BILL ANALYSIS �
AB 1898
Page 1
Date of Hearing: April 29, 2014
ASSEMBLY COMMITTEE ON JUDICIARY
Bob Wieckowski, Chair
AB 1898 (Brown) - As Introduced: February 19, 2014
PROPOSED CONSENT (As Proposed to be Amended)
SUBJECT : PUBLIC HEALTH RECORDS: REPORTING: HIV/AIDS
KEY ISSUE : IN ORDER TO POTENTIALLY FACILITATE BETTER TREATMENT
AND CARE OF HIV PATIENTS CO-INFECTED WITH ONE OR MORE OTHER
DISEASES, SHOULD PUBLIC HEALTH REPORTING REQUIREMENTS BE REVISED
TO ALLOW REPORTING OF HIV CO-INFECTION WITH HEPATITIS B,
HEPATITIS C, AND MENINGOCOCCAL INFECTION, FOR VERY SPECIFIC
PURPOSES ONLY?
SYNOPSIS
This bill, sponsored by the Health Officers Association of
California, proposes modest expansion of strict current limits
on public health reporting of confidential patient information
for persons infected with HIV/AIDS and other specified diseases.
According to the author and proponents, existing law too
broadly limits reporting cases of HIV/AIDS in patients that are
co-infected with other serious, communicable diseases. This
restriction limits the completeness of public health reporting
because HIV/AIDS related records may not be disclosed for
co-infection with other diseases, unless specifically provided.
Proponents contend that this bill is needed to allow
consolidated reporting of HIV/AIDS and other diseases that
frequently present as co-infections because such reporting will
help facilitate better care and treatment of infected persons
and follow-up of exposed individuals. As proposed to be
amended, this bill enables public health reporting for HIV
co-infection with hepatitis C, hepatitis B, and meningococcal
infection, but not salmonellosis or listeriosis, which for
epidemiological reasons appear to be less appropriate candidates
for inclusion. In addition, proposed amendments to the bill
clarify that any further disclosure of the HIV patient
information, subsequent to the initially authorized disclosure,
is not permitted without written authorization of the patient,
and is subject to specific penalties for unauthorized
disclosure. With these proposed amendments, the Disability
Rights Legal Center has agreed to remove its opposition, and the
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bill no longer has any opposition. The bill was previously
passed by the Health Committee on a 14-2 vote, and will be
referred to the Appropriations Committee if approved here.
SUMMARY : Revises limitations on public health reporting of
confidential patient information for persons infected with
HIV/AIDS and other specified diseases ("co-infections").
Specifically, this bill :
1)For the purpose of enhancing the completeness of coinfection
reporting to the federal Centers for Disease Control and
Prevention (CDC), expands the scope of authorized disclosures
to include public health records indicating HIV/AIDS and
coinfection with hepatitis B, hepatitis C, and meningococcal
infection.
2)For the purposes of the investigation, control, or
surveillance of coinfection with HIV and hepatitis B,
hepatitis C, and meningococcal infection, permits local public
health agency communicable disease staff to further disclose
the information to state public health agency staff.
3)For the purpose of facilitating appropriate medical care and
treatment of persons coinfected with HIV and hepatitis B,
hepatitis C, and meningococcal infection, local public health
agency disease control staff, as specified, may further
disclose the information to the following persons:
a) Other state or local public health agency disease
control staff, as specified.
b) The HIV-positive person who is the subject of the
record.
c) The health care provider who provides disease care for
hepatitis B, hepatitis C, or meningococcal infection to the
HIV-positive person who is the subject of the record.
4)Requires any disclosure authorized by this bill to include
only the information specified and necessary for the purpose
of that disclosure and to be made only upon agreement that the
information will be kept confidential, and will not be further
disclosed without written authorization. Further provides
that such disclosures will be subject to the penalties
specified by existing law.
EXISTING LAW :
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1)Requires DPH to establish a list of communicable and
noncommunicable diseases and conditions which local health
officers (LHOs) are required to report to DPH. (Health and
Safety Code Section 120130. All further references are to
this code unless otherwise stated.)
2)Provides that HIV or AIDS-related public health records
containing personally identifying information (hereafter
"HIV/AIDS patient information") that were developed or
acquired by a state or local public health agency shall be
confidential and shall not be disclosed, except as otherwise
provided for public health purposes or pursuant to a written
authorization by the person who is the subject of the record.
(Section 121025(a).)
3)Permits a state or local public health agency to disclose
HIV/AIDS patient information to other local, state, or federal
public health agencies or to corroborating medical
researchers, when the confidential information is necessary to
carry out the duties of the agency or researcher in the
investigation, control, or surveillance of disease, as
determined by the state or local public health agency.
