BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 980| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- 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, 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 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 CONTINUED AB 980 Page 2 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 clinics. 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 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. CONTINUED AB 980 Page 3 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 standards. 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 clinics. Background Existing Title 22 regulations (pertaining to the licensing of health facilities): 1.Requires primary care clinics providing abortion services as a CONTINUED AB 980 Page 4 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 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 CONTINUED AB 980 Page 5 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 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. CONTINUED AB 980 Page 6 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 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 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 CONTINUED AB 980 Page 7 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. CONTINUED AB 980 Page 8 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, Wagner 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 **** END **** CONTINUED