WILL CALL TO ORDER OUR TUESDAY,
APRIL NINTH. ASSEMBLY ON PUBLIC.
ON HEALTH. ON COMMUNITY HEALTH
TODAY, WE WILL BEGIN AS A
SUBCOMMITTEE. WE ARE WAITING ON
A REPUBLICAN COLLEAGUE TO BE
ABLE TO MOVE FORWARD BEFORE WE
BEGIN, I WOULD LIKE TO MAKE A
STATEMENT ON PROVIDING TESTIMONY
AT THIS HEARING, WE SEEK TO
PROTECT THE RIGHTS OF ALL WHO
PARTICIPATE IN THE LEGISLATIVE
PROCESS SO THAT WE CAN HAVE
EFFECTIVE DELIBERATION ON THE
CRITICAL ISSUES FACING
CALIFORNIA. ALL WITNESSES WILL
BE TESTIFYING IN PERSON. PLEASE
NOTE THE FOLLOWING CHANGE. WE
ALLOW TWO MAIN WITNESSES FOR A
MAXIMUM OF TWO MINUTES EACH,
INSTEAD OF THREE MINUTES.
ADDITIONAL TESTIMONY WILL ALSO
BE IN PERSON AND LIMITED TO
NAME, POSITION, AND
ORGANIZATION. IF YOU REPRESENT
ONE. ALL TESTIMONY COMMENTS ARE
LIMITED TO THE BILL AT HAND
.
WE'RE GOING TO MOVE FORWARD,
WHERE ARE MISSING OUR REPUBLICAN
COLLEAGUES TO BE ABLE TO FOLLOW
THE PROTOCOL, ALTHOUGH NOT THE
RULE, TO HAVE A REPUBLICAN
ASSEMBLY MEMBER IN COMMITTEE. WE
DON'T HAVE THAT. SO WE WILL MOVE
FORWARD ON CONSENT TODAY, THE
FOLLOWING BILLS ARE PROPOSED FOR
CONSENT FOR TODAY'S HEARING. ANY
MEMBER OF THE COMMITTEE MAY
REMOVE A BILL FROM CONSENT. WE
HAVE SEVEN ITEMS ON CONSENT.
ITEM ONE AB 1915 ARAMBULA WITH
THE MOTION OF Dð. PASS TO
APPROPRIATIONS. ITEM FOUR AB
1996 ALANIS WITH THE AMENDMENTS
A MOTION OF AMENDMENTS TO ARTS,
ENTERTAINMENT, SPORTS AND
TOURISM. ITEM FIVE AB 2043
BERNER Dð PASS TO APPROPRIATIONS
MOTION ITEM EIGHT AB 2129
PETRIE-NORRIS WITH A MOTION TO
AMEND WITH AMENDMENTS TO
APPROPRIATIONS. ITEM 14, AB
2356. WALLACE, WITH A MOTION OF
Dð PASS TO APPROPRIATIONS. ITEM
19, AB 2549. GALLAGHER, WITH A
MOTION OF Dð PASS TO HUMAN
SERVICES, ITEM NUMBER 32, HJR
TEN. ERWIN WITH A MOTION TO BE
ADOPTED. WITH THAT, WE WILL
BEGIN AS A SUBCOMMITTEE WITH THE
MEMBER THAT IS PRESENT TO
PRESENT THEIR BILL, MR. TO
PLEASE COME FORWARD. WE ARE ON
ITEM NUMBER THREE, AB 1977 TO.
ASSEMBLY MEMBER TY. GO AHEAD.
GOOD AFTERNOON, CHAIR AND MEMBER
OF THE COMMITTEE. I'M HERE TODAY
TO PRESENT ASSEMBLY BILL 1977, A
MODEST PROPOSAL TO ENSURE
CALIFORNIANS WITH DEVELOPMENTAL
DISABILITIES DON'T FACE BARRIERS
TO THE BEHAVIORAL HEALTH
TREATMENT THEY NEED. AND I WANT
TO THANK THE COMMITTEE STAFF FOR
WORKING WITH MY OFFICE AS THIS
BILL MOVES TO THE LEGISLATIVE
PROCESS. AB 1977 WAS A RESULT OF
THE CONVERSATION WITH LAURIE, A
MOM IN MY DISTRICT. LAURIE'S SON
WAS DIAGNOSED WITH AUTISM
SPECTRUM DISORDER AT A YOUNG AGE
AND NEEDED BEHAVIORAL HEALTH
TREATMENT TO MANAGE HIS
CONDITION. THIS BEHAVIOR, HEALTH
TREATMENT, IS LIFE CHANGING FOR
LAURIE'S SON. HOWEVER, LAURIE,
DESPITE HOW DESPITE HER SON'S
CONDITION BEING A LIFE LONG
DISORDER, HER INSURANCE PLAN
WOULD REQUIRE SHE PUT HER SON TO
A RE EVALUATION ASSESSMENT ONCE
EVERY TWO YEARS TO CONFIRM HIS
ORIGINAL AUTISM SPECTRUM
DISORDER DIAGNOSIS. THIS
REEVALUATION ASSESSMENT IS AN
EXTENSIVE PROCESS INVOLVING A
BACKGROUND, QUESTIONNAIRE,
INTERVIEW AND MORE. LAURIE SON
WOULD ALSO HAVE TO COMPLETE
ADDITIONAL TESTS EVERY SIX
MONTHS TO MAINTAIN HIS COVERAGE
FOR HIS BEHAVIORAL HEALTH
TREATMENT. THIS BURDENSOME
PROCESS WOULD PRESENT AN IN
CREDIBLE HURDLE TO LAURIE FAMILY
AND A REALLY STRESSFUL FOR HER
SON. THE PROCESS WOULD OFTEN
RESULT IN DELAY OR EVEN DENIAL
FOR HIS NECESSARY BEHAVIORAL
HEALTH TREATMENT. OR THIS FOR A
CONDITION THAT AMERICAN
PSYCHIATRIC ASSOCIATION
DESCRIBES AS A LIFELONG
DISORDER. SADLY, LAURIE SPURGEON
IS NOT AN ISOLATED INCIDENT.
SEVERAL HEALTH PLAN OPERATING IN
CALIFORNIA REQUIRE NEW AUTISM
DIAGNOSIS EVERY TWO YEARS IN
ORDER FOR PATIENTS TO RECEIVE
BEHAVIORAL HEALTH TREATMENT, IT
IS REQUIRED REGARDLESS, THE
PATIENTS HAVE A PREVIOUS
DIAGNOSIS WITH THEM AND IS
REQUIRED PRIOR TO AUTHORIZED
KING CARE AUTISM SERVICE
PROVIDERS HAVE REPORTING
AUTHORIZATION REQUESTS DELAY FOR
THE CHILDREN BECAUSE OF THIS
LASTING UP TO SIX MONTHS, SOME
PROVIDERS HAVE SEEN CARE DENIED
FOR A 12 AND UNDER AND A DELAY
IN BEHAVIORAL HEALTH TREATMENT
WILL HAVE AN IMPACT ON THE
CHILD. GIVEN THAT AUTISM IS A
LIFELONG CONDITION, IT MAKES NO
SENSE TO REQUIRE CONSTANT RE
DIAGNOSIS EVERY 2 TO 3 YEARS IN
ORDER FOR INDIVIDUALS TO RECEIVE
NECESSARY BEHAVIORAL HEALTH
TREATMENT. AB 1977 WOULD PUT AN
END TO THIS OUTDATED PRACTICE
AND PROHIBIT A HEALTH PLAN
SERVICE PLAN FROM REQUIRING AN
ENROLLED ENROLLEE PREVIOUSLY
DIAGNOSED WITH PERVASIVE
DEVELOPMENTAL DISORDER FOR
AUTISM, FROM NEEDING TO RECEIVE
NEW BEHAVIORAL DIAGNOSIS TO
MAINTAIN COVERAGE FOR BEHAVIORAL
HEALTH TREATMENT, WE HAVE WORKED
WITH THE CALIFORNIA MEDICAL
ASSOCIATION TO DRAFT REASONABLE
AMENDMENT TO AB 1977, WHICH
CLARIFIED THAT THIS BILL WOULD
NOT RESTRICT A TREATING PROVIDER
FROM REEVALUATING AND ENROLLING
TO UPDATE THEIR TREATMENT PLAN.
THIS SHOULD ADDRESS THE CONCERNS
RAISED BY THE OPPOSITION AND
ENSURE THAT PATIENTS CAN UPDATE
THEIR TREATMENT PLAN IF NEEDED.
IF THEY CANNOT CONDITION,
PARENTS WILL BE ABLE TO SCHEDULE
REEVALUATION ACTION BASED OFF OF
THEIR OWN EVALUATION OF THE
CHILDREN AUTISM CONDITION.
INSTEAD OF BEING FIXED TO AN
OVERBEARING REEVALUATION
SCHEDULE THAT RISKS JEOPARDIZING
NECESSARY TREATMENT, THIS BILL
IS SUPPORTED BY THE AMERICAN
ACADEMY OF PEDIATRICS.
CALIFORNIA. THE COURSE OF AUTISM
SERVICE PROVIDER, THE CALIFORNIA
STATE COUNCIL ON DEVELOPMENTAL
DISABILITY, AND OTHERS. THANK
YOU FOR CONSIDERING THIS MEASURE
AND LOOK FORWARD TO ANSWERING
ANY QUESTIONS YOU HAVE. I'M
HONORED TO INTRODUCE MY
WITNESSES ON THIS BILL. MELISSA
CORTEZ, ON BEHALF OF THE GALAXY
OF AUTISM SERVICE PROVIDER, AND
DANIEL SAVINO FROM THE
ASSOCIATION OF REGIONAL CENTERS
AGENCY. THANK YOU, MELISSA
CORTEZ, ON BEHALF OF TASK. THERE
WE GO. THANK YOU. MELISSA
CORTEZ, ON BEHALF OF CASPA CASPA
IS A NONPROFIT TRADE ASSOCIATION
OF AUTISM SERVICE PROVIDER
ORGANIZATIONS THAT HAVE
DEMONSTRATED, COMMITTED AND ARE
COMMITTED TO PROMOTING AND
DELIVERING EVIDENCE BASED
PRACTICES FOR INDIVIDUALS WITH
AUTISM. WE WANT TO THANK THE
AUTHOR FOR BRINGING THIS
IMPORTANT MEASURE FORWARD, AND
WE DID AN INFORMAL SURVEY
AMONGST OUR MEMBERS, AND WE
FOUND THAT THERE ARE, IN FACT,
SEVERAL PLANS IN CALIFORNIA THAT
ARE REQUIRED DURING THIS
REDIAGNOSIS. AND AS THE ASSEMBLY
MEMBER STATED, I'VE AUTISM IS A
LIFELONG DISORDER AND AUTISM IS
TYPICALLY DIAGNOSED BY A
PEDIATRICIAN, A PSYCHOLOGIST, OR
A NEUROLOGIST. HOWEVER, THE
GENERALLY ACCEPTED STANDARD OF
CARE FOR AUTISM IS APPLIED
BEHAVIOR ANALYSIS, WHICH IS
PROVIDED BY A BOARD CERTIFIED
BEHAVIOR ANALYST. THE BCBA
DEVELOPS AND IMPLEMENTS THE
TREATMENT PLAN SO WHEN A PATIENT
IS REQUIRED TO GET A NEW
DIAGNOSIS, THEY HAVE TO LEAVE
THIS TREATMENT PLAN FLOW. GO
BACK TO THE DIAGNOSING PROVIDER,
AND GETTING THAT NEW APPOINTMENT
IS WHAT'S CAUSING THE DELAY. AND
WE HAVE SEEN IN SOME CASES WHERE
HEALTH PLANS ARE DENYING
AUTHORIZATION OF EXISTING
TREATMENT BECAUSE THEY'RE
WAITING ON A DIAGNOSIS WITH
AUTISM, ANY DISRUPTIONS OR
DELAYS CAN HAVE ADVERSE IMPACTS.
AND I ALSO WANT TO NOTE THAT
EXISTING LAW REQUIRES A
TREATMENT PLAN TO INCLUDE
MEASURABLE GOALS OVER SPECIFIC
TIMELINES, AND FOR THAT
TREATMENT PLAN TO BE REVIEWED BY
PROVIDERS NO LESS THAN EVERY SIX
MONTHS AND MODIFIED AS
NECESSARY. THANK YOU. CAN YOU
WRAP UP YOUR COMMENTS? IT ALSO
ALLOWS THE HEALTH PLANS ACCESS
TO THAT, AND THEY HAVE A
TRADITIONAL PROTOCOLS WITH
UTILIZATION REVIEW. SO THERE'S
REALLY NO CLINICAL NEED FOR A
NEW DIAGNOSIS. WE AS YOUR
SUPPORT. DANIEL SAVINO
ASSOCIATION OF REGIONAL CENTER
AGENCIES THE REGIONAL CENTERS
COORDINATE SERVICES AND SUPPORTS
FOR WELL OVER 400,000
CALIFORNIANS WITH DEVELOPMENTAL
DISABILITIES. AUTISM BEING ONE
OF THE LEADING DIAGNOSES WITHIN
OUR SYSTEM. IT'S STATUTORY, AND
AS THE MEMBER HAD MENTIONED,
THERE'S AN EXISTING SCIENTIFIC
STANDARDS THAT AUTISM IS A
LIFELONG CONDITION. ONCE YOU'RE
DIAGNOSED, THIS IS WHERE WE'RE
AT, AND THEN WE WORK FROM THERE.
THERE ARE, AS RECENT AMENDMENTS
NOTE, CASES WHERE A REDIAGNOSIS
MAY BE NECESSARY TO MORE
APPROPRIATELY TAILOR TREATMENT.
BUT ONCE TREATMENT IS ONGOING,
IT'S PROVIDING A BENEFIT. THERE
IS NO NEED TO REASSESS FOR
WHETHER OR NOT THE INDIVIDUAL
HAS AUTISM. THE BASIS OF THE
CONVERSATION IS THAT THIS IS A
CONDITION THAT IS LIFELONG. THIS
TYPE OF BARRIER REALLY CREATES A
TREMENDOUS, TREMENDOUS CHALLENGE
FOR FAMILIES, IT'S NOT JUST A
SIMPLE PROCESS. MANY TIMES THIS
IS SOMETHING THAT REQUIRES
SERIOUS TIME, EFFORT AND
INVOLVEMENT. SO FOR FAMILIES WHO
MAY NOT HAVE READY ACCESS TO
SIGNIFICANT SICK LEAVE,
TRANSPORTATION, THE ABILITY TO
COORDINATE CHILD CARE FOR OTHER
FAMILY MEMBERS, THERE NOW FACING
A MAJOR BARRIER TO ACCESS AND
CAN POTENTIALLY LOSE ACCESS TO
THE SERVICE AT A VERY MINIMUM,
ARE GOING TO SEE IT DELAYED. WE
VERY MUCH APPRECIATE THE MEMBER
FOR HIS AUTHORSHIP OF THIS, AND
URGE THE COMMITTEE TO SUPPORT.
THANK YOU, THANK YOU. ARE THERE
ANY OTHER ADDITIONAL WITNESSES
IN SUPPORT IN THE ROOM? PLEASE
COME FORWARD. STATE YOUR NAME,
ORGANIZATION AND YOUR POSITION
ONLY. MADAM CHAIR, MEMBERS OF
THE COMMITTEE, BRANDON MARTY
WITH THE CALIFORNIA MEDICAL
ASSOCIATION. WE REALLY
APPRECIATE THE AUTHOR AND THE
COMMITTEE'S WORK ON THIS AND
APPRECIATE THE AMENDMENTS WE ARE
IN SUPPORT. THANK YOU, MADAM
CHAIR. MEMBERS, DYLAN ELLIOTT ON
BEHALF OF THE CALIFORNIA STATE
ASSOCIATION OF PSYCHIATRISTS IN
SUPPORT. THANK YOU. GOOD
AFTERNOON, MADAM CHAIR, AND
MEMBERS. TYLER RINDY, ON BEHALF
OF THE CALIFORNIA PSYCHOLOGICAL
ASSOCIATION AND SUPPORT AND THE
FORMAL LETTERS COMING. THANK
YOU, THANK YOU. ARE THERE ANY
PRIMARY WITNESSES IN OPPOSITION?
HILLARY. STATE. EACH WITNESS
WILL HAVE UP TO TWO MINUTES.
MADAM CHAIR MEMBERS, STEPHANIE
WATKINS, ON BEHALF OF THE
ASSOCIATION OF CALIFORNIA LIFE
AND HEALTH INSURANCE COMPANIES.
FIRST AND FOREMOST, I'D LIKE TO
THANK THE COMMITTEE. THE AUTHOR
AND THE SPONSORS. WE'VE HAD SOME
REALLY PRODUCTIVE CONVERSATIONS,
I THINK, AROUND ENSURING THAT WE
UNDERSTAND THAT THIS IS RELATED
TO A REEVALUATION OR A NEW
DIAGNOSIS PIECE VERSUS
EVALUATING THE TREATMENT PLAN,
WHICH I THINK YOU'VE ALL HEARD
IS A KEY COMPONENT TO CONTINUING
TO ENSURE THAT THE CHILD OR THE
INDIVIDUAL DIAGNOSED WITH AUTISM
CONTINUES TO HAVE THE RIGHT
TREATMENT. I THINK WE'D LIKE TO
CONTINUE, IF THE BILL MOVES
FORWARD TODAY TO WORK
COLLABORATIVELY TO SEE IF WE CAN
JUST GET SOME CLARIFICATION THAT
THE, REEVALUATION IS RELATED TO
THE DIAGNOSIS AND NOT TO THE
TREATMENT PLAN, WHICH IS JUST TO
ENSURE THAT IT'S CONSISTENT WITH
CURRENT LAW. SO FOR THAT REASON,
WE LOOK FORWARD TO POTENTIALLY
HAVING FURTHER CONVERSATIONS.
BUT TODAY WE ARE OPPOSED. GOOD
AFTERNOON, CHAIR AND MEMBERS OF
THE COMMITTEE, ROBERT BOYKIN
WITH THE CALIFORNIA ASSOCIATION
OF HEALTH PLANS. REGRETTABLY, IN
OPPOSITION TO AB 1977. WE WOULD
LIKE TO THANK THE AUTHORS OFFICE
AGAIN FOR GETTING WITH US IN
CONVERSATIONS ON THE ISSUE AND
APPRECIATE THE OVERARCHING
INTENT OF THE BILL. HOWEVER, WE
ALSO LIKE TO ALIGN OUR COMMENTS
WITH OUR COLLEAGUES AT EBCLC, AS
THE PAYERS IN THE HEALTH CARE
DELIVERY SYSTEM, WE HAVE UNIQUE
RESPONSIBILITY TO ENSURE THAT
PREMIUM DOLLARS ARE BEING SPENT
IN THE MOST EFFICIENT WAY
POSSIBLE, THAT OFTENTIMES
INCLUDES CONDUCTING PERIODIC
REEVALUATIONS OF THE TREATMENT
PLAN TO ENSURE OUR ENROLLEES ARE
RECEIVING THE BEST CARE POSSIBLE
. WE ARE OPEN TO DISCUSSIONS ON
WAYS TO STREAMLINE THIS EXISTING
PROCESS. HOWEVER, WE MUST DO SO
IN A WAY THAT WILL ALLOW US TO
MAINTAIN, OUR CLINICAL AND
FIDUCIARY RESPONSIBILITIES FOR
OUR ENROLLEES, FOR THESE
REASONS, WE ARE OPPOSED TO AB
1977. THANK YOU FOR YOUR TIME
TODAY. THANK YOU. ARE THERE ANY
ADDITIONAL WITNESSES IN
OPPOSITION? PLEASE COME FORWARD.
MADAM CHAIR, MEMBERS, JOHN
WINGER, ON BEHALF OF AMERICA'S
HEALTH INSURANCE PLANS, WOULD
JUST ALIGN OUR COMMENTS WITH CAP
AND THANK YOU. SEEING NO OTHER
WITNESSES IN OPPOSITION, I'LL
BRING IT BACK TO THE COMMITTEE
FOR ANY QUESTIONS OR COMMENT.
ALL RIGHT. WE ARE STILL
OPERATING AS A SUBCOMMITTEE. IT
DOESN'T SEEM LIKE THE COMMITTEE
HAS ANY COMMENTS AT THIS TIME.
MR. TIÂU CAN CLOSE. I REALLY
APPRECIATE THAT THE COMMITTEE
STAFF BEING, WORKING WITH MY
OFFICE ON THIS BILL, AND I AND I
RESPECTFULLY ASK FOR YOUR IVO.
THANK YOU. THANK YOU, ASSEMBLY
MEMBER, TO. WILL NOW MOVE TO
ITEM NUMBER SIX AB 2058. WEBER.
APOLOGIES, DOCTOR WOOD ARE YOU
PRESENT STILL? THERE YOU ARE.
THANK YOU. YOU MOVED ON ME. YOU
WENT FROM THERE TO THERE. SO
WE'LL MOVE FORWARD WITH ITEM
NUMBER 24. AB 2749 WOULD. THANK
YOU, MADAM CHAIR. FIRST OF ALL,
I'D LIKE TO THANK. I START BY
THANKING THE COMMITTEE AND YOUR
STAFF FOR YOUR WORK ON THIS
BILL. IN RECENT YEARS,
CALIFORNIA HAS MADE ENORMOUS
STRIDES TOWARD BOTH UNIVERSAL
HEALTH CARE COVERAGE AND LABOR
RELATIONS. IN 2022, I AUTHORED
AB 2530, WHICH REQUIRED COVERED
CALIFORNIA TO ADMINISTER A
PROGRAM FOR WORKERS WHO LOSE
HEALTH INSURANCE COVERAGE DURING
A LABOR DISPUTE. UNDER THIS
PROGRAM, THOSE CONSUMERS WOULD
RECEIVE THE SAME PREMIUM AND
COST SHARING SYSTEM ASSISTANCE.
AS A CONSUMER WHOSE HOUSEHOLD
INCOME IS AT 138.1% OF THE
FEDERAL POVERTY LEVEL DURING THE
FIRST YEAR OF AB 2530
IMPLEMENTATION, IT WAS
DISCOVERED THAT CLARIFICATION IS
NEEDED IN THE LANGUAGE, LABOR
DISPUTES, PARTICULARLY IN LARGE
INDUSTRIES, CAN BE COMPLEX AND
AFFECT SURROUNDING EMPLOYERS AND
WORKERS. THIS PROPOSAL CLARIFIES
ELIGIBILITY FOR THE PROGRAM TO
REACH THE INTENDED TARGET OF
WORKERS AND EMPLOYERS WHO ARE
DIRECTLY INVOLVED IN THE STRIKE.
IT ALSO PROVIDES ADDITIONAL
CLARIFICATIONS AND CHANGES TO
THE LAW THAT WILL BETTER ENABLE
COVERED CALIFORNIA TO IMPLEMENT
THE PROGRAM AND ENSURE THE
BENEFITS OF THIS IMPORTANT
PROGRAM OR ADMINISTRATIVE
EFFECTIVELY TO WORKERS WHO NEED
THEM. AB 2749 IS BEING AMENDED
TO ADDRESS CONCERNS RAISED BY
LABOR. HERE. TO TESTIFY IN
SUPPORT IS SARAH FLOCKS,
REPRESENTING A COALITION OF
LABOR ORGANIZATIONS INCLUDING
THE CALIFORNIA LABOR FEDERATION.
AND HERE TO ANSWER ANY TECHNICAL
QUESTIONS IS KELLY GREEN,
DIRECTOR OF COMMUNICATIONS AND
EXTERNAL AFFAIRS FOR COVERED
CALIFORNIA. MADAM CHAIR MEMBERS
SARAH FLOCKS, CALIFORNIA LABOR
FEDERATION, OAN. AND WE WANTED
TO THANK THE AUTHOR FOR TAKING
AMENDMENTS SO THAT WE COULD
FULLY SUPPORT THE BILL, TODAY IN
COMMITTEE. AND I'D LIKE TO SAY
THAT IT IS RARE FOR ME THAT I
GET TO SEE A BILL SIGNED INTO
LAW AND THEN SO EFFECTIVELY
IMPLEMENT IT AND USED BY WORKERS
, AFTER THIS BILL PASSED, WE
WENT INTO A STRIKE WAVE, THERE
WAS THE ENTERTAINMENT UNION
STRIKES, BUT THERE WERE ALSO
STRIKES THAT DID NOT GET A LOT
OF PUBLICITY, INCLUDING A STRIKE
BY TRANSPORTATION WORKERS,
PRIVATE SECTOR TRANSPORTATION
WORKERS, AND VISALIA. THIS WAS
BEFORE COVERED CALIFORNIA WAS
READY TO IMPLEMENT THE PROGRAM.
YET WORKERS WERE LOSING COVERAGE
AND A LOT OF THESE WERE COUPLES
THAT WORKED FOR THE SAME
COMPANY. AND SO THEY WERE
COMPLETELY LOSING COVERAGE.
COVERED CALIFORNIA SPRANG INTO
ACTION, HAD PEOPLE THAT WERE
AVAILABLE TO SEAMLESSLY GET
WORKERS ENROLLED ONTO COVERAGE.
SO THERE WAS NO GAP, AND THE
PROGRAM WAS EFFECTIVE. IT WAS A
REALLY AN EXAMPLE OF A LAW
WORKING ON THE GROUND AND MAKING
A DIFFERENCE IN WORKERS LIVES.
THESE CHANGES ARE THINGS THAT WE
LEARNED DURING THE PROCESS THAT
HOPEFULLY WILL MAKE IT WORK EVEN
BETTER, SO WE URGE YOUR AYE VOTE
THANK YOU. GO AHEAD. THANK YOU,
MADAM CHAIR. MEMBERS KELLY GREEN
WITH COVERED CALIFORNIA, JOINED
BY ALLISON PEASE, OUR ASSISTANT
GENERAL COUNSEL HERE. IF THERE
ARE ANY QUESTIONS. THANK YOU.
ARE THERE ANY OTHER WITNESSES IN
SUPPORT? PLEASE COME FORWARD.
STATE YOUR NAME, ORGANIZATION
AND POSITION ONLY. GOOD
AFTERNOON. MEMBER AND CHAIRS
BETH MALINOWSKI WITH SCA
CALIFORNIA IN SUPPORT. BETH
KAPPEL FOR TEAMSTERS AND UNITE
HERE ALSO IN SUPPORT AS AMENDED.
THANK YOU. THANK YOU. ARE THERE
ANY WITNESSES IN OPPOSITION?
PLAN TO TESTIFY? I'M NOT SEEING
ANY WITNESSES IN OPPOSITION AS
ME TWO'S. I'LL BRING IT BACK TO
THE COMMITTEE THEN. ANY MEMBERS?
ANY QUESTION? COMMENT NO, MISS.
DOCTOR. WHAT DO YOU MEAN, CLOSE,
JUST WHEN YOU HAVE A QUORUM AND
RESPECTFULLY REQUEST AN AYE
VOTE. THANK YOU. THANK YOU SO
MUCH. I KNOW THAT YOU KNOW
EXACTLY WHAT IT FEELS LIKE TO
BE. I DO HEAR I FEEL YOUR PAIN.
CHAIR. EMERITUS. DOCTOR WOOD
WILL BE MOVING FORWARD WITH ITEM
NUMBER 29 AB 3129. THANK YOU.
THANK YOU, MADAM CHAIR. I'D LIKE
TO START BY THANKING COMMITTEE
STAFF FOR THEIR WORK ON THIS
BILL. I WILL BE ACCEPTING THE
AMENDMENTS. THERE IS NO QUESTION
THAT TRENDS IN PRIVATE EQUITY
OWNERSHIP HAVE RAPIDLY INCREASED
AMONG ACROSS ALMOST ALL HEALTH
CARE SETTINGS. A STUDY PUBLISHED
IN JULY OF 2023 EVALUATING THIS
TREND DREW FROM A DATABASE OF
1778 STUDIES, WITH 55 BEING
EMPIRICAL RESEARCH STUDIES THAT
EVALUATED PRIVATE EQUITY OWNED
HEALTH CARE OPERATIONS ACROSS
THE OUTCOME MEASURES PRIVATE
EQUITY OWNERSHIP WAS MOST
CONSISTENTLY ASSOCIATED WITH
INCREASED COST TO PATIENTS OR
PAYERS, AND MIXED TO HARMFUL
IMPACTS ON QUALITY OUT OF FOUR
IMPACTS HEALTH, INCOMES,
OUTCOMES, COST TO PATIENTS OR
PAYERS, COST TO OPERATOR AND
QUALITY 25 WERE DETERMINED TO
HAVE HARMFUL OUTCOMES, NINE WERE
MIXED AND EIGHT HAD BENEFICIAL
OUTCOMES. I DON'T KNOW ABOUT
YOU, BUT I'M INTERESTED IN OUR
STATE PROTECTING PATIENTS BEFORE
THEY PAY MORE FOR LESS CARE OR
LESSER QUALITY OF CARE, NO
MATTER WHAT THE STATISTICS.
THAT'S WHY I'M HERE TO PRESENT
AB 3129 ALONG WITH THE SPONSOR.
OUR SPONSOR, ATTORNEY GENERAL
ROB BONTA. COLLEAGUES, I HOPE
YOU KNOW OF MY WORK THE PAST
NINE AND A HALF YEARS. IT'S ALL
ABOUT PROTECTING PATIENTS AND
CONTROLLING HEALTH CARE COSTS.
THAT'S WHY I'VE BEEN FOCUSED ON
THIS TREND FOR THE PAST SEVERAL
YEARS. AS A HEALTH CARE
PROVIDER, I HOLD DEAR STATE LAW.
BARRING THE CORPORATE PRACTICE
OF MEDICINE AND ENSURING THAT
PROVIDERS CAN PRACTICE
INDEPENDENT OF ANOTHER ENTITY
TELLING THEM HOW TO PRACTICE
THIS BILL REINFORCES THAT WE ALL
KNOW WHAT PRIVATE EQUITY'S FIRST
INTEREST IS MAKING A PROFIT.
THEY WOULDN'T RISK IT IF THEY
DIDN'T. WE ALSO KNOW THAT
TIMELINES ARE SHORT, OFTEN 3 TO
7 YEARS, AND WE KNOW THAT IN
ORDER FOR THEM TO MAKE A PROFIT,
THEY LOOK TO LOWER COSTS FOR THE
ENTITIES AS WELL AS INCREASE
LEVERAGE, MAKING THEM MORE
ATTRACTIVE TO FUTURE BUYERS IS
MAKING SOMETHING MORE EFFICIENT,
BAD? NO, BUT IT CAN BE HARMFUL
BY REDUCING STAFFING AND
LIMITING RESOURCES.
CONSOLIDATION CAN ALSO INCREASE
LEVERAGE, ALLOWING THEM TO
NEGOTIATE HIGHER FEES,
INCREASING THE COST OF HEALTH
CARE, AND POSSIBLY RESTRICTING
ACCESS TO CERTAIN SERVICES LIKE
REPRODUCTIVE HEALTH CARE. WE ARE
AWARE THAT PRIVATE EQUITY HAS
PROVIDED FUNDING FOR EXPANDING
SERVICES, BUT WE ARE ALSO AWARE
OF PRIVATE EQUITY TAKING SUCH A
HOLD ON AN AREA THAT THERE IS NO
LONGER COMPETITION, AND THAT
MONOPOLY CAN RESULT IN
NEGOTIATIONS OF HIGHER FEES
BECAUSE THERE IS NO OTHER
OPTION. THIS BILL DOES NOT
PREVENT THESE ACQUISITIONS. IT
DOES ALLOW THE ATTORNEY GENERAL
TO REVIEW THEM TO ENSURE THEY
ARE IN THE BEST INTERESTS OF
PATIENTS. AS I ALWAYS DO, I
CAREFULLY LISTEN TO OPPOSITIONS
CONCERNED, BUT THERE IS A BASIC
QUESTION HERE, GIVEN THE RESULTS
SHOWN BY MANY STUDIES, NOT JUST
ONE, THAT THERE ARE HARMFUL
OUTCOMES AND HOW CAN THE
OPPOSITION ARGUE THAT THESE
TRANSACTIONS SHOULD BE GETTING
AN AUTOMATIC RUBBER STAMP
WITHOUT ANY REVIEW? THIS TREND
CONTINUES TO GROW EXPONENTIALLY,
AND OUR GOAL SHOULD BE LOOKING
AT THE INVESTMENTS AND HOW THEY
ARE AFFECTING PATIENTS AND THE
COST TO HEALTH CARE. IF NOT US,
THEN WHO? TODAY, TO TESTIFY FOR
THE ATTORNEY IS DEPUTY ATTORNEY
GENERAL TIFFANY MATTHEWS AND THE
ATTORNEY GENERAL'S OFFICE. AND
KATIE VAN DINE'S, POLICY AND
LEGISLATIVE ADVOCATE FOR HEALTH
ACCESS. CALIFORNIA SPECIAL
ASSISTANT JAMES TOMA FROM THE
ATTORNEY GENERAL'S OFFICE IS
ALSO AVAILABLE FOR QUESTIONS.
THANK YOU. YOU CAN PROCEED WITH
TWO MINUTES TIME. GOOD AFTERNOON
, CHAIR AND COMMITTEE MEMBERS
TIFFANY MATTHEWS, DEPUTY
ATTORNEY GENERAL AND LEGISLATIVE
ADVOCATE AT THE CALIFORNIA
DEPARTMENT OF JUSTICE. I'M HERE
TODAY ON BEHALF OF ATTORNEY
GENERAL ROB BONTA, WHO IS A
PROUD SPONSOR OF AB 3129, AND HE
THINKS THE LEADERSHIP OF THE
ASSEMBLY MEMBER WOULD ON
ADDRESSING CONSOLIDATION IN OUR
HEALTH CARE SYSTEM. AB 3129
AUTHORIZES THE ATTORNEY GENERAL
TO REVIEW HEALTH CARE
TRANSACTIONS INVOLVING PRIVATE
EQUITY AND HEDGE FUNDS, AND IT
ALSO REINFORCES THE EXISTING BAR
ON THE CORPORATE PRACTICE OF
MEDICINE AS IT APPLIES TO THE
INTERFERENCE OF PRIVATE EQUITY
GROUPS OR HEDGE FUNDS IN THE
MEDICAL CARE OF PATIENTS. THE
BILL FOCUSES ON PRIVATE EQUITY
FOR TWO MAIN REASONS THE FIRST
REASON IS THAT THE PRIVATE
EQUITY BUSINESS MODEL, WHICH IS
DESIGNED TO BUY AN ASSET,
MAXIMIZE PROFITS AND THEN SELL
THAT ASSET, HAS CONCERNING
EFFECTS. WHEN APPLIED TO OUR
HEALTH CARE SYSTEM, WE ARE
SEEING HEALTH CARE FACILITIES
AND PROVIDER GROUPS BEING BOUGHT
UP BY PRIVATE EQUITY. CUTS TO
STAFF AND SERVICES ARE BEING
MADE TO INCREASE PROFITS, AND
THEN THAT FACILITY OR PROVIDER
GROUP IS SOLD, OFTENTIMES
SUSCEPTIBLE TO BANKRUPTCY,
FURTHER CONSOLIDATION OR
SHUTTING DOWN, JEOPARDIZING THE
SURROUNDING COMMUNITIES ACCESS
TO HEALTH CARE. AND THE SECOND
MAIN REASON IS THE ALARMING PACE
AT WHICH THESE PRIVATE EQUITY
ACQUISITIONS ARE HAPPENING. THEY
HAVE DOUBLED IN THE PAST DECADE.
AB 3129 WOULD SET UP OVERSIGHT
OVER THESE TRANSACTIONS, WHERE
THE ATTORNEY GENERAL WOULD HAVE
THE AUTHORITY TO APPROVE, DENY
OR APPROVE WITH CONDITIONS THESE
TRANSACTIONS BASED ON WHETHER
THEY ARE IN THE PUBLIC INTEREST.
THIS REVIEW PROCESS IS NOT AN
AUTOMATIC DENIAL OF THESE
TRANSACTIONS. THE OVERSIGHT IS
TO HELP ENSURE THAT CALIFORNIANS
HAVE ACCESS TO AFFORDABLE HEALTH
CARE, AND FOR THESE REASONS, WE
RESPECTFULLY REQUEST AN AYE VOTE
. THANK YOU. CAN GO AHEAD. GOOD
AFTERNOON, MADAM CHAIR AND
MEMBERS. I'M KATIE VAN ÓRDENES
WITH HEALTH ACCESS CALIFORNIA,
THE STATEWIDE HEALTH CARE
CONSUMER ADVOCACY COALITION, AND
WE ARE HERE IN PROUD SUPPORT OF
AB 3129 BY ASSEMBLY MEMBER WOULD
FOR MORE THAN 30 YEARS,
ATTORNEYS GENERAL OF BOTH
PARTIES HAVE HAD THE AUTHORITY
TO APPROVE, DENY OR APPROVE WITH
CONDITIONS AND MERGERS RELATED
TO NONPROFIT HEALTH CARE
TRANSACTIONS. IN THE LAST 30
YEARS, BETWEEN 80 AND 90% OF
THOSE NONPROFIT HOSPITAL MERGERS
HAVE BEEN APPROVED, MOSTLY WITH
CONDITIONS TO PROTECT CONSUMERS.
WHAT KIND OF CONDITIONS HAVE AGS
ASKED FOR TO KEEP EMERGENCY
ROOMS OPEN, TO KEEP LABOR AND
DELIVERY ROOMS OPEN, TO KEEP
CARDIAC CARE AND OTHER SERVICES
OPEN, TO NOT HIKE UP PRICES FOR
CONSUMERS AND TO NOT END MANAGED
CARE CONTRACTS FOR CONSUMERS,
FOR MEDI-CAL, AND TO NOT CLOSE
HOSPITALS, AS THESE ARE THE
EXACT KIND OF CONDITIONS THAT
COMMUNITIES NEEDS, COMMUNITIES
NEED, AND THAT WE HOPE TO SEE
MOVING FORWARD TO PROTECT ACCESS
TO AFFORDABLE HEALTH CARE IN
COMMUNITIES. IN THIS PROCESS IS
NOT NEW. WHAT IS NEW IS THAT
PRIVATE EQUITY IS TAKING OVER
HOSPITALS, SKILLED NURSING
FACILITIES AND DOCTORS GROUPS,
AND RESEARCH HAS SHOWN THAT THIS
DRIVES UP PRICES FOR HEALTH
CARE, CAN HAVE DANGEROUS IMPACTS
FOR QUALITY AS WELL AS RISKS FOR
ACCESS TO CARE IN COMMUNITIES.
AB 3129 WAS SUBJECT PRIVATE
EQUITY TO THE SAME KIND OF
OVERSIGHT AND PUBLIC SCRUTINY
THAT NONPROFIT HOSPITALS HAVE
HAD FOR DECADES. WHEN THERE IS A
MERGER AND ACQUISITION IN HEALTH
CARE, WE OFTEN HEAR ABOUT
WONDERFUL THINGS THAT WILL
HAPPEN, LIKE INNOVATION IN
EFFICIENCY. WE WANT TO HAVE THE
ATTORNEY GENERAL TO HAVE THE
OVERSIGHT AUTHORITY TO HOLD
PRIVATE EQUITY ACCOUNTABLE TO
THESE PROMISES AND PREVENT
NEGATIVE IMPACTS FOR OUR
COMMUNITIES. THANK YOU. AND I
RESPECTFULLY ASK FOR YOUR AYE
VOTE ON THIS BILL. THANK YOU.
ARE THERE ANY OTHER WITNESSES IN
SUPPORT? PLEASE STATE YOUR NAME,
ORGANIZATION, POSITION. MADAM
CHAIR, MEMBERS TIM MADDEN,
REPRESENTING THE CALIFORNIA
CHAPTER OF THE AMERICAN COLLEGE
OF EMERGENCY PHYSICIANS IN
SUPPORT. GOOD AFTERNOON AGAIN.
BETH MALINOWSKI, THE CEO,
CALIFORNIA. AND STRONG SUPPORT,
ALSO REGISTERING SUPPORT FOR
NEXT GEN CALIFORNIA. GOOD
AFTERNOON, MADAM CHAIR MEMBERS.
MARIE LOPEZ WITH THE CALIFORNIA
NURSES ASSOCIATION IN SUPPORT.
DYLAN ELLIOTT, ON BEHALF OF THE
CALIFORNIA STATE ASSOCIATION OF
PSYCHIATRISTS IN SUPPORT. THANK
YOU. AARON EVANS, ON BEHALF OF
NARAL. EXCUSE ME, FORMERLY NARAL
PRO-CHOICE CALIFORNIA, CURRENTLY
REPRODUCTIVE FREEDOM FOR ALL IN
SUPPORT. THANK YOU. SETH
BRAMBLE, SPEAKING ON BEHALF OF
THE CALIFORNIA TEACHERS
ASSOCIATION. WE ARE IN SUPPORT.
GOOD AFTERNOON, CHAIR MEMBERS
JANICE O'MALLEY WITH AFSCME
CALIFORNIA. HERE IN SUPPORT.
MADAM CHAIR MEMBERS BRANDON
MARTY WITH THE CALIFORNIA
MEDICAL ASSOCIATION SUPPORT THE
BILL AND CONCEPT. APPRECIATE THE
CONVERSATIONS THAT WE'VE HAD
WITH THE SPONSOR AND THE AUTHOR
THUS FAR, AND LOOK FORWARD TO
CONTINUING OUR WORK. THANK YOU.
GOOD AFTERNOON. CHAIR PETER
SIDHU, EUNUCH ACP EXECUTIVE VICE
PRESIDENT AND SUPPORT FOR THE
BILL. THANK YOU. ARE THERE ANY
PRIMARY WITNESSES IN OPPOSITION?
THANKS SO MUCH. YOU'LL EACH HAVE
TWO MINUTES. GOOD AFTERNOON,
MADAM CHAIR. MEMBERS OF THE
COMMITTEE, DOCTOR WOOD. THIS IS
AN ISSUE THAT HAS BEEN AROUND
FOR SOME TIME. AND, DOCTOR WOOD
AND I HAVE AGREED TO DISAGREE,
LET ME OFFER THAT. I'M HERE ON
BEHALF OF THE AMERICAN
INVESTMENT COUNCIL, AND, WE VIEW
AS AB 3129 TO PROPOSE A
SIGNIFICANT EXPANSION OF THE
AG'S POWERS OVER HEALTH CARE
TRANSACTIONS TO INCLUDE
UNPRECEDENTED OVERSIGHT OVER
CHANGES OF THE CONTROL OF
GOVERNANCE, OF HEALTH CARE
FACILITIES, INVOLVING PRIVATE
INVESTORS. FURTHER THESE NEW
REQUIREMENTS WOULD APPLY TO A
BROAD RANGE OF INVESTORS. WHILE
THE PROPOSED BILL USES
TERMINOLOGY FOCUSING ON PRIVATE
EQUITY AND HEDGE IN FACT, THE
BILL APPLIES IN A FAR BROADER
CAPACITY, IT WOULD, IMPACT ANY
INVESTOR IN THE HEALTH CARE
SPACE FURTHER, AB 3129 SEEKS TO
CUT OFF CRITICAL SOURCE OF
FUNDING FOR HEALTH CARE, AND WE
ALSO FIND THAT WHILE DOCTOR WOOD
HAS PRESENTED BOTH IN HIS FACT
SHEET AND HIS TESTIMONY, THE
STUDIES THAT SUPPORT THE
PROPOSITION IN THE BILL, THERE
ARE ALSO AN EQUAL AMOUNT OF
STUDIES THAT CONTRADICT THAT. I
WOULD POINT OUT TO THE ONE
FINDING IN THE STUDY THAT HE
PRESENTED, WHICH STATES MORE
STUDY IS NEEDED TO UNDERSTAND
THE IMPACT OF PE ACQUISITIONS ON
HEALTH CARE. MORE STUDY,
STARTING WITH THE DEVELOPMENT OF
BETTER DATA SETS, IS NEEDED TO
UNDERSTAND THE COMPLEX IMPACT OF
PE OWNERSHIP IN PHYSICIAN
PRACTICE AND HEALTH CARE MARKETS
. FINALLY, WE ALL KNOW ABOUT THE
ENACTMENT OF SENATE BILL 184,
WHICH CREATED THE OFFICE OF
HEALTH CARE AFFORDABILITY IN. IN
PRESENTING THIS BILL, I QUOTE,
THE PROPONENTS SAID THAT OCA
WILL COLLECT AND ANALYZE THE
HEALTH CARE MARKET FOR COST
DRIVERS AND TRENDS IN ORDER TO
DEVELOP DATA INFORMED POLICIES
AND ENFORCEABLE COST TARGETS
WITH THE GOALS OF CONTAINING
HEALTH CARE COSTS AND PROVIDING
QUALITY AND AFFORDABILITY
AFFORDABLE HEALTH CARE TO ALL
CALIFORNIANS. WE WOULD SIMPLY
ASK THAT YOU REJECT THIS BILL
AND LET OCA DO ITS JOB. PLEASE
GO AHEAD. THANK YOU. GOOD
AFTERNOON, CHAIR MEMBERS OF THE
COMMITTEE, RONNIE VERDUGO HERE
ON BEHALF OF THE CALIFORNIA
HOSPITAL ASSOCIATION,
RESPECTFULLY, IN OPPOSITION TO
AB 3129, WE BELIEVE PATIENTS
DESERVE ACCESS TO EFFECTIVE,
RELIABLE HEALTH CARE SERVICES.
AND THESE SERVICES DO DEPEND ON
CONSTANT INNOVATION AND
INVESTMENT HERE IN SACRAMENTO,
FOR EXAMPLE, PATIENTS HAVE BEEN
THE BENEFICIARIES OF A NEW
REHABILITATION HOSPITAL
RESULTING FROM A PARTNERSHIP
BETWEEN UC DAVIS AND PRIVATE
INVESTMENT. AS DRAFTED, AB 3129
IS AT A MINIMUM UNCLEAR. ABOUT
WHEN THE DEPARTMENT OF JUSTICE
WILL STEP IN TO REVIEW
TRANSACTIONS, GIVING IT BROAD
AUTHORITY TO APPROVE, REJECT OR
IMPOSE CONDITIONS WHICH CAN SLOW
OR ELIMINATE MUCH NEEDED
INVESTMENT IN HEALTH CARE. THE
BILL'S DEFINITION OF CHANGE OF
CONTROL IS ALSO UNCLEAR,
INCLUDING INDIRECT CONTROL AND
SHARING OF CONTROL, WHERE THERE
ARE EVEN MINOR CHANGES IN A
HOSPITAL'S GOVERNANCE. THE DOJ'S
EXISTING AUTHORITY OVER
NONPROFIT HOSPITAL TRANSACTIONS
HAS ALREADY SERVED AS A BARRIER
FOR INVESTMENT IN HEALTH CARE
AND WAS ONE OF THE CONTRIBUTING
FACTORS THAT LED TO THE CLOSURE
OF MADERA COMMUNITY HOSPITAL.
ACCESS TO ALL FINANCIAL TOOLS IS
CRITICAL, CRITICAL, PARTICULARLY
IN VULNERABLE COMMUNITIES WHERE
INVESTMENTS ARE NEEDED. IT'S
IMPORTANT TO NOTE CALIFORNIA
WILL BE REVIEWING THESE VERY
TRANSACTIONS THROUGH THE OFFICE
OF HEALTH CARE AFFORDABILITY.
THAT LAW PROHIBITS TRANSACTIONS
FROM CLOSING UNTIL 60 DAYS AFTER
OCA PUBLISHES ITS FINAL IMPACT
ANALYSIS. PLENTY OF TIME FOR THE
DOJ TO EXERCISE ITS CURRENT
AUTHORITY TO INVESTIGATE
ANTI-COMPETITIVE BEHAVIOR.
FURTHERMORE, CALIFORNIA HAS
NUMEROUS POLICIES IMPLEMENTED BY
HOSPITALS THAT ARE DESIGNED TO
PROTECT PATIENTS REGARDLESS OF
THEIR OWNERSHIP. AT LEAST FIVE
DIFFERENT DEPARTMENTS AND
AGENCIES CONDUCT EXTENSIVE
OVERSIGHT, AT ALL POINTS OF
PATIENT CARE. THESE POLICIES
ALIGN WITH THE HOSPITAL'S CORE
MISSION OF CARING FOR ITS
PATIENTS AND WORKERS.
UNFORTUNATELY, WHILE AB 31 29TH
MAY BE WELL INTENTIONED, WE
THINK IT RAISES MORE QUESTIONS
THAN ANSWERS. PUTTING AT RISK
INNOVATION AND ADDITIONAL
INVESTMENT IN PATIENT CARE. FOR
THESE REASONS, WE RESPECTFULLY
ASK FOR YOUR NO VOTE. THANK YOU.
THANK YOU. ARE THERE ANY OTHER
WITNESSES IN OPPOSITION? PLEASE
COME FORWARD. GOOD AFTERNOON,
CHAIR AND MEMBERS KIM STONE OF
STONE ADVOCACY ON BEHALF OF THE
CALIFORNIA ORTHOPEDIC
ASSOCIATION, IN A RESPECTFUL
OPPOSE, UNLESS AMENDED POSITION.
