BILL ANALYSIS Ó
AB 521
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Date of Hearing: April 21, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
AB 521
(Nazarian) - As Amended April 14, 2015
SUBJECT: HIV testing.
SUMMARY: Applies existing human immunodeficiency virus (HIV)
testing requirements for primary care clinics to hospital
emergency departments (EDs), as specified. Specifically, this
bill:
1)Requires each patient who has blood drawn in a hospital ED,
and who has consented to an HIV test, to be offered an HIV
test. Requires the test to conform with the U.S. Preventative
Services Task Force (USPS Task Force) recommendation. Exempts
from testing if the patient was tested, or offered testing and
declined, within the last 12 months. Requires subsequent
testing to be consistent with the most recent guidelines of
the USPS Task Force.
2)Allows a hospital ED to charge a patient to cover the cost of
HIV testing.
3)Indicates that a hospital ED has complied with these
requirements if an HIV test is offered.
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4)Requires a hospital ED to attempt to provide test results to
the patient prior to departure from the hospital. Allows the
hospital to inform the patient of a negative result by letter
or telephone if the patient leaves the hospital before test
result is available. Requires the hospital to inform a
patient with a positive test result in a manner consistent
with state law.
5)Deems a hospital ED to be in compliance with existing HIV
testing notification and counseling requirements if they
provide printed material to the patient that includes the
following information and advice:
a) Timely information and counseling, as appropriate, to
explain the results and the implications for the patient's
health;
b) If the patient tests positive for HIV infection,
information that there are numerous treatment options
available and identify followup testing and care that may
be recommended, including contact information for medical
and psychological services; and,
c) If the patient tests negative for HIV infection and is
known to be at high risk for HIV infection, information
advising the patient of the need for periodic retesting,
explaining the limitations of current testing technology
and the current window period for verification of results,
and may offer prevention counseling or a referral to
prevention counseling.
EXISTING LAW:
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1)Requires each patient who has blood drawn in a primary care
clinic, and who has consented to an HIV test, to be offered an
HIV test. Requires the test to conform with the USPS Task
Force recommendation. Exempts from testing if the patient was
tested, or offered testing and declined, within the last 12
months. Requires subsequent testing to be consistent with the
most recent guidelines of the USPS Task Force.
2)Allows a primary care clinic to charge a patient to cover the
cost of HIV testing.
3)Indicates that a primary care clinic has complied with these
requirements if an HIV test is offered.
4)A primary care clinic shall attempt to provide test results to
the patient prior to departure from the facility. Allows the
clinic to inform the patient of a negative result by letter or
telephone if the patient leaves the hospital before test
result is available. Requires the hospital to inform a
patient with a positive test result in a manner consistent
with state law.
5)Requires a medical care provider, after the results of an HIV
test have been received, to:
a) Ensure that the patient receives timely information and
counseling, as appropriate, to explain the results and the
implications for the patient's health;
b) If the patient tests positive for HIV infection, the
medical provider or the person who administers the test
shall inform the patient that there are numerous treatment
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options available and identify followup testing and care
that may be recommended, including contact information for
medical and psychological services; and,
c) If the patient tests negative for HIV infection and is
known to be at high risk for HIV infection, the medical
provider or the person who administers the test shall
advise the patient of the need for periodic retesting,
explain the limitations of current testing technology and
the current window period for verification of results, and
may offer prevention counseling or a referral to prevention
counseling.
6)Requires a medical care provider, except in the event that the
test is independently requested and prior to ordering an HIV
test, that a medical care provider inform the patient that the
test is planned, provide information about the test, inform
the patient that there are numerous treatment options
available for a patient who tests positive for HIV and that a
person who tests negative for HIV should continue to be
routinely tested, and advise the patient that he or she has
the right to decline the test. If a patient declines the
test, the medical care provider shall note that fact in the
patient's medical file.
7)Requires informed consent by the patient or their parent,
guardian, conservator, or other individual specified by law,
before administering an HIV test, except in the event that the
test is independently requested from an HIV counseling and
testing site employing a trained HIV counselor. Informed
consent may be provided orally or in writing, but consent
shall be documented, whether obtained orally or in writing, in
the client's medical record.
