BILL ANALYSIS Ó
AB 2892
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CONCURRENCE IN SENATE AMENDMENTS
AB
2892 (Committee on Environmental Safety and Toxic Materials)
As Amended August 8, 2016
Majority vote
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|ASSEMBLY: |78-1 |(June 1, 2016) |SENATE: |38-0 |(August 15, |
| | | | | |2016) |
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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.
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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.
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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
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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.
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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
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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