Bill Text: CA SB345 | 2023-2024 | Regular Session | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Health care services: legally protected health care activities.
Spectrum: Partisan Bill (Democrat 19-0)
Status: (Passed) 2023-09-27 - Chaptered by Secretary of State. Chapter 260, Statutes of 2023. [SB345 Detail]
Download: California-2023-SB345-Amended.html
NOYES
provider was located in California care was legal in the state in which it was provided at the time of the challenged conduct.
The Legislature finds and declares that the titles added to the Civil Code by this act further the purpose and intent of the California Privacy Rights Act of 2020, enacted by Proposition 24 at the November 3, 2020, statewide election, within the meaning of Section 25 of Proposition 24.
Bill Title: Health care services: legally protected health care activities.
Spectrum: Partisan Bill (Democrat 19-0)
Status: (Passed) 2023-09-27 - Chaptered by Secretary of State. Chapter 260, Statutes of 2023. [SB345 Detail]
Download: California-2023-SB345-Amended.html
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Amended
IN
Senate
April 10, 2023 |
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Amended
IN
Senate
March 16, 2023 |
CALIFORNIA LEGISLATURE—
2023–2024 REGULAR SESSION
Senate Bill
No. 345
| Introduced by Senator Skinner |
February 07, 2023 |
An act to amend Section 2746.5 of, and to add Section 852 to, the Business and Professions Code, to add Title 1.81.49 (commencing with Section 1798.99.90) and Title 1.81.7 (commencing with Section 1798.300) to Part 4 of Division 3 of the Civil Code, to amend Sections 762.020, 872.520, and 1710.50 of the Code of Civil Procedure, to amend Section 22171 of the Education Code, to amend Section 1317.1 of, and to add Section 123468.5 to, the Health and Safety Code, to amend Section 187 of, and to add Sections 1549.15 and 13778.3 to, the Penal Code, and to amend Sections 1003, 10954, 15405, and 19507 of the Probate Code, relating to
health care services.
LEGISLATIVE COUNSEL'S DIGEST
SB 345, as amended, Skinner.
Health care services: legally protected health care activities.
(1) Existing law provides for the licensure and regulation of various categories of medical professionals by boards within the Department of Consumer Affairs, including, among others, the Medical Board of California and the Dental Board of California. Existing law makes specified actions by licensed health care providers unprofessional conduct and, in certain cases, a criminal offense.
This bill would prohibit a board from suspending or revoking the license of a person regulated under the above healing arts provisions solely because the person provided a legally protected health care activity. In this connection, the bill would define a “legally protected health care activity” to mean specified acts, including exercising rights related to reproductive health care services or gender-affirming health care services secured
by the Constitution or the provision of insurance coverage for those services.
The bill would also prohibit a board from denying an application for licensure or suspending, revoking, or otherwise imposing discipline on a licensed person because they were disciplined or convicted of an offense in another state, if that disciplinary action was for providing a legally protected health care activity. The bill would further provide that the performance, recommendation, or provision of a legally protected health care activity by a health care practitioner acting within their scope of practice for a patient who resides in a state in which the performance, recommendation, or provision of that legally protected health care activity is illegal, does not, by itself, constitute professional misconduct, upon which discipline or other penalty may be taken.
(2) Existing law, the Confidentiality of Medical Information
Act, generally prohibits a health care provider, health care service plan, contractor, or corporation from sharing, selling, using for marketing, or otherwise using medical information for a purpose not necessary to provide health care services to the patient.
Existing law, as amended by the California Privacy Rights Act of 2020 (CPRA), an initiative approved by the voters at the November 3, 2020, statewide general election, imposes various obligations on businesses with respect to protecting consumer privacy and information, including requiring certain disclosures to consumers regarding a consumer’s rights under the act. The CPRA authorizes the Legislature to amend the act to further the purposes and intent of the act by a majority vote of both houses of the Legislature, as specified.
This bill would prohibit a business that tracks, uses, collects, or stores geographic location
data from tracking, using, storing, or selling data that contains the personally identifying information of a person physically located in or in close proximity to a family planning center, as defined. This bill would declare that its provisions further the purposes and intent of the CPRA.
(3) Existing law, the Reproductive Privacy Act, declares as contrary to the public policy of this state a law of another state that authorizes a person to bring a civil action against a person or entity that engages in certain activities relating to obtaining or performing an abortion. Existing law prohibits the state from applying an out-of-state law described above to a case or controversy in state court or enforcing or satisfying a civil judgment under the out-of-state law.
This bill would state that California law governs in any action against a person who provides or
receives by any means, including telehealth, reproductive health care services or gender-affirming health care services, as specified, if the provider was located in California care was legal in the state in which it was provided at the time of the challenged conduct.
The bill would state that interference with the right to reproductive health care services and gender-affirming health care services, as those terms are defined, is against the public policy of California. The bill would declare as a violation of public policy a public act or record of a foreign jurisdiction that, among other things, authorizes a person to bring a civil action against a person, provider, or other entity in California for, among other acts, seeking or providing reproductive or gender-affirming
health care services. The bill would authorize a person to institute and prosecute a civil action against a person who engages in abusive litigation, as defined, that infringes on or interferes with a legally protected health care activity, among other things. The bill would specify damages and costs authorized to be recovered and would specify circumstances under which a court may exercise jurisdiction over a person in such a civil action. The bill would authorize an aggrieved person, provider, or other entity to move to modify or quash a subpoena issued in connection with abusive litigation. The bill would specify the laws of California govern in a case or controversy heard in California related to reproductive or gender-affirming health care services, except as required by federal law.
