BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Sheila J. Kuehl, Chair
BILL NO: SB 1196
S
AUTHOR: Runner
B
AMENDED: March 24, 2008
HEARING DATE: March 26, 2008
1
FISCAL: No
1
CONSULTANT:
9
Patterson/sh
6
SUBJECT
Local government: Coroners
SUMMARY
Eliminates the requirement for a coroner to investigate the
death of an individual who had been attended to, in the 20
days before death, by a registered nurse who is a member of
a hospice interdisciplinary team, and provides discretion
to a coroner as to whether or not to perform or arrange for
an autopsy upon request of a decedent's legal next-of-kin.
CHANGES TO EXISTING LAW
Existing law:
Existing law requires a coroner to investigate the
circumstances, manner, and cause of specified types of
deaths, including violent, sudden, or unusual deaths;
unattended deaths; and deaths where the deceased has not
been attended to by a physician within 20 days before the
death occurred. Existing law affords the coroner
discretion to determine the extent of the inquiry into a
death occurring under natural circumstances, and allows the
coroner to authorize a physician to sign the certificate of
death, if the physician has sufficient knowledge to
reasonably state the cause of a death occurring under
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natural circumstances.
Existing law requires a coroner to perform or arrange for
an autopsy on a decedent upon a written request of the
surviving spouse, or in certain circumstances, a child,
parent, or other legal next-of-kin. Existing law requires
the cost of the autopsy to be borne by the person
requesting it.
Existing law defines hospice as a specialized form of
interdisciplinary health care that is designed to provide
palliative care, alleviate the physical, emotional, social,
and spiritual discomforts of an individual who is
experiencing the last phases of life due to the existence
of a terminal disease, and as well as to provide supportive
care to the primary caregiver and the family of the hospice
patient. Hospices must meet specified criteria, including
utilization of an interdisciplinary team to assess the
physical, medical, psychological, social, and spiritual
needs of the patient and the patient's family. A hospice
interdisciplinary team must include a physician, a
registered nurse, a social worker, a volunteer, and a
spiritual caregiver. The law requires the team to
generally operate under the medical direction of a
physician, but to be coordinated by a registered nurse.
This bill:
This bill would eliminate the requirement for a coroner to
investigate the death of an individual who had been
attended to, in the 20 days before death, by a registered
nurse who is a member of a hospice interdisciplinary team.
The bill would also change the requirement that a coroner
perform or arrange for an autopsy on a decedent upon
request of the surviving spouse, child, parent, or
next-of-kin, and place the decision to do so within the
discretion of the coroner
FISCAL IMPACT
Unknown.
BACKGROUND AND DISCUSSION
Purpose
According to the author, because of the requirement that
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coroners investigate the death of any individual not
attended to by a physician in the 20 days before death, too
many law enforcement hours are spent each year
investigating naturally occurring deaths of hospice
patients. The author asserts that, requiring the coroner
to visit the home of a deceased hospice patient is an
unnecessary diversion of scarce law enforcement resources,
as well as unsettling to family members struggling with the
loss of their loved one. The author states that neither
grieving family members, nor sheriff's deputies, who often
represent coroners, should be put in the position of
completing a police report for the death of a hospice
patient who had been attended to in the 20 days before
death by a registered nurse on the hospice care
interdisciplinary team, as a representative of the
patient's physician. The author contends that, permitting
the registered nurse on the hospice care interdisciplinary
team to satisfy the 20-day requirement will allow the
coroner and sheriff's department to attend to more
important duties, thereby allowing precious law enforcement
resources to be applied to crime without any additional
cost.
The author also states that current law allows a decedent's
legal next-of-kin to compel coroners to conduct additional
autopsies in cases where a cause of death has previously
been determined, sometimes by a previous autopsy. The
author states that, in most instances, the findings of the
second autopsy are used only to support planned or active
civil proceedings. The author argues that these types of
autopsy requests add additional burdens to the coroner's
caseload and have no relevance to the core legal mandate of
coroners. By affording discretion to a coroner to perform
or not to perform an autopsy requested by the next-of-kin,
the author asserts that more time may be spent working on
autopsy cases that impact both public health and the
criminal justice system.
Hospice services
Hospice provides palliative care to terminally ill patients
who are near or at the end of life, and who have decided to
forgo curative treatment. To qualify for hospice care, a
physician must determine that the patient has less than six
months to live. According to the California HealthCare
Foundation (CHCF), more than 88,000 Californians, half of
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them over 80 years of age, sought hospice services in 2004.
This figure represents a 93 percent increase from the
46,000 individuals who sought hospice services in 1996. A
majority of hospice patients (approximately 70 percent)
received hospice services in their own homes. CHCF reports
that even though patients with a prognosis of six months or
less to live are eligible for hospice care, nearly
two-thirds receive hospice services for less than one
month. Approximately 54 percent of hospice patients in
2004 spent 20 days or less in hospice.
While hospice care is provided under the medical direction
of the interdisciplinary team's physician, licensed nurses
and nursing aides are the primary providers of hospice care
to patients. According to the California Hospice and
Palliative Care Association (CHAPCA), it is not uncommon
for a hospice patient to go unattended by their physician
for more than 20 days.
