BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                      



           ------------------------------------------------------------ 
          |SENATE RULES COMMITTEE            |                   AB 499|
          |Office of Senate Floor Analyses   |                         |
          |1020 N Street, Suite 524          |                         |
          |(916) 651-1520         Fax: (916) |                         |
          |327-4478                          |                         |
           ------------------------------------------------------------ 
           
                                         
                                 THIRD READING


          Bill No:  AB 499
          Author:   Atkins (D), et al.
          Amended:  As introduced
          Vote:     21

           
           SENATE JUDICIARY COMMITTEE  :  3-1, 6/14/11
          AYES:  Evans, Corbett, Leno
          NOES:  Harman
          NO VOTE RECORDED:  Blakeslee
           
          SENATE APPROPRIATIONS COMMITTEE :  6-3, 8/25/11
          AYES:  Kehoe, Alquist, Lieu, Pavley, Price, Steinberg
          NOES:  Walters, Emmerson, Runner
           
          ASSEMBLY FLOOR :  50-25, 5/12/11 - See last page for vote


           SUBJECT  :    Minors:  medical care:  consent

           SOURCE  :     American Congress of Obstetricians and 
          Gynecologists, 
                        District IX
                      California STD Controllers Association
                      Health Officers Association of California


           DIGEST  :    This bill authorizes a minor, who is 12 years of 
          age or older, to consent to medical care related to the 
          prevention of a sexually transmitted disease. 

           ANALYSIS  :    Existing law provides that a minor who is 12 
          years of age or older who might have come into contact with 
                                                           CONTINUED





                                                                AB 499
                                                                Page 
          2

          a contagious, infectious, or 
          communicable disease may consent to medical care related to 
          the diagnosis or treatment of that disease if the disease 
          or condition is one that is required by law to be reported 
          to the local health officer, or is a sexually transmitted 
          disease as determined by the Director of the Department of 
          Health Services.  (Family Code Section 6926 (a))
           
          Existing law provides that the parents of a minor who has 
          consented to medical treatment for a communicable or 
          sexually transmitted disease are not liable for payment for 
          that care.  (Family Code Section 6926 (b)) 

          Existing law provides that a minor may consent to medical 
          care related to the prevention or treatment of pregnancy.  
          (Family Code Section 6925 (a)) 

          Existing law provides that a minor's consent under minor 
          consent statutes cannot be subject to disaffirmance because 
          of minority.  (Family Code Section 6921) 

          Existing law provides that a minor who is 12 years old or 
          older who is alleged to have been raped may consent to 
          diagnosis and treatment of that condition.  (Family Code 
          Section 6927)

          Existing law allows a minor alleged to have been sexually 
          assaulted to consent to medical care related to the 
          diagnosis and treatment of that condition.  (Family Code 
          Section 6928 (b))

          Existing law allows a minor to consent to medical care 
          related to the diagnosis or treatment of a drug or 
          alcohol-related problem.  (Family Code Section 6929 (b))

          Existing law provides that a minor may consent to medical 
          or dental care if that minor is over the age of 15, living 
          separate and apart from his or her parents whether with or 
          without his/her parents' consent, and managing his or her 
          own financial affairs.  (Family Code Section 6922 (c)) 

          This bill authorizes a minor, who is 12 years of age or 
          older, to consent to medical care related to the prevention 
          of a sexually transmitted disease.

                                                           CONTINUED





                                                                AB 499
                                                                Page 
          3


           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  No   
          Local:  No

          According to the Senate Appropriations Committee:

                          Fiscal Impact (in thousands)

             Major Provisions                2011-12     2012-13    
             2013-14               Fund  

            Medi-Cal vaccination          $1,200-$2,500 per 5 to 
            10% of              Federal/
            administrative fee            eligible cases           
            General*

            Post-exposure       Unknown; potentially 
            significantFederal/
            prophylactic HIV              costs of $750 to $1,550 
            per 1,000           General*
            treatment           cases

            Healthy Families              Unknown; potential cost 
            pressure            Federal/
            Program impact      on plan rates                      
            General

            Preventive services           Potential future cost 
            savings in          Federal/
                                diagnosis and treatment 
            costsGeneral*

            * Costs shared 50 percent General Fund, 50 percent 
            federal funds
           
           SUPPORT  :   (Verified  8/25/11)

          American Congress of Obstetricians and Gynecologists, 
            District IX (co-source)
          California STD Controllers Association (co-source)
          Health Officers Association of California (co-source)
          ACCESS Women's Health Justice
          ACT for Women and Girls
          American Civil Liberties Union

                                                           CONTINUED





                                                                AB 499
                                                                Page 
          4

          American Association of University Women
          Asian Communities for Reproductive Justice
          California Adolescent Health Committee
          California Coalition for Youth
          California Commission on the Status of Women
          California Communities United Institute
          California Family Health Council
          California Medical Association
          California National Organization of Women
          California Nurses Association
          California Primary Care Association
          California School Health Centers Association
          Children's Law Center of Los Angeles
          County of Los Angeles Board of Supervisors
          Having Our Say
          Kaiser Permanente
          Los Angeles Gay and Lesbian Center
          Maternal and Child Health Access
          Mental Health Association in California
          National Center for Youth Law
          National Association of Social Workers-California Chapter
          NARAL-Pro-Choice California
          National Council of Jewish Women
          Nevada County Citizens for Choice
          Planned Parenthood Affiliates of California
          Planned Parenthood Advocacy Project Los Angeles County
          Planned Parenthood Mar Monte
          Reproductive Justice Coalition of Los Angeles
          Women's Health Specialists

           OPPOSITION :    (Verified  8/25/11)

          California Catholic Conference
          California Right to Life Committee
          Capitol Resource Family Impact
          Capitol Resource Institute

           ARGUMENTS IN SUPPORT  :    The author writes:

            "There is a gap in the law relative to prevention of 
            sexually transmitted diseases (STDs).  Existing law only 
            specifies the ability to consent to diagnosis and 
            treatment.  This omission creates a barrier to 
            time-critical preventive services.  At the time the law 

                                                           CONTINUED





                                                                AB 499
                                                                Page 
          5

            was passed, the preventive options we have today did not 
            exist.

