BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: AB 2635
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AUTHOR: Portantino
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AMENDED: April 5, 2010
HEARING DATE: June 16, 2010
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REFERRAL: Public Safety
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CONSULTANT:
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Orr
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SUBJECT
Communicable disease: involuntary testing
SUMMARY
Adds nonsworn employees of a law enforcement agency whose
job description includes the collection of fingerprints to
the list of persons who, when exposed to an arrestee's
bodily fluids, can have the arrestee's blood tested for
communicable diseases.
CHANGES TO EXISTING LAW
Existing federal law:
Establishes the Occupational Exposure to Bloodborne
Pathogens Standard to address the significant health risks
many employees face as the result of occupational exposure
to blood and other potentially infectious materials (OPIM)
because they may contain bloodborne pathogens, including,
but not limited to hepatitis B virus (HBV), hepatitis C
virus (HCV), and HIV (human immunodeficiency virus).
Existing federal regulation:
Establishes regulations applicable to all occupational
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exposure to blood or other potentially infectious materials
as defined, by the Occupational Safety and Health
Administration, under the United States Department of
Labor.
Existing state law:
Establishes a process whereby a peace officer, firefighter,
custodial officer, custody assistant, uniformed employee of
a law enforcement agency whose job entails the care or
control of inmates in a detention facility, or emergency
medical provider who, while acting within the scope of his
or her duties, is exposed to an arrestee's blood or bodily
fluids, may petition a court for an order requiring testing
of the blood or bodily fluids for Human Immunodeficiency
Virus (HIV), hepatitis B, and hepatitis C.
Declares legislative intent that information that may be
vital to the health and safety of custodial personnel,
custodial medical personnel, peace officers, firefighters
and emergency medical personnel who are put at risk in the
course of their official duties, be obtained and disclosed
in an appropriate manner in order to ensure their health
and their relief from groundless fear of infection.
Existing state regulations:
Establishes regulations applicable to all occupational
exposure to blood or other potentially infectious materials
(OPIM) as defined, by the California Department of
Industrial Relations, including the use of universal
precautions to prevent contact with blood or OPIM. Under
circumstances in which differentiation between body fluid
types is difficult or impossible, all body fluids shall be
considered potentially infectious materials.
This bill:
Adds nonsworn employees of a law enforcement agency whose
job description includes the collection of fingerprints to
the list of persons who, when exposed to an arrestee's
bodily fluids, can have the arrestee's blood tested for
communicable diseases.
FISCAL IMPACT
The Assembly Appropriations Committee analysis estimates
negligible state court costs/savings to the extent this
bill results in additional/fewer hearings for county
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detention personnel forced to pursue a court hearing to
obtain an arrestee's blood sample in the wake of a bodily
fluid exposure.
BACKGROUND AND DISCUSSION
The author introduced this bill to correct an oversight in
last year's AB 169 (Portantino, Chapter 417, Statutes of
2009). AB 169 included nonsworn uniformed officers to the
category of employees (law enforcement and medical services
personnel) who, after exposure to an arrestee's bodily
fluids, may have that arrestee's blood tested, either
voluntarily or by court order, for specified communicable
diseases. It was brought to the author's attention that
there are other employees who come into contact with
arrestees who are frequently exposed to blood or other
bodily fluids who are not covered by this provision of law.
This bill adds employees of law enforcement agencies whose
duties include the collection of fingerprints.
Occupational exposure to bloodborne pathogens
Blood and other potentially infectious materials have long
been recognized as a potential threat to the health of
employees who are exposed to these materials by
percutaneous contact (penetration of the skin). Other
potentially infectious materials (OPIM) can include human
body fluids (semen, vaginal secretions, amniotic fluid,
saliva in dental procedures, any body fluid visibly
contaminated with blood, etc.), any unfixed tissue or organ
from a human living or dead; or HIV-containing cell or
tissue cultures, organ cultures, and HIV- or HBV-containing
culture medium or other solutions as well as blood, organs,
or other tissues from experimental animals infected with
HIV or HBV.
According to the National Institute for Occupational Safety
and Health, exposures to blood and other body fluids occur
across a wide variety of occupations. Health care workers,
as well as emergency response and public safety personnel,
can be exposed to blood through needlestick and other
sharps injuries, as well as through mucous membrane and
skin exposures. The pathogens of primary concern for the
Centers for Disease Control and Prevention (CDC) and the
National Institute for Occupational Safety and Health are
the human immunodeficiency virus (HIV), hepatitis B virus
(HBV), and hepatitis C virus (HCV). According to CDC
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recommendations, wounds and skin sites that have been in
contact with blood or bodily fluids should be washed with
soap and water, and mucous membranes should be flushed with
water. Immediate evaluation must be performed by a health
care professional. The evaluation should determine the type
of exposure, infectious status of the source, and the
susceptibility of the exposed person in order to determine
the treatment course.
Existing California regulations apply to all occupational
exposure to blood or other potentially infectious materials
(OPIM) as defined, with specified exceptions. The
regulations define occupational exposure as "reasonably
anticipated skin, eye, mucous membrane, or parenteral
contact with blood or other potentially infectious
materials that may result from the performance of an
employee's duties." Some facilities and operations are
considered by Cal/OSHA to involve "occupational exposure,"
as defined because the intrinsic nature of the facility or
operation is such that contact with blood or OPIM is
reasonably anticipated for at least some of the employees
involved with the facility or operation.
Under the regulations, employers of these facilities or
operations have the responsibility to conduct an exposure
determination to determine which tasks and procedures
involve occupational exposure as a part of complying with
the written Exposure Control Plan requirements. Employers
whose employees work in facilities other than those that
intrinsically involve occupational exposure are still
subject to regulations if the individual circumstances of
the facility or operation are such that the employee's
activities or tasks place them in contact with blood or
OPIM.
