BILL ANALYSIS AB 1963 SENATE COMMITTEE ON ENVIRONMENTAL QUALITY Senator S. Joseph Simitian, Chairman 2009-2010 Regular Session BILL NO: AB 1963 AUTHOR: Nava AMENDED: June 21, 2010 FISCAL: Yes HEARING DATE: June 28, 2010 URGENCY: No CONSULTANT: Amber Hartman SUBJECT : PESTICIDE POISONING SUMMARY : 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 local health officer (LHO) by telephone within 24 hours, and in writing within seven days, except that the information which is available to the physician is all that is required to be reported, as long as reasonable efforts are made to obtain the information. (Health and Safety Code 105200). 2) Requires LHOs receiving reports under the above-mentioned law to immediately notify the county agricultural commissioner and, at the LHO's discretion, to immediately notify the director of Office of Environmental Health Hazard Assessment (OEHHA) of each report received, and requires LHOs to report to the director of Department of Pesticide Regulation (DPR), the director of OEHHA, and the director of Industrial Relations, on a form prescribed by OEHHA, each case reported to him or her within even days after receipt of the report. (105200). 3) Requires employers who have employees regularly handling or exposed to specified pesticides to have a written agreement with a physician to provide medical supervision of those employees, and specifies the employer responsibilities for medical supervision, including testing at specified intervals, investigating work practices when employee AB 1963 Page 2 cholinesterase (ChE) levels fall below 80% of baseline and removing employees from the exposure if levels fall to 60% or less of baseline, as specified. (Food and Agriculture Code 12981; 3 Cal. Code Regs. 6728). This bill : 1) Requires laboratories that perform cholinesterase testing pursuant to 3 Cal. Code Regs. 6728 to report ChE results to DPR on a monthly basis. The reports must be submitted electronically and DPR must share them with OEHHA and DPH. 2) The laboratory shall report all information in its possession including: a) Test results. b) The purpose of the test. c) Name of the person tested. d) Contact information of the referring physician, testing laboratory, and person tested if available. e) Accession number of the specimen. 3) The referring physician shall note in the test order the purpose of the test. 4) Declares that the information collected and reported is confidential. 5) Requires OEHHA to review ChE results and provide consultation to the medical supervisor. 6) Requires DPR, OEHHA, and DPH to prepare a report on the effectiveness of medical supervision and laboratory-based reporting of ChE testing by December 31, 2015. Also requires the report to be made publicly available via the Internet. COMMENTS : 1) Purpose of Bill . According to the author, "AB 1963 is necessary to enable state agencies to effectively monitor the existing Cholinesterase (ChE) Medical Supervision Program and to better protect California farm workers from AB 1963 Page 3 pesticide poisoning. Since 1974, agricultural employers have been required to test pesticide applicators' and handlers' blood to ensure that they are not overexposed to organophosphate and carbamate pesticides, which suppress workers' ChE levels." The author continues, "Under the current program, if a worker is found to have suppressed ChE levels, the employer must remove the worker from the workplace and change the workplace to prevent actual pesticide poisoning. Currently, the Cholinesterase Medical Supervision Program does not include a requirement for ChE testing data to be delivered to any state agency responsible for worker health. Therefore, more than three decades after this program was enacted, the state has little oversight authority and it is impossible to judge the program's effectiveness and determine whether workers are actually being protected." 2) Cholinesterase (ChE) . ChE is one of many important enzymes needed for the proper functioning of the nervous systems of humans, other vertebrates, and insects. ChE enables neurons, or nerve cells, to return back to a "charged state". The ability of neurons to switch back and forth between charged (excited) states, allows them to conduct miniscule amounts of electricity, which is how the body sends messages to allow physical movement. If ChE is inhibited, even partially, then nerves begin to lose their ability to signal, which could result, in extreme cases, in paralysis and permanent nerve damage. Certain chemical classes of pesticides, such as organophosphates (OPs), carbamates (CMs) and chlorinated derivatives of nicotine (imidacloprid, fipronil), work against undesirable bugs by interfering with, or 'inhibiting' ChE. While the effects of ChE inhibiting products are intended for insect pests, these chemicals can also be poisonous, or toxic, to humans in some situations. Human exposure to ChE inhibiting chemicals can result from inhalation, ingestion, or eye or skin contact during the manufacture, mixing, or applications of these pesticides. 3) Background . In 1974, California established the ChE monitoring program. The program requires that pesticide AB 1963 Page 4 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 cholinesterase, 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 headache to convulsions, depending on the severity of the exposure. 