BILL ANALYSIS                                                                                                                                                                                                    



                                                                AB 1487
                                                                Page  1

        CONCURRENCE IN SENATE AMENDMENTS
        AB 1487 (Hill)
        As Amended August 10, 2010
        2/3 vote. Urgency
         
         ----------------------------------------------------------------- 
        |ASSEMBLY:  |     |(May 18, 2009)  |SENATE: |31-0 |(August 12,    |
        |           |     |                |        |     |2010)          |
         ----------------------------------------------------------------- 
                  (vote not relevant)


         ------------------------------------------------------------------------ 
        |COMMITTEE VOTE:  |18-0 |(August 24, 2010)   |RECOMMENDATION: |concur    |
        |                 |     |                    |                |          |
         ------------------------------------------------------------------------ 

        Original Committee Reference:    PUB. S.  

         SUMMARY  :  Extends, to January 1, 2014, the date by which the  
        Department of Public Health (DPH) is required to adopt regulations  
        prescribing sperm processing facilities' handling and storage of  
        sperm from donors who are carriers of human immunodeficiency virus  
        (HIV) and human T lymphotrophic virus (HTLV), and requires a  
        physician providing insemination and advanced reproductive  
        technologies (ART) to make specified disclosures to a recipient of  
        sperm from a HIV or HTLV reactive spouse, partner, or designated  
        donor.

         The Senate amendments  delete the Assembly version of this bill, and  
        instead:

        1)Require the testing of transplant donor tissue for infection with  
          HTLV only in tissues that are rich in viable leukocytes. 

        2)Require a physician providing ART to notify the recipient of  
          sperm from a HIV or HTLV reactive spouse, partner, or designated  
          donor of all of the following:

           a)   Sperm processing may not eliminate all of the risks of HIV  
             or HTLV transmission;

           b)   The sperm may be tested to determine whether or not it is  
             reactive for HIV or HTLV;









                                                                AB 1487
                                                                Page  2

           c)   The recipient must document prior to treatment that she has  
             a physician to provide ongoing care during and after her  
             fertility services; and,

           d)   Information about recommendations published by the American  
             Society of Reproductive Medicine (ASRM) regarding follow-up  
             testing for HIV and HTLV, and a requirement that the  
             recommendations regarding follow-up testing will be documented  
             in the recipient's medical record. 

        3)Clarify that a physician providing ART is not responsible for  
          prophylactic testing, monitoring, and follow-up of the recipient.  
           Require the physician to recommend follow-up testing for HIV or  
          HTLV, according to ASRM's published guidelines, to the physician  
          who will be providing the recipient's ongoing care, as specified.

        4)Require, in the event the recipient becomes HIV or HTLV positive,  
          the physician assuming ongoing care of the recipient to treat or  
          provide information regarding referral to a physician who can  
          provide ongoing treatment for HIV or HTLV.

        5)Extend the date by which DPH is required to adopt regulations  
          prescribing sperm processing facilities' handling and storage of  
          sperm from donors who are carriers of HIV, HTLV, or any other  
          virus DPH deems appropriate from January 1, 2010, to January 1,  
          2014.

        6)Permit DPH to propose to adopt, as initial regulations, specified  
          recommendations published by the ASRM using a specified process.

        7)Exempt adoption of regulations for sperm processing facilities  
          from requirements for written responses to public comments and  
          the Administrative Procedure Act. 

        8)Make other minor technical clarifying changes and add an urgency  
          clause to make the provisions of this bill take effect  
          immediately upon enactment.

         AS PASSED BY THE ASSEMBLY  , this bill increased from $3 to $6 the  
        fee charged for each inmate-initiated medical visit by an inmate  
        confined in a county or city jail.

         FISCAL EFFECT :  According to the Senate Appropriations Committee,  
        pursuant to Senate Rule 28.8, negligible state costs. 









                                                                AB 1487
                                                                Page  3

         COMMENTS  :  According to the author, HIV is now considered a chronic  
        disease, and many HIV-infected adults have near normal life  
        expectancy with typical life goals such as starting a family.  The  
        author states that due to advances in reproductive technologies,  
        sperm washing can separate healthy sperm from the other components  
        in semen that may contain HIV, removing 99.9% of HIV particles, so  
        HIV- and HTLV-infected sperm can be used in ART with virtually no  
        risk of transmission to mother and baby.  Over 4,500 assisted  
        reproduction procedures are documented in the literature with no  
        reports of HIV transmission when using standardized sperm washing  
        methods with either intrauterine insemination or in-vitro  
        fertilization.  SB 443 (Migden), Chapter 207, Statutes of 2007, was  
        intended to ensure access to reproductive treatment for  
        HIV-discordant couples (HIV-positive male and HIV-negative female).  
         However, the author states SB 443 was unclear about which medical  
        professionals were responsible for the care of the infected sperm  
        donor and for follow-up of the recipient, and included some medical  
        terminology that was inaccurate or insufficiently inclusive.  Also,  
        sperm infected with different types of HTLV, not just HTLV-I, can  
        be safely used once processed, so this bill uses the broader  
        language.  The author argues this bill is needed to fix those  
        problems.  

        The processing of sperm from a donor testing reactive for HIV or  
        HTLV is commonly referred to as sperm washing.  Numerous studies  
        have confirmed that HIV is primarily found in white blood cells and  
        plasma in semen, not generally within the sperm itself.  The sperm  
        washing process involves centrifuging the semen in order to  
        separate it from the sperm.  This process can also involve a  
        "swim-up" technique that removes inactive sperm.  The remaining  
        active sperm can then be used for insemination or ART.  Numerous  
        studies report that the sperm-washing process reduces HIV levels in  
        sperm, and the technology and procedures continue to improve.  


         Analysis Prepared by  :    Cassie Rafanan / HEALTH / (916) 319-2097  
         

                                                                 FN: 0006742