(4) Existing law permits a judgment creditor to apply for the entry of a judgment based on a sister state judgment by filing an
application with a superior court and requires the court clerk to enter a judgment based on the application. Existing law also requires courts to grant a stay enforcement of such a judgment under specified circumstances.
This bill would additionally require a court to grant a stay of enforcement of a sister state judgment if a money judgment or lien on real property was obtained for the exercise of a right guaranteed by the United States Constitution at the time the right was exercised, a right guaranteed by the California Constitution, or for aiding and abetting the exercise of those rights.
(5) Existing law defines murder as the unlawful killing of a human being, or a fetus, with malice aforethought. Existing law creates an exemption for a person who
commits an act that results in the death of a fetus under specific circumstances, including if the act is solicited, aided, abetted, or consented to by the mother of the fetus.
This bill would expand that exemption to include a mother who committed the act that resulted in the death of the fetus.
(6) Existing law requires the Governor to recognize a demand for extradition of a person if the demand meets specified requirements. Existing law permits the Governor to recognize a demand for extradition of a person charged with committing an act in this state, or in a 3rd state, that results in a crime in the demanding state. Existing law requires a magistrate, upon the filing of a verified complaint, to issue a warrant directed to any
peace officer commanding the officer to apprehend an individual in this state who is convicted, or has violated the terms of bail, probation, or parole, or who is charged with a crime, in another state and who is believed to be in this state.
This bill would, except as required by federal law, prohibit the Governor from recognizing a demand for the extradition of a person charged with legally protected health care activity, as defined, unless the demanding state alleges that the person was physically present in the demanding state at the time of the commission of the alleged crime and then fled.
(7) Existing law prohibits a state or local law enforcement agency or officer from knowingly arresting or knowingly participating in the arrest of any person for performing, supporting, or aiding in the
performance of an abortion or for obtaining an abortion, if the abortion is lawful in this state. Existing law prohibits a state or local public agency from cooperating with or providing information to an individual or agency from another state or a federal law enforcement agency, as specified, regarding a lawful abortion.
This bill would additionally prohibit a state or local government employee or a person acting on behalf of the local or state government, among others, from providing information or expending resources in furtherance of an investigation that seeks to impose civil or criminal liability or professional sanctions on an individual for a legally protected health activity occurring in this state.
care activity that occurred in this state or that would be legal if it occurred in this state. The bill would require any out-of-state subpoena to include an affidavit or declaration under penalty of perjury that the discovery request is not in connection with an out-of-state proceeding relating to a legally protected health care activity, except as specified. By requiring an individual seeking to discovery under these provisions to declare certain conditions are present under penalty of perjury, this bill would expand the crime of perjury and impose a state-mandated local program.
(8) Existing law refers to “unborn children” and “unborn persons” in various contexts, including, among others, defining low-risk pregnancy conditions for determining the scope of authorization of a certificate to practice nurse-midwifery, defining active labor for health facility licensing provisions, and defining spouse for
California State Teachers’ Retirement System benefits.
This bill would replace “unborn child” and “unborn person” with “fetus” in those provisions.
(9) Existing law also refers to “unborn persons” in various contexts, including naming unknown defendants in real property actions, allowing a court to appoint a guardian ad litem to advocate for inadequately represented interests in probate proceedings, allowing a guardian ad litem to give consent on behalf of a beneficiary who lacks legal capacity, and providing an exception for requiring a personal representative to file an account of the distributions of a decedent’s estate.
This bill would replace “unborn person” with “unborn beneficiary” in those provisions.
(10) The California
Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program:Bill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 852 is added to the Business and Professions Code, to read:852.
(a) Notwithstanding any other law, a board shall not suspend or revoke the license of a person regulated under this division solely because that person provided a legally protected health care activity, as defined in Section 1798.300 of the Civil Code.(b) Notwithstanding any other law, a board shall not deny an application for licensure under this division or suspend, revoke, or otherwise impose discipline upon a person licensed pursuant to this division because the person was disciplined for or convicted of an offense in another state in which they were licensed if the suspension, revocation, or other discipline was for providing a legally protected health care
activity, as defined in Section 1798.300 of the Civil Code.
(c) The performance, recommendation, or provision of any legally protected health care activity, as defined in Section 1798.300 of the Civil Code, by a health care practitioner acting within their scope of practice, for a patient who resides in a state in which the performance, recommendation, or provision of that legally protected health care activity is illegal, shall not, by itself, constitute professional misconduct under this division or any regulation governing the licensure, certification, or authorization of such practitioner, nor shall any license, certification certification, or authorization of a
health care practitioner be revoked, suspended, or annulled or otherwise subject to any other penalty or discipline provided in this division solely on the basis that the health care practitioner performed, recommended, or provided any legally protected health care activity for a patient who resides in a state in which the performance, recommendation, or provision of that legally protected health service is illegal.
SEC. 2.
Section 2746.5 of the Business and Professions Code is amended to read:2746.5.
(a) The certificate to practice nurse-midwifery authorizes the holder to attend cases of low-risk pregnancy and childbirth and to provide prenatal, intrapartum, and postpartum care, including interconception care, family planning care, and immediate care for the newborn, consistent with the Core Competencies for Basic Midwifery Practice adopted by the American College of Nurse-Midwives, or its successor national professional organization, as approved by the board. For purposes of this subdivision, “low-risk pregnancy” means a pregnancy in which all of the following conditions are met:(1) There is a single fetus.
