INTRODUCED BY   Committee on Health and Human Services (Senators
Ortiz (Chair), Battin, Chesbro, Escutia, Figueroa, Haynes, Kuehl,
Morrow, Polanco, Romero, Vasconcellos, and Vincent)

                        APRIL 1, 2002

   An act to amend Sections 104190, 104191, 104192, and 104193 of the
Health and Safety Code, relating to communicable diseases.


   SB 2097, Committee on Health and Human Services.  Lyme disease.
   Existing law establishes the Lyme Disease Advisory Committee in
the State Department of Health Services composed of specified members
appointed by the Director of Health Services.  Existing law requires
the department and the committee to perform various functions and
duties with respect to, among other things, the dissemination of
information regarding Lyme disease to the public and the medical
   This bill would expand the membership of the Lyme Disease Advisory
Committee, and would require the committee to establish a
subcommittee from its membership for purposes of revising the Lyme
disease reporting system.  It would also expand the duties of the
department with respect to Lyme disease prevention and data


  SECTION 1.  (a) The Legislature finds and declares all of the
   (1) The enactment of Senate Bill 1115 (Ch. 668, Stats. 1999),
established the Lyme Disease Advisory Committee and information
program in order to publicize information on Lyme disease, a
bacterial infection, as a major public health problem in California.

   (2) Despite current efforts, Lyme disease remains a significant
problem for numerous reasons, including insufficient information and
the lack of universally effective diagnostic tests or treatment
protocols.  The absence of positive laboratory proof is not
conclusive proof of the absence of Lyme disease.
   (3) Not all people who are bitten by a Western black-legged tick,
which is a type of tick capable of carrying Lyme disease, realize
that they have been bitten.  An actuarial study by the Lyme Disease
Foundation, Inc., and the Society of Actuaries found that, of 503
physician-diagnosed Lyme disease patients, only 30 percent realized
they had been bitten, and 55 percent did not report a rash.  Dr.
Joseph Burrascano, Jr., M.D., in "The New Lyme Disease Diagnostic
Hints and Treatment Guidelines for Tick Borne Illnesses," twelfth
edition, 1998, reported that erythema migrans, the rash that is
diagnostic of Lyme disease, was present in fewer than one-half of the
Lyme disease patients.  People who develop this rash, which is an
initial indicator of Lyme disease, should seek immediate antibiotic
treatment while the rash is visible and a correct diagnosis can be
   (4) Treatment failures occur in all stages of Lyme disease, but if
diagnosed and treated early, the chance of cure remains high.  If
not diagnosed and treated in time, complications may occur, treatment
is more difficult, and progressive disability may result.  The
persistence of Lyme disease is supported by data in peer reviewed
scientific literature.  In later stages of the disease, if antibiotic
therapy is terminated before active clinical symptoms have cleared,
relapse is likely.  Prolonged antibiotic treatment, both oral and
intravenous, may be necessary.
   (5) Some individuals affected by the advanced stages of Lyme
disease have suffered irreparable damage to their health, careers,
and family.  Musculoskeletal arthritis and cardiac and neurological
symptoms, including joint inflammation and pain, arthritis, irregular
heartbeat, facial palsy, severe fatigue, inability to concentrate,
and memory loss, are common in these individuals.  The neurological
symptoms are at times mistaken for multiple sclerosis or early
Parkinson's disease.  Many victims suffer permanent physical or
mental damage, or both, as a result of misdiagnosis, ignorance of the
disease, and lack of effective treatment.  Lyme disease may be
   (6) The key problems of undertreatment and misdiagnosis are in
part due to the need for further scientific development and
understanding of Lyme disease.
   (7) Some doctors and insurers claim that if a month of antibiotic
treatment fails to cure a patient, then the initial diagnosis of Lyme
disease was incorrect.  This attitude is the result of incomplete
reporting of response to extended antibiotic treatment in the medical
literature, as well as the inability of many physicians to correctly
diagnose Lyme disease and to monitor patient response to treatment
with a laboratory test.
   (8) While the federal Centers for Disease Control and Prevention
(CDC) began to collect data on Lyme disease in 1981 and designated
Lyme disease as a nationally notifiable disease in 1990, a uniform,
nationally recognized case definition was not adopted until 1991.
The number of new Lyme disease cases reported per year increased from
226 to 9,344 in that period.  Between 1992, the first year for which
consistent and comparable nationwide surveillance data were
available, and 2001, the reported number of Lyme disease cases
increased from 9,470 to a record level of 17,730, which is an
increase of 87 percent over the last decade.  The increase in
reporting is a reflection of the improved reporting standards, the
national application of those standards, and the increased incidence
of Lyme disease.  Lyme disease is now a reportable disease in all 50
states.  The CDC now states that Lyme disease accounts for more than
95 percent of vector-borne illness in the United States.  In January
2002, the CDC also reported that Lyme disease had reached record
levels, with 17,730 new cases recorded in 2001.  Even so, the CDC
believes that only one in 10 cases are actually reported.  In 1998,
the State of Connecticut designated Lyme disease a laboratory as well
as a physician reportable disease.  In 2001, the IgeneX, Inc.
laboratory in Palo Alto, California, alone had test results of 374
unduplicated new positive Lyme disease cases.  However, only 93 new
cases were recorded that year by the State Department of Health
Services.  Thus, despite the fact that over 10 percent of the
national population reside in California, new Lyme disease cases
reported in California accounted for only one-half of 1 percent of
the national total, indicating very substantial underreporting and
also that the state reporting procedures and criteria for Lyme
disease are in need of revision.  The Senate of Texas, in issuing its
November 2000 report on the Prevalence of Tick Borne Illness noted
"the rate of occurrence of tick-borne illness in the United States
has increased dramatically over the last few years.  This growth is
second only to AIDS/HIV among infectious diseases."  Cases of Lyme
disease have now been reported in 54 California counties.
   (9) The Western black-legged tick has been found in 55 of the 58
California counties, but is most common in the humid coastal areas
and on the western slope of the Sierra Nevada range, including areas
in southern California.  Thus, the risk of acquiring Lyme disease
varies by geographic area of exposure.  Of the cases of Lyme disease
in California for which the county of exposure was reported in the
year 2000, four counties accounted for nearly 40 percent of those
   (10) Lyme-infected ticks or nymphs have been identified in 41
counties in California to date.  However, only one county in
California, Mendocino County, has been adequately assessed for Lyme
disease risk to date, and the risk of infection from the nymph is
even greater than from the adult tick.
   (b) It is the intent of the Legislature that accurate information
on tick-borne illness be included in the curricula of all state
medical, veterinary, and nursing schools and of all continuing
medical education courses for health care practitioners and school
  SEC. 2.  Section 104190 of the Health and Safety Code is amended to
   104190.  As used in this article the following definitions apply:

