GOOD AFTERNOON, WELCOME TO THE
ASSEMBLY HEALTH COMMITTEE
HEARING ON APRIL 16TH. BEFORE WE
BEGIN, I WOULD LIKE TO MAKE A
STATEMENT ON PROVIDING TESTIMONY
AT THIS HEARING, ALL WITNESSES
WILL BE TESTIFYING IN PERSON. WE
ALLOW TWO MAIN WITNESSES FOR A
MAXIMUM OF TWO MINUTES EACH.
INSTEAD OF THREE MINUTES.
ADDITIONALLY, TESTIMONY WILL
ALSO BE IN PERSON AND LIMITED TO
NAME, POSITION, AND ORGANIZATION
. IF YOU ARE PRESENT, WE HAVE
THE CONSENT CALENDAR TODAY OF
SEVERAL ITEMS. THE FOLLOWING
BILLS ARE PROPOSED FOR CONSENT
FOR TODAY'S HEARING. ANY MEMBER
OF THE COMMITTEE MAY REMOVE A
BILL FROM CONSENT. ITEM NUMBER
THREE BILL AB 1936 BY CERVANTES.
ITEM NUMBER SEVEN AB 2072 BY
WEBER. ITEM NUMBER TEN AB 2119
BY WEBER. ITEM NUMBER SEVEN AB
2072 BY WEBER WITH AMENDMENTS.
ITEM NUMBER 11 AB 2131 VALENCIA.
ITEM NUMBER 12 AB 2340 BONTA.
ITEM NUMBER 13 AB 2376 BAINS.
ITEM NUMBER 14 AB 2434 GRAYSON
WITH AMENDMENTS. ITEM NUMBER 18
AB 2650 ZEBRA. ITEM 19 AB 2680
AGUIAR-CURRY. ITEM 25 AB 2995
JACKSON WITH AMENDMENTS. ITEM 26
AB 3149. GARCIA WITH AMENDMENTS.
ITEM 27 AB 3221. PELLERIN ITEM
29 AB 3271 JOE PATTERSON. WE
WILL START OUR HEARING AS A
SUBCOMMITTEE. AND, TO BE ABLE TO
ENSURE WE HAVE, TYPICALLY GO AND
FILE ITEM ORDER, BUT WE ARE
GOING TO ALLOW FOR DOCTOR
JACKSON TO PRESENT NOW. DOCTOR
JACKSON FILE ITEM ONE AB 1799.
PLEASE PROCEED WHENEVER YOU'RE
READY. DOCTOR JACKSON. MIKE'S
OKAY. THANK YOU, THANK YOU VERY
MUCH. LOOKING FORWARD TO YOUR
QUESTIONS. EXCEPT, MR. SAWYER,
DO NOT WANT ANY QUESTIONS FROM
HIM. OKAY, AB 1799, SEEKS TO
REQUIRE THE STATE PUBLIC HEALTH
OFFICER TO INCLUDE THE IMPACT OF
RACISM ON PUBLIC HEALTH IN THEIR
ANNUAL WRITTEN REPORT TO THE
GOVERNOR AND THE LEGISLATURE ON
THE STATE OF PUBLIC HEALTH IN
CALIFORNIA. THE CURRENT LAW
REQUIRES THE STATE PUBLIC HEALTH
OFFICER TO SUBMIT A WRITTEN
REPORT TO THE GOVERNOR AND THE
LEGISLATURE ON THE STATE OF
PUBLIC HEALTH IN CALIFORNIA, AND
PRESENT AN ANNUAL UPDATE TO
RELEVANT BUDGET COMMITTEES.
UNFORTUNATELY THIS REPORT
CURRENTLY DOES NOT ADDRESS OR
CAPTURE THE IMPACT OF RACISM ON
PUBLIC HEALTH, EVEN THOUGH
PUBLIC HEALTH PROFESSIONALS AND
ASSOCIATIONS HAVE ALREADY
DECLARED THAT RACISM IS A PUBLIC
HEALTH ISSUE, AND THUS LEAVES A
CRITICAL FACTOR IN PUBLIC HEALTH
OUTCOMES OFF THE TABLE, FURTHER
EXACERBATING THE HARM OF LEAVING
RACISM OUT OF PUBLIC HEALTH.
CONVERSATIONS DATA HAS SHOWN
THAT HISTORICALLY REDLINED
CENSUS TRACKS HAVE SIGNIFICANTLY
HIGHER RATES OF EMERGENCY
DEPARTMENT VISITS DUE TO ASTHMA,
SUGGESTING THAT THIS
DISCRIMINATORY PRACTICE MIGHT BE
CONTRIBUTING TO RACIAL AND
ETHNIC ASTHMA HEALTH
DISPARITIES. BY INCLUDING THE
IMPACT RACISM HAS ON PUBLIC
HEALTH. IN THIS REPORT, AB 1799
WILL ENSURE A COMPREHENSIVE VIEW
ON KEY ISSUES AND THE POTENTIAL
CAUSES OF THE ISSUES AND COULD
CAN ALSO POTENTIALLY LIMIT
EFFECTIVE POLICY SOLUTIONS TO
ADDRESS RACIAL DISPARITIES IN
HEALTH OUTCOMES. I RESPECTFULLY
ASK FOR AN AYE VOTE. THANK YOU,
DOCTOR JACKSON, SEEING ARE THERE
ANY WITNESSES IN SUPPORT? ANY
WITNESSES IN OPPOSITION? SEEING
NONE. WE'LL BRING IT BACK TO
COMMITTEE FOR COMMENT OR
QUESTIONS. JUST A COMMENT. MR.
JONES-SAWYER. OUT OF ORDER. I
WANT TO THANK YOU FOR BRINGING
THIS FORWARD. AS WE ALL KNOW,
THERE'S AN IMPLICIT BIAS. NOT
ONLY IN THE MEDICAL PROFESSION,
BUT IT HAS RAMIFICATIONS THAT
ARE, EVEN EXPERIENCED IN THE
ALGORITHMS THAT ARE DONE BY THE
HOSPITALS AND OTHER MEDICAL
FACILITIES, MY CASE, FOR
EXAMPLE, THEY PRESCRIBED ALL
SORTS OF DIFFERENT, DIABETES
MEDICINE WHEN IN FACT AN
AFRICAN-AMERICAN DOCTOR OR
ACTUALLY NURSE TOLD ME THAT I
NEEDED TO CHANGE MY DIET AND
LOSE SOME WEIGHT, WHICH
DRAMATICALLY HELPED ME. INSTEAD
OF LOOKING AT AN AFRICAN
AMERICAN SUCH AND SUCH AN AGE
WEIGHING SUCH AMOUNT THAT THAT
FIT A CERTAIN ALGORITHM, YOU HAD
TO GIVE THEM, PILLS AND PUT THEM
ON DIFFERENT SHOTS, THE REAL
SOLUTION WAS JUST BEING HAVING A
HEALTHY DIET. AND A LOT OF
TIMES, NOT LOOKING AT ME BY MY,
BY WHAT I LOOK LIKE IN MY RACE.
BUT BUT LOOKING AT ME AS THE
PERSON AND COMING UP WITH THE
PROPER DIAGNOSIS IS THE IS THE
BEST WAY. SO I, I APPLAUD YOU
FOR DOING THIS. THIS WILL BE
VERY HELPFUL TO BE ABLE TO
ASCERTAIN THAT INFORMATION AS WE
MOVE FORWARD. THANK YOU. MR.
JACKSON, I'LL BRING IT BACK TO
MYSELF. THANK YOU SO MUCH FOR
BRINGING THIS BILL FORWARD
TODAY. THIS BILL STRENGTHENS OUR
ANNUAL STATE OF THE PUBLIC
HEALTH REPORT, WHICH ALREADY
MENTIONS RACIAL DISPARITIES, BY
REQUIRING DPH TO DISCUSS THE
IMPACT OF RACISM ON THE
INFORMATION IN ITS REPORTS, BY
HAVING THE REPORT EXPAND ON WHAT
CAUSES RACIAL DISPARITIES,
NAMELY, THE HISTORICAL LEGACIES
OF STRUCTURAL RACISM. THIS BILL
WILL HELP THE LEGISLATURE MAKE
MORE INFORMED POLICY DECISIONS
ON PUBLIC HEALTH POLICIES IN THE
YEARS TO COME. WOULD YOU LIKE TO
CLOSE? I RESPECTFULLY ASK FOR AN
AYE VOTE. THANK YOU SO MUCH. AND
WHEN IT IS TIME FOR US TO BE
ABLE TO HAVE THAT WITH, ONCE WE
ESTABLISH QUORUM, WE WILL MOVE
FORWARD WITH THIS BILL. THANK
YOU. IN THE ROOM RIGHT NOW,
READY TO TEST? READY TO PRESENT,
THEIR BILLS ARE, MISS PELLERIN,
MISS PELLERIN, PLEASE COME
FORWARD. AND. THANK YOU, MADAM
CHAIR. I'LL BEGIN WITH AB 2866.
ITEM NUMBER 22. SO THANK YOU,
MADAM CHAIR. AND MEMBERS, FOR
THE OPPORTUNITY TO PRESENT AB
2866 IN MY DISTRICT ON MONDAY,
OCTOBER SECOND, 2023. ONE YEAR
OLD PEYTON COBB AND 18 MONTH OLD
LILLIAN HANNON LOST THEIR LIVES
IN A HORRIFIC EVENT. THESE
CHILDREN WERE AT A LICENSED HOME
DAYCARE LOCATED IN SAN JOSE WHEN
THREE TODDLERS ACCESS A SWIMMING
POOL LOCATED ON THE PREMISES,
UNSUPERVISED AFTER BEING
TRANSPORTED TO THE HOSPITAL IN
CRITICAL CONDITION, TWO OF THE
CHILDREN WERE PRONOUNCED DEAD. I
INTRODUCED AB 2866 TO TRY AND
PREVENT THIS TRAGEDY FROM EVER
HAPPENING AGAIN. THE DAYCARE HAD
MET THE CURRENT REQUIREMENTS FOR
POOL SAFETY. THE POOL WAS DEEMED
SAFE UNDER CURRENT SAFETY
STANDARDS BY CALIFORNIA. CODE
REQUIRES THAT THE CURRENT POOL
SAFETY CODE REGULATIONS ARE
OUTDATED AND HAVING BEEN ENACTED
IN 1996, THE SWIMMING POOL
SAFETY ACT REQUIRES A TWO STAGE
SAFETY SYSTEM TO BE INSTALLED IN
A HOME POOL. HOWEVER, THE
SWIMMING POOL SAFETY ACT HAD
LEFT AN EXEMPTION FOR ANY
FACILITY WHICH WAS REGULATED BY
THE STATE DEPARTMENT OF SOCIAL
SERVICES, WHICH INCLUDES DAYCARE
FACILITIES, GROUP HOMES AND
SENIOR FACILITIES. THE STATE
DEPARTMENT OF SOCIAL SERVICES
ONLY REQUIRES A FENCE TO PREVENT
AN ACCIDENTAL DROWNING. THE MAIN
ISSUES, ISSUE ARISES WHEN THE
POTENTIAL HAZARDS ASSOCIATED
WITH A SINGLE SAFETY MECHANISM,
THE ABILITY FOR A SINGLE
MECHANISM TO BE BYPASSED OR A
FAILURE ALLOWS FOR A DROWNING
HAZARD. IN THE CASE OF THE
DAYCARE RESPONSIBLE FOR LILLIAN
AND PAYTON, THE HOMEOWNER THE
PREVIOUS NIGHT HAD BYPASSED THE
GATE AND PROPPED IT OPEN. THIS
RESULTED IN THE GATE BEING
UNABLE TO SERVE THE INTENDED
SAFETY FUNCTION. IN AB 2866 WILL
CREATE A MULTIFACETED SAFETY
REQUIREMENT TO UPDATE THE
EXISTING STANDARDS TO ALLOW FOR
BETTER DROWNING PREVENTION
STANDARDS. THE BILL WOULD
REQUIRE AN UPDATED SAFETY
REQUIREMENT IN ADDITION TO THE
FENCE THAT MEET CURRENT
STANDARDS, AS WELL AS EITHER A
POOL COVER OR AN ALARM SYSTEM.
THIS WOULD CREATE A TWO STEP
SYSTEM THAT, IN THE EVENT OF A
FAILURE, A SECONDARY SAFETY
PRECAUTION WILL BE ABLE TO
PREVENT A DROWNING.
ADDITIONALLY, AB 2866 WILL
CREATE A REQUIREMENT FOR A DAILY
ASSESSMENT LOG TO DOCUMENT THAT
POOL AT FACILITIES ARE BEING
SECURED BY THE TWO STEP SYSTEM
IN ACCORDANCE WITH THE LAW.
BEFORE THE CENTER OPENS. I
BELIEVE WITH ME TO TESTIFY IN
SUPPORT IS BRYCE DOCKERY WITH
THE AMERICAN ACADEMY OF
PEDIATRICS.
GOOD AFTERNOON, MADAM. MADAM
CHAIR, MEMBERS, I'LL BE VERY
BRIEF. MY NAME IS BRYCE DOHERTY.
ON BEHALF OF THE AMERICAN
ACADEMY OF PEDIATRICS,
CALIFORNIA, THE PEDIATRICIANS IN
THIS STATE WORKED TIRELESSLY TWO
YEARS AGO WITH SENATOR NEWMAN TO
RETOOL THE SAFETY PRECAUTIONS
FOR, SWIMMING POOLS, BOTH PUBLIC
AND PRIVATE. AND WHAT THE
AMERICAN ACADEMY OF PEDIATRICS
HAS SHOWN STUDIES HAVE SHOWN
THAT THE SAFEST WAY TO PROTECT
CHILDREN FROM DROWNINGS IN POOLS
AND SPAS IS A FOUR SIDED FENCE.
AND THAT'S WHAT THIS BILL
PROVIDES FOR. WE'LL BE SAVING
CHILDREN IN THE STATE OF
CALIFORNIA, AND WE STRONGLY URGE
YOUR SUPPORT. THANK YOU. THANK
YOU. ARE THERE ANY OTHER
WITNESSES IN SUPPORT? ANY
WITNESSES IN SUPPORT? THANK YOU.
ISABELLA ARGUETA WITH THE HEALTH
OFFICERS ASSOCIATION OF
CALIFORNIA IN SUPPORT. THANK
YOU. THANK YOU. ARE THERE ANY
PRIMARY WITNESSES IN OPPOSITION?
OR OTHER WITNESSES IN OPPOSITION
? SEEING NONE. I'LL BRING IT
BACK TO THE COMMITTEE FOR
COMMENT OR QUESTIONS. THANK YOU.
WE STILL DO NOT HAVE A QUORUM,
SO WE ARE GOING TO, HOLD THE
BILL. I WILL SAY THANK YOU FOR
BRINGING THIS BILL FORWARD. IT
CERTAINLY REQUIRES A ENSURES
THAT WE REQUIRE SWIMMING POOLS
AND CHILD DAYCARE FACILITIES
REGULATED BY DSS TO BE EQUIPPED
WITH AT LEAST TWO SAFETY
FEATURES AND REQUIRES DAILY
INSPECTION OF THE DROWNING
PREVENTION FEATURES. THE
INCREASED SAFETY STANDARDS WILL
HELP KEEP OUR BABIES SAFE. WITH
THAT, I RESPECTFULLY ASK FOR
YOUR I VOTE. THANK YOU. WHEN
IT'S APPROPRIATE, THANK YOU WHEN
APPROPRIATE. WE'LL MOVE ON NOW
TO ITEM NUMBER 28 AB 3260. ALSO
PELLERIN, THANK YOU SO MUCH,
MADAM CHAIR AND MEMBERS, WHILE
MY OTHER BILL, AB 3221, WHICH IS
ON CONSENT, WILL IMPROVE TOP
DOWN ENFORCEMENT OF OUR STATE'S
HEALTH CARE LAWS BY EMPOWERING
THE DEPARTMENT OF MANAGED HEALTH
CARE TO CONDUCT ENFORCEMENT MORE
SWIFTLY AND MORE EFFICIENTLY.
THIS BILL, AB 3260, WILL IMPROVE
ENFORCEMENT FROM THE GROUND UP
BY EMPOWERING PATIENTS TO ACT ON
THEIR OWN BEHALF. THIS BILL
ADDRESSES TWO PROBLEMS. FIRST,
THE UNTIMELY RESOLUTION OF
CLAIMS AND GRIEVANCES BY HEALTH
PLANS AND INSURERS, AND SECOND,
THE LACK OF TRANSPARENCY AND DUE
PROCESS WHEN CONSUMERS FILE
REGULATORY COMPLAINTS TO ADDRESS
THE FIRST CONCERN. THIS BILL
WILL HARMONIZE STATE LAW WITH
FEDERAL LAW. REGARDING THE
TIMELINE FOR RESPONDING TO
CLAIMS FOR COVERAGE AND HOW
CLAIMS FOR URGENT CONDITIONS ARE
TREATED. IMPORTANTLY A
PROVIDER'S DESIGNATION OF
URGENCY WILL BE BINDING ON
HEALTH PLANS, AS IS THE CASE
UNDER FEDERAL LAW. THIS CLOSES A
LOOPHOLE WHEREBY PLANS COULD
SECOND GUESS THE CLAIMS URGENCY
AND TAKE UP TO 30 DAYS TO
RESPOND, RATHER THAN THE 72
HOURS THAT'S REQUIRED FOR URGENT
REQUESTS. THIS BILL ALSO ADDS AN
IMPORTANT PROTECTION FOR THOSE
WITH DEGENERATIVE CONDITIONS
CONDITIONS SUCH AS MISS
PRIORITIZING TREATMENT THAT CAN
MINIMIZE THE LOSS OF FUNCTION.
INSTEAD OF ONLY THOSE TREATMENTS
THAT CAN RESTORE THE PATIENT TO
FULL FUNCTION. THIS ENSURES THAT
PATIENTS RECEIVE THE CARE THEY
NEED DESPITE THE FACT THAT THEY
WILL LIKELY NEVER RETURN TO FULL
HEALTH CARE. DELAYED IS CARE
DENIED. THEREFORE, WHEN HEALTH
PLANS DON'T RESPOND TO REQUESTS
FOR CARE IN A TIMELY MANNER,
THIS BILL PROVIDES THAT AN
INTERNAL GRIEVANCE WILL
AUTOMATICALLY BE INITIATED ON A
CONSUMER'S HALF. THE BILL THEN
CLARIFIES THE TIMELINE AND
NOTIFICATION REQUIREMENTS FOR
GRIEVANCES, AGAIN BRINGING STATE
LAW INTO ACCORDANCE WITH FEDERAL
LAW. IF A HEALTH PLAN ALSO FAILS
TO RESPOND TO A GRIEVANCE WITHIN
THE REQUIRED TIMELINES, THAT
GRIEVANCE WILL AUTOMATICALLY
RESOLVE IN FAVOR OF THE
CONSUMER, MEANING THAT THEY CAN
GET WITH THEY CAN GET CARE WITH
THE ASSURANCE THAT IT WILL BE
COVERED. THIS PROVISION FOLLOWS
THE LEAD OF NEW YORK AND
MASSACHUSETTS, MASSACHUSETTS,
WHICH HAVE EQUIVALENT
PROVISIONS. LAST YEAR, DMHC
FOUND THAT OUR STATE'S LARGEST
HEALTH PLAN HAD FAILED TO
RESOLVE TENS OF THOUSANDS OF
GRIEVANCES WITHIN THE REQUIRED
TIME FRAME. THIS BILL PROVIDES A
STRONG INCENTIVE FOR THE FOR
THESE DISPUTES TO BE RESOLVED IN
A TIMELY MANNER, THEREBY
REDUCING THE LIKELIHOOD THAT
PATIENT CONDITION CONDITIONS
WORSEN AND SUBSEQUENTLY REQUIRE
MORE INTENSIVE AND COSTLY
TREATMENT WHILE THEY ARE STUCK
IN LIMBO WAITING FOR A HEALTH
PLAN RESPONSE. TO ADDRESS THE
SECOND CONCERN OF THE LACK OF
TRANSPARENCY IN DUE PROCESS AND
REGULATORY COMPLAINTS, THIS BILL
PROHIBITS EX PARTE COMMUNICATION
BETWEEN REGULATORY DEPARTMENTS
AND ANY SINGLE PARTY TO A
DISPUTE, WHETHER THAT BE THE
HEALTH PLAN OR THE PATIENT. AB
3260 WILL IMPROVE TRANSPARENCY
BY PERMITTING EACH PARTY TO SEE
INFORMATION PROVIDED TO THE
DEPARTMENTS IN CONNECTION WITH A
COMPLAINT. IT WILL ALSO IMPROVE
DUE PROCESS RIGHTS BY GIVING
EACH PARTY A REASONABLE
OPPORTUNITY TO RESPOND TO THE
OTHER SIDE'S ASSERTIONS.
UNFORTUNATELY THE CURRENT
REALITY AROUND COMPLAINTS
DISADVANTAGES CONSUMERS WHO SEE
OR HEAR LITTLE WHILE THEIR
COMPLAINT IS BEING REVIEWED, AND
HEALTH PLANS AND INSURERS, ON
THE OTHER HAND, ENJOY FREQUENT
AND REGULAR COMMUNICATION WITH
REGULATORS, REGULATORS. WHEN
HEALTH PLANS FAIL TO FOLLOW THE
LAW, CONSUMERS SUFFER THE
CONSEQUENCES. THESE COSTS FALL,
PARTICULARLY HARD ON UNDERSERVED
COMMUNITIES WHERE PATIENTS
CANNOT AFFORD TO PAY FOR CARE
OUT OF POCKET WHILE THEY WAIT
FOR HEALTH PLANS TO RESPOND TO
THEIR CLAIMS TO RESOLVE THEIR
GRIEVANCES, TAX PAYERS IN OUR
COUNTIES ALSO BEAR A COST
BECAUSE MANY OF THESE SAME
PATIENTS WILL SEEK CARE FROM
PUBLIC SERVICES. IN THE MEANTIME
. TO REITERATE, WHILE THIS BILL
WILL IMPROVE PROCESSES FOR ALL
MEDICAL SURGICAL ISSUES, WE ARE
PARTICULARLY EAGER TO SEE THE
IMPROVEMENTS IT WILL MAKE FOR
THOSE SEEKING TREATMENT FOR
BEHAVIORAL HEALTH AND SUBSTANCE
USE DISORDERS, AS THESE ARE SOME
OF THE AREAS WHERE PATIENTS
STRUGGLE MOST TO GET TIMELY AND
APPROPRIATE CARE. AND WITH ME TO
TESTIFY IN SUPPORT OF AB 360 IS
DOCTOR KARIN SACCO, LMFT. AND
BENJAMIN ECKERT, WHO'S THE
ASSISTANT DIRECTOR OF POLITICAL
COMMUNITY ORGANIZING FOR NEW W.
THANK YOU. YOU'LL EACH HAVE TWO
MINUTES. GOOD AFTERNOON, MADAM
CHAIR AND COMMITTEE MEMBERS. MY
NAME IS KARIN SACCO. I BECAME A
LICENSED MARRIAGE FAMILY
THERAPIST IN 2006, AND WENT ON
TO EARN MY DOCTORATE DEGREE IN
CLINICAL PSYCHOLOGY IN 2014, AND
BECAME LICENSED AS A
PSYCHOLOGIST IN 2019. THUS, I'M
A DUAL LICENSED MENTAL HEALTH
PROVIDER. I HAVE OVER 20 YEARS
OF EXPERIENCE, AND I CURRENTLY
PROVIDE DIRECT CLINICAL SERVICES
TO CALIFORNIA RESIDENTS IN MY
OUTPATIENT PRACTICE, THERE HAVE
BEEN TIMES IN WHICH MY
PROFESSIONAL TRAINING AND
EXPERTISE LEAD ME TO DETERMINE
THAT A CLIENT I'M SERVING NEEDS
A HIGHER LEVEL OF CARE THAN MY
PRACTICE CAN PROVIDE. IN OTHER
WORDS, OUTPATIENT THERAPY CANNOT
PROVIDE THE CARE NEEDED TO
MANAGE THEIR SEVERE MENTAL
HEALTH SYMPTOMS AND WHEN THIS
HAPPENS, TRANSITIONING TO A
HIGHER LEVEL OF CARE IS URGENT
AND MEDICALLY NECESSARY. THE
SIGNIFICANT EMOTIONAL DISTRESS
SOMEONE EXPERIENCES AT A TIME
LIKE THIS IS ONLY MADE WORSE
WHEN THEIR HEALTH PLAN FAILS TO
AUTHORIZE THE REQUEST FOR A
HIGHER LEVEL OF CARE, OR WORSE,
FAILS TO RESPOND TO THE REFERRAL
AT ALL. FOR AN AB 3260 WOULD
ALLEVIATE THE UNDUE HARDSHIP FOR
CONSUMERS BY REQUIRING HEALTH
PLANS TO INITIATE A GRIEVANCE ON
A CONSUMER'S BEHALF WHEN THEY
FAIL TO RESPOND TO CLAIMS WITHIN
THE TIME PERIOD, AND IN THE
MANNER REQUIRED BY EXISTING LAW.
I TRULY BELIEVE THAT THERE IS NO
ONE BETTER SUITED TO DETERMINE
WHETHER A PATIENT'S CONDITION IS
URGENT THAN THEIR THERAPIST.
CALIFORNIA'S FACING A BEHAVIORAL
HEALTH CRISIS, AND ONE OF THE
FIRST AND MOST IMPORTANT STEPS
IN ADDRESSING THIS CRISIS IS TO
IMPROVE ACCESS TO TIMELY AND
APPROPRIATE CARE FOR
COMMERCIALLY INSURED CONSUMERS.
I RESPECTFULLY REQUEST YOUR. I
VOTE ON AB 3260. THANK YOU.
PLEASE GO AHEAD. THANK YOU.
CHAIR AND MEMBERS, I'M BENJAMIN
ECKERT WITH THE NATIONAL UNION
OF HEALTH CARE WORKERS. WE'RE
THE LARGEST UNION OF PRIVATE
SECTOR BEHAVIORAL HEALTH
PROVIDERS. WE'VE SPONSORED TWO
BILLS THIS YEAR, AND AB 3260 IS
DESIGNED TO WORK IN TANDEM WITH
AB 3221 TO IMPROVE HEALTH PLAN
AND DISABILITY INSURER
COMPLIANCE WITH OUR STATE'S
PATIENT PROTECTIONS. THE PROCESS
OF SECURING COVERAGE FOR
MEDICALLY NECESSARY CARE AND FOR
RESOLVING DISAGREEMENTS AROUND
DENIALS CAN BE UNDERSTOOD AS
HAVING THREE STEPS. THE FIRST
STEP IS A REQUEST FOR
AUTHORIZATION. EVEN IF THAT
REQUEST IS DENIED, AN INTERNAL
GRIEVANCE CAN BE SUBMITTED,
WHICH IS THE SECOND STEP. AND IF
THE INTERNAL GRIEVANCES DENIED,
A REGULATORY COMPLAINT CAN BE
INITIATED, THAT'S THE THIRD
STEP, AND IT CAN INCLUDE AN
INDEPENDENT MEDICAL REVIEW. AB
3260 RESOLVES CONFLICTS BETWEEN
STATE AND FEDERAL LAW AND
CLARIFIES PARAMETERS INCLUDING
RESPONSE AND NOTIFICATION
TIMELINES FOR THESE STEPS,
MAKING THEM MORE ENFORCEABLE BY
CONSUMERS. WHEN HEALTH PLANS AND
DISABILITY INSURERS FAIL TO
COMPLY WITH THE TIMELINES AND
NOTIFICATION REQUIREMENTS FOR
THESE STEPS, PATIENTS CAN GET
STUCK IN LIMBO WAITING FOR
RESPONSES AND RESOLUTIONS. AS
NOTED, THE COSTS ASSOCIATED WITH
THIS FALL PARTICULARLY HARD ON
MEDICALLY UNDERSERVED
COMMUNITIES. LAST YEAR, IN A
SETTLEMENT WITH OUR STATE'S
LARGEST HEALTH PLAN, DMHC FOUND
THAT OVER ONLY A PERIOD OF
SEVERAL MONTHS, THE PLAN HAD
FAILED TO RESOLVE THOUSANDS OF
GRIEVANCES WITHIN THE REQUIRED
TIME FRAMES. THAT SAME
SETTLEMENT AGREEMENT ALSO NOTED
THAT DEFICIENCIES HAVE, QUOTE,
IMPACTED THE PLAN'S ABILITY TO
ENSURE ADEQUATE AND TIMELY
ACCESS TO BEHAVIORAL HEALTH CARE
SERVICES TO ITS ENROLLEES.
CONSUMER DESERVE THE TOOLS
NECESSARY TO ENSURE THEIR OWN
HEALTH PLAN COMPLIES WITH THE
LAW. THAT'S WHY AB 3260 WILL
PROVIDE FAIR AND EFFICIENT
CONSUMER PROTECTIONS TO ADDRESS
RAMPANT HEALTH PLAN VIOLATIONS
CITED BY REGULATORS AND NOTED AT
THE OCTOBER 2023 HEARING OF THE
SELECT COMMITTEE ON MENTAL
HEALTH AND ADDICTION. FINALLY,
WE'VE RECEIVED SOME QUESTIONS
ABOUT AB 3260, EXTENDING THE
TIME PERIOD FROM 6 TO 12 MONTHS
FOR CONSUMERS TO FILE A REQUEST
FOR AN INDEPENDENT MEDICAL
REVIEW. THE SPIRIT OF THIS
LANGUAGE IS TO PROTECT THOSE WHO
HAVE UNDERGONE A SIGNIFICANT
HEALTH CRISIS, WHICH CAN RESULT
IN EXTREME MENTAL, EMOTIONAL AND
FINANCIAL HARDSHIP. WE'VE SEEN
THAT SIX MONTHS IS JUST NOT
ENOUGH TIME TO RESOLVE THOSE
CHALLENGES AND ALSO NAVIGATE THE
EMR SYSTEM. IN CLOSING, I
RESPECTFULLY ASK FOR YOUR AYE
VOTE. THANK YOU. ARE THERE ANY
OTHER WITNESSES IN SUPPORT?
PLEASE COME FORWARD AND AS
THEY'RE COMING FORWARD, IF THERE
ARE ANY PRIMARY WITNESSES IN
OPPOSITION, PLEASE COME TO THE
TABLE. KATI VAN DINES WITH
HEALTH ACCESS CALIFORNIA IN
SUPPORT. THANK YOU. GOOD
AFTERNOON. WHITNEY FRANCIS WITH
THE WESTERN CENTER ON LAW AND
POVERTY IN SUPPORT. SENATOR
YOUNG, VICE PRESIDENT OF THE
CALIFORNIA ALLIANCE FOR RETIRED
AMERICANS AND STRONG SUPPORT
VANESSA KHN ON BEHALF OF THE
CALIFORNIA PAN ETHNIC HEALTH
NETWORK HERE IN SUPPORT Ó YODER
ON BEHALF OF THE CALIFORNIA
STATE ASSOCIATION OF
PSYCHIATRISTS, A CO-SPONSOR IN
SUPPORT. THANK YOU. THANK YOU,
DYLAN ELLIOTT, ON BEHALF OF THE
CALIFORNIA ACADEMY OF CHILD AND
ADOLESCENT PSYCHIATRY AND
SUPPORT. THANK YOU. AARON
TAYLOR, ON BEHALF OF THE
CALIFORNIA ASSOCIATION OF
MARRIAGE AND FAMILY THERAPISTS
AND SUPPORT. JOHN DREBINGER WITH
THE STEINBERG INSTITUTE IN
SUPPORT. THANK YOU, JENNIFER
SNYDER, WITH CAPITAL ADVOCACY ON
BEHALF OF THE CALIFORNIA LIFE
SCIENCES AND SUPPORT. GREG PULSE
FOR QUALITY CALIFORNIA IN
SUPPORT. SYMPHONY BARBI, ON
BEHALF OF PLANNED PARENTHOOD
AFFILIATES OF CALIFORNIA IN
SUPPORT. HEIDI STRUNK, CEO OF
MENTAL HEALTH AMERICA OF
CALIFORNIA, IN SUPPORT. KELLY
BROOKS, ON BEHALF OF THE BOARD
OF SUPERVISORS OF SANTA CLARA
COUNTY IN SUPPORT GEORGE TH¤U ON
BEHALF OF THE CALIFORNIA LABOR
FEDERATION. IN SUPPORT. THANK
YOU. ANY WITNESSES IN OPPOSITION
? YOU'LL HAVE TWO MINUTES EACH.
THANK YOU. GOOD AFTERNOON, MADAM
CHAIR. MEMBERS OF THE COMMITTEE,
JED HAMPTON WITH CALIFORNIA
ASSOCIATION OF HEALTH PLANS,
REPRESENTING 43 HEALTH PLANS
THAT COVER APPROXIMATELY 27
MILLION CALIFORNIANS THROUGHOUT
THE STATE. REGRETTABLY, WE ARE
HERE IN OPPOSITION TO AB 3260. I
WOULD LIKE TO THANK THE AUTHOR
AND HER STAFF, AS WELL AS THE
COMMITTEE STAFF, FOR ENGAGING
WITH US ON THIS BILL,
SPECIFICALLY, WE ARE CONCERNED
THAT THIS BILL WOULD ALLOW
HEALTH PLAN ENROLLEES TO SELF
REFER FOR SERVICES REQUIRING
UTILIZATION REVIEW IN THE SAME
MANNER CURRENTLY AFFORDED TO
PROVIDERS. GENERALLY SPEAKING,
PROVIDERS ARE RESPONSIBLE FOR
SUBMITTING AUTHORIZATION
REQUESTS TO THE HEALTH PLAN TO
ENSURE THAT A CLINICAL
EVALUATION HAS BEEN CONDUCTED
AND THAT THE REQUESTED SERVICE
IS APPROPRIATE FOR THE ENROLLEE.
ADDITIONALLY PROVIDERS MAINTAIN
HEALTH RECORDS OF THE ENROLLEE
THAT ARE NEEDED TO MAKE AN
ADEQUATE MEDICAL NECESSITY
DETERMINATION. THESE FACTORS ARE
CRITICAL TO ENSURE THAT THE
ENROLLEE IS RECEIVING TIMELY,
CLINICALLY APPROPRIATE CARE THAT
HAS BEEN SIGNED OFF BY A
PROVIDER, ALLOWING ENROLLEES TO
SELF REFER FOR SERVICES FROM OUR
PERSPECTIVE WILL ONLY COMPLICATE
AND DELAY THE EXISTING
AUTHORIZATION PROCESS. WE ARE
ALSO CONCERNED THAT THIS BILL
WOULD GRANT ENROLLEES AND THE
REPRESENTATIVES ACCESS TO
UNREDACTED COPIES OF ALL
CORRESPONDENCE CONCERNING THE
ENROLLEES GRIEVANCE. NOTABLY,
THIS PROVISION DOES NOT REQUIRE
THE DMHC TO SHARE WITH THE
HEALTH PLAN ANY INFORMATION OR
REBUTTALS THAT COME FROM THE
ENROLLEE OR THE REPRESENTATIVE,
NOR DOES THE PROPOSAL ALLOW FOR
HEALTH PLANS TO RECEIVE ACCESS,
EXCUSE ME? ACCESS TO THE SAME
UNREDACTED INFORMATION AFFORDED
TO THE ENROLLEE OR THEIR
REPRESENTATIVE, HEALTH PLANS
WOULD HAVE NO VIABLE WAY TO
COUNTER OR REBUT POTENTIALLY
INACCURATE OR MISLEADING
INFORMATION AND ADDITIONALLY,
THIS PROPOSAL DOES NOT TAKE INTO
ACCOUNT THAT THERE ARE EXISTING
AVENUES FOR ENROLLEES OR THEIR
REPRESENTATIVES TO ACCESS MUCH
OF THIS INFORMATION ALREADY,
WHETHER THAT BE THROUGH A PUBLIC
RECORDS ACT REQUEST, THROUGH A
SUBPOENA, OR THROUGH THE DMHC
HELPLINE, WHICH IS INTENDED TO
HELP CONSUMERS PROCESS BOTH
GRIEVANCES AND IMAGES MOVING
FORWARD. SO WE DO HAVE SOME
ADDITIONAL PROVISIONS OF THE
BILL THAT WE'D LIKE TO WORK
WITH. THE AUTHOR'S OFFICE ON,
BUT FOR NOW, WE ARE REGRETTABLY
OPPOSED TO AB 3260, AND LOOK
FORWARD TO CHATTING FURTHER.
THANK YOU. GO AHEAD WITH YOUR
TWO MINUTES. STEPHANIE WATKINS,
ON BEHALF OF THE ASSOCIATION OF
CALIFORNIA LIFE AND HEALTH
INSURANCE COMPANIES, WE TOO ARE
IN OPPOSITION TODAY, I GUESS.