THANK YOU. PRESTON YOUNG FROM
THE CALIFORNIA CHAMBER OF
COMMERCE HERE TODAY IN
OPPOSITION. MEGAN LOPER, ON
BEHALF OF THE UNITED HOSPITAL
ASSOCIATION, IN OPPOSITION. GOOD
AFTERNOON, MADAM CHAIR, AND
MEMBERS. CONNIE DELGADO, ON
BEHALF OF NEWPORT HEALTH CARE,
WITH CONCERNS FOR MANY OF THE
REASONS THAT MY COLLEAGUES
MENTIONED. THANK YOU. SEEING NO
OTHER WITNESSES IN OPPOSITION,
I'LL BRING IT BACK TO THE
COMMITTEE FOR A COMMENT OR
QUESTION. DOCTOR WEBER. GOOD
AFTERNOON. THANK YOU SO MUCH FOR
INTRODUCING THIS, THIS BILL AND
ALLOWING US TO CONTINUE THE
DISCUSSION OF HOW WE SHOULD BE
PROVIDING HEALTH CARE AND ACCESS
TO OUR RESIDENTS IN CALIFORNIA,
YOU KNOW, I AGREE WITH WHAT WAS
STATED BEFORE. I DEFINITELY
AGREE WITH THE CONCEPT,
DEFINITELY WANT TO THANK YOU FOR
THE INCLUSION OF THE NON-COMPETE
CLAUSE, BECAUSE THAT IS A HUGE
ISSUE FOR US, PROVIDERS. JUST
HAVE A COUPLE OF QUESTIONS THAT,
THAT EITHER YOU OR THE AG'S
OFFICE COULD, COULD ANSWER FOR
ME. SO YOU BREAK DOWN DIFFERENT
WAYS FOR NON PROVIDER VERSUS
PROVIDER VERSUS PROVIDER GROUPS.
SO WHAT WAS THE PURPOSE IN THOSE
DIFFERENT DEFINITIONS FOR EACH
OF THOSE CATEGORIES OR THE
THOUGHT PROCESS BEHIND IT. I
THINK IT'S PRETTY DIFFICULT TO
LUMP EVERYBODY ALL TOGETHER IN A
SINGLE CATEGORY. SO WE DO, WE
LOOK AT PAYERS, AND BREAK DOWN
HOW WE CONSIDER PAYERS. WE LOOK
AT PROVIDER, BEING DEFINED AS
TWO, TWO THROUGH NINE, HEALTH
CARE PROVIDERS AND THEN A
PROVIDER GROUP BEING LARGER THAN
THAT, I THINK THAT THOSE THAT
THERE ARE DISTINCTIVE
DIFFERENCES BETWEEN THOSE THREE
CATEGORIES OF, OF, OF PEOPLE AND
SO, SO YOU KNOW, THIS THIS PART
OF THAT IS WE'RE STILL WE ARE
THAT, THAT MAY STILL BE A LITTLE
BIT OF A WORK IN PROGRESS, BUT
IT IS A RECOGNITION THAT THERE,
THERE ARE DIFFERENCES, BASED ON
THE SIZES OF GROUP AND THE PAYER
PAYER COMPONENT AS WELL. I'LL,
I'LL ASK THE AG'S OFFICE IF THEY
HAVE ANY COMMENT. NÓ THAT THAT
THAT THAT IS CORRECT. DOCTOR
WOOD IS RIGHT THAT, YOU KNOW, WE
THE PRIVATE EQUITY HAVE BEEN
PARTICULARLY, ACTIVE WITH
PROVIDER GROUPS. AND SO WE ARE
TRYING TO FOCUS THOSE PROVISIONS
TO HIT THE DIFFERENCES BETWEEN
DIFFERENT GROUPS, YOU CAN SEE
THAT, YOU KNOW, THIS BILL
AFFECTS HEALTH CARE FACILITIES
BECAUSE THAT'S ALSO WHERE,
PRIVATE EQUITY WAS INACTIVE IN
TERMS OF HOSPITALS AND SO FORTH.
AND WITH PHYSICIAN GROUPS AND
PROVIDER GROUPS, WE WANTED TO
MAKE THAT CLEAR THAT THIS WOULD
APPLY THERE, BECAUSE THAT'S BEEN
ANOTHER SOURCE OF, PROBLEMS IN
TERMS OF THE PROVISION OF HEALTH
CARE ACCESS. THOSE THOSE
DEFINITIONS ARE TECHNICAL. AND
SO THEY ARE, AS DOCTOR WOOD
MENTIONED, STILL UNDER REVIEW TO
MAKE SURE THAT WE HAVE THIS.
RIGHT, BUT THAT WAS THE IDEA
TRYING TO FIND THE RIGHT MIX AND
THE RIGHT BALANCE FOR WHICH
GROUPS WOULD BE IMPACTED BY THE
BILL. YEAH. NO, I JUST FOUND IT
A LITTLE UNUSUAL THAT LIKE NON
PROVIDERS INCLUDE THIS AMOUNT
VERSUS PROVIDERS THAT INCLUDE
YOU KNOW THIS AMOUNT I WOULD
THINK THERE WOULD BE A LITTLE
BIT MORE UNIFORMITY. I THINK I
THINK THE REASON PART OF THE
REASON BEHIND THAT IS THAT WHAT
WE ARE SEEING, IN, IN THE, IN
THE ACQUISITION SPACE IS THAT
PRIVATE EQUITY IS TENDING TO
GOBBLE UP, SO TO SPEAK, MORE
SMALLER GROUPS, AND WHEN YOU CAN
GET TO A POINT WHERE YOU HAVE
NOW HAVE MARKET SUPERIORITY,
WHERE YOU HAVE ESSENTIALLY
ELIMINATED COMPETITION BY
GOBBLING UP A LOT OF A VARIETY
OF GROUPS, THEY'RE GOING TO COME
IN DIFFERENT SHAPES AND SIZES.
AND SO WE WANT TO BE SURE WE
CAPTURE THAT AND THAT, THAT,
THAT WHEN THE ATTORNEY GENERAL
IS LOOKING AT THESE MERGERS,
THAT THEY ARE AWARE THAT A
PARTICULAR GROUP HAS NOW NOW
OWNS A WHOLE BUNCH OF COMPONENT
S, OTHER SMALLER GROUPS THERE
THAT NOW MAKES THEM A BIGGER
PLAYER. AND THAT IS THE
CHALLENGE WHEN WE LOOK AT
COMPETITION IN THE MARKET, WE
SAW WE SAW LOOK, ALL THIS WORK
STARTS FROM BACK WITH SUTTER
HEALTH YEARS AGO. AND WE SAW
WHAT HAPPENED IN NORTHERN
CALIFORNIA, WHERE WE NOW PAY
MORE FOR HEALTH CARE IN NORTHERN
CALIFORNIA THAN IN SOUTHERN
CALIFORNIA, BECAUSE SUTTER
SYSTEMATICALLY WAS ABLE TO
CORNER THE MARKET. AND WHEN YOU
ARE THE ONLY OR YOU THE DOMINANT
FORCE IN THE MARKET AND THERE'S
NO COMPETITION, THAT'S HUGE
LEVERAGE WITH PROVIDERS, WITH
WITH PAYERS PARTICULARLY, AND
EMPLOYERS WHO NEED TO HAVE
COVERAGE FOR THEIR FOR THEIR
EMPLOYEES. YEAH. THANK YOU FOR
THAT CLARIFICATION, WHEN YOU IN
THE BILL, WHEN YOU TALK ABOUT
THE REVENUE THRESHOLD, IS THAT
BASED ON GROSS OR NET REVENUE.
IT'S GROSS REVENUE. GROSS
REVENUE. OKAY, AND THEN FOR THIS
PARTICULAR BILL, LOOKING AT THE
REVENUE THRESHOLD AS THE METRIC,
BUT IN PREVIOUS BILLS, YOU KIND
OF LOOKED AT LIKE PRACTICE SIZE
OR TRANSACTION VALUE, WHAT WAS
THE RATIONALE FOR THE
DIFFERENCE? IS IT THAT THIS IS
HOW THESE PRIVATE EQUITY GROUPS
MOVE OR WHAT WHAT WAS THE
RATIONALE FOR THE DIFFERENCE,
YOU KNOW, I THINK IF YOU LOOK AT
EARLIER BILLS, WE WERE IT WAS AS
LOW AS $5 MILLION. IT MAY HAVE
BEEN A BILL THAT EVEN SAID $1
MILLION, I CAN'T REMEMBER, I
CAN'T REMEMBER THAT FAR BACK,
QUITE FRANKLY. BUT, BUT, YOU
KNOW, IF YOU'RE LOOKING AT A
GROUP OF, OF, YOU KNOW, A
HANDFUL OF PROVIDERS THAT COULD
EASILY BE, YOU KNOW, 7 TO 9
PROVIDERS THAT COULD BE A $10
MILLION THRESHOLD OR LESS,
MOVING THERE. I THINK THE POINT
IS TO NOT WE'RE TRYING TO GET
OUR ARMS AROUND THE TOTALITY OF
WHAT'S HAPPENING IN THE
MARKETPLACE. AND SO THAT'S WHERE
THE THAT'S WHERE WE'RE TRYING TO
FIND THAT PARTICULAR SWEET SPOT.
I'LL SAY THIS FOR THE OPPOSITION
BECAUSE, BECAUSE, BECAUSE THEY
PROBABLY WILL IF THEY'RE ASKED,
PEOPLE WANT THIS TO BE LIKE $101
MILLION, WHICH IS THE FEDERAL,
THRESHOLD. AND I'M SORRY, THAT
THAT'S THAT'S WOULD BE WHOLLY
INAPPROPRIATE. IT WOULD NEVER
CAPTURE WHAT WE'RE TRYING TO DO
HERE. SO SO, BUT WE THINK AT
THIS POINT, UNTIL WE CAN BE
COMPELLED TO SEE IT ANOTHER WAY
WITH DATA, THAT $10 MILLION IS
AN APPROPRIATE THRESHOLD. THANK
YOU. AND THEN, WOULD LOVE FOR
YOU TO, TO COMMENT ON WHAT THE
OPPOSITION TALKED ABOUT WHEN
THEY ARE REFERRING TO THE OFFICE
OF HEALTH CARE AFFORDABILITY,
AND, YOU KNOW, THE DIFFERENCE IN
HOW THIS IS ONE OF THE AREAS IN
WHICH THE OFFICE OF HEALTH CARE
AFFORDABILITY IS SUPPOSED TO BE
KIND OF OVERSEEING. JUST GIVE
YOU THE OPPORTUNITY TO RESPOND.
THANK YOU. I APPRECIATE THAT. I
WORKED ON THE OFFICE OF HEALTH
CARE AFFORDABILITY, AS DID EVERY
MEMBER OF THE HEALTH COMMITTEE
STAFF FOR A LONG TIME. AND, THIS
WAS ONE OF THE THORNY ISSUES,
QUITE FRANKLY, CONSOLIDATION IN
THE MARKETPLACE. WE ALWAYS KNEW
WE WERE GOING TO GO BACK AND
HAVE TO, TO LOOK AT THIS
PARTICULAR ISSUE AS A MATTER OF
FACT, I INTRODUCED A BILL LAST
YEAR TO LOOK AT THIS PARTICULAR
ISSUE. WHAT'S DIFFERENT ABOUT
THIS BILL IS IT IS VERY TAILORED
TO THE PRIVATE EQUITY VENTURE
CAPITAL MARKET, WHICH IS WHICH
IS AN EMERGING CHALLENGE
NATIONWIDE. AND MY CONCERN IS
THAT, OKAY, ISN'T IT? OKA WASN'T
SPECIFICALLY TASKED IN THIS
ARENA. AND, AND I WANT TO GIVE
THEM THE TOOL TO BE ABLE TO LOOK
MORE CLOSELY AT THIS BEFORE IT'S
TOO LATE, BEFORE WE HAVE ANOTHER
SUTTER. THE SITUATION THAT
AFFECTS, HEALTH CARE THROUGHOUT
THE STATE AND DRIVES COSTS
HIGHER FOR PATIENTS. I WANT TO
THANK THE AUTHOR FOR BRINGING
THIS FORWARD. I KNOW THAT THIS
HAS BEEN REALLY AN OPPORTUNITY
FOR YOU TO TAKE YOUR MANY YEARS
OF SERVICE AS CHAIR OF THE
HEALTH COMMITTEE TO REALLY LOOK
AT SOME OF THE, AS YOU SAID,
SOME OF THE, EMERGENT TRENDS
THAT WE NEED TO BE, QUITE
FRANKLY, VERY CONCERNED ABOUT AS
WE THINK ABOUT THE
CORPORATIZATION OF OUR HEALTH
CARE SYSTEM. SO I'M VERY
THANKFUL TO YOU FOR BRINGING
THIS FORWARD, I BELIEVE THAT IT
IS WELL SITUATED TO ENSURE THAT
THE DEPARTMENT OF JUSTICE HAS
THE ABILITY TO REMARK ON THESE
KINDS OF ACQUISITIONS, GIVEN
THEIR PRIOR EXPERIENCE DOING SO
IN THE NONPROFIT CONTEXT, AND
WITH THAT, WE STILL DO NOT HAVE
A COMMITTEE ON THE WHOLE. SO,
ARTHUR, DO YOU HAVE ANY CLOSING
COMMENTS, PLEASE? I WANT TO
THANK THE CHAIR AND THE
COMMITTEE FOR QUESTIONS AND
APPRECIATE, APPRECIATE. THIS IS
A CHALLENGING, COMPLICATED
SUBJECT, I DON'T APPROACH IT
LIGHTLY, I WILL CONTINUE TO WORK
WITH OPPOSITION, ALTHOUGH I
THINK, MR. PERRY IS CORRECT, WE
MAY AGREE TO DISAGREE ON, ON
SOME OF SOME OF THESE ISSUES, I
AM CONCERNED ABOUT THE EMERGING
TRENDS. THIS ISN'T JUST THIS
ISN'T JUST PHYSICIANS GROUPS.
THIS IS SKILLED NURSING
FACILITIES, LABORATORIES,
POTENTIALLY. BUT THE BIGGEST
CONSOLIDATION WE'RE SEEING RIGHT
NOW NATIONWIDE IS IN SKILLED
NURSING FACILITIES. AND WHAT
WE'RE SEEING IS, IN SOME OF
THOSE FACILITIES, ONE OF THE
FIRST THINGS THAT'S HAPPENED IS,
IS TO CUT COSTS, IS TO REDUCE
STAFFING LEVELS TO TAKING CARE
OF SOME OF OUR MOST VULNERABLE
PEOPLE BY, BY BY REDUCING THE
CARE THAT'S PROVIDED TO PEOPLE.
AND I'M NOT SAYING THAT ALL
CONSOLIDATION IS BAD. I'M NOT.
AND BUT I DO WANT TO BE SURE
THAT PATIENTS, DON'T AND DON'T
HAVE TO BEAR THE COST OF, OF
CONSOLIDATION. THÀNH SIMPLY FOR
PROFIT. AND THAT'S REALLY WHAT
THIS IS ABOUT, PRIVATE EQUITY
FIRMS, VENTURE CAPITAL FIRMS ARE
ALL ABOUT PROFIT. I WOULD POINT
YOU TOWARDS AN ARTICLE IN
SUNDAY'S NEW YORK TIMES ABOUT A
COMPANY CALLED MULTIPLAN A
MULTIPLAN. AND IT'S COMPLICATED
AND I DON'T WANT TO TAKE TOO
MUCH OF THE COMMITTEE'S TIME
HERE, IS A VENTURE CAPITAL
FUNDED COMPANY THAT ACTS AS AN
INTERMEDIARY WITH INSURANCE
COMPANIES TO REDUCE
REIMBURSEMENTS TO HOSPITALS AND
SHIFT COSTS TO PATIENTS FOR A
FEE. THEY ARE FEE GENERATED,
MUCH LIKE PBMS ARE. AND THIS IS
ALL ABOUT PROFIT. THIS IS ALL
ABOUT PROFIT AND MAXIMIZING AND
SHIFTING COSTS. THAT ARTICLE
SHOULD RAISE THE HAIR ON THE
BACK OF YOUR NECK, AND I URGE
YOU TO READ THAT IT WAS IN
SUNDAY'S, SUNDAY'S NEW YORK
TIMES. THANK YOU. WITH THAT, I
RESPECTFULLY REQUEST AN AYE VOTE
WHEN YOU HAVE A QUORUM. THANK
YOU. DOCTOR, WOULD. WE ARE GOING
TO MOVE WITH FORWARD WITH YOUR
NEXT BILL, WHICH IS ITEM NUMBER
30 1AB 3218. OH YOU ARE. THANK
YOU VERY MUCH. I APPRECIATE, I
FIRST LIKE TO THANK THE
COMMITTEE AND THEIR STAFF FOR
THEIR EFFORTS ON THIS, ON THIS
MEASURE, STATE LAW PROHIBITS
FLAVORED TOBACCO PRODUCTS IN
CALIFORNIA VÀ, BUT
UNFORTUNATELY, THEY REMAIN
READILY AVAILABLE THROUGHOUT THE
STATE. THE HIGH RATE OF FLAVORED
TOBACCO USE AMONG YOUTH IS
ESPECIALLY CONCERNING, A 2023
STUDY BY THE CDC INDICATES THAT
AMONG MIDDLE AND HIGH SCHOOL
STUDENTS WHO USE TOBACCO, NEARLY
90% USE FLAVORED PRODUCTS. AB 38
3218 CREATES A PATHWAY TO
ENSURING FLAVORED TOBACCO
PRODUCTS ARE NO LONGER AVAILABLE
ON THE SHELVES OF RETAILERS AND
IN OUR COMMUNITIES. BY CREATING
AN AFFIRMATIVE LISTING OF
UNFLAVORED TOBACCO PRODUCTS THAT
ARE LEGAL IN CALIFORNIA, THIS
APPROACH WILL HELP RETAILERS
DETERMINE AT A GLANCE WHETHER
THE PRODUCT DELIVERED TO THE
STORES IS LEGAL OR NOT.
ADDITIONALLY, THE BILL
AUTHORIZES THE ATTORNEY GENERAL
TO PENALIZE DISTRIBUTORS THAT
SELL ILLEGAL TOBACCO PRODUCTS
AND MANUFACTURERS THAT FALSELY
CERTIFY THEIR PRODUCTS ARE
UNFLAVORED. AND FINALLY, THE
BILL ALSO AUTHORIZES LAW
ENFORCEMENT TO SEIZE ILLEGAL
ILLEGAL TOBACCO PRODUCTS FROM
DISTRIBUTORS. THESE
COMPREHENSIVE ENFORCEMENT STEPS
WILL HELP IMPLEMENT THE FLAVORED
TOBACCO BAN BY THE WAY, IT WAS
INTENDED HERE TO TESTIFY IN
SUPPORT IS TIFFANY MATTHEWS WITH
THE ATTORNEY GENERAL'S OFFICE,
THE SPONSOR OF THE BILL. AND,
GUM REP CORE WITH THE CAMPAIGN
FOR TOBACCO FREE KIDS, A
SPECIALIST ASSISTANT TO ATTORNEY
GENERAL, JAMES TOMA IS AVAILABLE
TO ANSWER ANY TECHNICAL
QUESTIONS. THANK YOU. PLEASE GO
AHEAD. GOOD AFTERNOON, CHAIR AND
MEMBERS TIFFANY MATTHEWS, DEPUTY
ATTORNEY GENERAL AND LEGISLATIVE
ADVOCATE FOR THE CALIFORNIA
DEPARTMENT OF JUSTICE. AND HERE
TODAY, ON BEHALF OF ATTORNEY
GENERAL ROB BONTA, SO AT THE
ATTORNEY GENERAL IS A PROUD
SPONSOR OF AB 3218, ALONG WITH
OUR CO SPONSORS, CAMPAIGN FOR
TOBACCO FREE KIDS, THE AMERICAN
LUNG ASSOCIATION, THE AMERICAN
CANCER SOCIETY, AND THE AMERICAN
HEART ASSOCIATION. ATTORNEY
GENERAL BONTA WOULD LIKE TO
THANK THE AUTHOR, ASSEMBLY
MEMBER JIM WOOD, AND THE
PRINCIPAL COAUTHOR, ASSEMBLY
SPEAKER ROBERT RIVAS, FOR
CARRYING THIS IMPORTANT PIECE OF
LEGISLATION THAT WILL ENSURE THE
SUCCESSFUL IMPLEMENTATION OF THE
FLAVORED TOBACCO BAN. WHEN THE
BAN WENT INTO EFFECT, OUR OFFICE
RECEIVED A NUMBER OF INQUIRIES
ASKING FOR GUIDANCE AND
ASSISTANCE IN EFFECTUATING THE
ROLLOUT OF THE LAW. OUR OFFICE
DRAFTED AB 3218. IN RESPONSE TO
THESE INQUIRIES AND AS A NEXT
STEP IN ACCOMPLISHING THE BAND'S
POLICY GOALS OF GETTING THESE
FLAVORED TOBACCO PRODUCTS OUT OF
THE HANDS OF OUR YOUTH, AB 3218
WOULD DO FIVE MAIN THINGS. FIRST
IS THAT IT WOULD ESTABLISH A
PUBLICLY AVAILABLE LIST OF ALL
TOBACCO PRODUCTS THAT ARE
PERMISSIBLY, UNFLAVORED AND
ALLOWED TO BE SOLD IN
CALIFORNIA. THE SECOND THING IS
THAT IT WOULD RENDER ILLEGAL
FLAVORED TO PRODUCTS PRODUCTS
INELIGIBLE FOR TAX STAMPS SO
THAT SUCH PRODUCTS CAN QUICKLY
BE REMOVED FROM COMMERCE AND
NEVER REACH OUR KIDS. THE THIRD
THING IS THAT IT WOULD HOLD THE
DISTRIBUTION CHAIN ACCOUNTABLE
AT A HIGHER LEVEL. THE FOURTH IS
IT WOULD CLARIFY THE DEFINITION
OF CHARACTERIZING FLAVOR TO
SPECIFICALLY PROHIBIT PRODUCTS
THAT IMPART MENTHOL LIKE COOLING
SENSATIONS. AND THE FIFTH AND
LAST IS THAT IT WOULD AUTHORIZE
THE ATTORNEY GENERAL TO OMIT
FROM THE UNFLAVORED LIST ANY
TOBACCO PRODUCTS LACKING THE
REQUIRED FDA AUTHORIZATION. IN
SOME AB 32, 18 WOULD HOLD
SELLERS OF ILLEGAL TOBACCO
PRODUCTS ACCOUNTABLE AND REDUCE
ACCESS TO FLAVORED TOBACCO
PRODUCTS, PARTICULARLY AMONG
YOUTH WHO GRAVITATE TOWARDS
THESE PRODUCTS AND HELP PREVENT
THEM FROM ENTERING A LIFETIME OF
ADDICTION. THANK YOU FOR YOUR
TIME TODAY AND I RESPECTFULLY
ASK FOR YOUR I VOTE. PLEASE GO
AHEAD. THANK YOU, MADAM CHAIR
AND COMMITTEE MEMBERS, MY NAME
IS ADAM RUCKER. I'M REPRESENTING
THE CAMPAIGN FOR TOBACCO FREE
KIDS AS A YOUTH MEMBER OF THE
BOARD. I'M HERE TODAY TO
CONTINUE THE ADVOCACY. WE BEGAN
WITH SB 793 AND THE REFERENDUM
IN 2022. AND TO REALLY FULFILL
THE MISSION I SET OUT ON AS A
MIDDLE SCHOOLER TO ENSURE
HEALTHIER FUTURES FOR MY
SIBLINGS, OUR COMMUNITIES AND
YOUTH ALL ACROSS CALIFORNIA. ON
BEHALF OF THE SPONSORS OF THE
FLAVORED TOBACCO LAW, I WANTED
TO PERSONALLY THANK ATTORNEY
GENERAL ROB BONTA AND DOCTOR
WOOD FOR THEIR DILIGENT WORK ON
THIS ISSUE WITH THE TOBACCO
INDUSTRY HAS MADE PASSING THIS
BILL NECESSARY AS WHILE THEY
LOST THEIR FIGHT TO KEEP KID
FRIENDLY FLAVORS ON THE SHELVES
HERE IN THE LEGISLATURE IN 2020,
AND THEN AGAIN AT THE BALLOT IN
2022, THAT HASN'T STOPPED THEM.
MENTHOL, LIKE CIGARETS, WERE
INVENTED TO REPLICATE THE TASTE
AND SENSATION PROVIDED BY
MENTHOL CIGARETS IN ORDER TO
KEEP UP THEIR RELENTLESS
TARGETING OF YOUTH IN OUR
COMMUNITIES OF COLOR. THIS BILL
WILL HELP CLARIFY WHAT IS A
FLAVORED TOBACCO PRODUCT AND
WHAT ISN'T. WITH A LIST, AND
UPDATE THE CHARACTERIZING FLAVOR
DEFINITION TO INCLUDE A NUMBING
OR COOLING SENSATION. THE
UNFLAVORED TOBACCO PRODUCT LIST
STARTS WITH A POSITION THAT THE
ONUS SHOULD BE ON THE TOBACCO
INDUSTRY TO SHOW THEIR PRODUCTS
AREN'T FLAVORED. THE STAKES FOR
PASSING THIS BILL ARE REALLY
SHOWN IN THE DATA FROM THE CDC
FOUNDATION THÀNH, STATING THAT
WHILE SALES OF FLAVORED
E-CIGARETTES HAVE DECLINED BY
70% SINCE SB 793 WENT INTO
EFFECT, OVER ONE THIRD OF
E-CIGARETTE SALES IN CALIFORNIA
ARE STILL FOR ILLEGAL FLAVORED
E-CIGARETTES. AS A RESULT, THESE
PRODUCTS ARE STILL GETTING INTO
THE HANDS OF CALIFORNIA'S KIDS,
WHICH IS WHY WE NEED YOU TO
PROTECT OUR COMMUNITIES AND
URGENT. I VOTE ON THIS CRITICAL
LEGISLATION. THANK YOU, THANK
YOU. ARE THERE ANY OTHER
WITNESSES IN SUPPORT IN THE ROOM
?
KELLY BROOKS, ON BEHALF OF THE
COUNTY HEALTH EXECUTIVES
ASSOCIATION OF CALIFORNIA AND
THE SANTA CLARA COUNTY BOARD OF
SUPERVISORS HERE IN STRONG
SUPPORT. BRANDON MAKI WITH THE
CALIFORNIA MEDICAL ASSOCIATION
IN SUPPORT. DYLAN ELLIOTT, ON
BEHALF OF THE AMERICAN HEART
ASSOCIATION. PROUD COSPONSORED
IN SUPPORT. THANK YOU. JESSICA
MORAN WITH THE CALIFORNIA DENTAL
ASSOCIATION IN SUPPORT. ADAM
OGDEN SMITH WITH THE AMERICAN
CANCER SOCIETY. CANCER ACTION
NETWORK, ALSO IN SUPPORT. Kò
STARBURST WITH THE AMERICAN LUNG
ASSOCIATION IN SUPPORT. THANK
YOU. ARE THERE ANY PRIMARY
WITNESSES IN OPPOSITION? THANK
YOU. YOU'LL HAVE TWO MINUTES.
THANKS, CHAIR. JOHN WINGER, ON
BEHALF OF THE CALIFORNIA FUELS
AND CONVENIENCE ALLIANCE,
REPRESENTING THE MAJORITY OF GAS
STATIONS AND CONVENIENCE STORES
IN THE STATE. FIRST, I'D LIKE TO
THANK THE AUTHOR AND THE
SPONSORS FOR THE CONTINUED
DIALOG ON THE BILL. APOLOGIES
FOR NOT GETTING OUR LETTER IN ON
TIME. WE WERE REVIEWING THE
AMENDMENTS LAST WEEK AND WANTED
TO SPEND SOME TIME ON THAT. SO
WE DO CURRENTLY HAVE AN OPPOSED,
UNLESS AMENDED POSITION ON THE
BILL, I THINK IN CONCEPT, A
TOBACCO DIRECTORY WOULD BE VERY
HELPFUL AND SOME STATEWIDE
GUIDANCE WOULD BE VERY HELPFUL.
WE'VE SEEN A PRETTY LARGE
PATCHWORK OF ENFORCEMENT ON THE
LOCAL LEVEL, WHICH HAS BEEN
DIFFICULT FOR OUR STATION OWNERS
TO COMPLY WITH, WE DO STILL HAVE
SOME REMAINING CONCERNS, JUST
OVER THE BROAD DISCRETION THAT
THE AG'S GIVEN IN THE BILL, WE
ALSO HAVE SOME CONCERNS AROUND
THE PERJURY, THE PENALTY OF
PERJURY LANGUAGE AND HOW THAT
WOULD KIND OF JIVE WITH THE FDA
BACKLOG ON APPROVAL OF PRODUCTS
AND THEN FINALLY, WE HAVE, SOME
EXISTING OR SOME ONGOING ISSUES
WITH THE DEFINITION OF
CHARACTERIZING FLAVORS. AND SO
WE'D LIKE TO CONTINUE THOSE
DISCUSSIONS. I THINK FROM OUR
PERSPECTIVE OF, IF THE LANGUAGE
IS OVERLY BROAD AND CAPTURES
MORE ADDITIONAL PRODUCTS, THAT
COULD BOLSTER THE ILLICIT MARKET
FURTHER, WHICH CONTINUES TO BE A
PROBLEM THAT WE SEE. AND SO WE'D
LIKE TO CONTINUE THOSE
DISCUSSIONS. BUT AS OF TODAY, WE
DO HAVE AN OPPOSED, AMENDED
POSITION. THANK YOU. THANK YOU.
ARE THERE ANY OTHER WITNESSES IN
OPPOSITION? PLEASE COME FORWARD.
DENNIS LOOPER, ON BEHALF OF THE
CALIFORNIA DISTRIBUTORS
ASSOCIATION, WE HAVE SOME
CONCERNS AND WOULD LIKE TO ALIGN
OUR COMMENTS WITH THE
CONVENIENCE STORES. THANK YOU.
MADAM CHAIR AND COMMITTEE
MEMBERS, TOBIAS WILKEN WITH THE
CALIFORNIA TAXPAYERS
ASSOCIATION. WE WERE UNABLE TO
TAKE A POSITION ON THIS BILL
BEFORE THE HEARING, BUT OUR
ORGANIZATION REGULARLY MONITORS
STATE TAX COLLECTIONS OF TOBACCO
TAX REVENUES. WE BELIEVE THAT
THE GROWING UNDERGROUND
ECONOMIES EFFECT ON TAX
COLLECTIONS IS SIGNIFICANT AND
NEEDS TO BE ADDRESSED. AND WHILE
I CAN'T OFFICIALLY PROVIDE A
POSITION FOR CAL TAX TODAY, WE
DO BELIEVE INCREASED ENFORCEMENT
OF EXISTING LAWS IS IMPORTANT.
THANK YOU, THANK YOU. I'LL BRING
IT BACK TO THE COMMITTEE FOR ANY
QUESTIONS OR COMMENTS. DOCTOR,
WHAT I WOULD LIKE YOU TO ADDRESS
THE QUERY FROM THE OPPOSITION
AROUND THE NAMING OF THE OF THE
FLAVORS AND WHAT THE IMPACT OF
THAT WOULD BE AND WHY AND WHY
THAT'S AN IMPORTANT PART OF THE
LEGISLATION. THANK YOU, MADAM
CHAIR. AND IT'S A IT'S A
CRITICAL PIECE OF THE
LEGISLATION, RIGHT NOW IT'S
DIFFICULT FOR CONVENIENCE STORE
OWNERS, RETAILERS TO KNOW WHAT'S
LEGAL AND NOT LEGAL, MY, MY
INSTINCT IS THAT THEY'RE THEY
RELY ON THEIR DISTRIBUTORS, AS
IS NOT UNUSUAL IN MANY
BUSINESSES TO, TO PROVIDE THEM
WITH PRODUCTS THAT ARE LEGAL,
HOWEVER, OUR, I THINK A LIST OF
WHAT IS LEGAL AND APPROVED AND,
THAT IS BY THE FDA, I THINK IS
AN IMPORTANT COMPONENT HERE. AND
THAT'S WHAT WE'RE STRIVING TO
DO. I CAN'T HELP THAT THE
INDUSTRY MIGHT FEEL THAT THERE
ARE SOME PRODUCTS THAT MIGHT BE
COMPLIANT, BUT HAVEN'T WORKED
THROUGH THE FDA PROCESS WHEN
THEY DO ULTIMATELY WORK FOR THE
FDA THROUGH THE FDA PROCESS,
THEY WILL BE ADDED TO THE LIST
OF ELIGIBLE PRODUCTS TO BE SOLD,
AND IN CALIFORNIA, WE DON'T HAVE
CONTROL OVER WHAT THE FEDERAL
GOVERNMENT DOES, IN THIS, IN
THIS ARENA. BUT, WE DO KNOW THAT
THERE ARE A LOT OF COUNTERFEIT
PRODUCTS AND THINGS THAT SHOW UP
ON THE MARKET, OUT THERE THAT
ARE AND, AND PART OF THIS IS
LOOKING AT HOW THINGS ARE
LABELED AND KEEPING PEOPLE
ACCOUNTABLE. IT'S NOT MY DESIRE
TO, TO, YOU KNOW, BANKRUPT, MOM
AND POP STORES AND ANY, ANYTHING
LIKE THAT. WE'VE, WE'VE, WE'VE
HEARD THIS ARGUMENT OVER AND
OVER AND OVER AGAIN FROM THE
TOBACCO INDUSTRY, BUT THERE ARE
SO MANY OTHER PROFIT CENTERS AND
SMALL CONVENIENCE STORES THAT,
I, I STRUGGLE TO SEE HOW THIS IS
GOING WITH, WITH THE WITH THE
DECREASING NUMBER OF SMOKERS AND
TOBACCO USERS IN CALIFORNIA. I
STRUGGLE TO SEE HOW THIS IS
GOING TO BE A MAJOR COMPONENT IN
, IN THE DEMISE OF, OF
BUSINESSES, WHICH IS OFTEN WHAT
WE HEAR. SO I THINK NO MORE
POWERFUL IS THE FACT THAT YOU
HAVE SOMEBODY WHO STARTED THIS
WORK WITH YOU WHEN THEY WERE IN
MIDDLE SCHOOL. SO I JUST WANT TO
COMMEND THE WITNESS FOR BEING
SUCH AN ADVOCATE FOR ALL OF OUR
HEALTH, PARTICULARLY OUR YOUTH,
AND BRINGING THAT VOICE INTO THE
ROOM. I APPRECIATE THAT. I
THINK, I THINK FINALLY I THROUGH
THE CHAIR, IF YOU DON'T MIND, I,
I THINK ONE OF THE MOST
IMPORTANT THINGS IS HERE. THIS
IS ABOUT PROTECTING THE YOUTH OF
THIS STATE FROM BEGINNING DOWN A
PATH TO TOBACCO USE. AND IT
HAPPENS THROUGH THE USE OF
FLAVORED TOBACCO PRODUCTS
BECAUSE THE FLAVORINGS MAKE IT
MORE PALATABLE. MENTHOL AND
OTHER KINDS OF FLAVORS MAKE IT
MORE PALATABLE. AND THEN ONCE
YOU'RE ADDICTED, YOU ARE
ADDICTED. AND IT IS THE HARDEST
THING TO KICK. SO THIS IS REALLY
ABOUT PROTECTING YOUTH AND, AND
THIS IS A GOOD EXAMPLE, I THINK
OF JUST LIKE THE FIRST BILL I
PRESENTED, THINGS ARE NOT ALWAYS
PERFECT OUT OF THE GATE. AND NOW
WE'RE SEEING THE OPPORTUNITY TO,
TO GO BACK AND REFINE AND MAKE
SURE THAT THIS BILL IS ACTUALLY,
DOING WHAT SB 977, 93 DID TO
HELP SUPPLEMENT THAT. JUST AS
WITH THE LABOR BILL ON STRIKING
WORKERS AND THEIR HEALTH CARE.
SO CAN WE TAKE THAT AS YOUR
CLOTHES, DOCTOR? YES,
ABSOLUTELY. THANK YOU, THANK
YOU, THANK YOU FOR PRESENTING
THE BILL. WE ARE STILL WITHOUT A
QUORUM, SO WE'LL MOVE ON TO OUR
NEXT ITEM. NEXT ITEM, WILL BE
ITEM NUMBER 12 AB 2258 CYBER.
MISTER. CYBER. FEEL FREE. AND IF
THERE ARE ANY WITNESSES IN
PRIMARY OPPOSITION, PLEASE MAKE
YOUR WAY FORWARD TO THE. GO
AHEAD. YOUR MIC'S NOT ON, MADAM
CHAIR, THANK YOU VERY MUCH. I
ALSO WANT TO THANK, ASSEMBLY
MEMBER JACKSON FOR LETTING ME
JUMP AHEAD OF HIM IN LINE. SO
THANK YOU, TODAY, I'M PROUD TO
PRESENT AB 2258, WHICH IS
SPONSORED BY INSURANCE
COMMISSIONER RICARDO LARA.
EQUALITY CALIFORNIA ÁP APLA
HEALTH, LOS ANGELES LGBTQ
CENTER, AND SAN FRANCISCO AIDS
FOUNDATION, A STUDY FOUND THAT A
$10 COST FOR HIV PREVENTION
MEDICATION DOUBLED TO
PRESCRIPTION ABANDONMENT RATES,
INCREASING THE POTENTIAL FOR HIV
INFECTION IN THOSE PATIENTS AS
BARRIERS TO PREVENTIVE CARE
FORCE PEOPLE TO CHOOSE BETWEEN
PREVENTING EXPENSIVE AND
DEVASTATING HEALTH PROBLEMS
BEFORE THEY OCCUR, AND PUTTING
FOOD ON THE TABLE WHILE WE DO
HAVE PROTECTIONS FOR PREVENTIVE
CARE IN CALIFORNIA, SOME OF THEM
ARE BASED ON FEDERAL
PROTECTIONS, AND THERE'S CONCERN
THAT RECENT COURT CASES MIGHT
PUT THE FEDERAL PREVENTIVE
SERVICES REQUIREMENTS, WHICH OUR
STATE RELIES ON, INTO PERIL.
THAT'S WHY AB 2258 IS SO
IMPORTANT, AS IT WILL CODIFY IN
CALIFORNIA EXISTING FEDERAL
GUIDANCE REQUIRING HEALTH PLANS
AND HEALTH INSURERS TO COVER
SERVICES THAT ARE INTEGRAL TO
DELIVERY OF RECOMMENDED
PREVENTIVE SERVICES WITHOUT OUT
OF POCKET COSTS, INCLUDING
REVERSIBLE CONTRACEPTIVES, PREP
HIV AND HIV, AND OTHER STI
SCREENINGS. IN ESSENCE, THIS
BILL IS ABOUT ENSURING THAT LOW
INCOME PEOPLE HAVE ACCESS TO THE
SAME COMPREHENSIVE AND
AFFORDABLE PREVENTIVE HEALTH
CARE AS ANYONE ELSE. WITH ME
TODAY IS SEBASTIAN PEREZ,
REPRESENTING APLA HEALTH AND
STESHA HODGES WITH THE
CALIFORNIA DEPARTMENT OF
INSURANCE, SPONSORS OF THE BILL
TO PROVIDE ADDITIONAL
INFORMATION AND ASSIST WITH
QUESTIONS. THANK YOU. YOU'LL
HAVE TWO MINUTES EACH. HONORABLE
CHAIR BONTA AND MEMBERS OF THE
ASSEMBLY HEALTH COMMITTEE, MY
NAME IS SEBASTIAN PEREZ, AND I'M
THE STATE AFFAIRS SPECIALIST AT
APL. APLA HEALTH CO-SPONSOR OF
AB 258. APLA HEALTH IS AN FQHC
THAT PROVIDES HIV AND STI
TESTING, TREATMENT AND
PREVENTIVE CARE TO THE LGBTQ
PLUS AND UNDERSERVED COMMUNITIES
OF LOS ANGELES COUNTY. SO TO
CURB THE SPREAD OF HIV AND STI,
WE OFFER LOW AND NO COST PREP,
PEP, AND STI SCREENING AND
TREATMENTS SERVICES, AS AS
ACCESSIBLY AS POSSIBLE. EXCUSE
ME, SO MANY OF OUR LOW INCOME
PATIENTS INITIALLY BELIEVE THAT
PREP IS TOO EXPENSIVE FOR THEM,
BUT OUR SERVICES INFORM THEM
THAT PREP MEDICATION AND HIV
TESTING AND STI SCREENING ARE
ACTUALLY AVAILABLE COST FREE TO
MANY CALIFORNIANS, AND COST
SHARING IS A BARRIER TO CARE.
PREVENTING SHARE OF COST ON PREP
RELATED INTEGRAL SERVICES LIKE
QUARTERLY PROVIDER VISITS AND
LAB TESTS REMOVES THOSE
BARRIERS. PREP AND PREP ARE
CLINICALLY PROVEN TO STOP THE
SPREAD OF HIV OVER 99% OF THE
TIME, BUT UPTAKE IS STILL
DISPROPORTIONATELY LOW AMONG
PATIENTS AT ELEVATED RISK FOR
HIV, NAMELY GAY AND BI BLACK AND
LATINX MEN AND TRANSGENDER WOMEN
OF COLOR. THE AFFORDABLE CARE
ACT PROVISIONS REQUIRE HEALTH
PLANS TO COVER CERTAIN
PREVENTIVE SERVICES WITH NO COST
SHARING, BUT THIS MANDATE HAS
BEEN CHALLENGED RECENTLY IN
TEXAS AND THE BRAIDWOOD
DECISION, A JUDGE RULED IN FAVOR
OF A COMPANY THAT REFUSED TO
INCLUDE PREP COVERAGE IN ITS
HEALTH PLAN ON RELIGIOUS GROUNDS
BECAUSE PREP AND, QUOTE PROMOTES
HOMOSEXUALITY, THE PLAINTIFFS
ALSO CHALLENGED THE
CONSTITUTIONALITY OF THE BODY OF
EXPERTS WHO ESTABLISHED
PREVENTIVE CARE GUIDELINES IN
THE ACA. IF BRAIDWOOD REACHES
THE US SUPREME COURT, THE COURT
COULD UPHOLD BRAIDWOOD, MAKING
THE PREVENTIVE CARE MANDATE
UNENFORCEABLE AND, CRUCIALLY,
LEAVING OUR PATIENTS AND MANY
OTHERS SEEKING PREVENTIVE CARE
AT RISK. AB 2258 WOULD CODIFY
THE GUIDELINES ON COST FREE
PREVENTIVE CARE FOR ALL
CALIFORNIANS, SORRY FOR ALL
CALIFORNIA REGULATED HEALTH
PLANS AND THEIR PATIENTS, I URGE
YOU TO VOTE AYE ON AB 2258.
THANK YOU FOR YOUR TIME. GOOD
AFTERNOON, MADAM CHAIR, AND
MEMBERS OF THE COMMITTEE. I AM
STESHA HODGES. I'M AN ASSISTANT
CHIEF COUNSEL AND CHIEF OF THE
HEALTH EQUITY AND ACCESS OFFICE
FOR THE CALIFORNIA DEPARTMENT OF
INSURANCE. I AM HERE TODAY ON
BEHALF OF INSURANCE COMMISSIONER
RICARDO LARA. FIRST, I WANT TO
THANK ASSEMBLY MEMBERS OF BIR
FOR AUTHORING AB 2258, THE
DEPARTMENT OF INSURANCE IS A
PROUD CO-SPONSOR OF THIS BILL.
EXISTING LAW REQUIRES COVERAGE
OF THE SAME PREVENTATIVE
SERVICES AS FOUND IN THE ACA
WITHOUT COST SHARING. BUT STATE
LAW DOES NOT INCORPORATE THIS
ASSOCIATED FEDERAL CLARIFYING
GUIDANCE. AB 2258 CODIFIES
EXISTING FEDERAL GUIDANCE
PROVIDING THAT INTEGRAL HEALTH
CARE SERVICES, WHICH ARE
NECESSARY TO PROVIDE A
RECOMMENDED PREVENTATIVE CARE
BENEFIT, MUST ALSO BE COVERED
WITHOUT COST SHARING. I WANT TO
STRESS THAT THIS REQUIREMENT TO
COVER INTEGRAL SERVICES WITHOUT
COST SHARING IS CURRENTLY
REQUIRED UNDER FEDERAL LAW,
CODIFYING THE INTEGRAL SERVICES
REQUIREMENT IN STATE LAW IS
PARTICULARLY URGENT IN THE WAKE
OF THE BRAIDWOOD VERSUS BECERRA
DECISION THAT CAME OUT OF TEXAS
LAST YEAR, WHICH STRUCK DOWN
PREVENTIVE CARE REQUIREMENTS
UNDER THE UNITED STATES
PREVENTIVE SERVICES TASK FORCE.
IF THAT DECISION IS ULTIMATELY
UPHELD BY THE COURTS AND THE
FEDERAL GUIDANCE ON INTEGRAL
SERVICES WILL BE UNENFORCEABLE,
ENACTING AB 2258 IS ONE WAY THE
STATE CAN ENSURE THAT SHOULD THE
BRAIDWOOD DECISION ULTIMATELY BE
UPHELD, CALIFORNIA'S CONSUMERS
ARE STILL AFFORDED THE FULL
PROTECTIONS OF INTEGRAL SERVICES
THAT WERE IN PLACE BEFORE THAT
DECISION. AND FOR THESE REASONS,
INSURANCE COMMISSIONER RICARDO
LARA AND THE DEPARTMENT OF
INSURANCE URGE YOUR AYE VOTE ON
OUR CO-SPONSORED BILL AB 2258.
THANK YOU. ANY OTHER WITNESSES
IN SUPPORT? THANK YOU, MADAM
CHAIR. MEMBERS. DOUG SUBERS, ON
BEHALF OF THE LOS ANGELES LGBT
CENTER, PLEASED TO BE A
CO-SPONSOR AND A STRONG SUPPORT.
THANK YOU. CHAIR AND MEMBERS
AARON EVANS, ON BEHALF OF
REPRODUCTIVE FREEDOM FOR ALL IN
SUPPORT. THANK YOU. DAVID
GONZALEZ, ON BEHALF OF THE
CALIFORNIA LIFE SCIENCES AND
SUPPORT. THANK YOU. GREG
PULSIPHER, ON BEHALF OF EQUALITY
CALIFORNIA, CO-SPONSOR AND
SUPPORT. MARTY LOPEZ, CALIFORNIA
NURSES ASSOCIATION IN SUPPORT
MOLLY ROBSON, PLANNED PARENTHOOD
AFFILIATES OF CALIFORNIA AND
SUPPORT SANDRA POOLE ON BEHALF
OF WESTERN CENTER ON LAW AND
POVERTY AND SUPPORT. RYAN SOUZA,
ON BEHALF OF THE SAN FRANCISCO
AIDS FOUNDATION. CO-SPONSOR AND
PROUD SUPPORT. THANK YOU, MADAM
CHAIR. MEMBERS. RANDY MARTIN
HERE ON BEHALF OF THE AIDS
HEALTHCARE FOUNDATION, IN STRONG
SUPPORT OF THIS VERY IMPORTANT
BILL. THANK YOU. KATIE VAN DINES
WITH HEALTH ACCESS CALIFORNIA IN
SUPPORT. THANK YOU. REGISTERING
SUPPORT ON BEHALF OF ACLU. ALEX
KHAN WITH THE CALIFORNIA CHRONIC
CARE COALITION AND SUPPORT ANY
WITNESSES IN OPPOSITION. SEEING
NONE, I'LL BRING IT BACK TO THE
COMMITTEE FOR COMMENT OR
QUESTION. VICE CHAIR. GO AHEAD.
OH, MY MIC IS ON. NO I JUST
WANTED TO SAY THAT, I IS THERE
ANY INFORMATION? HOW DID THAT
LAWSUIT OR ISSUE IN TEXAS GET,
BROUGHT TO LIGHT THE BRAIDWOOD
BRAIDWOOD MANAGEMENT? I MEAN,
WHAT CAUSED THEM TO LOOK AT IT?
I MEAN, I THINK THEY, I THINK
THEY, THEY, ARE CONCERNED ABOUT
THE COVERAGE OF THE VERY THINGS
THAT WE WANT COVERED THE
PREVENTIVE SERVICES FOR PREP, A
LOT OF THESE KINDS OF, COVERAGES
AND ESSENTIALLY WHAT THE BILL
DOES, WE RELY ON THAT FEDERAL
GUIDANCE TO MAKE SURE THAT OUR
CONSUMERS IN CALIFORNIA HAVE,
COVERAGE OF PREP AND ALL THESE
AFFILIATED SERVICES. AND SO THIS
IS SORT OF A PRECAUTIONARY BILL
BECAUSE OF THE LAWSUIT. IF IT
GOES THE WRONG WAY, WE WANT TO
MAKE SURE THAT WE ACTUALLY
CODIFY THE EXISTING FEDERAL
GUIDANCE IN CALIFORNIA LAW SO
THAT THOSE THOSE PROTECTIONS
CONTINUE FOR CALIFORNIA
CONSUMERS, YEAH. A COUPLE OF
YEARS AGO, I HAD A BILL THAT GOT
SIGNED, THANKFULLY, THAT, ADDED
TO THE TRAINING FOR PHYSICIANS,
THAT THEY COULD BE MORE
KNOWLEDGEABLE ABOUT PREP AND PEP
AND OTHER THINGS BECAUSE WE
FOUND THAT LESS THAN 30% OF
PHYSICIANS WERE EVEN FAMILIAR
WITH IT. BUT, YOU KNOW, I AGREE
THAT THE SCREENINGS AND
PREVENTATIVE CARE, ARE CRITICAL
NOT ONLY BECAUSE OF EARLY
DIAGNOSIS, TREATMENT FOR THE
PATIENT, BUT, QUALITY OF LIFE,
BUT ALSO IT'S A GREAT WAY TO
REDUCE COSTS IN THE END. SO
THANK YOU FOR BRINGING THIS BILL
FORWARD. THANK YOU. THANK YOU,
SEEING THAT, MR. ZUBIATE MAY
CLOSE, MADAM CHAIR AND MEMBERS,
THANK YOU VERY MUCH. I
RESPECTFULLY ASK FOR AN AYE VOTE
WHEN THE TIME COMES. THANK YOU
SO MUCH, MR. ZAVALA, WE'LL MOVE
FORWARD NOW WITH DOCTOR JACKSON,
WHO IS PATIENTLY WAITING. ITEM
NUMBER TWO, AB 1970.
