BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                            



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                                    THIRD READING


          Bill No:  AB 1577
          Author:   Atkins (D), et al.
          Amended:  6/3/14 in Senate
          Vote:     21


           SENATE HEALTH COMMITTEE  :  7-1, 6/11/14
          AYES:  Hernandez, Beall, De León, DeSaulnier, Evans, Monning,  
            Wolk
          NOES:  Nielsen
          NO VOTE RECORDED:  Morrell

           SENATE JUDICIARY COMMITTEE  :  6-1, 6/24/14
          AYES:  Jackson, Corbett, Lara, Leno, Monning, Vidak
          NOES:  Anderson

           SENATE APPROPRIATIONS COMMITTEE  :  Senate Rule 28.8

           ASSEMBLY FLOOR  :  62-5, 5/15/14 - See last page for vote


           SUBJECT  :    Certificates of death:  gender identity

           SOURCE  :     Equality California
                      Transgender Law Center


           DIGEST  :    This bill requires a person completing a death  
          certificate to record the decedent's sex to reflect the  
          decedent's gender identity, as specified.

           ANALYSIS  :    

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          Existing law:

          1.Requires each death to be registered with the local registrar  
            of births and deaths in the district in which the death was  
            officially pronounced or the body was found within eight  
            calendar days after the death and before the disposition of  
            the remains.

          2.Requires a funeral director to prepare the certificate and  
            register it with the local registrar and to obtain the  
            required information, other than medical and health data, from  
            the person or source best qualified supply this information.

          3.Requires the medical and health section data and the time of  
            death to be completed by the physician and surgeon last in  
            attendance, or in the case of a patient in a skilled nursing  
            or intermediate care facility, by a licensed physician  
            assistant legally authorized to certify and attest to the  
            facts, or in certain cases, to be completed by the county  
            coroner.

          4.Specifies that a certificate of death shall contain certain  
            information concerning the decedent necessary to establish the  
            fact of the death, including but not limited to the decedents  
            full name, sex, color or race, marital status, name of spouse,  
            date of birth and age at death, birthplace, usual residence,  
            and occupation. 

          This bill:

          1.Requires a person completing a death certificate to record the  
            decedent's sex to reflect the decedent's gender identity.   
            Requires the decedent's gender identity to be reported by the  
            informant, unless the person completing the certificate is  
            presented with a birth certificate, a driver's license, a  
            social security record, a court order approving a name or  
            gender change, a passport, an advanced health care directive,  
            or proof of clinical treatment for gender transition, in which  
            case the person completing the certificate is required to  
            record the decedent's sex as that which corresponds to the  
            decedent's gender identity as indicated in that document. 

          2.Requires, if none of these documents are presented and the  
            person with the right, or a majority of persons who have equal  

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            rights, to control the disposition of the remains, as  
            specified, is in disagreement with the gender identity  
            reported by the informant, the gender identity of the decedent  
            recorded on the death certificate to be as reported by that  
            person or majority of persons.

          3.Permits, if a document specified in #1 above is not presented  
            and a majority of persons who have equal rights to control the  
            disposition of the remains, as specified, do not agree with  
            the gender identity of the decedent as reported by the  
            informant, any one of those persons to file a petition, in the  
            superior court in the county in which the decedent resided at  
            the time of his or her death, or in which the remains are  
            located, naming as a party to the action those persons who  
            otherwise have equal rights to control the disposition and  
            seeking an order of the court determining, as appropriate, who  
            among those parties is to determine the gender identity of the  
            decedent.

          4.Prohibits a person completing the death certificate in  
            compliance with #1 above from being liable for any damages or  
            costs arising from claims related to the sex of the decedent  
            as entered on the death certificate.

          5.Requires a person completing the death certificate to comply  
            with the data and certification requirements by using the  
            information available to him/her prior to the deadlines for  
            completion specified in existing law.

          6.Establishes the above provisions as the Respect After Death  
            Act.

           Background
           
          The University of California, Berkeley Gender Equity Resource  
          Center defines transgender in the following manner:  Transgender  
          (sometimes shortened to trans or TG) people are those whose  
          psychological self (gender identity) differs from the social  
          expectations for the physical sex they were born with.  To  
          understand this, one must understand the difference between  
          biological sex, which is one's body (genitals, chromosomes,  
          etc.), and social gender, which refers to levels of masculinity  
          and femininity.  Often, society conflates sex and gender,  
          viewing them as the same thing.  But gender and sex are not the  

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          same thing.  Transgender people are those whose psychological  
          self (gender identity) differs from the social expectations for  
          the physical sex they were born with.  For example, a female  
          with a masculine gender identity or who identifies as a man.  A  
          University of California, Los Angeles Williams Institute study  
          from 2008 estimates that 0.3% of adults are transgender.

