BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 980|
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THIRD READING
Bill No: AB 980
Author: Pan (D), et al.
Amended: 7/10/13 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 7-2, 7/3/13
AYES: Hernandez, Beall, De León, DeSaulnier, Monning, Pavley,
Wolk
NOES: Anderson, Nielsen
SENATE APPROPRIATIONS COMMITTEE : 5-2, 8/26/13
AYES: De León, Hill, Lara, Padilla, Steinberg
NOES: Walters, Gaines
ASSEMBLY FLOOR : 47-21, 5/24/13 - See last page for vote
SUBJECT : Primary care clinics: abortion
SOURCE : Planned Parenthood Affiliates of California
DIGEST : This bill requires the California Building Standards
Commission (CBSC) to adopt emergency regulations to delete a
provision of the 2013 California Building Standards Code that
establishes building standards for primary care clinics that
provide abortion services, and prohibits the CBSC from adopting
any building code standards for clinics providing medication or
aspiration abortion services that differ from construction
standards applicable to other primary care clinics. Requires
the Department of Public Health (DPH), no later than July 1,
2014, to repeal or revise regulations relating to abortion
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services in primary care clinics to ensure that any requirements
specific to abortion services are consistent with applicable law
and medical standards of care.
ANALYSIS :
Existing law:
1.Licenses and regulates clinics, including primary care clinics
and specialty clinics such as surgical clinics, by DPH.
2.Permits DPH to issue a permit to authorize a clinic to offer
one or more special services, which is a type of care for
which DPH has established special standards for ensuring the
quality of care, including birth services and abortion
services.
3.Establishes the CBSC, consisting of the Secretary of the State
and Consumer Services Agency, and 10 members appointed by the
Governor, as specified.
4.Requires any building standard adopted or proposed by state
agencies to be submitted to, and approved or adopted by, the
CBSC. Requires building standards adopted by state agencies
and submitted to CBSC to be accompanied by an analysis written
by the state agency that proposes the standards to justify the
approval to the satisfaction of the CBSC.
5.Establishes the Reproductive Privacy Act, which prohibits the
state from denying or interfering with a women's right to
choose or obtain an abortion prior to viability of the fetus,
or when the abortion is necessary to protect the life or
health of the woman. Defines "abortion," for purposes of this
Act, as any medical treatment intended to induce the
termination of a pregnancy except for the purpose of producing
a live birth.
This bill:
1.States the intent of the Legislature to preempt, and to render
inoperative, a specific section of the 2013 Triennial Edition
of the California Building Standards Code that establishes
building standards for primary care clinics that provide
abortion services.
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2.Prohibits the CBSC, notwithstanding any other law, from
adopting building code standards that establish construction
requirements for primary care clinics that provide medication
or aspiration abortion services that differ from construction
standards applicable to other primary care clinics, as
specified.
3.Requires the CBSC, in conjunction with Office of Statewide
Health Planning and Development (OSHPD), to adopt emergency
regulations to delete a specific section of the 2013 Triennial
Edition of the California Building Standards Code that
establishes building standards for primary care clinics that
provide abortion services, including all cross-references to
that section, as soon as possible. Requires these emergency
regulations, notwithstanding the Administrative Procedures
Act, to become permanent without further regulatory action.
4.Requires DPH, no later than July 1, 2014, to repeal or revise
specific regulations relating to abortion services in primary
care clinics to ensure that requirements specific to abortion
services, if any are required, are consistent with applicable
law and medical standards of care.
Background
Existing Title 22 regulations (pertaining to the licensing of
health facilities):
1.Requires primary care clinics providing abortion services as a
special service to have adequate and appropriate equipment and
supplies to provide the services offered, including at least
the following: standard gynecological examination table;
pharyngeal suction equipment; oxygen source and mask; surgical
instruments necessary for the performance of the abortion;
emergency medications; and, appropriate intravenous fluids.