PLEASE PROCEED. THANK YOU VERY
MUCH, MADAM CHAIR, DON'T WORRY,
I'LL BE CASHING IN ON THAT. ON
THAT LINE. CHEATING OF MR.
ZUBIATE. ABSOLUTELY. YOU KNOW,
I'M GOING TO CASH IN THAT FAVOR,
THANK YOU VERY MUCH, MADAM CHAIR
, THIS BILL AIMS TO ADDRESS THE
EXISTING DISPARITIES AND MENTAL
HEALTH CARE ACCESS SERVICES
WITHIN CALIFORNIA'S, AFRICAN
AMERICAN COMMUNITIES. IT WILL
REQUIRE THE DEPARTMENT OF HEALTH
CARE ACCESS AND INFORMATION TO
ESTABLISH GUIDELINES FOR A
SPECIALIZED CERTIFICATE PROGRAM
TAILORED TO MENTAL HEALTH
NAVIGATORS WHO SEEK TO SERVE THE
AFRICAN AMERICAN COMMUNITY
WITHIN THE EXISTING COMMUNITY.
HEALTH WORKER CERTIFICATE
PROGRAM. ADDITIONALLY, THE BILL
MANDATES THE DEVELOPMENT OF
SPECIFIC TRAINING REQUIREMENTS
FOR THE CERTIFICATION AND
REPORTING REQUIREMENTS. THIS
BILL OFFERS A SOLUTION BY
PROVIDING SPECIALIZED TRAINING,
CERTIFICATION, AND A CLEAR
PATHWAY FOR AFRICAN AMERICAN
INDIVIDUALS IN CALIFORNIA TO
ACCESS PROPER MENTAL HEALTH
TREATMENT AND SERVICES. THIS
BILL ALSO ENSURES THE COLLECTION
AND REPORTING OF DATA ON
CERTIFIED CERTIFIED INDIVIDUALS
AND THOSE ACTIVELY ENGAGED IN
COMMUNITY HEALTH WORKER
POSITIONS, ENABLING
ACCOUNTABILITY AND TRACKING
PROGRESS, AND ADDRESSING MENTAL
HEALTH DISPARITIES. AND I'LL
TURN IT OVER TO MY WITNESS. GO
AHEAD. YOU'LL HAVE TWO MINUTES.
THANK YOU. I'M TRACY STAFFORD,
AND I'M THE CHAIR OF THE
CALIFORNIA BLACK HEALTH POLICY
ADVISORY COUNCIL. AND THIS IS A
GROUP THAT HAS COME TOGETHER TO
ADVANCE BLACK HEALTH EQUITY,
UNITING COMMUNITIES AND ELECTED
LEADERS TO RECOMMEND, CHAMPIONED
AND MONITOR POLICIES TARGETING
BLACK HEALTH INEQUITIES IN THE
STATE OF CALIFORNIA, OVER THE
LAST 18 MONTHS, WE HAVE GATHERED
WITH OVER, 13 STATEWIDE
ORGANIZATIONS FOCUSED IN THIS
AREA AND DOZENS OF INDIVIDUALS
WHO ARE PSYCHOLOGISTS,
PSYCHIATRISTS, HEALTH CARE
WORKERS, LABOR UNIONS, COMMUNITY
MEMBERS, BLACK HEALTH ORGANIZERS
AND ADVOCATES. AND WITH ALL OF
THE CHALLENGES THAT ARE FACED,
AS WITH BLACK HEALTH INEQUITIES,
WHAT CAME TO THE FOREFRONT AND
THE VERY TOP EVERY SINGLE
MEETING THAT WE HAD WAS MENTAL
HEALTH SERVICES AND PARTICIPANTS
SHARED PERSONAL AND CLIENT HEART
WRENCHING STORIES OF TRAUMA,
RELUCTANCE TO SEEK HELP, THE
WEIGHT OF UNSPOKEN TRAUMAS WHICH
WE CALL WEATHERING, AND THE
STRUGGLES OF NAVIGATING A MENTAL
HEALTH SYSTEM THAT FAILS TO
PROVIDE CULTURALLY COMPETENT
CARE, LEADING TO MISDIAGNOSIS OF
PARANOIA AND OTHER AFFLICTIONS
RATHER THAN THE VERY REAL RACIAL
RACIAL TRAUMA THAT IS OFTEN IN
PLAY. PARTICIPANTS SPOKE OF THE
CRUSHING WEIGHT OF SYSTEMIC
RACISM, BIAS, AND SOCIOECONOMIC
INEQUITIES, LEADING TO PROFOUND
STRESS AND ANXIETY IN BLACK
COMMUNITIES. THEY MOURNED THE
DEVASTATING CONSEQUENCES REYES,
INCLUDING BROKEN FAMILIES,
POVERTY, HOMELESSNESS AND
SUICIDE. WHEN MENTAL ILLNESS AND
RACIAL TRAUMA AND CHRONIC RACIAL
STRESS ARE LEFT UNTREATED AND
THIS CYCLE CONTINUES WITH EACH
GENERATION. IN ADDITION TO THE
EVERYDAY CHALLENGES THAT WE ALL
FACE, MOST BLACK AMERICANS,
ACCORDING TO HARVARD BUSINESS
REVIEW AND MANY OTHER
ORGANIZATIONS THAT MOST BLACK
AMERICANS, REGARDLESS OF
EDUCATION, SOCIOECONOMIC STATUS,
OR JOB TITLE, EXPECT ONE OR MORE
FORMS OF BIAS EVERY SINGLE DAY,
UNDERSCORING THE NEED FOR
CULTURALLY COMPETENT RESOURCES.
TO THAT END, PARTICIPANTS
OVERWHELMINGLY NOTED THE LACK OF
BLACK THERAPISTS, CITING THE
DISCONNECT THAT ARISES WHEN
CULTURAL UNDERSTANDING IS
MISSING FROM THERAPEUTIC
RELATIONSHIPS. AS MENTIONED, OR
WILL BE MENTIONED, ONLY 2% OF
PSYCHIATRISTS AND 4% OF
PSYCHOLOGISTS IN THE UNITED
STATES ARE BLACK. AND THAT
NUMBER, WHEN WE TALK ABOUT
CULTURALLY COMPETENT MENTAL
HEALTH PROFESSIONALS IN TERMS OF
THE BLACK EXPERIENCE, IS
ANTICIPATED TO BE A MERE
FRACTION OF THAT. THANK YOU. CAN
YOU WRAP UP YOUR COMMENTS? WELL
THANK YOU. THAT'S THE CLOSE.
OKAY. WELL, WE'LL STAY IN CLOSE,
IS THAT NOT ONLY IS THIS A
MENTAL, HAVE HEALTH MENTAL
HEALTH SUPPORT, BUT IT IS ALSO
MOST DEFINITELY A WORKFORCE
DEVELOPMENT BILL THAT WILL HELP
CREATE JOBS FOR PEOPLE WHO MAYBE
CANNOT AFFORD TO BE IN THE
MENTAL HEALTH AND MENTAL HEALTH
CAREERS. BUT THIS PROVIDES A WAY
INTO THAT. SO WE JUST ASK THAT
YOU CONSIDER, APPROVING THIS
BILL. THANK YOU, MISS STAFFORD.
ARE THERE ANY OTHER WITNESSES IN
THE ROOM IN SUPPORT? WITH THAT,
IF THERE ARE ANY PRIMARY
WITNESSES IN OPPOSITION, PLEASE
COME FORWARD TO THE TABLE. CAPS.
ON BEHALF OF THE CALIFORNIA
ALLIANCE OF CHILD AND FAMILY
SERVICES IN SUPPORT. MOLLY
ROBSON WITH PLANNED PARENTHOOD
AFFILIATES OF CALIFORNIA, AND
SUPPORT. DILLON ELLIOTT, ON
BEHALF OF THE CALIFORNIA STATE
ASSOCIATION OF PSYCHIATRY.
CGRTS, CURRENTLY WITH THE
SUPPORT OF AMENDED POSITION,
REALLY APPRECIATE THE AUTHOR'S
INTENTIONS WITH THE BILL. WOULD
JUST LIKE TO SEE THE PHRASE
BEHAVIORAL HEALTH MAKE IT IN
OFFERED FRIENDLY ADDITIONALLY
NAME ARE YOU DOING WHAT? YEAH.
ONE MORE. I APOLOGIZE, MADAM
CHAIR, ON BEHALF OF THE
CALIFORNIA MEDICAL ASSOCIATION
IN SUPPORT. THANK YOU. ON BEHALF
OF THE NATIONAL AFRICAN AMERICAN
CIVIL RIGHTS CHAIR, WE SUPPORT.
THANK YOU. ANY WITNESSES? OH
HELLO. DOMINIQUE PAXTON WITH
CALIFORNIA BLACK WOMEN'S HEALTH
PROJECT WE SUPPORT. THANK YOU.
ANY WITNESSES IN OPPOSITION?
SEEING NONE. I'LL BRING IT BACK
TO THE COMMITTEE FOR COMMENT OR
QUESTIONS. SEEING NONE, DOCTOR
JACKSON, THANK YOU FOR BRINGING
THIS FORWARD. YOU CONTINUE TO,
BE A LEADER IN THE SPACE,
PARTICULARLY AROUND MENTAL
HEALTH AND BEHAVIORAL HEALTH,
AND PARTICULARLY FOR BLACK
CALIFORNIANS. SO I VERY MUCH
APPRECIATE YOUR LEADERSHIP ON
THIS. AND IF YOU ARE OPEN TO IT,
I WOULD LOVE TO COAUTHOR THIS
BILL. THANK YOU, WITH THAT, YOU
MAY CLOSE, THANK YOU VERY MUCH,
MADAM CHAIR. THE RESEARCH IS
CLEAR, IF YOU, THE BEST WAY TO
BE ABLE TO SERVE SOMEONE,
PARTICULARLY IN ANYTHING IN
TERMS OF THEIR, ANY OF THEIR
HEALTH NEEDS, CULTURAL
COMPETENCY IS ESSENTIAL. A
CULTURAL COMPETENCY HAS TO GO
FURTHER THAN JUST SAYING I
RECOGNIZE THAT THERE'S
DIFFERENCES AND PEOPLE BELIEVE
IN DIFFERENT THINGS. BUT UNTIL
YOU REALLY BEGIN TO BE TRAINED
ON THE CULTURAL CONTEXT OF A
SPECIFIC POPULATION, THÀNH AND
THE WAY THEY RECEIVE INFORMATION
AND THE WAY THEY WANT TO BE
SERVED FROM A HISTORICAL CONTEXT
, THE SPECIFIC TYPES, OF ISSUES
THAT ARE UNIQUE TO THAT SPECIFIC
POPULATION, SUCH AS HISTORICAL
TRAUMA, RACIAL STRESS, ALL THOSE
TYPE OF THINGS GO INTO, THE
ISSUES THAT ARE AFFECTING
AFRICAN AMERICANS. SO NO MATTER
WHO IS SERVING AN AFRICAN
AMERICAN, AND, AND MOST LIKELY
IT WON'T EVEN BE AN AFRICAN
AMERICAN. SO TO BE ABLE TO
PROVIDE AN OPPORTUNITY TO GET
THAT TYPE OF TRAINING, SO THAT
THEY CAN DO JUST A LITTLE BIT
BETTER, TO BE ABLE TO HELP THE
POPULATION, MAKES A WORLD OF A
DIFFERENCE. I RESPECTFULLY ASK
FOR AN AYE VOTE. THANK YOU. AND,
WE WILL LOOK FORWARD TO THAT
MOTION ONCE WE HAVE A QUORUM.
THANK YOU. DOCTOR. OH, YEAH, I
FORGOT. I CAN I CAN JOIN YOUR
COMMITTEE, AND I CAN. I WOULD
LOVE THAT. PLEASE, PLEASE. WE
WILL MOVE FORWARD WITH ITEM
NUMBER 18, AB 2420. OH,
APOLOGIES. WE WILL MOVE FORWARD
WITH ITEM NUMBER 13 AB 2297
FREEDMEN.
THANK YOU, MADAM CHAIR. AND
MEMBERS, MEDICAL DEBT IS A
SIGNIFICANT DRIVER OF
BANKRUPTCY, POVERTY, AND RACIAL
INEQUITIES OVER A THIRD OF
CALIFORNIANS REPORT HAVING
MEDICAL DEBT AND HOSPITAL DEBT
ALONE MAKES UP OVER 70% OF ALL
MEDICAL DEBT. IN 2006,
CALIFORNIA CREATED THE HOSPITAL
FAIR PRICING ACT TO PROTECT
PATIENTS. MANY OF YOU WILL
RECALL OUR RECENT UPDATES TO THE
ACT IN 2021, INCLUDING AB 532 BY
DOCTOR WOOD AND MY BILL AB 1020.
WHILE THE PATIENT PROVISIONS WE
PUT INTO LAW ARE WORKING, WE'RE
ALSO LEARNING OF AREAS WHERE WE
NEED TO STRENGTHEN THE CODE. AB
2297 DOES THE FOLLOWING. IT
DEFINES CHARITY CARE,
DISTINGUISHING IT FROM
DISCOUNTED CAL CARE OR FINANCIAL
ASSISTANCE. CLARIFIES THAT
HOSPITALS MUST REVIEW
APPLICATIONS FOR CHARITY CARE OR
DISCOUNTED CARE WITHOUT
ARBITRARY DEADLINES. PROHIBITS
THE USE OF LIENS ON PROPERTY TO
COLLECT UNPAID MEDICAL BILLS
FROM FINANCIALLY ELIGIBLE
PATIENTS, AND ELIMINATES THE
CONSIDERATION OF ASSETS FROM
ELIGIBILITY CONSISTENT WITH
CURRENT MEDICARE RULES. IT'S
IMPORTANT TO REMEMBER THAT THESE
PATIENT PROTECTIONS APPLY ONLY
TO UNINSURED AND UNDERINSURED
PATIENTS WITH AN INCOME UNDER
400% OF THE FEDERAL POVERTY
LINE. FOR PATIENTS WITH LIMITED
RESOURCES, MEDICAL DEBT CAN BE
DEVASTATING, PUTTING THEM AT
RISK OF HOUSING INSTABILITY AND
FINANCIAL RUIN. RUIN. I BELIEVE
THAT IN A COUNTRY AS WEALTHY AS
THE UNITED STATES AND A STATE AS
WEALTHY AS CALIFORNIA, FOR THE
WHOLE CONCEPT OF MEDICAL
BANKRUPTCY AND MEDICAL DEBT, FOR
SOMEONE WHO IS JUST TRYING TO
SAVE THEIR LIFE OR THE LIFE OF A
LOVED ONE IS A COMPLETE, IT'S
REALLY, IT'S REALLY
UNACCEPTABLE. IT'S AN
ABOMINATION, IS WHAT IT IS. AND
THE FACT THAT WE ARE TAKING
PEOPLE'S HOMES AND PROPERTY OR
PUTTING A LIEN ON THEIR HOME
JUST BECAUSE THEY WANT TO GET
TREATMENT FOR A SICKNESS IS
SOMETHING THAT SHOULDN'T HAPPEN.
THIS BILL STRENGTHENS THE SAFETY
NET FOR PATIENTS IN NEED. AS
YOU'LL HEAR FROM THE CALIFORNIA
HOSPITAL ASSOCIATION, WE ARE
CONTINUING TO WORK WITH THEM ON
LANGUAGE TO ADDRESS THEIR
CONCERNS. THE COMMITTEE ANALYSIS
NOTES TWO OF THOSE AMENDMENTS
WITH WHICH FURTHER CLARIFY THE
DEFINITIONS FOR CHARITY CARE AND
DISCOUNTED PAYMENTS, AND ALLOWS
HOSPITALS TO CONSIDER A
PATIENT'S HEALTH SAVINGS ACCOUNT
WHEN DETERMINING ELIGIBILITY.
WE'LL ALSO CONTINUE OUR
CONVERSATIONS WITH THE
CALIFORNIA ASSOCIATION OF
COLLECTORS, ESPECIALLY AS WE
MOVE INTO THE ASSEMBLY JUDICIARY
COMMITTEE. AND I WILL SAY THAT
SOME OF THE CONCERNS OF THE
HOSPITAL ASSOCIATION THÀNH CAN
BE ADDRESSED BY THE HOSPITALS
THEMSELVES IN TERMS OF THE
AMOUNT OF TIME THAT CAN GO BY IF
THEY WOULD PROVIDE PATIENTS WITH
VERY CLEAR INFORMATION ABOUT HOW
TO APPLY FOR DEBT RELIEF AND HOW
TO APPLY FOR CHARITY CARE, THEN
MAYBE THEY WOULDN'T HAVE TO
WORRY ABOUT PEOPLE POPPING UP
LATER WHEN THEY BASICALLY ARE IN
FINANCIAL RUIN, REALIZING THAT
THEY WOULD HAVE BEEN ELIGIBLE.
THIS IS SOMETHING THAT CAN BE
DONE IF INFORMATION IS GIVEN TO
PEOPLE IN A LANGUAGE THEY
UNDERSTAND, PRESENT IT TO THEM
CLEARLY NOT BURIED IN SOME STACK
OF MEDICAL BILLS AND PAPERWORK
AT A TIME WHEN PEOPLE ARE THE
MOST VULNERABLE, WHEN THEY'RE
LEAVING THE HOSPITAL SICK AND
AFTER MAJOR SURGERIES. SO THERE
ARE WAYS THAT WE CAN DEAL WITH
THESE ISSUES WITHOUT PUTTING THE
BURDEN ON CRITICALLY SICK
INDIVIDUALS. WITH THAT, I HAVE
TESTIFYING IN SUPPORT TODAY,
LINDA WEI FROM THE WESTERN
CENTER OF LAW AND POVERTY AND
HUMBERTO CRUZ FROM LA PUENTE.
THANK YOU SO MUCH FOR YOUR
CONSIDERATION. GOOD AFTERNOON.
MY NAME IS HUMBERTO CRUZ, AND
I'M HERE TO SHARE MY FAMILY'S
EXPERIENCE FOLLOWING THE BIRTH
OF OUR CHILD IN 2010, MY WIFE
AND I WELCOMED OUR FIRST CHILD
AT QUEEN OF THE VALLEY HOSPITAL
IN WEST COVINA, CALIFORNIA. OUR
JOY QUICKLY TURNED TO CONCERN
WHEN OUR NEWBORN REQUIRED
EMERGENCY SERVICES AT AN
EXTENDED STAY IN THE NICU.
DESPITE HAVING WHAT I BELIEVE TO
HAVE BEEN ADEQUATE INSURANCE
COVERAGE THROUGH MY EMPLOYER, WE
WERE BLINDSIDED BY THE
EXORBITANT MEDICAL EXPENSES THAT
WERE NOT COVERED BY OUR
INSURANCE. THE HOSPITAL FAILED
TO INFORM US ABOUT THE OPTION TO
APPLY FOR FINANCIAL ASSISTANCE,
LEAVING US WITH A STAGGERING
BILL. THIS WAS JUST THE
BEGINNING OF A LONG AND
DISTRESSING JOURNEY THROUGHOUT
MEDICAL DEBT AND FINANCIAL
INSECURITY. IN THE YEARS TO
FOLLOW, THE SITUATION ONLY
WORSENED THE HOSPITAL DID NOT
PROVIDE ANY GUIDANCE ON MANAGING
THE DEBT, AND THEREFORE WE KNEW
IT. OUR ACCOUNT WAS SENT TO A
COLLECTION AGENCY. AS A RESULT
OF MY INABILITY TO TAKE TIME OFF
FROM MY NEW JOB TO APPEAR IN
COURT, A DEFAULT JUDGMENT WAS
ENTERED AGAINST ME. TO MAKE
MATTERS WORSE, WE WERE FORCED TO
SELL OUR HOME TO MY IN-LAWS,
ONLY TO DISCOVER THAT THERE WAS
A LIEN ON THE PROPERTY DUE TO
THE OUTSTANDING MEDICAL DEBT.
DESPITE OUR BEST EFFORTS TO MAKE
PAYMENTS, THE COLLECTION AGENCY
CONTINUED TO PURSUE US
RELENTLESSLY. THEY SEE 17,000
FROM THE SALE OF OUR IN-LAWS
HOME AND PLACED LEVIES ON MY
PERSONAL BANK ACCOUNT. OVER THE
COURSE OF 12 YEARS, MY FAMILY
AND I PAID NEARLY 23,000 TO
COLLECTION AGENCIES, DRAINING
OUR SAVINGS AND ACCRUING CREDIT
CARD DEBT IN THE PROCESS. THIS
ORDEAL HAS A PROFOUND IMPACT ON
OUR LIVES. WE HAVE STRUGGLED TO
MAINTAIN FINANCIAL STABILITY AND
THE STRESS AND UNCERTAINTY TO
TAKE HAS HAVE TAKEN TOLLS ON US.
THE 23,000 THAT WERE FORCED TO
PAY COULD HAVE BEEN USED TO
SECURE OUR FUTURE PAY, OUR
CHILDREN'S EXPENSES AND OVERALL
STABILITY. INSTEAD, IT HAS A
LOT. IT HAS BEEN LOST TO A
SYSTEM THAT FAILED TO PROVIDE US
WITH THE SUPPORT AND ASSISTANCE
WE DESPERATELY NEEDED. I SHARE
MY STORY NOT ONLY TO SEEK
JUSTICE FOR MY FAMILY, BUT ALSO
TO ADVOCATE FOR A GREATER
AWARENESS AND REFORM IN OUR
HEALTH CARE SYSTEM. NO FAMILY
SHOULD HAVE TO ENDURE THE
FINANCIAL DEVASTATION THAT WE
HAVE FACED SIMPLY BECAUSE A
MEDICAL EMERGENCY. IT IS TIME
FOR CHANGE, AND I HOPE THAT MY
SHARING, MY EXPERIENCE CAN WORK
TOWARDS A FUTURE WHERE NO ONE,
BUT NO ONE MUST CHOOSE BETWEEN
THEIR HEALTH AND THEIR FINANCIAL
SECURITY. THANK YOU. GOOD
AFTERNOON. LINDA WEI WITH
WESTERN CENTER ON LAW AND
POVERTY, PROUD CO-SPONSORS OF AB
2297, WHICH WOULD PROHIBIT THE
USE OF HOME LIENS IN THE
COLLECTION OF UNPAID HOSPITAL
BILLS FROM FINANCIALLY QUALIFIED
PATIENTS. UNFORTUNATELY, THESE
PROPERTY LIENS ARE REGULARLY
USED TO COLLECT UNPAID MEDICAL
DEBT, AS EVIDENCED BY A REVIEW
OF COUNTY ASSESSOR RECORDS AND
FELLOW WITNESS MR. CRUZ HERE
TODAY. IN ADDITION, THE BILL
WOULD ELIMINATE ASSET
CONSIDERATION AND FINANCIAL
ASSISTANCE DETERMINATION TO
ALIGN WITH MEDI-CAL ELIGIBILITY
RULES, SIMPLIFY THE FINANCIAL
ASSISTANCE APPLICATION PROCESS,
AND HELP PROTECT CALIFORNIA
SAVINGS FROM BEING DEPLETED WHEN
SEEKING HOSPITAL CARE.
CALIFORNIANS NEED THEIR SAVINGS
TO PREVENT POVERTY IN RETIREMENT
AND OLDER AGE, AS OF 2019, 7.4
MILLION CALIFORNIANS AGES 25 TO
64 DO NOT HAVE ACCESS TO AN
EMPLOYER SPONSORED RETIREMENT
PLAN, AND NEARLY HALF OF
CALIFORNIA'S PRIVATE SECTOR
WORKERS HAVE NO RETIREMENT
ASSETS AT ALL. FINALLY, THE BILL
WOULD CLARIFY THAT HOSPITALS
MUST REVIEW FINANCIAL ASSISTANCE
ELIGIBILITY AT ANY TIME AND
PROHIBIT APPLICATION DEADLINES
FOR FINANCIAL ASSISTANCE. OUR
LEGAL AID ADVOCATES REGULARLY
ASSIST CLIENTS WHO ARE DENIED
FINANCIAL ASSISTANCE DUE TO
ARBITRARY DEADLINES THAT
DISQUALIFY THEM. H CHI OR THE
DEPARTMENT OF HEALTH CARE ACCESS
AND INFORMATION, WHICH ENFORCES
THE HOSPITAL FAIR PRICING ACT,
INTERPRETS CURRENT LAW TO
PROHIBIT DEADLINES FOR
APPLICATION, AND THIS WOULD
CLEARLY REFLECT THIS. WE URGE
YOUR SUPPORT OF THIS BILL TO
PROVIDE MUCH NEEDED RELIEF FOR
LARGE HOSPITAL BILLS FOR LOW AND
MODERATE INCOME PATIENTS. THANK
YOU, THANK YOU, WE'LL ASK FOR
ANY, OTHER FOLKS IN SUPPORT OF
THE BILL. YOUR NAME,
ORGANIZATION AND POSITION ONLY.
THANK YOU. DYLAN ELLIOTT, ON
BEHALF OF THE CALIFORNIA STATE
ASSOCIATION OF PSYCHIATRISTS AND
SUPPORT, THANKS. KATIE VAN DINES
WITH HEALTH ACCESS CALIFORNIA IN
SUPPORT. THANK YOU. BETH
MALINOWSKI WITH SEIU CALIFORNIA
IN SUPPORT. HI. JANICE O'MALLEY
WITH AFSCME CALIFORNIA IN
SUPPORT. YASMEEN PELLETT WITH
JUSTICE AND AGING AND SUPPORT.
THANK YOU, DO WE HAVE ANY,
OPPOSITION? PLEASE COME FORWARD.
GOOD AFTERNOON. CHAIR. MEMBERS
OF THE COMMITTEE, RYAN VERDUGO
HERE ON BEHALF OF THE CALIFORNIA
HOSPITAL ASSOCIATION,
RESPECTFULLY, WE ARE OPPOSED,
UNLESS AMENDED, BUT I'LL BE
BRIEF, BECAUSE ALTHOUGH WE ARE
STILL SEEKING AMENDMENTS, THE
AUTHOR, THE SPONSORS, AND
COMMITTEE STAFF HAVE BEEN GREAT
IN WORKING WITH US IN TRYING TO
FIND REASONABLE SOLUTIONS TO OUR
ONGOING CONCERNS WITH THAT BEING
SAID, WE ESPECIALLY APPRECIATE
THE AMENDMENTS THAT HAVE BEEN
TAKEN SO FAR, WE DEFINITELY
THINK THAT THAT IS A STEP IN THE
RIGHT DIRECTION, OUR ONGOING
CONCERNS ARE REALLY CENTERED
AROUND CONFORMITY WITH FEDERAL
LAWS AND REGULATIONS THAT
PREVENT PROVIDERS FROM OFFERING,
SO-CALLED INCENTIVES, AND I'D
ONLY PUT QUOTATION MARKS ON THAT
BECAUSE, THEY'RE THEY CAN BE
PRETTY STRICT ABOUT THAT, SO
THINGS LIKE FREE DISCOUNTED
CARE, CO-PAY AND DEDUCTIBLE
WAIVERS FOR USING OUR SERVICES
COULD BE CONSIDERED INCENTIVES,
AND THEY COULD ONLY BE PROVIDED,
TO PATIENTS, STRICTLY BASED ON
THEIR INDIVIDUAL FINANCIAL NEED,
INCLUDING ASSETS. AND SO WITHOUT
THAT, THE OFFICE OF INSPECTOR
GENERAL, CONSIDERS THOSE WAIVERS
AS FRAUD AND ABUSE. AND SO I
THINK IT'S IMPORTANT FOR US TO
HAVE CLARIFICATION, AROUND THAT.
FINALLY, WE ALSO THINK THAT
THERE SHOULD BE SOME REASONABLE
DEADLINES ON WHEN PATIENTS CAN
APPLY FOR OR BECOME ELIGIBLE FOR
CHARITY OR DISCOUNTED CARE, BUT
I DO THINK THAT THESE ARE ALL
ISSUES THAT, HOPEFULLY CAN BE
SORTED OUT, WITH ONGOING
CONVERSATIONS WITH ALL OF THE
STAKEHOLDERS. SO WITH THAT,
THANK YOU, THANK YOU, THANK YOU,
MELISSA CORTEZ, ON BEHALF OF THE
CALIFORNIA ASSOCIATION OF
COLLECTORS, OUR PRIMARY CONCERN
WITH THIS BILL IS THE PROVISION
TO PRECLUDE HOSPITALS OR THEIR
ASSIGNEES FROM COLLECTING, OR
OBTAINING A LIEN AGAINST ANY
REAL PROPERTY, NOT JUST THE
PATIENT'S PRIMARY RESIDENCE. WE
BELIEVE THIS IS AN UNNECESSARY
EXPANSION OF EXISTING LAW, WHICH
ALREADY PROTECTS THE PATIENT'S
PRIMARY RESIDENCE. SO NOW WE'RE
LOOKING AT PATIENTS WITH SECOND
HOMES, VACATION HOMES. WHERE WE
WOULDN'T BE ABLE TO LEAN ON
THOSE. WE LOOK FORWARD TO
WORKING WITH THE AUTHOR AS THIS
BILL MOVES FORWARD. THANK YOU,
THANK YOU. ARE THERE OTHER
WITNESSES IN OPPOSITION?
SUPPORT. SORRY FOR THE DELAY, SO
I SEE ON BEHALF OF DISABILITY
RIGHTS CALIFORNIA, WE'RE IN
SUPPORT. THANK YOU. SO, SEEING
NO, WITNESSES IN OPPOSITION.
OKAY, WE CAN BRING IT BACK TO
THE COMMITTEE FOR COMMENTS.
QUESTIONS AS. I JUST WANT TO
THANK THE AUTHOR FOR BRINGING
THIS FORWARD AND THE SPONSORS. I
THINK THIS IS A REALLY IMPORTANT
ISSUE, YOU KNOW, MEDICAL DEBT
AND MEDICAL BANKRUPTCY CONTINUE
TO BE THE NUMBER ONE REASON FOR
BANKRUPTCY IN THE UNITED STATES,
YEAR AFTER YEAR AFTER YEAR, AND
COSTS ARE GOING UP AND UP. AND
I'VE WORKED SPECIFICALLY ON THE
CHARITY CARE ISSUE AND THE ISSUE
AROUND CHARITY CARE IS THAT MOST
PEOPLE DON'T KNOW ABOUT IT AND
THEY'RE NOT INFORMED, AND IT'S
NOT REALLY SHARED AS AN OPTION
FOR PATIENTS WHO REALLY NEED IT,
AND SO, YOU KNOW, I THINK THIS
IS A REALLY IMPORTANT PROTECTION
TO PROVIDE FOR, FOR PATIENTS AND
JUST A PIECE OF THE PUZZLE TO
MAKE SURE THAT PEOPLE ARE NOT
PUT IN FINANCIAL RUIN JUST FOR
SEEKING CARE THAT THEY NEED.
THANK YOU. AND I'D LOVE TO BE A
COAUTHOR. THANK YOU. WE'D LOVE
TO ADD YOU. THANK YOU. ANY OTHER
COMMENTS FROM THE COMMITTEE,
SEEING NONE. WE DON'T HAVE A
QUORUM YET, SO I'D ASK THE
AUTHOR IF YOU'D LIKE TO CLOSE,
YEAH, WE WILL CONTINUE TO WORK
WITH THE HOSPITAL ASSOCIATION
AND THE DEBT COLLECTORS TO TRY
TO ADDRESS ANY REASONABLE
CONCERNS. WE CERTAINLY WANT TO
MAKE SURE THAT IT WORKS FOR
EVERYBODY, AND I KNOW THAT THERE
ARE SOME TECHNICAL ISSUES IN
TERMS OF DEFINITIONS AND OTHERS
AND OTHER, LAWS THAT WE NEED TO
WORK AROUND. SO WE'LL CONTINUE
TO WORK WITH THEM. I WILL SAY,
IN TERMS OF THE OTHER REAL
ASSETS, THERE ARE PEOPLE WHO
HAVE A AN APARTMENT UNIT OR A
TOWNHOUSE THAT IS THEIR
RETIREMENT, THEY MAY NOT HAVE A
HUGE SOURCE OF INCOME. THEY MAY
HAVE HAD THAT PIECE OF PROPERTY
FOR A LONG TIME. THEY'RE RELYING
ON THAT TO PAY FOR THEMSELVES IN
RETIREMENT. AND THAT'S WHY WE
ARE TRYING TO PROTECT THOSE
ASSETS FROM BEING SEIZED TO
COLLECT DEBT THAT COULD THROW
THOSE PEOPLE INTO POVERTY WHEN
THEY'VE BEEN WAITING THEIR WHOLE
LIVES OR RELYING THEIR WHOLE
LIVES ON THAT EARLY INVESTMENT.
SO THERE ARE REASONS, YOU KNOW,
I UNDERSTAND IF SOMEONE HAS, YOU
KNOW, A WHOLE BUNCH OF SECOND
HOMES, WOULD THEY PROBABLY DON'T
QUALIFY FOR CHARITY CARE IN ANY
CASE. BUT WE'LL WORK TO MAKE
SURE THAT WE CAN STILL PROTECT,
YOU KNOW, PEOPLE'S REMAINING
ASSETS AS WE MOVE FORWARD. BUT
THAT IS THE RATIONALE BEHIND
THAT. AND WITH THAT, I WOULD
REQUEST AN AYE VOTE SO WE CAN
CONTINUE TO WORK ON THIS. THANK
YOU. THANK YOU. AND WE WILL TAKE
A VOTE AS SOON AS WE GET A
QUORUM. WE HAVE, OH, OKAY. SO
GOING IN SOME KIND OF ORDER ON
OUR AGENDA, MISS PETRIE-NORRIS
CAN PRESENT ITEM TEN AB 2169.
GOOD AFTERNOON, MADAM CHAIR AND
MEMBERS. I, THE COMMITTEE WAS
KIND ENOUGH TO PLACE MY MEASURE
ON CONSENT TODAY. THANK YOU, BUT
I AM STILL HERE TO PRESENT ON
BEHALF OF OUR COLLEAGUE,
ASSEMBLY MEMBER BAUER-KAHAN, AB
2169. AB 2169 AUTHORIZES
PRESCRIBERS TO ADJUST UP TO TWO
TIMES THE DOSE OR FREQUENCY OF A
DRUG WITHOUT A PRIOR
AUTHORIZATION, AS LONG AS THE
DRUG HAS BEEN APPROVED FOR
COVERAGE BY THE PLAN AND THE
PLANS PRESCRIBING PROVIDER
CONTINUES TO PRESCRIBE IT, IN
CALIFORNIA ALONE, 38% OF OUR
RESIDENTS ARE LIVING WITH ONE OR
MORE CHRONIC MEDICAL CONDITIONS.
PRESCRIPTION MEDICATIONS ARE
OFTEN A LIFELINE. HOWEVER, THE
ROAD TO FINDING EFFECTIVE
TREATMENT IS FRAUGHT WITH
CHALLENGES, AS PROVIDERS MAY
NEED TO ADJUST MEDICATION, OVER
TIME TO OPTIMIZE RESULTS.
UNFORTUNATELY, EACH ADJUSTMENT
RIGHT NOW REQUIRES APPROVAL FROM
HEALTH PLANS, A PROCESS THAT ALL
TOO LONG, ALL TOO OFTEN ENDS IN
DENIALS OR LENGTHY APPEALS,
THESE CREATE PERILOUS DELAYS IN
TREATMENT. FOR EXAMPLE, IN 2021,
A STAGGERING 87.5% OF PATIENTS
SUFFERING FROM INFLAMMATORY
BOWEL DISEASE IBD HAD TO APPEAL
THEIR INSURANCE DENIALS BEFORE
ULTIMATELY RECEIVING APPROVAL,
OFTENTIMES IN THAT SITUATION, BY
THE TIME A DECISION IS RENDERED,
PATIENTS MAY HAVE EXPERIENCED
WORSE WORSENING CONDITIONS OR
HAVE BEEN FORCED TO SWITCH TO
ALTERNATIVE MEDICATIONS, WHICH
LIMITS FUTURE TREATMENT OPTIONS.
IBD IS JUST ONE EXAMPLE OF MANY
CHRONIC ILLNESSES WHERE
INADEQUATE MEDICATION DOSAGE CAN
LEAD TO SEVERE COMPLICATIONS,
EVEN LIFE THREATENING ONES. WITH
ME IN SUPPORT TODAY IS LISA LUM
AND HER SON TREVOR. GOOD
AFTERNOON, MADAM CHAIR AND
MEMBERS. MY NAME IS LISA LUM.
THANK YOU FOR LETTING ME SPEAK
TODAY ON BEHALF OF MY SON
TREVOR, WHO IS DIAGNOSED WITH
CROHN'S DISEASE. TWO YEARS AGO
AT THE AGE OF NINE ON NOVEMBER
1ST, 2022, TREVOR WAS PLACED ON
REMICADE. OUR INSURANCE APPROVED
APPROVED THE FIRST THREE
INFUSIONS A FEW WEEKS APART AND
THEN A MAINTENANCE EVERY EIGHT
WEEKS. UNFORTUNATELY HE DID NOT
HAVE THE OPTIMAL LEVELS AFTER.
AFTER THE THIRD INFUSION, SO THE
DOCTOR REQUESTED TO CHANGE THE
MAINTENANCE FROM EVERY EIGHT
WEEKS TO EVERY FOUR. ON DECEMBER
20TH, THE FIRST DENIAL STATED
LACK OF MEDICAL NECESSITY. HIS
DOCTOR APPEALED AND ASKED FOR AN
EXPEDITED REVIEW, WHICH WAS ALSO
DENIED. ON JANUARY 21ST, A
SECOND DENIAL CAME, STATING
AGAIN, LACK OF MEDICAL NECESSITY
. EVEN AFTER MULTIPLE PHONE
CALLS AND SUBMITTED DOCUMENTS
FROM THE DOCTOR AND MYSELF, THIS
WAS NOW SIX WEEKS AFTER TREVOR'S
LAST INFUSION, AND HE HAD BEEN
HOME FROM SCHOOL WITH INCREASED
BLOODY STOOLS AND HAD TO START
ON STEROIDS BECAUSE OF ALL THE
WAITING, WE MADE A THIRD AND
LAST ATTEMPT TO ASK FOR AN
INCREASED DOSAGE AMOUNT AT THE
EIGHT WEEK INFUSION, AND AGAIN
DENIED ON JANUARY 25TH, I
SUBMITTED AN INDEPENDENT MEDICAL
REVIEW COMPLAINT TO THE
DEPARTMENT OF MANAGED HEALTH
CARE ON JANUARY 28TH, AFTER JUST
TWO DAYS OF THE DEPARTMENT'S
INVOLVEMENT, THE INSURANCE
FINALLY APPROVED THE FOUR WEEK
INTERVAL DOSE, ADMITTING THAT IT
WAS INDEED A MEDICAL NECESSITY
AND TREVOR IS NOW RECEIVING A
DOSE EVERY FOUR WEEKS. IT WAS A
VERY EMOTIONAL AND FRUSTRATING
TIME IN OUR LIVES, SEEING OUR
YOUNG SON IN PAIN AND BLEEDING.
WE WERE WORRIED, DESPERATE AND
AT THE MERCY OF THE INSURANCE
COMPANY. LUCKILY, I'M A STAY AT
HOME MOTHER AND I COULD DEVOTE
MY TIME TO THIS SITUATION EVEN
IF HIS MEDICAL TEAM AND I DIDN'T
ADVOCATE SO FIERCELY FOR TREVOR,
I DON'T KNOW HOW MUCH LONGER HE
WOULD HAVE SUFFERED. WE'RE HERE
TODAY HOPING TREVOR'S STORY
COULD PROVIDE ANOTHER
PERSPECTIVE ON THIS MATTER AND
COULD MAKE A DIFFERENCE IN
FORWARDING THE TREATMENT OF THIS
DISEASE. THANK YOU AND THANK
YOU, MISS LUM. AND THANK YOU,
TREVOR, FOR BEING HERE AND
SHARING YOUR STORY WITH US. AND
RYAN SPENCER IS ALSO HERE ON
BEHALF OF THE CROHN'S AND
COLITIS FOUNDATION, FOR ANY
TECHNICAL QUESTIONS THAT
COMMITTEE MEMBERS MAY HAVE.
OKAY. THANK YOU. DO WE HAVE ANY
WITNESSES IN SUPPORT ON RYAN
SPENCER, BEHALF OF THE CROHN'S
AND COLITIS FOUNDATION, WE ARE
SPONSORS OF THE MEASURE AND
SUPPORT. GOOD AFTERNOON, DYLAN
ELLIOTT, ON BEHALF OF THE
CALIFORNIA STATE ASSOCIATION OF
PSYCHIATRISTS IN THE CALIFORNIA
MEDICAL ASSOCIATION, IN SUPPORT.
THANK YOU. THANK YOU. CHAIR
MEMBERS TIM MADDEN, REPRESENTING
THE CALIFORNIA RHEUMATOLOGY
ALLIANCE AND THE CALIFORNIA
CHAPTER OF THE AMERICAN COLLEGE
OF CARDIOLOGY IN SUPPORT. K¾T VÀ
ÓRDENES WITH HEALTH ACCESS
CALIFORNIA IN SUPPORT. THANK YOU
. DAVID GONZALEZ ON BEHALF OF
THE CALIFORNIA LIFE SCIENCES AND
SUPPORT. KIM STONE STONE
ADVOCACY ON BEHALF OF THE
CALIFORNIA ORTHOPEDIC
ASSOCIATION IN SUPPORT. AND ALEX
KAHN, ON BEHALF OF THE
CALIFORNIA CHRONIC CARE
COALITION IN SUPPORT. THANK YOU.
DO WE HAVE WITNESSES IN
OPPOSITION? THÀNH, PLEASE COME
FORWARD
.
GOOD AFTERNOON, MADAM CHAIR.
MEMBERS OF THE COMMITTEE, JED
HAMPTON WITH CALIFORNIA
ASSOCIATION OF HEALTH PLANS.
REGRETTABLY HERE, IN OPPOSITION
TO AB 2169, FIRST AND FOREMOST,
WE'D LIKE TO THANK THE AUTHOR
WHO I KNOW IS NOT HERE TODAY,
BUT APPRECIATE.
ASSEMBLYMEMBER'S. PETRIE-NORRIS
FILLING IN, THE COMMITTEE STAFF
AS WELL AS THE SPONSORS. THIS IS
AN ISSUE THAT WE HAVE BEEN
WORKING ON FOR A FEW YEARS NOW,
REALLY TRYING TO GET TO THE
RIGHT SPOT, WE REALLY APPRECIATE
THE SPONSORS ENGAGING US ON THIS
AND CONTINUING TO FIND A WAY
FORWARD, REGRETTABLY, THOUGH,
YOU KNOW, FROM OUR PERSPECTIVE,
IT'S NOT QUITE THERE YET, YOU
KNOW, HEALTH PLANS RELY ON
SEVERAL CRITICAL UTILIZATION
MANAGEMENT PROTOCOLS TO ENSURE
THAT PATIENTS RECEIVE THE RIGHT
CARE AT THE RIGHT TIME FROM THE
RIGHT PROVIDER. AND THESE
PROTOCOLS ARE CRITICALLY
IMPORTANT TO PROMOTING SAFE,
EFFECTIVE AND AFFORDABLE CARE
FOR HEALTH PLAN ENROLLEES,
REGRETTABLY, AB 2169 WOULD
REMOVE OUR ABILITY TO REVIEW THE
CLINICALLY APPROPRIATE USE OF A
PRESCRIPTION DRUG WHEN THE
DOSAGE OF THE MEDICATION IS
INCREASED, WHICH WE BELIEVE
COULD LEAD TO SEVERAL UNINTENDED
CONSEQUENCES. IT IS IMPORTANT TO
NOTE THAT WHEN HEALTH PLANS
CHOOSE TO LIMIT THE INCREASED
DOSAGE OF A DRUG, IT'S USUALLY
FOR SAFETY REASONS, IT'S
GENERALLY ALSO USED TO ENSURE
THAT THESE MEDICATIONS ARE USED
CONSISTENT WITH FDA APPROVED
LABELING AND PRESCRIBED AT DOSES
THAT HAVE BEEN SHOWN TO BE
EFFICACIOUS, REGRETTABLY, THIS
THIS BILL DOES NOT INCLUDE
LANGUAGE THAT WOULD REQUIRE THE
DRUG TO BE PRESCRIBED CONSISTENT
WITH FDA LABELING OR PRESCRIBED
FOR SOMETHING THAT IS CONSISTENT
FOR WHICH THE DRUG HAS BEEN
APPROVED FOR THE FDA. SO WE ARE
CONCERNED ABOUT THE ABILITY, IN
THIS BILL THAT LIMITS OUR
CLINICAL OVERSIGHT AND ENSURES
THAT THE MEDICATIONS ARE
PRESCRIBED CONSISTENT WITH FDA
APPROVED LABELING. LASTLY, WE DO
BELIEVE THAT THIS THIS COULD
LEAD THIS BILL COULD LEAD TO
INCREASED COSTS IN HEALTH CARE
DELIVERY, WE WOULD ACKNOWLEDGE
THAT THIS BILL IS MUCH MORE
LIMITED IN SCOPE THAN PREVIOUS
ITERATIONS. SO WE DON'T THINK
THAT THE COSTS ARE GOING TO BE
QUITE AS HIGH AS PREVIOUS
ITERATIONS. BUT WE DO BELIEVE
THAT THIS BILL WILL, POTENTIALLY
HARM AFFORDABILITY BY
ENCOURAGING THE USE OF,
EXPENSIVE SPECIALTY AND BRAND
NAME DRUGS WHEN A GENERIC OR
LOWER COST BRAND IS EQUIVALENT.
SO FOR THESE REASONS, WE ARE
CURRENTLY OPPOSED. AGAIN,
APPRECIATE WORKING WITH THE
AUTHOR AND THE SPONSORS. LOOK
FORWARD TO HAVING THOSE
CONVERSATIONS MOVING FORWARD.
THANK YOU. STEPHANIE WATKINS, ON
BEHALF OF THE ASSOCIATION OF
CALIFORNIA LIFE AND HEALTH
INSURANCE COMPANIES, I WOULD
ECHO MANY OF MY COLLEAGUES
COMMENTS. WE TOO WOULD LIKE TO
EXTEND OUR APPRECIATION TO THE
AUTHOR AND THE SPONSOR. AS WAS
MENTIONED, WE'VE WORKED ON THIS
BILL, I THINK, FOR THREE YEARS
NOW, AND IT'S, IN THE CURRENT
FORM IS MUCH MORE NARROW. WE
APPRECIATE THE SPONSORS INTEREST
IN ADDRESSING OUR CONCERNS AT
THIS POINT. REGRETTABLY, WE ARE
OPPOSED. I THINK, WHEN YOU
REALLY LOOK AT THE BREADTH OF
THIS BILL, THE LION'S SHARE DOES
TOUCH OUR ENTIRE FORMULARY,
WHICH, WHILE WE CAN APPRECIATE
IN CERTAIN INSTANCES, IT MAKES
SENSE TO INCREASE THE DOSAGE OR
THE, INCREASE THE TIMES THAT
SOMEONE SOMETHING IS GIVEN. BUT
GIVEN THE BREADTH OF THIS BILL
AND HOW BROAD IT IS AND THAT IT
DOES COVER OUR ENTIRE FORMULARY
WITH SOME EXCEPTIONS, WE DO HAVE
SOME CONCERNS. WE'D LIKE TO
CONTINUE THOSE CONVERSATIONS,
ESPECIALLY AROUND THE FDA
APPROVAL, ESPECIALLY IF THE BILL
MOVES FORWARD TODAY. THANK YOU.
THANK YOU. DO WE HAVE ADDITIONAL
WITNESSES IN OPPOSITION? JON
WINGER, ON BEHALF OF AMERICA'S
HEALTH INSURANCE PLANS, WHICH
JUST ALIGN OUR COMMENTS WITH CAP
AND. THANK YOU, BRING IT BACK TO
THE COMMITTEE. Kò. YES, MISS
SCHIVO, I JUST WANTED TO, SEE IF
THERE WAS A SPONSOR, A RESPONSE
TO CONCERNS FROM THE OPPOSITION.
I WILL LET I WILL LET OUR
SPONSOR REPLY. SINCE I DON'T
WANT TO SPEAK OUT OF TURN ON THE
AUTHOR'S. UNDERSTOOD. GO FOR IT.
