California Assembly Bill AB2139 Amended / Bill

 BILL NUMBER: AB 2139AMENDED BILL TEXT AMENDED IN ASSEMBLY APRIL 2, 2014 INTRODUCED BY Assembly Member Eggman FEBRUARY 20, 2014 An act to  add Section 442.4 to   amend Sections 442, 442.5, and 442.7 of  the Health and Safety Code, relating to terminal illness. LEGISLATIVE COUNSEL'S DIGEST AB 2139, as amended, Eggman. End-of-life care: patient notification. Under existing law, the State Department of Public Health licenses and regulates health facilities, including hospice facilities, and the provision of hospice services. Existing law establishes the Medical Practice Act, which provides for the regulation and licensure of physicians and surgeons by the Medical Board of California.  Existing law authorizes an adult to give an individual, known as an agent, authority to make health care decisions for that individual in the event of his or her incapacity pursuant to a power of attorney for health care.  When a health care provider, as defined, makes a diagnosis that a patient has a terminal illness, existing law requires the health care provider to provide the patient, upon the patient's request, with comprehensive information and counseling regarding legal end-of-life options, as specified, and provide for the referral or transfer of a patient, as provided, if the patient's health care provider does not wish to comply with the patient's request for information on end-of-life options.  This   This bill would apply these provisions to an agent under a power of attorney for health care for a patient with a terminal illness diagnosis. The  bill would  additionally  require  a   the  health care provider  , as defined,  to notify the patient  or, when applicable, the agent  , when the health care provider makes a diagnosis that a patient has a terminal illness, of the patient's right to comprehensive information and counseling regarding legal end-of-life care options.  The bill would define the term "terminal illness" for these purposes.  Vote: majority. Appropriation: no. Fiscal committee: no. State-mandated local program: no. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:  SECTION 1.   Section 442 of the   Health and Safety Code   is amended to read:  442. For the purposes of this part, the following definitions shall apply: (a) "Actively dying" means the phase of terminal illness when death is imminent.  (b) "Agent" means an individual designated in a power of attorney for health care, as provided in Article 1 (commencing with Section 4670) and Article 2 (commencing with Section 4680) of Chapter 1 of Part 2 of Division 4.7 of the Probate Code, to make a health care decision for the patient who has been diagnosed with a terminal illness, regardless of whether the person is known as an agent or attorney in fact, or by some other term.   (b)   (   c)  "Disease-targeted treatment" means treatment directed at the underlying disease or condition that is intended to alter its natural history or progression, irrespective of whether or not a cure is a possibility.  (c)   (   d)  "Health care provider" means an attending physician and surgeon. It also means a nurse practitioner or physician assistant practicing in accordance with standardized procedures or protocols developed and approved by the supervising physician and surgeon and the nurse practitioner or physician assistant.  (d)   (   e)  "Hospice" means a specialized form of interdisciplinary health care that is designed to provide palliative care, alleviate the physical, emotional, social, and spiritual discomforts of an individual who is experiencing the last phases of life due to the existence of a terminal disease, and provide supportive care to the primary caregiver and the family of the hospice patient, and that meets all of the criteria specified in subdivision (b) of Section 1746.  (e)  (   f)  "Palliative care" means medical treatment, interdisciplinary care, or consultation provided to a patient or family members, or both, that has as its primary purpose the prevention of, or relief from, suffering and the enhancement of the quality of life, rather than treatment aimed at investigation and intervention for the purpose of cure or prolongation of life as described in subdivision (b) of Section 1339.31. In some cases, disease-targeted treatment may be used in palliative care.  (f)   (   g)  "Refusal or withdrawal of life-sustaining treatment" means forgoing treatment or medical procedures that replace or support an essential bodily function, including, but not limited to, cardiopulmonary resuscitation, mechanical ventilation, artificial nutrition and hydration, dialysis, and any other treatment or discontinuing any or all of those treatments after they have been used for a reasonable time.  (h) "Terminal illness" means a medical condition resulting in a prognosis of a life expectancy of one year or less, if the disease follows its normal course.   SEC. 2.   Section 442.5 of the   Health and Safety Code   is amended to read:  442.5. When a health care provider makes a diagnosis that a patient has a terminal illness, the health care provider shall  notify the patient of his or her right to, or when applicable,   the agent of the patient's right to, comprehensive information and counseling regarding legal end-of-life options and  , upon the  patient's   patient or agent's  request, provide the patient  or   agent  with comprehensive information and counseling regarding legal end-of-life care options pursuant to this section. When a terminally ill patient is in a health facility, as defined in Section 1250, the health care provider, or medical director of the health facility if the patient's health care provider is not available, may refer the patient  or   agent  to a hospice provider or private or public agencies and community-based organizations that specialize in end-of-life care case management and consultation to receive comprehensive information and counseling regarding legal end-of-life care options. (a) If the patient  or agent  indicates a desire to receive the information and counseling, the comprehensive information shall include, but not be limited to, the following: (1) Hospice care at home or in a health care setting. (2) A prognosis with and without the continuation of disease-targeted treatment. (3) The patient's right to refusal of or withdrawal from life-sustaining treatment. (4) The patient's right to continue to pursue disease-targeted treatment, with or without concurrent palliative care. (5) The patient's right to comprehensive pain and symptom management at the end of life, including, but not limited to, adequate pain medication, treatment of nausea, palliative chemotherapy, relief of shortness of breath and fatigue, and other clinical treatments useful when a patient is actively dying. (6)  The   If the patient has not appointed an agent under a power of attorney for health care, the  patient' s right to give individual health care instruction pursuant to Section 4670 of the Probate Code, which provides the means by which a patient may provide written health care instruction, such as an advance health care directive, and the patient's right to appoint a legally recognized health care decisionmaker. (b) The information described in subdivision (a) may, but is not required to, be in writing. Health care providers may utilize information from organizations specializing in end-of-life care that provide information on factsheets and Internet Web sites to convey the information described in subdivision (a). (c) Counseling may include, but is not limited to, discussions about the outcomes for the patient and his or her family, based on the interest of the patient. Information and counseling, as described in subdivision (a), may occur over a series of meetings with the health care provider or others who may be providing the information and counseling based on the patient's needs. (d) The information and counseling sessions may include a discussion of treatment options in a manner that the patient and his or her family  , or, when applicable, the agent,  can easily understand. If the patient  or agent  requests information on the costs of treatment options, including the availability of insurance and eligibility of the patient for coverage, the patient  or agent  shall be referred to the appropriate entity for that information.  SEC. 3.   Section 442.7 of the   Health and Safety Code   is amended to read:  442.7. If a health care provider does not wish to comply with his or her patient's request  or, when applicable, the agent's request  for information on end-of-life options, the health care provider shall do both of the following: (a) Refer or transfer a patient to another health care provider that shall provide the requested information. (b) Provide the patient  or agent  with information on procedures to transfer to another health care provider that shall provide the requested information.  SECTION 1.   Section 442.4 is added to the Health and Safety Code, to read: 442.4. When a health care provider makes a diagnosis that a patient has a terminal illness, the health care provider shall notify the patient of his or her right to comprehensive information and counseling regarding legal end-of-life options pursuant to Section 442.5.