(2) There is a cephalic presentation at onset of labor.
(3) The gestational age of the fetus is greater than or equal to 37 weeks and zero days and less than or equal to 42 weeks and zero days at the time of delivery.
(4) Labor is spontaneous or induced.
(5) The patient has no preexisting disease or condition, whether arising out of the pregnancy or otherwise, that adversely affects the pregnancy and that the certified nurse-midwife is not qualified to independently address consistent with this section.
(b) (1) The certificate to practice nurse-midwifery authorizes the holder to practice with a physician and surgeon under mutually agreed-upon
policies and protocols that delineate the parameters for consultation, collaboration, referral, and transfer of a patient’s care, signed by both the certified nurse-midwife and a physician and surgeon to do either of the following:
(A) Provide a patient with care that falls outside the scope of services specified in subdivision (a).
(B) Provide intrapartum care to a patient who has had a prior cesarean section or surgery that interrupts the myometrium.
(2) If a physician and surgeon assumes care of the patient, the certified nurse-midwife may continue to attend the birth of the newborn and participate in physical care, counseling, guidance, teaching, and support, as indicated by the mutually agreed-upon policies and
protocols signed by both the certified nurse-midwife and a physician and surgeon.
(3) After a certified nurse-midwife refers a patient to a physician and surgeon, the certified nurse-midwife may continue care of the patient during a reasonable interval between the referral and the initial appointment with the physician and surgeon.
(c) (1) If a nurse-midwife does not have in place mutually agreed-upon policies and protocols that delineate the parameters for consultation, collaboration, referral, and transfer of a patient’s care, signed by both the certified nurse-midwife and a physician and surgeon pursuant to paragraph (1) of subdivision (b), the patient shall be transferred to the care of a physician and surgeon to do either or both of the following:
(A) Provide a patient with care that falls outside the scope of services specified in subdivision (a).
(B) Provide intrapartum care to a patient who has had a prior cesarean section or surgery that interrupts the myometrium.
(2) After the certified nurse-midwife initiates the process of transfer pursuant to paragraph (1), for a patient who otherwise meets the definition of a low-risk pregnancy but no longer meets the criteria specified in paragraph (3) of subdivision (a) because the gestational age of the fetus is greater than 42 weeks and zero days, if there is inadequate time to effect safe transfer to a hospital prior to delivery or transfer may pose a threat to the health and safety of the patient or the fetus, the
certified nurse-midwife may continue care of the patient consistent with the transfer plan described in subdivision (a) of Section 2746.54.
(3) A patient who has been transferred from the care of a certified nurse-midwife to that of a physician and surgeon may return to the care of the certified nurse-midwife after the physician and surgeon has determined that the condition or circumstance that required, or would require, the transfer from the care of the nurse-midwife pursuant to paragraph (1) is resolved.
(d) The certificate to practice nurse-midwifery authorizes the holder to attend pregnancy and childbirth in an out-of-hospital setting if consistent with subdivisions (a), (b), and (c).
(e) This section shall not
be interpreted to deny a patient’s right to self-determination or informed decisionmaking with regard to choice of provider or birth setting.
(f) The certificate to practice nurse-midwifery does not authorize the holder of the certificate to assist childbirth by vacuum or forceps extraction, or to perform any external cephalic version.
(g) A certified nurse-midwife shall document all consultations, referrals, and transfers in the patient record.
(h) (1) A certified nurse-midwife shall refer all emergencies to a physician and surgeon immediately.
(2) A certified nurse-midwife may provide emergency care until the assistance of a physician and surgeon is
obtained.
(i) This chapter does not authorize a nurse-midwife to practice medicine or surgery.
(j) This section shall not be construed to require a physician and surgeon to sign protocols and procedures for a nurse-midwife or to permit any action that violates Section 2052 or 2400.
(k) This section shall not be construed to require a nurse-midwife to have mutually agreed-upon, signed policies and protocols for the provision of services described in subdivision (a).
SEC. 3.
Title 1.81.49 (commencing with Section 1798.99.90) is added to Part 4 of Division 3 of the Civil Code, to read:TITLE 1.81.49. Family Planning Center Location Data
1798.99.90.
(a) A business that tracks, uses, collects, or stores geographic location data shall not track, use, store, or sell data that contains the personally identifying information of a person physically located in or in close proximity to a family planning center.(b) For purposes of this section, “family planning center” means a business categorized as a family planning center by the North American Industry Classification System adopted by the United States Census Bureau, including, but not limited to, an abortion clinic, birth control clinic, pregnancy counseling center, or reproductive health services center.
(c) An aggrieved person or entity, including a family planning center, may institute and prosecute a civil action against any person or business who violates this section for injunctive and monetary relief and attorney’s fees within three years of discovery of the violation.
SEC. 4.
Title 1.81.7 (commencing with Section 1798.300) is added to Part 4 of Division 3 of the Civil Code, to read:TITLE 1.81.7. Reproductive and Gender-Affirming Health Care Services
1798.300.
As used in this title, the following definitions apply:(a) “Abusive litigation” means litigation or other legal action to deter, prevent, sanction, or punish a person engaging in legally protected health care activity by either of the following:
(1) Filing or prosecuting an action in a state other than California where liability, in whole or part, directly or indirectly, is based on a legally protected health care activity that occurred in California, was legal in the state in
which it occurred, including an action in which liability is based on a theory of vicarious, joint, or several liability.