(Section 120125(b).)
4)Provides that any disclosure authorized by (2) or (3) above
shall include only the information necessary for the purpose
of that disclosure and shall be made only upon agreement that
the information will be kept confidential and will not be
further disclosed without written authorization, except for
the following cases:
a) Specified disclosures to health care providers,
tuberculosis control staff, and STD control staff for the
purpose of enhancing completeness of HIV/AIDS,
tuberculosis, and sexually transmitted disease coinfection
reporting to the federal Centers for Disease Control and
Prevention (CDC). (Section 121025(c)(1).)
b) Specified disclosures to local public health agency
staff, the HIV patient, or his HIV-care provider for the
purpose of facilitating appropriate HIV/AIDS medical care
and treatment. (Section 120125 (c)(2).)
c) Specified disclosures to local public health agency
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staff, the HIV patient, or his HIV-care provider for the
purpose of facilitating appropriate medical care and
treatment of persons coinfected with HIV and tuberculosis,
syphilis, gonorrhea, or chlamydia. (Section 120125
(c)(3).)
5)No confidential public health record, as defined in
subdivision (c) of Section 121035, shall be disclosed,
discoverable, or compelled to be produced in any civil,
criminal, administrative, or other proceeding. (Section
120125(d).)
6)Prohibits the negligent, willful, or malicious disclosure of
the content of any confidential public health record, as
defined, to any third party, except pursuant to a written
authorization, as described or as otherwise authorized by law,
and establishes civil penalties for violations of these
provisions. (Section 120125 (e).)
FISCAL EFFECT : As currently in print this bill is keyed fiscal.
COMMENTS : This bill proposes modest expansion of strict current
limits on public health reporting of confidential patient
information for persons infected with HIV/AIDS and other
specified diseases. The bill is sponsored by the Health
Officers Association of California, representing the physician
health officers in the 61 city and county public health
jurisdictions in California.
Need for the bill. According to the author and proponents,
existing law too broadly limits reporting cases of HIV/AIDS in
patients that are co-infected with tuberculosis and sexually
transmitted diseases, specifically syphilis, gonorrhea or
chlamydia. This restriction limits the completeness of public
health reporting because HIV/AIDS related records may not be
disclosed for co-infection with other diseases and thus creates
barriers to HIV reporting and data collection used for follow-up
of exposed individuals. Proponents state: "Local health
departments already receive information about HIV cases and
cases of hepatitis, meningococcal infection, and [other
diseases]. However, current law forbids health departments from
receiving this information together in one form. This puts an
unnecessary burden on public health departments and medical care
providers, and creates barriers to effective patient care."
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In summary, supporters contend that this bill is needed to allow
consolidated reporting of HIV/AIDS and other diseases that
frequently present as co-infections because such reporting will
help facilitate better care and treatment of infected persons,
follow-up of exposed individuals, and further development of
intervention programs to prevent ongoing disease transmission.
Background on HIV coinfection with other diseases . Coinfection
means infection with more than one disease at the same time.
According to the Assembly Health Committee analysis:
Some coinfections commonly seen in people infected with
HIV include hepatitis B, hepatitis C, and tuberculosis.
The diseases can be treated although treatment does depend
on the type of coinfection as the possibility of drug
interaction always exists. The diseases listed in this
bill are very serious for those infected with HIV.
According to the Centers for Disease Control and
Prevention (CDC), those with HIV infection are
disproportionately affected by viral hepatitis.
Approximately one-third of people with HIV are coinfected
with either hepatitis B or C. This can cause long term
illness and death. Individuals who are co-infected with
HIV and hepatitis experience greater liver related health
problems than those who are not. Viral hepatitis also
progresses faster among people with HIV.
Another disease to be reported is meningococcal infection,
which is a type of meningitis, meaning it causes an
infection of the membranes covering the brain and spinal
cord. Complications can include loss of limbs, hearing
loss and, in 15% of cases, death if left untreated.
According to the CDC, approximately 25% of HIV-positive
individuals are co-infected with Hepatitis C and 10% are
co-infected with Hepatitis B. An estimated 80% of HIV-positive
individuals that engage or have engaged in injection drug use
are co-infected with Hepatitis C. There is a vaccine for
Hepatitis B, but there is no cure for the condition.
Conversely, there is no vaccine for Hepatitis C, but there is an
effective treatment that some believe may lead to a cure.
The National Institutes of Health provides guidelines on
HIV/AIDS treatment using antiretroviral medications that
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specifically outline the issues with treating individuals
co-infected with HIV and hepatitis. This is because there are
specific treatment concerns with these co-infections.
