BILL ANALYSIS Ó
SB 1090
Page 1
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;
SB 1090
Page 2
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;
SB 1090
Page 3
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
SB 1090
Page 4
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
SB 1090
Page 5
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
SB 1090
Page 6
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
SB 1090
Page 7
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
SB 1090
Page 8
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
SB 1090
Page 9