            "We now have time-critical prevention services for 
            sexually transmitted diseases.  Examples include the 
            hepatitis B vaccines, prophylactic post-exposure HIV 
            medications (which must be given within 72 hours of 
            exposure) and HPV vaccine which, if given before 
            exposure, can significantly reduce the risk of certain 
            cancers and abnormal, precancerous cervical cell changes 
            and genital warts.  In addition to these diseases being 
            sexually transmitted, they also have in common that they 
            can be life-long and are only treatable, not curable.  
            The treatments can be costly in both financial terms and 
            quality of life. 

            "These services are ? time-sensitive, and there are 
            long-term health implications if there is a failure to 
            obtain the services.  All of these therapies need to be 
            provided in a timely fashion to prevent significant harm. 
             Some adolescents, from difficult family situations, will 
            either delay or simply fail to obtain services if 
            confronted with a legal requirement of parental consent."

          The co-sponsor of the bill, the Executive Committee of the 
          California STD Controllers Association writes, "While most 
          teens involve their parents in medical decisions, even 
          those involving sensitive subjects, we need to allow for 
          those minors who can't or won't include their parents.  The 
          current requirement that minors obtain parental consent for 
          STD prevention services has resulted in missed and denied 
          opportunities for minors to receive vital and 
          time-sensitive medical care.  The need to provide 
          prevention services to this population is essential."

          The Health Officers Association of California, the 
          co-sponsor of this bill states, "Prevention of communicable 
          disease is a primary goal of public health.  Prevention 
          allows physicians to stop diseases before they start, 
          avoiding unnecessary pain, disability, and medical costs.  
          Preventive measures for STDs include counseling, 
          age-appropriate education, distribution of prophylaxis, and 
          vaccination against Hepatitis B and HPV.  Prevention is a 
          vital part of comprehensive care.  Provision of 

                                                           CONTINUED





                                                                AB 499
                                                                Page 
          6

          confidential prevention services will help California's 
          physicians protect the health of our young people."

          Also co-sponsoring the bill, the American Congress of 
          Obstetricians and Gynecologists, District IX (ACOG-IX) 
          writes:  "The reality is that teens have the highest rate 
          of sexual violence, with 1 in 6 women and 1 in 33 men 
          reporting sexual assault in their lifetimes.  Among victims 
          of Ýsexual] violence, the highest rate exists for those 25 
          years of age and below.  Thus, teens are at particular 
          risk.  What is of utmost concern to ACOG-IX is teen health 
          and safety.  Previous legislatures, in passing current 
          minor consent laws, have also taken this position.  ACOG 
          policy is to encourage minors to include their parents in 
          medical decisions.  However for some teens, good family 
          communication is not possible and actually may be 
          dangerous.  The California Supreme Court in a 1997 opinion 
          concluded that forcing parent communication about sensitive 
          health care can actually endanger teens physically and 
          emotionally and 'exacerbate the instability and 
          dysfunctional nature of the family relationship.'"

           ARGUMENTS IN OPPOSITION  :    The California Catholic 
          Conference, Inc. argues that "most parents are involved in 
          the lives of their minor children and want and need to know 
          if they are seeking medical care-regardless of whether the 
          care is preventative or curative.  Of course there are 
          occasions when parents do not adequately care for the 
          welfare of their minor child, but it is certainly not the 
          usual case."  The California Catholic Conference continues 
          with "this bill is dangerous because it expands a faulty 
          law which assumes that children know better than their 
          parents and because it will allow minors access to HPV 
          vaccines which may cause them permanent harm."  
           

           ASSEMBLY FLOOR  :  50-25, 5/12/11
          AYES:  Alejo, Allen, Ammiano, Atkins, Beall, Block, 
            Blumenfield, Bonilla, Bradford, Brownley, Buchanan, 
            Butler, Charles Calderon, Campos, Carter, Chesbro, Davis, 
            Dickinson, Eng, Feuer, Fletcher, Fong, Fuentes, Furutani, 
            Galgiani, Gatto, Gordon, Hall, Hayashi, Roger Hernández, 
            Hill, Huber, Hueso, Huffman, Lara, Bonnie Lowenthal, Ma, 
            Mendoza, Mitchell, Monning, Pan, Perea, V. Manuel Pérez, 

                                                           CONTINUED





                                                                AB 499
                                                                Page 
          7

            Skinner, Solorio, Swanson, Wieckowski, Williams, Yamada, 
            John A. Pérez
          NOES:  Achadjian, Bill Berryhill, Conway, Cook, Donnelly, 
            Beth Gaines, Grove, Hagman, Halderman, Harkey, Jeffries, 
            Jones, Knight, Logue, Mansoor, Miller, Morrell, Nestande, 
            Nielsen, Norby, Olsen, Silva, Smyth, Valadao, Wagner
          NO VOTE RECORDED:  Cedillo, Garrick, Gorell, Portantino, 
            Torres


          RJG:mw  8/26/11   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE

                                ****  END  ****
          





























                                                           CONTINUED