Bill Text: CA SB128 | 2015-2016 | Regular Session | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: End of life.
Spectrum: Partisan Bill (Democrat 23-0)
Status: (Failed) 2016-11-30 - From Assembly without further action. [SB128 Detail]
Download: California-2015-SB128-Amended.html
Bill Title: End of life.
Spectrum: Partisan Bill (Democrat 23-0)
Status: (Failed) 2016-11-30 - From Assembly without further action. [SB128 Detail]
Download: California-2015-SB128-Amended.html
BILL NUMBER: SB 128 AMENDED BILL TEXT AMENDED IN SENATE JUNE 1, 2015 AMENDED IN SENATE APRIL 14, 2015 AMENDED IN SENATE MARCH 17, 2015 INTRODUCED BY Senators Wolk and Monning (Principal coauthors: Senators Jackson and Leno) (Principal coauthors: Assembly Members Alejo and Eggman) (Coauthors: Senators Block, Hall, Hancock, Hernandez, Hill, McGuire, and Wieckowski) (Coauthors: Assembly Members Chu, Cooper, Frazier, Cristina Garcia, Low, Quirk, Rendon, and Mark Stone) JANUARY 20, 2015 An act to add Part 1.85 (commencing with Section 443) to Division 1 of the Health and Safety Code, relating to end of life. LEGISLATIVE COUNSEL'S DIGEST SB 128, as amended, Wolk. End of life. Existing law authorizes an adult to give an individual health care instruction and to appoint an attorney 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. This bill would enact the End of Life Option Act authorizing an adult who meets certain qualifications, and who has been determined by his or her attending physician to be suffering from a terminal disease, as defined, to make a request formedicationa drug prescribed pursuant to these provisions for the purpose of ending his or her life. The bill would establish the procedures for making these requests. The bill would also establish the forms to requestaid-in-dying medicationan aid-in-dying drug and, under specified circumstances, an interpreter declaration to be signed subject to penalty of perjury, thereby imposing a crime and state-mandated local program. This bill would require 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. This bill would prohibit a provision in a contract, will, or other agreement from being conditioned upon or affected by a person making or rescinding a request for the above-describedmedication.drug. The bill would prohibit the sale, procurement, or issuance of any life, health, or accident insurance or annuity policy, health care service plan, contract, or health benefit plan, or the rate charged for any policy or plan contract, from being conditioned upon or affected by the request. The bill would prohibit an insurance carrier from providing any information in communications made to an individual about the availability ofaid-in-dying medicationan aid-in-dying drug absent a request by the individual, his or her attending physician at the behest of the individual, or the individual's designee. The bill would also prohibit any communication from containing both the denial of treatment and information as to the availability of aid-in-dyingmedicationdrug coverage. This bill would provide immunity fromcivil or criminalcivil, criminal, administrative, employment, or contractual liability or professional disciplinary action for participating in good faith compliance with the act, and would specify that the immunities and prohibitions on sanctions of a health care provider are solely reserved for conduct provided for by the bill. The bill would provide that participation in activities authorized pursuant to this bill shall be voluntary. The bill would authorize a health care provider to prohibit its employees, independent contractors, or other persons or entities, including other health care providers, from participating in activities under this act while on the premises owned or under the management or direct control of that prohibiting health care provider, or while acting within the course and scope of any employment by, or contract with, the prohibiting health care provider. This bill would make it a felony to knowingly alter or forge a request formedicationdrugs to end an individual's life without his or her authorization or to conceal or destroy a withdrawal or rescission of a request formedicationa drug , if it is done with the intent or effect of causing the individual's death. The bill would make it a felony to knowingly coerce or exert undue influence on an individual to requestmedicationa drug for the purpose of ending his or her life or to destroy a withdrawal or rescission of a request. By creating a new crime, the bill would impose a state-mandated local program. The bill would provide that nothing in its provisions is to be construed to authorize ending a patient's life by lethal injection, mercy killing, or active euthanasia, and would provide that action taken in accordance with the act shall not constitute, amongothers,other things, suicide or homicide. This bill would require the State Public Health Officer to adopt regulations establishing additional reporting requirements for physicians and pharmacists to determine the use of, and compliance with, the act, and would require thestateState Public Health Officer to annually review a sample of certain records and the State Department of Public Health to make a statistical report of the information collected.This bill would require specified information to be documented in the individual's medical record, including, among other things, all oral and written requests for aid-in-dying medication.Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest. This bill would make legislative findings to that effect. 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. Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Part 1.85 (commencing with Section 443) is added to Division 1 of the Health and Safety Code, to read: PART 1.85. End of Life Option Act 443. This part shall be known and may be cited as the End of Life Option Act. 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-dyingmedication"drug " meansmedicationa drug determined and prescribed by a physician for a qualified individual, which the qualified individual may choose to self-administer to bring about his or her death due to a terminal disease. (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. (d)"Competent""Capacity to make medical decisions" means that,in the opinion of a court orin the opinion of an individual's attending physician, consulting physician, psychiatrist, or psychologist,the individual haspursuant 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, including communication through a person familiar with the individual's manner of communicating, if that person is available. (e) "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.(f) "Counseling" means one or more consultations, as necessary, between an individual and a psychiatrist or psychologist licensed in this state for the purpose of determining that the individual is competent and is not suffering from a psychiatric or psychological disorder or depression causing impaired judgment.(g)(f) "Department" means the State Department of Public Health. (g) "End of Life Option Act Checklist" means a checklist identifying each and every requirement that must be fulfilled by a health care provider to be in good faith compliance with the End of Life Option Act should the health care provider choose to participate. (h) "Health care provider" or"provider" means a person licensed, certified, or otherwise authorized or permitted by law to administer health care or dispense medication in the ordinary course of business or practice of a profession, including, but not limited to, physicians, doctors of osteopathy, and pharmacists. "Health care provider" or "provider" includes a health care facility as identified in Section 1250."provider of health care" means any person licensed or certified pursuant to Division 2 (commencing with Section 500) of the Business and Professions Code; any person licensed pursuant to the Osteopathic Initiative Act or the Chiropractic Initiative Act; any person certified pursuant to Division 2.5 (commencing with Section 1797) of this code; and any clinic, health dispensary, or health facility licensed pursuant to Division 2 (commencing with Section 1200) of this code. (i) "Informed decision" means a decision by an individual with a terminal disease to request and obtain a prescription formedicationa 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 themedicationdrug to be prescribed. (3) The probable result of taking themedicationdrug to be prescribed. (4) The possibility that the individual may choose not to obtain themedicationdrug or may obtain themedicationdrug but may decide not totakeingest it. (5) The feasible alternatives or additional treatment opportunities, including, but not limited to, comfort care, hospice care, palliative care, and pain control. (j) "Medically confirmed" means the medicalopiniondiagnosis 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. (k) "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. (l) "Mental health specialist" means a psychiatrist or a licensed psychologist.(k)(m) "Physician" means a doctor of medicine or osteopathy currently licensed to practice medicine in this state.(l)(n) "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.(m)(o) "Qualified individual" meansa competent adult whoan adult who has the capacity to make medical decisions and is a resident of California and has satisfied the requirements of this part in order to obtain a prescription formedicationa drug to end his or her life.(n)(p) "Self-administer" means a qualified individual's affirmative, conscious, and physical act ofusingingesting themedicationaid-in-dying drug to bring about his or her own death.(o)(q) "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. 