BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 2892| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- THIRD READING Bill No: AB 2892 Author: Committee on Environmental Safety and Toxic Materials, et al. Amended: 8/8/16 in Senate Vote: 21 SENATE ENVIRONMENTAL QUAL. COMMITTEE: 7-0, 6/29/16 AYES: Wieckowski, Gaines, Bates, Hill, Jackson, Leno, Pavley SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8 ASSEMBLY FLOOR: 78-1, 6/1/16 - See last page for vote SUBJECT: Pesticide poisoning SOURCE: Author DIGEST: This bill extends the sunset on the requirement for laboratories to electronically transmit specified agricultural worker pesticide exposure test results to the California Department of Pesticide Regulation (DPR) under the California Medical Supervision Program (Program) from January 1, 2017, to January 1, 2021, and makes other specified changes. Senate Floor Amendments of 8/8/16 clarify language concerning the role of the medical supervisor, type of laboratory and testing and reporting requirements for cholinesterase testing for agricultural workers. ANALYSIS: AB 2892 Page 2 Existing law: 1)Provides for the following, under California Code of Regulations (CCR), Title 3, §6728: a) Requires each employer, who has an employee who regularly handles organophosphate or carbamate (OP/CB) pesticides, to contract with a physician to provide medical supervision of the employee. b) Delineates the employer's responsibilities for medical supervision for employees regularly handling OP/CB pesticides, including requiring baseline cholinesterase tests and follow up tests after the employee has handled OP/CB pesticides, as specified. c) Requires an employer to remove an employee from exposure to OP/CB pesticides if the employee's cholinesterase level falls below specified baseline values. 2)Requires a laboratory that performs cholinesterase testing on human blood drawn in California under the Program, or drawn to respond to alleged or known exposure to cholinesterase inhibitors that resulted in illness, to report specified information, including test results, to DPR. 3)Requires the medical supervisor ordering a cholinesterase test under the Program to note in the test order the purpose of the test. 4)Requires the Office of Environmental Health Hazard Assessment (OEHHA) to review the cholinesterase test results and authorizes OEHHA to provide an appropriate medical or toxicological consultation to the medical supervisor. AB 2892 Page 3 5)Requires, by December 31, 2015, DPR and OEHHA, in consultation with the State Department of Public Health (DPH), to prepare a report on the effectiveness of the medical supervision program and on the utility of laboratory-based reporting of cholinesterase testing for illness surveillance and prevention. Clarifies that the joint report may include recommendations to the Legislature that DPR and OEHHA deem necessary. 6)Sunsets the cholinesterase result reporting requirements on January 1, 2017. 7)Requires any physician and surgeon who knows, or has reasonable cause to believe, that a patient is suffering from pesticide poisoning or any disease or condition caused by a pesticide to promptly report that fact to the local health officer by telephone within 24 hours. 8)Requires OEHHA to develop and implement, in cooperation with local health officers and state and local medical associations, a program of medical education to alert physicians and other health care professionals to the symptoms, diagnosis, treatment, and reporting of pesticide poisoning. This bill: 1) Extends the sunset on the requirement for laboratories to electronically transmit specified agricultural worker pesticide exposure test results to DPR under the California Medical Supervision Program from January 1, 2017, to January 1, 2021. 2) Requires that an employer satisfying his or her responsibilities for medical supervision of employees who AB 2892 Page 4 regularly handle pesticides contract with a medical supervisor registered with OEHHA. 3) Requires OEHHA to establish a procedure for registering and deregistering medical supervisors and to establish requirements for their performance. 4) Makes specified changes to the information a testing laboratory is required to report to DPR. Background 1) OP/CB pesticides. According to DPR, both OPs and CBs work as a pesticide by inhibiting the nerve enzyme cholinesterase, which breaks down the neurotransmitter acetylcholine, leading to the death of an insect. OPs and CBs can also affect humans by inhibiting cholinesterase. High exposure to OPs/ CBs can cause a variety of acute symptoms of neurological poisoning, including blurred vision, diarrhea, increased respiratory secretions, tremors, seizures, loss of consciousness, and death. The acute symptoms can sometimes mimic other illnesses, and sometimes people can be sub-clinically affected without showing major acute symptoms. Due to the potential for sub-clinical effects or misdiagnosis of the acute effects, it is useful to test for the depression of cholinesterase in order to identify potential overexposure. 