BILL ANALYSIS �
SENATE JUDICIARY COMMITTEE
Senator Hannah-Beth Jackson, Chair
2013-2014 Regular Session
AB 1898 (Brown)
As Amended May 6, 2014
Hearing Date: June 24, 2014
Fiscal: No
Urgency: No
NR
SUBJECT
Public health records: reporting: HIV/AIDS
DESCRIPTION
This bill would add hepatitis B, hepatitis C, and meningococcal
infection to the list of diseases that local public health
agencies reports to the Center for Disease Control and to the
state public health agency for the purpose of the investigation,
control, or surveillance of human immunodeficiency virus (HIV)
and co-infection.
This bill would only authorize disclosure of the information
necessary for the purpose of that disclosure and only upon the
agreement that the information will be kept confidential and
will not be further disclosed without written authorization.
BACKGROUND
The Health Insurance Portability and Accountability Act (HIPAA),
enacted in 1996, guarantees privacy protection for individuals
with regards to specific health information (Pub.L. 104-191, 110
Stat. 1936). Generally, protected health information (PHI) is
any information held by a covered entity which concerns health
status, provision of health care, or payment for health care
that can be connected to an individual. HIPAA privacy
regulations require health care providers and organizations to
develop and follow procedures that ensure the confidentiality
and security of PHI when it is transferred, received, handled,
or shared. HIPAA further requires reasonable efforts when
using, disclosing, or requesting PHI, to limit disclosure of
that information to the minimum amount necessary to accomplish
(more)
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the intended purpose. California's Confidentiality of Medical
Information Act (CMIA), also protects patient confidentiality
and provides that medical information may not generally be
disclosed by providers of health care, health care service
plans, or contractors without the patient's written
authorization. However, medical information may be shared with
other health care professionals or facilities for the purposes
of diagnosis or treatment of the patient.
Public health officials use disease reporting to monitor public
health, develop prevention strategies, allocate resources, and
facilitate research. California requires healthcare providers
to confidentially report more than 80 diseases and conditions to
local health officers. Acquired Immunodeficiency Syndrome
(AIDS) has been reportable in California for over 30 years.
Since AIDS cases represent later stages of the disease, AIDS
data are less useful than HIV data for public health
professionals to monitor the epidemic, and target and evaluate
prevention and treatment programs. California responded to need
for HIV data by implementing code-based HIV reporting in July
2002. The HIV reporting system in California is a dual
reporting system in which reports are required from both
laboratories and healthcare providers. Labs are required to
submit lab notifications of confirmed HIV tests to the provider
and to the local health department where the provider is
located.
Co-infection is the infection of more than one disease at the
same time. Existing law specifically authorizes reporting of
HIV co-infection only with tuberculosis, syphilis, gonorrhea,
and chlamydia. According to the Centers for Disease Control and
Prevention (CDC), those with HIV infection are
disproportionately affected by viral hepatitis, with
approximately one-third of people with HIV co-infected 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 in people with
HIV. Meningococcal infection, which is a type of meningitis,
causes an infection of the membranes covering the brain and
spinal cord. Complications can include loss of limbs, hearing
loss and, in some cases, death if left untreated. This bill
would add hepatitis B, C, and meningococcal infection to the
list of conditions that may be co-reported with HIV.
CHANGES TO EXISTING LAW
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Existing law , the California Constitution, provides that all
people have inalienable rights, including the right to pursue
and obtain privacy. (Cal. Const., art. I, Sec. 1.)
Existing federal law , the Health Insurance Portability and
Accountability Act (HIPAA), specifies privacy protections for
patients' protected health information and generally provides
that a covered entity, as defined (health plan, health care
provider, and health care clearinghouse), may not use or
disclose protected health information except as specified or as
authorized by the patient in writing. (45 C.F.R. Sec. 164.500
et seq.)
Existing law prohibits, under the State Confidentiality of
Medical Information Act (CMIA), providers of health care, health
care service plans, or contractors, as defined, from sharing
medical information without the patient's written authorization,
subject to certain exceptions. (Civ. Code Sec. 56 et seq.)
Existing law protects the privacy of individuals who are the
subject of blood testing for antibodies to human
immunodeficiency virus (HIV), as specified. (Health & Saf. Code
Sec. 120975.)
Existing law requires the Department of Public Health (DPH) to
establish a list of communicable and non-communicable diseases
and conditions which local health officers (LHOs) are required
to report to DPH. (Health & Saf. Code Sec. 120130.)