CHEN I HAVE THE SAME THING, WE
APPRECIATE THE TIME AND
COMMITMENT THE AUTHOR AND
SPONSORS HAVE PUT TOWARDS THE
BILL. WE DO HAVE SOME
SIGNIFICANT CONCERNS AS OUTLINED
BY MY COLLEAGUE, SPECIFICALLY
AROUND THE SELF-REFERRAL FOR
PATIENTS. I THINK, YOU KNOW, IF
YOU LOOK AT THAT IN THE TOTALITY
OF OUR HEALTH CARE SYSTEM,
REALLY DOES DISMANTLE THAT
RELATIONSHIP AND DIRECT
RELATIONSHIP BETWEEN PHYSICIANS
AND PATIENTS. AND THE NECESSITY
FOR THAT TO BE, SOMETHING THAT
THE PATIENT LOOKS TO THE DOCTOR
AND THE PROVIDER TO ASSIST THEM
AS THEY LOOK TO THEIR HEALTH
CARE NEEDS. ADDITIONALLY, WE DO
HAVE SOME CONCERNS AROUND THE
EMR EXTENSION. I THINK A LOT CAN
HAPPEN BETWEEN SIX AND 12
MONTHS, THOSE CASES COULD
PRESUMABLY BE REDIRECTED BACK TO
THE HEALTH PLAN AND RESOLVED
MORE QUICKLY WITHIN THE HEALTH
PLAN PRIOR AUTHORIZATION
PROCESS. SO FOR THOSE REASONS,
WE ARE OPPOSED TODAY, BUT DO
LOOK FORWARD TO HAVING CONTINUED
CONVERSATIONS IF THE BILL MOVES
FORWARD TODAY. THANK YOU, THANK
YOU. ANY ADDITIONAL WITNESSES IN
IN OPPOSITION, MADAM CHAIR
MEMBERS, JOHN WINGER I'LL BE OFF
. AMERICA'S HEALTH INSURANCE
PLANS WOULD JUST ECHO THE
COMMENTS OF CAP AND. DARBY
KERNAN ON BEHALF OF THE LOCAL
HEALTH PLANS OF CALIFORNIA.
REGRETTABLY IN OPPOSITION. THANK
YOU. I'LL BRING IT BACK TO THE
COMMITTEE FOR ANY QUESTIONS.
DOCTOR WEBER. GOOD AFTERNOON, I
HAVE A COUPLE OF QUESTIONS OR A
QUESTION AND A STATEMENT FOR THE
OPPOSITION. WHERE EXACTLY IS IT
STATING THAT THEY WOULD BE
ALLOWED TO SELF REFER AND BYPASS
THE PHYSICIAN? BECAUSE THAT IS
CONCERNING. I THANK YOU, DOCTOR
WEBER, THE PROVISION THAT WE
INTERPRET, WHERE WE INTERPRET
THAT QUESTION IS ON LET'S SEE
AND GET THE EXACT SUBSECTION FOR
YOU, SECTION 113 67.01,
SUBSECTION H, SAYS IN
DETERMINING WHETHER TO APPROVE,
MODIFY OR DENY REQUESTS BY
ENROLLEES OR PROVIDERS, WE
INTERPRET THAT TO, TO MEAN THAT,
THAT THE ENROLLEE THEMSELVES CAN
THEN SELF REFER FOR THOSE
UTILIZATION SERVICES. TO THE
AUTHOR. IS THAT YOUR INTENT?
BECAUSE I WOULD BE VERY
CONCERNED IF PEOPLE ARE
BYPASSING PROVIDERS AND DOING A
SELF REFERRAL. I'D LIKE MY
EXPERT HERE TO COMMENT ON THAT
PART. YEAH SURE. YES. TODAY
ALREADY IT IS NOT UNCOMMON FOR
ENROLLEES TO ASK THEIR HEALTH
PLANS FOR PRE CERTIFICATION OF
MEDICAL SERVICES. IT'S
ABSOLUTELY NOT THE INTENT THAT
AB 3260 ALTERS THE FUNDAMENTAL
STRUCTURE OF HEALTH PLANS,
WHEREBY FOLLOWING SUCH REQUESTS,
THEY COORDINATE UTILIZATION
REVIEW WITH ENROLLEES PROVIDERS.
I HAVE MORE INFORMATION. I'M
CERTAINLY HAPPY TO SHARE WITH
ALL OF THE MEMBERS, BUT IT'S NOT
AN INTENTION TO CREATE SOME SORT
OF A FUNDAMENTAL DIFFERENCE. AND
ALREADY CERTAIN HEALTH PLAN
CONTRACTS THAT ARE REGULATED BY
DMHC ACTUALLY PUT THE ONUS ON
ENROLLEES TO SEEK
PRE-CERTIFICATION. WE HAVE
SAMPLES OF SUCH CONTRACTS WE
COULD SHARE. CAN YOU CLARIFY
THAT WITH THE OPPOSITION? IF
THIS BILL IS TO MOVE FORWARD?
ABSOLUTELY. THE OTHER CONCERN I
HAVE IS, I QUESTION THE EXTENT 7
TO 12 MONTHS. I UNDERSTAND IF
YOU THINK SIX MONTHS ISN'T
ENOUGH TIME, BUT GENERALLY WHEN
YOU'RE DEALING WITH, YOU KNOW,
GETTING A MEDICAL BILL, YOU GET
THAT WITHIN, YOU KNOW, A MONTH
OR TWO OF YOUR SERVICE. AND TO
SAY THAT IT'S GOING TO TAKE YOU
TEN MONTHS TO FIGURE OUT THAT
YOU NEED TO DISPUTE IT, I THINK
THAT'S A, A BIT LONG. SO I WOULD
ALSO ASK THE AUTHOR TO CONTINUE
TO WORK TO, WORK WITH OPPOSITION
OR WORK WITH, YOU KNOW, WHOEVER
IS WORKING WITH YOU ON THIS BILL
TO LOOK AT THAT A LITTLE BIT
MORE. THANK YOU. ABSOLUTELY.
WE'RE HAPPY TO CONTINUE THOSE
CONVERSATIONS. THANK YOU SEE,
MISS CHAVEZ. I WANT TO THANK THE
AUTHOR FOR BRINGING FORWARD THIS
BILL, AND THINK THAT, YOU KNOW,
IT'S I THINK IT'S REALLY
CRITICAL THAT THESE ARE
DECISIONS THAT ARE MADE WITH
PROVIDERS WHO ARE, YOU KNOW,
FOCUSED ON THE CARE OF THE
PATIENTS AND, AND I DO I
ACTUALLY, I, I THINK IT'S FAIR
TO EXTEND IT THAT LONG BECAUSE
WHEN YOU HAVE SOMEONE IN A
MENTAL HEALTH CRISIS, IT'S ALL
CONSUMING AND IT'S ALL CONSUMING
FOR A WHILE. IT CAN TAKE A
WHILE, AND SO, SO, SO BEING ABLE
TO HAVE SOME GRACE AND HAVE SOME
TIME, I THINK IS FAIR, AND
CERTAINLY, YOU KNOW, IT DOESN'T
GUARANTEE THAT, THAT YOU'RE
GOING TO BE AWARDED THAT. RIGHT.
BUT YOU HAVE AT LEAST AN
OPPORTUNITY TO BRING IT FORWARD,
SO JUST, YOU KNOW, THANKFUL FOR
YOUR LEADERSHIP ON THIS ISSUE.
AND AND WANTED TO, SHARE THAT. I
THINK THAT'S REASONABLE. THANK
YOU. WELL, THANK YOU, ASSEMBLY
MEMBER PELLERIN FOR BRINGING
FORWARD THIS BILL, THIS BILL, I
THINK FURTHER STRENGTHENS,
CALIFORNIA'S STRONGEST CONSUMER
PROTECTION, WHICH IS THE RIGHT
OF AN ENROLLEE TO COMPLAIN AND
APPEAL A HEALTH PLANS DENIAL
PURSUANT TO CALIFORNIA LAW. I
APPRECIATE YOU FOR BRINGING
FORWARD THIS BILL. WITH THAT,
YOU MAY CLOSE. ONCE AGAIN, I
RESPECTFULLY ASK FOR AYE VOTE.
THANK YOU. THANK YOU. AND WHEN
WE HAVE ESTABLISHED QUORUM, WE
CAN CONSIDER THAT. I WANT TO
ALSO THANK YOU FOR ASKING FAR IN
ADVANCE FOR DISPENSATION TO GO
EARLIER, AND I AM GOING TO,
COMMITTEE ACTUALLY PRESENT MY
BILL, WHICH IS IN FILE ORDER
RIGHT NOW, FILE ITEM FOR AB
1975. I HAVE COMMITTEE MEMBERS
WHO HAVE BEEN HERE OR WITNESSES
THAT HAVE BEEN HERE SINCE 8 A.M.
SO WITH THAT, BUT FIRST I WILL
ESTABLISH QUORUM. SECRETARY,
PLEASE CALL THE ROLL. BONTA HERE
. BONTA. PRESENT. WALDEN.
WALDEN. PRESENT. EDGAR CURRY.
EDGAR. CURRY. PRESENT. ARAMBULA.
ARAMBULA PRESENT. WENDY.
CARILLO. WENDY. CARILLO.
PRESENT. FLORA HANEY. HANEY.
PRESENT. JOHN SAWYER PRESENT.
JOHN. SAWYER, PRESENT.
MAIENSCHEIN MCCARTY. JOE.
PATTERSON RODRIGUEZ. SANCHEZ.
SANTIAGO CHAVO. CHAVO. PRESENT.
WEBER WEBER, PRESENT. WE HAVE A
QUORUM, AND WE'LL MOVE TO ITEM
FOUR. AB 1975 ASSEMBLY MEMBER
BONTA. PROCEED WHEN YOU'RE READY
. THANK YOU. GOOD AFTERNOON,
CHAIR AND COMMITTEE MEMBERS.
FOOD IS LIFE. FOOD IS
SUSTENANCE. FOOD IS MEDICINE.
FOOD AS MEDICINE IS A PRIORITY
FOR ME AND IS A LEGISLATIVE
REPARATIONS PRIORITY FOR THE
CALIFORNIA LEGISLATIVE BLACK
CAUCUS. AB 1975 WOULD MAKE
MEDICALLY SUPPORTIVE FOOD AND
NUTRITION INTERVENTIONS A
COVERED BENEFIT TO ALL MEDI-CAL
RECIPIENTS WHEN DEEMED MEDICALLY
NECESSARY BY THEIR HEALTH CARE
PROVIDER. IN ADDITION, THIS BILL
WOULD MANDATE THE DEPARTMENT OF
HEALTH CARE SERVICES TO FORM A
COMMITTEE ON OR BEFORE JULY 1ST,
2025 AND ISSUE FINAL GUIDANCE BY
JULY 1ST, 2026 FOR THE
IMPLEMENTATION OF THESE
INTERVENTION SERVICES. OUR
WITNESSES TODAY ARE GIVING
TESTIMONY AND INCLUDE DOCTOR
STEPHEN CHEN, CHIEF MEDICAL
OFFICER OF THE ALAMEDA COUNTY
RECIPE FOR HEALTH, AND ELIZABETH
DURAN, PATIENT PARTICIPANT IN
RECIPE FOR HEALTH. IN ADDITION,
WE HAVE KATIE EDMOND, THE FOOD
AND AGRICULTURE POLICY MANAGER
WITH SPUR, TO ANSWER ANY
QUESTIONS. THANK YOU. THANK YOU.
CHAIRMAN AND HEALTH COMMITTEE
MEMBERS. MY NAME IS STEPHEN CHEN
AND I'M A FAMILY PHYSICIAN WITH
24 YEARS OF EXPERIENCE IN THE
SAFETY NET HEALTH SYSTEM AND THE
CHIEF MEDICAL OFFICER FOR
ALAMEDA COUNTY'S FOOD AS
MEDICINE PROGRAM, CALLED RECIPE
FOR HEALTH. WHY FOOD IS MEDICINE
. FIRST, THE BAD NEWS THE
AMERICAN PEOPLE ARE SICK WITH
CHRONIC HEALTH CONDITIONS AND
FOOD INSECURITY. THE GOOD NEWS
IS THAT FOOD IS MEDICINE.
PROGRAMS LIKE RECIPE FOR HEALTH
CAN HELP ADDRESS THIS PROBLEM IN
YOUR DISTRICTS AND ACROSS THE
STATE. RECIPE FOR HEALTH EQUIPS
SAFETY NET HEALTH PROVIDERS TO
PRESCRIBE PRODUCE PAIRED WITH
HEALTH COACHING TO PATIENTS WITH
FOOD INSECURITY AND OR CHRONIC
HEALTH CONDITIONS. THE PRODUCE
PRESCRIBED IS GROWN LOCALLY BY
BIPOC FARMERS WHO ARE USING
REGENERATIVE AND ORGANIC FARMING
PRACTICES, WHICH MINIMIZE TOXIC
PESTICIDE RESIDUE AND INCREASE
THE VITAMIN AND ANTIOXIDANT
CONTENT OF THE PRODUCE GROWN.
THE FOLLOWING HEALTH OUTCOMES
HAVE BEEN REPORTED BY OUR
EVALUATION TEAM FROM UCSF AND
STANFORD. ONE THIRD OF OUR
PATIENTS WITH PREDIABETES AND
DIABETES SHOW A CLINICALLY
MEANINGFUL REDUCTION IN THEIR
BLOOD SUGARS. TWO THIRDS OF THE
PATIENTS IMPROVE THEIR
CHOLESTEROL INDICATORS, THUS
REDUCING HEART DISEASE RISK.
NUMBER THREE, FOOD SECURITY
IMPROVES BY 25. AND NUMBER FOUR,
EMERGENCY ROOM VISITS ARE
REDUCED BY 15% FROM A LOCAL OR
FROM AN ECONOMIC PERSPECTIVE,
FOR EVERY $1 SPENT ON SOURCING
FOOD LOCALLY FROM BIPOC FARMERS,
$1.90 IS GENERATED LOCALLY FOR
THE FOR THE ECONOMY RECIPE FOR
HEALTH IS SCALED TO TEN HEALTH
CENTERS ACROSS ALAMEDA COUNTY
AND SERVED OVER 6000 PATIENTS.
83% OF THEM IDENTIFY AS BIPOC.
IN CLOSING, FOOD IS MEDICINE.
PROGRAMS LIKE RECIPE FOR HEALTH
CAN BE SCALED ACROSS THE STATE
BY MAKING MEDICALLY SUPPORTED
FOOD A PERMANENT MEDI-CAL
BENEFIT. I AND THE REST OF THE
RECIPE FOR HEALTH TEAM URGENT I
VOTE ON AB 1975. THANK YOU.
HELLO, MY NAME IS ELIZABETH
DURAN. I LIVE IN THE EAST BAY
AND I'M HERE TO SHARE ABOUT MY
EXPERIENCE WITH OPEN SOURCE
WELLNESS AND RECIPE FOR HEALTH.
THE PANDEMIC CAUSED ME TO LOSE
MY JOB OF 30 YEARS, INCLUDING
LOSING MY HEALTH INSURANCE. A
KNEE INJURY LED TO SURGERY, I
GAINED WEIGHT, I TOOK MEDICATION
FOR HIGH BLOOD PRESSURE. MY
DOCTOR OF TEN YEARS PRESCRIBED
ANXIETY PILLS FOR ME. SOON
AFTER, I FOUND MYSELF ON
MEDI-CAL AND AT TIBURCIO VASQUEZ
HEALTH CENTER. I WAS TERRIFIED.
MY NEW DOCTOR SUGGESTED A
PROGRAM WHICH WOULD INCLUDE FREE
ORGANIC VEGETABLES ONCE A WEEK,
PLUS HEALTH AND WELLNESS
COACHING CALLED RECIPE FOR
HEALTH. HE DESCRIBED THAT I
WOULD LEARN ABOUT NUTRITION AND
BE SUPPORTED BY A FRIENDLY
COMMUNITY. WITHIN A FEW DAYS, I
GOT A PHONE CALL FROM THE RECIPE
FOR HEALTH TEAM TO ENROLL ME IN
THE PROGRAM. IN WHAT I INITIALLY
ENVISIONED AS A WEIGHT LOSS
PROGRAM TURNED OUT TO BE SO MUCH
MORE. NOT ONLY DID I RECEIVE
BEAUTIFUL ORGANIC GREENS AND
VEGETABLES, I LEARNED OF THEIR
NUTRITIONAL VALUE AND HOW TO
INCORPORATE THEM INTO MY HEALTHY
DIET IN THE MOST AFFORDABLE WAY.
I AM COOKING AND EATING MUCH
BETTER TODAY. I LOOK FOR NEW
RECIPES ONLINE THAT INCLUDE
COLLARD GREENS AND SWISS CHARD,
THINGS THAT USED TO BE
UNFAMILIAR. I LEARNED HOW TO
INCORPORATE DIFFERENT TYPES OF
PHYSICAL ACTIVITY IN MY LIFE IN
ALL MY YEARS WITH PRIVATE
INSURANCE, NO ONE EVER ASKED ME
IF I WANTED TO LEARN ABOUT
HEALTHY EATING OR OFFERED
RESOURCES. OPEN SOURCE WELLNESS
HAS MADE ME FEEL WANTED AND
CARED FOR AGAIN WHEN I WAS
TURNED AWAY. ELSEWHERE. MY WORRY
HAS BECOME LESS, MY SLEEP MORE.
MY BLOOD PRESSURE IS AT A
HEALTHY LEVEL. I'M FEELING HAPPY
AGAIN AND NOT FROM A PILL. I
BECAME SO INSPIRED THAT I STAND
AS A PEER LEADER OF OPEN SOURCE
WELLNESS, WANTING TO INSPIRE
OTHERS WHO MAY BE IN A DIM
PLACE. AS I ONCE WAS.
CALIFORNIANS ACROSS THE STATE
LIKE ME, NEED THESE CRITICAL
PROGRAMS TO SUPPORT OUR HEALTH.
I URGE YOUR AYE VOTE. THANK YOU.
OTHER WITNESSES IN SUPPORT COME
FORWARD. NAME, ORGANIZATION AND
POSITION ONLY. THANK YOU, DARBY.
KERNAN I'M HERE ON BEHALF OF
THREE ORGANIZATIONS TODAY,
LEADING AGE CALIFORNIA, THE
LOCAL HEALTH PLANS OF CALIFORNIA
AND PROJECT OPEN HAND IN
SUPPORT. THANK YOU. HELLO.
CHRISTY FOY HERE ON BEHALF OF
FRESENIUS MEDICAL CARE AND
CALIFORNIA KIDNEY CARE ALLIANCE
IN STRONG SUPPORT. THANK YOU.
MADAM CHAIR MEMBERS RANDALL
MARTIN HERE ON BEHALF OF THE
AIDS HEALTHCARE FOUNDATION. THIS
IS A GREAT BILL. PLEASE SUPPORT.
THANK YOU. CHAIR GONZALEZ, ON
BEHALF OF THE AMERICAN DIABETES
ASSOCIATION AND STRONG SUPPORT.
KELLY BROOKS, ON BEHALF OF THE
COUNTY HEALTH EXECUTIVES
ASSOCIATION OF CALIFORNIA, THE
URBAN COUNTIES OF CALIFORNIA AND
THE RURAL COUNTY REPRESENTATIVES
OF CALIFORNIA HERE IN SUPPORT.
CHRISTINE SMITH, HEALTH, ACCESS
AND SUPPORT. SARAH NOCITO, ON
BEHALF OF THE CALIFORNIA CHRONIC
CARE COALITION AND SUPPORT. THE
SET SHORT ON BEHALF OF LOMA
LINDA UNIVERSITY HEALTH AND
SUPPORT. JENNIFER SNYDER WITH
CAPITAL ADVOCACY ON BEHALF OF
MOM'S MEALS AND STRONG SUPPORT.
HI THERE, MIA SCHWARTZ WITH THE
FOOD IS MEDICINE COLLABORATIVE.
WE'RE ALSO A PROUD CO-SPONSOR OF
THE BILL IN SUPPORT AND ALSO
FROM CALIFORNIA FOOD AND FARMING
NETWORK. GOOD AFTERNOON, LOUIS
BROWN, ON BEHALF OF THE AMERICAN
PISTACHIO GROWERS IN SUPPORT.
GOOD AFTERNOON, SYMPHONY BABI
WITH PLANNED PARENTHOOD
AFFILIATES OF CALIFORNIA IN
SUPPORT. RYAN SPENCER, ON BEHALF
OF THE AMERICAN COLLEGE OF OBGYN
IN DISTRICT NINE AND THE CROHN'S
AND COLITIS FOUNDATION IN
SUPPORT. THANK YOU VERY MUCH.
DYLAN ELLIOTT, ON BEHALF OF THE
CITY AND COUNTY OF SAN
FRANCISCO, AS WELL AS THE
CALIFORNIA MEDICAL ASSOCIATION,
BOTH IN SUPPORT. THANK YOU. I,
CARLY STELZER, ON BEHALF OF
FAMILY MAIL SACRAMENTO, IN
SUPPORT. WHITNEY FRANCIS WITH
THE WESTERN CENTER ON LAW AND
POVERTY IN SUPPORT. JED HAMPTON
WITH THE CALIFORNIA ASSOCIATION
OF HEALTH PLANS. APOLOGIES FOR
NOT APOLOGIES FOR NOT GETTING
OUR LETTER IN ON TIME, BUT WE
ARE IN SUPPORT. THANK YOU.
LUCINDA BAZILE WITH LIFELONG
MEDICAL CARE IN SUPPORT. THANK
YOU. DO WE HAVE ANY WITNESSES IN
OPPOSITION? SEEING NONE, I'LL
BRING IT BACK TO THE COMMITTEE.
WE HAVE A MOTION. WE HAVE A
SECOND. OKAY YES. MISS WEBER. I
JUST WANT TO REALLY THANK THE
CHAIR ONCE AGAIN FOR BRINGING
THIS BILL BACK. IT IS EXTREMELY
IMPORTANT, YOU KNOW, I THINK
SOMEONE IN THE AUDIENCE SAID IT
BEST. IT IS A GREAT BILL. IT'S
MORE THAN A GREAT BILL. AND
HOPEFULLY THIS TIME WE'LL BE
ABLE TO GET IT ALL THE WAY
THROUGH INTO THE GOVERNOR'S DESK
AND SIGN. I'M REALLY HAPPY TO
SEE THE VERY WIDE, DIVERSE
SUPPORT HERE. THE COALITION OF
SUPPORT RECOGNIZING, AS WAS
POINTED OUT BY, YOUR TWO
WITNESSES, THAT WE CAN REALLY Kò
LOWER THE COST OF HEALTH CARE,
GET PEOPLE OFF OF MEDICATIONS,
PREVENT HOSPITALIZATIONS,
PREVENT UNNECESSARY SURGERIES.
IF WE TAKE THIS KIND OF
PROACTIVE APPROACH AND ENSURE
THE THINGS THAT THEY ARE EATING
ARE HEALTHY AND SAFE, THEN WE
WOULDN'T SEE ALL OF THE OBESITY,
THE DIABETES, THE HIGH BLOOD
PRESSURE, ALL OF THESE CHRONIC
ILLNESSES THAT WE'RE SEEING NOT
ONLY IN OUR OLDER POPULATION,
BUT ALSO IN OUR IN OUR PEDIATRIC
AND ADOLESCENT POPULATIONS. SO I
REALLY WANT TO GIVE OUR CHAIR
YOUR KUDOS. THIS HAS BEEN
SOMETHING YOU'VE BEEN TALKING
ABOUT SINCE YOU CAME INTO THE
LEGISLATURE, I'M VERY PROUD THAT
YOU ALLOWED THIS TO BE ONE OF
THE BLACK CAUCUS PRIORITY BILLS,
AND JUST REALLY THANK YOU FOR
BRINGING THIS BACK UP AGAIN. YES
I WOULD JUST LIKE TO ECHO
ASSEMBLY MEMBER WEBBER'S
COMMENTS, I LOVE THIS BILL.
THANK YOU VERY MUCH FOR BRINGING
IT FORWARD. AND I'D LIKE TO BE A
KHÓ AS A COAUTHOR. MR. I'D ALSO
LOVE TO BE ADDED AS A COAUTHOR.
I THINK THIS IS SUCH AN
IMPACTFUL BILL. AND, AND
THERE'S, YOU KNOW, SO MUCH WE
CAN DO TO REALLY ADDRESS HEALTH
IF WE APPROACH IT IN THIS WAY.
THANK YOU. ANY OTHER COMMENTS, I
AGREE WITH THE COMMENTS. I THINK
IT'S AMAZING IT TOOK THIS LONG
FOR US, OUR SOCIETY AS A WHOLE,
TO UNDERSTAND HOW IMPORTANT
NUTRITIOUS FOODS ARE, ESPECIALLY
IN PREVENTATIVE MEDICINE, SO THE
WE DO HAVE A MOTION AND A SECOND
DO PASS TO APPROPRIATIONS, WOULD
YOU LIKE TO CLOSE? THANK YOU. I
CERTAINLY AM THANKFUL FOR THE
COAUTHOR REQUEST AND WILLINGLY
ACCEPT THOSE, I JUST WANT TO
THANK MISS DURAN. ACTUALLY WHO
I'VE GOTTEN TO SPEND SOME TIME
WITH OVER THE PAST COUPLE OF,
HOURS. AND THANK YOU FOR BEING
HERE, BUT, YOU KNOW, SHE TALKS
ABOUT SWISS CHARD AND OUR NEED
TO BE ABLE TO MAKE SURE THAT WE
ARE USING THAT AND INCORPORATING
THAT INTO A HEALTHY LIFE. AND, I
WANT TO JUST KIND OF HIGHLIGHT
HER STORY BECAUSE WE COULD HAVE
SO MANY CALIFORNIANS WHO ARE
ABLE TO TELL THE SAME STORY,
INSTEAD OF TELLING STORIES ABOUT
HOW THEY WENT TO THE EMERGENCY
ROOM OR NEEDED GASTRIC BYPASS
SURGERY, OR NEEDED TO START
TAKING PILLS, FOR A-1C OR ALL
THE OTHER THINGS THAT WE CAN DO.
THIS IS A VERY SIMPLE FIX. AND
IF WE'RE SMART, WE KNOW THAT IT
WILL COST VERY LITTLE COMPARED
TO HOW MUCH IT COSTS US RIGHT
NOW TO BE ABLE TO SUPPORT
PEOPLE. SO WITH THAT, I
RESPECTFULLY REQUEST YOUR RIGHT.
THANK YOU, MADAM SECRETARY.
PLEASE CALL THE ROLL. BONTA
BONTA I WALDEN I WALDEN I AGAR
CURRY AGAR CURRY I ARAMBULA
ARAMBULA I WENDY CARILLO WENDY
CARILLO I FLORA HANEY HANEY I
JOAN SAWYER.
JOHN. SAWYER. JOHN SAWYER I
MEAN, SHANE MCCARTY. JOE.
PATTERSON. RODRIGUEZ. SANCHEZ
SANTIAGO. SCHIAVO CHAU. VÚI.
WEBER. WEBER. I NINE VOTES, YOUR
BILL IS OUT. NUMBER. I SEE MISS
REYES OUT THERE, NEXT ON THE
LIST. AB2066.
ASSEMBLY MEMBER. REYES. PLEASE
BEGIN. THANK YOU, MADAM CHAIR.
AND MEMBERS, TODAY I AM
PRESENTING A B 2066 THE CLEAN
COFFEE ACT. I WOULD LIKE TO
THANK THE CHAIR AND HER STAFF
FOR WORKING WITH MY TEAM ON THIS
BILL AND COMMIT TO TAKING THE
AMENDMENTS, NARROWING THIS BILL
TO A LABELING REQUIREMENT
CONSISTENT WITH THE SHARED WITH
THE COMMITTEE AS PROPOSED TO BE
AMENDED, AB 2066 WILL REQUIRE
THE LABELING OF DECAFFEINATED
COFFEE, DECAFFEINATED COFFEE
PRODUCTS THAT UTILIZE A METHOD
THAT UTILIZING METHYLENE
CHLORIDE. I INTRODUCED THIS BILL
FOR A NUMBER OF REASONS, AS I
FOUND OUT THAT THERE WERE THREE
WAYS TO DECAFFEINATE COFFEE
THREE PROCESSES, AND ONE OF
THOSE USES METHYLENE CHLORIDE, A
KNOWN CARCINOGEN. AND SO WE'VE
WORKED TO TRY TO TAKE CARE OF
THAT ISSUE. I CAN TELL YOU THAT
THE IMPACT ON PREGNANT MOTHERS
WHO SWITCHED TO DECAFFEINATED
WAS THE BIGGEST CONCERN THAT I
HAD WHEN I WAS PREGNANT WITH MY
SON, IT WAS RECOMMENDED THAT I
SWITCH TO DECAFFEINATED COFFEE
BECAUSE OF THE POTENTIAL
NEGATIVE IMPACTS OF CONSISTENTLY
CONSUMING REGULAR COFFEE AND THE
IMPACT THAT WOULD HAVE ON HIS
HEALTH. I MUST ADMIT, I WAS
SHOCKED WHEN I FOUND OUT THAT
METHYLENE CHLORIDE IS COMMONLY
USED AS A METHOD FOR
DECAFFEINATED COFFEE BEANS, AND
THAT IT HAS A POTENTIAL TO LEAVE
ELEMENTS OF THIS TOXIC SUBSTANCE
IN COFFEE ONCE THE PROCESS IS
COMPLETED. METHYLENE CHLORIDE IS
A SUBSTANCE THAT HAS BEEN USED
IN PAINT STRIPPERS AS A
CHEMICAL, AND BATHTUB
REFINISHING, AND AS WELL AS
SEVERAL OTHER INDUSTRIAL USES.
USES. IT HAS NOW BEEN BANNED. IT
CAN BE CONTRACTED BY BREATHING
IT IN OR THROUGH DIRECT CONTACT,
AND IT HAS BEEN SCIENTIFICALLY
PROVEN THAT DURING PREGNANCY,
METHYLENE CHLORIDE CONTAMINATION
CAN BE PASSED FROM MOTHER TO
CHILD. GIVEN THESE IMPACTS,
REGULATIONS REGARDING THE USE OF
METHYLENE CHLORIDE DUE TO ITS
RISKS HAVE ESCALATED OVER THE
PAST FEW YEARS. IN APRIL OF LAST
YEAR, THE US ENVIRONMENTAL
PROTECTION AGENCY BANNED MOST
USES OF METHYLENE CHLORIDE,
CITING IT AS A DANGEROUS AND, I
QUOTE, DANGEROUS CHEMICAL KNOWN
TO CAUSE SERIOUS HEALTH RISKS
AND EVEN DEATH, END QUOTE.
CURRENTLY, THE ENVIRONMENTAL
DEFENSE FUND IS PETITIONING THE
FDA TO BAN METHYLENE CHLORIDE
USE IN FOODS ALTOGETHER. AS
MENTIONED EARLIER, IT'S
IMPORTANT TO NOTE THAT THIS IS
NOT THE ONLY WAY TO DECAFFEINATE
COFFEE. THERE ARE THREE TYPES OF
METHODS USED TO DECAFFEINATE
COFFEE. FIRST, THE SUPERCRITICAL
CARBON DIOXIDE CARBON DIOXIDE
METHOD NUMBER. THE NUMBER TWO,
THE SWISS WATER PRESS METHOD
ALSO KNOWN AS A WATER PROCESS
USED BY COMPANIES LIKE PEET'S
COFFEE. AND THIRD, THE METHYLENE
CHLORIDE METHOD THAT IS THE
SUBJECT OF THIS BILL'S
NOTIFICATION REQUIREMENTS. I'VE
HEARD VARIOUS OPPOSITION POINTS
HIGHLIGHTING CONCERNS WITH THE
BILL. HOWEVER, GIVEN VARIANCES
IN THE LEVEL OF METHYLENE
CHLORIDE LEFT DURING THIS
PROCESS, COMBINED WITH THE FACT
THAT ALMOST ALL OF THE
DECAFFEINATION OCCURS OUTSIDE OF
THE COUNTRY, I CONTINUE TO BE
CONCERNED REGARDING THE USE OF
THIS METHOD WHEN THERE ARE CLEAR
ALTERNATIVES. AB 2066 WILL
PROVIDE CONSUMERS WITH AN
OPPORTUNITY TO MAKE AN EDUCATED
DECISION REGARDING THEIR CHOICE
IN THE USE OF DECAFFEINATED
COFFEE. HERE TO TESTIFY IN
SUPPORT OF THE BILL ARE JACKIE
BOWEN, FOUNDER OF THE CLEAN
LABEL PROJECT AND SUSAN LITTLE,
SENIOR ADVOCATE FOR THE
ENVIRONMENTAL WORKING GROUP.
PLEASE GO AHEAD. YOU'LL HAVE TWO
MINUTES EACH. THANK YOU. CHAIR
AND MEMBERS, I'M JACQUELINE
BOWEN, REPRESENTING THE CLEAN
LABEL PROJECT, A NATIONAL
NONPROFIT WITH THE MISSION TO
BRING TRUTH AND TRANSPARENCY TO
CONSUMER PRODUCT LABELING.
BEFORE COMING TO CLEAN LABEL
PROJECT FOR 15 YEARS, I WORKED
FOR NSF INTERNATIONAL, THE WORLD
HEALTH, THE WORLD HEALTH
ORGANIZATION COLLABORATING
CENTER ON FOOD SAFETY AND WATER
QUALITY. HOWEVER MY MOST
CHERISHED ROLE IS THAT OF A MOM
OF A TWO YEAR OLD SON. IT'S
BECAUSE OF MY PERSONAL AND
PROFESSIONAL INTERESTS AND
PASSION. THAT CLEAN LABEL
PROJECT FOCUSES ITS ADVOCACY
EFFORTS ON SUPPORTING INFANT AND
MATERNAL HEALTH. WE'VE BEEN
ACTIVELY INVOLVED IN SUPPORTING
RECENT LEGISLATION, INCLUDING
CALIFORNIA'S AB 899, WHICH
MANDATES HEAVY METAL TESTING AND
DISCLOSURE FOR BABY FOODS AND
SIMILAR BILLS SUCH AS RUDY'S LAW
IN MARYLAND. THESE INITIATIVES
AIM TO PROTECT THE MOST
VULNERABLE POPULATIONS IN OUR
SOCIETY, AND THAT'S WHY I'M HERE
TODAY. THE BILL WE'RE DISCUSSING
PERTAINS TO THE USE OF METHYLENE
CHLORIDE AND A KNOWN CARCINOGEN.
IN THE DECAFFEINATION PROCESS OF
COFFEE, THE ENVIRONMENTAL
PROTECTION AGENCY BANNED
METHYLENE CHLORIDE FOR MOST
CONSUMER, INDUSTRIAL AND
COMMERCIAL USES TO SAFEGUARD THE
PUBLIC HEALTH, WITH THE NOTABLE
EXAMPLES INCLUDING THE
PROHIBITION OF THE USE OF
METHYLENE CHLORIDE FOR PAINT
STRIPPER. HOWEVER DESPITE THESE
REGULATIONS, METHYLENE CHLORIDE
IS STILL PERMITTED FOR USE IN
FOOD PRODUCTS, WHICH FALLS UNDER
THE JURISDICTION OF THE FDA. THE
BILL ADDRESSES A CRITICAL. THIS
BILL ADDRESSES A CRITICAL
REGULATORY GAP IN CALIFORNIA BY
QUESTIONING WHETHER A CHEMICAL
LIKE METHYLENE CHLORIDE LINKED
TO CANCER AND BANNED IN MANY
INDUSTRIAL APPLICATIONS, SHOULD
BE ALLOWED INTO IN COFFEE
DECAFFEINATION, ESPECIALLY
CONSIDERING THERE ARE READILY
AVAILABLE NON CARCINOGENIC
METHODS OF DECAFFEINATION
UTILIZED BY NUMEROUS COFFEE
PROVIDERS AT COMPARABLE COSTS,
AND ESPECIALLY CONSIDERING THAT
THE CONSUMERS REACHING FOR
DECAFFEINATED COFFEE ARE
OFTENTIMES PREGNANT WOMEN, THE
ELDERLY, OR OTHERS WITH MEDICAL
CONDITIONS, CANADA REQUIRES
LABELING. THE SIMPLE QUESTION
POSED BY THIS BILL IS SHOULD WE
REQUIRE MANDATORY LABELING OF
DECAFFEINATED COFFEE PRODUCTS
THAT USE THIS KNOWN CARCINOGEN,
METHYLENE CHLORIDE, FOR
DECAFFEINATION PURPOSES? YES.
THANK YOU, AND I'M AVAILABLE FOR
QUESTIONS. THANK YOU. COMMITTEE
AND CHAIR. GOOD AFTERNOON. MY
NAME IS SUSAN LITTLE AND I
REPRESENT THE ENVIRONMENTAL
WORKING GROUP. EWG RISES IN
SUPPORT OF AB 2066 BECAUSE WE
AND MANY OTHER PUBLIC HEALTH
ORGANIZATIONS ARE NOT AT ALL
CONFIDENT THAT THE US FOOD AND
DRUG ADMINISTRATION WILL TAKE
MEANINGFUL ACTION TO PREVENT
CONSUMERS FROM CONSUMING THIS
CARCINOGEN. SINCE 1958, THE LAW
WAS UNAMBIGUOUSLY STATED THAT
CARCINOGENS ARE NOT SAFE TO USE
IN FOOD. BY 1986, GOVERNMENT
STUDIES ESTABLISHED THAT
METHYLENE CHLORIDE CAUSES
CANCER, YET THE FDA HAS TAKEN NO
ACTION TO REMOVE IT FROM THE
FOOD SUPPLY OR TO WARN CONSUMERS
ABOUT ITS PRESENCE IN FOOD. IN
FACT, THE FDA ROUTINELY FAILS TO
ADEQUATELY OVERSEE CHEMICALS IN
THE FOOD SUPPLY AND IS NOT
REQUIRED TO RE REVIEW ADDITIVES
THAT IT'S APPROVED OR ALLOWED OR
ACT ON NEW SCIENTIFIC EVIDENCE
OF HARM CAUSED BY THOSE
ADDITIVES. AS A RESULT, MANY
FOOD CHEMICALS, SUCH AS
METHYLENE CHLORIDE HAVE NOT BEEN
MEANINGFULLY EVALUATED BY THE
FDA FOR MANY DECADES, WELL PAST
THE TIME WHEN THOSE STUDIES ARE.
