BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
AB 186 (Williams)
Hearing Date: 6/27/2011 Amended: 3/30/2011
Consultant: Katie Johnson Policy Vote: Health 9-0
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BILL SUMMARY: AB 186 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 local public health laboratories to undergo
further testing and to specify circumstances when 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 any time in consultation with California Conference
of Local Health Officers and the California Association of
Public Health Laboratory Directors instead of through the
existing regulatory process.
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Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13 2013-14 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.
CDPH currently has the authority to promulgate regulations to
require that samples of specified diseases be sent to local and
state public health laboratories. This bill would require a list
be developed and would exempt the establishment of and any
AB 186 (Williams)
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additions to the list from the regulatory process.
California regulations contain the list of dozens of reportable
diseases and the timeframes in which they must be reported to
local health officers and CDPH. They also specify when cultures
or 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. Samonella,
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. Currently, in the event of an outbreak,
CDPH would work with local public health jurisdictions to
augment both epidemiological and laboratory surveillance as
needed to monitor and control the outbreak. This could include a
recommendation to send samples to local and state laboratories
for testing.
Potential Increased Workload
This bill could increase the workload of both local and state
public health laboratories to the extent the establishment of
the list requires mandatory testing of cultures and specimens
not currently required by statute or regulation. Although the
stated intent of this bill is to address disease outbreaks,
there is no requirement in this bill that the list be
established and updated only in the event of an outbreak. The
list would be developed and then the department could update the
list at any time in consultation with stakeholders.
If this bill does not cause an increase in workload, there would
be no fiscal impact to CDPH; however, if this bill does cause an
increase in workload for CDPH, the department could need up to
$370,000 annually to support up to 3 staff, and maybe more,
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commencing with half year costs in FY 2011-2012. Actual costs
and staffing needs would depend on 1) the number of diseases
added to the list, 2) 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, and 3) the type of
testing required for the various diseases and the time required
to perform those assays. CDPH currently utilizes 3
microbiologists to test 800 - 1000 samples of salmonella
annually.
Similarly, there could be unknown costs to local public health
laboratories to hire additional staff to the extent that the
list increases the number of cultures and specimens that they
would analyze beyond current resources. Each local health
department is currently required to have services available at
an official public health laboratory that can include one run by
CDPH. 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, increased expenses could be found to be
reimbursable by the State Commission on Mandates. The sponsor of
the bill, the Health Officers Association of California, a group
representing local health officers, states that they do not
expect to see an increased workload resulting from this bill.
Although there is the potential for increased costs at the state
and local levels, this bill could also result in cost avoidance
for CDPH. To the extent that the department would have
promulgated regulations to require samples of a disease be sent
to laboratories for testing, the department would no longer
incur the cost and time associated with the development of those
regulations.
This bill is nearly identical to AB 2786 (Monning, 2010). The
Governor vetoed AB 2786 saying, "This bill is overly broad and
unnecessary. The Department of Public Health, in a public health
emergency, already has broad authority to request and receive
laboratory data. I am also concerned that the Department,
without such a public health emergency, could enact changes that
affect both private and public laboratories without any
regulatory oversight."
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