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<ns0:Id>20250SB__108899INT</ns0:Id>
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<ns0:ActionText>INTRODUCED</ns0:ActionText>
<ns0:ActionDate>2026-02-13</ns0:ActionDate>
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<ns0:SessionYear>2025</ns0:SessionYear>
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<ns0:MeasureNum>1088</ns0:MeasureNum>
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<ns0:AuthorText authorType="LEAD_AUTHOR">Introduced by Senator Blakespear</ns0:AuthorText>
<ns0:Authors>
<ns0:Legislator>
<ns0:Contribution>LEAD_AUTHOR</ns0:Contribution>
<ns0:House>SENATE</ns0:House>
<ns0:Name>Blakespear</ns0:Name>
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<ns0:Title> An act to amend Sections 1799.103 and 1861 of the Health and Safety Code, to amend Sections 4780, 4781.2, 4781.4, 4781.5, 4782, and 4783 of the Probate Code, and to amend Section 9270 of the Welfare and Institutions Code, relating to health care. </ns0:Title>
<ns0:RelatingClause>health care</ns0:RelatingClause>
<ns0:GeneralSubject>
<ns0:Subject>Health care decisions: life-sustaining treatment.</ns0:Subject>
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<ns0:DigestText>
<html:p>Existing law defines a request regarding resuscitative measures to mean a written document, signed by an individual with capacity or legally recognized health care decisionmaker and the individual’s physician that directs a health care provider regarding resuscitative measures, as prescribed. Existing law includes a prehospital “do not resuscitate” form, as developed by the Emergency Medical Services Authority or other substantially similar form, and Physician Orders for Life Sustaining Treatment form (POLST form), as approved by the Emergency Medical Services Authority as requests regarding resuscitative measures.</html:p>
<html:p>This bill would replace the term “Physician Orders for Life Sustaining Treatment” with “POLST.” The bill would authorize a request regarding resuscitative measures to be entered into by an individual with capacity or a health care,
agent, conservator, or surrogate, as defined, and a physician, nurse practitioner, or physician assistant acting under the supervision of the physician. The bill would specify that a request regarding resuscitative measures is entirely voluntary and the provision of care or admission to a facility cannot be conditioned on completion of or refusal to complete a POLST or prehospital “do not resuscitate” order.</html:p>
<html:p> Existing law prescribes requirements for forms for requests regarding resuscitative measures, including, among other things, that the form be signed by the executing parties.</html:p>
<html:p>The bill would specify that an electronic signature, as defined, is sufficient for any signature required for a request regarding resuscitative measures. The bill would require the document to contain the date on which the document was signed by the health care provider and the patient or their health care agent, conservator, or surrogate.</html:p>
<html:p>Under this bill, a request regarding resuscitative measures executed in another state or jurisdiction that complies with the laws of that state or jurisdiction or the laws of California is considered valid and enforceable in California to the same extent as a request regarding resuscitative measures validly executed in California. The bill would specify that, in the absence of knowledge to the contrary, a physician or other health care provider may presume that a request regarding resuscitative measures, whether executed in another state or jurisdiction or in California, is valid.</html:p>
<html:p>The bill would make conforming changes.</html:p>
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<ns0:Preamble>The people of the State of California do enact as follows:</ns0:Preamble>
<ns0:BillSection id="id_95644DDB-089B-4A8F-A1F7-FDC9EADF36D0">
<ns0:Num>SECTION 1.</ns0:Num>
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Section 1799.103 of the
<ns0:DocName>Health and Safety Code</ns0:DocName>
is amended to read:
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<ns0:Num>1799.103.</ns0:Num>
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<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
An employer shall not adopt or enforce a policy prohibiting an employee from voluntarily providing emergency medical services, including, but not limited to, cardiopulmonary resuscitation, in response to a medical emergency, except as provided in subdivisions (b) and (c).