THOSE STUDIES DON'T NO LONGER,
ARE RELEVANT IN TERMS OF THEY
DON'T THEY DON'T MEASURE UP TO
THE SAME TOXICOLOGY STANDARDS AS
THEY USE TODAY. YEARS AFTER THE
FDA APPROVED THE USE OF
METHYLENE CHLORIDE IN FOOD, IT
LOOKED AT THE CHEMICALS USE IN
COSMETICS. BASED ON THAT REVIEW,
THE FDA DETERMINED THAT
METHYLENE CHLORIDE IS A
CARCINOGEN AND PROHIBITED ITS
USE IN COSMETICS. IN 1989, BUT
FDA CONTINUES TO ALLOW IT TO BE
USED IN FOOD, EVEN THOUGH THE
LAW SPECIFICALLY BARS FDA FROM
PERMITTING CARCINOGENS TO BE
FOOD ADDITIVES. CALIFORNIA
SCIENTISTS AT CAL EPA HAVE ALSO
CONCLUDED THAT METHYLENE
CHLORIDE CAN CAUSE CANCER, AND
MOST RECENTLY, THE EPA HAS
DETERMINED THAT METHYLENE
CHLORIDE IS NOT SAFE FOR ANY
CONSUMER USE. MAKES NO SENSE
THAT A KNOWN CARCINOGEN IS
ALLOWED IN OUR FOOD, ESPECIALLY
WHEN ITS USE IS NOT NECESSARY.
NOT TO MENTION IN VIOLATION OF
FEDERAL LAW. AND CONSUMERS
SHOULD BE WARNED. THANK YOU.
THANK YOU ARE THERE ANY OTHER
ADDITIONAL WITNESSES IN SUPPORT?
BRIAN SPENCER WITH THE AMERICAN
COLLEGE OF OB-GYNS RECENTLY
APPROVED A SUPPORT POSITION ON
THIS BILL. THANK YOU. HELLO,
KAREN SCOTT, ON BEHALF OF
REPRODUCTIVE FREEDOM FOR ALL,
CALIFORNIA AND SUPPORT. ARE
THERE ANY PRIMARY WITNESSES IN
OPPOSITION? PLEASE COME FORWARD
AND SIT AT THE PRESENTER PANEL.
PLEASE. YOU'LL EACH HAVE TWO
MINUTES.
GOOD AFTERNOON. GOOD AFTERNOON,
MADAM CHAIR. MEMBERS OF THE
COMMITTEE, I'M BILL MURRAY. I'M
THE CEO AND THE PRESIDENT OF THE
NATIONAL COFFEE ASSOCIATION. WE
STRONGLY OPPOSE HB 2066. THE
BILL SPONSORS HAVE PRESENTED NO
EVIDENCE TO JUSTIFY PLACING
WARNINGS ON DECAFFEINATED COFFEE
, THE MAJORITY OF WHICH IS
EUROPEAN METHOD DECAF COFFEE,
WHICH UTILIZES METHYLENE
CHLORIDE. THEY HAVE NOT
PRESENTED ANY EVIDENCE BECAUSE
NO EVIDENCE EXISTS. GOVERNMENTS
AROUND THE WORLD, INCLUDING THE
EUROPEAN UNION, AUTHORIZE
EUROPEAN METHOD DECAF AS SAFE
DECADES. DECADES OF INDEPENDENT
SCIENTIFIC RESEARCH SHOW THAT
DECAFFEINATED COFFEE, LIKE ALL
COFFEE, IS ACTUALLY ASSOCIATED
WITH THE REDUCED RISK OF
MULTIPLE CANCERS AND OTHER
DISEASES. THERE'S NO EVIDENCE
SHOWING AN ASSOCIATION BETWEEN
EUROPEAN METHOD DECAF COFFEE AND
INCREASED RISK OF CANCER. QUITE
THE OPPOSITE. THE WORLD HEALTH
ORGANIZATION, THE AMERICAN
CANCER SOCIETY, THE AMERICAN
INSTITUTE FOR CANCER RESEARCH,
THE WORLD CANCER RESEARCH FUND,
AND CALIFORNIA'S OWN OFFICE OF
ENVIRONMENTAL HEALTH HAZARD
ASSESSMENT HAVE ALL DETERMINED
THAT DRINKING COFFEE, BOTH
REGULAR AND DECAF COFFEE,
DECREASE THE RISK OF ENDOMETRIAL
CANCER, LIVER CANCER, AND
SEVERAL OTHER CANCERS AND
CHRONIC DISEASES. THE ONLY
REMOTELY RELEVANT EVIDENCE FINDS
INCREASED RISKS OBSERVED IN
RODENTS WHEN THEY'VE BEEN
EXPOSED TO THE EQUIVALENT OF
30,000 CUPS OF COFFEE A DAY.
EUROPEAN METHOD DECAF HAS
ABSOLUTELY NO RELATION TO OTHER
PRODUCTS THAT CONTAIN METHYLENE
CHLORIDE. ANY SUCH COMPARISONS
ARE MISLEADING. FURTHERMORE,
THERE IS ZERO EVIDENCE THE
EUROPEAN METHOD DECAF PRESENTS
ANY RISK FOR PREGNANT WOMEN,
ACCORDING TO THE CDC'S PUBLIC
HEALTH STATEMENT. AND I QUOTE,
THERE HAVE NOT BEEN ANY REPORTS
OF A CONNECTION BETWEEN
METHYLENE CHLORIDE EXPOSURE
DURING PREGNANCY AND BIRTH
DEFECTS IN HUMANS. I UNDERSTAND
JUST A COUPLE OF HOURS AGO. THE
COMMITTEE HAS PROPOSED
AMENDMENTS TO REQUIRE WARNINGS.
I'LL TURN TO ANTHONY'S HAMPSON
TO DISCUSS OUR CONCERNS WITH THE
PROPOSAL IN MORE DETAIL. GREAT.
THANK YOU. CHAIR AND MEMBERS,
ANTHONY SAMPSON HERE ON BEHALF
OF THE NATIONAL COFFEE
ASSOCIATION, DID NOT INTEND TO
COME UP HERE TODAY, BUT GIVEN
THE LATE AMENDMENTS, JUST WANTED
TO MAKE SURE TO SPEAK A LITTLE
BIT, ABOUT THOSE, BEFORE DOING
THAT, I JUST WANT TO REEMPHASIZE
TWO POINTS THAT BILL MURRAY MADE
THAT ARE CRITICAL TO KEEP IN
MIND WHEN REVIEWING THE
AMENDMENTS. BEFORE YOU FIRST,
THERE IS NO EVIDENCE, THERE'S NO
DATA, NO SCIENCE LINKING
EUROPEAN METHOD DECAF TO
NEGATIVE HEALTH OUTCOMES.
SECOND, THERE IS A PLETHORA OF
EVIDENCE, DATA AND SCIENCE WHICH
WE'VE PROVIDED TO MEMBERS OF
THIS COMMITTEE AND TO THE CHAIR
SHOWING JUST THE OPPOSITE THAT
DRINKING COFFEE, INCLUDING
DECAF, THE MAJORITY OF WHICH IS
EUROPEAN METHOD DECAF, HAS
SIGNIFICANT HEALTH BENEFITS.
THESE POINTS SEEM TO HAVE
RESONATED WITH MANY MEMBERS OF
THE COMMITTEE, AND AS SUCH, WE
HAVE NOW SHIFTED TO A BAN ON
FROM A BAN ON EUROPEAN METHOD
DECAF TO PROPOSING A WARNING FOR
IT. BUT WHILE THE APPROACH HAS
SHIFTED, THE BODY OF EVIDENCE
REMAINS EXACTLY THE SAME. THERE
WAS NO EVIDENCE TO SUPPORT A
BAN, AND THERE IS NO EVIDENCE TO
SUPPORT A WARNING. TO BE CLEAR,
THE WARNING PROPOSAL BEFORE YOU
IS BY BY ITS VERY NATURE,
SUGGESTS THAT A HEALTH
PROTECTIVE PRODUCT IS UNSAFE.
THERE IS NO SENSE AT ALL IN
WARNING CONSUMERS ABOUT A
PRODUCT THAT IS PROVEN SAFE AND
ASSOCIATED WITH DECREASED RISK
OF MULTIPLE TYPES OF CANCER. THE
WARNING, BY ITS BY ITS NATURE OF
CALLING OUT ONE CHEMICAL, WOULD
MISLEAD CONSUMERS INTO BEING
FRIGHTENED OF THIS PRODUCT.
DESPITE THE OVERWHELMING BODY OF
EVIDENCE SUGGESTING THAT THEY
SHOULD NOT. FOR THOSE REASONS,
WE REQUEST A NO VOTE AND HAPPY
TO ANSWER ANY QUESTIONS. THANK
YOU. ANY ADDITIONAL WITNESSES IN
OPPOSITION? KATIE LITTLE WITH
THE CALIFORNIA LEAGUE OF FOOD
PRODUCERS PRODUCERS IN
OPPOSITION. THANK YOU. MEMBERS.
ROB SPIEGEL, CALIFORNIA
MANUFACTURERS AND TECHNOLOGY
ASSOCIATION IN OPPOSITION.
JENNIFER SNYDER, WITH CAPITAL
ADVOCACY ON BEHALF OF THE
CALIFORNIA RETAILERS
ASSOCIATION, IN OPPOSITION.
DENNIS ALBIANI, ON BEHALF OF
CONSUMER BRANDS ASSOCIATION, IN
OPPOSITION. GOOD AFTERNOON.
LOUIS BROWN, ON BEHALF OF THE
CALIFORNIA GROCERS ASSOCIATION,
IN OPPOSITION. I'LL BRING IT
BACK TO THE COMMITTEE FOR ANY
QUESTIONS OR COMMENTS. DOCTOR
WEBER. GOOD AFTERNOON, THANK YOU
FOR BRINGING THIS BILL FORWARD
AND ALLOWING FOR US TO HAVE THIS
VERY ROBUST CONVERSATION, NOW,
IN THE PRESENTATION, THÀNH,
SOMEONE MENTIONED THE FACT THAT
THERE ARE ALREADY LABELS IN
ANOTHER COUNTRY. CAN YOU
ELABORATE ON THAT? WHAT IS THIS
WARNING LABEL ALREADY PRESENT
AND ANYWHERE ELSE? OR WOULD
UNITED STATES BE THE FIRST?
THERE IS SOME LABELING THAT IS
CURRENTLY OCCURRING IN CANADA.
THERE IS ALSO A PROHIBITIONS
THAT ARE HAPPENING IN JAPAN AND
KOREA. IF I'M UNDERSTANDING
CORRECTLY, CAN YOU EXPLAIN THAT
LABELING? WHERE IS THE LABEL?
WHAT EXACTLY DOES IT STATE? I
CAN GET BACK TO YOU WITH MORE
INFORMATION ON THAT. OKAY, WELL
THEN SINCE THERE WERE LATE, LAST
MINUTE AMENDMENTS AND WE HAVEN'T
SEEN IT, WHAT IS THE THOUGHT
PROCESS BEHIND THE LABELING?
WHERE IS IT GOING TO GO? WHAT IS
IT GOING TO SAY? DO WE HAVE THAT
? THE LABEL, THE PROPOSED LABEL?
JUST DISCLOSE IS THAT THE
PRODUCT WAS MADE WITH METHYLENE
CHLORIDE PROCESS. OKAY. AND
WHERE IS IT GOING TO GO? IS IT
ON THE PACKAGING WHERE THE
PERSON WHO OWNS THE STORE IS
GOING TO SEE IT? IS IT ON THE
CUP WHERE THE CONSUMER CAN SEE
IT? WHERE WHERE ARE WE THINKING
THAT THE LABELING IS GOING? THE
LABEL WILL GO ON THE PACKAGE
ITSELF. AND IN A CLEARLY,
CLEARLY, A CLEAR PLACE. OKAY. SO
THE CONSUMER WOULDN'T
NECESSARILY SEE IT. THEY WOULD
SEE IT ON THE EXTERNAL PART OF
THE PACKAGE. YES. BUT IF YOU GO
TO A IF I GO TO STARBUCKS,
RIGHT, I DON'T SEE THE. NO, YOU
DON'T. RIGHT. SO THEY WOULDN'T
SEE IT. IT'S JUST THE STORE
OKAY. AND THERE'S BEEN A LOT OF
DISCUSSION ABOUT WHAT THE
EVIDENCE ACTUALLY SHOWS. SO WE
KNOW THAT IN LARGE QUANTITIES
THIS IS A HEALTH RISK. HAS THERE
BEEN ANY SPECIFIC STUDIES THAT
HAS LOOKED AT THIS PARTICULAR
METHOD IN COFFEE AND LINKED THAT
TO ANY ADVERSE HEALTH OUTCOMES?
THE ONE THING I WOULD SAY TO
THAT POINT IS, JUST AS THERE HAS
BEEN AN EVOLUTION OF THE
DECAFFEINATION PROCESS METHODS
OVER THE PAST 40 YEARS AS IT
RELATES TO MEDICAL ETHICS AND
CLINICAL TRIALS, I THINK IT
WOULD BE DIFFICULT TO CONDUCT
SOMETHING TO ASSESS, PROVIDE
THAT TYPE OF EXPOSURE, TO
INTENTIONALLY SEE AT WHAT POINT
IS THERE AN ADVERSE HEALTH
EFFECT ON AN UNBORN CHILD. NO, I
UNDERSTAND THAT, BUT WE DO IN
TERMS OF FINDING, YOU KNOW, ANY
DELIBERATE HUMAN STUDIES. I KNOW
THAT THERE'S SOME IN ANIMALS
RIGHT NOW. WELL, I COMPLETELY
UNDERSTAND THAT WE'RE NOT. IT
WOULD BE VERY UNETHICAL TO DO
THAT. HOWEVER, WE CAN DO
RETROSPECTIVE STUDIES. SO IF YOU
SEE THAT THERE IS A COMMONALITY,
WE CAN ALWAYS GO BACK AND ASSESS
IF THERE IS A COMMON FACTOR,
I.E. DECAF COFFEE LIKE IN
PREGNANCY OR SOMETHING. SO MY
QUESTION IS DO WE HAVE THAT
EVIDENCE? BECAUSE OFTENTIMES
WHEN WE REALIZE THAT SOMETHING
MAY BE, AN IMPACT OR CAUSE AN
IMPACT TO SOMEONE'S HEALTH IS
NOT THAT WE HAVE AN
INTENTIONALLY DONE IT, WE NOTICE
A TREND AND WE LOOK BACKWARDS TO
FIND THAT COMMON DENOMINATOR. DO
WE HAVE THAT FOR THIS PARTICULAR
DOCTOR WEBER. THANK YOU. I WANT
TO POINT OUT THAT THE STUDIES
THAT THE GENTLEMAN NEXT TO ME
HAVE TALKED ABOUT, THAT THOSE
STUDIES DON'T SPECIFICALLY CALL
OUT THE COFFEE THAT HAS BEEN OF
THAT HAS BEEN TREATED WITH
METHYLENE CHLORIDE. THEY'RE
TALKING ABOUT, OF COURSE,
STUDIES IN GENERAL ABOUT COFFEE
AND WHETHER IT HAS IT OR
DOESN'T. THAT'S NOT NECESSARILY
PART OF WHAT THEY'RE DISCUSSING.
ALSO THE 30,000 CUPS THAT
THEY'RE DISCUSSING, YOU KNOW,
THE, THE, THE FIGURE THEY
MENTIONED THAT WOULD RESULT IN
A, IN A RISK FACTOR OF 1 IN 10,
1 IN 10 PERSONS GETTING CANCER.
RIGHT. AND THAT IS A RISK FACTOR
THAT IS NOT AN ACCEPTABLE RISK
FACTOR PUT FORWARD BY ANY PUBLIC
HEALTH ORGANIZATION. USUALLY
IT'S A 1 IN 100,000 OR EVEN A 1
IN 1,000,000 RISK FACTOR THAT IS
CONSIDERED A SAFE LEVEL OR AN
ACCEPTABLE RISK FACTOR. ALSO I
JUST WANTED TO POINT OUT THAT
WHEN CAL EPA LOOKED AT METHYLENE
CHLORIDE, TO DETERMINE THE
PUBLIC HEALTH GOAL FOR, YOU
KNOW, FOR DRINKING WATER, THEY
DETERMINED THAT THE PUBLIC
HEALTH GOAL FOR DRINKING WATER
WOULD BE NO MORE THAN FOUR PARTS
PER BILLION, WHICH IS 2000 TIMES
BELOW THE FDA'S ACCEPTABLE
STANDARD. SO I JUST WANTED TO
JUST GIVE YOU AN IDEA THAT THERE
ARE INGESTION STUDIES. THE
PUBLIC HEALTH GOALS, BOTH AT THE
AT THE EPA LEVEL AND ALSO AT THE
EPA LEVEL, LOOK AT METHYLENE
CHLORIDE FROM THE STANDPOINT OF
WHAT IT WHAT COULD HAPPEN TO A
PERSON WHEN IT'S INGESTED. AND
THE EPA DETERMINED THAT THE
PUBLIC HEALTH THAT THE GOAL, THE
MAXIMUM CONTAMINANT LEVEL GOAL
FOR DRINKING WATER FOR METHYLENE
CHLORIDE WAS ZERO, SIMILAR TO
LEAD, RIGHT? SO IT'S ONE OF
THOSE, CARCINOGENS THAT EVEN
EVEN THE FDA, FDA DECIDED TO,
YOU KNOW, JUST SAY THAT IT
COULDN'T EVEN BE IN COSMETICS.
ONE OF THE FEW CHEMICALS THAT
CAN'T BE IN COSMETICS IS
METHYLENE CHLORIDE. I WOULD LIKE
TO HEAR FROM THE OPPOSITION ON
THIS, DOCTOR WEBER, TO ADDRESS
YOUR CONCERN ABOUT OUR RESEARCH,
ALL THE RESEARCH THAT WE
MENTIONED WAS CONDUCTED
INDEPENDENTLY OF THE INDUSTRY.
WE DO NOT SUPPORT OUR RESEARCH,
IT'S ALL ON THE UP SYSTEM. LET
ME ADDRESS JUST ONE STUDY,
BECAUSE THERE ARE LITERALLY
HUNDREDS OF THEM, AND YOU WERE
SPEAKING ABOUT PROSPECTIVE AND
RETROSPECTIVE STUDIES, THIS IS A
META ANALYSIS PROCESS THAT WAS
DONE BY JANET Â IN 2017. HE
LOOKED AT 18 COHORTS, AUDIENCE
PROSPECTIVELY AND EIGHT CASE
CONTROL STUDIES SPECIFICALLY AT
DECAFFEINATED COFFEE, THE
MAJORITY OF WHICH IS PRODUCED
WITH METHYLENE CHLORIDE.
EUROPEAN AND HE WAS LOOKING IN
PARTICULAR AT LIVER CANCER. THE
REASON IS BECAUSE THE SUPPORTERS
ALLEGED THAT METHYLENE CHLORIDE
IS ASSOCIATED WITH LIVER CANCER.
SO LOOKING AT THE DISEASE
ENDPOINT AND THE RESEARCH GIVES
US SOME INDICATION OF WHAT THE
FACTS ARE AND WHAT SCIENCE TELLS
US, THE AUTHORS LOOKED AT
2,272,642 PEOPLE. THEY CONCLUDED
, AND I QUOTE, INCREASED
CONSUMPTION OF CAFFEINATED
COFFEE AND TO A LESSER EXTENT,
DECAFFEINATED COFFEE, ARE
ASSOCIATED WITH A REDUCED RISK
OF LIVER CANCER AND VERY, VERY
SPECIFICALLY, THIS IS
HEPATOCELLULAR CARCINOMA. SO
SPECIFICALLY, A REDUCED RISK OF
HCC, INCLUDING IN PEOPLE WHO HAD
PREEXISTING LIVER DISEASE. THE
AUTHORS WENT ON TO SAY THESE
FINDINGS ARE IMPORTANT GIVEN THE
INCREASING INCIDENCE OF LIVER
DISEASE GLOBALLY AND ITS POOR
PROGNOSIS. THIS IS SIMPLY ONE
EXAMPLE. IT'S ALL AVAILABLE
PUBLICLY, NON-INDUSTRY SUPPORTED
AND IT ALL IS CONSISTENT, AS
THIS META ANALYSIS OR LITERATURE
REVIEW SUGGESTS. THIS IS NOT
SELECTING ONE STUDY OR ANOTHER
AS YOU WOULD APPRECIATE. THANK
YOU. THANK YOU. MADAM CHAIR, I
THINK THAT WHAT IS IMPORTANT IN
OUR PRESENTATION OF THIS BILL
HERE ARE THE SCIENTISTS. BUT FOR
ME, IT'S THE FACT THAT METHYLENE
CHLORIDE HAS BEEN BANNED EVEN IN
PAINT STRIPPERS. IT IS A PROCESS
USED FOR DECAFFEINATION, AND IT
IS ONE OF THREE THAT IS CAN
POTENTIALLY BE USED TO
DECAFFEINATE COFFEE. AND IT IS
NOT DONE IN CALIFORNIA FOR THE
DECAFFEINATION OF USING
METHYLENE CHLORIDE IS NOT EVEN
DONE HERE IN CALIFORNIA IT IS
DONE OUTSIDE OF CALIFORNIA AND
IT IS THEN IMPORTED HERE. I
THINK THAT AS WE MOVED FORWARD
IN THE DISCUSSIONS, THE, THE
OBJECTIONS FROM THE OPPOSITION
ARE WELL TAKEN. BUT I THINK THAT
A PERSON WHO IS GOING TO INGEST
A CUP OF COFFEE HAS THE RIGHT TO
KNOW WHICH METHOD IS USED, AND
IF METHYLENE CHLORIDE WAS USED,
EVEN IF IT IS TRACE ELEMENTS
THAT ARE LEFT IN THAT CUP OF
COFFEE. I WOULD WANT TO KNOW
THAT THAT WAS THE METHOD THAT
WAS USED AND THAT IT IS NOT
COMPLETELY EVAPORATED, AND IT
REMAINS IN THERE. AND IT DEPENDS
ON WHICH COFFEE. THERE WERE
BLIND STUDIES THAT WERE DONE
THAT SHOW MORE METHYLENE
CHLORIDE IN SOME OF THESE CUPS
OF COFFEE COMPARED TO OTHERS.
BUT THE FACT THAT IT STILL
REMAINS IN THAT CUP OF COFFEE,
KNOWING THAT THERE ARE TWO OTHER
METHODS OF DECAFFEINATED COFFEE,
I THINK IT IS, IS WHAT IS
IMPORTANT HERE. ONE OF THE SOME
ONE ARGUMENT WAS IT'S GOING TO
COST SO MUCH MORE. WELL THERE
ARE A NUMBER OF, OF, OF, OF
COFFEE. COFFEE. I'M TRYING TO
FIND MY NOTES. THE, THE
COMPANIES THAT USE THE
ALTERNATIVE METHODS INCLUDE
PEET'S COFFEE, DUTCH BROTHERS,
MCDONALD'S, FOLGERS TEMPLE.
THERE ARE OTHERS, BUT THOSE WE
KNOW FOR SURE USE ANYTHING BUT
METHYLENE CHLORIDE AND THEIR
COFFEE PRICES. I'M SURE WE ALL.
WE'RE ALL COFFEE DRINKERS. MOST
OF US ARE. WE HAVE SOME TEA
DRINKERS, BUT MOST OF US ARE
COFFEE DRINKERS. AND IF THE
PRICE IS GOING TO GO UP A FEW
CENTS, WE GET TO MAKE A CHOICE.
AND THAT'S REALLY WHAT THIS IS
ABOUT. IF YOU KNOW METHYLENE
CHLORIDE IS BEING USED TO
DECAFFEINATE YOUR CUP OF COFFEE,
YOU SHOULD KNOW. AND IF YOU FEEL
THAT IT'S JUST A TRACE ELEMENT,
YOU GET TO DECIDE THAT IF THAT'S
THE CUP OF COFFEE YOU WANT TO
DRINK. DOCTOR WEBER, YOU HAVE AN
ADDITIONAL QUESTION. JUST ONE
MORE COMMENT. WE'LL SEE WHAT
HAPPENS WITH THE BILL. BUT IF
THAT IS THE GOAL TO INFORM THE
CONSUMER OR LET THE CONSUMER
KNOW, JUST RECOGNIZE THAT THE
CONSUMER DOES NOT SEE THE ACTUAL
PACKAGE. SO IF THAT'S WHERE THE
LABEL IS GOING TO GO, THE
CONSUMER IS NOT GOING TO SEE
THAT. AND I ABSOLUTELY I'M SO
GLAD YOU BROUGHT THAT UP. AND
THIS BILL IS DOUBLE REFERRED. IT
WILL GO TO JUDICIARY NEXT. AND I
THINK THAT THAT IS SOMETHING
WE'RE GOING TO HAVE TO REMEDY.
BECAUSE YOU ARE ABSOLUTELY
CORRECT. IT IS THE CONSUMER WHO
SHOULD KNOW WHAT IS IN THAT
COFFEE. WELL, I, I DON'T DRINK
COFFEE, BUT I'VE CERTAINLY SPENT
A LOT OF TIME, LOOKING AT THIS
BILL, AND I WANT TO APPRECIATE
MY COMMITTEE STAFF FOR REALLY
BEING ABLE TO SIFT THROUGH THE
400 PAGE EPA REPORT. MANY
DIFFERENT SCIENTISTS HEARING
FROM BOTH PROPONENTS AND
OPPOSITION ON THIS BILL AND I
JUST WANT TO MAKE SURE THAT WE
ARE KIND OF SETTING A PRECEDENT
WHERE WE ARE ACTUALLY BASING
OUR, POLICY RECOMMENDATIONS ON
SCIENCE. AND SO, I KNOW AUTHOR,
YOU ARE INCREDIBLY PASSIONATE
ABOUT THIS ISSUE, AND I
APPRECIATE YOU, HAVING MANY
CONVERSATIONS WITH ME ABOUT
THIS. I STILL HAVE MAJOR
CONCERNS WITH THE DEPICTION OF,
WHAT HAS SO FAR NOT BEEN
RESEARCH BASED. THERE IS NO
EVIDENCE TO SUPPORT THAT. THERE
IS PASSAGE OF METHYLENE CHLORIDE
THROUGH THE DRINKING OF
DECAFFEINATED COFFEE FROM,
PREGNANT INDIVIDUAL TO THE
FETUS. WE JUST DON'T HAVE THE
SCIENCE TO SUPPORT THAT. WE DO
KNOW THAT A REPORT PUBLISHED IN
THE INTERNATIONAL JOURNAL OF
FOOD AND NUTRITIONAL SCIENCE
THAT THE AVERAGE AMERICAN COFFEE
DRINKER IS EXPECTED TO CONSUME
50 FOLD LESS METHYLENE CHLORIDE
THAN THE EPA. AND THEN, THE EPA
SUGGESTS, COULD BE IMMEDIATELY
HARMFUL AND 100,000 FOLD LESS
THAN THE AMOUNT THAT HAS BEEN
LINKED TO CANCER IN RAT STUDIES.
WE HAVE A LOT OF EVIDENCE TO THE
CONTRARY OF WHAT HAS BEEN
PRESENTED HERE TODAY. HOWEVER I
KNOW THAT YOU ARE INCREDIBLY
PASSIONATE ABOUT THIS BILL AND
AT SOME POINT, WE WILL NEED TO
MAKE SURE THAT WE'RE WEIGHING
IN, THE CONCERNS, LEGITIMATE
CONCERNS TO WANT TO HAVE HEALTHY
BABIES AND HAVE PEOPLE BE
HEALTHY OVERALL. AND WHETHER OR
NOT THROUGH THIS PARTICULAR FORM
OF DECAFFEINATION USE OF THIS
PROCESS, IT RESULTS IN ANY
CANCER. I JUST ALSO WANT TO
CLARIFY THAT MANY OF THE STUDIES
THAT HAVE BEEN SHARED ARE
FOCUSED ON INHALATION AND DERMAL
CONTACT IN LARGE QUANTITIES. IT
MAKES SENSE THAT METHYLENE
CHLORIDE IS PROHIBITED IN PAINT
THINNERS, WHERE PEOPLE ARE
INHALING OVER MASSIVE AMOUNTS OF
TIME REPEATEDLY, THE SUBSTANCE.
THAT IS NOT THE CASE WHEN IT IS
IN VERY SMALL TRACE AMOUNTS,
THROUGH THIS, DECHLORINATION
PROCESS ASSOCIATED WITH
DECAFFEINATED COFFEE, WITH THAT,
I WANT TO JUST SHARE THAT I WILL
BE SUPPORTING THIS BILL TODAY,
WITH THE AMENDMENTS STRIKING THE
BAN OF THE USE OF METHYLENE
CHLORIDE IN THE PROCESS OF
DECAFFEINATED COFFEE AND THE
SALE OF COFFEE THAT HAS BEEN
DECAFFEINATED USING METHYLENE
CHLORIDE AND REPLACING THESE
PROVISIONS WITH THE LABEL OF THE
FINAL COFFEE PRODUCT THAT STATES
METHYLENE CHLORIDE IS USED IN
THE DECAFFEINATION OF THE
PRODUCT. I WILL NOTE MY OVERALL,
QUITE FRANKLY, DISCOMFORT EVEN
WITH THAT, AND KNOW THAT THIS
WILL GO ON TO, JUDY LEARY
JUDICIARY COMMITTEE, WHERE YOU
WILL CONTINUE TO WORK ON THIS
BILL AND WITH OUR STAFF TO
REFINE THAT LANGUAGE AND TO
ADDRESS SOME OF THE CONCERNS
THAT WERE RAISED BY THE
COMMITTEE. THUS FAR. AND SEEING
NO OTHER COMMENTS FROM THE
COMMITTEE. GO AHEAD. I WANT TO
THANK YOU. YOU KNOW, I HAVE A
LOT OF CONCERN ON THIS BILL
LABELING IS NOT ALWAYS GOING TO
BE THE ANSWER. I'VE DONE BILLS
ON LABELING AND THEY ARE VERY
DIFFICULT. THEY'RE COSTLY, SO,
I'M WILLING TO GIVE YOU A CHANCE
TO GET THIS RIGHT, I DON'T KNOW
THAT I'M GOING TO BE CONVINCED
TO VOTE ON IT ON THE FLOOR, I
THINK WE'RE REALLY SPLITTING
HAIRS HERE, AND, YOU KNOW, WHEN
YOU SAY YOU'RE GOING TO BUY
COFFEE FROM WHATEVER VENDOR, NO
ONE KNOWS. NO ONE'S GOING TO
LOOK AT A LABEL ON A COFFEE CUP.
THEY'RE JUST NOT SO, WITH THAT,
I WILL SUPPORT YOUR BILL TODAY,
BUT I WILL BE TAKING A SECOND
LOOK AT IT BEFORE IT HITS THE
FLOOR. ASSEMBLY MEMBER WALDRON,
I JUST WANT TO SAY, ALSO, I KNOW
A LOT OF WORK HAS BEEN DONE ON
THIS BILL, I HAVE THE AMENDMENTS
HERE IN FRONT OF ME, AND THEY'LL
BE PUT INTO THE BILL, BETWEEN
NOW AND JUDICIARY. I'LL GET TO
SEE IT AGAIN IN JUDICIARY. SO
I'LL BE GIVING IT A COURTESY
VOTE TODAY TO SEE WHAT HAPPENS
WITH IT. THANK YOU. MISS CARILLO
. THANK YOU, MADAM CHAIR, AND
THANK YOU TO THE AUTHOR. AND,
THE WITNESS TESTIMONIES, AS WELL
AS THE OPPOSITION THAT'S HERE
TODAY. I THINK WHEN I FIRST
HEARD ABOUT THE BILL, I HAD A I
HAD SOME QUESTIONS RELATED TO,
WHO? WELL, ONE WHO IS PROCESSING
THE COFFEE. RIGHT. WHAT IS IT
GOING TO LOOK LIKE IF IT'S BEING
IMPORTED SINCE CLEARLY THAT,
THAT PROCESS IS NOT DONE HERE IN
THE STATE. QUESTIONS ABOUT
LABELING, QUESTIONS ABOUT,
VENDORS, QUESTIONS ABOUT COFFEE
SHOPS, HOW EXACTLY WILL THE
PUBLIC KNOW? I THINK, IN HEALTH
COMMITTEE, AND I'VE HAD THE
PRIVILEGE OF SERVING THIS
COMMITTEE FOR THE PAST, SINCE I
WAS ELECTED, ACTUALLY, WE'VE WE
HEAR A LOT OF BILLS RELATED TO,
WHAT IS NOW, I THINK A COMMON
THEME IN TERMS OF LIKE IS OUR
FOOD SAFE? HOW ARE WE PROCESSING
FOOD AND WHAT ARE THE
CONNECTIONS BETWEEN THE CHEMICAL
PROCESSING OF A VARIETY OF
DIFFERENT THINGS THAT WE CONSUME
AND DRINK, AND THE IMPACT THAT
THAT HAS ON OUR HEALTH. AND SO
IT'S A, IT'S RAISING A
CONSCIOUSNESS, I THINK, OF JUST
THE PRODUCTION OF THE FOOD
QUALITY IN AMERICA COMPARED TO
OTHER PLACES. AND MY PARENTS
DRINK COFFEE. I'M A COFFEE
DRINKER. I'M, I'M DRINKING TEA
NOW BECAUSE I'VE HAD MAYBE FOUR
CUPS OF COFFEE ALL DAY. BUT WE
DRINK DECAF AT NIGHT, MY PARENTS
ARE DECAF DRINKERS IN THE
EVENING AS WELL. I'M ON THE
WEBSITE NOW. LIKE THE CHECK YOUR
DECAF ORG AND WONDERING, YOU
KNOW, DOES IS THE BRAND THAT
THEY DRINK SAFE OR NOT, SOME OF
THE QUESTIONS THAT I HAD WITH
YOU, AND I'M GLAD THAT WE HAD AN
OPPORTUNITY TO TALK OVER THE
WEEKEND, WAS JUST THE SCIENTIFIC
STUDY BEHIND, WHAT IT IS THAT
YOU'RE PROPOSING AS WELL AS THE
OPPONENTS. THANK YOU FOR TAKING
TIME AND SENDING ME INFORMATION
AS WELL. I THINK THE CONCERN
THAT I HAVE IS ONE JUST THE
SCIENCE AROUND IT. RIGHT. WHAT'S
SAFE, WHAT'S NOT. BUT I HAVE
QUESTIONS ABOUT A VARIETY OF
DIFFERENT TYPES OF FOOD, RELATED
TO THAT, AND ULTIMATELY AT THE
END, LIKE, HOW DO WE HOW DOES
CALIFORNIA, JUST ONE, CREATE A
POLICY THAT'S GOING TO IMPACT
THAT, NATIONWIDE IN TERMS OF
LIKE THE IMPORT EXPORT CREATION
BUSINESS, HEALTH CARE, ETC? AND
HOW DO WE MAKE THAT A REALITY
AND HOW DO WE JUST CONSUME, IN
WAYS THAT ARE HEALTHY FOR US?
I'M LOOKING AT I'M LOOKING AT
THE WEBSITE NOW, AND I'M ALSO
READING NOW THAT I'M NOT SURE
I'M PRONOUNCING THIS RIGHT.
