BILL ANALYSIS Ó
AB 1667
Page 1
Date of Hearing: April 1, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 1667 (Williams) - As Amended: March 24, 2014
SUBJECT : Tuberculosis testing in schools.
SUMMARY : Replaces current mandatory tuberculosis (TB) testing
for school employees and volunteers with a TB risk assessment.
Specifically, this bill :
1)Prohibits a person from being initially employed or from being
employed under contract by a school district in a certified or
classified position unless the person has had a TB risk
assessment within the past 60 days. Applies to public
schools, private or parochial elementary or secondary schools,
or any nursery school.
2)Specifies that if no risk factors are identified by a TB risk
assessment, an examination is not required.
3)Requires, if TB risk factors are identified by a TB risk
assessment, those employees to be examined by a physician to
determine if they are free of infectious TB. Requires the
examination to consist of either an approved intradermal TB
test or any other test for TB that is recommended by the
federal Centers for Disease Control and Prevention (CDC) and
licensed by the federal Food and Drug Administration (FDA) and
requires, if the test is positive that the test be followed by
an X-ray of the lungs.
4)Requires employees who have no identified risk factors or who
test negative to undergo a TB risk assessment at least once
each four years.
5)Specifies that once an employee has been documented as having
TB, the risk assessment is no longer required.
6)Requires employees, after a TB risk assessment and, if
necessary, examination, to file with the district
superintendent, a certificate from the physician and surgeon
showing the employee was examined and found free from
infectious TB. Allows the county board of education to
require certificates be filed in the office of the county
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superintendent if a majority of school boards in the county
petition the county board of education and allows a school
district with an average daily attendance of 60,000 or more to
maintain the files for its employees in that district.
7)Clarifies that a governing board of a school district or the
governing authority of a private school, upon recommendation
of the local health officer, may require more extensive or
frequent physical exams.
8)Makes the risk assessment and if indicated, the TB test a
condition of employment and requires the cost to be borne by
the applicant. Allows schools or districts to reimburse
applicants once they are hired.
9)Requires existing employees to be reimbursed for the expense
of the TB assessment and test.
10) Requires a
volunteer in a school to have a certificate on file showing
that the person submitted to a TB risk assessment, and if
necessary, a TB test. Allows a school board to determine that
a TB risk assessment is not necessary if the volunteer does
not have frequent or prolonged contact with pupils.
11) Requires all
drivers, as a condition of contract with a governing board or
county superintendent of schools for providing the
transportation of pupils, to have a TB risk assessment and, if
indicated, the examination for TB within 60 days of initial
hire and be found free of infectious TB. Exempts, at the
discretion of the governing board or county superintendent of
schools drivers from the TB assessment and test requirement
who transport students infrequently without prolonged contact
with the pupils.
EXISTING LAW :
1)Prohibits a person from being initially employed, or put under
contract with a school district in a certified or classified
position unless they have had a TB test within the past 60
days to determine he or she has been found free of active TB.
Applies to public schools, private or parochial elementary or
secondary schools, or any nursery school.
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2)Requires the TB test to consist of an approved intradermal TB
test or any other test for TB that is recommended by the CDC
and licensed by the FDA and requires, if the test is positive,
that the test be followed by an X-ray of the lungs.
3)Allows a district superintendent or the governing authority of
a private school, to exempt a pregnant employee who tests
positive for TB from the requirement for an X-ray of the lungs
up to 60 days following termination of the pregnancy.
4)Requires employees who test negative for TB to be tested at
least once every four years.
5)Requires that once an employee has been documented as having
TB, the test is no longer required, and requires the employee
to be referred within 30 days to the local health officer to
determine the need for follow-up care.
6)Requires employees, after the test, to file a certificate from
the physician and surgeon showing the employee was examined
and found free from active TB. Allows the county board of
education to require that the certificates to be filed in the
office of the county superintendent if a majority of school
boards in the county petition the county board of education
and allows a school district with an average daily attendance
of 60,000 or more to maintain the files for its employees in
that district.
7)Requires all volunteers in a school to have a certificate on
file showing that within the last four years the person
submitted to a TB test and was found free of communicable TB.
Allows the governing authority of a school to determine that a
TB test is not necessary if the volunteer does not have
frequent or prolonged contact with pupils.
8)Allows the governing board of a school to pass a resolution,
after a hearing which finds that the health of pupils in the
district would not be jeopardized, allowing employees to file
an affidavit stating that they adhere to the faith or
teachings of any well-recognized religious sect that depends
upon prayer for healing and that to the best of their
knowledge, they are free of TB.
