BILL ANALYSIS                                                                                                                                                                                                    Ó




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                                UNFINISHED BUSINESS 


          Bill No:  SB 877
          Author:   Pan (D), et al.
          Amended:  8/18/16  
          Vote:     21 

           SENATE HEALTH COMMITTEE:  7-2, 4/13/16
           AYES:  Hernandez, Hall, Mitchell, Monning, Pan, Roth, Wolk
           NOES:  Nguyen, Nielsen

           SENATE APPROPRIATIONS COMMITTEE:  5-2, 5/27/16
           AYES:  Lara, Beall, Hill, McGuire, Mendoza
           NOES:  Bates, Nielsen

           SENATE FLOOR:  28-6, 6/1/16
           AYES:  Allen, Beall, Block, Cannella, De León, Galgiani,  
            Glazer, Hall, Hancock, Hernandez, Hertzberg, Hill, Hueso,  
            Jackson, Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell,  
            Monning, Moorlach, Nguyen, Pan, Roth, Wieckowski, Wolk
           NOES:  Bates, Berryhill, Fuller, Huff, Nielsen, Vidak
           NO VOTE RECORDED:  Anderson, Gaines, Morrell, Pavley, Runner,  
            Stone

           ASSEMBLY FLOOR:  63-15, 8/23/16 - See last page for vote

           SUBJECT:   Reporting and tracking of violent deaths


          SOURCE:    American Federation of State, County, and Municipal  
          Employees
                     Union of American Physicians and Dentist
          
          DIGEST: This bill requires the State Department of Public Health  
          (DPH) to establish and maintain the California Electronic  
          Violent Death Reporting System (CalEVDRS) and to collect data on  
          violent deaths, as specified.








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          Assembly Amendments (1) require DPH to post a summary and  
          analysis of the collected data on their Web site; (2) permit law  
          enforcement agencies, to the extent that funding is available,  
          to report to DPH data on the circumstances surrounding all  
          violent deaths from investigative reports and, if available,  
          laboratory toxicology reports to be used by DPH for the limited  
          purpose of conducting public health surveillance and  
          epidemiology. Require aggregate data to be public, but  
          individual identifying information to remain confidential.  
          Require the collected data to be based on the data elements of  
          the National Violent Death Reporting System (NVDRS) of the  
          federal Centers for Disease Control and Prevention (CDC); (3)  
          define "violent death" as a death resulting from the use of  
          physical force or power against oneself, another person, or a  
          group or community, and include, but is not limited to,  
          homicide, suicide, legal intervention deaths, unintentional  
          firearm deaths, and undetermined intent deaths; (4) require DPH  
          to enter into a contract, grant or other agreement with local  
          agencies, rather than counties, to collect the data.  Permit DPH  
          to enter into such an agreement with a local agency to collect  
          the data from other local agencies if specified conditions are  
          met; (5) require the data collected to be limited to data that  
          local agencies are authorized to collect within their respective  
          jurisdictions; and (6) require local agencies entering into an  
          agreement to collect data based on existing or new data elements  
          required by CalEVDRS only to the extent that resources are made  
          available.


          ANALYSIS: 


          Existing law: 


          1)Establishes DPH, which is responsible for various programs  
            relating to the health and safety of people in the state,  
            including licensing health facilities, regulating food and  
            drug safety, and monitoring and preventing communicable and  
            chronic diseases. 








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          2)Requires DPH to maintain birth, death, fetal death, still  
            birth, marriage and divorce records. 


          This bill:


          1)Requires DPH to establish and maintain the CalEVDRS and to  
            collect data on violent deaths, as defined and as reported  
            from data sources, including, but not limited to, death  
            certificates, law enforcement reports, and coroner or medical  
            examiner reports. Requires DPH to contract with local agencies  
            to collect this data. Permits DPH to enter into such an  
            agreement with a local agency to collect the data from other  
            local agencies if specified conditions are met. 


          2)Permits law enforcement agencies, to the extent that funding  
            is available, to report to DPH data on the circumstances  
            surrounding all violent deaths from investigative reports and,  
            if available, laboratory toxicology reports to be used by DPH  
            for the limited purpose of conducting public health  
            surveillance and epidemiology. Requires aggregate data to be  
            public, but individual identifying information to remain  
            confidential. Requires the collected data to be based on the  
            data elements of the NVDRS.


          3)Requires the data collected to be limited to data that local  
            agencies are authorized to collect within their respective  
            jurisdictions.


          4)Requires local agencies entering into an agreement to collect  
            data based on existing or new data elements required by  
            CalEVDRS only to the extent that resources are made available.


          5)Permits DPH to apply for grants provided under NVDRS and to  
            accept private or foundation moneys to implement this bill. 








