THIS- COMMITTEE TO ORDER THIS
IS SO WELCOME EVERYBODY I THINK
I HAVE THE RIGHT BUTTONS PUSHED.
A WELCOME EVERYBODY TO OUR
ANNUAL SOMETIMES ANNUAL.
OVERSIGHT HEARING ON THE
IMPLEMENTATION OF THE.
IMPLEMENTATION OF THE END OF
LIFE OPTION ACT AS PEOPLE KNOW
WHAT WE PASS THAT SOME YEARS
AND PART OF THE DEDICATION THAT
WE SAID WAS THAT WE WOULD HAVE
A YEARLY OVERSIGHT REVIEW JUST
TO SEE HOW WOULD HOW THE
IMPLEMENTATION IS COMING ALONG
IF THERE WERE ANY ISSUES
ANYTHING'S WE NEED TO ADDRESS-
AND SO EVERY YEAR WE GATHER
REPORTS FROM THE DATA THAT
COMES IN. I'M AND SAID TODAY.
I'LL BE HERE I SENATOR MONEY
WILL BE US AS WELL. WHO WAS ONE
THE AUTHOR AND WE'RE HONORED TO
HAVE WITH US. NOW RETIRED BUT
ALWAYS US SENATE SOME THE
LOWEST. WHO ANOTHER ONE OF THE
AUTHORS OF THIS BILL AND REALLY
REALLY DEDICATED A LARGE PART
OF HER WORK. TO SURE THAT WE
DIE IN THE BEST WAYS SO WE'RE
PLEASED TO BE HERE TODAY AND I
THINK AND I. THINK THIS AT OUR
MORNING WILL BE JOINING US AND
POTENTIALLY. ASSEMBLYMEMBER
FRAZIER WILL ALSO BE JOINING US.
BUT I THINK EVERYBODY FOR
COMING TODAY FOR THE INTEREST
IN THIS AND FOR OUR CONTINUED
WORK AS WE CONTINUE TO TRY TO.
MAKE SURE- THIS IS IMPLEMENTED
IN THE BEST POSSIBLE WAY AND
PEOPLE HAVE- THE MOST COMFORT
THAT THEY DESIRE AT THE LAST
DAYS OF THEIR LIFE- SO FIRST
WOULD OVER DATA WITH. WRITER
PANEL SYSTEMS LEVEL PANEL
HOSPICE PANEL. PATIENT PANEL
AND THEN PUBLIC COMMENTS- SO I
THINK WE WILL START WITH DR JIM
GREEN DEPUTY DIRECTOR OF THE
CENTER FOR HEALTH STATISTICS.
AND INFORMATION. WAS A WOULD
LIKE TO MAKE OPENING COME. TO
IT'S A GOOD HERE GOOD TO BE THE
HERE AND TO WATCH AND OBSERVE
THE PROGRESS. OF MET AID AND
DIE OFF THANK YOU TO ALL OF YOU
WHO WHO ARE PURCHASE A OVER THE
LAST. FOUR YEAR. IN THIS EFFORT
AND CONTINUE TO ON THIS EFFORT
N'EST. CHAIR EGGMAN WHO IS WAS
A X. Y. AND WE- AN EX.
SUPPORTER OF THIS EFFORT AND-
APPROACHES THIS IN THE MOST ON
HERE SENATOR MINING. WHO THIS
IN THE MOST DIRECT AND COME WAY
THANK YOU SEE FOR BY ME THANK
YOU VERY MUCH OF CENTER MY HAS
JOINED US OR WOULD YOU TO MAKES
OPEN COMMENTS WE HAVE THE THREE
AMIGOS ARE BACK HERE YOUR
REUNITED. AND IT FEELS SO GOOD.
GET THIS YOU MAY CHAIR YOU FOR.
ORGANIZED AND HOST IN. JUST
BRING I WANT TO THANK EVERYONE
WHO'S HERE AND THANK YOU IN
YOUR FOR ORGANIZING IN. WE CAN
TO RECEIVE. THE UPDATE OF
FAMILIES WHO OF. BEEN ABLE TO
TAKE ADVANTAGE OF THIS LAW.
HERE A PIECE. COMPASSIONATE
TRANS. IN OTHER WHO HAVEN'T USE
IT BUT WHO OF GAINED PIECE OF
MIND WE KNOW SOME. CAN IN MAY
SOME FINE TUNING IN THE FEW WE
WITH STE DID SOME LEGAL
CHALLENGES HERE IN CALIFORNIA
BUT I'M ALSO PLEASED TO SEE
THAT CALIFORNIA IS BEING USED
AS A MODEL IN OTHER STATES. AND
DANDY ISN'T HERE TODAY WE'LL
HEAR FROM HIM HE'S BEEN.
TRAVELING LIVING OUT OF A
SUITCASE FOR A FEW YEARS IN. SO
THIS IS A HUMAN RIGHTS EFFORT
AND HUMAN RIGHTS ISSUE IT'S
GREAT TO SEE OUR FORMER
COLLEAGUE SENATOR WON'T COME
BACK WHEN THIS IN. THE FOR BACK
TO MADAM CHAIR THANK YOU. THANK
YOU VERY MUCH OKAY NOW AT
DOCTOR GREEN. THANK YOU.
MINIMUM OF THE COMMITTEE NAME
IS JIM GREEN AND I SERVICE THE
DEPUTY DIRECTOR FOR THE
CALIFORNIA DEPARTMENT OF PUBLIC
HEALTH CENTER FOR HEALTH
STATISTICS INFORMATICS IN THAT
CAPACITY I OVERSEE THE STAFF
RESPONSIBLE FOR COLLECTION AND
PUBLICATION OF DATA REQUIRED BY
THE END OF LIFE OPTION ACT.
TODAY C. PH. IS PRESENT TO
PROVIDE YOU WITH A BRIEF
OVERVIEW OF THE DATA OUR OFFICE
HAS COMPILED AND REPORTED.
SINCE THE LAW WENT INTO EFFECT
ON JUNE NINTH TWO THOUSAND
SIXTEEN. STATE LAW PRESCRIBES
THE FORMS AND INFORMATION
REPORTABLE UNDER THE ACT THE
MANNER IN WHICH IS COLLECTED.
AS WELL AS PRIVATE PRIVACY
PROTECTIONS AFFORDED TO
PARTICIPANTS IN THEIR
HEALTHCARE PROVIDERS. SINCE THE
LAW WENT INTO EFFECT CITY PAGES
PUBLISHED THREE BATTERY. BASED
ON FORM SUBMITTED AND
REGISTERED CITY. THE TWO
SIXTEEN REPORT PRESENTED A
PARTIAL YEAR PARA WELL TO
SEVENTEEN IN TWO THOUSAND
EIGHTEEN REPORTS BOTH REPORTED
ON A FULL CALENDAR YEAR OF YOUR
LA ACTIONS. FOR JUNE NINTH TWO
THOUSAND SIXTEEN TO DECEMBER
THIRTY FIRST TWO THOUSAND
EIGHTEEN. PRESCRIPTIONS HAVE
BEEN WRITTEN FOR TOTAL OF ONE
THOUSAND ONE HUNDRED AND EIGHT
PEOPLE UNDER THE ACT. AND EIGHT
HUNDRED AND SEVEN INDIVIDUALS
ARE SEVENTY TWO POINT EIGHT
PERCENT. HAVE DIED FROM
INGESTING THE MEDICATIONS. OF
THESE EIGHT HUNDRED SEVEN
INDIVIDUALS SEVEN HUNDRED. OR
EIGHTY SIX POINT 7% WERE
RECEIVING HOSPICE AND OUR
PALLIATIVE CARE. TURNING TO THE
TWO THOUSAND EIGHTEEN CALENDAR
YEAR. FOUR HUNDRED FIFTY TWO
INDIVIDUALS RECEIVE
PRESCRIPTIONS AND THREE HUNDRED
THIRTY SEVEN INDIVIDUALS DIED
FOLLOWING THEIR INGESTION OF
THE PRESCRIBED AID IN DYING
DRUGS. THE THREE HUNDRED AND
THIRTY SEVEN AID IN DYING
TESTER IN TWO THOUSAND EIGHTEEN
IS A DECREASE FROM THREE
HUNDRED AND SEVENTY FOUR EIGHT
AND DINED US REPORTED DURING
TWO THOUSAND SEVENTEEN. THE
FRIEND THIRTY SEVEN INDIVIDUALS
WHO DIED IN TWO THOUSAND
EIGHTEEN FOLLOWING YESTERDAY'S
AND DYING DRUGS. INCLUDES
TWENTY THREE INDIVIDUALS WITH
PRESCRIPTIONS WRITTEN IN TWO
THOUSAND SEVENTEEN INGESTION
DIED FROM THE DRUGS STERN TWO
THOUSAND EIGHTEEN. OF THE FOUR
FIFTY TWO INDIVIDUALS WHO
RECEIVED PRESCRIPTIONS IN TWO
THOUSAND EIGHTEEN. FIFTY NINE
DIED FROM THEIR OWN LINE
ILLNESS OR OTHER CAUSES WHAT
SEVENTY NINE AND AN UNKNOWN
INGESTION STATUS. INDIVIDUALS
WITH AN UNKNOWN INGESTION
STATUS INCLUDE INDIVIDUALS WHO
HAVE NOT YET DIED. AS WELL AS
INDIVIDUALS WHO HAVE DIED AND
BEEN MATCHED TO A CALIFORNIA
DEATH CERTIFICATE. BUT FOR WHOM
A POSITION FOLLW WHAT FORM HAS
NOT BEEN RECEIVED YET BUY CD PH.
UNKNOWN VALUE PRESENTED IN THE
ANNUAL DATA REPORTS CAN LARGELY
BE ATTRIBUTED TO MISSING.
INCOMPLETE OR ILLEGIBLE FORMS.
WERE POSSIBLE UNKNOWN VALUES
ARE REPLACED WITH INFORMATION
FOR MATCHED CALIFORNIA DEATH
CERTIFICATES. FOR DEMOGRAPHIC
INFORMATION PRESENT IN THE
REPORTS THE DEATH CERTIFICATE
IS THE PRIMARY SOURCE. IN TWO
THOUSAND EIGHTEEN THE MAJORITY
OF INDIVIDUALS WHO DIED WERE
SIXTY YEARS OF AGE OR OLDER.
HAD HEALTH INSURANCE. AND WE'RE
RECEIVING HOSPICE AND OUR
PALLIATIVE CARE. MORE THAN
THREE QUARTERS OF THE
INDIVIDUALS WERE WHITE EIGHTY
EIGHT POINT 4% ALSO MORE THAN
THREE QUARTERS HAD SOME LEVEL
OF COLLEGE EDUCATION EIGHTY
POINT 1% IN TWO THOUSAND
EIGHTEEN ALMOST 70% OF IN FOR
INDIVIDUALS WHO DIED FROM
INGESTING AID IN DYING DRUGS
WERE IDENTIFIED TO HAVE SOME
FORM OF CANCER. WITH
NEUROLOGICAL DISEASES SUCH AS
AMYOTROPHIC LATERAL SCLEROSIS
AND PARKINSON'S DISEASE
ACCOUNTING FOR THE SECOND
LARGEST ILLNESS GROUP AT ABOUT
13% THIS IS CONSISTENT WITH THE
DISTRIBUTION OF UNDERLYING
ILLNESSES REPORTED IN THE TWO
THOUSAND SIXTEEN AND TWO
THOUSAND SEVENTEEN REPORTS.
SIMILARLY CANCER OF THE LUNG
AND BROKERS HAS CONSISTENTLY
BEEN THE MOST COMMON TYPE OF
CANCER REPORTER FOR AOL LIKE
INDIVIDUALS WHO DIED FROM
INGESTING AID IN DYING DRUGS
SINCE. TWO THOUSAND SIXTEEN. IN
TWO THOUSAND EIGHTEEN CV PH
FOUND THAT THE MAJORITY OF
INDIVIDUALS EIGHTY SEVEN POINT
FIVE PERCENT. INFORM THEIR
FAMILY THEIR DECISION AND
ADJUSTED THE DRUGS IN A PRIVATE
HOME. 92% SLIGHTLY OVER HALF OF
INDIVIDUALS HAD A POSITION OR
TRAIN HEALTHCARE PROVIDER
PRESIDENT AT INGESTION. EIGHTY
FOUR POINT 3% TWO GROUPS OF
DRUG CATEGORIES COMPRISE THE
MAJORITY OF PRESCRIPTIONS OF
AID IN DYING DRUGS. SEDATIVES
ALONE WERE PRESCRIBED. FOR
THIRTY SEVEN POINT 1% OF
INDIVIDUALS. WHY COMMON OF A
CARDIO TO. OPIOID AND SAID WERE
RISK FOR THIRTY FIVE PER OF END
OF. THE A TONIC IS USED AS A
HEART RATE WHILE THE OPR IN
CENTER OF CLASSIC ARE YOU TO SO.
AND SUPPRESSED BROUGH. THE LA
IN A REPORT COUNT EVENTS
OCCURRED DURING THE YOUR RICK
BY ON FOR SUBMITTED TO SEE THE-
IF IN AND RECEIVE A PERFECT
DURING THE COUNT YEAR BUT OR
HER AND JUST INSTEAD OF WAS ON.
THEN INDIVIDUAL BECAME IN THE
TOTAL NUMBER PRESCRIPTION
WRITTEN DURING THE YEAR. THE
INDIVIDUAL ALSO BE INCLUDED AN
ACCOUNT OF INDIVIDUALS WITH
UNKNOWN AND GESTIONE STATS. IF
THE INDIVIDUAL IS REPORTED TO
CD. HAVING AND JUST OF THE AID
IN DYING DRUG. THE FOLLOWING
YEAR. THEN THEY WILL BE
INCLUDED IN THE COUNT OF
INDIVIDUALS WITH PRESCRIPTIONS
WRITTEN DURING PRIOR YEARS. WHO
DIED FROM INGESTING AID IN
DYING DRUGS. AND THE NEXT
PUBLISHED DATA REPORT. FINALLY
INTO THE NINETEEN. CV PH
MARCHED AN ONLINE SUBMISSION
TOTAL ELECTRONIC. WHICH A HELP
WITH THE PRAYER ELIGIBILITY
PROBLEMS ON THE PAPER FORMS.
THE HOUSE PARTICIPANTS TO
SECURELY. SUBMIT AN
ELECTRONICALLY SIGN IT WELL A
FORMS ONLINE. THE PORTAL CAN BE
ACCESS FROM THE CD P. H. E. L.
L. A WEBSITE. THANK YOU FOR
YOUR ATTENTION BACK OUR
PREPARED REMARKS. THANK YOU
VERY MUCH- WHEN YOU PASSED
LEGISLATION LIKE THIS THAT YOU
THEN REALIZE LATER THAT YOU'VE
PEOPLE A LOT OF WORK HEY THINGS
THEY HAVE TO DO AN AND KEEP UP
WITH THE WE- THAT IN THE- SOME
ADJUSTMENTS HAVE BEEN MADE
WE'VE GONE. AND I'M SURE WILL
BE TO HAVE MORE WORK. THANK YOU
THANK YOU VERY MUCH. QUESTIONS
FROM CENTER. THE. NO OKAY I
THINK THINK THINK YOU MUCH. HIM
AND COMING CALLAHAN CALLAHAN NO
EIGHT. THANK YOU UP CEO OF
COMPASSION AND CHOICES A WE
KNOW A JUST OF THE LEGISLATION
AS WE AS THIS WORK ACROSS THE
COUNTRY THE YOU FOR YOUR WORK
HERE TO AND US A CHANCE TO
SHARE WITH YOU WHAT WE'VE SEEN
I'M WITH LIMITATION CALIFORNIA
BUT ALSO ACROSS ALL OF THE- TEN
AUTHORIZED JURISDICTIONS BUT
BEFORE I DO THAT I JUST WANT TO
TAKE A MOMENT TO REALLY THINK
IN ACKNOWLEDGE ALL OF YOU ON
THE- OUR SUPPORTERS AND MANY
OTHER. ON FELLOW AND WE ARE SO.
THE LEADERSHIP OF ASSEMBLY
AGAWAM EGGMAN OF CENTER MONEY
IN OF SENATOR WALK AND YOU HAVE
REALLY MADE A LOT OF TRIMMING
THE AMERICANS SO MUCH BETTER
THANK YOU. COMPARE AND CHOICES
HAS BEEN IN. IN A AND- OF THE-
AND OF LIKE OPTION ACTED ALSO
HAVE WORKED. ALL OF THE OFF.
JURISTIC AND WANTED TO SHOW.
THE EVIDENCE AND THE DATE FROM
ACROSS- ALL OF THOSE PLACE BUT
BEFORE I DO THAT- WANTED TO
JUST PUT THIS LAW IN CONTEXT
AND IT SOUNDS LIKE EACH OF YOU
HAVE HAD. EXPERIENCE TO TALK
WITH BUDDY. ENTER EL AN I IN MY-
THEM FORTUNATE THAT I GET TO
HAVE THAT EXPERIENCE ON A
REGULAR BASIS- THERE WAS ONE
WOMAN THAT I HAD A CONVERSATION
WITH FROM HALF MOON BAY. AND
SHE- CAN. AND IT WOULD TAKE HER.
AND HER. SHARING THAT X. WITH
ME. AND THEN ALL OF A SUDDEN
HER ENTIRE DEMEANOR CHANGED.
AND SHE TALKED ABOUT THE MOMENT
THAT SHE RECEIVED THE
PRESCRIPTION AND SHE SAID. THIS
WAS MY PRESCRIPTION FOR PEACE
OF MIND IT WAS A GIFT TO ME.
AND THAT IS WHAT THIS LAWS
ABOUT AND WHY IT IS MADE SUCH A
PROFOUND DIFFERENCE IN THE
LIVES OF SO MANY PEOPLE. THANK
YOU. WE KNOW FROM A COMBINED
FORTY YEARS OF EXPERIENCE
ACROSS TEN AUTHORIZED
JURISDICTIONS- THAT THERE HAS
BEEN NO NEGATIVE UNINTENDED
CONSEQUENCES AS A RESULT OF
THIS LW. THERE HAS NOT BEEN A
SINGLE INCIDENCE- OF PROVEN
ABUSE MISUSE OR COERCION ON
THAT'S BEEN THE EXPERIENCE IN
CALIFORNIA AND IT IS BEEN
EXPERIENCE AND EVERY OTHER
AUTHORIZED JURISDICTION. WE
ALSO KNOW FROM STUDIES THE
JOURNAL OF MEDICAL ETHICS-
REPORT CONCLUDED THAT ASSISTED
DYING DID NOT POSE ANY
HEIGHTENED RISKS FOR ANY
POPULATION INCLUDING VULNERABLE
POPULATIONS- WHAT WE'VE HEARD
FROM THE CALIFORNIA DATA WHICH
IS CONSISTENT ACROSS ALL OF THE
STATE'S IS THAT VERY FEW PEOPLE
WILL CHOOSE TO USE THE LAW. BUT
HUGE PERCENTAGES HAVE GOTTEN-
TREMENDOUS PEACE OF MIND FROM
SIMPLY KNOWING THE LOGS THIS-
WE HAVE SEEN RESEARCH STUDIES
THAT HAVE COME OUT- THAT HAVE A
DEMONSTRATED THAT AS A RESULT
OF THE IMPLEMENTATION OF
MEDICAL AID IN DYING THERE IS A
JOURNAL OF PALLIATIVE MEDICINE
STUDY. THAT IT IS RESULTED IN
MORE CANDID CONVERSATIONS
BETWEEN DOCTORS AND PATIENTS
HIGHER HOSPICE USAGE RATES AND
IMPROVED PALLIATIVE CARE
TRAINING FOR PHYSICIANS IN HERE
IN CALIFORNIA THE PHYSICIANS OF
CALIFORNIA HAVE REPORTED
SEVERAL THIS OP VERY SIMILAR
POSITIVE. BENEFITS AS A RESULT
OF THE LAW SO THE GOOD NEWS IS
WE HAVE A TREMENDOUS AMOUNT TO
FEEL GOOD ABOUT- THERE'S NO
NEGATIVE CONSEQUENCES AND THEY
HAVE BàN- IMPROVEMENTS FOR THE
INDIVIDUAL DYING PERSON AND
ALSO TO ALL OF END OF LIFE CARE
IN CALIFORNIA- UNFORTUNATELY
OR- THERE IS ROOM FOR
IMPROVEMENT WHICH OF COURSE IS
THE CASE ANY TIME THAT YOU TO
PASS A LAW AND WHAT I'D LIKE.
YOU TO SHARE A LITTLE OF A
AREAS. IN CAN FORGET AND RIPPED
ONCE IN THAT THE GREETINGS TO
ASSEMBLYMEMBER WHO JOINED US
WAS ALSO A COLD ON THIS BILL
BEEN CONSIST MEMBER OF THE
STILL COMMITTEE ON AND APPLY
ISSUES GOING TO MAKE ANY
REMARKS JIM. WITH THE ABILITY
FOR THE FAMILY TO BE SUPPORT OF
IS JUST SO ESSENTIAL. AND MY
HAT'S OFF TO EACH AND EVERYONE
OF YOU IN. THE CHAMBER TODAY
THANKING YOU FOR YOUR SUPPORT
BECAUSE- WE'VE ALL RIGHT UP
AGAINST THIS ISSUE AND- AND OUR
FAMILIES AND LOVED ONES. JUST
HUMAN BEINGS DESERVE THIS KIND
OF. UNITY SO THANK YOU THANK
YOU. AND THANK YOU. FRAZIER IN
TERMS OF THE SORT OF BROUGHT
OVER STROKES IS THAT THE LAW IS
WORKING TO PROTECT PATIENTS BUT
THAT THERE ARE JUST TOO MANY
REGULATORY REQUIREMENTS IT'S
ABOUT A THIRTEEN STEP PROCESS
FOR SOMEBODY TO GET THROUGH.
AND PEOPLE ARE UNFORTUNATELY
DIE IN TRYING TO GET THROUGH
THE PROCESS AND NEVER ACHIEVING
THAT PEACE OF MIND THAT-%
THEY'RESEEKING- WE'VE SEEN IT
REALLY- THERE'S A TON OF
DIFFERENT- CHALLENGES WITH THE
LAW THERE ARE THREE THAT KEEP
EMERGING AS THE TOP THINGS TO
CONSIDER A DRESSED IN FUTURE
LEGISLATION- THE FIRST IS THE
FIFTEEN DAY WAITING PERIOD.
THERE'S A STUDY THAT CAME OUT
FROM SOUTHERN SIR- THAT SHOWED
THAT AT LEAST A THIRD OF PEOPLE
WERE DYING DURING THAT FIFTEEN
DAY WAITING PERIOD- THAT KAISER
SOUTHERN IS AS SUPPORTIVE-
INSTITUTION THAT HAS- A PATIENT
NAVIGATORS. A LOT OF PEOPLE ARE
STARTING OUT IN ON SUPPORT OF
SYSTEMS OR SOMEBODY THAT'S MORE
FRAGMENTED SO YOU. THAT THE
NUMBER IS ACTUALLY FAR FAR
HIGHER THAN THE 30% THAT THEIR
STUDY SHOWED- THERE ARE OTHER
STATES THAT ARE ADDRESSING THIS
WITH SOME INNOVATIVE
LEGISLATION WERE AGAIN JUST
PASSED A LAW LAST SESSION. THAT
MAKES IT SO THAT THE DOCTORS
ARE ALLOWED TO WAIVE THE
FIFTEEN DAY WAITING PERIOD IF
SOMEBODY IS DEFINITELY GONNA
DIE. OR ALSO TO STATE- NEW YORK
IN MINNESOTA AT ARE ACTUALLY A
LIMóN. RECOGNIZING HER DO IT.
TEAM MEETING AS CAN SOMEBODY TO
SUFFER FIFTEEN. AND IT REALLY
IS DOES NOT PROVE TO HAVE ANY
ANY POSITIVE BENEFITS TO IT-
THE SECOND BIG CHALLENGE IS
THAT PATIENTS ARE HAVING A
REALLY DIFFICULT TIME GETTING
TO DOT. A AND THERE'S A HOST OF
REASONS FOR THIS ONE OF THE TOP
ONES THAT- REASONS IS THAT AS
YOU KNOW THERE'S AN OPT OUT
PROVISION FOR HEALTH SYSTEM SO
HELP SYSTEMS ARE ALLOWED TO
ALLOW ALL OF THEIR- DOCTORS- TO
NOT BE ALLOWED TO PARTICIPATE.
AS A RESULT OF THAT- THERE WAS
A STUDY THAT WAS PUBLISHED IN
JAMMEH THAT SHOWED THAT NINETY
SEVEN PERCENT. RELIGIOUS
INSTITUTIONS ALLOW PERSON IS A
PATIENT AND 35% OF SECULAR
HOSPITALS SO THAT REALLY
NARROWS THE NUMBER OF DOCTORS
THAT ARE POTENTIALLY ELIGIBLE
TO PARTICIPATE AT. WITH US SO
THAT'S ONE OF THE THINGS AND
THEN SOME OF THE PAPERWORK THAT
IS INVOLVED- IT REALLY CHECK
TEACHING PEOPLE DOCTORS HOW TO
DO THAT I AM. ALSO PRESENTS A
BARRIER AS WELL WHEN THEY HAVE
TO DO THAT SAME THING FOR OTHER
END OF LIFE OPTIONS. THERE ARE-
THREE DIFFERENT THINGS THAT
STATES ARE LOOKING AT TO
ADDRESS THIS- NEW MEXICO HAS A
REALLY INNOVATIVE PERMIT
PARISIAN THAT WAS IN THEIR LAST
LEGISLATION THAT ALLOWS A
PERSON WHO WAS ALREADY ON
HOSPICE CARE TO ALL. HAVE TO
GET ONE ADDITIONAL
CERTIFICATION SO THEY'VE MET
CERTIFICATION HAVING THAT SIX
MONTH ELIGIBLE CRITERIA. THE
ALL TO FIND ONE OTHER DOCTOR
THAT WOULD BE THE PRESCRIBING
DOCTOR. FIVE STATES THAT ARE
RIGHT. DANCING THAT WOULD
EXTEND- THE PRIVILEGES SO THAT-
APR ENDS AND PHYSICIANS'
ASSISTANTS ARE ALLOWED TO
PRESCRIBE. SO THERE'S FIVE
STATE DOING THAT THAT'S
LEGISLATURE. RIGHTLY ADVANCING
THROUGH HAWAII THIS SESSION
THEY'VE MADE IT THE PHARMACIST-
AND THEN THERE ARE SOME STATES
THAT HAVE LESS REPORTING
REQUIREMENTS THAN WHAT IS HERE
IN CALIFORNIA BOTH VERMONT AND
COLORADO DO AND OF COURSE
MONTANA HAS NON BECAUSE IT'S
THROUGH THE COURTS. THE THIRD-
BIG CHALLENGE THAT WE SEE WITH
THE LAW IS THAT THERE IS A LACK
OF TRANSPARENCY IN THE PRACTICE
SOMETIMES PATIENTS ARE NOT
GETTING COMPLETE INFORMATION
FROM THEIR HEALTH CARE
PROVIDERS YOU'LL HEAR SOME
STORIES ABOUT THAT LATER TODAY-
OTHER DOCTORS TO OBJECT TO THE
PRACTICE ARE REFUSE- PATIENCE-
REFUSING TO EVEN REFERRED TO
ANOTHER PRACTICE AND SUMMER
EVEN HOLDING MEDICAL. CARD
HOSTAGE- THAT IS JUST CRAZY- IN
DELAWARE THEY HAVE A PROVISION
I'M IN THEIR BILL THAT WOULD
ALLOW HEALTH FACILITIES THAT
POP OUT OF THE PRACTICE- TO
IMPLEMENT GET NOT TO BE.
IMPLEMENTED BORDERS ON THEIR
DOCTORS TO SILENCE THEM- AND
THEN THERE IS PENDING IN
WASHINGTON STATE LEGISLATION
THAT WOULD REQUIRE HOSPICES
HOSPITALS TO REPORT THEIR
POLICIES TO THE DEPARTMENT OF
HEALTH. SO THE DEPARTMENT OF
HEALTH CAN PUBLISH THEM AND
THAT WOULD THEN ALLOW PATIENTS
TO BE ABLE TO SELECT THEIR
FACILITIES BASED ON- THOSE THAT
ARE SUPPORTIVE OF THEIR VALUES
AND PRIORITIES THEY'RE ONLY
DOING HOSPITALS BUT WHAT WOULD
BE RIDLEY INNOVATIVE IS IF YOU
DID HOSPICES. WELL I THE SORT
OF BIG. C. AS YOU CAN WHERE
WRECK. THE X. OF ELIGIBLE
CRITERIA REMOVING ANY OF THE
COURSE SAVE CAR TO REALLY JUST
LOOKING FR VERY. PRACTICAL
WAYS THAT WE CAN ADDRESS SOME
OF THE CHALLENGES SO THAT YOU
BEAT THE ORIGINAL TENSION OF A
LOT BETTER. I'M GONNA END WITH
PERHAPSMY MOST IMPORTANT
MESSAGE OF THE DAY WHICH IS
REALLY ONE OF GRATITUDE-
WITHOUT QUESTION THE CALIFORNIA
AND OF LIFE OPTION ACT HAS
RESULTED IN A MORE
COMPASSIONATE AND OF LIFE
EXPERIENCE BOTH FOR THOSE WHO
CHOOSE AND HE TAKE THE OPTION.
BUT ALSO FOR EVERYBODY ELSE- IN
ADDITION SINCE CALIFORNIA-
IMPLEMENTED THIS LAW FIVE OTHER
STATES HAVE PASSED VERY SIMILAR
LEGISLATION AND WE KNOW FROM
EXPERIENCE THAT CALIFORNIA SUCH
A ROUGH ROBUST IN LARGE AND
DIVERSE STATE. TAKING THIS
IMPLEMENTING THIS LEGISLATION
WAS ONE OF THE REASONS THAT
GAVE THOUGHT THAT WAS LAWMAKERS
COME SO ON BEHALF. START
CALIFORNIA SUPPORTERS BUT ARE
SO IT'S NATIONWIDE AND LIKE TO
EXPRESS THANK. THANK YOU SO
MUCH. THANK YOU VERY MUCH.
THANKS VERY MUCH I'M- YEAH WHAT
WAS THINGS THAT YOU MENTION ARE
MMHM MY OFFICE AND I'M SURE
CENTER MONIES OFFICER OTHERS
GET GET A LOT OF CALLS AND MY
CHIEF OF STAFF SPENT BROKEN OUT
ARE ON THE PHONE SOMEBODY
CHRISTMAS EVE WHO WAS AT THAT
IN A TRUCK THAT SECOND POSITION
KNOWING THAT IT WAS GOING TO
NOW BE AFTER THE YEAR BEFORE
ANYTHING COULD HAPPEN. I'M SO
WE HAVE CERTAINLY HEARD THOSE
STORIES. AND SEEMINGLY AND ON
BE INTERESTED TO HEAR WHAT WE
HEAR FROM HEALTH SYSTEMS-
DIFFERENCES ACROSS THE STATE.
HAS BEEN. ALSO OF INTEREST TO
US- AND SO WE KNOW WHAT. A TO
POINT WE HAVE TO COME BACK TO
REVISIT. YOU KNOW WE HAVE A
SUNSET COMING UP IN AND AT THAT
POINT PERHAPS SOME CHANGES TO
BE MADE BUT WE'VE ALL BEEN VERY
RESISTANT TO. OPEN THIS BAG FOR
CHANGES UNTIL- WE'RE VERY SURE
OF THE DATA OF WHAT WOULD BE.
THE MOST COMPASSIONATE WAY. OF
GOING FORWARD- AND WE CERTAINLY
APPRECIATE ALL THE SUPPORT FROM
COMPASSION CHOICES REALLY
SERVING AS A HUB FOR FAMILIES.
IN NEED- AND WILL. THE TERM.
THANK YOU I WANNA THANK YOU FOR
YOUR TESTIMONY MORE IMPORTANTLY
THANYOUR TESTIMONY TODAY THE
WORK YOU'RE DOING EVERY DAY NOW
IN I'M FOLLOW UP. BEGIN
AMENDMENT ON THE FIFTEEN DAY
WAITING PERIOD. IT'S NOW
DISCRETIONARY WITH THE
ATTENDING PHYSICIAN LIFE HERE
SHEEN DETERMINES THAT THAT
FIFTEEN DAY WAIT WOULD BE
ONEROUS- THEY HAVE THE
AUTHORITY- AND THEN I THINK YOU
MENTIONED A COUPLE OF OTHER
STATES THAT ARE ALSO. NOT
REQUIRING THE FIFTEEN DAYS
THERE'S TWO STATES THAT HAVE
LEGISLATION PENDING IN NEW YORK
AND I THINK IT'S MINNESOTA
THAT- WOULD ELIMINATE IT BUT
IT'S NOT PASSED YET OKAY. MOM
BUT THOSE ALSO MIGHT PROVIDE A
MODEL OF- HOW PEOPLE ARE
APPROACHING IT LEGISLATIVELY-
COULD CERTAINLY WE HAVE HEARD
IN OUR OFFICES IN IN THE
HEARING THAT. THE CHAIR HOSTED
LAST YEAR. THAT WAS THE
TESTIMONY THERE WAS NO EVIDENCE
OF COERCION OF. BAD OUTCOMES-
ALL OF THE FOCUS WAS PEOPLE WHO
WERE THE IMPEDIMENT WAS THE
FIFTEEN DAYS SO I THINK THAT
CERTAINLY GOING TO BE ON OUR
RADAR FOR ANY- FUTURE- IN THE
LEGAL ARENA YOU DIDN'T REALLY
ADDRESS THIS BUT- WE'VE- FACE
CHALLENGES IN CALIFORNIA. ON
THE ATTORNEY GENERAL DEFENDS
CALIFORNIA'S LAW IN HAS BEEN
DOING A GREAT JOB OF DOING THAT
I'M ARE THERE WHAT'S THE STATUS
OF ANY OTHER LEGAL CHALLENGES
NATIONALLY OR- OTHERS PENDING
IN CALIFORNIA- SO OUT IN
CALIFORNIA- JUST FOR I'M SURE
YOU KNOW BUT FOR THOSE WHO
DON'T KNOW- THE CASE- IN THE
DISTRICT COURT- JUST FOUND THAT
THE LAW WAS PASSED
CONSTITUTIONALLY. AND THAT THE
OPPOSITION DID NOT- HAVE
STANDING TO BRING ALL THE OTHER
CLAIMS FORWARD OUR
UNDERSTANDING IS THAT TODAY-
THAT COURT CASE IS SUPPOSED TO-
THERE THE OPPOSITION IS ABOUT
ELENA. ST I'M DISTRICT COURT
LEVEL WHAT THAT AMENDED
COMPLAINT WILL SAY BUT THAT'S
SUPPOSED TO HAPPEN TODAY AND IF
IT HAPPENS AT SOME POINT WHILE
WE'RE HERE WHAT WILL LET YOU
KNOW- IN TERMS OF NATIONAL
LAWSUITS- THERE IS A LAWSUIT IN
NEW JERSEY- A DOCTOR IS
CLAIMING YOU DON'T WANT TO HAVE
TO- OR FOR. OR HANDLE MEDICAL.
