BILL ANALYSIS Ó SB 361 Page 1 Date of Hearing: August 19, 2015 ASSEMBLY COMMITTEE ON APPROPRIATIONS Jimmy Gomez, Chair SB 361 (Hill) - As Amended August 17, 2015 ----------------------------------------------------------------- |Policy |Health |Vote:|19 - 0 | |Committee: | | | | | | | | | | | | | | |-------------+-------------------------------+-----+-------------| | | | | | | | | | | | | | | | |-------------+-------------------------------+-----+-------------| | | | | | | | | | | | | | | | ----------------------------------------------------------------- Urgency: Yes State Mandated Local Program: YesReimbursable: No SUMMARY: This bill, an urgency measure, contains two requirements intended to combat antimicrobial resistance. Specifically, this bill: SB 361 Page 2 1)Requires skilled nursing facilities (SNFs) to, by January 2017, adopt and implement antimicrobial stewardship policies; requires compliance with related federal guidelines, and allows for state citations for non-compliance. 2)Requires a veterinarian who receives a license after January 1, 2018 to complete an approved course on the judicious use of antibiotics every four years as part of existing continuing education (CE) requirements. FISCAL EFFECT: 1)Minor and absorbable costs to the Licensing and Certification division of the California Department of Public Health (CDPH) to verify SNF compliance with the new antimicrobial stewardship policy requirement during the course of routine inspections or on a complaint basis (Licensing and Certification Fund). 2)Minor and absorbable costs to the Veterinary Medical Board to approve required courses and verify compliance with the new CE requirement (Veterinary Medical Board Fund). 3)Potential unknown, likely minor information technology costs to both departments for system modifications to capture the new requirements (Licensing and Certification Fund /Veterinary Medical Board Contingent Fund). COMMENTS: SB 361 Page 3 1)Purpose. The author indicates the overuse and misuse of antibiotics in medicine is a significant factor driving the development of antibiotic resistance, a growing public health threat. This bill intends to ensure best practices in the use of human and animal antibiotic administration to encourage judicious use. 2)Antimicrobial Stewardship. Antibiotics are credited with significantly reducing morbidity and mortality associated with bacterial infections. Unfortunately, widespread use of antibiotics has led to antibiotic resistance, which, according to the World Health Organization (WHO), is an increasingly serious threat to global public health. The WHO indicates evolution of drug-resistant strains is a natural phenomenon, but the use and misuse of antibiotics accelerates their emergence. Drug-resistant infections are often difficult to treat and can be deadly. The Centers for Disease Control and Prevention (CDC) indicates at least 2 million people become infected with resistant bacteria nationwide, and at least 23,000 people die as a direct result of these infections, each year. Antibiotic stewardship programs are designed to promote and measure the appropriate use of antibiotics in a facility, and are recommended by WHO, CDC, and DPH. DPH provides technical assistance to hospitals and other facilities to implement local antimicrobial stewardship programs as part of their Healthcare Acquired Infections program, and collects data on these programs that are submitted on a voluntary basis. 3)Current Related Legislation. SB 27 (Hill) restrict the use of medically important antimicrobial drugs in livestock, require a veterinarian's prescription or feed directive for use, eliminate the over-the-counter availability of these drugs, require the California Department of Food and Agriculture (CDFA) to develop a program to track antimicrobial drug use in livestock and the emergence of antimicrobial-resistant bacteria, and require CDFA to adopt judicious use and SB 361 Page 4 antimicrobial stewardship guidelines. 4)Prior Related Legislation. SB 1311 (Hill), Chapter 843, Statutes of 2014, requires all general acute-care hospitals to adopt and implement an antimicrobial stewardship policy that includes a process to evaluate the judicious use of antibiotics. Analysis Prepared by:Lisa Murawski / APPR. / (916) 319-2081