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SB-1336 Public health: End of Life Option Act.(2017-2018)

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Date Published: 04/02/2018 02:00 PM
SB1336:v98#DOCUMENT

Amended  IN  Senate  April 02, 2018

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Senate Bill
No. 1336

Introduced by Senator Morrell

February 16, 2018

An act to amend Sections 443.5, 443.19, 443.19 and 443.22 of the Health and Safety Code, relating to public health.


LEGISLATIVE COUNSEL'S DIGEST


SB 1336, as amended, Morrell. Public health: End of Life Option Act.
Existing law, the End of Life Option Act, authorizes 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 for an aid-in-dying drug for the purpose of ending his or her life. Prior to prescribing an aid-in-dying drug, existing law requires the attending physician to make certain determinations and verify, immediately before writing the prescription for an aid-in-dying drug, that the qualified individual is making an informed decision. Existing law requires the State Department of Public Health to create a report with information collected from attending physician followup forms and to post that report to its Internet Web site. Existing law requires that information to include, among other things, the underlying illness of the qualified individual. Existing law authorizes the Medical Board of California to update the attending physician checklists and forms required under these provisions.
Prior to prescribing an aid-in-dying drug, this bill would require an attending physician to request that a qualified individual inform the physician orally or in writing as to the motivating reason or reasons for receiving an aid-in-dying drug, as specified. The bill would require that information to be included in the report of the department described above. The bill would further require that report to This bill would require the report described above to further include additional information about each attending physician and the length of time that he or she provided care to a patient, and the areas of practice of each physician who wrote a prescription for an aid-in-dying drug, the motivating reason or reasons behind a patient’s decision to request the aid-in-dying drug, as specified, and the number of patients who received a mental health specialist assessment. assessment prior to receiving the aid-in-dying drug. The bill would require the Medical Board of California to make any necessary changes to the applicable forms to conform with these requirements.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.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 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 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 (o) of Section 443.1.

(2)Confirm 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 with ingesting the requested aid-in-dying drug.

(C)The probable result of ingesting the aid-in-dying drug.

(D)The possibility that he or she 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 he or she ingests the aid-in-dying drug prescribed pursuant to this part.

(B)Not ingesting the aid-in-dying drug in a public place.

(C)Notifying the next of kin of his or her request for 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.

(6)Inform the individual that he or she 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)For purposes of paragraph (7) of subdivision (b) of Section 443.19, request that the qualified individual inform the physician orally or in writing as to the motivating reason or reasons behind the individual’s decision to request the aid-in-dying drug. The question used to gather this information shall allow for the selection of multiple choices pursuant to, at a minimum, the following possible choices:

(A)Pain or the fear of pain.

(B)Concern about being a burden to others.

(C)Loss of autonomy.

(D)Sense of hopelessness.

(10)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.

(11)Fulfill the record documentation required under Sections 443.8 and 443.19.

(12)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.

(13)Give the qualified individual the final attestation form, with the instruction that the form be filled out and executed by the qualified individual within 48 hours prior to the qualified individual choosing to self-administer the aid-in-dying drug.

(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, Federal Express, or by messenger service.

(d)An attending physician shall not be precluded from prescribing an aid-in-dying drug pursuant to this part under circumstances in which the qualified individual chooses not to provide an answer to the question asked pursuant to paragraph (9) of subdivision (a).

SEC. 2.SECTION 1.

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

443.19.
 (a) The State Department of Public Health 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. The report shall include, but not be limited to, all of the following information:
(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 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, and the specialty or specialties of each physician. drugs and the areas of practice of each physician.
(6) Of people who died due to using 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.
(7) The motivating reason or reasons behind a patient’s decision to request the aid-in-dying drug pursuant to paragraph (9) of subdivision (a) of Section 443.5. the responses given to question 15 of the attending physician followup form described in Section 443.22.
(8) The number of patients who received a mental health specialist assessment prior to receiving the aid-in-dying drug.

(9)The length of time the attending physician has provided care to the patient prior to prescribing the aid-in-dying drug.

(c) The State Department of Public Health 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.

SEC. 3.SEC. 2.

 Section 443.22 of the Health and Safety Code is amended to read:

443.22.
 (a) (1) 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.
(2) The Medical Board of California shall make changes to the forms referenced in paragraph (1) as necessary so the forms capture the information needed to fulfill the reporting requirement in subdivision (b) of Section 443.19.
(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:
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