BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                  SB 422
                                                                  Page  1

          Date of Hearing:   June 28, 2011

                           ASSEMBLY COMMITTEE ON JUDICIARY
                                  Mike Feuer, Chair
                    SB 422 (Wright) - As Amended:  April 25, 2011

           SENATE VOTE :  39-1
           
          SUBJECT  :  REPORTING OF CERTAIN COMMUNICABLE DISEASES

           KEY ISSUES  : 

          1)should staff of the local public health agency for HIV partner 
            services be included in the group of those to which physicians 
            can disclose positive hiv test information?  

          2)Should local health staff be exempted from criminal and civil 
            liability for informing partners of a positive hiv test as 
            specified?

           FISCAL EFFECT  :  As currently in print this bill is keyed 
          non-fiscal.

                                      SYNOPSIS

          This non-controversial bill authorizes physicians to disclose 
          positive HIV test information to public health agency staff for 
          HIV partner services with the written consent of the patient.  
          The bill exempts from criminal and civil liability authorized 
          public health authorities who alert the specified partners of an 
          HIV positive person, without disclosing any identifying 
          information about the person believed to be infected with HIV.  
          The bill permits local health authorities to expunge the 
          identification information of a partner once a reasonable effort 
          to contact the partner has been undertaken.  According to the 
          author, the bill is essential to ensure that local health 
          authorities can properly do their important job of notifying 
          those potentially exposed to HIV without risking significant 
          criminal and civil liability.  This bill is supported by disease 
          prevention groups and has no known opposition. 

           SUMMARY  :  Revises existing law that permits the sharing of 
          information related to a positive HIV test between a physician, 
          a local health officer, and the HIV-positive person's sexual 
          partner, spouse, and/or persons with whom hypodermic needles 
          have been shared.  Specifically,  this bill  :  







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          1)Includes the "designated staff of the local public health 
            agency for HIV partner services" among the people to whom a 
            physician, who has a confirmed positive test for HIV of an 
            individual, may disclose that information without criminal or 
            civil liability. 

          2)Permits disclosure of identifying information of a person who 
            tests positive for HIV with the written consent of the 
            individual, as specified. 

          3)Exempts the designated local public health agency staff for 
            HIV partner services from civil and criminal liability 
            resulting from their informing potentially infected partners 
            of HIV patients of their potential exposure to HIV.
          4)Makes technical, conforming changes.

           EXISTING LAW  :

          1)Requires physicians and medical laboratories to report to the 
            local health officer all confirmed cases of HIV infection, 
            using the patient name, to ensure knowledge of current trends 
            in the HIV epidemic and to ensure that California remains 
            competitive for federal HIV and AIDS funding.  (Heath & Saf. 
            Code Sec. 121022 (a).)

          2)Provides that no physician who has the results of a confirmed 
            positive test for HIV infection of a patient under his or her 
            care may be held criminally or civilly liable for disclosing 
            non-identifying patient information to a person reasonably 
            believed to be the spouse, sexual partner, a person whom the 
            patient has shared a needle with, or to the local health 
            officer.  (Health & Saf. Code Sec. 121015 (a).)

          3)Authorizes a local health officer to alert any persons 
            reasonably believed to be a spouse, sexual partner or partner 
            of shared needles of an individual who has tested positive for 
            HIV about their potential exposure without disclosing 
            identifying patient information.  (Health & Saf. Code Sec. 
            121015 (d).)

          4)Provides that upon completion of the local health officer's 
            efforts to contact any of the specified partners, all records 
            containing any individual identifying information must be 
            expunged by the local health officer.  (Health & Saf. Code 
            Sec. 121015 (d).)







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          5)Imposes a fine of $5,000 to $25,000 and potential 
            incarceration for any person who wrongfully discloses the 
            results of an HIV test, except pursuant to a written 
            authorization, as defined.  (Health and Saf. Code Sec. 120980 
            et seq.)

