BILL ANALYSIS                                                                                                                                                                                                    



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          Date of Hearing:  April 14, 2015


                            ASSEMBLY COMMITTEE ON HEALTH


                                  Rob Bonta, Chair


          AB 775  
          (Chiu) - As Amended April 8, 2015


          SUBJECT:  Reproductive FACT Act.


          SUMMARY:  Requires licensed clinics that provide family planning  
          or pregnancy-related services to provide a notice to consumers  
          regarding their reproductive rights.  Requires unlicensed  
          facilities that provide pregnancy-related services to  
          disseminate and post a notice informing consumers that they are  
          not a licensed medical facility.  Specifically, this bill:  


          1)Enacts the Reproductive Freedom, Accountability, Comprehensive  
            Care, and Transparency Act (FACT Act).

          2)Defines, for purposes of the FACT Act, a licensed covered  
            facility as a licensed, or intermittent, clinic whose primary  
            purpose is providing family planning or pregnancy-related  
            services, and that satisfies two or more of the following:



             a)   The facility offers obstetric ultrasounds, obstetric  
               sonograms, or prenatal care to pregnant women;
             b)   The facility provides, or offers counseling about  
               contraception, or contraceptive methods;









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             c)   The facility offers pregnancy testing or pregnancy  
               diagnosis;


             d)   The facility advertises or solicits patrons with offers  
               to provide prenatal sonography, pregnancy tests, or  
               pregnancy options counseling; and, 


             e)   The facility has staff or volunteers who collect health  
               information from clients.



          3)Clarifies that the following types of clinics are not  
            considered covered facilities for the purposes of this bill:  

             a)   A clinic directly conducted, maintained, or operated by  
               the United States or any of its departments, officers, or  
               agencies; and,
             b)   A licensed primary care clinic that is enrolled as a  
               Medi-Cal provider and a provider in the Family Planning,  
               Access, Care, and Treatment Program.



          4)Defines, for purposes of the FACT Act, an unlicensed covered  
            facility as a facility that is not licensed by the State of  
            California and does not have a licensed medical provider on  
            staff, whose primary purpose is providing pregnancy-related  
            services and that satisfies two or more of the following:

             a)   The facility offers obstetric ultrasounds, obstetric  
               sonograms, or prenatal care to pregnant women; 
             b)   The facility offers pregnancy testing or pregnancy  
               diagnosis; 










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             c)   The facility advertises or solicits patrons with offers  
               to provide prenatal sonography, pregnancy tests, or  
               pregnancy options counseling; and, 


             d)   The facility has staff or volunteers who collect health  
               information from clients.



          5)Requires licensed covered facilities to disseminate the  
            following notice in English and in minority languages pursuant  
            to the federal Voting Rights Act, that states the following:



          "California has public programs that provide immediate free or  
          low-cost access to comprehensive family planning services  
          (including all FDA-approved methods of contraception), prenatal  
          care, and abortion, for eligible women.  To determine whether  
          you qualify, contact the county social services office at  
          [insert the telephone number]. "





          6)Requires the notice to be posted in a conspicuous place in the  
            licensed clinic, specifies the size of the type on the notice,  
            and requires a printed copy be given directly to the client,  
            either in written or digital form.  Allows the notice to be  
            combined with other mandated disclosures.

          7)Requires an unlicensed facility to disseminate a notice to  
            clients in English and in minority languages pursuant to the  
            federal Voting Rights Act that states the following:


               "This facility is not licensed as a medical facility by the  








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               State of California and has no licensed medical provider  
               who provides or directly supervises the provision of  
               services."  


          8)Specifies the size of the notice, the size type the notice is  
            printed in, and that the notice is to be posted conspicuously  
            in the entrance to the unlicensed facility and in at least one  
            other area where clients wait to receive services.  Requires  
            that the notice shall be given to clients onsite, and included  
            in any print and digital advertising materials.

          9)Establishes civil penalties for failure to comply with these  
            provisions, enforceable by the Attorney General (AG), a city  
            attorney, or county counsel if they have provided the facility  
            with reasonable notice of noncompliance and verified that the  
            violation was not corrected within 30 days from the date of  
            the notice.