(2) Attempting to enforce an order or judgment issued in connection with an action described in paragraph (1) by a party to the action or a person acting on behalf of a party to the action. A lawsuit shall be considered to be based on conduct that occurred in California was legal in the state in which it occurred if a part of an act or omission involved in the course of conduct that forms the basis for liability in the lawsuit occurs or is initiated in California,
a state in which the health care was legal, whether or not the act or omission is alleged or included in a pleading or other filing in the lawsuit.
(b) “Gender-affirming health care services” and “gender-affirming mental health care services” have the same meaning as defined in paragraph (3) of subdivision (b) of Section 16010.2 of the Welfare and Institutions Code.
(c) (1) “Legally protected health care activity” means any of the following:
(A) The exercise and enjoyment, or attempted exercise and
enjoyment, by a person of rights to reproductive health care services, gender-affirming health care services, or gender-affirming mental health care services secured by the Constitution or laws of California or the provision of insurance coverage for such services.
(B) An act or omission undertaken to aid or encourage, or attempt to aid or encourage, a person in the exercise and enjoyment or attempted exercise and enjoyment of rights to reproductive health care services, gender-affirming health care services, or gender-affirming mental health care services secured by the Constitution or laws of California.
(C) The provision of the health care services by a person duly licensed under the laws of California and physically present in California
and the provision of insurance coverage for the services, if the service is permitted under the laws of California, regardless of the patient’s location.
(2) “Legally protected health care activity” does not include a service rendered below the applicable professional standard of care or that would violate antidiscrimination laws of California.
(d) “Reproductive health care services” means and includes all services, care, or products of a medical, surgical, psychiatric, therapeutic, diagnostic, mental health, behavioral health, preventative, rehabilitative, supportive, consultative, referral, prescribing, or dispensing nature relating to the human reproductive system provided in accordance with the constitution and laws of this state, whether provided in person or by
means of telehealth services which includes, but is not limited to, all services, care, and products relating to pregnancy, assisted reproduction, contraception, miscarriage management, the termination of a pregnancy, or self-managed terminations.
1798.301.
Access to reproductive health care services and gender-affirming health care services is a right secured by the Constitution and laws of California. Interference with this right, whether or not under the color of law, is against the public policy of California.1798.302.
A public act or record of a foreign jurisdiction that prohibits, criminalizes, sanctions, authorizes a person to bring a civil action against, or otherwise interferes with a person, provider, or other entity in California that seeks, receives, causes, aids in access to, aids, abets, provides, or attempts or intends to seek, receive, cause, aid in access to, aid, abet, or provide, reproductive health care services or gender-affirming health care services shall be an interference with the exercise and enjoyment of the rights secured by the Constitution and laws of California and shall be a violation of the public policy of California.1798.303.
If a person, including a plaintiff, prosecutor, attorney, or law firm, whether or not acting under color of law, engages or attempts to engage in abusive litigation that infringes on or interferes with, or attempts to infringe on or interfere with, a legally protected health care activity, then an aggrieved person, provider, carrier, or other entity, including a defendant in the abusive litigation, may institute and prosecute a civil action for injunctive, monetary, or other appropriate relief within three years after the cause of action accrues.1798.304.
An aggrieved person, provider, or other entity, including a defendant in abusive litigation, may move to modify or quash a subpoena issued in connection with abusive litigation on the grounds that the subpoena is unreasonable, oppressive, or inconsistent with the public policy of California.1798.305.
If the court finds for the petitioner in an action authorized by Section 1798.303, recovery shall be in the amount of three times the amount of actual damages, which shall include damages for the amount of a judgment issued in connection with an abusive litigation, and any other expenses, costs, or reasonable attorney’s fees incurred in connection with the abusive litigation.1798.306.
(a) A court may exercise jurisdiction over a person in an action authorized by Section 1798.303 if any of the following apply:(1) Personal jurisdiction is found under Section 410.10 of the Code of Civil Procedure.
(2) The person has commenced an action in a court in California and, during the pendency of that action or an appeal therefrom, a summons and complaint is served on the person or the attorney appearing on the person’s behalf in that action or as otherwise permitted by law.
(3) The exercise of jurisdiction is permitted under the Constitution
of the United States.
(b) This section does not apply to a lawsuit or judgment entered in another state that is based on conduct for which a cause of action exists under the laws of California, including a contract, tort, common law, or statutory claims.
1798.307.
Notwithstanding any other law, the laws of California shall govern in a case or controversy heard in California related to reproductive health care services or gender-affirming health care services, except as may be required by federal law.1798.308.
This title shall not be construed to provide jurisdiction over a California resident in an out-of-state forum when the California resident has not availed themselves of that forum.SEC. 5.
Section 762.020 of the Code of Civil Procedure is amended to read:762.020.
(a) If the name of a person required to be named as a defendant is not known to the plaintiff, the plaintiff shall so state in the complaint and shall name as parties all persons unknown in the manner provided in Section 762.060.(b) If the claim or the share or quantity of the claim of a person required to be named as a defendant is unknown, uncertain, or contingent, the plaintiff shall so state in the complaint. If the lack of knowledge, uncertainty, or contingency is caused by a transfer to an unborn or unascertained beneficiary or class member, or by a transfer in the form of a contingent remainder, vested remainder subject to defeasance,
executory interest, or similar disposition, the plaintiff shall also state in the complaint, so far as is known to the plaintiff, the name, age, and legal disability (if any) of the person in being who would be entitled to the claim had the contingency upon which the claim depends occurred prior to the commencement of the action.
SEC. 6.
Section 872.520 of the Code of Civil Procedure is amended to read:872.520.
(a) If the name of a person described in Section 872.510 is not known to the plaintiff, the plaintiff shall so state in the complaint and shall name as parties all persons unknown in the manner provided in Section 872.550.(b) If the ownership or the share or quantity of the interest of a person described in Section 872.510 is unknown, uncertain, or contingent, the plaintiff shall so state in the complaint. If the lack of knowledge, uncertainty, or contingency is caused by a transfer to an unborn or unascertained beneficiary or class member, or by a transfer in the form of a contingent remainder, vested remainder subject to defeasance, executory
interest, or similar disposition, the plaintiff shall also state in the complaint, so far as is known to the plaintiff, the name, age, and legal disability (if any) of the person in being who would be entitled to ownership of the interest had the contingency upon which the right of such person depends occurred prior to the commencement of the action.
(c) The court shall upon its own motion or upon motion of any party make such orders for joinder of additional parties and for appointment of guardians ad litem pursuant to Sections 372, 373, and 373.5 as are necessary or proper.
SEC. 7.
Section 1710.50 of the Code of Civil Procedure is amended to read:1710.50.
(a) The court shall grant a stay of enforcement where:(1) An appeal from the sister state judgment is pending or may be taken in the state which originally rendered the judgment. Under this paragraph, enforcement shall be stayed until the proceedings on appeal have been concluded or the time for appeal has expired.
(2) A stay of enforcement of the sister state judgment has been granted in the sister state. Under this paragraph, enforcement shall be stayed until the sister state stay of enforcement expires or is vacated.
(3) The
judgment debtor has made a motion to vacate pursuant to Section 1710.40. Under this paragraph, enforcement shall be stayed until the judgment debtor’s motion to vacate is determined.
(4) A money judgment or lien on real property was obtained against a person or entity for exercising a right guaranteed under the United States Constitution as interpreted by the United States Supreme Court precedent at the time the right was exercised, or a right guaranteed under the California Constitution, or against a person or entity for aiding and abetting the exercise of said rights.
(5) Any other circumstance exists where the interests of justice require a stay of enforcement.
(b) The court may grant a stay of enforcement under this section on its own motion, on ex parte motion, or on noticed motion.
(c) The court shall grant a stay of enforcement under this section on such terms and conditions as are just including but not limited to the following:
(1) The court may require an undertaking in an amount it determines to be just, but the amount of the undertaking shall not exceed double the amount of the judgment creditor’s claim.
(2) If a writ of execution has been issued, the court may order that it remain in effect.
(3) If property of the judgment debtor has been levied upon under
a writ of execution, the court may order the levying officer to retain possession of the property capable of physical possession and to maintain the levy on other property.
SEC. 8.
Section 22171 of the Education Code is amended to read:22171.
(a) “Spouse” means a person who was continuously married to the member for the period beginning at least 12 months prior to the death of the member, unless a child is born to the member and the member’s spouse within the 12-month period or unless the spouse is carrying a fetus, conceived with the member.(b) “Spouse” also means a person who was married to the member for less than 12 months, if the member’s death was either accidental, or due to an illness, and the marriage took place prior to the occurrence of the injury or diagnosis of the illness that resulted in death.
(1) A member’s
death is defined as accidental only if the member received bodily injuries through violent, external, or accidental means and died as a direct result of the bodily injuries and independent of all other causes.
(2) This subdivision does not apply if, at the time of the marriage, the member could not have reasonably been expected to live for 12 months.
(c) Except as excluded by Sections 22661 and 23812, a person who is the registered domestic partner of a member, as established pursuant to Section 297 or 299.2 of the Family Code, shall be treated in the same manner as a spouse.
SEC. 9.
Section 1317.1 of the Health and Safety Code is amended to read:1317.1.
Unless the context otherwise requires, the following definitions shall control the construction of this article and Section 1371.4:(a) (1) “Emergency services and care” means medical screening, examination, and evaluation by a physician and surgeon, or, to the extent permitted by applicable law, by other appropriate licensed persons under the supervision of a physician and surgeon, to determine if an emergency medical condition or active labor exists and, if it does, the care, treatment, and surgery, if within the scope of that person’s license, necessary to relieve or eliminate the emergency medical condition, within the capability of the facility.
(2) (A) “Emergency services and care” also means an additional screening, examination, and evaluation by a physician, or other personnel to the extent permitted by applicable law and within the scope of their licensure and clinical privileges, to determine if a psychiatric emergency medical condition exists, and the care and treatment necessary to relieve or eliminate the psychiatric emergency medical condition, within the capability of the facility.
(B) The care and treatment necessary to relieve or eliminate a psychiatric emergency medical condition may include admission or transfer to a psychiatric unit within a general acute care hospital, as defined in subdivision (a) of Section 1250, or to an acute psychiatric hospital, as defined in subdivision (b) of Section
1250, pursuant to subdivision (k). Nothing in this subparagraph shall be construed to permit a transfer that is in conflict with the Lanterman-Petris-Short Act (Part 1 (commencing with Section 5000) of Division 5 of the Welfare and Institutions Code).
(C) For the purposes of Section 1371.4, emergency services and care as defined in subparagraph (A) shall not apply to Medi-Cal managed care plan contracts entered into with the State Department of Health Care Services pursuant to Chapter 7 (commencing with Section 14000), Chapter 8 (commencing with Section 14200), and Chapter 8.75 (commencing with Section 14590) of Part 3 of Division 9 of the Welfare and Institutions Code, to the extent that those services are excluded from coverage under those contracts.