   (a) "Disease" means Lyme disease recognized by the presence of the
spirochete  (Borrelia burgdorferi), a spiral-shaped bacterium, in
the human body, or coinfection with tick-borne diseases such as
babesiosis or ehrlichiosis.
   (b) "Lyme Disease Support Network" means the groups organized
through hospitals and volunteer organizations to counsel and provide
support to those individuals who have contracted the disease.
  SEC. 3.  Section 104191 of the Health and Safety Code is amended to
   104191.  (a) There is hereby created in the department the Lyme
Disease Advisory Committee composed of, but not limited to, the
following members:
   (1) One who is a member of the board of directors of the Lyme
Disease Resource Center.  An alternative resource center board member
may attend in place of this member if the member is unable to attend
due to  illness.
   (2) Three who are Lyme disease patients, with a preference for the
following distribution:
   (A) One from the Lyme Disease Support Network.
   (B) One who has successfully been treated in the early stages of
the disease.
   (C) One who has been under active treatment for the disease for at
least three years.
   (3) Two from the California Medical Association who are
practicing physicians who are knowledgeable of, and whose practice
includes the treatment of, both early- and late-stage Lyme disease.
These representatives shall be from different geographic areas of the
state, preferably one from northern California and one from southern
   (4) One local health officer.
   (5) One who is a university or research scientist, preferably one
with acknowledged expertise of the entomology of the Western
black-legged tick.
   (6) One who is a university immunology  or research scientist,
preferably one with acknowledged expertise in spirochetes and related
infectious diseases.
   (7) One representative from the department in a  scientific or
management position.
   (b) The Lyme Disease Advisory Committee shall meet no less than
three times a year and the committee may, from its own membership,
elect its own chair.
   (c) On an annual basis, the committee shall conduct an assessment
of its membership, and recommend any needed changes to the director.

