BILL ANALYSIS                                                                                                                                                                                                    






                                 SENATE HEALTH
                               COMMITTEE ANALYSIS
                        Senator Elaine K. Alquist, Chair


          BILL NO:       AB 2635                                      
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          AUTHOR:        Portantino                                   
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          AMENDED:       April 5, 2010                               
          HEARING DATE:  June 16, 2010                                
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          REFERRAL:      Public Safety                                
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          CONSULTANT:                                                 
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          Orr                                                          
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                                     SUBJECT
                                         
                   Communicable disease: involuntary testing

                                     SUMMARY
                                         
          Adds nonsworn employees of a law enforcement agency whose  
          job description includes the collection of fingerprints to  
          the list of persons who, when exposed to an arrestee's  
          bodily fluids, can have the arrestee's blood tested for  
          communicable diseases.

                             CHANGES TO EXISTING LAW
                                         
          Existing federal law:
          Establishes the Occupational Exposure to Bloodborne  
          Pathogens Standard to address the significant health risks  
          many employees face as the result of occupational exposure  
          to blood and other potentially infectious materials (OPIM)  
          because they may contain bloodborne pathogens, including,  
          but not limited to hepatitis B virus (HBV), hepatitis C  
          virus (HCV), and HIV (human immunodeficiency virus).
          
          Existing federal regulation:
          Establishes regulations applicable to all occupational  
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          exposure to blood or other potentially infectious materials  
          as defined, by the Occupational Safety and Health  
          Administration, under the United States Department of  
          Labor.

          Existing state law:
          Establishes a process whereby a peace officer, firefighter,  
          custodial officer, custody assistant, uniformed employee of  
          a law enforcement agency whose job entails the care or  
          control of inmates in a detention facility, or emergency  
          medical provider who, while acting within the scope of his  
          or her duties, is exposed to an arrestee's blood or bodily  
          fluids, may petition a court for an order requiring testing  
          of the blood or bodily fluids for Human Immunodeficiency  
          Virus (HIV), hepatitis B, and hepatitis C.

          Declares legislative intent that information that may be  
          vital to the health and safety of custodial personnel,  
          custodial medical personnel, peace officers, firefighters  
          and emergency medical personnel who are put at risk in the  
          course of their official duties, be obtained and disclosed  
          in an appropriate manner in order to ensure their health  
          and their relief from groundless fear of infection.  

          Existing state regulations:
          Establishes regulations applicable to all occupational  
          exposure to blood or other potentially infectious materials  
          (OPIM) as defined, by the California Department of  
          Industrial Relations, including the use of universal  
          precautions to prevent contact with blood or OPIM. Under  
          circumstances in which differentiation between body fluid  
          types is difficult or impossible, all body fluids shall be  
          considered potentially infectious materials.

          This bill:
          Adds nonsworn employees of a law enforcement agency whose  
          job description includes the collection of fingerprints to  
          the list of persons who, when exposed to an arrestee's  
          bodily fluids, can have the arrestee's blood tested for  
          communicable diseases.
          
                                  FISCAL IMPACT  

          The Assembly Appropriations Committee analysis estimates  
          negligible state court costs/savings to the extent this  
          bill results in additional/fewer hearings for county  




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          detention personnel forced to pursue a court hearing to  
          obtain an arrestee's blood sample in the wake of a bodily  
          fluid exposure. 

                            BACKGROUND AND DISCUSSION  
          
          The author introduced this bill to correct an oversight in  
          last year's AB 169 (Portantino, Chapter 417, Statutes of  
          2009). AB 169 included nonsworn uniformed officers to the  
          category of employees (law enforcement and medical services  
          personnel) who, after exposure to an arrestee's bodily  
          fluids, may have that arrestee's blood tested, either  
          voluntarily or by court order, for specified communicable  
          diseases. It was brought to the author's attention that  
          there are other employees who come into contact with  
          arrestees who are frequently exposed to blood or other  
          bodily fluids who are not covered by this provision of law.  
           This bill adds employees of law enforcement agencies whose  
          duties include the collection of fingerprints. 

