BILL ANALYSIS                                                                                                                                                                                                    �






                             SENATE COMMITTEE ON HEALTH
                          Senator Ed Hernandez, O.D., Chair

          BILL NO:       AB 2425
          AUTHOR:        Quirk
          AMENDED:       April 8, 2014
          HEARING DATE:  June 25, 2014
          CONSULTANT:    Moreno

           SUBJECT  :  Laboratories: review committee.
           
          SUMMARY  :  Exempts labs that are accredited in forensic alcohol  
          analysis by the American Society of Crime Laboratory  
          Directors/Laboratory Accreditation Board or another accrediting  
          agency, as specified, from the requirements in all existing  
          regulations related to Forensic Alcohol Analysis and Breath  
          Alcohol Analysis as they exist on January 1, 2015, until the  
          time when the Department of Public Health adopts regulations  
          that incorporate the Forensic Alcohol Review Committee's  
          revisions developed pursuant to existing law.

          Existing state statute:
          1.Requires labs engaged in the performance of forensic alcohol  
            analysis tests by or for law enforcement agencies on blood,  
            urine, tissue, or breath for the purposes of determining the  
            concentration of ethyl alcohol in persons involved in traffic  
            accidents or in traffic violations to comply with specified  
            regulations related to forensic alcohol labs as they exist on  
            December 31, 2004, until the time when those regulations are  
            revised pursuant to 3) below.

          2.Requires the Department of Public Health (DPH) to establish a  
            review committee (known as the Forensic Alcohol Review  
            Committee [FARC]), with specified membership, and requires the  
            FARC to meet at least once in each five-year period after its  
            initial meeting, or within 60 days of receipt of a request by  
            DPH or a member of committee.

          3.Requires the FARC to evaluate the regulations in 1) above and  
            determine revisions that will limit those regulations to those  
            that the FARC determines are reasonably necessary to ensure  
            the competence of the labs and employees to prepare, analyze,  
            and report the results of the tests and comply with applicable  
            laws. Requires the FARC to submit a summary of revisions to  
            the California Health and Human Services Agency (CHHSA).   
            Permits CHHSA, within 90 days of receiving the revisions, to  
                                                         Continued---



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            disapprove of one or more of the revisions.

          4.Requires DPH to adopt regulations that incorporate the FARC's  
            revisions, except those disapproved by CHHSA.

          Existing state regulations:
          1.Establish qualifications for forensic alcohol supervisors,  
            forensic alcohol analysts, or forensic alcohol analyst  
            trainees.  Require forensic laboratories to, among other  
            things:

               a.     Meet established laboratory performance and  
                 procedure standards;
               b.     Employ at least one forensic alcohol supervisor;
               c.     Maintain a quality control program in forensic  
                 alcohol analysis procedures;   
               d.     Demonstrate satisfactory performance in a  
                 proficiency testing program conducted, or approved, by  
                 DPH to evaluate the accuracy of the forensic alcohol  
                 analyses performed by the laboratory; 
               e.     Maintain records pertaining to personnel, analysis  
                 results, equipment, proficiency testing; and,
               f.     Pass on-site inspections by the department.

          This bill:
          1.Exempts labs that are accredited in forensic alcohol analysis  
            by the American Society of Crime Laboratory  
            Directors/Laboratory Accreditation Board (ASCLD/LAB) or  
            another accrediting agency approved by the FARC from the  
            requirements in all existing regulations related to Forensic  
            Alcohol Analysis and Breath Alcohol Analysis (Group 8  
            regulations) as they exist on January 1, 2015, until the time  
            when DPH adopts regulations that incorporate the FARC's  
            revisions developed pursuant to existing law.

          2.Requires the FARC to meet at least once every three years,  
            rather than once every five years. 

          3.Requires the FARC, in determining revisions to forensic  
            alcohol lab regulations, to take into consideration the  
            advancement and development of scientific processes, including  
            the reporting of results with an estimated uncertainty  
            measurement.  

          4.Permits CHHSA to disapprove of one or more of the revisions  
            within 30 days of receiving the revisions, rather than within  




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            90 days. 

           FISCAL EFFECT  :  According to the Assembly Appropriations  
          Committee analysis, negligible state fiscal effect.

           PRIOR VOTES  :  
          Assembly Health:         19- 0
          Assembly Appropriations:  17- 0
          Assembly Floor:          78- 0
           
          COMMENTS  :  
           1.Author's statement.  According to the author, the FARC was  
            created in 2004, in part, due to a 1999 audit. The committee  
            is comprised of scientific, law enforcement and legal  
            representatives and was given the authority to evaluate  
            regulations and provide revisions that will ensure the  
            competence of laboratories and employees to prepare, analyze,  
            and report the results of biological samples tested for  
            alcohol content and comply with applicable laws. Although the  
            committee has met regularly over the last ten years, DPH (who  
            as of 2007, has jurisdiction over FARC), and the Health and  
            Human Services Agency (CHHSA) have yet to approve any  
            regulatory changes. DPH's unwillingness to approve the  
            regulations impedes FARC from completing the work they have  
            been tasked to do. Additionally, antiquated regulations  
            compromise our public safety and prosecution of drunk drivers.  


          2.Forensic alcohol labs in California.  According to DPH, 39  
            forensic alcohol laboratories in California conduct alcohol  
            analysis of samples of blood, breath, urine, or tissue of  
            persons involved in traffic accidents or traffic violations.  
            City, county, and state governmental law enforcement agencies  
            operate 29 of these forensic alcohol laboratories, and 10 are  
            private laboratories.  Some of these private laboratories  
            provide testing services for law enforcement through  
            contractual arrangements with cities and counties.  Twenty-six  
            of the forensic alcohol laboratories (all governmental) are  
            accredited by the ASCLD/LAB. The 39 forensic alcohol  
            laboratories conduct or support the chemical testing  
            associated with the approximately 200,000 drunken driving  
            arrests each year. 

            According to DPH, as defined in the regulations, the only  
            activity of a "forensic alcohol laboratory" is the measurement  




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            of the concentration of alcohol in samples of blood, breath,  
            urine, or tissue of persons involved in traffic accidents or  
            in traffic violations; so by definition, a "forensic alcohol  
            lab" only performs forensic alcohol analysis.  However, the  
            regulations also note that forensic alcohol analysis "may be  
            an activity of a laboratory engaged in activities other than  
            alcohol analysis."  Forensic alcohol analysis is often  
            performed by governmental crime laboratories. These  
            laboratories perform a wide variety of forensic tests covering  
            a number of separate disciplines (toxicology, controlled  
            substances, DNA analysis, latent fingerprints,  
            firearms/toolmarks, tire tracks and footwear impressions,  
            trace evidence, questioned documents).  Of all these crime lab  
            tests, only alcohol analysis (a toxicology sub-discipline) is  
            currently subject to any regulation.

          3.Group 8 regs. According to DPH, the Group 8 regulations  
            establish the basic standards of performance and procedure for  
            forensic alcohol analysis.  They are designed to ensure the  
            competency of the forensic alcohol laboratories, the  
            qualifications of the employees of the laboratories, and the  
            accuracy of breath alcohol testing procedures used by law  
            enforcement agencies, which in turn ensures the admissibility  
            of tests into evidence in drunk driving cases.  The  
            performance standards set the requirements for method accuracy  
            and precision, non-interference from anticoagulants and  
            preservatives added to the sample, and results obtained when  
            subjects free of alcohol are tested. The procedure standards  
            include the requirements to calibrate a method with standards,  
            inclusion of blanks, analysis of quality control samples,  
            traceability to known primary standards, and duplicate  
            analyses of unknowns. There are personnel qualifications  
            requirements.  There are also standards of procedure covering  
            sample collection and retention.  There are similar  
            requirements covering breath alcohol analysis performed by law  
            enforcement personnel. These procedural requirements ensure  
            that the chemical testing in drunk driving cases is performed  
            consistently and competently throughout the state.  

            SB 1623 (Johnson), Chapter 337, Statutes of 2004, removed  
            DPH's authority to license these labs. Prior to this, DPH  
            operated a forensic alcohol laboratory licensing and  
            regulatory program for more than 30 years. Current statute  
            still requires forensic alcohol labs to comply with Group 8  
            regulations, and requires DPH to enforce the regulations. SB  
            1623 also established the FARC to evaluate the Group 8  




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            regulations in order to determine revisions that it determines  
            are reasonably necessary.  CHHSA can disapprove regulations  
            proposed by the FARC, but neither it nor DPH can promulgate  
            regulations on its own.  FARC was formed in 2005 and began its  
            meetings that year.  It conducted 23 meetings of the full  
            committee and proposed revisions to Group 8 regulations in  
            2010 and 2013 (see discussion in 6) below).   

            DPH also states that, with the passage of SB 1623, it has  
            ceased routine onsite inspections of forensic alcohol labs,  
            but continues to conduct inspections for cause, and is still  
            required to regulate the forensic alcohol laboratories.  DPH  
            annually requires two proficiency tests of each forensic  
            alcohol laboratory, but this includes one test from an  
            ASCLD/LAB-approved commercial provider, with the results then  
            submitted to DPH.

          4.Regulation versus accreditation. According to DPH, ASCLD/LAB  
            accredits laboratories in nine disciplines (not forensic  
            alcohol analysis) and the requirements are very general.  The  
            ASCLD/LAB requirements are mostly related to the management of  
            the laboratory, and they are not the equivalent of laboratory  
            regulations.  ASCLD/LAB accreditation requirements do not  
            provide any specific laboratory performance or procedure  
            standards for blood or breath alcohol analysis. DPH's  
            regulations include specific requirements to calibrate testing  
            methods with specified standards and provide analysis of  
            quality control samples. There are also standards of procedure  
            covering sample collection and retention.

          5.ASCLD/LAB. According to the ASCLD, it is a volunteer  
            not-for-profit organization, and all of its board of  
            directors, officers, committee members, and representatives  
            are volunteers who likely have a full-time management position  
            in a crime laboratory. The ASCLD/LAB is a body affiliated with  
            the ASCLD that accredits crime laboratories.  To be  
            accredited, a lab must submit an application and supporting  
            documents and pass an on-site inspection.  Accreditation is  
            good for five years.  ASCLD/LAB conducts a proficiency testing  
            program to assist labs in identifying areas where more  
            training or more stringent quality controls are necessary, and  
            in demonstrating their competency.  

          6.FARC and DPH communications.  In April 2010, the FARC  
            submitted proposed changes to the Group 8 regulations pursuant  




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            to SB 1623.  In a December 15, 2010 letter responding to the  
            proposed changes, DPH wrote: "While we agree that voluntary  
            accreditation programs are important, ASCLD/LAB guidelines do  
            not establish specific laboratory performance or procedure  
            standards for blood alcohol analysis, nor mention breath  
            alcohol analysis. The substitution of the ASCLD/LAB  
            requirements for the current program would not achieve the  
            statutory mandate of ensuring the competence of the  
            laboratories and their employees performing chemical testing  
            in support of California's drinking-and-driving laws? We  
            recognize and applaud the work of the Committee and encourage  
            the Committee to continue to work with [DPH] on a solution  
            that does not diminish public health and safety by ensuring  
            independent State oversight of forensic alcohol analysis."

            In March 2013, the FARC wrote a response to DPH's feedback on  
            their recommended revisions to the Group 8 regulations.  In  
            part, the letter states that the FARC did not agree that  
            replacing DPH oversight with self-oversight would diminish  
            public safety, but "?in an effort to reach compromise and to  
            move this regulation package forward after years of effort, we  
            propose?changes to the work product."  The letter went on to  
            outline four proposed changes to the proposed regulations  
            related to DPH evaluation of a lab's performance on  
            proficiency tests, DPH authority to review, approve, and test  
            the qualifications of employees, DPH authority to review and  
            approve training programs of employees, and requiring labs to  
            provide DPH with records of its activities.

            DPH's Chief Deputy Director of Policy and Programs responded  
            in February 2014, stating "?After the [FARC] proposed  
            revisions were incorporated, the revised regulations were  
            submitted to [CHHSA]. The California Department of Public  
            Health will be adopting regulations that incorporate FARC's  
            revisions, per Health and Safety Code 100702(f).  As such, I  
            have directed the CDPH Office of Regulations to proceed with  
            the rulemaking process to adopt regulations incorporating all  
            the revisions proposed by the FARC."  According to DPH, the  
            proposed revised regulations are currently with the Office of  
            Regulations where they are making minor technical changes to  
            some of the supporting documentation.  Once that is completed,  
            the regulations will start the official APA process.

          7.Prior legislation.  AB 599 (Hall), of 2009, would have  
            required FARC to submit to 
            CHHSA revisions to forensic alcohol laboratory regulations,  




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            and would have provided that until CHHSA adopts these  
            revisions, a forensic alcohol laboratory that is accredited by  
            ASCLD/LAB in forensic alcohol analysis satisfies requirements  
            for external proficiency testing.  AB 599 was vetoed by  
            Governor Schwarzenegger stating, "This bill is a premature  
            delegation of regulatory oversight from a state department to  
            a private entity.  If there is a more efficient manner to  
            provide oversight for forensic alcohol laboratories, I  
            encourage the stakeholders to work with the Department of  
            Public Health on a solution that does not eliminate important  
            state functions."

            SB 1623 eliminated the licensing authority of the Department  
            of Health Services (now DPH) over forensic alcohol  
            laboratories and created the FARC. 

            SB 1849 (Johnson), of 2000, would have required DHS to adopt  
            regulations governing the operation of forensic alcohol labs  
            and required DHS to convene a review committee to review the  
            regulations and would have allowed labs that meet  
            accreditation standards to be licensed if DHS determines that  
            the standards meet or exceed those in regulations.  SB 1849  
            was vetoed by Governor Davis who said he was confident DHS  
            would make progress in responding to the audit report and if  
            it did not, he would consider signing legislation in the  
            future.

          8.Support.  According to the sponsor, the Santa Clara County  
            District Attorney's Office, the failure to update the  
            regulations has put public safety at risk.  Since the last  
            update in 1986, the sponsor explains, there have been many  
            changes in the instrumentation and technology surrounding the  
            testing of specimens, the process by which it's done,  
            education requirements for laboratory employees, and  
            California statutes concerning driving under the influence.   
            The sponsor argues this bill recognizes how important it is  
            for the regulations to be incompliance with the law and  
            current laboratory standards and will allow the concepts  
            developed by the review committee to be adopted into  
            regulation.

          9.Policy comment.  The author states that this bill is necessary  
            because DPH has not updated Group 8 regulations that govern  
            forensic alcohol labs in 30 years. This is not the only case  
            of outdated regulations not being addressed by DPH.  There are  




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            numerous instances in which a regulated entity cannot operate  
            effectively because factors in today's world conflict with  
            regulations that have not been updated in 20 to 30 years. This  
            problem has affected health care facilities, labs, pharmacies,  
            and narcotic treatment facilities, among others.  There have  
            been a number of bills that have come through this Committee  
            to work around outdated regulations, without leaving  
            facilities unregulated entirely. Those bills have been drafted  
            to address specific instances in which an outdated regulation  
            was limiting the ability of providers to practice in the most  
            effective manner. For example, federal regulations were  
            amended in 2001 to allow for Sunday or holiday closure of  
            methadone clinics in certain cases while state regulations  
            have not been updated for over 20 years and require methadone  
            clinics to be open seven days a week. There are take-home  
            doses of methadone available that are safe to use, ensuring  
            that patients do not have a break in treatment if a facility  
            were closed one day a week. Another bill heard by this  
            Committee permits pharmacy technicians, rather than  
            pharmacists, to check expiration dates on the labels of drugs  
            in a hospital pharmacy - something currently prohibited by a  
            regulation not updated since its promulgation in 1986.  In  
            this instance, the frustration of DPH not updating regulations  
            resulted in the passage of SB 1923 in 2003, which took away  
            DPH's responsibility for updating the Group 8 regulations and  
            gave it to the FARC.  While it has taken a long time, new  
            regulations are moving forward.  It is unclear whether it is  
            good policy to permit forensic alcohol labs to go unregulated  
            due to frustration with a process that the Legislature itself  
            mandated, especially when it appears that the process is  
            advancing.  

           SUPPORT AND OPPOSITION  :
          Support:  Santa Clara District Attorney (sponsor)
                    California District Attorneys Association

          Oppose:   None received.



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