BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: AB 1225
A
AUTHOR: De La Torre
B
AMENDED: January 25, 2010
HEARING DATE: June 23, 2010
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CONSULTANT:
2
Orr
2
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SUBJECT
Emergency and disaster response exercises: infectious
diseases
SUMMARY
Requires the California Department of Public Health (CDPH)
and local public health departments, when conducting
emergency or disaster preparedness exercises relating to
the outbreak of an infectious disease, to establish a
process to identify deficiencies in the preparedness plans
and procedures and track implementation of corrective
measures. Requires the department to make an after-action
report (AAR) available on its website and/or upon request.
CHANGES TO EXISTING LAW
Existing law:
Establishes the California Emergency Services Act, which
sets forth the duties of state and local agencies in
emergency and disaster preparedness and response.
Existing regulations:
Establishes the Standardized Emergency Management System
(SEMS) to standardize and coordinate emergency response
activities involving multiple jurisdictions or agencies.
Continued---
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Requires all emergency response agencies to use SEMS in
responding to, managing, and coordinating multiple agency
or multiple jurisdiction incidents.
Requires any city, county, or city and county declaring a
local emergency for which the Governor proclaims a state of
emergency, and any state agency responding to that
emergency, to complete and transmit an AAR to the Office of
Emergency Services (OES) within 90 days of the close of the
incident period.
Requires the AAR to include:
A review of response actions taken.
How SEMS was applied.
Suggested modifications to SEMS.
Necessary modifications to plans and procedures.
Identified training needs.
Recovery activities.
This bill:
Requires CDPH and local health departments (LHD), when
conducting emergency or disaster preparedness exercises
relating to the outbreak of an infectious disease, to
establish a process to identify deficiencies in
preparedness plans and procedures and track the
implementation of corrective measures to ensure that
necessary improvements to the preparedness plans are made.
Requires the process to provide for the following:
Preparation of an after-action report (AAR) for
each disaster preparedness exercise conducted,
submitted to CDPH within 90 days of the exercise, or
within a time period required by the terms and
conditions of federal financial assistance DPH or the
LHD has received to prepare for an act of bioterrorism
or other public health emergency;
After action reports must include a review of
identified deficiencies, a review of response actions
taken, suggested modifications of plans and
procedures, and identifying training needs; and,
Written procedures to assist in the review,
consideration, and, if applicable, optional
implementation of recommendations included in AARs.
Requires CDPH to make an AAR available for the public by
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posting it on the department's website and/or providing a
copy upon request.
Declares intent language to ensure that state and local
agencies are as prepared as possible to respond to an
outbreak of infectious disease, including an influenza
pandemic, and that the provisions of this bill are designed
to supplement the terms and conditions of any federal
financial assistance that CDPH or local public health
departments receive to prepare for an act of bioterrorism
or other public health emergency.
FISCAL IMPACT
According to the Assembly Appropriations Committee
analysis, this bill has a minor fiscal effect and
absorbable workload to CDPH and LHDs to continue compliance
with federal and state emergency preparedness statutes and
regulations. Both state and federal law require the
completion of the preparedness items addressed in this
legislation.
BACKGROUND AND DISCUSSION
The author states that this bill is needed because
requiring CDPH and LHDs to submit AARs after emergency
preparedness exercises will enhance statewide preparedness
and improve the state's ability to identify and address
infectious disease outbreaks. The author notes that, while
DPH and LHDs are required to submit AARs after actual
emergencies, existing state and federal requirements do not
mandate AARs for emergency preparedness exercises.
Emergency preparedness
Proper emergency preparedness can save lives, protect
property, and reduce the costs associated with responding
to an emergency. Preparedness is an ongoing effort, in that
an entity can only be as prepared as resources and planning
allow. According to a report by the state auditor,
California has completed several tasks relating to
responding to infectious disease emergencies, but it has to
do more to improve its preparedness.