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Notwithstanding subdivision (a), an employer may adopt and enforce a policy authorizing employees trained in emergency services to provide those services. However, in the event of an emergency, any available employee may voluntarily provide emergency medical services if a trained and authorized employee is not immediately available or is otherwise unable or unwilling to provide emergency medical services.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
Notwithstanding subdivision (a), an employer may adopt and enforce a policy prohibiting an employee from performing emergency medical services, including, but not limited to, cardiopulmonary resuscitation, on a person who has expressed the desire to forgo resuscitation or other medical interventions through any legally recognized means, including, but not limited to, a do-not-resuscitate order, a POLST form, an advance health care directive, or a legally recognized health care decisionmaker.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
This section does not impose any express or implied duty on an employer to train its employees regarding emergency medical services or cardiopulmonary
resuscitation.
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<ns0:Num>SEC. 2.</ns0:Num>
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Section 1861 of the
<ns0:DocName>Health and Safety Code</ns0:DocName>
is amended to read:
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<ns0:Num>1861.</ns0:Num>
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<ns0:Content>
<html:p>For purposes of this chapter:</html:p>
<html:p>
(a)
<html:span class="EnSpace"/>
“Authorized user” means a person authorized by the authority to submit information to, or to receive information from, the POLST eRegistry, including health care providers, as defined in Section 4781 of the Probate Code, and their designees.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
“CEDRS” means the California Emergency Medical Services Data Resource System.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
“POLST” means a POLST form that fulfills the requirements, in any
format, of Section 4780 of the Probate Code.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
“POLST eRegistry” means the registry established pursuant to this chapter to make electronic, in addition to other modes of submission and transmission, POLST information available to authorized users in conjunction with, and as a part of, CEDRS.
</html:p>
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<ns0:Num>SEC. 3.</ns0:Num>
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Section 4780 of the
<ns0:DocName>Probate Code</ns0:DocName>
is amended to read:
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<ns0:LawSection id="id_768129C2-835A-4FF6-908E-F844F534336B">
<ns0:Num>4780.</ns0:Num>
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<ns0:Content>
<html:p>
(a)
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As used in this part:
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<html:p>
(1)
<html:span class="EnSpace"/>
(A)
<html:span class="EnSpace"/>
“Request regarding resuscitative measures” means a written document
that directs a health care provider regarding resuscitative measures that is signed by both of the following:
</html:p>
<html:p>
(i)
<html:span class="EnSpace"/>
An individual with capacity, or a health care agent, conservator, or surrogate.
</html:p>
<html:p>
(ii)
<html:span class="EnSpace"/>
The individual’s physician, nurse practitioner, or physician assistant acting under the supervision of the physician.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
A request regarding resuscitative measures is not an advance health care directive.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
“Request regarding resuscitative measures” includes one, or both of, the following:
</html:p>
<html:p>
(A)
<html:span class="EnSpace"/>
A prehospital “do not resuscitate” form as developed by the Emergency Medical Services Authority or other substantially similar form.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
A POLST (portable medical orders) form, as approved by the Emergency Medical Services Authority.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
“POLST” means
a request regarding resuscitative measures that directs a health care provider regarding resuscitative and life-sustaining measures.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
“Surrogate” has the same meaning as defined in Section 4643.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
A health care agent, conservator, or surrogate may execute the POLST form only if the individual lacks
capacity, or the individual has designated that the surrogate’s authority is effective pursuant to Section 4682.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
The POLST form and medical intervention and procedures offered by the form shall be explained by a health care provider, as defined in Section 4621. The form shall be completed by a health care provider based on patient preferences and medical indications, and signed by a physician, or a nurse practitioner or a physician assistant acting under the supervision of the physician and within
the scope of practice authorized by law, and the patient or their health care agent, conservator, or surrogate. The health care provider, during the process of completing the
POLST form, should inform the patient about the difference between an advance health care directive and the POLST form.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
An individual having capacity may revoke a POLST form at any time and in any manner that communicates an intent to revoke, consistent with Section 4695.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
A request regarding resuscitative measures may also be evidenced by a medallion engraved
with the words “do not resuscitate” or the letters “DNR,” a patient identification number, and a 24-hour toll-free telephone number, issued by a person pursuant to an agreement with the Emergency Medical Services Authority.
