SB 1088, Updating California’s Medical Decision-Making Tools, Signed by Governor Newsom
Sacramento, CA, September 30, 2026 --(PR.com)-- The Coalition for Compassionate Care of California (CCCC’s) Chief Executive Officer, Jennifer Moore Ballentine, MA, today announced that SB 1088, a bill to update and amend California’s laws governing do not resuscitate and portable medical orders, has been signed into law by Governor Newsom.
In California, adults have several options for stating their preferences for medical treatment when they are not able to speak for themselves. The California Advance Health Care Directive allows the person to appoint a durable healthcare power of attorney, or “healthcare agent” or surrogate, and state preferences for treatment in the context of incurable/irreversible illness or permanent unconsciousness and organ donation. Some versions of the form include statements of personal values and preferences for treatment in other circumstances. California also honors advance health care directives executed in other states.
Two other California tools convert a person’s preferences for treatment into actionable medical orders: the prehospital DNR (do not resuscitate) form and POLST. The prehospital DNR refuses CPR (cardiopulmonary resuscitation) when a person’s heart or breathing stop in a residential or community setting (e.g., at home, in public, or in a nursing home). It must be signed by the person or their authorized surrogate and a physician. POLST (Physician Orders for Life-Sustaining Treatment) allows a person to choose to receive CPR or not; to designate a “scope of treatment” they prefer to receive in a medical crisis (Full Treatment, Selected Treatment, or Comfort-Focused Treatment); and whether they wish to receive artificial nutrition long term, for a trial period, or not at all. POLST must be signed by the person or their authorized surrogate and a physician (MD/DO), nurse practitioner, or physician assistant. POLST must be honored in all settings: in the community and in all healthcare facilities by all healthcare professionals and first responders.
SB 1088 amended the statute governing the prehospital DNR and POLST, as well as several related statutes, to achieve more alignment across the several medical decision-making tools and clarify important aspects of practice.
“These amendments were motivated by a survey the Coalition for Compassionate Care of California undertook in 2024,” explained Jennifer Moore Ballentine, CCCC’s CEO. “The survey results showed there was a lot of confusion around the use of the several advance medical decision-making tools in California. Confusion can create real harm and undermine patients’ rights to receive the medical treatment they want and not receive treatment they don’t want. These amendments will strengthen the tools Californians use to express their wishes and expect to have them honored.”
Specifically, SB 1088,
Changes the name of the POLST form from “Physician Orders for Life Sustaining Treatment (POLST)” to “POLST (Portable Orders Listing Scope of Treatment).”
· Why? Because in California, not only physicians but also nurse practitioners and physician assistants/associates can sign POLST and to move away from the emphasis on “life-sustaining treatment” to a broader understanding of the application of POLST as medical orders.
Authorizes nurse practitioners and physician assistants/associates to also sign the prehospital DNR form.
· Why? Limiting signature of the prehospital DNR to physicians only creates problems for patients and their surrogates in regions and settings where physicians are scarce. This change also aligns the prehospital DNR with POLST, eliminating confusion about who is authorized to sign which form.
Specifies who, exactly, is authorized to sign a POLST on behalf of an incapacitated patient.
· Why? The previous language of “Legally recognized decisionmaker” to identify a surrogate has no real meaning in healthcare decisions law; however, some people are and other people are not authorized to sign a POLST for an incapacitated patient. SB 1088 clarifies/specifies that the only authorized signers of a POLST for an incapacitated patient are the person's appointed healthcare agent (healthcare power of attorney), guardian or conservator with healthcare decision-making authority, a surrogate orally designated by the patient when they had capacity or selected by a healthcare provider according to the specified process (sections 4711 and 4712 of the Probate Code), or a skilled nursing facility’s interdisciplinary team with patient representation.
Explicitly states that POLST is entirely voluntary and the provision of care or admission to a facility cannot be conditioned on completion of or refusal to complete a POLST or prehospital “do not resuscitate” order.
· Why? Because too often healthcare facilities present POLST as a requirement for admission, either by implication when it is included with all the other admission paperwork, or more directly. Some ambulance services refuse to transport a patient without a POLST. The law will now clearly state that no one can be required to complete a POLST as a condition of health care or service.
Authorizes electronic signature of POLST for electronic health records and the POLST eRegistry.
· Why? POLSTs are already being completed electronically, and the state of California is building a statewide electronic POLST registry. However, there was no specific provision in the law to say that electronic signatures are valid. The law will now state that clearly.
Requires healthcare personnel to honor POLSTs and POLST-like forms and prehospital DNRs executed in other states.
· Why? All 50 states now have some kind of POLST program, with substantially similar forms and nearly identical basic provisions. Many also have their own prehospital DNR forms. A tourist or temporary/part-time resident of California or someone who has recently moved to the state should have confidence that their prior POLST or prehospital DNR form will be honored.
These amendments will take effect on January 1, 2027. Changes to both the POLST and prehospital DNR forms will be made and new forms made available by CCCC, the California Hospital Association, and the California Emergency Medical Services Authority.
For more information about advance health care directives and decision making, visit CoalitionCCC.org>Resources>Advance Care Planning Resources.
For more information about POLST, visit CAPOLST.org.
For more information about the prehospital DNR, visit EMSA.gov.
About the Coalition for Compassionate Care of California
CCCC’s mission is to make conversations about serious illness a part of everyday life and palliative care a part of everyday healthcare. CCCC is a statewide coalition of organizations, institutions, healthcare providers, state agencies, and individuals working together to promote high-quality, compassionate palliative and end-of-life care for all Californians. Through advocacy, education, and resource development, CCCC is working to ensure that organizations and communities have the information, knowledge, and tools to increase access to palliative care.