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          6)Specifies that this bill does not limit data sources that DPH  
            is permitted to collect, which may include any public agency  
            document that may contain data on violent deaths.


          Background


          According to the CDC, violence is a public health problem that  
          affects individuals, families, and communities throughout the  
          US.  More than 56,000 Americans died because of homicide or  
          suicide in 2011, and violent deaths cost the U.S. an estimated  
          $107 billion in medical care and lost productivity every year.   
          According to the CDC, violence can be prevented, and accurate  
          information about it is key to directing, designing,  
          implementing, and evaluating prevention efforts.


          1)NVDRS.  According to the CDC, NVDRS is a state-based  
            surveillance system that, since 2002, links data from law  
            enforcement, coroners and medical examiners, vital statistics,  
            and crime laboratories to assist each participating state in  
            designing and implementing tailored prevention and  
            intervention efforts. NVDRS provides data on violence trends  
            at national and regional levels; each state can access all of  
            these important data elements from one central database.  
            States that are funded for NVDRS operate under a cooperative  
            agreement with CDC to whom all violent deaths are voluntarily  
            reported. NVDRS funded six states initially, and in 2014 the  
            CDC received funding to expand the system to a total of 32  
            states, illustrated in the map below:





            According to the CDC, the goal is to eventually include all 50  
            states, all U.S. territories, and the District of Columbia in  
            the system.  Descriptive data can be accessed free of charge  
            from a Web-based system, which goes beyond providing basic  








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            information, such as race, sex, and age, and also provides  
            comprehensive details on circumstances surrounding the violent  
            death. More detailed data from the NVDRS Restricted Access  
            Database (RAD) is available by request for users meeting  
            certain eligibility criteria. The NVDRS RAD is available for  
            public health research via a data sharing agreement that  
            places restrictions on how, when, and by whom the data may be  
            used.


          2)CalEVDRS.  According to DPH, from 2005 through 2010,  
            California was one of 17 states participating in NVDRS. Under  
            NVDRS, DPH contracted with county health departments to  
            collect data on violent deaths from four data sources - death  
            certificates, coroner/medical examiner records, law  
            enforcement reports, and crime laboratory records. During its  
            four years of data collection, the DPH compiled detailed  
            information on circumstances of more than 11,000 violent  
            deaths, including homicides and suicides in Alameda, Kern, Los  
            Angeles, Monterey, Riverside, Sacramento, San Francisco, San  
            Joaquin, San Mateo, Santa Clara, Shasta Solano, Stanislaus and  
            Yolo counties, which encompassed approximately 57% of the  
            state's total suicides and two-thirds of all homicides at the  
            time. According to DPH, due to its size, decentralized  
            government, privacy concerns and lack of resources among law  
            enforcement agencies, California was unable to obtain law  
            enforcement and crime lab records required by NVDRS and could  
            not reapply for funding.  However, DPH realized this  
            incompatibility early on in the NVDRS grant and, in its  
            commitment to expand the program statewide, secured funding to  
            develop CalEVDRS. CalEVDRS took advantage of California's  
            Electronic Death Registration System (CA-EDRS), which permits  
            counties to file death certificates. Using funds from the  
            David and Lucile Packard Foundation, DPH created a violent  
            death supplement to death certificates in CA-EDRS, which  
            captures information from coroners on violent death. To ensure  
            a smooth transition from NVDRS, CalEVDRS data elements were  
            created according to NVDRS specifications. The California  
            Wellness Foundation provided additional funding to reimburse  
            coroners for completing this supplement. Because detailed data  
            were not available from law enforcement, summary homicide data  
            from the California Department of Justice's Supplementary  








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            Homicide Reports were linked to provide as much information as  
            possible. Once funding was ended, resources and staffing to  
            support local data collection and manage the state level  
            program were lost. According to DPH, only Los Angeles County  
            has been able to continue to participate in Cal-EVDRS  
            consistently across time.


          3)Future NVDRS funding. DPH applied for the NVDRS funds in 2014  
            and although it had a passing score, DPH did not receive  
            funding because CDC did not have enough funding to support all  
            passing scores. CDC has issued a new Funding Opportunity  
            Announcement for which DPH intends to apply. The CDC  
            requirements have been substantively changed to make large  
            states more competitive (i.e., phasing in more cases over  
            time; not all 6,000 California violent deaths per year have to  
            be included), so California is likely to be competitive. 


