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MINUTES OF THE SENATE HEALTH AND HUMAN SERVICES

    STANDING COMMITTEE
THURSDAY, JANUARY 29, 2009
ROOM 250
STATE CAPITOL


Members Present:        Sen. D. Chris Buttars, Chair
                Sen. Allen M. Christensen
                Sen. David Hinkins
                Sen. Pat Jones
                Sen. Luz Robles

Member Excused:        Sen. Greg Bell

Staff Present:            Mark D. Andrews, Policy Analyst
                Cami Deavila, Committee Secretary

Public Speakers Present:    Maureen Henry, Utah Commission on Aging
                Lora Mengucci, Citizen
                Charlie Thronson, Utah Association of Justice
                Michelle McOmber, Utah Medical Association
                Kelly Atkinson, Utah Health Insurance Association
                Mike Weibel, Utah Medical Reserve Corps
            
                
A list of visitors and a copy of handouts are filed with the committee minutes.

Sen. Buttars called the meeting to order at 8:20 a.m.

1.     SB0087, Preferred Drug List Revisions (A. Christensen)

    S.B. 87 was not considered.

2.    SB0117, Advance Health Care Directive Act Amendments (A. Christensen)

    Sen. Christensen introduced the bill.

    Ms. Henry spoke for the bill.

    Ms. Mengucci spoke against the bill.

    MOTION: Sen. Christensen moved to amend S.B. 117, Advance Health Care Directive Act Amendments, as follows:


1.    Page 1, Line 16 :    

             16          .    authorizes a physician assistant
{   ,   }        or       a psychologist      {   , or a clinical social worker   } to


2.    Page 3, Line 77 through Page 6, Line 164 :    

             77          
{   (7) "Clinical social worker" means a person licensed as a clinical social worker under

             78      Title 58, Chapter 60, Mental Health Professional Practice Act.  
}

             79          
{   [   } (7)      {   ]   }      {   (8)   } "Declarant" means an adult who has completed and signed or directed the

             80      signing of an advance health care directive.
             81          
{   [   } (8)      {   ]   }      {   (9)   } "Default surrogate" means the adult who may make decisions for an individual

             82      when either:
             83          (a) an agent or guardian has not been appointed; or
             84          (b) an agent is not able, available, or willing to make decisions for an adult.
             85          
{   [   } (9)      {   ]   }      {   (10)   } "Emergency medical services provider" means a person who is licensed,

             86      designated, or certified under Title 26, Chapter 8a, Utah Emergency Medical Services System
             87      Act.
             88          
{   [   } (10)      {   ]   }      {   (11)   } "Generally accepted health care standards":

             89          (a) is defined only for the purpose of:
             90          (i) this chapter and does not define the standard of care for any other purpose under
             91      Utah law; and
             92          (ii) enabling health care providers to interpret the statutory form set forth in Section
             93      75-2a-117 ; and
             94          (b) means the standard of care that justifies a provider in declining to provide life
             95      sustaining care because the proposed life sustaining care:
             96          (i) will not prevent or reduce the deterioration in the health or functional status of a
             97      person;
             98          (ii) will not prevent the impending death of a person; or
             99          (iii) will impose more burden on the person than any expected benefit to the person.
             100          
{   [   } (11)      {   ]   }      {   (12)   } "Health care" means any care, treatment, service, or procedure to improve,

             101      maintain, diagnose, or otherwise affect a person's physical or mental condition.
             102          
{   [   } (12)      {   ]   }      {   (13)   } "Health care decision":


             103
         (a) means a decision about an adult's health care made by, or on behalf of, an adult, that
             104      is communicated to a health care provider;
             105          (b) includes:
             106          (i) selection and discharge of a health care provider and a health care facility;
             107          (ii) approval or disapproval of diagnostic tests, procedures, programs of medication,
             108      and orders not to resuscitate; and
             109          (iii) directions to provide, withhold, or withdraw artificial nutrition and hydration and
             110      all other forms of health care; and
             111          (c) does not include decisions about an adult's financial affairs or social interactions
             112      other than as indirectly affected by the health care decision.
             113          
{   [   } (13)      {   ]   }      {   (14)   } "Health care decision making capacity" means an adult's ability to make an

             114      informed decision about receiving or refusing health care, including:
             115          (a) the ability to understand the nature, extent, or probable consequences of health
             116      status and health care alternatives;
             117          (b) the ability to make a rational evaluation of the burdens, risks, benefits, and
             118      alternatives of accepting or rejecting health care; and
             119          (c) the ability to communicate a decision.
             120          
{   [   } (14)      {   ]   }      {   (15)   } "Health care facility" means:

             121          (a) a health care facility as defined in Title 26, Chapter 21, Health Care Facility
             122      Licensing and Inspection Act; and
             123          (b) private offices of physicians, dentists, and other health care providers licensed to
             124      provide health care under Title 58, Occupations and Professions.
             125          
{   [   } (15)      {   ]   }      {   (16)   } "Health care provider" is as defined in Section 78B-3-403 , except that it

             126      does not include an emergency medical services provider.
             127          
{   [   } (16)      {   ]   }      {   (17)   } (a) "Life sustaining care" means any medical intervention, including

