BILL ANALYSIS
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
2786 (Monning)
Hearing Date: 8/2/2010 Amended: 4/14/2010
Consultant: Katie Johnson Policy Vote: Health 8-0
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BILL SUMMARY: AB 2786 would require the California Department
of Public Health (CDPH) to establish a list of communicable
diseases and conditions for which clinical laboratories must
submit specimens to the local public health laboratory to
undergo further testing and to specify conditions under which
the specimens must also be submitted to the state public health
laboratory. The bill would permit the list to be established and
to be modified at anytime, instead of through the current
regulatory process, in consultation with stakeholders.
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Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12 2012-13 Fund
CDPH additional up to $185 up
to$370up to $370General
laboratory staff
Local public health unknown, but potentially
significant ifGeneral*
additional laboratory staff the laboratories workload
increased
enough to need to hire an additional
technician
*Could be eligible for reimbursement by the Commission on State
Mandates
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STAFF COMMENTS: This bill meets the criteria for referral to the
Suspense File.
This bill would require the California Department of Public
Health (CDPH) to establish a list of communicable diseases and
conditions for which clinical laboratories must submit specimens
to the local public health laboratory to undergo further testing
and to specify conditions under which the specimens must also be
submitted to the state public health laboratory. The list's
establishment would not be subject to the rulemaking process
under the Administrative Procedures Act (APA). Additionally,
CDPH could update the list at anytime, instead of through the
current regulatory process. Both the establishment and any
modifications of the list would be required to be done in
consultation with the California Conference of Local Health
Officers and the California Association of Public Health
Laboratory Directors.
Currently, no such list exists in a single place in statute or
regulations. California statute contains a requirement to
establish a list of reportable diseases and conditions,
communicable and non-communicable, in a manner similar to this
bill-exempt from the APA rulemaking process and in consultation
with stakeholders. California regulations contain the list of
dozens of reportable diseases and the timelines in which they
must be reported to local health officers and CDPH. They also
specify when cultures or
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AB 2786 (Monning)
specimens of certain diseases must be sent to a local public
health laboratory or CDPH laboratories. Currently, salmonella is
the only specimen required to be forwarded to the CDPH
laboratory from the local public health laboratory. Tuberculosis
and malarial blood films are required to be sent from a clinical
laboratory to either a local public health laboratory or to the
CDPH laboratory.
This bill would state that it is the intent of the Legislature
to enable prompt identification of an outbreak and rapid
reporting and laboratory identification during an outbreak
situation, the emergence of a new disease or condition, or the
recognition of an identified disease or condition that may
constitute a danger to the public's health?The public health
laboratory must obtain the necessary specimens from all sources
in order to be able to quickly identify the organisms causing
illnesses and compare the subtypes, thus allowing a timely
public health response.
Since the intent of this bill is to increase the ability of
state and local governments to adapt to emerging public health
risks through a system of culture and specimen testing, this
bill would increase the workload of both local and state public
health laboratories to the extent the establishment of the list
requires additional testing of cultures and specimens not
currently required by statute or regulation.
In order to provide for up to 3 staff to process an increased
amount of analysis, CDPH could need resources of up to $370,000
annually, commencing with half year costs in FY 2010-2011.
Actual costs and staffing needs would depend on the composition
of the list and the terms under which a clinical and/or local
public health laboratory would be required to submit a culture
or specimen to the state laboratory.
Similarly, there could be unknown costs to local public health
laboratories-each local health department is required to have
services available at an official public health laboratory that
can include one run by CDPH-to hire additional staff to the
extent that the list increases the number of cultures and
specimens that they would analyze. Again, actual costs and
staffing needs would depend on the magnitude of the increase of
cultures and specimens for which the list would require
characterization. Since this bill does not identify a specific
funding source for potential increased local costs, any
increased expenses could be found to be reimbursable by the
State Commission on Mandates.
Although there is the potential for increased costs at the state
and local levels, this bill could also result in cost avoidance
for CDPH-the department would no longer incur the cost and time
associated with the promulgation of regulations related to the
addition of a disease for which a local public health laboratory
or a CDPH laboratory would receive a specimen. However, any
potential savings would not fully offset the costs of providing
ongoing laboratory staff.