          10)Specifies that any civil penalties be deposited into the  
            General Fund if an action is brought by the AG, paid to the  
            treasurer of the city if an action is brought by a city  
            attorney, and paid to the county treasurer if an action is  
            brought by a county counsel.



          11)Requires the AG to post and maintain of the Department of  
            Justice's (DOJ) Internet Web site a list of the covered  
            facilities upon which a penalty has been imposed.



          12)Provides that if any provisions of this bill or its  
            application is held invalid, that invalidity will not affect  
            other provisions or applications that can be given effect  
            without the invalid provision or application.








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          13)Makes various findings and declarations regarding Californian  
            residents' rights to privacy and access to reproductive health  
            services. 


          EXISTING LAW:


          1)Licenses and regulates clinics, including primary care clinics  
            and specialty clinics such as surgical clinics, by the  
            Department of Public Health (DPH). 



          2)Provides for exemptions from licensing requirements for  
            certain types of clinics, including federally operated  
            clinics, local government primary care clinics, clinics  
            affiliated with an institution of higher learning, clinics  
            conducted as outpatient departments of hospitals, and  
            community or free clinics.  Also provides for exemptions for  
            community or free clinics that are operated on separate  
            premises from the licensed clinic and are only open for  
            limited services of no more than 20 hours a week (also known  
            as intermittent clinics).





          3)Authorizes DPH to take various types of enforcement actions  
            against a primary care clinic that has violated state law or  
            regulation, including imposing fines, sanctions, civil or  
            criminal penalties, and suspension or revocation of the  
            clinic's license.

          4)Grants a specific right of privacy under the California  








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            Constitution and provides that the right to have an abortion  
            may not be infringed upon without a compelling state interest.



          5)Requires, under the federal Voting Rights Act, voting  
            materials be translated in localities where there are more  
            than 10,000 or over 5% of the total voting age citizens in a  
            single political subdivision (usually a county, but a township  
            or municipality in some states) who are members of a single  
            minority language group, have depressed literacy rates, and do  
            not speak English very well.  The Census Bureau identifies  
            specific language groups for specific jurisdictions. 


          FISCAL EFFECT:  This bill has not been analyzed by a fiscal  
          committee


          COMMENTS: 


          1)PURPOSE OF THIS BILL.  According to the author, California has  
            a proud legacy of respecting reproductive freedom and funding  
            forward thinking programs to provide reproductive health  
            assistance to low income women.  The author notes that  
            according to the Department of Health Care Services, the  
            Patient Protection and Affordable Care Act expansion has made  
            millions of Californians, 53% of them women, newly eligible  
            for Medi-cal.  The author states because pregnancy decisions  
            are time sensitive, California women should receive  
            information about their rights and available services at the  
            sites where they obtain care.

          The author contends that, unfortunately, there are nearly 200  
            licensed and unlicensed clinics known as crisis pregnancy  
            centers (CPCs) in California whose goal is to interfere with  
            women's ability to be fully informed and exercise their  
            reproductive rights, and that CPCs pose as full-service  








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            women's health clinics, but aim to discourage and prevent  
            women from seeking abortions.  The author concludes that these  
            intentionally deceptive advertising and counseling practices  
            often confuse, misinform, and even intimidate women from  
            making fully-informed, time-sensitive decisions about critical  
            health care.

          2)BACKGROUND.



             a)   Crisis Pregnancy Centers.  CPCs are facilities, both  
               licensed and unlicensed, which present themselves as  
               comprehensive reproductive health centers, but are commonly  
               affiliated with, or run by organizations whose stated goal  
               is to prevent women from accessing abortions.  A 2015 NARAL  
               Pro-Choice America report on CPCs notes that the National  
               Institute of Family and Life Advocates (an organization  
               with over 1,300 CPC affiliates) states on its website that  
               it is on the front line of the cultural battle over  
               abortion, and its vision is to provide [CPCs] with legal  
               resources and counsel, with the aim of developing a network  
               of life-affirming ministries in every community across the  
               nation in order to achieve an abortion-free America.  The  
               NARAL report also sent several researchers into CPCs to  
               receive the counseling offered, and they widely reported  
               that they were provided with inaccurate information,  
               including only being given information regarding the risks  
               of abortion, being told that many women commit suicide  
               after having an abortion, and being told abortions can  
               cause breast cancer.

