BILL ANALYSIS                                                                                                                                                                                                    Ó

                                                                     SB 361

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          361 (Hill)

          As Amended  August 17, 2015

          2/3 vote.  Urgency

          SENATE VOTE:  35-0

          |Committee       |Votes|Ayes                  |Noes                |
          |                |     |                      |                    |
          |                |     |                      |                    |
          |                |     |                      |                    |
          |Health          |19-0 |Bonta, Maienschein,   |                    |
          |                |     |Bonilla, Burke,       |                    |
          |                |     |Chávez, Chiu, Gomez,  |                    |
          |                |     |Gonzalez, Roger       |                    |
          |                |     |Hernández, Lackey,    |                    |
          |                |     |Nazarian, Patterson,  |                    |
          |                |     |Ridley-Thomas,        |                    |
          |                |     |Rodriguez, Santiago,  |                    |
          |                |     |Steinorth, Thurmond,  |                    |
          |                |     |Waldron, Wood         |                    |
          |                |     |                      |                    |
          |Business &      |13-0 |Bonilla, Jones,       |                    |
          |Professions     |     |Baker, Burke, Campos, |                    |
          |                |     |Chang, Dodd, Eggman,  |                    |
          |                |     |Gatto, Mullin, Ting,  |                    |
          |                |     |Wilk, Wood            |                    |


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          |                |     |                      |                    |
          |                |     |                      |                    |
          |Appropriations  |17-0 |Gomez, Bigelow,       |                    |
          |                |     |Bloom, Bonta,         |                    |
          |                |     |Calderon, Chang,      |                    |
          |                |     |Daly, Eggman,         |                    |
          |                |     |Gallagher, Eduardo    |                    |
          |                |     |Garcia, Holden,       |                    |
          |                |     |Jones, Quirk, Rendon, |                    |
          |                |     |Wagner, Weber, Wood   |                    |
          |                |     |                      |                    |

          SUMMARY:  Requires, on or after January 1, 2018, a licensed  
          veterinarian who renews his or her license to complete a minimum  
          of one credit hour of continuing education on the use of  
          medically important antimicrobial drugs every four years.   
          Requires skilled nursing facilities (SNFs) to adopt and  
          implement an antimicrobial stewardship policy (ASP) by January  
          1, 2017, as specified.  Requires SNFs to update their ASPs to be  
          consistent with new guidelines established by the federal  
          Centers for Disease Control and Prevention (CDC) or other  
          professional organizations within three months of the  
          publication of such new guidelines.  Contains an urgency clause  
          to ensure that the provisions of this bill go into immediate  
          effect upon enactment.  

          FISCAL EFFECT:  According to the Assembly Appropriations  
          Committee, this bill would have minor and absorbable costs to  
          the Licensing and Certification (L&C) division of the Department  
          of Public Health (DPH) to verify SNF compliance with the new ASP  
          requirement during the course of routine inspections or on a  
          complaint basis (L&C Fund).  In addition, this bill would have  
          minor and absorbable costs to the Veterinary Medical Board (VMB)  
          to approve required courses and verify compliance with the new  
          continuing education requirement (VMB Fund).  Finally, the  


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          Assembly Appropriations Committee states there would be  
          potential unknown, likely minor information technology costs to  
          both departments for system modifications to capture the new  
          requirements (L&C Fund /VMB Contingent Fund).  

          COMMENTS:  According to the author, the overuse and misuse of  
          antibiotics in nursing homes can lead to the development of  
          antibiotic resistant infections, which is a national and  
          worldwide public health threat.  The author points to reports by  
          the CDC which state that at least two million Americans are  
          infected with antibiotic resistant infections annually, and are  
          the cause of death to approximately 23,000 people each year.   
          These reports also maintain that up to 50% of all antibiotics  
          prescribed for patients are unnecessary or are not optimally  
          effective as prescribed.  The author contends that 70% of  
          nursing home residents throughout the nation receive an  
          antibiotic each year, and that 27,000 residents acquire  
          antibiotic resistant infections, referring to research which  
          suggests that 25% to 75% of antibiotic use in long-term care  
          settings may be inappropriate and may contribute to the  
          prevalence of antibiotic resistance.  The author concludes that  
          ASPs are an effective way to promote judicious antibiotic use  
          and reduce antibiotic resistance, and that this bill is  
          necessary to alleviate a deficiency in existing law by extending  
          these programs to SNFs.

          California is the first, and remains the only state, to enact an  
          antimicrobial stewardship program.  DPH states the major  
          objectives of antimicrobial stewardship are to optimize clinical  
          outcomes for patients while minimizing toxicity and other  
          adverse events associated with antimicrobial use.  Since 2008,  
          California has required general acute care hospitals to develop  
          a process for monitoring the judicious use of antibiotics, and  
          has mandated that the results are monitored by quality  
          improvement committees.  Studies have shown that ASPs are  
          particularly active in community settings.  DPH currently offers  
          an ASP toolkit to the public, to provide hospital leadership and  


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          support staff with guidelines, resources, and practical examples  
          of how best to implement ASP practices.

          Existing California law requires the Veterinary Medical Board to  
          only renew licenses to practicing veterinarians who have  
          completed a minimum of 36 hours of continuing education in the  
          previous two years.  Current statute does not explicitly require  
          any hours of continuing education to be on the subject of the  
          use of antimicrobial drugs.

          The Health Officers Association of California supported a  
          previous version of this bill stating it is imperative for SNFs  
          to adopt policies that reduce the consequences of antibiotic  
          resistance because residents are often elderly or disabled  
          patients with underlying health conditions that make them more  
          vulnerable to contracting disease.  Blue Shield of California  
          also supported a previous version of this bill, contending that  
          it has been well documented by the CDC that antibiotics are  
          grossly overused in nursing homes and can lead to the  
          development of antibiotic resistant infections.  Blue Shield  
          also stated antibiotic resistant infections add considerable and  
          avoidable costs to the already overburdened healthcare system,  
          as these infections require prolonged and costlier treatments.   
          The California Optometric Association and CALPIRG supported a  
          previous version of this bill, stating that each year at least  
          two million Americans are infected with - and at least 23,000  
          Americans die from - antibiotic resistant infections.  The  
          California Long-Term Care Ombudsman Association also supported a  
          previous version of this bill, asserting that the current  
          practice of giving SNF residents antimicrobial medications prior  
          to confirmation or test results recommending such medications  
          puts residents at risk.

          There is no known opposition to this bill.


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          Analysis Prepared by:                                             
                          An-Chi Tsou / HEALTH / (916) 319-2097  FN: