BILL ANALYSIS
AB 221
Page 1
ASSEMBLY THIRD READING
AB 221 (Portantino)
As Introduced February 4, 2009
Majority vote
BUSINESS & PROFESSIONS 10-1 HEALTH 17-0
-----------------------------------------------------------------
|Ayes:|Hayashi, Emmerson, |Ayes:|Jones, Fletcher, Adams, |
| |Conway, Hernandez, Nava, | |Block, Carter, |
| |Niello, | |Conway, De La Torre, De |
| |John A. Perez, Price, | |Leon, Emmerson, Gaines, |
| |Ruskin, Smyth | |Hall, Hayashi, Hernandez, |
| | | |Bonnie Lowenthal, Nava, |
| | | |V. Manuel Perez, Audra |
| | | |Strickland |
|-----+--------------------------+-----+--------------------------|
|Nays:|Eng | | |
| | | | |
-----------------------------------------------------------------
APPROPRIATIONS 16-0
-----------------------------------------------------------------
|Ayes:|De Leon, Nielsen, | | |
| |Ammiano, | | |
| |Charles Calderon, Davis, | | |
| |Duvall, Fuentes, Hall, | | |
| |Harkey, Miller, | | |
| |John A. Perez, Price, | | |
| |Skinner, Solorio, Audra | | |
| |Strickland, Torlakson | | |
|-----+--------------------------+-----+--------------------------|
| | | | |
-----------------------------------------------------------------
SUMMARY : Permits HIV counselors to perform skin punctures to
withdraw blood for HIV testing, as specified. Specifically, this
bill :
1)Exempts HIV counselors from current law specifying procedures for
unlicensed individuals to perform skin punctures under specified
conditions.
2)Permits HIV counselors to perform skin punctures upon specific
AB 221
Page 2
authorization from a licensed physician and surgeon if:
a) He or she works under the direction of a licensed physician
or surgeon; and,
b) He or she has been trained in accordance with training
requirements established by the State Department of Public
Health (department), by a licensed physician and surgeon, or by
a licensed clinical laboratory scientist or bioanalyst in the
proper procedures to be employed when conducting the skin
puncture, and has a statement signed by the instructing
physician and surgeon, scientist, or bioanalyst that the
training has been successfully completed.
EXISTING LAW permits the Office of AIDS (Office) in the department
to participate in a rapid HIV test research program conducted with
the federal Centers for Disease Control and Prevention. Under this
program, HIV counselors trained by the Office may perform skin
punctures for purposes of withdrawing blood for test purposes, if
the HIV counselor meets prescribed requirements, including holding a
valid certification as a limited phlebotomist technician (LPT) by
the department.
FISCAL EFFECT : According to the Assembly Appropriations Committee:
1)No direct fiscal impact to authorize counselors meeting specified
oversight, training, and supervisory requirements to conduct rapid
HIV testing via skin punctures.
2)Minor savings to the extent rapid skin tests become less
administratively burdensome and costly to employers who are
required to provide approximately $2,500 in training per employee
to meet current phlebotomy training requirements.
3)Minor savings in testing costs to the extent this bill results in
a shift from a more expensive oral swab test ($12) to a less
expensive skin puncture test ($7). Due to recent budget cuts, the
statewide budget for HIV testing has been reduced from $10.4
million to $9.8 million. This bill helps ensure more people are
tested with fewer resources.
4)Major potential savings per 10 infections prevented. $3 million
in public savings will accrue to the extent this bill results in
informing 10 additional HIV-positive individuals of their status
AB 221
Page 3
who would otherwise not be tested. This estimate assumes a
$300,000 (cumulative lifetime savings) lifetime savings per
individual as quantified by research. Research indicates many HIV
positive individuals, once informed of their status, make behavior
changes that reduce transmission of the virus.
COMMENTS : According to the author's office, "The simplicity, safety
and ease of use of the finger stick technology demands very little
training. However, in order to perform a finger stick, California
law requires a person to be certified as a LPT. That requires a
person to receive 20 hours of didactic training and provide 25
finger sticks in a clinical setting. The only training that is
actually necessary in a finger stick rapid HIV testing protocol is
knowledge of universal precautions for infection control, which
takes no more than two hours of the LPT training. The remainder of
the didactic training consists of topics that are irrelevant to the
task of administering the rapid test.
"Since the LPT requirement was adopted, test sites have spent over
$1 million certifying LPTs, money that should have been spent
increasing access to HIV screening. That cost is more significant
in light of the limited state funds available for testing, which
shrank from $10.4 million to $9.8 million in the current year.
Further, the number of certified LPTs is artificially constrained
because the training and education costs prevent the certification
of more LPTs. AB 221 helps to remove an unnecessary barrier to
rapid HIV screening."
HIV counselors are certified by the Department of Public Health,
pursuant to Health & Safety Code 120871, which authorizes the
establishment of training programs throughout the state for
counselors for publicly funded HIV testing programs. These training
programs are conducted by community-based, nonprofit organizations
with demonstrated expertise in providing free, anonymous, or
confidential HIV testing services. HIV counselors are trained in
universal sanitary precautions, and sites offering rapid HIV testing
are required to meet the United States Department of Labor
Occupational Safety and Health Administration standards for
blood-borne pathogens.
According to materials provided by the sponsors, the ability for HIV
counselors to administer a finger stick test would result in
considerable cost savings. The finger stick test kit is $4 less
expensive than the oral swab test, which results in a savings to the
AB 221
Page 4
AIDS Healthcare Foundation of $160,000 per year. However, it would
cost $112,500 to certify the 45 staff HIV counselors to administer
the tests as LPTs as required in current law, wiping out 70% of the
savings.
Analysis Prepared by : Sarah Huchel / B. & P. / (916) 319-3301 FN:
0000573