443.2. (a) Acompetent,qualified individual who is an adult with the capacity to make medical decisions and with a terminal disease may make a request to receive a prescription foraid-in-dying medicationan aid-in-dying drug if all of the following conditions are satisfied: (1) Thequalifiedindividual's attending physician hasdetermineddiagnosed the individualto be suffering fromwith a terminal disease. (2) Thequalifiedindividual has voluntarily expressed the wish to receive a prescription for an aid-in-dyingmedication.drug. (3) Thequalifiedindividual is a resident of California and is able to establish residency through any of the following means: (A) Possession of a California driver 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) Thequalifiedindividual documents his or her request pursuant to the requirements set forth in Section 443.3. (5) The individual has the physical and mental ability to self-administer the aid-in-dying drug. (b) A personmay not qualifyshall not be considered a "qualified individual" under the provisions of this part solely because of age or disability. (c) A request for a prescription foraid-in-dying medicationan aid-in-dying drug under this part shall be made solely and directly by the individual diagnosed with the terminal disease and shall not be made on behalf of thepatientpatient, including, but not limited to, through a power of attorney, an advance health care directive,or a conservator.a conservator, health care agent, surrogate, or any other legally recognized health care decisionmaker. 443.3. (a)A qualifiedAn individualwishing to receiveseeking to obtain a prescription foraid-in-dying medicationan aid-in-dying drug pursuant to this part shall submit two oral requests, a minimum of 15 days apart, and a written request to his or her attending physician. The attending physicianmustshall directly, and not through a designee, receive all three requests required pursuant to this section. (b) A valid written request foraid-in-dying medicationan aid-in-dying drug under subdivision (a) shall meet all of the following conditions: (1) The request shall be in substantially the form described in Section 443.9. (2) The request shall be signed and dated, in the presence of two witnesses in accordance with paragraph (3), by thequalified individualindividual seeking themedication.aid-in-dying drug. (3) The request shall be witnessed by at least two other adult persons who, in the presence of thequalifiedindividual, shall attest that to the best of their knowledge and belief that thequalifiedindividual is all of the following: (A)Competent.A person who has the capacity to make medical decisions. (B) Acting voluntarily. (C) Not being coerced to make or sign the request. (c) Only one of the two witnesses at the time the written request is signed may: (1) Be related to the qualified individual by blood, marriage, registered domestic partnership, or adoption or be entitled to a portion of theperson'sindividual's estate upon death. (2) Own, operate, or be employed at a health care facility where thequalifiedindividual is receiving medical treatment or resides. (d) The attendingphysicianphysician, consulting physician, or mental health specialist of thequalifiedindividual shall not be one of the witnesses required pursuant to paragraph (3) of subdivision (b). 443.4. (a)A qualifiedAn individual may at any time withdraw or rescind his or her request foraid-in-dying medicationan aid-in-dying drug, or decide not to ingest an aid-in dying drug, without regard to thequalifiedindividual's mental state. (b) A prescription foraid-in-dying medicationan aid-in-dying drug provided under this part may not be written without the attending physician directly, and not through a designee, offering thequalifiedindividual an opportunity to withdraw or rescind the request. 443.5. (a) Before prescribingaid-in-dying medication,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 adultis competent.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 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. (C) Whether the requesting adult has voluntarily made the request foraid-in-dying medicationan aid-in-dying drug pursuant to Sections 443.2 and 443.3. (D) Whether the requesting adult is a qualified individual pursuant to subdivision (m) of Section 443.1. (2)Ensure the qualifiedConfirm that the individual is making an informed decision by discussing with him or her all of the following: (A) His or her medical diagnosis and prognosis. (B) The potential risks associated withtakingingesting the requested aid-in-dyingmedication to be prescribed.drug. (C) The probable result oftakingingesting the aid-in-dyingmedication to be prescribed.drug. (D) The possibility that he or she may choose to obtain the aid-in-dyingmedicationdrug but not take it. (E) The feasible alternatives or additional treatmentopportunities,options, including, but not limited to, comfort care, hospice care, palliative care, and pain control. (3) Refer thequalifiedindividual to a consulting physician for medical confirmation of the diagnosis and prognosis, and for a determination that thequalified individual is competentindividual has the capacity to make medical decisions and has complied with the provisions of this part.(4) Refer the qualified individual for counseling if appropriate. No aid-in-dying medication shall be prescribed until the person performing the counseling determines that the patient is not suffering from a psychiatric or psychological disorder or depression causing impaired judgment.(5) Ensure(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, whether or not the qualified individual is feeling coerced or unduly influenced by another person.