Essentially, antiretroviral therapy is recommended for patients
co-infected with Hepatitis B and for most with Hepatitis C.
There are clear preferences in the types of drug therapies used
to treat both conditions. With Hepatitis C, however, there are
other concerns related to the type of HIV and an individual's
ability to adhere to two regimens that result in a large pill
burden, drug interactions, and overlapping toxicities. In fact,
some clinicians might even choose to defer HIV treatment in some
cases of Hepatitis C co-infection.
By contrast, salmonellosis and listeriosis are serious
infections usually caused by consuming contaminated food, and
resulting in symptoms of fever, diarrhea, or other
gastrointestinal complications. Unlike hepatitis or meningitis,
CDC reports that most people with salmonellosis recover without
treatment after four to seven days. While it is true that
people with weakened immune systems (a defining characteristic
of HIV infection) are more likely to be vulnerable to
salmonellosis or listeriosis, that is true of almost every
communicable disease generally. It is instructive that neither
salmonellosis or listeriosis are mentioned in the NIH treatment
guidelines for HIV co-infection, and meningococcal infection is
mentioned once, but only as an opportunistic infection ("OI")
appurtenant to HIV infection, and in the context of discussing
treatment in the presence of any acute infection which might
have an impact on treatment.
For these reasons, it appears that hepatitis B and hepatitis C
are most epidemiologically similar to HIV, while salmonellosis
and listeriosis appear to be the least similar, with
meningococcal infection somewhere in the middle. These are
important factors to consider when evaluating the policy reasons
for revising California's strongly protective HIV
confidentiality laws to allow for increased disclosure to other
public health staff and treating physicians for the purpose of
improving treatment option for co-infected patients.
As proposed to be amended, this bill facilitates co-infection
reporting for hepatitis C, hepatitis B,and meningococcal
infection, but no longer salmonellosis or listeriosis. Existing
law specifically authorizes enhanced reporting of HIV
co-infection only with tuberculosis and the common sexually
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transmitted diseases of syphilis, gonorrhea, and chlamydia.
After fruitful discussions between the stakeholders, the author
now proposes to amend the bill to include hepatitis B, hepatitis
C, and meningococcal infection among the set of diseases
reportable as co-infections--but to no longer include
salmonellosis or listeriosis as proposed in the previous version
of the bill.
In addition, the author proposes several clarifying amendments
that seek to ensure the additional disclosures of HIV patient
records authorized by this bill are narrowly drawn and limited
to only the information necessary for the purpose of the
specific disclosure. Finally, as proposed to be amended, the
bill clarifies that any further disclosure of the HIV patient
information, subsequent to the initially authorized disclosure,
is not permitted without written authorization of the patient,
and is subject to specific penalties for unauthorized
disclosure.
ARGUMENTS IN SUPPORT : The Health Officers Association of
California notes that numerous state-level privacy protections,
unaffected by this bill, will still operate to protect privacy
and confidentiality of HIV patients. They explain:
AB 1898 will give no new information to health
departments. Health departments already receive
name-based reporting for cases of HIV, hepatitis B,
hepatitis C, salmonellosis, listeria, and meningococcal
infection. AB 1898 is a proposal to change the way the
information is received. This will eliminate duplication
of data and effort, and reduce the likelihood of missing
important clinical information that is vital to the care
of our HIV-positive clients.
A variety of national and state privacy laws apply to the data
and exist to protect the rights of patients. All health
department staff that have access to the HIV reporting system
are trained in confidentiality. The following privacy
provisions are included in the existing Health and Safety Code
and are unchanged by the bill.
No confidential public health record?shall be disclosed,
discoverable, or compelled to be produced in any civil,
criminal, administrative, or other proceeding.
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A person who negligently discloses the content of a
confidential public health record, as defined in
subdivision (c) of Section 121035, to any third party,
except pursuant to a written authorization, as described
in subdivision (a), or as otherwise authorized by law,
shall be subject to a civil penalty in an amount not to
exceed five thousand dollars ($5,000), plus court costs,
as determined by the court, which penalty and costs shall
be paid to the person whose record was disclosed.
Any person who commits [these acts] shall be liable to the
person whose confidential public health record was
disclosed for all actual damages for economic, bodily, or
psychological harm that is a proximate result of the act.
Nothing in this section limits or expands the right of an
injured person whose confidential public health record was
disclosed to recover damages under any other applicable
law.
REGISTERED SUPPORT / OPPOSITION :
Support
Health Officers Association of California (sponsor)
Opposition (unless amended)
Disability Rights Legal Center
Analysis Prepared by : Anthony Lew / JUD. / (916) 319-2334