BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: AB 1963
A
AUTHOR: Nava
B
AMENDED: June 21, 2010
HEARING DATE: June 30, 2010
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CONSULTANT:
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Orr/cjt
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SUBJECT
Pesticide poisoning
SUMMARY
Requires laboratories (labs) that perform cholinesterase
(ChE) testing for the purpose of determining workers'
pesticide exposure to electronically report test results to
the Department of Pesticide Regulation (DPR).
CHANGES TO EXISTING LAW
Existing law:
Establishes the Office of Environmental Health Hazard
Assessment (OEHHA) of the California Environmental
Protection Agency (CalEPA) which, among other duties, is
responsible for identifying the adverse effects of
chemicals in the environment, and assessing the health
risks associated with exposures to environmental
contaminants.
Requires OEHHA to develop and implement, in cooperation
with local health officers and state and local medical
associations, a program of medical education to alert
physicians to the symptoms, diagnosis, treatment, and
Continued---
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reporting of pesticide poisoning.
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.
Existing regulations:
Establishes the ChE medical supervision program. 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 percent of baseline
levels, and removing employees from the exposure if levels
fall to 60 percent or less of baseline, as specified.
This bill:
Requires labs that perform ChE testing to report to the DPR
the test results for every person tested, as well as other
specified information in the lab's possession.
Requires the medical supervisor ordering the ChE testing to
indicate the purpose of the test and to provide a copy of
the ChE test results or any recommendations to the tested
individual within 14 days of receiving the information.
Specifies that all information reported under this bill
will be confidential, except that the OEHHA, DPR, and the
Department of Public Health (CDPH) may 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.
Requires DPR to prepare a report on the ChE testing program
by December 31, 2015, in consultation with OEHHA and DPH,
and specifies issues the report may examine, including but
not limited to, evaluating and assessing the program's
effectiveness and making recommendations to the
Legislature.
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FISCAL IMPACT
According to the Assembly Appropriations Committee
analysis, this bill would result in minor absorbable costs
to OEHHA and DPR.
BACKGROUND AND DISCUSSION
According to the author, this bill is necessary to enable
state agencies to effectively monitor the existing ChE
medical supervision program and to better protect
California farm workers who are routinely exposed to
pesticides that suppress ChE levels. ChE is a nerve
enzyme, and overexposure to organophosphate and carbamate
pesticides can suppress a person's ChE to dangerously low
levels. The suppression of this enzyme can lead to a
variety of health hazards, including impaired reproduction;
an increased risk of spontaneous abortion; increased risk
of congenital defects resulting in fetal death and altered
birth parameters such as low birth weight and birth length;
low sperm count and poor semen quality in men; a weakened
immune system; an increased risk of non-Hodgkin's lymphoma
and leukemia; increased incidence of asthma; nerve damage;
severe neurological effects and death.
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 author claims that the state has
little oversight authority and that it is impossible to
judge the program's effectiveness.
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 local health officer, who in
turn reports it to state and local agriculture and worker
safety agencies. The second program, the ChE medical
supervision program, is a pesticide poisoning prevention
program. Workers who are regularly using organophosphate
and carbamate pesticides, both of which suppress ChE
levels, are required to be under medical supervision,
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including regular blood tests to determine whether the
pesticides are affecting the workers' ChE levels. If a
worker's ChE levels are suppressed, the employer must
remove the employee from the work environment and take
steps to further reduce employees' over-exposure. This
bill requires that information gathered through the
cholinesterase medical supervision program is transferred
to the state, so the state can meaningfully oversee the
program.
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 6 days in any 30-day period receive periodic
blood tests. According to OEHHA, cholinesterase testing is
the single most important tool in medical supervision of
pesticide workers. Cholinesterase testing, like all
biological monitoring, serves two separate functions:
1. To detect potentially serious individual exposures
before the occurrence of clinical illness, and,
2. To provide indirect monitoring of the workplace
exposure of the employee group as a whole, as
relatively small changes in the group's mean value of
cholinesterase levels may indicate that there is some
repeated, common, and correctable exposure.
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.