(6)(5) Counsel the qualified individual about the importance of all of the following: (A) Having another person present when he or shetakesingests the aid-in-dyingmedicationdrug prescribed pursuant to this part. (B) Nottakingingesting the aid-in-dyingmedicationdrug in a public place. (C) Notifying the next of kin of his or her request foraid-in-dying medication.an aid-in-dying drug. A qualified individual who declines or is unable to notify next of kin shall not have his or her 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 it.(7)(6) Inform thequalifiedindividual that he or she may withdraw or rescind the request foraid-in-dying medicationan aid-in-dying drug at any time and in any manner.(8)(7) Offer thequalifiedindividual an opportunity to withdraw or rescind the request foraid-in-dying medicationan aid-in-dying drug before prescribing the aid-in-dyingmedication.drug.(9)(8) Verify, immediately prior to writing the prescription for aid-in-dyingmedication,drug, that the qualified individual is making an informed decision.(10) Ensure(9) Confirm that all requirements are met and all appropriate steps are carried out in accordance with this part before writing a prescription foraid-in-dying medication.an aid-in-dying drug.(11)(10) Fulfill the record documentation required under Sections443.16 and 443.19.443.7 and 443.17. (11) Complete the End of Life Option Act Checklist and include it in the individual's medical record. (b) If the conditions set forth in subdivision (a) are satisfied, the attending physician may deliver the aid-in-dyingmedicationdrug in any of the following ways: (1)Dispense aid-in-dying medicationsDispensing 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,the attending physician may contactcontacting a pharmacist,informinforming the pharmacist of the prescriptions, anddeliverdelivering the written prescriptions personally, by mail, or electronically to the pharmacist, who may dispense themedicationsdrug 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 dispensedmedicationdrug to the qualified individual, the attending physician, or a person expressly designated by the qualified individual may be madeby:by personal delivery, or, with a signature required on deliver y, by United Parcel Service, United States Postal Service, Federal Express, or by messengerservice with a signature required at delivery.service. 443.6. Prior to a qualified individual obtainingaid-in-dying medicationan aid-in-dying drug from the attending physician, the consulting physician shall perform all of the following: (a) Examine thequalifiedindividual and his or her relevant medical records. (b) Confirm in writing the attending physician's diagnosis and prognosis. (c)Verify, in the opinion of the consulting physician, that the qualified individual is competent,Determine that the individual has capacity to make medical decisions, is acting voluntarily, and has made an informed decision. (d) If there are indications of a mental disorder, the consulting physician shall refer the individual for a mental health specialist assessment.(d)(e) Fulfill the record documentation required underSections 443.16 and 443.19.this part.443.7. (a) Unless otherwise prohibited by law, the attending physician may sign the qualified individual's death certificate. (b) The cause of death listed on the death certificate of an individual who uses aid-in-dying medication shall be the underlying terminal disease.443.7. All of the following shall be documented in the individual' s medical record: (a) All oral requests for aid-in-dying drugs. (b) All written requests for aid-in-dying drugs. (c) The attending physician's diagnosis and prognosis, and the determination that a qualified individual has the capacity to make medical decisions, is acting voluntarily, and has made an informed decision, or that the attending physician has determined that the individual is not a qualified individual. (d) The consulting physician's diagnosis and prognosis, and verification that the qualified individual has the capacity to make medical decisions, is acting voluntarily, and has made an informed decision, or that the consulting physician has determined that the individual is not a qualified individual. (e) A report of the outcome and determinations made during a mental health specialist's assessment, if performed. (f) The attending physician's offer to the qualified individual to withdraw or rescind his or her request at the time of the individual' s second oral request. (g) A note by the attending physician indicating that all requirements under Sections 443.5 and 443.6 have been met and indicating the steps taken to carry out the request, including a notation of the aid-in-dying drug prescribed. 443.8. A qualified individual may not receive a prescription foraid-in-dying medicationan aid-in-dying drug pursuant to thispart,part unless he or she has made an informed decision. Immediately before writing a prescription foraid-in-dying medicationan aid-in-dying drug under this part, the attending physician shall verify that the individual is making an informed decision. 