BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  AB 861
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          Date of Hearing:   March 29, 2011

                            ASSEMBLY COMMITTEE ON HEALTH
                              William W. Monning, Chair
            AB 861 (Hill and Nestande) - As Introduced:  February 17, 2011
           
          SUBJECT  :  California Stroke Registry.

           SUMMARY  :  Establishes the California Stroke Registry (CSR) 
          within the Department of Public Health (DPH) to serve as a 
          centralized repository for stroke data to promote quality 
          improvement for acute stroke treatment.  Requires that the 
          program will only be implemented to the extent funds from 
          federal or private sources are made available for this purpose.  
          Specifically,  this bill  :   

          1)Requires DPH to establish a statewide CSR to serve as a 
            centralized repository for stroke data to promote quality 
            improvement for acute stroke treatment.

          2)Requires CSR to align with the stroke consensus metrics 
            developed by national health organizations such as the federal 
            Centers for Disease Control and Prevention (CDC), the Joint 
            Commission, the American Heart Association (AHA), and the 
            American Stroke Association (ASA).

          3)Requires the acquisition of data for CSR to encompass all 
            areas of the state for which stroke data are available.

          4)Requires CSR to be under the direction of the Director of DPH 
            and housed within DPH's California Heart Disease and Stroke 
            Prevention Program (CHDSP) and permits CHDSP to accept, on 
            behalf of the state, grants of public or private funds for 
            CSR.

          5)Permits DPH to contract with an agency, including, but not 
            limited to, a health systems agency, single county health 
            department, multicounty health department groupings, or 
            nonprofit professional associations, representing a designated 
            reporting region for the purposes of collecting and collating 
            acute stroke data.

          6)Permits DPH to contract, or provide grant awards, to implement 
            public health activities to fulfill required funding award 
            objectives.








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          7)Requires the Director of DPH, in establishing the CSR, to do 
            the following:

             a)   Maintain a statewide stroke database that compiles 
               information and statistics on stroke care.  Requires DPH, 
               to the extent possible, to coordinate with the CDC, the 
               Joint Commission, AHA and ASA to avoid duplication and 
               redundancy;

             b)   Recommend that hospitals and emergency medical services 
               agencies report case-specific data on the treatment of 
               individuals with suspected acute stroke to the 
               representative of DPH, or any individual, agency, or 
               organization designated to cooperate with that 
               representative;

             c)   Encourage sharing of information and data among health 
               care providers to improve the quality of care for stroke;
             d)   Facilitate the communication and analysis of health 
               information and data among the health care professionals 
               providing care for individuals with stroke; and,

             e)   Consult with the Stroke Advisory Committee of the ASA 
               regarding ways in which to improve the quality of stroke 
               care and delivery in California.

          8)Requires all information collected for the CSR to be 
            confidential.  Requires DPH, or its designee, to use this 
            information to evaluate measures designed to improve the 
            quality of acute stroke treatment.

          9)Authorizes persons with a valid scientific interest who are 
            engaged in demographic, epidemiological, or other similar 
            studies related to health, and who meet qualifications as 
            determined by DPH, and who agree, in writing, to maintain 
            confidentiality, to have access to confidential information.  
            Requires, before confidential information is disclosed for 
            study, researchers to do both of the following:

             a)   Obtain approval of their committee for the protection of 
               human subjects established in accordance with existing law; 
               and,

             b)   Provide documentation to DPH that demonstrates to DPH's 








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               satisfaction that the entity has established the procedures 
               and ability to maintain the confidentiality of the 
               information.

          10)Requires any disclosure authorized by this bill to include 
            only the information necessary for the stated purpose of the 
            requested disclosure, used for the approved purpose, and not 
            to be further disclosed.

          11)Requires that the furnishing of confidential information to 
            DPH or its authorized representative, in accordance with this 
            bill, to not expose any person, agency, or entity furnishing 
            information to liability, and is prohibited from being 
            considered a waiver of any privilege or a violation of a 
            confidential relationship.

          12)Requires DPH to maintain an accurate record of all persons 
            who are given access to confidential information.  Requires 
            the record to include the name of the person authorizing 
            access; name, title, address, and organizational affiliation 
            of persons given access; dates of access; and, the specific 
            purpose for which information is to be used.  Requires the 
            record of access to be open to public inspection during normal 
            operating hours of DPH.

          13)Prohibits any part of the confidential information from being 
            available for subpoena, from being disclosed, discoverable, or 
            compelled to be produced in any civil, criminal, 
            administrative, or other proceeding, or from being deemed 
            admissible as evidence in any civil, criminal, administrative, 
            or other tribunal or court for any reason.

