Palliative Care and Public Policy in California

By guest author: Judy Thomas, CEO, Coalition for Compassionate Care of California (CCCC) 

The COVID-19 pandemic left its mark on California’s 2021 legislative session, with committee hearings held virtually to reduce exposure to the virus, and the introduction of a large number of health and pandemic-related bills. Despite the many challenges, some exciting public policy advancements related to POLST and palliative care were achieved. 

$10 Million in State Budget for POLST Registry 

State budget negotiations for the 2021‒2022 budget year began with the surprising news that the state had a $75.5 billion general fund surplus, opening the door to opportunities for expenditures that invest in California’s future. The Coalition for Compassionate Care of California (CCCC) and other advocates leveraged that opportunity to secure a one-time allocation of $10 million in the state budget to establish a statewide electronic registry for storing and retrieving POLST information. 

Designed to give seriously ill patients more control over the care they receive, POLST (Physician Orders for Life-Sustaining Treatment) is a standardized form that—when completed and signed by a physician, nurse practitioner, or physician assistant, and the patient (or their healthcare decision maker)—becomes a set of medical orders that must be followed by licensed healthcare providers across all care settings. These orders reflect the patient’s wishes regarding CPR, other life-sustaining treatment options, and general scope/goals for treatment from “full treatment” to “comfort-focused treatment.” But the current paper form can easily get lost between care settings, and an electronic registry would allow medical providers to access patients’ POLST information quickly and easily from anywhere in the state.  

The budget also includes an annual $750,000 allocation to support POLST quality and the broad ecosystem of healthcare providers who utilize or encounter POLST, from the social workers and clinicians who have POLST conversations with patients, to the physicians and emergency medical technicians (EMTs) who honor POLST medical orders during an emergency.  

The Emergency Medical Services Authority (EMSA), which was named in the state budget as the agency in charge of the project and related spending, has promised to work closely on the registry project with CCCC, the state’s nonprofit leader in POLST education and quality improvement efforts. The budget allocation does not specify a registry vendor or even a proposed structure—those aspects will be determined at a later date by EMSA in consultation with stakeholders such as CCCC. 

Hospice Palliative Care Program Extended 

Time was running out for a special pilot program that expands hospice services by allowing hospice licensees to provide palliative care to patients who are seriously ill, but not on hospice. The pilot program was set to end on December 31. That’s why the California Hospice and Palliative Care Association (CHAPCA) and CCCC co-sponsored a bill (Senate Bill 353) to extend the Palliative Care Pilot Program until January 1, 2027. The bill received bipartisan support and was signed by Governor Newsom in October.  

Legislation to Modernize Advance Care Planning 

In addition to advocating for state budget funding for a POLST registry, CCCC also worked with Assembly member Dr. Joaquin Arambula to introduce legislation (AB 1234) designed to support the development of the POLST registry. AB 1234 is a 2-year bill and will be taken up by the legislature when it reconvenes for the 2022 legislative session. 

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