Each employer who has an employee(s) with occupational
exposure to blood or OPIM is required to document an
exposure determination. The exposure determination is made
without regard to the use of personal protective equipment
since employees are considered exposed even if they wear
personal protective equipment.
Post-exposure procedures
Workers who are stuck by a needle or have any other type of
exposure to blood or OPIM must receive immediate
confidential medical screening and follow-up treatment.
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Treatment potentially includes medications to prevent
infection, according to current Public Health Service
guidelines, as soon as possible. Post-exposure prophylaxis
(PEP) is a short-term treatment to reduce the likelihood of
infection after exposure to a number of contagious
diseases, including HIV, HBV, and HCV. PEP is considered a
second line of defense when preventive efforts have failed
or were not possible, as is the case with sexual assault or
occupational exposure.
In the case of HIV, PEP typically involves providing one or
several anti-HIV drugs within 72 hours of exposure, which
are then taken for a four- to six-week period. According
to the World Health Organization (WHO), in order for PEP to
be most effective in preventing HIV infection, treatment
should be commenced as soon as possible after exposure and,
ideally, within two to four hours. One of the first
examples of PEP effectiveness was reported in a 1995 study,
which showed fewer HIV infections after occupational
exposure among health care workers who used PEP versus
those who took no prophylaxis after exposure. A recent
Canadian study found that, of 160 patients who had been
exposed to HIV and received PEP treatment, only one
infection was reported.
CDC recommendations for HBV exposure include the initiation
of the hepatitis B vaccine series to an unvaccinated person
who has been exposed. PEP with hepatitis B immune globulin
(HBIG) and/or hepatitis B vaccine series should be
considered after an evaluation of the HBV status of the
source and the vaccination and vaccine-response status of
the exposed person. According to the CDC, in the
occupational setting, multiple doses of PEP for HBV
initiated within one week following exposure, provides an
estimated 75 percent protection from infection.
According to the CDC, the estimated risk for infection
after a needlestick or cut exposure to HCV-infected blood
is approximately 1.8 percent. Additionally, several
studies have attempted to assess the effectiveness of
potential post-exposure treatment for HCV, but have been
difficult to interpret. No clinical trials have been
conducted to assess postexposure use of antiviral agents
(interferon) to prevent HCV infection, and antivirals are
not FDA approved for this use. The CDC states that an
established infection might need to be present before
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interferon can be an effective treatment.
Related bills
AB 169 (Portantino), Chapter 417, Statutes of 2009, added
custodial officers, custody assistants, and nonsworn
uniformed employees of a law enforcement agency, to the
list of persons who may seek to have an arrestee's blood
tested either voluntarily or by court order, for specified
communicable diseases when exposed to an arrestee's bodily
fluids while acting within the scope of his or her duties.
Prior legislation
AB 2737 (Feuer), Chapter 554, Statutes of 2008, permits a
peace officer, firefighter, or emergency medical personnel
who, while acting within the scope of his or her duties, is
exposed to an arrestee's blood or bodily fluids, as
defined, to petition the court, ex parte, for an order to
withdraw blood from the arrestee for testing for HIV,
AIDS-related conditions, and HCV.
AB 2423 (Cardenas), Chapter 342, Statutes of 2002, permits
testing of an available sample of a patient's blood for
various communicable diseases. Broadens the definition of
"available sample" of blood to include any sample obtained
prior to the patient's release, either before or after the
exposure incident.
SB 1239 (Russell), Chapter 708, Statutes of 1994,
authorizes the blood or other tissue or material of a
source patient, as defined, to be tested for HIV pursuant
to a prescribed procedure, either with or without the
consent of the source patient, and authorizes a health care
provider or first responder who experiences a "significant
exposure" to the blood or other potentially infectious
materials of the source patient to be informed of the HIV
status of that patient.
AB 1385 (Alpert), Chapter 519, Statutes of 1998, authorizes
an HIV test to be performed on any available blood or
patient sample of a source patient if that patient is
unable to provide informed consent under specified
conditions.
SB 2056 (Brulte), Chapter 254, Statutes of 1998, permits,
if the informed consent of the source patient cannot be
obtained because he or she is deceased, an HIV test to be
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performed on any blood or patient sample of the patient
legally obtained in the course of providing health care
services at the time of the exposure event.
SB 1239 (Russell), Chapter 708, Statutes of 1995, permitted
HIV testing of blood, or other tissue available from a
source patient without the consent of the patient if a
health care provider, first responder or other person has
experienced a significant workplace exposure to the
patient's blood or other infectious material.
Arguments in support
The American Federation of State, County, and Municipal
Employees (AFSCME) is sponsoring this bill. They claim that
recently fingerprint identification experts (FIEs) within
the Los Angeles Police Department were required, by special
order of the chief of police, to gather fingerprints from
suspected criminals while they were hospitalized. However,
this is a new duty for FIEs and their classification
doesn't have the same protections granted to other law
enforcement personnel. This bill would add FIEs to the list
of persons who may seek to have an arrestee's blood tested,
either voluntarily or by court order, for specified
communicable diseases when the FIE is exposed to that
arrestee's blood or bodily fluids while the FIE is acting
within the scope of his or her duties.
PRIOR ACTIONS
Assembly Floor: 76-0
Assembly Appropriations: 17-0
Assembly Public Safety:7-0
Assembly Rules: 11-0
COMMENTS
1. Double referral. This bill is double referred to the
Senate Public Safety Committee.
POSITIONS
Support: AFSCME (sponsor)
Oppose: None received
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