duties of an attending physician as specified in Section 443.5.
(B) Performing the duties of a consulting physician as specified in Section 443.6.
(C) Performing the duties of a mental health specialist, in the circumstance that a referral to one is made.
(D) Delivering the prescription for, dispensing, or delivering the dispensed aid-in-dying drug pursuant to paragraph (2) of subdivision (b) of, and subdivision (c) of, Section 443.5.
(E) Being present when the qualified individual takes utilizes the aid-in-dying drug prescribed pursuant to this part.
(3) “Participating, or entering into an agreement to participate, under this part” does not include doing, or entering into an agreement to do, any of the following:
(A) Diagnosing whether a patient has a terminal disease, grievous and irremediable medical condition, informing the patient of the medical prognosis, or determining whether a patient has the capacity to make decisions.
(B) Providing information to a patient about this part.
(C) Providing a patient, upon the patient’s request, with a referral to another health care provider for the purposes of participating under this part.
(g) Any action taken by a health care entity pursuant to this section shall not be reportable under Sections 800 to 809.9, inclusive, of the Business and Professions Code. The fact that a health care provider participates under this part shall not be the sole basis for a complaint or report of unprofessional or dishonorable conduct under Sections 800 to 809.9, inclusive, of the Business and Professions Code.
(h) This part does not prevent a health care provider from providing an individual with health care services that do not constitute participation in this part.
(i) Each health care entity shall post on the entity’s public internet website the entity’s current policy governing medical aid in dying.
(j) A health care entity shall not engage in false, misleading, or deceptive practices relating to its policy concerning end-of-life care services nor engage in coercion or undue influence under this part.

SEC. 9.

 Section 443.16 of the Health and Safety Code is amended to read:

443.16.
 (a) A health care provider may not be sanctioned for any of the following:
(1) Making an initial determination pursuant to the standard of care that an individual has a terminal disease grievous and irremediable medical condition and informing him or her the individual of the medical prognosis.
(2) Providing information about the End of Life Option Act to a patient upon the request of the individual.
(3) Providing an individual, upon request, with a referral to another physician.
(b) A health care provider that prohibits activities under this part in accordance with Section 443.15 shall not sanction an individual health care provider for contracting with a qualified individual to engage in activities authorized by this part if the individual health care provider is acting outside of the course and scope of his or her their capacity as an employee or independent contractor of the prohibiting health care provider.
(c) Notwithstanding any contrary provision in this section, the immunities and prohibitions on sanctions of a health care provider are solely reserved for actions of a health care provider taken pursuant to this part. Notwithstanding any contrary provision in this part, health care providers may be sanctioned by their licensing board or agency for conduct and actions constituting unprofessional conduct, including failure to comply in good faith with this part.

SEC. 10.

 Section 443.17 of the Health and Safety Code is amended to read:

443.17.
 (a) Knowingly altering or forging a request for an aid-in-dying drug to end an individual’s life without their authorization or concealing or destroying a withdrawal or rescission of a request for an aid-in-dying drug is punishable as a felony if the act is done with the intent or effect of causing the individual’s death.
(b) Knowingly coercing or exerting undue influence on an individual to request or ingest utilize an aid-in-dying drug for the purpose of ending their life or to destroy a withdrawal or rescission of a request, or to administer an aid-in-dying drug to an individual without their knowledge or consent, is punishable as a felony.
(c) For purposes of this section, “knowingly” has the meaning provided in Section 7 of the Penal Code.
(d) The attending physician, consulting physician, or mental health specialist shall not be related to the individual by blood, marriage, registered domestic partnership, or adoption, or be entitled to a portion of the individual’s estate upon death.
(e) This section does not limit civil liability or damages arising from negligent conduct or intentional misconduct in carrying out actions otherwise authorized by this part by any person, health care provider, or health care entity.
(f) The penalties in this section do not preclude criminal penalties applicable under any law for conduct inconsistent with the provisions of this part.

SEC. 11.