             b)   University of California, Hastings College of Law  
               research report.  In fall of 2009 the Assembly Business,  
               Professions and Consumer ProtectionCommittee, concerned  
               that CPCs throughout California were disseminating  
               medically inaccurate information about pregnancy options  
               available in the state, requested a report by the  
               University of California, Hastings College of Law regarding  








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               CPCs' practices and potential legislative options for  
               regulating them.  Completed in December of 2010, "Pregnancy  
               Resource Centers:  Ensuring Access and Accuracy of  
               Information," discusses several options for regulation  
               CPCs, ranging from creating new regulations, leveraging  
               existing regulations aimed specifically at medical  
               services, as well as creating a new statute.  Because  
               approaches that have treated CPCs and full-service  
               pregnancy centers differently have been challenged as  
               violating the First Amendment, the report concludes that  
               the best approach to a statutory change would regulate all  
               pregnancy centers, not just CPCs, in a uniform manner,  
               which is the approach that this bill adopts.



             c)   Legal challenges to CPC regulation.  In November 2014,  
               the Supreme Court rejected an appeal from several CPCs over  
               a 2011 New York City law that requires CPCs to inform  
               clients whether or not they have medical personnel on site.  
                New York City officials argued that the law is meant to  
               protect consumers from false advertising.



             In February of this year, a federal judge upheld the City of  
               San Francisco's regulation of CPCs, which prohibits clinics  
               from engaging in false or misleading advertising.  The law  
               allows a judge to order clinics to post notices saying  
               whether they offer abortions or abortion referrals.  The  
               ordinance was challenged by First Resort, a nonprofit  
               clinic owner, as a violation of free speech.  First  
               Resort's print and online advertisements stated that the  
               clinic offers "abortion information, resources and  
               compassionate support for women facing the crucial  
               decisions that surround unintended pregnancies and are  
               considering abortion."  In  First Resort, Inc., v. Board of  
               Supervisors of the City and County of San Francisco  , the  
               judges' ruling said the San Francisco law "only restricts  








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               false and misleading commercial speech, which is not  
               protected by the First Amendment."

          3)SUPPORT.  Black Women for Wellness and NARAL Pro-Choice,  
            California the co-sponsors of this bill as well as numerous  
            other organizations, including, California Council of Churches  
            IMPACT, California Latinas for Reproductive Justice, Maternal  
            and Child Health Access, and Planned Parenthood, California,  
            support this bill because it requires unlicensed facilities  
            that provide pregnancy-related care to inform clients that  
            they are not a licensed medical facility and do not have a  
            licensed provider on staff, enabling women to seek the care  
            they wish to obtain and providing context for counseling given  
            at these unlicensed facilities.  They also state that  
            distributing a notice of reproductive health services would  
            ensure that women in any reproductive health or pregnancy  
            counseling facility know that California respects their rights  
            and provides assistance.

          The California Primary Care Association (CPCA) states this bill  
            will protect patients by allowing them to fully understand  
            their rights when it comes to their reproductive freedom and  
            to not be deceived by organizations whose sole purpose is to  
            provide them with a biased view that does not allow them to  
            make their own informed choice.  CPCA notes that many of their  
            community clinics and health centers grew out of the women's  
            movement and their members believe a women's right to choose  
            is a fundamental health right that must be protected.

          The American Nurses Association, California (ANA\C) writes that  
            all California residents should have access to reproductive  
            health services, and more than 700,000 California women become  
            pregnant every year, approximately half of them  
            unintentionally.  ANA\C states thousands of women do not know  
            the legal options they have, or the funding resources  
            available to them, and this bill will help ensure that  
            pregnant women receive the information they need to make an  
            informed decision.