4) Reporting: physicians or labs ? The question of which entity is best suited to report ChE results to the state has arisen in stakeholder discussions. The laboratories feel that the physicians are better equipped to distribute the test result information, because they are actually in contact with the persons being tested. However, in actual practice, there are only seven labs statewide that do ChE testing. Practically speaking, it would seem that facilitating laboratory results with seven businesses rather than with hundreds or even thousands of physicians is a much more efficient method of collecting data. Additionally, there is legal precedent for laboratories reporting information to state agencies such as infectious disease results (e.g., positive HIV results) or lead poisoning test results. 5) Test order reporting by physicians . There are two major purposes for ordering the ChE test: a) to measure baseline ChE levels; or b) to measure ChE for suspected pesticide poisoning. The latter already must be reported, but the former is not currently reported and what this bill seeks to accomplish. The lab test order form does not always provide a "check box" for requesting or indicating whether the ChE test is for baseline or poisoning purposes. For this bill to be effective, the physicians must report this information. 6) Support . The organizations sponsoring this bill believe the existing ChE monitoring program is missing a critical link between baseline ChE information and poisoning level information. They say the current program fails both to AB 1963 Page 5 collect crucial information and to adequately protect farm workers who are routinely exposed to pesticides. The Pesticide Action Network points to a similar reporting program in place for two years in Washington state which has generated very important and useful information. 7) Opposition . The California Clinical Laboratory Association (CCLA) opposes this bill arguing that labs cannot comply with the reporting requirements being proposed because they do not actually see patients on whom the tests are performed, and do not have all of the information to make the reports required by this bill. CCLA states that referring health providers typically obtain the samples and that the reporting requirements should therefore be imposed on the ordering physician or other health provider. They also point out that submitting these reports electronically places an undue financial burden on them. 8) Related Legislation . AB 1530 (Lieber) 2007 was a very similar bill to AB 1963 except that it required OEHHA, rather than DPR, to administer the program, required an annual report rather than a single report, and had stricter information sharing requirements. (Died in Senate Appropriations Committee). 9) Suggested amendments . As currently written, it will be difficult for DPR to correctly assign consecutive ChE results to individuals with the same name. While contact and physician information might help to resolve this, it would be very useful to additionally collect a "unique identifier" that will help to distinguish two individuals with the same name, so that their respective samples can be analyzed properly. While a social security number is obviously inappropriate in this context, a date of birth should be useful in resolving same-named individuals. The committee may wish to require the inclusion of birth date as an additional piece of information the laboratories submit to DPR if they have it in their possession. 10)Referral to Rules Committee . If this measure is approved by this committee, the do pass motion must include the action to re-refer the bill to the Senate Rules Committee. AB 1963 Page 6 SOURCE : Pesticide Action Network of North America, Physicians for Social Responsibility - Los Angeles, Health Officers Association of California SUPPORT : ACT for Women and Girls, American Civil Liberties Union, American Congress of Obstetricians and Gynecologists (California), American Federation of State, County and Municipal Employees, California Church Impact, California Commission on the Status of Women, California Communities United Institute, California Labor Federation, California Latinas for Reproductive Justice, California Nurses Association, California Pan-Ethnic Health Network, California Public Health Association - North, California Primary Care Association, California Rural Legal Assistance Foundation, Californians for Alternatives to Toxics, Californians for Justice Collaborative, Clean Water Action, Commonweal, Consumer Attorneys of California, Dolores 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 - Educated Choices for Life Choice, Organizacion en California de Lideres Campesinas, Pesticide Watch, Physicians for Social Responsibility - Sacramento, Physicians for Social Responsibility - San Francisco Bay, Planned Parenthood Affiliates of California, Planned Parenthood Mar Monte, Planning and Conservation League, San Francisco City and County - Department of Public Health, Sierra Club California, Center for Environmental Health Research (U.C. Berkeley), United Farm Workers, Urban Habitat, 1 individual OPPOSITION : California Association for Medical Laboratory Technology, California Clinical Laboratory Association, Quest Diagnostics AB 1963 Page 7