443.9. (a) A request foraid-in-dying medicationan aid-in-dying drug as authorized by this part shall be in substantially the following form:REQUEST FOR MEDICATION TO END MY LIFE IN AREQUEST 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. I am suffering from ................, which my attending physician has determined is in its terminal phase and which has been medically confirmed. I have been fully informed of my diagnosis and prognosis, the nature of the aid-in-dyingdrugmedicationto be prescribed and potentialassociated risks,associated risks,the expected result, and the feasiblefeasiblealternatives or additional treatment options,opportunities,including comfort care, hospice care, palliative care,palliative care,and pain control. I request that my attending physician prescribemedication that will end my life in a humane andan aid-in-dying drug that will end my life in a humane and dignified manner if I choose to takeit, and Iit, and I authorize my attending physician tocontactanycontact 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 rescindI 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 the aid-in-dyingdrugmedicationto be prescribed. My attendingphysician hasphysician hascounseled me about the possibility that my deaththat my deathmay not be immediately upon the consumption ofconsumption of the medication.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) 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 arelative (by blood, marriage, or adoption) ofrelative (by blood, marriage, registered domestic partnership, or adoption) of the personthe personsigning this request or be entitled to a portionto a portionof the person's estate upon death. Only one ofOnly one ofthe two witnesses may own, operate , or beor beemployed at a health care facility where thetheperson 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 his or her attending or consulting physicians. (2) Notwithstanding paragraph (1), the written request may be prepared in English evenwherewhen the conversations or consultations or interpreted conversations or consultationswherewere 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 Medication to End MyI read the ""Request for an Aid-In-Dying Drug to End My Life'' to (insert name ofLife'' to (insert name of individual/patient) in (insert target language).(insert target language).Mr./Ms. (insert name of patient/qualified individual) affirmed to me that he/she understood the content of this form and affirmed his/her desire to sign this form under his/her 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 providedbypursuant to paragraph (2) shall not be related to the qualified individual by blood, marriage, registered domestic partnership, or adoption or be entitled to a portion of the person's estate upon death. An interpreter whose services are providedbypursuant to paragraph (2) shall meet the standards promulgated by the California HealthcareInterpretersInterpreting Association or the National Council on Interpreting in Health Care or other standards deemed acceptable by the department for health care providers in California. 443.10. (a) A provision in a contract, will, or otheragreement,agreement executed on or after January 1, 2016, whether written or oral, to the extent the provision would affect whether a person maymakemake, withdraw, or rescind a request foraid-in-dying medication,an aid-in-dying drug is not valid. (b) An obligation owing under any contractin effectexecuted on or after January 1, 2016, may not be conditioned or affected by a qualified individualmakingmaking, withdrawing, or rescinding a request foraid-in-dying medication.an aid-in-dying drug. 443.11. (a) The sale, procurement, or issuance of a life, health, or accident insurance or annuity policy, health care service plan contract, or health benefit plan, or the rate charged for a policy or plan contract may not be conditioned upon or affected by a person making or rescinding a request foraid-in-dying medication.an aid-in-dying drug. (b) Notwithstanding any other law, a qualified individual's act of self-administeringaid-in-dying medicationan aid-in-dying drug may not have an effect upon a life, health, or accident insurance or annuity policy other than that of a natural death from the underlying disease. (c) An insurance carrier shall not provide any information in communications made to an individual about the availability ofaid-in-dying medicationan aid-in-dying drug absent a request by the individual, his or her attending physician at the behest of the individual, or the individual's designee. Any communication shall not include both the denial of treatment and information as to the availability of aid-in-dyingmedicationdrug coverage. For the purposes of this subdivision, "insurance carrier" means a health care service planpursuant toas defined in Section 1345 of this code or ahealth insurer pursuant tocarrier of health insurance as defined in Section 106 of the Insurance Code. 443.12. (a) Notwithstanding any other law, a person shall not be subject tocivil or criminalcivil, criminal, administrative, employment, or contractual liability or professional disciplinary action for participating in good faith compliance with this part, including an individual who is present when a qualified individual self-administers the prescribed aid-in-dyingmedication.drug. (b) A health care provider 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(d).