9)Allows employees transferring from one district to another or
from a public to a private school, to provide a certificate
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from the previous employer showing that they were examined
within the past four years and found to be free of
communicable TB.
10)Requires all drivers, as a condition of contract with a
governing board or county superintendent of schools for
providing the transportation of pupils, to be examined for and
be found free of active TB. Exempts private contracted
drivers from the TB test requirement who transport students
infrequently, not to exceed once a month.
FISCAL EFFECT : This bill has not yet been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, the best
public health and medical evidence suggests that universal TB
testing is neither necessary nor cost-effective. School
employees and volunteers are not considered high-risk
populations. The number of certificated and classified staff
TB cases is low, and universal testing results in a number of
false positives. This can result in persons being
unnecessarily placed on potentially toxic treatment regimens.
2)BACKGROUND . According to the CDC, TB is a disease that is
spread through the air from one person to another. There are
two kinds of tests that are used to determine if a person has
been infected with TB bacteria: the tuberculin skin test and
TB blood tests. A positive TB skin test or TB blood test only
tells that a person has been infected with TB bacteria. It
does not tell whether the person has latent TB infection or
has progressed to TB disease. Other tests, such as a chest
X-ray and a sample of sputum, are needed to see whether the
person has TB disease. According to the CDC, TB tests are
generally not needed for people with a low risk of infection
with TB bacteria. Certain people should be tested for TB
bacteria because they are more likely to get TB disease,
including:
a) People who have spent time with someone who has TB
disease;
b) People with HIV infection or another medical problem
that weakens the immune system;
c) People who have symptoms of TB disease (fever, night
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sweats, cough, and weight loss);
d) People from a country where TB disease is common (most
countries in Latin America, the Caribbean, Africa, Asia,
Eastern Europe, and Russia);
e) People who live or work somewhere in the United States
where TB disease is more common (homeless shelters, prison
or jails, or some nursing homes); and,
f) People who use illegal drugs.
The two purified protein derivatives licensed by the FDA that
serve as antigens for TB tests have been experiencing
nationwide shortages since April 2013. In their September 4,
2013 health update, the CDC recommends allocating TB tests to
priority usages as determined by public health authorities.
Since 2000, the CDC has stated that screening of low-risk
persons and testing for administrative purposes should be
replaced by targeted testing. In 2006, the Department of
Public Health (DPH) and the California Tuberculosis
Controllers Association (CTCA) issued joint guidelines,
Targeted Testing and Treatment of Latent Tuberculosis
Infection in Adults and Children, which state that tuberculin
skin testing of low risk populations will result in
unnecessary treatment because of false-positive test results.
Currently five states (Florida, Texas, New Mexico, Nebraska,
and North Dakota) do not require teachers to be tested for TB.
3)SUGGESTED AMENDMENT . DPH and CTCA have jointly developed an
Adult Tuberculosis Risk Assessment Questionnaire, adapted from
a form developed by Minnesota's Department of Public Health TB
Prevention and Control Program and the CDC. The author may
want to consider amending the bill to require school districts
to use the TB assessment questionnaire developed by the CTCA
and DPH.
4)SUPPORT . The Health Officers Association of California, the
sponsor of this bill, writes that school employees and
volunteers are not considered high-risk populations and
replacing mandated universal testing of school personnel with
targeted screening will be more cost effective while still
protecting the state's teachers, volunteers, school employees,
and children from TB. The California Tuberculosis Controllers
Association supports the bill and references an American
Academy of Family Physicians statement noting, "Routine
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screening outside?high-risk groups dissipates resources and
leads to high false-positive test rates." The California
School Nurses Association supports this bill because it has
been demonstrated that school staff and volunteers are a low
risk population and thus the revised policy and protocol for
universal TB risk assessment and testing, if warranted, is
more efficacious and efficient.
5)PREVIOUS LEGISLATION . AB 1323 (DeSaulnier), Chapter 24,
Statutes 2007, expands the types of TB testing that may be
used to screen for, or to report, cases of active TB, to
include the use of any test recommended by the CDC and
licensed by the FDA.
6)DOUBLE REFERRAL . This bill has been double-referred. Should
this bill pass out of this Committee, it will be referred to
the Assembly Committee on Education.
REGISTERED SUPPORT / OPPOSITION :
Support
Health Officers Association of California (sponsor)
California Tuberculosis Controllers Association
California School Nurses Organization
County Health Executives Association of California
Opposition
None on file.
Analysis Prepared by : Lara Flynn / HEALTH / (916) 319-2097