BILL ANALYSIS
AB 2317
Page 1
ASSEMBLY THIRD READING
AB 2317 (Koretz)
As Amended May 26, 2006
Majority vote
HEALTH 11-1 APPROPRIATIONS
(vote not available)
-----------------------------------------------------------------
|Ayes:|Chan, Berg, Cohn, | | |
| |Dymally, Frommer, Jones, | | |
| |Lieu, Montanez, | | |
| |Nakanishi, Negrete | | |
| |McLeod, | | |
| |Ridley-Thomas | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Strickland | | |
| | | | |
-----------------------------------------------------------------
SUMMARY : Requires the Department of Health Services (DHS) to
conduct the Perinatal
Mood and Anxiety Disorders (PMAD) Community Awareness Campaign
(Campaign), as specified. Specifically, this bill :
1)Makes a number of findings and declarations regarding PMAD,
the number of women affected by it, and the lack of
information, screening, and treatment for the disorder.
2)Requires DHS to conduct the PMAD Campaign to:
a) Provide awareness, assistance, and information regarding
PMAD using television, print media, radio, Internet Web
sites, outdoor advertising, and other media where
appropriate, to disseminate information to pregnant women
and new mothers regarding the availability of services and
treatment for PMAD, which may include medication,
professional therapy and counseling, support groups, and
telephone crisis hotlines;
b) Establish an Internet Web site devoted to providing
information about the symptoms and treatment of PMAD that
is accessible to the general public; and,
AB 2317
Page 2
c) Undertake public education activities related to PMAD,
as appropriate.
3)Requires DHS to convene a work group to develop
recommendations on the most efficient and effective ways to
raise public awareness of the symptoms, warning signs, and
treatment of PMAD.
4)Requires the workgroup to be responsible for securing private
contributions to fund the campaign and permits it to include a
survivor of PMAD and members from the California Medical
Association (CMA), the American College of Obstetrics and
Gynecology (ACOG), the California Psychiatric Association,
Postpartum Support International (PSI), the California
Hospital Association (CHA), the California Psychological
Association, the California Nurses Association (CNA), the
California Association for Nurse Practitioners (CANP), and the
California Nurse Midwives Association.
5)Permits DHS to use nonpublic sources of funding to support the
activities of the workgroup and to fund the PMAD Campaign.
6)Requires the work group, by January 1, 2008, to prepare and
submit to DHS its recommendations relating to the PMAD
Campaign.
7)Requires voluntary contributions received for the purposes of
this bill to be deposited into the Community Postpartum
Anxiety and Mood Disorders Awareness Campaign Fund, which is
created under this bill in the State Treasury. Continuously
appropriates monies from the fund to DHS to implement this
bill.
8)Requires this bill to be implemented only after the Department
of Finance (DOF) determines that nonstate funds in an amount
sufficient to fully support PMAD Campaign activities have been
deposited. Requires the PMAD Campaign to continue to be
implemented thereafter only to the extent that DOF determines
that sufficient nonstate funds to fully support its activities
have been deposited for those purposes.
9)Requires DOF, if it determines that insufficient voluntary
contributions have been deposited by January 1, 2008, to
notify either the Chief Clerk of the Assembly or the Secretary
AB 2317
Page 3
of the Senate of this fact, in which case, the Campaign
remains in effect only until January 1, 2008, and unless there
is a later enacted statute that deletes or extends that date,
the statute is repealed.
EXISTING LAW requires DHS to:
1)Maintain a program of maternal and child health, including
pregnancy testing, perinatal health care, and nutrition.
2)Develop and provide information regarding a variety of
diseases and health care issues, including gynecological
cancers, breast cancer, hepatitis C, Lyme disease,
reproductive health, children's health, drug overdose,
HIV/AIDS, nutrition, and oral health.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, annual on-going cost pressure, likely in the hundreds
of thousands to millions of dollars annually, depending upon the
scope of the PMAD Campaign. This bill is operative only to the
extent nonstate funding is made available to fully support the
activities of the bill, so the amount of funding would depend
upon funds received.
COMMENTS : According to the author, no laws in California
currently exist in regards to postpartum depression information,
treatment or resources. Additionally, despite the high
statistics of occurrence, the state has not created a uniform
standard of care. There is a significant need for women and
families to be educated and made aware of the statistics and
symptoms related to PMAD as well as the treatment and support
options available. In raising the level of awareness, we can
reduce the stigma associated with PMAD, which prevents most
women from seeking adequate care.
PMAD affects childbearing women and takes many forms, including
depression, anxiety, panic disorder, obsessive-compulsive
disorder, and psychosis. Postpartum depression, which differs
from the "baby blues," affects approximately 10% of new mothers
and usually occurs within days of the delivery but could take
weeks to appear. Symptoms include sluggishness, fatigue or
exhaustion, feelings of hopelessness, appetite and/or sleep
disturbances, confusion, and lack of interest in the baby.
Postpartum depression can sometimes develop into psychosis
AB 2317
Page 4
following a traumatic event and often characterized by
hallucinations and/or delusions. Estimates of the prevalence of
psychotic episodes are one to two in every 1,000 deliveries.
The medical community does not fully understand all factors
contributing to PMAD, but it is commonly thought that it is
caused by physiological factors, such as hormone levels, and can
be exacerbated by external risk factors such as marital
problems, sleep deprivation, and pre-existing mental illness.
Women who have a prior postpartum mood episode and those who
have a history of mood disorders outside of pregnancy are at
higher risk of having a PMAD with psychotic features.
Many physicians contend that screening, diagnosis, and treatment
of PMAD is challenging due to a lack of awareness of the
seriousness of the problem, cracks in the health care system,
and the nature of the postpartum period. Breaks in continuity
of care add to the difficulties in screening and diagnosis. A
woman is frequently discharged from the hospital shortly after
delivery and usually does not see her obstetrician for six to
eight weeks later. Following that visit, she generally returns
to the care of her general practitioner, but contact with that
physician is not routine. The American Academy of Family
Physicians recommends universal screening, stating that doctors
should use a standard protocol when screening patients. The
American College of Obstetricians and Gynecologists (ACOG)
encourages its membership to screen patients for depression and
have an educational program related to recognizing and treating
depression in patients. Once diagnosed, the common mode of
treatment includes psychiatric evaluation, psychotherapy,
medication, and support groups.
A 2000 New Jersey law requires the Commissioner of Health and
Senior Services, the State Board of Medical Examiners, and the
New Jersey Board of Nursing to develop policies and procedures
for PMAD education and screening, including the provision of
PMAD information for all new mothers by birthing facilities and
screening for PMAD by physicians and nurse midwives as part of
prenatal and postnatal care. A 1997 New York state law requires
that information regarding postpartum depression be added to a
leaflet given to maternity patients at hospitals.
AB 367 (Koretz), of 2003, would have established the PMAD
Information Program in DHS' Maternal and Child Health Branch and
required the program to include continuing medical education
AB 2317
Page 5
activities, the posting of relevant information on the DHS
website, and communication through radio, television, and
billboards. AB 367 was held under submission in the Assembly
Committee on Appropriations. Earlier this year, AB 291 (Koretz)
would have required DHS to prepare an information sheet on
postpartum mood and anxiety disorders and would have required
health care providers to provide a copy of the information sheet
to pregnant women. This bill was set to be heard in the
Assembly Committee on Health, but the hearing was cancelled at
the request of the author.
Analysis Prepared by : Melanie Moreno / HEALTH / (916)
319-2097
FN: 0014729