BILL ANALYSIS
AB 159
Page 1
Date of Hearing: March 17, 2009
ASSEMBLY COMMITTEE ON HEALTH
Dave Jones, Chair
AB 159 (Nava) - As Amended: March 10, 2009
SUBJECT : Perinatal mood and anxiety disorders: task force.
SUMMARY : Authorizes the Department of Public Health (DPH) to
establish a task force to address perinatal mood and anxiety
disorders (PMAD). Specifically, this bill :
1)Authorizes DPH to establish a statewide task force to develop
a best practices model for public awareness and a standard of
care for PMAD which health care providers and organizations
may use.
2)Specifies the task force membership to include one
representative of each of the following:
a) Survivors of PMAD;
b) American College of Obstetrics and Gynecology (ACOG);
c) California Association of Nurse Practitioners;
d) California Nurse Midwives Association;
e) California Nurses Association;
f) California Medical Association;
g) California Psychiatric Association;
h) California Association of Marriage and Family
Therapists;
i) California Hospital Association;
j) Postpartum Support International; and,
aa) State Public Affairs Committee of the Junior Leagues of
California.
3)Authorizes the task force to use different media to increase
awareness, assistance, and information regarding PMAD,
including information regarding the availability of services
and treatment for PMAD, to undertake public education
activities related to PMAD and to establish a publicly
accessible Internet Web site on PMAD.
4)Authorizes the task force to establish a recommended standard
of care for pregnant women, new mothers and their families,
which may include: universal depression screening; increasing
women's access to mental health services; education and
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training for perinatal and mental health providers; and,
increasing perinatal mental health resources.
5)Requires DPH to use only nonpublic funding sources to support
the activities of the task force and authorizes voluntary
contributions received to be deposited into a continuously
appropriated new fund and account, the California PMAD
Awareness Fund.
6)Requires DPH to forward any recommendations of the task force
to the Legislature, the Governor and to all county health
departments.
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7)Makes legislative findings and declarations related to PMAD,
including:
a) One in five women suffer from PMAD and most are not
diagnosed;
b) One to two of every 1,000 new mothers can experience
postpartum psychosis, including such symptoms as manic
states, hyperactivity, inability to sleep, and avoidance of
the baby, with consequent delusions, hallucinations,
incoherence, and thoughts of harming the baby and herself;
and,
c) Many women are not adequately informed about, screened,
or treated for PMAD because they are uninsured, lack access
to comprehensive health care, or face cultural or
linguistic barriers to care.
EXISTING LAW :
1)Authorizes and requires DPH to implement various disease
prevention and health promotion programs, including a program
of maternal and child health. Authorizes the maternal and
child health program to include the provision of educational,
preventative, diagnostic, and treatment services, including
medical care and facilitating services directed toward
improving the health of mothers and children.
2)Establishes the comprehensive community-based perinatal
program to provide comprehensive perinatal care for the
purpose of reducing maternal, perinatal, and infant mortality
and morbidity through contracts, grants, and agreements with
health care providers through the Medi-Cal program.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, despite the
high prevalence of PMAD, many women are not adequately
informed about, screened for, or treated for PMAD, and the
state has not created a uniform standard of care or laws to
address postpartum depression information, treatment or
resources. The author states there is significant need for
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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, and that the stigma
associated with PMAD prevents many at-risk women from
accepting services and treatment for their disorder. The
author intends to raise awareness about PMAD in order to
reduce the stigma associated with PMAD, which prevents many
women from seeking adequate care. The author highlights the
story of Kristina Fuelling, a Placer County mother who was
sentenced to over six years in custody after suffering
postpartum depression that developed into psychosis, resulting
in her drowning her infant in the family home on Jan. 20,
2008. Her mental state was verified by two court doctors.
2)BACKGROUND . A 2003 article in the Journal of Women's Health
indicates that one in five pregnant women suffered significant
symptoms of depression, and only 14% of them reported
receiving any formal treatment for it. According to the
United States (U.S.) Centers for Disease Control and
Prevention (CDC), nearly 12% of mothers report being
moderately depressed and 6% report being severely depressed
after delivery. Maternal depressive symptoms have been shown
to affect the mother's responsiveness to the child in its
first few months, and behavioral problems, and delayed
cognitive and linguistic development of the child. Children
of depressed women are also at increased risk for child abuse,
depression, and other psychiatric illnesses such as conduct
disorder. CDC also states postpartum depression affects
marital relationships.
