BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: AB 2786
A
AUTHOR: Committee on Health
B
AMENDED: April 14, 2010
HEARING DATE: June 30, 2010
2
CONSULTANT:
7
Orr/cjt
8
6
SUBJECT
List of reportable diseases and conditions
SUMMARY
Allows the California Department of Public Health (CDPH) to
modify the list of communicable diseases and conditions for
which clinical labs must submit specimens to the local
public health laboratory to undergo further testing.
Allows CDPH to modify the list at any time, in consultation
with the California Conference of Local Health Officers
(CCLHO) and the California Association of Public Health
Laboratory Directors (CAPHLD).
CHANGES TO EXISTING LAW
Existing law:
Requires CDPH to establish a list of diseases and
conditions which local health officers are required to
report to CDPH. The list may include both communicable and
noncommunicable diseases. Allows CDPH to modify this list
in consultation with CCLHO and exempts this modification
from the administrative regulation and rulemaking
requirements under California's Administrative Procedures
Act (APA).
Continued---
STAFF ANALYSIS OF ASSEMBLY BILL 2786 (Committee on Health)
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Exempts from civil and criminal penalties any person or
facility that fails to provide notification of a
reportable disease or condition, unless the disease or
condition that is required to be reported has been printed
in the California code of Regulations (CCR) for at least
six months.
Existing regulations:
Require health care providers and laboratories to report
cases of specified communicable diseases to the local
health officer where the patient resides. Allow individuals
to also report suspected cases of reportable diseases,
where no health care provider is available. Specify the
method(s) and timeframes by which certain diseases may be
reported.
This bill:
Requires CDPH to establish a list of communicable diseases
and conditions for which clinical laboratories shall submit
a culture or a specimen to the local public health
laboratory to undergo further study.
Permits CDPH to modify the list at any time, after
consultation with the CCLHO and the CAPHLD, without being
subject to regular rulemaking requirements under APA, but
requires that CDPH file the revised list with the Secretary
of State for publication in the California Code of
Regulations (CCR).
Exempts physicians, surgeons and clinical labs that fail to
submit cultures or specimens for mandatory diseases from
civil and criminal penalties, unless they had been notified
by CDPH and the requirement had been noticed by CDPH for at
least six months in the CCR.
Deletes specific diseases that are enumerated in law as
mandatory reportable diseases.
Makes specified legislative findings and declarations
regarding the need to enable prompt identification of an
outbreak, send positive specimens to the public health
laboratory for identification, and enable CDPH to include
STAFF ANALYSIS OF ASSEMBLY BILL 2786 (Committee on Health)
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newly emerging diseases and conditions in a timely manner.
FISCAL IMPACT
According to the Assembly Appropriations Committee
analysis, minor absorbable costs to the CDPH to establish
and modify the list of required specimens.
BACKGROUND AND DISCUSSION
According to the sponsor, the Health Officers Association
of California (HOAC), this bill will allow CDPH and local
public health authorities to respond to a public health
emergency in a timely manner by removing the regulatory
requirement to include new diseases and conditions on the
list of reportable diseases and conditions. Under current
law, several dozen diseases are reportable by mandate and a
subset of these requires submission of specimens. While the
mandatory disease listing has changed over time, the
universe of diseases under consideration has remained
fairly stable. According to the sponsor, it could take as
long as one and one-half to two years for CDPH to update
the list of reportable diseases, under existing law.
Whereas under AB 2786, it could take as little as two
months, thereby providing CDPH greater flexibility in a
public health emergency.
Existing law does not exempt CDPH from complying with APA
requirements when modifying the list of reportable diseases
and conditions for which public health labs are required to
submit specimens. The sponsor notes that there have been
instances in which CDPH has requested clinical laboratories
to submit specimens on a voluntary basis for potentially
severe bacterial diseases such as Shiga-toxin producing E.
coli. The sponsor claims that providing these types of
samples on a voluntary basis does not ensure a large enough
sample size to detect common source outbreaks. This was
apparent during a recent E. coli outbreak, during which
clinical laboratories in California were not performing the
additional tests necessary for identifying clusters of
cases revealing a common source outbreak.
Communicable disease reporting
The list of nationally notifiable infectious diseases is
revised periodically. For example, a disease may be added
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to the list as a new pathogen emerges, or a disease may be
deleted as its incidence declines. Public health officials
at state health departments and CDC collaborate in
determining which diseases should be nationally notifiable;
the Conference of State and Territorial Epidemiologists
(CSTE), with input from CDC, makes recommendations annually
for additions and deletions to the list of nationally
notifiable diseases. However, reporting of nationally
notifiable diseases to CDC by the states is voluntary.