FISCAL EFFECT: This bill has not been analyzed by a fiscal
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committee.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, California has
led the way in identifying people living with HIV and linking
them with care and treatment. For example, AB 446 (Mitchell),
Chapter 589, Statues of 2013, requires public health clinics
to offer an HIV test. Until the Patient Protection and
Affordable Care Act has been fully implemented, EDs will
continue to play a critical role in delivering primary care
services to many new enrollees and the uninsured. Given that
there are more than 5,000 new HIV infections in California
every year, this bill will bridge the gap in lack of HIV
testing by requiring EDs to uniformly provide HIV testing.
2)BACKGROUND. HIV is the virus that can lead to acquired
immunodeficiency syndrome, or AIDS. Unlike some other viruses,
the human body cannot get rid of HIV. That means that once
you have HIV, you have it for life. No safe and effective
cure currently exists, but scientists are working hard to find
one, and remain hopeful. Meanwhile, with proper medical care,
HIV can be controlled. Treatment for HIV is often called
antiretroviral therapy or ART. It can dramatically prolong the
lives of many people infected with HIV and lower their chance
of infecting others. Before the introduction of ART in the
mid-1990s, people with HIV could progress to AIDS in just a
few years. Today, someone diagnosed with HIV and treated
before the disease is too far advanced can have a nearly
normal life expectancy. HIV affects specific cells of the
immune system, called CD4 cells, or T cells. Over time, HIV
can destroy so many of these cells that the body can't fight
off infections and disease. When this happens, HIV infection
leads to AIDS. According to the California Department of
Public Health (DPH), Office of AIDS, in California there were
119,878 living cases of HIV (AIDS and non-AIDS) as of December
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31, 2013.
3)SUPPORT. According to the sponsor, the AIDS Healthcare
Foundation (AHF), despite dramatic advances in treatment
options, this epidemic is far from over. There are more than
5,000 new infections in California every year. According to
DPH, 16% of Californians who are HIV-positive do not know they
are HIV-positive and thus are not getting treatment and
unwittingly expose uninfected people to HIV; that number jumps
to 58% for young people, up to age 24. The more than 20,000
Californians who do not know they are HIV-positive are causing
70% of the new infections, while the 84% of Californians who
are aware they are HIV-positive only cause 30% of new
infections.
AHF continues, this bill simply requires the offer of an HIV
test in an ED if blood is already being drawn for another
purpose. AHF writes that they recognize that EDs are
constantly under pressure to meet the immediate needs of their
patients. AHF concludes, this bill seeks to balance the
public health demands of controlling this epidemic with the
operational needs of an ED. AHF points at the Emergency Room
as the last remaining major source for the identification of
new people with HIV.
4)OPPOSITION. In opposition, the California Chapter of the
American College of Emergency Physicians (Cal/ACEP) argues
that while this bill may appear to be an easy and efficient
way to increase HIV diagnosis and treatment, it is
unfortunately extremely problematic. Although fewer than 5%
of doctors are emergency physicians, they handle a quarter of
all acute care encounters and more than half of acute care
visits by the uninsured. Diagnosing and treating HIV is an
important public health endeavor, but EDs are not the proper
venue for a diagnostic public health campaign. According to
Cal/ACEP, this bill would place additional stress on
California's overcrowded and burdened EDs, while diverting
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precious time away from patients with critical conditions
toward public health screening. Emergency physicians estimate
they draw blood from 50%of their 12 million patients per year.
If adding an HIV test only took an additional five minutes
that would result in an additional 30 million minutes, or 57
years, of care each year. Additionally, this bill provides no
funding for the test itself thereby placing another unfunded
mandate on EDs.
5)COMMITTEE COMMENT. The opposition has raised concerns about
the difficulty obtaining consent from those unable to provide
it, such as from a patient with a severe injury, illness,
mental disturbance, or some other factor. The Committee may
recommend that this bill be amended to waive the requirement
that an HIV test be offered when the patient is unresponsive,
unconscious, incapacitated, or otherwise unable to consent to
the test.
6)PREVIOUS LEGISLATION
a) AB 446 changes state HIV testing law requiring primary
care clinics to offer an HIV test when taking a blood draw,
upon the informed consent of the patient.
b) AB 1894 (Krekorian), Chapter 631, Statutes of 2008,
requires health care service plans and disability insurers
selling health insurance to offer testing for HIV
antibodies and AIDS, regardless of whether the testing is
related to a primary diagnosis.
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REGISTERED SUPPORT / OPPOSITION:
Support
AIDS Healthcare Foundation (sponsor)
Opposition
California Chapter of the American College of Emergency
Physicians (Cal/ACEP)
California Hospital Association
California Medical Association
Analysis Prepared by:Max Mikalonis / HEALTH / (916) 319-2097