In 2021, the California End of Life Option Act (EOLOA) was updated with the passage of SB 380 (Blakespear), extending the sunset provision for this Act to January 1, 2031 among other revisions. The act requires healthcare facilities (including Acute Hospitals, SNFs, Hospices, and medical offices) to post a publicly visible notice on their websites and offices stating their policy with respect to the EOLOA, including if they and their employees are prohibited from participating in this Act.  All of our readers who work in skilled nursing facilities should take time to ensure that the EOLOA policy is posted on the facility’s publicly-facing website, as required by Health & Safety Code (HSC) 443.15.

The option of Medical Aid in Dying is only available to a mentally competent adult who has a confirmed terminal illness with less than 6 months to live. The time from the first oral request to the second oral request was reduced to 2 days, and the clock starts ticking at the time of the first request, even if the provider to whom the first request was made does not participate. All providers must document this request in their patient care notes, even if they do not participate in the Act. In addition to the two oral requests, a valid written request must be signed, dated, and witnessed by two witnesses, of which only one can be either related by blood, marriage, domestic partnership, someone entitled to part of their estate, or by a person related to the place of residence or a provider of medical treatment. 

In entities licensed by the CA CCL (Community Care and Licensing) division, PIN 23-09-ASC (https://www.aadm.org/wp-content/uploads/2024/12/Facility-Rules-CA-2023.pdf )updates expectations that differ from the above settings. Entities are encouraged but not mandated to inform residents and prospective residents if they decide not to participate in EOLCA. However, they cannot evict or forbid a qualified resident from participating, since this is a Resident’s Right. They do not have to participate in storing, preparing the medication, or witnessing its ingestion, but may store the medication centrally at their facility or permit the resident to store it in a locked receptacle in their room that prevents access to their medication by other people. The resident is not required to inform the licensee or facility staff of their intent to exercise this right. However, qualified residents should be encouraged to develop a collaborative action plan with the facility. Prescribing physicians are required to counsel residents to:

1. Have another person present when they ingest the aid-in-dying “cocktail.”
2. Not ingest this “cocktail” in a public place (healthcare facilities are not considered public places).
3. Notify their next of kin of their plan.
4. Enroll in a hospice that participates or accommodates EOLCA.
5. Maintain the “cocktail ” in a safe and secure location.

As the Medical Director of a hospice focused on the RCFE setting, I and others were alarmed by a recent case report of unexpected chaos at the time an assisted living community resident chose to ingest their “cocktail,” which generally consists of extremely high doses of morphine, diazepam, phenobarbital, digoxin, and amitriptyline. On the morning of the planned evening ingestion, the patient’s hospice informed the resident they did not participate, disenrolled the patient, and informed the facility administrator of the patient’s imminent plan. This administrator then contacted the prescribing physician and demanded that the physician release their medical records (a HIPAA violation) for review, which the family and patient then authorized. About an hour later, the Administrator informed the prescribing physician and resident that this was suicide, could not take place at their facility where they had resided for 5 years, and added that the drug prescription wasn’t valid since the EOLOA process takes 2 months and requires two doctors to be at the bedside at the time of ingestion (obviously the administrator was shockingly misinformed on multiple counts). This patient then moved to another facility where she did ingest the “cocktail.” 

This sad situation is filled with violations of Resident Rights at a very vulnerable time of life and should not have happened. I do not know whether this hospice or RCFE has incurred regulatory or civil penalties, but in my opinion, a plaintiff’s attorney could make substantial claims against both entities. 

Could this happen in your hospice or RCFE? 

Now is the time to review your EOLOA policies and procedures to ensure they are up-to-date and support the patient and facility through disenrollment (if non-participating) and aftercare. Even though RCFEs, as non-healthcare facilities, are not required to disclose that they are non-participants, disclosure in the initial contract could lead to policies that honor a qualified patient’s future decision, support the counsel of the prescribing physician, and then collaborate regarding future actions.  It also might help a patient choose a facility that they feel confident would support them if they ever were facing this EOLOA decision.  Remember, RCFEs must accommodate this request, according to the Department of Social Services. Eviction is not an option.