ETHEL ACETATE IS ALSO
POTENTIALLY ANOTHER CHEMICAL
THAT'S USED. YES, IT IS. AND IS
THAT SAFE OR NOT? AND SHOULD
THAT BE INCLUDED IN THE BILL OR
NOT? I HAVE NO IDEA. I, YOU
KNOW, JUST KIND OF READING AND,
YOU KNOW, NOT KNOWING ENOUGH
ABOUT THE SCIENCE JUST MAKES ME
WONDER, YOU KNOW, WHAT THE BEST
PROCESS OF COFFEE IS, WHICH IS
MY CONCERN, AND REALLY WHAT THE
BEST WAY IS TO MOVE FORWARD,
I'LL BE GIVING IT A COURTESY I
TODAY TO ALLOW YOU THE
OPPORTUNITY TO MOVE FORWARD AND
HAVE THE POLICY DISCUSSIONS. I
DO RESERVE MY ABILITY TO BE ABLE
TO, YOU KNOW, VOTE DIFFERENTLY
OR NOT AT ALL ON THE ASSEMBLY
FLOOR. I DO WANT TO SEE I DO
APPRECIATE YOU DOING THE WORK
NECESSARY TO AT LEAST TRY TO
INFORM THE PUBLIC. AND ALSO
TAKING A LOOK AT WHAT THE FDA IS
DOING NATIONALLY ON ON THIS AS
WELL, AND WHAT THAT COULD
POTENTIALLY LOOK LIKE, FOR THOSE
OF US THAT THAT DO PROUDLY
CONSUME COFFEE, AND JUST WANT TO
DO IT IN A, IN A WAY THAT'S SAFE
AS WELL, AND USING ALL THE
SCIENTIFIC METHODS TO REALLY,
TRULY UNDERSTAND THAT. SO AGAIN,
I APPRECIATE THE CONVERSATION
AND, ALL THE WORK THAT THE
COMMITTEE HAS DONE AS WELL TO
MOVE THIS, TO REALLY GIVE US THE
OPPORTUNITY TO REVIEW THE
POLICY. SO THANK YOU, MADAM
CHAIR. THANK YOU AGAIN. I WILL
BE GIVING THIS A COURTESY. I AT
THIS POINT NOW KNOW THAT WE NEED
TO CONTINUE TO WORK ON THIS BILL
, IN JEWISH AND BEYOND. I WANT
TO RECOGNIZE AND APPRECIATE THE
PASSION THAT THE AUTHOR HAS
BROUGHT TO THIS ISSUE AND THE
CONCERN THAT SHE'S RAISING FOR
OUR OVERALL HEALTH. I ALSO WANT
TO RECOGNIZE AND ACKNOWLEDGE
THAT ALTHOUGH I DON'T DRINK IT,
COFFEE IS VERY HEALTHY FOR US
AND THERE ARE MANY STUDIES THAT
SHOW DECAFFEINATED COFFEE
INCLUDED, SHOW THE PURE BENEFITS
OF IT. SO IT'S A LOT FOR US TO
BE ABLE TO KIND OF WEIGH THE
OVERALL KIND OF PUBLIC HEALTH
IMPLICATIONS OF THIS BILL. THAT
IS OUR JOB AS LEGISLATURE RIGHT
NOW. WE SETTLED ON AMENDMENTS TO
PROVIDE A LABEL, I BELIEVE THAT
THE LANGUAGE OF THE LABEL STILL
NEEDS A LOT OF WORK. IT WILL
MOVE ON TO JUDICIARY WHERE THAT
WILL HAPPEN IN CONCERT WITH, OUR
STAFF HERE IN HEALTH AND WITH
THAT SECRETARY. PLEASE CALL THE
ROLL. OH, I NEED A MOTION MOVED
BY ARAMBULA IN A SECOND.
SECONDED BY SHIAVO. THE MOTION
IS Dð PASS TO JUDICIARY, AS
AMENDED TO JUDICIARY. PLEASE
CALL THE ROLL. I WANT TO I
WALDEN. WALDEN I AGAR AGAR CURRY
I ARAMBULA ARAMBULA I NGUYEN TÊ
CARILLO WENDY CARILLO I LARA.
HANEY HANEY I JOAN. SAWYER.
JOHN. SAWYER I MAIENSCHEIN.
MCCARTY. JOE. PATTERSON.
RODRIGUEZ. SANCHEZ SANCHEZ. NØ.
SANTIAGO. CHAU CHAU. VÚI. WEBER.
WEBER. I. THAT MEASURES OUT 9 TO
1. THANK YOU, THANK YOU. WE'RE
GOING TO TAKE A MOMENT, NOW THAT
WE'VE ESTABLISHED QUORUM TO, DO
THE CONSENT CALENDAR. I'VE
PREVIOUSLY READ IN. SO WE HAVE A
SECOND BY A MOTION BY
AGUIAR-CURRY, SECONDED BY DOCTOR
ARAMBULA. PLEASE CALL THE ROLL
ONTO I BONTA I WALDEN. WALDEN I
AGUIAR-CURRY AGAR CURRY I
ARAMBULA ARAMBULA I WENDY
CARILLO WENDY CARILLO I FLORA
HANEY. HANEY I JOAN SAWYER, JOHN
SAWYER I MAIENSCHEIN MCCARTY,
JOE PATTERSON. RODRIGUEZ.
SANCHEZ. SANCHEZ I SANTIAGO.
CHAU. CHAU. VÚI. WEBER. WEBER I
TEN ZERO. THE CONSENT CALENDAR
IS OUT WITH A VOTE OF 10 TO 0.
WE WILL MOVE ON NOW TO ITEM
NUMBER EIGHT AB 2098. GARCIA.
GOOD AFTERNOON, MADAM CHAIR AND
COLLEAGUES. AB 2098 PROVIDES
DISTRICT AND MUNICIPAL HOSPITALS
A MUCH NEEDED LIFELINE WHEN IT
COMES TO EXTENDING THE REPAYMENT
FOR THE TERMS OF THE CALIFORNIA
FINANCE AUTHORITY BRIDGE LOANS,
AS WE ALL HAVE BEEN MADE AWARE,
THERE ARE A NUMBER OF DIFFERENT
HOSPITALS UP AND DOWN THE STATE
OF CALIFORNIA THAT ARE AT THE
VERGE OF FINANCIALLY BREAKING,
WELL, AT THE AT THE VERGE OF
CLOSING ITS DOORS. AND THESE
HOSPITALS FIND THEMSELVES IN
MEDICALLY UNDERSERVED PARTS OF
THE STATE, THAT'S WHY THIS BILL
IS BEFORE YOU, IS TO HELP THOSE
HOSPITALS, STABILIZE THEMSELVES.
WE HAVE A WITNESS HERE WHO WILL
BE VERY BRIEF AND RESPECTFULLY
ASK FOR YOUR VOTE. MOVED BY
AGUILAR CURRY, SECONDED BY
SANCHEZ. PLEASE GO AHEAD WITH
TWO MINUTES OF TESTIMONY. GOOD
AFTERNOON, MADAM CHAIR AND
MEMBERS. CONNIE DELGADO, ON
BEHALF OF THE DISTRICT HOSPITAL
LEADERSHIP FORUM, AND WE WANT TO
THANK THE AUTHOR FOR HIS
COMMITMENT AND MANY OF THE
MEMBERS HERE FOR THEIR
COMMITMENT, FOR THESE HOSPITALS
WHO HAVE STRUGGLED OVER THE LAST
FEW YEARS. IN BUDGET YEAR 21 AND
22, DISTRICT HOSPITALS RECEIVED
$40 MILLION IN BRIDGE LOANS. AND
THIS BILL WILL LOOK TO IMPACT
YEAR TWO OF THOSE BRIDGE LOANS,
ASKING FOR JUST A LITTLE MORE
TIME TO REPAY THOSE LOANS, AND
ALLOW A LIFELINE FOR THESE
HOSPITALS TO KEEP THEIR DOORS
OPEN AND TO CONTINUE TO PROVIDE
SERVICES. WE RESPECTFULLY ASK
FOR YOUR I VOTE. ANY OTHER
WITNESSES IN SUPPORT? THANK YOU,
MADAM CHAIR. MEMBERS. SARAH
BRIDGE, ON BEHALF OF THE
ASSOCIATION OF CALIFORNIA
HEALTHCARE DISTRICTS AND STRONG
SUPPORT. THANK YOU. VANESSA
GONZALEZ WITH THE CALIFORNIA
HOSPITAL ASSOCIATION HERE IN
SUPPORT. THANK YOU. ANY
WITNESSES IN OPPOSITION? SEEING
NONE. I'LL BRING IT BACK TO THE
COMMITTEE FOR COMMENT. SEEING NO
COMMENT FROM THE COMMITTEE, WE
HAVE A MOTION AND A SECOND,
SECRETARY, PLEASE CALL THE ROLL.
OH, WOULD YOU LIKE TO CLOSE?
ESTÁ. IT'S Dð PASS TO
APPROPRIATION. BONTA I BONTA I
WALDRON WALDEN I AGAR AGAR CURRY
I ARAMBULA ARAMBULA I 1D CARILLO
WENDY CARILLO I FLORA HANEY.
HANEY I JONES-SAWYER
JONES-SAWYER I MAIENSCHEIN
MCCARTY. JOE PATTERSON.
RODRIGUEZ. SANCHEZ. SANCHEZ I
SANTIAGO. CHAVO. CHAVO I WEBER.
WEBER I THAT MEASURES OUT TEN
ZERO. THANK YOU SO MUCH. WE'LL
MOVE ON NOW TO ITEM NUMBER NINE
AB 2105. LOWENTHAL.
ASSEMBLY MEMBER LOWENTHAL,
PLEASE PROCEED. THANK YOU SO
MUCH, MADAM CHAIR. WE HAVE
ANOTHER WITNESS WHO IS IN THE
RESTROOM WHO WILL BE JOINING.
BOY, ALL THIS TALK ON COFFEE.
DOWN TO ONE CUP A DAY. THANK
YOU, MADAM CHAIR. MEMBERS, VERY
PLEASED TO PRESENT AB 2105,
WHICH REQUIRES A HEALTH CARE
SERVICE PLAN, CONTRACT OR HEALTH
INSURANCE POLICY ISSUED, AMENDED
OR RENEWED ON OR AFTER JANUARY
1ST, 2025, TO PROVIDE COVERAGE
FOR THE TREATMENT OF PEDIATRIC
AUTOIMMUNE NEUROPSYCHIATRIC
DISORDER ASSOCIATED WITH
STREPTOCOCCAL INFECTIONS OR
PANDAS AND PEDIATRIC ACUTE ONSET
NEUROPSYCHIATRIC SYNDROME, OR
PANS, PRESCRIBED OR ORDERED BY A
PHYSICIAN OR SURGEON. I'D LIKE
TO START BY BY ACCEPTING THE
COMMITTEE AMENDMENTS, AND THANK
THE CHAIR AND COMMITTEE STAFF
FOR THEIR VERY THOUGHTFUL WORK
ON THIS BILL. PANDAS AND PANS
ARE AN INFLAMMATORY DISEASE OF
THE BRAIN. THEY RESULT IN SUDDEN
ONSET, DEVASTATING BEHAVIORAL
AND NEUROLOGICAL DYSFUNCTION
THAT USUALLY OCCUR AFTER A
TRIGGERING INFECTION. THESE
DISORDERS ARE THOUGHT TO BE
CAUSED BY AUTOANTIBODIES
GENERATED AFTER THE INFECTION
THAT MISTAKENLY ATTACKED THE
BRAIN. ANTIBIOTICS OR ORAL
ANTI-INFLAMMATORY MEDICATION
HELP MOST CHILDREN, BUT A
MINORITY NEED STRONGER IMMUNE
MODULATING TREATMENTS, SUCH AS
INTRAVENOUS IMMUNOGLOBULIN OR
IVIG. DESPITE PUBLISHED PANDAS
AND PANDAS, PANDAS AND PANS
TREATMENT GUIDELINES THAT
ESTABLISHED A STANDARD OF CARE
IN 2017, INSURERS HAVE CONTINUED
TO ADHERE TO THEIR OWN POLICY
STATEMENTS FORBIDDING
AUTHORIZATION OF IMMUNE FOCUSED
TREATMENTS SUCH AS IVIG. AS A
RESULT, TREATMENTS ARE ROUTINELY
DENIED EARLY AND EXPEDIENT
TREATMENT OF PANDAS AND PANDAS
IS ESSENTIAL IN ORDER TO PREVENT
LONG TERME AND POTENTIALLY LIFE
THREATENING IMPACTS OF THESE
CONDITIONS. PATIENTS SEEKING
IMMUNE MODULATING TREATMENTS FOR
ACUTE PANDAS AND PANS ARE
FREQUENTLY DENIED AUTHORIZATION
FOR THESE TREATMENTS BY
INSURERS, AND MUST SEEK
INDEPENDENT MEDICAL REVIEW AT
THE DEPARTMENT OF MANAGED HEALTH
CARE. WHILE THE IMR PROCESS IS
EFFECTIVE, DECISIONS ARE
TYPICALLY RENDERED WITHIN 30
DAYS OF QUALIFICATION, MEANING
THAT THE INSURED MUST FIRST
RECEIVE A DENIAL FROM THEIR
INSURER. FILE A REQUEST FOR
INDEPENDENT MEDICAL REVIEW, AND
WAIT FOR A DECISION TO UPHOLD OR
OVERTURN THE INSURERS DENIAL.
BUT UNFORTUNATELY, IT'S TOO LATE
. IT'S TIMELINE IS SIMPLY TOO
LONG FOR CHILDREN SUFFERING FROM
PANDAS AND PANS, AND IS
FREQUENTLY LEADING TO KIDS
RECEIVING TREATMENT LONG AFTER
CURRENT TREATMENT GUIDELINES
RECOMMEND, ACCORDING TO THE
CLINICAL MANAGEMENT OF PEDIATRIC
ONSET NEUROPSYCHIATRIC SYNDROME,
EARLY CARE FOR PANDAS AND PANDAS
PATIENTS IS DEFINED AS RECEIVING
TREATMENT WITHIN TWO WEEKS OF
DIAGNOSIS. LATE CARE IS DEFINED
AS RECEIVING TREATMENT WITHIN 2
TO 4 WEEKS OF DIAGNOSIS, AND
VERY DELAYED CARE IS DEFINED AS
RECEIVING TREATMENT MORE THAN
FOUR WEEKS AFTER DIAGNOSIS.
BASED ON PUBLISHED CLINICAL
TREATMENT GUIDELINES FOR PANDAS
AND PANS DENIES DENIALS ARE
FREQUENTLY RESULTING IN VERY
DELAYED CARE FOR PANDAS AND
PANDAS PATIENTS, WHICH RESULTS
IN WORSE HEALTH OUTCOMES FOR
PATIENTS AND THE NEED FOR LONG
TERME CARE, WHICH RESULTS IN
GREATER COST TO PATIENTS AND
THEIR FAMILIES. INSURERS AND THE
STATE. THEY SAY TIMING IS
EVERYTHING, AND IN THE CASE OF
PANDAS AND PANDAS COULDN'T BE
MORE TRUE. EARLY AND EXPEDIENT
ACCESS TO THE TREATMENTS IS
CRUCIAL TO THE EFFECTIVE
TREATMENT OF PANDAS. PANDAS, IN
ORDER TO AVOID THE DEBILITATING
SYMPTOMS AND POTENTIALLY
PERMANENT NEUROLOGICAL DAMAGE,
SOMETIMES FATAL OUTCOMES
ASSOCIATED WITH THESE DISORDERS.
AB 205 WILL ENSURE THAT
INDIVIDUALS AND FAMILIES WHO ARE
CONFRONTED WITH THESE DISORDERS
DO NOT EXPERIENCE UNNECESSARY
DELAYS IN TREATMENT THAT CAN
LEAD TO DISASTROUS AND TRAGIC
OUTCOMES. IT IS MY PLEASURE TO
INTRODUCE DOCTOR ANGELA TANG,
THE MOTHER OF A CHILD AND DOCTOR
SUSAN MANFULL, CO-FOUNDER AND
EXECUTIVE DIRECTOR OF THE ALEX
MANFULL FUND, WHO ARE HERE TO
TESTIFY IN SUPPORT OF AB 205.
THANK YOU. YOU EACH HAVE TWO
MINUTES. THANK YOU. GOOD
AFTERNOON, MADAM CHAIR AND OTHER
MEMBERS. THANK YOU VERY MUCH FOR
ALLOWING ME TO ADDRESS THE
COMMITTEE ON THIS VERY IMPORTANT
TOPIC TODAY. MY NAME IS SUSAN
MANFULL. I AM A NATIVE OF
FRESNO, CALIFORNIA, ALTHOUGH NOW
I LIVE IN NEW HAMPSHIRE. I HAVE
VERY STRONG TIES IN MY HOME
STATE HERE, BUT I HAVE COME TO
SEE YOU TODAY SPECIFICALLY TO
TESTIFY ABOUT THIS BILL. I AM
THE CO-FOUNDER AND EXECUTIVE
DIRECTOR OF THE ALEX MANFORD
FUND. AS ASSEMBLY MEMBER,
LOWENTHAL JUST SAID AS AS THIS
THIS GROUP SUPPORTS RESEARCH AND
EDUCATION AND AWARENESS IN
PANDAS AND PANS. BUT I AM HERE
TODAY AS A MOTHER BECAUSE MY
DAUGHTER ALEX CANNOT BE HERE
TODAY. SHE'S NO LONGER ALIVE TO
TELL HER STORY. SO I'M GOING TO
TELL IT FOR YOU IN TWO MINUTES,
I PROMISE. I SHE WAS A PARAGON
OF HEALTH. ONE MINUTE REMAINING.
OKAY, I'M NOT TALKING FAST
ENOUGH. ALL RIGHT? UNTIL SHE HAD
STREP AT THE SAME TIME THAT SHE
HAD MONO. SHE WAS OUR ONLY CHILD
, AND SHE LOST HER LIFE AT 26
YEARS OLD IN 2018. BECAUSE SHE
DID NOT HAVE A TIMELY DIAGNOSIS
AND TREATMENT. IN FACT, SHE
DIAGNOSED HERSELF WITH PANDAS
AND THEN SHE WAS ABLE TO GET AN
APPOINTMENT WITH THE TOP
NEUROLOGIST, WHO CONFIRMED HER
SUSPICIONS AND ORDERED
TREATMENT. MY HUSBAND AND I AND
MY DAUGHTER THEN WORKED TO
PREPARE THE, TO PREPARE FOR THIS
NOTORIOUS BATTLE WITH INSURANCE
COMPANIES. HOWEVER SHE DIED
BEFORE SHE WAS ABLE TO GET
TREATMENT. WE DONATED HER BRAIN
TO NIH AND TO GEORGETOWN, WHERE
WE ESTABLISHED A BRAIN BANK
CALLED POND. IT'S FOR STAT
STANDS FOR PANDAS, PANS, AND
OTHER NEURO IMMUNE DISORDERS.
IT'S THE ONLY BRAIN BANK IN THE
COUNTRY. SO IF I MAY, I HAVE 30
MORE SECONDS. OKAY. THANK YOU,
SHE HERS WAS THE FIRST BRAIN IN
THAT BANK. AND IN LESS THAN
THREE YEARS, WE HAVE SEVEN
BRAINS. THERE THE YOUNGEST ONE
IS 14 YEARS OLD. MOST OF THEM
ARE TEENAGERS. THIS IS A
REMARKABLE GROWTH FOR A DISORDER
THAT'S SO LITTLE KNOWN IN A
BRAIN BANK THAT HAS NOT YET BEEN
PROMOTED. NOW I'M TALKING ABOUT
THESE BRAINS AS IF THEY ARE
COMMODITIES. THEY ARE NOT. IN
FACT, I WANT TO LET YOU KNOW
THAT TODAY THE FAMILY WHO
DONATED ONE OF THE BRAINS IS
CELEBRATING THE 17TH BIRTHDAY OF
THAT YOUNG PERSON WHO DIED DUE
TO THE PANDAS IN ALEX'S BRAIN. I
CAN TELL YOU THE DAMAGE IN HER
BRAIN IF YOU'D LIKE, BUT SHE
SUSTAINED BRAIN DAMAGE, THERE
WAS EVIDENCE OF INFLAMMATION.
EXACTLY WHERE THE CLINICAL
SYMPTOMS SUGGESTED THAT THAT
DAMAGE SHOULD BE, AND WHERE THE
BRAIN SCANS SUGGESTED THAT THEY
SHOULD BE. SHE HAD GLIOSIS IN
HER BRAIN. THAT'S EVIDENCE OF
BRAIN DAMAGE THAT'S SEEN IN
ALZHEIMER'S PATIENTS, IN MS.
PATIENTS AND OTHER VERY SERIOUS
NEUROLOGICAL DISORDERS. SO
PLEASE VOTE. I PLEASE SUPPORT
THIS BILL. THANK YOU VERY MUCH.
THANK YOU. LET'S GO AHEAD, I'LL
TALK FAST. MY NAME IS DOCTOR
ANGELA TANG. FIVE YEARS AGO, PAN
STRUCK DOWN MY 15 YEAR OLD. MY
HEALTHY SOCCER PLAYER COULD NO
LONGER WALK. MY STRAIGHT-A
STUDENT COULDN'T WRITE. HE SPAT
OUT FOOD IF AN INTRUSIVE THOUGHT
STRUCK. AND HE NEEDED ME AT HIS
SIDE. EVEN DURING HIS TORTURED
SLEEP, WE DROPPED OUT OF SCHOOL,
WORK AND LIFE WITH TWO DOCTOR
PARENTS. MY SON GOT EVERY ORAL
MEDICINE IN THE 2017 TREATMENT
GUIDELINES BY EXPERT CLINICS
LIKE STANFORD AND HARVARD, WHEN
HE COULD NO LONGER DRINK, HE WAS
SCHEDULED FOR A FEEDING TUBE.
THE GUIDELINES SAY THAT THE NEXT
MEDICINE IS IVIG, BUT POLICIES
BY ANTHEM, AETNA AND OTHERS SAY
THAT IVIG IS NOT MEDICALLY
NECESSARY. EXPERIMENTAL AND
UNPROVEN. I LUCKILY WORK FOR A
LARGE MEDICAL GROUP ISSUING
AUTHORIZATIONS AND DENIALS FOR
15 YEARS AND MY DOCTOR
CONNECTIONS GOT HIM IVIG WITH
IMPROVEMENT IN A WEEK. NO
FEEDING TUBE TODAY HE'S OFF
MEDICINES AND HE'S A PRE-MED IN
COLLEGE NEARBY AND ONE DAY HE
MAY BE YOUR DOCTOR. MY SON GOT
IVIG SEVEN WEEKS FROM ONSET
ACCORDING TO THE GUIDELINES,
PAST FOUR WEEKS IS VERY DELAYED
CARE. BUT OF THE HUNDREDS OF
CASES I'VE SEEN, INCLUDING AT
THE STANFORD PANS CLINIC, WHERE
I AM NOW AN ADJUNCT CLINICAL
ASSOCIATE PROFESSOR, NOT ONE HAS
RECEIVED IVIG FASTER THAN MY SON
. THE NORM IS MONTHS TO YEARS OF
BRAIN INFLAMMATION BEFORE
INSURANCE AGREES TO PAY, OR IS
FORCED TO PAY BY REGULATORS OR
PARENTS, SELL OFF ASSETS TO PAY,
OR KIDS GET INSTITUTIONALIZED OR
THEY DIE. MY OPINIONS ARE MY
OWN. AS AN INSURANCE INSIDER,
PARENT AND PANS RESEARCHER, AND
TODAY I MAKE GOOD ON THE OATH I
TOOK TO BECOME A DOCTOR. WHEN I
ASK YOU TO PROTECT THE YOUTH WHO
LACK DOCTOR PARENTS, SOME SAY
THAT EXISTING REGULATIONS WHERE
INSURERS USE POLICIES BY
NAMELESS EMPLOYEES WHO HAVE
NEVER HEARD OF THIS DIAGNOSIS TO
AUTOMATICALLY DENY IVIG AND THEN
HAVE 30 DAYS TO RESPOND TO
APPEALS, ARE SUFFICIENT FOR THIS
URGENT DIAGNOSIS. PLEASE
CONSIDER IF INSURER DEFINITIONS
OF MEDICAL NECESSITY SHOULD
VIOLATE PEER REVIEWED CLINICAL
PRACTICE GUIDELINES, BY WHICH AB
2105 DEFINES MEDICAL NECESSITY.
LET'S STOP INSURERS PASSING THE
BUCK TO TAXPAYERS AND SPECIAL ED
UNEMPLOYMENT AND DISABILITY.
THIS BILL COSTS $7,000 TO ENACT
AND LESS THAN A PENNY IN
INSURANCE PREMIUMS. JUST TO WRAP
UP, TODAY, I GIVE VOICE TO THE
YOUTH WHOSE BRAINS LIE AT
GEORGETOWN AND TO DOCTORS WHO
ARE SHACKLED IN THEIR ATTEMPTS
TO HELP AND TODAY YOU CHOOSE FOR
CALIFORNIA'S KIDS, NO, FOR
ALEX'S PATH OR I FOR MY SON'S
PATH. THANK YOU VERY MUCH. THANK
YOU. ARE THERE ANY OTHER
WITNESSES IN SUPPORT? PLEASE
LINE UP. GOOD AFTERNOON, MADAM
CHAIR. MEMBERS THANK YOU. TO THE
AUTHOR. I WOULD KIDANI
REPRESENTING THE CALIFORNIA
CHILDREN'S HOSPITAL ASSOCIATION
VERY, VERY STRONG SUPPORT.
IMPORTANT. BILL. APPRECIATE YOU.
THANK YOU, WE'LL DO NAME
ORGANIZATION AND POSITION ONLY.
AARON TAYLOR, ON BEHALF OF THE
MEMORIAL CARE. THANK YOU. PLEASE
SUPPORT THIS BILL. MITCH STEIGER
WITH CFT, A UNION OF EDUCATORS
AND CLASSIFIED PROFESSIONALS
ALSO IN SUPPORT BRANDON MAKI
WITH THE CALIFORNIA MEDICAL
ASSOCIATION IN SUPPORT. NICOLE
MORALES, ON BEHALF OF CHILDREN
NOW IN SUPPORT. JENNIFER SNYDER
WITH CAPITAL ADVOCACY ON BEHALF
OF THE CALIFORNIA LIFE SCIENCES
IN SUPPORT. CHRIS WHITTY PENS
PATIENT SINCE THREE YEARS OLD IN
SUPPORT. DOCTOR DENISE
CALAPRICE, A CLINICAL RESEARCHER
AT STANFORD PANS CLINIC SPEAKING
ON MY OWN BEHALF, I'M THE AUTHOR
OF SEVERAL OF THE STUDIES THAT,
ANGELA MENTIONED AND THE PARENT
OF TWO KIDS WHO DID GET VERY
EARLY TREATMENT FOR PANS AND
VERY SUCCESSFUL TREATMENT. AND
I'M HERE IN STRONG SUPPORT.
KELLY RILEY, PANDAS MOM AND
STRONG SUPPORT. DIANA PULLMAN,
EXECUTIVE DIRECTOR OF PANDAS
NETWORK I REPRESENT OVER 40,000
FAMILIES NATIONWIDE AND
WORLDWIDE. I'M IN STRONG
SUPPORT. THANK YOU. I'M TOM
PULLMAN, THE FATHER OF GARRETT
PULLMAN, WAS THE FIRST CHILD IN
CALIFORNIA IN 2007 TO RECEIVE
IVIG, AS A FOOTNOTE, JUST
RECENTLY, HE GRADUATED, A TOP
HONORS FROM BERKELEY IN CHEMICAL
ENGINEERING. THANK YOU, DAVID
GONZALEZ. ON BEHALF OF AMERICA'S
PHYSICIAN GROUPS AND STRONG
SUPPORT OF THIS IMPORTANT
MEASURE. SHARI WILSON PANS, MOM
AND MEMBER OF THE CALIFORNIA
COALITION FOR PANS BARNA'S
ADVOCACY. I SUPPORT AB 2105 WITH
ALL MY HEART. DOCTOR JAMIE
CANDELARIA GREEN I'M A
RESEARCHER IN SPECIAL EDUCATION
AND AUTHOR OF WORKS ON PANS AND
EDUCATION AND THE PROUD MOTHER
OF A SURVIVOR OF THIS DREADFUL
DISEASE WHO'S NOW SERVING IN OUR
MILITARY. I STRONGLY SUPPORT
THIS BILL. THANK YOU. HI, MY
NAME IS JENSEN AND I HAVE
PANDAS. WE NEED YOUR SUPPORT.
KIDS CANNOT KEEP SUFFERING.
THANK YOU. HI. ELISE BURGER.
PARENT OF JENSEN. AND ALSO EMERY
M. CAN YOU SAY HI? 11 YEARS OLD,
ONE ADOPTED, ONE BIOLOGICAL, TWO
PANDAS PANS. WE NEED YOU GUYS.
IT'S TIME. THANK YOU. JONATHAN
BURGER LIKE A DEFIBRILLATOR FOR
CARDIAC ARREST. IVIG SAVES LIVES
. OUR KIDS. WE SAW IT. SAVED
THEIR NAME AND ORGANIZATION.
HOUSEHOLD AFFILIATION. THANK YOU
FOR SUPPORTING 2105. THANK YOU.
SAVES LIVES. MY NAME IS VIOLETTE
RODRIGUEZ SOFER, AND I'M A PROUD
MOTHER OF A 17 YEAR OLD WITH
PANS AND PANDAS. I SUPPORT THIS
STRONGLY. THANK YOU. EXCUSE ME.
GOOD AFTERNOON. DAVID SOFER,
FATHER OF 17 YEAR OLD MIRANDA,
WHO IS SUFFERING FROM THIS
CRUSHING DISEASE AND IVIG IS
HELPING HER. THANK YOU IN
SUPPORT. STRONG SUPPORT. MY NAME
IS APRIL RONI. I'M WITH THE
CALIFORNIA COALITION FOR PANDAS.
PANDAS ADVOCACY. I'M A PUBLIC
SCHOOL TEACHER AND I STRONGLY
SUPPORT THIS BILL FOR MY SON,
AIDEN AND ALL CHILDREN WHO NEED
ACCESS TO THIS MEDICATION. THANK
YOU. ARE THERE ANY WITNESSES IN
OPPOSITION?
THANK YOU. YOU'LL EACH HAVE TWO
MINUTES. GO AHEAD, THANK YOU,
MADAM CHAIR. MEMBERS OF THE
COMMITTEE, JED HAMPTON WITH THE
CALIFORNIA ASSOCIATION OF HEALTH
PLANS, HERE, REGRETTABLY, IN
OPPOSITION TO AB 2105, WE WOULD
LIKE TO THANK THE AUTHOR, HIS,
HIS STAFF, COMMITTEE STAFF, AND
I DO WANT TO, YOU KNOW,
ACKNOWLEDGE AND THANK THE
WITNESSES HERE IN SUPPORT,
OBVIOUSLY, IT'S A VERY TOUGH,
VERY SENSITIVE ISSUE. AND WE
CERTAINLY REALIZE THAT AND
UNDERSTAND THAT AND ARE
CERTAINLY SYMPATHETIC TO THAT,
SO I DID WANT TO ACKNOWLEDGE ALL
THE WITNESSES HERE IN SUPPORT
TODAY, I DO WANT TO POINT OUT
THAT OUR PRIMARY CONCERN WITH
THE BILL IS RELATED TO THE
ABSENCE OF THE MEDICAL NECESSITY
LANGUAGE, WHICH IS A STANDARD
CONDITION FOR HEALTH PLANS AND
DETERMINING THE COVERAGE OF
SPECIFIC SERVICES. I AM
REVIEWING THE COMMITTEE
ANALYSIS. IT DOES APPEAR THAT
THE AUTHOR IS GOING TO BE
ADDRESSING THAT THAT ISSUE VIA,
AMENDMENTS, BUT WE HAVE NOT SEEN
THE AMENDMENTS OR THE LANGUAGE
YET ON, ON, ON THAT. BUT WE ARE
LOOKING FORWARD TO REVIEWING
THAT WITH OUR MEMBERS, AND
SEEING, YOU KNOW, WHERE THAT
TAKES OUR MEMBER PLANS, WE WOULD
ALSO POINT OUT THAT THAT BOTH
THE ASSEMBLY AND THE SENATE
HEALTH COMMITTEE CHAIRS, YOU
KNOW, HAVE INTRODUCED BILLS THIS
YEAR TO BEGIN THE PROCESS OF
REVIEWING CALIFORNIA'S ESSENTIAL
HEALTH BENEFITS BENCHMARK PLAN
FOR THE 2027 PLAN YEAR, AND WE
DO THINK THAT THAT IS, SOMETHING
WE IS SOMETHING THAT WE DO
SUPPORT CONCEPTUALLY, AND THINK
THAT THAT'S PROBABLY A BETTER
WAY OF HANDLING SOME OF THESE,
BENEFIT MANDATES MOVING FORWARD.
SO LOOK FORWARD TO BEING A PART
OF THAT PROCESS. BUT WE ARE
OPPOSED FOR THE REASONS LOOK
FORWARD TO SEEING THE AMENDMENTS
SHORTLY. AND AGAIN, THANK THE
AUTHOR. THE SPONSORS AND THE
STAFF AND THE WITNESSES HERE IN
SUPPORT. GO AHEAD. STEPHANIE
WATKINS, ON BEHALF OF THE
ASSOCIATION OF CALIFORNIA LIFE
AND HEALTH INSURANCE COMPANIES,
WE TOO ARE IN OPPOSITION TODAY,
WOULD ECHO MANY OF MY COLLEAGUES
COMMENTS. WE UNDERSTAND THE
SENSITIVITY AROUND THIS DISEASE
AND LOOK FORWARD TO HAVING THOSE
FUTURE CONVERSATIONS AND
REVIEWING THE AMENDMENTS. AS MY
COLLEAGUE MENTIONED, THE MEDICAL
NECESSITY STANDARD IS SORT OF
THE BENCHMARK OR RUBRIC AROUND
HOW WE DESIGN OUR HEALTH CARE
PRODUCTS. AND WE'VE WE'VE
CONTINUED TO SORT OF WANT TO
WORK WITH AND HAVE THAT
DISCUSSION ABOUT THE IMPORTANCE
OF INCLUDING THAT STANDARD, AND,
AND WOULD LIKE TO CONTINUE THOSE
CONVERSATIONS, ESPECIALLY IN
THAT BROADER DISCUSSION WITH THE
POTENTIAL FOR A BENCHMARK PLAN
AND THE EVALUATION OF THE ÁP AS
THESE BILLS MOVE FORWARD THIS
YEAR. SO THANK YOU. ANY
ADDITIONAL WITNESSES IN
OPPOSITION, MADAM CHAIR,
MEMBERS, JOHN WINGER, ON BEHALF
OF AMERICA'S HEALTH INSURANCE
PLANS, WOULD JUST ECHO THE
COMMENTS. CAP AND I LOOK FORWARD
TO FUTURE CONVERSATIONS. THANK
YOU. I'LL BRING IT BACK TO THE
COMMITTEE FOR ANY QUESTIONS OR
COMMENTS. VICE CHAIR. THANK YOU,
MADAM CHAIR, I JUST WANT TO SAY
THAT, YOU KNOW, WE SEE SO MANY
TIMES WHERE EARLY DETECTION,
EARLY TREATMENT CAN MAKE SUCH A
BIG DIFFERENCE IN THE QUALITY OF
LIFE OF PEOPLE, ESPECIALLY YOUNG
PEOPLE. WE WANT TO MAKE SURE
THAT, YOU KNOW, WE CAN INTERVENE
AS QUICKLY AS POSSIBLE, YOU KNOW
, A DEVASTATING ILLNESS LIKE
THIS IS ONE OF THOSE THAT I
THINK ALL OF US AGREE NEEDS TO,
GET THE TREATMENT AS SOON AS
POSSIBLE, I WANT TO THANK THE
WITNESSES FOR COMING FORWARD, I
KNOW IT'S DIFFICULT TESTIFYING
HERE, BUT WE HEAR YOU AND I WILL
BE SUPPORTING THE BILL. THANK
YOU. AND I ALSO WANT TO THANK
THE AUTHOR FOR YOUR COMMITMENT
TO THIS DISEASE AND FOR PUTTING
FORTH LANGUAGE THAT WILL
HOPEFULLY STRENGTHEN THIS BILL
AND CONTINUE TO BRING AWARENESS
TO PANDAS AND PANS. AND I WANT
TO ESPECIALLY THANK THE
COALITION THAT I WAS ABLE TO
MEET WITH, PRIOR TO THIS HEARING
TO REALLY HELP ME TO UNDERSTAND
THE TRUE IMPACT AND, AND THE
CONCERNS THAT YOU HAVE IN TERMS
OF NOT BEING ABLE TO GET TIMELY
TREATMENT IN A WAY THAT IS
HELPFUL TO YOU ALL, I ALSO WANT
TO RECOGNIZE THAT WE ARE ON BOTH
THE SENATE SIDE AND ASSEMBLY
SIDE GOING THROUGH A BROADER
PROCESS. AND I MENTIONED TO THIS
TO YOU ALL THAT WE'LL LOOK AT
THE ESSENTIAL HEALTH BENEFITS
AND, AND KNOW THAT THAT WILL BE,
ANOTHER OPPORTUNITY, IF YOU
WILL, TO BE ABLE TO, LOOK AT
ADDRESSING AND TREATMENTS AND
CONDITIONS LIKE THIS, WITH THAT,
MY RECOMMENDATION FOR THIS BILL
IS AN I, ASSEMBLY MEMBER.
LOWENTHAL, WOULD YOU LIKE TO
CLOSE, YES. THANK YOU, MADAM
CHAIR AND COMMITTEE. I WANT TO
COMMEND THE FAMILIES THAT CAME
HERE TODAY AND THE PROPONENTS OF
THIS BILL THAT THAT CAME TO
SPEAK. IT'S A VERY EMOTIONAL
ISSUE. AND I ALSO WANT TO OFFER
A HUG TO THOSE IN OPPOSITION. I
CAN SEE HOW CHALLENGING IT IS
AND DIFFICULT IT IS FOR YOU TO
BE ON THE OPPOSITE SIDE OF THIS.
THIS IS AN ISSUE, CLEARLY THAT
AFFECTS THE FAMILIES, BUT IN
TRUTH, IT AFFECTS ALL OF US.
WE'RE ALL PAYING FOR NOT DEALING
WITH THIS. THESE FAMILIES HAVE
TO UTILIZE, MANY OF WHOM HAVE TO
UTILIZE STATE SOCIAL SAFETY NET
SERVICES, BECAUSE THE ONSET IS
SO ACUTE AND SO DEBILITATING
THAT THEY HAVE TO LEAVE THEIR
JOBS RIGHT AWAY TO CARE FOR
THEIR CHILDREN, THEIR AILING
CHILDREN, FOR A PROCESS THAT
WILL ULTIMATELY GET APPROVED. SO
THERE'S A COST, A HUGE COST FOR
US NOT DEALING WITH THIS. I
REALLY, TRULY APPRECIATE THE
CONSIDERATION. THANK YOU, MADAM
CHAIR, AND RESPECTFULLY ASK FOR
YOUR VOTE. THANK YOU, ASSEMBLY
MEMBER LOWENTHAL, DO I HAVE A
MOTION? SO MOVED BY
AGUIAR-CURRY, SECONDED BY DOCTOR
ARAMBULA WITH THAT SECRETARY,
PLEASE CALL THE ROLL. IT IS Dð
PASS AS AMENDED TO
APPROPRIATIONS TO I TO. I
WALDEN. WALDEN I AGUIAR-CURRY
AGUIAR-CURRY. I ARAMBULA
ARAMBULA I WENDY CARILLO. WENDY
CARILLO I FLORA HANEY, JOAN.