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          Forward Together supports this bill, opining; women in  
            California face a threat from manipulative crisis pregnancy  
            centers which pose as comprehensive reproductive health  
            centers, but are, in fact, anti-choice organizations that  
            target women with the goal of blocking them from considering  
            abortion as an option and using proven contraceptive methods.   
            Forward Together contends that CPCs use false and misleading  
            advertising to appeal to women, who think they may be pregnant  
            and are looking for comprehensive reproductive health care,  
            and then manipulate and shame these women by peddling  
            medically inaccurate information about abortion and  
            contraception.

          4)OPPOSITION.  The California Catholic Conference (CCC) opposes  
            this bill stating, on its surface, the bill proposes to  
            regulate the state's pregnancy centers, but in actuality is  
            aimed at discriminating against those pregnancy centers that  
            hold a pro-life viewpoint.  CCC contents that such unfair  
            legislation may discourage women from getting the assistance  
            that they need and deserve as well as expose many of these  
            pregnancy centers to needless criminal or civil sanctions for  
            failure to comply.  CCC concludes that because they believe  
            all life is sacred, they support programs which offer medical,  
            economic and emotional support for pregnant women and  
            children, so that they can make life-affirming choices.



          The California Right to Life Committee, Inc. (CRLC) opposes this  
            bill and states that, if enacted, it could set a precedent for  
            many other businesses that are not like or appreciated by one  
            group in society which could bring a law suit against another  
            business, company, or agency.  CRLC asks us to consider car  
            dealerships:  what if they were to be seen as  
            anti-environmental with misleading advertising, selling too  
            many cars, and making citizens not anxious to take high speed  
            rail?  CRLC asks; would it not be possible that the California  
            High Speed Rail Authority require that car dealerships  
            advertise High Speed Rail locations, schedules, and fees?   








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            CRLC argues the provisions of this bill would not be best  
            practice for the car industry any more that it would be for  
            pro-life pregnancy centers to have to promote services which  
            they consider morally reprehensible.

          5)DOUBLE REFERRAL.  This bill is double referred; upon passage  
            in this committee, this bill will be referred to the Assembly  
            Judiciary Committee.



          6)SUGGESTED AMENDMENT.  As noted in existing law above, the  
            federal Voting Act applies to political subdivisions (usually  
            a county, but sometimes a township or municipality) and refers  
            to populations that, "don't speak English very well."  Because  
            the covered facilities subject to the provisions of this bill  
            are not likely to be familiar with federal Voting Act  
            requirements, and state law already contains language that  
            provides more specific guidance on which languages health  
            related information should be translated into in each county,   
            the Committee may wish to amend the bill to strike the  
            references to federal law and instead require covered  
            facilities to translate the notices required by this bill into  
            the primary threshold languages for Medi-Cal beneficiaries as  
            determined by the Department of Health Care Services for the  
            county in which the covered facility is located.



          7)POLICY COMMENT.  This bill requires the AG to post and  
            maintain on the DOJ Internet Web site a list of the covered  
            facilities upon which a penalty has been imposed for  
            noncompliance.  Because an action against a covered facility  
            may be brought by a city attorney or county counsel, as well  
            as the AG, should this bill pass this committee, the author  
            may wish to consider working with the Judiciary Committee to  
            clarify how the AG will know a covered facility was cited when  
            the action was brought by an agency other than the DOJ.  









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          REGISTERED SUPPORT / OPPOSITION:


          SupportBlack Women for Wellness (cosponsor)


          NARAL Pro-Choice California (cosponsor)
          Act for Women and Girls
          American Congress of Obstetricians and Gynecologists
          California Association for Nurse Practitioners
          California Council of Churches IMPACT
          California Latinas for Reproductive Justice
          California Primary Care Association
          California Women's Law Center
          California Women Lawyers
          Forward Together
          League of Women Voters of California
          Maternal And Child Health Access
          National Abortion Federation
          Planned Parenthood Affiliates of California
          Religious Coalition for Reproductive Choice, California
          Western Methodist Justice Movement
          Women's Community Clinic
          Women's Health Specialists


          Opposition
          Sacramento Life Center


          The California Catholic Conference
          The California Right to Life Committee, Inc.


          Analysis Prepared by:Lara Flynn / HEALTH / (916) 319-2097











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