BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 1090
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|AUTHOR: |Mitchell |
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|VERSION: |February 17, 2016 |
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|HEARING DATE: |April 6, 2016 | | |
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|CONSULTANT: |Melanie Moreno |
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SUBJECT : Sexually transmitted diseases: outreach and screening
services
SUMMARY : Requires the Department of Public Health, to the extent funds
are appropriated by the Legislature for these purposes, to
allocate funds to counties for sexually transmitted disease
outreach and screening services.
Existing law:
1)Requires the Department of Public Health (DPH) to develop and
review plans and provide leadership and consultation for, and
participate in, a program for the prevention and control of
"venereal disease." Defines "venereal disease" as syphilis,
gonorrhea, chancroid, lymphopathia venereum, granuloma
inguinale, and chlamydia.
2)Permits DPH to establish, maintain, and subsidize clinics,
dispensaries, and prophylactic stations for the diagnosis,
treatment, and prevention of venereal disease. Permits DPH to
provide medical, advisory, financial, or other assistance to
the clinics, dispensaries, and stations.
3)Permits DPH to furnish treatment for a case or for a group of
cases in rural counties or cities upon the recommendation of
the local health officer if adequate facilities for the
treatment are not available in the county or city.
This bill:
1)Requires DPH, to the extent funds are appropriated by the
Legislature for these purposes, to allocate funds to counties
for sexually transmitted disease (STD) outreach and screening
services as follows:
SB 1090 (Mitchell) Page 2 of ?
a) Counties are targeted and prioritized based on
population and incidence of STDs;
b) Funds are allocated to targeted counties in a
manner that balances the need to spread funding to as
many counties as possible and the need to provide
meaningful services to each funded county; and,
c) Each recipient county demonstrates that it
has: identified priority target populations;
satisfactorily described its outreach protocols;
included community-based partners for outreach and
screening; and, allocated resources for laboratory
costs.
2)Requires DPH to develop measures for each county funded to
demonstrate accountability. Requires DPH to monitor activities
in funded counties, based on the accountability measures
required in order to assess the effectiveness of outreach and
screening efforts.
3)Permits DPH, if a county declines the grant, to solicit
proposals from community-based organizations to provide
outreach and screening services in accordance with the same
mandates and accountability measures applicable to the
counties pursuant to 1) above.
4)Requires DPH to authorize innovative and impactful outreach
and screening services, including, but not limited to:
a) Voluntary screening for STDs among inmates and
wards of county adult and juvenile correctional
facilities;
b) Social media platforms that allow a person to
receive test results, share test results with
partners, access treatment services and reduce
administrative costs;
c) State-of-the-art testing modalities that
ensure swift and accurate screening for STDs; and,
d) Community-based testing and disease
investigation.
FISCAL EFFECT :
This bill has not been analyzed by a fiscal committee.
COMMENTS :
1)Author's statement. According to the author, STDs remain a
large and persistent public health challenge for the citizens
SB 1090 (Mitchell) Page 3 of ?
of our state. The increasingly large number of cases makes
STDs the most commonly reported communicable disease in
California. Exacerbating the problem is the fact that because
STDs are often asymptomatic, the burden of the disease is far
greater than the number of reported cases. It is astonishing
that infections that have been easily preventable and
treatable for decades are on the rise in dramatic fashion. We
can reverse this deplorable situation through more robust and
systematic prevention and health interventions. There is a
serious lack of funds directed at this epidemic. However,
there is also insufficient statutory direction to DPH in terms
of addressing priorities and defining and implementing
innovative mechanisms for engaging people who are at greatest
risk for exposure to a STD. The consequences of inattention
are varied, expensive and often permanent. Not only can a STD
lead to infection with HIV, it can lead to infertility, heart
and kidney disease and complicated pregnancies. Inadequate
attention perpetuates a growing epidemic with increasing costs
to society. It is essential that every dollar be spent in
ways that have the greatest impact.
2)California data. According to DPH, California ranked first
among all states in 2014 for the total number of cases for
chlamydia, gonorrhea, syphilis, and congenital syphilis. In
2014, bacterial STDs (chlamydia, gonorrhea, and syphilis)
significantly increased. Important disparities persist, with
the highest rates found among young people, African-Americans,
and gay and bisexual men. Chlamydia remains the most common
reportable disease in California. The highest rates were among
young women. Rates among African-American teens and young
adult women were the highest of any group, and three to five
times higher than white young women. Gonorrhea rates continued
to increase sharply across all regions of the state. San
Francisco, Shasta, and Kern Counties had the highest rates.
Racial disparities persisted with rates among
African-Americans six times higher than among whites. Early
syphilis cases continued to increase across all regions of
California, with the vast majority of cases among men who have
sex with men. However, the number of cases among females of
reproductive age increased by 56% from 2013. Racial
disparities continued with African-American male rates being
twice as high as among white males.
