SB 1323 Hawaii Senate · 2026 Regular Session

RELATING TO HEALTH CARE.

Summary

Adopts the Uniform Health Care Decisions Act (2023), as modified, to replace existing chapters related to advance health care directives and advance mental health care directives. (CD1)

Issues: ✓ Healthcare

Bill status passed both 4 of 5 stages cleared

Introduction

Jan 2025

Committee Review

Apr 2025

Senate Passage

Mar 2025

House Passage

Apr 2025

Governor

Introduced Jan 21, 2025 Last action Apr 2, 2026

Maddy AI version diff · 5 comparisons

What changed between versions

SB1323_SD1 → SB1323_SD2 · 5 edits

MODERATE

This bill updates the Hawaii Health Care Decisions Act to modernize definitions, clarify the roles of default surrogates, and align terminology with current legal standards. Key changes include redefining 'Health care' to explicitly include mental health care, updating the timeline for default surrogate declarations, and refining the criteria for when a person can be disqualified as a surrogate. These adjustments aim to improve clarity for healthcare providers and ensure that individuals' wishes regarding medical decisions are respected more effectively.

Scope change

The scope of the bill's applicability remains focused on health care decision-making in Hawaii, but the definition of 'health care' is expanded to explicitly include mental health care, broadening the protections and guidelines to cover mental health scenarios more clearly.

DEFINITION

The definition of 'Health care' was updated to explicitly include mental health care, ensuring that mental health decisions are treated with the same legal weight as physical health decisions.

Terminology related to 'Health care professional' and 'Responsible health care professional' was standardized to ensure consistency across the statute.

REQUIREMENT

The process for default surrogates was refined to include clearer language about when a professional can request interested persons to choose a new surrogate if the current one is unwilling or unable to comply with duties.

The bill was updated to reflect changes in the Hawaii Revised Statutes, ensuring that references to other laws and sections are accurate and up-to-date.

ELIGIBILITY

Criteria for disqualifying a default surrogate were adjusted to include specific conditions, such as when a potential surrogate refuses to provide a timely declaration or is involved in legal proceedings like divorce or annulment.

SB1323_HD2 → SB1323_SD1 · 7 edits

MODERATE

This bill updates Hawaii's advance health care laws by adopting the Uniform Health-Care Decisions Act (2023) to consolidate existing rules into a single, clearer chapter. It expands the definition of 'Advanced Practice Registered Nurse' to include psychiatric specialization, clarifies how to determine if a person lacks capacity, and strengthens protections for individuals who create 'Ulysses clauses' to prevent revoking mental health directives during a crisis. The changes also update cross-references to other state laws and repeal the old, separate chapters for health care and mental health care directives.

Scope change

The bill consolidates previously separate chapters (327E and 327G) into one unified chapter, expanding the scope to include more detailed definitions and procedures for default surrogates and capacity assessments.

DEFINITION

Updated the definition of 'Advanced Practice Registered Nurse' to explicitly require an accredited national certification in psychiatric mental-health specialization.

Clarified the definition of 'Reasonably available' for agents and default surrogates to include the willingness and ability to comply with duties in a timely manner.

REQUIREMENT

Revised the definition of 'Capacity' to clarify that an individual has capacity if they can communicate decisions independently or with appropriate services like supported decision-making.

Added a 'Ulysses clause' provision allowing individuals to direct that their advance mental health care directive cannot be revoked if they are experiencing a specific psychiatric or psychological event.

Updated the list of professionals who can determine lack of capacity to include physicians, psychologists, and advanced practice registered nurses.

ENFORCEMENT

Increased statutory damages for intentional violations of health care professional duties from $5,000 to $50,000.

TECHNICAL

Repealed the old chapters 327E and 327G and replaced them with a single consolidated chapter.

SB1323_CD1 → SB1323_HD1 · 25 edits

MAJOR

This bill updates Hawaii's health care decision laws by adopting a new Uniform Health Care Decisions Act that consolidates previous rules into a single chapter. It clarifies definitions, strengthens protections for patients' wishes regarding life-sustaining treatment, and sets a future effective date of July 1, 3000, likely as a placeholder for a future legislative session.

Scope change

The bill's scope is expanded by replacing two separate chapters (327E and 327G) with one unified chapter, and it adds new definitions for 'cohabitant' and 'family member' to clarify who can act as a default surrogate.

TIMELINE

The effective date was changed from immediate approval to July 1, 3000, indicating this is a draft version awaiting future enactment.

DEFINITION

Definitions for 'cohabitant' and 'family member' were added to clarify eligibility for default surrogates.

The definition of 'minor' was changed from 'under eighteen' to 'less than eighteen' to align with standard legal terminology.

REQUIREMENT

The process for appointing default surrogates was streamlined, and the requirements for declaring a default surrogate were updated.

The powers of agents and default surrogates were clarified to ensure they act in accordance with the patient's known wishes.

The bill now explicitly states that agents and default surrogates must have a fiduciary duty to the patient.

The bill was updated to include mental health care directives within the scope of the new unified act.

The bill was updated to include provisions for advance mental health care directives.

The bill was updated to include provisions for the revocation of advance health care directives.

The bill was updated to include provisions for the withdrawal of agents.

The bill was updated to include provisions for the duties of health care professionals.

The bill was updated to include provisions for the decision-making authority of guardians.

The bill was updated to include provisions for immunity from liability for health care professionals.

The bill was updated to include provisions for prohibited conduct and damages.

The bill was updated to include provisions for the effect of copies of advance health care directives.

The bill was updated to include provisions for judicial relief.

The bill was updated to include provisions for the construction of the act.

The bill was updated to include provisions for the uniformity of application and construction.

