BILL ANALYSIS
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|Hearing Date:January 11, 2006 |Bill No:SB |
| |162 |
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SENATE COMMITTEE ON GOVERNMENT MODERNIZATION, EFFICIENCY, AND
ACCOUNTABILITY
Senator Liz Figueroa, Chair
Bill No: SB 162 Author: Senator Ortiz
As Amended: March 30, 2005 Fiscal:Yes
SUBJECT: State Department of Public Health.
SUMMARY: Establishes a Department of Public Health (DPH) within
the Health and Human Services Agency, and transfers various
responsibilities relating to public health, currently
administered by the Department of Health Services (DHS), to the
new department. Establishes a 13-member Public Health Board to
provide public and expert involvement in the development of
policies, regulations, and programs administered by the DPH or
directly affecting the health of Californians. Requires this
bill to be implemented on January 1, 2007, but only if an
appropriation for the purposes of this bill is made in the
Budget Act of 2006.
Existing law: Establishes the DHS within the Health and
Human Services Agency and gives the DHS responsibility over
a variety of health-related programs, including public
health, Medi-Cal and other public aid health care programs.
This bill:
1)Establishes the DPH within the Health and Human Services
Agency, under the control of a State Health Officer who is a
licensed physician appointed by the Governor and confirmed by
the Senate.
2)Provides that the DPH succeeds to, and is vested with, the
duties, purposes, responsibilities, and jurisdiction exercised
by the DHS, as specified, with respect to all the following
provisions of law:
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a) The Office of Binational Border Health;
b) The Public Health Federal Fund, and the state laboratory
in Richmond;
c) Regulation of laboratories;
d) Provisions of law relating to local health officers;
e) Vital Records and Health Statistics;
f) Disease Prevention and Health Promotion;
g) Environmental Health;
h) Communicable Disease Prevention and Control; and,
i) Maternal, Child and Adolescent Health Care.
3)States the intent of the Legislature that the jurisdiction of
the DPH also includes other programs that are related to
public health.
4)Transfers the Division of Rural Health from the DHS to the
DPH.
5)Transfers the Office of AIDS from the DHS to the DPH.
6)Transfers the authority to commence all proper and necessary
actions for the following purposes from the DHS to the DPH:
to conjoin and abate nuisances dangerous to health; to compel
the performance of any act specifically enjoined upon any
person, officer, or board, by any law of this state relating
to public health; and, to protect and preserve the public
health.
7)Transfers the authority to perform certain activities to
protect, preserve and advance the public health from the DHS
to the DPH, including studies, demonstrations of innovative
methods, provision of training programs, and dissemination of
information.
8)Requires the DPH to have the same rulemaking authority vested
in the DHS with respect to those programs transferred from
that department. Requires all regulations heretofore adopted
by the DHS relating to public health or any other function
performed by the DHS to remain in effect and be fully
enforceable unless and until readopted, amended, or repealed
by the State Health Officer.
9)Transfers from the DHS to the DPH the requirement to maintain
a laboratory and branch laboratories as may be necessary to
perform the microbiological, physical, and chemical analyses
required to meet the responsibilities of the DPH.
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10)States the intent of the Legislature that all public health
programs currently operated through the DHS to be transferred
to the DPH, without regard to whether or not that public
health program has been formally created by statute, and
defines "public health program," for purposes of this intent
language, as referring primarily to programs and functions
that seek to prevent illness and promote health, as compared
to programs involving either the direct delivery of health
care services or the payment for those services.
11)Establishes the Public Health Board (Board) to provide public
and expert involvement in the development of policies,
regulations, and programs administered by the DPH or directly
affecting the health of Californians.
12)Requires the Board to consist of 13 voting members, as
follows:
a) A dean of a California school of public health,
appointed by the Governor;
b) A dean of a California school of nursing, appointed by
the Governor;
c) A dean of a California school of medicine, appointed by
the Governor;
d) A public laboratory director, appointed by the Governor;
e) Two public members of national stature with broad
experience and professional expertise in public health, one
each appointed by the Speaker of the Assembly and the
Senate Committee on Rules;
f) Two members from community-based organizations with an
interest and mission of promoting public health, one each
appointed by the Speaker of the Assembly and the Senate
Committee on Rules;
g) The State Health Officer (who is required to be the
chairperson);
h) The physician leader of the state's medical emergency
response system;
i) The President of the California Conference of Local
Health Officers;
j) The health officer of a large metropolis, appointed by
the President of the California Conference of Local Health
Officers; and,
aa) A rural health officer, appointed by the President of
the California Conference of Local Health Officers.
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13)Requires members of the Board to serve on a voluntary basis
and not receive any compensation for the performance of their
duties.
14)Requires the Board to be provided independent professional
staff through the reassignment of existing resources.
