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