NO THANK YOU. WELL, A COUPLE
THINGS. I THINK THE ISSUE THAT
WE'RE TALKING ABOUT HERE IS NOT
ABOUT SOME EXPERIMENTAL DRUGS,
SOME HIGH COST DRUGS THAT THE
PLAN HASN'T ALREADY APPROVED AND
COVERED. WE'RE TALKING ABOUT A
DRUG THAT THE PLAN HAS APPROVED
AND COVERED AND HAS BEEN
PRESCRIBED TO THE PATIENT. AND
THEY'RE STABLE AND THE DRUG IS
WORKING. SO ALL WE'RE ASKING FOR
IS FOR THAT PROVIDER TO BE ABLE
TO OPTIMIZE THAT DRUG, WHICH THE
PLAN HAS ALREADY APPROVED
COVERAGE FOR, TO THE FULLEST
EXTENT POSSIBLE, BECAUSE THE
ONLY OTHER OPTION THAT THE
PROVIDER AND THE PATIENT HAS IS
TO MOVE OFF OF THAT DRUG AND GO
TO ANOTHER DRUG, WHICH THERE'S A
LIMITED NUMBER OF DRUGS OUT
THERE, PARTICULARLY FOR IBD
PATIENTS. AND THAT DRUG MAY OR
MAY NOT WORK, BUT THEY KNOW THIS
DRUG DID AT ONE POINT. AND SO IF
THEY CAN MAXIMIZE THAT DOSE,
THEY'LL BE ABLE TO DO THAT. NOW,
WHEN YOU'RE TALKING ABOUT THE
FDA APPROVAL, WHICH IS A
QUESTION THAT CAME UP, SOMETIMES
THE FDA WILL APPROVE IT FOR,
SAY, IN OUR CASE, INFUSIONS
TAKES EIGHT WEEKS FOR AN
INFUSION, SIX WEEKS WOULD BE
CONSIDERED OFF LABEL, BUT IT'S
STILL THE SAME DRUG. AND BUT YET
THE LEVELS ARE LOWER IN THE
PATIENT. SO THE ONLY WAY YOU CAN
INCREASE THAT LEVEL OF THAT SAME
DRUG IS TO OPTIMIZE THE DOSE.
INSTEAD OF GOING EIGHT WEEKS TO
SIX WEEKS. TECHNICALLY THAT
WOULD BE OFF LABEL, BUT THAT IS
WHAT THE MEDICAL PROVIDER WHO
SEES THIS PATIENT EVERY SO
OFTEN, BUT FREQUENTLY,
UNFORTUNATELY, AND THEY KNOW THE
NEEDS OF THEIR PATIENT BETTER
THAN THE HEALTH PLANS, FRANKLY.
AND SO THAT'S WHAT I HAVE. THANK
YOU. ANY OTHER COMMENTS OR
QUESTIONS FROM THE COMMITTEE? I
JUST WANT TO SAY THAT, YOU KNOW,
WHEN WE'RE TALKING ABOUT CHRONIC
CONDITIONS, WE CAN SEE A LOT OF
TIMES HOW SOMETHING COULD CAUSE
A SPIKE, SOMETHING IF THE
PATIENT IS STABLE, THEN ALL OF A
SUDDEN THERE'S A STRESS
SITUATION OR SOMETIMES SUNLIGHT
OR SOMETIMES, SOME MIXING WITH
ANOTHER A DRUG THAT IS A
TEMPORARILY TAKEN OR SOMETHING
LIKE THAT COULD CAUSE A SPIKE IN
THE SYMPTOMS OR, YOU KNOW, IN
SOME CASES, MAYBE THE PATIENT'S
DOING MUCH BETTER AND THEY NEED
TO LOWER IT. BUT IN THOSE CASES
WHERE AND I THINK IT'S MORE
CRITICAL WHERE YOU'RE LOOKING AT
HAVING TO INCREASE THE DOSE, IT
SEEMS TO ME THAT THE TIMING IS
SO CRITICAL THAT THEY GET ACCESS
TO THE THAT DRUG. AND, YOU KNOW,
IF THERE'S A WAY TO STREAMLINE
THE PROCESS, WHATEVER IT IS. AND
I UNDERSTAND WHAT YOU'RE TRYING
TO DO. SO, WE DON'T HAVE A
QUORUM, OBVIOUSLY, WE'RE FAR
FROM IT. SO WE DON'T WE CAN'T DO
A MOTION, BUT WE WILL BE TAKING
UP THE BILL, WHEN WE DO AND DO,
WOULD YOU LIKE TO CLOSE? YES.
AND, THANK YOU FOR THOSE
COMMENTS, ON BEHALF OF THE
AUTHOR, I'LL SIMPLY SAY, I KNOW
IT'S THE INTENT OF THE AUTHOR TO
ESTABLISH REALLY ROBUST
GUARDRAILS AND PARAMETERS TO
ENSURE THAT, THIS IS NOT SUBJECT
TO, TO ABUSE. AND THAT'S WHY
IT'S LIMITED TO SITUATIONS WHERE
A SPECIFIC DRUG HAS ALREADY BEEN
PRESCRIBED AND SITUATIONS WHERE
THE PRESCRIBER CONTINUES TO BE
THE SAME PRESCRIBER, AGAIN, ON
BEHALF OF THE AUTHOR, I KNOW
THAT SHE WILL CONTINUE THE
CONVERSATIONS AND CONTINUE TO
WORK WITH THE CONCERNS OF THE
OPPOSITION AND ENSURE THAT WE
HAVE A POLICY MOVING FORWARD,
THAT, KEEPS, KIDS LIKE, TREVOR
HERE SAFE AND HEALTHY. SO WITH
THAT ON AT THE APPROPRIATE TIME,
ON BEHALF OF ASSEMBLY MEMBER
BAUER-KAHAN, I WOULD
RESPECTFULLY ASK FOR YOUR I VOTE
. THANK YOU SO MUCH. THANK YOU.
OKAY. ASSEMBLY MEMBER CALDERON,
GOING IN ORDER. AUTHOR. ORDER
FILE NUMBER 18, AB 2428. AND SHE
ALSO HAS FILED 28 AB 3030.
GOOD AFTERNOON. CHAIR AND
MEMBERS, ASSEMBLY BILL 2428
WOULD REQUIRE MEDI-CAL MANAGED
CARE PLANS TO REIMBURSE
COMMUNITY BASED ADULT DAY
SERVICE PROVIDERS AT A RATE
EQUAL TO OR GREATER THAN THE
AMOUNT PAID BY THE MEDI-CAL FEE
FOR SERVICE DELIVERY SYSTEM.
COMMUNITY BASED ADULT DAY
SERVICES OFFER AN ALTERNATIVE TO
NURSING HOME CARE FOR THOUSANDS
OF LOW INCOME SENIORS LIVING
WITH CHRONIC MEDICAL
DISABILITIES AND MENTAL HEALTH
CONDITIONS. PROVIDERS ARE
REIMBURSED THROUGH CONTRACTS
ESTABLISHED WITH MANAGED CARE
PLANS FOR SERVICES PROVIDED TO
MEDI-CAL RECIPIENTS IN 2011, A
SERIES OF MEDI-CAL COST
REDUCTION MEASURES LED TO A 10%
PROVIDER PAYMENT REDUCTION,
WHICH WAS RESTORED IN 2019.
DESPITE THE RATE RESTORATION,
ADULT DAY SERVICE PROVIDERS HAVE
STRUGGLED TO KEEP CENTERS OPEN
AS SOME MANAGED CARE PLANS HAVE
FAILED TO FULLY RESTORE RATES
WITHOUT IMMEDIATE INTERVENTION,
THESE CENTERS WILL CONTINUE
CLOSING, LEAVING THOUSANDS OF
HIGH RISK ELDERLY CALIFORNIANS
WITH NO PLACE TO RECEIVE
SERVICES. THIS BILL WILL ENSURE
THAT A VULNERABLE AND GROWING
POPULATION OF ELDERLY
CALIFORNIANS CAN STILL ACCESS
THESE SERVICES FOR YEARS TO
COME. WITH ME IN SUPPORT OF THE
BILL ARE CHYUAN LEE, BOARD OF
DIRECTORS, PRESIDENT OF THE
CALIFORNIA ASSOCIATION FOR ADULT
DAY SERVICES, AND LYDIA
MICHAILIDIS, INTERIM EXECUTIVE
DIRECTOR OF THE CALIFORNIA
ASSOCIATION FOR ADULT DAY
SERVICES. GOOD AFTERNOON, MADAM
CHAIR AND MEMBERS, I'M LYDIA
MICHAILIDIS AS ASSEMBLY MEMBER,
CALDERON SAID, REPRESENTING
COMMUNITY BASED ADULT SERVICES
THROUGHOUT THE STATE OF
CALIFORNIA. ASSEMBLY MEMBER
TALKED ABOUT OUR BACKGROUND. I
WANTED TO JUST ADD THAT THIS
PROGRAM IS AUTHORIZED UNDER THE
STATE'S CAL AIM 1115 WAIVER, AND
THIS PROGRAM WAS THE FIRST LONG
TERME SERVICES AND SUPPORTS
PROGRAM TO BE SWEPT UNDER THE
AUSPICES OF MEDI-CAL MANAGED
CARE BACK IN 20 WAS AROUND 20
1112. AND THEN THE GREAT
RECESSION HIT. AND AS ASSEMBLY
MEMBER SAID, PROVIDER RATES WERE
SLASHED 10% ACROSS THE BOARD TO
HELP BALANCE THE BUDGET. WHEN
THE STATE BUDGET IMPROVED AND
THE LEGISLATURE AND THE GOVERNOR
RESTORED THE PROVIDER RATES BACK
TO THAT PRE-RECESSION LEVEL ON
JULY 1ST, 2019, ALL PARTIES
EXPECTED THAT THE MANAGED CARE
PLANS WOULD UNDERSTAND YOUR
INTENT TO RESTORE SEE BASE RATES
BECAUSE AS YOUR BILL ANALYSIS
POINTS OUT, THE CAPITATED RATES
FOR THE MANAGED CARE PLANS TOOK
THIS INTO ACCOUNT. SO THE PLANS
WERE MADE WHOLE FOR ALL OF THOSE
PLANS THAT WERE PAYING BELOW
THAT RATE. AFTER HEARING FROM
MANY PROVIDERS FRUSTRATED IN
THEIR ATTEMPTS TO GET THESE
INSURANCE COMPANIES TO RESTORE
THEIR RATES, WE HAD TO JUMP IN
TO HELP. WE IDENTIFIED FOR
MANAGED CARE PLANS AS THE
ANALYSIS DESCRIBES, THAT
CONTINUED PAIN, THE REDUCED RATE
ENACTED BY THE LEGISLATURE, EVEN
THOUGH THEY ARE ONLY FOR PLANS,
THEY REPRESENT A LARGE NUMBER OF
THESE CONTRACTED SEA BASE
PROVIDERS. AFTER COUNTLESS ZOOM
MEETINGS, EMAILS, DOCUMENTATION
AND LET'S NOT FORGET THE
PANDEMIC. TWO OF THESE PLANS
BEGAN IN 2022 TO TAKE THE
NECESSARY STEPS TO RETROACTIVELY
MAKE THEIR CONTRACTED CENTERS
WHOLE. BUT TWO OTHER PLANS
REMAIN WHAT I'LL CALL A WORK IN
PROGRESS. THIS IS NEITHER AN
EFFICIENT NOR A SUSTAINABLE
PROCESS FOR OUR SMALL PROVIDERS
OR THE ASSOCIATION TO UNDERTAKE.
THAT IS WHY WE WANT TO THANK
ASSEMBLY MEMBER CALDERON FOR
JUMPING OUT TO HELP US AND PUT
IN PLACE THIS PREVENTIVE POLICY.
AND KAY, MY PRESIDENT OF THE
ASSOCIATION THIS YEAR WILL
DESCRIBE THE UNIQUE POSITION
THAT CBAS ARE IN AND WHY THIS IS
SO IMPORTANT. SO THANK YOU
AGAIN. MY NAME IS KAY LEE AND
I'M THE PRESIDENT OF THE BOARD
OF DIRECTORS OF THE CALIFORNIA
ASSOCIATION FOR ADULT DAY
SERVICES. AS A BOARD MEMBER, I
AM ONE OF THE MANY SMALL
NONPROFIT AND USUALLY FAMILY
BUSINESS ORGANIZATIONS THAT ARE
SERVE AS THE ADULT DAY HEALTH
CARE PROVIDERS THROUGHOUT THE
STATE TO PROVIDE NEEDED SERVICES
FOR OUR PARTICIPANTS, MOST OF
WHOM ARE FROM HISTORICALLY
UNDERSERVED AND VULNERABLE
COMMUNITIES. HOWEVER, THE MANY
DIFFICULTIES OF BEING A SMALL
COMMUNITY BASED PROVIDER HAVE
CREATED ONGOING BARRIERS FOR
BOTH PROVIDERS AND PARTICIPANTS.
SINCE CBAS, CENTERS HAVE
TRANSITIONED TO WORKING WITH
MANAGED CARE ORGANIZATIONS,
WE'VE BEEN FACED WITH MANY OF
THE CHALLENGES ASSOCIATED WITH
SUCH RELATIONSHIPS AND WHERE
THERE IS A CLEAR POWER
IMBALANCE, MANY PROVIDERS DO NOT
HAVE THE RESOURCES OR THE POWER
TO NEGOTIATE CONTRACTS. DESPITE
OSTENSIBLY BEING TOLD THAT THEY
ARE FREE TO DO SO. AS YOU'LL SEE
IN THE ANALYSIS IS WHAT IS LEFT
ARE TAKE IT OR LEAVE IT
CONTRACTS, WHICH ARE WITH
PROVIDERS HAVING TO AGREE TO LOW
REIMBURSEMENT RATES THAT DO NOT
COME CLOSE TO COVERING THE
ACTUAL COSTS OF CARE THAT
CONTINUE TO RISE YEAR AFTER
YEAR, AND SO WITHOUT AGREEING TO
THESE CONTRACTS, LARGE SWATHS OF
THE STATE WOULD BE LEFT WITHOUT
ANY PROVIDERS ABLE TO SERVE
THESE MEDI-CAL COMMUNITIES
BECAUSE OF THE LACK OF MEDI-CAL
PROVIDERS IN LARGE PARTS OF THE
STATES AND WITHIN COMMUNITY
BASED SETTINGS, MOREOVER, CBAS
CENTERS ARE UNIQUE BECAUSE OUR
PROGRAMS UNIVERSALLY SERVE A
HIGH NUMBER OF MEDI-CAL
BENEFICIARIES, WITH MANY
PROVIDERS ENROLLMENTS BEING 100.
ALL MEDI-CAL BENEFICIARIES, AND
BEING UNIQUELY POSITIONED TO
CONTINUE TO PROVIDE CARE BECAUSE
IT IS, BY DESIGN, PLACED TO
SERVE HIGH RISK POPULATIONS, AND
SO PROVIDERS HAVE NO OTHER
OPTIONS FOR FINANCIAL RESOURCES
OR PAYER SOURCES WITH BETTER
REIMBURSEMENT RATES. ALL OF
THESE FINANCIAL PRESSURES
CONTINUE TO CONTRIBUTE TO AN
IMPENDING CRISIS, IN WHICH CBAS
CENTERS MAY BE UNABLE TO
CONTINUE TO PROVIDE SERVICES FOR
COMMUNITIES THROUGHOUT THE
STATE. WE THEREFORE RESPECTFULLY
ASK FOR YOUR AYE VOTE TO HELP
PARTIALLY MITIGATE FINANCIAL,
THE FINANCIAL RUIN OF A LOT OF
THESE PROGRAMS AND TO PROTECT
CBAS CENTERS AND THE
COMMUNITIES, PROACTIVELY AND TO
SERVE AS A PROTECTION FOR ANY
FUTURE CUTS. THANK YOU. THANK
YOU. ARE THERE ADDITIONAL
WITNESSES IN SUPPORT? NAME
ORGANIZATION ONLY. MADAM CHAIR
AND MEMBERS, MONICA MILLER,
REPRESENTING ALZHEIMER'S, ORANGE
COUNTY, ALZHEIMER'S SAN DIEGO
AND ALZHEIMER'S LOS ANGELES IN
SUPPORT AND WE THANK THE AUTHOR.
THANK YOU. YASMIN PILLARD WITH
JUSTICE AND AGING AND SUPPORT.
THANK YOU. PETER HANSEL,
ADVOCACY VOLUNTEER FOR AARP
CALIFORNIA ON BEHALF OF AARP AND
ITS 3.2 MILLION MEMBERS AND
SUPPORT THE BILL. GOOD
AFTERNOON, RYAN SOUZA ON BEHALF
OF LEADINGAGE CALIFORNIA AND
SUPPORT. THANK YOU, THANK YOU.
DO WE HAVE ANY WITNESSES IN
OPPOSITION? SEEING NONE, I'LL
BRING IT TO THE COMMITTEE.
COMMENTS, QUESTIONS. THIS IS A
GOOD BILL, MAY I BE ASKED? I
DON'T KNOW IF I'M ALREADY ON AS
A COAUTHOR OR NOT, BUT I'D LIKE
TO BE. THANK YOU. AND I'D LOVE
TO ADD YOU AS A COAUTHOR. I KNOW
, OH, OKAY. WELL, WE DON'T HAVE
A QUORUM, AS I STATED BEFORE, SO
WE WILL TAKE UP THE BILL WHEN WE
DO. WOULD YOU LIKE TO CLOSE,
YES. I RESPECTFULLY ASK FOR AN
AYE VOTE AT THE APPROPRIATE TIME
. GREAT. THANK YOU SO MUCH. NOW,
YOU DO HAVE A SECOND BILL, ITEM
28, AB 3030.
THE CHAIR AND MEMBERS. ASSEMBLY
BILL, 3030 WOULD REQUIRE HEALTH
CARE PROVIDERS DEPLOYING I FOR
PATIENT COMMUNICATION TO
DISCLOSE THE TECHNOLOGY USAGE.
I'D LIKE TO START OFF BY
THANKING THE COMMITTEE FOR
WORKING WITH MY STAFF ON THIS
BILL. AND I WILL BE ACCEPTING
ALL THE COMMITTEE'S AMENDMENTS,
ACROSS THE STATE, PILOT PROGRAMS
ARE TESTING THE USE OF
GENERATIVE ARTIFICIAL
INTELLIGENCE OR CHEN AI, AS A
TOOL TO ASSIST CLINICIANS WITH
PATIENT COMMUNICATIONS. FOR
INSTANCE, UC SAN DIEGO HEALTH
CURRENTLY HAS A PILOT
INTEGRATING CHEN AI INTO
MYCHART, A PLATFORM WHERE
PROVIDERS CAN MESSAGE WITH THEIR
PATIENTS AS HEALTH CARE
PROVIDERS DEPLOY CHEN, AI
PATIENTS SHOULD BE AWARE OF WHO
THEY ARE COMMUNICATING WITH TO
ENSURE CONFIDENCE IN THE HEALTH
CARE THAT THEY'RE RECEIVING. AB
3030 IS A GOOD GOVERNANCE BILL
SEEKING TO ADVANCE THE ETHICAL
USE OF AI CHEN IN HEALTH CARE,
AND I DON'T HAVE ANY WITNESSES.
I HAVE STAFF FOR TECHNICAL
QUESTIONS. OKAY, GREAT. THANK
YOU. ARE THERE ADDITIONAL
WITNESSES IN SUPPORT IN THE
AUDIENCE? SEEING NONE ANY
OPPOSITION.
GOOD AFTERNOON. VANESSA GONZALEZ
WITH THE CALIFORNIA HOSPITAL
ASSOCIATION. AND WE'RE NOT IN
OPPOSITION. WE ACTUALLY DON'T
HAVE A POSITION ON THE BILL AT
THIS TIME. HOWEVER, WE DO HAVE
CONCERNS WITH THE PROPOSED
COMMITTEE AMENDMENT TO STRIKE
THE LANGUAGE, PROTECTING
HOSPITALS AND PROVIDERS FROM
CIVIL AND CRIMINAL LIABILITY.
APPRECIATE THE DISCUSSIONS THAT
WE'VE HAD WITH THE AUTHOR AND
STAFF, AND LOOK FORWARD TO THE
CONTINUED DISCUSSIONS. THANK
YOU. THANK YOU. SEEING NO
ADDITIONAL OPPOSITION, BRING IT
TO THE COMMITTEE. ANY COMMENTS?
JUST JUST A QUICK THIS IS GOING
TO PRIVACY AFTER THIS. CORRECT?
OKAY. I'M NOT GOING TO I'M NOT
GOING TO DRILL YOU. YOU'RE GOING
TO GET THAT LATER. YES I WILL
NO, BUT THANK YOU BECAUSE THIS
IS SUCH A INCREDIBLE TOPIC RIGHT
NOW. AND SO WE NEED TO ADDRESS
IT AT ALL LEVELS. SO THANK YOU
VERY MUCH FOR BRINGING IT
FORWARD AND BRINGING IT TO LIGHT
FOR ALL OF US SITTING UP HERE AT
THE DAIS. THANK YOU. THANK YOU,
WOULD YOU LIKE TO CLOSE? YES,
THIS IS YOU KNOW, THIS IS A
NUANCE. IT'S A NEW KIND OF AREA
THAT WE'RE LOOKING AT IN TERMS
OF POLICY. AND IT'S SO IMPORTANT
FOR ALL OF OUR FUTURE. SO I AM
COMMITTED TO CONTINUING TO
CONTINUE TO WORK ON THE BILL,
AND I RESPECTFULLY ASK FOR AN
AYE VOTE AT THE APPROPRIATE
TIME. THANK YOU. OKAY, MR.
GABRIEL, YOU'VE BEEN VERY
PATIENT, BUT, YOU HAVE A NUMBER
OF ITEMS TO PRESENT, BUT, ITEM
20, AB 22550.
THANK YOU VERY MUCH, MADAM VICE
CHAIR AND MEMBERS, I WANT TO
START BY THANKING THE COMMITTEE
FOR THEIR THOUGHTFUL FEEDBACK
AND ASSISTANCE WITH THIS BILL. I
AM PLEASED TODAY TO PRESENT AB
2550, A MEASURE THAT WILL
SUPPORT CALIFORNIA'S SMALL
BUSINESSES BY CUTTING RED TAPE
AND REMOVING OUTDATED OR
NEEDLESS REGULATIONS THAT DRIVE
UP COSTS FOR NEIGHBORHOOD
RESTAURANTS, NEIGHBORHOOD
RESTAURANTS ARE THE BACKBONE OF
COMMUNITIES ACROSS CALIFORNIA
AND EMPLOY ONE OF THE MOST
DIVERSE WORKFORCES IN OUR STATE.
BUT TOO MANY ARE STRUGGLING IN
NEED OF REGULATORY FLEXIBILITY
TO HELP THEM RECOVER FROM
ECONOMIC LOSSES ASSOCIATED WITH
THE PANDEMIC AND RISING
INFLATION. AB 2550 WAS WRITTEN
IN PARTNERSHIP WITH SMALL
BUSINESS LEADERS. TO ADDRESS
THESE ISSUES. HEAD ON. IT
PROVIDES APPROPRIATE FLEXIBILITY
SO THAT RESTAURANTS CAN MAKE
DESIGN DECISIONS THAT ARE BEST
SUITED FOR THEM AND THEIR
CUSTOMERS. THE REGULATORY
FLEXIBILITY THIS BILL PROVIDES
IS NOT A MANDATE, BUT CREATES A
SET OF OPTIONS, GUIDED BY
EXPERTS TO ALLOW SMALL
RESTAURANTS TO FLOURISH. WE HAVE
BEEN IN CONVERSATION WITH LOCAL
ENVIRONMENTAL HEALTH EXPERTS AND
REGULATION ENFORCEMENT
PROFESSIONALS, AND EXPECT THAT
WE WILL REFINE THE BILL AS IT
MOVES THROUGH THE PROCESS. AB
2550 IS SUPPORTED BY A BROAD
COALITION FROM ACROSS CALIFORNIA
THAT INCLUDES THE LOS ANGELES
COUNTY BUSINESS FEDERATION, THE
CALIFORNIA RESTAURANT
ASSOCIATION, AND NUMEROUS
CHAMBERS OF COMMERCE. THERE'S
CURRENTLY NO REGISTERED
OPPOSITION FOR THIS BILL. WITH
ME TODAY TO TESTIFY IN SUPPORT
OF THE MEASURE ARE EDDIE
NAVARETTE, THE EXECUTIVE
DIRECTOR OF THE INDEPENDENT
HOSPITALITY COALITION, AND EDNA
AZPIRI, OWNER AND HEAD CHEF AT
IYARA THAI, A FAMILY OWNED THAI
RESTAURANT IN LOS ANGELES. THANK
YOU AND RESPECTFULLY REQUEST
YOUR AYE VOTE. THANK YOU. YOU
WILL EACH HAVE TWO MINUTES.
THANK YOU. HONORABLE MEMBERS. MY
NAME IS EDDIE NAVARETTE,
EXECUTIVE DIRECTOR AT THE
INDEPENDENT HOSPITALITY
COALITION. THE INDEPENDENT
HOSPITALITY COALITION IS AN
ORGANIZATION OF HOSPITALITY
OPERATORS, ADVOCATES AND WORKERS
WHOSE WHOLE PURPOSE IS TO
PROVIDE COMMUNITY SUPPORT AND
AWARENESS OF OUR ROLE IN THE
ECONOMIC FABRIC OF SOCIETY TODAY
. SPEAKING ON BEHALF OF A
DIVERSE COMMUNITY OF
NEIGHBORHOOD RESTAURANTS
THROUGHOUT THE L.A. COUNTY
LANDSCAPE, MEMBERS MEDIA OUTLETS
SUCH AS THE FRESNO BEE, THE
SFGATE, LA TIMES, WALL STREET
JOURNAL, AND MORE HAVE ALL
REPORTED SUBSTANTIAL LOSSES TO
OUR COMMUNITY WITHIN THE LAST
YEAR. POST-PANDEMIC, BUSINESSES
HAVE BEEN FACED WITH SOME OF THE
LARGEST CHALLENGES, FROM
INCREASED RENTS, ON COSTS, ON
EVERYTHING, ENVIRONMENTAL
CHALLENGES AND RED TAPE, RED
TAPE CREATES BARRIERS FOR
UNDERSERVED COMMUNITIES, MAKING
THE AMERICAN DREAM MUCH LESS
ATTAINABLE. THE LAYERS OF
OUTDATED, CONTRADICTORY POLICIES
THAT EXIST DO NOT REFLECT THE
PROGRESS OF OUR INDUSTRY. AB
2550 IS AN ADAPTIVE REUSE
INITIATIVE FOR SMALL BUSINESS.
BY LOWERING THE BARRIERS TO
ENTRY, SUPPORTING AN ALREADY
STRUGGLING COMMUNITY, AND
SUPPORTING INVESTMENT INTO OUR
OLDER BUILDING STOCK, REDUCING
CARBON EMISSIONS FROM NEW
CONSTRUCTION, WE PROPOSE UPDATES
TO A FEW HANDFULS OF OUTDATED,
LOW TO NO IMPACT CODE SECTIONS
THAT GIVE SMALL BUSINESS OWNERS
TOOLS TO REBUILD EXISTING
BUSINESSES OR TO BUILD NEW ONES,
FOSTERING SMALL BUSINESS GROWTH
AND EQUITY IN OUR COMMUNITIES.
THESE UPDATES WILL GIVE
EXCEPTIONS IN AREAS WHERE LOCAL
JURISDICTIONS ARE POWERLESS,
WHILE INSIGNIFICANT TO A LARGER
BUSINESS, TO A SMALLER BUSINESS,
THEY MAY MAKE ALL THE DIFFERENCE
ON BEHALF OF A SMALL BUSINESS
OWNERS, LOCAL CHAMBERS AND
COMMUNITY ASSOCIATIONS. WE LOOK
FORWARD TO YOUR AYE VOTE IN
MOVING THIS IMPORTANT PIECE OF
POLICY FORWARD. THANK YOU. HI,
MY NAME IS VANESSA ASASHORYU.
I'M A CHEF AND MANAGING OWNER OF
MY FAMILY'S RESTAURANT. I RETIRE
IN LOS ANGELES. MY FAMILY MOVED
TO LA WHEN I WAS FIVE. MY
PARENTS HAVE OPENED AND CLOSED
NUMEROUS RESTAURANTS IN LOS
ANGELES. I GREW UP AS A
RESTAURANT KID, LIKE MANY, DOING
HOMEWORK IN THE STORAGE ROOM AND
HELPING WHERE I COULD AFTER
SCHOOL AND ON WEEKENDS FOR MY
PARENTS, RUNNING A MOM AND POP
RESTAURANT WAS BACKBREAKING
MAKING MADE CHALLENGING BY
INCREASING COSTS AND THE LAYERS
OF COMPLEXITY TO COMPLY WITH
GOVERNMENT REGULATIONS. SEEING
MY PARENTS SACRIFICED TO CREATE
OUR COMMUNITY, CREATE FOR OUR
COMMUNITY COMPELLED ME TO RETURN
TO THE INDUSTRY IN 2012. THAT
WAS A YEAR I HELPED MY PARENTS
ACHIEVE THE AMERICAN DREAM. AS
HOME AS SMALL BUSINESS OWNERS,
BY TAKING OUT A LOAN AND
PURCHASING THE BUILDING THAT
HOUSES OUR RESTAURANT AND THE
UNIT NEXT DOOR. THAT WAS ALSO
THE YEAR I LEARNED MANY HARD
LESSONS ABOUT THIS INDUSTRY. MY
GOAL WAS TO COMBINE THE TWO
UNITS TO MEET THE GROWING
DEMANDS OF OUR THRIVING
RESTAURANT. WITHOUT BRINGING IN
INVESTORS. I WAS IMMEDIATELY
FACED WITH COSTLY AND TIME
CONSUMING PERMITTING OBSTACLES.
MANY OF THE REGULATIONS WERE
OUTDATED AND OVER RESTRICTIVE,
WITH NO BEARING TO THE HEALTH
AND SAFETY OF THE PUBLIC. I LIKE
TO SHARE YOU WITH. I SHARE A
PERSONAL EXAMPLE. WE WERE TOLD
TO PUT IN A BELOW GROUND GREASE
INTERCEPTOR. THAT WOULD BE THAT
WOULD COST UPWARDS OF 100 K,
REQUIRE EXTENSIVE DIGGING, AND
WOULD TAKE 2 TO 3 MONTHS TO
COMPLETE. THE ALTERNATIVE ABOVE
GROUND INTERCEPTOR WOULD COST
ONLY 30 K AND COULD BE INSTALLED
IN ONE WEEK, AND WOULD EASILY BE
COULD EASILY BE ACCESSED FOR
MAINTENANCE AND CLEANING, AND
HAS FAR LESS ENVIRONMENTAL
IMPACT. DUE TO THIS AND OTHER
OBSTACLES, CONSTRUCTION IS STILL
NOT COMPLETED. THIS WILL. THIS
BILL WILL SOLVE THAT PROBLEM.
THIS BILL, AB 2550, WILL HELP
SMALL BUSINESSES LIKE MY FAMILY
ALLEVIATE UNNECESSARY REGULATORY
BURDENS TO OPEN OR GROW THEIR
RESTAURANTS. THIS BILL'S PURPOSE
EXCEPTIONS PROPOSES EXCEPTIONS
TO ALLOW FOR ABOVE GROUND GREASE
INTERCEPTORS TO BE INSTALLED IN
KITCHENS AND OTHER REGULATIONS
TO FOSTER ECONOMIC GROWTH FOR
RESTAURANTS. THANK YOU, THANK
YOU. ARE THERE ANY OTHER
WITNESSES IN SUPPORT? THANK YOU,
MADAM CHAIR AND MEMBERS. MATT
SUTTON OF THE RESTAURANT
ASSOCIATION, REALLY APPRECIATE
YOUR SUPPORT OF THE BILL TODAY.
I APPRECIATE THE AUTHOR'S
LEADERSHIP HERE. CONTINUED TO
BRING RESTAURANT ISSUES INTO
YOUR COMMITTEE, WHICH I KNOW IS
A BIT OF A CHANGE FOR YOUR
JURISDICTION. BUT THANK YOU.
WE'RE IN SUPPORT OF THE BILL.
THANK YOU. HI. CAROL GONZALEZ
HERE ON BEHALF OF INCLUSIVE
ACTION FOR THE CITY AND SUPPORT.
THANK YOU. THANK YOU. ANY
WITNESSES IN OPPOSITION SEEING
NONE. WE'LL BRING IT BACK TO THE
COMMITTEE. SEEING NO COMMENTS,
MISTER GABRIEL, YOU MAY CLOSE.
THANK YOU. THANK YOU VERY MUCH,
MADAM CHAIR, AS YOU KNOW,
SUPPORTING OUR NEIGHBORHOOD
RESTAURANTS HAS BEEN SOMETHING
THAT WE'VE BEEN WORKING ON SINCE
THE COVID 19 PANDEMIC THAT BEGAN
WITH AB 61 TO PROVIDE REGULATORY
RELIEF. WE HAD THE GOOD FORTUNE
OF HAVING THAT BILL SIGNED AT A
DELICIOUS NEIGHBORHOOD
RESTAURANT IN YOUR DISTRICT, AS
YOU I'M SURE YOU RECALL, AND YOU
KNOW, THE CHALLENGES THAT THESE
FOLKS CONTINUE TO FACE WITH
INFLATION IS SIGNIFICANT. AS YOU
HEARD. AND SO WOULD
RESPECTFULLY, AT THE APPROPRIATE
TIME, REQUEST YOUR I VOTE ON
THIS BILL. THANK YOU, WE WILL
MOVE ON TO YOUR NEXT ITEM ON THE
AGENDA, WHICH IS AB, SORRY, ITEM
22 AB 2700.
PLEASE GO AHEAD. OH, THANK YOU
VERY MUCH, MADAM CHAIR. MEMBERS,
LET ME AGAIN START BY THANKING
THE COMMITTEE FOR THEIR
THOUGHTFUL WORK ON THIS BILL. WE
ARE HAPPY TO ACCEPT THE
COMMITTEE'S PROPOSED AMENDMENTS.
I AM PLEASED TODAY TO PRESENT AB
2700, A MEASURE THAT WILL
CONNECT PEOPLE EXPERIENCING A
BEHAVIORAL HEALTH CRISIS TO CARE
FACILITIES SUCH AS CRISIS
STABILIZATION UNITS AND SOBERING
CENTERS. ULTIMATELY, THIS BILL
IS ABOUT MAKING SURE PEOPLE CAN
GET THE RIGHT CARE AT THE RIGHT
TIME, IN THE RIGHT PLACE, AND IN
THE RIGHT MANNER. CURRENTLY,
STATE LAW LIMITS WHERE
INDIVIDUALS EXPERIENCING WHERE
AMBULANCES MAY TRANSPORT AN
INDIVIDUAL EXPERIENCING
BEHAVIORAL HEALTH CRISIS. AS A
RESULT, INDIVIDUALS IN CRISIS
ARE TAKEN FREQUENTLY TO
OVERCROWDED AND OVERWHELMED
EMERGENCY ROOMS THAT MAY HAVE
STRAINED RESOURCES TO ADDRESS
THEIR BEHAVIORAL HEALTH NEEDS.
OVER THE LAST FEW YEARS,
RESEARCHERS HAVE STUDIED THE
IMPACT OF SEVERAL LOCAL PILOT
PROGRAMS THAT HAVE ALLOWED
AMBULANCES TO TRANSPORT
INDIVIDUALS EXPERIENCING
BEHAVIORAL HEALTH CRISIS TO AN
ALTERNATE DESTINATION. THESE
PILOTS HAVE PRODUCED ENCOURAGING
RESULTS. AN INDEPENDENT
EVALUATION OF THESE PROGRAMS BY
THE UNIVERSITY OF CALIFORNIA,
SAN FRANCISCO FOUND THAT
TRANSPORT TO ALTERNATIVE
DESTINATIONS CONSIDERABLY
LOWERED AMBULANCE PATIENT
OFFLOAD TIMES, MEANING AMBULANCE
CREWS COULD RESPOND MORE QUICKLY
TO OTHER 911 CALLS. SIMILARLY,
LAW ENFORCEMENT SPENT LESS TIME
ON BEHAVIORAL HEALTH TRANSPORTS,
WHICH FREED THEM TO FOCUS ON
THEIR PUBLIC SAFETY
RESPONSIBILITIES. THESE
EFFICIENCIES ARE CRITICAL AS WE
FACE A DAUNTING MENTAL HEALTH
CARE CRISIS. TENS OF THOUSANDS
OF INDIVIDUALS BATTLING
ADDICTION AND MENTAL ILLNESS ARE
TRAPPED IN A RELENTLESS CYCLE
CYCLING THROUGH HOSPITALS, JAILS
AND HOMELESSNESS. OUR HOSPITALS
ARE OFTEN STRETCHED BEYOND
CAPACITY. THIS BILL WILL ENSURE
THAT WE PLAN AND PREPARE AT THE
LOCAL LEVEL TO MAKE USE OF SAFE
MEDICAL TREATMENT OPTIONS
AVAILABLE IN DEALING WITH THE
BEHAVIORAL HEALTH CRISIS IN OUR
STATE, I'M GRATEFUL FOR THE
CONTINUED COOPERATION AND
CONVERSATION WITH THE CALIFORNIA
PROFESSIONAL FIREFIGHTERS, THE
EMERGENCY ROOM PHYSICIANS, AND
THE CALIFORNIA NURSES
ASSOCIATION. AS WE WORK VERY
CLOSELY TO ADDRESS THE CONCERNS
RAISED WITH ME TODAY TO TESTIFY
IN SUPPORT OF THIS MEASURE ARE
TERE GAMBOA EASTMAN, DIRECTOR OF
GOVERNMENT AFFAIRS AT THE
STEINBERG INSTITUTE, AND CHRISTY
GONZALEZ, CHIEF PROGRAMS OFFICER
AT WELLSPACE HEALTH. THANK YOU.
AND AT THE RIGHT TIME, WOULD
RESPECTFULLY REQUEST YOUR AYE
VOTE. YOU'LL EACH HAVE TWO
MINUTES. THANK YOU. GOOD
AFTERNOON, CHAIR AND MEMBERS
TARA GAMBOA EASTMAN WITH THE
STEINBERG INSTITUTE, THE PROUD
SPONSOR OF AB 2700. THIS BILL IS
ABOUT MORE THAN EXPANDING
SUCCESSFUL TRIAGE TO ALTERNATE
DESTINATION PROGRAMS. IT'S ABOUT
EXPANDING THEM AT THE RIGHT
TIME. THE LEGISLATURE HAS
CHAMPIONED SOME OF THE BIGGEST
REFORMS TO BEHAVIORAL HEALTH
CRISIS SYSTEM IN THE COUNTRY.
YOU PASSED AB 988 TO IMPLEMENT
THE NEW NATIONAL BEHAVIORAL
HEALTH CRISIS LINE, WHICH CAME
WITH A PROMISE, THE PROMISE THAT
EVERYONE IN A BEHAVIORAL HEALTH
CRISIS WILL HAVE SOMEONE TO
CALL, SOMEONE TO COME AND
SOMEWHERE TO GO. YOU HAVE
INVESTED BILLIONS OF DOLLARS
INTO BUILDING THESE ALTERNATE
DESTINATIONS THROUGH THE B CHIP
PROGRAM WITH BILLIONS MORE
COMING AS PART OF PROPOSITION
ONE. YOU HAVE PASSED LEGISLATION
ENSURING COMMERCIAL INSURANCE
COVERAGE FOR CRISIS SERVICES
OFFERED AT ALTERNATIVE
DESTINATIONS AND MEDI-CAL IS
COVERING MORE OF THESE SERVICES
AS PART OF CAL AIM CAL IS IN THE
PROCESS OF FUNDAMENTALLY
TRANSFORMING ITS RESPONSE TO
BEHAVIORAL HEALTH CRISIS. THE
NEXT STEP IS INTEGRATING OUR
SYSTEM SO THAT PEOPLE CAN ACCESS
THE SERVICES WE HAVE SPENT YEARS
AND BILLIONS OF DOLLARS
INVESTING IN RIGHT NOW. ACCESS
TO BEHAVIORAL HEALTH CRISIS
SERVICES ARE HAMPERED BY THE
FACT THAT AMBULANCES CAN'T TAKE
PEOPLE TO THE LOCATIONS WHEN
THAT CARE WOULD BE APPROPRIATE.
TRIAGE TO ALTERNATE DESTINATION
PROGRAM PILOTS HAVE BEEN
OPERATING FOR YEARS AND HAVE
BEEN INDEPENDENTLY EVALUATED.
RESEARCHERS HAVE DEEMED THESE
PROGRAMS SAFE AND EFFECTIVE. WE
HAVE A STRONG REGULATORY
FRAMEWORK IN PLACE TO ENSURE
PARAMEDICS ARE APPROPRIATELY
TRAINED AND THAT PATIENT SAFETY
IS FRONT AND CENTER. NOW IS THE
RIGHT TIME TO EXPAND
CALIFORNIA'S TRIAGE TO ALTERNATE
DESTINATION PROGRAMS TO ENSURE
EVERYONE GETS THE HELP THEY NEED
WHEN THEY NEED IT. RESPECTFULLY
REQUEST YOUR I VOTE. THANK YOU,
THANK YOU. PLEASE PROCEED. GOOD
AFTERNOON. MY NAME IS CHRISTY
GONZALEZ AND I'M WITH WELLSPACE
HEALTH. WELLSPACE HEALTH IS A
SACRAMENTO BASED NONPROFIT
COMMUNITY HEALTH SYSTEM THAT
INTEGRATES MEDICAL, HEALTH CARE,
DENTAL HEALTH CARE, BEHAVIORAL
HEALTH CARE, AND OTHER
SUPPORTIVE SERVICES SUCH AS
BEING A 988 SUICIDE AND CRISIS
LINE PROVIDER FOR OVER 32
COUNTIES IN THE STATE,
RECOGNIZED THAT THERE NEEDS TO
BE A REAL WORLD SOLUTION TO
CALIFORNIA'S BEHAVIORAL HEALTH
CRISIS. WELLSPACE HEALTH HAS
CREATED A CONTINUUM OF CRISIS
CARE RIGHT HERE IN SACRAMENTO
COUNTY. Kò TO THAT CRISIS SYSTEM
IS THE CRISIS RECEIVING FOR
BEHAVIORAL HEALTH.
AFFECTIONATELY KNOWN AS CRIB,
LOCATED IN DOWNTOWN SACRAMENTO,
IT'S A DEDICATED LOCATION, OPEN
24 HOURS A DAY, SEVEN DAYS A
WEEK. AND IT WAS OPENED IN 2020
AT THE HEIGHT OF THE PANDEMIC,
WHEN THERE WAS ELEVATED CRITERIA
TO BE ABLE TO GET INTO THE ED
AND GET INTO THE EMERGENCY ROOM,
WE WANTED TO MAKE SURE THAT
THERE WAS A PLACE FOR PEOPLE IN
BEHAVIORAL HEALTH CRISIS TO BE
RECEIVED IMMEDIATELY. SINCE
OPENING IN 2020, WE HAVE
PROVIDED MORE THAN 9500
BEHAVIORAL HEALTH CRISIS
SESSIONS. OF THOSE PATIENTS SEEN
SINCE 2020, 7% OF THEM HAVE
VOLUNTARILY GONE ON TO SEEK
BEHAVIORAL HEALTH SERVICES AND
ONLY 2% OF THEM HAVE NEEDED SOME
HIGHER LEVEL OF CARE, SUCH AS AN
EMERGENCY DEPARTMENT VISIT
WELLSPACE. HEALTH'S CRIB IS
CURRENTLY DESIGNATED AS A CAL
AIM SOBERING CENTER AND
CERTIFIED AS AN OUTPATIENT
CRISIS STABILIZATION SERVICES BY
SACRAMENTO COUNTY'S MENTAL
HEALTH PLAN IN 2020 AND 2021.
CRIB WAS WAS DESIGNATED AS AN
ALTERNATIVE DESTINATION UNDER
SACRAMENTO COUNTY EMERGENCY
MEDICAL SERVICES AGENCY'S COVID
19 ERA ASSESS AND REFER POLICY
AND WE ARE CURRENTLY INCLUDED IN
THE COUNTY'S PLAN FOR FUTURE
ALTERNATE DESTINATION PROGRAMS
AT CRIB. THERE IS A PATIENT
OFFLOAD TIME OF ONLY THREE
MINUTES. PATIENTS ARE CURRENTLY
REFERRED INTO CRIB BY AUTHORIZED
REFERRAL PARTNERS, SUCH AS NINE
EIGHT TEAM, AND WE HOPE TO
INCLUDE EMERGENCY MEDICAL
PROFESSIONALS IN THAT. AND WE
URGE YOUR AYE VOTE. THANK YOU.
ARE THERE ANY OTHER WITNESSES IN
SUPPORT AND WHILE THEY'RE
COMING, IF THERE ARE ANY
WITNESSES, PRIMARY WITNESSES IN
OPPOSITION, PLEASE COME FORWARD.
PLEASE GO AHEAD. GOOD AFTERNOON,
GLENN BACCHUS, FOR THE
PROSECUTORS ALLIANCE OF
CALIFORNIA AND THE ELLA BAKER
CENTER FOR HUMAN RIGHTS AND
SUPPORT. JOHN DREBINGER WITH THE
STEINBERG INSTITUTE, SPONSOR OF
THE BILL, ALSO EXPRESSING
SUPPORT ON BEHALF OF THE KENNEDY
FORUM AND CALIFORNIANS FOR
SAFETY AND JUSTICE. THANK YOU.
LEAH BARROWS, ON BEHALF OF
CALIFORNIA HOSPITAL ASSOCIATION,
IN SUPPORT. CHEN MURPHY, ON
BEHALF OF THE CALIFORNIA
ASSOCIATION OF ALCOHOL AND DRUG
PROGRAM EXECUTIVES IN SUPPORT,
THANK YOU. ANY PRIMARY WITNESSES
IN OPPOSITION? THANK YOU, MADAM
CHAIR. I'LL BE REALLY BRIEF,
DOUG SUBERS, ON BEHALF OF THE
CALIFORNIA PROFESSIONAL
FIREFIGHTERS, AS NOTED IN THE
ANALYSIS, WE DO HAVE AN OPPOSING
THIS AMENDED POSITION ON THE
BILL. BUT WE'VE BEEN WORKING
DILIGENTLY WITH THE AUTHOR ON
AMENDMENTS THAT NOT ONLY WOULD
ADDRESS OUR CONCERNS, BUT ALSO
MOVE CPF TO SUPPORT. SO WE
REALLY LIKE TO THANK THE AUTHOR
FOR THAT ENGAGEMENT AND LOOK
FORWARD TO WORKING TO FINALIZE
THOSE AMENDMENTS SO THAT WE
COULD GET TO THAT POSITION.
THANK YOU. MADAM CHAIR, MEMBERS
TIM MADDEN REPRESENT THE
CALIFORNIA CHAPTER OF THE
AMERICAN COLLEGE OF EMERGENCY
PHYSICIANS. WE'RE ALSO OPPOSE
THIS AMENDED POSITION. DID WANT
TO THANK THE AUTHOR AND THE
SPONSORS FOR THEIR
CONVERSATIONS, WE'RE ENCOURAGED
WITH THE AUTHOR'S COMMENTS ON
ADDRESSING OUR CONCERNS AND LOOK
FORWARD TO CONTINUING THOSE
CONVERSATIONS. ADDITIONAL WILL
OFFER JUST THE NAME ORGANIZATION
, AND POSITION. THANK YOU. GOOD
AFTERNOON, MADAM CHAIR. MARTY
LOPEZ, CALIFORNIA NURSES
ASSOCIATION UNFORTUNATELY, WE
ARE IN OPPOSED AS WELL WITH
CONCERNS WITH THE ELIMINATION OF
THE EMERGENCY ROOMS AS A DEFAULT
FOR CONSIDERATION FOR PATIENTS
WITH CONSIDERATIONS FOR
BEHAVIORAL HEALTH, BUT CONTINUE
LOOKING FORWARD TO WORKING WITH
THE OFFICER'S OFFICE. THANK YOU.
THANK YOU. I'LL BRING IT BACK TO
THE COMMITTEE FOR ANY QUESTIONS
OR COMMENTS. YEAH THANK YOU, MR.
RODRIGUEZ. YES. THANK YOU. I
WANT TO THANK THE MEMBER FOR
BRINGING THIS BILL FORWARD.
OBVIOUSLY, EMS IS IN MY BACKYARD
FOR OVER 30 YEARS, AND I'D LIKE
TO SEE WHERE WE'RE GOING. WE'RE
DEFINITELY CHANGING THE WAY
WE'RE PROVIDING, ESPECIALLY
EMERGENCY CARE IN OUR IN OUR
STREETS THROUGHOUT THE STATE.