(e). (c) Notwithstanding any other law, a health care provider 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, including, but not limited to, determining the diagnosis or prognosis of an individual, determining the capacity of an individual for purposes of qualifying for the act, providing information to an individual regarding this part, and providing a referral to a physician who participates in this part.(c)(d) (1) A request by a qualified individual to an attending physician to provideaid-in-dying medicationan 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)A request by an individual to a pharmacist to dispense aid-in-dying medication in good faithNo actions taken in compliance with the provisions of this part shallnotconstitute or provide the basis for any claim of neglect or elder abuse for any purpose of law.(d)(e) (1) Participation in activities authorized pursuant to this part shall be voluntary. A person or entity that elects, for reasons of conscience, morality, or ethics, not to engage in activities authorized pursuant to this part is not required to take any action in support of a patient's decision under this part, except as required by Sections 442throughto 442.7, inclusive. (2) 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,the prior health care provider shall transfer, upon request, a copy of the qualified individual's relevant medical records to the new health care provider.the individual may request a copy of his or her medical records pursuant to law.(e) (1) Subject to paragraph (2), notwithstanding any other law, a health care provider may prohibit its employees, independent contractors, or other persons or entities, including other health care providers, from participating in activities under this part while on premises owned or under the management or direct control of that prohibiting health care provider or while acting within the course and scope of any employment by, or contract with, the prohibiting health care provider.(2) A health care provider that elects to prohibit its employees, independent contractors, or other persons or entities, including health care providers, from participating in activities under this part, as described in paragraph (1), shall first give notice of the policy prohibiting participation in this part to the individual or entity. A health care provider that fails to provide notice to an individual or entity in compliance with this paragraph shall not be entitled to enforce such a policy against that individual or entity.(3) Subject to compliance with paragraph (2), the prohibiting health care provider may take action, including, but not limited to, the following, as applicable, against any individual or entity that violates this policy:(A) Loss of privileges, loss of membership, or other action authorized by the bylaws or rules and regulations of the medical staff.(B) Suspension, loss of employment, or other action authorized by the policies and practices of the prohibiting health care provider.(C) Termination of any lease or other contract between the prohibiting health care provider and the individual or entity that violates the policy.(D) Imposition of any other nonmonetary remedy provided for in any lease or contract between the prohibiting health care provider and the individual or entity in violation of the policy.(4) Nothing in this subdivision shall be construed to prevent, or to allow a prohibiting health care provider to prohibit any other health care provider, employee, independent contractor, or other person or entity from any of the following:(A) Participating, or entering into an agreement to participate, in activities under this part, while on premises that are not owned or under the management or direct control of the prohibiting provider or while acting outside the course and scope of the participant's duties as an employee of, or an independent contractor for, the prohibiting health care provider.(B) Participating, or entering into an agreement to participate, in activities 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 prohibiting provider.(5) In taking actions pursuant to paragraph (3), a health care provider 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.(6) For purposes of this subdivision:(A) "Notice" means a separate statement in writing advising of the prohibiting health care provider policy with respect to participating in activities under this part.(B) "Participating, or entering into an agreement to participate, in activities under this part" means doing or entering into an agreement to do any one or more of the following:(i) Performing the duties of an attending physician specified in Section 443.5.(ii) Performing the duties of a consulting physician specified in Section 443.6.(iii) Delivering the prescription for, dispensing, or delivering the dispensed aid-in-dying medication pursuant to paragraph (2) of subdivision (b) of, and subdivision (c) of, Section 443.5.(iv) Being present when the qualified individual takes the aid-in-dying medication prescribed pursuant to this part.(C) "Participating, or entering into an agreement to participate, in activities under this part" does not include doing, or entering into an agreement to do, any of the following:(i) Making an initial determination that a patient has a terminal illness and informing the patient of the medical prognosis.