   (d) To facilitate a cohesive working relationship among committee
members and an additional sense of stability to the committee's
composition, each appointed member shall serve a three-year renewable
term unless the member is removed by the director pursuant to
subdivision (g).  The three-year terms for both current and new
members shall commence on January 1, 2003.
   (e) (1) The committee shall designate a subcommittee of its
members to review current reporting procedures and recommend changes
in order to simplify, facilitate, and expedite a more accurate and
complete Lyme disease reporting system.
   (2) In order to facilitate accomplishment of the committee's
activities using existing resources of the department, the committee
may consult with and advise department staff regarding the
prioritization of other Lyme disease-related work, or the division of
Lyme disease-related work between the department and, on a volunteer
basis, individual committee members.
   (f) When a revised reporting system  has been developed and
recommended to the department, the functions of the subcommittee
shall be terminated and its functions assumed by the committee, which
may recommend any further change as it deems appropriate consistent
with evolving tick infectivity data, the incidence of Lyme disease,
and advances in its effective diagnosis.
   (g) Members of  the committee shall be appointed by, and serve at
the pleasure of, the director.  In making these appointments, the
director shall consider recommendations forwarded by the Lyme Disease
Resource Center.
   (h) Each member of the committee shall serve without compensation
or reimbursement, although a member may be eligible for reimbursement
if his or her participation would impose a financial hardship.
Reimbursement shall be limited to expenses for travel and necessary
internal communication incurred by the member in the performance of
his or her duties on the committee.
   (i) The meetings of  the committee shall be publicly announced at
least one month prior to a meeting, and all meetings shall be open to
the public.
  SEC. 4.  Section 104192 of the Health and Safety Code is amended to
   104192.  (a) The Lyme Disease Advisory Committee shall advise and
make recommendations to the department regarding subjects including,
but not limited to, all of the following:
   (1) The content and geographic distribution of Lyme disease
educational materials.
   (2) How best to provide information and outreach to the medical
   (3) How best to provide information and outreach to the general
   (4) Populations at risk of contracting Lyme disease.
   (b) The committee shall review and make recommendations on, prior
to their submission for publication,  all educational and media
materials developed by the department bearing on Lyme disease that
are intended for health care practitioners or the general public.
  SEC. 5.  Section 104193 of the Health and Safety Code is amended to
   104193.  The department shall do all of the following:
   (a) Establish a Lyme disease information program that provides
educational materials and information services on Lyme disease to the
general public and the medical community.  The Lyme disease
information program shall provide information on all of the
   (1) The disease in general, including its symptoms.
   (2) Activities that increase one's risk of contracting the
   (b) Promote the ways to protect oneself from contracting the
disease, utilizing current standards and recommendations developed by
the federal Centers for Disease Control and Prevention, including
the use of protective clothing and tick repellants such as an
acaricide or pesticide sprayed on clothing before being worn.
Protective clothing includes light-colored long pants and long
   (c) Not adopt rigid diagnostic or treatment limitations.
   (d) With the recommendation of the Lyme Disease Advisory
Committee, and to the extent that departmental resources allow,
consider the potential of new diagnostic and treatment procedures
that have scientific foundation, particularly those that may be
effective for the later stages of Lyme disease.
   (e) Provide detailed but broad and inclusive information regarding
Lyme disease, its varied and common symptoms, and its treatment to
physicians and surgeons, including the use of both oral and
intravenous antibiotics, and other evidence-based effective
treatments, as they are recognized and publicly available.
   (f) To the extent that departmental resources allow, the
department shall provide the information specified in subdivision (e)
to veterinarians, nurse practitioners, and school nurses.  This
provision of information may be accomplished by the department by
providing the information to professional associations representing
these providers.  If the department provides the information to
professional associations, the department shall request that these
professional associations make the information available to
association members who request the information.
   (g) To the extent that departmental resources allow, the
department shall make the information specified in subdivision (e)
available on its Internet Web site in order to facilitate
accessibility of information and provider education.
   (h) Identify those segments of the population that are especially
at risk of contracting Lyme disease and may provide workshops, with
detailed information on the disease in those areas or  communities,
considering recommendations for these workshops provided by the Lyme
Disease Advisory Committee.
   (i) In collaboration with interested counties, communities,
research scientists, health care practitioners, or members of the
Lyme Disease Advisory Committee, the committee shall encourage the
conduct of research and its funding to identify the risk of Lyme
disease in counties or areas of California where Lyme disease is
considered to be endemic.
   (j) Provide information to the Occupational Safety and Health
Standards Board about risk factors for exposure to Lyme disease.
   (k) Encourage the use of integrated pest management to control and
reduce tick  populations.
   (l) On or before December 15, 2003, and annually thereafter, to
the extent that departmental resources allow, compile the interim
year reports that have been previously shared with the Lyme Disease
Advisory Committee and issue a consolidated report to be submitted to
each member of the Senate Committee on Health and Human Services and
each member of the Assembly Committee on Health.  This report may
include information on any consequential changes in the incidence of
Lyme disease, changes in reporting procedures to facilitate the
reporting of Lyme disease by physicians and other licensed health
practitioners and school nurses, and changes in known effective
treatment.  These annual reports to committee members should be
accompanied by pamphlets, brochures, and articles published by staff
of the department and intended for education of members of the public
or medical community.  These annual reports shall be subject to
feedback, and, if possible, prior review, by the Lyme Disease
Advisory  Committee.