WHEN WE'RE LOOKING AT, MY JUST A
COUPLE CONCERNS I HAVE AS THIS
BILL LOOKS TO MOVE FORWARD IS
WHAT IS I KNOW THE STEINBERG
INSTITUTE IS ONE THAT'S THE
SPONSOR AND DOING A LOT OF THIS
WORK. SO WHY DON'T YOU TALK A
LITTLE BIT ABOUT THE EDUCATION
AND TRAINING. SO WHAT'S BEING
DIFFERENTLY TRAINED OR EDUCATING
OUR FIRST RESPONDERS TO KNOW
THAT WHEN THEY SHOW UP ON A CALL
THAT THIS ISN'T REALLY A MEDICAL
EMERGENCY, THIS IS A MENTAL
HEALTH CRISIS, OR MAYBE A
SOBERING CENTER OR WHATEVER IS
DOING, BECAUSE MY BIGGEST FEAR
IS, AS FIRST RESPONDERS, YOU'RE
NOT DOCTORS. YOU'RE NOT SUPPOSED
TO DIAGNOSE. SO NOW YOU'RE GOING
TO MAKE THESE FOLKS DIAGNOSE
RIGHT IN A WAY THAT NEVER BEEN
BEFORE. SAU BUT WHAT TRAINING IS
BEING DONE DIFFERENTLY TO MAKE
SURE THAT THERE ARE CATCHING THE
RIGHT SIGNS OR SIGNALS THAT TELL
THEM WHAT THEY SHOULD OR
SHOULDN'T BE DOING WITH THE
PATIENT? YEAH, THANK YOU SO MUCH
FOR THE QUESTION, THIS BILL
WOULD LOOK TO EXPAND AN EXISTING
PILOT PROGRAM THAT INCLUDED AN
ADDITIONAL TRAINING REQUIREMENT
FOR PARAMEDICS THAT WOULD BE
DOING THIS WORK. I BELIEVE IT'S
OVER 100 HOURS OF ADDITIONAL
TRAINING THAT THEY WOULD HAVE TO
DO TO MAKE SURE THAT THEY ARE
ABLE TO IDENTIFY THE APPROPRIATE
SIGNS AND SYMPTOMS. BUT THE
REGULATIONS FOR THE EXISTING
PILOT PROGRAM THAT WE WOULD BE
MAKING SURE APPLIED TO THIS
EXPANSION ENSURE THAT PEOPLE ARE
NOT TRANSFERRED OR TAKEN OUT OF
THE EMERGENCY ROOM. IF THERE'S A
CONCERN OVER A PHYSICAL HEALTH
CONDITION. THERE HAS BEEN VERY,
VERY LITTLE PEOPLE GOING BACK TO
THE EMERGENCY ROOM IN THE PILOT
PROGRAMS, UCSF FOUND THAT 98% OF
PEOPLE WERE EFFECTIVELY SERVED
AT THE ALTERNATIVE DESTINATIONS
BECAUSE THE WELL-TRAINED
PARAMEDICS WERE SO ABLE TO MAKE
THE APPROPRIATE CALL, 2% OF
PEOPLE WERE TAKEN BACK TO THE
EMERGENCY ROOM FOR A PHYSICAL
HEALTH CONDITION, BUT THEN WERE
ULTIMATELY TAKEN BACK TO THE
ALTERNATE DESTINATION, WHICH WE
WOULD SEE AS A SUCCESS. PEOPLE
ENDED UP GETTING THE CARE THAT
THEY NEEDED SAFELY. YEAH, YEAH.
AS YOU AS YOU STATED. YEAH.
BECAUSE OBVIOUSLY A LOT OF THESE
PATIENTS DON'T NEED TO BE IN THE
ER, AS YOU KNOW, RIGHT NOW, IF
YOU GO TO AN ER HALF OF THEM
PROBABLY DON'T NEED TO BE THERE.
AND THE OTHER THING I'M LOOKING
AT, HOW DO WE MAKE SURE MAYBE
WITH THE DATA THAT'S BEING OUT
THERE THAT THERE IS A FACILITY
IN EVERY COMMUNITY. RIGHT.
BECAUSE JUST TAKE SACRAMENTO
HERE, FOR EXAMPLE. IF, OUR FIRST
RESPONDERS GO OUT AND THIS
PATIENT NEEDS TO GO TO A MENTAL
FACILITY AND THERE ISN'T ONE
NEARBY, AND THEY GOT TO GO
OUTSIDE THE CITY LIMITS, WHAT
THAT DOES TO THE RESPONSE TIME,
BECAUSE NOW YOU JUST TOOK A, A
UNIT OUT OF SERVICE, SO TO
SPEAK, TO GO FOR AN HOUR OR SO,
DEPENDING ON WHERE THEY'RE AT.
YOU'RE TAKING THEM OUT OF
SERVICE. SO IS THERE TALK WITHIN
THE BILL OR MAYBE WITH PROP ONE
WE TALKED ABOUT THAT. MAKE SURE
THERE IS A FACILITY IN EACH
COMMUNITY. BECAUSE IF NOT, I
THINK WE'RE GOING TO HAVE
ANOTHER ISSUE WITH DELAYED
RESPONSE TO OTHER EMERGENCIES,
BECAUSE NOW WE JUST TOOK THAT
UNIT OUT OF SERVICE, SO TO
SPEAK. RIGHT? YEAH. PART OF THIS
BILL WOULD BE A GAPS AND NEEDS
ANALYSIS, ASSESSING ALL OF THE
FACILITIES THAT WE HAVE
STATEWIDE. ONE OF THE BIG
PROBLEMS THAT WE HAVE IS WE'VE
INVESTED BILLIONS OF DOLLARS,
BUT DON'T ACTUALLY HAVE A SENSE
OF WHAT FACILITIES ARE AVAILABLE
LOCALLY. SO WE REALLY WANT TO
GET A GOOD SENSE OF WHAT WE HAVE
AND WHAT WE NEED TO GET TO THE
PERFECT VISION OF WHAT
ALTERNATIVE DESTINATION COULD
LOOK LIKE, IN THE MEANTIME,
ABSOLUTELY HAPPY TO CONSIDER,
YOU KNOW, MAKING SURE THAT THIS
WORKS FOR ESPECIALLY OUR RURAL
COMMUNITIES WHERE WE'RE NOT
ASKING FOLKS TO, YOU KNOW, GO
OUT OF OUT OF CITY LIMITS OR OUT
OF COUNTY LIMITS WHERE IT
WOULDN'T MAKE SENSE. WE WANT TO
MAKE SURE THAT PEOPLE HAVE
TIMELY ACCESS TO CARE. CORRECT.
BUT OKAY, THAT WAS JUST A COUPLE
QUESTIONS CONCERNS I HAD, BUT
I'M LOOKING FORWARD TO
SUPPORTING THE BILL, AND I THINK
I MIGHT EVEN COME TO MY
COMMITTEE NEXT. I'M NOT SURE,
BUT JUST FOOD FOR THOUGHT AS
THIS BILL MOVES ALONG. AND,
THANK YOU AGAIN FOR BRINGING
THIS BILL FORWARD. THANK YOU. IT
IS TRUE. SHOULD THIS PASS OUT OF
THIS COMMITTEE, IT'S GOING
STRAIGHT TO YOU, MR. RODRIGUEZ,
WITH THAT, ASSEMBLY MEMBER.
GABRIEL, WOULD YOU LIKE TO CLOSE
? YEAH. THANK YOU VERY MUCH,
MADAM CHAIR. AND I JUST WANT TO
THANK THANK OUR COLLEAGUE FOR
HIS THOSE, THOUGHTFUL POINTS. I
THINK YOU'RE HITTING ON EXACTLY
SOME OF THE CONVERSATIONS THAT
WE'RE HAVING AS STAKEHOLDERS
THAT WE NEED TO RESOLVE, I ALSO,
OF COURSE, WANT TO ACKNOWLEDGE
YOUR INCREDIBLE LIVED EXPERIENCE
IN THIS AREA AND THE WISDOM AND
INSIGHT THAT YOU BRING HERE. SO
IF WE ARE ABLE TO PASS A
COMMITTEE TODAY, LOOK FORWARD TO
CONTINUING THAT CONVERSATION IN
YOUR COMMITTEE. I GUESS WHAT I
WOULD OFFER IS THAT WE'RE REALLY
ENCOURAGED BY THE RESULTS OF THE
PILOT PROGRAM, RIGHT? THE
STATISTICS THAT THE WITNESS
CITED HERE, WITH THE FACT THAT
98% OF THE TIME THEY'RE GETTING
IT RIGHT, THE FIRST TIME, 2% OF
THE TIME, FOLKS ARE NEEDING TO
GO BACK TO THE ED, BUT THEN
ULTIMATELY ENDING UP BACK IN
THAT ALTERNATE DESTINATION. I
THINK THOSE ARE PRETTY
ENCOURAGING STATISTICS. AND AS
YOU MENTIONED, ANYONE WHO'S BEEN
INTO AN ED VIRTUALLY ANYWHERE IN
THE STATE OF CALIFORNIA RECENTLY
UNDERSTANDS THE NEED FOR THIS
BILL. SO WITH THAT, WE'RE AT THE
RIGHT MOMENT. WOULD RESPECTFULLY
REQUEST AN AYE VOTE. THANK YOU.
I DEFINITELY APPRECIATE YOUR
CONTINUED WORK WITH THE CURRENT,
FOLKS WHO ARE IN OPPOSITION,
PARTICULARLY THE FIREFIGHTERS
AND THE NURSES AND THE EMERGENCY
DOCS, BECAUSE THEY ARE A
FRONTLINERS. AND, AND I'M SURE
THAT YOU WILL BE ABLE TO
CONTINUE TO WORK ON THIS, TO PUT
IT IN IN GOOD SHAPE FOR MOVING
FORWARD WITH IT. WE WILL MOVE ON
NOW. THANK YOU SO MUCH TO YOUR
LAST BILL FOR THE DAY. WE SHOULD
HAVE JUST CREATED A SPECIAL
SESSION CALLED CHAIR GABRIEL'S
SESSION, ITEM NUMBER 26, AB
2899.
THANK YOU VERY MUCH, MADAM
CHAIR. WE DO APPRECIATE THE
OPPORTUNITY TO DISCUSS SO MANY
IMPORTANT ISSUES IN YOUR
COMMITTEE. SO THANK YOU FOR, FOR
HAVING US. AND I WANT TO ALSO,
AGAIN, THANK THE COMMITTEE FOR
THEIR THOUGHTFUL WORK ON THE
BILL AND ACCEPT THE COMMITTEE'S
PROPOSED AMENDMENTS. I AM
PLEASED TODAY TO PRESENT AB
2899, WHICH WILL BRING GREATER
TRANSPARENCY TO THE WAY THE
CALIFORNIA DEPARTMENT OF PUBLIC
HEALTH RESPONSE TO COMPLAINTS
REGARDING THE VIOLATION OF
CALIFORNIA'S NURSE TO PATIENT
RATIO LAWS. SINCE THE PASSAGE OF
Kò STAFFING RATIO LAWS, THE
CALIFORNIA DEPARTMENT OF PUBLIC
HEALTH HAS HELD THE IMPORTANT
RESPONSIBILITY OF ENFORCING
THESE RATIOS. DESPITE THE LAWS
ON THE BOOKS, NURSES HAVE
PERSISTENTLY RAISED CONCERNS
ABOUT CONTINUOUS VIOLATION OF
THE LAW WITHIN THEIR WORKPLACES.
THESE CONCERNS HAVE BEEN
CAREFULLY DOCUMENTED THROUGH THE
SUBMISSION OF THOUSANDS OF
STAFFING COMPLAINTS TO CDF. AB
2899 WILL SUPPORT WORKPLACE
SAFETY EFFORTS AND IMPROVE
TRANSPARENCY BY REQUIRING CDF TO
CONCURRENTLY NOTIFY BOTH THE
HOSPITAL AND THE INDIVIDUAL WHO
REPORTED THE VIOLATION, ALONG
WITH THEIR COLLECTIVE BARGAINING
AGENT OR REPRESENTATIVE,
REGARDING THE ACTION TO BE TAKEN
FOR SUBSTANTIATED VIOLATIONS.
SAFE NURSE TO PATIENT RATIOS ARE
CRUCIAL FOR ENSURING THAT
PATIENTS RECEIVE THE APPROPRIATE
LEVEL OF CARE AND ATTENTION, AND
FAILURE TO ADHERE TO THESE
RATIOS CAN LEAD TO ERRORS,
DELAYS, AND DELAYS IN CARE AND
COMPROMISE. PATIENT SAFETY. IT
IS OUR EXPECTATION WITH A LITTLE
MORE SUNLIGHT AND TRANSPARENCY,
THESE HOSPITALS WILL BETTER
ADHERE TO THE STAFFING LAW IN
ORDER TO MAINTAIN HIGH QUALITY
CARE FOR THE PATIENTS AND ALSO A
SAFE WORKING ENVIRONMENT FOR OUR
FRONTLINE HEALTH CARE HEROES.
THIS BILL HAS NO REGISTERED
OPPOSITION AND WITH ME TODAY TO
TESTIFY IN SUPPORT OF THIS
MEASURE ARE PETER SIDHU, RN,
EXECUTIVE VICE PRESIDENT OF UHC,
HCP, AND DIANE SMITH, RN, A
MEMBER OF SEIU 521. THANK YOU.
AND AT THE APPROPRIATE TIME,
RESPECTFULLY REQUEST YOUR AYE
VOTE. GOOD AFTERNOON. I WOULD
LIKE TO THANK THE CHAIR AND THE
MEMBERS OF THE HEALTH COMMITTEE
FOR THE OPPORTUNITY TO SPEAK IN
SUPPORT OF AB 2899. MY NAME IS
PETER SIDHU. I AM THE EXECUTIVE
VICE PRESIDENT OF THE UNITED
NURSES ASSOCIATION OF CALIFORNIA
, A UNION OF HEALTH CARE
PROFESSIONALS. BUT MORE
IMPORTANTLY, I AM A 20 YEAR
CRITICAL CARE ICU NURSE. I'VE
BEEN THROUGH H1N1, EBOLA, COVID,
AND I UNDERSTAND THE STRESS OF
THOSE TIMES. BUT THAT'S NOT WHAT
BURNED ME OUT. IT WAS THE
CHRONIC UNDERSTAFFING AND
UNDERSTAFFING THAT MADE ME AND
MANY MORE LIKE ME, LEAVE THE
BEDSIDE. WHEN A NURSE IS
CONSISTENTLY WORKING IN AN
UNDERSTAFFED UNIT, IT NOT ONLY
PLACES TREMENDOUS STRAIN ON THE
NURSE RESPONSIBLE FOR MANAGING
MORE PATIENTS, BUT ALSO THE
SAFETY OF THAT UNIT. OVER TIME,
THESE PERSISTENT VIOLATIONS OF
THE NURSE TO PATIENT RATIOS
ERODE THE TRUST IN THE
REGULATORY SYSTEM. BECAUSE THE
LAWS ESTABLISHED TO SAFEGUARD
AND PROTECT BOTH NURSES AND
PATIENTS ARE NOT EFFECTIVELY
ENFORCED, AB 26 AB 2899 WILL
REQUIRE DPH TO SHED LIGHT ON THE
DETERMINATIONS AS TO IMPOSE OR
NOT TO IMPOSE A FINE ON A
HOSPITAL FOR A NURSE STAFFING
RATIO VIOLATION. SPECIFICALLY,
IT REQUIRES DPH TO PROVIDE A
STATEMENT OF REASONS FOR NOT
IMPOSING A FINE DESPITE FINDING
A SUBSTANTIATED VIOLATION. THE
PROVISION WILL ALSO BRING
TRANSPARENCY TO A PROCESS THAT
IS CURRENTLY SHROUDED IN MYSTERY
AND LEAVES NURSES ON THE FRONT
LINE WONDERING WHY THEIR
EMPLOYER WAS ALLOWED TO BREAK
THE LAW. IT IS IMPORTANT TO NOTE
THAT AB 2899 DOES NOT ESTABLISH
ANY NEW VIOLATIONS, PENALTIES OR
ENFORCEMENTS. IT MERELY REQUIRES
THE DISSEMINATION OF INFORMATION
ABOUT THE CURRENT PROCESS
REGARDING VIOLATIONS. MOREOVER,
IS LIMITED IN SCOPE TO
SITUATIONS WHERE THE
SUBSTANTIATED VIOLATION AND DOES
NOT IMPOSE ANY REQUIREMENTS. IN
CASE THERE IS NO SUBSTANTIATED
VIOLATION. THANK YOU, THANK YOU.
PLEASE GO AHEAD. GOOD AFTERNOON.
MY NAME IS DIANE SMITH. I'M A
REGISTERED NURSE AND A CHARGE
NURSE AT KERN MEDICAL IN THE
MOTHER BABY UNIT. I'VE WORKED
THERE FOR 21 YEARS. I'M SO PROUD
OF THE WORK WE DO. PROVIDING
CARE TO HIGH RISK OBSTETRIC
PATIENTS FROM ALL OVER THE
CENTRAL VALLEY. SHORT STAFFING
PUTS OUR MOTHERS AND NEWBORNS AT
INCREASED RISK OF SERIOUS BUT
PREVENTABLE COMPLICATIONS IN
SPITE OF COMPLAINTS BEING FILED,
WE ARE CONTINUOUSLY EXPECTED TO
WORK AT A RATIO. WE'RE NOT
GETTING THE SOLUTIONS OUR
PATIENTS NEED. I'VE SUBMITTED
TWO SEPARATE COMPLAINTS WITH CDP
RECENTLY. THE FIRST WAS WHEN TWO
PATIENTS DIDN'T GET THE MINIMUM
TWO HOUR RECOVERY PERIOD
REQUIRED AFTER THEIR C-SECTION
BECAUSE OF SHORT STAFFING AND
LABOR AND DELIVERY. EACH HAD
POSTPARTUM HEMORRHAGING LESS
THAN ONE HOUR AFTER BEING
TRANSFERRED TO OUR UNIT, I FILED
THE SECOND COMPLAINT AFTER WE
HAD TO ADMIT A POST-DELIVERY AND
RECOVERY. MOTHER AND BABY
COUPLET WHEN WE WEREN'T STAFFED
TO CARE FOR THEM IN THE FIRST
PLACE, WE WERE OUT OF RATIO FOR
OVER HALF THE UNIT, HALF THE
SHIFT ON THAT UNIT. AND WHILE
HAVING TO ADMIT EVEN MORE
POST-DELIVERY COUPLET PATIENTS
FROM LABOR AND DELIVERY, IN
SPITE OF THE SUBSTANTIATED
COMPLAINTS ABOUT SHORT STAFFING
MANAGEMENT HAS ONLY PROVIDED
TEMPORARY BAND-AIDS THAT HAVE
RESULTED IN POOR PATIENT
OUTCOMES. WE MUST ENSURE THEY'RE
FOLLOWING THROUGH WHEN
COMPLAINTS ARE FILED, AB 2899
WILL MAKE SURE THAT BOTH THE
PERSON FILING THE COMPLAINT AND
THEIR UNION WILL KNOW THE STEPS,
MANAGEMENT SHOULD BE TAKING TO
COME INTO COMPLIANCE WITH THE
LAW. THIS ISSUE JUST DOESN'T
AFFECT OUR LICENSE AND
UNLICENSED STAFF. IT TRULY HARMS
THE VULNERABLE POPULATION WE
SERVE. I'M HERE TODAY ON THEIR
BEHALF. PLEASE HELP US MAKE SURE
HOSPITALS PUT THE SAFETY AND THE
LIVES OF OUR PATIENTS IN THE
FOREFRONT OF CARE AND PASS. AB
29 2899 THANK YOU, THANK YOU.
ARE THERE ANY OTHER WITNESSES IN
SUPPORT? AND IF THERE ARE ANY,
PRIMARY WITNESSES IN OPPOSITION,
PLEASE COME FORWARD TO THE.
MADAM CHAIR MEMBER SARA FLOCKS,
CALIFORNIA LABOR FEDERATION, IN
SUPPORT. THANK YOU. HI, MADAM
CHAIR, JANICE O'MALLEY, AFSCME,
CALIFORNIA, IN SUPPORT. ANA
PALACIO, REGISTERED NURSE AT
KERN MEDICAL HOSPITAL,
REPRESENTING SEIU LOCAL 521 IN
SUPPORT AND ON BEHALF OF SEIU
CALIFORNIA IN SUPPORT. THANK
YOU. ANY WITNESSES IN OPPOSITION
? SEEING NONE. I WILL BRING IT
BACK TO COMMITTEE FOR COMMENT OR
QUESTION ON, THANK YOU FOR
BRINGING THIS BILL FORWARD. I
UNFORTUNATE WE HAVE A VERY GOOD
FRIEND WHO IS IN THE NURSING
PROFESSION AND HAS WALKED AWAY
FROM THE HOSPITAL SHE'S WORKING
AT NOW, WORKING FOR SCHOOL
DISTRICT SO SHE CAN MAKE SURE
SHE CAN DO THE THING THAT SHE
LOVES THE MOST IS TAKING CARE OF
PEOPLE AND NOT BEING RIDICULED.
AND PUT DOWN IN A, TOXIC
ENVIRONMENT. SO THANK YOU FOR
BRINGING THIS BILL FORWARD. MR.
GABRIEL, YOU MAY CLOSE, THANK
YOU VERY MUCH FOR THAT. ASSEMBLY
MEMBER. AND I WILL TELL YOU,
PART OF THE REASON THAT I'VE
ARRIVED AT THIS ISSUE WORKED ON
IS MY MOM WORKED FOR MANY YEARS
AS A NURSE, IN LABOR AND
DELIVERY. AND I KNOW STORIES OF
HER WORKING 40 YEARS AGO, SHE
WOULD SHARE WITH ME WHEN SHE
FELT THAT THEIR HOSPITAL WAS SO
OUT OF RATIO THAT SHE WAS
WORRIED THAT SHE WOULD PUT
PATIENT SAFETY AT RISK IF SHE
STOPPED TO GO TO THE BATHROOM
DURING A 12 HOUR SHIFT. SO THIS
HAS BEEN AN ISSUE THAT HAS
PERSISTED FOR A LONG TIME. WE'RE
FORTUNATE TO HAVE SOME GOOD LAWS
ON THE BOOKS HERE IN THE STATE
OF CALIFORNIA, BUT WE ALL KNOW
THAT GOOD LAWS WITHOUT
ENFORCEMENT DON'T MAKE A
DIFFERENCE. AND THAT'S WHAT THIS
BILL IS ABOUT. IT'S ABOUT MOVING
FORWARD ON THAT ENFORCEMENT
PIECE SO THAT THESE FOLKS WHO
ARE WHO, WHO ALL OF US HAVE
ACKNOWLEDGED OUR HEALTH CARE
HEROES AND DID HEROES WORK
DURING THE PANDEMIC, CAN HAVE A
SEAT AT THE TABLE AND CAN HAVE A
SAFE WORK ENVIRONMENT, AS CAN
OUR PATIENTS. SO WITH THAT,
RESPECTFULLY REQUEST AND I VOTE.
THANK YOU SO MUCH FOR BRINGING
THIS BILL FORWARD. MR. GABRIEL.
IT'S I HAVE A NURSE AUNTIE
MYSELF, 23 YEARS OB-GYN, NURSE
AND IT'S SO IMPORTANT THAT WE
CONTINUE TO PROTECT OUR
FRONTLINE HEALTH CARE PROVIDERS.
SO THANK YOU FOR THIS BILL AND
FOR THE, THE, PACKAGE OF BILLS
THAT YOU WERE ABLE TO BRING
FORWARD TO THIS COMMITTEE. AND I
KNOW YOU HAVE A LOT OF IMPORTANT
WORK TO DO. SO THANK YOU FOR
YOUR TIME. THANK YOU VERY MUCH.
APPRECIATE IT. WE WILL MOVE ON
NOW TO, MR. VÆ VALLAPUDUA BILL
AB, 2701, ITEM NUMBER 23.
THERE YOU GO. THANK YOU, MADAM
CHAIR. MEMBERS AB 2701 WILL
EXPAND CALIFORNIA MEDICAL DENTAL
BENEFITS TO INCLUDE A SECOND
CLEANING AND EXAM FOR ADULTS AGE
21. PLUS CURRENTLY, CURRENT
MEDI-CAL DENTAL BENEFITS COVER
TWO CLEANING AND EXAMS PER YEAR
FOR THOSE UP TO THE AGE OF 21.
HOWEVER, ONCE AN INDIVIDUAL IS
AGE 21 PLUS THEIR MEDI-CAL
BENEFITS DWINDLE DWINDLES TO
ONLY COVER ONE CLEANING AND EXAM
PER YEAR. WELL CALIFORNIA
MEDI-CAL DENTAL BENEFITS
INCLUDES MORE THAN SUBSTANTIAL
AND COMPREHENSIVE DENTAL
TREATMENT THAN THE OTHER STATES.
THE LIMITATIONS OF ONLY ONE
CLEANING ANNUAL IS WHERE
CALIFORNIA FALLS BEHIND WITH A
SECOND CLEANING OF AN EXAM.
DENTAL CGRTS CAN DETECT ORAL
HEALTH COMPLICATIONS, PREVENT
TOOTH LOSS, AND EVEN DETECT
EARLY HEART PROBLEMS AND SEVERE
AND SEVERAL REPORTS SUGGEST POOR
DENTAL HEALTH IS LINKED TO
DIABETES, DEMENTIA AND OTHER
DISEASES. WITH ME TODAY TO
TESTIFY AND TO ANSWER ANY
QUESTIONS IS JESSICA MORAN WITH
THE CALIFORNIA DENTAL
ASSOCIATION. PLEASE GO AHEAD.
YOU'LL HAVE TWO MINUTES. GOOD
AFTERNOON. CHAIR MEMBERS JESSICA
MORAN WITH THE CALIFORNIA DENTAL
ASSOCIATION. APPRECIATE THE
AUTHOR FOR BRINGING UP THIS
BILL, DESPITE RECENT INVESTMENTS
AND IMPROVEMENTS IN THE MEDI-CAL
PROGRAM, SUCH AS PROP 56,
TOBACCO TAX INVESTMENTS AND CAL,
AIM AS LONG AS WELL AS
ADMINISTRATIVE FIXES, THERE ARE
STILL HOLES IN THE BENEFITS THAT
ARE COVERED BY MEDI-CAL. AB 2701
WOULD ESTABLISH AN EQUITABLE
STANDARD OF CARE FOR ADULTS WHO
ARE ENROLLED IN MEDI-CAL TO
RECEIVE THEIR TWO CLEANINGS AND
TWO VISITS AND CLEANINGS A YEAR.
SORRY, PREVENTION IS Kò. AS
AUTHOR MENTIONED IN AVOIDING
DENTAL DISEASE AND COMORBIDITIES
DOWN THE LINE. RESPECTFULLY ASK
FOR YOUR AYE VOTE TODAY. OTHER
WITNESSES IN SUPPORT VANESSA
KAHENA ON BEHALF OF THE
CALIFORNIA PAN ETHNIC HEALTH
NETWORK AND SUPPORT. JENNIFER
TANNEHILL WITH AARON REED AND
ASSOCIATES ON BEHALF OF THE
CALIFORNIA DENTAL HYGIENIST AND
SUPPORT. KELLY BROOKS, ON BEHALF
OF THE COUNTY HEALTH EXECUTIVES
ASSOCIATION OF CALIFORNIA, IN
SUPPORT LINDA HèA WITH WESTERN
CENTER ON LAW AND POVERTY IN
SUPPORT ANY WITNESSES IN
OPPOSITION. SEEING NONE, I WILL
BRING IT BACK TO COMMITTEE FOR
COMMENT OR QUESTION. I HAVE ONE
QUESTION. JUST CLARIFICATION.
MR. CAN YOU SHARE WITH THE
INDUSTRY STANDARD RIGHT NOW IS
OR MAYBE FOR CDA, INDUSTRY
STANDARD RIGHT NOW IS FOR DENTAL
PLANS FOR THE AMOUNT OF, WELL
CARE. VISITS. SO FOR COMMERCIAL
PATIENTS IT'S TYPICALLY TWO
CLEANINGS PER YEAR. THE ADA
RECOMMENDS, YOU KNOW, GETTING
CLEAN AND CLEANINGS AS OFTEN AS
POSSIBLE, BUT FOR COMMERCIAL
PAY, IT IS TWO CLEANINGS A YEAR,
AND I WOULD ALSO JUST ADD THAT
27 OTHER STATES, A LOT HAVE
THEIR MEDICAID RECIPIENTS
RECEIVE TWO CLEANINGS A YEAR. SO
THIS IS WHAT ONE OF THE, ONE OF
THE AREAS THAT CALIFORNIA FALLS
SHORT IN COMPARED TO OTHER
STATES, RIGHT. AND WE'RE STILL
KIND OF RECOGNIZING THAT EVEN
THOUGH THERE'S A STANDARD OF
WANTING TO CLEANINGS PER YEAR,
WE STILL HAVE, AN ISSUE WITH,
MEDI-CAL BEING ACCEPTED FOR MANY
DENTISTS AS WELL. SO YES,
SEPARATE ISSUE, BUT RELATED FOR
SURE IN TERMS OF OVERALL ACCESS.
WELL, THANK YOU FOR THAT, WITH
THAT, MR. VILLOPOTO, YOU CAN
CLOSE. YEAH I'D LIKE TO JUST SAY
THAT, YOU KNOW, WHEN THIS FIRST
WHEN THIS BILL FIRST CAME
FORWARD, I WAS I EVEN CALLED MY
DENTIST JUST TO JUST TO KIND OF
FIND OUT WHAT USUAL HAPPENS.
LIKE HOW MANY, HOW MANY
CLEANINGS DO WE HAVE A YEAR. BUT
THEN I DUG DEEPER TO REALIZE
THAT, IT IS VERY TRUE THAT A LOT
OF DISEASES, IF YOU'RE NOT, IF
WE'RE NOT TAKING CARE OF OUR
HYGIENE, YOU'LL WE'RE GOING TO
BE ABLE TO PREVENT A LOT OF
DIFFERENT DISEASES, ESPECIALLY
AT OUR HOSPITALS. SO, THIS BILL
REALLY MAKES A LOT OF SENSE. SO
ASKING FOR YOUR VOTE TODAY.
THANK YOU. AND WHEN WE ARE ABLE
TO ESTABLISH QUORUM, WE WILL
CERTAINLY MOVE FORWARD, THANK
YOU SO MUCH FOR THE PRESENTATION
. WE WILL MOVE ON NOW TO WHILE
WE ARE WAITING FOR THE LAST NON
COMMITTEE MEMBERS PRESENTATION.
WE WILL GO WITH OUR, MAJORITY
LEADER, CECILIA AGUIAR-CURRY
.
THIS IS ITEM ITEM 11 AB 2237.
THANK YOU, MR. CHAIR. AND
MEMBERS, FIRST, I WOULD LIKE TO
THANK THE COMMITTEE STAFF FOR
THEIR CONTINUED WORK WITH OUR
OFFICE AND ACCEPT THE COMMITTEE
AMENDMENTS. AS WE KNOW, THIS
WILL BE AN ONGOING CONVERSATION
WITH ALL STAKEHOLDERS SO THAT
OUR MOST VULNERABLE YOUTH COME
FIRST. TODAY, CALIFORNIANS YOUTH
ARE FACING A MENTAL HEALTH
CRISIS. WE'VE HEARD THAT
NUMEROUS TIMES TODAY. SINCE
2017, RATES OF ANXIETY AND
DEPRESSION AMONG CALIFORNIA'S
CHILDREN HAVE SHOT UP 70, AND
ONE THIRD OF CALIFORNIA'S
ADOLESCENTS EXPERIENCE SERIOUS
PSYCHOLOGICAL DISTRESS. BETWEEN
2019 AND 21, INCLUDING A 20%
INCREASE IN ADOLESCENT SUICIDE
RATES. MANY FAMILIES STRUGGLE TO
FIND AFFORDABLE MENTAL HEALTH
CARE FOR THEIR CHILDREN.
SPECIALTY MENTAL HEALTH SERVICES
PROVIDED BY COUNTY MENTAL HEALTH
PLANS PROVIDE A KEY LIFELINE FOR
OVER 243,000 YOUTH ACROSS
CALIFORNIA. IN ORDER TO RECEIVE
THESE SERVICES, YOUTH UNDER 21
MUST HAVE A CONDITION PLACING
THEM AT HIGH RISK FOR A MENTAL
HEALTH DISORDER, HAVE
SIGNIFICANT IMPAIRMENT AND
MENTAL HEALTH DISORDER, OR HAVE
SIGNIFICANT TRAUMA LIKE SEXUAL
ASSAULT. HOWEVER, WHEN YOUTH
MOVE FROM COUNTY TO COUNTY,
THEIR MENTAL HEALTH CARE IS
HALTED WHILE THEY REESTABLISH
ELIGIBILITY. WHEN THEY'RE MOVING
FROM COUNTY TO COUNTY. THIS
RESULTS IN GAPS IN MENTAL HEALTH
CARE THAT CAN BURDEN FAMILIES
AND RISK MINORS ENTERING THE
FOSTER CARE SYSTEM. THIS BILL
SUPPORTS FAMILIES BY
STREAMLINING ELIGIBILITY ACROSS
COUNTY LINES FOR HIGH RISK YOUTH
WHO QUALIFY FOR SPECIAL
SPECIALTY MENTAL HEALTH SERVICES
. HIS AB 2237 WOULD REQUIRE THAT
DCS ISSUE GUIDANCE TO SUPPORT
COUNTIES, COORDINATE AND
EXPEDIATE THE TRANSFER,
ESPECIALLY MENTAL HEALTH
SERVICES, FROM ONE COUNTY TO
ANOTHER. THIS BILL WILL HELP
EMPOWER FAMILIES WHO DON'T KNOW
HOW TO NAVIGATE COMPLICATED
SOCIAL SERVICES SO THAT THEIR
YOUTHS CAN CONTINUE TO.
CONTINUITY OF CARE IS PRESERVED.
TODAY I HAVE WITH ME COURTNEY
THOMAS, SENIOR MANAGER OF
OPERATIONS AT THE CALIFORNIA
COUNCIL OF COMMUNITY BEHAVIORAL
HEALTH AGENCIES. WELCOME PLEASE
GO AHEAD. THANK YOU. CHAIR,
MEMBERS AND STAFF OF THE
COMMITTEE. AS MENTIONED, I'M
COURTNEY THOMAS. I'M A SENIOR
MANAGER OF OPERATIONS. AND ON
BEHALF OF THE CALIFORNIA COUNCIL
OF COMMUNITY BEHAVIORAL HEALTH
AGENCY. CIBA, I THANK YOU FOR
HEARING AB 30 AB 2237 DURING
THIS COMMITTEE. SO CIBA IS A
STATEWIDE ASSOCIATION OF MENTAL
HEALTH AND SUBSTANCE USE
DISORDER COMMUNITY AGENCY,
SERVING OVER 1 MILLION
CALIFORNIANS ACROSS THE
LIFESPAN. IT'S COMMON TO SEE
MANY FAMILIES IN CALIFORNIA RELY
ON THE COUNTY'S SPECIALTY MENTAL
HEALTH SERVICES, OR SMA. HS,
IT'S A KEY LIFELINE FOR MEDI-CAL
BENEFICIARIES ACROSS THE STATE
AND IN THE FISCAL YEAR OF 2020
TO 2021, THE SERVICE SYSTEM
PROVIDED SERVICES TO OVER
243,000 YOUTH UNDER THE AGE OF
21, 73% OF THOSE WERE BLACK
INDIGENOUS PEOPLE OF COLOR.
HOWEVER, WHEN CHILDREN YOUTH
UNDER THE AGE OF 21, AS
MENTIONED, MOVE FROM COUNTY TO
COUNTY, THEY MUST START FRESH,
RESULTING IN GAPS IN MENTAL
HEALTH CARE THAT CAN BURDEN
FAMILIES AND RISK MINORS
ENTERING THE FOSTER CARE SYSTEM.
THIS BILL SUPPORTS FAMILIES BY
STREAMLINING ELIGIBILITY ACROSS
COUNTY LINES FOR HIGH RISK YOUTH
WHO QUALIFY FOR SPECIALTY MENTAL
HEALTH SERVICES. AS MENTIONED,
CALIFORNIA'S FOSTER YOUTH ARE
FACING A MENTAL HEALTH CRISIS.
BETWEEN 2019 AND 2021, THERE WAS
A STAGGERING 20% INCREASE IN
YOUTH SUICIDE. AB 2237 KEEPS
CRITICAL MENTAL HEALTH COVERAGE
INTACT, SO THAT YOUTH CAN MOVE
AND TRANSITION WHERE MENTAL
HEALTH CARE IS MOST CRITICAL.
SPECIFICALLY, AS MENTIONED, WHEN
A MINOR RECEIVING SPECIALTY
MENTAL HEALTH SERVICES IN ONE
COUNTY MOVES TO A NEW COUNTY,
THE NEW COUNTY MUST PROVIDE
CONTINUED SPECIALTY MENTAL
HEALTH SERVICES WHILE THEY
CONDUCT THE REQUIRED
INVESTIGATION AND TRANSFER
PROCESS. AS THIS BILL PRESERVES
COUNTY'S ABILITY TO CONDUCT
APPROPRIATE REVIEWS TO MEET
CHANGING MENTAL HEALTH NEEDS AND
CONDITIONS, WHILE ALSO ENSURING,
AS I MENTIONED, THE CONTINUITY
OF CARE FOR YOUTH. THANK YOU
AGAIN. CHAIR MEMBERS AND STAFF
FOR ALLOWING US TO EXPRESS THE
NEED OF THIS BILL. AND CIBA IS A
PROUD IS THE PROUD SPONSOR.
THANK YOU. THANK YOU, ARE YOU
GOING TO SPEAK AS WELL? YOU'RE
JUST HERE FOR TECHNICAL SUPPORT.
THANK YOU, ANY OTHER WITNESSES
IN SUPPORT? GOOD AFTERNOON.
THANK YOU. DYLAN ELLIOTT, ON
BEHALF OF THE CALIFORNIA ACADEMY
OF CHILD AND ADOLESCENT
PSYCHIATRY AND SUPPORT. THANK
YOU. THANK YOU. ANY WITNESSES IN
OPPOSITION? SEEING NONE, I'LL
BRING IT BACK TO THE COMMITTEE,
AND I'LL JUST START BY SAYING,
HUGE GRATITUDE TO THE AUTHOR FOR
BRINGING FORWARD THIS BILL. I'VE
WORKED WITH MANY YOUTH OVER
YEARS, AND ONE OF THE BIGGEST
STRUGGLES THAT THEY HAVE IS TO
CONTINUE TO HAVE, CONSISTENCY OF
CARE AS THEY GET SHUTTLED AROUND
THROUGHOUT OUR, EITHER FAMILY
REGULATION SYSTEM OR WHATEVER IS
HAPPENING WITH THEM PERSONALLY.
SO VERY THANKFUL FOR THIS BILL
AND BELIEVE THAT IT WILL PROVIDE
TREMENDOUS AMOUNT OF SUPPORT TO
MANY YOUTH IN CALIFORNIA. SO AND
THANK YOU TO OUR SPONSORS AS
WELL. WITH THAT, WE ACTUALLY DO
HAVE QUORUM NOW, SO WE WILL
FIRST SECRETARY TAKE THE ROLE,
WOULD YOU LIKE TO CLOSE FIRST
MAJORITY LEADER? I WOULD, FIRST
OF ALL, THIS IS A REALLY
IMPORTANT BILL. AND IT CAME TO
MY ATTENTION BY MY FELLOW. AND
WHEN WE WERE BEING TOLD THAT A
CHILD MOVES FROM COUNTY TO
COUNTY AND LOSES, THAT CONTINUED
THE CONTINUED SUPPORT THAT THEY
NEED, I THOUGHT I WAS SHOCKED
THAT HOW MUCH TIME IT TAKES AND
HOW SOMEONE COULD FALL THROUGH
THE CRACKS. SO I'M HONORED TODAY
TO PRESENT THIS BILL TO YOU. YOU
KNOW, IT TAKES IT'S AN IMPORTANT
FIRST STEP FOR MAINTAINING
CONTINUITY OF CARE FOR OUR MOST
VULNERABLE YOUTH, AND HELPS
RELIEVE BURDENS ON FAMILIES AND
CAREGIVERS. AND I HOPE YOU WILL
ALL SUPPORT THIS BILL. IT'S A
IT'S NOT ONLY IS IT PERSONAL,
IT'S JUST IT'S THE RIGHT THING
TO DO. SO THANK YOU VERY MUCH.
THANK YOU. WITH THAT TO
ESTABLISH QUORUM SECRETARY, CAN
YOU CALL THE ROLL BONTA HERE TO
PRESENT WALDEN. WALDEN PRESENT.
AGAR. CURRY AGAR. CURRY.
PRESENT. ARAMBULA WENDY.
CARILLO. LARA. HANEY ANY
PRESENT. JONES. SAWYER. PRESENT.
JOHN. SAWYER. PRESENT MAIN.
SHINE. MAINE. SHINE. PRESENT.
MCCARTY. JO. PATTERSON
RODRIGUEZ. RODRIGUEZ. PRESENT.
SANCHEZ SANCHEZ. PRESENT.
SANTIAGO SANTIAGO. PRESENT
WEBBER. WE HAVE ESTABLISHED
QUORUM. SO THIS IS ITEM 11. AB
2237. DO I HAVE A MOTION? THE
MOTION WOULD BE DO PASS, AS
AMENDED TO HUMAN SERVICES. SO
SECOND, I THINK I HEARD MR.
RODRIGUEZ AND MISS SANCHEZ
SECONDED A SECRETARY. PLEASE
CALL THE ROLL. AYE. BONTA. AYE.
WALDEN WALDEN. AYE.
AGUIAR-CURRY. AGAR. CURRY. AYE.
ARAMBULA WENDY. CARILLO. LARA.
HANEY HANEY. AYE. JOHN. SAWYER.
AYE. JOHN. SAWYER. AYE.
MAIENSCHEIN MAIENSCHEIN. AYE.
MCCARTY. JO. PATTERSON.
RODRIGUEZ RODRIGUEZ. AYE.
SANCHEZ SANCHEZ. AYE. SANTIAGO.
SANTIAGO. AYE. CHAVO WEBBER. 9
TO 0. THAT MOTION PASSES. BILL
IS OUT. THANK YOU VERY MUCH.
THANK YOU. WE ARE GOING TO NOW
MOVE FORWARD WITH VOTING ON THE
BILLS THAT WE HAVE ALREADY HEARD
SINCE WE HAVE QUORUM. AND THEN
WE'LL MOVE BACK TO HEARING
ADDITIONAL BILLS. SO WITH THAT
WE WILL START WITH OUR CONSENT
CALENDAR. MOTIONED BY WALDRON.
SECONDED BY RODRIGUEZ. PLEASE
CALL THE ROLL. BONTA I BONTA I
WALDRON. WALDEN I AGUIAR-CURRY
AGUIAR-CURRY I ARAMBULA WENDY
CARILLO LARA HANEY. HANEY I
JONES. SAWYER I JONES. SAWYER I
MAINCHAIN MAINCHAIN I MCCARTY.
JOE PATTERSON. RODRIGUEZ.
RODRIGUEZ I SANCHEZ. SANCHEZ I
SANTIAGO. SANTIAGO I CHAVO
WEBBER 9090. THE CONSENT
CALENDAR IS OUT. WE'LL MOVE NOW
TO ITEM NUMBER TWO AB 1970.
THAT'S Dð PASSED AS AMENDS,
SECOND MOTION BY AGUIAR-CURRY,
SECONDED BY JOHN SAWYER. PLEASE
CALL ROLL. IT'S DUE. PASS TO
APPROPRIATIONS. BONTA I BONTA I
WALDRON. TO WALDEN, I
AGUIAR-CURRY AGUIAR-CURRY I
ARAMBULA WENDY CARILLO LARA.
HANEY. HANEY I JONES. SAWYER I
JOHN SAWYER I MAINCHAIN
MAINCHAIN I MCCARTY. MCCARTY. I
JOE. PATTERSON. RODRIGUEZ
RODRIGUEZ I SANCHEZ. SANCHEZ NOT
VOTING. SANTIAGO SANTIAGO I
CHAVO WEBBER NINE ZERO. THAT
MEASURES OUT NINE ZERO. WE'LL
MOVE ON TO ITEM NUMBER THREE AB
1977 TO MOTION IS Dð PASS TO
APPROPRIATIONS MOVED BY
AGUIAR-CURRY, SECONDED BY
SANCHEZ. CALL THE ROLL. BONTA I
MONTA I WALDEN. WALDEN I
AGUIAR-CURRY AGUIAR-CURRY I
ARAMBULA WENDY CARILLO. FLORA.
HANEY. HANEY I. JONES. SAWYER I
JONES. SAWYER I MAIENSCHEIN
MAIENSCHEIN I MCCARTY. MCCARTY I
JOE PATTERSON. RODRIGUEZ.
RODRIGUEZ I SANCHEZ. SANCHEZ I
SANTIAGO. SANTIAGO I SCHIAVO.
WEBBER THAT MOTION. THAT MEASURE
CARRIES TEN ZERO. IT'S OUT. ITEM
NUMBER TEN AB 2169. THE MOTION
WOULD BE Dð. PASS TO
APPROPRIATIONS BY AGUILAR CURRY,
SECONDED BY WALDEN. CALL THE
ROLL, PLEASE. BONTA I BONTA I
WALDEN. WALDEN I AGUIAR-CURRY
AGUIAR-CURRY I ARAMBULA WENDY
CARILLO. LARA HANEY. HANEY I.
JONES. SAWYER I JONES. SAWYER I
MAIENSCHEIN. MAIENSCHEIN I
MCCARTY. MCCARTY I JOE.
PATTERSON. RODRIGUEZ. RODRIGUEZ
I SANCHEZ. SANCHEZ. NOT VOTING.
SANTIAGO SANTIAGO I SCHIAVO.
WEBBER NINE ZERO. THAT MEASURES
OUT NINE ZERO. ITEM NUMBER 12 AB
2258. MOTION IS Dð PASS TO
APPROPRIATIONS BY WALDEN.
SECONDED BY AGUIAR-CURRY. PLEASE
CALL THE ROLL. BONTA I BONTA I
WALDEN. WALDEN I AGUIAR-CURRY
AGUIAR-CURRY I ARAMBULA WENDY
CARILLO. FLORA HANEY. HANEY I
JONES. SAWYER I JONES. SAWYER I
MAINCHAIN MAINCHAIN I MCCARTY.
MCCARTY I JOE. PATTERSON.
RODRIGUEZ RODRIGUEZ I SANCHEZ.
SANCHEZ. NOT VOTING SANTIAGO.
SANTIAGO I CHAVO WEBBER NINE
ZERO. THAT MEASURE PASSES NINE
ZERO. WE'LL MOVE ON TO ITEM 13
AB 2297. FRIEDMAN MOTION. IT
WOULD BE Dð PASS AS AMENDED TO
JUDICIARY, BUT MOVED BY
AGUIAR-CURRY. CAN I HAVE A
SECOND? SECOND BY JOHN SAWYER,
PLEASE CALL THE ROLL BONTA. I
AYE WALDEN WALDEN I AGAR CURRY
AGAR CURRY I ARAMBULA WENDY
CARILLO. FLORA HANEY. HANEY I
JONES. SAWYER. AYE. JOAN SAWYER.
AYE. MAIN SHANE. MAIN SHRINE I
MCCARTY. MCCARTY. I JOE.
PATTERSON RODRIGUEZ. RODRIGUEZ.
I SANCHEZ. SANCHEZ NO. SANTIAGO.
SANTIAGO. I CHAVO WEBBER 9191.
THAT MOTIONS OUT. THAT MEASURES
OUT. WE'LL MOVE ON TO 18 AB 2428
DO PASS TO APPROPRIATIONS. AND I
ENTERTAIN A MOTION BY
AGUIAR-CURRY, SECONDED BY.
HANEY, PLEASE MOVE FORWARD WITH
THE ROLL. BONTA I BONTA I WALDEN
WALDEN I AGUIAR-CURRY
AGUIAR-CURRY I ARAMBULA WENDY
CARILLO FLORA HANEY. HANEY I
JOHN SAWYER I JOHN SAWYER I MAIN
SEAN MAIN SHRINE I MCCARTY.
MCCARTY I JOE PATTERSON.
RODRIGUEZ. RODRIGUEZ I SANCHEZ.
SANCHEZ I SANTIAGO. SANTIAGO I
CHAVO WEBBER I ZERO TEN ZERO
THAT MOTION THAT MEASURES OUT.
ITEM NUMBER 20 AB 2550 MOTION IS
Dð PASS TO BUSINESS AND
PROFESSIONS. AGUIAR-CURRY MOVED.
SANCHEZ SECONDS. PLEASE CALL THE
ROLL. BONTA. AYE. BONTA AYE.
WALDEN. WALDEN. AYE.
AGUIAR-CURRY. AGAR. CURRY AYE.
ARAMBULA. WENDY. CARILLO. LARA.
HANEY HANEY. AYE. JONES. SAWYER.
AYE. JONES. SAWYER. AYE.
MAIENSCHEIN MAIENSCHEIN. AYE.
MCCARTY. MCCARTY. IJO. PATTERSON
RODRIGUEZ. RODRIGUEZ. AYE.
SANCHEZ. SANCHEZ. AYE SANTIAGO.
SANTIAGO. AYE. SABO. WEBBER TEN
ZERO TEN ZERO. THAT MEASURES
OUT. ITEM NUMBER 22 AB 2700.
GABRIEL, THE MOTION IS Dð PASS
AS AMENDS TO EMERGENCY
MANAGEMENT. I HAVE A MOTION
AGUIAR-CURRY SECONDED BY
RODRIGUEZ. PLEASE CALL THE ROLL.
BONTA. HI, BONTA. AYE. WALDEN.
WALDEN AYE. AGUIAR-CURRY.
