BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                    SB 1090


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          Date of Hearing:  June 28, 2016


                            ASSEMBLY COMMITTEE ON HEALTH


                                   Jim Wood, Chair


          SB  
          1090 (Mitchell) - As Amended June 1, 2016


          SENATE VOTE:  39-0


          SUBJECT:  Sexually transmitted diseases:  outreach and screening  
          services.


          SUMMARY:  Requires the Department of Public Health (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.  Specifically,  
          this bill:  


          1)Requires DPH, to the extent funds are appropriated by the  
            Legislature, to allocate funds to local health jurisdictions  
            for STD outreach and screening services in accordance with the  
            following:

             a)   Requires counties to be targeted and prioritized based  
               on population and incidence of STDs;

             b)   Requires funds to be 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;








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             c)   Requires each recipient county to demonstrate to DPH  
               that the county has done all of the following:



               i)     Identified priority target populations;

               ii)    Satisfactorily described its outreach protocols;



               iii)   Included community-based partners for outreach and  
                 screening; and,



               iv)    Allocated resources for laboratory costs.



             d)   Requires DPH to develop measures for each county to  
               demonstrate accountability.

          2)Requires DPH to authorize innovative and impactful outreach  
            and screening services, including, but not limited to, the  
            following:

             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;











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             c)   State-of-the-art testing modalities that ensure swift  
               and accurate screening for STDs; and,



             d)   Community-based testing and disease investigation.



          3)Requires DPH to monitor activities in funded counties, based  
            on the accountability measures required under 1) d) above in  
            order to assess the effectiveness of outreach and screening  
            efforts.


          4)Prohibits DPH from spending more than 10% of any funds  
            appropriated by the Legislature for administrative costs.


          5)Deletes references in existing law to "venereal disease" and  
            instead uses the term "sexually transmitted diseases," which  
            is defined as diseases that are primarily transmitted through  
            sexual contact.


          EXISTING LAW:   



          1)Requires 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  








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            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.



          FISCAL EFFECT:  According to the Senate Appropriations  
          Committee:



          1)Unknown costs to provide funding to local health jurisdictions  
            (General Fund).  This bill requires DPH to make funding  
            available, upon appropriation by the Legislature, to local  
            health jurisdictions.  The amount of funding available under  
            the bill is unknown at this time and would depend on future  
            budget appropriations.  Staff is not aware of any significant  
            source of funding that could be used for this new program  
            other than the General Fund. 


          2)Unknown costs to provide program administration, including  
            developing program guidelines, reviewing applications,  
            awarding grants, and monitoring accountability requirements on  
            grantees.  If the amount of funding made available in the  
            future were $10 million per year, DPH would be able to spend  
            up to $1 million per year to administer the program.


          COMMENTS:  


          1)PURPOSE OF THIS BILL.  According to the author, this bill is  
            necessary because STDs remain a large and persistent public  
            health challenge for the citizens of our state.  The  
            increasingly large number of cases makes STDs the most  








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            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  
            an STD.  The consequences of inattention are varied, expensive  
            and often permanent.  Not only can an 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)BACKGROUND.  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, the last year for which full data is available,  
            bacterial STDs (chlamydia, gonorrhea, and syphilis)  
            significantly increased over 2013 and even more dramatically  
            for the five year period from 2010 to 2014.  During that time  
            chlamydia rose by 12%, gonorrhea by 68%, and primary and  
            secondary syphilis by 86%.  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  








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            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.  The number of  
            infants born with congenital syphilis nearly doubled for the  
            second consecutive year.



          3)STD CONTROL BRANCH.  According to DPH, the STD Control Branch  
            (STDCB) carries out five core functions to address STD  
            prevention and control:  surveillance; health promotion and  
            education; assessment and assurance of access to quality  
            clinical STD services within the jurisdiction; disease  
            investigation and partner services; and, communication/policy.  
             STDCB has developed a contractual scope of work with local  
            health jurisdictions (LHJs), which includes minimum standards  
            for its core functions.  STDCB 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.  STDCB may, and  
            currently does, subcontract with community based organizations  
            (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 FY  
            2015-16, the number was $3.5 million, and the Governor's  
            budget proposed $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  








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            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.  This bill will help reverse these  
            trends by supporting more robust and systematic health  
            interventions and preventions.





          REGISTERED SUPPORT / OPPOSITION:




          Support


          AIDS Healthcare Foundation (sponsor)


          California Black Health Network


          California Chapter of the American College of Emergency  
          Physicians


          Community Action Fund of Planned Parenthood of Orange and San  
          Bernardino Counties










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          Planned Parenthood Action Fund of Santa Barbara, Ventura & San  
          Luis Obispo Counties


          Planned Parenthood Action Fund of the Pacific Southwest


          Planned Parenthood Advocacy Project Los Angeles County


          Planned Parenthood Advocates Pasadena and San Gabriel Valley


          Planned Parenthood Affiliates of California


          Planned Parenthood Mar Monte


          Planned Parenthood Northern California Action Fund





          Opposition



          None on file.




          Analysis Prepared by:John Gilman / HEALTH / (916)  
          319-2097











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