BILL ANALYSIS                                                                                                                                                                                                    






                         SENATE COMMITTEE ON EDUCATION
                              Gloria Romero, Chair
                           2009-2010 Regular Session
                                        

          BILL NO:       AB 70
          AUTHOR:        Norby
          AMENDED:       August 2, 2010
          FISCAL COMM:   Yes            HEARING DATE:  August 11,  
          2010
          URGENCY:       Yes            CONSULTANT:Kathleen Chavira

           NOTE  :  This bill has been amended to replace its contents  
          and this is the first time the bill is being heard in its  
          current form.

           SUBJECT  :  Genetic Testing
          
           KEY POLICY ISSUES  

          Should the educational and research activities of the  
          California State University (CSU) and the University of  
          California (UC) be statutorily restricted? 

          Should the CSU and UC be required to "pay back" funds  
          expended pursuant to legal judgments or settlements  
          resulting from specified research activities?  

          
           SUMMARY  

          This bill, until January 1, 2015, requests that California  
          State University (CSU) and the University of California  
          (UC) refrain from making "unsolicited requests" of DNA  
          samples from enrolled or prospective students and requires  
          the reversion of unexpended appropriations from the General  
          Fund (GF) in an amount equal to amounts expended for  
          judgments or settlements resulting from informed consent  
          violations related to these "unsolicited requests."

           BACKGROUND  

          Current law authorizes persons conducting or operating a  
          clinical laboratory to accept assignments for tests, and  
          report results for such tests only to persons licensed  
          under healing arts provisions of law or their  




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          representatives.  
          (Business and Professions Code 1288)

           Protection of Human Subjects in Medical Experimentation Act  
           
           (Health and Safety Code  24170-24179.5)  
           
          Current law requires a list of rights of a subject in a  
          medical experiment.  This list is required to include,  
          among other things, the right to:

                 Be informed of the nature and purpose of the  
               experiment.

                 Be given an explanation of the  
               procedures/drugs/devices to be followed/used.

                 Be given a description of discomforts and risks.

                 Be given an explanation of any benefits to the  
               subject.

                 Be given a disclosure of any alternative  
               procedures, drugs or devices, and their relative risks  
               and benefits.

                 Be informed of the avenues of medical treatment, if  
               any, available to the subject afterwards if  
               complications should arise.

                 Be given a chance to ask any questions about  
               experiments/procedures.

                 Be instructed that consent may be withdrawn at any  
               time and participation discontinued without prejudice.

                 Be given a copy of the signed and dated written  
               consent form.

                 Be given the opportunity to determine whether to  
               consent without any element of force, fraud, deceit,  
               duress, coercion, or undue influence on the decision.  
               (Health and Safety Code  24170 & 24172)

          Current law also defines "informed consent" as  
          authorization for a medical experiment after the following  




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          conditions have been satisfied:

                 The subject or subject's conservator or guardian,  
               or other representative is provided with a copy of the  
               experimental subject's bill of rights, as specified.

                 A written consent form is signed and dated by the  
               subject or the subject's conservator or guardian, or  
               other representative.

                 The subject or subject's conservator or guardian,  
               or other representative, is informed both verbally and  
               within the written consent form of the following:

                  o         An explanation of the procedures to be  
                    followed, as specified.  
                  o         A description of any discomfort and risks  
                    to be expected.
                  o         An explanation of any benefits to be  
                    expected, if applicable.
                  o         A disclosure of any alternative  
                    procedures, drugs, or devices and their relative  
                    risks and benefits.
                  o         An estimate of the expected recovery  
                    time.
                  o         An offer to answer any inquiries  
                    concerning the experiment or the procedures.
                  o         An instruction to the subject that  
                    consent may be withdrawn at any time, without  
                    prejudice to the subject.
                  o         The name, institutional affiliation, if  
                    any, and address of the person(s) performing and  
                    responsible for the experiment.
                  o         The name of the sponsor or funding  
                    source, or manufacturer if the experiment  
                    involves a drug or device, and any organization  
                    under which the experiment is being conducted.
                  o         The name, address, and phone number of an  
                    impartial third party, to whom complaints may be  
                    addressed.
                  o         The material (as defined) financial stake  
                    or interest that the investigator or research  
                    institution has in the outcome of the medical  
                    experiment. 
                  o         The written consent form is signed and  
                    dated by any person other than the subject or the  




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                    conservator or guardian, or other representative  
                    of the subject, as specified in Section 24175,  
                    who can attest that the requirements for informed  
                    consent to the medical experiment have been  
                    satisfied.
                  o         Consent must be voluntary and freely  
                    given without any element of force, fraud,  
                    deceit, duress, coercion, or undue influence. 
                   (Health and Safety Code  24170 & 24172)
           
          ANALYSIS
           
           This bill, an urgency measure, until January 1, 2015  :

          1)   Requests the CSU and the UC to refrain from making an  
               "unsolicited request" to students (enrolled or  
               prospective) for a DNA sample for genetic testing  
               purposes.

          2)   Defines an "unsolicited request" as transmittal of  
               materials designed to collect DNA to any person or  
               entity without their prior invitation or permission.

          3)   Requires the UC and the CSU to report to the  
               Controller, Governor and Legislature in writing, on a  
               quarterly basis, on the total amount of expenditures  
               (irrespective of source), to satisfy legal judgments  
               resulting from informed consent violations related to  
               "unsolicited requests" for DNA samples.  More  
               specifically it:

                    a)             Requires the first of these  
                    reports be submitted on or before January 1,  
                    2011.

                    b)             Requires subsequent quarterly  
                    reports be submitted in January, April, July, and  
                    October of each year. 

          4)   Requires the Controller to revert to the GF any  
               unencumbered moneys previously appropriated from the  
               GF to the UC and CSU in an amount equal to the amount  
               of expenditures reported by each, respectively, under  
               #3.