AGUIAR-CURRY. AYE. ARAMBULA
WENDY. CARILLO. LARA HANEY.
HANEY. AYE. JONES. SAWYER. AYE.
JONES. SAWYER AYE. MAIENSCHEIN.
MAIENSCHEIN. AYE. MCCARTY.
MCCARTY. IJO PATTERSON.
RODRIGUEZ. RODRIGUEZ. AYE.
SANCHEZ SANCHEZ. AYE. SANTIAGO.
SANTIAGO. AYE WEBBER. TEN ZERO.
THAT MEASURES OUT. AB 2701. ITEM
NUMBER 23 VIA MOTION IS Dð. PASS
TO APPROPRIATIONS. ÓRDENES IS
THERE A MOTION? AGUIAR-CURRY
SECONDED BY HANEY. PLEASE CALL
THE ROLL. BONTA. AYE. BONTA.
AYE. WALDEN. WALDEN AYE.
AGUIAR-CURRY. AGUIAR-CURRY. AYE.
ARAMBULA WENDY. CARILLO. LARA.
HANEY HANEY. AYE. JONES. SAWYER
A. DOAN. SAWYER. AYE.
MAIENSCHEIN MAIENSCHEIN. AYE.
MCCARTY. MCCARTY. AYE. JOE.
PATTERSON RODRIGUEZ. RODRIGUEZ.
AYE SANCHEZ. SANCHEZ. AYE.
SANTIAGO. SANTIAGO AYE. WEBBER
WEBBER. AYE. 11 ZERO. MOTION
THAT MEASURES OUT 11 ZERO. ITEM
NUMBER 24, AB 2749, WOULD DO
PASS AS AMENDED, TO
APPROPRIATIONS. AGUILAR MOVES
AGUIAR-CURRY MOVES, SECONDED BY
SECOND JONES. SAWYER, PLEASE
CALL THE ROLL. AYE, AYE. WALDEN.
WALDEN AYE. AGUIAR-CURRY.
AGUIAR-CURRY. AYE. ARAMBULA.
WENDY. CARILLO FLORA. HANEY.
HANEY. AYE. JONES. SAWYER. AYE
JOHN. SAWYER. AYE. MAIENSCHEIN.
MAIENSCHEIN. AYE. MCCARTY
MCCARTY. AYE. JOE. PATTERSON.
RODRIGUEZ RODRIGUEZ. AYE.
SANCHEZ. SANCHEZ. NOT VOTING.
SANTIAGO. SANTIAGO. AYE. VO
WEBBER. WEBER. AYE. SENSOR THAT
MEASURES OUT TEN ZERO. ITEM
NUMBER 26 AB 2899. GABRIEL THE
MOTION IS TO PASS, AS AMENDED,
TO APPROPRIATIONS. CAN I HAVE A
MOTION? ITEM NUMBER 26. OH MOVED
BY AGUIAR-CURRY. THANK YOU,
DOCTOR WEBER. SECONDED PLEASE
CALL THE ROLL. I WANT TO. AYE.
WALDEN. WALDEN. NOT VOTING.
EDGAR CURRIE. EDGAR. CURRIE.
AYE. ARAMBULA. WENDY. CARILLO.
FLORA HANEY. HANEY. AYE. JOHN.
SAWYER. AYE JOHN. SAWYER. AYE.
MAIENSCHEIN. MAIENSCHEIN. AYE.
MCCARTY MCCARTY. SAID AYE.
MCCARTY. AYE. JOE PATTERSON.
BEALL. HOLT PHÐ. PATTERSON. AYE.
RODRIGUEZ. RODRIGUEZ. AYE.
SANCHEZ SANCHEZ. NOT VOTING.
SANTIAGO SANTIAGO. AYE. SCHIAVO.
WEBBER WEBBER. AYE. LIKE. OOPS
YES. MAYBE 28. 99. TÍNH TEN
ZERO. THAT MEASURES OUT TEN
ZERO. WE WILL MOVE ON THIS BILL.
YES VOTE CHANGE. SANCHEZ TO
SUPPORT SANCHEZ FROM NOT VOTING
TO AYE. THAT'S 11 TO 0. THAT'S
11 ZERO. THAT MEASURES OUT. WE
WILL MOVE TO ITEM NUMBER 28 AB
3030. DO PASS AS AMENDED TO
PRIVACY AND CONSUMER PROTECTION.
MOVED BY AGUIAR-CURRY. SECONDED
BY WALDEN. PLEASE CALL THE ROLL.
BONTA AYE. BONTA. AYE. WALDRON.
WALDEN. AYE. AGUIAR-CURRY IGER.
CURRIE. AYE. ARAMBULA. WENDY.
CARILLO. LARA HANEY. HANEY. AYE.
JONES. SAWYER AYE. JOHN. SAWYER.
AYE. MAIENSCHEIN. MAIENSCHEIN.
AYE. MCCARTY MCCARTY. AYE. JOE.
PATTERSON. JO. PATTERSON. AYE.
RODRIGUEZ RODRIGUEZ. AYE.
SANCHEZ. SANCHEZ. AYE. SANTIAGO
SANTIAGO. AYE. CHAVO. WEBBER.
WEBER. AYE. ARAMBULA ARAMBULA.
AYE. QUINTERO. THAT HAS 13 ZERO.
THAT MEASURES OUT AS WELL. ITEM
NUMBER 29, AB 3129. WOULD. THIS
IS Dð PASS AS AMENDED TO
JUDICIARY. AND JUST TO NOTE
THIS, DO I HAVE A MOTION MOVED
BY AGUIAR-CURRY, SECONDED BY
ARAMBULA. PLEASE CALL THE ROLL.
BONTA I BONTA. AYE. WALDRON.
WALDEN. NÓ EDGAR. CURRY. EDGAR.
CURRY. AYE. ARAMBULA. ARAMBULA
AYE. WENDY. CARILLO. LARA. HANEY
HANEY. AYE. JOHN. SAWYER. AYE.
JOHN. SAWYER. AYE. MAIENSCHEIN
MAIENSCHEIN. AYE. MCCARTY.
MCCARTY. IJO. PATTERSON JO.
PATTERSON. NÓ. RODRIGUEZ
RODRIGUEZ. AYE. SANCHEZ.
SANCHEZ. NÓ. SANTIAGO SANTIAGO.
NØ. SCHIAVO. WEBBER WEBBER. AYE.
THAT MEASURES OUT 10 TO 3. WE'LL
MOVE ON TO, ITEM NUMBER 31, AB
3218. THE MOTION IS Dð PASS TO
JUDICIARY. DOCTOR WOULD YOU HAVE
A MOTION MOVED BY AGUIAR-CURRY,
SECONDED BY DOCTOR WEBER, PLEASE
CALL THE ROLL. BONTA I WANT TO.
AYE. WALDRON. WALDEN. NOT VOTING
. AGUIAR-CURRY. AGUIAR-CURRY.
AYE. ARAMBULA ARAMBULA. AYE.
WENDY. CARILLO LARA. HANEY
HANEY. AYE. JOHN. SAWYER. AYE.
JOHN. SAWYER. AYE. MAIENSCHEIN
MAIENSCHEIN. AYE. MCCARTY.
MCCARTY. IJO. PATTERSON JO.
PATTERSON. NOT VOTING. RODRIGUEZ
RODRIGUEZ. AYE. SANCHEZ SANCHEZ.
NOT VOTING. SANTIAGO. SANTIAGO.
AYE SABO. WEBER. WEBER. AYE AND
AS A POINT OF PERSONAL
PRIVILEGE, I WOULD LIKE TO NOTE
THAT AB 3218 BY DOCTOR WOOD
MARKS LIKELY THE LAST MEASURE
THAT HE WILL BRING BEFORE THE
ASSEMBLY. HEALTH COMMITTEE, A
COMMITTEE THAT HE SHEPHERDED AND
STEWARDED AS A LEADER FOR NINE
YEARS. AND WE'RE INCREDIBLY
THANKFUL TO DOCTOR WOOD FOR HIS
SERVICE OVER TIME AND, AND
CERTAINLY UNFLAVORED TOBACCO
LIST. BILL AB 3218 WILL GO DOWN
AS A POINT IN OUR HISTORY. THANK
YOU SO MUCH THAT, MEASURE IS OUT
10 TO 0. DOCTOR WOOD. WE WILL
NOW RESUME WITH OUR, BILLS ON
FILE. MOVING TO DOCTOR WEBER.
SHE'S READY. ITEM NUMBER SIX, AB
2058.
GOOD AFTERNOON. CHAIR AND
MEMBERS. I'M HERE TO PRESENT AB
2058, A BILL ON MEDICAL DEVICES.
AS MEDICAL DEVICES ARE THE
TECHNOLOGIES THAT DIAGNOSE,
TREAT, AND IMPROVE A PERSON'S
HEALTH AND WELL-BEING AND
INCLUDE BOTH LOW AND HIGH RISK
MEDICAL DEVICES. THESE PRODUCTS
MAY VARY FROM TONGUE DEPRESSORS,
BEDPANS, MEDICAL THERMOMETERS,
TO INSULIN PUMPS AND COMPLEX
PACEMAKERS. AS A PHYSICIAN, I
UNDERSTAND THE IMPORTANCE OF
THESE ADVANCEMENTS IN SCIENCE
AND TECHNOLOGY. ADVANCEMENTS IN
THIS MEDICAL TECHNOLOGY HAVE
RESULTED IN SIGNIFICANT POSITIVE
IMPACTS FOR PATIENTS AND THE
HEALTH CARE INDUSTRY AS A WHOLE.
IT HAS INCREASED LIFE EXPECTANCY
FOR AMERICANS BY FIVE YEARS AND
REDUCE THE DURATION OF HOSPITAL
STAYS BY 38% FROM TEN DAYS TO
6.2 DAYS. STILL, THESE
TECHNOLOGIES AND DEVICES ARE NOT
WITHOUT FLAW. THE FINAL
CALIFORNIA REPARATIONS TASK
FORCE RELEASED IN JUNE,
HIGHLIGHTED THE DISPARITIES THAT
EXIST WITHIN THE USE OF THESE
MEDICAL DEVICES. BUT THIS
DISPARITY HAS ALSO BEEN
HIGHLIGHTED IN STUDIES AND OTHER
REPORTS IN A VARIETY OF MEDICAL
AND NON-MEDICAL PUBLICATIONS FOR
OVER A DECADES, AND HAVE
SIGNIFICANTLY INCREASED SINCE
THE COVID 19 PANDEMIC. LET'S
TAKE THE PULSE OXIMETER OXIMETER
, FOR EXAMPLE. THIS DEVICE THIS
IS A DEVICE THAT WE HAD THAT WE
USE TO DETERMINE THE OXYGEN
LEVEL AND PATIENTS SINCE 1974,
THIS FDA APPROVED DEVICE IS AS
COMMON IN THE HEALTH CARE
SETTING AS A BLOOD PRESSURE CUFF
. HOWEVER, STUDIES SINCE ITS
EARLY AS 1976, BEFORE I WAS EVEN
BORN, HAVE DEMONSTRATED THAT IT
IS LESS ACCURATE AMONG PATIENTS
WITH DARKER SKIN AND THEREFORE
RESULT IN ADVERSE HEALTH
OUTCOMES FOR THOSE PATIENTS.
MANY CLINICAL STUDIES IN ADULTS
AND CHILDREN HAVE SHOWN A CLEAR
DIFFERENCE IN PULSE OX READINGS
VERSUS THE ACTUAL BLOOD
SATURATION LEVELS. GENERALLY
SHOWING FALSELY HIGHER READINGS
IN PEOPLE OF RACIAL AND ETHNIC
MINORITIES. IN FACT, A
RETROSPECTIVE STUDY PUBLISHED IN
JAMA OF JULY OF 22 CONFIRMED
THAT ASIAN, BLACK AND HISPANIC
PATIENTS WERE LESS LIKELY TO
RECEIVE THE SUPPLEMENTAL OXYGEN
THAT THEY NEEDED BECAUSE OF
THEIR FALSELY ELEVATED PULSE OX
RATINGS. THIS RESULTED IN
INCREASED MORBIDITY, AND THIS IS
BECAUSE WE IN THE MEDICAL
PROFESSION UTILIZE THESE MEDICAL
DEVICES TO CREATE MEDICAL
ALGORITHMS FOR TREATMENT AND
MANAGEMENT OF PATIENTS. SO, FOR
EXAMPLE, IF A INSTITUTION
DETERMINES THAT YOUR OXYGEN
SATURATION IS LESS THAN 92, THEN
THEY DEVELOP AN ALGORITHM THAT
STATES THAT YOU SHOULD START ON
SUPPLEMENTAL OXYGEN. BUT IF THE
DEVICE THAT IS BEING USED TO
TEST YOUR OXYGEN LEVEL GIVES YOU
A FALSELY ELEVATED READING OF
95, BUT IN ACTUALITY, YOU'RE 90,
THEN YOU'RE NOT RECEIVING THE
TREATMENT AND THE CARE THAT YOU
SHOULD. AND UNFORTUNATELY, THE
PULSE OX MONITOR IS NOT THE ONLY
DEVICE THAT HAS BEEN SHOWN TO
NOT BE EFFECTIVE IN PERSONS OF
COLOR. A RECENT STUDY BY EMORY
UNIVERSITY FOUND THAT FOREHEAD
THERMOMETERS WERE SIGNIFICANTLY
LESS ACCURATE, 26% LOWER THAN
ORAL THERMOMETERS. IN DETECTING
FEVERS FOR BLACK PATIENTS, AND
HOW MANY OF US NOW GO AND SEE
OUR DOCTOR TO THE HOSPITAL AND
HAVE OUR TEMPERATURES TAKEN ON
OUR FOREHEAD AND NO LONGER
ORALLY SEE THESE TYPES OF
INACCURACIES CAN LEAD TO DELAYS
IN DIAGNOSIS OR DRUG
ADMINISTRATION, AND COULD
POSSIBLY HAVE FATAL
IMPLICATIONS. DISPARITY IN
EFFECTIVENESS HAS MANY TIMES
BEEN ATTRIBUTED TO THE LACK OF
TESTING ON DIVERSE POPULATIONS
BEFORE A DEVICE IS PLACED ON THE
MARKET. IN DECEMBER OF 2022,
PRESIDENT BIDEN SIGNED INTO LAW
THE CONSOLIDATED APPROPRIATIONS
ACT OF 2023, WHICH INCLUDED
REQUIREMENT THAT CLINICAL TRIAL
SPONSORS SUBMIT TO THE SECRETARY
OF THE US DEPARTMENT OF HEALTH
AND HUMAN SERVICES A, QUOTE,
DIVERSE ACTION PLAN FOR MOST
MEDICAL DEVICE STUDIES, BUT
STILL MORE MUST BE. DONE NOW. AB
2058 REQUIRES A MEDICAL DEVICE
MANUFACTURER TO INCLUDE A
DISCLOSURE ON THE DEVICE OR ITS
PACKAGED MATERIAL ON THE KNOWN
LIMITATIONS ON THE EFFECTIVENESS
OF THE DEVICE DUE TO CERTAIN
CHARACTERISTICS OF THE PATIENT,
INCLUDING, BUT NOT LIMITED TO
AGE, COLOR, GENDER, OR RACE.
WHILE THERE ARE FEDERAL EFFORTS
TO ADDRESS DIVERSITY IN THE
DEVELOPMENT OF DEVICES,
CONSUMERS, INCLUDING PHYSICIANS
AND HEALTH CARE FACILITIES STILL
NEED TO BE INFORMED OF POTENTIAL
LIMITATIONS OF MEDICAL DEVICES
THAT MAY ARISE. EVEN IF YOU DO
HAVE DIVERSE CLINICAL TRIALS.
AND WITH THAT, I THANK YOU AND
RESPECTFULLY ASK FOR YOUR AYE
VOTE ON AB 2058. MOVE THE BILL
MOVED BY AGUIAR-CURRY, SECONDED
BY VÌ ARAMBULA, THANK YOU, ARE
THERE ANY WITNESSES, OTHER
WITNESSES IN SUPPORT? ANY
WITNESSES IN OPPOSITION? MADAM
CHAIR, MEMBERS JOHN WINGER, ON
BEHALF OF THE ADVANCED MEDICAL
TECHNOLOGY ASSOCIATION, WHERE
THE NATIONAL TRADE ASSOCIATION
FOR MEDICAL DEVICE INDUSTRY,
DON'T HAVE A FORMAL POSITION
RIGHT NOW. WANT TO THANK THE
AUTHOR FOR THE CONTINUED
CONVERSATIONS WE'VE BEEN
DISCUSSING A LOT AROUND THIS
ISSUE AND TRYING TO KIND OF
FIGURE OUT WHAT THE RIGHT
STRUCTURE WOULD, WOULD BE. I
THINK UNDER THE CURRENT
STRUCTURE OF THE BILL, WE DO
HAVE QUITE A FEW CONCERNS, BOTH
AROUND AROUND COST GOING THROUGH
THE FDA PROCESS FOR CHANGING
EVEN LABELING CAN HAVE PRETTY
SIGNIFICANT COSTS. WE ALSO HAVE
SOME CONCERNS AROUND THE
LIABILITY IF THERE IS SOME SORT
OF, IF THERE IS SOME
DETERMINATION LATER ON THAT THE
DEVICE HAS SOME SORT OF, FAULT,
THEN THE LIABILITY THAT GETS
PLACED ON THE MANUFACTURER. WE
HAVE SOME CONCERNS AROUND THAT,
WE ALSO HAVE A FEW CONCERNS
AROUND JUST POTENTIAL UNINTENDED
CONSEQUENCES OF ADDING
DISCLAIMERS AND HAVING
CONTRAINDICATIONS, JUST TO
LEGALLY PROTECT YOURSELF. BUT
THEN THERE CAN BE SOME
UNINTENDED CONSEQUENCES THERE
THAT LIMIT THE USE OF PRODUCTS
IN THE FUTURE. AND WE'VE
ACTUALLY HAD A COUPLE INSTANCES
LIKE THAT WITH THE FDA. AND WE
CAN WE CAN TALK THROUGH KIND OF
THOSE ISSUES AT A LATER DATE,
BUT CURRENTLY DO HAVE SOME
PRETTY SIGNIFICANT CONCERNS WITH
THE STRUCTURE OF THE BILL, BUT
LOOK FORWARD TO CONTINUING THE
CONVERSATIONS. THANK YOU. THANK
YOU MADAM. MADAM CHAIR MEMBERS,
DAVID GONZALEZ, ON BEHALF OF THE
CALIFORNIA LIFE SCIENCES, I'D
LIKE TO ASSOCIATE OURSELVES WITH
THE COMMENTS OF MR. WENGER, WANT
TO CONTINUE TO WORK WITH, DOCTOR
WEBER ON THIS IMPORTANT ISSUE. I
WANT TO THANK HER FOR HER KIND
COMMENTS ABOUT THE INDUSTRY AT
THE BEGINNING OF HER OPENING. SO
THANK YOU. AND WE LOOK FORWARD
TO THE CONTINUED CONVERSATIONS.
DOCTOR WEBER, WOULD YOU I'LL
BRING IT BACK TO THE COMMITTEE
NOW FOR ANY COMMENT, DOCTOR, I
WANT TO NOTE THAT THIS IS A PART
OF, AS YOU HIGHLIGHTED, A PART
OF THE CALIFORNIA REPARATIONS
TASK FORCE REPORT FINDINGS. AND
I'M THANKFUL THAT WE HAVE AN
OPPORTUNITY TO ADDRESS THE
INADEQUACY CURRENTLY OF MEDICAL
DEVICES FOR PATIENTS WITH DARKER
SKIN, DARKER MELANIN AND, AND WE
KNOW THAT THAT INABILITY WILL
INCREASE ADVERSE HEALTH OUTCOMES
FOR PATIENTS. RIGHT NOW. SO, WE
APPRECIATE THAT YOU ARE MOVING
FORWARD WITH THIS BILL. AND,
WE'LL CONTINUE TO WORK WITH THE
OPPOSITION, AS STATED, TO FIGURE
OUT A GOOD PLACE FOR THE BILL TO
LAND. ULTIMATELY, WITH THAT,
PLEASE CLOSE. WELL, I WANT TO
THANK THE COMMITTEE STAFF, FOR
THE AMAZING ANALYSIS OF THIS
BILL. AND, YOU KNOW, THIS IS ONE
OF THE THINGS THAT CAME OUT OF
THE CALIFORNIA REPARATIONS TASK
FORCE. BUT AS STATED IN MY
OPENING STATEMENT, THIS IS NOT
SOMETHING THAT JUST IMPACTS
BLACK AMERICANS. IT HAS BEEN
SHOWN TO NEGATIVELY DIS,
DISPROPORTIONATE IMPACT. ASIANS,
HISPANICS, YOU KNOW, ANYONE WITH
MELANATED COLOR AND THE ISSUE IS
THAT AS WE MOVE INTO MORE INTO A
SOCIETY THAT RELIES MORE ON
THESE DEVICES, AND WE CREATE
ALGORITHMS ON HOW WE'RE GOING TO
TREAT PATIENTS BASED ON THEM, IF
IT'S FLAWED FROM THE BEGINNING,
THEN EVERYTHING DOWNSTREAM WILL
BE FLAWED. SO WE'LL CONTINUE TO
WORK WITH THE OPPOSITION VERY
MUCH LOOKING FORWARD TO GETTING
ACTUAL LANGUAGE THAT THAT WOULD
MAKE THEM COMFORTABLE. BUT AT
THE END OF THE DAY, WE CANNOT
ALLOW OUR OPENNESS, AND THE NEED
FOR, FOR BETTER TECHNOLOGY IN
THE FUTURE TO CONTINUE TO ALLOW
FOR THESE MEDICAL DISPARITIES TO
EXIST HERE IN OUR, IN OUR
COUNTRY. SO WITH THAT, I
RESPECTFULLY ASK FOR YOUR AYE
VOTE ON AB 2058. THANK YOU.
THANK YOU DOCTOR WEBER, DO I
HAVE A MOTION? OH WE DO. OKAY.
THE MOTION IS DUE. PASS TO
APPROPRIATIONS. PLEASE CALL THE
ROLL. AYE. BONTA. AYE. WALDEN
AGAR. CURRY AGAR. CURRY. AYE.
ARAMBULA ARAMBULA. AYE. NGUYEN
DE CARILLO. FLORA. HEANEY HANEY
I JONES. SAWYER A JONES. SAWYER.
AYE. MAIENSCHEIN MAIENSCHEIN.
AYE. MCCARTY. MCCARTY. AYE. JO.
PATTERSON JO. PATTERSON. AYE.
RODRIGUEZ. RODRIGUEZ AYE.
SANCHEZ. SANCHEZ. NOT VOTING.
SANTIAGO SANTIAGO. AYE. CHAVO
WEBER. WEBER. AYE. THAT MEASURES
OUT 11 TO 0, WE HAVE ONE AUTHOR
WHO IS NOT A COMMITTEE MEMBER,
SO WE ARE GOING TO GIVE THEM
TIME TO WORK THEIR WAY, THEIR
WAY OVER FROM ANOTHER COMMITTEE
THAT THEY ARE ON. SO WE'LL MOVE
FORWARD WITH A B 2365 HANEY,
ITEM NUMBER 15.
THANK YOU, MADAM CHAIR, I'LL
KEEP THIS RELATIVELY SHORT AND
SWEET. THIS BILL HAS NO
OPPOSITION AND A LOT OF SUPPORT,
IT WILL BRING CALIFORNIA
CONSUMERS, BUT WILL PROTECT
CALIFORNIA CONSUMERS BY
ESTABLISHING HEALTH AND SAFETY
REGULATIONS FOR KRATOM PRODUCTS
SOLD IN THE STATE. KRATOM. IF
YOU'RE NOT FAMILIAR WITH IT, IS
A TREE IN THE COFFEE FAMILY
NATIVE TO SOUTHEAST ASIA. IN LOW
DOSES, KRATOM PRODUCES A
BENEFICIAL STIMULANT EFFECT LIKE
INCREASED ENERGY, ALERTNESS,
CONCENTRATION, PHYSICAL ENERGY,
AND PRODUCTIVITY. BUT IN HIGH
DOSES, KRATOM CAUSES A SEDATIVE
EFFECT AND OTHER NEGATIVE
SYMPTOMS LIKE NAUSEA, INCREASED
HEART RATE, INSOMNIA, AND SOME
PSYCHOTIC SYMPTOMS LIKE
HALLUCINATIONS AND CONFUSION.
ADDITIONALLY, CONSISTENT KRATOM
USE CAN LEAD TO DEPENDENCY, AND
SOME PEOPLE DO USE KRATOM AS A
LESS DANGEROUS REPLACEMENT FOR
OPIOIDS AND OPIOID USE DISORDER.
IN THE ABSENCE OF FEDERAL ACTION
, MANY STATES HAVE DECIDED TO
REGULATE KRATOM SO THAT ONLY
SAFE AND UNADULTERATED PRODUCTS
ARE BEING SOLD TO CONSUMERS.
HOWEVER, NEARLY 25% OF ALL
KRATOM SALES IN THE UNITED
STATES ARE IN CALIFORNIA, AND
WITH THE INCREASED DEMAND FOR
KRATOM PRODUCTS AND A LACK OF
REGULATIONS, SOME MANUFACTURERS
HAVE IRRESPONSIBLY CREATED
STRONGER AND MORE POTENT KRATOM
CONCENTRATES TO PUT INTO THEIR
PRODUCTS TO PREVENT ADULT,
UNADULTERATED, HIGH POTENCY
PRODUCTS FROM HURTING CALIFORNIA
CONSUMERS, AB 2365 WILL ENACT
ROBUST REGULATIONS FOR KRATOM
PRODUCTS. IT WILL ENSURE
MANUFACTURERS ARE ONLY PRODUCING
SAFE PRODUCTS AND THAT CONSUMERS
ARE ABLE TO MAINTAIN ACCESS TO
THE BENEFITS OF SAFE AND
REGULATED KRATOM, WITH ME HERE
TODAY TO TESTIFY IS DAVID
QUINTANA, ON BEHALF OF THE
GLOBAL KRATOM COALITION. AND WE
ARE HAPPY TO ALSO ANSWER ANY
TECHNICAL QUESTIONS. THANK YOU.
YOU'LL HAVE TWO MINUTES MOVED BY
RODRIGUEZ. SECONDED BY, Z Ã NØ
BY DOCTOR ARAMBULA TRYING TO CUT
YOU OFF, I KNOW, GOOD AFTERNOON,
CHAIRWOMAN, DAVID QUINTANA HERE
ON BEHALF OF THE GLOBAL KRATOM
COALITION TO SPEAK IN SUPPORT OF
AB 2365. THIS BILL BRINGS WELL
STRUCTURED COMMON SENSE
REGULATION TO THE BURGEONING
CREATIVE INDUSTRY IN CALIFORNIA.
AND IT DOES SO IN THREE WAYS.
FIRST, IT DEFINES KRATOM AND
KRATOM PRODUCTS AND ESTABLISHES
RIGOROUS PACKAGING AND LABELING
STANDARDS, WE FEEL THIS
INFORMATION IS ESSENTIAL TO
EMPOWER CONSUMERS TO MAKE SAFE
AND INFORMED DECISIONS.
SECONDLY, IT SETS AGE
RESTRICTIONS FOR PURCHASE,
LIMITING KRATOM PRODUCTS TO
ADULT, SAFEGUARDS PUBLIC HEALTH
AND PREVENTS POTENTIAL MISUSE
WITH UNDERAGE POPULATIONS.
THIRD, IT MANDATES REGISTRATION
AND COMPLIANCE WITH TESTING
REQUIREMENTS FOR KRATOM
PROCESSORS. REGISTRATION AND
TESTING KRATOM PRODUCTS WILL
ROOT OUT THE BAD PLAYERS IN THE
INDUSTRY AND HELP ENSURE PRODUCT
SAFETY AND QUALITY, THAT WILL
REDUCE THE RISK OF EXPOSURE TO
HARMFUL CONTAMINANTS OR
ADULTERANTS THE REGULATION AND
COMPLIANCE CALLED FOR IN THIS
BILL ARE CURRENTLY NONEXISTENT
IN CALIFORNIA, BUT ARE ESSENTIAL
FOR PROTECTING CONSUMERS FROM
UNSAFE PRODUCTS WHILE HOLDING
THE INDUSTRY ACCOUNTABLE. AS 25%
OF THE KRATOM MARKET IN
CALIFORNIA, THIS BILL ENSURES
THAT OUR STATE WILL HAVE ACCESS
TO SAFE, QUALITY KRATOM PRODUCTS
, LEADING THE WAY IN PROMOTING
PUBLIC HEALTH AND SUPPORTING A
THRIVING CREATIVE INDUSTRY.
THANK YOU. ANY OTHER WITNESSES
IN SUPPORT? ANY WITNESSES IN
OPPOSITION? I'LL BRING IT BACK
TO THE COMMITTEE. ANY COMMENTS,
QUESTIONS? MR. HANEY, YOU MAY
CLOSE, THANK YOU. RESPECTFULLY
ASK FOR YOUR VOTE. THANK YOU.
THE MOTION IS DUE. PASS TO
ENVIRONMENTAL SAFETY. WE ALREADY
HAVE A MOTION. AND A SECOND.
PLEASE CALL THE ROLL. BONTA I
BONTA I WALDRON AGUIAR-CURRY
AGUIAR-CURRY I ARAMBULA ARAMBULA
I WENDY CARILLO WENDY CARILLO I
FLORA HANEY HANEY I JONES-SAWYER
I DON'T SAWYER I MAIENSCHEIN
MAIENSCHEIN I MCCARTY MCCARTY I
JOE PATTERSON JOE PATTERSON I
RODRIGUEZ. RODRIGUEZ I SANCHEZ.
SANCHEZ. NOT VOTING SANTIAGO.
SANTIAGO I CHAVO WEBBER. WEBER I
. SIERRA THAT MEASURES OUT 12 TO
0. WE'RE GOING TO MOVE ON NOW TO
DOCTOR ARAMBULA. HE HAS THREE
BILLS. OH FOUR. WE MAY DOCTOR
ARAMBULA TAKE A YEAH WE MAY.
DOCTOR ARAMBULA TAKE AN
INSTRUMENTAL BREAK. SO TO SPEAK.
IF OUR NON COMMITTEE AUTHOR,
APPROACHES, WE WILL START WITH
ITEM NUMBER SEVEN AB 2110, MOVED
BY SANTIAGO, SECONDED BY
RODRIGUEZ. PLEASE GO AHEAD WHEN
YOU'RE VERY READY. DOCTOR
ARAMBULA.
THANK YOU, MADAM CHAIR AND
MEMBERS. I WANT TO START BY
THANKING THE COMMITTEE FOR THEIR
DILIGENT WORK ON THIS BILL. I
ACKNOWLEDGE THE CONCERNS THAT
THE COMMITTEE HAS LAID OUT IN
THEIR ANALYSIS, AND AM COMMITTED
TO ENGAGING WITH THE DEPARTMENT
OF HEALTH CARE SERVICES AND
OTHER STAKEHOLDERS AS THIS BILL
MOVES FORWARD. ALL CALIFORNIANS
SHOULD HAVE ACCESS TO TRAUMA
INFORMED SCREENINGS BY HEALTH
CARE PROVIDERS THAT THEY TRUST
BECAUSE COMMUNITY HEALTH WORKERS
AND DOULAS ARE THE TRUSTED
PROVIDERS FOR SO MANY. AB 2110
AUTHORIZES THEM TO RECEIVE
MEDI-CAL REIMBURSEMENT FOR
CONDUCTING ACS SCREENINGS AS
ACES OR ADVERSE CHILDHOOD
EXPERIENCE. ACES ARE TRAUMATIC
CHILDHOOD EXPERIENCES LIKE
ABUSE, NEGLECT, OR EXPOSURE TO
VIOLENCE, MENTAL ILLNESS,
DIVORCE, SUBSTANCE ABUSE, OR
CRIMINAL ACTIVITY AT HOME.
INDIVIDUALS WITH MULTIPLE ACES
ARE AT RISK OF TOXIC STRESS
PHYSIOLOGY AND OFTEN FACE
SIGNIFICANTLY INCREASED RISK FOR
THE LEADING CAUSES OF DEATH AND
INCLUDING HEART DISEASE, STROKE,
CANCER, DIABETES, AND MORE.
WHILE NOT ELIGIBLE FOR MEDI-CAL
REIMBURSEMENT, COMMUNITY HEALTH
WORKERS AND DOULAS ARE UNIQUELY
POSITIONED TO CONDUCT ACES
SCREENINGS BECAUSE THEY ARE SEEN
AS HIGHLY TRUSTED PROVIDERS WHO
EMPHASIZE THE TWO GENERATION
APPROACH. THIS IS CRUCIAL
BECAUSE THE ACES CAN FOLLOW A
PATTERN OF INTERGENERATIONAL
TRAUMA, WHERE CHILDREN OR
PARENTS WITH ACES CAN BE AT
GREATER RISK THEMSELVES.
TESTIFYING IN SUPPORT OF AB 2110
IS NUALA O'LOAN GANJOO, WITH THE
FRESNO COMMUNITY HEALTH
IMPROVEMENT PROJECT AND LIBYA
ALEJO'S WITH CULTIVA LA SALUD.
PLEASE GO AHEAD. YOU'LL EACH
HAVE TWO MINUTES. GREETINGS,
COMMITTEE. MY NAME IS NOLA
LAGUNJU. I AM A CERTIFIED
COMMUNITY HEALTH WORKER WITH
FRESNO HOPE NØ, FRESNO COMMUNITY
HEALTH IMPROVEMENT PARTNERSHIP.
I AM HUMBLY REQUESTING YOUR
SUPPORT OF AB 2110. AS IT
CURRENTLY STANDS, AS WE WANT TO
ACKNOWLEDGE THE WORK OF CHW AND
DOULAS WHEN IT COMES TO ADVERSE
CHILDHOOD EXPERIENCES. BEST
KNOWN AS ACE SCREENINGS. AS MANY
PEOPLE KNOW, ACE CAN LEAD TO
TOXIC STRESS WITHIN A CHILD AS
ABUSE, NEGLECT, SUBSTANCE USE,
AND OTHER TRAUMATIC EXPERIENCES.
GROWING UP CAN ALL LEAD TO
TRAUMA THAT STAYS WITH THEM.
PAST CHILDHOOD. S¼ LIKE MYSELF
ARE OFTEN POSITIONED TO BE
PILLARS OF SUPPORT IN THE
COMMUNITY AS WE FIND OURSELVES
IN SUPPORTING FAMILIES WHOM
WHICH WE BUILD RELATIONSHIPS,
SUPPORT AND CARE. AGENCIES SUCH
AS THE BLACK WELLNESS PROSPERITY
CENTER CO-SPONSORS OF THIS BILL
ALSO AGREE WITH THIS EXTENSION
TO. THROUGH THIS, WE OFTEN
UNDERSTAND EACH OTHER AS SOME OF
THEM MAY BE FROM THE SAME
BACKGROUND, OTHERS MAY BE FROM
THE SAME NEIGHBORHOODS. CDD AND
DOULAS ARE OFTEN WITH FAMILIES
THAT FIND THEMSELVES LOOKING FOR
SUPPORT, CARE, AND
UNDERSTANDING, AS MANY WOULD
REFUTE SHARING THEIR TRAUMAS
OUTSIDE OF THEIR COMMUNITY.
BECAUSE OF THIS, E.H. AND DOULAS
ARE GIVEN THE UNIQUE EXPERIENCE
AND OPPORTUNITY TO COMPLETE ACES
SCREENINGS AND IN TURN, SUPPORT
FAMILIES WHO WOULDN'T NORMALLY
COME FORWARD EXPRESSING THEIR
NEEDS TO THEIR MEDICAL
PROVIDERS. I HOPE THIS
ENCOURAGES YOU TO SUPPORT AB
2110, AS WE WANT TO MAKE SURE
THAT DOULAS AND CHW ARE
RECOGNIZED FOR THEIR WORK IN
ACES AND THEIR COMMUNITY, AND
EXPAND CARE OPPORTUNITIES FOR
ALL IN THE NAME OF THE COMMUNITY
HEALTH CARE. BY HAVING THE
OPPORTUNITY TO RECEIVE ACES
AWARENESS TRAINING AND DOULAS
WILL BE BETTER EQUIPPED TO
SUPPORT FAMILIES AND MITIGATING
THE ADVERSE EFFECTS OF ACES,
WHICH WILL ULTIMATELY LEAD TO
BETTER HEALTH OUTCOMES FOR
CHILDREN, FAMILIES AND OUR
COMMUNITY. AS A CHW MYSELF, I
HAVE SEEN FIRSTHAND THE POSITIVE
IMPACT THAT THIS TYPE OF SUPPORT
CAN HAVE ON FAMILIES. I HOPE YOU
WILL CONSIDER SUPPORTING AB
2110, AS IT RECOGNIZES THE
IMPORTANT WORK THAT OUR C.H.W
AND DOULAS TO WORK DO IN OUR
COMMUNITIES. THANK YOU. GO. GO
AHEAD. HELLO. GOOD AFTERNOON, MY
NAME IS LÀ VALLEJO, AND I AM A
COMMUNITY HEALTH WORKER FOR LA
SALUD, AND MY ROLE AS CSB, I
HAVE DEVELOPED TRUSTING
RELATIONSHIPS WITH THE COMMUNITY
BY SPENDING TIME WITH THEM AND
ESTABLISHING REPORT. BECAUSE OF
THIS, I HAVE BECOME A TRUSTED
SOURCE OF INFORMATION AND
SUPPORT FOR THE COMMUNITY, THIS
WILL MAKE THE SCREENING MORE,
MORE COMFORTABLE FOR THE
COMMUNITY MEMBERS THAT WE SERVE.
IN MY ROLE AS A CHW, I HAVE
ESTABLISHED CONNECTIONS WITH
OTHER COMMUNITY BASED
ORGANIZATIONS TO FACILITATE,
FACILITATE, FACILITATE,
FACILITATE REFERRALS AND
COLLABORATIONS TO ENSURE OUR
PARTICIPANTS RECEIVE THE
SERVICES THEY REQUIRE AS A
C.H.W, I PROVIDE CULTURALLY
SENSITIVE CARE TO MY
PARTICIPANTS IN ORDER TO ENSURE,
AS THEY ARE COMFORTABLE AND
UNDERSTOOD, AS MANY COMMUNITIES
IN THE CENTRAL VALLEY SPEAK
MULTIPLE LANGUAGES AND DIALECTS,
LANGUAGE CAPACITY IS EXTREMELY
IMPORTANT AS A RESULT OF
EMBRACING DIVERSITY AND
ACKNOWLEDGING CULTURAL
DIFFERENCES, I HAVE CREATED A
SAFE SPACE WHERE MY PARTICIPANTS
CAN EXPRESS THEIR CONCERNS AND
EXPERIENCES. I HAVE SHARED ALSO
MY PERSONAL LIVED EXPERIENCES
SIMILAR TO THOSE TO MY
PARTICIPANTS, BRINGING UNIQUE
PERSPECTIVES, COMBINING A DEEP
UNDERSTANDING TO THE NEEDS OF
OUR COMMUNITIES, EVERYONE SHOULD
BE ABLE TO RECEIVE TRAUMA
INFORMED ACS SCREENINGS FROM
HEALTH CARE PROVIDERS THEY
TRUST. MANY COMMUNITY MEMBERS
OFTEN TURN TO C.H.W AND DOULAS
FOR THIS REASON. THIS WILL GIVE
THE COMMUNITY WE SERVE THE
OPPORTUNITY TO GET FASTER
SERVICES. REGARDING ACES, THIS
IS WHY I SUPPORT AB 2110. THANK
YOU. THANK YOU. OTHER WITNESSES
IN SUPPORT DILLONLIAM. ON BEHALF
OF THE CALIFORNIA STATE
ASSOCIATION OF PSYCHIATRISTS AND
SUPPORT. THANK YOU. LINDA HèA
WITH WESTERN CENTER ON LAW AND
POVERTY IN SUPPORT NORLIN WITH
CHILDREN NOW IN SUPPORT CATHY
MOSSBERG, LOCAL HEALTH PLANS OF
CALIFORNIA IN SUPPORT. KELLY
BROOKS, ON BEHALF OF THE COUNTY
HEALTH EXECUTIVES ASSOCIATION OF
CALIFORNIA IN SUPPORT. THANK
YOU. ANY WITNESSES IN
OPPOSITION? SEEING NONE, I'LL
BRING IT BACK TO THE COMMITTEE
FOR COMMENT OR QUESTION. I
BELIEVE WE ALREADY HAVE A MOTION
AND A SECOND, I WILL SAY I THANK
YOU, DOCTOR ARAMBULA, FOR
WORKING WITH, COMMITTEE STAFF ON
THIS ONE, WITH LISA, I KNOW THAT
THERE WAS, SOME BACK AND FORTH
JUST TO KIND OF UNDERSTAND THE
ISSUE OF RECOGNIZING THE
CRITICAL IMPORTANCE OF COMMUNITY
HEALTH WORKERS, PROMOTERS AND
REPRESENTATIVES AND ALSO
RECOGNIZING THE REQUIREMENT TO
HAVE THAT HAPPEN UNDER A
CLINICAL SETTING AND HAVE THE,
RESPECTIVE BILLING PRACTICES
MIRROR, MIRROR THAT. SO I KNOW
THAT YOU'LL KEEP ON WORKING ON
THAT ISSUE AND WITH THAT, WE ARE
RECOMMENDING, CHAIR'S
RECOMMENDATION. I PLEASE CALL
THE ROLL. OH, SORRY. THANK YOU
FOR THE OPPORTUNITY TO PRESENT.
I RESPECTFULLY ASK FOR AN AYE
VOTE. THANK YOU. BONTA I BONTA I
WALDEN WALDEN I AGAR AGAR CURRY
I ARAMBULA I ARAMBULA I WENDY
CARILLO WENDY CARILLO I FLORA
HANEY HANEY I JOAN SAWYER I JOAN
SAWYER I MAINCHAIN MAINCHAIN I
MCCARTY. MCCARTY I JO PATTERSON.
JO PATTERSON I RODRIGUEZ.
RODRIGUEZ I SANCHEZ. SANCHEZ I
SANTIAGO. SANTIAGO I WEBER.
WEBER I AND THE MOTION WAS TO
PASS TO APPROPRIATIONS. 14 ZERO
THAT MEASURES OUT AND. WE WILL
ROTATE IN YOUR NEXT SET OF
WITNESSES. DOCTOR ARAMBULA FOR
ITEM NUMBER NINE, AB 2001 61.
THANK YOU, MADAM CHAIR. AND
MEMBERS, I FIRST WANT TO THANK
THE COMMITTEE FOR YOUR WORK, AND
WE'LL BE TAKING THE COMMITTEE
AMENDMENTS TODAY. IT IS
ESSENTIAL THAT THE FIRST
EPISODE, PSYCHOSIS OR EARLY
PSYCHOSIS, BE IDENTIFIED BEFORE
INDIVIDUALS EXPERIENCE HARM,
BECAUSE THE CURRENT LANDSCAPE OF
FIRST EPISODE PSYCHOSIS
INTERVENTION IS FRAGMENTED AND
THAT THE STANDARDS OF PRACTICE
CAN VARY FROM COUNTY TO COUNTY.
AB 2161 WILL DIRECT THE MENTAL
HEALTH SERVICES OVERSIGHT AND
ACCOUNTABILITY COMMISSION TO
CREATE A STRATEGIC PLAN TO
UNDERSTAND PSYCHOSIS AND TO
DOCUMENT THE PHYSICAL IMPACT OF
UNADDRESSED PSYCHOSIS. THIS BILL
WILL DIRECT THE DEPARTMENT OF
HEALTH CARE SERVICES TO PARTNER
WITH THE èC TO DEVELOP A PLAN
TO ESTABLISH THE CENTER OF
MENTAL HEALTH, WELLNESS AND
INNOVATIONS, WHICH WILL PROMOTE
EVIDENCE BASED PRACTICES TO
IMPROVE BEHAVIORAL HEALTH
SERVICES AND TO BRING
TRANSFORMATIVE CHANGE IN
BEHAVIORAL HEALTH SERVICE
DELIVERY. MOREOVER, EARLY
PSYCHOSIS OCCURS WHEN A PERSON
FIRST EXPERIENCES PSYCHOLOGICAL
DISTURBANCES THAT MANIFEST AS
DISTURBED THOUGHTS, PERCEPTIONS,
OR HAVING TROUBLE IN
DISTINGUISHING REALITY FROM
ILLUSION. UNTREATED PSYCHOSIS
MAY RESULT IN IMPAIRED JUDGMENT,
PUTTING INDIVIDUALS AT RISK OF
ENGAGING IN DANGEROUS BEHAVIORS
SUCH AS SELF-HARM, SUBSTANCE
ABUSE, AND SUICIDE. IN THE
UNITED STATES, APPROXIMATELY
100,000 YOUNG PEOPLE EXPERIENCE
EPISODES OF PSYCHOSIS EVERY
YEAR, WITH AN AVERAGE ONSET IN
THE LATE TEENS TO MID 20S
THROUGH COORDINATED SPECIALTY
CARE, MEDICAL PROFESSIONALS CAN
TAKE STEPS TO DEVELOP
SPECIALIZED TREATMENT PLANS FOR
THEIR PATIENTS. ADDITIONALLY, IN
CALIFORNIA, THERE ARE 30 EARLY
PSYCHOSIS PROGRAMS THROUGHOUT 24
OF THE 58 COUNTIES IN THE STATE
TO TREAT THE ESTIMATED 100,000
YOUNG PEOPLE WHO EXPERIENCED
PSYCHOSIS EACH YEAR, THE STATE
NEEDS AN ESTIMATED 300
ADDITIONAL PSYCHOSIS PROGRAMS TO
MEET THE NEEDS IN COMMUNITIES,
ESPECIALLY IN OUR RURAL AND
REMOTE AREAS. THIS BILL WILL
HELP US TO MOVE UPSTREAM AND
ULTIMATELY TO REDUCE LONG TERME
COSTS IN OUR PUBLIC HOSPITALS
AND OUR PRISONS. THE STATE CAN
TAKE A LEAD ROLE IN DEVELOPING
STRATEGIES TO PROVIDE RESOURCES
ON EARLY PSYCHOSIS FOR OUR MOST
VULNERABLE POPULATIONS. IN
SUPPORT OF AB 2161 TODAY, OUR
TWO WITNESSES, BONNIE HOTS, WHO
WILL SHARE HER LIVED EXPERIENCE
STORY, AND DOCTOR TARA
NIEDERMAN, EXECUTIVE DIRECTOR OF
THE UC DAVIS EARLY PSYCHOSIS
PROGRAMS, DOCTOR EMILY, YOU HAVE
A MOTION FROM SANTIAGO AND
SECONDED BY RODRIGUEZ. WITNESSES
YOU'LL HAVE UP TO TWO MINUTES.
GOOD AFTERNOON, CHAIR BONTA AND
MEMBERS OF THE COMMITTEE. MY
NAME IS BONNIE HOTS, AND I'M THE
MOTHER OF A DAUGHTER LIVING WITH
PSYCHOSIS. I'M ALSO AN ADVOCATE
FOR EARLY INTERVENTION AND HAVE
SUPPORTED MANY OTHER FAMILIES
GOING THROUGH THIS WITH THEIR
CHILDREN. I GREATLY APPRECIATE
THE OPPORTUNITY TO BE HERE, AND
I WANT TO THANK ASSEMBLY MEMBER
ARAMBULA FOR AUTHORING 2161. IN
MY VIEW, IT'S A LIFELINE FOR
PARENTS DESPERATE TO SAVE THEIR
CHILDREN FROM THIS ILLNESS. I
KNOW THAT DESPERATION. BACK IN
2008, MY 15 YEAR OLD DAUGHTER
RACHEL WAS ACCEPTED INTO THE UC
DAVIS EARLY INTERVENTION PROGRAM
THAT WAS ABLE TO ROLL BACK THE
WORST OF HER SYMPTOMS AND SAVE
HER LIFE. IT WAS EXTREMELY HARD
TO FIND THE CARE SHE NEEDED BACK
THEN. IT TOOK ALMOST TWO YEARS
OF SEARCHING, PRECIOUS YEARS AS
THE WINDOW FOR EARLY
INTERVENTION CLOSED. DESPERATE
YEARS OF FEELING HELPLESS,
WATCHING THE DAUGHTER I KNEW
SLIP AWAY ONCE LOVING, HIGH
ACHIEVING AND FOCUSED. EXCITED
TO BE IN HIGH SCHOOL AND AS A
FRESHMAN. ALREADY LOOKING
FORWARD TO COLLEGE, RACHEL
BECAME WITHDRAWN, DISORGANIZED
AND AGGRESSIVE. SHE ABANDONED
ALL HER INTERESTS AND BEGAN
FAILING CLASSES. BY THE TIME WE
FOUND CARE, SHE WAS SUICIDAL.
YOU WOULD THINK THAT SUCH A
DEVASTATING ILLNESS, ONE THAT
OUR ATTACKS, OUR CHILDREN'S
MINDS AND DERAILS THEIR
POTENTIAL AT A TIME WHEN THEY
ARE JUST STARTING TO GROW INTO
IT. YOU WOULD THINK THAT SUCH AN
ILLNESS WOULD WARRANT AN ALL
HANDS ON DECK APPROACH, BUT
THAT'S NOT WHAT'S HAPPENING IN
THIS. CARE IS STILL STILL ALL
THESE YEARS LATER, LARGELY NOT
AVAILABLE. INSTEAD, IT'S A
PATCHWORK QUILT FULL OF HOLES
THAT CHILDREN AND THEIR FAMILIES
ARE FALLING THROUGH. WE CAN DO
BETTER. SO I RESPECTFULLY
REQUEST YOUR AYE VOTE ON AB
2161. THANK YOU. THANK YOU,
THANK YOU SO MUCH, MADAM CHAIR.
AND COMMITTEE FOR HEARING THIS
TODAY. AND THANK YOU TO ASSEMBLY
MEMBER ARAMBULA FOR SUPPORTING
THIS WORK. MY NAME IS TARA
NEEDHAM. I'M A CHILD CLINICAL
PSYCHOLOGIST, PROFESSOR IN THE
DEPARTMENT OF PSYCHIATRY AT UC
DAVIS, AND THE EXECUTIVE
DIRECTOR OF OUR EARLY PSYCHOSIS
PROGRAMS, I ALSO HAVE THE
PRIVILEGE OF SERVING AS THE
DIRECTOR FOR THE EPI CAL PROGRAM
HERE IN CALIFORNIA, WHICH WAS
DEVELOPED AS A PARTNERSHIP
BETWEEN THE OVERSIGHT AND
ACCOUNTABILITY COMMISSION, NOW
THE DEPARTMENT OF HEALTH CARE
SERVICES AND MULTIPLE CALIFORNIA
COUNTIES, SINCE 2018, WE'VE BEEN
BUILDING A NETWORK OF EARLY
PSYCHOSIS PROGRAMS ACROSS THE
STATE OF CALIFORNIA, WITH THE
GOAL OF HARMONIZING DATA
COLLECTION TO, AS ASSEMBLY
MEMBER ARAMBULA SAID, UNDERSTAND
EXACTLY WHAT'S GOING ON, IN OUR
COMMUNITIES AND HOW TO DO
BETTER, AS WELL AS TO PROVIDE
TRAINING AND TECHNICAL
ASSISTANCE TO THOSE COMMUNITIES
WHO WANT TO BUILD PROGRAMS LIKE
OURS, RIGHT NOW, WE ARE
CURRENTLY WORKING WITH 42 OF THE
58 COUNTIES ACROSS THE STATE TO
ENHANCE EPI PROGRAMING, BUT
WE'RE JUST BEGINNING, AS THE
ASSEMBLY MEMBER SAID, WE NEED
MORE THAN 300 PROGRAMS TO SERVE
THE NEED IN OUR STATE, AND WE'RE
NOT THERE YET. WE HAVE ABOUT A
10TH OF THAT, AND OUR NETWORK IS
FRAGILE. WE ARE BUILT WITH
PIECEMEAL FUNDS AND ONE TIME
FUNDS, THIS BILL SEEKS TO FIX
THAT PROBLEM. IT DIRECTS THE OAC
AND DCS TO DEVELOP A PLAN TO
MEET THE EARLY PSYCHOSIS NEEDS
ACROSS OUR STATE AND TO CODIFY
THE CENTER THAT WE HAVE WORKED
SO HARD TO BUILD TO ENSURE THAT
ALL CALIFORNIANS HAVE ACCESS TO
HIGH QUALITY EPI CARE FOR MANY
YEARS TO COME. WE REALLY
APPRECIATE YOUR CONSIDERATION OF
THIS REQUEST AND AN AYE VOTE.
ANY OTHER WITNESSES IN SUPPORT?
TOBY EWING FOR THE MENTAL HEALTH
COMMISSION IN SUPPORT AND HERE
TO ANSWER ANY QUESTIONS THAT THE
COMMITTEE MAY HAVE. THANK YOU,
MADAM CHAIR. THANK YOU. ANY
WITNESSES IN OPPOSITION? SEEING
NONE. I'LL BRING IT BACK TO THE
COMMITTEE FOR COMMENT. I'LL MAKE
A QUICK THANK YOU, DOCTOR
ARAMBULA, FOR BRINGING THIS
FORWARD AS YOU KNOW, WE'VE HAD
TRAGEDY IN MY DISTRICT AT UC
DAVIS, AND I WAS COMMITTED TO
SEE HOW I MIGHT BE ABLE TO HELP
OUR FAMILIES AND OUR STUDENTS.
WE'VE HAD MANY COME INTO OUR
OFFICES TALKING ABOUT MENTAL
HEALTH NEEDS AND HAVING TO WAIT
TWO AND THREE WEEKS TO GET SOME
KIND OF HELP. THIS BILL IS A
GOOD FIRST STEP, TO MOVE
FORWARD, I'D LIKE TO BE A
COAUTHOR OF THE BILL. THANK YOU.
MISS WALDRON, GO AHEAD. THANK
YOU. I ALSO WOULD LIKE TO BE
ADDED AS A COAUTHOR. THANK YOU,
DOCTOR ARAMBULA, FOR BRINGING
FORWARD THIS BILL. IT'S
INCREDIBLY IMPORTANT AS OUR
WITNESSES SO POIGNANTLY STATED.
VERY THANKFUL FOR YOUR BRINGING
YOUR STORY FORWARD, TO BE ABLE
TO SHINE A LIGHT ON THE
DEVASTATING IMPACTS THAT CAN
HAPPEN. AND ALSO, THE PROACTIVE
STEPS THAT WE'RE ABLE TO TAKE
WITH THIS LEGISLATION. SO WITH
THAT, WE HAVE A MOTION AND A
SECOND, MR. ARAMBULA, WOULD YOU
LIKE DOCTOR ARAMBULA WOULD YOU
LIKE TO CLOSE RESPECTFULLY ASK
FOR AN AYE VOTE? THANK YOU. CALL
THE ROLL, PLEASE. IT'S DUE PASS,
AS AMENDED TO OPPOSE BONTA. I
WANT TO I. WALDRON. WALDRON I
AGREE. CURRY. CURRY I ARAMBULA I
ARAMBULA I WENDY CARILLO WENDY
CARILLO I FLORA HANEY. HANEY I
JOAN SAWYER. JOAN SAWYER I
MAIENSCHEIN MAIENSCHEIN I
MCCARTY. MCCARTY. I JOE
PATTERSON. JOE PATTERSON I
RODRIGUEZ. RODRIGUEZ. I SANCHEZ.
SANCHEZ. I SANTIAGO. SANTIAGO. I
CHAVO. WEBER. WEBER. I. 14 ZERO.
THAT MEASURES OUT. 14 ZERO.
THANK YOU, DOCTOR ARAMBULA. AND
THANK YOU TO THE WITNESSES. WE
WILL MOVE ON TO ITEM NUMBER 16 A
B 2390 WITH DOCTOR ARAMBULA.
PLEASE PROCEED. THANK YOU, MADAM
CHAIR AND MEMBERS. CHILDREN AND
ADOLESCENTS WHO USE SOCIAL MEDIA
SHOULD BE SAFE FROM HARM. AB
2390 WILL ADDRESS THE MENTAL
HEALTH IMPACTS HAPPENING NOW
THAT ARE THE RESULT OF
INTENTIONALLY ADDICTIVE DESIGN
OF SOCIAL MEDIA PLATFORMS. THE
PROMISE OF SOCIAL MEDIA WAS TO
BUILD VIRTUAL COMMUNITIES THAT
WOULD BRING PEOPLE TOGETHER TO
SHARE INFORMATION AND IDEAS. IN
MANY WAYS, THAT PROMISE HAS BEEN
FULFILLED. SOME PLATFORMS RAIMES
HAVE BILLIONS OF USERS AND ACT
AS A DIGITAL THREAD CONNECTING
FRIENDS AND FAMILIES.
UNFORTUNATELY, SOCIAL MEDIA
COMPANIES HAVE ABUSED THEIR
POSITIONS AS FACILITATORS OF
SOME OF THE MOST PERSONAL HUMAN
INTERACTIONS BY PRIORITIZING
SCREEN TIME AND PROFITS OVER THE
MENTAL HEALTH OF THEIR USERS.
SOCIAL MEDIA'S ADDICTIVE DESIGN
EXACERBATES COMPULSIVE AND
OBSESSIVE BEHAVIORS, DETRACTING
FROM REAL WORLD IN-PERSON
ENGAGEMENT AND CONTRIBUTING TO
SOCIAL ISOLATION. A 2022 SURVEY
FOUND THAT 35% OF TEENAGERS
REPORT USING ONE OF THE FIVE
MAJOR SOCIAL MEDIA PLATFORMS
SEVERAL TIMES A DAY. CHILDREN
AND ADOLESCENTS WHO SPEND MORE
THAN THREE HOURS A DAY ON SOCIAL
MEDIA DOUBLED THEIR RISK OF
MENTAL HEALTH ISSUES, INCLUDING
ANXIETY AND DEPRESSION. BECAUSE
CHILDREN AND ADOLESCENT ARE THE
MOST HEAVILY IMPACTED, IT IS
IMPORTANT TO ME THAT THIS EFFORT
BE LED BY THE VOICES OF THOSE
WHO ARE ON THE FRONT LINES OF
THIS EPIDEMIC. AB 2390
ESTABLISHES A PEER TO PEER PILOT
PROGRAM TO DEVELOP METHODS TO
MITIGATE THE HARM TO YOUTH AND
ADOLESCENTS, CAUSE BY MODERN
SOCIAL MEDIA. PLATFORM DESIGN. I
TRUST THAT THE KIDS KNOW WHAT
THEY NEED. THIS BILL WILL
PROVIDE THE SPACE FOR THEM TO
ACT WITH ME. TESTIFYING IN
SUPPORT OF AB 2390 IS DOCTOR FLO
COFER, SENIOR DIRECTOR OF POLICY
OF PUBLIC HEALTH ADVOCATES, AND
NANCY AGUILAR, YOUTH PARTICIPANT
AT YOUTH LEADERSHIP INSTITUTE.
THANK YOU. YOU'LL EACH HAVE TWO
MINUTES. PLEASE PUT ON YOUR MIC.
EXCUSE ME. THANK YOU. GOOD
AFTERNOON. MEMBERS OF THE
ASSEMBLY HEALTH COMMITTEE. MY
NAME IS DOCTOR FLO COFER, AND I
AM THE SENIOR DIRECTOR OF POLICY
FOR PUBLIC HEALTH ADVOCATES. AND
WE ARE ONE OF THE CO-SPONSORS OF
AB 2390, WHICH IS THE SOCIAL
MEDIA HARM REDUCTION PILOT TO
ENGAGE PEER PROGRAMS AND
DEVELOPING AND EVALUATING A
CURRICULUM TO CREATE HEALTHY
SOCIAL MEDIA HABITS. AND K TO 12
ONLINE SAFETY STANDARDS, SOCIAL
MEDIA IS A REALLY NEW
TECHNOLOGY, AND I MUST REMIND US
OF THAT. IT EXISTS IN AND IS
ALSO CONTRIBUTED TO A MAJOR
RESTRUCTURING OF SOCIAL
ENGAGEMENT. AND SO WE WANT TO
STATE PLAINLY THAT IT DOES A LOT
OF GOOD ALLOWING PEOPLE TO FIND
NICHE COMMUNITIES TO SUPPORT
THEIR IDENTITIES AND INTERESTS.
AND MANY PEOPLE, INCLUDING YOUNG
PEOPLE, USE SOCIAL MEDIA AND
HAVE POSITIVE EXPERIENCES.
HOWEVER, THERE ARE ALSO RISKS
YOUTH SPEND A LOT OF TIME ON
SOCIAL MEDIA. AN AVERAGE OF
ALMOST FIVE HOURS A DAY, AND
WHETHER THROUGH A COMBINATION OF
THE CONTENT THAT THEY ENCOUNTER
OR SOCIAL MEDIA REPLACING OR
COMPETING WITH OTHER ACTIVITIES,
MANY OF THEM DESCRIBE SOCIAL
MEDIA AS A MAJOR AND DIRECT
CONTRIBUTOR TO DEPRESSION AND
ANXIETY, AND SIMILAR TO HOW THE
VAST MAJORITY OF PEOPLE IN
VEHICLES TRAVEL FROM POINT A TO
POINT B SAFELY. WE CAN BOTH
APPRECIATE THE BENEFITS OF
EFFICIENT TRANSPORTATION AND
THEIR HARMS, POLLUTION AND
VEHICLE CRASHES AND SO THIS BILL
IS INTENDED TO HELP YOUTH
MAXIMIZE THOSE BENEFITS AND
MINIMIZE THE HARMS. AND I WANT
TO REMIND YOU THAT PARENTAL
SUPPORT FOR THIS IS HIGH AND
BIPARTISAN. THERE IS AN ALMOST
DESPERATE PASSION AMONG PARENTS
FOR HELP IN NAVIGATING
APPROPRIATE AND SAFE ONLINE
HABITS. AND THE BILL FOCUSES ON
THE LEADERSHIP OF YOUNG PEOPLE
WHO USE SOCIAL MEDIA AND WHO
KNOW THE DIFFERENCE BETWEEN TIK
TOK AND TIC TAC TOE TO HELP
DEVELOP SAFETY STANDARDS TO HELP
KEEP THEMSELVES AND THEIR PEERS
SAFE. AND FOR THOSE REASONS, WE
URGE YOU TO VOTE YES. THANK YOU.
GOOD AFTERNOON. MY NAME IS NANCY
AGUILAR AND I'M A PART OF
HEALTHY ONLINE PLATFORMS FOR
EVERYONE HOPE YOUTH COALITION, A
PROGRAM UNDER YOUTH LEADERSHIP
INSTITUTE IN HOPE. WE ARE
WORKING TOWARDS HOLDING ONLINE
PLATFORMS ACCOUNTABLE FOR THE
HARM YOUTH RECEIVE WHILE
UPLIFTING, HEALTHY, POSITIVE
MESSAGES. YOUTH ARE EXPOSED TO A
LOT OF THINGS ON SOCIAL MEDIA,
BOTH GOOD AND BAD. I'M AN
OBSERVER IN SOCIAL MEDIA. I
RARELY COMMENT ON POSTS, BUT I
ENJOY CONSUMING CONTENT LIKE ART
FROM FELLOW ARTISTS I ENJOY. AS
AN OBSERVER, I'VE SEEN THE
SPACES YOUTH TURN TO FOR FINDING
ENJOYMENT AND COMMUNITY HAVE
CAUSED STRESS AND HARM. I'VE
SEEN YOUTH FACE HARASSMENT AND
DEATH THREATS. SOME EVEN HAD
THEIR INFORMATION DOX WHICH PUTS
THEM IN DANGER. I'VE BEEN ABLE
TO TALK ABOUT THESE ISSUES AND
EXPERIENCES YOUTH FACE ONLINE.
IN HOPE. WE CONDUCTED A RESEARCH
STUDY TO UNDERSTAND THE
RELATIONSHIP BETWEEN YOUTH AND
SOCIAL MEDIA AND CREATE A YOUTH
CENTERED RECOMMENDATIONS TO THE
PLATFORMS. DESIGN. IT'S BEEN SO
GREAT TO HAVE A SPACE TO SHARE
MY EXPERIENCES AND EXPRESS ANY
FEARS AND CONCERNS WITH OTHER
YOUTH. I'VE ALSO TALKED ABOUT MY
EXPERIENCE AS AN OLDER SIBLING
IN HOPE, HOW I'M TRYING TO
NAVIGATE MY YOUNGER BROTHER,
WANTING TO USE SOCIAL MEDIA THAT
AREN'T FOR HIS AGE AS WELL AS
WAYS I'VE HELPED CONTROL HIS
GAME USAGE WITH SCREEN TIMES AND
PARENTAL CONTROLS I FOUND
HELPFUL. IMPLEMENTING AB 2390
WOULD HELP INFORM YOUTH LIKE MY
YOUNGER BROTHER ABOUT THE HARM
SOCIAL MEDIA CAN HAVE, AND HELP
YOUTH LEARN HOW TO USE THESE
PLATFORMS IN A HEALTHY AND A
HEALTHY WAY, AND TEACH GOOD
HABITS WILL BE SO HELPFUL,
ESPECIALLY LEARNING THIS BEFORE
REACHING THE MINIMUM AGE
REQUIREMENT FOR THESE PLATFORMS
SO THEY CAN BE PREPARED AS THEY
GROW OLDER, THEY CAN TALK ABOUT
THEIR EXPERIENCES AND USING
SOCIAL MEDIA WITH EACH OTHER AND
SEE WHAT EFFECTS IT'S HAD ON
THEM. IT'S A GREAT OPPORTUNITY
TO CONNECT WITH EACH OTHER AND
SEE WHAT EXPERIENCES ARE SHARED
WITH THE GOOD OR BAD. HAVING A
SPACE TO TALK ABOUT THESE THINGS
IS NEEDED WHEN IT'S A BIG PART
OF OUR LIVES. HAVING A HEALTHY
AND SAFE SPACE WITH A GOOD
COMMUNITY IS WHAT YOUTH NEED.
THIS IS WHAT THE HOPE YOUTH
COALITION PROVIDES WITH SIMILAR
PEER TO PEER PROGRAMS. DO IT'S
WHAT SOCIAL MEDIA SHOULD BE, BUT
IT'S NOT AT THAT PLACE YET. BUT
WE CAN START A PATH TOWARDS THAT
NOW. THANK YOU. THANK YOU SO
MUCH. ARE THERE ANY OTHER
WITNESSES IN SUPPORT? ANY
WITNESSES IN SUPPORT? GOOD
AFTERNOON, GLEN BACCHUS FOR THE
ELLA BAKER CENTER FOR HUMAN
RIGHTS AND SUPPORT. SAMANTHA
VIGIL, PHD STUDENT AT UC DAVIS,
IN SUPPORT. DREW SINGEL,
PROFESSOR OF COMMUNICATION AT UC
DAVIS IN SUPPORT. HOPE YOUTH
COALITION COORDINATOR, YOUTH
LEADERSHIP INSTITUTE IN SUPPORT.
MY NAME IS TAYLOR AGUILAR. I AM
A PART OF THE YOUTH HOPE
COALITION AND I SUPPORT WENDY
PACHECO WITH THE YOUTH
LEADERSHIP INSTITUTE IN SUPPORT.
I'M THREE OF US DIRECTOR WITH
YOUTH LEADERSHIP INSTITUTE AND
SUPPORT JOHNSON DEL ROSARIO,
MANAGER AT YOUTH LEADERSHIP
INSTITUTE IN SUPPORT MIKE
ESPINOSA WITH THE CHILDREN'S
MOVEMENT OF FRESNO IN SUPPORT.
ASHLEY HERNANDEZ WITH FRESNO
COMMUNITY HEALTH IMPROVEMENT
PARTNERSHIP IN SUPPORT. THANK
YOU. ANY WITNESSES IN OPPOSITION
? SEEING NONE, I WILL BRING IT
BACK TO COMMITTEE. MR. MCCARTY
MOVES THE BILL. PATTERSON
SECONDS. AND THEN ALSO. OH, YOU
ACTUALLY HAVE A COMMENT? OH
SORRY. SECOND AND THE SAME. MR.
JONES-SAWYER SECONDS. MR.
PATTERSON, YOUR COMMENT. OKAY.
THANK YOU, APPRECIATE YOU
BRINGING THIS, BILL. I'M THE
VICE CHAIR OF THE PRIVACY
COMMITTEE, AND I DON'T KNOW IF
THIS GOES TO THIS COMMITTEE NEXT
. IT DOES. OKAY. WELL, GOOD. I
GUESS I'LL SEE IT THERE AS WELL,
I'M SURPRISED THERE ISN'T MORE
ATTENTION GIVEN TO THIS BILL.
THERE'S A LOT OF ATTENTION TO
THIS SUBJECT. I ALMOST EVERY
PRIVACY COMMITTEE MEETING, THIS
COMES UP AND, YOU KNOW, SOME OF
THE ISSUES CENTER AROUND
PENALTIES AND THINGS LIKE THAT.
BUT I THINK THIS IS A GOOD
APPROACH BECAUSE WE'RE REALLY
TALKING ABOUT IT. AND WE SHOULD
TAKE A LOOK. WE SHOULD STUDY IT
FIRST. YOU KNOW, AND, YOU KNOW,
SEE AND CREATE A PROGRAM TO HOW
WE CAN REDUCE THE EFFECTS IF
THEY EXIST. I MEAN, I THINK WE
KIND OF ASSUME I HAVE FOUR KIDS,
MY THREE YEAR OLD KID, BY THE
WAY, CAN ALREADY KIND OF LIKE,
SCROLL THROUGH THINGS. IT'S
PRETTY SAD. MY FAULT, BAD
PARENTING. BUT, BUT, YOU KNOW,
I'M REALLY CONCERNED ABOUT, THE
IMPACTS AND AS REFERENCED BY
YOUR WITNESSES, I THINK THE
THERE ARE OBVIOUSLY POSITIVE,
OUTCOMES AS WELL. AND WE
SHOULDN'T DISMISS THOSE, BUT I
THANK YOU FOR BRINGING THIS
BILL, AND I'M LOOKING FORWARD TO
SUPPORTING IT. MR. MCCARTY.
YEAH. THANK YOU. JUST TO FOLLOW
ON THAT, I KNOW DOCTOR RAMBLA,
WE SPOKE A BIT ABOUT THIS
EARLIER TODAY, AND I TOLD YOU
THAT I WAS I READ RECENTLY THIS
ATLANTIC REPORT, AND I'VE READ
IT, AND I HAVE TO PUT IT DOWN
BECAUSE IT'S SO TRIGGERING,
BECAUSE I THINK ABOUT WHAT THIS
GENERATION DID TO, FRANKLY, KIDS
. AND, YOU KNOW, I HAVE
TEENAGERS AND THEY'RE THE
WHEELHOUSE RIGHT NOW, 15 YEAR
OLDS. AND I REMEMBER WHEN I
FIRST GOT AN IPHONE, THEY WERE
ABOUT TWO. AND THERE WERE SOME
COOL LITTLE APPS ON THERE. AND
LIKE, LOOK, THEY CAN USE THIS
LITTLE APP. AND THEY GOT OUR OLD
PHONES AND THEY WERE USING IT.
AND THEN, YOU KNOW, THEY
EVENTUALLY FIGURED OUT HOW TO
MAKE THEIR OWN SOCIAL MEDIA
ACCOUNTS WITHOUT US. AND WE
FOUND OUT FROM SOMEBODY ELSE.
AND SO THE KIDS KNOW WHAT'S
GOING ON. AND IT WAS IT'S
TRIGGERING TO READ THOSE
ATLANTIC ARTICLES AND THE
IMPACTS BECAUSE IT'S SO PROFOUND
ON A GENERATION OF KIDS. BUT AS
MR. PATTERSON SAID, TOO FRANKLY,
MY OWN KIDS LIKE, WHAT WHAT DID
WE DO? AND I'M DEEPLY CONCERNED
AS FAR AS THE IMPACTS SOCIAL,
EMOTIONAL, ACADEMIC, JUST BEING
ADULTS AND INTERACTING. AND, YOU
KNOW, WE GOT A NOTICE LAST WEEK
FROM OUR SCHOOL THAT THE SCHOOL
IS TAKING AWAY MCCLATCHY HIGH
SCHOOL, RIGHT HERE. CELL PHONES
DURING CLASS. LIKE FINALLY
THEY'RE STEPPING UP. BUT THEN,
YOU KNOW, THEY'RE NOT DURING THE
LUNCH PERIOD AND DURING PASSING
PERIOD IN THE BREAK. AND SO, YOU
KNOW, KIDS ARE WALKING DOWN THE
HALLS AND THEY'RE NOT
INTERACTING. AND SO THERE'S SO
MANY SOCIETAL ISSUES. AND WE CAN
GO ON AND ON. AND ON ON HERE.
BUT THE POINT THAT I THINK IS
IMPORTANT IS THIS ISN'T THE
PRIVACY COMMITTEE, THIS IS THE
HEALTH COMMITTEE. THIS IS I
THINK IT'S A PUBLIC HEALTH
ISSUE. AND, YOU KNOW, WE TAKE IT
ON THESE BATTLES WITH SOCIAL
MEDIA COMPANIES ABOUT THEIR ROLE
IN THIS. AND I 100% SUPPORT
THAT. I THINK WE SHOULD. BUT I
APPLAUD THIS EFFORT. LOOKING AT
HOW THIS IMPACTS ALL THESE OTHER
UNDERLYING ISSUES AS WELL. SO
THANK YOU. MR. JONES-SAWYER, AND
I WANT TO THANK YOU, TOO, FOR
BRINGING THIS FORWARD. I HAVE A
BILL, GOING THROUGH RIGHT NOW,
JUDICIARY. AND THEN SOME OTHERS,
ON SOCIAL MEDIA AND SOCIAL MEDIA
COMPANIES AND THEIR, THEIR
IMPACT, IS DISHEARTENING TO KNOW
THAT JUST RECENTLY, IN THE
SENATE, HEARINGS, WE FOUND OUT
THAT SNAPCHAT AND OTHERS ARE
REDUCING THE NUMBER OF PEOPLE
THAT ARE THERE TO ACTUALLY
OVERSEE, SEE, AND MAKE SURE THAT
PEOPLE WHO ARE INVOLVED IN
CRIMINAL ACTIVITY DRUGS,
FENTANYL, HUMAN TRAFFICKING, ALL
OF THAT, THEY'RE REDUCING THAT
STAFF BY A CONSIDERABLE AMOUNT.
AND ALL THE DIFFERENT PLATFORMS.
RAIMES, MY BILL WILL LOOK TO
HAVE PENALTIES, CIVIL PENALTIES,
WHERE PEOPLE CAN SUE. AND WE'RE
HOPING THAT THAT WILL GET THEIR
ATTENTION, BECAUSE IF YOU HAVE
100 OR 1000 PEOPLE, SUING FOR $1
MILLION APIECE, THAT WILL GET
THEIR ATTENTION REAL QUICK AND
HOPEFULLY, THEY WILL UNDERSTAND
THEIR LIABILITIES, NOT ONLY THE
RISK TO, TO YOUNG PEOPLE AND THE
HARM THAT THEY'RE DOING THAT
THEY'LL WAKE UP AND SAY THAT
THAT IS THEIR NUMBER ONE
PRIORITY AND THAT PROFITS ARE
NOT TO SUPPLANT PEOPLE. PEOPLE
ARE MORE IMPORTANT THAN PROFITS.
AND WE NEED TO NEED TO MAKE SURE
THAT THESE COMPANIES UNDERSTAND
THAT. AND HOPEFULLY WE CAN WORK
TOGETHER SO THAT WE CAN WE CAN
TALK ABOUT THOSE HARMS BECAUSE,
IT'S COMING OUT NOW. AND I THINK
THE STATE NEEDS TO TAKE A
LEADING ROLE IN THAT, BECAUSE
OTHER, OTHER PARTS OF THE
COUNTRY COULD. THE FEDERAL
GOVERNMENT IS VERY SLOW TO DOING
ANYTHING IF NOT DOING NOTHING AT
ALL. AND SO THIS IS OUR
OPPORTUNITY TO BE A LEADER IN
IT. SO I THANK YOU FOR DOING
THIS. DOCTOR. ARAMBULA YOU CAN
CLOSE. THANK YOU. I RESPECTFULLY
ASK FOR AN AYE VOTE. THANK YOU.
WE HAVE A MOTION AND A SECOND.
THE MOTION IS Dð PASS TO PRIVACY
AND CONSUMER PROTECTION. PLEASE
CALL THE ROLL BONTA I BONTA. AYE
WALDEN. WALDEN. AYE. CURRY AGAR.
CURRY. AYE. ARAMBULA ARAMBULA.
AYE. WENDY CARILLO. WENDY.
CARILLO AYE. FLORA HANEY. HANEY.
AYE. JOHN. SAWYER. AYE. JOHN.
SAWYER AYE. MAIENSCHEIN.
MAIENSCHEIN. AYE. MCCARTY.
MCCARTY AYE. PATTERSON. JO.
PATTERSON. AYE. RODRIGUEZ
RODRIGUEZ. AYE. SANCHEZ.
SANCHEZ. NOT VOTING. SANTIAGO.
SANTIAGO. SHABO WEBER. WEBER.
AYE. 13 TO THAT MEASURE. PASSES
13 TO 0. WE'LL MOVE ON NOW TO
ITEM NUMBER 21. AB 2657. DOCTOR
ARAMBULA, THIS IS YOUR SECOND
BILL RELATED TO SOCIAL MEDIA.
AND PLEASE PROCEED WHENEVER
YOU'RE READY. THANK YOU. MADAM
CHAIR. IN MY PREVIOUS
PRESENTATION ON AB 2390, I
EXPLAINED THAT WE NEEDED TO
PROVIDE SOMETHING OF A LIFELINE
FOR CHILDREN AND ADOLESCENTS WHO
ARE CURRENTLY AT RISK OR ALREADY
IN CRISIS. MY MOTIVATION FOR
INTRODUCING AB 2657 IS THE SAME,
BUT WE ARE LOOKING UPSTREAM
INSTEAD. SOCIAL MEDIA IS
ADDICTIVE. DESIGN EXACERBATES
THE COMPULSIVE AND OBSESSIVE
BEHAVIORS AND PREVENTS USERS
FROM EXPERIENCING REAL WORLD,
IN-PERSON ENGAGEMENT. THIS HAS
LED TO A LITANY OF ISSUES. ONE
STATISTIC THAT HAS HIT ME
ESPECIALLY HARD IS THAT IN 2021,
23.6 OF FEMALE TEENS REPORTED
HAVING A SUICIDE PLAN AS A
FATHER OF THREE DAUGHTERS, THAT
IS TERRIFYING BECAUSE OF THE
RISKS OF HARM ASSOCIATED WITH
SOCIAL MEDIA USE. THE OFFICE OF
THE U.S. SURGEON GENERAL CANNOT
CONCLUDE THAT SOCIAL MEDIA IS
SAFE FOR CHILDREN AND
ADOLESCENTS. IT'S TIME THAT
CALIFORNIA MOVE AWAY FROM
PLAYING WHACK A MOLE WITH OUR
ATTEMPTS TO REGULATE SOCIAL
MEDIA. WHILE TECHNOLOGY
COMPANIES CONTINUE TO EXPERIMENT
ON OUR CHILDREN. AB 2657
ESTABLISHES A COMMISSION THAT
WILL INVESTIGATE THE METHODS
USED BY SOCIAL MEDIA COMPANIES
TO MAXIMIZE SCREEN TIME AT THE
EXPENSE OF MENTAL HEALTH,
COMPRISED OF SPECIALIZED
SUBCOMMITTEES, THE COMMISSION
WILL RECOMMEND A HOLISTIC
REGULATORY FRAMEWORK INTENDED TO
MITIGATE FUTURE NEGATIVE
IMPACTS, RESULTING FROM SOCIAL
MEDIA ON THE MENTAL HEALTH OF
CHILDREN AND ADOLESCENTS.
TESTIFYING IN SUPPORT OF AB 2657
IS DOCTOR FLO COFER, SENIOR
DIRECTOR OF POLICY AT PUBLIC
HEALTH ADVOCATES, AND MICHAEL
ESPINOSA, THE EXECUTIVE DIRECTOR
OF THE CHILDREN'S MOVEMENT OF
FRESNO. PLEASE GO AHEAD. HELLO
AGAIN. MY NAME IS DOCTOR FLO
COFER AND I'M THE SENIOR
DIRECTOR OF POLICY FOR PUBLIC
HEALTH ADVOCATES. AND AS
MENTIONED, AB 2657 WILL
ESTABLISH A SOCIAL MEDIA
COMMISSION TO CREATE
RECOMMENDATIONS TO PROTECT YOUNG
PEOPLE, ESPECIALLY FOCUSING ON
THEIR MENTAL WELL-BEING AND AS
MENTIONED BEFORE, SOCIAL MEDIA
IS THIS NEW TECHNOLOGY THAT HAS
CREATED A MAJOR RESTRUCTURING OF
OUR SOCIETY AND SOCIAL
ENGAGEMENT. AND THERE ARE BOTH
BENEFITS AND RISKS. AMONG THE
RISKS THAT HAVE BEEN HIGHLIGHTED
AND THAT THERE IS THAT ARE
CREATING MOMENTUM TO BE ABLE TO
PASS NEW LEGISLATION TO PROTECT
YOUTH INCLUDE PEER REVIEWED
STUDIES SHOWING THAT SOCIAL
MEDIA IS A MAJOR DIRECT
CONTRIBUTOR TO THE YOUTH MENTAL
HEALTH CRISIS, AND THAT 37% OF
YOUNG PEOPLE SAY SOCIAL MEDIA IS
THE PRIMARY CAUSE OF POOR MENTAL
HEALTH COMPARED TO FAMILY AND
COMMUNITY EXPECTATIONS, SCHOOL
PRESSURE AND BULLYING, WHICH ARE
KNOWN TO BE RISKS TO YOUTH
MENTAL HEALTH AND A PRIMARY
CAUSE OF STRESS. AND SO THE
STATE OF CALIFORNIA HAS A
RESPONSIBILITY TO DEVELOP
EVIDENCE INFORMED POLICY. AND
THAT IS REALLY WHAT THIS BILL IS
INTENDING TO DO. YOUNG PEOPLE
MAY BE AT PARTICULAR RISK
BECAUSE THEIR BRAIN REGIONS
INVOLVED IN RESISTING TEMPTATION
AND REWARD ARE NOT YET FULLY
DEVELOPED. AND SO IT'S IMPORTANT
THAT AS WE CONSIDER LEGISLATION
TO REGULATE AND ENSURE THE
SAFETY OF CALIFORNIA'S YOUTH, WE
DO SO WITH INPUT FROM YOUNG
PEOPLE WHO USE SOCIAL MEDIA,
FROM EDUCATORS, PARENTS AND
EXPERTS, WITH THE FULL
CONSIDERATION OF EXISTING
RESEARCH. AND FOR THOSE REASONS,
WE URGE YOU TO VOTE YES. THANK
YOU, THANK YOU. PLEASE PROCEED.
GOOD AFTERNOON. MY NAME IS
MICHAEL ESPINOSA, AND I'M THE
EXECUTIVE DIRECTOR OF THE
CHILDREN'S MOVEMENT OF FRESNO.
WE ARE A COMMUNITY ORGANIZING
GROUP DEVOTED TO THE BELIEF THAT
RESIDENTS WHO ARE DIRECTLY
IMPACTED BY SOCIAL PROBLEMS CAN
AND SHOULD HAVE A SEAT AT
DECISION MAKING TABLES,
ESPECIALLY WHERE THEIRS OR THEIR
CHILDREN'S LIVES ARE IMPACTED BY
THOSE DECISIONS. THE IMPACTS OF
SOCIAL MEDIA ON CHILDREN'S LIVES
LIFE OUTCOMES ARE COMPLEX, TO
SAY THE LEAST. WE HAVE THE
CHILDREN'S MOVEMENT OF FRESNO
ARE IN CONSTANT COMMUNICATION
WITH GRASSROOTS COMMUNITIES, AND
IN FACT, ONE OF OUR MAJOR
PROJECTS, OUR IMPLEMENTATION OF
COMMUNITY SCHOOLS THROUGHOUT
FRESNO UNIFIED SCHOOL DISTRICT.
THROUGH THIS PROJECT, WE'VE BEEN
IN ONE ON ONE COMMUNICATION
WITH, HUNDREDS OF SCHOOL
CHILDREN, PARENTS, SCHOOL STAFF,
BOTH CLASSIFIED AND CERTIFICATED
AND ACROSS THE BOARD. CONCERNS
ABOUT CYBERBULLYING ISSUES THAT
GROW OUT OF SOCIAL MEDIA USE ARE
A TOP CONCERN. AGAIN, HEARING
THE STORIES FROM ACROSS THE
BOARD, FROM NOT ONLY PARENTS WHO
ARE CONCERNED ABOUT THE IMPACTS
OF THEIR ON THEIR CHILDREN, BUT
ALSO THE KIDS THEMSELVES TRYING
TO FIGURE OUT HOW THEY NAVIGATE
THE COMPLEX SITUATIONS AND THE
COMPLEX RELATIONSHIPS THAT THEY
DEVELOP WITH OTHER STUDENTS. A
COMMISSION OF THIS NATURE WOULD
ALLOW US TO SHARE OUR DIRECT
TESTIMONY, TO INFORM DISCERNMENT
AROUND THIS HIGHLY COMPLEX ISSUE
, ALONGSIDE EXPERTS AND OTHER
KEY STAKEHOLDERS. THANK YOU,
THANK YOU. ANY OTHER WITNESSES
IN SUPPORT? SAMANTHA VIGIL, PHD
STUDENT IN THE DEPARTMENT OF
COMMUNICATION AT UC DAVIS, IN
SUPPORT THROUGH SINGLE PROFESSOR
OF COMMUNICATION AT UC DAVIS, IN
SUPPORT WITH YOUTH LEADERSHIP
INSTITUTE. IN SUPPORT NANCY
AGUILAR WITH YOUTH LEADERSHIP
INSTITUTE IN SUPPORT. ARLETTE
AGUILAR ON YOUTH LEADERSHIP AND
SUPPORT. EMILY RIVAS, DIRECTOR
WITH YOUTH LEADERSHIP INSTITUTE,
IN SUPPORT. WENDY PACHECO WITH
THE YOUTH LEADERSHIP INSTITUTE
AND SUPPORT JOHNSON NAZARIAN
WITH THE YOUTH LEADERSHIP
INSTITUTE IN SUPPORT. BRANDON
MARGIE WITH THE CALIFORNIA
MEDICAL ASSOCIATION IN SUPPORT.
THANK YOU. ANY WITNESSES IN
OPPOSITION? SEEING NONE, I KNOW
THAT THE COMMITTEE WAS ABLE TO
RESPOND OR PROVIDE COMMENT TO
THE PRIOR LEGISLATION, WHICH
ALSO FOCUSED ON SOCIAL MEDIA. SO
I WILL JUST, ROUND OUT THE
COMMENTS RELATED TO BOTH BILLS,
OBVIOUSLY WE KNOW THAT SOCIAL
MEDIA IS NEGATIVE, IMPACTING THE
MENTAL HEALTH OF OUR CHILDREN.
AND QUITE FRANKLY, YOUNG ADULTS
AND ADULTS AND WE'RE VERY
APPRECIATIVE OF YOUR FOCUS,
DOCTOR ARAMBULA, IN THIS AREA, I
WITH MY THREE YEAR OLD CHILDREN
ALSO. THANK YOU, AND I KNOW THAT
THERE ARE MANY MEMBERS WHO ARE
FOCUSED ON THIS IN THE
LEGISLATURE, AND I ASSUME THAT
OVER TIME, KIND OF IN SHORT
ORDER, I SHOULD SAY WE WILL NEED
TO MOVE TO KIND OF COORDINATE
OUR COLLEAGUES EFFORTS TO MAKE
SURE THAT WE'RE PROVIDING A MORE
HOLISTIC, AND, FOCUSED WAY TO BE
ABLE TO ADDRESS THESE CONCERNS,
PARTICULARLY AS IT RELATES TO
YOUNG ADULTS IN OVERALL HEALTH
AND SOCIAL MEDIA. SO WITH THAT,
I APPRECIATE YOU WORKING TO DO
THAT OVER TIME WITH OUR FELLOW
LEGISLATORS. AND, YOU MAY CLOSE.
THANK YOU. I RESPECTFULLY ASK
FOR AN AYE VOTE. THANK YOU. I
THINK WE NEED A MOTION. AND A
SECOND MOVED BY SANTIAGO.
SECONDED BY JONES-SAWYER. THE
MOTION IS Dð PASS TO PRIVACY AND
CONSUMER PROTECTION. PLEASE CALL
THE ROLL. BONTA. AYE, AYE.
WALDRON. WALDRON AYE.
AGUIAR-CURRY. AGUIAR-CURRY. AYE.
ARAMBULA. AYE ARAMBULA AYE.
WENDY. CARRILLO. WENDY.
CARRILLO. AYE. FLORA HANEY.
JONES-SAWYER. AYE. JOHN. SAWYER.
AYE. MAIENSCHEIN WEINSTEIN. AYE.
MCCARTY. MCCARTY. AYE. JOE
PATTERSON. JOE. PATTERSON. AYE.
RODRIGUEZ. RODRIGUEZ AYE.
SANCHEZ SANCHEZ. NOT VOTING.
SANTIAGO SANTIAGO. AYE. SHAVO.
WEBER. 11 ZERO. THAT MEASURES
OUT. 11 TO 0. WE'LL MOVE ON NOW
TO ASSEMBLY MEMBER CARRILLO'S
BILL, WHICH IS ITEM NUMBER 17 AB
2411. I GOOGLED IT. GOOD
MCCARTY'S OPPONENT MOVE THE BILL
. MOVED BY RODRIGUEZ. SECONDED
BY WALDRON. WHENEVER YOU'RE
READY. THANK YOU, MADAM CHAIR.
I'M PROUD TO PRESENT AB 2411,
WHICH WILL ESTABLISH A LOCAL
BEHAVIORAL HEALTH YOUTH ADVISORY
BOARD AND CALIFORNIA'S LARGER
COUNTIES. NUMEROUS SURVEYS.
SURVEYS SHOW THAT THE MENTAL
HEALTH OF YOUNG CALIFORNIANS
HAVE BEEN TRENDING IN THE WRONG
DIRECTION OVER THE LAST DECADE
BETWEEN PANDEMIC ERA ISOLATION,
SOCIAL MEDIA, AND THE THREAT OF
GUN VIOLENCE IN OUR SCHOOLS, OUR
YOUNGEST GENERATION HAS DEALT
WITH ANXIETY AND STRESSORS THAT
MANY OF US HAVEN'T DEALT WITH.
THIS GENERATION ALSO IS OUR MOST
DIVERSE, AND OUR MOST
UNDERREPRESENTED COMMUNITIES ARE
THE ONES WHERE YOUTH ARE LESS
LIKELY TO BE SCREENED FOR
DEPRESSION AND RECEIVE
TREATMENT. AB 2411 IS ABOUT
ACKNOWLEDGING THAT WE NEED TO
LISTEN TO THE VOICES OF YOUNG
PEOPLE THEMSELVES, TO UNDERSTAND
WHAT THEY GO THROUGH AND HOW IT
CAN BE MADE BETTER THROUGH THE
LENS OF PUBLIC HEALTH. BY
REQUIRING ALL COUNTIES OVER
80,000 PEOPLE IN POPULATION, IN
THE POPULATION, TO HAVE A
BEHAVIORAL HEALTH YOUTH ADVISORY
BOARD WILL ENSURE THAT THERE
PERSPECTIVE IS FRONT AND CENTER.
IN A CONVERSATION ABOUT HOW TO
BEST SERVE THEM HERE TO SPEAK
MORE ABOUT THE BILL, IF NEEDED,
IS RADU CHAUHAN, MEMBER OF THE
SACRAMENTO COUNTY BEHAVIORAL
HEALTH YOUTH ADVISORY BOARD, AND
TOBY EWING, EXECUTIVE DIRECTOR
OF THE MENTAL HEALTH SERVICES
OVERSIGHT AND ACCOUNTABILITY
COMMISSION. THANK YOU. YOU HAVE
TWO MINUTES. GOOD AFTERNOON,
CHAIR BONTA AND MEMBERS OF THE
COMMITTEE. MY NAME IS RADU
CHAUHAN, AND I SUPPORT ASSEMBLY
BILL 2411 AND THANK ASSEMBLY
MEMBER CARRILLO FOR AUTHORING
THIS BILL. NOW ELEVATING YOUTH
VOICE IS VITAL FOR OUR SOCIETY
TO FUNCTION FOR TWO REASONS ONE
INCLUDING YOUTH PERSPECTIVE WITH
DIVERSE BACKGROUNDS ENSURES A
BROADER RANGE OF EXPERIENCES AND
CONCERNS CONSIDERED IN DECISION
MAKING. THIS LEADS TO MORE
EQUITABLE AND MORE
REPRESENTATIVE POLICIES. TWO
YOUTH CAN OFTEN HAVE A FIRM
GRASP OF CURRENT TRENDS. THEIR
INSIGHT CAN BE HELPFUL FOR
POLICYMAKERS TO UNDERSTAND THE
EVOLVING NEEDS OF OUR SOCIETY
TODAY. CRAFTING SOLUTIONS THAT
RESONATE WITH BOTH THE YOUNG AND
THE OLDER GENERATIONS. NOW THIS
COOPERATION CREATES A MORE
COHESIVE SOCIETY WHERE BOTH
EVERYONE FEELS MORE HEARD AND
REPRESENTED ON A BOARD. MYSELF I
ALSO WE ALSO GIVE INPUT TO
DIFFERENT IDEAS. FOR EXAMPLE,
LAST YEAR OUR BOARD DRAFTED A
POLICY BRIEF FOR SCHOOLS AROUND
THE COUNTY TO NOT ONLY FOCUS ON
EDUCATION, BUT ALSO THE MENTAL
AND PHYSICAL WELL-BEING OF A
CHILD. NOW, WITH INTENSIVE
RESEARCH AND SOME GUIDANCE, WE
PRESENTED THESE POLICIES TO THE
BOARD OF SUPERVISORS AND THE
SACRAMENTO COUNTY OF EDUCATION.
AND ONE TRIGGERED RESPONSE FROM
OUR POLICIES FROM THE COUNTY OF
EDUCATION WAS ACTUALLY ADDING
MORE CLINICIANS TO THEIR
SCHOOLS, WHICH WILL SEE IN THE
NEXT YEAR. AND THIS WAS FOR THE
INTENT ON FOCUSING ON THE
HOLISTIC WELL-BEING OF A CHILD
IN THEIR COMMUNITY. NOW, IN
SHORT, WHAT I'M TRYING TO SAY IS
THAT A THRIVING SYSTEM WITH
YOUTH VOICE IS MORE INCLUSIVE
AND A MORE FUTURE ORIENTED
APPROACH TO HOW WE APPROACH OUR
CIVIC SYSTEM, FOR THESE REASONS,
I RESPECTFULLY RESPECT YOUR EYE
ON THE FOR TWO, ON THE TWO FOR
ONE ONE. BILL. THANK YOU. THANK
YOU SO MUCH, MADAM CHAIR AND
MEMBERS. TOBY EWING, ON BEHALF
OF THE STATE'S MENTAL HEALTH
COMMISSION, SOON TO BE
BEHAVIORAL HEALTH COMMISSION, I
WANT TO THANK THE AUTHOR,
ASSEMBLY MEMBER AND COMMISSIONER
CARILLO FOR LEADERSHIP ON THIS
BILL, RESPECTFULLY ASK FOR YOUR
AYE VOTE AND HERE TO ANSWER ANY
QUESTIONS YOU MAY HAVE. THANK
YOU. ARE THERE ANY OTHER
WITNESSES IN SUPPORT? ANY
WITNESSES IN OPPOSITION? SEEING
NONE, I WILL BRING IT BACK TO
THE COMMITTEE. I'LL JUST START
OFF BY SAYING THANK YOU SO MUCH
TO THE AUTHOR FOR BRINGING THIS
FORWARD. I THINK MANY OF US
OFTEN TALK ABOUT HOW WE CAN
INTEGRATE YOUTH VOICE. THIS,
COMMISSION AND THE OPPORTUNITY
TO ESTABLISH YOUTH MENTAL HEALTH
BOARDS. ACTUALLY IS ABOUT
FUNDAMENTALLY YOUTH VOICE AND
MAKING SURE THAT, IT CAN'T BE
WITHOUT THEM, UNLESS WE HEAR
FROM THEM. SO THANK YOU SO MUCH
FOR PROVIDING THE STRUCTURE TO
BE ABLE TO DO IT. IF YOU ARE
OPEN TO CO AUTHORS, I WOULD LOVE
TO CO AUTHOR, AND WITH THAT,
MISS CARRILLO PLEASE Þ VICE
CHAIR PLEASE GO AHEAD. MAY I
CLOSE. SORRY I JUST WANTED TO
MAKE A COMMENT. WHEN I WAS
LOOKING AT THE BILL, I WAS
THINKING THAT, YOU KNOW, YOUNG
PEOPLE ARE THE ONE OF THE GROUPS
THAT WE REALLY WANT TO GET, YOU
KNOW, MORE ACCESS TO TREATMENT
AND SERVICES AND MENTAL HEALTH
IF THEY'RE NEEDED, AND ALSO MORE
AWARENESS. AND ONE OF THE
BIGGEST STUMBLING BLOCKS WE
ALWAYS FACE WHEN WE DEAL WITH
MENTAL HEALTH IS STIGMA. AND
TALKING ABOUT IT, I THINK IF WE
HAVE YOUNG PEOPLE OUT THERE
TALKING ABOUT IT, IT KIND OF
WILL. I THINK IN A LOT OF WAYS
REDUCE THE STIGMA. PART OF IT
AMONG YOUNG PEOPLE AND ALSO GET
PEOPLE TALKING ABOUT IT. YOU
KNOW, IF IT'S ON A SCHOOL CAMPUS
OR WHEREVER IT IS, IT'S JUST THE
MORE WE TALK ABOUT IT, THE
BETTER. SO I ALSO WOULD LIKE TO
BE A CO AUTHOR POSSIBLE. THANK
YOU. GLAD TO HAVE YOU. THANK YOU
SO MUCH FOR YOUR TESTIMONY, MISS
JOANNE. LET ME CLOSE. THANK YOU
MADAM CHAIR AND MEMBERS, MADAM
CHAIR AND MEMBERS, I SAW A
GRAPHIC THAT I REALLY LIKED A
WHILE AGO. IT WAS A YOUNG
STUDENT ORCHESTRA. I IMAGINED
THEM IN, LIKE, SECOND GRADE AND
THIRD GRADE. AND THE GRAPHICS
STATES. AND THERE WAS ANOTHER
PHOTO. IT WAS THE LOS ANGELES
PHILHARMONIC. AND IT SAID, IN
ORDER TO HAVE THIS, WE HAVE TO
HAVE THIS. THE SECOND AND THIRD
GRADE YOUNG STUDENTS, LEARNING
HOW TO PLAY MUSIC IN ORDER FOR
US TO HAVE EQUITY AMONGST
VARIOUS DIFFERENT SECTORS AND
THE WORKFORCE, WHERE MENTAL
HEALTH IS A STIGMA, I'M THINKING
LAW ENFORCEMENT, HOSPITAL HEALTH
CARE WORKERS, ETC. WE HAVE TO
CREATE A PATHWAY IN WHICH YOUNG
PEOPLE NOW ARE ABLE TO ACCESS
THE RESOURCES AND TALK ABOUT
MENTAL HEALTH AS THEY GROW
OLDER. THEY ARE ALSO TAKING
THESE CONSIDERATIONS INTO THE
VERY WORK THAT THEY DO. AND I
LIKE THE RECORD TO REFLECT THAT.