          14)Requires that this bill not prohibit the publication by DPH 
            of reports and statistical compilations that do not in any way 
            identify individual cases or individual sources of 
            information.

          15)Requires that the individual to whom the information pertains 
            have access to his or her own information in accordance with 
            existing law.

          16)Makes the following definitions:

             a)   Ischemic stroke means an occlusion of a blood vessel 
               that blocks blood flow to the brain, depriving the brain of 








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               oxygen, and resulting in brain tissue death.  This 
               definition includes transient ischemic attacks, defined as 
               stoke-like symptoms for less than 24 hours; and,

             b)   Hemorrhagic stroke means as a rupture of a blood vessel, 
               resulting in bleeding into or around the brain.

          17)Prohibits this bill from preempting the authority of 
            facilities or individuals providing diagnostic or treatment 
            services to patients with stroke to maintain their own 
            facility-based stroke registries.

          18)Prohibits this bill from being construed as a medical 
            practice guideline and from being used to restrict the 
            authority of a hospital to provide services for which it has 
            received a license under state law.

          19)Requires this bill to be implemented only to the extent funds 
            from federal or private sources are made available for this 
            purpose.

          20)Makes various finding and declarations regarding the 
            prevalence of stroke in California and the importance of rapid 
            identification, diagnosis, and treatment of stroke to save 
            lives.

           EXISTING LAW  :  

          1)Permits DPH to do all of the following in order to protect, 
            preserve, and advance public health: a) studies; b) 
            demonstrations of innovative methods; c) evaluations of 
            existing projects; d) provisions of training programs; and, e) 
            dissemination of information.

          2)Permits DPH, in performing activities listed in 2) above, to 
            do all of the following: a) perform the activity directly; b) 
            enter into contracts, cooperative agreements, or other 
            agreements for the performance of the activity; and, c) award 
            grants for the performance of the activity.

           FISCAL EFFECT  :   This bill has not yet been heard by a fiscal 
          committee.

           COMMENTS  :    









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           1)PURPOSE OF THIS BILL  .  According to the author, a voluntary 
            stroke registry was established in DPH in 2007 and 
            approximately 42 hospitals across the state have participated. 
             The author maintains that codifying the voluntary registry 
            will likely lead to a much greater rate participation and 
            increasing the amount of information that can be collected on 
            strokes, the types of treatment victims receive, and the 
            impacts of those treatments will provide medical professionals 
            with a roadmap to improved care.  Additionally, the author 
            maintains that establishment of a stroke registry in statute 
            will improve the potential for California to receive and 
            accept federal grants through CDC.  The author asserts that 
            the CDC has been tasked with implementing state-based 
            registries to measure and track acute stroke care.  According 
            to the author, a second round of CDC funding is forthcoming 
            but absent a stroke registry in statute, California will be 
            ineligible to receive those federal funds.

           2)BACKGROUND  .  According to the National Institute of 
            Neurological Disorders and Stroke (NINDS), a stroke, or "brain 
            attack," occurs when blood circulation to the brain fails.  
            Brain cells can die from decreased blood flow and the 
            resulting lack of oxygen.  NINDS states that there are two 
            broad categories of stroke: those caused by a blockage of 
            blood flow and those caused by bleeding.  While not usually 
            fatal, a blockage of a blood vessel in the brain or neck, 
            called an ischemic stroke (PRONOUNCED i-skee-meek), is the 
            most frequent cause of stroke and is responsible for about 80% 
            of strokes.  These blockages stem from three conditions: the 
            formation of a clot within a blood vessel of the brain or 
            neck, called thrombosis; the movement of a clot from another 
            part of the body such as the heart to the neck or brain, 
            called embolism; or, a sever narrowing of an artery in or 
            leading to the brain, called stenosis.  Bleeding into the 
            brain or the spaces surrounding the brain causes the second 
            type of stroke, called hemorrhagic stroke.

          Stroke occurs in all age groups, in both sexes, and in all 
            races.  In African Americans, stroke is more common, and more 
            deadly - even in young and middle-aged adults - than for any 
            ethnic or other racial group in the United States.  Scientists 
            have found more and more severe risk factors in some minority 
            groups and continue to look for patterns of stroke in these 
            groups.  Some of the most important treatable risk factors for 
            stroke are: high blood pressure; cigarette smoking; heart 








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            disease; history of stroke; and, diabetes.