 Section 443.19 of the Health and Safety Code is amended to read:

443.19.
 (a) The State Department of Public Health department shall collect and review the information submitted pursuant to Section 443.9. The information collected shall be confidential and shall be collected in a manner that protects the privacy of the patient, the patient’s family, and any medical provider or pharmacist involved with the patient under the provisions of this part. The information shall not be disclosed, discoverable, or compelled to be produced in any civil, criminal, administrative, or other proceeding.
(b) On or before July 1, 2017, and each year thereafter, based on the information collected in the previous year, the department shall create a report with the information collected from the attending physician followup form and post that report to its Internet Web site. internet website. The report shall include, but not be limited to, all of the following based on the information that is provided to the department and on the department’s access to vital statistics:
(1) The number of people for whom an aid-in-dying prescription was written.
(2) The number of known individuals who died each year for whom aid-in-dying prescriptions were written, and the cause of death of those individuals.
(3) For the period commencing January 1, 2016, to and including the previous year, cumulatively, the total number of aid-in-dying prescriptions written, the number of people who died due to use utilization of aid-in-dying drugs, and the number of those people who died who were enrolled in hospice or other palliative care programs at the time of death.
(4) The number of known deaths in California from using aid-in-dying drugs per 10,000 deaths in California.
(5) The number of physicians who wrote prescriptions for aid-in-dying drugs.
(6) Of people who died due to using utilizing an aid-in-dying drug, demographic percentages organized by the following characteristics:
(A) Age at death.
(B) Education level.
(C) Race.
(D) Sex.
(E) Type of insurance, including whether or not they had insurance.
(F) Underlying illness.
(c) The State Department of Public Health department shall make available the attending physician checklist and compliance form, the consulting physician compliance form, and the attending physician followup form, as described in Section 443.22, by posting them on its Internet Web site. internet website.

SEC. 12.

 Section 443.215 of the Health and Safety Code is repealed.
443.215.

This part shall remain in effect only until January 1, 2031, and as of that date is repealed.

SEC. 13.

 Section 443.22 of the Health and Safety Code is repealed.
443.22.

(a)The Medical Board of California may update the attending physician checklist and compliance form, the consulting physician compliance form, and the attending physician followup form, based on those provided in subdivision (b). Upon completion, the State Department of Public Health shall publish the updated forms on its Internet Web site.

(b)Unless and until updated by the Medical Board of California pursuant to this section, the attending physician checklist and compliance form, the consulting physician compliance form, and the attending physician followup form shall be in the following form:

PRINTER PLEASE NOTE: TIP-IN MATERIAL TO BE INSERTED

SEC. 14.

 Section 443.22 is added to the Health and Safety Code, to read:

443.22.
 (a) The Medical Board of California shall develop and update, as necessary, an attending physician compliance form, a consulting physician compliance form, and an attending physician followup form.
(b) The forms described in subdivision (a) shall require all of the following:
(1) The patient’s name, date of birth, and address.
(2) The name, address, phone number, and license number of all the following individuals:
(A) The attending physician.
(B) The consulting physician.
(C) The mental health specialist.
(D) The pharmacist.
(3) Information relating to the patient’s grievous and irremediable medical condition.
(4) The name and dosage of any aid-in-dying drug and antiemetic drug prescribed, the method of delivery for the prescription, and the date the medication was prescribed.
(5) The patient’s time and location of death.
(6) A disclosure of whether a health care provider was present at the time the patient self-administered the aid-in-dying drug.
(7) A disclosure of whether the attending physician or another health care provider was present at the time of death.
(8) The date the aid-in-dying drug was self-administered.
(9) The date of the patient’s death.
(10) The time between the patient’s self-administration of the lethal dose of the aid-in-dying drug and the patient’s unconsciousness.
(11) The time between the patient’s self-administration of the lethal dose of the aid-in-dying drug and the patient’s death.
(12) The location where the qualified individual self-administered the aid-in-dying-drug.
(13) Disclosure of any complications that occurred after the patient’s self-administration of the lethal dose of the aid-in-dying drug.
(14) Disclosure of whether the emergency medical system was activated for any reason after the patient’s self-administration of the lethal dose of the aid-in-dying drug.
(c) The forms described in subdivision (a) shall also include all of the following:
(1) An eligibility checklist to confirm that the patient is a qualified individual authorized to be prescribed an aid-in-dying drug pursuant to this part.
(2) Compliance checklists for attending physicians, consulting physicians, and mental health specialists to confirm that all of the duties and requirements under this part have been satisfied.
(3) Signed attestations of the attending physician, consulting physician, and mental health specialist that all of the duties and requirements under this part have been satisfied.
(4) Disclosures of any deadlines and requirements imposed on the attending physician or consulting physician by the department with regard to the forms described in this section, including the deadline and method by which the forms are required to be returned to the department.
(5) Any other information that the board deems necessary.
(d) The department shall publish the forms described in subdivision (a) and any updates to the forms on its internet website.

SEC. 15.

 No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.
SECTION 1.

It is the intent of the Legislature to enact legislation to expand the End of Life Option Act.

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