In California, adults have several options for stating their preferences for medical treatment when they are not able to speak for themselves. The California Advance Health Care Directive allows the person to appoint a durable healthcare power of attorney, or “healthcare agent” or surrogate, and state preferences for treatment in the context of incurable/irreversible illness or permanent unconsciousness and organ donation. Some versions of the form include statements of personal values and preferences for treatment in other circumstances. California also honors advance health care directives executed in other states.
Two other California tools convert a person’s preferences for treatment into actionable medical orders: the prehospital DNR (do not resuscitate) form and POLST. The prehospital DNR refuses CPR (cardiopulmonary resuscitation) when a person’s heart or breathing stop in a residential or community setting (e.g., at home, in public, or in a nursing home). It must be signed by the person or their authorized surrogate and a physician. POLST (Physician Orders for Life-Sustaining Treatment) allows a person to choose to receive CPR or not; to designate a “scope of treatment” they prefer to receive in a medical crisis (Full Treatment, Selected Treatment, or Comfort-Focused Treatment); and whether they wish to receive artificial nutrition long term, for a trial period, or not at all. POLST must be signed by the person or their authorized surrogate and a physician (MD/DO), nurse practitioner, or physician assistant. POLST must be honored in all settings: in the community and in all healthcare facilities by all healthcare professionals and first responders.
SB 1088 amended the statute governing the prehospital DNR and POLST, as well as several related statutes, to achieve more alignment across the several medical decision-making tools and clarify important aspects of practice.
“These amendments were motivated by a survey the Coalition for Compassionate Care of California undertook in 2024,” explained Jennifer Moore Ballentine, CCCC’s CEO. “The survey results showed there was a lot of confusion around the use of the several advance medical decision-making tools in California. Confusion can create real harm and undermine patients’ rights to receive the medical treatment they want and not receive treatment they don’t want. These amendments will strengthen the tools Californians use to express their wishes and expect to have them honored.”
Specifically, SB 1088,
Changes the name of the POLST form from “Physician Orders for Life Sustaining Treatment (POLST)” to “POLST (Portable Orders Listing Scope of Treatment).”
· Why? Because in California, not only physicians but also nurse practitioners and physician assistants/associates can sign POLST and to move away from the emphasis on “life-sustaining treatment” to a broader understanding of the application of POLST as medical orders.
Authorizes nurse practitioners and physician assistants/associates to also sign the prehospital DNR form.
· Why? Limiting signature of the prehospital DNR to physicians only creates problems for patients and their surrogates in regions and settings where physicians are scarce. This change also aligns the prehospital DNR with POLST, eliminating confusion about who is authorized to sign which form.
Specifies who, exactly, is authorized to sign a POLST on behalf of an incapacitated patient.
· Why? The previous language of “Legally recognized decisionmaker” to identify a surrogate has no real meaning in healthcare decisions law; however, some people are and other people are not authorized to sign a POLST for an incapacitated patient. SB 1088 clarifies/specifies that the only authorized signers of a POLST for an incapacitated patient are the person's appointed healthcare agent (healthcare power of attorney), guardian or conservator with healthcare decision-making authority, a surrogate orally designated by the patient when they had capacity or selected by a healthcare provider according to the specified process (sections 4711 and 4712 of the Probate Code), or a skilled nursing facility’s interdisciplinary team with patient representation.
Explicitly states that POLST is entirely voluntary and the provision of care or admission to a facility cannot be conditioned on completion of or refusal to complete a POLST or prehospital “do not resuscitate” order.
· Why? Because too often healthcare facilities present POLST as a requirement for admission, either by implication when it is included with all the other admission paperwork, or more directly. Some ambulance services refuse to transport a patient without a POLST. The law will now clearly state that no one can be required to complete a POLST as a condition of health care or service.
Authorizes electronic signature of POLST for electronic health records and the POLST eRegistry.
· Why? POLSTs are already being completed electronically, and the state of California is building a statewide electronic POLST registry. However, there was no specific provision in the law to say that electronic signatures are valid. The law will now state that clearly.
Requires healthcare personnel to honor POLSTs and POLST-like forms and prehospital DNRs executed in other states.
· Why? All 50 states now have some kind of POLST program, with substantially similar forms and nearly identical basic provisions. Many also have their own prehospital DNR forms. A tourist or temporary/part-time resident of California or someone who has recently moved to the state should have confidence that their prior POLST or prehospital DNR form will be honored.
These amendments will take effect on January 1, 2027. Changes to both the POLST and prehospital DNR forms will be made and new forms made available by CCCC, the California Hospital Association, and the California Emergency Medical Services Authority.
For more information about advance health care directives and decision making, visit CoalitionCCC.org>Resources>Advance Care Planning Resources.
For more information about POLST, visit CAPOLST.org.
For more information about the prehospital DNR, visit EMSA.gov.
About the Coalition for Compassionate Care of California
CCCC’s mission is to make conversations about serious illness a part of everyday life and palliative care a part of everyday healthcare. CCCC is a statewide coalition of organizations, institutions, healthcare providers, state agencies, and individuals working together to promote high-quality, compassionate palliative and end-of-life care for all Californians. Through advocacy, education, and resource development, CCCC is working to ensure that organizations and communities have the information, knowledge, and tools to increase access to palliative care.
Contact
Coalition for Compassionate Care
Jennifer Ballentine
916-779-7502
https://CoalitionCCC.org
Jennifer Ballentine
916-779-7502
https://CoalitionCCC.org
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