          According to AHA and ASA, stroke is the third leading cause of 
            death in California.  Each year stroke kills approximately 
            15,585 Californians and accounts for almost 200,000 
            hospitalizations.  Stroke is the leading cause of severe, 
            long-term disability in California.  While 50-70% of stroke 
            survivors regain functional independence, 15-30% are 
            permanently disabled and 20% of stroke survivors require 
            institutional care at three months after the onset.  According 
            to the CDC, the estimated direct and indirect costs in 2010 of 
            stroke in the United States was $73.3 billion.

           3)PAUL COVERDALE NATIONAL ACUTE STROKE REGISTRY  .  In 2001, 
            Congress charged CDC with implementing state-based registries 
            to track acute stroke care and to use data from the registries 
            to improve the quality of care.  Congress named the registry 
            the Paul Coverdale National Acute Stroke Registry (PCNASR) 
            after the late U.S. Senator Paul Coverdell of Georgia, who 
            suffered a fatal stroke in 2000 while serving in Congress.  
            The goals of PCNASR include: to measure, track, and improve 
            the quality of care and access to care for stroke patients; 
            decrease rate of premature death and disability; eliminate 
            disparities in care; support the development of stroke systems 
            of care that emphasize quality of care; improve access to 
            rehabilitation and opportunities for recovery; and, increase 
            the workforce and scientific knowledge for stroke surveillance 
            within stroke systems of care.  In June 2004, the CDC funded 
            the state health departments of Georgia, Illinois, 
            Massachusetts, and North Carolina to establish statewide 
            stroke registries to improve acute care in hospitals.  
            According to the CDC, by the end of the three-year project 
            period, over 180 hospitals were participating and over 45,000 
            stroke patients benefited from hospital participation.  In 
            July of 2007, CDC awarded funds to Georgia, Massachusetts, 
            Michigan, Minnesota, North Carolina, and Ohio to continue to 
            improve this work.  According to the author, explicit 
            statutory authority is needed for California to be eligible 
            for the CDC funds.

           4)STATE ACTIVITY  .  In 2003, the state of California recognized 
            the need to take the lead in coordinating and focusing the 
            statewide assault on heart disease and stroke.  The California 
            Legislature passed AB 1220 (Berg), Chapter 395, Statutes of 
            2003, which established a 12-member Heart Disease and Stroke 








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            Prevention and Treatment Task Force to develop California's 
            Master Plan for Heart Disease and Stroke Prevention and 
            Treatment for 2007-2015 to reduce the morbidity, mortality, 
            and economic burden of heart disease and stroke in the state.  
            Establishment of a stroke registry is consistent with the 
            recommendations contained in the Mater Plan.  

          CHDSP is housed within DPH and was established to reduce 
            premature death and disability from heart disease and stroke 
            among Californians.  CHDSP currently administers the state's 
            voluntary stroke registry.  DPH also administers a Birth 
            Defects Monitoring Program, a Parkinson's Disease Registry and 
            the Ken Maddy California Cancer Registry.

           5)SUPPORT  .  According to the sponsors of this bill, AHA and ASA, 
            by centralizing stroke data, the state will be able to 
            identify geographic areas that are doing well and what their 
            best practices are which can then be implemented statewide and 
            improve the care and treatment of stroke victims.  All other 
            supporters attest to the need for immediate diagnosis and 
            treatment of stroke to save lives as well as to significantly 
            reduce long term disability such as neurological damage, 
            paralysis, and speech and language difficulties.  Supporters 
            write that by providing vital information on stroke care, this 
            bill will improve quality of patient care and contribute to a 
            substantial cost savings to the state.

           6)RELATED LEGISLATION .  ACR 8 (Butler and Bonnie Lowenthal), 
            Resolution Chapter 2, Statutes of 2011 recognizes the Month of 
            February 2011 as American Heart Month in California, and 
            February 4, 2011, as Wear Red Day in California in order to 
            raise awareness of the importance of the ongoing fight against 
            heart disease and stroke; and urges public support for Go Red 
            for Women events.

           7)PREVIOUS LEGISLATION  .  AB 1220 (Berg), Chapter 395, Statutes 
            of 2003, established a 12-member Heart Disease and Stroke 
            Prevention and Treatment Task Force to develop a Master Plan 
            for California.

           REGISTERED SUPPORT / OPPOSITION  :   

           Support  
          American Health Association (co-sponsor)
          American Stroke Association (co-sponsor)








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          Adelante Media Group
          California Pacific Medical Center
          San Mateo County Health System
          University of California, Los Angeles
          Numerous Individuals

           Opposition  
          None on file.
           

          Analysis Prepared by  :    Tanya Robinson-Taylor / HEALTH / (916) 
          319-2097