BILL ANALYSIS                                                                                                                                                                                                    Ó


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                                    THIRD READING

          Bill No:  AB 980
          Author:   Pan (D)
          Amended:  9/5/13 in Senate
          Vote:     21

          SENATE HEALTH COMMITTEE  :  7-2, 7/3/13
          AYES:  Hernandez, Beall, De León, DeSaulnier, Monning, Pavley,  
          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 states the intent of the Legislature that  
          all primary care clinics, including primary care clinics that  
          provide abortion services, be subject to the same licensing and  
          building standards.  This bill requires the California Building  
          Standards Commission (CBSC), in conjunction with the Office of  
          Statewide Health Planning and Development (OSHPD), to repeal a  
          specific provision of the 2013 Triennial Edition of the Building  
          Standards Code, as soon as possible, and to repeal certain  
          provisions of the 2013 Triennial Edition of the California  
          Plumbing Code pertaining to licensed clinics.  This bill grants  


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          OSHPD emergency regulatory authority to implement these  
          provisions, and makes these regulations permanent without  
          further regulatory action.  This bill requires the Department of  
          Public Health (DPH), no later than July 1, 2014, to repeal  
          certain regulations relating to abortion services in primary  

           Senate Floor Amendments  of 9/5/13 recast the provisions of the  
          bill with language that is substantially similar to the current  
          language; however, there are two primary differences between the  
          current bill and these amendments.  First, these amendments  
          include a provision repealing the portion of the California  
          Plumbing Code that permitted less stringent plumbing  
          requirements for clinics. According to OSHPD, the plumbing code  
          sections are the subject of a lawsuit based on whether or not  
          the review requirements of the California Environmental Quality  
          Act were met.  Secondly, instead of directing DPH to "revise or  
          repeal" specified regulations pertaining to abortion services in  
          primary care clinics, these amendments simply require DPH to  
          repeal these same specified regulations.

           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  

          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.



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          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.State the intent of the Legislature that all primary care  
            clinics, including primary care clinics that provide abortion  
            services, be held to the same licensing and building  

          2.Requires the California Building Standards Commission (CBSC),  
            in conjunction with OSHPD, to repeal 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.

          3.Requires CBSC, in conjunction with OSHPD, to repeal sections  
            of the 2013 Triennial Edition of the California Plumbing Code  
            pertaining to licensed clinics that were approved by the CBSC  
            on April 24, 2013.

          4.Grants OSHPD emergency regulatory authority to implement the  
            above two paragraphs, and requires the regulations adopted  
            pursuant to the above two paragraphs to become permanent  
            without further regulatory action.

          5.Requires DPH, no later than July 1, 2014, to repeal specified  
            regulations relating to abortion services in primary care  

          Existing Title 22 regulations (pertaining to the licensing of  
          health facilities):

          1.Requires primary care clinics providing abortion services as a  



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            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  
            have a system operative on a 24-hour basis ensuring  
            availability of staff for follow-up care or referral of  

          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  



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          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  
          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  

           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.



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           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).

           SUPPORT :   (Verified  9/6/13)

          Planned Parenthood Affiliates of California (source) 
          American Civil Liberties Union of California
          American Congress of Obstetricians and Gynecologists, District  
          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  9/6/13)

          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  



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          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  
          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.  



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          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,  
            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,  
          NO VOTE RECORDED:  Allen, Bonta, Fox, Gordon, Gorell, Grove,  
            Holden, Skinner, Waldron, Wilk, Vacancy, Vacancy

          JL:nl  9/6/13   Senate Floor Analyses 

                           SUPPORT/OPPOSITION:  SEE ABOVE

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