BILL ANALYSIS
AB 221
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Date of Hearing: March 31, 2009
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Mary Hayashi, Chair
AB 221 (Portantino) - As Introduced: February 4, 2009
SUBJECT : HIV testing: skin punctures.
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
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 : Unknown
COMMENTS :
Purpose of this bill . According to the author's office, "The
AB 221
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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."
Background . 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
State 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 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.
Arguments in support : The AIDS Healthcare Foundation writes,
"The most essential tool for expanding access to HIV screening
is the HIV rapid test, which can be administered either through
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a finger stick or an oral swab. However, current law has
created impediments that constrain access to rapid HIV tests.
Finger stick rapid tests are administered by HIV counselors who
are required, by law, to be certified also as a LPT. LPT
certification requires 20 hours of didactic training and 25
practical supervised finger sticks. The cost of that training,
approximately $2500 per person, has discouraged test sites from
increasing the number of HIV counselors who are LPTs.
"This irrational policy has resulted in a curriculum that does
not educate but instead fills a prescribed number of hours. The
most important part of training, learning infection control, is
provided during the HIV counselor training, not the LPT
training. Nearly all of the 20 LPT training hours are used
practicing finger sticks on dummies and other students while
using a retractable safety lancet that requires little to no
instruction."
Double-referred: This bill is double-referred to Assembly
Health Committee.
REGISTERED SUPPORT / OPPOSITION :
Support
AIDS Healthcare Foundation (sponsor)
San Francisco AIDS Foundation (sponsor)
AIDS Project Los Angeles
California Medical Association (CMA)
City and County of San Francisco
Opposition
None on file.
Analysis Prepared by : Sarah Huchel / B. & P. / (916) 319-3301