BILL ANALYSIS �
SB 460
Page 1
Date of Hearing: August 13, 2013
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
SB 460 (Pavley) - As Amended: August 6, 2013
SENATE VOTE : 39-0
SUBJECT : Prenatal testing program: education.
SUMMARY : Requires the Department of Public Health (DPH) to
include information regarding environmental health in the
California Prenatal Screening Program Prenatal Patient Booklet
(Prenatal Patient Booklet) and to post that information on DPH's
Internet Website. Specifically, this bill :
1)Requires DPH to include information regarding environmental
health in the Prenatal Patient Booklet including, but not
limited to, the following statement:
"We encounter chemicals and other substances in
everyday life that may effect your developing fetus.
Fortunately, there are steps you can take to reduce
your exposure to these potentially harmful substances
at home, in the workplace, and in the environment.
Many Californians are unaware that a number of everyday
consumer products may pose potential harm. Prospective
parents are encouraged to read more about this topic to
learn about simple actions to promote a healthy
pregnancy."
2)Requires DPH to include in the Prenatal Patient Booklet links
to educational materials derived from peer-reviewed and
science-based materials relating to environmental health and
reproductive toxins, including educational materials developed
by the University of California on environmental health and
reproductive toxins.
3)Requires DPH to send a notice to all distributors of the
Prenatal Patient Booklet, informing them of the change to the
Prenatal Patient Booklet. Requires DPH, in the notice, to
encourage obstetrician-gynecologists and midwives to discuss
environmental health with their patients and to direct their
patients to the appropriate page or pages in the Prenatal
Patient Booklet for additional information.
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4)Requires the new information to be included in the Prenatal
Patient Booklet when the Prenatal Patient Booklet is otherwise
revised and reprinted, in order to minimize costs.
5)Allows DPH to modify the language in the booklet after
consultation with experts in the field of environmental health
and reproductive toxins.
EXISTING LAW :
1)Establishes DPH and, among other things, requires DPH to
administer the Genetic Disease Screening Program (GDSP), a
statewide program for prenatal testing for genetic disorders
and birth defects.
2)Requires DPH to establish eligibility criteria for the GDSP,
including the definition of conditions and circumstances that
result in a high risk of a detectable genetic disorder or
birth defect.
3)Requires DPH to develop an educational program for physicians,
surgeons, and the public (which includes developing and
distributing the Prenatal Patient Booklet) regarding the GDSP
and its availability, to ensure that genetic counseling is
given in conjunction with the GDSP, and to designate prenatal
diagnosis centers throughout the state to meet the need for
these services.
4)Requires DPH to administer a grant program for approved
nonprofit prenatal diagnosis centers with subsidy grants
awarded based on the number of low-income women referred to
the center, the number of prenatal diagnosis performed in the
previous year at that center, and the estimated size of unmet
need for prenatal diagnostic procedures in the center's
service area.
5)Requires DPH to expand prenatal screening to include all tests
that meet or exceed the current standard of care as
recommended by nationally recognized medical or genetic
organizations and sets the increase in the fee charged to
patients for that expansion at $40.
FISCAL EFFECT : According to the Senate Appropriations
Committee, there will be minor costs to DPH to develop new
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materials and notify physicians.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, many pregnant
women are uninformed about environmental health and how
reproductive toxins can inhibit the health and development of
their unborn children. A recent University of California, San
Francisco survey of 2,600 obstetricians and gynecologists
nationwide found that most do not warn their pregnant patients
about chemicals in food, consumer products, or the environment
that could endanger their fetuses. A growing body of research
has shown that pregnant women's exposure to harmful chemicals
can increase the changes of cognitive and neurological
impairment and cancer later in life. If pregnant women
receive information about environmental health, they will be
better equipped to make more informed decisions and possibly
reduce their exposure to harmful reproductive toxins. In this
way, women can help reduce the chances that their children
will suffer from lifelong or future health conditions, such as
cancer.
2)BACKGROUND . The U.S. Department of Labor Occupational Safety
and Health Administration defines a reproductive toxin as a
chemical "which affects the reproductive capabilities
including chromosomal damage (mutations) and effects on
fetuses (teratogenesis)."
In 1986, California voters approved the Safe Drinking Water
and Toxic Enforcement Act, better known as Proposition 65.
Proposition 65 requires the State to publish a list of
chemicals known to cause cancer, birth defects, or other
reproductive harm. The list is updated at least once a year
and has grown to include approximately 800 chemicals since it
was originally published in 1987. Proposition 65 requires
businesses to notify Californians about significant amounts of
chemicals in the products they purchase, in their homes or
workplaces, or those that are released into the environment.
The California Office of Environmental Health Hazard
Assessment (OEHHA) administers the Proposition 65 program.