15)Requires the Board to do all of the following:
a) Through public meetings, provide oversight of public
health programs and regulations to improve effectiveness,
examine ways to better use existing resources, analyze
cost-effective alternatives for improving the health and
safety of Californians, and comment on regulations that
will affect the public health;
b) Encourage the participation of related government
agencies, such as the health professions boards and the
National Guard, as well as foundations and professional
associations, including the County Health Executives
Association, the Public Hospital Association, the
California Medical Association, the California Health Care
Association, the Western Occupational and Environmental
Medical Association, the California Conference of Local
Health Department Nursing Directors, and the public health
associations;
c) Systematically assess the opportunities to consolidate
or coordinate the work of other state health-related
advisory boards, such as the Health Policy and Data
Advisory Committee of the Office of Statewide Health
Planning and Development;
d) Encourage the development of effective partnerships to
tap the expertise of California's universities, academic
medical centers, community clinics, foundations, private
medicine, and the National Guard;
e) Explore strategic relationships with biotechnology and
other high technology sectors; and,
f) Report at least annually to the Governor and Legislature
on the priorities for government actions to improve the
public health and on ways resources could be used more
effectively.
16)Requires the DHS, or the DPH if it has been established
pursuant to this bill, to convene a workgroup of experts to
develop specific recommendations on the creation of the DPH
and how the DPH fits into a long-term strategy to improve the
future of public health leadership in California. Requires
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the workgroup to provide its recommendations and strategy to
the Governor and Legislature six months after the convening of
the workgroup. Specifies that this provisions shall only be
implemented upon the receipt by the DHS of sufficient nonstate
resources to cover all costs, including the costs of staff
resources and of implementing this section. Specifies that
the establishment of the DPH is not contingent upon the
formation or recommendations of this workgroup.
17)Specifies that this bill, with the exception of the working
group described above, becomes operative on January 1, 2007,
and only if an appropriation for the purposes of this bill is
made in the Budget Act of 2006.
FISCAL EFFECT: Unknown.
COMMENTS:
1)Purpose. According to the author, public health programs
and goals are constantly overlooked and overshadowed by
the Medi-Cal program. Furthermore, several independent
studies have concluded that California suffers from a
severe lack of strong and effective state public health
leadership. A new department would create the
opportunity to build strong leadership, resulting in
increased protection of the public health and safety for
Californians.
California's local public health officers are among the
first responders to any public health threat, and are the
first to identify unusual disease occurrences. These
officials must not only respond to threats of
bioterrorism, but must continue to control the spread of
diseases such as meningitis, HIV, hepatitis C, and
Chlamydia, among others. Counties rely on local public
health agencies to detect and respond effectively to
significant threats, including major outbreaks of
infectious disease, pathogens resistant to antimicrobial
agents, and acts of bioterrorism.
2)Senate Public Health Hearing. On June 2, 2004, the Senate
Health and Human Services Committee held a hearing titled
"Public Health: Will California Rise to the Challenge?"
Representatives from a variety of organizations, including
RAND, the Little Hoover Commission, the California Medical
Association, the California Conference of Local Health
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Officers, and the County Health Executives Association of
California testified before the Committee regarding the nature
of work undertaken by DHS, the role of public health at that
state and local levels, and the need for a separate State DPH.
Studies on the subject by the Little Hoover Commission and
RAND were reviewed and a Legislative Analyst Office analysis
of the Little Hoover Commission report was shared with members
of the Committee.
3)Little Hoover Commission Reports. In April 2003, the Little
Hoover Commission released a report that found that
California's public health leadership and organizational
structure is ill-prepared to fulfill the primary obligation of
reducing injury and death from threats to public health such
as environmental hazards, bioterrorism and emerging infectious
diseases. The report recommended that a public health
department, separate from Medi-Cal and other public health
insurance programs, be created to focus on emerging threats,
with physician and science-based leadership and an advisory
board that links California's health assets and experts. The
report went on to name core public health functions that the
new department should undertake, including laboratory,
surveillance, and prevention services; emergency services;
food, drug, and drinking water safety; and functions of the
Office of Statewide Health Planning and Development (OSHPD).
The Little Hoover Commission conducted their study because of
concerns about the ability of California's public health
system to respond to a large-scale public health emergency,
especially in light of the elevated concerns as the United
States faces potential threats of bioterrorism. With the
events following September 11, 2001, many are concerned that
possible terror attacks may include unconventional weapons,
such as biological pathogens.
In June of 2005, the Little Hoover Commission followed up on its
April 2003 report and other recommendations it has made in the
past few years regarding the preparedness of California to
respond to emergencies. The Commission stated that it found
that several of its prior recommendations for improvements
have not been made a priority, and urged the Governor and the
Legislature to prioritize certain recommendations, including
enacting legislation to establish the separate department of
public health, with physician leadership and with advice and
oversight of a scientific public health board.
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4)RAND Study. In June 2004, the RAND Center for Domestic and
International Health Security released a report that examined
California's public health preparedness as a result of a
request for this information by the Little Hoover Commission.
