BILL ANALYSIS Ó AB 2892 Page 1 CONCURRENCE IN SENATE AMENDMENTS AB 2892 (Committee on Environmental Safety and Toxic Materials) As Amended August 8, 2016 Majority vote -------------------------------------------------------------------- |ASSEMBLY: |78-1 |(June 1, 2016) |SENATE: |38-0 |(August 15, | | | | | | |2016) | | | | | | | | | | | | | | | -------------------------------------------------------------------- Original Committee Reference: E.S. & T.M. SUMMARY: Updates and enhances the California Medical Supervision Program (Program) by extending the sunset on the requirement for laboratories to transmit cholinesterase test results to the state; requiring the Office of Environmental Health Hazard Assessment (OEHHA) to register medical supervisors; and, requiring medical supervisors to report depressions in cholinesterase levels as a pesticide illness. The Senate amendments: 1)Require employers, in order to satisfy their responsibilities for medical supervision of their employees who regularly handle pesticides, to contract with a medical supervisor registered with OEHHA. AB 2892 Page 2 2)Make changes to current reporting requirements, under the Program, on laboratories by requiring them to report the purpose of the test, as indicated by the medical supervisor, as a cholinesterase test requested for an agricultural worker under medical supervision, and, if it is, whether it is for a baseline, followup, or recovery test. 3)Under the Program, the purpose of the cholinesterase test as a test requested for an agricultural worker under medical supervision, as indicated by the medical supervisor, and whether it is a baseline, followup, or recovery test. 4)Delete from statute the requirement that, for cholinesterase tests performed under the Program, laboratories transmit to the Department of Pesticide Regulation (DPR) the name, address, and telephone number of the health care provider and the accession number of the specimen. 5)Require medical supervisors to ensure that the results of cholinesterase tests performed under the Program are received by the employer. 6)Require medical supervisors to report to the local health officer any worker with cholinesterase depression indicating pesticide exposure, pursuant to existing law on pesticide poisoning reporting. 7)Require OEHHA to establish a procedure for registering and deregistering medical supervisors for the purposes of outreach and training and authorize OEHHA to establish reasonable requirements for the performance of medical supervisors. 8)Extend the sunset date, from 2019 to 2021, on the requirement for laboratories, as part of the Program, to electronically transmit specified agricultural worker cholinesterase test results to DPR. AB 2892 Page 3 9)Require DPR and OEHHA to prepare and publicly post an update on the effectiveness of the medical supervision program and the utility of laboratory-based reporting of cholinesterase testing for illness surveillance and prevention by January 1, 2021. 10)Make other technical and conforming changes. EXISTING LAW: 1)Requires each employer who has an employee who regularly handles organophosphate or carbamate pesticides (OP/CB pesticides) to contract with a physician to provide medical supervision of the employee. 2)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. 3)Requires a laboratory that performs cholinesterase testing on human blood drawn 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 and whether the test is baseline or other periodic testing, to DPR. 4)Sunsets the cholinesterase test result reporting requirements on January 1, 2017. AS PASSED BY THE ASSEMBLY, this bill extended the sunset, from January 1, 2017, to January 1, 2019, on the requirement for AB 2892 Page 4 laboratories, as part of the Program, to electronically transmit cholinesterase test results to DPR. FISCAL EFFECT: This bill was approved by the Senate Appropriations Committee pursuant to Senate Rule 28.8; therefore, enactment of this bill could result in minor, if any, costs. COMMENTS: Organophosphate and carbamate (OP/CB) pesticides: 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 mimic other illnesses, and 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 to OPs/ CBs. California Medical Supervision Program (Program): The Program was established in 1974 to protect pesticide handlers from 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. AB 2892 Page 5 Reporting requirements: Prior to 2010, the state received very little information from the field to determine whether the Program was effective. However, AB (AB) 1963 (Nava), Chapter 369, Statues 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. AB 1963 also required, by December 31, 2015, DPR and OEHHA 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. DPR and OEHHA submitted the resultant report, "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 take to improve the Program to and improve the utility of the data collected. DPR and OEHHA also made two recommendations that the legislature would need to enact for Program improvement, including that 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. This bill would enact the first recommendation in the report by extending the cholinesterase reporting requirement through January 1, 2021. It also makes additional improvements to the Program, such as requiring OEHHA to register medical supervisors AB 2892 Page 6 so that it can provide better outreach and oversight of participating physicians; and, requiring medical supervisors to report depressions in cholinesterase levels as a pesticide illness so that DPR and the local agricultural commissioner can appropriately track and follow-up on over-exposure cases. Analysis Prepared by: Shannon McKinney / E.S. & T.M. / (916) 319-3965 FN: 0004343