OEHHA, which is part of the California Environmental
Protection Agency (Cal/EPA), also evaluates all currently
available scientific information on substances considered for
placement on the Proposition 65 list. Businesses are required
to provide a "clear and reasonable" warning before knowingly
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and intentionally exposing anyone to a listed chemical. This
warning can be given a variety of ways, such as labeling a
product, posting signs at the workplace, distributing notices
at a rental housing complex, or publishing notices in a
newspaper. Proposition 65 has increased public awareness
about the adverse effects of exposures to listed chemicals.
For example, Proposition 65 has resulted in greater awareness
of the dangers of alcoholic beverage consumption during
pregnancy. According to Cal/EPA, they do not do outreach to
the public or the medical community about reproductive toxins
on the Proposition 65 list.
The California Department of Industrial Relations administers
the California Occupational Safety and Health Program
(Cal/OSHA), which applies to all public and private sector
places of employment, with the exception of federal employees,
private sector employers on Native American lands, maritime
activities, private contractors working on land designated as
exclusive federal jurisdiction, and employers that require
federal security clearances. According to Cal/OSHA, they do
not conduct public outreach regarding reproductive toxins, but
do inform labor and management about safe workplace
environments.
As discussed under existing law, the Prenatal Patient Booklet
is provided to pregnant women as part of DPH's GDSP. SB 962
(Migden), Chapter 517, Statutes of 2007, among other things,
mandated that information be added to the Prenatal Patient
Booklet regarding prenatal cord blood banking and the
information was added in January of 2008.
According to DPH the Prenatal Patient Booklet was last updated
in April 2013, and at that time 800,000 Prenatal Patient
Booklets were printed, about a year's supply. DPH plans to
update the Prenatal Patient Booklet again in the Spring of
2014.
3)SUPPORT . The Breast Cancer Fund is the sponsor of this bill
and writes, although it is not common knowledge, scientists
now know that breast cancer begins in the womb. A fetus is
exposed to hundreds, if not thousands, of chemicals during
gestation. The placenta, once thought to be a barrier, cannot
filter these chemicals and as a result, babies are now born
"pre-polluted," their bodies carrying the burden of hundreds
of chemicals before they even breathe air. These chemicals
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can be found in household products like canned food, cleaning
products, cosmetics, cookware, toys, and furniture. This
information will educate women about the importance of
avoiding hazardous substances in every day consumer products
during their pregnancy.
The March of Dimes California Chapter also supports this bill
and states, as environmental hazards have been linked to birth
defects, there is a nexus between this information and the
content of the Prenatal Patient Booklet. It is critical that
prospective parents are educated about these risks and given
information about steps they can take to ensure a health
pregnancy.
The American Congress of Obstetricians and Gynecologists,
District IX-California, writes in support of this bill that, a
startling amount of new scientific evidence shows in the
impact of environmental exposures on reproductive health
including fetal and childhood development. There is a history
of the Prenatal Patient Booklet being used for purposes other
than prenatal screening with one page devoted to information
about umbilical cord blood banking. Toxic exposure
information, especially about how to reduce exposures, is
critical, time sensitive information and as obstetricians,
they believe the Prenatal Patient Booklet is an excellent
vehicle to share that information, as all pregnant patients
already receive the Prenatal Patient Booklet.
4)PREVIOUS LEGISLATION . SB 962 (Migden), Chapter 517, Statutes
of 2007, among other things, mandated that information be
added to the Prenatal Patient Booklet regarding prenatal cord
blood banking.
5)REQUESTED AMENDMENTS . The Chair has requested additional
amendments that the information linked to in the Prenatal
Patient Booklet be evidence-based. According to the US
Department of Health and Human Services, in the health care
field, evidence-based practice (or practices) generally refers
to approaches to prevention or treatment that are validated by
some form of documented scientific evidence. Evidence-based
practice stands in contrast to approaches that are based on
tradition, convention, belief, or anecdotal evidence.
Furthermore, given that advances in research happen on a
continuous basis it is not prudent to rely on one source of
information and the Chair has requested amendments to delete
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the reference to "educational materials developed by the
University of California" and instead require that DPH provide
a link to evidence-based, peer-reviewed materials relating to
environmental toxins and their potential effects on a
developing fetus. Finally, the Chair has requested that,
should DPH modify the language in the booklet in the future,
they consult with medical experts in the field of
environmental health and reproductive toxins.
REGISTERED SUPPORT / OPPOSITION :
Support
Breast Cancer Fund (sponsor)
American Academy of Pediatrics
American Congress of Obstetricians and Gynecologists, District
IX-California
American Federation of State, County and Municipal Employees,
AFL-CIO
March of Dimes California Chapter
Opposition
None on file.
Analysis Prepared by : Lara Flynn / HEALTH / (916) 319-2097