BILL ANALYSIS Ó
SB 659
Page 1
Date of Hearing: July 3, 2012
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
SB 659 (Negrete McLeod) - As Amended: June 15, 2012
SENATE VOTE : Not relevant.
SUBJECT : Immunizations: disclosure of information: tuberculosis
TB screening.
SUMMARY : Adds tuberculosis (TB) screening results to the
information that may be disclosed from a patient's medical
record to the Department of Public Health (DPH) and local health
departments (LHDs) operating countywide or regional immunization
information and reminder systems. Defines TB screening as an
approved intradermal tuberculin test or any other test for
tuberculosis infection that is recommended by the federal
Centers for Disease Control (CDC) and Prevention and licensed by
the federal Food and Drug Administration.
EXISTING LAW :
1)Permits LHDs to operate immunization information systems in
conjunction with DPH either separately within their individual
jurisdictions, jointly among more than one jurisdiction, or
both.
2)Permits health care providers and other agencies to disclose
specified information from a patient's medical record to DPH
and LHDs operating countywide or regional immunization
information and reminder systems. Permits LHDs and DPH to
disclose this information with each other, and, upon a request
for information pertaining to a specific person, to health
care providers taking care of the patient.
3)Specifies the purposes for which LHDs and DPH are permitted to
disclose specified information from a patient's medical
record, upon request, to each other and other specified
agencies.
4)Requires health care providers and other agencies to maintain
the confidentiality of medical record immunization
information. Permits civil action and criminal penalties for
the wrongful disclosure of such information. Prohibits a
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health care provider or other agency from sharing medical
record information with an immunization system if the patient
or client, or parent or guardian of the patient or client
refuses.
FISCAL EFFECT : This bill, as amended has not yet been analyzed
by a fiscal committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, TB screening
results are currently collected by physicians and provided to
patients (and/or their parents) on the same document as
immunization information (commonly known as yellow cards).
TB testing results, however, are not as readily available as
immunization records. The medical provider either has to
re-enter (by hand) the TB screening results on the yellow card
each time they print out a new card from an immunization
registry, or have the parents keep the old yellow cards as a
record of the TB screening results.
2)BACKGROUND .
a) TB . According to the CDC, TB is a contagious disease
caused by germs that are spread through the air and usually
affects the lungs, but it can also affect other parts of
the body, such as the brain, the kidneys, or the spine.
The general symptoms of TB include feelings of sickness or
weakness, weight loss, fever, and night sweats. Other
symptoms include coughing, chest pain, and the coughing up
of blood. According to DPH, in 2008, California had the
secondhighest annual TB incidence rate in the nation: 7.0
cases per 100,000 people, compared to the national average
of 4.2 cases per 100,000 people.b) Of the 13,000 cases of
TB reported in the United States in 2008, 21% were reported
in California. Following a large increase in TB in the
late 1980s and early 1990s, state, local, and national
tuberculosis control efforts were strengthened.
Subsequently, the TB case rate in California declined 50%
between 1992 and 2008. However, the annual rate of decline
has slowed significantly and was just 1% in 200708.
c) Immunization Registries . All 50 states have an
immunization registry. In California, DPH operates the
California Immunization Registry (CAIR). According to
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CAIR, it consists of 10 regional immunization registries
(mostly county regions), which provide a computerized
system intended to assist providers to track patient
records, reduce missed opportunities, and help fully
immunize Californians of all ages. Providers use web-based
registry software to enter immunization data or may opt to
exchange data via their existing electronic medical records
system. Other agencies, such as schools, child care
centers, and the Women, Infants and Children Program or WIC
may also participate in CAIR. CAIR allows access to
immunization data from other participating providers in
California. In the coming years, CAIR will integrate its
existing regional databases and data may be securely
exchanged across all areas of California. When fully
integrated, CAIR will provide the state with the data to
assess immunization coverage rates, identify pockets of
need, and analyze how best to ensure full immunization
coverage for the state.
d) Disclosure of Immunization Status . Existing law allows
health care providers to share patient immunization
information with an immunization registry as long as the
patient or patient's parent is informed about the registry.
Health care providers and other agencies like schools,
child care facilities, health plans, foster care agencies,
and county welfare departments may disclose the following
information from the patient's medical record to local
health departments or DPH :
i) The name of the patient or client and names of
the parents or guardians of the patient or client;
ii) Date of birth of the patient or client;
iii) Types and dates of immunizations received by the
patient or client;
iv) Manufacturer and lot number for each
immunization received;
v) Adverse reaction to immunizations received;
vi) Other nonmedical information necessary to
establish the patient's or client's unique identity and
record;
vii) Current address and telephone number of the
patient or client and the parents or guardians of the
patient or client;
viii) Patient's or client's gender; and,
ix) Patient's or client's place of birth.
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Health care providers, schools, child care facilities,
foster care agencies, health plans, LHDs, DPH, and any
other entity that is authorized are required to maintain
the confidentiality of the information disclosed above, and
could be subject to civil action and criminal penalties for
the wrongful disclosure of such information. The
information disclosed shall only be used under the
following conditions: to provide immunization services the
patient or client, including issuing reminder
notifications; provide or facilitate provision of
third-party payer payments for immunizations; compile and
disseminate statistical information of immunization status
on groups of patients or clients; or, as authorized by the
Confidentiality of Medical Information Act for health care
providers. Schools and other programs cannot access the
addresses or phone numbers of participants, and can only
look up at the shot records of the children they serve.
Prior to sharing immunization information to the registry,
a health care provider is required to inform the patient or
the parent or guardian of the patient by ordinary mail
which must include a reasonable means for refusal such as a
return form or contact telephone number. If a patient or
parent refuses to allow the information to be shared, the
health care provider is allowed to maintain access to the
information for purposes of patient care or protecting the
public health.
3)SUPPORT . The Health Officers Association of California (HOAC)
writes that not being able to collect TB screening results in
CAIR is a time-consuming endeavor for providers and an
inconvenience for parents. HOAC states that allowing CAIR to
record these results will have the added benefit of helping
schools to expedite the registration of students, as they
could be reviewed at the same time school personnel are
reviewing immunization information.
4)RELATED LEGISLATION . The June 16, 2011 version of SB 922
(Negrete McLeod) was substantially similar to the provisions
of this bill and would have added TB screening results to the
list of information that may be collected and disclosed
through the state's immunization registry system. Amendments
were taken to remove these provisions and change the author to
SB 922 (Steinberg), Chapter 431, Statutes of 2011, and require
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that all project labor agreements (PLAs) incorporate specified
provisions, and prohibits state funding assistance, after
January 1, 2015, on public works projects of charter cities
having ordinances prohibiting the use of PLAs.
REGISTERED SUPPORT / OPPOSITION :
Support
Health Officers Association of California (sponsor)
County of Santa Clara Board of Supervisors
Opposition
None on file.
Analysis Prepared by : Roz Pulmano / HEALTH / (916) 319-2097