ACOG advocates addressing psychosocial issues of women in their
childbearing years. In a Committee Opinion published in
August 2006, the ACOG Committee on Health Care for Underserved
Women states psychosocial screening should be performed at
least once each trimester for all women seeking pregnancy
evaluation or prenatal care. The Committee Opinion states
women who receive psychosocial screening each trimester are
half as likely to have a low-birth-weight or preterm baby.
The Committee Opinion also states the prevalence of major
depression in pregnancy is 11%, and if not treated, is
associated with unfavorable health behaviors and subsequent
fetal growth restriction, preterm delivery, placental
abruption (a cause of bleeding and maternal and fetal
mortality), and newborn irritability.
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3)SUPPORT . The sponsor of this bill, the State Public Affairs
Committee of the Junior Leagues of California, state there may
be as many as 800,000 new cases of PMAD in the U.S. each year,
and that most cases are undiagnosed and untreated. Numerous
local Junior League chapters and St. Joseph Hospital write in
support that PMAD can result in harm to the mother, baby, and
those around them. The American Federation of State, County,
and Municipal Employees supports this bill stating that PMAD
can include anxiety disorders, such as panic disorder and
obsessive-compulsive disorder, and it is the duty of the
Legislature to combat PMAD.
4)SUPPORT IF AMENDED . ACOG, District IX/California and the
California Medical Association (CMA) support this bill if
amended to delete provisions authorizing the task force to
develop standards of care. CMA argues that a voluntary state
task force is not the appropriate entity to develop standards
of care or guidelines for medical care. ACOG suggests the
task force be authorized to instead identify national
guidelines for care, and to also identify barriers to
screening and treatment, and options for reducing those
barriers.
5)RELATED LEGISLATION . AB 420 (Salas), pending in the Assembly,
would require DPH to conduct the PMAD Community Awareness
Campaign to increase awareness and provide education to
pregnant women and new mothers on PMAD and to convene a
workgroup, which would be required to prepare recommendations
relating to the implementation of the awareness campaign. AB
420 would authorize DPH to use nonpublic sources of funding to
support the activities of the workgroup and fund the campaign,
and prohibit the use of public funds.
6)PREVIOUS LEGISLATION .
a) AB 367 (Koretz) of 2003, would have established the PMAD
Information Program in DPH (then Department of Health
Services [DHS]) Maternal and Child Health Branch and would
have required the program to include continuing medical
education activities, the posting of relevant information
on the DPH Website, and communication through radio, TV,
and billboards. AB 367 was held under submission on the
Assembly Committee on Appropriations' Suspense File.
b) AB 291 (Koretz) of 2005, would have required DPH (then
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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, as specified. AB 291 was not heard in the
Assembly Health Committee at the request of the author.
c) AB 2317 (Koretz) of 2006, would have required DPH (then
DHS) to conduct the PMAD Community Awareness Campaign. The
Governor vetoed AB 2317, stating: "As crafted, the bill is
technically flawed. It will not result in an effective
community awareness campaign because it establishes program
parameters and a time frame that are not workable, and
lacks proper funding."
7)QUESTIONS AND COMMENTS .
a) Should this bill require DPH to work with the Department
of Mental Health (DMH) if a task force is funded and
established?
b) This bill authorizes DPH to convene a task force, but
does not specify whether DPH may have a presence on the
task force. Should DPH and DMH also have membership on the
task force?
c) Should some portion of the task force members be
appointed by the Speaker of the Assembly and the Senate
Rules Committee?
d) Should this bill, rather than authorizing the task force
to develop standards of care and a best practices model,
authorize the task force to develop recommendations and
educational materials for DPH's perinatal health programs?
e) The author may wish to consider the following technical
and clarifying amendments:
i) Page 2, lines 4-15: Provide a definition of PMAD,
rather than stating that
"PMAD is a more appropriate term;"
ii) Page 2, lines 16-18: This statistic seems
incorrect;
iii) Page 2, line 28: Delete "begin with" and replace
with "have;"
iv) Page 3, lines 15-16" Delete these lines if PMAD is
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defined in the first section; and,
v) Page 4, line 10: Insert "and provide" before
"assistance."
REGISTERED SUPPORT / OPPOSITION :
Support
State Public Affairs Committee of the Junior Leagues of
California (sponsor)
American Federation of State, County, and Municipal Employees
California Communities United Institute
Center for Postpartum Health
Child Abuse Prevention Center
Junior League of Fresno
Junior League of Los Angeles, Inc.
Junior League of Riverside, Inc.
Junior League of Sacramento
Junior League of Santa Barbara, Inc.
Los Angeles County Perinatal Mental Health Task Force
Postpartum Support International
St. Joseph Hospital
2 individuals
Opposition
None on file.
Analysis Prepared by : Allegra Kim / HEALTH / (916) 319-2097