Existing law requires health care providers and laboratories to
report cases of HIV infection to the local health officer using
patient names, as specified, and requires the LHO to report
unduplicated HIV cases by name to DPH. (Health & Saf. Code Sec.
121022.)
Existing law requires health records containing personally
identifying information relating to HIV or AIDS, which were
developed or acquired by state or local public health agencies,
to be confidential and not be disclosed, except as provided by
law for public health purposes or in accordance with a written
authorization by the patient, as specified. (Health & Saf. Code
Sec. 121025(a).)
Existing law authorizes a state or local public health agency to
disclose HIV/AIDS patient information to other local, state, or
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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. (Health
& Saf. Code Sec. 120125(b).)
Existing law provides that any disclosure authorized by the two
provisions immediately 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:
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 co-infection reporting to the federal
Centers for Disease Control and Prevention (CDC) (Health &
Saf. Code Sec. 121025(c)(1).);
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
(Health & Saf. Code Sec. 120125 (c)(2).); and
specified disclosures to local public health agency staff, the
HIV patient, or his HIV-care provider for the purpose of
facilitating appropriate medical care and treatment of persons
co-infected with HIV and tuberculosis, syphilis, gonorrhea, or
chlamydia. (Health & Saf. Code Sec. 120125 (c)(3).)
This bill would add hepatitis B, hepatitis C, and meningococcal
infection to the list of diseases that local public health
agency communicable disease staff are allowed 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.
This bill would make other clarifying changes.
COMMENT
1.Stated need for the bill
According to the author:
According to the Centers for Disease Control and Prevention
(CDC), those with HIV infection are disproportionately
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affected by viral hepatitis. Approximately one third of
people with HIV are co-infected with either HBV or 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
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 cases of hepatitis, 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.Maintains patient privacy while improving coordination of care
This bill would authorize the local public health agency
communicable disease staff to disclose the occurrence of HIV and
co-infection with hepatitis B, hepatitis C, and meningococcal
infection to the state public health agency staff for the
purposes of the investigation, control, and surveillance. The
sponsor of this bill, the Health Officers Association of
California (HOAC), notes that there are many state-level
protections that will not be affected by this bill, and will
still operate to protect the privacy of HIV patients. HOAC
writes:
Current law has the stated goals of enhancing the completeness
of public health reporting and facilitating appropriate care
and treatment of persons living with HIV/AIDS. However, the
Health & Safety Code currently limits these efforts to cases
of HIV/AIDS that are co-infected with a few specific diseases:
tuberculosis, syphilis, gonorrhea or chlamydia. HIV/AIDS
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related public health records may not be disclosed for other
diseases.
Local health departments already receive information about HIV
cases and cases of hepatitis 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 patient care.
This bill would allow local public health agencies instead to
co-report these additional three diseases. Just as a patient's
privacy is protected when the local health agency reports
instances of chlamydia occurring at the same time as HIV/AIDS,
existing law ensures that co-reporting of the three diseases
under this bill will be subject to the same protections under
the Confidentiality of Medical Information Act (CMIA) and the
federal Health Insurance Portability and Accountability Act
(HIPAA) (see Background).
In support, the California Academy of Preventative Medicine
writes, "patients who have co-infections are the ones with the
highest morbidity and mortality, and they require special care
with complex coordination. Communication to and from the local
health department would be helpful in managing these patients.
AB 1898 removes an obstacle to reporting and communication of an
important aspect of many complex cases. It will help assure
that confidentiality laws regarding HIV are not construed so as
to obstruct optimal medical care."
3.Clarifies that patient authorization is required for further
disclosure
This bill would require that any disclosure of co-infection
shall include only the information necessary for the purpose of
that disclosure and shall be made only upon the agreement that
the information will be kept confidential and will not be
further disclosed without written authorization.
Arguably, this is a restatement of existing law, which already
requires written authorization for disclosure of medical
information under the CMIA. However, including this language in
the code provision which specifically deals with reporting of
co-infection, will further ensure that patient's confidentiality
and privacy rights are protected.
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Support : California Academy of Preventative Medicine; County
Health Executives Association of California
Opposition : None Known
HISTORY
Source : Health Officers Association of California
Related Pending Legislation : None Known
Prior Legislation :
SB 249 (Leno, Chapter 445, Statutes of 2013) authorized the
sharing of health records involving the diagnosis, care, and
treatment of HIV or AIDS related to a beneficiary enrolled in
the 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.
Prior Vote :
Assembly Floor (Ayes 68, Noes 2)
Assembly Judiciary Committee (Ayes 10, Noes 0)
Assembly Health Committee (Ayes 14, Noes 2)
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