Reporting is currently mandated (i.e., by state legislation
or regulation) only at the state level. The list of
diseases that are considered notifiable, therefore, varies
slightly by state. All states generally report the
internationally quarantinable diseases (i.e., cholera,
plague, and yellow fever) in compliance with the World
Health Organization's International Health Regulations.
In California, some diseases only require reporting from
health care providers by electronic transmission, including
facsimile, telephone, or mail within seven calendar days of
identification. Examples of these diseases include
Hepatitis (B, C, and D), Tetanus, and Toxic Shock Syndrome.
Diseases can also be required to be reported within one
working day of identification, including, but not limited
to foodborne diseases, Meningitis, Pertussis (Whooping
Cough), West Nile Virus, and Tuberculosis. More acutely
infectious diseases such as Avian Influenza, Rabies (human
or animal), and exposure to Anthrax all require immediate
reporting by telephone. Two or more cases of foodborne
disease from separate households suspected to have the same
source of illness, are also cause for immediate reporting
by telephone.
Clinical laboratories
Clinical laboratories include all hospital laboratories and
community laboratories that receive tests from health care
providers for analysis. Under regulation, labs are
required to report test results on certain diseases
considered to be of "public health importance." Health
care providers who know of a case, or suspected case, of
any disease or condition on the CDPH list are required to
report to the local health officer of the jurisdiction
where the patient resides and are required to send
specimens to a clinical laboratory. Clinical laboratories
are also required by regulation to report positive
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specimens to the local public health department.
Currently, laboratories are required to report communicable
diseases, pathogens, and viral infections. Clinical
laboratories are required to submit specimens for those
listed diseases and conditions, while specimens for
non-listed diseases and conditions are submitted on a
voluntary basis. If there is a known or suspected outbreak
of a particular disease or condition that is listed, the
local health officer must report to it CDPH within a
specified time period, and take the necessary steps to
prevent further contamination or infection.
The list of communicable diseases and conditions for which
laboratories in California must submit cultures is
currently established by regulation and adding or deleting
a disease or condition requires an administrative
regulation change under APA. The APA does permit adoption
of emergency regulations, but requires a 5-day public
notice, and emergency regulations can only remain in effect
for up to 180 days.
E. coli
According to the CDC, Shiga toxin-producing Escherichia
coli (STEC) are a leading cause of bacterial intestinal
infections in the United States. STEC transmission occurs
through consumption of a wide variety of contaminated
foods, including undercooked ground beef, unpasteurized
juice, raw milk, and raw produce (e.g., lettuce, spinach,
and alfalfa sprouts); through ingestion of contaminated
water; through contact with animals or their environment;
and directly from person to person (e.g., in child-care
settings). Prompt, accurate diagnosis of STEC infection is
important because appropriate treatment early in the course
of infection might decrease the risk for serious
complications such as renal damage and improve overall
patient outcome. In addition, prompt laboratory
identification of STEC strains is essential for detecting
new and emerging serotypes, for effective and timely
outbreak responses and control measures, and for monitoring
trends in disease epidemiology.
Related bills
AB 2541 (Portantino) would delete the exemption from
electronic reporting for
STAFF ANALYSIS OF ASSEMBLY BILL 2786 (Committee on Health)
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HIV infections and would make conforming changes. The bill
would provide that health care providers and laboratories
report cases of HIV infection to the local health officer
using patient names and set guidelines regarding such
reports.
Prior legislation
SB 356 (Negrete McLeod) of 2007 was nearly identical to
this bill. SB 356 was vetoed by Governor Schwarzenegger
because the delay in passing the 2008-2009 state budget
forced him to prioritize the bills sent to his desk.
AB 1091 (Negrete McLeod), Chapter 262, Statutes of 2003,
allows CDPH, in consultation with the California Conference
of Local Health Officers, to modify the list of reportable
diseases that health care providers are required to report.
CDPH can modify this list at any time without having to
comply with APA requirements.
PRIOR ACTIONS
Assembly Health: 18-0
Assembly Appropriations: 15-0
Assembly Floor: 74-0
POSITIONS
Support: Health Officers Association of California
(sponsor)
Oppose: None received