(ii) Providing information to a patient about the End of Life Option Act.(iii) Providing a patient, upon the patient's request, with a referral to another health care provider for the purposes of participating in the activities authorized by the End of Life Option Act.(7) Any action taken by a prohibiting provider pursuant to this subdivision shall not be reportable under Sections 800 through 809.9, inclusive, of the Business and Professions Code. The fact that a health care provider participates in activities under this part shall not be the sole basis for a complaint or report by another health care provider of unprofessional or dishonorable conduct under Sections 800 through 809.9, inclusive, of the Business and Professions Code.(f) Nothing in this part shall prevent a health care provider from providing an individual with health care services that do not constitute participation in this part.443.13. (a) Subject to subdivision (b), notwithstanding any other law, a health care provider may prohibit its employees, independent contractors, or other persons or entities, including other health care providers, from participating in activities under this part while on premises owned or under the management or direct control of that prohibiting health care provider or while acting within the course and scope of any employment by, or contract with, the prohibiting health care provider. (b) A health care provider that elects to prohibit its employees, independent contractors, or other persons or entities, including health care providers, from participating in activities under this part, as described in subdivision (a), shall first give notice of the policy prohibiting participation under this part to the individual or entity. A health care provider 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. (c) Subject to compliance with subdivision (b), the prohibiting health care provider 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 prohibiting health care provider. (3) Termination of any lease or other contract between the prohibiting health care provider 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 prohibiting health care provider and the individual or entity in violation of the policy. (d) Nothing in this section shall be construed to prevent, or to allow a prohibiting health care provider to prohibit any other 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, in activities under this part, while on premises that are not owned or under the management or direct control of the prohibiting provider or while acting outside the course and scope of the participant's duties as an employee of, or an independent contractor for, the prohibiting health care provider. (2) Participating, or entering into an agreement to participate, in activities 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 prohibiting provider. (e) In taking actions pursuant to subdivision (c), a health care provider 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 section: (1) "Notice" means a separate statement in writing advising of the prohibiting health care provider policy with respect to participating in activities under this part. (2) "Participating, or entering into an agreement to participate, in activities 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 the aid-in-dying drug prescribed pursuant to this part. (3) "Participating, or entering into an agreement to participate, in activities 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, 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 in the activities authorized by this part. (g) Any action taken by a prohibiting provider 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 in activities under this part shall not be the sole basis for a complaint or report by another health care provider of unprofessional or dishonorable conduct under Sections 800 to 809.9, inclusive, of the Business and Professions Code. (h) Nothing in this part shall prevent a health care provider from providing an individual with health care services that do not constitute participation in this part.443.13.443.14. (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 and informing him or her 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 withsubdivision (e) of Section 443.12Section 443.13 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 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 taken pursuant to thispartpart, and those health care providers may be sanctioned for conduct and actions not included and provided for in this part if the conduct and actions do not comply with the standards and practices set forth by the Medical Board of California.443.14.443.15. (a) Knowingly altering or forging a request foraid-in-dying medicationan aid-in-dying drug to end an individual's life without his or her authorization or concealing or destroying a withdrawal or rescission of a request foraid-in-dying medicationan 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 requestaid-in-dying medicationan aid-in-dying drug for the purpose of ending his or her life or to destroy a withdrawal or rescission of a request is punishable as a felony. (c) For purposes