BILL ANALYSIS �
SB 422
Page 1
Date of Hearing: June 28, 2011
ASSEMBLY COMMITTEE ON JUDICIARY
Mike Feuer, Chair
SB 422 (Wright) - As Amended: April 25, 2011
SENATE VOTE : 39-1
SUBJECT : REPORTING OF CERTAIN COMMUNICABLE DISEASES
KEY ISSUES :
1)should staff of the local public health agency for HIV partner
services be included in the group of those to which physicians
can disclose positive hiv test information?
2)Should local health staff be exempted from criminal and civil
liability for informing partners of a positive hiv test as
specified?
FISCAL EFFECT : As currently in print this bill is keyed
non-fiscal.
SYNOPSIS
This non-controversial bill authorizes physicians to disclose
positive HIV test information to public health agency staff for
HIV partner services with the written consent of the patient.
The bill exempts from criminal and civil liability authorized
public health authorities who alert the specified partners of an
HIV positive person, without disclosing any identifying
information about the person believed to be infected with HIV.
The bill permits local health authorities to expunge the
identification information of a partner once a reasonable effort
to contact the partner has been undertaken. According to the
author, the bill is essential to ensure that local health
authorities can properly do their important job of notifying
those potentially exposed to HIV without risking significant
criminal and civil liability. This bill is supported by disease
prevention groups and has no known opposition.
SUMMARY : Revises existing law that permits the sharing of
information related to a positive HIV test between a physician,
a local health officer, and the HIV-positive person's sexual
partner, spouse, and/or persons with whom hypodermic needles
have been shared. Specifically, this bill :
SB 422
Page 2
1)Includes the "designated staff of the local public health
agency for HIV partner services" among the people to whom a
physician, who has a confirmed positive test for HIV of an
individual, may disclose that information without criminal or
civil liability.
2)Permits disclosure of identifying information of a person who
tests positive for HIV with the written consent of the
individual, as specified.
3)Exempts the designated local public health agency staff for
HIV partner services from civil and criminal liability
resulting from their informing potentially infected partners
of HIV patients of their potential exposure to HIV.
4)Makes technical, conforming changes.
EXISTING LAW :
1)Requires physicians and medical laboratories to report to the
local health officer all confirmed cases of HIV infection,
using the patient name, to ensure knowledge of current trends
in the HIV epidemic and to ensure that California remains
competitive for federal HIV and AIDS funding. (Heath & Saf.
Code Sec. 121022 (a).)
2)Provides that no physician who has the results of a confirmed
positive test for HIV infection of a patient under his or her
care may be held criminally or civilly liable for disclosing
non-identifying patient information to a person reasonably
believed to be the spouse, sexual partner, a person whom the
patient has shared a needle with, or to the local health
officer. (Health & Saf. Code Sec. 121015 (a).)
3)Authorizes a local health officer to alert any persons
reasonably believed to be a spouse, sexual partner or partner
of shared needles of an individual who has tested positive for
HIV about their potential exposure without disclosing
identifying patient information. (Health & Saf. Code Sec.
121015 (d).)
4)Provides that upon completion of the local health officer's
efforts to contact any of the specified partners, all records
containing any individual identifying information must be
expunged by the local health officer. (Health & Saf. Code
Sec. 121015 (d).)
SB 422
Page 3
5)Imposes a fine of $5,000 to $25,000 and potential
incarceration for any person who wrongfully discloses the
results of an HIV test, except pursuant to a written
authorization, as defined. (Health and Saf. Code Sec. 120980
et seq.)
COMMENTS : This non-controversial bill seeks to promote greater
partner notification for those persons potentially exposed to
HIV by expanding the liability coverage for authorized
physicians and public health officials who notify potentially
infected partners of HIV patients. The author states:
Senate Bill 422 is needed in order to better empower
California's local public health departments to help to
prevent HIV transmission. There is a need to specify a
legal process for a physician to identify an HIV-infected
patient to designated local public health staff, so that
the patient can be interviewed for information about
exposed partners. The current law can be interpreted as
absolutely prohibiting a physician from identifying a
patient to local public health for partner services. Only
if the local public health staff know who the patient is
and how to reach him/her, can it be possible for an
experienced public health partner services specialist to
communicate with the patient to encourage him/her to
identify all possible exposed persons and how the public
health specialist can help to contact them.
There is a need to reassure local public health staff that
communication with exposed partners is exempt from criminal
or civil liability. By doing this, SB 422 will encourage
more partner services that can help interrupt the spread of
HIV and thus save lives, as well as saving significant
health care expenses to the state that would result from
preventable new infections.
There is also a need to clarify a legal requirement that
information about exposed partners be expunged from public
health records. This requirement can currently be
interpreted to require premature expunging of contact
information, after an exposed person has been contacted but
before adequate information and proper referrals have been
arranged. SB 422 would clarify that information about
partners would not be expunged from public health records
until the partners had been alerted to their exposure and
SB 422
Page 4
referred for appropriate care and follow-up, as authorized
in current law.
For any other communicable disease, this bill would not be
necessary, because local public health agencies would
automatically be communicating in this manner. But because
there are significant penalties in the Health and Safety
Code for "unauthorized disclosure" of HIV information,
including information in public health records, it is
necessary to clarify in the law what types of disclosure
are exempt from these penalties.
