BILL ANALYSIS Ó
AB 186
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Date of Hearing: March 22, 2011
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 186 (Williams) - As Introduced: January 25, 2011
SUBJECT : Reportable diseases and conditions.
SUMMARY : Permits the California Department of Public Health
(DPH) to modify the list of communicable diseases and conditions
for which clinical labs must submit specimens to the local
public health laboratory to undergo further testing and allows
DPH to modify the list at any time in consultation with the
California Conference of Local Health Officers (CCLHO) and the
California Association of Public Health Laboratory Directors
(CAPHLD). Specifically, this bill :
1)Makes legislative findings and declarations regarding the need
to enable prompt identification of an outbreak, send positive
specimens to the public health laboratory for identification,
and enable DPH to include newly emerging diseases and
conditions in a timely manner.
2)Requires DPH to establish a list of communicable diseases and
conditions for which clinical laboratories shall submit a
culture or a specimen to the local public health laboratory to
undergo further study.
3)Permits DPH to modify the list at any time, after consultation
with the CCLHO and the CAPHLD, without being subject to
California's Administrative Procedures Act (APA), which
governs the adoption of regulations, but requires that DPH
file the revised list with the Secretary of State for
publication in the California Code of Regulations (CCR).
4)Exempts clinical labs that fail to submit cultures or
specimens for mandatory diseases from civil and criminal
penalties, unless the requirement has been noticed by DPH for
at least six months in the CCR.
5)Deletes specific diseases that are enumerated in law as
mandatory reportable diseases, thereby allowing DPH to
reconstitute the list in consultation with CCLHO.
EXISTING LAW :
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1)Requires DPH to establish a list of diseases and conditions
which health care providers and local health officers are
required to report to the local public health department.
Allows DPH to modify this list and exempts this modification
from requirements, governing changes in administrative
regulations under APA.
2)Under regulation, requires labs to report test results on
certain diseases considered to be of "public health
importance."
3)Does not exempt DPH from complying with APA requirements when
modifying the list of reportable diseases and conditions for
which public health labs are required to submit specimens.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, technology is
not currently available in California public health
laboratories for different sub-typing techniques, such as DNA
fingerprinting, that can be used to identify clusters of
various organisms that cause illness. The author states that
use of this specialized testing can help identify outbreaks
and sources of outbreaks so they can be mitigated, and for
this to be an effective public health tool, the public health
laboratory needs to obtain the necessary specimens from all
sources in order to be able to quickly identify the organisms
causing illnesses and compare the subtypes, thus allowing a
timely public health response. The author contends that by
allowing DPH to quickly add conditions to the list of diseases
for which clinical laboratories must submit specimens, this
bill may save lives during an emergency.
2)BACKGROUND . Health care providers who know of a case, or
suspected case, of any disease or condition on the DPH list
are required to report to the local health officer of the
jurisdiction where the patient resides and are required to
send specimens to a clinical laboratory. Clinical
laboratories include all hospital laboratories and community
laboratories that receive tests from health care providers for
analysis. Clinical laboratories are also required by
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regulation to report positive specimens to the local public
health department. Currently laboratories are required to
report communicable diseases, pathogens, and viral infections.
Clinical laboratories are required to submit specimens for
those listed diseases and conditions, while specimens for
non-listed diseases and conditions are submitted on a
voluntary basis. If there is a known or suspected outbreak of
a particular disease or condition that is listed, the local
health officer must report to DPH within a specified time
period, and take the necessary steps to prevent further
contamination or infection.
The list of communicable diseases and conditions for which
laboratories must submit cultures is established by regulation
and adding or deleting a disease or condition requires an
administrative regulation change under APA. The APA was
intended to ensure transparency and full public participation
when agencies change their regulations. The APA does permit
adoption of emergency regulations, but requires a five-day
public notice, and emergency regulations can only remain in
effect for up to 180 days. According to the sponsor, it could
take one and one-half to two years for DPH to update the list
of reportable diseases, whereas under this, it could take as
little as two months.
3)SUPPORT . The Health Officers Association of California
(HOAC), the sponsors of this bill, write that public health
laboratories are the front line in the war against disease
outbreaks. These labs can quickly identify sub-types of
contaminants such as E coli so that a common source outbreak
can be identified and investigated. HOAC further states that
public health laboratories can also examine avian flu isolates
for strain typing to determine their potential to result in a
human pandemic. HOAC contends that this bill will enable
public health laboratories to better protect all Californians
during the outbreak of a dangerous disease.
4)PREVIOUS LEGISLATION .
a. AB 2786 (Committee on Health) of 2010 contained
identical provisions to this bill. AB 2786 was vetoed
by Governor Schwarzenegger, who stated in part: "The
Department of Public Health, in a public health emergency,
already has broad authority to request and receive
laboratory data. I am also concerned that the Department,
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without such a public health emergency, could enact changes
that affect both private and public laboratories without
any regulatory oversight."
b. SB 356 (Negrete McLeod) of 2007 is nearly identical to
this bill. SB 356 was vetoed by Governor Schwarzenegger
because the delay in passing 2008-2009 State Budget forced
him to prioritize the bills sent to his desk. According to
the Governor, SB 356 did not meet his standard as priority
legislation.
c. AB 1091 (Negrete McLeod), Chapter 262, Statutes of 2003
allows DPH, in consultation with the California Conference
of Local Health Officers, to modify the list of reportable
diseases that health care providers are required to report.
DPH can modify this list at any time without having to
comply with APA requirements.
REGISTERED SUPPORT / OPPOSITION :
Support
Health Officers Association of California (sponsor)
Opposition
None on file.
Analysis Prepared by : Melanie Moreno / HEALTH / (916)
319-2097