             128      procedures, administration of medication, or use of a medical device, that maintains life by
             129      sustaining, restoring, or supplanting a vital function.
             130          (b) "Life sustaining care" does not include care provided for the purpose of keeping a
             131      person comfortable.
             132          
{   [   } (17)      {   ]   }      {   (18)   } "Life with dignity order" means an order, designated by the Department of


             133
     Health under Section 75-2a-106 (5)(a), that gives direction to health care providers, health care
             134      facilities, and emergency medical services providers regarding the specific health care
             135      decisions of the person to whom the order relates.
             136          
{   [   } (18)      {   ]   }      {   (19)   } "Minor" means a person who:

             137          (a) is under 18 years of age; and
             138          (b) is not an emancipated minor.
             139          
{   [   } (19)      {   ]   }      {   (20)   } "Physician" means a physician and surgeon or osteopathic surgeon licensed

             140      under Title 58, Chapter 67, Utah Medical Practice Act or Chapter 68, Utah Osteopathic
             141      Medical Practice Act.
             142          
{   (21)   }        (20)       "Physician assistant" means a person licensed as a physician assistant under Title

             143      58, Chapter 70a, Physician Assistant Act.
             144          
{   (22)   }        (21)       "Psychologist" means a person licensed as a psychologist under Title 58, Chapter

             145      61, Psychologist Licensing Act.
             146          [(20)]
{   (23)   }        (22)       "Reasonably available" means:

             147          (a) readily able to be contacted without undue effort; and
             148          (b) willing and able to act in a timely manner considering the urgency of the
             149      circumstances.
             150          [(21)]
{   (24)   }        (23)       "Substituted judgment" means the standard to be applied by a surrogate

             151      when making a health care decision for an adult who previously had the capacity to make
             152      health care decisions, which requires the surrogate to consider:
             153          (a) specific preferences expressed by the adult:
             154          (i) when the adult had the capacity to make health care decisions; and
             155          (ii) at the time the decision is being made;
             156          (b) the surrogate's understanding of the adult's health care preferences;
             157          (c) the surrogate's understanding of what the adult would have wanted under the
             158      circumstances; and
             159          (d) to the extent that the preferences described in Subsections [(21)] (24)(a) through (c)
             160      are unknown, the best interest of the adult.
             161          [(22)]
{   (25)   }        (24)       "Surrogate" means a health care decision maker who is:

             162          (a) an appointed agent;
             163          (b) a default surrogate under the provisions of Section 75-2a-108 ; or


             164          (c) a guardian.

3.    Page 6, Lines 171 through 181 :    

             171          (2) To overcome the presumption of capacity, a physician, physician assistant,
             172      psychologist,
{   clinical social worker,   } or an APRN who has personally examined the adult and

             173      assessed the adult's health care decision making capacity must:
             174          (a) find that the adult lacks health care decision making capacity;
             175          (b) record the finding in the adult's medical chart including an indication of whether
             176      the adult is likely to regain health care decision making capacity; and
             177          (c) make a reasonable effort to communicate the determination to:
             178          (i) the adult;
             179          (ii) other health care providers or health care facilities that the [physician or APRN]
             180      person who makes the finding would routinely inform of such a finding; and
             181          (iii) if the adult has a surrogate, any known surrogate.

    The motion passed unanimously.

     MOTION: Sen. Christensen moved to pass S.B. 117, Advance Health Care Directive Act Amendments, as amended, out of committee with a favorable recommendation.

    The motion passed unanimously.

    Sen. Christensen assumed the chair.

3.    SB0119, Hospital Emergency Room Task Force (D.C. Buttars)

    Sen. Buttars introduced the bill.

    Mr. Thronson, Ms. McOmber, and Mr. Atkinson spoke for the bill.

    Mr. Weibel spoke to the bill.
    
     MOTION: Sen. Buttars moved to pass S.B. 119, Hospital Emergency Room Task Force, out of committee with a favorable recommendation.

    The motion passed unanimously.

    Sen. Buttars resumed the chair.

4.    SB0111, Health Care Workforce Financial Assistance Program Amendments (G. Davis)


    Sen. Gene Davis introduced the bill.

    Sen. Robles moved to amend S.B. 111, Health Care Workforce Financial Assistance Program Amendments, as follows:

1.    Page 3, Lines 60 through 66 :    

             60          26-46-102. Creation of program -- Duties of department.
             61          (1) There is created within the department the Utah Health Care Workforce Financial
             62      Assistance Program to provide, within funding appropriated by the Legislature for this purpose:
             63          (a) professional education scholarships and loan repayment assistance to health care
             64      professionals who locate or continue to practice in underserved areas[.]; and
             65          (b) loan repayment assistance to geriatric professionals
{   , regardless of whether the

             66      geriatric professionals provide services in underserved areas  
}
.

    The motion passed unanimously.

    Sen. Christensen moved to pass S.B. 111, Health Care Workforce Financial Assistance Program Amendments, as amended, out of committee with a favorable recommendation.

    The motion passed unanimously.

    Sen. Christensen moved to adjourn the meeting.
    
    The motion passed unanimously.

    The meeting adjourned at 9:10 a.m.

    Minutes were reported by Cami Deavila, Secretary.



                    _______________________________________
                     D. Chris Buttars, Committee Chair