          Occupational exposure to bloodborne pathogens  
          Blood and other potentially infectious materials have long  
          been recognized as a potential threat to the health of  
          employees who are exposed to these materials by  
          percutaneous contact (penetration of the skin). Other  
          potentially infectious materials (OPIM) can include human  
          body fluids (semen, vaginal secretions, amniotic fluid,  
          saliva in dental procedures, any body fluid visibly  
          contaminated with blood, etc.), any unfixed tissue or organ  
          from a human living or dead; or HIV-containing cell or  
          tissue cultures, organ cultures, and HIV- or HBV-containing  
          culture medium or other solutions as well as blood, organs,  
          or other tissues from experimental animals infected with  
          HIV or HBV. 

          According to the National Institute for Occupational Safety  
          and Health, exposures to blood and other body fluids occur  
          across a wide variety of occupations. Health care workers,  
          as well as emergency response and public safety personnel,  
          can be exposed to blood through needlestick and other  
          sharps injuries, as well as through mucous membrane and  
          skin exposures.  The pathogens of primary concern for the  
          Centers for Disease Control and Prevention (CDC) and the  
          National Institute for Occupational Safety and Health are  
          the human immunodeficiency virus (HIV), hepatitis B virus  
          (HBV), and hepatitis C virus (HCV).  According to CDC  




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          recommendations, wounds and skin sites that have been in  
          contact with blood or bodily fluids should be washed with  
          soap and water, and mucous membranes should be flushed with  
          water.  Immediate evaluation must be performed by a health  
          care professional. The evaluation should determine the type  
          of exposure, infectious status of the source, and the  
          susceptibility of the exposed person in order to determine  
          the treatment course.

          Existing California regulations apply to all occupational  
          exposure to blood or other potentially infectious materials  
          (OPIM) as defined, with specified exceptions. The  
          regulations define occupational exposure as "reasonably  
          anticipated skin, eye, mucous membrane, or parenteral  
          contact with blood or other potentially infectious  
          materials that may result from the performance of an  
          employee's duties." Some facilities and operations are  
          considered by Cal/OSHA to involve "occupational exposure,"  
          as defined because the intrinsic nature of the facility or  
          operation is such that contact with blood or OPIM is  
          reasonably anticipated for at least some of the employees  
          involved with the facility or operation. 

          Under the regulations, employers of these facilities or  
          operations have the responsibility to conduct an exposure  
          determination to determine which tasks and procedures  
          involve occupational exposure as a part of complying with  
          the written Exposure Control Plan requirements. Employers  
          whose employees work in facilities other than those that  
          intrinsically involve occupational exposure are still  
          subject to regulations if the individual circumstances of  
          the facility or operation are such that the employee's  
          activities or tasks place them in contact with blood or  
          OPIM. 

          Each employer who has an employee(s) with occupational  
          exposure to blood or OPIM is required to document an  
          exposure determination. The exposure determination is made  
          without regard to the use of personal protective equipment  
          since employees are considered exposed even if they wear  
          personal protective equipment.

          Post-exposure procedures
          Workers who are stuck by a needle or have any other type of  
          exposure to blood or OPIM must receive immediate  
          confidential medical screening and follow-up treatment.  




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          Treatment potentially includes medications to prevent  
          infection, according to current Public Health Service  
          guidelines, as soon as possible. Post-exposure prophylaxis  
          (PEP) is a short-term treatment to reduce the likelihood of  
          infection after exposure to a number of contagious  
          diseases, including HIV, HBV, and HCV.  PEP is considered a  
          second line of defense when preventive efforts have failed  
          or were not possible, as is the case with sexual assault or  
          occupational exposure.  

          In the case of HIV, PEP typically involves providing one or  
          several anti-HIV drugs within 72 hours of exposure, which  
          are then taken for a four- to six-week period.  According  
          to the World Health Organization (WHO), in order for PEP to  
          be most effective in preventing HIV infection, treatment  
          should be commenced as soon as possible after exposure and,  
          ideally, within two to four hours.  One of the first  
          examples of PEP effectiveness was reported in a 1995 study,  
          which showed fewer HIV infections after occupational  
          exposure among health care workers who used PEP versus  
          those who took no prophylaxis after exposure.  A recent  
          Canadian study found that, of 160 patients who had been  
          exposed to HIV and received PEP treatment, only one  
          infection was reported. 

          CDC recommendations for HBV exposure include the initiation  
          of the hepatitis B vaccine series to an unvaccinated person  
          who has been exposed.  PEP with hepatitis B immune globulin  
          (HBIG) and/or hepatitis B vaccine series should be  
          considered after an evaluation of the HBV status of the  
          source and the vaccination and vaccine-response status of  
          the exposed person.  According to the CDC, in the  
          occupational setting, multiple doses of PEP for HBV  
          initiated within one week following exposure, provides an  
          estimated 75 percent protection from infection.  