AND THAT EVEN THAT IS A
VIOLATION OF HIS CONSTITUTIONAL
RIGHT AND THAT THE LAW- AS PAST
SHOULD NOT BE- VALID OR LEGAL-
SO THAT'S MAKING ITS WAY
THROUGH THE COURTS- AS WELL IN
NEW JERSEY THOSE ARE THE ONLY
TWO STATES THAT HAVE THIS
SPECIFICALLY CHALLENGED- THE
BIGGER THING THAT'S TAKING
PLACE WITH. WHICH THE
CALIFORNIA ATTORNEY GENERAL HAS
BEEN VERY INVOLVED IN IS THE
HHS OFFICE OF CIVIL. RIGHTS
AND- THAT OFFICE THE
REGULATIONS THAT CAME OUT ON IT
REALLY- GIVE A TREMENDOUS
AMOUNT OF WEIGHT. TO A
DOCTOR'S- ABILITY TO AND
DOCTORS AND NURSES HEALTH CARE
PROVIDERS ANYONE WHO ACCESS IS
THE PATIENT. THEIR BILITY TO
OPT OUT OF PARTICIPATING IT'S
TO THE POINT THE WAY THEY'RE
WRITTEN WHERE A PERSON A
SECRETARY COULD CHOOSE NOT TO
TURN OVER THE PRESCRIPTION THAT
AND NOT TELL ANYONE THAT THAT'S
WHAT THEY'VE DONE. FORTUNE THE-
ATTORNEY SPEND AWAY. DOES NOT.
DID YOU SEE THAT SHIPPED PLAY I
NASH AND SOMETHING WE'RE PAYING
ATTENTION TO AND TRY TO AVOID
GOOD WILL THANK YOU FOR THAT
UPDATE NINETY ONE AND JUST ON
THE RECORD ACKNOWLEDGE THE
SUPPORT OF GOVERNOR NEWSOME'S
OFFICE AND ATTORNEY GENERAL
HAVE YOU EVER SANTA WHO HAVE
BEEN REPRESENTING THE STATE IN
DEFENDING THE LAW IN I KNOW
COMPASSIONATE CHOICES HAS AS
WELL. SO THANK YOU. THANK YOU
MADAM CHAIR. KIM THANK YOU VERY
MUCH FOR ALL THE ENERGY AND
EFFORT THAT SINCE HE HAS DONE.
NOT ONLY IN OUR STATE BUT-
NATIONALLY- I WANTED TO TALK A
LITTLE BIT ABOUT- THE DIFFERENT
SYSTEMS AND- WHETHER- IN OTHER
IN ANY OF THE OTHER TEN-
EXPERIENCES STATE EXPERIENCES.
THERE IS ANY KIND OF. MORE THAN
ENCOURAGEMENT BUT MANDATE TO
REFER. OR TELL ABOUT THE LAW-
WE DON'T HAVE THAT IN HOURS AND
WE DELIBERATELY LEFT OUT-
BECAUSE THERE WAS CONCERN ABOUT
THAT ON- MANY OF UNFUNDED
PROFESSIONALS. OUT PARTS BUT
AND THE INSTITUTIONS BUT I'M
WONDERING WHETHER THERE'S BEEN
ANY PROGRESS IN THIS AREA.
THERE ARE NOT NONE AT ALL OF
THE STATES HAVE THE SAME OP AT
THE SAME- SAME OPT OUT YEAH THE
AND THE CHALLENGER- WITH A
MANDATORY. OUT WHY THINK YOU
COULD PROBABLY DO A MANDATORY
WERE FOR ALL MADE TO A
GOVERNMENT WEBSITE YES- THE-
THAT'S EXACTLY THE- IT ALLEN'S
ALLEN THAT WERE SEEN AROUND
RELIGIOUS FREEDOM VERSUS PAID
NOT LET ME AND- THAT. BE
BALANCED WAY UP TO THE SUPREME
COURT AND SO. HOW YOU GET AND
I'M REALLY HOPEFUL THAT THAT
MIGHT BE SOME AT- WELL. WILLING
TO TAKE ON OBVIOUSLY YOU HAVE
AN ATTORNEY GENERAL WHO IS
BILLS REALLY STRONGLY THAT
PATIENT SHOULD HAVE. A VOICE
AND THAT A DOCTOR'S- SORT OF-
DOCTORS CAN OPT OUT SHOULD NOT
OVER. FOR IN. THAT WOULD BE
GREAT TO LOOK AT INNOVATIVE
WAYS TO DO DEL PROBLEM. THE
CLOSEST WITH THE PROVISION THEY
HAVE IN THEIR BILL- BUT- NO ONE
HAD NO ONE IS AUTHORIZED
LEGISLATION THAT HAS. REALLY
ADDRESSED THE ISSUE. I'VE
NOTICED THAT OVER THE LAST FEW
YEARS SINCE HE HAS SPENT A
GREAT DEAL OF BOB. EFFORT
TALKING ABOUT HOW ALZHEIMER'S
AND PARKINSON'S. AND I'M
CURIOUS AS TO WHERE YOUR
ORGANIZATION IS AT THIS POINT
WITH THE TEN STATES AND THAT
ISSUE SURE- AND THAT IS
INCIDENTLY WHEN PEOPLE COME
TALK TO ME ABOUT THIS BILL HERE
THAT IS THE MAJOR ISSUE THAT
SENIORS BURN UP ALL THE TIME.
YEAH I MENTION YEAH SO WE CAN
OPERATE OUT MEDICAL AID IN
DYING FROM HOW TO ADDRESS
ALZHEIMER'S AND DEMENTIA AS YOU
KNOW FROM PASSING THIS LOG BOOK
POOR SAFEGUARDS THAT ARE PART
OF MEDICAL AID IN DYING IS THAT
THE PERSON HAS TO BE MENTALLY
CAPABLE AND ABLE TO SELF AND
JUST THE MEDICATION- AND- IF
YOU IMAGINE GIVEN THE INEQUITY.
THAT WE HAVE WITHIN OUR HOW.
DUMB BEAT. THAT MIGHT HAVE IF
WE WERE TO EXTEND THAT TO-
SOMEBODY WHO'S LOOKING YOU LOOK
AT THE COUNTRIES THAT ARE DOING
THAT ENTIRELY DIFFERENT
ECONOMIC AND HEALTH CARE
SYSTEMS- BUT THAT DOESN'T MEAN
THAT WE SHOULD ALLOW PEOPLE
WITH DEMENTIA TO DIE IN THERE
ARE EGGS ACTUALLY LEGAL
EXISTING OPTIONS RIGHT NOW THAT
SOMEBODY. RIGHT NOW WE'RE
KEEPING PEOPLE I FOR DECADES
YAWNED YEAR WHICH THEY COULD
THANKS **** THAT. BECAUSE YOU
KEEP SENDING LIFE YOU THAT AND
PEOPLE ARE OUT RIGHT. TO CLAIM
THAT IS WE JUST PUT TOGETHER ON.
THAT HOUSE UP TO GO. SITE PER
JUDY ANY OF YOUR CAN. IT'S FOR.
THEY CAN DOT THE POINT AT WHICH
THEY WOULD ONE OR GO TO. AT
THAT WOULD ALLOW THEM REALIZE A
NATURAL DEATH AND IT WILL CUT
YEARS OF THEIR- YOU KNOW IT'S
THINGS LIKE DON'T GIVE SOMEBODY
THE END OF. IF THEY GET IN. OR
IF THEY HARPER YOU DON'T HAVE
TO KEEP GIVING THEM THE HEART
MEDICATIONS THERE'S ALL KINDS
OF WAYS THAT WE CAN SHORTEN THE
LENGTH OF TIME SOMEONE SUFFERS
WITH TO. I'M DO A BADGE AND
THAT AT SOME POINT- YOU'RE
GONNA HAVE THE SAME
IMPLEMENTATION PROBLEM WITH
THAT YOU HAVE WITH MEDICALLY TO
DINE IT'S COMPLETELY LEGAL. BUT
GETTING A SYSTEM TO SUPPORT YOU
WILL BE A CHALLENGE SO WE WOULD
LIKE TO AND SOME BRING
LEGISLATION THAT PROTECTS.
BEARS THAT MAY IT THAT HELPS.
BEFORE COMFORTABLE HONORING
PATIENTS WHICH IS AND SO THAT'S
NOT SOMETHING WE'VE AT THE
THING I'M DOING AND- YEAR'S
THANK YOU THANK. TALK LITTLE.
IT IS IN. OR STATE JUST JUST.
NEW MAN CO UP HERE IN HOT. THAT
THE YOU DON'T NEED FOR THE
FIFTY DAYS TO IT. SAID YOU BUT
JUST LAST WEEK IT'S LIKE. I
HAVE A- THIS TIME THEY'RE IN A
YEAR. OKAY. OKAY END IS IT A
FAIRLY CONSISTENT ACROSS THE
COUNTRY THE SAME. POPPING OUT
OF POSITIONS THAT SAME LEVEL AS
WE HAVE IN CALIFORNIA IN YEAH
UNFORTUNATELY IT'S THE SAME
THING AND IT IT- IT'S
CHALLENGING- BECAUSE YOU KNOW
DOCTORS DO HAVE THE RIGHT TO BE
ABLE TO OPT OUT I BELIEVE THAT-
AND I DON'T KNOW WHAT
CALIFORNIA'S LAWS AROUND THAT
BUT I DO THINK THAT- EIGHT RN'S
WILL TRANSPORT FROM THIS. YES
SO WHY HE IS THE FIRST STATE
THAT'S REALLY I THINK THEY HAVE
A GOOD SHOT OF PASSING AT THIS
LEGISLATION THIS LEGISLATIVE
SESSION AND NURSES ARE ABOUT
CURING THEY'RE NOT ABOUT YOU
KNOW ABOUT HEALING AND
PROLONGED NEED AND SO THEY
REALLY UNDERSTAND AND THE
EXPIRY OF A DOT PERSON AT A
FLIGHT YOU KNOW HAD A BAD AND
WITH THEM AND HAVE. PORTS THAT
CEDAR IS SO WHAT HELP LAWS
THAT'S AND THAT WOULD FOR. I
HEAR. PR INS ARE NOW NOT IN
HEALTH. YEAH WELL YEAH HADN'T
ONCE I DON'T SEE OF BUT I DON'T
I DON'T SEE WINGS. THE LEAD TO
FULL. YEAH YEAH YEAH YEAH YET.
YEAH THE- OKAY NEED OF SUMMER
FRAZIERTHE- I'M OKAY AGAIN
THANK YOU FOR ALL ALL THAT YOU
DO AND ALL THAT YOU'LL CONTINUE
TO DO- ANNA AND WILL CONTINUE
TO USE YOU AS A RESOURCE AND
RESPECT AND THANK YOU FOR YOUR
WORK. THANK YOU THANK. PROVIDER
PANEL THAT DOCTOR CATHERINE
FOREST DR RYAN. STE HE'LL TELL
ME HOW TO SAY HIS NAME AND THEN
DOCTOR PIRRIE PATEL.
WELCOME
ALL AND FOR THE AUDIENCE SAKE
THEY'LL INTRODUCE THEMSELVES WE
HAVE REPRESENTATION FROM
STANFORD SETTER AND KAISER SOME
OF THE SOME OF OUR FOLKS WHO
HAVE BEEN PARTICIPATING WITH
US- SO DOCTOR PATEL. HI YES
GOOD MORNING- THINKS HAVING ME
AT. SO MANY MISS PERKY PATEL
AMY PALLIATIVE CARE PHYSICIAN I
KNOW IT LISTEN IT'S LISTEDON
THE AGENDA THAT I'MWITH KAISER
SOUTHERN CALIFORNIA I JUST WANT
TO BE CLEAR I HAVEN'T STARTED
MY CLINICAL WORK- WITH THAT
TEAM YET- BUT I WAS ALSO THE CO
CHAIR OF THE END OF LIFE OPTION
EXCEPT COMMITTEE AND THE LEAD
FOR PHYSICIAN EDUCATION. CITY
OF HOPE AT THE CAMPUS AS WELL
AS THE SATELLITE LOCATIONS-
DURING MY TIME WITH THAT
INSTITUTION. SO MY EXPERIENCES
ARE GOING TO BE FROM TIME AT
CITY OF HOPE OKAY- THE FIRST
PATIENT THAT REQUESTED MEDICAL
AID IN DYING FROM ME I WAS IN
TWO THOUSAND AND EIGHTEEN- AND
I WHAT IS. AN CURRENTLY NERVOUS
AT FIRST- IT COULD NOT HAVE
BEEN MORE SO AT WITH THE OUT. I
REMEMBER THE SHUTTLE VERY TO. I
ONLY ABOUT A WONDERFUL LIFE A
VERY FULFILLING LIFE A LOT OF
FAMILY. HAVING EVERYTHING YOU
COULD EVER WANTED OF THE STATE
AT THAT TIME. BECAUSE HIS
DUTIES I WAS DESCRIBING TO ME
THAT HE HAD LOST ALL HIS
DIGNITY. I'M HE HAD LOST HIS
PURPOSE AND HE NO LONGER FOUND
ENJOYMENT IN LIFE. AND HIS
DAUGHTER IS ADULT DAUGHTER WHO
HAD ACCOMPANIED HIM THAT VISIT.
WAS GOING A LOT OF WHAT HER
FATHER WAS SAYING AND- SHE WAS
A PRO. YOUR FULL. OKAY I.
KNOWING THE OF STE WILL VERY SO
THE AND A MAN HER FATHER HAD
BEEN A WHILE SHE WOULD
CERTAINLY MISS HIM WOULD WANT
NOTHING MORE THAN FOR HIM TO
REGAIN SOME OF THAT CONTROL
THAT THE CANCER HAD TAKEN AWAY
FROM HIM FOR SO MANY YEARS I
MEAN THAT WAS VERY TOUCHING
VERY MEANINGFUL ON TEAM HERE
THAT FROM HER- AND THIS LAW
IT'S- AWFUL TO ME IT'S A LOT OF
SUPPORT I HAVE MY OWN BELIEFS
AND PASSIONS OF WHY WENT INTO
MEDICINE AT PACIFIC LEE INTO A
POT OF CARE. THERE'S A LOT OF
TIME WE WORK WITH PATIENTS THAT
HAVE A CHRONIC AND DEBILITATING
ILLNESSES WHERE WE ARE
FORTUNATELY INTO A IS THAT
WE'RE NOT ABLE TO OFFER MEDICAL
TREATMENTS AND THAT THERE IS
BALK CAN YOU TO ARM MAKE THEM
DECLINE SLOWLY INTO RATE AND
THIS LAW I WAS THAT RETAIN SOME
OF THAT CONTROL ABLE TO USE.
THANK WANT TO LIVE WITHOUT
HELLO ROLL I'M RATHER THAN
LETTING THE DISEASE DO THAT FOR
THEM. OUR WITH MIKE'S. I WOULD
CAN PAY BUT- SEE WHAT END STAGE.
DOES TO SO. IS A IS A TERRIBLE
THING TO WITNESS- SEEING THEIR
FAMILIES WATCH THEM SLOWLY
DECLINE. IS EVEN MORE DIFFICULT
AND- BEING ABLE TO ALLOW
SOMEONE TO CHOOSE HOW THEY WANT
TO DIE WHEN WE- WANT TO A LOT
LET THEM CHOOSE HOW THEY WANT
TO LIVE I THINK IS A VERY VERY
IMPORTANT THING. I'M SO THEY
CAN KEEP SOME OF THE NITTY. TO
ME I. AT SOME OF THE STUFF THAT
A LOT OF THESE PATIENTS ARE
THEY'RE GOING TO INTO OR
WHETHER PHYSICAL OR EMOTIONAL.
OF SOME OF THE BARRIERS I'VE
ENCOUNTERED- AS I THINK CAME AS
ALREADY MENTIONED. ARE I DON'T
THINK WE HAVE ENOUGH
PARTICIPATING PROVIDERS- IN MY
EXPERIENCE THAT HAS BEEN.
BECAUSE I THINK THERE'S JUST A
LACK OF UNDERSTANDING MAYBE OF
THE LAW- FROM THE PROVIDER
STANDPOINT- AND UNCERTAINTY
ABOUT WHAT THAT PROCESS LOOKS
LIKE. AND I THINK THAT WILL GET
BETTER AS WE'VE HAD MORE DATA
AND MORE EXPERIENCES WITH THESE
PATIENT. COUNTERS AND SEEING
THESE GOOD OUTCOMES I THINK
THAT THAT WILL CHANGE. AS WELL
AS PROVIDING ON AFTER FOR
EDUCATION FOR A PHYSICIAN
COLLEAGUES I'VE ALSO FOUND A-
PERIOD AGAIN AS AS PREVIOUSLY
MENTIONED BY THE TIME A PATIENT
HAS COME TO ME. ARE THEY ARE
INCREDIBLY ILL AND IT'S OFTEN
DIFFICULT FOR THEM TO MAKE IT
TO THAT FOLLOW UP APPOINTMENT.
I'VE HAD EXPERIENCES WERE
PATIENTS THAT HAD TO YOU KNOW
BE BROUGHT IN ON GURNEYS. AND
THEY TELL ME THAT IN ITSELF IS-
VERY DEMORALIZING AFTER
EVERYTHING THEY'VE ALREADY BEEN
THROUGH. A OR THE ACTUALLY DIE
IN THE PROCESS BEFORE THEY ARE
ABLE TO MAKE IT'S THAT FOLLOW
UP. I HAVE ONE PATIENT COUNTER
SPECIFICALLY THAT- WAS VERY
MEANINGFUL TO ME. I HAD THE
OPPORTUNITY OF TAKING CARE OF
THIS WOMAN. FOR ALMOST TWO
YEARS OF VERY HIGHLY EDUCATED
INDIVIDUAL- AND THROUGHOUT THE
COURSE OF HER DIAGNOSIS SHE WAS
A VERY REASONABLE PERSON I'VE
HAD VERY REAL EXPECTATIONS. FOR
HER PROGNOSIS AS WELL AS FOR
TREATMENT OUTCOMES. AND SHE
KNEW AND SHE VERBALIZE TO ME
THAT YOU KNOW MIRACLES RARELY
IF EVER HAPPEN. ESPECIALLY
YOU'RE TALKING ABOUT METASTATIC
CANCER- BUT THAT SHE WAS. FOR
WHAT. AS DISEASE SPREAD BODY I
AND EVENTUALLY TO HER BRAIN SHE
HAD REQUESTED MEDICAL AID IN
DYING FROM ME AND WHEN SHE MADE
IT TO HER SECOND VISIT I AND WE
GIVE FOR THE PRESCRIPTION AND
SHE HUGGED ME AND THANKED ME
AND SAID YOU GAVE ME THE
MIRACLE THAT I DIDN'T THINK I'D
BE A- FIVE. SO YOU YOU FOR THE
TIME VERY MUCH THANK YOU ON THE
SO IN YOUR IN YOUR WORK DID YOU
HAVE SOMEONE IN TO REFER HER TO.
FOR THAT FOR THAT SECOND THAT
FEATHER THAT FIFTEEN DAY
WAITING PERIOD DID YOU MEAN
WHAT WHAT WAS A PROCESS IN THE
CITY OF HOPE FOR THE REFERRAL
TO PLACE BUT SO WHAT WHAT WE'RE
THERE ARE CURRENTLY DOING AT
THE TIME- IS. YOU WOULD GET THE
REQUEST- WE GET THE REQUEST FOR
PATIENT I'M NOT ALL PHYSICIANS
AT THE INSTITUTION OF COURSE
ARE PARTICIPATING PROVIDERS- I
WAS ONE OF THEM FOR ANY PATIENT
TO AND SO WITH THAT REFERRAL
WOULD COME TO ME I WOULD- THAT
FIRST VERBAL AND THEN FROM THAT
DAY THEY WOULD. THE SECOND
VISIT WAS SET UP WITH MYSELF AS
WELL AT THE SAME POSITION
DURING THE FIRST AND SECOND
VERBAL I'M AND WE WILL TRY OUR
BEST TO MAKE THAT CONSULTING
VISIT WHICH WOULD BE FOR.
ANOTHER PHYSICIAN- ON EITHER
THAT FIRST OR SECOND DAY TO
JUST CONSOLIDATE THOSE VISITS I
AND WE HAVE A LIST IN THE
INSTITUTION ON FROM THE END OF
LIFE OPTION EXCEPT COMMITTEE
THAT I MENTIONED- KNOWS WHICH
ARE PARTICIPATING ATTENDING
PROVIDERS AND OR CONSULTING
PROVIDERS. OKAY IT'LL COME
EMBEDDED INTO THE SYSTEM
CORRECT SO THE FIFTEEN DAY
STARTED THE MINUTE THEY ASKED.
ANOTHER THING THAT WE'VE HEARD
AND- I THINK WHAT WILL ADDRESS
THAT LATER- IS SOMEBODY MAKING%
WANTING TO MAKE THAT FIFTEEN
DAY REQUEST AND THEN THE
PHYSICIAN SAY NO I DON'T DO
THAT AND I'M HAVING A HARD TIME
EVEN FINDING SOMEBODY ELSE WHAT
COULD BE. ANOTHER TWO WEEKS
BEFORE THEY FIND SOMEONE TO
MAKE THAT INITIAL REQUEST FOR
THAT FIFTEEN DAY STARTING NAY.
A RE OUT. SO IT ACTUALLY WE ARE
STARTED IN THE WOULD SEE. THE
FIRST AT. PROVIDE AND THAT WAS
PART OF MY EFFORT TO I WAS
LEADER THE EDGE. I TARGETED ALL
THE PHYSICIANS ON THE MAIN
CAMPUS AS WELL AS THE
SATELLITE. WE HAD TO SOCIAL
WORKERS THAT WERE ALSO TRYING
TO REACH OUT TO ANY. NON
PHYSICIAN PROVIDERS. JUST TO
SPREAD THE EDUCATION THROUGHOUT
THE INSTITUTION. OF WHAT THE
LAW WAS WHAT IT ENTAILED AND
WHAT YOU COULD DO EVEN IF YOU
YOURSELF DID NOT WANT TO
PARTICIPATE. HOW YOU COULD GET
YOUR PATIENT SEEN AS SOON AS
POSSIBLE- AND SO WE DID NOT
START WHEN THEY WHEN THEY-
FIRST MENTIONED IT WOULD START
WHEN FACT. FIFTEEN DAY. AND
TIME WOULD START WHEN THEY SAW
THEIR FIRST. VISIT WHICH WAS
NOT ALWAYS WITH THEIR
HEMATOLOGY ONCOLOGY PHYSICIAN.
THE QUESTION FOR. THE AND I
JUST WANNA SAY WHEN. YOU WHERE
I WAS A HOSPICE SO SHE WORKER
AND I'M ALL ON THEIR FORGET TO
A PATIENT I HAD OUT IN.
PATTERSON AND BEEN A SAID
CANCER THROUGHOUT HER BODY AND
WENT TO HER BRAIN INTO AND I'LL
NEVER FORGET HER TELLING ME. I
FEEL LIKE I'M STRAPPED ON A
RAILROAD TRACK AND THE TRAIN IS
COMING. IN LIKE TOWARD THE END
AND SHE DID WHEN I SEE HER SHE
JUST SHE WAS LIKE. WHO TELL
THANK YOU FOR YOUR OKAY ADD
DOCTOR FORCED I THANK YOU SO
MUCH FOR HAVING ME AGAIN AND- I
AM VERY LITTLE AT STANFORD AND
MOSTLY TEACHING AT THE UCSAN
FRANCISCO RESIDENT FAMILY
MEDICINE RESIDENCY PROGRAM IN
SALINAS AND MONTEREY COUNTY
SOME MOSTLY WEARING MY UCSF
HAT- AND I WANTED TO TELL YOU
ABOUT TO RECENT- PATIENTS- I
MOSTLY TEACHING THESE DAYS
SINCE YOU LAST SAW ME-
RECOGNIZING THAT SHORTAGE OF
PRESCRIBING PHYSICIANS. I HAVE
TAUGHT IN MENDOCINO COUNTY
CINEMA COUNTY MONTEREY COUNTY
SANTA CRUZ COUNTY- SAN LUIS
OBISPO COUNTY- ALAMEDA COUNTY-
AND FOR A FEW THERE'S A FEW
MORE IN THERE- RECOGNIZING THAT
THE SILOS OF LARGE PROVIDERS
ARE ABLE TO SET UP SYSTEMS BUT
THE SAFETY NET CONNECTS THE
PEOPLE THAT ARE IN CATHOLIC
SYSTEMS THAT AREN'T HAVING
TRAININGS. DON'T HAVE ACCESS
AND THE CALIFORNIA ACADEMY OF
FAMILY PHYSICIANS WHO I'VE ALSO
TAUGHT WITH RYAN IS TRYING TO
DO OUTREACH TO TRY AND GET TO
PRIMARY CARE WHICH IS WHERE
PEOPLE OFTEN HAVE SOME OF THESE
CRUCIAL CONVERSATIONS ABOUT
SERIOUS ILLNESS AND ON- OPTIONS
COUNSELING FOR THE END OF LIFE
AND I WANT TO JUST HIGHLIGHT-
UP FEATURE OF THE BILL THAT I
REALLY APPRECIATE WHICH OF THE
INCLUDES. TALKING ABOUT OPTIONS
WE KNOW THAT THAT PEACE OF MIND
IS I HAVE THIS BUT WHAT ABOUT
ALL THESE OTHER THINGS THAT ARE
ACTUALLY ON PEOPLE'S MINDS AND
I JUST WANT TO SAY THAT I'VE
TAKEN THAT AND I BELIEVE THEN
THAT THE CULTURE OF FAMILY
MEDICINE WE TAKE THAT HEART THE
THAT IS ONE OF THE THINGS WE-
OKAY IN THE TRAY. SOUTH AND IF
FOR THAT VERY SCARY. SO I DOING
THIS TRY AT IT IT THE FIRST ONE
I USE PATIENT THAT RE. UP CAME
MY GOD COM THEY FAMILIES ME OF
THE OF GONNA SHOW YOU THE BUT
THEY DIDN'T WANT TO BE LIVE
STREAMED ON LIKE TO SHOW YOU
THE V. IT'S A PATIENT WHO IS A
LIFELONG GOOD AS STE. WHO WHO'S
PHYSICIAN WAS IN ONE OF MY
TRAININGS AND MERCED FOR SAY
MERCED COUNTY. ON AND WITH
PALLIATIVE CARE FIFTH. AND
AWAKENED THAT THIS COULD BE A
POSSIBILITY- THIS PERSON
ACTUALLY PARTICIPATED WITH IN
MY TRAINING AND IN RYAN'S
TRAINING SO PART OF THE SYSTEM
OF TRAINING ONE ANOTHER. WROTE
THE PRESCRIPTION AS A- THIS IS
I HAVE THIS NEVER THOUGHT SHE
WOULD USE IT BUT IN THE END
STAGES FOR DISEASE WAS REALLY
SUFFERING DALY. SUFFERING AND
DECIDED THAT SHE WOULD TAKE IT
SHE ALWAYS HER NAME IS JACK I
WAS ALLOWED TO SHARE THAT HER
NICKNAME IS CHAT. SHE ALWAYS
THOUGHT THAT SHE WOULD DIE
WOULD WANT TO DIE TO THE SONG
LEAVING ON A JET PLANE. IN THE
VIDEO IS HEARD SINGING AND
DANCING TO IT- SHE TOOK THE
MEDICATIONS AS INSTRUCTED IN
THE NEWEST ITERATION OF
MEDICATIONS WHICH AGAIN THE
SCIENCE IS A MERGING OF WHAT
AND HOW CAN WE DO THIS MORE.
AFFECTED WHAT ARE THE BEST
PRACTICES LAST WEEKEND- RYAN
WAS PRESENTING AT THE NATIONAL
ON CONDITION CONFERENCE ON
MEDICAL AID IN DYING WE KNOW
MORE OF WHAT WORKS HOW TO DO
IT- BOTH. EFFECTIVELY AND COST
EFFECTIVELY ON AND SHE TOOK THE
MEDICATION AND HAD GUTS- MONEY
TO SEDATION AND PASSED AWAY
WITHIN TWO HOURS WHICH IS OUR
GOAL AT. NOT WHAT SHE THOUGHT.
AND EXACTLY WHAT SHE LOVED AND
HAD INCREDIBLE GRATITUDE FOR
THE OPTION OF THIS ACCENT SO. I
JUST WANTED TO ON THE SHAPE OF
THE PROVIDER AND THEN. SHIP YOU
KNOW THE PROVIDER WAS IN THE
TRAINING OKAY SHE PRESCRIBED TO
A PATIENT THE PATIENT'S FAMILY
SENT ME THE VIDEO AND GAVE ME
PERMISSION TO TELL THE STORY.
SO THIS PATIENT LIVED IN A IN A
RURAL AREA. NOT IN ONE OF THE
BIG SITES THAT YOU'RE GOING TO
HEAR A YOU'LL HEAR MOST ABOUT
NOT FROM A BIG AREA. BUT
BECAUSE WE BEGUN TO DO THIS
TRAINING LOOKING AT THE ACCESS
PROBLEM- AND BY THE WAY HER
RACIAL DOCTORS WERE IN THE
CATHOLIC SYSTEM AND- LOOKED AT
HER LIKE SHE WAS LIKE. NO ONE
WAS GONNA HAVE THAT
CONVERSATION WITH HER SHE DID
NOT HAVE ACCESS TO THAT
INFORMATION. SO ONE OF MY MAIN
THINGS THAT I WANTED TO SAY WAS
RIGHT NOW THE LAW DOES NOT SAY
ANY PHYSICIAN IS OBLIGATED TO
SAY A THING. IT SAYS PATIENTS
HAVE ACCESS YOU KNOW HAVE THE
RIGHT. TO IT BUT THERE'S
NOTHING THAT SAYS ANYTHING
ABOUT WHAT WE ARE RESPONSIBLE
FOR SO I WOULD LIKE TO TAKE A
LOOK AT WHAT COULD WE DO THAT
IS THAT REALLY SPEAKS TO
HEALTH. JUSTICE IN THIS STATE
AND HEALTH JUSTICE AS IF YOU
DON'T KNOW TO ASK. YOU WILL NOT
FIND OUT SO HOW CAN WE REALLY
LOOK AT THAT AND BE MORE
PROACTIVE ABOUT HOW WE GIVE
INFORMATION NOT ALL OPTIONS
INCLUDING THE LEGAL AID AN
OPTION DYING IN. MULTIPLE
LANGUAGES. AND THAT BECAUSE OUR
HEALTH SYSTEM REALLY DOES IS IT
IS NOT ADDRESSING HEALTH
JUSTICE INCLUDING THIS IN MY
OPINION RIGHT NOW. AND THEN THE
SECOND THING IS THAT IT REALLY
DOES- PROCESS ITSELF IS BASED
ON AUTONOMY WHICH IS ALSO NOT.
PARTICULARLY CULTURALLY
APPROPRIATE TO THE OTHER CASE I
HAD HAD TO DO WITH A YOUNG
BLACK NEXT PAGE MINE. WHO
REALLY DID HIS FAMILY TO BE
INVOLVED AND THE WAY THE SYSTEM
IT WORKS IT. TO BE A RELATION I
TIME ISSUE AND SO. WE WERE ABLE
TO WORK THAT IS BUT JUST NOTE
SELF. CAME UP VERY MUCH THROUGH.
THE A PATIENT AUTONOMY
PERSPECTIVE AND THAT MAY NOT BE
APPROPRIATE FOR ALL POPULATION
SO JUST WANT TO. HIGHLIGHT THAT
WE PROBABLY WOULD MORE MOVING
THROUGH IN CALIFORNIA WE COULD
ACTUALLY. YOU KNOW WE INHERITED
FROM OREGON AND WASHINGTON
MAYBE PERHAPS NOT AS DIVERSE AS
OUR OWN STATE AND WE HAVE
OPPORTUNITIES HERE TO ADDRESS
THAT AS WELL. AND YOU HAVE
SPECIFIC IDEAS FOR BOTH YOUR
FIRST AND YOUR SECOND POINT I'M
LEARNING OKAY YEAH I LEARNING-
SO THE ANSWER IS I BELIEVE. I
DON'T HAVE THE ANSWERS BUT I
KNOW SOME OF THE PEOPLE TO WORK
WITH I'M THINKING OUT OF- TRACY
BUSH AT IN AND SOUTHERN
CALIFORNIA IS. ONE OF PEOPLE I
WOULD WANT TO WORK WITH AND
THERE'S OTHER PEOPLE. ON IN
SANTA CRUZ COUNTY BASED ON THIS
WE'RE WORKING ON HOW CAN ALSO
WE ADDRESS- PROVIDERS WERE
TALKING ABOUT DOING TRAININGS
THERE'S BEEN A LOT OF WORK AND
HOSPICE AND PALLIATIVE CARE
WHICH HAVE. THEIR SPECIALS HAVE
LONGER TIME THAN PRIMARY CARE.
AND THE NATION REMUNERATION IS
VERY. INTENT ON WHAT YOU'RE
DOING HOW MUCH TIME YOU HAVE DO
IT. I WANT TWO. INNINGS THAT
SPEAK TO THAT HOW CAN I DO
TRAININGS THAT FIT IN THAT
TIME. THE PEOPLE HAVE BEEN
WORDS THAT WORK THE TRAINING
THAT I DID- IN MONTEREY AND
MERCED WAS WITH RACHEL
BERNACCHI FOM THE TOOK ALIGN
CENTER. AND IT WAS WORDS THAT
WORK HOW CAN WE GET WORDS THAT
WORK OUT INTO THE WORLD SO WE
CAN HAVE CRUCIAL SHORT
CONVERSATIONS BECAUSE THAT'S
THE TYPE WE HAVE- BUT COULD WE
WORK ON REMUNERATION SO IN
PRMARY CARE FOR INSTANCE THE
SAFETY NETS. OR YOU KNOW ACROSS
HEALTH. YOU COULD HAVE MORE
ROBUST CON. ABOUT ALL. I AM
ASKED HAVE IN YOUR- IN YOUR-
PAMPHLETS OR IN YOUR ON
PACKETS. OCTOBER TWENTY
NINETEEN STUDY FROM THE
CALIFORNIA HEALTH CARE FROM.
STEP ON END OF LIFE IN THAT
WE'RE PEOPLE DOT AND WORK WITH
ON IT I IS THEIR ACCESS TO.
CARE AND HOSPICE SERVICE. NOT
WERE YOU WANTED TO DIE NO HAVE
THE CONVERSE. YOU WHY. BECAUSE
OF YOU'RE POOR YOU SURE
APPOINTMENT. AND PEOPLE DON'T
HAVE TIME THE MATERIALS ARE
AVAILABLE TO YOU YOU MAY NOT
KNOW WHAT QUESTIONS TO ASK. SO
AGAIN. PULLING THESE PIECES OUT
WE KNOW THAT THERE'S SOME WORK
TO DO THERE AND OUT ENCOURAGE
YOU AND YOUR STAFF TO ACTUALLY
READ THAT REPORTS OF IT'S AN
EXCELLENT REPORT WITH A BIG
DATA BASE LOOKING AT. HOW DO WE
DO AT THE END OF LIFE AND WHAT
CAN WE DO BETTER THIS IS ONE
PIECE OF IT- SO I'LL END WITH
THIS OTHER- STORY WHICH IS MY
OWN FAMILY. I THINK- RELATIVE
TO OTHER PHYSICIANS IN THE
STATE I MIGHT KNOW A LITTLE
BIT. ACCESS TO CARE MY UNCLE-
CAME DOWN AFTER HOSPITALIZATION
IN OREGON AND WASHINGTON- HAD
HAD ACCESS TO CARE THERE AND
END OF LIFE AND IT TURNS OUT.