           Reporting and use of data  .  The Department of Public Health  
          (DPH) uses the data collected through death certificates for  
          public health research and planning.  According to DPH, this  
          bill would not change the way the State Registrar records the  
          death certificate or reports public health data, as the  
          certificate cannot be altered after registration by the local  
          registrar (i.e., information that is listed on the death record  
          is required to be reported).  According to DPH, this bill will  
          also not affect the way causes of death are reported in data.   
          The coding of causes of death for California vital records is  
          provided by the National Centers for Health Statistics (NCHS).   
          In coding causes of death, NCHS adheres to the World Health  
          Organization Nomenclature Regulations specified in the most  
          recent revision of the International Statistical Classification  
          of Diseases and Related Health Problems.  In general, pursuant  
          to the ICD 10 Mortality Manual 2a 2014, Section N. Sex and Age  
          Limitations, if the underlying cause of death appears to be  
          inconsistent with the gender, the accuracy of the underlying  
          cause of death is re-examined and the gender is verified.  In  
          addition, verification of the inconsistency can be accomplished  
          through examination of name, occupation, and other items on the  
          certificate.  If the gender is determined to be incorrect, the  
          data record is corrected.  If the gender entry is correct but  
          not consistent with the underlying cause of death, the death is  
          coded to "Other ill-defined and unspecified causes of  
          mortality."  Sometimes on a case-by-case basis, inconsistencies  
          in the underlying cause of death and gender are coded as  
          "unspecified" underlying causes of death, e.g., "unspecified  
          cancer," or they may be coded to the secondary cause of death if  
          it is consistent with the gender, e.g., a primary cause of death  
          for a male with ovarian cancer that has metastasized to the  
          kidneys may be coded as kidney cancer.

           Comments
           
          According to the author's office, the Respect After Death Act  
          will ensure that transgender individuals who have memorialized  

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          their gender identity on their legal documents can be recognized  
          properly at death.  Additionally, AB 1577 will provide  
          protection from civil suits for funeral directors and coroners  
          who follow the letter of the law.  Once we are deceased, we are  
          often at the mercy of others to treat us with dignity.  The very  
          least we can do is ensure individuals are given basic human  
          dignity by honoring their authentic selves when they pass so  
          that more pain is not inflicted upon grieving loved ones or the  
          community.

           Prior Legislation
           
          AB 1121 (Atkins, Chapter 651, Statutes of 2013) creates, as of  
          July 1, 2014, an optional administrative procedure for a  
          transgender person born in California to amend gender and name  
          on his/her birth certificate without first obtaining a court  
          order.

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    
          Local:  Yes

           SUPPORT  :   (Verified  8/5/14)

          Equality California (co-source)
          Transgender Law Center (co-source)
          AFSCME, AFL-CIO
          California Communities United Institute
          City and County of San Francisco
          Civil Justice Association of California

           OPPOSITION  :    (Verified  8/5/14)

          Capitol Resource Family Impact

           ARGUMENTS IN SUPPORT  :    The Transgender Law Center and Equality  
          California, the co-sponsors of this bill write that current  
          California law governing the completion of death certificates  
          fails to provide sufficient direction to the authorities, such  
          as funeral directors and coroners who are responsible for  
          determining a person's gender designation after death.  In some  
          cases, this lack of clarity has resulted in the issuance of a  
          death certificate that inaccurately reflects a transgender  
          person's gender.  When a transgender person is ascribed the  
          incorrect gender, whether on official documents or in the media,  

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          it is disrespectful to the memory of the deceased person and can  
          be deeply painful and stigmatizing to grieving friends, family,  
          and fellow community members.  The Civil Justice Association of  
          California supports this bill because it grants civil immunity  
          to coroners and funeral home directors when they record the sex  
          of a transgendered person and will allow those professionals to  
          do their jobs without fear of a meritless lawsuit.

           ARGUMENTS IN OPPOSITION  :    Capitol Resource Family Impact  
          opposes this bill because it would give an acquaintance the  
          legal authority to change the legal gender of a person after  
          death, and they believe if a person chose to not take the legal  
          steps to change his/her gender during his/her lifetime, no  
          individual should have the right to make that change for that  
          person after their death.
          
           ASSEMBLY FLOOR  :  62-5, 5/15/14
          AYES:  Achadjian, Alejo, Ammiano, Bloom, Bocanegra, Bonilla,  
            Bonta, Bradford, Brown, Buchanan, Ian Calderon, Campos, Chau,  
            Chávez, Chesbro, Cooley, Dababneh, Daly, Dickinson, Eggman,  
            Fong, Frazier, Garcia, Gatto, Gomez, Gonzalez, Gordon, Gorell,  
            Gray, Hagman, Hall, Roger Hernández, Holden, Jones-Sawyer,  
            Levine, Linder, Lowenthal, Maienschein, Medina, Mullin,  
            Muratsuchi, Nazarian, Nestande, Pan, Perea, John A. Pérez, V.  
            Manuel Pérez, Quirk, Quirk-Silva, Rendon, Ridley-Thomas,  
            Rodriguez, Salas, Skinner, Stone, Ting, Wagner, Weber,  
            Wieckowski, Williams, Yamada, Atkins
          NOES:  Bigelow, Donnelly, Beth Gaines, Grove, Wilk
          NO VOTE RECORDED:  Allen, Conway, Dahle, Fox, Harkey, Jones,  
            Logue, Mansoor, Melendez, Olsen, Patterson, Waldron, Vacancy


          JL:e  8/5/14   Senate Floor Analyses 

                           SUPPORT/OPPOSITION:  SEE ABOVE

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