BILL ANALYSIS �
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|SENATE RULES COMMITTEE | AB 1667|
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THIRD READING
Bill No: AB 1667
Author: Williams (D)
Amended: 8/6/14 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 8-0, 6/18/14
AYES: Hernandez, Morrell, Beall, DeSaulnier, Evans, Monning,
Nielsen, Wolk
NO VOTE RECORDED: De Le�n
SENATE APPROPRIATIONS COMMITTEE : 7-0, 8/4/14
AYES: De Le�n, Walters, Gaines, Hill, Lara, Padilla, Steinberg
ASSEMBLY FLOOR : 76-1, 5/28/14 - See last page for vote
SUBJECT : Tuberculosis testing in schools
SOURCE : Health Officers Association of California
DIGEST : This bill replaces current mandatory tuberculosis
(TB) testing for school employees and volunteers with a TB risk
assessment administered by a health care provider.
ANALYSIS :
Existing law:
1. Prohibits a person from being initially employed, or put
under contract with a school district in a certified or
classified position, unless they have had a TB test within
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the past 60 days to determine if he/she has 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
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.
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 for 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 showing the employee was examined and
found free from active TB.
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.
Allows the governing authority of a school to determine that
a TB test is not necessary if the volunteer does not have
frequent or prolonged contact with pupils.
8. Allows the governing board of a school 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. Allows employees transferring from one district to another or
from a public to a private school, to provide a certificate
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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.
This bill:
1. Replaces current mandatory TB testing for school employees
and volunteers with a TB risk assessment administered by a
health care provider. 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.
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. Permits a
person who is subject to these requirements to submit to an
examination that complies with #4) below instead of
submitting to a TB risk assessment.
4. Requires the examination to consist of either an approved
intradermal TB test or any other test for TB that is
recommended by the CDC and licensed by the FDA and requires,
if the test is positive that the test be followed by an X-ray
of the lungs.
5. Requires employees who have no identified risk factors, or
who test negative, to undergo a TB risk assessment at least
once each four years.
6. Specifies that once an employee has been documented as having
TB, the risk assessment is no longer required.
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7. Requires employees, after a TB risk assessment and, if
necessary, an examination, to file with the district
superintendent, a certificate from the physician and surgeon,
physician assistant, or nurse practitioner showing the
employee was examined and found free from infectious TB.
8. Permits a governing board of a school district or the
governing authority of a private school, upon recommendation
of the local health officer, to require more extensive or
frequent physical exams.
9. Makes the risk assessment and, if indicated, the TB test a
condition of employment and requires the cost to be borne by
the applicant. Allows schools or districts to reimburse
applicants once they are hired.
10.Requires existing employees to be reimbursed for the expense
of the TB assessment and test.
11.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. Allows 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. Permits a person who is subject to these
requirements to take an examination that complies with #4)
above instead of submitting to a TB risk assessment.
12.Requires DPH, in consultation with the California
Tuberculosis Controllers Association (CTCA), to develop a
risk assessment questionnaire, to be used to conduct TB risk
assessments. Requires the risk assessments questionnaire to
be administered by a health care provider which shall be
specified on the questionnaire. Specifies that the risk
assessment questionnaire is exempt from the rulemaking
provisions of the Administrative Procedure Act.
13.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.
Exempts, at the discretion of the governing board or county
superintendent of schools drivers from the TB assessment and
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test requirement who transport students infrequently without
prolonged contact with the pupils.
Background
According to the CDC, TB is a disease that is spread through the
air from one person to another. There are two kinds of tests
that are used to determine if a person has been infected with TB
bacteria: the tuberculin skin test and TB blood tests. A
positive TB skin test or TB blood test only tells that a person
has been infected with TB bacteria. It does not tell whether
the person has latent TB infection or has progressed to TB
disease. Other tests, such as a chest X-ray and a sample of
sputum, are needed to see whether the person has TB disease.
According to the CDC, TB tests are generally not needed for
people with a low risk of infection with TB bacteria. Certain
people should be tested for TB bacteria because they are more
likely to get TB disease, including:
People who have spent time with someone who has TB disease;
People with HIV infection or another medical problem that
weakens the immune system;
People who have symptoms of TB disease (fever, night sweats,
cough, and weight loss);
People from a country where TB disease is common (most
countries in Latin America, the Caribbean, Africa, Asia,
Eastern Europe, and Russia);
People who live or work somewhere in the United States where
TB disease is more common (homeless shelters, prison or jails,
or some nursing homes); and
People who use illegal drugs.
Prior legislation
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AB 1323 (DeSaulnier, Chapter 24, Statutes 2007) expanded the
types of TB testing that may be used to screen for, or to
report, cases of active TB, to include the use of any test
recommended by the CDC and licensed by the FDA.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee:
Likely reduction in costs for school districts, by switching
from mandatory testing to a risk assessment. Existing law,
school districts are authorized to reimburse applicants for
employment and are required to reimburse current employees for
the cost of being tested for tuberculosis. A risk assessment
by a health care provider is likely to be less costly than a
test. Therefore, to the extent that school districts are
currently reimbursing applicants and employees for those
costs, the costs to school districts are likely to be lower
under this bill.
SUPPORT : (Per Senate Health Committee analysis of 6/9/14 --
unable to verify at time of writing)
Health Officers Association of California (source)
American Academy of Pediatrics
American Lung Association in California
California Academy of Family Physicians
California Academy of Preventative Medicine
California Medical Association
California School Nurses Organization
California Tuberculosis Controllers Association
County Health Executives Association of California
ARGUMENTS IN SUPPORT : The Health Officers Association of
California, the sponsor of this bill, writes that school
employees and volunteers are not considered high-risk
populations and replacing mandated universal testing of school
personnel with targeted screening will be more cost effective
while still protecting the state's teachers, volunteers, school
employees, and children from TB. CTCA supports this bill and
references an American Academy of Family Physicians statement
noting, "Routine screening outside?high-risk groups dissipates
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resources and leads to high false-positive test rates." The
California School Nurses Association supports this bill because
it has been demonstrated that school staff and volunteers are a
low risk population and thus the revised policy and protocol for
universal TB risk assessment and testing, if warranted, is more
efficacious and efficient.
ASSEMBLY FLOOR : 76-1, 5/28/14
AYES: Achadjian, Alejo, Allen, Ammiano, Bigelow, Bloom,
Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian
Calderon, Campos, Chau, Ch�vez, Chesbro, Conway, Cooley,
Dababneh, Dahle, Daly, Dickinson, Fong, Fox, Beth Gaines,
Garcia, Gatto, Gomez, Gonzalez, Gordon, Gorell, Gray, Grove,
Hagman, Hall, Harkey, Roger Hern�ndez, Holden, Jones,
Jones-Sawyer, Levine, Linder, Logue, Lowenthal, Maienschein,
Mansoor, Medina, Melendez, Mullin, Muratsuchi, Nazarian,
Nestande, Olsen, Pan, Patterson, Perea, John A. P�rez, V.
Manuel P�rez, Quirk, Quirk-Silva, Rendon, Ridley-Thomas,
Rodriguez, Salas, Skinner, Stone, Ting, Wagner, Waldron,
Weber, Wieckowski, Wilk, Williams, Yamada, Atkins
NOES: Eggman
NO VOTE RECORDED: Donnelly, Frazier, Vacancy
JL:d 8/6/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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