           COMMENTS  :  This non-controversial bill seeks to promote greater 
          partner notification for those persons potentially exposed to 
          HIV by expanding the liability coverage for authorized 
          physicians and public health officials who notify potentially 
          infected partners of HIV patients.  The author states:

               Senate Bill 422 is needed in order to better empower 
               California's local public health departments to help to 
               prevent HIV transmission.  There is a need to specify a 
               legal process for a physician to identify an HIV-infected 
               patient to designated local public health staff, so that 
               the patient can be interviewed for information about 
               exposed partners.  The current law can be interpreted as 
               absolutely prohibiting a physician from identifying a 
               patient to local public health for partner services. Only 
               if the local public health staff know who the patient is 
               and how to reach him/her, can it be possible for an 
               experienced public health partner services specialist to 
               communicate with the patient to encourage him/her to 
               identify all possible exposed persons and how the public 
               health specialist can help to contact them. 

               There is a need to reassure local public health staff that 
               communication with exposed partners is exempt from criminal 
               or civil liability. By doing this, SB 422 will encourage 
               more partner services that can help interrupt the spread of 
               HIV and thus save lives, as well as saving significant 
               health care expenses to the state that would result from 
               preventable new infections.

               There is also a need to clarify a legal requirement that 
               information about exposed partners be expunged from public 
               health records. This requirement can currently be 
               interpreted to require premature expunging of contact 
               information, after an exposed person has been contacted but 
               before adequate information and proper referrals have been 
               arranged.  SB 422 would clarify that information about 
               partners would not be expunged from public health records 
               until the partners had been alerted to their exposure and 







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               referred for appropriate care and follow-up, as authorized 
               in current law.

                For any other communicable disease, this bill would not be 
               necessary, because local public health agencies would 
               automatically be communicating in this manner. But because 
               there are significant penalties in the Health and Safety 
               Code for "unauthorized disclosure" of HIV information, 
               including information in public health records, it is 
               necessary to clarify in the law what types of disclosure 
               are exempt from these penalties.

           Protects Physicians from Criminal and Civil Liability for 
          Disclosures of Information of Positive HIV Tests to Local Public 
          Health Agency Staff for Partner Notification Services:   Under 
          existing law a physician is permitted to notify a person 
          potentially infected with HIV by sexual contact or 
          needle-sharing about their potential exposure without incurring 
          liability.  The physician must additionally inform the local 
          health officer of all confirmed HIV cases and submit the name of 
          the infected patient to local health officials in charge of 
          tracking potential clusters of infections. However, the law 
          prohibits doctors from referring that patient to local health 
          staff for counseling and interviews about potential partner 
          contact.  Even though the local health department is given the 
          patient's name they cannot contact an HIV patient for follow-up.

          This bill seeks to protect physicians who identify an 
          HIV-infected patient for the purposes of referring them to local 
          public health authorities for follow-up and partner 
          identification interviews.  Supporters contend these referrals 
          are essential to preventing further spread of HIV, as public 
          health staff must be able to interview the patient and determine 
          the identity of individuals who may have been exposed to HIV.  
          This bill creates a standard process whereby physicians can 
          legally refer infected patients to public health officials in 
          order to better identify and locate the patient's partners.

           Protects Public Health Staff for Partner Services from Liability 
          for Disclosing Non-Identifying Information of Positive HIV 
          Tests:   Under existing law, the local health officer and 
          treating physicians may alert any persons reasonably believed to 
          be a spouse, sexual partner or partner of shared needles of an 
          HIV positive patient, without disclosing any identifying 
          information. This bill extends this protection to the public 
          health officials responsible for HIV partner notifications.  







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          Without this protection public health officials face significant 
          fines for improper disclosure and may hesitate to notify persons 
          potentially infected with HIV.  This bill ensures that HIV 
          partner services staff who, as a part of their official duties, 
          track down and inform those who may have been exposed to HIV, do 
          not face significant civil and criminal penalties for improper 
          disclosure.