SAWYER, JOHN SAWYER, I
MAIENSCHEIN MCCARTY. JO.
PATTERSON. RODRIGUEZ SANCHEZ.
SANCHEZ. I SANTIAGO, CHAVO CHAU.
VÚI. WEBER. THAT MEASURE IS ON
CALL. IT NEEDS ONE MORE VOTE.
THANK YOU. WE ARE GOING TO MOVE
ON NOW TO ITEM NUMBER 15. AB
2449 TO.
ASSEMBLY MEMBER. TO GO AHEAD.
AND WHILE YOUR WITNESSES GET
SITUATED. THANK YOU, MADAM
CHAIR. AND MEMBERS OF THE
COMMITTEE, I WANT TO THANK THE
COMMITTEE STAFF FOR THEIR HARD
WORK ON THE ANALYSIS AND THE
COLLABORATION WITH MY OFFICE. AB
2449 WOULD CLARIFY THAT THE
QUALIFIED APPLIED BEHAVIOR
ANALYSIS CREDENTIAL BOARD IS A
NATIONAL ENTITY THAT MAY CERTIFY
A QUALIFIED, QUALIFIED AUTISM
SERVICE PROVIDER AND AUTO RIDER
CERTIFICATION TO BE ACCREDITED
BY THE AMERICAN NATIONAL
STANDARDS INSTITUTE, ALSO KNOWN
AS NCAI. THE QUALITY, THE
QUALIFIED APPLIED BEHAVIOR
ANALYSIS BOARD, OR WABA, WAS
ESTABLISHED IN 2012 AND IS AN
AGENCIES WHOSE MISSION IS TO
ESTABLISH THE HIGHEST STANDARD
OF CARE AND EMPOWER ALL
PROFESSIONALS WHO PROVIDE
BEHAVIORAL HEALTH INTERVENTION
SERVICES TO INDIVIDUALS WITH
AUTISM. GÂY IS A SECOND LARGEST
CERTIFYING BODY FOR APPLIED
BEHAVIOR ANALYSIS IN THE US, AND
THE LARGEST INTERNATIONALLY.
HOWEVER CERTIFICATION ARE
INTEGRAL TO A PROVIDER COMMUNITY
FOR INDIVIDUALS IN STATE WITH
LARGE MILITARY POPULATION, MANY
OF WHICH RECOGNIZE QUALIFY FOR
THE LICENSING OF AUTISM SERVICE
PROVIDER, I'LL SAY IS SEEING A
SURGE IN THE NUMBER OF CHILDREN
WITH AUTISM, RESULTING IN A
SHORTAGE OF QUALIFIED AUTISM
SERVICE PROVIDER, PARTICULARLY
IN LOW INCOME COMMUNITIES. AB
2449 SEEKS TO MEET THIS SHORTAGE
OF PROFESSIONAL CAREGIVERS BY
ADDING AN ADDITIONAL LICENSING
ORGANIZATION THAT IS RECOGNIZED
FEDERAL AND WORLDWIDE FOR THEIR
HIGH STANDARD. THIS WILL
EFFECTIVELY END CALIFORNIA
RELIANCE ON A SINGLE ENTITY TO
PROVIDE ALL CERTIFICATION BY
CREATING COMPETITION IN THE
FIELD. AB 2449 WOULD NOT ONLY
AUTHORIZE NC TO ASSIST IN THE
BACKFIELD OF PROFESSIONAL OF THE
PROFESSION, REQUIRING STATE
LICENSURE AND CERTIFICATION, BUT
ALSO PROVIDE A POTENTIAL
SOLUTION FOR PEOPLE WHO REPORT
DIFFICULTY GAINING EMPLOYMENT
WITH ME TO TESTIFY IN SUPPORT OF
OUR HOLY WHEN IT GOES TO THE
EXECUTIVE DIRECTOR OF CUIABA
RESIDENTIAL BOARD AND BEDBURG
EXECUTIVE DIRECTOR OF AUTISM
SOCIETY, INLAND EMPIRE. I ALSO
LIKE TO MENTION THAT I HAVE
WARREN MERKEL, THE VICE
PRESIDENT OF POLICY, WOULD NC
AND DREW PATTERSON WITH THE
AUTISM BEHAVIOR SERVICES TO
ANSWER ANY ADDITIONAL TECHNICAL
QUESTIONS. THANK YOU. YOU'LL
EACH HAVE TWO MINUTES. THANK
YOU, MADAM CHAIR. AND MEMBERS OF
THE COMMITTEE, I APPRECIATE THIS
OPPORTUNITY TO SPEAK ON THE, THE
SUPPORT OF CALIFORNIA AB 2449.
MY NAME IS HOLLY BENINCASA. I'M
THE EXECUTIVE DIRECTOR WITH THE
ABA CREDENTIALING BOARD, THIS
BILL WILL CREATE ACCESS TO CARE.
AND THAT IS THE BIGGEST THING
THAT WE ARE LOOKING FOR IS
ACCESS TO CARE WITH INDIVIDUALS
WITH AUTISM. IT IS CRUCIAL FOR
EXPANDING ACCESS TO THE
ESSENTIAL SERVICES. SHEBA'S
INVOLVEMENT WILL ENSURE A
BROADER RANGE OF QUALIFIED
PROVIDERS ADDRESSING THE GROWING
DEMAND FOR AUTISM SERVICES
ACROSS CALIFORNIA. WE DO INCLUDE
AN AUTISM COMPONENT IN OUR
COURSEWORK, WHICH IS SO
IMPORTANT TO KNOW WHO IT IS THAT
YOU'RE WORKING WITH. ABOUT 90%
OF CASES INVOLVE, EXCUSE ME,
APPLIED BEHAVIOR ANALYSIS IS THE
SCIENCE. AND, IT'S PREDOMINANTLY
A PREDOMINANTLY APPLIED TO
INDIVIDUAL WITH AUTISM, IT IS
IMPORTANT THAT THE THESE
PROFESSIONALS HAVE AN
UNDERSTANDING OF WHO THEY'RE
WORKING WITH. AND UC SANTA
BARBARA ACTUALLY IS A IS ONE OF
OUR COURSEWORK PROVIDERS. THEY
THEY ARE AN ACCREDITED
UNIVERSITY, AS YOU WELL KNOW,
CHABA HAS PHILANTHROPIC
ENDEAVORS WHERE EVERY WE ARE A
FOR PROFIT ENTITY. BUT EVERY,
EVERY PENNY GOES BACK INTO THE
CREDENTIALING PROGRAM. AND THIS
ALLOWS US FOR, GIVING DISCOUNTS
TO DEVELOPING COUNTRIES WHO HAVE
LIMITED ACCESS TO THE CARE THAT
THEY NEED, AND THE CDC NOW
REPORTING AUTISM ONE 1 IN 22 IN
CALIFORNIA ALONE. IT IS
IMPORTANT THAT WE HAVE ACCESS TO
CARE, SO IN CONCLUSION, I WOULD
LIKE TO THANK YOU FOR YOUR TIME
AND, SUPPORT. 2449. THANK YOU.
YOU'LL HAVE TWO MINUTES. THANK
YOU. GOOD AFTERNOON, MADAM CHAIR
, AND MEMBERS OF THE COMMITTEE.
AND I'M GOING TO TRY TO DO THIS
WITHOUT TEARS. SO I'M GOING TO
TRY. MY NAME IS BETH BURT. I'M
THE EXECUTIVE DIRECTOR FOR THE
AUTISM SOCIETY INLAND EMPIRE.
I'M THE CO-CHAIR OF AUTISM
SOCIETY OF CALIFORNIA PUBLIC
POLICY. MORE IMPORTANTLY, I'M
THE PROUD PARENT OF TWO YOUNG
MEN, ONE OF WHOM HAS AUTISM.
ABOUT 25 YEARS AGO, IT TOOK OUR
FAMILY SIX MONTHS TO GET
SERVICES FOR MY SON. HE WAS
THREE AND A HALF WHEN WE BEGAN
THE JOURNEY, AND AS YOU CAN
IMAGINE, IT'S AN EMOTIONAL
JOURNEY FOR ANYBODY. AND I WAS
NO DIFFERENT. BUT MY EMOTION
TURNED TO CRISIS. MY BEAUTIFUL
BABY BOY STARTED RAGING FOR
EITHER 60 TO 90 MINUTES EVERY
SINGLE DAY, AND I'M NOT TALKING
ABOUT A TODDLER'S TEMPER
TANTRUM. I'M TALKING ABOUT HE
WENT FULL ON ATTACKING ME,
HITTING, SPITTING, BITING,
PINCHING ME SO HARD IT LEFT
BRUISES ALL OVER MY BODY. I WAS
SWEATING MANY, MANY DAYS JUST
TRYING TO RESTRAIN THEM. AND
THERE'S OTHER DAYS WHERE I WOULD
HAVE TO HOLD HIM IN HIS BEDROOM
WITH THE DOOR SHUT AND LISTENING
TO HIM CRYING, SCREAMING AND
JUST COMPLETELY OUT OF CONTROL.
AND I DIDN'T KNOW WHAT TO DO.
OUR FAMILY WAS IN CRISIS AND I
WAS IN CRISIS. COMING OUT OF
COVID, IT IS THE SAME THING FOR
THESE FAMILIES. NOW. WE'RE
HEARING THAT MANY PARENTS ARE
FACING SIX MONTHS TO 12 MONTHS
WAIT TIMES. WE'RE NOT TALKING
ABOUT FAMILIES THAT ARE JUST
WAITING FOR A DOCTOR'S
APPOINTMENT. WE'RE TALKING ABOUT
FAMILIES WHO CAN'T COMMUNICATE
WITH THEIR CHILD. WE'RE TALKING
ABOUT FAMILIES WHO HAVE CHILDREN
LIKE MINE THAT ARE COMPLETELY
OUT OF CONTROL. AND THEY FEEL
ALONE. WE'RE SUPPORTING THIS
BILL BECAUSE IT'S GIVING
CRITICAL ACCESS TO CHILDREN AND
FAMILIES RIGHT AWAY. AND THAT IS
SORELY NEEDED. I URGE THE
COMMITTEE TO PASS THIS BILL, SO
FAMILIES THAT CAN BEGIN THEIR
AUTISM TREATMENT AS SOON AS
POSSIBLE AND WITHOUT HAVING TO
GO THROUGH THE CRISIS. WE DID.
THANK YOU. MOVED BY AGUILAR
CURRY, SECONDED BY SHIAVO. THANK
YOU. ARE THERE ANY OTHER
WITNESSES IN SUPPORT? ERIC
LINDER, REPRESENTING QUALIFIED
APPLIED BEHAVIOR ANALYSIS
ANALYSIS IN SUPPORT. RICK
ROLLINS, ON BEHALF OF THE AUTISM
BUSINESS ASSOCIATION AND ALSO A
PARENT OF A 34 YEAR OLD SON WITH
AUTISM. I'M. TERRY RINDY, ON
BEHALF OF THE CALIFORNIA
PSYCHOLOGICAL ASSOCIATION AND
SUPPORT. THANK YOU, THANK YOU.
ANY WITNESSES IN OPPOSITION
?
PLEASE GO AHEAD. YOU'LL EACH
HAVE TWO MINUTES. OKAY. GOOD
AFTERNOON. MY NAME IS MATT
MCALEER FROM THE CALIFORNIA
ASSOCIATION FOR BEHAVIOR
ANALYSIS. WE ARE A NONPROFIT
TRADE ASSOCIATION REPRESENTING
PROVIDERS OF BEHAVIOR ANALYTIC
SERVICES IN CALIFORNIA. ON THE
CRITICAL ISSUE WE SEE WITH THE
BILL IS THAT THE ABA
CERTIFICATION DOES NOT MEET THE
CHARACTERISTICS OF LICENSING OR
CERTIFICATION PROGRAMS CURRENTLY
IN STATUTE. IN CALIFORNIA, THE
LEGISLATURE HAS DETERMINED
REPEATEDLY THAT THE PRACTICE OF
BEHAVIORAL HEALTH PROFESSION
INDEPENDENTLY, THAT IS, WITHOUT
SUPERVISION. INDIVIDUALS MUST
MEET STANDARDS THAT HAVE BEEN
DEVELOPED BY THEIR RESPECTIVE
PROFESSIONS. THESE INCLUDE AN
ADVANCED DEGREE FROM AN
ACCREDITED UNIVERSITY,
SUPERVISED EXPERIENTIAL TRAINING
AND PASSAGE OF A PROFESSIONAL
EXAMINATION THAT'S BOTH
PSYCHOMETRICALLY AND LEGALLY
VALIDATED AND COMPLY WITH THE
CODE OF ETHICS THAT HAS BEEN
DEVELOPED BY A NONPROFIT
PROFESSIONAL ASSOCIATION OR
CREDENTIALING ENTITIES IN THEIR
RESPECTIVE PROFESSIONS. THESE
LEGISLATIVE DECISIONS ARE
EVIDENCED IN THE CURRENT STATE
LAWS FOR LICENSED PSYCHOLOGISTS,
CLINICAL COUNSELORS, MARRIAGE
AND FAMILY THERAPISTS, AND
CLINICAL SOCIAL WORKERS. THE
BOARD CERTIFIED BEHAVIOR ANALYST
CERTIFICATION IS RECOGNIZED AND
CODIFIED IN CALIFORNIA STATUTE
AS QUALIFICATION FOR PRACTICING
BEHAVIOR ANALYSIS.
PROFESSIONALLY, THE REQUIREMENTS
FOR OBTAINING THAT CERTIFICATION
MIRROR. MIRROR THE REQUIREMENTS
FOR OBTAINING LICENSES IN OTHER
BEHAVIORAL HEALTH PROFESSIONS IN
THE STATE. IN STARK CONTRAST,
THE ABA CERTIFICATION DOES NOT
MEET THE LICENSING AND
CERTIFICATION PROGRAM.
CERTIFICATION PROGRAMS. TO
PRACTICE IN CALIFORNIA, THE
ELIGIBILITY REQUIREMENTS, EXAM
CONTENT ADMINISTRATION, AND
ETHICS CODE ARE DEVELOPED BY A
PRIVATE, FOR PROFIT ORGANIZATION
. NO COURSEWORK FROM AN
ACCREDITED UNIVERSITY IS
REQUIRED. INSTEAD, COURSES FOR
THE CERTIFICATION MAY BE
OBTAINED FROM INDIVIDUALS OR
PRIVATE COMPANIES THAT ARE
APPROVED SOLELY BY THE PRIVATE
ENTITY THAT OWNS AND OPERATES
THE CERTIFICATION PROGRAM. THE
CERTIFICATION IS ALSO SPECIFIC
TO AUTISM INTERVENTION, AND
WHILE NEEDED, THIS IS NOT A
PROFESSION. NONE OF THE
BEHAVIORAL HEALTH PROFESSIONS
REGULATED IN CALIFORNIA CONSIDER
TRAINING AND EXAMINATION CONTENT
THAT IS LIMITED TO OR FOCUSED ON
A SINGLE CLIENT POPULATION.
ADOPTION OF THIS BILL WOULD PUT
INDIVIDUALS WITHIN CALIFORNIA
AND THEIR FAMILIES LIVING WITH
AUTISM AT RISK AND UNDERMINE THE
INTEGRITY OF ALL BEHAVIORAL
HEALTH PROFESSIONS IN THE STATE.
WE URGE A NO VOTE ON 2449. THANK
YOU. GO AHEAD. MADAM CHAIR,
MEMBERS OF THE COMMITTEE, MY
NAME IS MARIEL FERNANDEZ. I'M
THE VICE PRESIDENT OF GOVERNMENT
AFFAIRS FOR THE COUNCIL FOR
AUTISM SERVICE PROVIDERS. CASP
IS A NONPROFIT TRADE ASSOCIATION
OF AUTISM SERVICE PROVIDER
ORGANIZATIONS THAT HAVE A
COMMITTED THAT ARE COMMITTED TO
PROMOTING AND DELIVERING
EVIDENCE BASED PRACTICES FOR
INDIVIDUALS WITH AUTISM. WE
REPRESENT 54 CALIFORNIA BASED
ORGANIZATIONS SERVING THOUSANDS
OF CHILDREN AND ADULTS ON THE
SPECTRUM. SHABA AND THE QBA
CREDENTIAL LACK SUFFICIENT
EDUCATIONAL AND EXPERIENTIAL
LEARNING REQUIREMENTS TO ENSURE
COMPETENCE IN THE PRACTICE OF
BEHAVIOR ANALYSIS, KNOWLEDGE AND
THE SCIENTIFIC UNDERPINNINGS OF
THE STUDY BEHAVIOR AND
SUFFICIENT SAFEGUARDS TO ENSURE
COMPETENCE TO DO NO HARM TO SOME
OF CALIFORNIA'S MOST VULNERABLE
CITIZENS. CHILDREN WITH AUTISM.
AS YOU'VE HEARD, SHABA IS A FOR
PROFIT ENTITY AND THERE ARE
POTENTIAL DISADVANTAGES OF FOR
PROFIT CREDENTIALING ENTITIES,
INCLUDING LACK OF TRANSPARENCY,
A POTENTIAL CONFLICTS OF
INTEREST, OWNERSHIP INFORMATION
IS UNAVAILABLE ON THE CHABA
WEBSITE. THE AMERICAN BOARD OF
MEDICAL SPECIALTIES, AMERICAN
SPEECH LANGUAGE HEARING
ASSOCIATION, THE ASSOCIATION FOR
MARITAL AND FAMILY THERAPY,
REGULATORY BOARDS, THE AMERICAN
BOARD OF PROFESSIONAL
PSYCHOLOGISTS, AND THE BEHAVIOR
ANALYST CERTIFICATION BOARD ARE
ALL NONPROFIT CREDENTIALING
ENTITIES. THE STANDARD FOR
PROFESSIONAL CREDENTIALING IS A
NONPROFIT ENTITY WITH
TRANSPARENT BUSINESS PRACTICES,
INCLUDING GOVERNING PRACTICES
AND ORGANIZATIONAL STRUCTURE.
YOU'VE HEARD THAT THE ADDITION
OF THE QBA CREDENTIAL WILL
INCREASE ACCESS TO CARE. THERE
ARE CURRENTLY A LIMITED NUMBER
OF QBS IN CALIFORNIA OF THE 843
ACTIVE CHABA CERTIFICATES AS OF
MONDAY, ONLY 21 OF THOSE OBTAIN
A QBA. THIS ISSUE HAS BEEN HEARD
IN MULTIPLE STATES, INCLUDING
TEXAS, GEORGIA, VIRGINIA,
NEVADA, KANSAS, WASHINGTON AND
OREGON, AND EACH OF THESE STATES
HAVE INDICATED THAT THEY WILL
NOT MODIFY TO RECOGNIZE THE QBA.
THANK YOU FOR YOUR TIME AND YOUR
SERVICE TO THE GREAT STATE OF
CALIFORNIA AND YOUR COMMITMENT
TO PROTECTING CHILDREN AND
ADULTS WITH AUTISM. I
RESPECTFULLY REQUEST A NAY VOTE.
THANK YOU. ARE THERE ANY OTHER
WITNESSES IN OPPOSITION? PLEASE
COME FORWARD. SEEING NONE, I'LL
BRING IT BACK TO THE COMMITTEE
FOR QUESTIONS OR COMMENTS. MR.
TODD, YOU CAN CLOSE. YES, I'D
LIKE TO. I'D LIKE TO THANK THE
CHAIR FOR HER SUPPORT ON THE
BILL. AB 2449 WOULD EXPAND
ACCESS TO SERVICES TO THE
STATE'S POPULATION THAT CANNOT
ACCESS THEM DUE TO THE LIMITED
NUMBER OF OPTIONS OF QUALIFIED
AUTISM SERVICE PROVIDER. AB 2449
IS THE NEXT STEP TOWARD HELPING
FAMILIES WHO'VE BEEN IMPACTED BY
AUTISM. SO I HUMBLY ASK FOR YOUR
I VOTE. THANK YOU. AND I JUST
WANT TO THANK THE AUTHOR FOR HIS
CONTINUED TO COMMITMENT TO THE
ISSUE OF ATTEMPTING TO INCREASE
PROVIDER ACCESS TO CHILDREN WITH
AUTISM, ESPECIALLY. IT'S A
CLEARLY A PASSION AND POLICY
AREA FOCUS FOR YOU. AND WITH
THAT, THE MOTION IS Dð PASS TO
APPROPRIATIONS. PLEASE CALL THE
ROLL. BONTA I WANTA I WALDEN.
WALDEN. I AGUIAR-CURRY
AGUIAR-CURRY I ARAMBULA WENDY
CARILLO WENDY CARILLO I FLORA.
KATIE JOHN SAWYER, JOHN. SAWYER
I MAIENSCHEIN MCCARTY. JOE.
PATTERSON. RODRIGUEZ SANCHEZ.
SANTIAGO. SHABO CHAU. VÚI WEBER.
THAT MEASURE IS ON CALL. IT
NEEDS THREE MORE VOTES. THANK
YOU. WE'LL MOVE FORWARD WITH
ITEM NUMBER 17. AB 2490
PETRIE-NORRIS.
PLEASE PROCEED WHEN YOU'RE
READY. YOU GOOD AFTERNOON, MADAM
CHAIR AND MEMBERS, I'M PLEASED
TO JOIN YOU TODAY TO PRESENT AB
2490 TO EXPAND AND IMPROVE
ACCESS TO REPRODUCTIVE CARE IN
EMERGENCY DEPARTMENTS ACROSS THE
STATE OF CALIFORNIA. FOR MANY
PREGNANT CALIFORNIANS, EMERGENCY
ROOMS ARE THE MOST ACCESSIBLE
SOURCE OF MEDICAL CARE DUE TO A
LACK OF HEALTH INSURANCE AND
SHORTAGES OF PRIMARY CARE
PROVIDERS, OB GYNS, AND
REPRODUCTIVE HEALTH CLINICS.
UNFORTUNATELY, TOO MANY
EMERGENCY DEPARTMENTS AND THEIR
STAFF ARE UNDERPREPARED TO
ENSURE PATIENTS GET QUALITY
MISCARRIAGE, CONTRACEPTION, AND
ABORTION RELATED CARE. THEY JUST
WEREN'T TRAINED FOR IT. THE
RESULT OF ALL OF THIS IS THAT IT
PUTS SOME OF OUR MOST VULNERABLE
PATIENTS AT INCREASED RISK. SOME
ERS HAVE PUT TOGETHER THEIR OWN
PROTOCOLS TO MAKE SURE THEIR
DOCTORS ARE PREPARED FOR THESE
SCENARIOS, BUT IT'S NOWHERE NEAR
ADEQUATE TO MEET THE NEED. AB
2490 ESTABLISHES THE
REPRODUCTIVE HEALTH EMERGENCY
PREPAREDNESS PROGRAM WITHIN THE
DEPARTMENT OF HEALTH CARE ACCESS
TO EXPAND AND IMPROVE
REPRODUCTIVE HEALTH CARE IN
EMERGENCY ROOMS ACROSS THE
STATE. I'M PLEASED TO BE JOINED
TODAY BY TWO WITNESSES, DOCTOR
KELLY QUINLEY AND DOCTOR RAKESH
SAXENA. THANK YOU. THANK YOU.
GOOD AFTERNOON, MADAM CHAIR AND
MEMBERS. MY NAME IS MONICA
SAXENA. I AM A PRACTICING
EMERGENCY PHYSICIAN AND CLINICAL
ASSISTANT PROFESSOR AT STANFORD
UNIVERSITY SCHOOL OF MEDICINE. I
SPEAK TO YOU TODAY IN MY
PERSONAL CAPACITY. IN MARCH OF
2022, MY COLLEAGUES AND I
INITIATED A MEDICATION ABORTION
PROTOCOL IN THE EMERGENCY
DEPARTMENT. TO MY KNOWLEDGE,
STANFORD IS THE FIRST EMERGENCY
DEPARTMENT IN THE COUNTRY TO DO
SO. THE IMPETUS FOR THE PROTOCOL
IS ALIGNED WITH THE ETHOS OF
EMERGENCY MEDICINE. ANY PATIENT,
ANY PROBLEM, ANY TIME. EMERGENCY
MEDICINE PHYSICIANS ARE NOT ONLY
THE FRONT LINE. WE ARE OFTEN THE
FIRST LINE, MEANING WE ARE THE
TOUCH POINT FOR A PATIENT'S
ENTRY INTO THE HEALTH CARE
SYSTEM. THIS IS ESPECIALLY TRUE
OF PREGNANT PERSONS, WHERE OF
THE 2.7 MILLION PREGNANT PERSONS
WHO VISIT THE EMERGENCY
DEPARTMENT, EMERGENCY
DEPARTMENTS ANNUALLY, 13% ARE
NOT AWARE THEY ARE PREGNANT
UNTIL THEY ARE IN THE EMERGENCY
DEPARTMENT. ONE REASON STANFORD
IS ABLE TO PROVIDE MEDICATION
ABORTIONS FOR OUR PATIENTS IS
BECAUSE OF THE EMERGENCY
PHYSICIANS KNOWLEDGE OF THE TWO
DRUG MEDICATIONS USED IN
ABORTION. THESE DRUGS,
MIFEPRISTONE AND MISOPROSTOL,
ARE ROUTINELY USED IN THE
TREATMENT OF MISCARRIAGES AS AN
EMERGENCY MEDICINE PHYSICIAN, I
KNOW THE PHYSIOLOGY OF THESE
DRUGS, HOW THEY WORK IN THE BODY
AND THEIR SIDE EFFECTS
CLINICALLY PROVIDING ABORTIONS
FOR MY PATIENTS DID NOT REQUIRE
ME TO AUGMENT MY BASELINE
MEDICAL KNOWLEDGE. WHAT WAS
REQUIRED WAS LEARNING HOW TO
IMPLEMENT THE PROTOCOL INTO THE
EXISTING HOSPITAL SYSTEM. AS
SUCH, TO IMPLEMENT THE PROTOCOL
TOOK ONE AND A HALF YEARS. I AM
DEEPLY PROUD OF OUR EFFORTS AT
STANFORD AND BELIEVE CALIFORNIA
PATIENTS SHOULD HAVE MORE
OPTIONS THAN JUST THE STANFORD
EMERGENCY DEPARTMENT TO RECEIVE
REPRODUCTIVE HEALTH CARE IN AN
EMERGENCY CARE SETTING. THE
FINANCIAL AND LOGISTICAL SUPPORT
PROVIDED TO EMERGENCY
DEPARTMENTS AND AB 2490 WOULD
MAKE PROVIDING MEDICATION
ABORTION OAN IN THE EMERGENCY
DEPARTMENT A REALITY FOR OTHER
HOSPITALS AND BENEFIT THE WOMEN
OF CALIFORNIA AS AN EMERGENCY
MEDICINE PHYSICIAN, I STRONGLY
SUPPORT THE BILL. THANK YOU.
THANK YOU. I APPRECIATE THAT.
THANK YOU. HELLO, MADAM CHAIR
AND COMMITTEE MEMBERS, MY NAME
IS KELLY QUINLEY. I'M AN
EMERGENCY PHYSICIAN. I PRACTICE
HERE IN CALIFORNIA. I'M ALSO A
BOARD MEMBER ON THE BOARD OF
DIRECTORS OF THE CALIFORNIA
CHAPTER OF THE AMERICAN COLLEGE
OF EMERGENCY PHYSICIANS, AND I
REPRESENT THAT ORGANIZATION IN
SUPPORT OF THIS BILL AS WELL.
THE SUPREME COURT DECISION HAS
GREATLY LIMITED THE AVAILABILITY
OF ABORTION RELATED HEALTH CARE
FOR MANY PATIENTS IN THIS
COUNTRY. BUT ANOTHER FORCE
THAT'S RESTRICTING HEALTH CARE
ACCESS IN OUR SYSTEM, WHERE IT'S
ALREADY DIFFICULT FOR MANY TO
ACCESS MEDICAL CARE, IS THE
PROGRESSIVE CLOSURE OF MANY
LABOR AND DELIVERY UNITS ACROSS
THE UNITED STATES. NOW, IN
CALIFORNIA ALONE, WE HAVE SEEN
CLOSE TO 50 HOSPITALS CLOSED
THEIR LABOR AND DELIVERY
PROGRAMS SINCE 2012, AND THE
MAJORITY OF THOSE CLOSURES HAVE
ACTUALLY HAPPENED IN THE LAST 3
TO 4 YEARS. AS THESE CLOSURES
ACCELERATE, THEY'RE LEAVING MANY
OF OUR MOST VULNERABLE PATIENTS
WITH EVEN LESS ACCESS TO CARE.
AND THIS MEANS THAT FOR PATIENTS
IN CALIFORNIA, WHEN THEY HAVE A
PREGNANCY RELATED MEDICAL NEED,
WHETHER IT BE BEFORE PREGNANCY
WITH CONTRACEPTION NEEDS EARLY
IN PREGNANCY FOR AN ECTOPIC
PREGNANCY OR MISCARRIAGE, OR
LATER IN PREGNANCY, THE
EMERGENCY DEPARTMENT MAY PROVIDE
THE CLOSEST AND OR THE ONLY
FEASIBLE ACCESS POINT TO A
MEDICAL PROVIDER, BUT LABOR AND
DELIVERY CLOSURES MEAN THAT FOR
MANY HOSPITALS, THERE ARE NO
LONGER OBSTETRICIANS IN THE
HOSPITAL AROUND THE CLOCK. FOR
IN-PERSON CONSULTATIONS AND
PROCEDURES, SO EMERGENCY
PHYSICIANS NEED TO BE PREPARED
TO PROVIDE THIS CARE. BUT THEY
OFTEN LACK THE SKILLS THAT ARE
NEEDED AS EMERGENCY MEDICINE
TRAINING HAS TRADITIONALLY
INCLUDED SOME ASPECTS OF THIS
CARE, BUT NOT ALL. FOR EXAMPLE,
THE MINIMUM REQUIREMENT FOR AN
EMERGENCY PHYSICIAN TO GRADUATE
RESIDENCY IS TO DELIVER TEN
BABIES ONLY, WHICH IS WOEFULLY
INSUFFICIENT TO REPLACE SERVICES
WHERE LAD UNITS HAVE CLOSED. THE
CREATION OF THE REPRODUCTIVE
HEALTH EMERGENCY PREPAREDNESS
PROGRAM WOULD, ON AN OPT IN
BASIS FOR CALIFORNIA EDS, FILL
IN GAPS IN TRAINING AND
RECONCILE THOSE WITH THE NEEDS
OF OUR PATIENTS, AND WOULD ALSO
HELP ENSURE THAT CALIFORNIANS
ARE CARED FOR IN EMERGENCY
DEPARTMENTS WHERE THEIR
PROVIDERS HAVE KNOWLEDGE OF
SAFE, EFFECTIVE AND EVIDENCE
BASED REPRODUCTIVE HEALTH CARE.
IN DOING SO, WE HOPE TO RAISE
THE STANDARD OF CARE THAT WILL
BE THE MODEL FOR OTHER STATES TO
ADOPT AS WELL. THANK YOU, THANK
YOU. ARE THERE ANY OTHER
WITNESSES IN SUPPORT? RYAN
SPENCER, ON BEHALF OF THE
AMERICAN COLLEGE OF OBGYNS,
DISTRICT NINE, IN SUPPORT
SHANNON OLIVIERI WITH
REPRODUCTIVE FREEDOM FOR ALL
CALIFORNIA. WE ARE A SPONSOR ON
THE BILL IN SUPPORT. GOOD
AFTERNOON. BILL BARCELONA WITH
AMERICA'S PHYSICIAN GROUPS IN
SUPPORT. HELLO. ANGELA DASILVA,
WOMEN'S ADVISORY BOARD, CITY OF
WEST HOLLYWOOD IN SUPPORT.
HELLO, KIM ROBINSON WITH BLACK
WOMEN FOR WELLNESS ACTION
PROJECT, ALSO A CO-SPONSOR HERE
IN STRONG SUPPORT AS WELL AS
BLACK WOMEN FOR WELLNESS IN
SUPPORT. HELLO. ALINA CHÁVEZ
WITH TEACH, ALSO A CO-SPONSOR OF
THIS BILL, IN STRONG SUPPORT.
GRACE GLASER, ON BEHALF OF VALOR
US IN SUPPORT. ALEXIS RODRIGUEZ
WITH THE CALIFORNIA MEDICAL
ASSOCIATION IN SUPPORT SYMPHONY
BARBIE PLANNED PARENTHOOD
AFFILIATES OF CALIFORNIA AND
SUPPORT. THANK YOU. ARE THERE
ANY WITNESSES IN OPPOSITION?
SEEING NONE, BRINGING IT BACK TO
THE COMMITTEE FOR QUESTIONS OR
COMMENT? SEEING NONE, PLEASE
CLOSE. THANK YOU, MADAM CHAIR.
THE GOAL OF AB 2490 IS TO ENSURE
THAT PREGNANT CALIFORNIA IN
CRISIS ARE ABLE TO RECEIVE
QUALITY, COMPREHEND CARE NO
MATTER WHAT PART OF THE STATE
THEY LIVE IN AND NO MATTER THEIR
ZIP CODE. WITH THAT, I
RESPECTFULLY ASK FOR YOUR I
VOTE. THANK YOU, THANK YOU. I
APPRECIATE THAT, WE NEED A
MOTION AND A SECOND. OH, WE HAVE
A MOTION. A MOTION BY
AGUIAR-CURRY, SECONDED BY CHAU.
THANK YOU, PLEASE CALL THE ROLL.
THE MOTION IS DO PASS TO
APPROPRIATIONS. I BONTA I
WALDEN. WALDEN. NÓ AGUIAR-CURRY
AGUIAR-CURRY I ARAMBULA WENDY
CARILLO WENDY CARILLO I FLORA
HANEY, JOHN. SAWYER. JOHN.
SAWYER I MAIENSCHEIN MCCARTY.
JOE. PATTERSON. RODRIGUEZ.
SANCHEZ SANTIAGO. SCHIAVO CHAU.
VÚI. WEBBER. THAT IS MEASURES ON
CALL NEEDS ONE MORE VOTE. THANK
YOU. THANK YOU, MADAM CHAIR.
THANK YOU. MEMBERS SORRY. FOUR
MORE. THANK YOU. IT'LL GET
THERE. WE'RE MOVING ON TO ITEM
NUMBER 21, AB 2859. PATTERSON.
SORRY ABOUT THAT.
WELL, THANK YOU, MADAM CHAIR AND
MEMBERS, WE WILL BE ACCEPTING
THE COMMITTEE AMENDMENTS,
APPRECIATE THE WORK THAT THE
COMMITTEE HAS DONE, IN PROPOSING
THE AMENDMENTS, WITH RESPECT TO
THOSE, THAT WERE REQUESTING
THEM, ASKED ME AND OUR
CALIFORNIA PROFESSIONAL
FIREFIGHTERS APPRECIATE BOTH OF
THOSE ORGANIZATIONS, AND WE
ACCEPT THOSE, COMMITTEE
AMENDMENTS. AB 2859, BUILDS ON
PREVIOUS LEGISLATION ON THE
PUBLIC FIRE AND LAW ENFORCEMENT
AGENCIES ARE NOW AUTHORIZED TO
ESTABLISH PEER SUPPORT PROGRAMS
FOR THEIR MEMBERS TO ADDRESS A
RANGE OF EMOTIONAL AND
PROFESSIONAL CHALLENGES. BUT
UNFORTUNATELY, EMTS, AMBULANCE
EMPLOYEES FACE SIMILAR
CHALLENGES IN THEIR DAILY ROLES
THAT MAY ALSO IMPACT THEIR
MENTAL HEALTH. HOWEVER, THIS IS
NOT ADEQUATELY ADDRESSED BY
EXISTING PEER SUPPORT PROGRAMS,
AND THAT LEADS TO A POTENTIAL
GAP IN BOTH EMOTIONAL AND
PROFESSIONAL ASSISTANCE FOR
THESE CRITICAL FIRST RESPONDERS.
ALSO, GIVEN THE CURRENT STAFFING
SHORTAGES SEEN ACROSS THE STATE,
THE TIME AND THE NEED IS
OBVIOUSLY NOW TO CLOSE THIS GAP
AND TO GIVE THEM THE SAMPLE HELP
NOW OFFERED TO THEIR FELLOW
FRONTLINE SAFETY PROFESSIONALS.
AB 2859 WOULD ENACT A PEER TO
PEER SUPPORT PROGRAM FOR
EMERGENCY MEDICAL TECHNICIANS
AND AMBULANCE EMPLOYEES. AB 2859
WOULD OFFER COMPREHENSIVE
SUPPORT FOR THE EMOTIONAL AND
PROFESSIONAL CHALLENGES THAT
THEY FACE WHILE THEY ARE IN ON,
ON, ON DUTY FOR US AND IN VERY
DIFFICULT AND EMOTIONAL
CIRCUMSTANCES. MAYBE 2859, AIMS
TO ENHANCE THE OVERALL
WELL-BEING AND THE RESILIENCE OF
EMTS AND AMBULANCE STAFFERS BY
FOSTERING A NEW SUPPORTIVE
NETWORK WITHIN THEIR OWN
PROFESSIONAL COMMUNITY. THIS
LEGISLATION IS CO-SPONSORED AND
HAS THE SUPPORT OF THE
CALIFORNIA AMBULANCE ASSOCIATION
, AND IT IS ALSO SUPPORTED BY
THE EMERGENCY MEDICAL SERVICES
ADMINISTRATORS ASSOCIATION OF
CALIFORNIA AND THE EMS DIRECTORS
ASSOCIATION OF CALIFORNIA, AND
HERE WITH ME TO TESTIFY IN
SUPPORT OF AB 2859, OUR SHAD
THOMAS. HE'S THE MANAGER OF THE
CLINICAL MEDICAL HEALTH FOR
GLOBAL MEDICAL RESPONSE. AND
KATIE ANDREWS, WHO IS THE EMS
COORDINATOR FOR TUOLUMNE COUNTY.
MADAM CHAIR, MEMBERS OF THE
COMMITTEE, THANK YOU VERY MUCH
FOR THIS OPPORTUNITY. MY NAME IS
SHAD THOMAS. I'M A LICENSED
CLINICAL SOCIAL WORKER EMPLOYED
AS THE MANAGER OF CLINICAL
MENTAL HEALTH BY GLOBAL MEDICAL
RESPONSE, THE PARENT COMPANY OF
AMERICAN MEDICAL RESPONSE AND
REACH, AMONG OTHERS. MY DUTIES
INCLUDE PROVIDING PEERS WITH
CLINICAL CRITICAL INCIDENT
STRESS MANAGEMENT TRAINING,
SUPPORT, CONSULTATION TO OUR
PEER TEAMS NATIONALLY. I'M
SPEAKING ON BEHALF OF THE
CALIFORNIA AMBULANCE ASSOCIATION
. THERE'S AN OVERWHELMING BODY
OF RESEARCH DEMONSTRATING THE
POSITIVE OUTCOMES ASSOCIATED
WITH PEER SUPPORT AND THE
SERVICES OUTLINED IN THIS BILL.
IN MY PROFESSIONAL OPINION AND
PERSONAL EXPERIENCE, THERE IS
NOT A MORE EFFECTIVE, EFFICIENT
INTERVENTION IN REDUCING THE
POTENTIAL IMPACT OF NEW CRITICAL
INCIDENTS AND SUPPORTING THE
GROWTH AND HEALING THAT IS
POSSIBLE COMING OUT OF PREVIOUS
EVENTS. ON GROUPS AND
INDIVIDUALS. ONE OF THE MOST
SIGNIFICANT CONTRIBUTING FACTORS
TO THE KNOWN NEGATIVE OUTCOMES
ASSOCIATED WITH CRITICAL
INCIDENT STRESS IN EMS IS THE
FEAR THAT CONFIDENTIALITY WILL
BE BROKEN, LEADING INTO NEGATIVE
CHANGES IN HOW COWORKERS VIEW
THE INDIVIDUAL AND THAT THERE
WILL BE NEGATIVE IMPACTS ON
THEIR CAREER. THIS BELIEF
CONTRIBUTES DIRECTLY TO MORE
SEVERE NEGATIVE OUTCOMES SUCH AS
SUBSTANCE USE AND SUICIDAL
IDEATION. MANY EMS PROFESSIONALS
DO NOT CONSIDER THEIR
PROFESSIONS JUST A PAYCHECK, BUT
AS A DEEP PART OF THEIR PERSONAL
IDENTITY. THIS MEANS THE FEAR
ASSOCIATED WITH ACCESSING
SUPPORT IS NOT ABOUT LOSING
THEIR JOB, BUT ABOUT LOSING THE
RESPECT OF THEIR PEERS AND A
DEEP, IMPORTANT PART OF WHO THEY
ARE. EASING THIS FEAR WILL HAVE
A POSITIVE IMPACT ON THE
WILLINGNESS TO UTILIZE SUPPORT
SERVICES AND CAUSE A POSITIVE
SHIFT IN EMS CULTURE.
PROFESSIONALLY, AS AN LCSW AND
PERSONALLY AS A COMBAT VETERAN
WHO HAS UTILIZED SIMILAR
SERVICES, I STRONGLY VOICED MY
SUPPORT FOR ASSEMBLY BILL 2859
AND I RESPECTFULLY CONSIDER OR
RECOMMEND THAT YOU DO THE SAME.
THANK YOU. GOOD AFTERNOON, MADAM
CHAIR. MEMBERS OF THE COMMITTEE,
TWO DAYS FROM NOW MARKS THE
SOLEMN TWO YEAR ANNIVERSARY OF A
TRAGIC EVENT THAT SHOOK OUR
LOCAL EMS COMMUNITY TO ITS CORE.
IT WAS ON THIS DAY THAT WE LOST
ONE OF OUR OWN, NOT TO A
PHYSICAL INJURY IN THE LINE OF
DUTY, BUT TO MENTAL HEALTH
STRUGGLES THAT SO MANY OF OUR
EMERGENCY MEDICAL SERVICES FACE
SILENTLY. THIS LOSS SPURRED DEEP
REFLECTION ON THE CHALLENGES OF
OUR EMS, ON THE CHALLENGES OUR
EMS PROFESSIONALS FACE, BOTH ON
THE FRONT LINES AND IN PRIVATE.
MY NAME IS KATIE ANDREWS, EMS
COORDINATOR FOR TUOLUMNE COUNTY
AND EMT FOR NEARLY 20 YEARS. I'M
HERE TODAY TO URGE EACH OF YOU
TO VOTE YES ON AB 2859, WHICH
ADDRESSES A SIGNIFICANT GAP IN
CALIFORNIA LAW. CURRENTLY, OUR
LAWS ALLOW FOR AND PROVIDE
PROTECTIONS FOR LAW ENFORCEMENT
AND FIRE PERSONNEL PARTICIPATING
IN PEER SUPPORT PROGRAMS,
RECOGNIZING THE UNIQUE STRESSES
THAT THEY ENCOUNTER. HOWEVER,
OUR EMS PROFESSIONS WHO FACE
SIMILAR, SIMILARLY DEMANDING
SITUATIONS DO NOT HAVE THE SAME
LEVEL OF SUPPORT AND PROTECTIONS
. PEER SUPPORT PROGRAMS HAVE
PROVEN TO BE INCREDIBLY
EFFECTIVE IN PROVIDING A
CONFIDENTIAL AND UNDERSTANDING
ENVIRONMENT FOR INDIVIDUALS TO
SHARE THEIR EXPERIENCES, SEEK
GUIDANCE AND ACCESS MENTAL
HEALTH RESOURCES, PEER SUPPORT,
PEER SUPPORT PROGRAMS ALSO
ENHANCE EMOTIONAL RESILIENCE,
REDUCE MENTAL HEALTH STIGMA, AND
IMPROVE JOB SATISFACTION. BY
ENACTING THIS BILL, WE NOT ONLY
ACKNOWLEDGE THE UNIQUE
CHALLENGES FACED BY EMS
PROFESSIONALS, BUT ALSO EMPOWER
THEM TO PRIORITIZE THEIR MENTAL
HEALTH WITHOUT FEAR OF JUDGMENT
OR REPERCUSSIONS. IT IS OUR DUTY
TO ENSURE THEY HAVE THE SUPPORT
AND RESOURCES THEY NEED TO
NAVIGATE THEIR OWN CHALLENGES.
LET US HONOR THE MEMORY OF MY
FALLEN, FALLEN COLLEAGUE BY
STANDING TOGETHER TO PASS AB
2859 AND CREATE A SAFER,
HEALTHIER ENVIRONMENT FOR ALL
EMS PROFESSIONALS IN OUR STATE.
THANK YOU. THANK YOU. IS THERE
ANY ADDITIONAL WITNESS IN
SUPPORT? HI, DARBY KERNAN, ON
BEHALF OF THE EMERGENCY MEDICAL
SERVICES ADMINISTRATORS
ASSOCIATION OF CALIFORNIA, MSAC
IN SUPPORT. THANK YOU. ARE THERE
ANY WITNESSES IN OPPOSITION?
GOOD AFTERNOON, CHAIR MEMBERS.
JANICE O'MALLEY WITH THE
AMERICAN FEDERATION OF STATE
COUNTY MUNICIPAL EMPLOYEES HERE
ON BEHALF OF OUR AFSCME UNITED
EMS WORKERS LOCAL 4911, WE WERE
OPPOSED, UNLESS AMENDED ON THE
BILL, WANTED TO EXPRESS OUR
GRATITUDE AND APPRECIATION FOR
ACCEPTING THE COMMITTEE
AMENDMENTS THAT WILL THEN REMOVE
OUR OPPOSITION TO THE BILL,
THERE IS ABSOLUTELY VALUE IN
PEER TO PEER SUPPORTS FOR OUR
EMS WORKERS. WE JUST WANTED TO
ENSURE THAT THEY HAD INPUT ON
DEVELOPING THE PROGRAM, TO
ENSURE THAT IT BENEFITS ALL OF
THEM IN A POSITIVE WAY. SO THANK
YOU VERY MUCH. THANK YOU, MADAM
CHAIR AND MEMBERS, DOUG SUPERS,
ON BEHALF OF THE CALIFORNIA
PROFESSIONAL FIREFIGHTERS. WE
DON'T HAVE A FORMAL POSITION ON
THE BILL, BUT WE'D LIKE TO THANK
THE COMMITTEE AND THE AUTHOR FOR
ACCEPTING THE AMENDMENTS TODAY
AND WORKING WITH US. THANK YOU.
THANK YOU. ANY ADDITIONAL
WITNESSES IN OPPOSITION? I'LL
BRING IT BACK TO THE COMMITTEE.
SEEING NO COMMENT. I WILL JUST
OFFER A THANK YOU TO THE AUTHOR
FOR BRINGING FORWARD THIS
LEGISLATION. AS YOU KNOW, I
SHARED, RECENTLY A, ADJOURNMENT
IN MEMORY, FOR A FALLEN
FIREFIGHTER IN MY DISTRICT WHO
WAS A FRIEND AND, CERTAINLY KNOW
FROM THAT EXPERIENCE THAT IT'S
INCREDIBLY IMPORTANT THAT OUR
FIRST RESPONDERS HAVE THE KIND
OF SUPPORT THAT THEY NEED. SO
THANK YOU FOR BRINGING THIS
FORWARD. AND I WANT TO JUST
THANK THE AUTHOR AS WELL FOR
WORKING WITH THE, WITH AFSCME
AND THE FIREFIGHTERS TO ENSURE
THAT IT'S A HOLISTIC PROGRAM
THAT INCLUDES AND INTEGRATES THE
NEEDS OF, OF THE WORKFORCE IN A
WAY, AND ALSO ENSURES THAT
THERE'S NO, CONFLICTING ISSUE
WITH THE EXISTING PROGRAMS FOR
FIREFIGHTERS, IN TERMS OF PEER
SUPPORT GROUPS. WITH THAT, MY
RECOMMENDATION IS AND I PLEASE
CLOSE, I APPRECIATE, WORKING
WITH THE COMMITTEE, APPRECIATE
THOSE, WHO SPOKE AND, AND, WE
TOOK THOSE AMENDMENTS. THEY WERE
GOOD FAITH AMENDMENTS. WE,
APPRECIATE THE FACT THAT, WE CAN
HAVE THESE KIND OF DISCUSSIONS.
WHEN YOU THINK ABOUT WHAT THESE
EMTS DO, THEY SHOW UP AT PLACES
WHERE HORROR HAS HAPPENED, AND
THEY HAVE TO FACE IT, AND THEY
HAVE TO MAKE SPLIT SECONDS
DECISIONS, AND AS THE MAYOR OF
FRESNO FOR EIGHT YEARS, I SAW
WHAT OUR EMTS DID UP CLOSE AND
PERSONAL AND FIRSTHAND. AND GOT
TO KNOW A LOT OF THEM, OVER MY
PERIOD IN TENURE, THEY DESERVE
THIS KIND OF HELP AND SUPPORT.
THEY'RE GOING TO GET IT. AND I'M
GRATEFUL FOR THE OPPORTUNITY ON
THEIR BEHALF TO PRESENT THIS
BILL AND ASK FOR YOUR SUPPORT.
THANK YOU. THANK YOU. I NEED A
MOTION. MOTION BY WALDRON,
SECONDED BY AGUIAR-CURRY. I CAME
THAT WAY FIRST. THE MOTION IS TO
PASS, AS AMENDED, TO JUDICIARY.
PLEASE CALL THE ROLL. AYE, AYE.
WALDRON WALDRON. AYE.
AGUIAR-CURRY. AGUIAR-CURRY. AYE.
ARAMBULA WENDY. CARILLO. WENDY.
CARILLO. AYE FLORA. HANEY JONES.
SAWYER. JONES. SAWYER. AYE.
MAIENSCHEIN MCCARTY. JO.
PATTERSON. RODRIGUEZ. SANCHEZ
SANTIAGO. SCHIAVO CHAU. VÚI.
WEBER. WEBER. AYE. THAT MEASURES
ON CALL. IT NEEDS TWO MORE
VOTES. THANK YOU. WE ARE GOING
TO MOVE NOW TO ITEM NUMBER 24.
APOLOGIES TO ASSEMBLY MEMBER
GIBSON. ASSEMBLY MEMBER LEE
APPARENTLY HAS WITNESSES WHO
NEED TO BE ABLE TO EXIT MORE
SWIFTLY AND ASKED FOR A PREVIOUS
DISPOSITION ON THAT. AB 2960
ASSEMBLY MEMBER LEE. ALL RIGHT.
THANK YOU, CHAIR AND MEMBERS,
TODAY I'M PRESENTING AB 2960,
THE STATE OF CALIFORNIA IS
EXPERIENCING A METEORIC RISE IN
SEXUALLY TRANSMITTED DISEASE
INFECTIONS OF EVERY KIND ACROSS
GENDERS AND AGE GROUPS, ACROSS
RACE AND ETHNICITY. BUT ONE THAT
STANDS OUT IS CONGENITAL
SYPHILIS, WHERE A PREGNANT
PERSON WITH SYPHILIS INFECTS
THEIR FETUS. UNLIKE OTHER STIS,
CONGENITAL SYPHILIS TOO OFTEN
LEADS TO TRAGIC OUTCOME A
STILLBIRTH OR NEONATAL DEATH.
CALIFORNIA HAS WITNESSED A1A
1,500% INCREASE IN CONGENITAL
SYPHILIS OVER THE PAST DECADE.
WE HAVE THE 11TH HIGHEST
CONGENITAL SYPHILIS RATE IN THE
COUNTRY, AND THE RATE IN
CALIFORNIA IS 63% HIGHER THAN
THE NATIONAL RATE. WE HAVE
FAILED TO GET AHEAD OF THE
EPIDEMIC AND TURN IT IN A
POSITIVE DIRECTION. CURRENT LAW
CAN BE VERY IMPACTFUL WHEN
MANDATORY TESTING AND TREATMENT
OF A PREGNANT PERSON CAN ENSURE
A HEALTHY DELIVERY. IN MOST
CASES. BUT ACCORDING TO THE CDC,
MORE THAN 10% OF THE CASES THAT
ARE IDENTIFIED AND TREATED DO
NOT SAVE THE BABY. AND
AGGRAVATING THE SITUATION IS
THAT AT LEAST 15% OF PREGNANT
PERSONS ARE GETTING NO OR AN
ADEQUATE PRENATAL CASE AND NOT
GETTING TESTED, AND TREATED FOR
SYPHILIS. AB 2966 TO GET AHEAD
OF THE PROBLEM BY OFFERING A
SYPHILIS TEST TO A PERSON WHO
CAN GET PREGNANT BEFORE THEY GET
PREGNANT. IT ALSO WILL HELP TO
ENGAGE MANY PERSONS WHO ARE
PREGNANT, BUT ARE NOT RECEIVING
ADEQUATE PRENATAL CARE. OUR
APPROACH TO THIS EPIDEMIC
EPIDEMIC MUST BE MORE FORCEFUL
OR WE WILL CONTINUE TO SEE A
SHAMEFUL RISE IN DEATHS CAUSED
BY CONGENITAL SYPHILIS. I HAVE
WITH ME DOCTOR JEFFREY KLAUSNER,
A LEADING EXPERT ON STD
PREVENTION AND CONTROL AND A
PROFESSOR AT UT, USC'S KECK
SCHOOL OF MEDICINE, AND RAN
MARTIN ON BEHALF OF THE AIDS
HEALTHCARE FOUNDATION AND THE
SPONSOR OF THE MEASURE. THANK
YOU. PLEASE GO AHEAD. YOU'LL
EACH HAVE TWO MINUTES. MADAM
CHAIR AND MEMBERS. HELLO. MY
NAME IS DOCTOR JEFFREY KLAUSNER.
I'M A PRACTICING INTERNIST AND
INFECTIOUS DISEASE PHYSICIAN,
PROFESSOR OF MEDICINE AND PUBLIC
HEALTH AT THE KECK SCHOOL OF
MEDICINE, UNIVERSITY OF SOUTHERN
CALIFORNIA. I'M HERE
REPRESENTING MYSELF TODAY. FROM
1995 TO 2010, I SERVED AS A
PUBLIC HEALTH OFFICER
RESPONSIBLE FOR SYPHILIS
PREVENTION WITH THE US, CDC AND
THE CITY AND COUNTY OF SAN
FRANCISCO, AND HAVE SERVED AS
PAST PRESIDENT OF THE CALIFORNIA
STD CONTROLLERS ASSOCIATION. I'M
SPEAKING IN STRONG SUPPORT OF AB
2960, WHICH WOULD INCREASE
SYPHILIS CASE FINDING AMONG
THOSE WHO CAN BECOME PREGNANT IN
CALIFORNIA. NHÀ SYPHILIS IS VERY
SERIOUS. BABIES BORN WITH
SYPHILIS OFTEN DIE OR ARE LEFT
WITH LIFELONG DISABILITY. IN
2021, THE CALIFORNIA DEPARTMENT
OF PUBLIC HEALTH REPORTED 528
CASES OF NEWBORN SYPHILIS ARISE
FROM ONLY 33 IN 2012 AND THAT
SAME PERIOD, EARLY SYPHILIS
CASES IN FEMALES INCREASED OVER
TEN FOLD SINCE SALAS IS HIGHLY
PREVENTABLE AND TREATABLE WITH A
SIMPLE BLOOD TEST AND A SHOT OF
PENICILLIN IN ADULTS, SYPHILIS
CAN BE CURED, BUT NOT ALL
PREGNANT PEOPLE CAN BE CURED
BEFORE SPREADING SYPHILIS TO
THEIR FETUS. THAT'S WHY WE MUST
FIND AND TREAT SYPHILIS IN
PEOPLE BEFORE THEY BECOME
PREGNANT. IN THE 1950S, WHEN THE
FREQUENCY OF SYPHILIS WAS ABOUT
10% IN THE GENERAL POPULATION,
LAWS WERE PUT IN PLACE TO ENSURE
ROUTINE SYPHILIS TESTING,
ROUTINE TESTING OR TREATMENT
RESULTED IN DRAMATIC DECLINES IN
SYPHILIS OVER THE NEXT DECADE.
WE HAVE A SIMILAR OPPORTUNITY
NOW TO REDUCE SYPHILIS AND SAVE
BABIES LIVES BY ENSURING THOSE
AT RISK ARE OFFERED VOLUNTARY
TESTING. I URGE YOU TO SUPPORT
AB 2960 AND HELP PROTECT THOSE
MOST VULNERABLE. MADAM CHAIR,
MEMBERS, RAND MARTIN, ON BEHALF
OF THE AIDS HEALTHCARE
FOUNDATION, I WANT TO START BY
GIVING YOU A LITTLE HISTORY
LESSON ABOUT WHAT AGIF DID TEN
YEARS AGO WHEN THE HIV EPIDEMIC
WAS REALLY ON THE RISE. EVERY
MONTH OR EVERY YEAR, IT WAS
GOING UP AND UP AND UP, WE
SPONSORED A BILL THAT HOLLY
MITCHELL CARRIED FOR US, AB 446
THAT MANDATED AN OFFER OF AN HIV
TEST AT ALL PUBLIC HEALTH
CLINICS THAT WAS ENACTED AND
WENT INTO EFFECT IN 2014. IN
2014, WE STARTED TO SEE THOSE
NUMBERS START TO COME DOWN. NOW
WE DON'T TAKE OWNERSHIP OF THAT
100, BUT WE DO KNOW THAT THAT
EDUCATIONAL OPPORTUNITY HAD A
HAD A MATERIAL EFFECT ON THE
ABILITY OF THE STATE TO GET
AHEAD OF THE HIV EPIDEMIC AND
TURN THE CORNER. WE BELIEVE THAT
THE SAME THING CAN HAPPEN WITH
SYPHILIS. WE'RE PARTICULARLY
CONCERNED ABOUT CONGENITAL
SYPHILIS. THE REASON THIS BILL
FOR, FOR EXAMPLE, ONLY ADDRESSES
PEOPLE WHO CAN BECOME PREGNANT
IS BECAUSE THEY'RE THE ONES WHO
CAN PASS ON THE SYPHILIS TO THE
FETUS, SO WE WANTED TO GET TO
THAT ISSUE MORE MORE IMPORTANTLY
THAN THAN ANY OF THE OTHER STDS
THAT ARE ALSO OUT OF CONTROL,
BUT ALSO HAVE, CAN BE CAN BE
DEALT WITH WITH, WITH TREATMENT
VERY EFFECTIVELY, I DO WANT TO
POINT OUT THAT WHAT THE BILL
DOES DOES ALIGN WITH WHAT PUBLIC
HEALTH GENERALLY SAYS TODAY
ABOUT, ROUTINE TESTING, THE, THE
DEPARTMENT OF PUBLIC HEALTH IN
BOTH ITS, RECOMMENDATIONS ON
SYPHILIS SCREENING AND IN ITS
RECOMMENDATIONS RELATIVE TO
TESTING IN EMERGENCY DEPARTMENTS
, SUPPORT VERY STRONGLY THE IDEA
OF ROUTINE OPT OUT TESTING FOR
NOT ONLY SYPHILIS, BUT HIV AND
HEPATITIS C. THIS BILL FOLLOWS
THOSE GUIDELINES, AND WE THINK
THAT IT WILL HAVE THE EFFECT
THAT WE WANT IT TO HAVE, AS IT
DID TEN YEARS AGO, 11 YEARS AGO
WITH HIV. WE URGE YOUR AYE VOTE.
THANK YOU. THANK YOU. ARE THERE
ANY OTHER ADDITIONAL WITNESSES
IN SUPPORT? CHAIR MEMBERS CATHY
MOSSBERG WITH THE CENTRAL ACCESS
HEALTH IN SUPPORT. THANK YOU.
ANY WITNESSES IN OPPOSITION
?
THANK YOU, MADAM CHAIR. MEMBERS.
RYAN SPENCER, ON BEHALF OF THE
AMERICAN COLLEGE OF OBGYN NINE
RESPECTFUL OPPOSITION TO AB
2960. FIRST AND FOREMOST, ACOG
SHARES THE AUTHOR AND SPONSORS
DESIRE TO HALT THE RISE IN
SYPHILIS INFECTION RATES. THESE
EFFORTS ARE CRUCIAL AND MUST BE
SUSTAINED THROUGH TARGETED,
EVIDENCE BASED PUBLIC HEALTH
INITIATIVES. UNFORTUNATELY, THE
APPROACH UNDERTAKEN IN AB 2960
IS DIFFERENT. IT MANDATES THAT
SYPHILIS TESTING IS OFFERED ON
AN ANNUAL BASIS TO EVERY SINGLE
INDIVIDUAL WHO MAY GET PREGNANT,
REGARDLESS OF RISK, INDICATION
OR CLINICAL RECOMMENDATIONS.
CONTRARY TO WHAT WAS JUST SAID,
THIS BLANKET APPROACH CAN LEAD
TO UNNECESSARY ANXIETY,
POTENTIAL STIGMA, AND THE
DIVERSION OF TIME AND LIMITED
HEALTH CARE RESOURCES FOR FROM
HIGHER RISK POPULATIONS WHO ARE
IN GREATER NEED OF THESE
SERVICES. AS STAY IN THE
ANALYSIS, THE DEPARTMENT OF
PUBLIC HEALTH IDENTIFIES THESE
HIGH RISK INDIVIDUALS AS SUCH AS
THOSE WHO ARE PREGNANT OR
SEXUALLY ACTIVE OR INCARCERATED
IN A CERTAIN AREA, AND ONLY A
SUBSET TO BE TESTED, FREQUENTLY
REQUIRING HEALTH PROFESSIONALS
TO OFFER AN ANNUAL MEDICAL
PROCEDURE SUCH AS SYPHILIS
SCREENING, TO INDIVIDUALS NOT
BASED ON CLINICAL GUIDANCE CAN
STRAIN THE RELATIONSHIP BETWEEN
A PATIENT AND THEIR PROVIDER.
I'VE HEARD THE QUESTION WHAT IS
THE HARM IN OFFERING A TEST TO
SOMEONE WHO DOES NOT NEED IT?
ONE HARM IS THIS A PATIENT
HAVING TO WONDER IF A MEDICAL
PROCEDURE IS BEING OFFERED DUE
TO MEDICAL NECESSITY OR CLINICAL
JUDGMENT, OR BECAUSE THE
PROVIDER PROVIDER IS REQUIRED BY
LAW TO DO SO? REGARDLESS OF
INDICATION. EVEN IF YOU TOOK
EXISTING CLINICAL GUIDANCE AND
PLACED IT INTO STATUTE, PROBLEMS
WOULD STILL EXIST. NEW DATA MAY
SURFACE IN THE FUTURE THAT
HIGHLIGHTS NEW EVIDENCE BASED
APPROACHES THAT TARGETS A
SPECIFIC, AT RISK POPULATION
PROVEN TO LOWER SYPHILIS
INFECTIONS. BUT UNFORTUNATELY,
IF THIS LAW GOES INTO EFFECT AND
DESPITE NEW CLINICAL GUIDANCE,
WE WOULD STILL NEED TO DEDICATE
VIABLE RESOURCES TO MEET A
SPECIFIC REQUIREMENT, EVEN TO
THOSE WHO MAY NOT NEED IT. THIS
IS NOT HOW SCIENCE, MEDICINE,
INNOVATIONS OF PUBLIC HEALTH
SHOULD WORK. IT SHOULD BE
EVIDENCE AND RESEARCH BASED AND
FLUID. AND UNFORTUNATELY, AS
LAUDABLE AS THIS INTENT MAY BE,
THIS IS NOT THE CASE WITH AB
2960. I ASK FOR YOUR I VOTE, I
ASK FOR YOUR NO VOTE. TRICKY,
TRICKY. THERE I'LL TAKE THAT.
YOU'LL HAVE TWO MINUTES. GOOD
AFTERNOON, ALEXIS RODRIGUEZ WITH
THE CALIFORNIA MEDICAL
ASSOCIATION, REPRESENTING NEARLY
50,000 PHYSICIANS AND MEDICAL
STUDENTS ACROSS THE STATE IN
RESPECTFUL OPPOSITION TO AB
2966. ALTHOUGH C-M-A UNDERSTANDS
THE INTENT OF AB, AB 2960 IS TO
CONTROL AND DECREASE THE SPREAD
OF SYPHILIS, WE MUST OPPOSE THE
APPROACH TO REQUIRE A SYPHILIS
TEST TO BE OFFERED TO ANY
INDIVIDUAL THAT CAN BECOME
PREGNANT, REGARDLESS OF CLINICAL
GUIDANCE. PER CDPH GUIDELINES,
SYPHILIS TESTING IS RECOMMENDED
TO CERTAIN HIGH RISK GROUPS,
PREGNANT INDIVIDUALS BEING ONE
OF THEM, AND LAMENTED ONLY A FEW
YEARS AGO. SB 306 PAN ENSURES
HEALTH CARE PROVIDERS ARE ABLE
TO PROVIDE SYPHILIS SCREENINGS
AND TESTING WITH PRENATAL CARE
IN ACCORDANCE WITH GUIDELINES
PUBLISHED BY CDPH. THESE
GUIDELINES RECOMMEND ALL
PREGNANT PATIENTS ARE SCREENED
TWICE DURING PREGNANCY, ONCE IN
THEIR FIRST TRIMESTER AND AGAIN
IN THEIR THIRD TRIMESTER. THE
DECISION FOR A PHYSICIAN TO
OFFER A MEDICAL PROCEDURE, A
PROCEDURE TO THEIR PATIENT,
SHOULD BE BASED ON THE
PROFESSIONAL JUDGMENT OF A
POTENTIAL RISK FACTORS AND
THROUGH CONVERSATIONS WITH THEIR
PATIENT MANDATE. A PHYSICIAN TO
OFFER ANY SORT OF MEDICAL
PROCEDURE COULD HARM THE PATIENT
PHYSICIAN RELATIONSHIP AND
POTENTIALLY STEER THE
CONVERSATION AWAY FROM THE
INITIAL REASON THE PERSON SOUGHT
CARE. THESE TYPES OF
CONVERSATIONS HAVE THE ABILITY
TO DELAY CARE AND PUT AN
UNNECESSARY BURDEN ON PHYSICIANS
AND THEIR PATIENTS. FOR THESE
REASONS, CMAS AND RESPECTFUL
OPPOSITION AND ASKS FOR A NO
VOTE THANK YOU. OTHER WITNESSES
IN OPPOSITION. THANK YOU, MADAM
CHAIR MEMBERS DAVID GONZALEZ, ON
BEHALF OF AMERICA'S PHYSICIAN
GROUPS, RESPECTFULLY IN
OPPOSITION. MADAM CHAIR, MEMBERS
TIM MADDEN, REPRESENTING THE
CALIFORNIA CHAPTER OF THE
AMERICAN COLLEGE OF EMERGENCY
PHYSICIANS. WE HAVE AN OPPOSE
UNLESS AMENDED POSITION AND AN
AVAILABLE TO ANSWER ANY
QUESTIONS IF NECESSARY. VANESSA
GONZALEZ WITH THE CALIFORNIA
HOSPITAL ASSOCIATION, ALSO WITH
AN OPPOSE, UNLESS AMENDED, A
POSITION TO REMOVE THE
REQUIREMENT FOR HOSPITAL
EMERGENCY DEPARTMENTS TO PROVIDE
THE TESTING. A HOSPITAL
EMERGENCY DEPARTMENTS ARE
EXPERIENCING HIGH CAPACITY AND
SHOULD CONTINUE TO FOCUS ON
EMERGENCY CARE. THANK YOU. I
WILL BRING IT BACK TO THE
COMMITTEE FOR QUESTIONS OR
COMMENTS. DOCTOR WEBER. THANK
YOU. CHAIR AND, HOPEFULLY YOU'LL
INDULGE ME WITH THESE QUESTIONS
THAT I HAVE, BECAUSE THIS, I
THINK IS A VERY IMPORTANT ISSUE,
I WANT TO THANK THE AUTHOR AND
THE SPONSORS FOR BRINGING THIS
UP, ALLOWING US TO HAVE THIS
DISCUSSION HERE TODAY, I THINK,
OR AT LEAST I HOPE YOU KNOW
EVERYONE IS VERY CONCERNED WITH
THE RISE IN NOT ONLY SYPHILIS
AND CONGENITAL SYPHILIS. AND,
YOU KNOW, AS AN OBGYN, IT IS
DEFINITELY SOMETHING THAT WE
DEAL WITH HERE WITH TESTING,
WHEN SOMEONE COMES IN FOR THEIR
INITIAL PRENATAL VISIT AND THEN
ONCE AGAIN, AT SOME POINT IN
THEIR THIRD TRIMESTER, BUT THIS
THIS BILL IS VERY PROBLEMATIC
FOR ME. A LOT OF CONCERNS WITH
IT, THE FIRST IS THAT YOU WOULD
TEST ANYONE WHO HAS THE
POTENTIAL TO GET PREGNANT. THAT
ESSENTIALLY MEANS ANYONE, ONCE
THEY START HAVING THEIR PERIOD,
ONCE THEY REACH MENARCHE. AND AS
AN OB GYN THAT SPECIALIZES IN
PEDIATRIC AND ADOLESCENT
GYNECOLOGY, IT IS NOT UNCOMMON
FOR ME TO HAVE A PATIENT AS
YOUNG AS 9 OR 10. WE DO NOT
CONSIDER THAT PRECOCIOUS PUBERTY
ANYMORE, BUT TO COME IN WITH
THEIR PERIOD AND YOU KNOW, I
WHEN THE OPPOSITION WAS SPEAKING
ABOUT THE DOCTOR PATIENT
RELATIONSHIP, YOU ALL HAVE NO
IDEA HOW MANY TIMES IT WAS VERY
IT WAS VERY CONTENTIOUS BETWEEN
MYSELF AND A PARENT WHEN I
WANTED TO DISCUSS WITH THAT
PARENT IN PRIVATE OR THAT CHILD
IN PRIVATE WHEN THEY'RE 12,
ABOUT CERTAIN THINGS. OR IF I
ASK THEM OR IF I SCREEN THEM, I
MEAN, IT'S A, ESPECIALLY IF THAT
CHILD DIDN'T NECESSARILY NEED
IT. AND SO I JUST WANT TO
HIGHLIGHT THAT, THAT THAT IS
TRULY THE CASE. IF YOU DON'T SEE
AND MANAGE PEDIATRIC AND
ADOLESCENT PATIENTS, THEN YOU
DON'T UNDERSTAND. SOMETIMES THE
DIFFICULTY THAT YOU HAVE WHEN
YOU BRING THESE VERY ADULT
QUESTIONS INTO A SPACE, INTO A
CHILD, THAT MAY NOT EVEN BE
THERE. AND SO THIS BLANKET,
ANYBODY WHO CAN GET PREGNANT IS
EXTREMELY CONCERNING, THE OTHER
THING I FOUND INTERESTING IN
THIS IS THAT YOU SPECIFICALLY
CALL OUT A MEDICINE TO BE USED
IF PENICILLIN ISN'T AVAILABLE,
WHICH I THINK IS ALSO A
PROBLEMATIC BECAUSE YOU'RE
PUTTING THAT IN STATUTE. AND YET
THAT MEDICATION MAY NOT BE AS
EFFECTIVE IN THE FUTURE. THERE
MAY BE ANOTHER ONE THAT'S
BETTER. AND YET WE WOULD BE
PASSING INTO LAW AND MEDICATION
THAT WE MUST USE INSTEAD OF
USING SOMETHING THAT MAY BE
BETTER IN THE FUTURE. AND I
THINK THAT'S ALSO VERY
PROBLEMATIC WHEN WE ARE TALKING
ABOUT PUTTING INTO LAW WHAT
PHYSICIAN AND HEALTH CARE
PRACTITIONERS SHOULD BE DECIDING
BASED ON NEWER TECHNOLOGY AND
EVIDENCE. I'M ALSO CONCERNED
WITH A TREND THAT WE SEE WITH
SOME OF THE LEGISLATION THAT WE
AS LEGISLATORS OVERALL KNOW MORE
ABOUT WHAT'S GOING ON IN THE
HEALTH CARE SPACE AND THE
SCIENCE SPACE, WHAT THE EVIDENCE
SHOWS, THAN THOSE WHO DO THIS ON
A, ON A DAILY BASIS, I WOULD
LIKE TO ASK MY FELLOW PHYSICIAN
BECAUSE I COULD NOT FIND THIS,
BUT YOU HAVE BEEN IN THIS FIELD
FOR A VERY LONG TIME. WHERE IS
THE STUDY THAT SHOWS THAT
PATIENTS WHO HAD CONGENITAL
SYPHILIS OR DELIVERED A BABY
THAT HAD CONGENITAL SYPHILIS,
HAD BEEN SEEN BY A HEALTH CARE
PROVIDER HERE IN CALIFORNIA
WITHIN A YEAR OR TWO YEARS OF
THEM GETTING PREGNANT, THEY WERE
AT RISK AND DID NOT GET SCREENED
. I COULDN'T FIND THAT STUDY
RIGHT. SO THE NATIONAL DATA,
WHICH WAS REPORTED BY THE CDC
AND A REPORT CALLED VITAL SIGNS,
SHOW THAT ABOUT HALF OF, WOMEN
WHO HAD SYPHILIS AND DELIVERED A
BABY WITH CONGENITAL SYPHILIS
WERE SEEN IN THE EMERGENCY ROOM.
AND, YOU KNOW, VERY FEW SAW IT,
YOU KNOW, PRENATAL CARE. SO I
THINK THAT'S WHY THE, YOU KNOW,
AUTHOR WAS ADDED EMERGENCY ROOM
VENUES AS A PLACE TO MEET. I
MEAN, I THINK WE RECOGNIZE THERE
ARE IMPORTANT SOCIAL
DETERMINANTS OF HEALTH. AND, YOU
KNOW, WE'D ALL LOVE TO BE ABLE
TO ADDRESS THOSE SOCIAL
DETERMINANTS. BUT, YOU KNOW, WE
HAVE TO BE PRACTICAL AND WE HAVE
TO RESPOND TO THE, YOU KNOW,
CRISIS NOW, RIGHT? I, I
COMPLETELY UNDERSTAND THAT
THERE'S A REASON WHY AND I'M
SURE YOU'RE AWARE WE AND WITHIN
THE HEALTH CARE SPACE HAVE MOVED
FROM JUST A BLANKET. I'M GOING
TO DO THIS FOR EVERYBODY TO
SOMETHING THAT'S MORE AN
EVIDENCE BASED APPROACH. I AM
ALSO KIND OF GUILTY WHEN PEOPLE
COME IN. I'D LOVE TO JUST ORDER
EVERY SINGLE TEST. JUST TO, YOU
KNOW, EASE MY PEACE OF MIND. BUT
THERE IS A REASON WHY WE HAVE AN
EVIDENCE BASED APPROACH. AND SO
I WASN'T ABLE TO FIND ANY STUDY
SPECIFICALLY HERE IN CALIFORNIA
THAT SHOW THAT PATIENTS WHO
DELIVER A CHILD WITH CONGENITAL
SYPHILIS HAD THE OPPORTUNITY TO
BE SEEN BY A HEALTH CARE
PROVIDER PRIOR TO THAT
PREGNANCY. THEY WERE AT RISK AND
WERE NOT SCREENED, BECAUSE
THAT'S ESSENTIALLY WHAT WE'RE
TRYING TO GET AT, RIGHT, AND
THAT'S ESSENTIALLY WHAT THIS
BILL IS STATING. SCREEN
EVERYBODY BEFORE THEY GET
PREGNANT. AND I HAVEN'T SEEN ANY
EVIDENCE THAT IF WE DO THAT,
THAT THAT WOULD ULTIMATELY
CHANGE THE OUTCOME. ESSENTIALLY.
I HAVEN'T SEEN EVIDENCE THAT
SAYS THAT THE PEOPLE WHO ARE
DELIVERING BABIES WITH
CONGENITAL SYPHILIS SEE HEALTH
CARE PROVIDERS PRIOR TO THEM
GETTING PREGNANT. SO THAT'S A
CONCERN BECAUSE WE'RE MOVING
AWAY FROM WHAT EVIDENCE SHOWS
VERSUS NOT, BUT I DO WANT TO
LOOK AT THE EVIDENCE AND
ACTUALLY CDC, SOMEONE HAD TALKED
ABOUT RECOMMENDATION. CDC
RECOMMENDS, OF COURSE SCREENING
OF ALL PREGNANT PEOPLE, AND
TAKING AN INDIVIDUAL RISK BASED
APPROACH TO SYPHILIS SCREENING
FOR OTHERS AND HEALTHY PEOPLE.
GOAL OF 2030, LOOKS AT, YOU
KNOW, REDUCING THE RATE AND THAT
IF YOU HAVE A RATE OF 4.6 PER
100,000, THEN YOU NEED TO DO
THAT RISK BASED SCREENING OF
AGES LIKE 15 TO 44. SO WHAT DO
YOU THINK? HERE IN CALIFORNIA,
THE COUNTIES OF ALPINE, COLUSA,
INYO, LASSEN, MODOC, EXCUSE ME
IF I'M SAYING THESE WRONG.
PLUMAS, SAN BENITO AND SIERRA
HAVE IN COMMON. THEIR INCIDENT
RATE OF PRIMARY OR SECONDARY
SYPHILIS BETWEEN THOSE BETWEEN
15 AND 44 IS ZERO ZERO. BUT WHAT
THIS BILL WOULD BE SAYING IS
THAT WE MUST GO INTO THOSE
COUNTIES Tê AND TEST EVERYBODY,
EVEN THOUGH THERE'S NO EVIDENCE
THAT WE SHOULD BE DOING THAT,
YOU KNOW, I'M, I'M VERY
CONCERNED AGAIN WITH MOVING AWAY
FROM EVIDENCE BASED TO DO
SCREENING EVERYBODY. AND I ALSO
JUST WANT TO POINT OUT THAT THE
COUNTIES HERE IN CALIFORNIA THAT
HAVE A 4.6 PER 100,000 PRIMARY
SYPHILIS RATE, OR HIGHER, THEY
ARE SCREENING PEOPLE WHO
ACTUALLY COME TO SEE PHYSICIANS,
PER THE CDC WEBSITE, AND SO, YOU
KNOW, I'M, I'M UNFORTUNATELY, I
DON'T SEE ANY EVIDENCE THAT
THESE INDIVIDUALS WHO HAVE THESE
CHILDREN ARE GETTING CARE PRIOR
TO THEIR PREGNANCY AND JUST NOT
BEING SCREENED, I DON'T SEE ANY
RATIONALE WHY WE SHOULD GO
AGAINST, LIKE, MEDICAL GUIDANCE
AND NATIONAL GUIDANCE, NATIONAL
RECOMMENDATIONS, I REALLY
RESPECT WHAT YOU ARE TRYING TO
DO. ASSEMBLY MEMBER LEE, BUT
UNFORTUNATELY, I WILL NOT BE
ABLE TO SUPPORT THIS BILL TODAY.
THANK YOU.
WOULD YOU LIKE TO RESPOND AT ALL
? ASSEMBLY MEMBER LEE? SURE, YOU
KNOW, THANK YOU FOR YOUR
COMMENT. YOU RIGHTLY IDENTIFIED
THAT THERE ARE ABOUT, TEN PLUS
HEALTH JURISDICTIONS IN THE
STATE OF CALIFORNIA. OF THE 61
HEALTH JURISDICTIONS THAT HAVE,
A LOW OR ABSENT RATE OF
SYPHILIS. BUT THAT LEAVES THE 45
OTHER HEALTH JURISDICTIONS WITH
ALL RESIDENTS, IN THOSE HEALTH
JURISDICTIONS, OF THE 45 DEFINED
BY THE CALIFORNIA DEPARTMENT OF
PUBLIC HEALTH AT INCREASED RISK,
BOTH THE UNITED STATES
PREVENTIVE SERVICES TASK FORCE
RECOMMENDS THAT PEOPLE AT
INCREASED RISK, RECEIVE SYPHILIS
TESTING, THE CALIFORNIA
DEPARTMENT OF PUBLIC HEALTH
RECOMMENDS, PEOPLE WITH
INCREASED RISK RECEIVE SYPHILIS
TESTING, AND THE CDC, OF WHICH I
SIT ON THE GUIDELINES FOR
SYPHILIS RECOMMENDATIONS,
RECOMMENDS THOSE AT INCREASED
RISK. SO THE RESIDENTS IN THE
45, HEALTH JURISDICTIONS OUT OF
THE 61 ARE INDEED AT INCREASED
RISK. AND WE TAKE A PUBLIC
HEALTH APPROACH, WHICH MEANS,
YOU KNOW, SOMETIMES WE LOOK AT
THE ENTIRE POPULATION AND THE
WELLNESS OF THE ENTIRE
POPULATION OF CALIFORNIA
RESIDENTS TO MAKE POLICY
RECOMMENDATIONS. I THANK YOU FOR
THAT, AND I RESPECTFULLY
DISAGREE. I DON'T THINK THAT A
NINE YEAR OLD OR A TEN YEAR OLD
WHO IS MENOCAL, WHO HAPPENS TO
LIVE IN A CITY WITH AN INCREASED
RISK, IS AT IS AT INCREASED RISK
JUST BECAUSE THEY HAPPEN TO LIVE
THERE IF THEY'VE NEVER BEEN
SEXUALLY ACTIVE, NOT EVEN
THINKING OF SEXUAL ACTIVITY, AND
AGAIN, THOSE COUNTIES THAT YOU
MENTIONED ARE DOING THE
INDIVIDUAL RISK BASED ASSESSMENT
THAT THE CDC RECOMMENDS. THANK
YOU. AND SHIAVO. I SHARE SOME OF
THE CONCERNS, ESPECIALLY AROUND
TESTING. KIDS, I HAVE ONE OF
THEM, AN 11 YEAR OLD, AND, AND I
CAN SEE HOW UNCOMFORTABLE AND
AWKWARD THAT WOULD BE, WITH
PARENTS OF, OF YOUNG CHILDREN,
ESPECIALLY AS PERIODS ARE
STARTING YOUNGER AND YOUNGER
AMONGST OUR GIRLS, SO, YOU KNOW,
I HOPE THAT THERE CAN BE SOME
CONSIDERATION AND DISCUSSION
AROUND THIS AND THE
APPROPRIATENESS OF THIS. I THINK
THAT THAT WOULD MAKE A LOT OF
SENSE, AND, YOU KNOW, AND ALSO
UNDERSTANDING HOW BUSY AND
OVERWHELMED OUR ERS ARE, YOU
KNOW, I HEAR WHAT YOU'RE SAYING
AROUND THE ERS BEING WHERE SOME
PEOPLE GET THEIR HEALTH CARE,
RIGHT. AND OBVIOUSLY WE'RE DOING
A LOT TO TRY TO HELP ADDRESS
THAT SO THAT THAT'S NOT
HAPPENING, BECAUSE WE KNOW IT'S,
IT'S, IT'S THE MOST EXPENSIVE
FORM OF HEALTH CARE WE COULD BE
PROVIDING. AND IT'S NOT A
PARTICULARLY EFFECTIVE LONG
TERME, SO, SO, YOU KNOW, SO I, I
, I HAVE RESERVATIONS ABOUT THAT
PIECE AS WELL, I'M WHERE I'M
SORRY. I DON'T KNOW, BUT WHERE
IS THIS GOING AFTER THIS? IT'S
GOING TO APPROACH. OKAY, YOU
KNOW, I DO THINK THE BILL NEEDS
SOME WORK AND I WILL GIVE A
COURTESY VOTE HERE TODAY TO
ALLOW THAT TO CONTINUE IN THOSE
DISCUSSIONS, TO CONTINUE, AND
RESERVE, MY VOTE FOR THE FLOOR
TO DEPENDING ON HOW IT MOVES
FORWARD. THANK YOU. I WANT TO Þ
MISS CARILLO. THANK YOU, MADAM
CHAIR, I, I TOO WOULD LIKE TO
ALIGN MY COMMENTS WITH THAT OF
MY COLLEAGUE AND WHO IS A OB GYN
AND, SEVERAL CONCERNS RELATED TO
THE, THE IMPLEMENTATION OF THE
POLICY, BUT EVEN MORE CONCERN,
RELATED TO BIAS AND STIGMA FOR
YOUNG GIRLS, WOMEN AND PEOPLE
WHO CAN GET PREGNANT. AND I
THINK IF THE IF THE IF THE ISSUE
IS THAT, THAT THERE'S A RISE IN
SYPHILIS, I WOULD PREFER TO SEE
POLICY THAT'S RELATED TO
INFORMATION FOR ANYONE OF ANY
GENDER TO HAVE ACCESS TO STD
EDUCATION, AND WHILE IT MAY,
CURRENTLY EXIST, I THINK THERE
COULD BE IT COULD THERE COULD BE
MORE DONE. AND SO I JUST, I, I
FIND IT PROBLEMATIC THAT WE PUT
THE ONUS ONLY ON YOUNG GIRLS,
WOMEN AND INDIVIDUALS WHO CAN
GET PREGNANT. AND I JUST HAVE A,
A FUNDAMENTAL DISAGREEMENT, WITH
ANY HEALTH POLICY THAT DOES THAT
. AND I THINK IN PREVIOUS ISSUES
RELATED TO HIV AIDS AND OTHER
STDS, WE HAVE SEEN THAT THAT HAS
HAPPENED IN THE PAST, AND I
WOULD NOT LIKE TO REPEAT IT, I'M
, I DO BELIEVE THAT THERE IS
VERY GOOD INTENTION TOWARDS THE
BILL, BUT I'M NOT SURE THAT THIS
IS THE RIGHT APPROACH, AND I
WOULD CERTAINLY AGAIN, I'LL JUST
SAY AGAIN, I WOULD LIKE TO SEE
ALL INDIVIDUALS, REGARDLESS OF
GENDER, BE HELD TO THE SAME
STANDARD WHEN IT COMES TO A RISE
IN STDS, SPECIFICALLY WITH
SYPHILIS. THANK YOU. MR.
JONES-SAWYER, AND AS YOU
PROBABLY CAN TELL, THERE'S A
THERE'S A LOT OF RETICENCE.
CGRTS, AND THERE WAS A LOT OF
INFORMATION. I'M GLAD YOU
BROUGHT IT UP TO THIS COMMITTEE
BECAUSE IT IS A CONCERN. IT IS
SOMETHING THAT WE NEED TO WORK
ON. AND THEN SOMETIMES IN SOME
OF THESE BILLS, THE METHODOLOGY
OR THE, THE PARTICULAR PUBLIC
POLICY THAT IS BROUGHT BEFORE US
MAY NOT BE THE, THE, THE CORRECT
WAY TO, TO MOVE ON THIS AND
SOMETIMES WE GIVE A COURTESY
VOTE SO THAT YOU CAN WORK ON IT
SO THAT YOU CAN MASSAGE IT SO
THAT WE CAN GET IT TO A POINT
WHERE, NOT ONLY YOU GET TO A
COMFORT LEVEL, BUT, I THINK
YOU'RE GOING TO GO A LITTLE BIT
FURTHER WITH SOME OF THE, SOME
OF THE MEMBERS HERE, TO, TO
PROVE THAT THE METHODOLOGY THAT
YOU'RE USING IS THE RIGHT IS THE
RIGHT ONE BECAUSE, YOU'RE GOING
TO NEED SOME BACKUP AND I AND I
TO SHARE SOME OF THE SAME
CONCERNS. I THINK WHAT WE WOULD
LIKE TO DO, SOME OF US LIKE TO
GIVE YOU A COURTESY VOTE HERE,
BUT RESERVE AS YOU HEARD, YOU'RE
PROBABLY HEARING MORE AND MORE
OF NOW WHEN TO RESERVE OUR VOTE,
LATER, ESPECIALLY IF IT GETS OUT
OF APPROPRIATE ÓRDENES, FOR THE
FLOOR TO SEE IF IT GETS TO A
POINT WHERE, EVERYBODY IS A LOT
MORE COMFORTABLE AND WE BELIEVE
THAT THIS IS THE CORRECT WAY TO
MOVE FORWARD. AND SO, YOU WILL
HAVE A COURTESY VOTE FOR ME
TODAY AND HOPEFULLY YOU'LL
YOU'LL BE ABLE TO WORK ON THIS
AND TALK TO THE PROFESSIONALS
AND ESPECIALLY PEOPLE WHO'VE HAD
A PLETHORA OF EXPERIENCE IN THIS
THAT SIT ON THIS COMMITTEE THAT
YOU CAN TALK TO. I CAN HELP YOU
GET GET IT TO A POINT WHERE
IT'LL IT'LL MAKE SENSE TO
EVERYONE TO VOTE FOR IT LATER ON
. I'LL JUST ADD THESE COMMENTS.
SO IN CALIFORNIA, CALIFORNIA HAS
HAD 528 CASES OF CONGENITAL
SYPHILIS IN 2021. SO 528 BABIES.
WE KNOW THAT THAT'S A KIND OF A
CRITICAL MASS WHERE, DISEASE IS
BEING PASSED FROM MOTHER TO
CHILD IN RECORD PROPORTION
NUMBERS. SO THIS IS OBVIOUSLY,
YOU KNOW, THERE'S A LOT OF
PASSION AROUND THIS, AND THERE'S
ALSO A NEED TO BE ABLE TO
ADDRESS WHAT I BELIEVE TO BE A
TRUE SYPHILIS CRISIS. I THINK
WHAT YOU'VE HEARD FROM THE
COMMITTEE COMMENTS IS THAT THERE
ARE ASPECTS OF THIS BILL THAT
ARE ARE FAR REACHING AND PERHAPS
TOO BROAD, AND, YOU KNOW, THERE
IS SOMETHING TO SAY ABOUT THE
FACT AND THIS IS, A PART OF THE
ANALYSIS, THAT THERE ARE PEOPLE
BIRTHING PEOPLE AND WOMEN WHO
ARE GOING TO THE ED FOR THE
FIRST TIME WHERE WHO ARE NOT
GETTING THE KIND OF PRENATAL
CARE THAT THEY NEED TO FOR
SEEING FOR THE FIRST TIME, AS
THEY ARE ABLE TO, PRESENT
THEMSELVES IN THE, IN THE ED
DEPARTMENT'S, I WILL BE
SUPPORTING THIS BILL RIGHT NOW,
BUT I THINK YOU'VE HEARD VERY
CLEARLY FROM THE COMMITTEE THAT
IT WOULD MAKE A LOT OF SENSE TO,
AS THIS MOVES FORWARD, IF SHOULD
IT MOVE FORWARD, OUT OF THIS
COMMITTEE TO FOCUS AND TAKE
AMENDMENTS THAT ALLOW FOR A
SEVERE NARROWING AROUND THIS,
AND ALSO TO ADDRESS THE KIND OF
THE, CHEN ORDER, PARITY ISSUES
AND QUITE FRANKLY, NOT TARGETING
ONE PARTICULAR GROUP IN THIS, I
FEEL GREATLY MORE COMFORTABLE
WITH THIS BILL. IF IT FOCUSED
PARTICULARLY AROUND, PEOPLE WHO
ARE PRESENTING AS ALREADY
PREGNANT, WHO WHO HAD A NEED TO
BE IN WHO WERE PRESENTING, WHO
HAD NOT RECEIVED PRENATAL CARE
PRIOR TO, PRIOR TO THEIR VISIT
IN THE ED. SO I BELIEVE, I KNOW
THAT YOU WORK YOUR BILL'S, I
BELIEVE AUTHOR, AND I TRUST YOU
THAT YOU WILL CONTINUE TO WORK
ON THIS BILL SHOULD IT PASS OUT
OF THE COMMITTEE. AND FOR THOSE
REASONS, I AM GIVING, A
RECOMMENDATION OF I RIGHT NOW.
AND HOPE THAT WE HAVE AN
OPPORTUNITY TO CONTINUE TO WORK
ON THIS BILL, GIVEN THE
INCREDIBLE CRISIS THAT WE'RE
FACING RIGHT NOW. WITH THAT,
WOULD YOU LIKE TO CLOSE? YES,
THANK YOU, MADAM CHAIR. AND I
APPRECIATE YOUR MY
RECOMMENDATION TODAY AND YOUR
FLEXIBILITY FOR MY WITNESS, I
JUST WANT TO SAY THAT I
APPRECIATE ALL THE COMMENTS
TODAY IN THE DISCUSSION IN THE
COMMITTEE. I ESPECIALLY
APPRECIATE DOCTOR WEBBER'S LIVED
EXPERIENCES, OF COURSE, IN OB
GYN, BUT YOU KNOW, TO PUT INTO
CONTEXT, I WANT TO REITERATE
WHAT MY WITNESS WAS TALKING
ABOUT IS THIS IS A PUBLIC HEALTH
CRISIS, RIGHT? SYPHILIS IS
BASICALLY LIKE A 17TH CENTURY
DISEASE THAT IS VERY CURABLE AND
VERY TREATABLE IN THIS DAY AND
AGE. BUT YET, EVEN ON YOUR FRONT
PAGE OF ANALYSIS, IN THE LAST
TEN YEARS, SYPHILIS HAS
INCREASED 287. NOW, I'M NOT A
DOCTOR, BUT I AM THE ONLY
LEGISLATOR WHO IS UNDER 30 YEARS
OLD, AND I'M WITHIN THAT YOUNGER
CATEGORY THAT WE'RE WORRIED
ABOUT AND, YOU KNOW, THE ONE
THING THAT REALLY PERVADES WHY
IT'S WHY STD IS REALLY WHY THEY
CAN PROLIFERATE AND WHY THEY CAN
BE SO SUCCESSFUL IS BECAUSE
YOUNG PEOPLE, ESPECIALLY EVEN IN
MY AGE GROUP, WITHOUT EVIDENCE,
BELIEVE WE'RE INVINCIBLE,
BELIEVE WE HAVE NO DISEASES
WHATSOEVER. AND I AGREE WITH
SOME OF THE CARILLO I THINK IT
SHOULD APPLY TO MORE PEOPLE,
BROADLY SPEAKING, BUT I DON'T
KNOW IF MY OPPOSITION WILL LIKE
THAT, BUT I THINK IT SHOULD
APPLY TO MORE PEOPLE MORE
BROADLY. BUT THE ENEMY OF PUBLIC
HEALTH AND THE PROLIFERATION OF
STIS IS THAT PEOPLE WALK AROUND
WITHOUT EVER BEING TESTED,
ASSUMING THAT THEY NEVER HAVE
THESE DISEASES. NOW, THIS BILL
IS NARROW FOR, YOU KNOW, A LOT
OF FEEDBACK REASONS TO BE
FOCUSED ON CONGENITAL SYPHILIS,
THAT REALLY TERRIBLE PHENOMENON
WHERE A PARENT CAN PASS IT ON TO
THEIR FETUS AND IT MIGHT BE TOO
LATE FOR THAT FETUS, THE PARENT
MIGHT BE SAVED, AND THEY MIGHT
BE ABLE TO OBVIOUSLY RECOVER
FROM THAT, BUT IT MIGHT BE TOO
LATE FOR THE BABY. AND THAT'S
WHY WE WANTED TO FOCUS ON THAT
ASPECT. AND CONGENITAL SYPHILIS
ITSELF HAS INCREASED 1,500. AND
AGAIN, STRESSING THIS IS A
DISEASE FROM LIKE THE MEDIEVAL
TIMES, AND THAT WE HAVE SO MUCH
MEDICINE TO TREAT THAT. BUT THIS
IS ON THE RISE WITH SO MANY
OTHER DISEASES. AND I BELIEVE
THAT A ROBUST SYSTEM OF TESTING
THAT CAN BE REALLY UNIVERSAL AS
BEST AS POSSIBLE IS THE BEST WAY
TO DECREASE THAT STIGMA. NOW, WE
ALL LIVE THROUGH A PUBLIC HEALTH
CRISIS WHERE WE EASILY WERE ABLE
TO SPREAD COVID TO EACH OTHER
BECAUSE SIMPLY, WE THOUGHT WE
DID NOT HAVE IT AS WELL. AND SO
I'M REALLY COMMITTED TO CONTINUE
WORKING THIS BILL. I THINK WE
CAN WORK ON LEGISLATION TO
DOCTOR WEBBER'S POINT ABOUT
NARROWING IT TO SEXUALLY ACTIVE
INDIVIDUALS IF THAT IS MORE
APPROPRIATE. BUT WE REALLY DO
NEED TO ADDRESS THIS ALARMING
RISE IN SYPHILIS AND MAKE SURE
THAT IT IS NOT PASSED
UNWITTINGLY ONTO A BABY WHO
MIGHT HAVE VERY FEW OPTIONS, BUT
RESPECTFULLY ASK FOR YOUR AYE
VOTE TODAY, AND I APPRECIATE ALL
THE COMMENTS TODAY IN THE
COMMITTEE. I JUST ALSO WANT TO
HIGHLIGHT YOU TRIGGERED ANOTHER
THOUGHT IN YOUR CLOTHES, THE
COMMENT THAT, DOCTOR WEBER MADE
ABOUT ENSURING THAT WE'RE NOT
PUTTING INTO STATUTE A
PARTICULAR TYPE OF TREATMENT, I
THINK IS VERY WELL TAKEN AND
NEEDS TO BE REVIEWED AS WELL. IN
YOUR, AS YOU CONTINUE, SHOULD
YOU GET OUT OF THIS COMMITTEE?
DULY NOTED. THANK YOU, MADAM
CHAIR. THANK YOU. WITH THAT, THE
, DO WE HAVE A MOTION? MOVED MY
BY SHIAVO, SECONDED BY JOHN
SAWYER. THE MOTION IS DUE. PASS
AS AMENDED. JUST DO PASS TO
APPROPRIATIONS. PLEASE CALL THE
ROLL ONTO AYE. ONTO AYE. WALDRON
WALDRON NOT VOTING. HAGER. CURRY
HAGER. CURRY. NOT VOTING.
ARAMBULA WENDY. CARILLO. WENDY.
CARILLO NOT VOTING. FLORA
HAYNIE, JOHN. SAWYER, JOHN.
SAWYER. AYE. MAIENSCHEIN
MCCARTY. JOE. PATTERSON SANCHEZ.
SANTIAGO. SABO CHAU. VÚI WEBER.
WEBER. NO. THAT MOTION IS ON.
CALL IT NEEDS FIVE MORE VOTES.
MR. GIBSON, ITEM NUMBER 20, AB
2775.
MOVED BY WALDRON. SECONDED BY
DOCTOR WEBER. THANK YOU VERY
MUCH. YOU KNOW WHAT THAT MEANS?
I ABSOLUTELY DO KNOW WHAT THAT
MEANS. THANK YOU VERY MUCH FOR
ALLOWING ME TO PRESENT ASSEMBLY
BILL 2775, WHICH SEEKS TO
CLARIFY THE EMSA'S AUTHORITY TO
DEVELOP GUIDELINES SURROUNDING
TELEMEDICINE WITH ME TO PROVIDE
SUPPORTING TESTIMONY, IS DOUG
SCHUBERT, A REPRESENTATIVE FROM
THE CALIFORNIA PROFESSIONAL
FIREFIGHTERS AND ALSO TIM
MADDEN, REPRESENTING THE
CALIFORNIA EMERGENCY ROOM
PHYSICIANS. THANK YOU, CHAIR AND
MEMBERS, TIM MADDEN REPRESENTING
THE CALIFORNIA CHAPTER OF THE
AMERICAN COLLEGE OF EMERGENCY
PHYSICIANS, CO-SPONSOR OF HB
2775. MAKE THIS BRIEF AS
MENTIONED, AB 2775 CONTINUES TO
BUILD ON CALIFORNIA'S COMMITMENT
TO PROVIDING SAFE, HIGH QUALITY
COMMUNITY PARAMEDICS AND
SERVICES BY CLARIFYING THE
EMERGENCY MEDICAL SERVICE
AUTHORITY'S AUTHORITY TO DEVELOP
GUIDELINES SURROUNDING
TELEMEDICINE, INCLUDING
CONSIDERING DATA COLLECTION
SYSTEMS USED IN COMMUNITY
PARAMEDICINE. WITH THESE
GUIDELINES IN PLACE, THE
UTILIZATION OF TELEMEDICINE
WOULD OPERATE UNDER CONSISTENT
GUIDANCE ACROSS SYSTEMS.
IMPROVING ACCESS TO CARE. FOR
THESE REASONS, WE RESPECTFULLY
ASK FOR YOUR VOTE. THANK YOU,
MADAM CHAIR. MEMBERS DOUG
SIEVERS, ON BEHALF OF THE
CALIFORNIA PROFESSIONAL
FIREFIGHTERS, PLEASED TO BE HERE
AS A CO-SPONSOR OF AB 2775. I'D
LIKE TO THANK MR. GIBSON FOR HIS
LEADERSHIP ON THESE ISSUES. CPF
IS PROUD TO HAVE WORKED ON
INNOVATION IN THE PRE-HOSPITAL
CARE SPACE THAT TRIES TO CONNECT
PATIENTS WITH THE RIGHT CARE AT
THE RIGHT TIME. WE THINK AS LONG
AS WE ARE, WE'D LIKE TO CONTINUE
TO WORK ON INNOVATION IN THIS
SPACE. BUT INNOVATION THAT IS
PATIENT CENTERED. AND FOR THOSE
REASONS, WE WOULD ASK FOR YOUR
VOTE. THANK YOU, THANK YOU. ANY
OTHER WITNESSES IN SUPPORT?
ELAINE BACHELOR, MLK COMMUNITY
HEALTH CARE IN SUPPORT. ANY
WITNESSES IN OPPOSITION? SEEING
NONE, I'LL BRING IT BACK TO THE
COMMITTEE FOR COMMENT OR
QUESTION. MR. GIBSON, YOU MAY
CLOSE RESPECTFULLY ASK FOR AN
AYE VOTE. THANK YOU, THANK YOU.
CAN I HAVE A MOTION FOR THIS
BILL, OR DID WE DO THAT ALREADY?
SO SORRY. WITH THAT. THANK YOU,
MR. GIBSON, FOR BRINGING FORWARD
THIS, VERY IMPORTANT BILL FOR US
AND SECRETARY, PLEASE CALL THE
ROLL. THE MOTION IS DUE. PASS TO
APPROPRIATIONS ONTO. AYE. ONTO
AYE. WALDRON WALDRON. AYE. AGAR.
AGAR. CURRY. AYE ARAMBULA.
WENDY. CARILLO. WENDY. CARILLO.
AYE. FLORA HANEY. CHEN. SAWYER.
AYE. JOHN. SAWYER. AYE.
MAIENSCHEIN MCCARTY. JOE.
PATTERSON. RODRIGUEZ. SANCHEZ
SANTIAGO. CHAVO WEBBER. WEBER.
AYE. THAT MEASURES. UNCLE NEEDS
THREE MORE VOTES. THANK YOU FOR
YOUR PATIENCE, MR. GIBSON. WE
WILL MOVE ON TO ITEM NUMBER 23,
AB 2956. BURNER.
GOOD AFTERNOON. CHAIR. MEMBERS.
THANK YOU FOR THE CHAIR AND THE
COMMITTEE STAFF FOR WORKING WITH
US ON THIS BILL. I WANT TO START
BY ACCEPTING THE COMMITTEE'S
AMENDMENTS. AB 2956 WOULD ADOPT
A 12 MONTH CONTINUOUS
ELIGIBILITY FOR ADULTS AND
PRESERVE FEDERAL FLEXIBILITIES
TO MEDI-CAL TO PREVENT
PROCEDURAL DISENROLLMENTS
HUNDREDS OF THOUSANDS OF
CALIFORNIANS ARE EXPERIENCING
GAPS IN THEIR HEALTH CARE DUE TO
MEDI-CAL. CURRENT DISENROLLMENT
PROCESS. THIS IS REALLY
UNACCEPTABLE. DURING THE
PANDEMIC, CALIFORNIA STEPPED UP
BY ADOPTING MANY FEDERAL
FLEXIBILITIES TO REMOVE
UNNECESSARY BARRIERS TO MAKE
SURE PEOPLE ON MEDI-CAL WERE
COVERED. IT HAD A POSITIVE
EFFECT ON OUR HEALTH CARE
SYSTEM, RELIEVING ADMINISTRATIVE
COSTS AND TIME. SINCE THE PUBLIC
HEALTH EMERGENCY WAS LIFTED,
OVER A MILLION CALIFORNIANS HAVE
BEEN LOSING ACCESS TO MEDICAL
COVERAGE IN THE FIRST SIX MONTHS
FOLLOWING THE UNWINDING PERIOD.
I KNOW WE'RE NAVIGATING AN
INCREDIBLY DIFFICULT BUDGET
YEAR, BUT WE SHOULD NOT HAVE TO
WAIT FOR ANOTHER PUBLIC HEALTH
EMERGENCY TO FIX OUR CURRENT
MEDI-CAL ENROLLMENT PROCESS.
CALIFORNIA HAS THE HIGHEST
DISENROLLMENT RATE AT 92% OVER
SIMPLE CLERICAL ERRORS,
ACCORDING TO THE CALIFORNIA
DEPARTMENT OF HEALTH CARE
SERVICES, 20,000 200,000
CALIFORNIANS WERE DROPPED FROM
MEDI-CAL IN SEPTEMBER 2023 FOR
LACKING NECESSARY PAPERWORK TO
SUBMIT, BEING STILL BEING
ELIGIBLE FOR COVERAGE. THESE ARE
FAMILIES WHO CANNOT GO TO THE
DOCTOR FOR CHECKUPS AND HEALTH
SERVICES. SIMPLY FOR A TYPO OR
LACKING A PIECE OF PAPER.
CALIFORNIA NEEDS THIS BILL
BECAUSE WE SHOULDN'T HAVE TO
WAIT FOR ANOTHER PUBLIC HEALTH
EMERGENCY TO MAKE SURE PEOPLE
ARE COVERED BY MEDI-CAL. WE
SHOULD DO IT NOW. WE SHOULD. I
RESPECTFULLY ASK FOR AYE VOTE
AND I HAVE HERE WITH ME WHITNEY
FRANCIS WITH THE WESTERN CENTER
ON LAW AND POVERTY AND PAOLA
ILLESCAS WITH THE LATINO
COALITION FOR A HEALTHY
CALIFORNIA. TWO CO-SPONSORS OF
THIS BILL. AGUIAR-CURRY MOVES
THE BILL. SECONDED BY CARRILLO.
THANK YOU, YOU'LL EACH HAVE TWO
MINUTES. GOOD AFTERNOON, CHAIR,
AND MEMBERS OF THE COMMITTEE.
THANK YOU. I'M PAOLA LASKA,
SENIOR PROGRAM MANAGER WITH
LATINO COALITION FOR A HEALTHY
CALIFORNIA. OUR MISSION IS TO
ADVANCE AND PROTECT LATINO
HEALTH THROUGH POLICY AND
ADVOCACY TO BUILD HEALTHY
COMMUNITIES IN CALIFORNIA. AND
THIS IS INCLUDING THROUGH OUR
PROGRAM, WHERE OUR STATEWIDE
NETWORK OF PROMOTORAS COORDINATE
COMMUNITY CONVERSATIONS IN EIGHT
DIFFERENT REGIONS ACROSS
CALIFORNIA, INCLUDING SAN DIEGO,
LOS ANGELES, CENTRAL COAST,
CENTRAL VALLEY, BAY AREA, AND
SACRAMENTO. OUR PROMOTORAS
PROVIDE UP TO DATE HEALTH
INFORMATION TO COMMUNITIES
ACROSS THE STATE IN A CULTURALLY
INFORMED AND LINGUISTICALLY
COMPONENT. WAYS ON IMPORTANT
UPDATES REGARDING I-10 AND
MEDI-CAL. MEDI-CAL PROGRAM IS A
SAFETY NET PROGRAM THAT PROVIDES
HEALTH CARE ACROSS ACCESS TO
MILLIONS OF LOW INCOME
CALIFORNIANS. UNFORTUNATELY,
SINCE THE UNWINDING PROCESS
BEGAN LAST YEAR, THE
DISENROLLMENTS RACE OF LATINO
COMMUNITIES HAVE BEEN AVERAGING
NEARLY 50% ON A MONTHLY BASIS,
AND THE MAJORITY ARE NON-ENGLISH
SPEAKING POPULATIONS. THE
REALITY OF THIS IS SHOCKING.
WE'VE HEARD IN SAN DIEGO WOMEN
THAT THEY HAVE SHARED THAT THEY
HAVE HAD TO ENDURE PAIN FOR
WEEKS BECAUSE THEY HAVE BEEN
UNABLE TO SEE THEIR OB GYN DUE
TO BEING SUDDENLY DISENROLLED IN
MEDI-CAL IN ORANGE COUNTY,
PEOPLE WITH ASTHMATIC CONDITIONS
ARE LOOKING FOR ALTERNATIVES TO
THE USUAL MEDICATIONS, WHICH ARE
THOUSANDS OF DOLLARS, AND WHILE
THEY'RE WAITING TO BE
REDETERMINED ELIGIBLE AND IN
CENTRAL COAST, MANY MESOAMERICAN
INDIGENOUS COMMUNITIES CANNOT
FIND HELP IN THEIR LANGUAGE. THE
SYSTEM TO NAVIGATE MEDI-CAL
ENROLLMENT IS ALREADY DIFFICULT
IN THE DISENROLLMENT PROCESS IS
ONLY ANOTHER BARRIER. THE AB
2956 HAS SOLUTIONS TO EASE THIS
CRISIS AND DIMINISH
INTERRUPTIONS AND CONTINUITY OF
CARE. HEALTH CARE SERVICES ARE
CRUCIAL TO ONE'S LIFE, AND ANY
DISRUPTION THREATENS WELL-BEING.
BY ENACTING 29 AB 2956, IT
ENSURES PEOPLE WHO ARE STILL
ELIGIBLE FOR MEDI-CAL ARE NOT
WRONGFULLY TERMINATED. I
RESPECTFULLY ASK FOR YOUR AYE.
VOTE FOR AB 2956. THANK YOU.
GOOD AFTERNOON, CHAIR AND
MEMBERS WHITNEY FRANCIS WITH THE
WESTERN CENTER ON LAW AND
POVERTY, PROUD CO-SPONSOR OF AB
2956, WHICH WOULD ENSURE
MEDI-CAL MEMBERS KEEP THEIR
HEALTH CARE COVERAGE BY ADOPTING
A 12 MONTH CONTINUOUS
ELIGIBILITY FOR ADULTS AND
MAKING CURRENT FEDERAL UNWINDING
FLEXIBILITIES PERMANENT. EACH
MONTH, TENS OF THOUSANDS OF LOW
INCOME CALIFORNIANS ARE BEING
CUT FROM THEIR MEDI-CAL
BENEFITS, EVEN WHEN THEY ARE
LIKELY STILL ELIGIBLE FOR
MEDI-CAL. OVER 80% OF MEDI-CAL
DISENROLLMENTS ARE FOR
PROCEDURAL REASONS, MEANING
PEOPLE ARE BEING DISENROLLED FOR
MISSING PAPERWORK RATHER THAN
BEING DISENROLLED BECAUSE THE
COUNTY FOUND THEM INELIGIBLE.