According to CHAPCA, the role of the coroner in the death
of a hospice patient varies between counties, and is
largely determined by the coroner's own interpretation of
the law. For example, in Lake County, when a hospice
patient dies, the hospice is required to contact the
coroner to report the death if that patient had not been
seen by their physician in the last 20 days of life. The
coroner will arrive at the home of the patient, will
generally call the patient's doctor to request that he or
she sign the certificate of death, and, upon agreement by
the doctor, which occurs in almost all cases, will leave
the home. In some counties, hospices notify the coroner
when a patient enters into hospice, and also when that
patient dies. In these counties, the coroner will often
forgo an investigation of the death of that patient. In
other counties, the need for an investigation into the
death of a hospice patient is determined by the coroner who
happens to be on duty at the time the death is reported.
Autopsy services
Generally, coroners make the determination of whether or
not to perform an autopsy on a decedent. Most often,
autopsies are performed when a death is considered
unexpected, traumatic, or unusual. A decedent's legal
next-of-kin may request in writing that the coroner perform
an autopsy, whether or not an autopsy has already been
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performed. Individuals may also request that a coroner
from a county other than the one in which the decedent died
perform the autopsy. The individual requesting the autopsy
is generally required to bear the cost of the autopsy,
which varies between counties. For example, in Sacramento
County, the cost for a coroner to perform a requested
autopsy is estimated at $2,500, whereas, in Los Angeles
County, it is estimated to cost approximately $5,000.
A decedent's next-of-kin may seek private autopsy services
at their own expense. A number of private autopsy services
conduct business in California, offering various services
such as full or partial autopsies, toxicology analyses,
neuropathology services, including post-mortem diagnoses,
and medical malpractice and wrongful death investigations.
Costs for these private services vary between providers.
One service, based in Southern California charges $2,995 to
perform a full autopsy. A Sacramento-based company charges
between $2,800 and $5,500 for a full autopsy, including
travel expenses.
Prior legislation
AB 2646 (Daucher, 2006) would have required the Commission
on Peace Officer Standards and Training (POST) to evaluate
its coroner's death investigation course for the need to
include information regarding death from terminal illness,
laws related to hospice care and services, reporting
requirements and procedures relating to hospice licensure,
and hospice reporting requirements regarding disposition of
controlled substances. This bill was vetoed.
Arguments in support
The California State Coroner's Association (CSCA), CHAPCA,
and Hospice Services of Lake County state that this bill
would reduce the deployment of scarce coroner and law
enforcement resources used to investigate natural deaths,
and would avoid placing grieving family members through the
process of completing a police report when they have just
lost a loved one. The organizations also state that
removing the burden of a home visit to verify the cause of
death of a hospice patient will allow law enforcement
resources to be put to better use.
CSCA also states that there are currently less than 70
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forensic pathologists practicing in California. CSCA
states that this shortage of forensic pathologists has
resulted in significant cost increases for their services,
and that demand for forensic pathologists has increased
significantly, thereby delaying case processing times for
coroners. CSCA states that this bill will clarify current
law, so that coroners will be able to devote more time to
activities that better serve the public and that impact
public health and safety.
California Advocates for Nursing Home Reform (CANHR) states
that it would support the bill if amended to delete
provisions eliminating the duty of the coroner to perform
an autopsy at the request of the next-of-kin. CANHR also
states that the rationale for these provisions is dubious
given the lack of statistics on the number of individual
autopsy requests received per year, and the fact that the
expense of these autopsies is borne by the family members,
not the counties. CANHR questions whether the costs of
private autopsy services are the same as those charged by
the coroner, and if the results of private autopsy services
are given the same credibility in court as the coroner's
results. CANHR states that county coroners are public
servants employed by local governments to serve the
citizens of those localities, and that taking away the duty
to serve local citizens, thereby leaving the decision to
perform autopsies to the complete discretion of the
coroner, would be a disservice to taxpayers.
COMMENTS AND QUESTIONS
1.Scope of problem stemming from autopsy requests by
families is unclear. It is
unclear to what extent autopsy requests from families of
decedents impact coroner resources, as it does not appear
that data is available on the number of such requests
received by coroners.
2. Elimination of coroner's autopsy services could impose
barriers to families. While private autopsy services may
be available, elimination of a coroner's mandated services
could result in the imposition of cost or quality barriers
on a family's ability to obtain an autopsy. For example,
if a coroner denies a family's request for an autopsy, and
the family resides in a county where private autopsy
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services are unavailable, the family may be forced to
contract with a private service from another region, and
pay additional fees to cover travel expenses or other
costs. These kinds of barriers could diminish a family's
ability to pursue an autopsy in cases where the family may
question the cause of death, or have questions or concerns
over circumstances surrounding the death.
POSITIONS
Support: California State Coroner's Association (sponsor)
Hospice Services of Lake County (sponsor)
California Advocates for Nursing Home Reform (if
amended)
California Hospice and Palliative Care Association
Sheriff-Coroner of San Bernardino County
Oppose: None received.