BILL ANALYSIS �
AB 1667
Page 1
Date of Hearing: April 9, 2014
ASSEMBLY COMMITTEE ON EDUCATION
Joan Buchanan, Chair
AB 1667 (Williams) - As Amended: April 2, 2014
[Note: This bill was double referred from the Health Committee
and was heard by that committee as it relates to issues under
its jurisdiction.]
SUBJECT : Tuberculosis testing in schools.
SUMMARY : Deletes requirements for private and public school
employees and volunteers to undergo universal tuberculosis (TB)
testing; and, instead requires private and public school
employees and volunteers to complete a TB risk assessment and
receive follow up evaluation, testing and care if the person has
TB risk factors. Specifically, this bill :
1)Prohibits a person from being initially employed or from being
employed under contract by a school district in a certified or
classified position unless the person has had a TB risk
assessment within the past 60 days; and, applies this
requirement to all public schools, private or parochial
elementary or secondary schools, or any nursery school.
2)Specifies that if no risk factors are identified by a TB risk
assessment, an examination is not required.
3)Requires, if TB risk factors are identified by a TB risk
assessment, those employees to be examined by a physician to
determine if they are free of infectious TB. Requires the
examination to consist of either an approved intradermal TB
test or any other test for TB that is recommended by the
federal Centers for Disease Control and Prevention (CDC) and
licensed by the federal Food and Drug Administration (FDA) and
requires, if the test is positive that the test be followed by
an X-ray of the lungs.
4)Requires employees who have no identified risk factors or who
test negative to undergo a TB risk assessment at least once
each four years.
5)Specifies that once an employee has been documented as having
TB, the risk assessment is no longer required.
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6)Requires employees, after a TB risk assessment and, if
necessary, examination, to file with the district
superintendent, a certificate from the physician and surgeon
showing the employee was examined and found free from
infectious TB; and, authorizes the county board of education
to require certificates be filed in the office of the county
superintendent if a majority of school boards in the county
petition the county board of education and allows a school
district with an average daily attendance of 60,000 or more to
maintain the files for its employees in that district.
7)Clarifies that a governing board of a school district or the
governing authority of a private school, upon recommendation
of the local health officer, may require more extensive or
frequent physical exams.
8)Makes the risk assessment and if indicated, the examination a
condition of employment and requires the cost to be borne by
the applicant; and, authorizes schools or districts to
reimburse applicants once they are hired.
9)Requires existing employees to be reimbursed for the expense
of the TB assessment and test.
10) Requires a volunteer in a school to have a
certificate on file showing that the person submitted to a TB
risk assessment, and if necessary, a TB test. Authorizes a
school board to determine that a TB risk assessment is not
necessary if the volunteer does not have frequent or prolonged
contact with pupils.
11) Requires all drivers, as a condition of
contract with a governing board or county superintendent of
schools for providing the transportation of pupils, to have a
TB risk assessment and, if indicated, the examination for TB
within 60 days of initial hire and be found free of infectious
TB; and, exempts, at the discretion of the governing board or
county superintendent of schools drivers from the TB risk
assessment and test requirement who transport students
infrequently without prolonged contact with the pupils.
12) Requires the Department of Public Health, in
consultation with the California TB Controllers Association to
develop a risk assessment questionnaire to be used in TB risk
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assessments.
FISCAL EFFECT : Unknown
EXISTING LAW :
1)Prohibits a person from being initially employed, or put under
contract with a school district, private school or nursery
school, in a certified or classified position unless they have
had a TB test within the past 60 days to determine he or she
has been found free of active TB.
2)Requires the TB test to consist of an approved intradermal TB
test or any other test for TB that is recommended by the
Center for Disease Control (CDC) and licensed by the Food and
Drug Administration (FDA) and requires, if the test is
positive, that the test be followed by an X-ray of the lungs.
3)Allows a district superintendent or the governing authority of
a private school, to exempt a pregnant employee who tests
positive for TB from the requirement for an X-ray of the lungs
up to 60 days following termination of the pregnancy.
4)Requires employees who test negative for TB to be tested at
least once every four years.
5)Requires that once an employee has been documented as having
TB, the test is no longer required, and requires the employee
to be referred within 30 days to the local health officer to
determine the need for follow-up care.
6)Requires employees, after the test, to file a certificate from
the physician and surgeon showing the employee was examined
and found free from active TB. Authorizes the county board of
education to require that the certificates to be filed in the
office of the county superintendent if a majority of school
boards in the county petition the county board of education
and allows a school district with an average daily attendance
of 60,000 or more to maintain the files for its employees in
that district.
7)Requires all volunteers in a school to have a certificate on
file showing that within the last four years the person
submitted to a TB test and was found free of communicable TB.
Authorizes the governing authority of a school to determine
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that a TB test is not necessary if the volunteer does not have
frequent or prolonged contact with pupils.
