BILL ANALYSIS                                                                                                                                                                                                    Ó




                   Senate Appropriations Committee Fiscal Summary
                           Senator Christine Kehoe, Chair

                                          AB 186 (Williams)
          
          Hearing Date: 8/25/2011         Amended: 3/30/2011
          Consultant: Katie Johnson       Policy Vote: Health 9-0
          _________________________________________________________________
          ____
          BILL SUMMARY: AB 186 would require the California Department of 
          Public Health (CDPH) to establish a list of communicable 
          diseases and conditions for which clinical laboratories must 
          submit specimens to local public health laboratories to undergo 
          further testing and to specify circumstances when the specimens 
          must also be submitted to the state public health laboratory. 
          The bill would permit the list to be established and to be 
          modified at any time in consultation with California Conference 
          of Local Health Officers and the California Association of 
          Public Health Laboratory Directors instead of through the 
          existing regulatory process.
          _________________________________________________________________
          ____
                            Fiscal Impact (in thousands)
           Major Provisions         2011-12      2012-13       2013-14     Fund
           CDPH additional                       up to $185       up 
          to$370up to $370General
          laboratory staff

          Local public health             unknown, but potentially 
          significant ifGeneral*
          additional laboratory staff     the laboratories workload 
          increased
                                   enough to need to hire an additional 
          technician               

          *Could be eligible for reimbursement by the Commission on State 
          Mandates
          _________________________________________________________________
          ____

          STAFF COMMENTS:  SUSPENSE FILE.
          CDPH currently has the authority to promulgate regulations to 
          require that samples of specified diseases be sent to local and 
          state public health laboratories. This bill would require a list 
          be developed and would exempt the establishment of and any 
          additions to the list from the regulatory process.








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          California regulations contain the list of dozens of reportable 
          diseases and the timeframes in which they must be reported to 
          local health officers and CDPH. They also specify when cultures 
          or specimens of certain diseases must be sent to a local public 
          health laboratory or CDPH laboratories. Currently, salmonella is 
          the only specimen required to be forwarded to the CDPH 
          laboratory from the local public health laboratory. Samonella, 
          tuberculosis, and malarial blood films are required to be sent 
          from a clinical laboratory to either a local public health 
          laboratory or to the CDPH laboratory.

          This bill would state that it is the intent of the Legislature 
          to enable prompt identification of an outbreak and rapid 
          reporting and laboratory identification during an outbreak 
          situation, the emergence of a new disease or condition, or the 
          recognition of an identified disease or condition that may 
          constitute a danger to the public's health. The public health 
          laboratory must 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. Currently, in the event of an outbreak, 
          CDPH would work with local public health jurisdictions to 
          augment both epidemiological and laboratory surveillance as 
          needed to monitor and control the outbreak. This could include a 
          recommendation to send samples to local and state laboratories 
          for testing.

          Potential Increased Workload
          This bill could increase the workload of both local and state 
          public health laboratories to the extent the establishment of 
          the list requires mandatory testing of cultures and specimens 
          not currently required by statute or regulation. Although the 
          stated intent of this bill is to address disease outbreaks, 
          there is no requirement in this bill that the list be 
          established and updated only in the event of an outbreak. The 
          list would be developed and then the department could update the 
          list at any time in consultation with stakeholders.

          If this bill does not cause an increase in workload, there would 
          be no fiscal impact to CDPH; however, if this bill does cause an 
          increase in workload for CDPH, the department could need up to 
          $370,000 annually to support up to 3 staff, and maybe more, 
          commencing with half year costs in FY 2011-2012. Actual costs 








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          and staffing needs would depend on 1) the number of diseases 
          added to the list, 2) the terms under which a clinical and/or 
          local public health laboratory would be required to submit a 
          culture or specimen to the state laboratory, and 3) the type of 
          testing required for the various diseases and the time required 
          to perform those assays. CDPH currently utilizes 3 
          microbiologists to test 800 - 1000 samples of salmonella 
          annually. 

          Similarly, there could be unknown costs to local public health 
          laboratories to hire additional staff to the extent that the 
          list increases the number of cultures and specimens that they 
          would analyze beyond current resources. Each local health 
          department is currently required to have services available at 
          an official public health laboratory that can include one run by 
          CDPH. Again, actual costs and staffing needs would depend on the 
          magnitude of the increase of cultures and specimens for which 
          the list would require characterization. Since this bill does 
          not identify a specific funding source for potential increased 
          local costs, increased expenses could be found to be 
          reimbursable by the State Commission on Mandates. The sponsor of 
          the bill, the Health Officers Association of California, a group 
          representing local health officers, states that they do not 
          expect to see an increased workload resulting from this bill.

          Although there is the potential for increased costs at the state 
          and local levels, this bill could also result in cost avoidance 
          for CDPH. To the extent that the department would have 
          promulgated regulations to require samples of a disease be sent 
          to laboratories for testing, the department would no longer 
          incur the cost and time associated with the development of those 
          regulations. 

          This bill is nearly identical to AB 2786 (Monning, 2010). The 
          Governor vetoed AB 2786 saying, "This bill is overly broad and 
          unnecessary. 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, 
          without such a public health emergency, could enact changes that 
          affect both private and public laboratories without any 
          regulatory oversight."











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