Currently, the California Code of Regulations requires
employers to provide medical supervision for employees who
regularly handle pesticides that contain an organophosphate
or a carbamate labeled with the signal words, "Danger"
(Toxicity Category I) or "Warning" (Toxicity Category II),
for the commercial or research production of an
agricultural plant commodity. Medical supervision is a
surveillance program that monitors applicators of such
pesticides. It consists of periodic measurements of
cholinesterase activity levels in applicators that are
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compared to measurements of baseline cholinesterase
activity levels, which were established prior to exposure
to cholinesterase-inhibiting organophosphate and carbamate
pesticides. Appropriate testing enables the physician to
detect the existence of overexposure among a group of
employees or in an individual worker before the occurrence
of clinical illness. If excessive exposure is detected, the
employer is directed to re-examine the workplace and
pesticide handling procedures. Under the regulations, the
employer is responsible for removing employees from
exposure upon recommendation of the medical supervisor.
Medical supervision is important because it can detect
excessive exposure before workers become clinically ill.
There are antidotes for poisoning, which if administered
early and in adequate amounts, can save the lives of
victims who have absorbed even several times the fatal dose
of cholinesterase-inhibiting pesticides. Medical
supervision is also important because it reinforces to the
employees and employers how highly toxic the Toxicity
Categories I and II pesticides are and promotes vigilance.
The employer is required to follow the recommendations of
the medical supervisor concerning matters of occupational
health.
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.
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 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 local health officers
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(LHOs).
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.
Related bills
AB 2541 (Portantino) would delete the exemption from
electronic reporting for HIV infections and would make
conforming changes, and provide that health care providers
and laboratories report cases of HIV infection to the local
health officer using patient names and set guidelines
regarding such reports. Pending in the Senate Health
Committee.
Prior legislation
AB 1530 (Lieber) of 2007 contained substantially similar
provisions to this bill. Held in the Senate Appropriations
Committee.
Arguments in 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
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the effectiveness of the program and protect farm workers
from dangerous overexposure to pesticides.
Arguments in 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.
PRIOR ACTIONS
Assembly Environmental Safety & Toxic Materials5- 1
Assembly Health 12- 5
Assembly Appropriations 11- 5
Assembly Floor 50-27
Senate Environmental Quality 5-2
COMMENTS
1. Amendments from Environmental Quality Committee. When
the Senate Environmental Quality Committee heard this bill
on June 28, 2010, they accepted an amendment which will
need to be taken in this committee. The amendment adds
"date of birth" to the list of items sent by the
laboratories to DPR, for the purpose of distinguishing
between patients with the same name.
2. Missing information. The author may wish to clarify that
a clinical lab may exclude items from the reports they
file, if those items have not been provided by the
physician who ordered the test.
POSITIONS
Support: Health Officers Association of California (HOAC)
(co-sponsor)
Pesticide Action Network (co-sponsor)
American Civil Liberties Union
American Congress of Obstetricians and
Gynecologists, District IX
American Federation of State, County and Municipal
Employees (AFSCME)
California Church IMPACT
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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 (CPEHN)
California Public Health Association - North
California Primary Care Association (CPCA)
California Rural Legal Assistance Foundation
Californians for Alternatives to Toxics
Californians for Justice Collaborative
Californians for Pesticide Reform
Clean Water Action
Commonweal
Consumer Attorneys of California
Dolores Heurta Foundation
East Yard Communities for Environmental Justice
Fresno Coalition Against the Misuse of Pesticides
(FresCAMP: Positive
Alternatives)
Healthy Child Healthy World
Natural Resources Defense Council (NRDC)
Organizaci?n en California de Lideres Campesinas,
Inc.
Pesticide Watch
Physicians for Social Responsibility, Sacramento
Chapter
Physicians for Social Responsibility, San Francisco
Bay Area Chapter
Physicians for Social Responsibility, Los Angeles
Planned Parenthood Affiliates of California (PPAC)
Planned Parenthood Mar Monte
San Francisco Department of Public Health
Sierra Club California
United Farm Workers
University of California, Berkeley Center for
Children's Environmental
Health Research
An individual
Oppose: California Association for Medical Laboratory
Technology (CAMLT)
California Clinical Laboratory Association
Quest Diagnostics
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