THERE'S NO RECIPROCITY. SO IF
YOU START THE PROCESS IN ONE
STATE AND YOU COME HERE YOU
RESET THE CLOCK. AND IT WAS
LOVELY HE HAD A LOVELY HOSPICE
DEATH WELL SUPPORTED BY THE
PALLIATIVE CARE COMMUNITY IN MY
OWN CITY OF SANTA CRUZ. BUT IT
MADE ME THINK A LITTLE BIT
ABOUT AS WERE EXPANDING WITH
ONE OUT OF FIVE AMERICANS NOW
WITH ACCESS COULD WE ADJUST SO
THAT IF YOU START SOMEPLACE
ELSE COULD WE ACKNOWLEDGE THAT
AS STARTED IN OUR STATE- AND I
WILL WOULD SAY I WOULD HAVE
LOVED FOR HIM TO HAVE ACCESS HE
WAS AT THE BEDSIDE FROM FROM MY
AUNT WHO HAD A BEAUTIFUL- EIGHT
AND DOT CRY IN THE SPOT. AID IN
DYING- DEATH IN WASHINGTON HE
WAS NOT AFFORDED THAT HERE IN
HIS TIME BECAUSE HE NEEDED THE
HELP OF OUR FAMILY AND HE CAME
TO WHERE HE NEEDED HIS SOCIAL
SUPPORT AND IT'S THE REVERSE OF
WHAT WE HAD. A FIVE YEARS AGO
AND ISN'T THAT INTERESTING AND
ISN'T THAT WONDERFUL ALL AT
ONCE SO THANK YOU FOR THE
OPPORTUNITY TO SPEAK WITH YOU
AND THANK YOU FOR YOUR FOR
SITES IN YOUR WILLINGNESS TO
CONSIDER IMPROVING ON WHAT IS
ARTISTS BEGAN HERE IN
CALIFORNIA. THANK YOU FOR ALL
YOUR ALL YOUR WORK AND
DEDICATION AND IN SPREADING THE
WORD AND HELPING OTHER
PHYSICIANS I THINK THAT'S IT
THE YOU TOUCHED ON SOMETHING
VERY KEY AROUND THE ISSUE OF
ACCESS AND I JUST LIKE TO ASK
MAYBE FOR BOTH OF YOU BUT THE
ISSUE OF THE IDEA CAME UP.
BEFORE BUT IF YOU'RE IN HOT
STAND OUT THAT COULD SEE AS-
ONE THE ONE OF THE POINT IN
TIME. BUT IT ARE THE ARE THE
REALLY HOSP. ALSO NOT
PARTICIPATING RIGHT SO IF THE
IF THEY ARE PART OF THAT SAME
SYSTEM THEN WE'RE FACED WITH
SOME OF THE SAME HURDLES. I
THINK THAT THE ISSUE IS ONCE A
HOSPICE REFERRAL IS MADE THAT
BY DEFINITION IS A SIX MONTH-
SO IT IT'S. A QUALIFIER IT'S
NOT THAT YOU RELY ON THAT
HOSPICE. RIGHT BUT IT'S ONE OF
THE QUALIFY EXCEPT. IT'S
INSTEAD OF A- A VISIT IS THE
POINT SO THAT'S THE IT THE
ADVANTAGES THAT GIVES YOU THAT.
BY THE WAY I THINK ALSO. JUST
WATCHING PEOPLE THROUGH THE
PROCESS- NOW THAT THAT WAITING
PERIOD DOESN'T. MAKES IT
DOESN'T MAKE SENSE IT DOES
DOESN'T MAKE SENSE HAVING TO
PEOPLE'S THINKING CAPS. IS
THIS. DOES IT IS THE SIM BAY
TERMINAL DIAGNOSIS. THAT'S A
SAFEGUARD BUT THE WAITING
PERIOD IS NOT A SAFE GUARD.
SAYS LIKE TO JUST TRYING TO RE
EVALUATE WHAT WHY ARE WE DOING
THIS IS A BARRIER TO CARE OR
DOES IT SERVE A PURPOSE. WHAT'S
THE POINT AND SAID IT'S A
BARRIER TO CARE BUT THE HOSPICE
REFERRAL THAT'S ACTUALLY WE'RE
ALREADY DOING THAT IN OUR WORK
OF. GO INTO COURT IN HOSPICE OR
NOT. OKAY THANK YOU MADAM CHAIR
LOOKING FOR TO HEARING YOUR
TESTIMONY BUT I DO WANT TO
ACKNOWLEDGE MY CONSTITUENT
DOCTOR FOREST AND- TO JUST
THANK YOU FOR THE OUT REACH
YOU'VE DONE THROUGHOUT MUCH OF
MY DSTRICT SAN LUIS OBISPO
COUNTY INCLUDED. IN YOU TOUCHED
ON THIS BUT THE DIFFERENCE
BETWEEN ACCESS IN LARGE URBAN
AREAS IN RURAL AND IT SEEMS
LIKE SOME OF THE REFORMS WERE
TALKING ABOUT WOULD ALSO
FACILITY ACCESS IN RURAL AREAS
IS THAT. CORRECT THAT'S TRUE AS
WELL YES AGAIN GETTING TO WHEN
YOU ONLY HAVE ONE PROVIDES CAME
UP AND MEANT MENDOCINO COUNTY
HOW CAN I SUPPORT THE MENDOCINO
PHYSICIANS AND ONE OF THEM WAS
YOU COULD JUST SAY YOU WOULD
KNOW THAT THAT'S NOT WITH WE
JUST IF WE EXPANDED ACCESS OR
SHORTEN THE TIME PERIOD OR THIS
MANY MANY DIFFERENT THINGS BUT
YEAH. FOR CHEER WHEN THIS
DOCTOR OF. IN IN NON ENGLISH
LANGUAGE I KNOW COMPASSIONATE
CHOICES PUBLISH SOME OF ITS
MATERIALS. IN MULTIPLE
LANGUAGES HOW ABOUT HAVE YOU
HAD ACCESS REGION OR THEIR
SPANISH LANGUAGE MATERIALS THAT
ARE AVAILABLE. FOR PATIENTS
THERE ARE BUT AGAIN. THEIR
AVAILABILITY IS DIFFERENT THAN
ACCESS TO THEM IS THAT'S REALLY
WHAT I'M THINKING SO RIGHT NOW.
IF YOU KNOW IF I WOULD GO AND
GET THOSE MATERIALS- IN AND THE
CALIFORNIA ACADEMY OF FAMILY
PHYSICIANS HASN'T UCLA HAVE I
MEAN WE DO HAVE PATIENT
EDUCATION MATERIALS IN MULTIPLE
LANGUAGES BUT THEY'RE ONLY
AVAILABLE IF PEOPLE KNOW TECH
ASK FOR THEM AND THAT'S THE
HEALTH JUSTICE PIECE OF IT WHAT
IS THE- WHAT IS OUR DUE
DILIGENCE AND GETTING THOSE
OPTIONS INFORMATION. AND BY THE
WAY THIS IS NOT JUST EIGHT AND
DYING THIS IS PALLIATIVE CARE
AND HOSPICE AS WELL YOU KNOW
FOR THOSE THAT YOU'VE WORKED ON
HOSPICE THIS IS A BIG THING
ABOUT HOW CAN WE TALK ABOUT
HOSPICE IF YOU YOU IF IN THE
REPORT THAT I'M TALKING ABOUT
THEY TALK ABOUT WHEN WE
DESCRIBE WHAT PALETTE OF KERR
AND HOSPICES. PEOPLE SAY YES IF
YOU JUST USE THE WORD
PALLIATIVE CARE. NOW SO THAT'S
HOW DO WE TALK ABOUT IT AND IS
IT AVAILABLE TO EVERYBODY DO
YOU HAVE TO ASK FOR. REPORTS IN
ONE OF THE- POSSIBLE REFORMS AS
WE MOVE FORWARD. REQUIRING EVEN
NON PARTICIPATING INSTITUTIONS
ARE PHYSICIANS IN END OF LIFE
OPTION MINIMALLY BE REQUIRED TO
MAKE MATERIALS AVAILABLE ABOUT
THE RANGE OF OPTIONS- FOR THEIR
CONSIDERATION- IN THEN YOU YOU
REFERENCE GETTING BETTER ON THE
COMBINATION OF MEDICATIONS AND
AFFORDABILITY SPENDING ISSUE.
IS THERE A COMBINATION OF
MEDICATIONS THAT THE YOU
CONSIDER TO BE THE BEST. THE
BEST TOOL. YES WELL THERE'S A
THERE'S SEVERAL DIFFERENT
CHOICES BUT THAT LAST WEEKEND
AT WAS IT LAST WEEK AND ALREADY
MY GOODNESS TIME FLIES AT THE
NATIONAL THERE'S A NEW NEW
NATIONAL ACADEMY THAT'S FORM TO
BE ABLE TO JUST TO WORK AND
SCHERER- DATA TO BE ABLE TO
WORK ON BEST PRACTICES- AND TO
SHARE THAT INFORMATION SO THAT
WE CAN CONTINUE TO HONE ON THAT
AND IT'S MORE WIDELY AVAILABLE
NOW IN THE WE ARE NOT WE'RE
WE'RE MOVING FROM YOU JUST HAVE
TO KNOW WHO TO NOTE TO
PRESCRIBE TO. THIS IS WHAT WE
KNOW ABOUT THIS MEDICATION AND
HERE'S THE PHYSIOLOGY OF WHAT
WE'RE WORKING WITH MOVING IN
AND TO WEAR WORK SHOULD BE
WHICH IS YOU KNOW BEST
PRACTICES SO I THINK RYAN
ACTUALLY MUCH MORE AT HIM SHE
OR THEN IN THEM JUST MY FINAL
COMMENT DOCTOR YOU REFER TO
YOUR CURRENT TEACHING AT- IN
MONTEREY COUNTY ATHLETIC DAD
MEDICAL CENTER. PLACE NEAR AND
DEAR TO MY HEART. YOU KNOW. I'M
TO THANK YOU FOR THE WORK THAT
YOU'RE DOING THERE THANK YOU
FOR SOME MONTEREY COUNTY GETS
ITS- I FEEL LIKE I'M BACK IN
BACK WHERE I NEED TO BE IT'S
BEEN A PLEASURE THANK YOU.
THANK YOU. THANK YOU MADAM
CHAIR. OKAY THE DOCTOR.
SPIELVOGEL SEE I SAID THAT'S-
SO FIRST I JUST WANT TO SAY
THANK YOU FOR THE OPPORTUNITY
TO BE HERE TODAY AND TO TALK
ABOUT THIS REALLY IMPORTANT
ISSUE. SO MY NAME IS RYAN
SPIELVOGEL I AM A FAMILY
PHYSICIAN WITH SUTTER- HERE IN
SACRAMENTO AND A FACULTY FOR
THE CENTER FAMILY MEDICINE
RESIDENCY PROGRAM HAS KIND OF
THE MAIN PART OF MY JOB. I
WANTED TO START BY JUST TELLING
THE STORY OF THE FIRST PATIENT
THAT I HAD GO THROUGH EMAIL
AWAY. AND HE BASICALLY CAME TO
ME IT LITERALLY ON THE DAY THE
LAW WAS WENT INTO PRACTICE. HE
WAS REFERRED TO ME AS NAMES
PERCIVAL INTERESTINGLY YEAR-
NAMED AFTER THE LEGENDARY NIGHT
WHO SOUGHT THE FOR THE HOLY
GRAIL- AND HE HE WAS A VERY
AFFABLE MAN IN HIS LATE
NINETIES. WHO HAD DEVELOPED IN
STAGE KIDNEY DISEASE I AND
TRIED DIALYSIS FOUND THAT HE
FELT PRETTY MISERABLE ON THE
DAY OF DIALYSIS AND ALSO THE
DAY AFTER DIALYSIS WHICH IS FOR
THOSE OF YOU WHO KNOW THE
SCHEDULE OF DIALYSIS PRETTY
MUCH EVERY DAY. SO HE MADE A
VERY DIFFICULT DECISION OF
TAKING HIMSELF OFF OF DIALYSIS
AND EVERYBODY THOUGHT THAT HE
WOULD PASS PRETTY QUICKLY BUT
HE LASTED A LOT LONGER THAN
PEOPLE HAD PREDICTED. AND JUST
KIND OF SLOWLY LINGERED WITH
PROGRESSIVE SYMPTOMS AS TOXINS
BUILT UP IN HIS BODY. IT'S A HE
CAME TO ME WHEN WAS PRETTY
IMPAIR PHYSIC IMPAIRED ALREADY-
WALKING WITH A WALKER WITH A
DECENT AMOUNT OF ASSISTANCE-
AND HE RELAYED TO ME I ASKED
HIM WHY ARE YOU SEEKING THIS
OUT. NOT KNOWING WHAT THE
ANSWER WAS GOING TO BE- AND HE
TOLD ME THAT HE WAS YOU KNOW A
YEAR AGO PLAYING DOUBLES TENNIS.
I AND- THAT NOW HE HE CAN'T GET
OUT OF BED WITHOUT SOMEBODY
HELPING HIM HE CAN'T GO INTO
HIS GARDENING LIKE HE ALWAYS
USED TO DO. AND BECAUSE OF THE
TOXINS BUILDING UP IN HIS BLOOD
HIS TASTE BUDS DIDN'T WORK
ANYMORE AND EVERYTHING TASTED
LIKE CARDBOARD. AND SO HEY THEN
S. WILL OKAY WHEN DO YOU SEE
YOURSELF TAKING THIS LIKE WHAT
IS THE KIND OF. THE TIME FOR
YOU BECAUSE I REALLY DIDN'T
KNOW THE ANSWER TO THAT
QUESTION WAS GONNA BE IN HE
SAID. IN THIS IS INTERESTING
THAT IT'S SOMETHING THAT I
FREQUENTLY HERE IS THAT WHEN I
AM UNABLE TO WIPE MY OWN BEHIND
IT IS TIME FOR ME TO GO. WHICH
IS A LITTLE TAKEN ABACK BY
THAT- BUT I. WENT WITH IT IT'S
NOT MY DECISION TO MAKE. I AND
I SAW HIM AGAIN AFTER THE
FIFTEEN DAY WAITING PERIOD- TWO
AND A HALF WEEKS LATER- AND
THEN HE DID IN JEST- THE AID IN
DYING DRUG. SURROUNDED BY
FRIENDS AND FAMILY. I AND I
HEARD FROM THE DAUGHTER
AFTERWARDS WHERE SHE SAID IT
WAS AMAZING WE HAD A MEMORIAL
FOR DAD WHILE HE WAS STILL
ALIVE. AND SURROUNDED BY
EVERYBODY HE WENT OUT WITH THE
SUNSET ON HIS PORCH. WITH HIS
FAVORITE MUSIC PLAYING. AND
THAT IS REALLY UNIQUE AND I
WASN'T REALLY EXPECTING THAT.
BECAUSE PEOPLE BEFORE NOW I
HAVEN'T REALLY BEEN ABLE TO
PLAN THEIR- DEATHS- BUT THIS
ALLOWS PEOPLE TO PUT THAT FINAL
SENTENCE ON THAT LAST CHAPTER
OF THEIR LIFE IN THE PERIOD ON
THAT LAST. SENTENCE OF THE LAST
CHAPTER. I'M SO WHAT DID I FROM
PERCIVAL ONE THING IS THAT A
DIGNITY IS IN THE EYE OF THE
BEHOLDER I I'M A DOCTOR AND SO
WHEN HE TOLD ME THAT IN WRITING
HIS OWN BEHIND WOULD BE KIND OF
THE FINAL OKAY I'M DONE. MOMENT
THAT'S NOT WHAT I WOULD HAVE
CHOSEN BECAUSE TO ME THAT
DIDN'T SEEM LIKE THAT MUCH OF A
LOSS OF DIGNITY. BUT TO HIM
THAT MEANT MY LIFE IS NO LONGER
WORTH LIVING AND THAT'S NOT
GOING TO COME BACK SO HE HAD
BEEN IT'S IMPORTANT TO NOTE. IN
HOSPICE THIS WHOLE TIME AND
THEY'D BEEN MANAGING SOME OF
HIS OTHER SYMPTOMS BUT THERE
ARE SOME THINGS THAT HOSPICE
CANNOT MANAGE. FOR INSTANCE
PROGRESSIVE DECLINE AND
FUNCTIONING. HE'S NOT GONNA GET
THAT BACK HE'S NOT GONNA BE
ABLE TO PLAY DOUBLES TENNIS
AGAIN. NO MATTER WHAT- AND AS
AND LOSS OF DIGNITY AND LOSS OF
DIGNITY IS NOT UP TO ME TO THE
FINER FOR ANYBODY TO DEFINE
IT'S UP TO YOU. SO AND BY THE
WAY JUST A QUICK SIDE NOTE I DO
TAKE ISSUE THAT SOMEHOW THE
TERM DEATH DIGNITY HAS BECOME
ASSOCIATED WITH MEDICAL AID IN
DYING BECAUSE PEOPLE WHO ARE IN
HOSPICE CAN OF DIGNIFIED
DEATHS- WHO ARE. NOT IN HOSPICE
IN CHOOSE TO JUST CONTINUE TO
PLOW THROUGH WITH AGGRESSIVE
CHEMO RIGHT UNTIL THE END THEY
CAN HAVE A DIGNIFIED DEATH TO.
DIGNITY IS UP TO USED TO DEFINE
AND WHEN YOU FEEL LIKE YOU'VE
LOST DIGNITY THAT'S THAT'S
PERSONAL SMALLER WE HAD. I
REMIND MYSELF NOW ANYTIME I SEE
SOMEBODY WITH A TERMINAL
CONDITION THAT- THE LIFETIME
PREVALENCE TOO MUCH TO
EVERYBODY'S SURPRISE THE
LIFETIME PREVALENCE OF DEATH IS
A 100% SO. EVERY HI IS. AND
DEATH. BOTH IN IN TRANSIT IN
THIS. THE THAT IT'S HAPPENED TO
LITERALLY EVERYBODY. HIM THAT'S
EVER EXISTED BIRTH AND DEATH.
IT'S AN INTRINSICALLY UNIQUE
ANY DEEPLY PERSONAL EXPERIENCE
SO NO TWO DEATHS ARE THE SAME
AND SO BEING ABLE TO GIVE
PEOPLE ANOTHER OPTION FOR HOW
THEY CAN EXPERIENCE IT IS
IMMENSELY POWERFUL SO THAT WE
DON'T JUST HAVE DISEASE WHAT WE
CALL DISEASE DIRECTED CARE
PLOWING THROUGH WITH CHEMO
PLOWING THROUGH WITH DIALYSIS
OR HOSPICE CARE COMFORT
DIRECTED CARE TREATING YOUR
SYMPTOMS ALLOWING THE DISEASE
TO NATURALLY TAKE YOU. BUT ALSO
GIVING YOU THE ABILITY TO SAY
I'M ABOUT TO PASS ANYWAY SO LET
ME DCIDE WHEN AND HOW THAT'S
GOING TO BE. SO I WANT TO TALK
NOW ABOUT- EARL OF THIS IS THIS
PATIENT IS A LITTLE BIT UNIQUE
IN MY EXPERIENCE IN THAT MOST
OF MY PATIENTS ARE REFERRED TO
ME- SO I KIND OF KNOW WHAT I'M
GETTING WHEN I GO INTO THAT
CONVERSATION- OUR GIRLS
ACTUALLY ATION OF MINORS AS
PRIMARY CARE DOCTOR. AND I
HADN'T SEEN HIM FOR ABOUT TWO
YEARS IN THE LAST TIME I'D SEEN
HIM HE WAS PRETTY WELL AND THEN
HE COMES TO ME AFTER RECENT
HOSPITALIZATION HOSPITALIZATION
I HADN'T KNOWN BUT IN THE
INTERVAL HE DEVELOPED. SQUAMOUS
CELL CARCINOMA OF THE OF THE
THROAT AND IT WAS METASTATIC
CAN YOU HAVE BEEN THROUGH MANY
ROUNDS OF CHEMO AND SOME
SURGERIES- AND SO IS COMING TO
ME FOR HOSPITAL FOLLOW UP.
AFTER HE HAD SOME- SIDE EFFECTS
COMPLICATIONS OF CHEMO. AND HE
LOOKED HORRIBLE. AND HE HAD HAD
METASTATIC CANCER THEM QUICKLY
LEAFING THROUGH ALL OF THE
ONCOLOGISTS NOTES FROM A
DIFFERENT INSTITUTION WHICH IS
SOMEHOW WHICH IS PART OF HOW I
DIDN'T KNOW THAT THIS IT
HAPPENS IS AT A DIFFERENT
INSTITUTION. AND I'M LOOKING
ALL MY GOSH HAS HE EVER HAVE
THEY EVER HAD A GOALS OF CARE
CONVERSATION WITH THIS GUY-
WILL WHAT IS HIS PROGNOSIS AND
EVERYTHING IN THERE SAYING LIKE
HE'S TERMINAL. HIS PROGNOSIS IS
POOR SO WE'RE GONNA SWITCHING
OVER TO THIS OTHER CHEMO
REGIMEN. AND MOVE FORWARD IN
ELEVEN MRI TO FOLLOW UP TO SEE
HOW MUCH HE'S PROGRESS TO THE
CANCERS PROGRESSED IN ANOTHER
SIX MONTHS. NOTHING IN THERE
ABOUT GOALS OF CARE HAVING THAT
CONVERSATION WITH HIM. SO YOU
KNOW HE'S COMING TO ME TO TALK
ABOUT HIS THE SEED OF COLITIS
RECENT EPISODE IN THE HOSPITAL
I SAY. EARL WE NEED TO TALK A
LITTLE BIT LIKELY THIS IS MY
LAST PATIENT ON FRIDAY SO I HAD
SOME TIME. MY WIFE WASN'T VERY
APPRECIATIVE THIS BUT I HAD
SOME TIME. AND I SAY LET'S
LET'S TALK ABOUT WHAT YOU WANT
TO DO HERE BECAUSE HE'S LIKE
WELL BUT MY ONCOLOGIST SAID. I
NEED TO GET AN MRI IN SIX
MONTHS- YOU DON'T NEED TO AND I
KIND OF WENT THROUGH WITH HIM.
HELLO WHAT I NORMALLY SAY OR
PREVIOUSLY SAID ABOUT DISEASE
DIRECTED CARE VERSES STE YOU'RE
OBVIOUSLY SUFFERING ON THIS.
SYMPTOM DIRECTED CARE AND BY
THE WAY I DON'T KNOW IF YOU
KNOW THIS BUT IN CALIFORNIA NOW
WE HAVE A THIRD OPTION. AND
HE'LL KINDA GINGERLY BRINGING
IT UP AND AS SOONAS I BRING IT
UP HE GOES I WANT THAT. AND I
SAID. GIRL I WASN'T REALLY
EXPECTING YOU TO REACT THAT WAY
YOU KNOW. HIS TO SOMETHING YOU
CAN THINK ABOUT HE'S LIKE NO NO
NO NO NO I DIDN'T EVEN KNOW
THAT THAT I COULD SAY NO TO THE
CAME- LET ALONE THAT I COULD
SAY THAT I'M DONE- SO. I'M
DONE. I'M NOT GONNA HAVE A
RECOVERY- I DID TALK HIM INTO
TRYING HOSPICE FOR A LITTLE BIT
TO SEE IF THEY COULD HELP WITH
THE SYMPTOMS. AND HE DID TRY IT
FOR A LITTLE WHILE AND THEN HE
SAID NOPE. THAT WASN'T THAT
WASN'T ENOUGH FOR ME I'M- DONE
AND HE ENDED UP ALSO INGESTING.
AND THROUGH WIFE AT THE TIME
WAS CRYING IN THAT FIRST OFFICE
VISIT. SHE WAS NOT ON BOARD BUT
AGAIN AFTERWARDS I HEARD FROM
HER- JUST HOW POWERFUL
EXPERIENCE SO THAT WAS WHEN
SHE- KIND OF ACCEPTED THAT HE
WAS. AND HE ACCEPTED THAT HE
WAS TYING A LOT FASTER THAN SHE
DID. WHICH IS ACTUALLY VERY.
CALM. FOR THE FAMILY. AS IN
KIND OF. EVERY PAGE THAT I'VE
HAD GO THROUGH THIS WITHOUT
EXCEPTION. OF THE PATIENTS HAVE
BEEN IMMENSELY APPRECIATIVE TO
HAVE THIS OPPORTUNITY AND TO
HAVE ACCESS. AND THE FAMILIES
HAVE BEEN AS WELL- EVERYONE
TALKS ABOUT HOW POWERFUL THIS
WAS AN EXPERIENCE AFTER THE
FACT. SO KIND OF IN CLOSING. I
JUST WANT TO MENTION HOW
POURTANT LAW IS FOR. POWER
BEING EVIL. AND DISENFRANCHISED
POPULATION- OF PEOPLE WHO ARE
DYING OF WHICH EVERYONE WILL
ONE DAY BE. FEEL LIKE MEDICINE
HAS LEFT THEM BEHIND. I SAID
THIS IS IMPORTANT FOR BEING
ABLE TO GIVE PEOPLE A BIT OF
THAT POWER BACK. IT IS
IRONICALLY ONE OF THE MOST
REWARDING THINGS THAT I DO IN
MY MEDICAL PRACTICE. BEING A
PRIMARY CARE DOCTOR- IN I'D SAY
IT'S RIGHT UP THERE WITH
DELIVERING BABY IS AND WHO SOME
OF THE CONTRACT. CARE THAT YOU.
IT'S. ECHOING FEEL LIKE I'M
GONNA ASK A LOT OF THINGS HAVE
ALREADY COME UP- THE WAITING
PERIOD I'VE HAD A NUMBER OF
PATIENTS EITHER CALM WHEN THEY
ARE TO THIS WHEN THEY ARE.
PLANNING AHEAD. OF LIKE MY
FIRST PATIENT PERCIVAL. OVER
MANY OF MY PATIENTS OR WHEN
THEY ARE. REALLY TERMINAL- WHEN
THEY ARE ACTIVELY DYING AND YOU
CAN NOW YOU KNOW AS THE
PROVIDER WHEN YOU SEE THEM. OF
THIS PERSON IS NOT GOING TO
MAKE IT THROUGH THE WAITING
PERIOD. I AND ABOUT HALF MY
PATIENTS TELL. IF AND IF NOT A
pTHE EARLY DAYS AND NOW IT'S A
LITTLE BIT LESS THAN HALF I'D
SAY- SO THAT THAT IS ONE
PARTICULAR BARRIER. ANOTHER ONE
IS ACCESS- PROVIDERS MANY
PROVIDERS EITHER ARE
COMFORTABLE OR WHEN I TALK WITH
THEM BECAUSE I DO A LOT OF
TRAININGS WITH THE CLINICIANS
OTHER CLINICIANS AND CENTER
MEDICAL GROUP- THEY JUST. HAVE
THIS IDEA THAT ALL AGES HERE
IT'S REALLY COMPLICATED. AND
THEN I TRIED TO DISPEL FOR THEM
BREAK DOWN INTO LIKE. A REALLY
THAT COMPLICATED JUST TO
INFORMED CONSENT THIS GOT IN
WITH. LIKE IF EVERY NICHOLS.
AND HERE THEY STE. OF I'M FACT
FOR AS PRO SO A LOT OF MY
RESIDENTS ARE. VERY INTO. IN
THIS PROCESS AND OVER HALF OF
THEM ACTUALLY ARE TAKING PART
IN SEEING PATIENTS- AND SO THAT
HAS BEEN GREAT FOR TRAINING
THAT'S OUR NEXT GENERATION OF
PHYSICIANS- BUT ALSO. I THINK
WITH DOCTOR PATEL KIND OF
BROUGHT UP WHEN YOU GUYS WERE
TALKING ABOUT HOW. THE FIRST
VERBAL REQUEST WHICH YOU WOULD
THINK IS THE FIRST VERBAL TO
REQUEST WITH THE PATIENCE THING
IS THE FIRST VERBAL REQUEST IS
NOT ACTUALLY IN THE EYES OF THE
LAW THE FIRST VERBAL REQUEST.
SO FROM MY STANDPOINT IN THE
LAW YOU HAVE TO BE SITTING IN
FRONT OF ME. AND TELL ME THAT
YOU WANT A MEDICATION TO HELP
YOU AND YOUR LIFE. AT THE
PATIENTS ALREADY SAID THAT
BEFORE. THEY SAID THAT TO THEIR
OWN PRIMARY CARE DOCTOR.
RELEASE SAID THAT TO THEIR
THEIR OWN ONCOLOGIST I'M DONE I
WANT THAT THAT DEATH WITH
DIGNITY THING. THEY'VE SAID
THAT ALREADY AND FREQUENTLY
THEY SAID THAT LIKE ONE OR TWO
MONTHS AGO ALREADY. AND THEN
THE ANSWER THAT THEY GRAVEL AS
WELL I DON'T REALLY KNOW HOW TO
DO THAT OR YOU KNOW I DON'T
REALLY KNOW WHO YOU GO TO FOR
THAT. AND SO THEN THEY COME TO
ME AND THEY SAY WELL I'VE
ALREADY GIVEN THREE VERBAL
REQUESTS. THEY SAY WELL IN THE
EYES OF A LOT IT DIDN'T
ACTUALLY COUNT. SO THEN THEY
HAVE TO DO IN A- DIRECTIONAL.
FIFTEEN DAY WAITING PERIOD WHEN
THEY'VE ACTUALLY IN. IN FACT
ALREADY BEEN WAITING. A COUPLE
OF MONTHS. SETS ONE BARRIER
ANOTHER BARRIER. AND THEN I'D
SAY THE THIRD THAT I JUST WANT
TO MENTION HIS. I GET A LOT OF
PEOPLE WHO ARE COMING TO ME
FROM THREE FOUR HOURS AWAY.
FROM YOU I'VE HAD PEOPLE COME
TO ME FOR ME OF SAMITY OR NEAR
THE OREGON BORDER BECAUSE THEY
DON'T HAVE SOMEONE CLOSER. AND
THESE ARE PEOPLE WHO ARE.
SUFFERING AND HAVE A LOT OF
PHYSICAL LIMITATIONS. A AND SO
MAKING THEM SCHLEP THEIR WAY
DOWN TO SACRAMENTO SO THAT THEY
CAN SIT WITH ME FOR THIRTY
MINUTES OR FORTY FIVE MINUTES.
IS ALSO ON DECK. FIVE AND SO.
HAVE NOW. WE HAVE THESE ONE
DEVICES WE CAN HAVE A VIDEO
CONFERENCE WITH SOMEBODY. ALL
OF THEM ALSO HAVE THESE
WONDERFUL DEVICES. SO YOU CAN
HAVE A FACE TO FACE WITH
SOMEBODY IN THEIR BED IN THEIR
HOME WHERE THEY DON'T ACTUALLY
HAVE TO COME TO YOU AND UNDERGO
MORE SUFFERING JUST TO BE ABLE
TO GET THIS THING THAT'S
POSSIBLY. LESSENING THEIR
SUFFERING. SO THAT'S ANOTHER
POTENTIAL LIMITATION IN ALL OF
THIS IS NOW WE HAVE THE
TECHNOLOGY YOU CAN VIEW
SOMEBODY YOU CAN SEE THEIR
LIVING ENVIRONMENT YOU CAN SEE
THEIR FUNCTION. MOTHER SO IN
THE COMFORT OF THEIR HOME BUT
CURRENTLY THAT'S NOT REALLY
EXPLOSIVELY. ALLOWABLE AND IT'S
SOMETHING ANOTHER AREA WE CAN
IMPROVE. I'M UNDER MUCH THANK
YOU- AGAIN IT'S ONE THINK ALL
THREE OF YOU FOR NOT ONLY YEAR
IMMEDIATE SERVICE YOUR PATIENCE
BUT HELPING TO EDUCATE OTHERS
ON. DOCTOR SPIELVOGEL I'M
CURIOUS OR FOR ANY OF YOU
VETERANS ADMINISTRATION WHAT'S
HAPPENING TO VETERANS WHOSE
CARE IS PROVIDED THROUGH THE VA
FEDERALLY FUNDED ARE DOCTORS
MAKING REFERRALS AT AT THE VA.
I HAVE NOT HAD ANY REFERRALS AT
THE VA BUT IT'S ALSO IMPORTANT
TO NOTE THAT HE WITH REFERRALS
OR NO IF SOMEONE HAS MEDICARE.
MEDICARE HAS EXPLICITLY SAID
THAT YOU CAN BILL FOR THIS SO
IT'S ALL OUT OF POCKET OR OUT
OF OUR POCKET ANYWAY. SONO NO
Vì ã PAYMENT YEAH SO I'VE
HAD VA PATIENTS AND WHAT
HAPPENS IS THEY CONTACT THEY DO
WHAT PEOPLE DO WHICH IS TO TRY
AND FIND OUT WHO IS IN THERE IN
THE CONCIERGE OR THE DIRECT
CARE WORLD THAT THEY CAN ACCESS
SO THE ACCESS BECOME FINANCIAL
BARRIER. AND THEN AND OR OR CAN
MAKE ACCESS IT THROUGH THEIR-
IN SOME OTHER WAY SO YOU CAN
GET ALL OF THE VISITS COVERED
BY MEDICARE BECAUSE THAT'S JUST
AND OF LIFE COUNSELING. SO ALL
THE VISITS CAN COUNT BUT AT THE
POINT WHEN THE PRESCRIPTION IS
WRITTEN THAT'S AN UNCOVERED
VISIT SO THAT'S THE WAY THE
WORK AROUND HAS BEEN AS-
BECAUSE- THE LAW. INCLUDES END
OF LIFE COUNSELING AND- THAT
THAT THAT IT IS IN THE
COUNSELING PIECE OF IT BUT
USING FEDERAL DOLLARS FOR THE
ACTUAL PRESCRIPTION CAN'T. NO
NO. IN TO BE SELF MOTIVATED TO
LOOK TO DO WE KNOW IF DOCTORS
WITHIN THE VA SYSTEM ARE MAKING
PATIENTS- AWARE OF THE OPTION
EVEN IF THEY CAN'T PROVIDE IT I
ENVY I DON'T I DON'T KNOW ABOUT
THAT. I DON'T HAVE THAT
INFORMATION NO AND I CAN'T I
DIDN'T. I DON'T KNOW THE AND
ADDS THAT THAT WOULD BE
INTERESTING TO FIND OUT I MEAN
IT'S NOT DIFFERENT THAN OTHER
THINGS THAT HAVE A RESTAURANT
AND SLIKE. AMINA MEDICAL
MARIJUANA OR YOU KNOW CUT
CONTRACEPTIVE SERVICES ARE THAT
FOR- AND PORTION SERVICES AND
THINGS LIKE THAT BUT I DON'T
ACTUALLY KNOW. THE REGION I
REPRESENT THERE'S- VETERANS
SENT A LOT OF VIETNAM VET SINCE
WE'RE A- IN MAY WHO HAVE.
DEVELOPED SOME OF WHOM BELIEVE
THEY'RE RELATED TO THEIR
SERVICE. BUT IF. THE NEEDS TO
ME MAYBE. A BETTER. OF JUST
PUBLIC EDUCATION SO THAT
THEY'RE NOT DEPENDENT ON
LEARNING OF OPTIONS IN THEIR
CURRENT CARE SYSTEM OF FOR HAVE
A PURPOSES I WROTE ABOUT OF FAT
IN MY VOX PIECE I WROTE A PIECE
ABOUT AID IN DYING IN A VOX
ARTICLE. IN IT'S A COMPOSITE OF
THREE VETERANS- ALL OF WHOM
FOUND ME PRIVATELY AND- USED
THEIR SUPPLEMENTAL INSURANCE TO
ACCESS ME AT STANFORD. SO WE'RE
NOT THERE ACE SAYS ORDER DO
THAT. AND MEDIC AS COVER SPIT
SERVICE. BUT WORK AROUND YOU'LL
THIS LATER THE WORKER. HAVING
TO DO WITH AID IN DYING OR NEW
RIGHT I'M NO AT. HERE FOR THOSE
THE HAWK. THANK YOU. BOMB SO TO
ALL OF YOU I'M AND WE'VE HEARD
OF THIS FIFTY DAY REPEAT SO
SOUNDS LIKE YOU THINK THE FIFTY
DAY NOT NECESSARY. BUT HOW
ABOUT THAT HOW ABOUT SEEING TO
PHYSICIANS. IS THAT. ARE I
ACTUALLY THINK THAT THAT IS
NECESSARY- ACT. CASH IN THE-
FIFTY TO SIXTY YEAR SOME ODD
CASES THAT HAVE BEEN AT SOME
LEVEL OF PART OF ONLY ONE OF
WHICH I FELT LIKE WAS NOT A
GOOD CANDIDATE- AND HAVING THE
SECOND PHYSICIAN THERE WAS KIND
OF NECESSARY TO CATCHING THAT
SO VERY RARE VERY RARE THAT
PATIENTS ARE NOT ELIGIBLE- BUT
IT DOES FACILITY THAT
CONVERSATION. I AGREE I THINK
THAT THE VISIT IS HELPFUL- I
DON'T NECESSARILY KNOW WHAT THE
RIGHT NUMBER OF DISEASES IN
BETWEEN YOU KNOW THE VISITS OR-
HAVING THAT TWO SEPARATE
WITHOUT FIRST ATTENDING BUT I
THINK- I AGREE I THINK IN ALL
THE PATIENTS THAT I'VE SEEN-
HAD IT HAD THAT HASN'T BEEN THE
BARRIER BECAUSE WE CAN DO THOSE
VISITS ON THE SAME DAY BACK TO
BACK. BILLY THANK OPENING UP TO
OF VIDEO VISITS USING
TELEMEDICINE FOR RURAL AREAS OR
ACCESS ISSUES. IT OPENS MY MIND
I THINK AS SOMEONE WHO DOESN'T
PRACTICE IN A MAJOR
METROPOLITAN AREA. WHERE ACCESS
IS A BIGGER ISSUE I THINK THAT
IT'S SHORT SIGHTED TO THINK.
