BILL ANALYSIS
AB 1963
Page 1
Date of Hearing: April 20, 2010
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 1963 (Nava) - As Amended: April 13, 2010
SUBJECT : Pesticide poisoning.
SUMMARY : Requires laboratories (labs) that perform
cholinesterase (ChE) testing for the purpose of determining
workers' pesticide exposure to electronically report specified
test results to the Department of Pesticide Regulation (DPR).
Specifically, this bill :
1)Requires labs that perform ChE testing to report to, DPR, the
ChE test results for every person tested, the purpose of the
test, the name of the person tested, the name, address, and
phone number of the healthcare provider or medical supervisor
who ordered the test, the accession number of the specimen,
the date that the sample was collected from the patient and
the date the analysis was performed, and contact information
for the person tested and his or her employer, if known and
readily available.
2)Authorizes the Department of Public Health (DPH) to assess a
fine of up to $200 per person against any lab that knowingly
fails to meet the reporting requirements of this bill.
3)Requires the medical supervisor ordering the ChE testing to
provide a copy of the ChE test results or any recommendations
to the tested individual within 14 days of receiving the
information.
4)Specifies that all information reported under this bill will
be confidential, but permits the Office of Environmental
Health Hazard Assessment (OEHHA), DPR, and DPH to share the
information only for the purpose of surveillance, case
management, investigation, environmental assessment,
environmental remediation, or abatement with the appropriate
county agricultural commissioner or local health officer
(LHO).
5)Requires OEHHA to review the cholinesterase test results and
permits OEHHA to provide an appropriate medical or
toxicological consultation to the medical supervisor.
AB 1963
Page 2
6)Permits OEHHA, in consultation with DPR and the LHO, to
provide medical and toxicological consultation, as
appropriate, to the county agricultural commissioner to
address medical issues related to the investigation of
cholinesterase inhibitor-related illness.
7)Requires DPR and OEHHA, in consultation with DPH, by December
31, 2013, to prepare a report on the effectiveness of the
medical supervision program and the utility of
laboratory-based reporting of ChE testing for illness
surveillance and prevention. Permits the report to include
recommendations to the Legislature deemed necessary. Requires
DPR and OEHHA to make the report publicly available on their
Web sites.
EXISTING LAW :
1) Requires any physician who knows or has reasonable cause
to believe that a patient is suffering from pesticide
poisoning or any disease or condition caused by a pesticide
to promptly report that fact to the LHO by telephone within
24 hours, and in writing within seven days.
2) Requires LHOs receiving the reports above to immediately
notify the county agricultural commissioner and, at the
LHO's discretion, to immediately notify the Director of
OEHHA of each report received. Requires LHOs to report to
the Director of DPR, the Director of OEHHA, and the Director
of the Department of Industrial Relations each case reported
to him or her within seven days after receipt of the report.
3) Requires employers who have employees regularly handling
or exposed to organophosphate and carbamate pesticides to
have a written agreement with a physician to provide medical
supervision of those employees, and specifies employer
responsibilities for medical supervision, including testing
at certain intervals, investigating work practices when
employee ChE levels fall below 80% of baseline and removing
employees from the exposure if levels fall to 60% or less of
baseline, as specified.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
AB 1963
Page 3
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill is
necessary to allow state agencies to effectively monitor the
existing ChE medical monitoring program and to better protect
California farm workers who are routinely exposed to dangerous
levels of the pesticides that affect ChE levels. The author
points out that submission of the reports contemplated in this
bill are made much easier in light of electronic reporting
capabilities than they would have been when the ChE monitoring
program was first established. The Cholinesterase Medical
Supervision Program does not include any requirement for test
results to be delivered to any state agency responsible for
worker health; thus nearly three decades after this program
was enacted, it is impossible to judge its effectiveness.
2)CALIFORNIA MONITORING PROGRAM . In 1974, California
established the ChE monitoring program. The program requires
that pesticide handlers (mixers, loaders, and applicators) who
work with Category I or II organophosphates or N-methyl
carbamate insecticides for more than six days in any 30-day
period receive periodic blood tests. Excessive exposure to
these insecticides can inhibit an enzyme in the nervous system
known as acetyl ChE, referred to as ChE. The blood tests,
often referred to as "medical monitoring," measure ChE.
Adequate levels of the enzyme ChE are necessary for normal
nerve function. Low ChE levels can cause a variety of symptoms
from headaches to convulsions, depending on the severity of
the exposure.
The normal level of ChE varies greatly among people.
Therefore, when monitoring a person's ChE level, it is
necessary to determine how much ChE that person normally has.
This is done by taking a blood sample at a time when the
person has not been exposed to ChE inhibitors for several
months. A person's normal ChE level is called the baseline.
Once a person's baseline is established, it is used for
comparison in future blood analyses to see if the person's
level of ChE has changed. California requires medical
monitoring for ChE, a requirement imposed on employers for
workers with specific exposure levels or specific ChE levels.
