BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  AB 861
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          ASSEMBLY THIRD READING
          AB 861 (Hill and Nestande)
          As Amended May 27, 2011
          Majority vote 

           HEALTH              16-0        APPROPRIATIONS      17-0        
           
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          |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 








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            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 








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            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.









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          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.








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           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