BILL ANALYSIS Ó
SB 361
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SENATE THIRD READING
SB
361 (Hill)
As Amended August 17, 2015
2/3 vote. Urgency
SENATE VOTE: 35-0
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|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 | |
SB 361
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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 | |
| | | | |
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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:
0001534