(D) This paragraph does
not expand, restrict, or otherwise affect the scope of licensure or clinical privileges for clinical psychologists or other medical personnel.
(b) “Emergency medical condition” means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in any of the following:
(1) Placing the patient’s health in serious jeopardy.
(2) Serious impairment to bodily functions.
(3) Serious dysfunction of any bodily organ or part.
(c) “Active labor” means a labor at a time at which
either of the following would occur:
(1) There is inadequate time to effect safe transfer to another hospital prior to delivery.
(2) A transfer may pose a threat to the health and safety of the patient or the fetus.
(d) “Hospital” means all hospitals with an emergency department licensed by the state department.
(e) “State department” means the State Department of Public Health.
(f) “Medical hazard” means a material deterioration in medical condition in, or jeopardy to, a patient’s medical condition or expected chances for recovery.
(g) “Board” means the Medical Board of California.
(h) “Within the capability of the facility” means those capabilities that the hospital is required to have as a condition of its emergency medical services permit and services specified on Services Inventory Form 7041 filed by the hospital with the Office of Statewide Health Planning and Development. Department of Health Care Access and Information.
(i) “Consultation” means the rendering of an opinion or advice, prescribing treatment, or the rendering of a decision regarding hospitalization or transfer by telephone or other means of communication. When
determined to be medically necessary, jointly by the treating physician and surgeon, or by other appropriate licensed persons acting within their scope of licensure, under the supervision of a physician and surgeon, and the consulting physician and surgeon, “consultation” includes review of the patient’s medical record, examination, and treatment of the patient in person by a consulting physician and surgeon, or by other appropriate licensed persons acting within their scope of licensure under the supervision of a consulting physician and surgeon, who is qualified to give an opinion or render the necessary treatment in order to stabilize the patient. A request for consultation shall be made by the treating physician and surgeon, or by other appropriate licensed persons acting within their scope of licensure under the supervision of a treating physician and surgeon, provided the request is made with
the contemporaneous approval of the treating physician and surgeon. The treating physician and surgeon may request to communicate directly with the consulting physician and surgeon, and when determined to be medically necessary, jointly by the treating physician and surgeon and the consulting physician and surgeon, the consulting physician and surgeon shall examine and treat the patient in person. The consulting physician and surgeon is ultimately responsible for providing the necessary consultation to the patient, regardless of who makes the in-person appearance.
(j) A patient is “stabilized” or “stabilization” has occurred when, in the opinion of the treating physician and surgeon, or other appropriate licensed persons acting within their scope of licensure under the supervision of a treating physician and surgeon, the patient’s
medical condition is such that, within reasonable medical probability, no material deterioration of the patient’s condition is likely to result from, or occur during, the release or transfer of the patient as provided for in Section 1317.2, Section 1317.2a, or other pertinent statute.
(k) (1) “Psychiatric emergency medical condition” means a mental disorder that manifests itself by acute symptoms of sufficient severity that it renders the patient as being either of the following:
(A) An immediate danger to themselves or to others.
(B) Immediately unable to provide for, or utilize, food, shelter, or clothing, due to the mental disorder.
(2) This subdivision does not expand, restrict, or otherwise affect the scope of licensure or clinical privileges for clinical psychologists or medical personnel.
(l) This section shall not be construed to expand the scope of licensure for licensed persons providing services pursuant to this section.
SEC. 10.
Section 123468.5 is added to the Health and Safety Code, to read:123468.5.
(a) (1) California law governs in any action, whether civil, administrative, or criminal, against any person who provides, receives, aids or abets in providing or receiving, or attempts to provide or receive, by any means, including telehealth, the health care services described in paragraph (2) if the(2) Reproductive health care services and
gender-affirming health care services, including gender-affirming mental health care services, are subject to paragraph (1).
(b) “Reproductive health” has the same meaning as set forth in Section 1798.300 of the Health and Safety Code.
(c) “Gender-affirming health care services” and “gender-affirming mental health care services” have the same meaning as defined in paragraph (3) of subdivision (b) of Section 16010.2 of the Welfare and Institutions Code.
SEC. 11.
Section 187 of the Penal Code is amended to read:187.
(a) Murder is the unlawful killing of a human being, or a fetus, with malice aforethought.(b) This section shall not apply to any person who commits an act that results in the death of a fetus if any of the following apply:
(1) The act complied with the former Therapeutic Abortion Act (Article 2 (commencing with Section 123400) of Chapter 2 of Part 2 of Division 106 of the Health and Safety
Code) or the Reproductive Privacy Act (Article 2.5 (commencing with Section 123460) of Chapter 2 of Part 2 of Division 106 of the Health and Safety Code).
(2) The act was committed by a holder of a physician’s and surgeon’s certificate, as defined in the Business and Professions Code, in a case where, to a medical certainty, the result of childbirth would be death of the mother of the fetus or where her the mother’s death from childbirth, although not medically certain, would be substantially certain or more likely than not.
(3) The act was committed, solicited, aided, abetted, or consented to by
the mother of the fetus.
(c) Subdivision (b) shall not be construed to prohibit the prosecution of any person under any other provision of law.
SEC. 12.
Section 1549.15 is added to the Penal Code, to read:1549.15.
(a) For purposes of this section, the following terms have the following meanings:(1) “Gender-affirming health care” and “gender-affirming mental health care” have the same meaning as in paragraph (3) of subdivision (b) of Section 16010.2 of the Welfare and Institutions Code.