           Giving Public Health Officials the Tools to Thoroughly Reach Out 
          to Those Potentially Infected with HIV:   Existing law 
          unnecessarily limits the ability of public health officials to 
          adequately perform their duties in two key ways (beyond the 
          unclear liability discussed above).  First, existing law permits 
          only the local health officer to notify patients they believe 
          have been exposed to HIV.  Historically, local health officers 
          ran the daily operations of the department, but as health 
          departments have grown, local health officers are now 
          administrative and political heads and rarely perform day-to-day 
          functions like partner notifications.  To confront this reality, 
          this bill expands those legally permitted to notify those 
          potentially exposed to HIV to include those health department 
          officials who specialize in partner notification services.  By 
          expanding the group permitted to notify those potentially 
          exposed to HIV, this bill shifts the burden from the individual 
          public health officer to the staff of partner notification 
          services, who are trained in notifying those exposed to 
          communicable diseases can undertake this delicate function.  

          Secondly, under existing law, if a public health officer's 
          initial attempt to contact a potentially infected partner is 
          unsuccessful, the record of that partner must, nonetheless, 
          still be immediately expunged.  Under this bill, the public 
          health staff gain greater flexibility and time to further 
          investigate and attempt to locate the potentially infected 
          partner before their records must be destroyed.  By permitting 
          the public health agency to maintain records until referral for 
          care and follow-up is completed, public health officials can use 
          all necessary means to track down a potentially infected person, 
          thus at minimum notifying a potential carrier of the disease.  
          This provision is consistent with the bill's general goal of 
          increasing the ability of local health officials to notify 
          potentially infected partners of HIV patients.  By giving the 
          officials more opportunity to contact a partner, this provision 
          aims to lessen the number of people unknowingly infected with 
          HIV. 
           







                                                                 SB 422
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          ARGUMENTS IN SUPPORT  :  Beyond AIDS writes that this bill will 
          "connect the dots" to improve current law by empowering 
          necessary public health communication for the prevention and 
          control of the spread of HIV infections.  The California Medical 
          Association writes that it is very important that physicians are 
          able to communicate with the appropriate personnel to help 
          control the transmission HIV.  The California Academy of 
          Preventive Medicine states that by facilitating communication 
          and disclosure among health departments, health care providers, 
          and patients, this bill can result in more complete and accurate 
          surveillance to track who is being infected with HIV, so that 
          preventive efforts can be targeted to the people at risk.  The 
          Infectious Disease Association of California writes that when 
          providing information about suspected contacts to a local health 
          officer, an HIV positive patient cannot be identified to allow 
          the health department staff to interview him or her in order to 
          get information that they do not have time and techniques to 
          collect, and that this bill will help assure such communication 
          is possible.  

          Prior Legislation  :  AB 2541 (Portantino and Fletcher), Chapter 
          470, Statutes of 2010, deleted the HIV exemption from authorized 
          electronic reporting and explicitly provided disclosure 
          authority to state and local public health personnel for the 
          purpose of providing complete information regarding sexually 
          transmitted disease surveillance to the federal government.

          AB 2658 (Horton), Chapter 449, Statutes of 2008 required 
          laboratories to electronically submit all cases of "reportable 
          diseases and conditions" (including AIDS) within one year of the 
          establishment of the new state electronic laboratory reporting 
          system.  However, AB 2658 exempts HIV reporting from this 
          requirement in order to allow the Department of Public Health 
          sufficient time to ensure the new system's data architecture is 
          in line with HIV-specific reporting requirements and that the 
          system would meet federal standards for HIV reporting.

          SB 699 (Soto), Chapter 20, Statutes of 2006, required health 
          care providers and laboratories to report HIV cases by the 
          patient's name rather than code in order to comply with federal 
          funding requirements.


           REGISTERED SUPPORT / OPPOSITION  :

           Support 







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          AIDS Healthcare Foundation
          Beyond AIDS 
          California Academy of Preventive Medicine
          California Medical Association
          Infectious Disease Association of California
          3 individuals
           
            Opposition 
           
          None on file


           Analysis Prepared by  :   Drew Liebert and Nicholas Liedtke / JUD. 
          / (916) 319-2334