</html:p>
<html:p>
(f)
<html:span class="EnSpace"/>
A request regarding resuscitative measures in any form is entirely voluntary and the provision of care or admission to a facility shall not be conditioned on completion of or refusal to complete a POLST or prehospital “do not resuscitate” order.
</html:p>
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<ns0:Num>SEC. 4.</ns0:Num>
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Section 4781.2 of the
<ns0:DocName>Probate Code</ns0:DocName>
is amended to read:
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<ns0:Fragment>
<ns0:LawSection id="id_B7237E21-FE35-4576-8C6C-93A7E983D18B">
<ns0:Num>4781.2.</ns0:Num>
<ns0:LawSectionVersion id="id_797118FE-CAFA-4BDC-8EA7-A362AE65A1BF">
<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
A health care provider shall treat an individual in accordance with a POLST form.
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
Subdivision (a) does not apply if the POLST form requires medically ineffective health care or health care contrary to generally accepted health care standards applicable to the health care provider or
institution.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
A physician may conduct an evaluation of the individual and, if possible, in consultation with the individual, or the individual’s health care agent, conservator, or surrogate, issue a new order consistent with the most current information available about the individual’s health status and goals of care.
</html:p>
<html:p>
(d)
<html:span class="EnSpace"/>
The health care agent, conservator, or surrogate of an individual without capacity
shall consult with the physician who is, at that time, the individual’s treating physician prior to making a request to modify that individual’s
POLST form.
</html:p>
<html:p>
(e)
<html:span class="EnSpace"/>
An individual with capacity may, at any time, request alternative treatment to that treatment that was ordered on the form.
</html:p>
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<ns0:Num>SEC. 5.</ns0:Num>
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Section 4781.4 of the
<ns0:DocName>Probate Code</ns0:DocName>
is amended to read:
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<ns0:Fragment>
<ns0:LawSection id="id_B0A3F610-CA29-4148-B94F-353EB226ABA8">
<ns0:Num>4781.4.</ns0:Num>
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<ns0:Content>
<html:p>If the orders in an individual’s request regarding resuscitative measures directly conflict with their individual health care instruction, as defined in Section 4623, then, to the extent of the conflict, the most recent order or instruction is effective.</html:p>
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<ns0:Num>SEC. 6.</ns0:Num>
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Section 4781.5 of the
<ns0:DocName>Probate Code</ns0:DocName>
is amended to read:
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<ns0:Num>4781.5.</ns0:Num>
<ns0:LawSectionVersion id="id_0701165D-1FDD-43C7-A27D-7B04533E33D9">
<ns0:Content>
<html:p>The health care agent, conservator, or surrogate shall make health care decisions pursuant to this part in accordance with Sections 4684 and 4714.</html:p>
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<ns0:BillSection id="id_475C097A-EB23-4F5A-9EB4-52995600F3F0">
<ns0:Num>SEC. 7.</ns0:Num>
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Section 4782 of the
<ns0:DocName>Probate Code</ns0:DocName>
is amended to read:
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<ns0:LawSection id="id_B7CFDF8C-CF73-4BFB-926B-068FB8C435E6">
<ns0:Num>4782.</ns0:Num>
<ns0:LawSectionVersion id="id_E7D89601-24F3-4452-BDD4-E1179FE10066">
<ns0:Content>
<html:p>A health care provider who honors a request regarding resuscitative measures is not subject to criminal prosecution, civil liability, discipline for unprofessional conduct, administrative sanction, or any other sanction, as a result of their reliance on the request, if the health care provider (a) believes in good faith that the action or decision is consistent with this part, and (b) has no knowledge that the action or decision would be inconsistent with a health care decision that the individual signing the request would have made on
their own behalf under like circumstances.</html:p>
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<ns0:BillSection id="id_644DA30F-DC7C-49A2-B0B0-3326A8D19DA4">
<ns0:Num>SEC. 8.</ns0:Num>
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Section 4783 of the
<ns0:DocName>Probate Code</ns0:DocName>
is amended to read:
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<ns0:LawSection id="id_23EB3C8B-6109-4AC4-B5C3-25B7926CB34B">
<ns0:Num>4783.</ns0:Num>
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<html:p>
(a)
<html:span class="EnSpace"/>
Forms for requests regarding resuscitative measures printed after January 1, 1995, shall contain the following:
<html:br/>
</html:p>
<html:p class="Boundary00">
“By signing this form, the health care agent, conservator, or surrogate as defined in Section 4643 of the Probate Code acknowledges that this request regarding resuscitative measures is consistent with the known desires of, and with the best interest of, the individual who is the subject of the form.”