(2) “Legally protected health care activity” means and includes both of the following acts and omissions by providers and facilitators of reproductive health
care services and gender-affirming health care and gender-affirming mental health care to the extent they are not in violation of the constitution or the laws of this state:
(A) Any act or omission undertaken to aid or encourage, or attempt to aid or encourage, a person in the exercise or attempted exercise of laws of this state, or to provide insurance coverage for such services or care.
(B) The provision of such reproductive health care services or gender-affirming health care or gender-affirming mental health care by a person duly licensed under the laws of this state and the provision of insurance coverage for such services or care is permitted
under the laws of this state, regardless of the patient’s location.
(3) “Reproductive health care services” means and includes all services, care, or products of a medical, surgical, psychiatric, therapeutic, diagnostic, mental health, behavioral health, preventative, rehabilitative, supportive, consultative, referral, prescribing, or dispensing nature relating to the human reproductive system provided in accordance with the constitution
and laws of this state, whether provided in person or by means of telehealth services which includes, but is not limited to, all services, care, and products relating to pregnancy, assisted reproduction, contraception, miscarriage management, the termination of a pregnancy, or self-managed terminations.
(b) Notwithstanding Section 1549.1 or any other law law, and except as required by federal law, a demand for the extradition of a person charged with any legally protected health care
activity shall not be recognized by the Governor unless the executive authority of the demanding state alleges in writing that the accused was physically present in the demanding state at the time of the commission of the alleged crime, and that thereafter, that person fled from that state. in accordance with Section 1548.2.
SEC. 13.
Section 13778.3 is added to the Penal Code, to read:13778.3.
(a) For purposes of this section, the following terms shall have the following meaning:(1) “Gender-affirming health care” and “gender-affirming mental health care” have the same meaning as in paragraph (3) of subdivision (b) of Section 16010.2 of the Welfare and Institutions Code.
(2) “Legally protected health care activity” shall have the same meaning as in Section 1549.15.
(3) “Reproductive health
care services” shall have the same meaning as in Section 1549.15.
(b) A state or local government employee, person or entity contracted by a state or local government, or person or entity acting on behalf of a local or state government shall not cooperate with or provide information to any individual or out-of-state agency or department regarding any legally protected health care activity or otherwise expend or use time, moneys, facilities, property, equipment, personnel, or other resources in furtherance of any investigation or proceeding that seeks to impose civil or criminal liability or professional sanctions upon a person or entity for any legally protected health activity occurring in this state.
care activity that occurred in this state or that would be legal if it occurred in this state.
(c) This section does not prohibit compliance with a valid, court-issued subpoena or warrant which does not relate to a law seeking to impose civil or criminal liability or professional sanctions for a legally protected health care activity, or in response to the written request of a person who is the subject of such an investigation or proceeding, to the extent necessary, in each case, to fulfill such request.
(d) Any out-of-state subpoena or warrant shall include an affidavit or declaration under penalty
of perjury that the discovery is not in connection with an out-of-state proceeding relating to any legally protected health care activity unless the out-of-state proceeding meets all of the following requirements:
(1) Is based in tort, contract, or on statute.
(2) Is actionable, in an equivalent or similar manner, under the laws of this state.
(3) Was brought by the patient who received legally protected health care activity or the patient’s legal representative.
SEC. 14.
Section 1003 of the Probate Code is amended to read:1003.
(a) The court may, on its own motion or on request of a personal representative, guardian, conservator, trustee, or other interested person, appoint a guardian ad litem at any stage of a proceeding under this code to represent the interest of any of the following persons, if the court determines that representation of the interest otherwise would be inadequate:(1) A minor.
(2) A person who lacks legal capacity to make decisions.
(3) An unborn beneficiary.
(4) An
unascertained person.
(5) A person whose identity or address is unknown.
(6) A designated class of persons who are not ascertained or are not in being.
(b) If not precluded by a conflict of interest, a guardian ad litem may be appointed to represent several persons or interests.
(c) The reasonable expenses of the guardian ad litem, including compensation and attorney’s fees, shall be determined by the court and paid as the court orders, either out of the property of the estate involved or by the petitioner or from any other source as the court orders.
(d) Before a court appoints a guardian ad litem
pursuant to this chapter, a proposed guardian ad litem shall disclose both of the following to the court and all parties to the action or proceeding:
(1) Any known actual or potential conflicts of interest that would or might arise from the appointment.
(2) Any familial or affiliate relationship the proposed guardian ad litem has with any of the parties.
(e) If a guardian ad litem becomes aware that a potential conflict of interest has become an actual conflict of interest or that a new potential or actual conflict of interest exists, the guardian ad litem shall promptly disclose the conflict of interest to the court.
SEC. 15.
Section 10954 of the Probate Code is amended to read:10954.
(a) Notwithstanding any other provision of this part, the personal representative is not required to file an account if any of the following conditions is satisfied as to each person entitled to distribution from the estate:(1) The person has executed and filed a written waiver of account or a written acknowledgment that the person’s interest has been satisfied.
(2) Adequate provision has been made for satisfaction in full of the person’s interest. This paragraph does not apply to a residuary devisee or a devisee whose interest in the estate is subject to abatement, payment of
expenses, or accrual of interest or income.
(b) A waiver or acknowledgment under subdivision (a) shall be executed as follows:
(1) If the person entitled to distribution is an adult and competent, by that person.