THAT IF YOU LIVE IN AN AREA
WHERE THERE'S JUST ONE PERSON
PRESCRIBING ANY DON'T OPEN UP.
TO HAVING A SECOND MIND. AT
WORK SO. I DON'T I THINK IT'S A
GOOD IDEA YEAH AND IT'S REALLY
IMPORTANT FOR SIX THE SAFEGUARD
I'VE- RIGHT NOW STAY RAN I
THOUGHT TO IS GOOD BUT I THINK
THAT IT COULD BE AND SHOULD BE.
MADE AVAILABLE THROUGH-
TELEMEDICINE AND MAKE JUST
MAKING SURE THAT WE SAFEGUARD
THAT OPTION SO THAT THE PATIENT
RIGHTS IN AREAS THAT ARE NOT.
WE FOUND ARE NOT IN THE
METROPOLITAN AREAS ARE
PROTECTED OTHERWISE IT REALLY
IS YOU KNOW. CITY OPTION AND
NOT A REAL OPTION AND HOW ABOUT
THE THIS THE IDEA OF THE FIRST
WE NEED TO BE THE ATTENDING
THAT'S COME UP A COUPLE TIMES
LIKE IF YOU'RE ATTENDING IS NOT
A PARTICIPANT AND WON'T REFER
YOU OFF SO SHOULD IT HAVE TO BE
AN ATTENDING PHYSICIAN TO YOU.
OR YOUR PHYSICIAN IS ABLE TO
GET VERY LITERALLY LIKE IT'S
CARRIED THEIR PHYSICIAN YEAH SO
THAT IS. PROBLEMATIC LANGUAGE
IN THE- BILL- BELIEVE IT'S IT
DEFINES THE ATTENDING PHYSICIAN
AS THE PHYSICIAN THAT HAS THE-
THE PRIMARY RESPONSIBILITY FOR
THE PATIENTS HEALTH CARE AN
UNDERLYING CONDITION. I'M
PARAPHRASING BUT THAT'S PRETTY
CLOSE TO WHAT THE LAW SAYS. AND
THAT THAT'S PROBLEMATIC BECAUSE
SO MANY PEOPLE'S P. C. PEAS OR
ONCOLOGISTS OR WHOEVER IT IS
THAT'S THEIR PRIMARY PHYSICIAN
IS DOING THIS. AND SO THEN IF
THEY REFERRED TO ME IN A
MEETING FOR THEM FOR THE FIRST
TIME. YOU KNOW I'M NOT GONNA
TAKE THE EXTRA TIME MAKE THEM
WAIT EVEN MORE FOR ME TO
ESTABLISH A RELATIONSHIP WITH
THEM BEFORE SAYING NOW I'M
ACCEPTING YOUR VERBAL REQUEST.
SO THAT THAT IS PROBLEMATIC
LANGUAGE AND IN THE BILL FROM
THAT WAS. WAS PART OF THE
NEGOTIATIONS TO GET IT TO GET
IT DONE AS A SAFEGUARD YET
CENTER WALKING INTO. YEAH I
THINK THAT THIS OPPORTUNITY FOR
AN ORDER. SO IT THAT'S IN THE
IDEAL WORLD THAT'S WHAT IT IS
BUT MAYBE THIS IS OPPORTUNITY
FOR OR SO IF THE IF THE PATIENT
IF THE PHYSICIAN IS NON. UP
PARTICIPATING THAT IT COULD BE
OR F. IS A PARTICIPATING
PHYSICIAN. SO THAT BECAUSE I AS
UP SOMEONE WHO. VALUES
CONTINUITY OR A PATIENT WHO IS
AFRAID THAT THEY'RE GOING TO
LOSE. THE CONTINUITY OR
PHYSICIAN THAT THEY HAVE. A
LOYALTY RELATIONSHIP WITH YOU
ACTUALLY DO WANNA PRESERVE
BATON AND I'VE HAD PEOPLE THAT
HAVE COME TO ME AND THEY
THEY'RE WORRIED THAT THEY'RE-
FICTIONAL BAND. AND WE TRY AND
WE CHAT TRAIN PRESERVE THOSE
RELATIONSHIP IMPROPER IMPORTANT
RELATIONSHIPS AT THE AND FLY.
AND NOT MY TAKE YOUR TIRE
RESTED FAMILY IN OF. LIKE DO I
HAVE TO LEAVE YOU NOTES. ON
PRESS THAT SOME THIS AN ARE YOU
NEEDING. TO USE IN ALL. GIVE
HER. TO JUST EXT. ROBERT
DOCTORS FEEL OF THE THIS. WHAT
I PERCEIVE TO BE THIS GO THAT
EXISTS. FAMILY PROVIDERS AND
THIS THE ONCOLOGISTS THE FOLKS
THAT ARE THAT ARE THE GENERAL'S.
FIGHTING THAT DISEASE THERE'S
JUST IT SEEMS TO ME JUST A
TREMENDOUS GULF AND BLESS THE
FAMILY PROVIDERS THE FAMILY OF
PHYSICIANS AND THE ASSOCIATION
FOR. AN WELL BEING CONFRONTED
WITH HIS AND DEALING WITH THIS.
I WAS INTERESTED WHEN YOU
TALKED ABOUT THE FACT YOU'RE
TEACHING ROLE- WITH THE
RESIDENTS. THERE NEEDS TO BE A
LOT MORE I MEAN DO YOU DO THIS
BECAUSE YOUR SYSTEM. REQUIRES
IT OR DO YOU DO THIS JUST
BECAUSE- YOU HAVE EXPERIENCE
AND THINK THIS IS AN IMPORTANT
THING FOR THE RESIDENTS TO
LEARN. THE LATTER- SO ME AND MY
TWO TWO COLLEAGUES THAT I WORK
WITH WHO ARE ALSO PARTICIPATING
WE ACTUALLY SPENT ABOUT A YEAR
YEAR AND A HALF. KINDA LEARNING
THIS IN GOING TO PATIENTS AMONG
US OUT BEFORE WE EVEN OPENED IT
UP TO THE RESIDENCE HE FELT
COMFORTABLE- DOING IT THERE IS
THE RESIDENTS WERE ASKING FOR
IT- SO WE OPENED IT UP TO THAT
AND CURRENTLY I'M MORE ACT AS
AIR TRAFFIC CONTROL. AMONG
PATIENTS TO THE RESIDENCE
TEACHING THEM BUT ALSO KIND OF
GIVING THEM EXPERIENCE HANDS ON
EXPERIENCE WITH PATIENTS THAT
THEY FEEL COMFORTABLE WHEN THEY
GRADUATE. HELLO PLEASE YES
CONTACT FAR I WAS JUST GONNA
SAY WE'VE BEEN TEACHING AT THIS.
FOR THE TEACHER OF FAIR
MEDICINE BECAUSE NEW YORK IS IN
US BUT HAS WRAPPED RAMPING UP
IN- COLORADO HAS BEEN THE
ANYONE WHO'S RECENTLY PASSED
HAS RESIDENCY PROGRAMS OF
COURSE OREGON HAS BEEN TEACHING
IN ITS PROGRAMS AND WASHINGTON.
SO WE'VE BEEN BAND TOGETHER TO
TRY TO FIGURE OUT HOW CAN WE DO
SOMETHING THAT ACTUALLY MEETS
THE CRITERIA FOR BEST PRACTICES
IN TEACHING SO THAT'S ACTUALLY
GOING ON AND BRIAN'S PER MINUTE
HE'S WORKED WITH SOME OF THOSE
PEOPLE AND IT'S OFFERED. SOME
OF THOSE MATERIALS STELLAR.
LIKE EVERY ELSE ONE OF THE BACK
BACK. TO BE ABLE TO MOVE THIS
FAMILY MEDICINE I DON'T THINK
THAT IT'S ACCURATE TO SAY THAT
ONLY FAMILY PHYSICIANS ARE
PRESCRIBING THOUGH AT STANFORD-
NEUROLOGISTS ARE PRESCRIBING
ONCOLOGISTS ARE PRESCRIBING
IT'S VERY INDIVIDUAL HOW PEOPLE
SEE IT. WITHIN THEIR PRACTICE
IF YOU MOVE FROM HERE TO CARE
IF INDIVIDUALS SEE IT AS PART
OF THEIR PRACTICE SO I DON'T.
AND PALLIATIVE CARE LIKE SOME
OF THE PALLIATIVE CARE PEOPLE
ARE LEFT DON'T WANT TO DO IT
BUT SOME OF EMBRACE DEBT. AS
HOW THEY SEE IT AS AS IN THE-
INNER FOR TWICE I WOULD BE
HESITANT TO. TO CARVE IT OUT I
THINK THE REASON FAMILY
MEDICINE HAS BEEN- EMBRACING IS
BECAUSE IT IS A MOVE IN GENERAL
TO MOVE CRUCIAL CONVERSATION.
THE TOP TO THAT WOULD HAVE.
THIS REFERRALS. PAL CARE IS IN.
IN THE- IN THE TWO. FOR HOT
TAKE OF PEOPLE IN THE WAY THE
THEY MOST DESIRES TO BE MORE
PATIENT CENTERED THAT'S I THINK
THAT'S WHAT'S HAPPENING IN
PRIMARY CARE IN JAIL. GENERAL
INTERNAL MEDICINE TO IS HAVING
THE SAME CONVERSATION. THANK
YOU. SIDE INTERNET FOR YOU. IN
YOUR CONVERSATION YOU MENTIONED
THAT MEDICARE DID NOT- COVER
THE FINAL VISIT. WHAT IS AN
APPROXIMATE COST- TO
INDIVIDUALS. AND I KNOW IT CAN
BE A BROAD SPECTRUM BUT IT'S A
BRAND IT'S A BRAND NEW LOT BY
THE WAY THAT'S RESTRICTING IN
AGAIN AND YOU'LL HEAR MORE
ABOUT THEM THAT THE RESTRICTION
ON IT BUT- IT VARIES BECAUSE IT
DEPENDS A LOT ON THE ON THE
PHYSICIAN BUT WE HAVE THE CALL.
THE MEDICATIONS DOWN TO ABOUT
FIVE HUNDRED DOLLARS MORE OR
LESS ENDED IT GONE UP AT ONE
POINT TWO THOUSANDS BY THE
MEDICATIONS HAVE SHIFTED AS WE
UNDERSTAND OF MORE THE
PHYSIOLOGY OF WHAT WORKS BEST
FOR- COMING XIN OF THINGS TO
HAVE. CONSISTENT SEDATION AND
RELIABLE FAST- DEATH. TO BE
EXCEPT X. IN THAT IS FEDERAL IN
WHEN YOU GO INTO CLINICAL STUFF
LIKE HOW IS THAT GOING TO COME.
IN THAT'S MY KEEP TALKING NAY
YOU'RE TALKING FEDERAL LAW
FEDERAL LOCK FEDERAL MEDICARE
FEDERAL MEDICARE CORRECT OKAY.
SO IN A PROCESS OF THEM I GUESS
NOT UNDERSTANDING. THE
CONTINUED CARE COST- I JUST
DON'T UNDERSTAND THE THINKING
THAT GOES ALONG WITH THIS WHEN
WE TALK ABOUT DIGNITY BUT WE
ALSO TALK ABOUT HEALTHCARE
COSTS. AND YOU KNOW IT END OF I
UNDERSTAND THE MACHINE
SOMETIMES. BUT AGAIN I THINK
THAT THROUGH OUR ROLE. AB SURF
AS TO THE CHAIRS EFFORTS AND
WHAT NOT THAT THERE MIGHT. BE A
REQUEST THROUGH A RESOLUTION-
EGGMAN ALL AGING THAT THIS IS
ONE OF THE FASTEST SERVER. NAME
PRODUCER- HARMFUL TO- WHAT IT'S
TRYING TO ACCOMPLISH IN AND MAY
BE PREVENTING- AN OPPORTUNITY
FOR PEOPLE TO HAVE A- IN A
WONDERFUL WITH THEIR END OF
THEIR LIFE SO I. YOU BRING THAT
UP YEAH I THINK IT IS AN
IMPORTANT POINT TO NOTE THAT
EXPLICITLY BANNING YOUR
INSURANCE COMPANY FROM- FROM
FROM REIMBURSING FOR THESE
SERVICES. PUTS IN EXTRA ONUS ON
THE PATIENT AND GOES TOWARDS IT
THIS IS THE YOU KNOW HOW PEOPLE
WITH HIGHER SOCIOECONOMIC
STATUS ARE GONNA BE ABLE TO
ACCESS THIS RIGHT MORE. THAN
PEOPLE OF LOWER SOCIO ECONOMIC
STATUS WE DO A LOT OF SHOWS US
TO. HE AND INSIDE IT SAID DONE
TO THE BANNING ON TITLE USING
TITLE TENNIS TEN FUNDING. IT'S
AN AYE DOWN. AND WHEN AND WHEN
DID THIS GOING TO AFFECT US
JUDGE. I THINK WHAT UP I'LL
DEFERRED THE HOSPICE BUT- SO. A
NOTE ON. GOVERNOR BROWN DID
AUTHORIZE THE USE OF MEDI CAL.
PRESUMABLY THAT SOMEBODY WHO
HASN'T REACHED THE AGE OF SIXTY
FIVE BUT WHO IS SUFFERING FROM
A TERMINAL ILLNESS AND THAT IS
NOT FEDERAL MEDICAID HOW
DOLLARS THOSE ARE OUT OF OUR
GENERAL FUND CALIFORNIA DOLLARS
TO. RESPECT THAT FEDERAL
PROHIBITION ON THAT THAT LEVEL
OF ACCESS I THINK IS IMPORTANT
TO INCLUDE AS AS WE HAVE THIS
CONVERSATION YEAH I WANTED TO
JUST POINT OUT THAT WHEN THE
LAW PASSED AWAY THIRTY DOING
EDUCATE IN THE SAFETY NETS THAT
WAS AN INTERESTING THING
BECAUSE THE SAFETY NET CLINICS
WHICH TAKE MEDICAID- A UNIQUE
MEDI CAL WE'RE NOT AWARE OF
THAT AND THOUGHT THAT THE BAND
WAS THE SAME WOULD BE THE SAME.
AND WHEN THEY FOUND THAT WAS
NOT THE CASE. THAT THAT WHEN
THEY'RE PROVIDERS BECAME
INTERESTED IN HOW COULD THEY
THEY ARE. OKAY THANK YOU THANK
YOU ALL VERY MUCH FOR YOUR WORK
THANK YOU YOU. NEXT IS THE
HEALTH SYSTEMS PANEL. I'M GOING
TO HEAR FROM A KAISER NORTH AND
CITY OF HOPE. DAVID KAT AND
DOCTOR CHANDA JUNGLE. THANK YOU
VERY MUCH. WHO WHO HAVE
RELATING FIRST AWESOME THANK
YOU SO THINK YOU TO YOU
CONGRESSMAN EGGMAN AND ALSO
ALSO THE COMMITTEE MEMBERS DO
YOU GUYS HAVE BOOKED SO
DILIGENTLY AT PASSING SOMETHING
SO CRUCIAL I'M HOPING TODAY NOT
ONLY JUST ECHOING WHAT ALL MY
COLLEAGUES HERE HAVE SAID BUT
ALSO MAYBE PERHAPS. TRYING TO
OFFER SOME SOLUTIONS FROM THE
PHYSICIAN WHO ALSO SITS AS AN
ADMINISTRATOR AT CITY OF HOPE-
IN BRINGING SOME PERSPECTIVES
TO LIGHT SO- IT IS A PRIVILEGE
FOR ME IN AN HONOR TO BE
SITTING THAT EVERYBODY HERE IN
THIS ROOM I FEEL I'M IN THE
COMPANY OF SAFE FRIENDS
ACTUALLY COMPARED TO A LOT OF
THE HEALTHCARE WORLD OUT THERE
THAT DOES NOT DO THIS OPTION AS
A VERY ABOUT THAT OPTION FOR
OUR PATIENTS. I'M SUMMIT
TRAINED POSITIVE IN HOSPICE
POSITION AT CITY OF HOPE I'VE
BEEN THERE OVER FOUR YEARS AND
ACTUALLY WITH THE LAST FOUR
YEARS I'VE HAD MULTIPLE I AM IN
MULTIPLE ROLES THERE SO. ONE OF
THE RULES THAT I'M VERY. ABOUT
THE I ACT IN THE CHAIR OF THE
IN OF LIFE OPTION EXCEPT
COMMITTEE. AND DOCTOR PATEL WHO
JUST LEFT US IS OUT A DEAR
FRIEND OF MINE AND WE HAVE A
VERY HARD TO GET. THE LOA ACT
HERE REALLY VERY PRESENT IN OUR
INSTITUTION AND I WOULD LIKE TO
SHED SOME LIGHT ON HOW WE
ACTUALLY CAME ABOUT. DOING THIS
SO AS MOST OF YOU KNOW CITY OF
HOPE IS A CANCER CENTER LITTLE
LEAGUE EAST OF LOS ANGELES. AND
IT IS A CENTER THAT DEALS WITH
MOST ADVANCE AND COMPLEX
CANCERS IT IS ALSO A TRIAL
CENTER. SO IN A SITUATION OR AN
INSTITUTION THAT ACTUALLY HAVE
SO MANY TRIALS- GOING ON TO
ADVANCE. CURED OF CARE FOR
CANCER IN OF ITSELF IT'S A
CHALLENGE TO PRESENT SOMETHING
LIKE THE END OF LIFE OPTION. TO
THE POSITIONS THAT ARE
PARTICIPATING IN THESE TRIALS
BUT I'VE BEEN FORTUNATE TO SAY
THAT OVER THE LAST FOUR YEARS
WE HAVE SEEN SUCH. GROWTH IN
TERMS OF THE COMPASSION AND
UNDERSTANDING TO ASSIST LAW
BECAUSE OF THE WORK YOU'VE
DONE. AND I'M HOPING SOME OF
THE PROCESSES THAT WE'VE PUT
INTO PLACE APTLY CAN BE
IMPLEMENTED THOUGHT OTHER
INSTITUTIONS THAT MIGHT. MIGHT
NEED THE SPORT- WHEN I CAME ON
AS- YOU A SUB COMMITTEE CHAIR
WHICH SITS ON THE ACTUALLY. THE
ETHICS COMMITTEE IT WAS ALREADY
A BLESSING- MOST INSTITUTIONS
HAVE POSITION. DURING THIS
INDIVIDUALLY OR ON THEIR OWN.
AT CITY OF HOPE WE ACTUALLY
FORMED A STEERING COMMITTEE
THAT SETS UNDER THE ETHICS
COMMITTEE. JUST PART OF THE
MEDICAL EXECUTIVE COMMITTEE
ACCESS WHO YOU LIKE THIS.
BOTTOM THE- RESPONSE. I HAVE A
ACTUALLY WORKING TO ENSURE.
THAT THE STEERING COMMITTEE.
APPROVED MEMBERS ON AT THE WILL
NOT THOSE BARRIERS TO THIS LAW
BUT ACTUALLY ADVANCE THIS LAW.
PATIENTS THAT ACTUALLY NEEDED
WE- FROM THE ONSET VIEW CREATED.
STE EDGE. PROGRAMS OF V.
DECIDED TO SURVEY OUR
PHYSICIANS TWICE NOT JUST ONCE
MANY STATIONS HAVE. NOT YET
SURVEYED MOST OF THE POSITIONS
BUT SERVING THE PHYSICIANS TO
REALLY GET THEIR THOUGHTS ARE
THAT POSITION ON THIS ACT. ARE
BASED ON THE RESULTS BE GOD AND
AS YOU CAN IMAGINE IN THE
CANCER CENTER WHERE MOST OF
THEM. HAVE DECLINED TO
PARTICIPATE. WE ACTUALLY CAME
UP WITH A GROUP OF PHYSICIANS
THAT ACTUALLY WILL CHAMPION
THIS EFFORT AND THESE ARE THE
POSITIONS. A HANDFUL OF THAT
THAT HAVE BEEN CHAMPIONING THIS
THROUGHOUT THE ENTIRE
INSTITUTION. WE HAVE THE
DILIGENTLY TO CREATE EDUCATION
PROTOCOLS READ BE TASKED.
PHYSICIANS IN THE STEERING
COMMITTEE YOU TO GO AND-
EDUCATE EACH AND EVERY
DEPARTMENT AT. AT CITY OF HOPE
ABOUT THE OPTION ACT. UP A LOT
OF MISUNDERSTANDINGS WILL
CLARIFIED BY DOING THIS AND A
LOT OF MORE. POSITIONS WERE
OPEN TO REFERRING THAT PATIENTS
AND PARTICIPATING IN. THE ACT
ITSELF- PART OF THE
SUBCOMMITTEE IS ALSO ADDRESSING
THE OUT HALF THE SAYS LOOKING
AT THE LAW LOOKING AT THE
POLICY IS. LOOKING AT WAYS HOW
WE CAN ACTUALLY REALLY MAKE IT
BETTER NOT ONLY FOR PATIENTS
BUT MAYBE WHAT THE
INSTITUTIONS- SUCH AS
COMPASSION SHORTER THAN UP
INSTITUTIONS THAT ACTUALLY.
ACTUALLY PROVIDE MOST LAW. UP
THE PATIENTS THAT NEED IT. ONE
THING I WILL SAY IS. THAT. AS A
PHYSICIAN SITTING HERE I AYE
OLD LIKE TO THINK THE- HEALTH
SYSTEMS CAN EXIST FOR POSITION.
AND PART. AND PRACTICES EXIST
WITHOUT THE- UP MOST OF PLEASE
SO I FEEL THE ROLE OF HEALTH
SYSTEMS IS REALLY- TO. OFFER
THE BEST PRACTICES THAT BE CAN
AS AS HUMANS TO PATIENTS THAT
ACTUALLY NEEDED I LOOK AT
MADISON. FROM MY OWN EXPERIENCE
HAVING INTERNET AFTER MY FATHER
DIED IS NOT AS AS A PROFESSION
BUT AS A- AS A HUMAN ACT THAT.
IF WE ARE CAPABLE OF PROVIDING
THIS SERVICE OR THIS ASPECT OF
THE POSITION WE SHOULD BE
PROVIDING THIS TO ALL OF
PATIENTS AND ONE THING I'VE
REALIZED IS ABOUT A PHYSICIAN
IS THAT. THESE PATIENTS THAT
THAT OUR TERMINAL THAT ARE.
REALLY STRUGGLING EVERY DAY
ONCE HEY ALLEGE A BALL AND
HOSPICE. TO AVAIL THEMSELVES TO
THIS ACT THEY DON'T CHOOSE TO.
TO DO THIS JUST OUT OF THE BLUE
IF PART ABOUT IT THE PART ABOUT
HOW THEY WANT TO DIE THEY DON'T
THEY'VE TALKED ABOUT. HOW THEY
WANT TO LIVE THE LAST FEW DAYS.
I'M AS PHYSICIANS I FEEL LIKE
THERE'S STILL A LOT OF CONTROL.
IN TERMS OF HOW YOU WANT TO
PATIENTS TO DIE I THINK
PHYSICIANS HAVE A LOT OF
LEARNING TO DO AND GIVING UP.
CONTROL PLAGUE. OR SUBJECT THE
PATIENTS DO THEIR VIEWS OF
INDIGNITY. MAN AT ONE OF THE
THINGS I FEEL IS THAT THESE
PATIENTS- THEY JUST WANT TO DIE
A PIECE THAT AND THAT IS WHAT
WE HAVE TRIED TO MAKE POSSIBLE
AT CITY OF HOPE. WE B. S. IN
THE COMMITTEE WE RECRUIT VERY
ACT. PROGRESS BE AND THE WE DO
THAT IS EDUCATE AND OUT THE-
THAT'S OF HOPE FOR A- IS
ACTUALLY VERY. UNIQUE IT'S AN
IT'S VERY BUT AT ALSO HAS ROOMS
IMPROVE. BEHALF DO. SOCIAL
WORKERS THE HAVE BEEN I. JUST
TO LEAD THE END OF LIFE OPTION.
SO ANYTIME HAVE PATIENTS OR
PHYSICIANS ASKING FOR THE END
OF LIFE OPTION ACT. THE FIRST-
DEAD THE SOCIAL WORKERS GOT TO
EDUCATE THESE THESE PATIENTS-
AFTER THEY EDUCATE THEM ON THE
OFTEN WORK WITH PHYSICIANS TO
DETERMINE THE PROGNOSIS. AND
THEN WE REFER THEM TO
PHYSICIANS THAT ARE
PRESCRIBERS. MY DEAL LIKE
DOCTOR PATEL SAID THAT THERE'S
STILL A DEARTH OF PHYSICIANS
THAT ACTUALLY PRESCRIBED THEM
THESE OF POSITIONS- THAT ON
COLLEGES- EVEN COLLEGES AND
OTHER PHYSICIANS AT CITY OF
HOPE THAT REALLY ARE NOT
COMFORTABLE. IN PRESCRIBING OR
PARTICIPATED IN THIS ACT AND SO
IT FALLS IN FEW THAT THAT ARE
PARTICIPATING TO ACTUALLY DO
THE FIRST FOUR OF THOSE AND THE
SECOND FOR BILLS RARE. AS WE'VE
HEARD THAT REALLY BECOMES AN
ISSUE THE WAITING IT IS AN
ISSUE BECAUSE OF THAT- ONE OF
THE THINGS WE'VE DONE IS
ACTUALLY WE'VE CREATED NOW
MATERIALS AND MULTIPLE
LANGUAGES AND THEY'RE TRYING TO
EXPAND THAT FIFTEEN SPANISH BIT
ON KOREAN. A BASED ON REALLY
CASH AREA THAT SERVES SO THAT
THE DOCTOR SPEAK TO THE
POPULATION. AND ENVY ARE TRYING
TO WORK WITH OUR LEGAL TEAM OF
WHICH AS WE KNOW MULTIPLE
EAGLE- THE LAW IS INTERPRETED
IN MULTIPLE WAYS AND MULTIPLE
INSTITUTION. AND WORKING ON THE
TEAM ACTUALLY. ASK EARNED AS
POSSIBLE SO ONE EXAMPLE. OF USE
THAT REPEATED I ASKED LEGAL
SUPPORT AND- YOU KNOW THAT
THING IN LOS SAYS I AS A- KID
BRING UP. LAW DUE TO THE
PATIENT. I HAVE REPEATED BEEN
TELLING OF THE LAWS VERY CLEAR
ABOUT THE- AND SO THIS IS MY
NEXT MISSION IN. SHARING THIS
OF COULD IS TO TAKE THIS A UP
TO. THING IT IS. IT. ACT NOT IN
THE LAW AND BE. TO THIS UP AS A
HUMAN BECAUSE MEAN IT FOR ME IT
CAN DOWN TO. BEING TRANSPARENT
BUT I. GIVING THEM ALL AND FOR.
AND I THINK THE BIG BARRIER IS
THAT IF ARE. INHABITED TALKING
TO THEM OF. ALL OF END OF LIFE
OPTIONS WE ARE COME. THE WE ARE
NOT EVEN TO WHAT'S ON PINNACLE
I THINK THERE'S A LOT HEAD AND
THERE MY OTHER ROLE ACT. IS
BESIDE BEING A PUTZ POSITION
AND THE END OF LIFE OUR ACTS ME
IS ACT. THE DIRECTOR OF
GRADUATE MEDICAL EDUCATION- AT
CITY OF HOPE- AND EDUCATION IS
EXTREMELY PASSIONATE FOR ME NOT
JUST IN. ECOLOGY CATION BUT
ALSO END OF LIFE EDUCATION. I
DON'T FEEL THAT WE SHOULD LET
ANYONE GO THROUGH THE MEDICAL
EDUCATION SYSTEM WITHOUT
LEARNING AS MUCH ABOUT DEATH
AND DYING AS THE- ABOUT. GIVING
BIRTH ANTI CARE OF XIN. ARE I
I'VE- THAT. IN MY I WROTE A
PAPER LAST YEAR THAT THERE'S
THAT SAID THAT IF WE TEACH SO
MUCH ABOUT GIVING BIRTH. AND
WRITING DEATH CERTIFICATES THE
FAMOUS SO MUCH OF IT THAT'S IN
BETWEEN AND THAT'S WHY I PUT
THE MISSION THAT. WE SHOULD NOT
BE LETTING ANYONE DIE WITHOUT
HAVING EXTENSIVE DEBT
CONVERSATIONS WITH THEM I THINK
WE HAVE TO NORMALIZE DYING WE
HAVE TO NORMALIZE THE FACT
THAT. YES BE A 100% EACH ONE OF
US GOING TO DIE AND THAT WE
NEED TO HAVE CHOICES WE NEED TO
KNOW HOW WE WANT TO DIE. WE ALL
WILL DIE IT'S I FOR. ONE THAT
NOTE SIDE. OF THE PRIVILEGE
ONCE THE LUCKY. THEY ACTUALLY A
CHOICE THEY WANT TO DIE. THAT'S
THE UNFORTUNATE ONES THAT HAVE
STRATEGIES BY ACCIDENT THAT
SUDDENLY THE LIGHTS A CUT SHORT
THAT. DON'T EVEN GET THE
OPPORTUNITY TO ACTUALLY DECIDE
THEMSELVES A HOT CONVERSATIONS.
HELLO YEAR I'M I CREATED THE
AND THE FLY. SOME AT CITY HOPE.
I THINK CANCER CENTER THAT
ACTUALLY DOES NOT TALK ABOUT
DEATH AND DYING. IT WAS THE
FOR. ONE EVER IT'S OF HOPE IN
ITS HISTORY. OF AND WHICH HOW
OF. GETTING GETTING HELP FROM
CNC. TO PUTTING TOGETHER AND
END OF LIFE OPTION ACT PANEL
BUT ALSO NOT JUST STOP TALKING
ABOUT. EVERY ASPECT OF IN THE
FLY FROM SEVEN THIRTY IN THE
MORNING TO SIX THIRTY IN THE
EVENING. I WILL BE PROUD TO SAY
THAT AT THE END OF THE DAY IT
OF A MORE THAN TWO HUNDRED
PEOPLE STILL SITTING THERE. AND
PARTICIPATING IN THE SYMPOSIUM
TO THE FACT THAT THERE WAS THAT
THE INSTITUTION HAS RECOGNIZED
ITS- ITS EXCELLENCE AND HAS
INDICTED NOW FOR FIVE YEARS. SO
WE WILL CONTINUE THIS
CONVERSATION ON MULTIPLE BILLS.
AT IT IS OPEN EVERYONE ACROSS
THE NATION TO ATTEND- ONE OF
THE THINGS I FEEL VERY STRONGLY
AS A PHYSICIAN IS THAT THAT
THIS NOT ONLY NEEDS TO BE DONE
AT THE RESIDENT. AND FELLOWS
LEVEL AS I WILL BE IMPLEMENTING
IN MY OWN INSTITUTION. BUT IT
NEEDS TO BE TAUGHT AT THE LEVEL
OF MEDICAL STEEP. THESE ARE
PEOPLE THAT FEAR TRAINING. TO
WORK HUMANS. AND THAT AND
THERE'S REASON THAT I'M- STE.
SHOULD NOT STOCK THE STE FROM
EARLY ON. THERE IS A DOES
HAVING THROUGH MANY SCHOOL A
DOES OF. REALLY CA. THAT
ACTUALLY EVEN. COVERS POSITIVE
OR END OF LIFE ISSUES I THINK
THAT'S SOMETHING MEDICAL
SCHOOLS AND THE SOCIETY SHOULD.
STRONGLY LOOK AT. THE OTHER
THING I WILL SAY IS THAT I KNOW
LAST YEAR THE MEDICAL- BOARD
ACTUALLY IN CALIFORNIA. SAID
THAT ANY PHYSICIAN WHO HAD A
LICENSE UP TO TWENTY SEVENTEEN.
SHOULD BE LOOKING TO GET AT
LEAST TWELVE- CREDITS OF
CONTINUING EDUCATION AND
DEFLECTED GOV END OF LIFE
PATIENTS END OF LIFE CARE ALSO
IN TERMS OF OPIOIDS- I FEEL
LIKE WITH OUR SYMPOSIUM AND MY
TRAINING FOR. GUIDANCE FOR OUR
FELLOWS AND RESIDENTS WE ARE
MEETING THAT. BUT I THINK THIS
IS SOMETHING THAT SHOULD BE
MANDATED AT ALL- ALL
INSTITUTIONS- TO MAKE SURE THAT
THEIR- THEIR PHYSICIANS
ACTUALLY HAVE THAT END OF LIFE
CARE TRAINING. I'M I FEEL AND
PHYSICIANS BE OFTEN GET SO BUSY
AND WRAPPED UP NOT ONLY VERY
PRACTICES THAT BEHALF BUT OUR
OWN PERSONAL FAMILY LIVES AND
REALLY. THAT THE DUTIES WE HAVE
BESIDES BEING POSITIONS. I
THINK SOME OF THESE THINGS IF
THEY'RE NOT REALLY. MAN BY BY
IT REALLY LAW EVEN IS TO YOU.
THEY WILL NEVER BE LOOKED AT
AND EVEN REMAIN SUBLET. ONLY TO
THE PINNACLE THE ICE RUBIO I
FEEL THAT. WE AS AS A SOCIETY
IN TERMS OF THE THERE ARE
MULTIPLE BARRIERS THAT BEGIN
BEGIN- OVERCOME. I THINK
PROVIDE A PARTICIPATION IS A
BIG ISSUED MEANT INSTITUTION
AND THAT'S A BIG ISSUE
ELSEWHERE I THINK EDUCATION
EDUCATION EDUCATION AND
COMPASSIONATE EDUCATION IS THE
KEY TO THAT- I HAVE OFTEN SAID
THAT THAT THAT THEIR SYMPOSIUM
I AM HAPPY TO PARTNER BUT- THE
GOVERNMENT'S THE STATE. WITH
THE REALLY ANYONE TO REALLY
TAKE THIS TO RURAL AREAS
BECAUSE I DO SEE PATIENTS THAT
COME FROM FAR AWAY THAT THAT DO
NOT HAVE ACCESS TO THIS
INFORMATION. AND PROVIDERS
DON'T HAVE THAT ACCESS THE
PATIENTS WILL NEVER HAVE THAT
ACCESS OR OR INFORMATION- WE
BELIEVE THAT YOU KNOW OUR
INSTITUTION AS BEHIND IN
TELEHEALTH EXPLORING ABOUT
OPTIONS AND THAT IS SOMETHING
BE OF BE LOOKING TO PUSH IN OUR
INSTITUTION AS WELL. THE OTHER
THING IS THERE HAS TO BE-
REALLY CULTURAL CHANGE WITH
EVERY INSTITUTION FACING THAT
YOU KNOW WHEN YOU ARE FACED
WITH COMES BUT WITH PATIENTS
THAT HAVE PRO PROGNOSES AND
THAT A HOSPICE ELIGIBLE WHICH
IS ONE OF THE CRITERIA IS. UP
YOU HAVE TO START THIS
CONVERSATION AT THAT POINT AND
NOT WHEN THEY HAVE. A FEW DAYS
LEFT BECAUSE MOST OF THEM AS WE
SEE DO NOT EVEN GO THROUGH THE
PROCESS I CANNOT MAKE IT TO THE
PROCESS. ONE OF THE THINGS THAT
ALSO NEEDS HAPPEN IS THE- I
THINK A V. ALL AS A AS A TEAM.