<html:br/>
</html:p>
<html:p>
(b)
<html:span class="EnSpace"/>
A printed form substantially similar to that
described in subparagraph (A) of paragraph (2) of subdivision (a) of Section 4780 is valid and enforceable if all of the following conditions are met:
</html:p>
<html:p>
(1)
<html:span class="EnSpace"/>
(A)
<html:span class="EnSpace"/>
The form is signed by the individual, or the individual’s health care agent, conservator, or surrogate, and a physician, nurse practitioner, or physician assistant acting under the supervision of the physician.
</html:p>
<html:p>
(B)
<html:span class="EnSpace"/>
An electronic signature, as defined in Section 1633.2 of the Civil Code, shall be sufficient for any signature required for a request regarding resuscitative measures.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
The form directs health care providers regarding resuscitative measures.
</html:p>
<html:p>
(3)
<html:span class="EnSpace"/>
The form contains all other information required by this section.
</html:p>
<html:p>
(4)
<html:span class="EnSpace"/>
The form contains a date on which the document was signed by the health care provider and the patient or their health care agent, conservator, or surrogate.
</html:p>
<html:p>
(c)
<html:span class="EnSpace"/>
(1)
<html:span class="EnSpace"/>
A request regarding resuscitative measures or substantially similar instrument executed in another state or jurisdiction in compliance with the laws of that state or jurisdiction or of this state is valid and enforceable in this state to the same extent as a POLST form validly executed in this state.
</html:p>
<html:p>
(2)
<html:span class="EnSpace"/>
In the absence of knowledge to the contrary, a physician or other health care provider may presume a request regarding resuscitative measures, whether executed in another state or jurisdiction or in this state, is valid.
</html:p>
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<ns0:BillSection id="id_01A53C74-F83B-406F-9FC5-3D86E718AABA">
<ns0:Num>SEC. 9.</ns0:Num>
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Section 9270 of the
<ns0:DocName>Welfare and Institutions Code</ns0:DocName>
is amended to read:
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<ns0:LawSection id="id_1F31F566-9403-4B53-9CF2-67AAD8463312">
<ns0:Num>9270.</ns0:Num>
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<ns0:Content>
<html:p>
(a)
<html:span class="EnSpace"/>
A public patient representative shall not participate in an interdisciplinary team review of a decision that would directly and inexorably lead to death.
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<html:p>
(b)
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Notwithstanding subdivision (a), a public patient representative may participate in an interdisciplinary team review to create or revise POLST forms, as specified in Part 4 (commencing with Section 4780) of Division 4.7 of the Probate Code, Do Not Resuscitate, comfort care orders, and elections of hospice care. The public patient representative shall ascertain whether that
care is consistent with the resident’s individual health care instructions, if any, and other expressed wishes, to the extent known, or otherwise whether the proposed intervention appears consistent with the best interest of the resident.
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