of this section, "knowingly" has the meaning provided in Section 7 of the Penal Code. (d) Nothing in this section shall be construed to limit civil liability. (e) The penalties in this section do not preclude criminal penalties applicable under any law for conduct inconsistent with the provisions of thispart.section.443.15.443.16. Nothing in this part may be construed to authorize a physician or any other person to end an individual's life by lethal injection, mercy killing, or active euthanasia. Actions taken in accordance with this part shall not, for any purposes, constitute suicide, assisted suicide,mercy killing,homicide, or elder abuse under the law.443.16.443.17. (a) The State Public Health Officer shall annually review a sample of records maintained pursuant to Section443.19443.7 and shall adopt regulations establishing additional reporting requirements for physicians and pharmacists pursuant to this part. (b) The reporting requirements shall be designed to collect information to determine utilization and compliance with this part. 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. (c) Based on the information collected, the department shall provide an annual compliance and utilization statistical report aggregated by age, gender, race, ethnicity, and primary language spoken at home and other data the department may determine relevant. The department shall make the report public within 30 days of completion of each annual report. (d) The State Public Health Officer shall make available to health care providers the End of Life Option Act Checklist by posting it on its Internet Web site.443.17.443.18. A person who has custody or control of any unused aid-in-dyingmedicationdrugs prescribed pursuant to this part after the death of the patient shall personally deliver the unused aid-in-dyingmedicationdrugs for disposal by delivering it to the nearest qualified facility that properly disposes of controlled substances, or if none is available, shall dispose of it by lawfulmeans.means in accordance with guidelines promulgated by the California State Board of Pharmacy or a federal Drug Enforcement Administration approved take back program.443.18.443.19. Any governmental entity that incurs costs resulting from a qualified individual terminating his or her life pursuant to the provisions of this part in a public place shall have a claim against the estate of the qualified individual to recover those costs and reasonable attorney fees related to enforcing the claim.443.19. All of the following shall be documented in the individual's medical record: (a) All oral requests for aid-in-dying medication. (b) All written requests for aid-in-dying medication. (c) The attending physician's diagnosis and prognosis, determination that a qualified individual is competent, acting voluntarily, and has made an informed decision, or that the attending physician has determined that the individual is not a qualified individual. (d) The consulting physician's diagnosis and prognosis, and verification that the qualified individual is competent, acting voluntarily, and has made an informed decision, or that the consulting physician has determined that the individual is not a qualified individual. (e) A report of the outcome and determinations made during counseling, if performed. (f) The attending physician's offer to the qualified individual to rescind his or her request at the time of the qualified individual's second oral request. (g) A note by the attending physician indicating that all requirements under Sections 443.5 and 443.6 have been met and indicating the steps taken to carry out the request, including a notation of the aid-in-dying medication prescribed.SEC. 2. The Legislature finds and declares that Section 1 of this act, which adds Section443.16443.17 to the Health and Safety Code, imposes a limitation on the public's right of access to the meetings of public bodies or the writings of public officials and agencies within the meaning of Section 3 of Article I of the California Constitution. Pursuant to that constitutional provision, the Legislature makes the following findings to demonstrate the interest protected by this limitation and the need for protecting that interest: (a) Any limitation to public access to personally identifiable patient data collected pursuant to Section443.16443.17 of the Health and Safety Code as proposed to be added by this act is necessary to protect the privacy rights of the patient and his or her family. (b) The interests in protecting the privacy rights of the patient and his or her family in this situation strongly outweigh the public interest in having access to personally identifiable data relating to services. (c) The statistical report to be made available to the public pursuant to subdivision (c) of Section443.16443.17 of the Health and Safety Code is sufficient to satisfy the public's right to access. SEC. 3. The provisions of this part are severable. If any provision of this part or its application is held invalid, that invalidity shall not affect other provisions or applications that can be given effect without the invalid provision or application. SEC. 4. 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.