BILL ANALYSIS �
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1898
AUTHOR: Brown
AMENDED: May 6, 2014
HEARING DATE: June 18, 2014
CONSULTANT: Moreno
SUBJECT : Public health records: reporting: HIV/AIDS.
SUMMARY : Adds hepatitis B, hepatitis C, and meningococcal
infection to the list of diseases that local public health
agency communicable disease staff are permitted to disclose,
along with personally identifying information in public health
records, to state public health agency staff for the purposes of
the investigation, control, or surveillance of HIV co-infection.
Existing law:
1.Requires public health records relating to HIV/AIDS,
containing personally identifying information, as specified,
to be confidential and not be disclosed, except as otherwise
provided by law for public health purposes or pursuant to a
written authorization by the person who is the subject of the
record or by his or her guardian or conservator.
2.Permits a state or local public health agency, or an agent of
that agency, to disclose personally identifying information in
public health records, as specified, 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.
3.Authorizes the following disclosures for the completeness of
HIV/AIDS, tuberculosis, and sexually transmitted disease
co-infection reporting to the federal Centers for Disease
Control and Prevention (CDC):
a. The local public health agency HIV surveillance
staff may further disclose the information to the health
care provider who provides HIV care to the HIV-positive
person who is the subject of the record, as specified;
b. Local public health agency tuberculosis control
staff may further disclose the information to state
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AB 1898 | Page 2
public health agency tuberculosis control staff, who may
further disclose the information, without disclosing
patient identifying information, to the CDC, to the
extent the information is requested by the CDC, for
purposes of the investigation, control, or surveillance
of HIV and tuberculosis co-infections; and,
c. Local public health agency sexually transmitted
disease control staff may further disclose the
information to state public health agency sexually
transmitted disease control staff, who may further
disclose the information, without disclosing patient
identifying information, to the CDC, to the extent it is
requested by the CDC, for the purposes of the
investigation, control, or surveillance of HIV and
syphilis, gonorrhea, or chlamydia co-infection.
This bill:
1.Adds hepatitis B, hepatitis C, and meningococcal infection to
the list of diseases that local public health agency
communicable disease staff are permitted to disclose, along
with personally identifying information in public health
records, to state public health agency staff for the purposes
of the investigation, control, or surveillance of HIV
co-infection.
2.Makes other clarifying, conforming changes to existing law.
FISCAL EFFECT : This bill has been keyed non-fiscal.
PRIOR VOTES :
Assembly Health: 14- 2
Assembly Judiciary: 10- 0
Assembly Floor: 68- 2
COMMENTS :
1.Author's statement. According to the author, those with HIV
infection are disproportionately affected by viral hepatitis.
Approximately 1/3 of people with HIV are co-infected with
either the hepatitis B virus (HBV) or hepatitis C virus (HCV).
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.
Reporting co-infection with HIV and HBV or HCV to public
health officials facilitates interventions to ensure proper
treatment of the individual and evaluation of exposed
AB 1898 | Page
3
contacts. Meningococcal meningitis causes an infection of the
membranes covering the brain and spinal cord. Complications
can include loss of limbs, hearing loss and, in 15 percent of
cases, death if left untreated. Reporting HIV and
meningococcal co-infection will enhance public health efforts
to respond to and prevent meningococcal outbreaks among the
HIV positive population. Local health departments already
receive information about HIV cases and hepatitis B and C, and
meningococcal infection. 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.
2.HIV and hepatitis. People with HIV who are co-infected with
either HBV or HCV are at increased risk for serious,
life-threatening complications. As a result, anyone living
with HIV should be tested for HBV and HCV. Co-infection with
hepatitis may also complicate the management of HIV infection.
Of people with HIV in the United States, about 25 are
co-infected with HCV, and about 10 percent are co-infected
with HBV. About 80 percent of people with HIV who inject
drugs also have HCV.
3.HIV and meningitis. A December 2000 article in the journal
Emerging Infectious Diseases reported on a 1999 case of what
is thought to be the first reported case of disseminated
meningococcemia in a patient co-infected with HIV and HCV.
First, the authors concluded that liver disease from
conditions like HCV is an important risk factor for
meningococcal disease. Because hypocomplementemia occurs
commonly in patients infected with HCV, particularly when
cirrhosis is present, these patients are at increased risk for
meningococcal infection. Patients who are co-infected with
HIV and HCV may be at even greater risk for meningococcal
infection because of accelerated liver destruction. For
example, patients co-infected with HIV and HCV have a higher
progression to hepatic fibrosis and a 3.5-fold increase in
hepatic cirrhosis, when compared to patients with HCV alone.
4.Double referral. This bill is double referred. Should it
pass out of this committee, it will be referred to the Senate
Committee on Judiciary.
5.Prior legislation. SB 249 (Leno), Chapter 445, Statutes of
AB 1898 | Page 4
2013, authorized the sharing of health records involving the
diagnosis, care, and treatment of HIV or AIDS related to a
beneficiary enrolled in federal Ryan White Act funded programs
who may be eligible for health care under the federal Patient
Protection and Affordable Care Act between DPH and qualified
entities, as specified.
AB 2541 (Portantino), Chapter 470, Statutes of 2010,
authorized specified disclosures of public health records
relating to HIV or AIDS between specified local public health
agency staff, health care providers, specified state public
health agency staff, and HIV positive individuals who are the
subject of the records, for the purposes of enhancing
completeness of sexually transmitted disease reporting to the
CDC and offering and coordinating care and treatment services
to HIV positive persons.
SB 699 (Soto), Chapter 20, Statutes of 2006, requires health
care providers and laboratories to report cases of HIV
infection to the local health officer using patient names and
requires local health officers to report HIV cases by name to
the Department of Public Health.
6.Support. The Health Officers Association of California
(HOAC), the sponsors of this bill, state that while local
health departments already receive information about HIV cases
and cases of hepatitis and meningococcal infection, it is
against the law to report on this information on the same
form. This creates a burden on public health departments and
medical providers and also creates a barrier to effective
patient care. HOAC states that this bill is an important step
towards remedying this situation.
SUPPORT AND OPPOSITION :
Support: Health Officers Association of California (sponsor)
County Health Executives Association of California
Oppose: None received.
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