(2) If the person entitled to distribution is a minor, by a person authorized to receive money or property belonging to the minor. If the waiver or acknowledgment is executed by a guardian of the estate of the minor, the waiver or acknowledgment may be executed without the need to obtain approval of the court in which the guardianship proceeding is pending.
(3) If the person entitled to distribution is a conservatee, by the conservator of the estate
of the conservatee. The waiver or acknowledgment may be executed without the need to obtain approval of the court in which the conservatorship proceeding is pending.
(4) If the person entitled to distribution is a trust, by the trustee, but only if the named trustee’s written acceptance of the trust is filed with the court. In the case of a trust that is subject to the continuing jurisdiction of the court pursuant to Chapter 4 (commencing with Section 17300) of Part 5 of Division 9, the waiver or acknowledgment may be executed without the need to obtain approval of the court.
(5) If the person entitled to distribution is an estate, by the personal representative of the estate. The waiver or acknowledgment may be executed without the need to obtain approval of the court
in which the estate is being administered.
(6) If the person entitled to distribution is incapacitated, is an unborn beneficiary, is unascertained, or is a person whose identity or address is unknown, or is a designated class of persons who are not ascertained or are not in being, and there is a guardian ad litem appointed to represent the person entitled to distribution, by the guardian ad litem.
(7) If the person entitled to distribution has designated an attorney in fact who has the power under the power of attorney to execute the waiver or acknowledgment, by either of the following:
(A) The person entitled to distribution if an adult and competent.
(B) The attorney
in fact.
(c) Notwithstanding subdivision (a):
(1) The personal representative shall file a final report of administration at the time the final account would otherwise have been required. The final report shall include the amount of compensation paid or payable to the personal representative and to the attorney for the personal representative and shall set forth the basis for determining the amounts.
(2) A creditor whose interest has not been satisfied may petition under Section 10950 for an account.
SEC. 16.
Section 15405 of the Probate Code is amended to read:15405.
For the purposes of Sections 15403 and 15404, the consent of a beneficiary who lacks legal capacity, including a minor, or who is an unascertained or unborn beneficiary may be given in proceedings before the court by a guardian ad litem, if it would be appropriate to do so. In determining whether to give consent, the guardian ad litem may rely on general family benefit accruing to living members of the beneficiary’s family as a basis for approving a modification or termination of the trust.SEC. 17.
Section 19507 of the Probate Code is amended to read:19507.
(a) In this section, a notice period begins on the day notice is given under subdivision (c) and ends 59 days after the day notice is given.(b) An authorized fiduciary may exercise the decanting power without the consent of any person and without court approval in compliance with this part.
(c) Except as otherwise provided in subdivision (h), an authorized fiduciary shall give notice of the intended exercise of the decanting power not later than 60 days before the exercise to all of the following:
(1) Each settlor of the first trust, if living or then in
existence.
(2) Each qualified beneficiary of the first trust.
(3) Each holder of a presently exercisable power of appointment over any part or all of the first trust.
(4) Each person that currently has the right to remove or replace the authorized fiduciary.
(5) Each other fiduciary of the first trust.
(6) Each fiduciary of the second trust.
(7) The Attorney General, if subdivision (b) of Section 19514 applies.
(d) Unless the trust instrument provides otherwise, an authorized fiduciary
shall give notice under subdivision (c) to the guardian ad litem for a qualified beneficiary who is a minor and has no representative or who is an unascertained or unborn beneficiary. If a guardian ad litem has not been appointed at the time of the notice, the authorized fiduciary shall seek the appointment of one. The court may appoint a guardian ad litem, for purposes of this section, in instances where the only matter before the court is that appointment.
(e) If an authorized fiduciary knows, or has reason to know, that a person entitled to notice under subdivision (c) is substantially unable to manage that person’s own financial resources or resist fraud or undue influence, the authorized fiduciary shall give notice under subdivision (c) to that person and to the individual appointed to act on that person’s behalf, including, but not
limited to, an attorney-in-fact under a power of attorney. If no such individual has been appointed at the time of the notice, the authorized fiduciary shall seek the appointment of such an individual. The court may appoint a guardian ad litem, for purposes of this section, in instances where the only matter before the court is that appointment.
(f) An authorized fiduciary is not required to give notice under subdivision (c) to a person who is known to the fiduciary but cannot be located by the fiduciary after reasonable diligence.
(g) A notice under subdivision (c) shall include all of the following:
(1) A description of the manner in which the authorized fiduciary intends to exercise the decanting power, which
shall include a statement as to the authorized fiduciary’s reason for the proposed decanting and an explanation as to the differences between the first trust and the second trust or trusts.
(2) The proposed effective date for exercise of the power.
(3) A copy of the first trust instrument.
(4) A copy of all second trust instruments.
(5) A warning, set out in a separate paragraph in not less than 10-point bold type, or a reasonable equivalent thereof, that states the following:
“If you do not bring a court action to contest the proposed trust decanting (the proposed changes to the
trust) within 59 days of this notice, you will lose your right to contest the decanting.”
(h) The decanting power may be exercised before expiration of the notice period under subdivision (a) if all persons entitled to receive notice waive the period in a signed waiver.
(i) The receipt of notice, waiver of the notice period, or expiration of the notice period does not affect the right of a person to file an application under Section 19509 that asserts either of the following:
(1) An attempted exercise of the decanting power is ineffective because it did not comply with this part or was an abuse of discretion or breach of fiduciary duty.
(2) Section 19522 applies to the exercise of the decanting power.
(j) The notice required by this section shall be served by mail to the last known address, pursuant to Section 1215, or by personal delivery.