8)Authorizes the governing board of a school district to pass a
resolution, after a hearing which finds that the health of
pupils in the district would not be jeopardized, allowing
employees to file an affidavit stating that they adhere to the
faith or teachings of any well-recognized religious sect that
depends upon prayer for healing and that to the best of their
knowledge, they are free of TB.
9)Authorizes employees transferring from one district to another
or from a public to a private school, to provide a certificate
from the previous employer showing that they were examined
within the past four years and found to be free of
communicable TB.
10)Requires all drivers, as a condition of contract with a
governing board or county superintendent of schools for
providing the transportation of pupils, to be examined for and
be found free of active TB. Exempts private contracted
drivers from the TB test requirement who transport students
infrequently, not to exceed once a month.
COMMENTS : This bill deletes existing requirements for school
employees and volunteers to undergo universal TB testing to
determine whether the person has active TB; and, instead
requires school employees and volunteers to complete a TB risk
assessment questionnaire and only if the person has TB risk
factors, then they must undergo a TB test.
According to the author, "The California Conference of Local
Health Officers (CCLHO) Communicable Disease (CD) Committee
requested that the California Tuberculosis Controllers
Association (CTCA) render a position on the mandated practices
of TB examination of teachers and other school employees and
volunteers. The best public health and medical evidence
suggests that universal TB testing is neither necessary nor
cost-effective. The Mantoux tuberculin skin test (TST) or any
currently-available FDA-approved TB infection test should be
applied routinely only among high-risk populations. School
employees and volunteers are not considered high-risk
populations. The number of Certificated and Classified Staff TB
cases is low, and universal testing results in a number of false
positives. This can result in persons being unnecessarily
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placed on potentially toxic treatment regimens."
Further the author states, "In a position statement, CTCA
recommended that the mandated practices of TB examination of
teachers and other school employees and volunteers be replaced
with a TB risk assessment questionnaire administered to teachers
and other school employees on hire and volunteers on initial
volunteer assignment, and TB testing based on the results of the
TB risk assessment. Each TB Control Program must utilize the
epidemiology of TB in their jurisdiction to decide how best to
apply this strategy at the local level. These recommendations
are consistent with guidelines from numerous expert bodies and
will allow the TB Control Programs to work most effectively to
detect and control TB in California. This bill would replace
current mandatory tuberculosis (TB) examination with a TB risk
assessment, and follow up TB testing based on the results of
that assessment, for the following groups:
a. Persons employed by a school district in a certificated
or classified position (Education Code, Section 49406)
b. Persons employed by a private or parochial elementary or
secondary school, or any nursery school (Health & Safety
Code, Sections 121525 and 121555)
c. Persons providing for the transportation of private
school pupils under authorized contract (Health & Safety
Code, Section 121525)
d. Volunteers with "frequent or prolonged contact with
pupils" (Education Code, Section 49406; Health & Safety
Code, Section 121545)."
According to the Assembly Health Committee, "The two purified
protein derivatives licensed by the FDA that serve as antigens
for TB tests have been experiencing nationwide shortages since
April 2013. In their September 4, 2013 health update, the CDC
recommends allocating TB tests to priority usages as determined
by public health authorities. Since 2000, the CDC has stated
that screening of low-risk persons and testing for
administrative purposes should be replaced by targeted testing.
In 2006, the Department of Public Health (DPH) and the
California Tuberculosis Controllers Association (CTCA) issued
joint guidelines, Targeted Testing and Treatment of Latent
Tuberculosis Infection in Adults and Children, which state that
tuberculin skin testing of low risk populations will result in
unnecessary treatment because of false-positive test results.
Currently five states (Florida, Texas, New Mexico, Nebraska, and
North Dakota) do not require teachers to be tested for TB."
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Who will be impacted ? The TB risk assessment consists of the
following questions:
1)History of positive TB test or TB disease?
2)One or more signs and symptoms of TB (prolonged cough,
coughing up blood, fever, night sweats, weight loss, excessive
fatigue)?
3)Close contact with someone with infectious TB disease?
4)Foreign board person? (Any country other than the US, Canada,
Australia, New Zealand or counties in Western or Northern
Europe)
5)Traveler to high TB-prevalence country for more than 1 month?
(Same countries as above)
6)Current or former resident or employee of correctional
facility, long-term care facility, hospital or homeless
shelter?
The committee should recognize that the TB risk assessment will
not eliminate the TB test requirement for school employees and
parent volunteers born in Mexico, any Central or South American
country or any Asian country, among others. While the risk
assessment will reduce the number of TB tests performed on
school employees and parent volunteers, the reduction will not
be as great as other states with less diversity.
REGISTERED SUPPORT / OPPOSITION :
Support
American Academy of Pediatrics
American Lung Association
California Medical Association
California School Nurses Organization
California Tuberculosis Controllers Association
County Health Executives Association of California
Health Officers Association of California
Opposition
None on file.
Analysis Prepared by : Chelsea Kelley / ED. / (916) 319-2087
AB 1667
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