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. AB 186 (Williams) Page 1 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 AB 186 (Williams) Page 2 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." AB 186 (Williams) Page 3