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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