          Comments


          Author's statement.  According to the author, "violence is a  
          threat to public health and proper data could be used to prevent  
          violent deaths. In 1975 a national database tracking detailed  
          information on car deaths in the nation helped decrease and  
          prevent car fatalities. The data did not get rid of cars but  
          made them safer. SB 877 will do the same thing. Re-creating  
          CalEVDRS allows us to do research on how we can best prevent  
          violent deaths. It shows us what is working and what is not. We  
          cannot prevent these types of deaths if we do not understand  
          what is driving them. SB 877 lets us make smarter decisions so  
          we can prevent violence."


          FISCAL EFFECT:   Appropriation:    No          Fiscal  
          Com.:YesLocal:   No

          According to the Assembly Appropriations Committee, DPH received  
          a tentative award of funding on July 13, 2016 through the CDC in  
          order to resume participation in the NVDRS.  The actual funding  
          amount is not able to be released until the award is official.   








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          Assuming funds are appropriated or available through private  
          sources:


          1)Ongoing costs of $460,000 per year for staff to oversee  
            contracts with counties and law enforcement organizations,  
            analyze data, and prepare reports (General Fund (GF or  
            potentially federal/private funds, if available). 


          2)Ongoing costs of $300,000 for payments to counties and law  
            enforcement agencies to reimburse counties and law enforcement  
            agencies who would provide information to DPH for entry into  
            the tracking system (GF or potentially federal/private funds,  
            if available).  Previously, DPH provided reimbursement to  
            local government agencies to reimburse them for the time  
            needed to provide information to DPH.


          3)DPH has an existing database that was used for such reporting  
            - however, to the extent reinstating the program requires any  
            upgrade, expansion, or ongoing maintenance of CalEVDRS, there  
            could be unknown, likely minor information technology costs  
            (GF or potentially federal/private funds, if available).




          SUPPORT:  (Verified  8/23/16)


          American Federation of State, County, and Municipal Employees  
          (co-source)
          Union of American Physicians and Dentist (co-source)
          American Academy of Pediatrics, California
          American Foundation for Suicide Prevention Center
          California Academy of Family Physician
          Child Abuse Prevention Center
          Health Officers Association of California
          National Alliance on Mental Illness
          National Association of Social Workers
          Physicians for Social Responsibility








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          Physicians for Social Responsibility, San Francisco


          OPPOSITION:   (Verified8/23/16)


          None received

          ARGUMENTS IN SUPPORT:  The Union of American Physicians and  
          Dentists and the American Federation of State, County, and  
          Municipal Employees, write that this bill will help better  
          understand the circumstances and risk factors that lead to  
          violent deaths in California through the use of innovative,  
          efficient data collection from the richest data sources on  
          violent deaths.  The American Academy of Pediatrics, California  
          states that in order to address this highly preventable public  
          health crisis, it is essential to understand the personal,  
          familial, and community conditions and behaviors that contribute  
          to violent childhood death.  The American Foundation for Suicide  
          Prevention Center writes that to design effective violence  
          prevention strategies, an essential first step is to ensure the  
          availability of complete, accurate and timely information,  
          particularly with regard to populations at risk and the  
          circumstances and predisposing factors that contribute to deaths  
          from violence, and that by linking this data, CalEVDRS can  
          reveal new insights into the prevention of violent deaths,  
          insights that can be used by state public health officials to  
          better target their prevention activities. Physicians for Social  
          Responsibility writes that California claims to be a national  
          leader in violence prevention, and in order to make that claim,  
          it is imperative that the state collect complete data on the  
          circumstances of violent deaths and share that data with NVDRS.  
          The National Association of Social Workers writes that "we  
          cannot prevent violent deaths if we do not understand what is  
          driving them."

           ASSEMBLY FLOOR:  63-15, 8/23/16
           AYES: Achadjian, Alejo, Arambula, Atkins, Baker, Bloom,  
            Bonilla, Bonta, Brown, Burke, Calderon, Campos, Chang, Chau,  
            Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Daly, Dodd,  
            Eggman, Frazier, Cristina Garcia, Eduardo Garcia, Gatto,  
            Gipson, Gomez, Gonzalez, Gordon, Gray, Roger Hernández,  








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            Holden, Irwin, Jones-Sawyer, Lackey, Levine, Linder, Lopez,  
            Low, Maienschein, McCarty, Medina, Mullin, Nazarian,  
            Obernolte, O'Donnell, Olsen, Quirk, Ridley-Thomas, Rodriguez,  
            Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting,  
            Waldron, Weber, Williams, Wood, Rendon
           NOES: Travis Allen, Bigelow, Brough, Dahle, Beth Gaines,  
            Gallagher, Grove, Harper, Jones, Mathis, Mayes, Melendez,  
            Patterson, Wagner, Wilk
           NO VOTE RECORDED: Hadley, Kim




          Prepared by:Melanie Moreno / HEALTH / (916) 651-4111
          8/23/16 20:14:27


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