BILL ANALYSIS                                                                                                                                                                                                    Ó




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          |SENATE RULES COMMITTEE            |                       AB 2892|
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                                    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:










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          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.  









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          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  








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             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  








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             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  








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             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)








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          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  ****








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