BILL ANALYSIS                                                                                                                                                                                                    



                                                                       



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          |SENATE RULES COMMITTEE            |                   SB 148|
          |Office of Senate Floor Analyses   |                         |
          |1020 N Street, Suite 524          |                         |
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                                 THIRD READING


          Bill No:  SB 148
          Author:   Oropeza (D), et al
          Amended:  5/20/09
          Vote:     21

           
           SENATE HEALTH COMMITTEE  : 10-1, 04/01/09
          AYES: Alquist, Strickland, Cedillo, Cox, DeSaulnier, Leno,  
            Maldonado, Negrete McLeod, Pavley, Wolk
          NOES: Aanestad

           SENATE APPROPRIATIONS COMMITTEE  :  Senate Rule 28.8


           SUBJECT  :    Mammogram machines:  inspection:  posting of  
          results

           SOURCE  :     Author


           DIGEST  :    This bill requires facilities that operate  
          mammogram machines to post notices of serious violations in  
          an area that is visible to patients.  Requires the  
          Department of Public Health to post on its website the  
          inspection results for each facility that provides  
          mammography services. 

          ANALYSIS  :   Under the Radiation Control Law, the Department  
          of Public Health (DPH) administers provisions that  
          establish standards for, and regulates sources of, ionizing  
          radiation.  Existing law requires DPH to license persons  
          who receive, possess, or transfer radioactive materials,  
          and devices or equipment utilizing these materials.  
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          Existing law gives DPH, or any state or local agency with  
          which an agreement has been made, the power to enter  
          property, within the jurisdiction of the agency, in order  
          to inspect and determine whether there is compliance with  
          the state's standards and requirements.

          This bill:

          1.Requires facilities that operate a mammogram machines to  
            post notices of "serious violations" (defined as a  
            violation that poses a significant threat to public  
            health) in an area that is visible to patients.

          2.Defines "serious violation" as a deviation, identified by  
            an inspector, form federal Mammography Quality Standards  
            Act of 1992 standards, in effect as of December 31, 2009,  
            that may seriously compromise the quality of mammography  
            services that are offered by the facility.

           Background
           
          Under the federal Mammography Quality Standards Act (MQSA),  
          a mammography facility must be certified as providing  
          quality mammography services.  For a facility to be  
          certified, it must be accredited by a federally approved  
          private nonprofit or state accreditation body.  The Food  
          and Drug Administration (FDA) has approved the American  
          College of Radiology (ACR) and the States of Arkansas,  
          Iowa, and Texas as accreditation bodies.  The facility must  
          also undergo an annual inspection conducted by federally  
          trained and certified federal or state personnel.

          Before a facility performs any mammography examinations in  
          California, it must obtain:  (1) accreditation by the ACR;  
          (2) certification from the FDA; and (3) certification by  
          the DPH's Radiologic Health Branch (RHB).  In the case that  
          a notice of violation is issued regarding radiological  
          working conditions (or any other order issued pursuant to  
          the Radiation Control Law), regulations require the  
          facility to conspicuously post the notice within two  
          working days after receipt.  The facility's response, if  
          any, must be posted within two working days after it is  
          sent to RHB.  These documents must remain posted for a  

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          minimum of five working days or until action correcting the  
          violation has been completed, whichever is later.  A  
          conspicuous posting is not defined under the Radiation  
          Control Law or regulations, and according to the author, it  
          is common practice to post notices in an area only visible  
          to facility staff, so that they are aware of necessary  
          corrective action. 

          There are three possible "levels of observations" resulting  
          from an MQSA inspection, ranging from Level 1 (representing  
          the most serious noncompliance's with MQSA standards) to  
          Level 3 (representing minor deviations from MQSA  
          standards):  (1) a Level 1 observation indicates that the  
          inspector found one or more deviations from MQSA standards  
          that may seriously compromise the quality of mammography  
          services offered by the facility, (2) a Level 2 observation  
          indicates that the facility's performance is generally  
          acceptable.  However, the inspector did find one or more  
          deviations from MQSA standards that may compromise the  
          quality of mammography services offered by the facility,  
          (3) a Level 3 observation indicates that the facility's  
          performance is generally satisfactory.  However, the  
          inspection did show one or more minor deviations from MQSA  
          standards.

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    
          Local:  Yes

           SUPPORT  :   (Verified  5/19/09)

          American Cancer Society
          American Federation of State, County and Municipal  
          Employees
          Breast Cancer Action
          Breast Cancer Fund
          California Nurses Association
          Disability Rights Legal Center
          Latino Health Alliance


           ARGUMENTS IN SUPPORT  :    The California Nurses Association  
          states that, when a facility that has been issued a notice  
          of violation continues to perform exams, it places a  
          woman's health at risk if a misdiagnosis is made.  Breast  

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          Cancer Action, the Breast Cancer Fund, the Disability  
          Rights Legal Center, and the Latino Health Alliance states  
          women should be able to make conscious and educated  
          decisions about which facility they use to conduct their  
          breast examination and mammogram.  Supporters further state  
          that breast cancer diagnosis and treatment can be  
          devastating for women, and it is unfair to keep them in the  
          dark about the results of a facility's annual inspection.


          CTW:do     5/19/2009   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE

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