AS A TEAM IN THE TO DECIDE THAT
YOU KNOW THIS IS NOT SOMETHING
THAT JUST POSITION SHOULD BE
ALLOWED TO PRACTICE. THERE IS
YET ANOTHER SET OF VISIT OF A
PROVIDERS NURSE PRACTITIONERS
PA'S THAT ARE AS AS EDUCATED
AND ASK CAPABLE OF DOING THIS
SO BY ADDING THOSE PEOPLE TO
PARTICIPATE IN BEING PROVIDERS
AND PRESCRIBERS. WE WILL
ACTUALLY EXPAND THE SCOPE IN
THE HORIZON OF THIS LAW-
THERE'S A LOT THAT THIS LAW HAS
BROUGHT THERE'S A LOT THAT YOU
CAN CHANGE TOGETHER AND MY
PLEASE THAT HOPEFULLY VEAS
PROVIDERS INSTITUTIONS CAN WORK
WITH YOU. TO MAKE IT HAPPEN.
AND WIESE WELCOME YOUR IDEAS
ABOUT EXPANDING THIS AND HOPE
THAT YOU CONTINUE TO HAVE THIS
CONVERSATION WITH IN YOUR
PROFESSION. HAS THAT'S MOST
MOSTLY THE BIGGEST STICKING
POINT IN BEING ABLE TO EXPAND
I. AM FURTHER. AND I JUST WANNA
SAY AS COMMITTEES HAPPEN PEOPLE
HAVE TO STEP OFF AND IT DIDN'T
IT'S NOTHING ABOUT WHO'S BEING
PRESENT AND I WILL BE HERE AT
THE ENTIRE TIME BUT OTHER
PEOPLE HAVE WE'LL HAVE TO.
WE'LL HAVE TO LEAVE THEM THANK
YOU THANK YOU VERY MUCH FOR
WHAT YOU'RE PROVIDING I THINK
IT'S A ESSENTIAL AND AN
EXCITING TO SEE SOMEBODY- WITH
AS MUCH ENTHUSIASM AND- AND THE
TIME AND THE VISION I THINK TO
CARRY THIS FORWARD. I DID MY-
MY DISSERTATION MISTING IS TWO
THOUSAND AND ONE SO ALMOST.
TWENTY YEARS AGO ON END OF LIFE
AND THE MEXICAN AMERICAN
CULTURE ESSAY INTERCEPTED END
OF LIFE AND ONE OF THE BIG
TAKEAWAYS WAS MORE PHYSICIAN
EDUCATION AROUND AND LIFE SINCE
THAT WAS TWENTY YEARS AGO WE'RE
STILL HAVE THAT SAME
CONVERSATION. THANK YOU. THANK
YOU SIR MORNING MY NAME IS
DAVID CONAN TIME AN INTERNIST
SERVING AS REGIONAL CO MEDICAL
DIRECTOR OF THE NORTHERN
CALIFORNIA KAISER PERMANENTE A
END OF LIFE OPTION PROGRAM. AND
ON BEHALF OF OUR LEADERSHIP
TEAM I APPRECIATE THE
OPPORTUNITY TO SHARE OUR
EXPERIENCE IMPLEMENTING THE END
OF LIFE OPTION ACT. AND SERVING
PATIENTS REQUEST MEDICAL AID IN
DYING. IN TWENTY FIFTEEN WE THE
END OF LIFE UP ACT WAS AN-
BECAUSE PERMANENTE RECOGNIZE
THAT SOME OVER EIGHT MILLION.
CALIFORNIA MEMBERS OF WANT TO
AVAIL THEMSELVES OF THIS OPTION
AND WOULD REQUEST MEDICAL AID
IN DYING FROM US. AND OUR
MISSION OF PROVIDING
COMPREHENSIVE CARE TO OUR
MEMBERS LED US TO DECIDE TO OPT
IN AS A HEALTH CARE SYSTEM.
ONCE THAT DECISION WAS MADE OUR
GUIDING PRINCIPLES FOR OUR
PROGRAM BECAME CLEAR. FIRST IN
NO PATIENT WOULD CHOOSE MEDICAL
AID IN DYING DUE TO AN
INABILITY TO ACCESS HIGH
QUALITY HOSPICE AND PALLIATIVE
CARE SERVICE. SECOND WE WOULD
HONOR OUR PHYSICIANS AND STAFF
CHOICES TO PARTICIPATE OR NOT.
AS AN INTEGRATED SYSTEM WITH A
LARGE MEDICAL GROUP WE KNEW
THAT WE COULD DEVELOP A STRONG
PROGRAM BECAUSE WE HAVE ENOUGH
PHYSICIANS AND STAFF TO ALLOW
CHOICE AND PARTICIPATION. AND
WE HAVEN'T THE INFRASTRUCTURE
THAT WOULD ALLOW FOR SMOOTH AND
SUCCESSFUL OPERATIONS. WE ARE
PROUD TO REPORT THAT 99% OF OUR
PATIENTS WHO QUALIFY TO HAVE A
PRESCRIPTION WRITTEN UNDER THE
LAW OUR ON HOSPICE HAVE HAD A
PALLIATIVE CARE CONSULTATION OR
BOTH. AND THAT WE HAVE HAD
ENOUGH PROVIDERS OPTING IN TO
ALLOW THOSE WHO OPT OUT TO FEEL
COMFORTABLE AND SUPPORTED. WE
CONTINUE TO ALLOW FOR THE
PROSPECT THAT PHYSICIANS VIEWS
CAN CHANGE OVER TIME. AND THUS
WE HAVE NOT IMPLEMENTED A ONE
TIME DECLARATION TO OPT IN OR
OUT. INSTEAD OF OUR PATIENT
COORDINATORS INVITE PHYSICIANS
TO PARTICIPATE PATIENTS BASED
ON PATIENT PREFERENCES. AND
PROVIDE AN ALTERNATE- PHYSICIAN
FOR THOSE WHO OPT OUT.
PHYSICIANS CAN MAKE THEIR OWN
PERSONAL DETERMINATION WITHOUT
WORRYING THAT THE PATIENT'S
NEEDS WON'T BE MATT. OF NOTE
ROUGHLY TWO THIRDS OF OUR
PHYSICIANS WHO REFER PATIENTS
TO THE PROGRAM ARE WILLING TO
PARTICIPATE IN SOME FASHION.
TODAY I WOULD LIKE TO SHARE
SOME OF OUR PROGRAMS ELEMENTS
THAT HAVE LED LED TO ITS
SUCCESS AS WELL AS FEEDBACK WE
RECEIVE FROM PATIENTS AND
PHYSICIANS ABOUT THE EXPERIENCE
OF PARTICIPATING. I WILL ALSO
LIKE TO SHARE SOME IDEAS UP
ABOUT OPPORTUNITIES FOR
IMPROVEMENT. FOR CONSIDERATION
BY THE COMMITTEE. ONE OF THE
KEYS TO THE SUCCESS OF OUR
PROGRAM HAS BEEN THE PATIENT
COORDINATOR POSITION. OUR
RECORDING NADER'S WORSE AN
ABSOLUTELY SPECTACULAR GROUP OF
WOMEN OUT TALK TO EACH REFERRED
PATIENT. PROVIDING AN OVERVIEW
OF THE LAW AND THE PROCESS BY
PHONE. IF THE PATIENT IS
INTERESTED IN PROCEEDING THE
COORDINATOR IDENTIFIES THE
PARTICIPATING PHYSICIANS
SCHEDULES THE APPOINTMENTS
INITIATES THE PAPERWORK AND
SCHEDULES THE MEDICATION
DELIVERY. THE COORDINATORS
THERE FOR EVERY STEP OF THE
PROCESS ENSURING IT GOES
SMOOTHLY AND PROVIDING A
CENTRAL CONTACT FOR PATIENTS
AND FAMILIES. AS WELL AS
PHYSICIANS. ALSO QUESTIONS GET
ANSWERED AND NOTHING FALLS
THROUGH THE CRACKS. BEYOND
ASSISTING THE PATIENT THE
COORDINATOR WORKS WITH THE
PHYSICIAN TO REVIEW THE
REQUIRED STEPS ENSURE THAT
DOCUMENTATION IS COMPLETED AND
CONNECT FIRST TIME PHYSICIANS
WITH A MENTOR TO PROVIDE
COACHING AND REASSURANCE. THE
COORDINATORS ARE AN ESSENTIAL
RESOURCE AND PROGRAM WE'RE NOT
BE SUCCESSFUL WITHOUT THEM. A
SECOND KEY OF OUR PROGRAM HAS
BEEN THE EXTENSIVE TRAINING
THAT WE HAVE DEVELOPED ACROSS
THE ORGANIZATION TO HELP
PREPARE PHYSICIANS AND STAFF.
THIS HAS INCLUDED COMMUNICATION
TRAININGS FOR PHYSICIANS
PHARMACISTS AND PATIENT
COORDINATORS THAT FOCUS ON HOW
TO HAVE CONVERSATIONS WITH
PATIENTS ABOUT THIS OPTION.
WE'VE ALSO DONE TO REGION WIDE
ON VIDEO CONFERENCES NUMEROUS
SPECIALTY DEPARTMENT MEETINGS
GROUND ROUNDS AND SCHWARTZ
CENTER ROOMS. EDUCATION HAS
BEEN KEY IN ENSURING
PARTICIPATING PHYSICIANS AND
STAFF PROVIDE A HIGH LEVEL OF
SERVICE TO OUR PATIENTS AND TO
ALLOW TIME TO REFLECT ON THE
LAW TO HELP INDIVIDUALS
DETERMINE WHETHER TO
PARTICIPATE AND HOW TO REFER.
TO MAINTAIN THE PATIENT
PERSPECTIVE IN OUR WORK WE
REGULARLY INCLUDE PATIENT AND
FAMILY FEEDBACK PRESENTATIONS
AS PART OF EDUCATION JUST LIKE
YOU'RE DOING TODAY. MY THIRD
IMPORTANT ELEMENT OF OUR
PROGRAM IS RELATED TO OUR
PHARMACISTS. WE HAVE TO
DISPENSING PHARMACIES IN OUR
REGION AND MORE THAN THIRTY
TRAINED PHARMACISTS THAT GO TO
THE HOME TO DELIVER THE
MEDICATION AND PROVIDE
CONSULTATION TO THE PATIENT AND
FAMILY ON HOW TO PREPARE. STORE
AND SAFELY DISPOSE OF THE
MEDICATION IF IT'S NOT
INTERESTED. A FOURTH AREA I
WOULD LIKE TO HIGHLIGHT AS OUR
EFFORTS TO PARTNER WITH OUR
PATIENTS HOSPICE AGENCIES TO
ENSURE THAT PATIENTS HAVE
SUPPORT FROM HOSPICE SHOULD
THEY CHOOSE TO INGEST. HOSPICE
HAS GREAT EXPERTISE TO PROVIDE
INCLUDING HELPING PATIENTS
DETERMINE TIMING OF MEDICATION
INGESTION. EMOTIONAL AND
SPIRITUAL SUPPORT FOR THE
PATIENT AND FAMILY AND
BEREAVEMENT SERVICES. A FINAL
KEY TO THE SUCCESS OF OUR
PROGRAM IS RELATED TO
INFRASTRUCTURE AND LEADERSHIP.
ACCESSING IN QUALIFYING
PATIENTS FOR MEDICAL AID IN
DYING REQUIRES A PROCESS AND
WORK FLOWS WE HAVE CREATED
CLINICAL WORK FLOWS THAT ARE
EMBEDDED IN OUR INFRASTRUCTURE.
REFERRALS CAN BE PLACED IN OUR
ELECTRONIC REFERRAL SYSTEM AND
DOCUMENTATION TOOLS EXIST IN
OUR ELECTRONIC MEDICAL RECORD
FOR VISITS AND MEDICATION
ORDERING. IN ADDITION WE HAVE A
PHYSICIAN AND ADMINISTRATIVE
LEAD IN EACH SERVICE AREA TO
PROVIDE SUPPORT ON CAISSONS AND
STREAMLINE OPERATIONS TO HELP
FACILITATE TIMELY PROCESS AND
COMPLIANCE WITH THE LAW. I
WOULD LIKE TO SHIFT GEARS NOW
TO REVIEW SOME OF THE FEEDBACK
THAT WE HAVE HEARD FROM
PARTICIPATING PATIENTS AND
FAMILIES. WE CONSISTENTLY HEAR
FROM PATIENTS AND FAMILIES HOW
GRATEFUL THEY ARE TO HAVE THIS
OPTION REGARDLESS OF WHETHER OR
NOT PATIENTS END UP TAKING THE
EIGHT AND ON MEDICATION. THEIR
FEEDBACK UNDERSCORES THAT THE
LAW HAS BEEN SUCCESSFUL. IN
GETTING MANY DYING PATIENTS.
THEIR THEIR WISH TO HAVE SOME
MEASURE OF CONTROL OVER THE END
OF THEIR LIFE. OUR
PARTICIPATING PHYSICIANS OF
REPORTED A GREAT SENSE OF
MEANING IN THEIR WORK. AND
THOSE THAT DON'T PARTICIPATE
ARE APPRECIATIVE THAT THEY HAVE
COLLEAGUES WHO WILL ACCEPT
REFERRALS. BASED ON FEEDBACK
WE'VE RECEIVED IN OUR
EXPERIENCE TO DATE I'D LIKE TO
HIGHLIGHT FOR AREAS WHERE THERE
MAY BE SOME OPPORTUNITIES FOR
CONSIDERATION. THE FIRST
CHALLENGING AREA IS RELATED TO
ELIGIBILITY. THE CURRENT
ELIGIBILITY REQUIREMENTS CREATE
LIMITATIONS FOR INDIVIDUALS
WITH NARROW GENERATIVE DISEASES
LIKE A ALAS. FINDING OPTIMAL
TIMING IN A SETTING OF
DECLINING MOTOR FUNCTION WHILE
STAYING TRUE TO THE REQUIREMENT
OF SELF ADMINISTRATION IS
CHALLENGING FOR THIS POPULATION
OF PATIENTS. IN ADDITION WHILE
CAUTION IS CERTAINLY WARRANTED
FOR PEOPLE SUFFERING FROM
DEMENTIA THE LACK OF ABILITY OF
INDIVIDUALS WITH DEMENTIA TO
EXERCISE THIS OPTION IS AN
AREA. OF FRUSTRATION THAT WE
HAVE HEARD IN ABUNDANCE AND IS
LIKELY INCREASE OVER TIME
GIVING OUR AGING POPULATION.
SECONDLY WE BELIEVE THAT THERE
IS AN OPPORTUNITY TO REVIEW
THAT FIFTEEN DAY WAITING HER
HEAD FROM A LEGAL AND
LOGISTICAL PERSPECTIVE AS
YOU'VE HEARD ABOUT MULTIPLE-
OCCASIONS THIS MORNING OFTEN
PATIENTS THINK THE FIFTEEN DAY
WAITING PERIOD STARTS WHEN THEY
FIRST ASKED ABOUT THE OPTION
BUT THAT. IS NOT USUALLY THE
CASE BECAUSE THE FIFTEEN DAY
CLOCK DOESN'T START UNTIL THEY
ARE MEETING WITH THE ATTENDING
PHYSICIAN. IT CAN TAKE TIME TO
CONNECT THEM WITH THAT DOCTOR.
THIS CREATES STRESS AND ANXIETY
FOR THE PATIENT. ESPECIALLY IF
THEIR HEALTH IS IN DECLINE. OUR
PATIENT COORDINATORS TELL
PATIENTS IT WILL TYPICALLY TAKE
THREE TO FOUR WEEKS TO GET
THROUGH THE PROCESS BASED ON
THE TIME IT TAKES TO IDENTIFY
PHYSICIANS GET APPOINTMENTS
COMPLETE DOCUMENTATION AND
COORDINATE DELIVERY OF THE
PRESCRIPTION. AND AS WE'VE
SPOKEN ABOUT OREGON NOW ALLOWS
THE ATTENDING PHYSICIAN TO
WAIVE THE WAITING PERIOD IF
WARRANTED. A THIRD PRACTICAL
CONSIDERATION IS REGARDING DATA
REPORTING WHICH WE HAVE FOUND
TO BE UNNECESSARILY CUMBERSOME.
INITIALLY FORMS WERE COMPLETED
BY HAND AND SUBMITTED BY FAX OR
MAIL CITY PH HAS CREATED AN
ONLINE REPORTING SYSTEM AS YOU
HEARD ABOUT JOHN IT ACTUALLY
HAS MANY KINKS THAT DO NOT MAKE
IT A PARTICULARLY VIABLE
ALTERNATIVE. AND WE WOULD
RECOMMEND ENHANCEMENTS IN THE
ELECTRONIC REPORTING SYSTEM TO
MAKE IT EASIER TO ENTER DATA
SIGN FORMS ELECTRONICALLY AND
RECEIVE SIGNED COPIES BUT FOR
MEDICAL RECORDS. LASTLY WOULD
LIKE TO CALL YOUR ATTENTION TO
THE MEDICATION. THERE HAVE BEEN
CHALLENGES WITH MEDICATION
SUPPLY. AS YOU KNOW- SEEK A
BARBER TELL IS NOT CURRENTLY ON
THE MARKET AND ALTERNATIVES ARE
ARE BEING USED. THE COST AT THE
END OF LIFE MEDICATIONS AS OF
STILL QUITE HIGH RAISING THE
QUESTION OF. WHETHER IT IS
READILY AVAILABLE TO PATIENTS
OF ALL SOCIAL ECONOMIC STATUS.
WE DO PROVIDE FINANCIAL
ASSISTANCE IN SOME CASES TO
ALLOW MEMBERS TO FOR THE
MEDICATION. DESPITE THESE
CHALLENGES KAISER PERMANENTE
HAS BEEN ABLE TO PROVIDE
EXCELLENT MEDICAL AID IN DYING
SERVICES TO OUR PATIENTS.
IMPLEMENTING A PROGRAM TO
PROVIDE THIS SERVICE IN A LARGE
HEALTH SYSTEM HAS REQUIRE
THOUGHTFUL PROGRAM PLANNING AND
IMPLEMENTATION AS WELL AS
RESOURCES. WE ARE PROUD OF THE
PROGRAM WE HAVE DEVELOPED AND
HAPPY TO SHARE OUR LEARNINGS
WITH OTHER HEALTH SYSTEMS WHO
ARE LOOKING TO ENHANCE OUR
START THEIR OWN PROGRAMS.
REALLY APPRECIATE THE
OPPORTUNITY TO SHARE OUR
EXPERIENCE WITH. I WANT TO
THANK YOU BOTH IN THE ABSENCE
OF OUR CHAIR HOMEY RETURNING
MOMENTARILY. THE PROGRAM AT
CITY OF HOPE FROM HAVING AS THE
DESIGNATED COMMITTEE JUST SEEMS
LIKE YEAR SETTING AGREE
STANDARD IN. AIRED TO SHAREIT
IN KAISER I HAD A QUESTION
DOCTOR COMMENT ON THAT PATIENT
COORDINATORS. WHO COORDINATE
WITH PATIENT APPOINTMENTS
MEDICATIONS COORDINATE WITH THE
PHYSICIAN AT WHAT POINT DOES
THAT PATIENT COORDINATOR GET
INVOLVED IS THAT BASED ON A
PHYSICIAN'S. CONSULTATION WITH
THE PATIENT THAT THEY WANT TO
PURSUE THIS THEN THE ENGAGE THE
PATIENT COORDINATOR THERE ARE
ACTUALLY A COUPLE OF DIFFERENT
PORTALS UHHUH SO WE DO HAVE- IN
OUR- ELECTRONIC REFERRAL SYSTEM
WE HAVE A PORTAL WHERE A
PHYSICIAN WHO HEARS FROM A
PATIENT THAT THEY'D LIKE TO.
EITHER LEARN ABOUT THE PROGRAM
OR FOR A QUITE SURE THAT THEY
WANT TO PARTICIPATE- THE
PHYSICIAN CAN SEND A REFERRAL.
AND THAT WILL RESULT IN A AN
INITIAL PHONE CONTACT WITH A
PATIENT COORDINATOR GENERALLY
WITHIN A DAY OR TWO. OUR OUR
OUR REGIONAL CALL CENTER IS
ACTUALLY ALSO EMPOWERED TO- TO
LINK PATIENTS TO THE PROGRAM AS
WELL IF A PATIENT CALLS UP THE
CALL CENTER. EXPRESSING AN
INTEREST IN THE PROGRAM. THANK
YOU. LET ME JUST SEE IF THEY
HAVE ANY QUESTIONS. TURNING
BACK TO MADAM CHAIR DO YOU HAVE
ANY QUESTIONS FOR NO I DON'T
THINK SO I THINK EVEN THE VERY
CLEAR- I GUESS MY ONE QUESTION
ALTHOUGH I THINK MY ANSWER IT
IN MY HEAD IS LIKE IT'S LIKE
THE ASSEMBLY AND THE SENATE
WERE WERE IN UNDER ONE DOWN BUT
WE'RE TWO DIFFERENT AGENCIES.
BECAUSE THERE'S BEEN SOME
DIFFERENT EXPERIENCE WITH
KAISER SOUTH AND THERE HAS BEEN
WITH KAISER NORTH- AND IS THERE
ARE YOU WORKING ON A BRIDGE FOR
THE DOME. SO THERE ARE ARE SOME
ELEMENTS OF OUR LEADERSHIP
STRUCTURES THAT ARE IN COMMON
AND SOME THAT ARE A BIT
SEPARATE- SO I THINK WE'RE
MAKING ATTITUDE TO COORDINATE
MORE REGULARLY WITH OUR
COUNTERPARTS IN SOUTHERN
CALIFORNIA AND TO AND TO REALLY
LEARN FROM ONE ANOTHER SENATE.
MODEL YEAH. UP OKAY ALL RIGHT
THANK YOU VERY MUCH A TWO THE
TIME THANK UP HERE HAVE A
KAISER ON THE HUGE YOU DO AND
FOR THE CITY OF HOPE WHAT A
WHAT A UNIQUE PLACE TO REALLY
DELVE INTO THIS PRACTICE THANK
YOU THANK YOU FOR EVERYTHING
YOU ALL HAVE DONE ABSOLUTELY I
WANT TO COME TO I WANT TO COME
TO YOUR YOUR- YOUR STARTING
NEXT YEAR. LIGHT TO OCCUR
HAVING A COVER TENTH OKAY.
THANK YOU THE THING ON THE HAVE
ALL OF THE. OKAY THE UK. AND
THE OFFICE OKAY SO UP THAT.
YEAH YEAH THAT CALIFORNIA'S
SENATE OKAY OKAY OKAY THANK YOU
VERY MUCH AND I AND THERE SOME
KIND WERE ABOUT OUR STE BUT
WE'RE CHECKING IN WE DON'T
THINK WE NEED TO LEAVE ROOM
SOME NEEDS TO BOARD THE YOU
WON'T GET IT'S LIKE STREAMS
EVEN IF US IN THIS HAVE TO I'LL
BE HERE MORE SURE EVERYBODY WHO
CAME TO SPEAK- GETS A CHANCE TO
BE HEARD. THE NEXT UP W HAVE
THE HOSPICE PANEL- ADD. FROM
SEASONS AUSPICE MISSION HOSPICE
IN OLYMPIA HOSPICE CARE.
WELCOME. AND I AM ENGAGE IN
ANOTHER ENDEAVOR RIGHT NOW IN
MY LIFE FORM SPENDING A LOT OF
TIME KNOCKING ON DOORS IN HOMES
AROUND THE TOOK THREE COUNTIES
AND- I FEEL LIKE A HOSPICE
WORKER AGAIN HALF THE TIME I
WALKING UP TO THE DOOR OF DOING
A QUICK ASSESSMENT I'M LOOKING
AT WHEELCHAIR ACCESS YEAH
ANYWAY WE WILL ALWAYS BE A
GOOD. REGULAR THE COMPACT OKAY.
OKAY KNOW HOW WOULD LIKE TO SEE
IF HELLO MY NAME IS ANNA SAFARI
IN AND I AM THE OWNER OF
OLYMPIA HOSPICE CARE LOCATED IN
SHERMAN OAKS CALIFORNIA FIRST
AND FOREMOST I WOULD LIKE TO
SAY THANK YOU FOR CONVENING
THIS FORM. AND ALONG WITH A
SPEAK ABOUT MY PERSONAL
EXPERIENCE WITH MEDICAL AID IN
DYING AND THE END OF LIFE
OPTION ACT WORKING IN THE
HOSPITAL THREE FOR THE PAST TEN
YEARS. I KNEW WHEN THE BILL WAS
FIRST PASSED IN TWO THOUSAND
SIXTEEN THAT WE WOULD NEED TO
MAKE A DECISION AS A TEAM
WHETHER WE WOULD BE ABLE TO
SUPPORT THE PROGRAM CAN YOU
MOVE THE MIKE A LITTLE BIT
CLOSER MAYBE. SURE OKAY THING
ON. ACCOUNT JUST CONTINUE. YEAH
SO I KNEW WHEN THE BILL WAS
PASSED BACK IN TWO THOUSAND
SIXTEEN THAT WE WOULD NEED TO
MAKE A DECISION IF WE WERE
GOING ON BREAKS THE LAW. OR
NOT. SO WHEN WE MET FIRST WITH
THE TEAM TO DISCUSS- IT WAS A
VERY DIFFICULT SUBJECT TO TALK
ABOUT. AND WE KIND OF LEFT IT
AS IT IS AND WE SAID WE WILL
TALK ABOUT IT AT A LATER TIME.
A FEW WEEKS LATER I GOT OUT TO
SEE A POTENTIAL PATIENT IN A
HOSPITAL TO DO A EXPLANATION OF
BENEFITS. SHE TOTALLY TOOK ME
BY SURPRISE. LITTLE LADY IN A
BED CANCER PATIENT AS SHE
LOOKED AT ME AND SHE SAID YOU
KNOW SHE SHE ASKED MY HOUSE WAS
COMPANY AND MY NAME MEANT WHAT
MY POSITION IS AND SHE SAID. DO
YOU OFFER THE AND THE LIFE
OPTION ACT I IMMEDIATELY SAID
NO. AND SHE LOOKED AT
MICHIGAN'S WILL IF YOU WERE IN
MY SHOES YOU WOULD. AND THAT TO
ME WAS LIKE THE LIGHTS GOING
OFF AM I THOUGHT OF HER I'D-
STILL CONVERSION HER IN THE BED
MMHM THOUGHT OF HER PAIN HER.
FRUSTRATION FOR ME TO SAY NO
AND OBVIOUSLY SHE DID NOT SIGN
UP WITH US. I LEFT BACK TO THE
OFFICE- THOUGHT ABOUT IT FOR A
FEW DAYS. US OUR IT TEAM TO SIT
DOWN SO WE CAN DISCUSS THIS ALL
OVER AGAIN. AT THAT POINT WE
SAID LET'S BRING IN
COMPASSIONATE CHOICES BECAUSE
THEY WERE THE ONES THAT KIND OF
INTRODUCED US TO. MEDICAL AID
IN DYING AND IF WE WOULD BE A
PART OF THE- OCT WE BROUGHT
THEM IN AND DAY TAUGHT AND
EDUCATED AND SHOWED US SO MUCH.
AND KINDA LIKE HELD OUR HAND. I
THANK HIM AND KAREN MARIN GREEN
SHE WAS EXCELLENT AND SAID. SO
THEY KINDA LIKE HELPED US
UNDERSTAND THE ACT AND FROM
THAT POINT ON WE WROTE OUR
POLICIES AND PROCEDURES AS A
TEAM. ACCORDANCE BY THE LAW AND
WE SAID WE ARE GOING TO BE
EMBRACING THE LAW. AND I WANT
TO SAY FROM MY PERSONAL
EXPERIENCE. IT HAS BEEN
TRANSFORMATIONAL FOR ME AS A
PERSON AS A TEAM AS A COMPANY I
THINK EMPATHY IS THE MOST
IMPORTANT PART IN THIS WHOLE
THING. IF WE- USE EMPATHY WE
WILL UNDERSTAND WHAT PEOPLE
FEEL WHAT FAMILIES GO THROUGH
AND WE CAN. EMBRACE IT IN A
DIFFERENT WAY AND NOT JUDGE
PEOPLE FOR WHAT THEY CHOOSE
BECAUSE I THINK THAT'S WHAT THE
WHOLE STIGMA TO THEM AS A PROP
MEDICAL AID IN DYING. SO I TOOK
PRIDE IN MY JOURNEY I COMMEND
MY TEENS OPENNESS TO THIS
CHANGE AND THEIR DEDICATION TO
ADVOCATING FOR OUR PATIENTS AS
A MATTER OF FACT MY SON. ALSO
HAS THE HOSPICE COMPANY IN THE
ORANGE COUNTY AREA AND WHEN I
BROUGHT THIS UP TO HIM ABOUT
TWO YEARS AGO HE SAID YOU KNOW
MOM I DON'T THINK I CAN DO THAT.
I SAID YOU KNOW WHAT. MY
RECOMMENDATION TO YOU IS YOU
HAVE TO BE OPEN AND YOU HAVE TO
THINK ABOUT WHAT PEOPLE GO
THROUGH. YOU HAVE TO EMBRACE.
THE FAMILY'S CHOICE THE PATIENT
CHOICE BOTTOM LINE IS PATIENT
CHOICE. AND I COULD SAY HE DID.
AND HE CURRENTLY HAS THREE
PATIENTS THAT ARE DOING THE
MEDICAL AID IN DYING. CURRENTLY
SO I JUST WANT TO GIVE A BRIEF-
SIX MONTH ANALYSIS ABOUT OUR
COMPANY SO THE LAST SIX MONTHS
WE HAVE HAD FOURTEEN PATIENTS
SIGN ON TO HOSPICE CARE FOR
MEDICAL AID IN DYING AND THEY
COME ON SPECIFICALLY FOR THAT
YES THEY CAME ON SPECIFICALLY
FOR MEDICAL AID IN DYING FOR A
WHICH CAME FROM DIFFERENT
HOSPICE AGENCIES THAT DID NOT
SUPPORT THE ACT OR COULD NOT.
MEET THEIR NEEDS. I DON'T THE
FOURTEEN TEN HAVE LREADY TAKEN
THE MEDICATION AND HAVE DIED
PEACEFULLY. AND WITH DIGNITY.
AS A MATTER OF FACT ONE OF THE
PATIENTS THAT DID PASS AWAY
WROTE US A YELP REVIEW TWO DAYS
BEFORE HE PASSED AWAY. I'M NOT
KIDDING YOU DON'T KNOW YOUR- HE
WAS BORN ON FEBRUARY ONE AND HE
ABOUT THE YELP REVIEW AND YOU
PUT. TWO ONE FORTY THREE TO TWO
ONE TWENTY TWENTY. AND I
BROUGHT UP THE FACT AND I SAID
WHAT IF YOU TAKE THE MEDICATION
AND DON'T DON'T DON'T DIE ON
THE FIRST HE SAID WELL IT IS
WHAT IT IS I TOOK IT ON THAT
DATE. SO AND TWO OF THE
PATIENTS ARE CURRENTLY ON OUR
SERVICE WAITING FOR WE'RE JUST
WAITING FOR THEM TO LET US KNOW
WHEN THEY WANT TO TAKE IT AND
TWO OF THEM DIED BEFORE TAKING
THE MEDICATION SOLD TEN OUT OF
THE FOURTEEN HAVE ALREADY
PASSED. BUT THE COMFORT OF
HAVING THE PRESCRIPTION
DEFINITELY- OH YES YES. SO SENS
OFFERING THE SERVICE I HAVE
BEEN ASKED BY TWO FAMILY
MEMBERS ALREADY TO WITNESS AND
BE THERE AND BELIEVE ME. I
CANNOT FORGET THAT SITE EVER IN
MY LIFE IT'S A VERY. I THOUGHT
GOING AND I WOULD BE SAD AND I
WOULD BE BUT IT'S JUST SO
BEAUTIFUL AND YOU SEE YOU KNOW
EVERYBODY COMES TOGETHER THEY
SAY GOODBYES AND- THE PATIENT
IS. HAPPY DAY THEY KNOW EXACTLY
WHAT THEY'RE GOING TO BE DOING
THEY'LL TAKE A POPSICLE OR
THEY'LL TAKE A CHASER BEFORE
THEY DO THE CONCOCTION. AND
THEY'RE JUST HAPPY DEL GOING TO
BED YOU KNOW ONE OF THEM I
WITNESSED THE WIFE WENT INTO
BED WITH THEM WITH THEIR DOG
AND JUST WAITED. UNTIL HE
PASSED WHICH I THINK WAS JUST
BEAUTIFUL. ANOTHER NOTE- OUR
YOUNGEST PATIENT THAT TOOK THE
MEDICATION ABOUT THREE WEEKS
AGO WAS JUST TWENTY NINE YEARS
OLD. HE HAD STOMACH CANCER WAS
REFERRED TO US FROM CITY OF
HOPE THANK YOU DOCTOR BANERJEE
FROM HERE. AND HE TOOK THE
MEDICATION TWENTY NINE YEAR OLD
AND HE PASSED AWAY THE CAN OF
IN A- COMFORT. SO OUR TEAM AT
OLYMPIA HOSPICE CARE HAS ALWAYS
BELIEVED IN EDUCATING PEOPLE
AND GIVING THEM THE INFORMATION
AND SUPPORT TO MAKE DECISIONS.
SO WE'VE BEEN DEDICATING A LOT
OF OUR TIME TO EDUCATE DOCTORS
OFFICES- UNLIKE DOCTOR BANERJEE
DID SAID OUR MEDICAL DIRECTOR
WAS AT THE CONFERENCE ROOM AT
CITY OF HOPE BACK IN SEPTEMBER.
TALKING ABOUT THE MEDICAL AID
IN DYING EDUCATING BUT THE ONE
OF THE BIGGEST OBSTACLES THAT
WOULD THAT I FACE PERSONALLY
AND OUR COMPANY FACES IS.
DOCTORS OUT THERE DO NOT KNOW
BOARD THEY KNOW THEY DON'T WANT
TO BRING IT UP- AND THAT HURTS
THE PATIENTS AT THE END OF THE
DAY. FOUR THEY GET REFER TO
DIFFERENT HOSTAGES CITIES.