I WILL ALIGN MY, CLOSING
COMMENTS WITH THAT OF MISS
SHARON, AND I'M REALLY GRATEFUL
FOR HER, COURAGE AND FOR HER
TESTIMONY HERE TODAY. THANK YOU.
RESPECTFULLY REQUEST AN AYE
VOTE. THANK YOU. THE MOTION IS
Dð PASS TO APPROPRIATIONS, WE
HAVE A MOTION AND A SECOND. SO
PLEASE CALL THE ROLL. BONTA I.
BONTA. AYE. WALDEN. WALDEN. AYE
AGUIAR-CURRY AGUIAR-CURRY. AYE.
ARAMBULA ARAMBULA. I WENT TO
CARILLO. WENDY. CARILLO. AYE.
FLORA HANEY. HANEY. AYE. JOAN
SAWYER. CHEN. SAWYER. AYE.
MAIENSCHEIN. MAIENSCHEIN. AYE.
MCCARTY JO. PATTERSON. JO.
PATTERSON. AYE. RODRIGUEZ
RODRIGUEZ. AYE. SANCHEZ.
SANCHEZ. NOT VOTING. SANTIAGO
SANTIAGO. AYE. WEBBER. 11 ZERO.
THAT MEASURE PASSES. 11 TO 0.
THANK YOU SO MUCH, MR. CARRILLO.
WE WILL MOVE ON TO ITEM NUMBER
20 5AB 2871. BRIAN MAIENSCHEIN.
MOVED BY SANTIAGO. SECONDED BY
DOCTOR ARAMBULA.
PLEASE PROCEED WHENEVER YOU'RE
READY. THANK YOU VERY MUCH,
MADAM CHAIR AND MEMBERS,
CALIFORNIA IS FACING A
STAGGERING NUMBER OF OVERDOSE
DEATHS. THE IMPACT OF FENTANYL
ALONE HAS BEEN FELT IN EVERY ONE
OF OUR DISTRICTS. AB 2871
CREATES A NEW TOOL TO HELP
COMBAT THIS CRISIS AND PREVENT
FUTURE DEATHS. THE BILL ALLOWS
COUNTIES TO CREATE OVERDOSE
FATALITY REVIEW TEAMS COMPOSED
OF PUBLIC HEALTH PROFESSIONALS,
LAW ENFORCEMENT, DRUG TREATMENT
PROVIDERS, AND LOCAL NONPROFIT
ORGANIZATIONS. THESE TEAMS WILL
EXAMINE THE CIRCUMSTANCES
SURROUNDING INDIVIDUAL OVERDOSE
DEATHS TO IDENTIFY COMMONALITIES
OR OTHER ACTIONABLE ITEMS THAT
CAN LEAD TO INFORM EFFORTS TO
PREVENT FUTURE OVERDOSE. REYES.
THE BILL IS MODELED OFF OF
EXISTING REVIEW TEAMS SUCH AS
CHILD DEATH REVIEW TEAMS,
DOMESTIC VIOLENCE DEATH REVIEW
TEAMS, AND ELDER AND DEPENDENT
ADULT DEATH REVIEW TEAMS. WITH
ME TO TESTIFY IN SUPPORT IS
DOCTOR ERIC BERG, THE MEDICAL
CONSULTANT FOR PUBLIC HEALTH
SERVICES WITH THE COUNTY OF SAN
DIEGO. PLEASE PROCEED. THANKS.
HI. COMMITTEE MEMBERS, MY NAME
IS DOCTOR ERIC BERG. I'M A
MEDICAL CONSULTANT WITH THE
COUNTY OF SAN DIEGO AND A
PRACTICING EMERGENCY PHYSICIAN.
SO THE COUNTY OF SAN DIEGO IS
PROUD TO SPONSOR THIS BILL THAT
WILL HELP COUNTIES ADDRESS THE
DRUG. AND OPIOID CRISIS LOCALLY,
AB 2871 WOULD ALLOW COUNTIES TO
CREATE OVERDOSE FATALITY REVIEW
TEAMS TO ENGAGE IN SYSTEMWIDE
REVIEW AND INFORMATION SHARING
ACROSS EIGHT ACROSS COUNTY
AGENCIES, LOCAL STAKEHOLDERS AND
EXPERTS. WHEN THERE'S A DRUG
FATALITY WITH THE SOLE PURPOSE
OF PREVENTING FUTURE, FUTURE
FATALITIES. I TRUST THE HEALTH
COMMITTEE UNDERSTANDS THE
MAGNITUDE OF THE OVERDOSE
CRISIS, BUT I'LL REVIEW A FEW
QUICK STATISTICS HERE. SO IN
2022 ALONE, OVER A 11,000
CALIFORNIANS DIED FROM DRUG
OVERDOSES IS MORE THAN DOUBLE
THE NUMBER FROM 2018. AND
BETWEEN 2019 AND 2021, OPIOID
RELATED DEATHS INCREASED BY 121,
ACCORDING TO CDPH. SO THE
OVERDOSE FATALITY REVIEW TEAMS
WOULD HELP STREAMLINE THE
ABILITY TO SHARE INFORMATION
ABOUT INDIVIDUALS AND HELP TO
IDENTIFY OPPORTUNITIES FOR
IMPROVEMENT AT THE SYSTEM LEVEL
BY ALLOWING STAKEHOLDERS THAT
MAY HAVE HAD CONTACT WITH THE
DECEASED TO WORK TOGETHER TO TRY
TO IDENTIFY GAPS IN SERVICE
DELIVERY. CURRENTLY, THE DATA IS
SILOED BETWEEN DIFFERENT
AGENCIES AND STAKEHOLDERS, AND
THAT INFORMATION CANNOT BE
EASILY SHARED, BECAUSE A LOT OF
THAT IS PROTECTED AND
CONFIDENTIAL BY LAW. SO FOR
EXAMPLE, IN A FENTANYL OVERDOSE,
A FATALITY REVIEW TEAM MAY HELP
IDENTIFY OPPORTUNITIES FOR
INTERVENTION IN SYSTEMS THAT
THESE INDIVIDUALS ARE LIKELY TO
HAVE HAD CONTACT WITH DURING
THEIR LIFE, INCLUDING HEALTH
CARE, BEHAVIORAL HEALTH, SOCIAL
SERVICES, AND LAW ENFORCEMENT.
RECOGNIZING AND SEIZING THESE
OPPORTUNITIES MAY HELP PREVENT
FUTURE DEATHS. THANK YOU FOR
YOUR TIME. THANK YOU. OTHER
WITNESSES IN SUPPORT. GOOD
AFTERNOON. THANK YOU, DILLON
ELLIOTT, ON BEHALF OF THE COUNTY
OF FRESNO, CURRENTLY SUPPORTIVE.
AMENDED. THANK YOU. THANK YOU.
KELLY BROOKS, ON BEHALF OF THE
COUNTY HEALTH EXECUTIVES
ASSOCIATION OF CALIFORNIA AND
THE URBAN COUNTIES OF CALIFORNIA
IN SUPPORT. SARAH DUQUETTE, ON
BEHALF OF THE RURAL COUNTY
REPRESENTATIVES OF CALIFORNIA
AND STRONG SUPPORT. THANK YOU.
ANY WITNESSES IN OPPOSITION?
SEEING NONE, I WILL BRING IT
BACK TO THE COMMITTEE. ASSEMBLY
MEMBER MAIENSCHEIN VERY MUCH
APPRECIATE THIS BILL. I THINK
YOU'VE IN PARTICULAR BEEN VERY
FOCUSED ON ADDRESSING OUR OPIOID
CRISIS AND FEELS AND THIS FEELS
VERY MUCH A STEP IN THE POSITIVE
RIGHT DIRECTION THAT TAKES A
PUBLIC HEALTH FOCUS, THAT ALLOWS
US TO BE ABLE TO REALLY
UNDERSTAND THE WAYS IN WHICH OUR
SYSTEMS ARE NOT WORKING TOGETHER
IN ORDER TO BE ABLE TO SUPPORT
EVERY CALIFORNIAN AS WE DEAL
WITH THIS OPIOID CRISIS. AND
THANK YOU TO THE TESTIMONY THAT
YOU OFFERED FROM SAN DIEGO. I
HOPE YOU'RE STAYING OVERNIGHT
AND ENJOYING OUR TIME HERE, IN
SACRAMENTO, WITH THAT, SEEING NO
OTHER COMMENT FROM COMMITTEE
MEMBERS, THE WE NEED A MOTION.
OH, WE HAVE A MOTION AND A
SECOND. AND THE MOTION IS DUE
PASS TO PRIVACY AND CONSUMER
PROTECTION. PLEASE CALL THE
ROLL. BONTA, I, I WALDEN WALDEN
I AGUIAR-CURRY AGUIAR-CURRY. I
ARAMBULA ARAMBULA I WENDY
CARILLO WENDY CARILLO I LARA
LARA I HANEY. HANEY I JOAN
SAWYER JOHN SAWYER I MAINTAIN
WEINSTEIN I MCCARTY JOE
PATTERSON, JOE PATTERSON I
RODRIGUEZ. ROGER RODRIGUEZ I
SANCHEZ. SANCHEZ I SANTIAGO.
SANTIAGO I WEBER. WEBER I. THANK
YOU, THANK YOU, MISS MCKENNA,
THAT BILL PASSES OUT 14 TO 0.
MISS MCKENNA, PLEASE MAKE YOUR
WAY TO, THE WHERE ARE WE? 1100?
IN THE SINGLE, IN THE IN THE
SWING SPACE. I AM GOING TO DO MY
BILL NOW
.
GOOD AFTERNOON. MEMBERS OF THE
COMMITTEE. I AUTHORED THIS BILL
AB 3161. BECAUSE RACIAL BIAS IN
HEALTH CARE DISPROPORTION
AFFECTS COMMUNITIES OF COLOR,
RACIAL AND ETHNIC MINORITY
GROUPS ARE MORE LIKELY TO LIVE
IN SEGREGATED AND DISADVANTAGED
NEIGHBORHOODS, LARGELY DUE TO
STRUCTURAL DISCRIMINATION AND
RACISM, STRUCTURAL
DISCRIMINATION AND RACISM. IN
HEALTH CARE LEADS TO LIMITED
ACCESS TO TREATMENT AND
PREVENTIVE CARE, WHICH IN TURN
INCREASES RISKS FOR MORBIDITY
AND MORTALITY. FURTHER, BLACK
INDIGENOUS PEOPLE OF COLOR
COMMUNITIES EXPERIENCE HIGHER
RATES OF MEDICAL MISDIAGNOSIS
AND PATIENT ADVERSE EVENTS WHEN
COMPARED TO WHITE PATIENTS. THIS
BILL WILL REQUIRE HOSPITALS TO
ANALYZE PATIENT SAFETY EVENTS BY
SOCIODEMOGRAPHIC FACTORS TO
IDENTIFY DISPARITIES IN THESE
EVENTS. THE BILL ALSO REQUIRES
HOSPITAL SAFETY PLANS TO INCLUDE
A PROCESS FOR ADDRESSING RACISM
AND DISCRIMINATION, AND ITS
IMPACTS ON PATIENT HEALTH AND
SAFETY, INCLUDING MONITORING
SOCIODEMOGRAPHIC DISPARITIES IN
PATIENT SAFETY EVENTS AND
DEVELOPING INTERVENTIONS TO
REMEDY KNOWN DISPARITIES AND
ENCOURAGING FACILITY STAFF TO
REPORT SUSPECTED INSTANCES OF
RACISM AND DISCRIMINATION. WE
CAN'T SOLVE THE PROBLEMS OF
RACIAL BIAS AND DISPARITIES IN
PATIENT SAFETY EVENTS UNTIL WE
HAVE REAL DATA ABOUT THE SCOPE
OF THE PROBLEM IN CALIFORNIA,
THIS BILL WILL PROVIDE THAT
DATA. THANK YOU. AND AS
WITNESSES TODAY, WE'RE GOING TO
PROVIDE TWO MINUTES OF
TESTIMONY. I HAVE CO-SPONSORS OF
THE BILL ON KI¾M AND POLICY
DIRECTOR FOR THE BLACK WOMEN FOR
WELLNESS ACTION PROJECT, AND
RONALD COLMAN, BSA, MANAGING
DIRECTOR OF POLICY AT CPN. GOOD
EVENING. MY NAME IS RONALD
COLEMAN, BSA, MANAGING DIRECTOR
OF POLICY AT THE CALIFORNIA PAN
ETHNIC HEALTH NETWORK. C-PEN.
I'M HAPPY TO BE HERE TODAY TO
OFFER TESTIMONY AS A CO-SPONSOR
AND IN SUPPORT OF AB 3161, WHICH
WOULD ESTABLISH A MECHANISM TO
TRACK RACISM AND DISCRIMINATION
IN HEALTH CARE WHILE ALSO
SUPPORTING PATIENTS IN ACCESSING
JUSTICE. RACIAL DISCRIMINATION
AND IMPLICIT BIAS CONTINUE TO
PLAGUE THE HEALTH CARE INDUSTRY
AND NEGATIVELY IMPACT HEALTH
OUTCOMES FOR PATIENTS. THESE
CHALLENGES MAY LEAD TO SERIOUS
INJURY, MISDIAGNOSIS, OR EVEN
DEATH. WELL DOCUMENTED NATIONAL
RESEARCH SHOWS THAT COMMUNITIES
OF COLOR ARE MORE LIKELY TO
EXPERIENCE PATIENT SAFETY EVENTS
THAN THEIR WHITE COUNTERPARTS.
HERE IN CALIFORNIA, CDPH HAS
OVERSIGHT OVER FACILITIES AND IS
REQUIRED TO REVIEW ADVERSE
PATIENT SAFETY EVENTS. HOWEVER,
IT IS NOT COLLECTING DEMOGRAPHIC
OR SEXUAL ORIENTATION OR GENDER
IDENTITY INFORMATION IN
CONNECTION WITH THESE EVENTS.
THAT'S PROBLEMATIC FOR TRACKING
TRENDS RELATED TO WHO IN OUR
STATE IS ACTUALLY BEING HARMED.
AB 3161 UPDATES THE INFORMATION
COLLECTED WHILE ALSO
STREAMLINING WHAT'S CURRENTLY A
PRETTY CONFUSING COMPLAINT
PROCESS FOR PATIENTS. IT WOULD
ALSO ESTABLISH A SEAMLESS
MECHANISM FOR PATIENTS TO ACCESS
JUSTICE IN CONNECTION WITH THEIR
COMPLAINTS. AB 3161 CERTAINLY
WON'T END RACISM,
DISCRIMINATION, IMPLICIT BIAS IN
HEALTH CARE SETTINGS, BUT IT
WILL GIVE PATIENTS AND THE STATE
THE TOOLS IT NEEDS TO IDENTIFY
PROBLEMATIC ACTORS ACROSS THE
INDUSTRY. FOR THESE REASONS, WE
RESPECTFULLY ASK FOR YOUR AYE
VOTE, AND WE THANK THE CHAIR FOR
HER LEADERSHIP. GOOD AFTERNOON,
AND THANK YOU, MADAM CHAIR AND
COMMITTEE MEMBERS. MY NAME IS
KIYA AND I'M POLICY DIRECTOR
WITH BLACK WOMEN FOR WELLNESS
ACTION PROJECT. WE ARE A
REPRODUCTIVE JUSTICE COMMUNITY
BASED ORGANIZATION COMMITTED TO
IMPROVING THE HEALTH AND
WELL-BEING OF BLACK WOMEN AND
GIRLS. I'M HERE AS A PROUD
CO-SPONSOR TO EXPRESS OUR STRONG
SUPPORT FOR AB 3161, THE EQUITY
IN HEALTH CARE ACT, WHICH WILL
WORK TO ADDRESS THE RACIAL AND
IMPLICIT BIAS IN HEALTH CARE AND
PROVIDE PATHWAYS TO JUSTICE FOR
COMMUNITY MEMBERS WHO EXPERIENCE
HARM TO DUE TO DISCRIMINATION
WHEN RECEIVING CARE, ADVERSE
HEALTH EVENTS TAKE MANY FORMS,
AND RESEARCH REVEALS THAT
DISPARITIES AND QUALITY OF CARE
EXIST ACROSS A VARIETY OF THE
PATIENT. SAFETY INDICATORS, WITH
BLACK, INDIGENOUS, AND OTHER
PEOPLE OF COLOR BEARING THE
BURDEN. EVEN AS QUALITY OF CARE
AND OUTCOMES HAVE IMPROVED FOR
EVERYONE, RACIAL AND ETHNIC
DISPARITIES PERSIST IN THE US
AND CALIFORNIA. THE
DISPROPORTIONATELY POOR HEALTH
OUTCOMES IN MATERNAL MORBIDITY
AND MORTALITY THAT BURDEN BLACK
MAMAS AND BIRTHING PEOPLE IS
EMBLEMATIC OF THIS. WE KNOW THE
STATISTICS. MORE THAN 80% OF
PREGNANCY RELATED DEATHS HAVE
BEEN FOUND BY MATERNAL MORTALITY
REVIEW COMMITTEES. TO BE
PREVENTABLE. BLACK MAMAS ARE
MORE THAN THREE TIMES MORE
LIKELY TO DIE FROM PREGNANCY
RELATED CAUSES, REGARDLESS OF
TYPICALLY MITIGATING FACTORS OF
EDUCATION AND SOCIOECONOMIC
STATUS. BLACK MAMAS AND BIRTHING
PEOPLE ARE OFFERED FEWER
TREATMENT OPTIONS, FREQUENTLY
EXPERIENCED DELAYS IN CARE, AND
ARE SUBJECTED TO BIASED DECISION
MAKING. WE KNOW THE DEVASTATING
AND HARROWING STORIES, WHETHER
IT'S OF APRIL VALENTINE, BRIDGET
KRAMER OR MY DEAR FRIEND WHOSE
MULTIPLE COMPLAINTS ABOUT
UNCHARACTERISTIC HEADACHES
DURING HER PREGNANCY WENT
IGNORED BY HER DOCTOR, LEADING
TO AN EMERGENCY C-SECTION TO
DELIVER HER BABY AT 1 POUND.
LUCKILY, THEY BOTH SURVIVED THE
ORDEAL, BUT NOT WITHOUT LASTING
EFFECTS. OUR COMMUNITIES ARE
BURDENED WITH SUCH STORIES OF
DEATH, NEAR DEATH AND SEVERE
MORBIDITY OR INJURY. WHAT
HAPPENS AFTERWARDS? WHAT
PROTOCOLS ARE IN PLACE TO
ADDRESS SAFETY EVENTS THAT
LIKELY RESULTED FROM RACISM OR
DISCRIMINATION? DO WE JUST SAY
SORRY AND GO HOME LEAVING
PATIENTS AND THEIR FAMILIES
SADDLED WITH THE RESULTING
BURDENS OF CHRONIC HEALTH ISSUES
AND ASSOCIATED MEDICAL COSTS?
I'M GOING TO KEEP GOING BECAUSE
MY TWO MINUTES THIS MEANS. SO WE
HAVE TO ENGAGE INTERVENTIONS
THAT ARE RESPONSIVE TO THE
ISSUES AT HAND. THIS BILL SAYS
THINK ABOUT SOCIODEMOGRAPHIC
FACTORS IN YOUR ANALYSIS OF
ADVERSE EVENTS. IT SAYS AT LEAST
CREATE A SAFETY PLAN AND
PROTOCOLS REFLECTIVE OF AND
RESPONSIVE TO THE CRISIS AT
HAND. IT SAYS AT MINIMUM, REPORT
AND TRACK THE DATA THAT GIVES US
MORE COMPREHENSIVE AND CLEARER
PICTURES OF THE ISSUES OUR
COMMUNITIES HAVE. THE STORIES
SCARS VISIBLE AND INVISIBLE, AND
INEQUITABLE HEALTH OUTCOMES. TO
DEMONSTRATE THAT BIAS, RACIAL,
GENDER AND A SLEW OF OTHERS
EXIST IN OUR HEALTH CARE SYSTEM.
THIS, COUPLED WITH THE MOUNTING
RESEARCH THAT ESTABLISHES THE
ROLE OF IMPLICIT BIAS AND RACISM
IN HEALTH OUTCOMES, TELL US THAT
WE MUST TAKE MEANINGFUL STEPS TO
ERADICATE THIS PHENOMENON IN OUR
HEALTH CARE SYSTEM. AB 3161 IS
THAT MEANINGFUL STEP TO WORK TO
ADDRESS THE VERY REAL HARMS OF
BIAS? AS PROUD CO-SPONSORS OF
3161, I RESPECTFULLY URGE YOU TO
VOTE YES ON THIS CRITICALLY
IMPORTANT BILL. THANK YOU FOR
YOUR ATTENTION AND THANK YOU,
CHAIR BONTA, FOR YOUR LEADERSHIP
ON THIS CRITICALLY IMPORTANT
ISSUE. WITNESSES IN SUPPORT.
THANK YOU VERY MUCH, DYLAN
ELLIOTT, ON BEHALF OF THE
CALIFORNIA STATE ASSOCIATION OF
PSYCHIATRISTS AND STRONG
SUPPORT. THANK YOU, SANDRA
POOLE, ON BEHALF OF WESTERN
CENTER ON LAW AND POVERTY AND
SUPPORT. MATT LUJAN, SEIU
CALIFORNIA IN SUPPORT JENNIFER
ROBLES WITH HEALTH ACCESS
CALIFORNIA IN SUPPORT. HI. GOOD
AFTERNOON. CAROL GONZALEZ HERE
ON BEHALF OF HISPANAS ORGANIZED
FOR POLITICAL EQUALITY AND
SUPPORT. THANK YOU, THANK YOU.
DO WE HAVE ANY WITNESSES IN
OPPOSITION? SEEING NONE, BRING
IT TO THE COMMITTEE. ANY
COMMENTS? QUESTIONS. MOTION. DO
WE HAVE A MOTION? WE HAVE A
MOTION. AND A SECOND DO PASS TO
JUDICIARY, MADAM AUTHOR WOULD
YOU LIKE TO CLOSE? THANK YOU. I
RESPECTFULLY REQUEST YOUR. I
VOTE AS WE CONTINUE TO ADVANCE
OUR ABILITY AS A STATE TO
RECOGNIZE THE HEALTH DISPARITIES
THAT EXIST AMONGST VARIOUS
COMMUNITIES, PARTICULARLY
COMMUNITIES OF COLOR, AND VERY
MUCH HOPE THAT WE WILL BE ABLE
TO PASS THIS OUT OF COMMITTEE.
THANK YOU. THANK YOU. CHAIRWOMAN
MADAM SECRETARY, PLEASE CALL THE
ROLL. BONTA. I WANT TO I,
WALDRON, I WALDRON I
AGUIAR-CURRY AGUIAR-CURRY I
ARAMBULA ARAMBULA I WENDY
CARRILLO. WENDY CARILLO I FLORA.
FLORA I HANEY HANEY I
JONES-SAWYER I JONES-SAWYER I
MAINCHAIN MAINCHAIN I MCCARTY.
JO. PATTERSON. JO. PATTERSON I
RODRIGUEZ. RODRIGUEZ I SANCHEZ.
SANCHEZ. NOT VOTING. SANTIAGO.
SANTIAGO. I CHAVO. WEBBER. WEBER
I. PERKINS THE BILL IS 13 ZERO.
YOUR BILL PASSES. MISS OKAY.
MISS MCKENNA. ITEM 27 AB 2998. I
THINK I HEARD A MOTION FROM
SANTIAGO. SECONDED BY RODRIGUEZ.
THANK YOU GUYS SO MUCH. MAKE
SURE TO PRESS YOUR MICROPHONE.
ASSEMBLYMEMBER. THANK YOU GUYS
SO MUCH. GOOD AFTERNOON, CHAIR
AND MEMBERS, I'M HERE TO PRESENT
AB 2998, WHICH AIMS TO PERMIT
MINORS TO CARRY AND ADMINISTER
AN. OKAY. I CAN'T EVEN SAY THE
NAME NOW. NALOXONE OAN
HYDROCHLORIDE SUCH AS NARCAN IN
SCHOOLS AND OTHER PUBLIC PLACES
AS AN EMERGENCY MEASURE TO
COUNTER OPIOID OVERDOSE. SUBJECT
TO APPROVAL BY A DOCTOR. TODAY I
HAVE WITH ME A DOCTOR SMITH AND
WHO REPRESENTS THE LOS ANGELES
UNIFIED SCHOOL DISTRICT, AND
BRIAN RIX READ, READING PREPARED
REMARKS FROM DOROTHY JOHNSON,
REPRESENTING THE ASSOCIATION OF
CALIFORNIA ADMINISTRATION. THANK
YOU. PLEASE PROCEED. YOU'LL HAVE
TWO MINUTES. GOOD AFTERNOON.
CHAIR BONTA AND MEMBERS OF THE
COMMITTEE. MY NAME IS DOCTOR
SMITHA MALHOTRA, AND I AM THE
CHIEF MEDICAL DIRECTOR FOR LOS
ANGELES UNIFIED SCHOOL DISTRICT.
I'M A PEDIATRICIAN BY TRAINING,
AND I'M HERE TODAY TO URGE YOUR
SUPPORT FOR ASSEMBLY BILL 2998
BY ASSEMBLY MEMBER. MEMBER
MCKENNA. THIS LEGISLATION WOULD
PERMIT MINORS TO CARRY AND
ADMINISTER OVER THE COUNTER
NALOXONE HYDROCHLORIDE, ALSO
KNOWN AS NARCAN, AS AN EMERGENCY
MEASURE WHILE ON A SCHOOL CAMPUS
OR PARTICIPATING IN SCHOOL
ACTIVITIES, AND PROTECTS THEM
FROM LIABILITY WHEN USING IT IN
GOOD FAITH TO COUNTER AN
OVERDOSE. IN RESPONSE TO THE
DEVASTATING EPIDEMIC OF OPIOID
OVERDOSES IN LOS ANGELES, LAUSD
IMPLEMENTED NUMEROUS
INITIATIVES, INCLUDING THE
OPIOID TASK FORCE LAUNCHED THIS
SCHOOL YEAR, WHICH EXPANDS
PARTNERSHIPS WITH COMMUNITY
BASED ORGANIZATIONS AND AGENCIES
THROUGHOUT LOS ANGELES AND
ALIGNS OUR EFFORTS TO KEEP OUR
COMMUNITIES SAFE. IN OCTOBER OF
2022, LAUSD BEGAN RECEIVING OVER
THE COUNTER NARCAN, ONE BRAND OF
NALOXONE THROUGH CALIFORNIA'S
NALOXONE DISTRIBUTION PROJECT.
THESE DOSES ARE AVAILABLE AT ALL
K THROUGH 12 SCHOOLS. ADULT
EDUCATION CENTERS, AND EARLY ED
CENTERS. THEY'RE ALSO PROVIDED
TO SCHOOL NURSES AND TRAINED
PERSONNEL, AND HAVE PROVEN
CRITICAL IN THE FIGHT AGAINST
OVERDOSE. HOWEVER STAFF THAT CAN
ACCESS THE MEDICATION ARE NOT
ALWAYS AVAILABLE IN THOSE
IMMEDIATE CRITICAL MOMENTS OF AN
OVERDOSE, AND FIRST RESPONDERS
MAY BE MINUTES AWAY. IN FEBRUARY
OF 2023, LA USD CREATED A POLICY
SUPPORTED BY THE LOS ANGELES
COUNTY DEPARTMENT OF PUBLIC
HEALTH TO NOT ISSUE FORMAL
DISCIPLINE IF A STUDENT CARRIES
NALOXONE ON CAMPUS AS AN EXTRA
LAYER OF PROTECTION AGAINST THE
FENTANYL CRISIS, AB 2998 IS
NECESSARY TO CLARIFY THIS
AUTHORIZATION IN STATUTE AND
CREATE AN ADDITIONAL STATEWIDE
TOOL IN THE FIGHT AGAINST
FENTANYL, NHÀ OXONE CAN ONLY
REVERSE AN OPIOID OVERDOSE. IT
DOES NOT REVERSE OVERDOSES
CAUSED BY OTHER DRUGS. IT CANNOT
BE USED TO GET HIGH. IT IS NOT
ADDICTIVE. IT DOES NOT HAVE AN
EFFECT ON A PERSON WITH NO
OPIOIDS IN THEIR SYSTEM. THERE
ARE NO LONG TERME EFFECTS. THERE
IS NO TOLERANCE BUILDING TO IT.
IT IS SAFE AND EFFECTIVE FOR ALL
POPULATIONS, INCLUDING CHILDREN
AND PREGNANT WOMEN. THE BOTTOM
LINE IS THIS BILL WILL INCREASE
THE CHANCES OF LIFE SAVING
COUNTERMEASURES IN THE CASE OF
AN OVERDOSE, AND LAUSD IS PROUD
TO SPONSOR THIS BILL. AND I
THANK YOU FOR YOUR COMMITMENT TO
STUDENT HEALTH. THANK YOU, THANK
YOU. YOU MAY PROCEED. GOOD
AFTERNOON, CHAIR AND MEMBERS. MY
NAME IS BRIAN RIX. I'M THE
LEGISLATIVE LIAISON FOR LOS
ANGELES UNIFIED. I'M READING
PREPARED REMARKS FROM DOROTHY
JOHNSON. SHE'S A LEGISLATIVE
ADVOCATE FOR ASSOCIATION OF
CALIFORNIA SCHOOL
ADMINISTRATORS, WHO
UNFORTUNATELY HAD TO HAD TO
LEAVE. EXCUSE ME. WE'RE HERE TO
SUPPORT AB 2998 BY
ASSEMBLYMEMBER MCKINLEY. THIS
BILL ALLOWS MINORS TO CARRY AND
ADMINISTER NALOXONE
HYDROCHLORIDE AS AN EMERGENCY
MEASURE IN PUBLIC SPACES,
INCLUDING SCHOOLS. EXPANDING
ACCESS TO NALOXONE IS AMONG THE
MOST IMPACTFUL INTERVENTIONS IN
DECREASING OPIOID DEATHS AND
SAVING LIVES. ALTHOUGH MOST
PROFESSIONAL FIRST RESPONDERS
CARRY NALOXONE, THEY MAY NOT
ARRIVE IN TIME TO REVERSE AN
OPIOID OVERDOSE. AND
UNFORTUNATELY, THE SAME IS TRUE
FOR SCHOOL PERSONNEL. A STUDENT
MIGHT BE UNIQUELY POSITIONED TO
RESPOND IMMEDIATELY TO AN
OVERDOSE WHEN ONE OF THEIR
CLASSMATES MIGHT BE IN DANGER.
WE HAVE SADLY HEARD TOO MANY
STORIES OF ON CAMPUS OVERDOSES,
AND THIS IS A COMMON SENSE
APPROACH TO SHARE HELP. WHEN
HELP IS MOST NEEDED, WE
RESPECTFULLY URGE YOUR AYE VOTE.
ANY OTHER WITNESSES IN SUPPORT?
MADAM CHAIR, MEMBERS OF THE
COMMITTEE, BRANDON MAKI WITH THE
CALIFORNIA MEDICAL ASSOCIATION.
I WANT TO THANK THE AUTHOR AND
THE COMMITTEE FOR WORKING WITH
US ON THE AMENDMENTS, AND WE
SUPPORT THE BILL. THANK YOU. ANY
WITNESSES IN OPPOSITION? SEEING
NONE, I WILL BRING IT BACK TO
COMMITTEE. MISTER PATTERSON,
THANK YOU. APPRECIATE THIS.
BILL, LAST YEAR I HAD A BILL,
AND I, FELL VICTIM TO SENATE
APPROPRIATIONS, SO I'M
REINTRODUCED IT THIS YEAR TO
REQUIRE SCHOOLS TO CARRY
NALOXONE. AND, JUST KEEP TRYING
UNTIL IT HAPPENS, BUT, YOU KNOW,
VERY MINIMAL COST. BUT, ONE
THING I'VE LEARNED THROUGH THE
PROCESS, I ACTUALLY HAVE NARCAN
IN MY OFFICE, BUT ONE THING I'VE
LEARNED THROUGH THIS PROCESS IS
THAT OBVIOUSLY, THE TYPES OF
NALOXONE PRODUCTS ARE EVOLVING
RAPIDLY. FOR EXAMPLE, THERE'S,
SOMETHING THAT'S POTENTIALLY
CLOSE A NASAL SWAB, WHICH IS NOT
NALOXONE HYDROCHLORIDE, BUT YOUR
LANGUAGE IS BROAD ENOUGH, AND
IT'S CHEAPER BY THE WAY. BUT
YOUR LANGUAGE IS BROAD ENOUGH TO
COVER THAT. IT SAYS, OR OTHER
OPIOID ANTAGONISTS, I JUST KNOW
I JUST KNOW YOU AS WELL AS ME.
WANT TO BE CLEAR? TO MAKE SURE.
HEY, AS AS THE TECHNOLOGY
EVOLVES, WE DON'T WANT TO HAVE
TO COME BACK AND CHANGE THE LAW.
RIGHT. SO SO I WOULD JUST, YOU
KNOW, CAUTION YOU AS YOU GO
THROUGH THIS PROCESS AND MAKE
SURE YOUR INTENT IS MET ON THAT.
BUT I THINK IT'S A GREAT BILL,
OBVIOUSLY. AND I HOPE, HOPEFULLY
SCHOOLS WILL, A LOT OF SCHOOLS
CARRY IT BY THEMSELVES. I THINK
EVEN LA UNIFIED RIGHT NOW. SO MY
SCHOOL DISTRICT DOES, BUT
HOPEFULLY EVERY SCHOOL DISTRICT
WON'T. A LOT OF SCHOOL DISTRICTS
DON'T BECAUSE IT'S NOT REQUIRED
AND THEY'RE WORRIED ABOUT THE
LIABILITY. SO UNTIL WE REQUIRE
THEM TO CARRY IT AND GIVE THEM
THE LIABILITY, IMMUNITY, THAT
THEY MIGHT NOT CARRY IT. SO
ANYWAYS, THANK YOU FOR YOUR
EFFORTS AND LOOKING FORWARD TO
SUPPORTING IT. IF YOU HAVE AN
OPPORTUNITY TO ADD A COAUTHOR,
I'D LOVE TO COAUTHOR THE BILL.
THANK YOU. MR. HANEY, AND THEN
MR. JONES-SAWYER, I ALSO JUST
WANT TO COMMEND THE AUTHOR AND
L.A. UNIFIED FOR LEADING ON
THIS, I, A NUMBER OF US HAVE
BEEN DOING EVERYTHING WE CAN TO
GET NARCAN EVERYWHERE. AND ALSO
MAKING SURE THAT PEOPLE
UNDERSTAND THAT IT IS EASY TO
USE, IT'S GREAT IF YOU HAVE A
TRAINING AND ALL OF THAT, BUT
IT'S NOT ESSENTIAL. YOU CAN USE
IT. AND PEOPLE SHOULD BECOME
COMFORTABLE WITH USING IT,
INCLUDING, TRAGICALLY YOUNG
PEOPLE. AND UNDERSTAND THAT
THERE ISN'T THIS THREAT OF,
LIABILITY ASSOCIATED WITH IT. SO
I REALLY APPRECIATE THE BILL.
I'D ALSO LOVE TO BE ADDED AS A
AS A COAUTHOR, AND I HOPE THAT
ALL OF US CAN WORK TOGETHER TO
MAKE SURE THAT THAT NARCAN IS
EVERYWHERE, WHERE IT CAN SAVE A
LIFE. THANK YOU, MR.
JONES-SAWYER. THEN, MISS SCHIAVO
AND I AND I ALSO COMMEND YOU ON
BRINGING THIS FORWARD. AND I
HOPE THAT, GENERAL MCKENNA WILL
ALLOW ME TO BE A COAUTHOR TO THE
BILL. TO BE EVEN THOUGH YOU
CAN'T PRONOUNCE NALOXONE
HYDROCHLORIDE, IT'S REALLY
IMPORTANT THAT WE HAVE NARCAN
EVERYWHERE. AND SO, POINT OF
ORDER, MR. JONES-SAWYER. THANK
YOU. ALLOW ME TO BE A COAUTHOR.
THANK YOU. ALMOST AT THE END,
CLEARLY, I ALSO WANT TO THANK
THE AUTHOR. THANK LAUSD, FOR
THEIR LEADERSHIP ON THIS ISSUE,
WHICH IS HALF MY DISTRICT IS
LAUSD, AND WOULD BE HAPPY TO BE
A COAUTHOR AS WELL. I COAUTHORED
WITH MR. PATTERSON LAST YEAR HIS
BILL, AND HOPEFULLY IT'LL GET
OVER THE FINISH LINE THE NEXT
TRY, BUT I THINK THAT THIS IS A
REALLY IMPORTANT EFFORT AND
HAPPY TO SUPPORT IT. MISS
MCKENNA, I JUST WANT TO CLARIFY
THAT YOU'RE ACCEPTING THE
COMMITTEE AMENDMENTS. YES THANK
YOU SO MUCH. AND, I TOO, JUST
WANT TO APPRECIATE THAT YOU ARE
CONTINUING TO, TAKE ON A
LEADERSHIP ROLE IN THIS, ISSUE,
PARTICULARLY ADDRESSING
OVERJOYED, OPIOID OVERDOSE DOSES
AND, FENTANYL USAGE AND IT IS A
LONG DAY, BUT VERY THANKFUL THAT
WE CAN END ON A POSITIVE NOTE.
AND IF YOU ARE ACCEPTING AUTHORS
CO AUTHORS, I'D LOVE TO CO
AUTHOR AS WELL. YES I AM AND
THANK YOU GUYS. I RESPECTFULLY
ASK FOR YOUR AYE VOTE. THANK
YOU. I THINK WE ALL TOOK A BUNCH
OF LAUGHING GAS APPARENTLY, WITH
THAT I THINK WE HAVE A MOTION.
AND A SECOND THE MOTION IS TO
PASS, AS AMENDED, TO JUDICIARY
THREE, PLEASE CALL THE ROLL.
BONTA. AYE BONTA. AYE. WALDEN.
WALDEN. AYE. AGAR AGAR. CURRY.
AYE. ARAMBULA ARAMBULA. AYE.
WENDY. CARILLO WENDY. CARILLO
AYE. FLORA. LARA. AYE. HANEY
HANEY. AYE. JONES. SAWYER A
JONES. SAWYER. AYE. MAIN CHAIN.
MAIENSCHEIN. AYE. MCCARTY JO.
PATTERSON. JO. PATTERSON. AYE.
RODRIGUEZ RODRIGUEZ. AYE.
SANCHEZ. SANCHEZ. AYE. SANTIAGO
SANTIAGO. AYE. CHAVO. CHAU. VÚI.
WEBER. WEBER. AYE. CARDI. AYE.
16 ZERO. THAT MEASURE PASSES 16
ZERO. THANK YOU SO MUCH. WITH
THAT, WE'VE HEARD ALL OF THE
BILLS ON FILE TODAY. SO NOW WE
WILL GO THROUGH THE AGENDA TO
ALLOW, COMMITTEE MEMBERS TO ADD
ON TO VOTES. EVERYTHING IS OUT.
SO WE ARE ONLY ADDING ON TO
BILLS AT THIS POINT. WE'LL START
WITH THE CONSENT CALENDAR.
ARAMBULA ARAMBULA. AYE. WENDY
CARILLO. WENDY. CARILLO. AYE.
FLORA LARA. AYE. MCCARTY
MCCARTY. AYE. PATTERSON.
PATTERSON. AYE CHAU. AYE. WEBER.
WEBER. AYE 16 ZERO MEASURES OUT
16 ZERO. START WITH, ITEM TWO AB
1970 ARAMBULA ARAMBULA. AYE.
WENDY CARILLO. WENDY. CARILLO.
AYE. LARA. LARA NOT VOTING. JOE
PATTERSON. JOE PATTERSON NOT
VOTING. SANCHEZ CHAVO. CHAU.
VÚI. WEBER. WEBER. AYE. CAN YOU
PUT YOUR MIC ON, PLEASE? I HAVE
YOU AS NOT VOTING.
13 ZERO MEASURES. NOW 13 ZERO.
ITEM NUMBER THREE AB 1977 TO
ARAMBULA ARAMBULA. AYE. WENDY
CARILLO WENDY CARILLO. AYE. LARA
LARA. AYE. JOE PATTERSON. JOE
PATTERSON. AYE CHAVO. CHAVO.
AYE. WEBER WEBER. AYE. 16 ZERO
MEASURE IS NOW 16 ZERO OUT.
MOVING ON TO ITEM NUMBER SIX AB
2058 WEBER. WALDRON WALDRON.
AYE. WENDY CARILLO. WENDY.
WENDY. CARILLO. AYE LARA. LARA.
AYE CHAVO. CHAVO. AYE. 15 ZERO
MEASURES NOW. 15 ZERO. ITEM
NUMBER SEVEN AB 2110 ARAMBULA
LARA LARA. AYE CHAVO. CHAVO.
AYE. 16 ZERO MEASURES NOW 16
ZERO. MOVING ON TO ITEM NUMBER
NINE. AB 2161 ARAMBULA LARA
LARA. AYE. CHAVO CHAVO AYE 16
ZERO. MEASURE NOW 16 ZERO.
MOVING ON TO ITEM NUMBER TEN. AB
2169. BAUER KHN ARAMBULA
ARAMBULA. AYE. WENDY CARRILLO.
CARRILLO, WENDY. CARRILLO. AYE.
FLORA LARA NOT VOTING. JOE
PATTERSON. JOE. PATTERSON. AYE.
CHAVO CHAVO. AYE. WEBER. WEBER.
AYE 14 ZERO. THAT VOTE IS NOW 14
ZERO. MOVING ON TO ITEM NUMBER
11, AB 2237 AGUIAR-CURRY.
ARAMBULA. ARAMBULA. AYE WENDY.
CARRILLO. WENDY. CARRILLO. AYE.
FLORA. FLORA AYE. MCCARTY.
MCCARTY. I JOE. PATTERSON JOE.
PATTERSON. AYE. CHAVO. CHAVO.
AYE. WEBER WEBER. AYE. 16 ZERO
VOTES FOR THAT MEASURE NOW. 16
ZERO. MOVING ON TO ITEM NUMBER
12, AB 2258 ZERO ARAMBULA
ARAMBULA. AYE. WENDY CARRILLO.
WENDY CARRILLO. AYE. FLORA.
FLORA. NOT VOTING. JOE
PATTERSON. JOE PATTERSON NOT
VOTING. CHAVO. CHAVO. AYE WEBER.
WEBER. AYE. 13 ZERO 13 ZERO. ON
THAT MEASURE. ITEM NUMBER 13 AB
2297. ARAMBULA ARAMBULA. AYE.
WENDY CARRILLO, WENDY CARRILLO.
AYE. FLORA LARA. NØ JOE
PATTERSON. JOE PATTERSON NOT
VOTING. CHAVO. CHAVO. AYE. WEBER
WEBER. AYE. 13 TWO TWO. THAT
MEASURE IS NOW AT 13 TO 2 VOTES.
ITEM NUMBER 15 AB 2365. HANEY
WALDRON. WALDRON. AYE. FLORA
LARA. AYE CHAVO CHAU. VÚI 15
ZERO. JUST NOW. 15 ZERO. ITEM
NUMBER 16 AB 2390. ARAMBULA LARA
. LARA. AYE CHAVO. CHAVO I 15
ZERO MEASURE NOW HAS 15 TO 0
VOTES. ITEM NUMBER 17 AB 2411.
CARRILLO LARA LARA. AYE MCCARTY.
MCCARTY. AYE CHAVO CHAU VÚI
WEBER. WEBER. AYE 15 ZERO. THAT
MEASURE NOW HAS 15 VOTES TO
ZERO. ITEM NUMBER 18 AB 2428.
CALDERON ARAMBULA ARAMBULA. AYE.
WENDY CARRILLO, WENDY. CARRILLO.
AYE. FLORA LARA. AYE JOE.
PATTERSON. JOE. PATTERSON. AYE.
CHAVO CHAVO. AYE. WEBER. WEBER.
AYE. 16 ZERO. THAT MEASURE NOW
HAS 16 VOTES TO ZERO, MOVING ON
TO ITEM 20, AB 2550. GABRIEL
ARAMBULA. ARAMBULA. AYE. WENDY
CARRILLO. WENDY CARRILLO. AYE.
FLORA LARA. AYE. JOE PATTERSON.
JOE PATTERSON. AYE. CHAVO.
CHAVO. AYE. WEBER. WEBER AYE. 16
ZERO MEASURES NOW AT 16 TO 0.
ITEM NUMBER 21, AB 2657 ARAMBULA
LARA. LARA. AYE. HANEY. HANEY.
AYE CHAVO. CHAVO AYE. WEBER
WEBER. AYE. 15 ZERO MEASURE NOW
HAS 15 VOTES TO ZERO AT ITEM
NUMBER 22, AB 2700, GABRIEL
ARAMBULA ARAMBULA. AYE. WENDY
CARRILLO. WENDY CARRILLO. AYE.
FLORA LARA NOT VOTING. JOE
PATTERSON. JOE PATTERSON NOT
VOTING. CHAVO CHAVO. AYE. WEBER.
WEBER. AYE MAY I MAKE A VOTE
CHANGE FROM AYE TO NOT VOTING?
SANCHEZ. AYE TO NOT VOTING. 13
TO 0. THAT MEASURE IS NOW AT 13
TO 0. ITEM NUMBER 23 AB 2701 VÆ
VALLAPUDUA ARAMBULA ARAMBULA.
AYE. WENDY CARRILLO. WENDY.
CARRILLO. AYE. FLORA. LARA. AYE
JOE PATTERSON. JOE. PATTERSON.
AYE. CHAVO CHAVO AYE. 16 ZERO
MEASURE NOW HAS 16 VOTES TO
ZERO. ITEM NUMBER 24, AB 2749
WOULD ARAMBULA ARAMBULA. AYE.
WENDY CARRILLO. WENDY CARRILLO.
AYE. FLORA FLORA NOT VOTING. JOE
PATTERSON. JOE. PATTERSON. AYE.
CHAVO CHAVO. AYE 14 ZERO MEASURE
NOW IS 14 VOTES TO ZERO. ITEM
NUMBER 25 AB 2871 MAIENSCHEIN
MCCARTY. MCCARTY. AYE. CHAVO
CHAVO AYE 16 ZERO MEASURE NOW IS
16 VOTES TO ZERO. ITEM NUMBER 26
AB 2899 ARAMBULA ARAMBULA. AYE.
WENDY CARRILLO. WENDY CARRILLO.
AYE. LARA LARA. AYE. CHAVO.
CHAVO AYE. 15 ZERO YOU NOW 15
VOTES TO ZERO ON THAT. MCKINLEY,
ITEM 27 AB 20. EVERYBODY OKAY.
WE HAVE THAT ONE. ITEM NUMBER
28, AB 3030. CALDERON WENDY.
CARRILLO. WENDY CARRILLO. AYE.
FLORA. LARA. AYE. CHAVO CHAVO
AYE. 16 ZERO MEASURE NOW HAS 16
VOTES TO ZERO. ITEM NUMBER 29,
AB 3129. WOULD WENDY CARRILLO.
WENDY CARRILLO. AYE. FLORA LARA
NØ. CHAVO. CHAVO I. 12 TO 4. NOW
IT'S 12 TO 4 VOTES, ITEM NUMBER
31 AB 3218. WOULD WANT TO DO
YOURS? DO WE HAVE ANY. DO WE
HAVE ONE? WELL SORRY. ITEM 30 A
B 3161 TO MCCARTY. MCCARTY AYE.
SHABU SHABU. AYE. 15 ZERO
MEASURE HAS 15 VOTES TO ZERO.
ITEM 31 AB 3218. WOULD WENDY
CARRILLO. WENDY CARRILLO. AYE.
FLORA LARA NOT VOTING. CHAU CHAU
VÚI 12 ZERO. THAT MEASURE HAS 12
VOTES TO ZERO. ITEM NUMBER 32.
THAT'S A CONSENT. OH, THAT'S ON
CONSENT. WE ARE DONE, WITH THAT,
WE ADJOURN OUR ASSEMBLY HEALTH
COMMITTEE MEETING