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