SAYING YES WE DO I'M BASED ACT
THINKING THE PATIENTS WILL DIE
EARLIER. BUT THEN. AT THE END
WHEN THEY SAY NO WE WANT TO DO
IT THEN THAT'S WHEN THEY'LL
START LOOKING FOR US ONLINE OR-
WORD OF MOUTH OR BY EIGHT
COMPASSION CHOICERS ARE AND THE
LIFE OPTIONS YOU KNOW THEY'LL
FIND US SOMEWHERE. SO THAT'S
ONE OF THE BIGGEST OBSTACLES
AND YOU KNOW IF INSTITUTIONS
LIKE CITY OF HOPE AND KAISER
AND WHATEVER. IF THEY CANNOT DO
IT IN HOUSE AND THEY WOULD LOOK
OUT AND REFERRED TO THE
AGENCIES THAT CAN DO THIS. IT
WOULD MAKE IT SO MUCH EASIER
FOR THE PATIENT I GOT A CALL
FROM A HOSPITAL IN LONG BEACH
ON FRIDAY WE HAD A PATIENT THAT
MY SON ACTUALLY SERVICED. THE
NURSE PRACTITIONER CALLED AND
SAID YOU KNOW YOU GUYS ARE SO
AHEAD OF THE GAME SHE SAID YOU
GUYS STREAMLINED THIS PROCESS
IT TOOK US SEVENTEEN DAYS. FROM
START TO FINISH AND THAT FAMILY
WAS LOOKING FOR AN AGENCY FOR
OVER THREE YEARS. THAT WOULD
ACTUALLY TAKE THAT ON. SO WE
HAVE STREAMLINED THE PROCESS
WHERE- WE KNOW WHAT WE'RE DOING
WE KNOW ALL THE FORMS WE KNOW
ALL YOU KNOW OUR DOCTORS WE DO
USE TELEMEDICINE AS THE SECOND
VISIT. OUR DOCTOR DOES THE FACE
TIME WHICH HAS BEEN INCREDIBLY
HELPFUL BECAUSE THAT CUTS THE
TIME. SO WHEN OUR SECOND DOCTOR
DOES THE FACE TIME THE THIRD
THE ATTENDING GOES OUT THE SAME
NIGHT OR THE NEXT DAY. FROM
THAT POINT ON PRESCRIPTIONS
FILLED PATIENT GETS IT IN TWO
DAYS AND THEN WE ARE THERE TO
STAY WITH THEM UNTIL THE END. A
WE HAVE CONTINUES CARE NURSES
BY BEDSIDE THROUGHOUT THE END.
SO WE'VE KIND OF LIKE TAKEN
THIS WHOLE. MEDICAL AID IN
DYING AND IT'S LIKE A WHOLE
DIFFERENT SECTION OF HOSPICE
CARE FOR- IT CAN'T BE WITH. OUT
EACH OTHER BECAUSE WE'RE A TEAM
BUT WITH OUR SOCIAL WORKER AND
A BEREAVEMENT AND THE MEDICAL
DOCTORS ONBOARD AND- THANK GOD
I HAVE A GREAT TEAM OF NURSES
THAT ARE. SUPPORTIVE OF THIS.
SO THAT'S WHAT WE DO AND WE ARE
IN LOS ANGELES. THANK YOU VERY
MUCH ARE YOU'RE WELCOME THANK
YOU VERY MUCH. HI I'M US TO
CANCEL FROM MISSION HOSPICE AND
HOME CARE AND SOME A TALE.
WHERE THE LONGEST SERVING-
NONPROFIT IN THAT COUNTY- ONE
OF THE FEW REMAINING WE'VE
RECENTLY PARTNERED- WITH- SANTA
CRUZ AND- SAN DIEGO TO STRING
FORCES WITH OTHER NON A NON
PROFITS- TO HELP DEVELOP. THE
STRENGTH FOR EACH OTHER AND FOR
PATIENTS- SO I EAT AT I HAD
NOTES THAT I WAS GONNA MMHM. SO
WE'LL SEE- IT I STARTED-
GRADUATED- FROM NURSING SCHOOL
IN TWENTY FIFTEEN A IT WAS A
COMING LICENSE IN TWENTY
SIXTEEN AND THEN WAS HIRED BY
MISSION HOSPICE- EARLY AND IN
MARCH AND TWENTY SIXTEEN AND-
AND- THE CONVERSATION ABOUT THE
APPROACHING OR PENDING
POTENTIAL LAW PASSING. STARTED
AND WITH THE COMPANY TO DO WAS
HAVE A CONVERSATION- AMONGST.
OF YOU DIRECTORS AND THE BOARD
AND THEN EXTEND THE
CONVERSATION TO AND MANAGERS
AND EMPLOYEES- ABOUT- OPTING IN
AND SUPPORTING END OF LIFE
OPTION ACT WHICH WE DID. AND
HAVE BEEN- ACTIVE ACTIVELY
SUPPORTING- SINCE THEN WE HAVE.
THREE DOCTORS WHO- WILL- AND
PARTICIPATE- WE CAN- WE
SOMETIMES HAD GET REFERRALS
FROM- COMMUNITY DOCTORS AND
THEN ONE OF OUR DOCTORS WILL
THEN- TO THE SECOND VISIT OR-
IF SOMEBODY INITIATES HELLO A
WHEN END OF LIFE MEDICAL AID IN
DYING. AT THE- ONCE OUR ON OUR
SERVICE BUT TWO OF OUR DOCTORS
CAN ACTUALLY PROVIDE THOSE TWO
VISITS- WE- IN AN OF THAT
SOMETIME YOU KNOW EVERY IT'S
JUST IT'S SUCH A WIDE VARIETY
OF CASES WE HAVE SOME PEOPLE
WHO ARE. YOUNGER THE FIRST
PATIENT I WORKED WITH IT WAS
MUCH OLDER ACT I ACTUALLY WAS
NOT OUR CASE MANAGER BUT I- BUT
I WAS ASKED TO STEP IN AND SHE
WAS IN HER LATE EIGHTIES. I AM
SO SOME. ARE NO THEY KNOW WHERE
THEY'RE GOING THEY KNOW WHERE
THEY'RE HEADED THERE IF THEY
THEY WANT TO GET. THEIR PLAN IN
PLACE TO GET THE MEDICATIONS AS
SOON AS POSSIBLE. AND THEN THEY
CAN. THEN THEY CAN MAKE THE
DECISION ABOUT WHEN- I AM
CURRENTLY WORKING WITH A- I'M
CASE MANAGER TO ALSO KNOW
CLINICAL AT MANAGER. COMES OVER
TO THE OFFICE BY STILL HAVE
SOME PATIENTS IN THE FIELD. AND
ONE OF MY PATIENTS IS INFECTION
WALKED THE HOLES. HERE THE
NIGHT BEFORE I GUESS THE LAW
PASSED THEM TRYING TO. TO YOU
KNOW GET OUT HIS LAST WORDS
MMHM MMHM AND- SO SHE'S ON OUR
SERVICE NOW SHE'S- AT MINIMAL
REQUESTING MINIMAL SERVICE FROM
HOSPICE. SHE WANTS TO REMAIN IN
SHE WANTS HER QUALITY OF LIFE I
MEAN THAT THAT'S THE QUALITY OF
LIFE IS CIRCLE. AND SHE GETS TO
GO OUT TO. LUNCH AND SPEND TIME
WITH THE FAMILY. INCREASING
PAIN SHE HAS LUNG CANCER WITH
MINUTES THE BRAIN TO THE BONE.
SO SYMPTOMS ARE INCREASING BUT
AND SHE'S NOT YET DECIDED IF
SHE WILL ACTUALLY DO IT BUT SHE
IS SET TO GO. AND SHE KNOWS
IT'S THERE SO IT HAS FREED HER-
ONE OF THE THINGS THAT. THAT
AND I JUST HOPE ALONG COME.
WITH THE- AN NURSE IS INVOLVED
IN AN END OF LIFE IN. YOU KNOW
THE- WHO IN SUBMIT MEDICAID YES
WHICH THE- ON USUAL MISS OF
THIS THAT WE WALK IN AND WE SIT
WITH PEOPLE. AT THE END- AND
WHILE THE INGESTRE MEDICATION
AND- HOW FOR FREEING IT IS FOR
THE PATIENT BUT ALSO FOR THE
FAMILY. AND TO WATCH THEIR IF
IT'S APPROPRIATE YOU KNOW WE
SIT WITH THEM THROUGHOUT THE
DAY. UNTIL THE PATIENT PASSES
BUT HOW FREEING IT IS FOR THE
FAMILY AS WELL THERE'S A YOU
KNOW WHEN PEOPLE PASSED
SUDDENLY OR PEOPLE EVEN HAVE
BEEN UNDER HOSPICE SERVICE NAY
DIE NATURALLY- WITHOUT. WITHOUT
MEDICAL AID IN DYING SOMETIMES
THERE'S MORE BEREAVEMENT
SERVICES NEEDED BUT IT'S
TYPICALLY NOT THE CASE THAT
SOMEONE WITH END OF LIFE-
OPTION ACT- WHO INGESTED-
TYPICALLY THE FAMILIES. THERE
WITH THEM EVERYONE AT EIGHT
YEAH SO- IN TERMS OF STATISTICS
AND WHAT WE TRY TO RETRIEVE
SOME STATISTICS AND YOU KNOW
AT. ONE POINT LATER DAY WILL
RETRIEVE THOSE- BUT PROBABLY
pWE'VE WE'VE- BEEN WITH A
HUNDRED AND THIRTY PATIENTS- I
DON'T KNOW HOW MANY PEOPLE
HAVE- YOU KNOW HAVE THE
MEDICATION RUN OUT OF TIME.
HAVE MEDICATION CHOOSE NOT TO
OR OR- YOU KNOW. IT RUNS THE
GAMUT TO I'VE HAD PEOPLE SAY
YOU KNOW I JUST WANNA GO
BARGAIN TAKE A PILL. AND I SEE
NO. YOU CAN THAT HERE. YOU KNOW
AND- I THINK ONE OF THE BIG.
CHALLENGES IS THAT WE CAN'T SAY
ANYTHING I MEAN AS A NURSE I
CAN'T SAY ANYTHING I CAN'T
BRING UP THE TOPIC. BUT THE
INSTANT THERE'S ANY QUESTION I
CAN IN THE INSTANT THERE'S A
QUESTION I COMMUNICATE THAT TO
THE MD AND THE TEAM IS ON IT. I
THINK THAT'S THAT'S ALL. YOU
HAVE ANY QUESTIONS THANK YOU.
GOOD MORNING MY NAME IS ELAINE
IS NOT A LOT OF SKIN I AM THE
VICE PRESIDENT OF PATIENT
EXPERIENCE FOR SEASONS HOT
HEALTH CARE WE CURRENTLY
OPERATE IN NINETEEN STATES FOUR
OF WHICH HAVE. A RESPECTED END
OF LIFE OPTION ACT. AND SEVEN
SITES HERE IN CALIFORNIA ALONE-
I ALSO HAPPEN TO BE THE MEMBER
A MEMBER OF THE- ETHICS
ADVISORY COUNCIL FOR AN H. P.
C. OF THE NATIONAL HOSPICE AND
PALLIATIVE CARE ORGANIZATION.
AND ONE OF THE SUB WORKGROUP
THAT I SIT ON IS A WORK GROUP
THAT IS PROVIDING RESOURCES TO-
AGENCIES HOSPICE AGENCY
SPECIFICALLY WHO ARE BOTH IN
GAS STATES. WHO HAVE A LOT AND
NO STATES WHO DO NOT HAVE A LOT
BECAUSE THERE ARE IN FACT.
CROSSOVER CHALLENGES THAT NEXT
FROM NOT. BECAUSE WE'RE A
NATIONAL AGENCY IN MANY HAVE
BROUGHT UP FEDERAL BENEFITS
VERSUS STATE. AND WE HAVE TAKEN
A POSITION OF ENGAGED
NEUTRALITY WHICH HONORS PATIENT
CHOICE. AND WE ARE VERY LUCKY
OUR TAGLINE IS HONORING LIFE AN
OFFERING HOPE WE WERE ALREADY
IN OREGON WHEN THE STATE WHEN
THE WHEN THE LAW PASSED IN
CALIFORNIA. AND SO WE WERE
REALLY ABLE TO GET AHEAD OF IT.
AND ONE OF THE THINGS THAT WE
DID WAS WE DID CHANGE OUR
PROTOCOL SO WE HAD QUITE A FEW
INDIVIDUALS WHO WERE- VERY
STRONG PATIENT ADVOCATES AT THE
NATIONAL LEVEL AT THE SITE
LEADERSHIP LEVEL AND AT THE
SITE LEVEL SO PEOPLE STOP. AND
WE SAT TOGETHER AND WE LOOKED
AT THE CURRENT PROTOCOL THAT WE
HAD FOR OREGON AND DECIDED THAT
IT DIDN'T QUITE HIT OUR TAGLINE
OF HONORING LIFE AND OFFERING
HOPE. AND SO WE REALLY CREATE
ED A PROTOCOL THAT WAS KIND OF
UNIQUE AT THE TIME AND I'M
REALLY FORTUNATE TO HEAR MORE
AND MORE THAT. OTHER PROTOCOLS
ARE CHANGING IN LINE WITH THAT.
SO THE THREE DISTINCT ELEMENTS
OF OUR PROTOCOL WERE THAT. THEY
HAD TO INVOLVE THEIR NDP THAT'S
THEIR NATIONAL DIRECTOR OF
PATIENT EXPERIENCE SO. THAT
INDIVIDUAL IS. A PATIENT
EXPERIENCE FOR US IS EVERYTHING
PSYCHO SOCIAL AND ETHICS
RELATED. SO THEY HAD TO INVOLVE
THAT INDIVIDUAL AND THEY HAVE
TO INVOLVE THE REGIONAL HOSPICE
MEDICAL DIRECTOR AND THE
REASONS FOR THAT WAS BOTH TO
SUPPORT THE STAFF. TO MAINTAIN
STATISTICS RELATED TO HOW MANY
PATIENTS PURSUED TO THE ACT IN
ANY AT ANY STOP ON THE JOURNEY.
AND ALSO TO PROVIDE SUPPORT TO
THE LEADERSHIP. THE SECOND IS
AS WE DO ALLOW OUR PHYSICIANS
TO ACT AS ATTENDING OR
CONSULTING'S BY LAW IF THEY SO
CHOOSE. ON THAT'S ALWAYS BEEN
OUR CASE SINCE THE LAW WAS
PASSED IN CALIFORNIA AND
ACTUALLY JUST PRIOR TO ITS
PASSING IN CALIFORNIA. THE LAST
IS THAT WE ALLOW OUR STAFF TO
BE PRESENT AT TIME OF
INGESTION. IT FELT VERY AWKWARD
TO HAVE STOPPED STEP AWAY AT
THE TIME OF INGESTION AND THEN
BE TOLD IT'S OKAY YOU CAN GO
BACK INTO PER EVENING NOW. SO
WE'VE WE'VE ALLOWED OUR STAFF
TO BE PRESENT AT TIME OF
INGESTION ONE OF THE THINGS
THAT WE'VE NOTICED THAT JUST
CHANGED SINCE THE LAST HEARING.
IS THAT OUR STAFF HAS BECOME
SIGNIFICANTLY BETTER AT
OFFERING TRUE INFORMED CONSENT.
UNDERSTAND WHAT YOU BROUGHT UP
THAT YOU CAN'T INITIATE THE
DIALOGUE WE ALLOW THEM TO
INITIATE THE DIALOGUE AROUND
CHOICES- AND THEN. KNOWING THAT
THEY CAN NUMBER FOR THAT BACK
TO THE ATTENDING PHYSICIAN WHO
WILL THAT AND WALK THEM THROUGH
ITS ACTUALLY. REASONABLE FOR
THEM SO THEY WILL SHARE CHOICES
LIKE- PALLIATIVE SEDATION IF
IT'S MEDICALLY INDICATED THEY
WILL SHARE CHOICES LIKE V. SIDE
VOLUNTARY STOPPING OF EATING
AND DRINKING THEY WILL SHARE.
AND OF LIFE OPTIONS ACT WITH
THE PATIENTS SO THAT THEY
REALLY UNDERSTAND IT AND THEY
WILL BE MINDFUL OF THE FACT
THAT THERE IS A CLAUSE IN THE
LAW AROUND THE NEXT OF KIN NOT
KNOWING. NECESSARILY WITHOUT
PERMITS EXPLICIT PERMISSION
FROM THE PATIENT. WE STARTED
EARLY EDUCATION ROLL OUT BEFORE
THE LAW WAS IMPLEMENTED IN
CALIFORNIA AND WE LEARNED
ANOTHER UNIQUE THING. HOW WE AS
LEADERS PRESENTED THE LAW. MADE
AN ENTIRELY DIFFERENT
PRESENTATION AND HOW ARE STAFF.
RECEIVED THAT INFORMATION AND
SO WHAT WE'VE DONE SINCE THE
LAST HEARING IS WE HAVE OUR OF.
OUR RIGHTS STATEMENT. AND THEN
THREE SPECIFIC TASKS THAT ARE
AT THE START AND FRAMEWORK OF
EVERY EDUCATION SESSION. THE
STATEMENT IS THIS IS A DIVISIVE
TOPIC. CLEAR BUT WE ARE
ADDRESSING THE ELEPHANT IN THE
ROOM. AND THE THREE ELEMENTS
THAT WE REQUIRE IS THAT THEY
KNOW THE LAW OF THE STATE THAT
THEY'RE IN. THAT THEY KNOW OUR
PROTOCOL AND UNDERSTAND OUR
PROTOCOL INCLUDING ITS
LIMITATIONS. AND THAT THEY
DEMONSTRATE HUMILITY.
IRRESPECTIVE OF WHERE THEY AS A
STAFF MEMBER STAND ON NOT LAW
TO BE GOOD SUPPORTS FOR EACH
OTHER AS COLLEAGUES BECAUSE
THERE ARE OTHER DIVISIVE TOPICS
THAT WE HAVE AND WE EXPERIENCE
AND HOSPICE CARE AND SO THE
SHOULD BE NO DIFFERENT AND
WE'VE NOTICED A TREMENDOUS
SHIFT IN HOW THE EDUCATION IS
RECEIVED. AND WE'VE NOTICED
THAT MANY OF OUR STAFF MEMBERS
WE HAVE CHAMPIONS OF OUR SITES
THAT JUST BECOME THE EXPERTS IN
KNOWING WHAT THE LAW STATES
WHAT THE PROTOCOL IS BECAUSE
EVEN SOME OF THEM WHO ARE NOT
PARTICIPATING- BECAUSE THEY
FEEL LIKE THAT'S AN IMPORTANT
PIECE OF THE HUMILITY AND BEING
A GOOD TEAM MEMBER. AB IN OUR
CURRENT STATE SINCE TWENTY
SEVENTEEN. WE HAVE HAD A
HUNDRED PATIENTS AVAIL
THEMSELVES OF THE LAW AND MANY
MORE THAT HAVE JOURNEYED
THROUGH- AT VARIOUS PHASES LIKE
MANY OTHERS HAVE SAID A LOT OF
OUR CHALLENGES ARE RELATED TO
ACCESS AN- HOUR EVEN ARE
EDUCATION INCLUDE OUR VERY
FIRST EXPERIENCE WAS ACTUALLY A
PATIENT IN OREGON. WHO WAS
APART WAS UNDER HOSPICE
AGENCIES CARE NOT OUR OWN WHEN
THEY WALKED HER THROUGH THE LAW
THEY TOOK HER ALL THE WAY TO
THE POINT OF WRITING A
PRESCRIPTION AND THEN THEY
DROPPED HER FROM SERVICE. AND
OUR TEAM IT WAS OUR VERY FIRST
EXPERIENCE IN OUR TEAM DIDN'T
QUITE KNOW WHAT TO DO WE DID
HAVE A PROPER PROTOCOL IN PLACE
BUT FIRST EXPERIENCES CAN BE A
LITTLE ROCKY. AND THEY WERE
ABLE TO WALK HER THROUGH THE
ATTENDING PHYSICIAN THAT HAD
WRITTEN THE SCRIPT FOR HER. AB
WITHOUT GOING INTO A LOT OF
DETAILS WAS TOLD BY THE AGENCY
THAT IF YOU WRITE TO THE SCRIPT
AND PURSUE AND CONTINUE THIS.
YOU WILL BE TERMINATED FROM
EMPLOYMENT. AND HE RESIGNED ON
THE SPOT AND WALKED OUT. AND SO
HE WAS ABLE TO CONTINUE THE
PROCESS WITH US AND WE WERE
VERY LUCKY BECAUSE OTHERWISE
SHE WOULD NOT HAVE BEEN ABLE TO
CONTINUE THE PROCESS WHAT WAS
SAD AND WHAT WE LEARNED IN THE
EXPERIENCE WAS. AND MANY OF
SAID IF THERE WAS SOME
RECIPROCITY OR SOME PORTABILITY
FROM ONE PLACE TO THE NEXT IT
COULD MAKE A HUGE DIFFERENCE
SHE REALLY WANTED THE SOCIAL
WORKER AND THE CHAPLAIN AND THE
NURSE THAT SHE HAD BEOME CLOSE
TO IN THE OTHER AGENCY TO BE
PRESENT. SHE EIGHT ZERO
RELATIONSHIPS WITH OUR STAFF
MEMBERS WHEN SHE CAME ON BOARD
AND VERY LITTLE TIME. TO TRULY
BE ABLE TO UTILIZE THE LAW AND
SO IN PLACE WHAT SHE DID WAS
SHE EXT LEAST ACCEPTED OUR
EXECUTIVE DIRECTOR AND A
CLINICAL DIRECTOR TO BE PRESENT
AT BEDSIDE BUT MISSED THE OTHER
ELEMENTS AND ATOMS HER PLEA.
AND SO IT WAS SOMETHING WE HAD
LOW AROUND. OUR PRESENCE OUR
PRESENCE FROM THE BEGINNING
THROUGH TO THE END. AND ALSO
OUR INVOLVEMENT IN ENGAGEMENT
WITH MANY OTHER AGENCIES CROSS
COLLABORATING INTRA. AGENCY AS
WELL. AND SOME OF THE OTHER
ACCESS ISSUES ARE STILL A
COMMON HOSPICE ISSUE IT'S NOT A
SPECIFIC ISSUE TO THE LAW IT'S
THE AVERAGE LENGTH OF STAY IS
STILL VERY SHORT. HOSPICE
REFERRALS ARE COMING TOO LATE
SO IF A HOSPITAL SYSTEM OR A
PHYSICIAN IS NOT PARTICIPATING.
THEY'RE REFERRING THE PATIENT
FAR LEADER THAT NOT FIFTEEN DAY
WINDOW MAY ALLOW THEM TO
PROCESS THROUGH. AND THERE IS A
LACK OF PROVIDERS SO WE ARE
VERY FORTUNATE WE HAVE A NUMBER
OF OUR PHYSICIANS WHO ARE BOTH
ATTENDING AND CONSULTING BY
LAW. AND UNTIL WE STARTED USING
TELEMEDICINE FOR THE CONSULTING
PIECE THEY WERE FLYING ALL
ACROSS CALIFORNIA TO ENSURE
THESE PATIENTS WERE ABLE TO
TAKE WITHIN THEIR TIMELINE BUT
THEN WHAT THEY ARE SORT OF
PERFECT END OF LIFE EXPERIENCE
RENT OF LIFE. HE WOULD LOOK
LIKE. AND THEN THE FINANCIAL
AND BILLING WHICH CONTINUES TO
CAUSE SOME SOCIAL INEQUITIES.
HAS BEEN REALLY CHALLENGING FOR
A LOT OF OUR PATIENTS AND
FAMILIES THAT'S ONE OF THE
LIMITATIONS OF OUR PROTOCOL
THAT WE SHARE. THAT WE TALK
ABOUT WE'VE BEEN LUCKY ON
OCCASION WITH PRIVATE INSURANCE
AGENCIES BEING ABLE TO CALL
AND- MAKE A CASE FOR A
PARTICULAR INDIVIDUAL BUT THE
NEXT TIME WE CALL THEM WE HAVE
TO START THAT CASE ALL OVER
AGAIN FOR NEW INDIVIDUAL. AND
THEN THE FACILITY OPT OUT HAD
BEEN A TREMENDOUS CHALLENGE FOR
US AS WELL- WE DO HAVE
EXCEPTIONAL SOCIAL WORKERS. WHO
WILL HELP US MOVE PATIENTS AND
GET THEM INTO ANOTHER. SPACE
BUT THERE ARE FACILITIES THAT
HAVE REALLY CAUSED SOME
BARRIERS TO GETTING THEM THERE
AND SO THAT'S SOMETHING THAT
WE'D LIKE TO CONTINUE WORKING
OUT. I THINK THAT'S THE BIGGEST
PIECE OF WHAT'S GONE ON WITH US
SO I THINK YOU MADAM CHAIR AND
COMMITTEE. FOR ENGAGING AND
CONTINUING THIS CONVERSATION
ALLOWING US TO ALL LEARN FROM
ONE ANOTHER AND GET TO KNOW ONE
ANOTHER SO THAT WE CAN. REALLY
HELP OUR PATIENTS ON WHAT
THEY'RE PERFECT END OF LIFE
JOURNEY LOOKS LIKE. THANK YOU
THANK YOU. CAN I WANT TO THANK
ALL THREE OF YOU FOR PIONEERING
IN YOUR INSTITUTIONS IN YOUR
COMMUNITIES. STATE OF
CALIFORNIAN BEYOND. I DID WANNA
CLARIFYING A QUESTION FOR NURSE
CANCEL YOU INDICATED I MIGHT
HAVE MISUNDERSTOOD BUT THAT YOU
DON'T AFFIRMATIVELY MAKE PEOPLE
AWARE OF THEIR CHOICES THAT
THAT'S- MAYBE THE STAFF AS A
NURSE AND AM IN THE HOME AND I
MEAN UNLESS SOMEBODY ASKS ME
ABOUT IT. I CAN'T BRING IT OUT
OF A DOCTOR CAN- IT IN I DON'T
KNOW BEEN FAIRLY THIS NOT LAW.
IS THAT YOUR INTERPRETATION OF
THE LAW OR YOUR INSTITUTIONS
IMPLEMENTATION POLICY. POLICY
AND RIGHT ON A POLICY THAT SO
IN FACT THERE WERE THE- FOR A
WHILE THE DOCTORS WERE. THEY
WERE JUST WAITING FOR PATIENTS
TO BRING AN OFFENSE BUT NOW
THEY CAN AND NOW THEY DO- YES
NO WAY I DO WANT TO CLARIFY
THAT IN THAT IS PART OF IS WE
DISCUSSED DURING THE PHYSICIAN
TRAINING. SOME WHO OPT OUT DO
THEY HAVE AN OBLIGATION MORAL
OBLIGATION TO MAKE PEOPLE AWARE.
THERE'S NOT CURRENTLY A LEGAL
OBLIGATION IN IN THE LAW AS
WRITTEN TODAY BUT IT'S
SOMETHING THAT I THINKS BEING
LOOKED AT AND IF A DOCTOR IS
DOES NOT OFTEN HE HE WILL PASS
THE- YOU KNOW PASSED THE
PATIENT ON FOR ANOTHER DOCTOR
WHO IS IMPORTANT. IT'S BEEN MY
EXPERIENCE IS THAT OUR DOCTORS
DON'T WITHHOLD. IN THAT
INFORMATION QUESTION. THANK YOU
AND DID YOU HAVE A- ON THE WAY
WE HANDLE THAT SITUATION IS
WHEN WE GO OUT TO DO A AND- YOU
WILL BE EXPLANATION OF BENEFITS.
I DO. I DO IT AS WELL IF I FEEL
LIKE THE FAMILY BECAUSE SOME
FAMILIES ARE SOMETIMES
EMBARRASSED. THAT I WANT TO
BRING IT UP. THEY DON'T WANT TO
TALK ABOUT IT THEY FEEL LIKE
THEY'RE GOING TO BE THE CAUSE
OF THEIR PARENTS TO DIE OR
THEIR EAST YOU KNOW THEY WANT
TO START THE PROCESS SO. I
KINDA LIKE LOOK AT THE FAMILY
DYNAMIC AND THIS HAS HAPPENED A
LOT AND YOU KNOW WHEN THEY SAY
WHEN CAN WE USE MORPHINE OR
WHENCAN WE DO THIS. SO I DO
SAY YOU KNOW OUR COMPANY ARE
ONLY IF YOU ARE AWARE BUT OUR
COMPANY DOESN'T BASED AND THE
LIFE OPTION ACT. SO IT'S
SOMETHING TO THINK ABOUT WE CAN
GIVE YOU MORE INFORMATION ON
THIS YOU CAN YOU KNOW WILL GIVE
YOU ALL THE PAPERWORK HE WOULD
NEED. OUR DOCTORS DO SUPPORT IT
WE DO A TO PRESCRIBE IT AND-
YOU COULD SEE THIS. OR OF COME.
COMING ON TO THEM WERE DAY KNOW
THAT THAT IS AN OPTION AND-
THEY HAVE USED IT. AND THEY
HAVE LISTENED SO THAT'S THE WAY
WE HANDLE IT RIGHT IN AS WE
MOVE THE LEGISLATION THROUGH I
THINK ONE OF OUR ASPIRATIONS.
WAS TO RAISE AWARENESS ABOUT
HOSPICE AND PALLIATIVE CARE AS
WELL AND I THINK WE HAVE A
LEAST ANECDOTAL EVIDENCE THAT.
THERE'S BEEN GREATER UPTAKE. IN
JUST MORE CONVERSATIONS ABOUT
END OF LIFE OPTIONS WHICH IS
ONE OF THE GOALS. IN I DID HAVE
A QUESTION FOR SOUNDS LIKE YOU
ARE USING TELEMEDICINE FOR THE
CONSULTATIONS. IN I'M GLAD TO
HEAR THAT- I'M NOT AWARE OF ANY
PROHIBITION IN THE- PROVISION
IS NOT RIGHT. WE HAVE AS WELL.
MMHM IN THAT ARE IN I REPRESENT
AN AREA THAT. IS LARGELY RURAL
IN. PUTTING SAN LUIS OBISPO WE
HAD A PATIENT THERE WHO HAD TO.
BECAUSE OF OP DOWN INSTITUTIONS
IN THAT. COMMUNITY HAD TO
TRAVEL TO U. C. L. A. FOR.
FIRST CONSULTATION OUR CONSUL
IT CETERA. IN THAT SENSE FOUR
FOUR AND A HALF HOUR DRIVE AND
GET THOSE CALLS A LOT FROM LIKE
THE WORLD AREAS IT CAN GO UP
THERE AND WE CAN ADMIT WE CAN
DO IT BUT THEN IF WE GET A PRN
CALL IN THE MIDDLE OF THE NIGHT
IT'S GOING TO BE A THREE FOUR
HOUR DRIVING YOU DON'T WANT TO
COMMIT TO SOMETHING LIKE THAT
IN. OUR PREFERENCES TO BE
PRESENT OBVIOUSLY ON OUR
PHYSICIANS PREFERENCES TO BE
PRESENT AND AT EVERY ONSULT
THE PHYSICIAN WILL ALWAYS CALL
ME HEY CAN WE TALK THROUGH THIS
CASE WHICH IS A LOT FOR HUNDRED
CASES YEAH BUT I LOVE SPEAKING
TO THEM WHAT WE HOW WE DO
MANAGE ABOUT FROM THE COERCION
ANGLE BECAUSE THAT'S ALWAYS A
CONCERN THAT THE OR THE ETHICS
AND FULL OF IT IS THAT WE TRY
AND ENSURE THAT A STAFF MEMBER
OF OURS. IS PRESENT AT THE
BEDSIDE AT THE SAME TIME
ESPECIALLY IF THE PATIENT HAS
INDICATED THAT THEY DO NOT WANT
ANY OF FAMILY ARE OF KIN TO BE
AWARE- WE'VE SADLY HAD TO STILL
CASES OF THAT AND SO IT'S
CAUSED US TO CREATE. A I NEED
TO PROVIDE A GREATER SOME WORST.
NOT SOME THAT WERE PUTTING INTO
IS THAT AND TING A CALL FOR
THEM. ESPECIALLY IN THE
SCENARIOS STAFF NOW WILL BE
PRESENT. AND WE WILL USE. OUR
INTER SKYPE FOR BUSINESS SOME
VERY. OF PROTECTED TELEMEDICINE
IF I MAY ADD WHEN WE ARE. I
MEAN WE OBVIOUSLY IT'S PATIENT
WHO'S MAKING A DECISION WE
APPROACH AND IF THEY APPROACH
US THEN WE INFORM THEM. WE
DON'T IF A FAMILY MEMBER I
DON'T TYPICALLY EVER- RESPOND
TO- IF I'D FAMILY MEMBER. ASKS
ABOUT IT I MEAN I CAN TELL THEM
WHAT IT IS BUT I DON'T. IT THIS
IS NOT A SUBJECT THAT A- THAT I
NEED TO COVER WITH THEM ABOUT
THE PATIENT- BUT ALSO IN TERMS
OF IF SOMEBODY'S IN A FACILITY
THE LAWS I UNDERSTAND. IS NOT.
ENOUGH. AS A- AS THAT IS. AT
YOU KNOW WE HAVE PATIENTS. IN
FACILITIES. THE FACILITY WERE
NOT INFORMED. BECAUSE IT'S THE
LAW THAT THE PATIENT THE PAGE
IS THE PATIENTS. IT IS THERE
IT'S THEIR RIGHT THEY DON'T
HAVE TO TELL ANYBODY THEY COULD
TAKE THAT MEDISAVE MEDICATION
ONCE THEY GET IT AND HAVE IT IN
THE ROOM AND GET WITHOUT IS
PRESENT. WE WANT TO BE
PRESIDENT- WE DO INFORMED WE
HAVE- IN SERVICES FOR
FACILITIES AND LET THEM KNOW
ABOUT END OF LIFE OPTION EQUITY
AND LET THEM KNOW ABOUT
PARTICIPATION SO THEY KNOW IT'S
YOU KNOW THEY KNOW THAT THEY
UNDERSTAND THE LAW- BUT- I
THINK THE CHALLENGES WE'VE HAD
WITH SOME OF THAT IS THERE ARE
FACILITIES THAT HAVE PARTICULAR
PROTOCOLS AROUND FEEDING
PATIENTS. AND WE KNOW THAT THAT
THERE NEEDS TO BE AN INNOCENT
ORDER FOR A PATIENT TO BE ABLE
TO INGEST AND TO BE ABSORBED IN
SOME RESPECT SO. HE WE USUALLY
HAVE THE PATIENT ACKNOWLEDGE
AND MANY MANY OF THE TIMES WHEN
WE GET A FACILITY FOR ALL IT'S
USUALLY THE ADDITION SPOKEN TO
THE FACILITY WHOSE THEN
NOTIFIED US AND THEN THEY SAID
WE'RE GONNA DO THIS YOU GUYS
HAVE TO MOVE THIS NATION OR
WHATEVER VARIATION OF MY-
THREE. THANK YOU CHAIR AND
AFTER EXT MYSELF MY STAFF IS
GOING TO BE MY- THE PATIENT
TESTIMONY IN PUBLIC. TED SO WE
WILL HEARING IT IN. AGAIN I
WANT TO THANK THE CHAIR FOR.
ASSISTANCE THIS THANK YOU FOR
YOUR PRESENCE TODAY YOU ARE
VERY MUCH FOR YOUR WORK. GIVE
ME ONE PUT DOWN HIS GAVEL AND
IS GO BACK TO. THANK YOU. OKAY
I NEXT WE WILL HAVE THE PATIENT
PANEL HAD SPINAL BY MCKEON
JULIE STROUD AMANDA VIEGAS IN
SHERRIN FELLS. AND I AND I WILL
SAY I WAS THE AUTHOR OF A LAW
THE YEAR BEFOREWE PASS THIS
ONE. IT IS BECAUSE IT USED TO
BE IF A IF THE PATIENT ASKED
YOU KNOW DO I HAVE TERMINAL
ILLNESS ONE OF MY CHOICES THEY
HAD ASKED THE POSITION WE FLIP
THAT AROUND THAT WHEN SOMEBODY
IS GIVEN THE DYING JUST THERE'S
TO GO OVER THE FULL SPECTRUM OF
OPTIONS THAT PEOPLE HAVE. TO
THAT THAT IS THE LAW. OKAY
WELCOME THANK YOU AND THANK YOU
FOR SITTING THROUGH A- ALONG
HEARING BUT WE THINK IT WAS
IMPORTANT FOR EVERYBODY'S VOICE
TO BE HEARD. SO I THINK. WE'RE
HERE FOR. DON'T KNOW WHO'D LIKE
TO START. THANK HI GOOD MORNING
THANK YOU FOR HAVING US HERE
AND- LISTENING TO THIS VERY
IMPORTANT DISCUSSION MY NAME'S
AMANDA VIEQUES- ON JUNE
NINETEENTH OF. LAST YEAR I LOST
MY HUSBAND CHRIS DAVIS IN AN
ATROCIOUS EXCRETE PAINFUL
MANNER. THE SWEET LOVING MAN I
GREW UP ALONGSIDE WHO ALWAYS
PUT MY WELL BEING FIRST DIED
EXACTLY HOW HE FEARED. AN
AGONIZING PAIN. HIS DEATH WHICH
CAME FIVE MONTHS AFTER HIS
DIAGNOSIS OF AGGRESSIVE BLADDER
CANCER WITH SQUAMOUS CELL
CARCINOMA VARIATION WAS
ANYTHING BUT PEACEFUL. HE WAS
ONLY TWENTY NINE. WHAT WE
ENVISIONED AS A JOYOUS TIME OF
PICKING INVITATIONS AND
ENJOYING OUR HONEYMOON. TURNED
INTO A QUICK COURT ROOM WEDDING
AND A NIGHTMARE FULL OF
HOSPITAL VISITS CHEMOTHERAPY
CATHETERS NEEDLES AND MACHINES.