2) California Medical Supervision Program. According to DPR, the Program was established in 1974 when the use of cholinesterase-inhibiting pesticides was extremely prevalent in California agriculture. While the use of cholinesterase-inhibiting pesticides has declined over the years, according to the most recent data, from 2008-2013, OP/CB use remained at between 4.1 to 5.1 million pounds applied per year. The goal of the Program is to protect pesticide handlers from AB 2892 Page 5 excessive exposure to OPs and CBs. It requires employers to contract with a licensed physician as a "medical supervisor" to periodically test the cholinesterase level of workers who regularly handle these pesticides. Under the Program, the medical supervisor establishes baseline values of cholinesterase during non-exposure periods for each employee, and periodically measures cholinesterase activity levels while the worker handles OPs/CBs. If the employee's cholinesterase is depressed below certain levels, the employer must take immediate specified actions to reduce exposure, such as promptly retesting the employee, evaluating the work practices, or immediately removing the employee from further exposure. 3) Reporting requirements. While the Program had been in existence for more than 30 years, prior to 2010, the state received very little information from the field to determine whether the Program was effective. However, AB 1963 (Nava, Chapter 369, Statutes of 2010) added Section 105206 to the Health & Safety Code, which requires laboratories that conduct cholinesterase tests as a part of the Program to report test results to DPR. The results are then analyzed by DPR and OEHHA, in consultation with the DPH. AB 1963 also required, by December 31, 2015, DPR and OEHHA, in consultation with the DPH, to prepare a report on the effectiveness of the medical supervision program and on the utility of laboratory-based reporting of cholinesterase testing for pesticide illness surveillance and prevention. AB 1963 stated that the joint report may include recommendations to the Legislature that DPR and OEHHA deem necessary. DPR and OEHHA submitted the resultant "The Report to the California Legislature: California's Cholinesterase Test Results" in December 2015, which found that overall, the Program appears effective in protecting agricultural workers who handle cholinesterase-inhibiting pesticides. The report did find, however, that based on the data submitted from 2011-2013, the utility of the data analysis is hampered by the inclusion of thousands of records from individuals who are not in the Program, and by missing data on the purpose of the cholinesterase test. DPR and OEHHA laid out specific "future directions," or actions that the two entities will AB 2892 Page 6 take to improve the Program and improve the utility of the data collected. DPR and OEHHA also made two recommendations for Program improvement: (a) Cholinesterase reporting should continue at least through December 31, 2018, so that DPR and OEHHA can obtain additional data with clearer information on the purpose of the test and to allow further evaluation of the Program; and, (b) Transferring cholinesterase reporting responsibilities from the laboratories to the medical supervisors may ultimately be a more efficient way to implement the Program. Comments Purpose of Bill. According to the author, while the agricultural use of OP/CB pesticides has declined over the decades, millions of pounds of these highly toxic pesticides are still applied every year in California. The Program is designed to protect agricultural workers who regularly mix, load, or apply OP/CB pesticides. In order to ensure that the Program is effective, agricultural worker pesticide exposure data (cholinesterase test results) are transmitted to the DPR. This data transmission requirement sunsets on January 1, 2017. AB 2892 extends this sunset to January 1, 2019, so that the state can continue to effectively evaluate and manage the Program, and to prevent worker pesticide illness due to the overexposure to OP/CB pesticides. Related/Prior Legislation AB 1963 (Nava, Chapter 369, Statutes of 2010) requires clinical laboratories that perform cholinesterase testing for the purpose of determining workers' pesticide exposure to electronically report test results to the DPR. FISCAL EFFECT: Appropriation: No Fiscal Com.:YesLocal: No SUPPORT: (Verified8/8/16) AB 2892 Page 7 California Rural Legal Assistance Foundation Center for Farmworker Families Health Officers Association of California Pesticide Action Network, North America Physicians for Social Responsibility, Los Angeles Physicians for Social Responsibility, San Francisco Bay Area Chapter Swanton Berry Farms OPPOSITION: (Verified8/8/16) None received ASSEMBLY FLOOR: 78-1, 6/1/16 AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Quirk, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Rendon NOES: Harper NO VOTE RECORDED: Beth Gaines Prepared by: Rachel Machi Wagoner / E.Q. / (916) 651-4108 8/10/16 15:57:21 **** END **** AB 2892 Page 8