Protects Physicians from Criminal and Civil Liability for
Disclosures of Information of Positive HIV Tests to Local Public
Health Agency Staff for Partner Notification Services: Under
existing law a physician is permitted to notify a person
potentially infected with HIV by sexual contact or
needle-sharing about their potential exposure without incurring
liability. The physician must additionally inform the local
health officer of all confirmed HIV cases and submit the name of
the infected patient to local health officials in charge of
tracking potential clusters of infections. However, the law
prohibits doctors from referring that patient to local health
staff for counseling and interviews about potential partner
contact. Even though the local health department is given the
patient's name they cannot contact an HIV patient for follow-up.
This bill seeks to protect physicians who identify an
HIV-infected patient for the purposes of referring them to local
public health authorities for follow-up and partner
identification interviews. Supporters contend these referrals
are essential to preventing further spread of HIV, as public
health staff must be able to interview the patient and determine
the identity of individuals who may have been exposed to HIV.
This bill creates a standard process whereby physicians can
legally refer infected patients to public health officials in
order to better identify and locate the patient's partners.
Protects Public Health Staff for Partner Services from Liability
for Disclosing Non-Identifying Information of Positive HIV
Tests: Under existing law, the local health officer and
treating physicians may alert any persons reasonably believed to
be a spouse, sexual partner or partner of shared needles of an
HIV positive patient, without disclosing any identifying
information. This bill extends this protection to the public
health officials responsible for HIV partner notifications.
SB 422
Page 5
Without this protection public health officials face significant
fines for improper disclosure and may hesitate to notify persons
potentially infected with HIV. This bill ensures that HIV
partner services staff who, as a part of their official duties,
track down and inform those who may have been exposed to HIV, do
not face significant civil and criminal penalties for improper
disclosure.
Giving Public Health Officials the Tools to Thoroughly Reach Out
to Those Potentially Infected with HIV: Existing law
unnecessarily limits the ability of public health officials to
adequately perform their duties in two key ways (beyond the
unclear liability discussed above). First, existing law permits
only the local health officer to notify patients they believe
have been exposed to HIV. Historically, local health officers
ran the daily operations of the department, but as health
departments have grown, local health officers are now
administrative and political heads and rarely perform day-to-day
functions like partner notifications. To confront this reality,
this bill expands those legally permitted to notify those
potentially exposed to HIV to include those health department
officials who specialize in partner notification services. By
expanding the group permitted to notify those potentially
exposed to HIV, this bill shifts the burden from the individual
public health officer to the staff of partner notification
services, who are trained in notifying those exposed to
communicable diseases can undertake this delicate function.
Secondly, under existing law, if a public health officer's
initial attempt to contact a potentially infected partner is
unsuccessful, the record of that partner must, nonetheless,
still be immediately expunged. Under this bill, the public
health staff gain greater flexibility and time to further
investigate and attempt to locate the potentially infected
partner before their records must be destroyed. By permitting
the public health agency to maintain records until referral for
care and follow-up is completed, public health officials can use
all necessary means to track down a potentially infected person,
thus at minimum notifying a potential carrier of the disease.
This provision is consistent with the bill's general goal of
increasing the ability of local health officials to notify
potentially infected partners of HIV patients. By giving the
officials more opportunity to contact a partner, this provision
aims to lessen the number of people unknowingly infected with
HIV.
SB 422
Page 6
ARGUMENTS IN SUPPORT : Beyond AIDS writes that this bill will
"connect the dots" to improve current law by empowering
necessary public health communication for the prevention and
control of the spread of HIV infections. The California Medical
Association writes that it is very important that physicians are
able to communicate with the appropriate personnel to help
control the transmission HIV. The California Academy of
Preventive Medicine states that by facilitating communication
and disclosure among health departments, health care providers,
and patients, this bill can result in more complete and accurate
surveillance to track who is being infected with HIV, so that
preventive efforts can be targeted to the people at risk. The
Infectious Disease Association of California writes that when
providing information about suspected contacts to a local health
officer, an HIV positive patient cannot be identified to allow
the health department staff to interview him or her in order to
get information that they do not have time and techniques to
collect, and that this bill will help assure such communication
is possible.
Prior Legislation : AB 2541 (Portantino and Fletcher), Chapter
470, Statutes of 2010, deleted the HIV exemption from authorized
electronic reporting and explicitly provided disclosure
authority to state and local public health personnel for the
purpose of providing complete information regarding sexually
transmitted disease surveillance to the federal government.
AB 2658 (Horton), Chapter 449, Statutes of 2008 required
laboratories to electronically submit all cases of "reportable
diseases and conditions" (including AIDS) within one year of the
establishment of the new state electronic laboratory reporting
system. However, AB 2658 exempts HIV reporting from this
requirement in order to allow the Department of Public Health
sufficient time to ensure the new system's data architecture is
in line with HIV-specific reporting requirements and that the
system would meet federal standards for HIV reporting.
SB 699 (Soto), Chapter 20, Statutes of 2006, required health
care providers and laboratories to report HIV cases by the
patient's name rather than code in order to comply with federal
funding requirements.
REGISTERED SUPPORT / OPPOSITION :
Support
SB 422
Page 7
AIDS Healthcare Foundation
Beyond AIDS
California Academy of Preventive Medicine
California Medical Association
Infectious Disease Association of California
3 individuals
Opposition
None on file
Analysis Prepared by : Drew Liebert and Nicholas Liedtke / JUD.
/ (916) 319-2334