SORRY OKAY. WE ANXIOUSLY
BETWEEN HOSPITAL STAYS AN
OVERLY OPTIMISTIC DOCTOR
APPOINTMENTS NAY EVEN AWARE
THAT HE WOULD NOT MAKE IT TO
HIS THIRTIETH BIRTHDAY. DOCTORS
DID NOT DISCLOSE THE NATURE OF
HIS PROGNOSIS IN ITS ENTIRETY.
OUR OPTIMISM OF ITS FULL
RECOVERY NEVER FOR AID UNTIL
CHRIS EXPERIENCED AN
UNTREATABLE BOWEL OBSTRUCTION
CAUSED BY A RAPIDLY GROWING
TUMOR THAT HAD INFESTED HIS
ABDOMEN. WE HAD JUST WATCHED
HIS GRANDMOTHER PASSED FROM THE
SAME COMPLICATION JUST TWO
YEARS PRIOR. AND WE KNEW THAT
HE WOULD NEVER EAT AGAIN. HE
WOULD HAVE BEEN THE TUBE
TRAINING FECAL MATTER FROM HIS
THROAT AND OUT OF HIS NOSE. WE
KNEW HE WOULD BE TORTURED. AND
TORTURED IS AN UNDERSTATEMENT.
HE WOULD NEVER XP FAVORITE
MEALS. THE PURELY AWFULLY QUICK
WOULD ONLY PROCEEDED BUBBLE
WILL HOLD IN THE STORE. THAT
WOULDN'T CLOSE. I DON'T WANT TO
DIE LIKE MY GRANDMOTHER CHRIS
CALMLY TOLD ME. I DON'T WANT TO
BE A LIFELESS SHELL. WHAT ARE
USED TO BE. I WANT LAST WORDS I
WANTED DIET ON MY OWN STE. HE
DID NOT WANT TO DIE. HE
EXPRESSED HIS DISAPPOINTMENT IN
NOT HAVING TIME TO DO THE
THINGS HE WANTED. HOWEVER HE
KNEW HIS MORTALITY WAS IMMINENT
AND HE JUST DIDN'T WANT TO
SUFFER UNNECESSARILY. HIS
REQUEST WAS NOT OUT OF THE
ORDINARY MOST PEOPLE DO NOT
WANT TO DIE IN IN.
UNFORTUNATELY MY HUSBAND DIED
EXACTLY HOW HE FEARED MOST WITH
TWO TWENTY VARIOUS BODILY
FLUIDS NEVER TO PROTRUDE HIS
STOMACH KIDNEYS AND TRUST. THE
PAIN HE ENTERED WAS
UNFATHOMABLE. A SIMPLE SHIFTING
MOVEMENT OR ACCIDENTAL BUMP. TO
IS BAD LEFT IN AN AGONY. HIS
SWOLLEN SKIN WERE BURSTING OPEN
FROM THE PRESSURE MEDINA. CHRIS
WANTED TO USE CALIFORNIA'S AND
OF LIFE OPTION KNOCKED. BUT
UNFORTUNATELY A RELIGIOUS
HOSPITAL I THINK SYSTEM DENIED
MY HUSBAND ITS FINAL WISH TO
MAINTAIN SOME COMFORT IN HIS
FINAL DAYS SO YOU COULD DIE
GENTLY. ONE MEDICAL AID IN
DYING. IS LEGAL HERE IN
CALIFORNIA IT CAN BE TO ACCESS
THIS COMPASSIONATE WHAT.
DOCTORS TOLD CHRIS HE HAD LESS
THAN TWO WEEKS TO LIVE. THAT
MEANT HE WOULD NOT SURVIVE THE
MINIMUM FIFTEEN DAY WAITING
PERIOD BETWEEN THE FIRST AND
SECOND VERBAL REQUESTS FOR
MEDICAL AID IN DYING AT THE END
OF LIFE. OPTION ACT REQUIRES
FOR PATIENTS TO ACCESS AND OF
LIFE CARE. MY HUSBAND WAS
DENIED OF LIFE. AND THE
PEACEFUL DEATH. HE IS NOT AN
ANOMALY I KNOW THERE ARE OTHER
SUFFERING RIGHT NOW AND BEING
DENIED THIS HUMAN RIGHT IN MY
OPINION. MORE THAN THREE OUT OF
FOUR CALIFORNIANS SUPPORT THE
END OF LIFE OPTION ACT
ACCORDING TO A TWO THOUSAND
FIFTEEN POLL BY THE INSTITUTE
OF GOVERNMENTAL STUDIES AT THE
UNIVERSITY OF CALIFORNIA
BERKELEY. HOWEVER THERE ARE TOO
MANY ROAD BLOCKS FROM ANY DYING
CALIFORNIANS TO ACCESS THIS
LAW. SOME DOCTORS DO NOT INFORM
THEIR PATIENTS OF ALL OF THEIR
END OF LIFE OPTIONS AND THERE
ARE STILL TOO MANY ROBOTS TO
MAKE IT IMPOSSIBLE FOR
CALIFORNIANS TO DIE PEACEFULLY.
FINDING A SUPPORT OF DOCTOR OR
FACILITY IS ESPECIALLY
CHALLENGING DEPENDING ON WHERE
YOU LIVE. AND BY LAW. NO
SERVICE TO THE- HOSPITAL'S MAY
ALSO PROHIBIT THEIR DOCTORS
AFFILIATED WITH THEM FROM
PARTICIPATING IN THE LAW. AS
EITHER AN ATTENDING OR
CONSULTING PHYSICIAN. A
RELIGIOUS HOSPITAL IN SOUTHERN
CALIFORNIA TREATING CHRIS IS
ONE OF MANY FACE BY FAITH BASED
HOSPITALS IN THE STATE THAT
PROHIBITS DOCTORS TO PRESCRIBE
MEDICAL AID IN DYING. THIS
HOSPITAL REFERRED US TO A
HOSPICE IT BELIEVED WOULD BE
WILLING TO PRESCRIBE MEDICAL
AID IN DYING. HOWEVER THE
HOSPICE MISINFORMED US BY
WRONGLY SAYING IT WAS ILLEGAL
IN CALIFORNIA AND CONTRADICTED
ITSELF BY SAYING THE ONLY A
DOCTOR IN NORTHERN CALIFORNIA
COULD OFFER TO WRITE THIS
PRESCRIPTION. ALL OF THIS
INFORMATION WAS SIMPLY WRONG
AND IN TRUE. THEY ALSO SAID HE
WOULD MOST LIKELY NEED TO SIX
MONTHS TO COMPLETE THIS ENTIRE
PROCESS WHEN IN FACT A PATIENT
CAN GET THROUGH THE PROCESS IN
A MINIMUM OF FIFTEEN DAYS. THAT
FIFTEEN DAYS OF THE SUFFERING
MY HUSBAND ENTERED IS STILL TOO
LONG. FIFTEEN DAYS OF PAIN THAT
CANNOT BE CONTROLLED BY THE
HIGHEST NICK RECORDED
MEDICATION AND HIM BEGGING TO
GO HOME IT'S TOO LONG. HE DID
NOT HAVE TIME TO GO THROUGH
THAT LINK THE PROCESS AND HE
WANTED TO SPEND HIS LAST DAYS
IN PEACE HOLDING MY HAND AS I
TOLD HIM HOW MUCH I LOVED HIM.
I STRONGLY BELIEVE THAT DOCTORS
HEALTHCARE SYSTEMS AND HOSPICES
SHOULD INITIATE CONVERSATIONS
TO ENSURE THAT PATIENTS ARE
FULLY INFORMED OF ALL OF THEIR
END OF LIFE OPTIONS AND FULLY
SUPPORTED IN THEIR VISION
THINKING. YES WELL LIFE. HE
LOVED ME. HE LIVED HELP PEOPLE
IN NEED. BUT HE WAS DENIED. HE
MAINTAINED A WILL POWER THAT
COULD NOT BE SHATTERED BY THE
AGONIZING DEATH THAT OFTEN
ACCOMPANIES AGGRESSIVE
METASTATIC CANCER. LIFE AND
DEATH ARE ONE THEIR INTEGRAL TO
EACH OTHER. WHEN HOW ONE LIVES
TO LEAVE THIS EARTH IS HIGHLY
PERSONAL. WATCHING THE LOVE OF
MY LIFE TO END A LITTLE WAY
DROWNING IN HIS OWN BODY IN
BAKING TO GO HOME WAS
EXCRUCIATING I CAN'T THINK OF
HIM IN A POSITIVE WAY WITHOUT
SEEN HIS FACE AS HE WAS. DYING
HE SHOULD NOT HAVE SUPPER THAT
WAY. NO ONE SHOULD. AND ALONE
ALLOWING THE DYING THE OPTION
TO PASS PEACEFULLY IN THEIR
FINAL MOMENTS RATHER THAN
SUFFER NEEDLESSLY IS NOT ABOUT
POLITICS IT'S NOT ABOUT
RELIGION OR PRECONCEIVED
JUDGMENTS IT'S ABOUT HUMANITY.
THANK YOU. THANK YOU ANNA WE'RE
SORRY FOR YOUR LOSS THANK YOU
AND THANK YOU FOR SPEAKING FOR
CHRIS THANK YOU. HI I'M JULIE
STROUD AND I'M VERY GRATEFUL
FOR THE OPPORTUNITY TO BE HERE
AND TO SHARE MY FAMILY'S
EXPERIENCE WITH CALIFORNIANS AT
THE END OF LIFE OPTION THAT.
THANK YOU FOR THAT OPPORTUNITY.
SO TO GIVE SOME BACKGROUND MY
FATHER BARRY STROUD MOVED TO
CALIFORNIA IN NINETEEN SIXTY
ONE TO TAKE A TEACHING POSITION
AT THE UNIVERSITY OF CALIFORNIA
BERKELEY IN THE DEPARTMENT OF
PHILOSOPHY HE TAUGHT THERE FOR
OVER FIFTY FIVE. NINE MONTHS
AGO AT THE AGE OF EIGHTY FOUR
MY BRILLIANT ACTIVE HEALTHY
FATHER WAS DIAGNOSED WITH
GLIOBLASTOMA MULTIFORME. THE
MOST AGGRESSIVE ANDDEADLY FORM
OF BRAIN CANCER. WHEN THEY
FOUND THE TUMOR IT WAS ALREADY
VERY LARGE AND A PANEL OF
DOCTORS RECOMMENDED THAT HE FOR
CO TREATMENT WHICH WOULD DO
MORE HARM THAN GOOD AND ENTER
HOSPICE. THEY GAVE HIM A
PROGNOSIS OF TWO MONTHS GIVE OR
TAKE. I'M NOT VERY FIRST DAY AS
WE SAT TOGETHER AS A FAMILY
ABSORBING THAT SHOCKING NEWS.
ONE OF THE FIRST THINGS WE
DISCUSSED WHAT'S CALIFORNIA'S
END OF LIFE OPTION. A LOT OF
THAT WE HAD CELEBRATED THE
PASSAGE OF. AS A FAMILY A FEW
YEARS EARLIER. BUT NEVER
IMAGINED HOW PROFOUNDLY IT
WOULD AFFECT OUR FAMILY. MY
EXPRESSED THAT HE HAD NO
INTEREST IN THE LONGEVITY OF
HIS LIFE INDEPENDENT OF THE
QUALITY OF THAT LIFE AND HE
MADE THE DECISION TO ENTER
KAISER'S HOME HOSPICE PROGRAM.
WHEN HE WAS ADMITTED TO HOSPICE
HE ADDS THE ADMITTING NURSE FOR
INFORMATION ON THE END OF LIFE
OPTION AND SHE GAVE HIM THE
PHONE NUMBER TO KAISER NORTHERN
CALIFORNIA AS AND OF LIFE
OPTION PROGRAM. I'D RARELY SEEN
DAD NERVOUS BUT HE WAS NERVOUS
THE PLACE THAT CALL. HE WANTED
TO GET IT RIGHT TO BE SURE THAT
HE MET ALL THE REQUIREMENTS AND
CHECKED ALL THE BOXES. THE
PROGRAM COULDN'T HAVE BEEN MORE
STELLAR THEY LOCATED THE
PRESCRIBING PHYSICIAN WHO CAME
TO MY DAD'S HOUSE WITHIN A WEEK
OF HIS FIRST- CALL FOR HIS OR
REQUEST. THEN THE FIFTEEN DAY
WAITING PERIOD BEGAN AND THOSE
WERE AN ANXIOUS FEW WEEKS IN
HIS HOUSEHOLD. BECAUSE HE'D
ONLY HAD ONCE AGAIN TO FIND THE
TUMOR NONE OF US KNEW INCLUDING
THE DOCTORS HOW QUICKLY HIS
DISEASE WHAT PROGRESS. WE WERE
WARNED ABOUT WHAT MIGHT BE
COMING WHICH INCLUDED
EXCRUCIATING HEADACHES SEIZURES
PARALYSIS LOSING THE ABILITY TO
SPEAK OR SWALLOW. AND MOST
IMPORTANT TO MY PHILOSOPHER OF
THE MIND FATHER LOSING THE
ABILITY TO THINK. THE WAS
TICKING MORE WAYS THAN ONE HE
SPENT MANY AN ANXIOUS NIGHT
WONDERING AND WORRYING OUT LOUD
IF HE'D BE COMPASS MANTIS WHEN
THE FINAL APPOINTMENT ARRIVED.
LUCKILY HE WAS I REMEMBER HIS
FEELINGS OF ACCOMPLISHMENT AND
ACHIEVEMENT THAT HE HAD FILLED
THE PROGRAM'S REQUIREMENTS. THE
PHARMACIST AND PROGRAM
COORDINATOR PATIENT COORDINATOR
DELIVERED THE AID IN DYING
MEDICATION A MONTH AFTER HIS
FIRST CALLED THE END OF LIFE
OPTION PROGRAM. AFTER THEY LEFT
OUR HOUSE HIS RELIEF WAS
PALPABLE IT'S HERE HE SAID OF
THE MEDICATION IT'S FINALLY
HERE. EVER THE AUTHOR AND
LECTURER MY DAD HAD BEEN
WORKING ON THE STATEMENT HE
PLANNED TO MAKE WHEN HE TOOK
THE MEDICAID'S AND- IT WAS. I
AM TAKING THIS MEDICATION TO
AVOID A MANNER OF LIVING THAT
IS UNACCEPTABLE FOR A MEETING
FULL HUMAN LIFE. THIS STATEMENT
BECAME INVALUABLE TO US IT WAS
OUR SHARED LANGUAGE BASED ON
HIS VALUES WE TALKED ABOUT WHAT
A MEANINGFUL HUMAN LIFE MEANT
TO HIM. WE EXPLORED WHAT HE
FELT HE NEEDED TO COMPLETE IN
HIS LIFE BEFORE TAKING THE
MEDICATION WE PLANNED WHO HE
WOULD WANT IN THE ROOM WHEN HE
TOOK IT. AND AS HE AND WORK
MORE TAX OF HIS OWN. WE ASKED
HIM IF HIS CONDITION WAS
UNACCEPTABLE YET. ONE OF THE
MOST FASCINATING THINGS IS THAT
FINISH LINE KEPT MOVING HIM.
THE PRESENCE OF THE MEDICAID IN
HIS HOME AND THE OPTION TO TAKE
IT WERE EXTRAORDINARILY
MEANINGFUL AND IMPORTANT TO MY
THAT. IT GAVE HIM PEACE OF
MIND. IT ALLEVIATED HIS FEAR
AND ANXIETY ABOUT THE PAIN AND
SUFFERING HE WOULD BE FORCED TO
INDOOR WITHOUT THE MEDICATION
AND- AT A TIME WHEN HE WAS
LOSING POWER AND CONTROL. OVER
EVERYTHING. DAD BUT EXERCISE
POWER AND CONTROL OVER HIS MOST
PRECIOUS RESOURCE HIS LIFE A
LIFE HE LEFT. HE TOLD US THAT
THE TRAIN WHAT'S COMING DOWN
THE TRACKS. WE COULD ALL SEE IT
WE ALL KNEW IT WAS COMING. THE
MEDICATION GAVE HIM THE POWER
TO REMOVE HIMSELF FROM THE
TRACKS IN HIS OWN TIME AND ON
HIS OWN TERMS. ULTIMATELY MY
DAD DIDN'T INGEST THE
MEDICATION AS IT'S CANCER
PROGRESSED HE DIDN'T EXPERIENCE
THE HEADACHES AND SEIZURES
NOTCH- PAIN ASSOCIATED WITH
BRAIN CANCER. HE JUST BEGAN TO
SLEEP MORE AND MORE HE SLIPPED
INTO A COMA FOR LESS THAN THE
DAY AND DIED ON AUGUST NINTH
JUST TEN WEEKS AFTER HIS
DIAGNOSIS. EVEN THOUGH HE
DIDN'T TAKE THE MEDICATION I
REALIZE NOW THAT IT STARTED
WORKING THE MINUTE AND ENTERED
HIS HELP. IT HAD THE DESIRED
EFFECT AT THE MOST AGONIZING
TIME AND ALL OF OUR LIVES. THE
MEDICATION BROUGHT US COMFORT.
FOR A LECTURE REFLECTING ON HIS
LIFELONG LOVE AFFAIR WITH
PHILOSOPHY AND HIS ILLUSTRIOUS
CONTRIBUTIONS TO THE FIELD MY
DAD ONCE WROTE I FEEL AMONG THE
MOST FORTUNATE PEOPLE IN THE
WORLD'S. HE WAS FORTUNATE EVEN
AND HOW HE DIED. HE DESCRIBED
THE FINAL MONTHS OF HIS LIFE AS
A WONDERFUL TIME DESPITE THE
DISMAL CIRCUMSTANCES HE ENJOYED
FOOD WINE AND CONVERSATION
UNTIL THE FINAL WEEK OF HIS
LIFE. HE WAS ABLE TO REFLECT ON
HIS LIFE AND RECEIVE ALL BUT
LOVE AND A LIVING MEMORIAL THAT
FLOODED HIS WAY. AND HE HAD THE
OPPORTUNITY TO REALIZE TO
RECOGNIZE THAT WHAT HE HOPED HE
HAD BEEN DOING WITH HIS LIFE HE
HAD IN FACT DONE. YOU WITH
FORTUNATE INDEED FORTUNATE TO
LIVE IN THE STATE THE
PRIORITIZE THE QUALITY OF HIS
DEATH AS MUCH AS THE QUALITY OF
ITS LIFE. FORTUNATE TO BE
SHEPHERDED THROUGH THIS PROCESS
BY THE FANTASTIC KAISER
NORTHERN CALIFORNIA AND OF LIFE
OPTION PROGRAM. FORTUNATE THAT
FOR HIM THE PROCESS WENT AS
WELL AS IT COULD GO. FORTUNATE
TO DIE PEACEFULLY IN HIS OWN
HOME SURROUNDED BY HIS FAMILY.
MAY WE ALL BE SO FORTUNATE. IN
CLOSING I WANT TO THANK YOU AND
THANK ALL OF THE IF. MY DAD
BERRY IS JUST ONE OF THE
STATISTICS YOU'LL HEAR AT NEXT
YEAR'S OVERVIEW HEARING. AND
THERE ARE HUNDREDS MORE FATHERS
BROTHERS MOTHERS SISTERS SONS
AND DAUGHTERS HUSBANDS AND
WIVES LIKE HIM. EACH ONE HAS
THEIR OWN STORY. HE UNDERSTOOD
THE GRAVITY OF THE REQUEST THAT
HE WAS MAKING FOR MEDICAL AID
IN DYING. AND HE HAD A DEEP
APPRECIATION AND GRATITUDE FOR
THE PRESCRIBING PHYSICIAN
CONSULTING PHYSICIAN PATIENT
COORDINATOR AND PHARMACIST
FIFTH FILLED HIS REQUEST. OUR
FAMILY IS INDEBTED TO THE
PATIENTS AND FAMILIES WHO
TRAVEL THIS ROAD BEFORE US THE
ACTIVISTS AND ADVOCATES THE
LEGISLATORS WHO SUPPORT
CALIFORNIA'S AND OF LIFE OPTION.
MY DAD SAID IT TOOK A SPECIAL
KIND OF COURAGE. SO THANK YOU
FOR YOUR COURAGE. THANK YOU.
GOOD MORNING I THINK WE'RE I
THINK WE'RE IN THE AFTERNOON
BUT ARE WE OKAY I'LL TRY TO GO
FAST NO YOU DON'T HAVE TO GO
FAST IF YOU TAKE YOUR TIME AND
YOUR STORY- MY NAME IS BONNIE
MCKEE AGAIN I LIVE AND WORK AS
A LICENSED CLINICAL SOCIAL
WORKER IN GRASS VALLEY WITH THE
PART ON MEDICAL SYSTEM DOES NOT
ALLOW ITS PROVIDERS TO
PARTICIPATE. AM I REALIZE AND
LISTENING TODAY THAT SO MUCH OF
MY STORY YOU'VE ALREADY HEARD.
THIS IS MY MOTHER'S STORY. THIS
IS RADICAL REPORT. MY MOTHER
FAMILY HERIS MADE HIM FOR ME
SIX MONTHS BEFORE SHE WAS
UNEXPECTEDLY DIAGNOSED WITH
METASTATIC BREAST CANCER IN
JUNE TWO THOUSAND THIRTEEN.
CANCER SHOULD FIRST BATTLED
EIGHTEEN YEARS PRIOR WAS IN HER
BONES IN ALREADY CAUSING PAIN.
FEBRUARY FIFTH TWENTY EIGHTEEN
MY MOTHER LEFT ICE GRANTED
VENTURE EARLY ONLY A FEW DAYS
AHEAD OF THE DREADFUL DEATH
CANCER IT WAS BRINGING. SHE
DIED PEACEFULLY HOW BY MYSELF
AND MY FATHER THANKS TO THE END
OF LIFE OPTION. HOWEVER
ACCESSING THIS COMPASSIONATE
LAW WAS NOT EASY. THERE WERE
HURDLES NO ONE SHOULD HAVE TO
GO THROUGH. THE PROCESS OF
ACCESSING LAW ADDED ANXIETY AND
DISTRESS FROM MY MOTHER DURING
HER LAST DAYS OF LIFE AND FOR
MYSELF AND MY FATHER DURING A
TIME OF OUR INTENSE GRIEF. MY
MOTHER'S GREATEST FEAR OF
SUFFERING WHILE DYING CAME FROM
WATCHING MY BROTHER SUFFER
BEFORE HIS DEATH FROM AN
AGGRESSIVE FORM OF SKIN CANCER
IN TWO THOUSAND AND TWO. AND
FOR HER YEARS OF EXPERIENCE AS
A HOSPICE CARE GIVER. SHE KNEW
WHAT HER FUTURE WITH TERMINAL
BREAST CANCER LOOKS LIKE. WHEN
THE PRIMARY CARE DOCTOR GAVE
FOR THE NEWS MY MOTHER TOLD MY
FATHER IN ME AND I REMEMBER
SITTING IN HER LIVING ROOM ON
HER COUCH. IF I WASN'T CHICKEN
I WOULD GET THE GUN AND GET IT
OVER WITH RIGHT NOW. PROMISE ME
YOU WON'T LET ME SUFFER. MY DAD
PROMISED BUT THERE WAS NO E. L.
O. A AT THE TIME SO WE
REASSURED HER HOSPICE WOULD
PROVIDE THE BEST CARE POSSIBLE
WHEN THE TIME CAME. FOR FOUR
AND A HALF YEARS MY MOTHER
FOUGHT BREAST CANCER WAS SMART
DRUGS AND CHEMOTHERAPY AND
AROUND OF RADIATION. BUT THE
CANCER CONTINUE TO SPREAD TO
HER BONES INTO HER LUNGS AND
LIVER. MY MOTHER'S PAIN WAS
NEVER MANAGED WELL BUT SHE KEPT
FIGHTING. BECAUSE OF PAIN IN
DECEMBER TWO THOUSAND SEVENTEEN
MY MOM COULD NOT LAY ON THE
TABLE FOR THE CT SCAN THAT
WOULD HAVE CONFIRMED IF THE
CANCER HAD SPREAD TO HER BRAIN.
NEVER THE LESS IT WAS OBVIOUS
TREATMENT WAS NOT WORKING. SHE
WAS IN CONSTANT PAIN LOSING
WEIGHT INCREASINGLY ANXIOUS AND
AGITATED. BATTLING BAO ISSUES
AND SHE WAS SPENDING HER DAYS
LYING ON THE COUCH OR IN BED.
SHE COULD NO LONGER PUT ON HER
HEARINGS. SHE WAS DONE FIGHTING.
MY MOM WENT TO HER ONCOLOGIST
BEFORE CHRISTMAS AND TOLD HIM
SHE WAS READY FOR HOSPICE AND
SHE ASKED FOR THE MEDICAL AID
IN DYING PRESCRIPTION TO END
HER SUFFERING. HAD BROUGHT UP
THE MEDICAL AID IN DYING LIGHT
TO HER TWICE. PREVIOUSLY ONCE
WHEN THE LAW WAS FIRST PASSED.
IN THE A YEAR LATER BY GIVING
HER A PAMPHLET AND JUST SAYING
THIS IS HERE SHE PUT IT AWAY
EACH TIME AND WE DID NOT
DISCUSS IT. SADLY HER
ONCOLOGIST DECLINE TO WRITE THE
PRESCRIPTION. HE DID THANKFULLY
REFER HER TO A PRIMARY CARE
PHYSICIAN WITHIN SUTTER WHO
WOULD WRITE THE PRESCRIPTION.
BUT NOT TURN HER OWN DOCTOR
BECAUSE THEIR OWN CENTER PCP HE
WAS FIFTEEN MINUTES FROM HOME.
IT ALSO DECLINED TO WRITE THE
PRESCRIPTION. THE DOCTOR WHO
WOULD SEE HER WAS AN HOUR'S
DRIVE AWAY IN SACRAMENTO. AN
HOUR DOESN'T SEEM LIKE MUCH.
EXCEPT WHEN YOU'RE DYING. IN
PAIN. THE HOSPICE TEAM OUR
LOCAL HOSPICE OF THE FOOT HILLS
WAS ON BOARD RIGHT AWAY IN
THEIR SUPPORT OF THE LAW. WE
ASSUME THAT THE FIRST REQUEST
OF THE ONCOLOGIST WAS THE FIRST
OFFICIAL ASK I SEE NOW THAT'S
COMMON THIS IS WHAT HAPPENED
WITH US. EVEN AFTER READING
ONLINE INFORMATION STILL DIDN'T
UNDERSTAND THAT THAT WASN'T THE
FIRST ASK ONCOLOGIST ALSO SEEM
THE SAME HE TOLD HER YOU HAVE
TO WAIT FIFTEEN DAYS TO SEE THE
DOCTOR THAT WILL WRITE THE
PRESCRIPTION AS A RESULT MY MOM
SCHEDULED THE FIRST AVAILABLE
APPOINTMENT BEYONCE THAT
FIFTEEN DAYS. OVER THOSE WEEKS
MY MOM'S CONDITION CONTINUE TO
WORSEN. WE ALKED ABOUT HOW TO
MANAGE YOUR PAIN AND ANXIETY
FOR THE CAR RIDE TO SACRAMENTO.
IT TOOK A TREMENDOUS AMOUNT OF
COURAGE FOR HER TO GET IN THE
CAR THAT DAY. THE DOCTOR WAS
KIND AND THOROUGH AS HE WENT TO
THE PROCESS THEN SAID. YOU HAVE
TO COME BACK AFTER FIFTEEN DAYS
FOR THE SECOND APPOINTMENT. AND
THE CONSULTATIONDOCTOR WILL BE
HERE THAT DAY TO. THE DID
GRACIOUSLY COORDINATE THOUGHT
IT WAS AWESOME. WE ALL WE HAD
ALL INCLUDING MEMBERS AND CALL
JUST ASSUMED INCORRECTLY THAT
THIS WAS THE SECOND APPOINTMENT.
MY RESPONSE. WAS YOU'RE KIDDING
RIGHT. SHE DOESN'T KNOW SHOULD
BE ABLE TO MAINTAIN MENTAL
CAPACITY AND THE ABILITY TO
TAKE THE MEDICINE FOR THAT LONG
WE ALL THOUGHT THIS WAS THE
SECOND APPOINTMENT. THE
GRACIOUS DOCTOR WHOM EVER
GRATEFUL TO. EXPLAIN THAT BOTH
VERBAL ASKS HAD TO BE TO THE
SAME DOCTOR FIFTEEN DAYS APART
THE FIRST ACT ASK DIDN'T COUNT.
I WISH I COULD DRAW A PICTURE
OF MY MOM'S FACE DROPPING.
PLEASE REMEMBER THIS DOCTOR WAS
IN THE SAME MEDICAL SYSTEM AS
HER ONCOLOGIST HE HAD ACCESS TO
HER RECORDS. HER UNCLE JUST
NEVER EXPRESSED ANY CONCERN
ABOUT HER CAPACITY HE KNEW THAT
SHE- KNEW WHAT SHE WAS ASKING
FOR AND THAT SHE WAS GOING TO
DIE WITHIN SIX MONTHS AND
LIKELY MUCH- MY MOTHER SPENT
TWO MORE LONG WEEKS LIVING WITH
THE FEAR THAT SHE WOULD OSE
THE MENTAL CAPACITY AND
PHYSICAL ABILITY NECESSARY TO
ACCESS THE LAW. IT SHOULD STILL
BE SUFFERING. SHE WAS SO
WORRIED ABOUT THE SECOND CAR
RIDE. THAT SHE HAD A SPECIAL
MEETING WITH A HOSPICE NURSE TO
MAKE A PLAN FOR HANDLING HER
PAIN AND ANXIETY. MY MOTHER WAS
A COURAGEOUS WARRIOR WHO DEALT
WITH PAIN AND SUFFERING WITH
GRACE. SHE WAS NO CHICKEN SHE
SUFFERED FOR YEARS WILL
FIGHTING FOR MORE TIME WITH US
AT THAT SECOND APPOINTMENT I
WATCH TRULY ON THE BED SHE
COULD ONLY LAY DOWN. SHE DID
NOT HAVE THE ENERGY TO SET UP
IN THE CHAIR. SHE LAID CLOSE
YOUR EYES AND BREEZE. I WATCHED
HER BREATHING AND I WONDERED
SHE GONNA DIE RIGHT HERE IN
THIS DOCTOR'S OFFICE NOT AT
HOME WHERE SHE SHOULD BE
BECAUSE OF THIS FIFTY IS.
ACTUALLY BEEN THIRTY BY THEN
THIRTY TWO FOR MORE. THE DAY
AFTER THE DOCTOR'S APPOINTMENT
THE PICKED UP HER MEDICAL AID
IN DYING MEDICATIONS IN
SACRAMENTO IT WAS ANOTHER
HOUR'S DRIVE FOR ME AT THE
CLOSEST COMPOUNDING PHARMACY
THE DOCTOR KNEW OF ACCESS TO
THE CONTACTING CAMPAIGNING
PHARMACIES I THINK THAT'S
ANOTHER ISSUE HAVEN'T HEARD
TODAY BUT I THINK THERE'S
SOMETHING TO THAT YEAH. THE
LOCAL COMPOUNDING PHARMACY HAD
JUST GONE OUT OF BUSINESS IN
GRASS VALLEY SO WE CAN USE THE
MARTINIS. HER SECOND POINT WAS
ON THURSDAY. AND FRIDAY PICKED
UP HER MEDICATON ON SATURDAY
SHE LOST HER BATTLE. UNDERWAY
FROM THE BED TO THE BATHROOM IN
HER ROOM. MY FATHER WAS A
PRIMARY CARE GIVER AND I LIVE
NEXT DOOR. THIS WAS THE
INDIGNITY. THAT SHE DID NOT
WANT TO LIVE WITH. ON SUNDAY
SHE WOKE UP WITH A HEADACHE.
AND SHE SAID OKAY I'M READY.
BUT THE NIGHT BEFORE SHE HAD
ONE BITE OF KRAFT MAC AND
CHEESE. HAD DARIEN IT'S THERE
WAS CONCERN ON HER PART. ABOUT
ABSORPTION THOUGH THE
MEDICATION THAT SHE WAS
PRESCRIBED WAS ENOUGH TO
BASICALLY PUT DOWN AN ELEPHANT
IT WOULD NOT HAVE BEEN AN ISSUE
THE SHE FOLLOWS THE RULES. WE
DIDN'T WANT ANY. CONFUSION CAN
COMPLICATIONS. AND SO. ON
MONDAY MORNING AND PLANTED A
ROSE FOR HER AND SHE HAD DONE
FOR HER FRIEND JANICE. WHO HAD
DIED THAT WAS IN HER BREAST
CANCER SUPPORT GROUP FROM YEARS
BEFORE. AND ON MONDAY. SHE TOOK
THE MEDICATION. AND SHE DIED
PEACEFULLY ASLEEP TWENTY THREE
MINUTES LATER. THERE WAS NO
MORE PAIN AND WE'RE SUFFERING
AND NO MORE NO ONE IS MORE
GRATEFUL THAN I AND MY FATHER
ARE TO NOTE THAT SHE DIDN'T
HAVE TO SUFFER THE LAST DAYS OF
INDIGNITY THE CANCER WAS
ALREADY BRINGING. SHE GOT TO
CHOOSE AND WE GOT TO FILL THE
PROMISE WE MADE THE DAY SHE WAS
DIAGNOSED. WELL I'M GLAD SHE
WAS ABLE TO USE MEDICAL AID IN
DYING AND EVER GRATEFUL FOR THE
SYSTEM THAT SUPPORTS IT. IN
INDIVIDUALS WHO SUPPORTED AND
EVERYBODY WHO'S WORKED FOR AND
CONTINUES TO WORK. FOR IT NO
ONE SHOULD HAVE TO ENTER
ADDITIONAL DISTRUSTS BECAUSE OF
BURDENSOME REGULATORY
REQUIREMENTS. MY FATHER. HE
WANTED TO BE HERE TODAY BUT HE
TOOK MY KIDS TO THE BUS STOP
INSTEAD THIS MORNING. IS A TWO
TIME PROSTATE CANCER SURVIVOR
HE HAD MALIGNANT MELANOMA. THE
WHICH MY BROTHER DIED FROM. AND
HE'S HAD PUPS IN THIS COLON. IN
WHICH HE DOESN'T DO THE
COLONOSCOPY IS ANYMORE. I PRAY
THAT HE SHOULD RECEIVE TERMINAL
NEWS. WHICH WITH OUR FAMILY
HISTORY IS QUITE LIKELY. HE
WON'T HAVE TO GO THROUGH ALL MY
MOTHER WENT THROUGH. THANK YOU
ALL FOR EVERYTHING YOU'RE DOING
SUPPORT MEDICAL IN DYING. AND
FOR LISTENING TO MY MOTHER'S
STORY. SHE MAKE YOU ROSCOE.