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Responsibility for California's emergency response
preparedness lies with several local, state, and federal
entities. The initial response to any type of emergency,
including one caused by an infectious disease, is the
responsibility of the local jurisdiction in which the
emergency occurs. An infectious disease outbreak is one of
several types of events that can trigger an emergency
response. Infectious disease emergencies can be caused by
biological agents, including bacteria, viruses, fungi, and
other microorganisms, and can have natural, accidental, or
intentional origins. Examples of biological agents that
are considered high priority bioterrorism threats include
anthrax, avian flu, botulism, plague, smallpox, and
tularemia.
The Office of Emergency Services (OES) is the lead
emergency management agency in California and coordinates
the state's response to major emergencies. OES has
identified CDPH as the state's lead department for
responding to public health emergencies such as infectious
disease emergencies. CDPH is responsible for coordinating
statewide public health assistance during disasters and
providing specialized services using state health
laboratories.
The Emergency Medical Services Authority (EMSA) is
responsible for supporting CDPH during public health
emergencies by managing the state's medical response and
establishing medical response policies and procedures
within the framework of the overall state response.
After-action reports
An AAR is a professional discussion of a project or an
activity that includes the participants and focuses
directly on tasks and goals. It enables the individuals
involved to learn for themselves what happened, why it
happened, what went well, what needs improvement and what
lessons can be learned from the experience. AARs give
entities an opportunity to identify problems and successes
that occurred during an emergency preparedness exercise and
to take corrective action (such as revising emergency plans
and procedures).
According to guidelines by the U.S. Department of Homeland
Security, Office of Domestic Preparation, entities should
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establish a tracking process to ensure that improvements
recommended in the after-action reports are made. Tracking
the implementation status is a sound practice to ensure
that state entities address all relevant recommendations in
AARs, which can serve as important tools for increasing
overall preparedness levels. The lessons learned from these
activities can help inform and improve the state's
understanding of the process behind public health emergency
response, as well as the strategies and tactics employed
before, during, and after an event.
State Auditor's report
In August 2005, the California State Auditor (CSA) issued a
report concerning California's preparedness to respond to
an infectious disease emergency. The CSA stated that
California needs to do more to improve its preparedness,
citing that CDPH (then the Department of Health Services)
did not have a tracking system for following up on
recommendations identified in AARs. The CSA stated that,
without a tracking system for following AARs, CDPH reduces
the likelihood that it will take appropriate and consistent
corrective action.
According to the auditor, state entities can enhance
emergency plans and procedures for responding to
emergencies when they occur by conducting emergency
exercises and completing post-exercise evaluations.
Federal guidelines suggest that entities establish tracking
procedures to ensure that they take corrective action on
deficiencies identified in AARs. Both OES and EMSA had
established tracking systems in 2005.
Prior legislation
AB 2584 (De La Torre) of 2006 and AB 2996 (De La Torre) of
2008, were similar to this bill. Governor Schwarzenegger
vetoed both bills due to concerns about duplication of
current efforts without an accompanying increase in public
protection.
Arguments in opposition
The California Department of Public Health believes this
bill is unnecessary because the role of AARs in disaster
preparedness is already addressed in various emergency
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preparedness statutes, regulations, and guidelines. They
claim that SEMS requires the Governor's Office of Emergency
Services along with local and state agencies to complete an
AAR within 120 days from any declared disaster. In
addition, the Centers for Disease Control and Prevention
(CDC) Cooperative Agreement Guidance for Public Health
Emergency Preparedness also requires development of an AAR
and corrective actions after drills, exercises or actual
events, as a condition of receiving grant funds for public
health emergency preparation. CDPH claims to have
implemented a written procedure for developing AARs and
corrective action plans, and has posted the procedures on
the CDPH website for use by CDPH programs. They claim they
expressed disagreement with the auditor's report, and have
been subsequently advised by the auditor that their AAR
procedures are in compliance with the auditor's
expectations.
PRIOR ACTIONS
Assembly Rules: 10-0
Assembly Health: 14-1
Assembly Appropriations: 12-5
Assembly Floor: 10-0
COMMENTS
1. Effect of this bill. This bill will codify the existing
practice to develop AARs for drills and exercises involving
infectious diseases.
POSITIONS
Support: None received
Oppose: California Department of Public Health
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