To complete their assessment, they reviewed the federal
Centers for Disease Control and Prevention (CDC) Local
Preparedness Capacity Inventories from 2002 and conducted a
series of site visits to determine preparedness for a public
health emergency. Among their findings were:
a) There is widespread variation among local health
jurisdictions with respect to ability to respond to
infectious disease outbreaks and other public health
threats;
b) There is considerable ambiguity surrounding the
appropriate roles for a local health jurisdiction, other
local agencies and the DHS;
c) There appears to be lacking a strong, central leadership
and coordination of public health; and,
d) The current organization of public health preparedness
activities in California leads to redundancies and
inefficiencies.
Based on those findings, RAND made a number of
recommendations, including that the organization of public
health in California be examined and that the role of strong,
central leadership focused on public health at a state level
is a key component to that reexamination. The study also
called for improvement in the statewide epidemiologic
information system and the maintenance of a highly skilled
public health workforce in California, including workforce
planning activities. Finally, the report called for an
evaluation of public health preparedness at the state level to
more fully understand the preparedness issues identified in
the report. According to RAND, such an analysis would be
considered background work required prior to reorganization of
public health in California.
In cases involving major disease outbreaks, city, county, and
state health departments act as the nation's first line of
defense, supported by the CDC, the National Institutes of
Health, and other federal agencies. Local health departments
serve as the backbone for detection and response to a
biological weapons attack, supporting local law enforcement,
fire departments, and HAZMAT teams in identifying the
bacteria, and controlling its spread.
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1)LAO Analysis. In early 2004, the author of this bill
requested that the LAO analyze the Little Hoover Commission
report. The LAO analysis outlined the advantages and
disadvantages of creating a DPH. According to the report, DHS
is projected to dedicate over 48% of its staff and 96% of its
total resources to health service delivery (for Medi-Cal and
other health care programs) in 2003-04. Therefore, the
distribution of resources may have effect on the focus of the
DHS and its leadership on the Medi-Cal program.
According to the LAO, the main advantage of centralizing public
health activities is a greater focus on improving health
through public health activities. Additionally, to the extent
that reductions or slower growth in public health activities
are a reflection of DHS priorities, it is possible that a
separation from Medi-Cal would put public health budgets in a
stronger position to compete for resources. A centralization
of public health programs may also expedite policy and budget
decisions and increase overall department responsiveness to
constituency groups. Finally, a centralization of core public
health functions in one department may reveal funding
opportunities that are not currently apparent or accessible.
The LAO analysis also outlined perceived disadvantages to the
creation of a new DPH. As proposed by the Little Hoover
Commission, the DPH would be on par with the California Health
and Human Services Agency (CHHSA) and other cabinet-level
agencies, with the director reporting directly to the
Governor. The LAO analysis suggested that the location of the
DPH outside of CHHSA would probably hinder state efforts to
coordinate health-related programs and activities.
Additionally, the separation of DHS public health programs
from Medi-Cal could lead to missed opportunities for the
integration of public health research and information gained
in the field into health care delivery systems (such as
Medi-Cal managed care).
Also as proposed by the Little Hoover Commission, the
consolidation of OSHPD and Emergency Medical Services
Authority (EMSA) with a new public health department may
result in a lower emphasis on the departments' current
activities and lengthen the decision-making process in
relation to their issues. Additionally, these departments
would have to compete against other public health programs for
management's time and resources.
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SB 162 does not place the DPH in the cabinet nor include OSHPD
or EMSA.
2)Related Legislation. AB 2769 (Richman, 2004) would have
established a DPH and a Public Health Improvement Board and
specified that the DPH is responsible for the administration
of all public health programs. This bill failed passage in
the Assembly Health Committee.
SB 858 (Ortiz, principal coauthor Richman, 2004) was virtually
identical to this bill. SB 858 was held in the Assembly
Appropriations Committee.
3)Arguments in Support. The Health Officers of California
(HOAC), the sponsor of SB 162, argues that DHS has as its
main concern the multi-billion dollar Medi-Cal program,
the size of which overshadows public health. As a
result, they believe that public health preparedness and
leadership have been in decline since the formation of
DHS in the 1970s.
The Little Hoover Commission states in support that shortly
after the terrorist attacks of September 11, 2001, the
Commission identified the public health system as the
weakest link in California's homeland defense. The
Commission concluded, based on a subsequent review of the
public health infrastructure, that strengthening the
public health system would require changes in
organizational structure, and recommended that a new
Department of Public Health be created to consolidate
public health functions.
The California Medical Association also support this bill,
arguing that a separate Department of Public Health would
help create a more coordinated, multidisciplinary
approach to addressing public health threats, and would
strengthen the capabilities at the stat and local levels
to respond to emerging public health problems.
The California Association of Professional Scientists
(CAPS) states that it is concerned that public health can
get lost in the shuffle because it is combined in DHS
with a variety of human services functions. CAPS argues
that organizing the office to provide more emphasis on
public health will serve all Californians better,
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particularly given the public health threats that are
looming.
SUPPORT AND OPPOSITION:
Support:
Health Officers of California (sponsor)
California Association of Professional Scientists
California Medical Association
Little Hoover Commission
Opposition: None on file
Consultant:Vincent D. Marchand