The first three blood analyses must be done at 30-day
intervals, if the person is regularly handling ChE-inhibiting
insecticides during each of those 30-day periods. After the
first three blood tests, the laboratory will determine how
AB 1963
Page 4
often the person must return for additional testing. If the
laboratory makes no recommendation as to frequency of testing,
monitoring must be done every 60 days. California law also
requires all physicians to promptly report suspected pesticide
exposure or exposure-related illnesses to LHOs.
3)CONFIDENTIALITY OF INFORMATION . Every staff member of OEHHA's
Pesticide and Environmental Toxicology Branch who has access
to confidential records is required to sign a "Confidentiality
Pledge," which states that a breach of the confidentiality for
personal medical information at any level is cause for
immediate corrective and/or adverse action. The Pledge also
indicates that accidental breaches of confidentiality will not
be excused. According to OEHHA, personal medical information
includes all patient, research subject, physician, and health
care facility data. The Pledge states that all patient data
are protected from disclosure to third parties by the
confidentiality requirements of the Information Practices Act
and are exempt from disclosure under the Public Records Act.
These statutes prohibit the release of personal identifiers or
information that may allow identification of an individual.
OEHHA policy also prohibits personal identifiers from being
transmitted or published through e-mail, publications,
presentations, or any other public medium.
4)PESTICIDE POISONING REPORTING. California has two systems for
worker and consumer pesticide reporting and investigations.
One program requires the reporting of all known or suspected
cases of pesticide poisoning to the LHO, who in turn reports
it to state and local agriculture and worker safety agencies.
In addition to this emergency reporting, workers who are
regularly using organophosphates and carbamates pesticides are
required to be under medical supervision that includes regular
blood test to determine whether the organophosphates and
carbamates are effecting the of ChE levels. Under current
worker's medical supervision and reporting requirements, if a
worker is removed from work because his/her ChE activity
levels are depressed but the worker is asymptomatic, then
these test results are not reported as a suspected pesticide
poisonings.
5)PRIOR LEGISLATION . AB 1530 (Lieber) of 2007 contained
substantially similar provisions to this bill. AB 1530 was
held in the Senate Appropriations Committee.
AB 1963
Page 5
6)DOUBLE REFERRAL . This bill was heard by the Environmental
Safety and Toxic Materials Committee on April 6, 2010 where it
passed by a vote of 5-1.
7)SUPPORT . Supporters state that nearly three decades after the
ChE Medical Supervision program was enacted, it is impossible
to judge its effectiveness because the program does not
include any requirements for test results to be delivered to
state agencies responsible for worker health and workplace
safety. Supporters assert that this bill will give state
officials the necessary information to monitor the
effectiveness of the program and protect farm workers from
dangerous overexposure to pesticides.
8)OPPOSITION . Opponents state that clinical labs are willing to
report information in their possession, however they should
not be required to seek information or be penalized if
information requested (such as name and address of the person
tested) is not provided by the physician ordering the test.
9)AMENDMENTS . The author requests that the Committee approve
the following amendments:
a) On page 5, line 33 after "information" insert "in its
possession"
b) On page 6, line 6, delete " the analysis was performed"
and insert "result was reported"
c) On page 6, line 16 after "shall" insert "note in the
test order the purpose of the test, pursuant to 105206
(b)(2), and"
REGISTERED SUPPORT / OPPOSITION :
Support
Pesticide Action Network of North America (cosponsor)
Physicians for Social Responsibility - Los Angeles (cosponsor)
Health Officers Association of California (cosponsor)
ACT for Women and Girls
American Civil Liberties Union
American Congress of Obstetricians and Gynecologists
(California)
California Labor Federation
California Latinas for Reproductive Justice
AB 1963
Page 6
California Nurses Association
California Primary Care Association
California Public Health Association - North
California Rural Legal Assistance Foundation
Californians for Alternatives to Toxics
Californians for Justice Collaborative
Center for Children's Environmental Health Research, U.C.
Berkeley
Center for Environmental Health
Clean Water Action
Commonweal
Consumer Attorneys of California
Delores Huerta Foundation
East Yard Communities for Environmental Justice
Environmental Center of San Luis Obispo County
Fresno Coalition Again the Misuse of Pesticides
Healthy Child Healthy World
Natural Resources Defense Council
Nevada County Citizens for Choice
Organizacion en CA de Lideres Campesinas (Lideres Campesinas)
Pesticide Action Network
Pesticide Watch
Physicians for Social Responsibility - Sacramento Chapter
Physicians for Social Responsibility - San Francisco Bay Chapter
Planned Parenthood Affiliates of California
Planned Parenthood, Mar Monte
San Francisco Department of Public Health, Environmental Health
Section
Sierra Club California
Urban Habitat
One individual
Opposition
California Association for Medical Laboratory Technology
California Clinical Laboratory Association
Quest Diagnostics
Analysis Prepared by : Melanie Moreno / HEALTH / (916)
319-2097