DIVERSE THE ROSCOE NEW IT
SHOULD SO I LOVE CHICKENS
LIMITS AGGRESSIVELY TO THE
HOUSE NEXT DOOR SHE MADE ROCK
RIPPER REPORTS ARE HOUSE ROSS
REPORT RAPPER YEAH SHE WAS A
QUILTER. AND LOVELY AND SHE
GARDENS AND I HAVE HANDS ON MY
WALLS IN THE KITCHEN ALSO BUT
THIS REALLY SPEAKS TO HER
SPIRIT. THANK YOU THANK YOU.
CHEN THIS IS TOUGH GAME THE
LAST ONE FOR THE WHOLE DAY BUT
GIVE IT A GO SO GOOD MORNING-
ASSEMBLY MEMBER EGGMAN AND
OTHER COUNCIL MEMBERS THANK YOU
FOR ALLOWING TO TELL MY STORY
AND THANK YOU FOR YOUR EFFORTS
AND GETTING THIS LAW PASSED MY
NAME IS SHARON FELLS MY HUSBAND
LERI BILLS PASSED AWAY ON
JANUARY SEVENTEENTH TWENTY
NINETEEN AFTER TAKING THE END
OF LIFE MEDICATION. LARRY WAS
ONLY FORTY NINE YEARS OLD WHEN
HE WAS DIAGNOSED WITH STAGE
FOUR BELL CANCER. THE PROGNOSIS
WAS NOT GOOD AND THE DOCTORS
GAVE HIM ABOUT A YEAR AND A
HALF TO LIVE. WE'RE LIVING IN
AUSTRALIA AT THE TIME. OF FOR
LARRY'S WORK SO WHERE ARE YOU
AFTER GETTING THE NEWS DECIDED
WE SHOULD TAKE HIS TAKE EARLY
RETIREMENT MOVE BACK TO
SACRAMENTO. WHERE WE HAD MANY
FRIENDS AND DEEP ROOTS
ESTABLISHED HERE ALSO HOPEFUL
THAT THERE MIGHT BE OTHER
OPTIONS OF WHAT TREATMENT WISE
HERE IN THE US. SO ON JUNE
TWENTY FOUR. WE ARRIVE BACK IN
SOUTH. OUR CLOSELY FOLLOWING
THE MEDICAL AID IN DYING ACT. A
LEARN I DISCUSS THIS OPTION AND
WE'RE BOTH VERY STRONG
ADVOCATES FOR THE BILL. FOR THE
NEXT THREE YEARS LARGELY
TOLERATED HIS CHEMO RELATIVELY
WELL WE'RE ABLE TO ENJOY THE
THINGS THEY LOVE MOST TRAVEL
GOLF GOOD FOOD AND GOOD WINE.
EVERY TIME IS ON CALL DISARM IT
SAY YOU LOOK LIKE JUST WALKED
OFF THE GOLF COURSE HE NEVER
LOST WEIGHT NEVER LOST HIS HAIR
YOU ALWAYS LOOK THE OPTIMAL IN
HEALTH. UNFORTUNATELY IN TWENTY
SEVENTEEN SEPTEMBER A
COLONOSCOPY REVEALED A SURGEON
GROWTH OF THE TUMORS. SAID THIS
MEANT THE CHEMO REGIME WAS NO
LONGER WORKING AND YOU HAVE TO
GO TO THE STRONGER TREATMENT
PLAN- HE'S GOING TO GIVE IT A
TRY HE WAS ADAMANT HE DID NOT
WANT TO SUFFER. HORRIFIC SIDE
EFFECTS JUST TO PROLONG HIS
LIFE HIS MANTRA WAS ALWAYS
QUALITY OF LIFE OVER QUANTITY
OF LIFE. EARLY ON THERE MADE
VERY TO ME AMAZON CALL TO. YOU
TO IT. BUT PRIORITIES ORAL A
LIFE YOU COULD. HE DID NOT WANT
TO BE INCOME PAIN OR TO A TWO
WAS. THAT MAKE IMPACT THE FIVE.
AT THIS POINT MEDICALLY
UNTIMELY PASS. AT MERRY NEW
WOULD WANT THIS OP SHOULD THE
TIME. HE'S ON COLLEGE EXPLAINED
THE- AND IT TO NOT A PER. BUT
HE WOULD BE ABLE TO REFER
DOCTOR TO A PARTICIPATING
DOCTOR. SO IN THE FALL TWENTY
SEVENTEEN MARKETS ARE THE NEW
ROUND OF STRONGER CHEMO.
HOWEVER WITHIN A FEW MONTHS THE
SIDE EFFECTS WERE BECOMING
UNBEARABLE. SO IN MAY HE
DECIDED TO STOP ALL FURTHER
TREATMENTS. A FEW MONTHS LATER
THE BLOOD WORK WAS SHOWING THE
SIGNS THAT THE DISEASE IS
PROGRESSING. THE ON CALL JUST
CONFIRMED HE HAD ABOUT SIX
MONTHS SO IN AUGUST WE STARTED
THE PROCESS OF THE MEDICAL AID
IN DYING SAID. WE MET WITH THE
FIRST DOCTOR WHO CONFIRMED HER
HIS PROGNOSIS WITH AND MET WITH
THE SECOND DOCTOR A FEW WEEKS
LATER WE ARE READY TO SCHEDULE
THAT THIRD EMPLOYMENT ONE OUT
OF THE BLUE WE GOT A CALL FROM
HIS ONCOLOGIST. ADVISING US OF
BRANDY CLINICAL TRIAL FOR BELL
CANCER IN MY ROOM BE A PERFECT
CANDIDATE SO ALL OF A SUDDEN WE
HAD NEW HOPE. AND THIS IS WHAT
WE'VE BEEN WAITING. SO THANKS
TO GET STARTED. SO THE CLINICAL
TRIAL BEGAN THE END OF OCTOBER.
AND ALL WAS GOING WELL EXCEPT
FOR PERSISTENT COUGH THAT HE
DEVELOPED. AND THEN HE
DEVELOPED EXPO- EXCRUCIATING
PAIN SOON AFTER. IT TURNS OUT A
FISTULA OR OPENING HAD FORMS IN
HIS COLON WHICH ACOSTA SERIOUS
INFECTION. AND THEN THERE WAS
REMOVED FROM THE CLINICAL TRIAL
SO ALL HOPE WAS STASHED. AT
THIS POINT WE HADN'T EVEN
THOUGHT ABOUT RESCHEDULING THAT
THIRD AND FINAL DOCTOR'S
APPOINTMENT BECAUSE WE DIDN'T
FEEL WE ARE IN THE IMMINENT
DANGER. UNFORTUNATELY A COUPLE
WEEKS GO BY IN THE PAIN
CONTINUES TO WORSEN AND ON
CHRISTMAS DAY I TOOK HIM TO THE
EMERGENCY ROOM. THE OUR DOCTOR
TOLD DISINFECTED FISTULA HAD
NOW TURNED INTO A FLESH EATING
BACTERIA. THAT WOULD RAVAGE HIS
BODY WITHIN THREE DAYS HE WAS
ADMITTED INTO THE HOSPITAL AND
GIVEN MASSIVE AMOUNTS OF PAIN
THAT'S TO KEEP THEM COMFORTABLE.
ON DECEMBER TWENTY EIGHT HE WAS
SENT HOME UNDER HOSPICE CARE.
AT THIS POINT HE WAS ON SOME
MEDICATION HE WAS UNCONSCIOUS.
BEFORE WE LEFT THE HOSPITAL I
FRANTICALLY CALLED THE MEDICAL
AID IN THE HUNT DOCTOR TO SEE
IF I CAN GET HIM IN FOR THAT
ONE LAST APPOINTMENT. AND THE
DOCTOR SAID HE WOULD HAVE TO
COME TO HIS OFFICE. AND HE
WOULD ALSO HAVE TO BE MENTALLY
CAPABLE TO ANSWER THE
QUESTIONS. AT THAT POINT WHERE
WAS NOT AWAKE NOR ABLE TO EVEN
GET TO THE OFFICE SO. AGAIN WE-
THOUGHT WE WERE. WE WERE OUT OF
LUCK. BECAUSE OF WARY
SIGNIFICANT MEDICAL NEEDS
HOSPICE NURSES AND HOSPICE-
HOME HEALTH CARE WAS COMING OUT
TWICE A DAY. EXCUSE ME HE
REMAIN MOSTLY UNCONSCIOUS FOR
NEW YEAR'S EVE YOU START TO
WAKE UP AND STARTED TALKING TO
IS NO EXPLANATION FOR IT OTHER
THAN HIS BODY WAS SO YOUNG AND
STRONG AND NOT READY TO GIVE UP
BY JANUARY SEVENTH HE WAS
TALKING IS TAKING LESS LESS
PAIN MEDS. WAS WAKING UP. AS HE
CONTINUED TO MAKE SMALL
IMPROVEMENTS. WE DISCUSS THE
OPTION OF GETTING HIM TO SEE
THE DOCTOR FOR THE THIRD AND
FINAL VISIT LARRY WAS
DETERMINED TO MAKE THAT
APPOINTMENT SOMEONE JANUARY
FOURTEENTH I SCHEDULED THE
APPOINTMENT FOR TWO DAYS LATER.
IT'S A GOOD TREMENDOUS AMOUNT
OF EFFORT TO GET HIM INTO THE
CAR AND DRIVING THE THIRTY
MINUTES TO THE OFFICE AND
BECAUSE WE NEEDED LARRY TO BE
AWAKE AND AWARE WE HAD TO
LIMITS PAVEMENTS THAT MORNING
SO HERE HE IS SITTING IN THE
CHAIR COULD BARELY SET.
EXCRUCIATING PAIN AND THAT'S TO
ANSWER THESE QUESTIONS TO THE
DOCTOR SATISFACTION. I WAS SO
WORRIED HE WOULDN'T MAKE IT
THROUGH ONLY BE DENIED THE
PRESCRIPTION. THANKFULLY THE
DOCTOR SAID IT WAS HE WAS FINE
AND WE GOT THE MEDICATION.
PRESCRIBED AND I WAS ABLE TO
PICK IT UP THE NEXT DAY. THE
COST WAS SEVEN HUNDRED DOLLARS.
AND THAT WAS NOT COVERED BY ANY
INSURANCE. I CALLED HOSPICE TO
TELL WARY SELDOM WHERE WE'LL BE
TAKING THE MEDICATION ON THE
THURSDAY THE SEVENTEENTH. THEN
FOR ME NO ONE FROM HOSPICE
COULD BE THERE AND THEY ARE NOT
ALLOWED TO BE INVOLVED IN THE
PROCESS AT ALL. SOMEONE JANUARY
SEVENTEENTH I PICKED UP THE
MEDICATION. WHICH REQUIRED ME
TO BE AWAY FOR THE LAST FEW
PRECIOUS HOURS OF HIS LIFE.
ALTHOUGH IN THE END I WAS ABLE
TO GRANDSON IS FINAL WAS DYING
OF HIS TERMS. IT WAS MUCH MORE
STRESSFUL THAN IT REALLY NEED
TO BE. BUT LASES SUFFERING WAS
OVER. IN RETROSPECT I WAS
DISAPPOINTED WITH THE LACK OF
SUPPORT AND INFORMATION I
RECEIVED. FROM BOTH UC DAVIS
HAS SUCH A HOSPICE. IF ONLY I'D
KNOWN MORE ABOUT THE LAW AND
THE REQUIREMENTS. I WITH THE
PROCESS COULD HAVE MADE A LOT
EASIER. INSTEAD I RELIED ON THE
INFORMATION I WAS GIVEN BY. THE
DOCTORS AT UC DAVIS WHICH WAS
WHAT THE TO. PROTOCOLS SO MY
HEART THANKS GOOD EACH IN THE-
OF YOU FOR. TAKING THIS ALL
POSSIBLE I HOPE WE CAN CONTINUE
TO KEEP IT ON THE BOOKS BEHIND
TWENTY SIX TWENTY TWENTY SIX.
AND ALSO MAKE FURTHER
ENHANCEMENTS THANK YOU FOR ALL
OF ME TO SHARE MY STORY. THANK
YOU AND THANK YOU TO EVERYBODY
WHO. WHO WHO WILL COME AND
SHARE YOUR STORY AND YOU KNOW.
THERE'S I DON'T HAVE WORDS
RIGHT WITH RESPECT YOU IF WE
FEEL YOUR PAIN WE YOU KNOW WE
HAVE ALL LOST SOMEBODY AND HAVE
HAVE TRAVERSE THIS JOURNEY THAT
YOU NOW KNOW IS. SACRED AND
FULL OF HILLS AND THINGS THAT
YOU DON'T EXPECT- AND REALLY
CALLS ON A SIGNATURE THINK AS
HUMAN BEINGS TENDING TO A PART
THAT WE DIDN'T EVEN KNOW
EXISTED. TO BE ABLE TO GET
THROUGH THE SOUTH THANK YOU FOR
LOVING FAMILIES THANK YOU FOR
COMING HERE IS TODAY TO SHARE
STORIES. AND MY COMMITMENT FOR
THE DRAG ME ON HERE ALL YOU
KNOW HOW TO MY BEST TO ADDRESS
SOME OF THE ISSUES THAT WE'VE
UNCOVERED. AND TO MAKE SURE
THAT THIS DOESN'T GO. THANK YOU
VERY MUCH THANK YOU. WE'RE
GONNA HAVE TIME FOR SOME PUBLIC
COMMENTS AND I SEE MR DAN TIAS
IN THE HADITH LIKE. ART IF YOU
AND IF YOU WANT TO SAY ANYTHING.
HAS BEEN PEOPLE RECALL BURNING
MAN AND THEN THE RIGHT THERE I
THINK AT THE. BUT TURNOUT YES
OKAY. SO MY NAME IS DAN DEUS.
BERNARD WAS MY WIFE I HAVE A
FEW ITEMS ARE PREPARED BUT JUST
BECAUSE IT'S COME UP SO MANY
TIMES- I FIGURED I'D SURE THE
FOLLOWING REGARDING THE FIFTEEN
DAY WAITING PERIOD- BECAUSE- OF
OVER THE YEARS OF COURSE HAVE
HAD COUNTLESS PEOPLE WHO
APPROACH ME. IN CALIFORNIA AS
WELL AS OTHER STATES- FOR
STARTERS EVEN THAT TERM FIFTY
DAY FIFTEEN DAY WAITING PERIOD.
WAITING WAITING FOR WHAT. IT IT
SUGGESTS THAT THE PATIENT NEEDS
TIME TO COOL DOWN OR THAT
THEY'RE MAKING AN IRRATIONAL OR
IMPULSIVE DECISION AT AND LET
ME BE CLEAR ABOUT THIS BRITNEY
BEGAN THINKING ABOUT HER PATH
FORWARD THE MINUTE THAT WE
DISCOVER THAT BRAIN TUMOR AND
THAT WAS MONTHS BEFORE SHE
WOULD NEED TO APPLY FOR MEDICAL
AID IN DYING. ALSO WHAT WE ARE
ASKING THE PATIENT TO WAIT
FIFTEEN DAYS. THE CANCER
DOESN'T PAUSE FOR THOSE TWO
WEEKS DOES IT. THAT BRAIN TUMOR
BERNICE GOAL. IT'S NOT SAYING-
WERE ON A WAITING PERIOD FOR
FIFTEEN DAYS THERE FOR THE
CANCER CELLS ARE SIMPLY GOING
TO AGREE TO STOP MULTIPLYING
FOR THAT PERIOD OF TIME. THAT'S
NOT THE WAY THAT WORKS.
BRITNEY'S GOAL JUST LIKE THE
HUNDREDS OF TERMINALLY ILL
INDIVIDUALS WHO HAVE APPROACHED
ME OVER THE YEARS. IS TO LIVE
AS LONG AS POSSIBLE SO A
TERMINALLY ILL INDIVIDUAL
DOESN'T NEED FIFTEEN DAYS TO
PROCESS THE REALITY. OF HOW
THEIR DISEASE WILL AND THEIR
LIFE. THE FAMILY MIGHT. SO ALL
PUT THAT IN THERE THE FAMILY OF
COURSE THEY THEY WANT THIRTY
DAYS IF THEY COULD GET A THEY
WANT THIRTY YEARS WITH THEIR
LOVED ONE. BUT THAT'S NOT WHAT
THE FIFTEEN DAYS IS TALKING
ABOUT THIS WAITING PERIOD THE
PATIENTS. EVERY PATIENT I'VE
MET THEIR NAVIGATING WITH THIS
WITH OUR EYES WIDE OPEN AND SO
THE FIFTEEN DAY PERIOD IS
RATHER OWNERS- AND ONLY BECAUSE
CENTER MONNING HEAD HAD BROUGHT
IT UP I JUST WANTED TO- ANSWER
A QUESTION REGARDING THE VA-
AND THIS WAS AN EXPERIENCE
PERSONAL EXPERIENCES WAS A KID
THAT I'VE KNOWN SINCE WERE FIVE
YEARS OLD. HIS NAME IS JOHN
BISSINGER. HE WAS IN THE ARMY.
AND HE WAS RECEIVING HIS CARE
THROUGH THE VA. LIVE IN
CALIFORNIA DOWN SAN DIEGO AND
WHEN HE BROUGHT UP THE TOPIC OF
MEDICAL AID IN DYING LIKELY
BECAUSE HE HAD A VERY GOOD.
RELATIONSHIP WITH HIS PHYSICIAN
HE WAS TERMINALLY ILL WOULD
QUALIFY FOR THIS YET A CHRONIC
DISEASE THAT SPANNED NEARLY TWO
DECADES- HIS PHYSICIAN SAID
THAT HE WOULD ALLOW THAT
CONVERSATION JUST THAT ONE TIME.
BUT BEYOND THAT IF YOUNG WAS TO
BRING IT UP AGAIN- YOUNG TOLD
ME THAT WHAT HIS OF PHYSICIAN
SAID IS THAT THE PROTOCOL FOR
THE VA IS THAT HE WOULD THEN
HAVE TO PUT HIM IN A- A
PSYCHIATRIC EVALUATION. BECAUSE
HE'S ESSENTIALLY GOING AGAINST
THE POLICY SO IT'S JUST AN
EXAMPLE OF WHERE POLICY AND
PROCESS OF THE VA IN THIS CASE
IS GETTING IN THE WAY OF
PATIENT CARE- AND THAT'S
SOMETHING THAT WHEN I'VE BEEN
IN DC WORKING ON AND I KNOW
THAT'S A FEDERAL ISSUE IT'S
NOTHING THAT WE CAN CONTROL
HERE IN THE STATE BUT- IT IS
JUST A MATTER OF TRAINING FOR-
THE MEN AND WOMEN IN. UNIFORM
THAT RECEIVE THEIR CARE- FROM
THE VA- THAT IT IS HANDLED IN
A- IN A WAY THAT. DOESN'T YEAH.
CAST THOSE PEOPLE WHO WERE
ASKING FOR A RIGHT THAT IS
LEGAL IN THE STATE AND A SENSE
OF SHAME THEM JUST FOR ASKING
SO. THANKS I JUST WANTED SURE
THOSE TWO ITEMS BECAUSE THERE
WERE PERTINENT TO THE ONES WHO
WERE BROUGHT UP AND I'LL BE
QUICK ON MY PREPARED REMARKS-
SO YES BRITNEY BRITNEY IS CASE
RECEIVED. A LOT OF ATTENTION-
SHE DIED FIVE YEARS AGO-
BECAUSE WE HAD TO LEAVE OUR
HOME HERE IN CALIFORNIA DRIVE
TO OREGON. SO SHE WOULD HAVE
THE OPTION OF THIS OF A GENTLE
DYING PROCESS. SHE WAS ALSO
ONLY TWENTY NINE YEARS OLD. THE
REASON BERNIE SPOKE UP WAS
BECAUSE SHE WAS FIGHTING FOR
TERMINALLY ILL INDIVIDUALS THAT
MAY NOT HAVE A VOICE. SHE SPOKE
UP SO THAT NO ONE ELSE IN
CALIFORNIA SPECIFICALLY BUT IN
ANY STATE. WHATEVER HAVE TO
LEAVE THEIR HOME AFTER BEING
TOLD YOU HAVE SIX MONTHS TO
LIVE. REGARDING THAT EXPERIENCE
USER BRITNEY'S WORDS SHE WOULD
SAY. HAVING TO LEAVE OUR HOME
THIS IS SUCH A HUGE AND
JUSTICE. AND A MONUMENTAL WASTE
OF TIME. IT WAS TIME OF COURSE
THAT BRITNEY DIDN'T REALLY HAVE
TO SPARE. BUT NOW WITH GREAT
PRIDE IN THE IMPACT THAT HER
STORY HAS MADE- MY TESTIMONY
TODAY OR WHAT I'M SHARING IT
MIRRORS OF THE TESTIMONY THAT I
PROVIDED AT THE LAST SELECT
COMMITTEE COMMITTEE HEARING.
BUT NOW THOSE WORDS ARE
AMPLIFIED BECAUSE TWO MORE
YEARS OF PASSED. I CONTINUE TO
HAVE COUNTLESS TERMINALLY ILL
INDIVIDUALS AND THEIR FAMILY
MEMBERS SHARE WITH ME. HOW
GRATEFUL THEY ARE TO HAVE THIS
OPTION IN CALIFORNIA.
ADDITIONALLY WHAT THEY SHARE IS
THAT THEY WISH THE PROCESS
WOULD RUN SMOOTHER WE FOR SOME
CASES OF WORD HAS GONE WELL
KAISER NOR CAL SEEMS TO DO A
REALLY GOOD JOB AND OTHER
INSTITUTIONS WHERE IT'S NOT.
THEY WISH OUR NEIGHBORING OR
THEIR LOCAL MEDICAL
INSTITUTIONS WOULD MAKE THIS
OPTION AVAILABLE TO THEIR
PATIENTS AND PHYSICIANS ALIKE.
AND THAT THE CHURCH AND OTHER
RELIGIOUS INSTITUTIONS WOULD
STOP TRYING TO IMPOSE THEIR
NARROW BELIEF SYSTEM ON TO THE
REST OF SOCIETY. SPECIFICALLY
THAT REGULARLY SHOULD THE NEED
TO SHORTEN THE FIFTEEN DAY
WAITING PERIOD SHORTENED DOWN
TO SOMETHING MAYBE LESS THAN
FIVE DAYS. IN THEIR WISDOM
THESE TERMINALLY ILL PATIENTS
HAVE ACCURATELY DECIPHERED. BUT
THE FIFTEEN DAY WAITING PERIOD
IS VERY LIKELY A POLITICAL
COMPROMISE OF SORTS. INSTEAD OF
ANYTHING THAT ACTUALLY BENEFITS
THE PATIENT. THEY REITERATE THE
SENSE OF SALAS AND RELIEF A TWO
BY SIMPLY HAVING QUALIFY FOR
THE PROGRAM. AND THE USUALLY
FOLLOWED UP. WITH A COMMENT
STATING THEIR HOPE THAT THEY'LL
NEVER NEED TO UTILIZE THE
MEDICATION. THEY'RE GLAD TO SEE
THE CULTURAL CHANGES WHICH ARE
SLOWLY TAKING PLACE THE SIMPLE
RECOGNITION OF OUR COLLECTIVE
HUMANITY AND MORTALITY. THE
SIMPLE RECOGNITION THAT LIFE
ALL LIFE EVENTUALLY COMES TO AN
END AND THAT ENDINGS MATTER.
LISTENING LISTEN TO THE
INDIVIDUALS TESTIFY HERE TODAY.
I FEEL A GREAT SENSE OF PRIDE
IN BRITNEY'S. ADVOCACY AND
LEGACY I LOOK BACK AT THE LAST
FEW WEEKS OF HER LIFE AND I
MARVEL AT HER DETERMINATION TO
MAKE A DIFFERENCE FOR THE REST
OF US EVEN IF SHE WAS
NAVIGATING HER OWN TIME PROCESS
DURING THAT TIME. IN TWO
THOUSAND AND FOURTEEN. LASTLY
WHEN SHE THAT THERE WERE ONLY
FOUR STATES WITH THIS OPTION
NOW THERE ARE TEN- I'VE SPOKEN
AT PALLIATIVE CARE CONFERENCES-
TO SHARE WITH THE MEDICAL
COMMUNITY TO MAKE THE MORE
FAMILIAR WITH THE REALITY IN
SAFE PART OF THIS PROGRAM I'VE
SHARED HER MESSAGE OF HOPE AND
LIVING WITH ADD BIOETHICS
CONFERENCES UNIVERSITIES HIGH
SCHOOLS AND EVEN TO EIGHTH
GRADE CLASSROOMS OF BEEN
FOURTEEN DIFFERENT STATE
CAPITALS. THIS IS HOW I KEEP MY
PROMISE TO HER- AND REGARDS TO
THE EDUCATION SIDE OF THINGS
FOR PHYSICIANS BRITAIN IS NOW
IN THREE TEXT BOOKS. AND A
COUPLE OF ONLINE COURSES AS
WELL. I'M STILL WORKING ON THE
AMA ANOTHER MEDICAL GROUPS TO
ADOPT A POSITION OF SUPPORT OR
AT THE VERY LEAST NEUTRALITY
BECAUSE I KNOW THAT WENT A LONG
WAY FOR US HERE. IN CALIFORNIA
WHEN THE CMA- TOOK THE POSITION
OF NEUTRALITY AND SO STATE BY
STATE- WORKING ON THAT AS WELL
AS A NATIONAL ORGANIZATION SO
THANK YOU VERY MUCH FOR LETTING
ME SHARE- ON. AN UPDATE ON
EVERYTHING THAT SO WE'VE BEEN
WORKING ON THANKS THANK YOU
VERY MUCH DAN. ANYBODY ELSE
LIKE TO MAKE PUBLIC COMMENTS AT
THIS TIME. IN MY- THANK YOU
CHAIR. EKLUND AND TO THE OTHER
MEMBERS OF THE SELECT COMMITTEE
THANK YOU FOR THIS HEARING. AND
FOR CONTINUING TO SUPPORT THOSE
WHO ARE SUFFERING AND THEIR
FAMILIES WHO SEEK TO END THEIR
SUFFERING. I AM THE RIVER
MADISON SHOCKLEY AND I AM THE
PASTOR OF THE PILGRIM UNITED
CHURCH OF CHRIST IN CARLSBAD
CALIFORNIA. AS A MINISTER I SIT
WITH PEOPLE AT THE END OF THEIR
LIVES IN THEIR DYING DAYS. AND
I'VE WATCHED HELPLESSLY AS TOO
MANY TERMINALLY ILL
CALIFORNIANS HAVE. NEEDLESSLY
SUFFERED ALL DYING. SITTING
WITH THE WIFE WATCHING HER
HUSBAND SUFFOCATE. I WE'VE
HEARD TO DATE WE ARE GRATEFUL
GRATEFUL FOR YOU AND FOR THOSE
WHO SUPPORTED AND BROUGHT THIS
LAW TO CALIFORNIA BUT THE LAW
IS STILL TOO DIFFICULT. TO
ACCESS. AS A RELIGIOUS LEADER I
AM CONCERNED ABOUT THE HURDLES
WE HAVE HEARD ABOUT TODAY. THE
MAKE IT DIFFICULT FOR DYING
PEOPLE TO USE THIS
COMPASSIONATE LAW TO DIE
PEACEFULLY. I WANT TO ENCOURAGE
YOU TO RECOGNIZE THE DIVERSITY
OF SPIRITUAL BELIEFS AND
PRACTICES IN THE STATE OF
CALIFORNIA AND IN THE UNITED
STATES AND OF COURSE IN THE
WORLD. THE FASTEST GROWING
RELIGIOUS MOVEMENT IS SPIRITUAL
BUT NOT RELIGIOUS. AND SO WHEN
WE SPEAK OF PEOPLE OF FAITH.
THAT F. IS NOT CAPITAL AND THE
P. IS NOT CAPITAL THERE ARE
MANY MANY PEOPLE OF MANY MANY
FAKES. AS A MINISTER OF THE
UNITED CHURCH OF CHRIST IN MY
CONGREGATION NADA NOMINATION
SUPPORT THIS LAW. WE ARE SO
GLAD THAT WE ARE ABLE TO LIVE
OUR FAITH. TO THE END OF OUR
LIVES AND THOSE WHO WOULD DENY
US THAT OPPORTUNITY. ARE
DENYING US OUR FREEDOM OF
RELIGION. AND SO WE NEED TO
REMEMBER THAT AS WELL. THE ROAD
BLOCK THESE ROADBLOCKS WE'VE
HEARD ABOUT TODAY ONLY
EXACERBATE THE LACK OF ACCESS
FOR PEOPLE OF COLOR POOR PEOPLE
AFRICAN AMERICANS LATINOS. WHO
ALREADY SUFFER DISPARATE CARE
IN OUR MEDICAL SYSTEMS. WHO
ALREADY SUFFER LACK OF ACCESS
TO HEALTH CARE. AND THOSE
OPTIONS AT THE END OF LIFE NEED
TO BE AVAILABLE TO EVERYONE
REGARDLESS OF THEIR
SOCIOECONOMIC STATUS. RACE
RELIGION. ETHNICITY NATIONALITY
OR LANGUAGE. WE KNOW THAT
AFRICAN AMERICANS LATINOS
ACCESS HOSPICE AT A LOWER RATE
THAN. WHY POPULATIONS AND THIS
LEADS TO MANY OTHER
COMPLICATIONS EIGHT LEAVE
HOSPICE SOONER GO TO. HOSPITALS
EMERGENCY ROOMS AND THIS GIVES
THEM A VERY DIFFERENT DINING
EXPERIENCE ONE WITH MORE
UNNECESSARY TREATMENTS ONE WITH
MORE UNNECESSARY PAIN. AND SO
WE ASK THAT YOU CONTINUE TO.
SUPPORT THIS LAW TO ENCOURAGE
EVERYONE TO SHARE THE
INFORMATION THAT'S VITAL FOR
EVERYONE TO ACCESS THIS LAW TO
KNOW THAT THEY CAN HAVE THE
CHOICE. THAT THEY CAN BE
EMPOWERED TO CHART THEIR OWN
END OF LIFE JOURNEY. AND THAT.
IT'S AVAILABLE FOR THEM. AND
THAT THEY HAVE A RIGHT TO IT IF
YOU NEED. SUPPORT IN SPREADING
THAT WORD- COMPASSIONATE
CHOICES ON WHOSE BOARD I'M
PRIVILEGE TO SERVE. HI MY I
MYSELF WILL BE GLAD TO GO TO
YOUR DISTRICT OR TO WHEREVER
PEOPLE NEED TO HEAR THE
INFORMATION TO LET PEOPLE KNOW
THE PEOPLE OF FAITH SUPPORT
THIS LAW. AND THAT DYING PEOPLE
DO NOT NEED TO DIE. IN
EXCRUCIATING PAIN WHEN THERE IS
A MEDICAL OPTION. IT'S CAUSED
ME TO RETHINK THE WAY I DELIVER
THE GOSPEL MESSAGE. YOU'VE BEEN
TOO MANY FUNERALS AND THERE'S
SOME STANDARD PASSAGES BUT- IN
THE TEN YEARS FIFTEEN YEARS NOW
I GUESS IT'S BEEN. THAT I'VE
BEEN ACTIVE IN THIS MOVEMENT MY
THEOLOGY HAS EVOLVED IN I HEAR
THE WORDS DIFFERENTLY NOW IN
THOSE FINAL WORDS AT THE
GRAVESIDE WOULD BE STATE ST
PAUL WHO SAYS DEATH. WHERE IS
YOUR VICTORY. DEATH WISHES TO A-
THROUGH THE END OF LIFE OPTION
ACT. WE CAN TAKE THE STING
AFTER DEATH ALLOW PEOPLE TO DIE
PEACEFULLY. IN THE ARMS OF
THEIR LOVED ONES THANK YOU.
THANK YOU VERY MUCH. THANK YOU
VERY MUCH. THANK YOU SO MUCH
ASSEMBLY MEMBER EGGMAN I WILL
BE VERY BRIEF I KNOW WE'VE GONE
OVER TIME BUT I WANTED TO THANK
YOU SO MUCH FOR THIS HEARING
IT'S BEEN SO INCREDIBLY
POWERFUL THANK YOU TO EVERYONE
WHO HAS SPOKEN TODAY- AND GIVEN
THEIR TIME TO DO THIS WORK ON
THE GROUND. MY NAME SAMANTHA
TROUT I'M THE CALIFORNIA STATE
DIRECTOR FOR COMPASSIONATE
CHOICES AND- WE'VE BEEN WORKING
REALLY HARD ON IMPLEMENTATION
OF THE LOST SINCE TWO THOUSAND
FIFTEEN AND WE HAVE A LOT OF
GREAT FREE RESOURCES- FOR
ANYONE WHO'S INTERESTED WE HAVE
BROCHURES ABOUT THE END OF LIFE
OPTION ACTIVITY LEGISLATORS
WOULD LIKE TO HAVE THEM IN
THEIR OFFICE WERE HAPPY TO
PROVIDE THAT. WE HAVE WE TRY TO
DO PEER TO PEER EDUCATION
ACROSS THE STATE WHENEVER AND
WHEREVER WE CAN WE HAVE-
VOLUNTEERS WHO WILL DO
PRESENTATIONS IN SPANISH- WE
ALSO MATERIALS TRANSLATED INTO
SPANISH CHINESE ON A AND A FEW
OTHER LANGUAGES- I WANTED TO
ALSO SHARE OUR FINISH STRONG
TOOLS THIS IS SEPARATE FROM THE
END OF LIFE OPTION ACT IT'S
DIFFERENT FROM PLAYED IN DYING
BUT IT HELPS PEOPLE PREPARE. UP
DIAGNOSIS OF DEMENTIA. WE ALSO
HAVE A DOC THE LINE IT'S A CON.
CONSULTATION WHERE A DOCTOR WHO
WANTS TO SUPPORT THEIR PATIENT
IN THE OPTION OF MEDICALLY TO
DYING OR ANOTHER END OF LIFE
OPTION. CAN CALL IT'S FREE
COMPLETELY CONFIDENTIAL AND
THEY CAN TALK TO ANOTHER DOCTOR
WHO'S- PRESCRIBE MEDICAL AID IN
DYING IT CAN HELP WALK THEM
THROUGH THAT- SO THANK YOU SO
MUCH FOR EVERYTHING THAT YOU'VE
DONE FOR PROVIDING. PATIENTS IN
CALIFORNIA THIS OPTION AND FOR
THE WORK THAT YOU DO THANK YOU.
THANK YOU. OKAY HIDING THAT
BRINGS US TO A CLOSE I WANT TO
THANK EVERYBODY FOR TAKING THE
TIME AND EFFORT AND ENERGY TO
COME AND SPEND THE DOUBLE
MORNING IN PART OF THE
AFTERNOON WITH US- AND ALL CALL
UPON ALL OF YOU WHEN WE HAVE TO
GO BACK FOR ANOTHER VOTE
BECAUSE AT SOME POINT WE NEED
TO GO BACK TO THIS LEGISLATURE
AND FIX SOME OF THE THINGS THAT
WE'VE TALKED ABOUT AND
HOPEFULLY REMOVED TO SUNSET-
SO- AS PEOPLE WHO AROUND IN.
TWENTY FIFTEEN NO IT WAS QUITE
A STRUGGLE- AND- AS YOU KNOW
IT'S HARDER TO TAKE THINGS AWAY
FROM PEOPLE SO AT YOU KNOW I
I'M HOPING THE STRUGGLE WON'T
BE AS HARD BUT YOUR STORIES AND
YOUR EXPERIENCES- AND THE
COMMUNICATION OF YOUR LOVED
ONES THEIR VOICES SPEAK THROUGH
YOU WE WILL IS ALWAYS THE MOST
POWERFUL TOOL WE HAVE. TO
CHANGED TOWARDS LAWS GREATER
PASSION SO THANK YOU ALL FOR
COMING TODAY AND WITH THE BILL.
MEETING ADJOURNED.