BILL ANALYSIS �
AB 1667
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CONCURRENCE IN SENATE AMENDMENTS
AB 1667 (Williams)
As Amended August 6, 2014
Majority vote
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|ASSEMBLY: |76-1 |(May 28, 2014) |SENATE: |35-0 |(August 20, |
| | | | | |2014) |
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Original Committee Reference: HEALTH
SUMMARY : Replaces current mandatory tuberculosis (TB) testing
for school employees and volunteers with a TB risk assessment
administered by a health care provider.
The Senate amendments exempt the adoption of the risk assessment
questionnaire from regulatory adoption requirements under the
Administrative Procedure Act.
AS PASSED BY THE ASSEMBLY , this bill replaced current mandatory
TB testing for school employees and volunteers with a TB risk
assessment administered by a health care provider. Requires,
upon initial employment, individuals under contract by a school
district in a certified or classified position to undergo a TB
risk assessment and for current employees who have no identified
risk factors or who test negative to undergo a TB risk
assessment at least once every four years. Requires further
examinations for individuals identified with a TB risk factor,
as specified. Clarifies that a governing board of a school
district or the governing authority of a private school may
require more extensive or frequent physical exams, and that the
cost of the TB risk assessment to employees be reimbursable, as
specified.
FISCAL EFFECT : According to the Senate Appropriations
Committee, there is a likely reduction in costs for school
districts, by switching from mandatory testing to a risk
assessment. Under current 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
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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 the bill.
COMMENTS : According to the author, the best public health and
medical evidence suggests that universal TB testing is neither
necessary nor cost-effective. 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. The author also
states that this can result in persons being unnecessarily
placed on potentially toxic treatment regimens.
According to the Centers for Disease Control and Prevention
(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:
1)People who have spent time with someone who has TB disease;
2)People with human immunodeficiency virus infection or another
medical problem that weakens the immune system;
3)People who have symptoms of TB disease (fever, night sweats,
cough, and weight loss);
4)People from a country where TB disease is common (most
countries in Latin America, the Caribbean, Africa, Asia,
Eastern Europe, and Russia);
5)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,
6)People who use illegal drugs.
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Currently five states (Florida, Texas, New Mexico, Nebraska, and
North Dakota) do not require teachers to be tested for TB.
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.
The California Tuberculosis Controllers Association supports the
bill and references an American Academy of Family Physicians
statement noting, "Routine screening outside?high-risk groups
dissipates 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.
There is no opposition to this bill.
Analysis Prepared by : Paula Villescaz / HEALTH / (916)
319-2097
FN: 0004450