BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 2786|
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THIRD READING
Bill No: AB 2786
Author: Assembly Health Committee
Amended: 4/14/10 in Assembly
Vote: 21
SENATE HEALTH COMMITTEE : 8-0, 6/30/10
AYES: Alquist, Strickland, Aanestad, Cedillo, Leno,
Negrete McLeod, Pavley, Romero
NO VOTE RECORDED: Cox
SENATE APPROPRIATIONS COMMITTEE : 11-0, 8/12/10
AYES: Kehoe, Ashburn, Alquist, Corbett, Emmerson, Leno,
Price, Walters, Wolk, Wyland, Yee
ASSEMBLY FLOOR : 74-0, 5/6/10 (Consent) - See last page for
vote
SUBJECT : List of reportable diseases and conditions
SOURCE : Health Officers Association of California
DIGEST : This bill allows the Department of Public Health
(DPH) 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, and allows DPH 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).
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ANALYSIS :
Existing law
1. Requires DPH to establish a list of diseases and
conditions which local health officers are required to
report to DPH. The list may include both communicable
and noncommunicable diseases. Allows DPH 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).
2. 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 requires health care providers and
laboratories to report cases of specified communicable
diseases to the local health officer where the patient
resides. Allows individuals to also report suspected cases
of reportable diseases, where no health care provider is
available, and specifies the method(s) and timeframes by
which certain diseases may be reported.
This bill:
1. Requires DPH 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.
2. Permits DPH 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 DPH file the revised list with
the Secretary of State for publication in the CCR.
3. 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
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notified by DPH and the requirement had been noticed by
DPH for at least six months in the CCR.
4. Deletes specific diseases that are enumerated in law as
mandatory reportable diseases.
5. 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 DPH to include
newly emerging diseases and conditions in a timely
manner.
Background
Communicable disease reporting . The list of nationally
notifiable infectious diseases is revised periodically.
For example, a disease may be added 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
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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 DPH 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 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 DPH 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
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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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee analysis:
Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12
2012-13 Fund
CDPH additional up to $185 up
to$370up to $370 General
laboratory staff
Local public health unknown, but
potentially significant General*
additional laboratoryif the laboratories workload
increased
staff enough to need to hire an
additional
technician
*Could be eligible for reimbursement by the Commission on
State Mandates
SUPPORT : (Verified 8/16/10)
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Health Officers Association of California (source)
ARGUMENTS IN SUPPORT : According to the sponsor, the
Health Officers Association of California (HOAC), this bill
allows DPH 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 DPH to update the list of reportable
diseases, under existing law. Whereas under this bill, it
could take as little as two months, thereby providing CDPH
greater flexibility in a public health emergency.
Existing law does not exempt DPH 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 DPH 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.
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Anderson, Arambula, Beall, Bill
Berryhill, Tom Berryhill, Blakeslee, Blumenfield,
Bradford, Brownley, Buchanan, Caballero, Charles
Calderon, Carter, Chesbro, Conway, Cook, Coto, Davis, De
Leon, DeVore, Emmerson, Eng, Evans, Feuer, Fletcher,
Fong, Fuentes, Fuller, Furutani, Gaines, Galgiani,
Garrick, Hagman, Hall, Harkey, Hayashi, Hernandez, Hill,
Huber, Huffman, Jeffries, Jones, Knight, Lieu, Logue,
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Bonnie Lowenthal, Ma, Miller, Monning, Nava, Nestande,
Niello, Nielsen, Norby, V. Manuel Perez, Portantino,
Ruskin, Salas, Saldana, Silva, Skinner, Smyth, Solorio,
Audra Strickland, Swanson, Torlakson, Torres, Torrico,
Tran, Villines, Yamada, John A. Perez
NO VOTE RECORDED: Bass, Block, De La Torre, Gilmore,
Mendoza, Vacancy
CTW:do 8/16/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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