3)DPH's STD Control Branch. California statute refers to
"venereal disease" and "sexually transmitted diseases" for
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purposes of the work that the STD Control Branch conducts.
According to DPH, the STD Control Branch carries out five core
functions to address STD prevention and control in California:
surveillance, health promotion and education, assessment and
assurance of access to and quality of clinical STD services
within the jurisdiction, disease investigation and partner
services, and communication/policy. The STD Control Branch
has developed a contractual scope of work with local health
jurisdictions (LHJs), which includes minimum standards for its
core functions. The STD Control Branch currently has contracts
with 27 counties and one city health jurisdiction (28 of 61
California LHJs); funds are distributed among LHJs according
to a data-driven funding allocation formula. The STD Control
Branch may, and currently does, subcontract with CBOs. The
LHJ contract process allows for funding of CBOs through a
subcontract. The funding is earmarked to support a
comprehensive scope of work, including STD surveillance and
case reporting (which are legally mandated activities of
LHJs). Funding for local assistance through this program has
remained fairly consistent over the past three years. In
fiscal year (FY) 2014-15, DPH distributed $3.2 million (state
and federal funds) to locals for STD control activities, in
2015-16, the number was $3.5 million, and the Governor's
budget proposes $3.3 million for FY 2016-17.
4)Support. The AIDS Healthcare Foundation (AHF) writes that the
lack of resources to address the continuing epidemic of STD
infection is profoundly troubling and that the consequences of
inattention are varied, expensive, and often permanent. AHF
states that from the larger public health perspective,
inattention also perpetuates a growing epidemic with
increasing costs to society. Other supporters write that the
increasingly large number of cases makes STDs the most
commonly reported communicable disease in California, and it
is unacceptable that a bacterial infection that has been
easily preventable and treatable for decades is on the rise in
such dramatic fashion. SB 1090 will help reverse these trends
by supporting more robust and systematic health interventions
and preventions.
5)Policy comments.
a) LHJ authority. This bill permits DPH to solicit
proposals from CBOs if a county declines a grant. While
this bill is limited to funding for outreach and
screening, surveillance and surveillance-based disease
SB 1090 (Mitchell) Page 5 of ?
intervention is a legally mandated function of LHJs.
There are also important aspects of local government
authority to set policy that a CBO would not be able to
fulfill, and a CBO would not be able to take on the
authority of a LHJ to conduct surveillance. The author
may wish to clarify that any funding provided to a CBO
under this bill may supplement, but does not supplant the
authority of a LHJ.
b) Outdated statute. The statute that authorizes the
STD Control Branch's work is Health and Safety Code (HSC)
Sections 120500 - 120605, and refers to "venereal
disease," which is an outdated term. The current
nomenclature is "sexually transmitted diseases" or
"sexually transmitted infections." Additionally, the STDs
that are the focus of state and local efforts go beyond
the diseases listed in current statute. The current key
focus of DPH's work is on controlling syphilis,
gonorrhea, and chlamydia. However, DPH's focus has
changed over the years and may change in the future.
Therefore, all references to specific diseases should be
removed from statute. The author may wish to amend this
bill to update existing statute to define STDs more
broadly, such as: "Sexually transmitted diseases are
defined as diseases that are primarily transmitted
through sexual contact."
Current statute (HSC 120520) also provides DPH with
authority to "establish, maintain, and subsidize clinics,
dispensaries, and prophylactic stations for the
diagnosis, treatment, and prevention of venereal
diseases, and may provide medical, advisory, financial,
or other assistance to the clinics, dispensaries, and
stations as may be approved by it." According to DPH,
this language is outdated and refers to a time when
specialized clinics were established by the DPH and LHJs.
DPH no longer directly supports clinics, which are
operated exclusively by LHJs. Additionally, only a small
number of LHJs operate clinics focused solely on STDs;
only 6 of the 11 highest morbidity LHJs have STD clinics.
In line with the intent of this bill and the assistance
DPH does provide to locals, the author may wish to update
current statute to read: "The department may provide
medical, advisory, financial, or other assistance to
organizations as may be approved by it."
c) LHJs vs. counties. This bill requires DPH to
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allocate funding to counties for STD outreach and
screening. However, the public health system in
California at the local level consists of 61 LHJs (58
county health departments and three city health
departments). The author may wish to amend this bill
refer to LHJs rather than counties.
SUPPORT AND OPPOSITION :
Support: AIDS Healthcare Foundation (sponsor)
American Federation of State, County and Municipal
Employees, AFL-CIO
Planned Parenthood Action Fund of Santa Barbara,
Ventura & San Louis Obispo Counties
Planned Parenthood Advocates Pasadena and San Gabriel
Valley
Planned Parenthood Mar Monte
Oppose: None received.
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