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
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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
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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
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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
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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.
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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
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