BILL ANALYSIS �
AB 599
Page 1
Date of Hearing: April 16, 2013
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 599 (Donnelly) - As Introduced: February 20, 2013
SUBJECT : Minors: vaccinations: parental consent.
SUMMARY : Provides that existing law which allows a minor who is
12 years of age or older and who may have come into contact with
an infectious, contagious, or communicable disease to consent to
medical care, as specified, does not authorize a minor to
receive a vaccine without the consent of the parent or guardian
of the minor.
EXISTING LAW :
1)Authorizes a minor who is 12 years of age or older and who may
have come into contact with an infectious, contagious, or
communicable disease to consent to medical care related to the
diagnosis or treatment of the disease, if the disease or
condition is one that is required by law or regulation to be
reported to the local health officer, or is a related sexually
transmitted disease (STD), as may be determined by the
Department of Public Health. Authorizes a minor who is 12
years of age or older to consent to medical care related to
the prevention of STDs. Provides that the minor's parents or
guardian are not liable for payment for medical care provided
under these provisions.
2)Provides that a minor may consent to medical care or dental
care if all of the following conditions are satisfied:
a) The minor is 15 years of age or older;
b) The minor is living separate and apart from his/her
parents or guardians, whether with or without the consent
of a parent or guardian and regardless of the duration of
the separate residence;
c) The minor is managing his/her own financial affairs,
regardless of the source of the minor's income; and,
d) The parents or guardians are not liable for medical care
or dental care provided, as specified.
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3)Authorizes a physician and surgeon or dentist, with or without
the consent of the minor patient, to advise the minor's parent
or guardian of the treatment given or needed if the physician
and surgeon or dentist has reason to know, on the basis of the
information given by the minor, the whereabouts of the parent
or guardian.
4)Defines medical care as X-ray examination, anesthetic, medical
or surgical diagnosis or treatment, and hospital care under
the general or special supervision and upon the advice of or
to be rendered by a physician and surgeon licensed under the
Medical Practice Act. Defines dental care as X-ray
examination, anesthetic, dental or surgical diagnosis or
treatment, and hospital care by a dentist licensed under the
Dental Practice Act.
5)Prohibits the governing authority of a school or other
institution from unconditionally admitting any person as a
pupil of any private or public elementary or secondary school,
child care center, day nursery, nursery school, family day
care home, or development center, unless prior to his or her
first admission to that institution he or she has been fully
immunized against diphtheria, haemophilus influenzae type b
(except for children who have reached the age of four years
and six months), measles, mumps, and whooping cough, (except
for children who have reached the age of seven years),
poliomyelitis, rubella, tetanus, hepatitis B, and chickenpox,
as specified.
FISCAL EFFECT : None
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill
preserves and protects the well-being of minors in California,
by insuring that medical decisions relating to a minor's
health are made in conjunction with a parent or guardian. The
author cites a law review article entitled "Medical Decisions
and Children: How Much Voice Should Children Have in Their
Medical Care?" which indicated that researchers found that
minors are generally unable to incorporate future values into
medical decision making and they tend to look at short term
goals and values and ignore long-term factors, such as their
own changing interests and priorities. Second, psychologists
warn that theories of minor competence overlook psycho-social
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factors which mean that a minor may be competent but may act
in an immature way and make questionable decisions due to the
burdens of peer pressure. These findings highlight the risks
inherent in current law, which by allowing minors to make
medical decisions concerning the administration of a vaccine
without consulting a parent or guardian, puts the child at
risk. This bill recognizes that the issue of minor competency
is complicated and its measure is to be determined by medical
professionals and not by legislators or school officials.
2)BACKGROUND .
a) Minors Consenting to Medical Care . The Family Code
includes several provisions relating to a minor's ability
to consent to medical or dental care. Specifically, a
minor may consent to medical or dental care if the minor is
15 years or age or older, is living apart from his or her
parents or guardian, as specified, and, the minor is
managing his or her own financial affairs. Additionally, a
minor is authorized to consent to medical care related to
the prevention or treatment of pregnancy.
To prevent transmission of STDs, AB 499 (Atkins) Chapter 652,
Statutes of 2011, authorized a minor who is 12 years of age
or older to consent to medical care related to the
diagnosis or treatment of STDs. Moreover, a minor who is
12 years of age or older and who is alleged to have been
raped is authorized to consent to medical care related to
the diagnosis or treatment of the condition and the
collection of medical evidence with regard to the alleged
rape. Other conditions that a minor who is 12 years of age
or older may consent to include diagnosis and treatment of
a drug-or-alcohol related problem, and mental health
treatment or counseling, as specified.
b) Human Papillomavirus (HPV) and HPV Vaccine . The HPV
vaccine is the vaccine that this bill prohibits minors who
are 12 years of age or older from obtaining unless there is
parent or guardian consent. According to the Centers for
Disease Control and Prevention (CDC), HPV is the most
common sexually transmitted infection. There are more than
40 HPV types that can infect the genital areas of males and
females, and these types could also infect the mouth and
throat. Most people who become infected do not know they
have it, never develop symptoms or health problems, and the
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HPV disappear within two years. However, sometimes HPV
infections will persist and can cause a variety of serious
health problems, including genital warts, recurrent
respiratory papillomatosis (throat warts), and, cervical
cancer. CDC points out that approximately 79 million
Americans are currently infected with HPV, and about 14
million people become newly infected each year. The use of
condoms, limiting the number of sexual partners, and HPV
vaccines may lower one's chances of getting HPV.
