BILL ANALYSIS �
-----------------------------------------------------------------
|SENATE RULES COMMITTEE | AB 1898|
|Office of Senate Floor Analyses | |
|1020 N Street, Suite 524 | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
-----------------------------------------------------------------
THIRD READING
Bill No: AB 1898
Author: Brown (D)
Amended: 8/18/14 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 JUDICIARY COMMITTEE : 7-0, 6/24/14
AYES: Jackson, Anderson, Corbett, Lara, Leno, Monning, Vidak
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 68-2, 5/19/14 - See last page for vote
SUBJECT : Public health records: reporting: HIV/AIDS
SOURCE : Health Officers Association of California
DIGEST : This bill adds hepatitis B, hepatitis C, and
meningococcal infection to the list of diseases that local
public health agencies 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.
Senate Floor Amendments of 8/18/14 make technical changes to
provisions related to the terms under which specified
CONTINUED
AB 1898
Page
2
disclosures can be made.
ANALYSIS :
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/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 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
CONTINUED
AB 1898
Page
3
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.Requires any disclosure authorized under these provisions to
include only the information necessary for the purpose of that
disclosure and to be made upon the agreement that the
information will be kept confidential, and prohibits specified
disclosures from being made without written authorization.
2.Adds hepatitis B, hepatitis C, and meningococcal infection for
HIV/AIDS co-infection reporting to the CDC, and authorizes,
for purposes of the investigation, control, or surveillance of
HIV and its co-infection with hepatitis B, hepatitis C, and
meningococcal infection, local public health agency
communicable disease staff to further disclose the information
to state public health agency staff, who may further disclose
the information to the CDC, as specified.
Comments
According to the author's office, those with HIV infection are
disproportionately affected by viral hepatitis. Approximately
one-third 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 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% 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, existing law forbids
CONTINUED
AB 1898
Page
4
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.
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% are co-infected with HBV.
About 80% of people with HIV who inject drugs also have HCV.
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.
Prior Legislation
SB 249 (Leno, Chapter 445, Statutes of 2013) authorizes 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 Affordable Care Act between the Department
of Public Health (DPH) and qualified entities, as specified.
AB 2541 (Portantino, Chapter 470, Statutes of 2010) authorizes
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
CONTINUED
AB 1898
Page
5
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 DPH.
FISCAL EFFECT : Appropriation: Yes Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 8/22/14)
Health Officers Association of California (source)
California Academy of Preventive Medicine
County Health Executives Association of California
Executive Committee of the California Sexually Transmitted
Diseases Controllers Association
ARGUMENTS IN SUPPORT : The Health Officers Association of
California (HOAC), the sponsor 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.
ASSEMBLY FLOOR : 68-2, 5/19/14
AYES: Achadjian, Alejo, Allen, Bigelow, Bloom, Bocanegra,
Bonta, Bradford, Brown, Buchanan, Ian Calderon, Campos, Chau,
Ch�vez, Chesbro, Conway, Cooley, Dababneh, Dahle, Daly,
Dickinson, Donnelly, Eggman, Fox, Frazier, Beth Gaines,
Garcia, Gatto, Gonzalez, Gordon, Gorell, Gray, Grove, Hagman,
Hall, Harkey, Roger Hern�ndez, Holden, Jones, Jones-Sawyer,
Levine, Linder, Logue, Maienschein, Melendez, Mullin,
Muratsuchi, Olsen, Pan, Patterson, Perea, V. Manuel P�rez,
Quirk, Quirk-Silva, Rendon, Ridley-Thomas, Rodriguez, Salas,
Skinner, Stone, Wagner, Waldron, Weber, Wieckowski, Wilk,
Williams, Yamada, Atkins
CONTINUED
AB 1898
Page
6
NOES: Ammiano, Ting
NO VOTE RECORDED: Bonilla, Fong, Gomez, Lowenthal, Mansoor,
Medina, Nazarian, Nestande, John A. P�rez, Vacancy
JL/RM:k 8/22/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
**** END ****
CONTINUED