2.Requires, in primary care clinics providing abortion services,
a physician certified by the American Board of Obstetrics and
Gynecology or trained in performing abortions to be
responsible for the abortion service, and that only a
physician responsible to the professional director of the
clinic to perform abortions. Requires a licensed nurse to be
present in the clinic when an abortion is performed, and to
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have a system operative on a 24-hour basis ensuring
availability of staff for follow-up care or referral of
patients.
3.Requires primary care clinics performing abortion services to
have a floor area which can accommodate the patient, the
equipment and supplies, and the staff required for the
abortion service, and requires a post-abortion recovery area
to be maintained. Requires space for a counseling area to be
maintained, which can be the same area as the post-abortion
recovery area, but must provide privacy for those patients who
request it.
Existing Title 24 regulations (pertaining to building
construction standards) requires, effective January 1, 2014,
primary care clinics providing abortion services, in addition to
meeting the minimum requirements for other primary care clinics,
to include the following:
1.A treatment room with a minimum of 120 square feet. Permits
treatment rooms used for aspiration abortion, however, to be
sized as examination rooms;
2.A post-abortion recovery area, with certain specified
clearance and privacy requirements;
3.A private room or area of at least 60 square feet for
pre-abortion and post-abortion counseling.
OSHPD building standards and the California Building Standards
Code. OSHPD is the adopting agency for building standards for
health facilities, including clinics. The CBSC, which is
responsible for adopting and publishing the California Building
Standards Code, which is updated every three years, accepts
building standard recommendations from state adopting agencies
related to the types of buildings that fall under their
respective jurisdictions. The 2013 code was recently adopted,
and will take effect on January 1, 2014. Until then, the 2010
code remains in effect.
New OSHPD 3SE classification . During the process of updating
the building standards code for the 2013 edition, OSHPD proposed
a new subcategory of clinics that would be exempt from certain
requirements that applied to other clinics. Clinics are
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referred to in the building codes as OSHPD 3 facilities, and
this new exempted subcategory is called OSHPD 3SE. The OSHPD
3SE classification consists of primary care clinics providing
services that have to meet requirements described in Section
1226.6 of Title 24 of the California Code of Regulations
(clinics that are without treatment rooms and that perform
procedures in examination rooms), as well as rehabilitation
clinics and psychology clinics. Clinics performing abortions
must meet additional requirements described in Section 1226.7 of
Title 24, which requires these clinics to have treatment rooms,
as well as other space requirements based on Title 22 regulatory
requirements described in existing law above. However, Section
1226.7 specifically permits treatment rooms for aspiration
abortion to be sized as examination rooms. The OSHPD 3SE
exemption does not apply to clinics that are required to comply
with Section 1226.7. By eliminating Section 1226.7, with its
additional requirements for abortion services, the authors
intent is that those primary care clinics performing medication
and aspiration abortion services would be treated the same as
other primary care clinics, and would fall under the 3SE
exemption.
OSHPD 3SE exemptions . OSHPD proposed that CBSC provide
exemptions from certain requirements in the Mechanical Code
related to ventilation air supply and duct systems, and from
certain requirements in the Plumbing Code related to
disinfection of potable water systems, hot-water-heating
equipment, and minimum vent pipe length. Ultimately, CBSC only
adopted the 3SE exemptions from the Plumbing Code requirements,
and did not adopt the Mechanical Code exemptions.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Minor costs to OSHPD and CBSC to develop and adopt emergency
regulations (Hospital Building Fund and Building Standard
Administration Special Revolving Fund).
One-time costs of about $130,000 per year for two years for
DPH to review and revise any existing regulations that may be
in conflict with the requirements of the bill (Licensing and
Certification Program Fund).
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SUPPORT : (Verified 8/29/13)
Planned Parenthood Affiliates of California (source)
American Civil Liberties Union of California
American Congress of Obstetricians and Gynecologists, District
IX
California Family Health Council
California Primary Care Association
NARAL Pro-Choice California
Planned Parenthood Advocacy Project Los Angeles County
Planned Parenthood of the Pacific Southwest
Planned Parenthood Pasadena and San Gabriel Valley
Planned Parenthood of Santa Barbara, Ventura and San Luis Obispo
Counties, Inc.