Two HPV vaccines are licensed by the Food and Drug
Administration (FDA) and recommended by CDC. These
vaccines are Cervarix (made by GlaxoSmithKline) and
Gardasil (made by Merck). Cervarix and Gaardasil are
licensed, safe and effective for females ages nine through
26 years. CDC recommends that all 11 or 12 year old girls
get the three doses of either brand of HPV vaccine to
protect against cervical cancer. CDC points out that
Gardasil is also effective for males ages nine through 26
years. CDC recommends Gardasil for all boys aged 11 or 12
years, and for males aged 13 through 21 years, who did not
get any or all of the three recommended doses when they
were younger. For HPV vaccine to work best, it is very
important for preteens to get all three doses long before
any sexual activity with another person begins. It is
possible to be infected with HPV on the first sexual
contact. Also, the vaccine produces higher antibody that
fights infection when given at this age compared to older
ages.
3)SUPPORT . The California Chiropractic Association believes
that requiring the involvement of an adult in the informed
consent is an important aspect of the decision to receive a
vaccine.
4)OPPOSITION . The American Congress of Obstetricians and
Gynecologists and the American Association of University Women
state that it does not make sense to restrict minors from
being able to protect themselves against costly and even
life-threatening diseases. Prevention is far better medicine
and is more cost-effective than treatment. The American
Academy of Pediatrics states this bill prevents teens from
obtaining needed health care services. The California Medical
Association indicates that while physicians generally prefer
to involve parents in the medical decisions of their teenage
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patients and strive to do so whenever possible, there may be
situations where parental consent is not possible. In the
case of HPV, the vaccine can protect males and females against
some of the most common types of HPV that can lead to disease
and cancer, including cervical cancer, and barriers to its
access should not be implemented.
5)DOUBLE REFERRAL . This bill is double referred, should it pass
out of this Committee, it will be referred to the Assembly
Committee on Judiciary.
6)RELATED LEGISLATION . AB 689 (Bonta), pending in Assembly
Appropriations Committee, requires each general acute care
hospital to offer onsite vaccinations for influenza to all
inpatients prior to discharge, annually, beginning no later
than October 1 and ending on the following April 1, as
specified.
7)PREVIOUS LEGISLATION .
a) AB 499 (Atkins) Chapter 652, Statutes of 2011, allows a
minor who is 12 years of age or older to consent to medical
care related to the prevention of a sexually transmitted
disease.
b) AB 16 (Evans) of 2008 would have required health care
service plan contracts and health insurance policies that
provide coverage for cervical cancer treatment or surgery
to also provide coverage for a human papillomavirus (HPV)
vaccine beginning on January 1, 2009. AB 16 was vetoed by
then Governor Schwarzenegger who indicated "The addition of
a new mandate, no matter how small, will only serve to
increase the overall cost of health care. California
currently has 44 mandates on its health care service plans
and health insurance policies. While these mandates are
well-intentioned, the costs associated with guaranteed
coverage means that these costs are passed through to the
purchaser and consumer. These mandates are a significant
driver of cost. Every day, a growing number of employers
and individuals are struggling to pay for their health
care. We cannot afford to increase these costs without
enacting other measures that improve efforts aimed at
prevention, address affordability of care and share
responsibility between individuals, providers, employers
and government."
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c) AB 1429 (Evans) of 2007 would have required health care
service plan contracts and health insurance policies that
provide coverage for HPV vaccine beginning January 1, 208.
AB 1429 was vetoed by then Governor Schwarzenegger who
indicated that "While I support increased access to
preventive services, I cannot support this bill as it may
contribute to rising premiums. Further, a mandate is not
necessary as this vaccine is already routinely provided by
health plans and insurers. Mandating its coverage is
unnecessary, restrictive and may increase costs."
REGISTERED SUPPORT / OPPOSITION :
Support
California Catholic Conference, Inc.
California Chiropractic Association
Opposition
American Academy of Pediatrics
American Association of University Women
American Civil Liberties Union of California
American Congress of Obstetricians and Gynecologists, District
IX
California Immunization Coalition
California Medical Association
Children's Law Center of California
Analysis Prepared by : Rosielyn Pulmano / HEALTH / (916)
319-2097