California Nursing Home Abuse Lawyer Blog
A significant update to California’s POLST framework is moving steadily through the state legislature. Senate Bill 1088, authored by Catherine Blakespear and sponsored by the Coalition for Compassionate Care of California (CCCC), has received overwhelming bipartisan support and is expected to bring several important improvements to how POLST forms are used throughout the state.
For years, POLST has stood for “Physician Orders for Life Sustaining Treatment.” These forms serve an important role in documenting a patient’s wishes regarding emergency medical interventions, resuscitation, hospitalization, and other end of life care decisions. However, SB 1088 recognizes that the current framework can be improved to better reflect modern healthcare practices and patient autonomy.
One of the most visible changes proposed by the bill is a new meaning for the POLST acronym. Under SB 1088, POLST would stand for “Portable Orders Listing Scope of Treatment.” This change reflects the reality that POLST forms are no longer exclusively completed by physicians. Nurse practitioners and physician assistants may also participate in the process under California law. The updated terminology is also intended to remove the potentially misleading phrase “life sustaining treatment,” which can imply that every medical intervention will meaningfully extend life. In many situations, particularly for frail elderly patients with advanced illness, interventions such as CPR may be unlikely to achieve that outcome.
The legislation also modernizes POLST administration by expressly authorizing electronic signatures. This change is particularly important as the Emergency Medical Services Authority prepares to implement a statewide electronic POLST registry. Ensuring that electronically executed forms are legally recognized will improve accessibility, reduce administrative barriers, and make patients’ treatment preferences more readily available when needed.
Another important provision addresses interstate recognition of medical orders. SB 1088 directs healthcare professionals to honor substantially similar POLST type orders originating from other states. This change will help ensure continuity of care for patients who travel or relocate and reduce confusion during medical emergencies.
The bill also standardizes language regarding who may complete a POLST form on behalf of an incapacitated patient. Current law refers to a “legally recognized decisionmaker,” terminology that has sometimes created uncertainty. SB 1088 replaces that phrase with the more commonly understood term “surrogate,” creating consistency with other areas of healthcare decision making law.
Perhaps most importantly, the bill strengthens patient protections by making clear that completion of a POLST form is entirely voluntary. Although the POLST form itself prominently states that it is not mandatory, existing statutes do not expressly contain that protection. As a result, concerns have arisen that some healthcare facilities may improperly pressure patients to complete POLST forms as a condition of admission or continued care. SB 1088 would explicitly prohibit requiring a POLST for any purpose, including admission to a skilled nursing facility, assisted living facility, or other healthcare setting.
The bill has already passed both the Senate Health Committee and Senate Judiciary Committee without opposition. It subsequently received unanimous approval on the Senate floor and now moves to the Assembly, where it will be considered by the Assembly Health and Judiciary Committees. While a few technical amendments are anticipated, supporters remain optimistic that the legislation will continue to advance.
If enacted, SB 1088 will modernize California’s POLST system, improve patient choice, facilitate electronic healthcare records, and reinforce the principle that end of life treatment decisions belong to patients and their families, not healthcare institutions. These reforms represent a meaningful step forward in ensuring that medical care remains aligned with individual values, goals, and informed consent.
