BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1577
AUTHOR: Atkins
AMENDED: June 3, 2014
HEARING DATE: June 11, 2014
CONSULTANT: Moreno
SUBJECT : Certificates of death: gender identity.
SUMMARY : Requires a person completing a death certificate to
record the decedent's sex to reflect the decedent's gender
identity, as specified.
Existing law:
1.Requires a funeral director, or person acting in lieu of, to
prepare a death certificate and register it with the local
registrar. Requires the funeral director to obtain required
information (other than medical and health section data) from
the person or source best qualified to supply this information
(referred to as the "informant").
2.Requires death certificates to be divided into two sections,
with the first section containing items necessary to establish
the fact of the death, including all of the following and
those other items as the State Registrar may designate:
a. Personal data concerning decedent, including full
name, sex, color or race, marital status, name of spouse,
date of birth and age at death, birthplace, usual
residence, and occupation and industry or business;
b. Date of death, including month, day, and year;
c. Place of death;
d. Full name of father and birthplace of father, and
full maiden name of mother and birthplace of mother;
e. Informant;
f. Disposition of body information including signature
and license number of embalmer if body embalmed or name
of embalmer if affixed by attorney-in-fact; name of
funeral director, or person acting as such; and date and
place of interment or removal, as specified;
g. Certification and signature of attending physician
and surgeon or certification and signature of coroner
when required to act by law, as specified; and,
h. Date accepted for registration and signature of
Continued---
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local registrar, as specified.
3.Requires the second section to contain items relating to
medical and health data, including all of the following and
other items as the State Registrar may designate:
a. Disease or conditions leading directly to death and
antecedent causes;
b. Operations and major findings thereof;
c. Accident and injury information; and,
d. Information indicating whether the decedent was
pregnant at the time of death, or within the year prior
to the death, if known, as determined by observation,
autopsy, or review of the medical record, as specified.
This bill:
1.Requires a person completing a death certificate to record the
decedent's sex to reflect the decedent's gender identity.
Requires the decedent's gender identity to be reported by the
informant, unless the person completing the certificate is
presented with a birth certificate, a driver's license, a
social security record, a court order approving a name or
gender change, a passport, an advanced health care directive,
or proof of clinical treatment for gender transition, in which
case the person completing the certificate is required to
record the decedent's sex as that which corresponds to the
decedent's gender identity as indicated in that document.
2.Requires, if none of these documents are presented and the
person with the right, or a majority of persons who have equal
rights, to control the disposition of the remains, as
specified, is in disagreement with the gender identity
reported by the informant, the gender identity of the decedent
recorded on the death certificate to be as reported by that
person or majority of persons.
3.Permits, if a document specified in 1) above is not presented
and a majority of persons who have equal rights to control the
disposition of the remains, as specified, do not agree with
the gender identity of the decedent as reported by the
informant, any one of those persons to file a petition, in the
superior court in the county in which the decedent resided at
the time of his or her death, or in which the remains are
located, naming as a party to the action those persons who
otherwise have equal rights to control the disposition and
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seeking an order of the court determining, as appropriate, who
among those parties is to determine the gender identity of the
decedent.
4.Prohibits a person completing the death certificate in
compliance with 1) above from being liable for any damages or
costs arising from claims related to the sex of the decedent
as entered on the death certificate.
5.Requires a person completing the death certificate to comply
with the data and certification requirements by using the
information available to him or her prior to the deadlines for
completion specified in existing law.
FISCAL EFFECT : According to the Assembly Appropriations
Committee analysis:
likely minor, if any, state fiscal effect.
Of about 230,000 deaths in California annually, approximately
700 deaths are expected among transgender individuals. Although
this bill applies to all deaths, as a practical matter it would
likely only address the subset of this 700 that may have issues
with discrepancies in gender identification. Under this bill,
counties could be required to process additional legal
documents, leading to potential state-reimbursable mandate
costs. However, workload to comply with this bill at the county
level appears minor, and mandate claims appear unlikely.
PRIOR VOTES :
Assembly Health: 17- 1
Assembly Appropriations:14- 3
Assembly Floor: 62- 5
COMMENTS :
1.Author's statement. According to the author, the Respect
After Death Act will ensure that transgender individuals who
have memorialized their gender identity on their legal
documents can be recognized properly at death. Additionally,
AB 1577 will provide protection from civil suits for funeral
directors and coroners who follow the letter of the law. Once
we are deceased, we are often at the mercy of others to treat
us with dignity. The very least we can do is ensure
individuals are given basic human dignity by honoring their
authentic selves when they pass so that more pain is not
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inflicted upon grieving loved ones or the community.
2.Background. The University of California, Berkeley Gender
Equity Resource Center defines transgender in the following
manner: Transgender (sometimes shortened to trans or TG)
people are those whose psychological self (gender identity)
differs from the social expectations for the physical sex they
were born with. To understand this, one must understand the
difference between biological sex, which is one's body
(genitals, chromosomes, etc.), and social gender, which refers
to levels of masculinity and femininity. Often, society
conflates sex and gender, viewing them as the same thing. But
gender and sex are not the same thing. Transgender people are
those whose psychological self (gender identity) differs from
the social expectations for the physical sex they were born
with. For example, a female with a masculine gender identity
or who identifies as a man. A University of California, Los
Angeles Williams Institute study from 2008 estimates that 0.3
percent of adults are transgender.
3.Reporting and use of data. DPH uses the data collected
through death certificates for public health research and
planning. According to DPH, this bill would not change the way
the State Registrar records the death certificate or reports
public health data, as the certificate cannot be altered after
registration by the local registrar (i.e., information that is
listed on the death record is required to be reported).
According to DPH, this bill will also not affect the way
causes of death are reported in data. The coding of causes of
death for California vital records is provided by the National
Centers for Health Statistics (NCHS). In coding causes of
death, NCHS adheres to the World Health Organization
Nomenclature Regulations specified in the most recent revision
of the International Statistical Classification of Diseases
and Related Health Problems. In general, pursuant to the ICD
10 Mortality Manual 2a 2014, Section N. Sex and Age
Limitations, if the underlying cause of death appears to be
inconsistent with the gender, the accuracy of the underlying
cause of death is re-examined and the gender is verified. In
addition, verification of the inconsistency can be
accomplished through examination of name, occupation, and
other items on the certificate. If the gender is determined to
be incorrect, the data record is corrected. If the gender
entry is correct but not consistent with the underlying cause
of death, the death is coded to "Other ill-defined and
unspecified causes of mortality" Sometimes on a case-by-case
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basis, inconsistencies in the underlying cause of death and
gender are coded as "unspecified" underlying causes of death,
e.g., "unspecified cancer," or they may be coded to the
secondary cause of death if it is consistent with the gender,
e.g., a primary cause of death for a male with ovarian cancer
that has metastasized to the kidneys may be coded as kidney
cancer.
4.Double referral. This bill is double referred. Should it
pass out of this committee, it will be referred to the Senate
Judiciary Committee.
5.Prior legislation. AB 1121 (Atkins), Chapter 651, Statutes of
2013, creates, as of July 1, 2014, an optional administrative
procedure for a transgender person born in California to amend
gender and name on his/her birth certificate without first
obtaining a court order.
6.Support. The Transgender Law Center and Equality California,
the cosponsors of this bill write in support that current
California law governing the completion of death certificates
fails to provide sufficient direction to the authorities, such
as funeral directors and coroners who are responsible for
determining a person's gender designation after death. In
some cases, this lack of clarity has resulted in the issuance
of a death certificate that inaccurately reflects a
transgender person's gender. When a transgender person is
ascribed the incorrect gender, whether on official documents
or in the media, it is disrespectful to the memory of the
deceased person and can be deeply painful and stigmatizing to
grieving friends, family, and fellow community members. The
Civil Justice Association of California supports this bill
because it grants civil immunity to coroners and funeral home
directors when they record the sex of a transgendered person
and will allow those professionals to do their jobs without
fear of a meritless lawsuit.
7.Opposition. Capitol Resource Family Impact opposes this bill
because it would give an acquaintance the legal authority to
change the legal gender of a person after death, and they
believe if a person chose to not take the legal steps to
change his or her gender during his or her lifetime, no
individual should have the right to make that change for that
person after their death.
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SUPPORT AND OPPOSITION :
Support: Equality California (co-sponsor)
Transgender Law Center (co-sponsor)
American Federation of State, County and Municipal
Employees, AFL-CIO
California Communities United Institute
City and County of San Francisco
Civil Justice Association of California
Oppose: Capitol Resource Family Impact
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