Six Rivers Planned Parenthood
Women's Community Clinic
OPPOSITION : (Verified 8/29/13)
California Catholic Conference, Inc.
California Right to Life Committee, Inc.
Capitol Resource Family Impact
Coalition for Women and Children
Concerned Women for America of California
John Paul the Great Catholic University Students for Life
Life Priority Network
ARGUMENTS IN SUPPORT : According to Planned Parenthood
Affiliates of California (PPAC), the sponsor of this bill, OSHPD
recently proposed changes to update building standard
regulations for the construction of community clinics. These
changes align the state's regulations with national building
standards by exempting most primary care clinics from certain
plumbing standards in order to reduce costs without compromising
patient safety. Unfortunately, PPAC states that OSHPD's proposal
did not include primary care clinics that provide abortions.
Because of this, beginning in 2014, all new primary care clinics
that provide abortion, even when those are abortion pills or
very early abortion procedures) would have to meet rigorous and
expensive construction standards while primary care clinics
providing other, similar procedures, would not. PPAC states
that there is no medical reason to discriminate against clinics
that provide medication or early abortion procedures by
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requiring different plumbing and ventilation standards. The
American Civil Liberties Union states in support that imposing
unequal and burdensome building standards on clinics providing
abortions is a tactic often used in other states to impede
access by making it more difficult and expensive for
reproductive health providers to open and maintain their
facilities. The American College of Obstetricians and
Gynecologists, District IX, states in support that it opposes
legislation or other requirements that single out abortion
services from other outpatient procedures. The California
Primary Care Association states that with millions more
individuals coming into the health care system, more providers
and facilities will be needed to meet the growing demand for
health care. Requiring all primary care clinics to be held to
the same building standards aligns with the state's goal of
expanding access.
ARGUMENTS IN OPPOSITION : The California Catholic Conference
states in opposition that the claim by this bill's supporters
that medical and aspiration abortions are so safe that they are
basically the same as the services provided by other primary
care clinics is specious and demonstrably false. The California
Catholic Conference states that abortion is neither a trivial
procedure nor a primary care service. Following an abortion,
women can experience complications ranging from cramping and
vaginal bleeding to nausea, vomiting, diarrhea, chills, or fever
- and in rare cases, hemorrhage requiring a blood transfusion.
Concerned Women for America also opposes this bill, stating that
medical facilities must be prepared for patient complications,
including providing appropriately constructed treatment rooms.
Capitol Resource Family Impact states that it opposes this bill
because it allows abortions to be performed in examination rooms
instead of surgical treatment rooms and eliminates the
requirement to provide post-abortion recovery and counseling
areas where privacy is provided for patients requesting it. The
Coalition for Women and Children states in opposition that the
building code that this bill seeks to delete is not changing or
increasing current requirements for abortion clinics, but
leaving in place requirements that have been proven effective.
ASSEMBLY FLOOR : 47-21, 5/24/13
AYES: Alejo, Ammiano, Atkins, Bloom, Blumenfield, Bocanegra,
Bonilla, Bradford, Brown, Buchanan, Ian Calderon, Campos,
Chau, Chesbro, Cooley, Daly, Dickinson, Eggman, Fong, Frazier,
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Garcia, Gatto, Gomez, Gray, Hall, Roger Hernández,
Jones-Sawyer, Levine, Lowenthal, Medina, Mitchell, Mullin,
Muratsuchi, Nazarian, Pan, Perea, V. Manuel Pérez, Quirk,
Quirk-Silva, Rendon, Stone, Ting, Weber, Wieckowski, Williams,
Yamada, John A. Pérez
NOES: Achadjian, Bigelow, Chávez, Conway, Dahle, Donnelly, Beth
Gaines, Hagman, Harkey, Jones, Linder, Logue, Maienschein,
Mansoor, Melendez, Morrell, Nestande, Olsen, Patterson, Salas,
Wagner
NO VOTE RECORDED: Allen, Bonta, Fox, Gordon, Gorell, Grove,
Holden, Skinner, Waldron, Wilk, Vacancy, Vacancy
JL:nl 8/29/13 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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