San Francisco Health Network outlines End of Life Option Act procedures, training and safeguards

The San Francisco Department of Public Health on Tuesday presented a detailed plan to implement the California End of Life Option Act across its hospitals and clinics, saying participation by physicians and staff will be voluntary and accompanied by training and ethics oversight.

Sneha Patel, senior health program planner in the department—s Office of Policy and Planning, outlined the law—s eligibility and procedural requirements and how the San Francisco Health Network intends to meet them. "Prescribing an aid in dying drug is completely voluntary for any physician," Patel said, adding that the network will develop online training for physicians who opt in to serve as attending or consulting physicians.

The policy the department proposed follows the statute—s process: two oral requests made by the patient at least 15 days apart, a written request witnessed by two individuals, an attending-physician eligibility assessment and counseling about alternatives (including hospice and palliative care), and referral to a mental health specialist when there are concerns about capacity. Patel said the network—s medical staff office will track which physicians volunteer to participate and that regulatory affairs offices will oversee required state forms and documentation.

The department also addressed medication logistics and coverage. Patel said seconal is the most commonly used aid-in-dying drug and that it will be available at San Francisco General and Laguna Honda Hospital pharmacies. "Medi-Cal is covering the cost of the drug as well as patient visits for all Medi-Cal patients," she said.

Commissioners pressed staff on early experience since the law took effect in June 2016. Physicians on the panel reported four or five inquiries and one patient who completed the process and received medication but, to their knowledge, had not ingested it. The panel noted that many inquiries do not result in ingestion because some patients die during the 15-day waiting period or decide against using the medication.

The commission discussed whether hospital spaces count as public spaces for ingestion, noting the law prohibits public ingestion. Presenters said the network does not anticipate permitting ingestion in inpatient hospital units, and that when patients lack a private residence the transitions team will try to secure appropriate placement. Laguna Honda, where residents live long-term on site, is handling the resident question separately because residents would be acting in their place of residence.

On ethical oversight, the department said hospital ethics committees will be available for consults when questions of coercion, capacity or disputed eligibility arise, but that mandatory ethics consultation for every case is not planned; ethics input would be used when needed. Staff said they will revisit the policy after an initial set of cases to make any necessary refinements.

The commission asked for a resolution supporting implementation to come back at the next meeting so the body can formally register its positions and any suggested amendments.