          5)   Clarifies that the bill's provisions do not prohibit  




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               the performance of genetic testing and counseling in  
               the course of a patient's medical care by a licensed  
               health care provider in a university facility.

          6)   Repeals these provisions as of January 1, 2015. 

           STAFF COMMENTS  

           1)   Need for the bill  .  According to the author, this bill  
               prevents taxpayers from incurring financial liability  
               resulting from UC and CSU violation of state and  
               federal genetic testing laws.  The author asserts that  
               the activities being conducted under the UC Berkeley  
               2010 On the Same Page program violate California laws  
               that require that a physician order related clinical  
               laboratory tests and that outline the procedures for  
               securing informed consent under the Protection of  
               Human Subjects in Medical Experimentation Act.

           2)   Overly broad  ?  This bill prohibits any unsolicited  
               request of students for DNA samples for the purposes  
               of genetic testing.  As drafted, the bill's  
               prohibition could be broadly applied and could  
               restrict the ability of the UC and CSU to engage in  
               educational and research activity beyond the specific  
               UC Berkeley project it is intended to address.   
               According to the CSU, thousands of students in  
               introductory life science courses routinely take DNA  
               samples from their cheeks to learn about blood type.   
               Genetic testing is also a necessary part of many  
               degree program curricula offered.  Is it the intent of  
               the Legislature to limit these types of educational  
               and research activities?  

           3)   Compromises funding for direct instruction  .  This bill  
               requires the "payback" to the state of any GF funds  
               appropriated to each segment in an amount equal to the  
               amount of any settlements or judgments relative to  
               violations of "informed consent"  irrespective of  
               source  .  Is this reasonable? Staff notes that GF  
               appropriations typically support student enrollment  
               and instruction.  Why should funding provided for  
               instructional purposes be used to "offset" costs  
               related to research activity?  Should students be  
               penalized for research activities undertaken at the  
               University's discretion?  




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           4)   UC Berkeley On the Same Page program  .  According to  
               the UC, On the Same Page is an annual program for all  
               transfer and freshmen students entering the UC  
               Berkeley College of Letters and Sciences.  Its purpose  
               is to engage students and faculty in meaningful  
               discussion about important societal issues.  This  
               year, the program asked students to voluntarily submit  
               a DNA sample (provided) via mail for purposes of  
               testing for three genetic traits as a component of the  
               program's selected topic of study, Personalized  
               Medicine.  Participation is voluntary and students  
               were informed that aggregated results and their  
               interpretation would be presented at a program lecture  
               to be held early in fall semester. The "study" was  
               reviewed and approved by the UC Berkeley Institutional  
               Review Board.  Analysis of DNA samples are to be  
               performed at an on-campus laboratory.  Students were  
               asked to submit the DNA sample postmarked by August 6,  
               2010.  According to the UC, approximately 350-400  
               student samples have been received. The 2010 On the  
               Same Page project and its implementation raises a  
               number of questions, including: 

                     Is this an educational or research activity?   
                 Do provisions of the Clinical Laboratory Improvement  
                 Act (which requires that laboratories doing this  
                 type of laboratory work meet specific state  
                 standards) apply?  

                     Does the design and process of the On the Same  
                 Page project provide sufficient structure for  
                 ensuring student's understanding of the implications  
                 of providing their DNA or the implications of the  
                 test results? Does the nature of the information  
                 gathered and its implication require a higher  
                 standard for informed consent than what was used to  
                 solicit participation by students?
                
                      Does this scheme provide sufficient privacy  
                 protections?   According to the informed consent  
                 document provided to students, once analysis of the  
                 three genes is complete, the DNA sample will be  
                 destroyed by incineration.  However, a faculty  
                 member conducting research study in the area of  
                 personalized medicine will save the submitted data  




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                 for future teaching purposes and for possible  
                 publication of the aggregated data and its analysis.  
                 The document notes the possibility that the data  
                 will be unaggregated for the purposes of  
                 publication, but asserts that it will be  
                 identifiable only by a barcode which only the  
                 student would be provided.  Should data provided for  
                 a specific class project be available for future  
                 research and publication?  Were students  
                 sufficiently informed of any potential compromising  
                 of their confidentiality?  

           1)   Related informational hearing  . The Assembly Higher  
               Education Committee held an oversight hearing on  
               Tuesday, August 10, 2010, on the subject of the  
               University of California at Berkeley's "Bring Your  
               Genes to Cal" Freshman Orientation Project.  The  
               issues and concerns raised and discussed included the  
               following:

                     What is genetic testing and how are genetic  
                 tests generally used?

                     Is the UC Berkeley project an educational  
                 exercise or research?

                     Were students provided adequate information  
                 regarding the project and was legal informed consent  
                 obtained from the students?

                     What are California's laboratory requirements  
                 for this type of genetic testing and why are these  
                 requirements in place?

                     What are the privacy risks to students?

                     How do students perceive privacy and the  
                 sharing of personal information?

               It is unclear what outcome is expected as a result of  
               this hearing.

          1)   Does this bill address the problem  ? Although a number  
               of legitimate questions can (and have) been raised  
               regarding the UC Berkeley On the Same Page program for  
               2010, it does not appear that this bill specifically  




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               addresses these issues.  Rather than penalize the  
               unsolicited collection of DNA samples, it may be more  
               appropriate to outline appropriate procedures to be  
               followed and clarify applicable statutes relative to  
               the solicitation of student DNA samples for purposes  
               of genetic testing. Staff notes that the author is  
               expected to offer amendments that more directly  
               address the issues raised by the UC Berkeley  
               situation.

           SUPPORT  

          None received.

           OPPOSITION

           University of California
          California State University