The bill was updated to include provisions for saving provisions.

The bill was updated to include provisions for transitional provisions.

The bill was updated to include provisions for the amendment of existing statutes.

The bill was updated to include provisions for the repeal of existing statutes.

The bill was updated to include provisions for the severability of the act.

The bill was updated to include provisions for the statutory material to be repealed.

The bill was updated to include provisions for the effective date of the act.

Floor votes

How they voted

This bill passed the Senate by voice vote (no roll call recorded).

Full legislative history

Actions timeline

Total actions

Key actions

Committee

Amendments

Apr 30, 2025

Committee

Recommitted to Conference committee as amended in CD 1 with none voting no and Representative(s) Cochran, Hussey excused.

lower

Apr 30, 2025

Committee

Recommitted to Conference Committee.

upper

Apr 24, 2025

Lower · Passed

Reported from Conference Committee (Conf Com. Rep. No. 88) as amended in (CD 1).

lower

Apr 24, 2025

Introduced

48 Hrs. Notice (as amended CD 1) 04-30-25.

upper

Apr 24, 2025

Upper · Passed

Reported from Conference Committee as amended CD 1 (Conf. Com. Rep. No. 88).

upper

Apr 24, 2025

Lower · Passed

The Conference Committee recommends that the measure be Passed, with Amendments. The votes were as follows: 3 Ayes: Representative(s) Takayama, Poepoe, Garcia; Ayes with reservations: none; 0 Noes: none; and 0 Excused: none.

lower

Apr 24, 2025

Upper · Passed

The Conference committee recommends that the measure be PASSED, WITH AMENDMENTS. The votes of the Senate Conference Managers were as follows: 3 Aye(s): Senator(s) San Buenaventura, Rhoads, Hashimoto; Aye(s) with reservations: none ; 0 No(es): none; and 1 Excused: Senator(s) Fevella.

upper

Apr 23, 2025

Upper · Passed

Conference committee meeting to reconvene on 04-24-25 3:30PM; Conference Room 329.

upper

Apr 22, 2025

Upper · Passed

Conference committee meeting scheduled for 04-23-25 3:30PM; Conference Room 329.

upper

Apr 8, 2025

Amended

Senate disagrees with House amendments.

upper

Apr 8, 2025

Introduced

Received from House (Hse. Com. No. 605).

upper

Apr 4, 2025

Lower · Passed

Passed Third Reading as amended in HD 2 with Representative(s) Iwamoto voting aye with reservations; none voting no (0) and Representative(s) Cochran excused (1). Transmitted to Senate.

lower

Mar 25, 2025

Lower · Passed

The committee on JHA recommend that the measure be PASSED, WITH AMENDMENTS. The votes were as follows: 10 Ayes: Representative(s) Tarnas, Poepoe, Belatti, Cochran, Hashem, Perruso, Takayama, Todd, Garcia, Shimizu; Ayes with reservations: none; 0 Noes: none; and 1 Excused: Representative(s) Kahaloa.

lower

Mar 21, 2025

Committee

Reported from HLT (Stand. Com. Rep. No. 1421) as amended in HD 1, recommending passage on Second Reading and referral to JHA.

lower

Mar 19, 2025

Lower · Passed

The committee on HLT recommend that the measure be PASSED, WITH AMENDMENTS. The votes were as follows: 9 Ayes: Representative(s) Takayama, Keohokapu-Lee Loy, Amato, Chun, Marten, Olds, Takenouchi, Alcos, Garcia; Ayes with reservations: none; 0 Noes: none; and 0 Excused: none.

lower

Mar 6, 2025

Committee

Referred to HLT, JHA, referral sheet 19

lower

Mar 4, 2025

Introduced

Received from Senate (Sen. Com. No. 306) in amended form (SD 2).

lower

Mar 4, 2025

Upper · Passed

Report adopted; Passed Third Reading, as amended (SD 2). Ayes, 25; Aye(s) with reservations: none . Noes, 0 (none). Excused, 0 (none). Transmitted to House.

upper

Feb 20, 2025

Upper · Passed

The committee(s) on JDC recommend(s) that the measure be PASSED, WITH AMENDMENTS. The votes in JDC were as follows: 4 Aye(s): Senator(s) Rhoads, Chang, San Buenaventura, Awa; Aye(s) with reservations: none ; 0 No(es): none; and 1 Excused: Senator(s) Gabbard.

upper

Feb 18, 2025

Upper · Passed

The committee(s) on JDC will hold a public decision making on 02-20-25 10:01AM; CR 016 & Videoconference.

upper

Feb 14, 2025

Upper · Passed

Report adopted; Passed Second Reading, as amended (SD 1) and referred to JDC.

upper

Feb 14, 2025

Committee

Reported from HHS (Stand. Com. Rep. No. 532) with recommendation of passage on Second Reading, as amended (SD 1) and referral to JDC.

upper

Feb 5, 2025

Upper · Passed

The committee(s) on HHS recommend(s) that the measure be PASSED, WITH AMENDMENTS. The votes in HHS were as follows: 4 Aye(s): Senator(s) San Buenaventura, Aquino, Hashimoto, Keohokalole; Aye(s) with reservations: none ; 0 No(es): none; and 1 Excused: Senator(s) Fevella.

upper

Jan 31, 2025

Upper · Passed

The committee(s) on HHS has scheduled a public hearing on 02-05-25 1:00PM; Conference Room 225 & Videoconference.

upper

Jan 27, 2025

Committee

Referred to HHS, JDC.

upper

Jan 23, 2025

Introduced

Introduced and passed First Reading.

upper

Jan 21, 2025

Introduced

Pending Introduction.

upper

1 primary · 0 co-sponsors