BILL ANALYSIS Ó AB 861 Page 1 ASSEMBLY THIRD READING AB 861 (Hill and Nestande) As Amended May 27, 2011 Majority vote HEALTH 16-0 APPROPRIATIONS 17-0 ----------------------------------------------------------------- |Ayes:|Monning, Logue, Ammiano, |Ayes:|Fuentes, Harkey, | | |Atkins, Bonilla, Eng, | |Blumenfield, Bradford, | | |Gordon, Hayashi, Roger | |Charles Calderon, Campos, | | |Hernández, Bonnie | |Davis, Donnelly, Gatto, | | |Lowenthal, Mitchell, | |Hall, Hill, Lara, | | |Nestande, Pan, | |Mitchell, Nielsen, Norby, | | |V. Manuel Pérez, Smyth, | |Solorio, Wagner | | |Williams | | | | | | | | ----------------------------------------------------------------- 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 be by voluntary reports and 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 AB 861 Page 2 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. 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 voluntarily reported 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 that is voluntarily reported 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 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. 9)Authorizes persons with a valid scientific interest who are AB 861 Page 3 engaged in demographic, epidemiological, or other similar studies related to health, and who meet qualifications determined by DPH, and who agree, in writing, to maintain confidentiality, to access confidential information. Requires, before confidential information for research purposes 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 satisfaction that the entity has established the procedures and ability to maintain the confidentiality of the information. 10)Requires an entity that receives confidential information from DPH to ensure the confidentiality of the information. Requires DPH to provide only information that does not identify individual cases or institutional or individual sources of information. 11)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. 12)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. 13)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. AB 861 Page 4 14)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. 15)Requires that this bill not prohibit the publication of reports and statistical compilations that do not in any way identify individual cases or institutional or individual sources of information. 16)Requires that the individual to whom the information pertains have access to his or her own information in accordance with existing law. 17)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 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. 18)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. 19)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. 20)Requires this bill to be implemented only to the extent funds from federal or private sources are made available for this purpose. 21)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. AB 861 Page 5 FISCAL EFFECT : According to the Assembly Appropriations Committee, one-time start-up costs, likely in the range of $200,000 to $400,000, and ongoing costs of around $800,000 annually to fund stroke registry operations. The bill is contingent on receipt of federal or private funding for this purpose. COMMENTS : 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 greater rate participation and an increased 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. Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916) 319-2097 FN: 0000997