          According to the CDC, the estimated risk for infection  
          after a needlestick or cut exposure to HCV-infected blood  
          is approximately 1.8 percent.  Additionally, several  
          studies have attempted to assess the effectiveness of  
          potential post-exposure treatment for HCV, but have been  
          difficult to interpret.  No clinical trials have been  
          conducted to assess postexposure use of antiviral agents  
          (interferon) to prevent HCV infection, and antivirals are  
          not FDA approved for this use.  The CDC states that an  
          established infection might need to be present before  




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          interferon can be an effective treatment. 

          Related bills
          AB 169 (Portantino), Chapter 417, Statutes of 2009, added  
          custodial officers, custody assistants, and nonsworn  
          uniformed employees of a law enforcement agency, to the  
          list of persons who may seek to have an arrestee's blood  
          tested either voluntarily or by court order, for specified  
          communicable diseases when exposed to an arrestee's bodily  
          fluids while acting within the scope of his or her duties.
          
          Prior legislation
          AB 2737 (Feuer), Chapter 554, Statutes of 2008, permits a  
          peace officer, firefighter, or emergency medical personnel  
          who, while acting within the scope of his or her duties, is  
          exposed to an arrestee's blood or bodily fluids, as  
          defined, to petition the court, ex parte, for an order to  
          withdraw blood from the arrestee for testing for HIV,  
          AIDS-related conditions, and HCV. 

          AB 2423 (Cardenas), Chapter 342, Statutes of 2002, permits  
          testing of an available sample of a patient's blood for  
          various communicable diseases. Broadens the definition of  
          "available sample" of blood to include any sample obtained  
          prior to the patient's release, either before or after the  
          exposure incident.  

          SB 1239 (Russell), Chapter 708, Statutes of 1994,  
          authorizes the blood or other tissue or material of a  
          source patient, as defined, to be tested for HIV pursuant  
          to a prescribed procedure, either with or without the  
          consent of the source patient, and authorizes a health care  
          provider or first responder who experiences a "significant  
          exposure" to the blood or other potentially infectious  
          materials of the source patient to be informed of the HIV  
          status of that patient.  

          AB 1385 (Alpert), Chapter 519, Statutes of 1998, authorizes  
          an HIV test to be performed on any available blood or  
          patient sample of a source patient if that patient is  
          unable to provide informed consent under specified  
          conditions. 

          SB 2056 (Brulte), Chapter 254, Statutes of 1998, permits,  
          if the informed consent of the source patient cannot be  
          obtained because he or she is deceased, an HIV test to be  




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          performed on any blood or patient sample of the patient  
          legally obtained in the course of providing health care  
          services at the time of the exposure event.

          SB 1239 (Russell), Chapter 708, Statutes of 1995, permitted  
          HIV testing of blood, or other tissue available from a  
          source patient without the consent of the patient if a  
          health care provider, first responder or other person has  
          experienced a significant workplace exposure to the  
          patient's blood or other infectious material.

          Arguments in support
          The American Federation of State, County, and Municipal  
          Employees (AFSCME) is sponsoring this bill. They claim that  
          recently fingerprint identification experts (FIEs) within  
          the Los Angeles Police Department were required, by special  
          order of the chief of police, to gather fingerprints from  
          suspected criminals while they were hospitalized. However,  
          this is a new duty for FIEs and their classification  
          doesn't have the same protections granted to other law  
          enforcement personnel. This bill would add FIEs to the list  
          of persons who may seek to have an arrestee's blood tested,  
          either voluntarily or by court order, for specified  
          communicable diseases when the FIE is exposed to that  
          arrestee's blood or bodily fluids while the FIE is acting  
          within the scope of his or her duties.
          
                                  PRIOR ACTIONS

           Assembly Floor:          76-0
          Assembly Appropriations: 17-0 
          Assembly Public Safety:7-0
          Assembly Rules:          11-0 

                                     COMMENTS
           

          1. Double referral. This bill is double referred to the  
          Senate Public Safety Committee. 

                                    POSITIONS  
                                        
          Support:  AFSCME (sponsor)


          Oppose:   None received




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