PROCEDURAL DISENROLLMENTS IN
MEDI-CAL RESULT IN ELIGIBLE,
ELIGIBLE PEOPLE CYCLING ON AND
OFF THE PROGRAM. THIS RESULTS IN
GAPS IN HEALTH CARE COVERAGE AND
CAN LEAD TO DELAYS IN CARE,
INCLUDING POSTPONED DOCTOR'S
VISITS OR MISSED PRESCRIPTION
REFILLS. ENROLLEES OF COLOR,
PARTICULARLY LATINA ENROLLEES,
ARE DISPROPORTIONATELY
DISENROLLED DUE TO PROCEDURAL
BARRIERS, MAKING AB 2596A MATTER
OF HEALTH EQUITY. WHILE MANY
MEDI-CAL MEMBERS CONTINUE TO
LOSE COVERAGE, EACH MONTH,
FEDERAL FLEXIBILITIES HAVE
INCREASED AUTOMATIC RENEWALS AND
REDUCED PROCEDURAL
DISENROLLMENTS. THE FEDERAL
UNWINDING FLEXIBILITIES ARE
SCHEDULED TO EXPIRE AT THE END
OF THIS YEAR. IF WE LET THESE
FLEXIBILITIES EXPIRE, IT WILL BE
MORE DIFFICULT TO BRING THEM
BACK AND THE GAINS IN AUTOMATIC
RENEWALS WILL BE LOST. THIS BILL
WOULD ENSURE THAT CALIFORNIANS
CAN KEEP THEIR MEDI-CAL COVERAGE
WITHOUT BURDENSOME
ADMINISTRATIVE BARRIERS. THIS
BILL WOULD ALSO CONTINUE
IMPROVEMENTS TO COUNTY WORKFLOWS
AND REDUCE WORKLOADS FOR RENEWAL
PROCESSING. THIS BILL HAS NO
OPPOSITION. WE URGE YOUR AYE
VOTE TO SAFEGUARD MEDI-CAL
COVERAGE FOR CALIFORNIANS. THANK
YOU, THANK YOU. ARE THERE OTHER
WITNESSES IN SUPPORT? DYLAN
ELLIOTT, ON BEHALF OF THE
CALIFORNIA STATE ASSOCIATION OF
PSYCHIATRISTS IN SUPPORT, THANK
YOU. ANGELA VASQUEZ WITH THE
CHILDREN'S PARTNERSHIP
CO-SPONSOR AND STRONG SUPPORT.
THANK YOU. MARK FAROOQ,
CALIFORNIA HOSPITAL ASSOCIATION
IN SUPPORT. AARON TAYLOR, ON
BEHALF OF THE CALIFORNIA DENTAL
ASSOCIATION AND SUPPORT.
SYMPHONY BARBIE ON BEHALF OF
PLANNED PARENTHOOD AFFILIATES OF
CALIFORNIA IN SUPPORT. KELLY
BURKS, ON BEHALF OF THE SANTA
CLARA COUNTY BOARD OF
SUPERVISORS IN SUPPORT. HI.
DARBY KERNAN ON BEHALF OF THE
LOCAL HEALTH PLANS OF CALIFORNIA
AND LEADINGAGE, CALIFORNIA, IN
SUPPORT. KIM LEWIS, ON BEHALF OF
THE CALIFORNIA COALITION FOR
YOUTH AND CHILDREN, NOW IN
SUPPORT. CHRISTINE SMITH,
HEALTH, ACCESS AND SUPPORT.
MARVELOUS. WITH THE LATINO
COALITION FOR A HEALTHY
CALIFORNIA CO-SPONSOR AND STRONG
SUPPORT. ON YOUR MOBILE WITH
BLACK WOMEN FOR WELLNESS ACTION
PROJECT IN SUPPORT. MATT LACY
WITH SEIU CALIFORNIA IN SUPPORT.
TIM MADDEN REPRESENT THE
CALIFORNIA CHAPTER OF THE
AMERICAN COLLEGE OF EMERGENCY
PHYSICIANS IN SUPPORT. THANK
YOU. ANY WITNESSES IN OPPOSITION
? SEEING NONE, I WILL BRING IT
BACK TO THE COMMITTEE FOR
COMMENT OR QUESTION. I WANT TO
THANK THE AUTHOR FOR BRINGING
FORWARD THIS BILL, I THINK,
NOTHING GOOD CAME OUT OF COVID.
NOTHING BUT THE REALITY THAT IT
HIGHLIGHTED AN OPPORTUNITY FOR
US TO BE ABLE TO, CREATE SOME
FLEXIBILITIES IN OUR ONGOING
COVERAGE OF CARE SO THAT PEOPLE
WOULDN'T GET LOST. I REALLY
APPRECIATE THE WITNESSES IN YOUR
TESTIMONY EXPRESSING THAT, IS
ONE THING THAT WE CAN AT LEAST
HAVE SOME SOLVE AROUND. SO I
WANT TO THANK THE AUTHOR FOR
BRINGING FORWARD THIS VERY
THOUGHTFUL BILL AND KIND OF
FINDING THE SWEET SPOT OF HOPE,
WITHIN OUR MEDI-CAL ENROLLMENT
SYSTEM TODAY, IF IT'S IF YOU'RE
OPEN TO IT, I WOULD LOVE TO BE
ADDED AS A COAUTHOR, WITH THAT,
I THINK WE HAVE A MOTION AND A
SECOND AND ASK THE SECRETARY TO
CALL THE ROLL Ó WOULD YOU LIKE
TO CLOSE? I WOULD LOVE TO ADD
YOU AS A COAUTHOR AND
RESPECTFULLY ASK FOR YOUR AYE
VOTE. THANK YOU. IT'S Dð PASS,
AS AMENDED, TO APPROPRIATIONS TO
I TO I, WALDRON WALDEN I
AGUIAR-CURRY AGUIAR-CURRY I
ARAMBULA WENDY CARILLO WENDY
CARILLO I LARA HANEY. JOAN
SAWYER. JOAN SAWYER I
MAIENSCHEIN MCCARTY. JO.
PATTERSON. RODRIGUEZ. SANCHEZ
SANTIAGO. CHAVO WEBBER. THAT
MEASURES ON CALL. IT NEEDS FOUR
MORE VOTES. THANK YOU. WE WILL
MOVE ON TO ITEM 30, AB 3275.
SORIA.
WALDRON MOVES. JOAN SAWYER
SECONDS. PLEASE GO AHEAD. PUT
YOUR MIC ON. THANK YOU. CHAIR
AND MEMBERS. THANK YOU FOR THE
OPPORTUNITY TO PRESENT THIS
BILL. I WANT TO TAKE THE TIME TO
THANK THE CHAIR AND HER STAFF
FOR WORKING ON THIS BILL. I ALSO
ACCEPT THE COMMITTEE AMENDMENTS
NOTED IN THE ANALYSIS AS, THE
SPEAKER AND I INTRODUCED THIS
BILL BECAUSE WE KNOW THAT MANY
SMALL AND RURAL HOSPITALS ARE
DESPERATE TO BE PAID ON TIME FOR
THE SERVICES THEY PROVIDE TO
PATIENTS. OFTEN THESE THESE
HOSPITALS ARE THE SAFETY NET
PROVIDERS OR THE PROVIDERS OF
LAST RESORT IN MANY STRUGGLING
RURAL COMMUNITIES IN CALIFORNIA,
NINE RURAL HOSPITALS HAVE CLOSED
SINCE 2005, AND 16 HOSPITALS ARE
CURRENTLY AT RISK OF CLOSING.
FINANCIAL DISTRESS IS THE MAIN
REASON FOR THESE CLOSED OR AT
RISK HOSPITALS. TO THESE
PROVIDERS. IN THE BATTLE TO
REMAIN OPEN, EVERY PENNY COUNTS.
AB 3275 IS A NARROW BILL THAT
WILL THAT SHORTENS THE EXISTING
TIME FRAME FOR HEALTH PLANS TO
PAY CLEAN AND UNCONTESTED CLAIMS
SUBMITTED BY SMALL AND RURAL
CRITICAL ACCESS AND DISTRESSED
PROVIDERS TO TEN BUSINESS DAYS
IN CALIFORNIA, THERE ARE 37
CRITICAL ACCESS HOSPITALS, 16
DISTRESSED HOSPITALS AND ABOUT
25 TO 30 THAT ARE LIKELY TO
QUALIFY UNDER THE SMALL AND
RURAL DEFINITION. WE'RE ALSO
ASKING DEPARTMENT OF MANAGE
HEALTH CARE TO COME UP WITH A
LIST OF SERVICES TO BE PAID IN
FIVE DAYS AFTER RECEIPT OF A
CLAIM, AS LONG AS THE PROVIDER
CAN DOCUMENT THAT CARE WAS
PROVIDED. CURRENT LAW REQUIRES
HEALTH PLANS TO PAY PROVIDERS
UNCONTESTED CLAIMS WITHIN 30 OR
45 DAYS. HOWEVER SOME HEALTH
PLANS ARE NOT MEETING THIS LEGAL
OBLIGATION. MEMBERS AS YOU MAY
BE AWARE, MADERA COMMUNITY
HOSPITAL IN MY DISTRICT WAS
FORCED TO CLOSE ITS DOORS IN
DECEMBER OF 2022 AFTER PROVIDING
HEALTH CARE SERVICES TO THE
COMMUNITY FOR OVER 50 YEARS. THE
IMPACT TO THE COMMUNITY HAS BEEN
DEVASTATING IN THE SPEAKER'S
DISTRICT. HIS DISTRESSED
HOSPITAL HAD $4 MILLION IN
OUTSTANDING CLAIMS AGAINST A
HEALTH PLAN FROM AUGUST TO
DECEMBER OF 2022. THESE
PRACTICES ARE SIMPLY NOT
SUSTAINABLE, AND I BELIEVE THE
TIMELINES IN THIS BILL WILL
MUTUALLY BE BENEFICIAL TO BOTH
PARTIES, SMALL AND RURAL
PROVIDERS TO SUBMIT COMPLETED
CLAIMS AND HEALTH PLANS TO PAY
THESE CLAIMS SOONER. WITH ME
TODAY TO TESTIFY IN SUPPORT OF
AB 3275 IS KAREN PEARL PELL
PERELINI, CEO OF MADERA
COMMUNITY HOSPITAL. AND THEN WE
ALSO HAVE DOCTOR ELAINE,
BACHELOR OF CEO MARTIN LUTHER
KING JUNIOR COMMUNITY HOSPITAL
IN LOS ANGELES. GO AHEAD AND PUT
YOUR MIC ON. THANK YOU. GOOD
AFTERNOON, CHAIR MEMBERS. THANK
YOU FOR ALLOWING ME TO SPEAK
HERE TODAY. AND SPECIAL THANKS
TO ASSEMBLY WOMAN SORIA FOR
AUTHORIZING AUTHOR AUTHORING
THIS BILL. MY NAME AGAIN IS
KAREN PAOLINELLI. I AM THE CEO
FOR MADERA COMMUNITY HOSPITAL.
AS MANY OF YOU ALREADY KNOW,
THAT MADERA COMMUNITY HOSPITAL
CLOSED ITS DOORS BACK IN 20TH
DECEMBER OF 2022. HISTORICALLY,
MADERA HOSPITAL HAD BEEN IN
OPERATIONS FOR 51 YEARS, AND
ALTHOUGH WE SURVIVED AS AN
INDEPENDENT HOSPITAL FOR 51
YEARS, IT WAS NOT WITHOUT
CHALLENGES. AND WHEN COVID CAME
AROUND IN 2020, IT TOOK A TOLL
ON THE HOSPITAL'S FINANCIALS.
TODAY, I'M GOING TO FOCUS ON THE
FINANCIAL CHALLENGES MADERA
FACED IN REGARDS TO LOW
REIMBURSEMENT AND TIMELINESS OF
PAYMENTS. SORRY ABOUT THAT.
LET'S SEE ONE OF THE MOST
CRITICAL CHALLENGES MADERA FACED
PRIOR TO OUR CLOSURE OF THE
HOSPITAL WAS THE ONGOING ISSUES
WITH THE REIMBURSEMENT OF HEALTH
CARE CLAIMS. OUR OUR LARGER
LARGEST PAYERS WERE HMO,
MEDI-CAL, MEDICARE AND HMO,
MEDICARE ADVANTAGE PLANS. MADERA
HAD A HUGE PROBLEM WITH TIMELY
PAYMENTS. IN SOME CASES, IT
WOULD TAKE UP TO SIX MONTHS FOR
US TO GET PAID AND EVEN WHEN WE
DID FINALLY GET REIMBURSEMENT,
THE OVERHEAD REQUIRED FOR THE
PATIENTS TO HAVE A SERVICE AND
THE HOSPITAL TO GET PAID WAS
VERY COSTLY. THE REIMBURSEMENT
TO HOSPITALS BY PAYERS WAS NOT
ADEQUATE TO COVER THE COST OF
SERVICES THAT WE WERE PROVIDING.
OUR HOSPITAL, LIKE MANY OTHER
HOSPITALS, USES PRIMARY
PRIMARILY USES AN ELECTRONIC
BILLING SYSTEM, AND ONE MIGHT
ASSUME THAT A CLEAN BILL WITHOUT
ANY ERRORS WOULD
STRAIGHTFORWARDLY RESULT IN A
TIMELY PAYMENT. UNFORTUNATELY,
THIS IS FAR FROM REALITY.
HISTORICALLY, EVEN WITH CLEAN
SUBMISSIONS, AT LEAST 30% OF OUR
BILLING CLAIMS REQUIRED AN
ADDITIONAL SOME ADDITIONAL
ATTENTION AND MANAGEMENT MANUAL
INTERVENTION BY OUR STAFF. THIS
INEFFICIENCY IN THE BILLING
PROCESS NOT ONLY STRAINED OUR
ADMINISTRATIVE RESOURCES, BUT IT
ALSO DELAYED THE FLOW OF CRUCIAL
FUNDS NECESSARY TO OUR
OPERATIONS. WHEN A HOSPITAL GETS
A DENIAL, IT IS COSTLY FOR THE
HOSPITAL. IT TAKES A HIGHLY PAID
RN PHYSICIAN. IN SOME CASES AN
ATTORNEY, TO ASSIST A HOSPITAL
IN WRITING AN APPEAL. THIS CAN
PRESENT A POTENTIAL SIGNIFICANT
FINANCIAL LOSS OF TENS OF
THOUSANDS OF DOLLARS TO THE
HOSPITAL. ANOTHER COMMON
PRACTICE OF PAYERS IS RETRACTING
PAYMENTS, WHICH IS A PROCESS
WHERE AN INSURANCE COMPANY
REQUESTS AND REVIEWS MEDICAL
RECORDS. OKAY. I'M SORRY, CAN I
CAN I JUST GET A COUPLE 30S MORE
? AS YOU CAN SEE, OKAY. LET ME
TRY. THERE'S I JUST WANT TO SAY
I WANT TO SAY THAT I WANT THIS
COMMITTEE TO UNDERSTAND THAT
MADERA COMMUNITY HOSPITAL
SUFFERED GREATLY OVER THE YEARS
DUE TO INADEQUATE REIMBURSEMENT,
DELAYS IN PAYMENT OR PAYER
INEFFICIENCIES, AND A TELLING
EXAMPLE OF THE CONSEQUENCES OF
THESE INADEQUATE REIMBURSEMENTS
SEEN IN THE RECENT WAS SEEN IN
THE RECENT CLOSURE OF MADERA
COMMUNITY HOSPITAL, AND
STRUGGLES OF HOSPITALS THAT
SERVE A HIGH PERCENTAGE OF
MEDI-CAL PAYMENTS. MADERA THANK
YOU SO MUCH. WE'RE PAST OUR TWO
MINUTE MARK. APPRECIATE IT.
WE'RE GONNA, ARE THERE ANY OTHER
WITNESSES IN SUPPORT, GOOD
AFTERNOON. I'M DOCTOR ELAINE
BATCHELOR, CEO OF MLK COMMUNITY
HOSPITAL AND HEALTH SYSTEM.
THANK YOU FOR GIVING ME THE
OPPORTUNITY TO SPEAK IN SUPPORT
OF AB 3275. MLK COMMUNITY
HOSPITAL IS A PRIVATE HOSPITAL
SERVING A PUBLIC MISSION. WE
WERE CREATED TO SERVE THE
HISTORICALLY UNDERSERVED
COMMUNITY OF SOUTH LOS ANGELES.
FOLLOWING THE CLOSURE OF KING
DREW MEDICAL CENTER, BUILT AS A
RESPONSE TO THE 1960 FIVE WATTS
RIOTS. WE OPERATE TODAY WITH A
FIVE STAR QUALITY RATING FROM
THE CENTER FOR MEDICARE AND
MEDICAID SERVICES AND AN A
RATING FOR PATIENT SAFETY. OUR
HOSPITAL'S PATIENT POPULATION IS
60% LATINO AND 40%
AFRICAN-AMERICAN, AND 96% OF OUR
PATIENTS ARE PUBLICLY INSURED OR
UNINSURED. BECAUSE WE ARE
UNDERPAID FOR THESE PATIENTS.
OUR HOSPITAL IS IN SERIOUS
FINANCIAL DISTRESS PAYMENT
PRACTICES OF MANAGED CARE PLANS,
FROM DELAYED AUTHORIZATIONS TO
DENIAL OF CLAIMS TO DELAYS IN
CLAIMS PAYMENT, EXACERBATE OUR
FINANCIAL CHALLENGES. IN 2022,
WE LOST 23,000,020 23 WE LOST 41
MILLION, AND WE COULD LOSE $26
MILLION. THIS FISCAL YEAR, WE
RECEIVED A DISTRESSED HOSPITAL
LOAN PAYMENT TO HELP US KEEP OUR
HOSPITAL OPEN. THROUGH THIS
WINTER, I WANT TO EMPHASIZE TO
THE COMMITTEE THAT EXPEDITING
PAYMENTS FROM HEALTH PLANS WOULD
SUPPORT US FINANCIALLY AND IS A
STEP IN THE RIGHT DIRECTION. AND
FOR THAT REASON, WE ARE PLEASED
TO SUPPORT AB 3275. THANK YOU,
THANK YOU. ADDITIONAL WITNESSES
IN SUPPORT. GOOD AFTERNOON,
MADAM CHAIR, AND MEMBERS. CONNIE
DELGADO, ON BEHALF OF THE
DISTRICT HOSPITAL LEADERSHIP
FORUM IN SUPPORT. TIM MADDEN,
REPRESENTING THE CALIFORNIA
CHAPTER OF THE AMERICAN COLLEGE
OF EMERGENCY PHYSICIANS IN
SUPPORT. DYLAN ELLIOTT, ON
BEHALF OF THE CALIFORNIA MEDICAL
ASSOCIATION IN SUPPORT. THANK
YOU. PAT WAYLAND ELLISON WILSON
ADVOCACY HERE ON BEHALF OF
EUNUCH UNIONS, HEALTH CARE
PROFESSIONALS IN SUPPORT. MARK
FAROOQ, ON BEHALF OF THE
CALIFORNIA HOSPITAL ASSOCIATION
IN SUPPORT THE SET SHORT ON
BEHALF OF ADVENTIST HEALTH AND
SUPPORT. GOOD AFTERNOON, BETH
MALINOWSKI WITH SEIU CALIFORNIA
IN SUPPORT. GOOD AFTERNOON,
STEVE STARK, ON BEHALF OF
AMERICAN ADVANCED MANAGEMENT
INCORPORATED IN SUPPORT. ARE
THERE ANY WITNESSES IN
OPPOSITION?
YOU'LL HAVE TWO MINUTES EACH.
THANK YOU. GOOD AFTERNOON, MADAM
CHAIR. MEMBERS OF THE COMMITTEE,
JED HAMPTON WITH CALIFORNIA
ASSOCIATION HEALTH PLANS HERE.
REGRETTABLY, IN OPPOSITION TO AB
3275. I WOULD LIKE TO THANK THE
AUTHOR AND HER STAFF, AS WELL AS
THE COMMITTEE, FOR ENGAGING WITH
US ON THIS BILL. I WANT TO START
BY SAYING THAT HEALTH PLANS HAVE
A VESTED INTEREST IN MAKING SURE
HOSPITALS STAY OPERATIONAL SO
THEY CAN CONTINUE TO PROVIDE THE
QUALITY CARE TO ALL OF PATIENTS
THAT WE SERVE. HEALTH PLANS HAVE
AND WILL CONTINUE TO DO OUR PART
TO HELP OUT EVEN THE MOST
DISTRESSED HOSPITALS. ONE
SPECIFIC WAY HEALTH PLANS HAVE
DONE THIS IS BY ESTABLISHING
CONTRACTUAL RELATIONSHIPS WITH
HOSPITALS TO SERVE OUR ENROLLEES
WHEN THEY NEED THESE VITAL
SERVICES, CALIFORNIA HOSPITALS
RECEIVE BILLIONS OF DOLLARS
EVERY MONTH FROM HEALTH PLANS,
REGARDLESS OF PATIENT VOLUME,
THROUGH CAPITATED ARRANGEMENTS.
THE ARRANGEMENTS ARE VOLUNTARY
CONTRACTS WHERE THE HEALTH PLAN
MAKES PERIODIC PAYMENTS TO
PROVIDERS. THESE PAYMENTS ARE
NOT TIED TO PATIENT VOLUME AND
PROVIDE AN IMPORTANT FUNDING
SOURCE FOR KEEPING HOSPITALS
OPERATING. ADDITIONALLY, HEALTH
PLANS ALSO RECENTLY SUPPORTED
THE REAUTHORIZED VERSION OF THE
MANAGED CARE ORGANIZATION TAX, A
TAX THAT FALLS DIRECTLY ON OUR
MEMBERS, TO IMPROVE THE MEDI-CAL
PROGRAM THROUGH A VARIETY OF
RATE INCREASES FOR MEDI-CAL
PROVIDERS. THE DISTRESSED
HOSPITAL LOAN PROGRAM, WHICH
PROVIDES RELIEF WITH INTEREST
FREE LOANS TO NOT FOR PROFIT AND
PUBLIC HOSPITALS, RECEIVED $150
MILLION OF THIS MONEY. IN
ADDITION TO THE $300 MILLION IN
GENERAL FUND SPENDING THAT THAT
THEY HAD ALREADY RECEIVED
THROUGH THE GENERAL FUND. SO
REGRETTABLY, AB 3275, FROM OUR
PERSPECTIVE, IGNORES ALL OF THE
WORK THE CALIFORNIA HEALTH PLANS
HAVE DONE TO HELP OUT THESE
FINANCIALLY DISTRESSED
HOSPITALS, AND INSTEAD PROPOSES
A SERIES OF MEASURES THAT WE
BELIEVE WILL NOT SOLVE THE
PROBLEM THAT THIS BILL IS
INTENDING TO SOLVE, SPECIFICALLY
, AB 3275 REDUCES DRAMATICALLY
THE AMOUNT OF TIME THE HEALTH
PLANS HAVE TO ADJUDICATE AND PAY
CLAIMS. DESPITE THE ROBUST
REGULATORY FRAMEWORK THAT IS
ALREADY IN PLACE AROUND TIMELY
PAYMENT OF HOSPITALS, HEALTH
PLANS ALREADY HAVE A SPECIFIED
AMOUNT OF TIME TO REIMBURSE
PROVIDERS, AND IF WE FAIL TO PAY
A CLAIM ON TIME, 95% OF THE TIME
WITHIN THE STATUTORY FRAMEWORK,
WE ARE SUBJECT TO INTEREST.
FINANCIAL PENALTIES, PENALTIES
AND ENFORCEMENT AGAINST THE
PLAN. SO, IN CLOSING, THIS BILL
CREATES A COMPLEX, NEW PROCESS
FOR EDUCATING AND PAYING CLAIMS
THAT WE DO NOT BELIEVE WILL
SOLVE THE INTENDED PURPOSE OF
THIS BILL, AND FOR THESE
REASONS, WE ARE RESPECTFULLY
OPPOSED. THANK YOU, MADAM CHAIR.
MEMBERS, STEPHANIE WATKINS, ON
BEHALF OF THE ASSOCIATION OF
CALIFORNIA LIFE AND HEALTH
INSURANCE COMPANIES, WE TOO, ARE
HERE IN OPPOSITION TODAY. I
MEAN, I THINK ALL OF US DO
UNDERSTAND THE IMPORTANCE AND
THE ROLE THAT HOSPITALS, PLAY
WITHIN THE HEALTH CARE SYSTEM.
THEY'RE A CRITICAL PART OF OUR
SYSTEM AND ONE THAT I THINK ALL
OF US WOULD LIKE TO HAVE A
CONVERSATION, GOING FORWARD
ABOUT THE POSSIBILITY OF HOW WE
CAN PARTICIPATE AND CONTINUE TO
LOOK AT WAYS TO BE THOUGHTFUL
ABOUT HOW THE PAYMENT STRUCTURE
WORKS. UNFORTUNATELY, THE WAY
THE BILL IS DRAFTED TODAY, GIVEN
THE CREATION OF A BIFURCATED
SYSTEM, THE IT UPGRADES, IT
WOULD BE NECESSARY. IF YOU
REALLY LOOK AT HOW BROAD THE
BILL IS, IT LOOKS TO NOT ONLY
THE HOSPITALS, BUT ALL THE
PROVIDERS WHO HAVE ADMITTING
RIGHTS WITHIN THOSE HOSPITALS
WOULD ALSO KHÓ BE DECLARED TO BE
DISTRESSED AND THEREFORE THEN
THE TIME FRAMES WOULD HAVE TO BE
IN PLACE. WE THINK THAT THERE
MAY BE A PATHWAY FORWARD TO HAVE
ADDITIONAL CONVERSATIONS. I
THINK WE ALL, LIKE I MENTIONED,
SEE THE IMPORTANCE OF THE
HOSPITAL SYSTEMS WITHIN OUR
HEALTH CARE SYSTEM AND HOW
CRITICAL THEY ARE,
UNFORTUNATELY, THE WAY THIS BILL
IS DRAFTED, WE THINK THAT THE
COSTLY NATURE OF IT, ESPECIALLY
THE COMPLICATIONS OF A NEW IT
SYSTEM AND HOW YOU WOULD
BIFURCATE THOSE SYSTEMS AND
PAYMENT PROCESS, PROVIDE A LOT
OF CONCERN FOR OUR MEMBERS. SO
FOR THOSE REASONS, WE ARE
OPPOSED. THE BILL DOES MOVE
FORWARD TODAY. WE LOOK FORWARD
TO FUTURE CONVERSATIONS. THANK
YOU. CHAIR AND MEMBERS KATHY
MOSSBERG WITH THE LOCAL HEALTH
PLANS OF CALIFORNIA.
UNFORTUNATELY, WE ARE OPPOSED AS
WELL, BUT OPEN TO CONVERSATIONS
MOVING FORWARD. ANY OTHER
ADDITIONAL WITNESSES IN
OPPOSITION? SEEING NONE, I WILL
BRING IT BACK TO THE COMMITTEE
FOR COMMENT OR QUESTION, MR.
JONES-SAWYER, NOW, I'LL JUST
SAY, LET ME BECAUSE I PROBABLY
AM SPEAKING FOR MY, MY
COLLEAGUE, ASSEMBLY MEMBER
GIBSON, WHO'S VERY FAMILIAR WITH
MARTIN LUTHER KING AND THE
EXCELLENT WORK THAT DOCTOR
BATCHELOR IS DOING, REALLY
TRYING TO, PROVIDE SERVICES, TO
AN UNDERSERVED COMMUNITY. AND
THEY'VE DONE AN EXEMPLARY JOB AT
DOING THAT TO THE POINT THAT
THEY'RE OVERWHELMED WITH THE
NUMBER OF PEOPLE THAT ARE COMING
IN, WHICH IS FAR BEYOND WHAT
THEY HAD ANTICIPATED. WHEN THEN,
I THINK MARK RIDLEY THOMAS HAD
HAD WORKED TO, TO REPOSITION THE
HOSPITAL IN A WAY THAT THEY
COULD BE AN ASSET TO THE
COMMUNITY. MARTIN LUTHER KING
HAS ALWAYS BEEN THERE, TO TAKE
CARE OF THOSE WHO COULDN'T TAKE
CARE OF THEMSELVES, WHO COULDN'T
FINANCIALLY TAKE CARE OF
THEMSELVES, AND DISTRESS MEDICAL
SITUATIONS AND, TO LOSE THEM OR
TO HAVE THEM GO UNDER, IN, IN,
IN WATTS AND IN SOUTH CENTRAL
LOS ANGELES, WOULD BE,
CATASTROPHIC. AND WE NEED TO DO
WHATEVER WE CAN TO, TO ENSURE
THAT NOT ONLY HER HOSPITAL BUT
IN AND OTHERS ARE, ARE ABLE TO
STAY AFLOAT. BECAUSE IF WE DON'T
, THE UNDERSERVED, IN THOSE
COMMUNITIES, IF YOU THINK THE
MEDICAL CARE, IS BAD IN THOSE IN
THOSE THOSE DISTRICTS NOW GOD
KNOWS WHAT IT WOULD BE LIKE
WITHOUT THEM, AND SO WE NOT ONLY
DO WE NEED TO LOOK AT WAYS, WE
CAN, WE CAN MAKE SURE WE CAN GET
SOME KIND OF ECONOMIC FINANCIAL
RELIEF THIS WAY, BUT WE ALSO
PROBABLY NEED TO LOOK AT SOME
OTHER OPTIONS TO WITH THE
MEDI-CAL, MEDICARE, WE NEED TO
LOOK AT THEM ALL BECAUSE WE NEED
TO REPOSITION HOW THAT WAS DONE.
AND I BELIEVE WE'VE TALKED ABOUT
SOME WAYS TO DO THAT. THIS IS
JUST ONE OF THEM. AND, WE NEED
TO MOVE FORWARD AND WE NEED TO
DO THAT AS SOON AS POSSIBLE,
BECAUSE THE LAST THING WE NEED
TO HAVE IS FOR ANY OF THESE
DOORS TO CLOSE, I MEAN, I YOU
HAVE. NO, I MEAN, WE JUST CAN'T
HAVE THAT HAPPEN, AND SO I WILL
BE VOTING FOR THIS TODAY. I'LL
MAKE IT QUICK. MAJORITY LEADER.
GO AHEAD, THANK YOU VERY MUCH
FOR BRINGING THIS FORWARD. I'D
LIKE TO BE A COAUTHOR. I TOO,
HAD THIS SAME ISSUES BACK IN
2018. WE WERE TRYING TO MAKE
SURE ON HOW THE REPAYMENT
SCHEDULES WERE BEING DONE, I
BELIEVE THERE'S AN AUDIT DONE
AND IT JUST SPARKED ME THAT I
NEED TO FIND OUT IF THAT BILL
WAS IMPLEMENTED CORRECTLY BACK
IN FROM 2018. SO I APPRECIATE
THE BILL. OUR RURAL COMMUNITIES
ALWAYS ARE JUST STRUGGLING. AND,
I DON'T KNOW ABOUT YOU, BUT I'D
LIKE TO BE PAID ON TIME TO BE
ABLE TO DO THIS JOB. SO I WOULD
ONLY IMAGINE THAT THE HOSPITALS
WANT TO BE PAID ON TIME AS WELL.
SO THANK YOU. I KNOW THAT THE
AUTHOR IS DEEPLY PASSIONATE
ABOUT THIS. YOU ARE CHAIRING A
SELECT COMMITTEE ON DISTRESSED
HOSPITALS. YOU HAVE MADEIRA. WE
ALL, THE CALIFORNIA LEGISLATIVE
BLACK CAUCUS ALSO HEARD FROM THE
MLK HOSPITAL AS WELL, AND WE
KNOW THAT OUR HOSPITALS,
PARTICULARLY OUR RURAL HOSPITALS
AND, ARE SUFFERING RIGHT NOW. SO
I APPRECIATE THE AUTHOR'S FOCUS
AND INTENTION IN BRINGING THIS
BILL FORWARD, THANK YOU FOR
MEETING WITH ME AND LOOKING OVER
SOME OF THE CONCERNS THAT I HAD
ABOUT THE BILL, WHICH REALLY
RELATES TO WHETHER OR NOT THIS
FOCUS ON DELAYED CLAIMS AND THE
TIMETABLE SET AROUND THAT ARE
GOING TO RESULT IN, IN THE
INTENDED CONSEQUENCES THAT I
KNOW THAT YOUR YOU'RE HOPING
FOR. SO I KNOW AND, THAT YOU
WILL CONTINUE TO WORK ON THIS
BILL WITH THE, OPPONENTS TO TRY
TO GET TO A PLACE WHERE WE KNOW
THE INTENTION IS ALSO ACHIEVABLE
IN TERMS OF PASSAGE AND
OBVIOUSLY, THIS IS A JOINTLY
AUTHORED BILL BY THE SPEAKER OF
THE ASSEMBLY. WITH THAT, I MY
RECOMMENDATION IS AN AYE VOTE.
AND, YOU MAY CLOSE. THANK YOU,
CHAIR, FOR, THOSE COMMENTS, JUST
IN CLOSING, I WANT TO THANK ALL
OF YOU. FIRST OF ALL, BECAUSE
LAST YEAR, YOU GUYS WERE
INCREDIBLE IN MAKING SURE THAT
WE DID, ENSURE THAT MLK DIDN'T
CLOSE AND OTHER HOSPITALS ACROSS
THE STATE, THAT MADEIRA WILL
REOPEN, AND I WOULD BE REMISS IF
I DIDN'T ALSO SHOW MY
APPRECIATION TO THE HEALTH PLANS
AS AS STATED AND ACKNOWLEDGED,
THE SUPPORT THAT THEY'VE
PROVIDED ALSO, THROUGH THE
MANAGED CARE ORGANIZATION TAX,
WHICH THEY SPOKE ABOUT. SO I DO
WANT TO SHOW MY APPRECIATION.
OBVIOUSLY THERE THERE IS A LOT
OF WORK TO BE DONE AROUND,
DISTRESSED HOSPITALS AND HEALTH
CARE ACCESS IN OUR COMMUNITIES
AND IN THE STATE OF CALIFORNIA.
AND SO I LOOK FORWARD TO
CONTINUING THE CONVERSATIONS, TO
MEETING WITH THE STAKEHOLDERS,
TO MAKE SURE THAT WHAT COMES
OUT, IN THIS, PIECE OF
LEGISLATION, IS WITH THE
INTENDED GOAL TO ENSURE THAT
HOSPITALS, YOU KNOW, CONTINUE TO
PROVIDE THE CRITICAL SERVICES,
AND THAT THE TIMELINES ARE
REALISTIC AND ACHIEVABLE AS YOU
MENTIONED, CHAIRWOMAN. SO
LOOKING FORWARD TO THE CONTINUED
CONVERSATION. AND I
RESPECTFULLY, RESPECTFULLY ASK
FOR AN AYE VOTE. THANK YOU. THE
MOTION IS Dð PASS AS AMENDED TO
A PROPS. PLEASE CALL THE ROLL
MONTE. I WANT A AYE WALDRON.
WALDRON. AYE AGUIAR-CURRY. AGAR.
CURRY. AYE. ARAMBULA WENDY.
CARILLO LARA. HANEY. HANEY. AYE.
JOHN. SAWYER CHEN. SAWYER. AYE.
MAIN SHRINE. MAIN SHRINE. AYE.
MCCARTY MCCARTY. AYE. JOE.
PATTERSON. RODRIGUEZ RODRIGUEZ.
AYE. SANCHEZ. SANTIAGO CHAVO.
WEBER. WEBER. AYE KAISER. THAT
MEASURE IS NINE VOTES TO ZERO
AND IS OUT OF THE COMMITTEE.
THANK YOU. WE WILL MOVE ON TO
ITEM NUMBER TWO. WE'RE ON TO
COMMITTEE. LEGISLATION NOW AB
1895. DOCTOR WEBER
.
PLEASE PROCEED WHENEVER YOU'RE
READY. GOOD EVENING. CHAIR AND
MEMBERS. I AM HERE TO PRESENT AB
1895, A BILL TO PROVIDE THE
STATE WITH MORE ADVANCED
NOTIFICATION WHEN A HOSPITAL HAS
ASSESSED THAT THEIR MATERNITY
UNIT IS AT RISK FOR CLOSURE. WE
ARE UNFORTUNATELY FACING A
MATERNAL CRISIS IN OUR STATE AND
AROUND THE COUNTRY. A RECENT
INVESTIGATION PUBLISHED BY
CALMATTERS IN NOVEMBER OF 2023
SHOWED THAT VAST STRETCHES OF
CALIFORNIA ARE LOSING MATERNITY
CARE ACCESS, WITH THE CLOSURE OF
DOZENS OF HOSPITALS AND THE
CLOSURE OF MATERNITY UNITS
SPECIFICALLY. IN FACT, THIS
INVESTIGATION REVEALED THAT 46
MATERNITY UNITS HAVE CLOSED
THEIR SERVICE SINCE 2012, AND 27
OF THOSE HAVE TAKEN PLACE IN THE
LAST THREE YEARS. IN FACT, 12
COUNTIES DO NOT HAVE ANY
HOSPITALS, WITH LABOR AND
DELIVERY UNITS
DISPROPORTIONATELY IMPACTING OUR
MINORITY AND LOW INCOME
COMMUNITIES. LEAVING ONCE AGAIN
THE MOST VULNERABLE CALIFORNIANS
WITH INCREASINGLY DIMINISHED
CARE. LAST MONTH IN MY DISTRICT,
SCRIPPS HEALTH ANNOUNCED THAT IT
WOULD BE CLOSING ITS LABOR AND
DELIVERY UNIT. CHULA VISTA IS
THE SECOND LARGEST CITY IN SAN
DIEGO COUNTY, AND NOW WILL ONLY
HAVE ONE LABOR AND DELIVERY UNIT
FOR ITS RESIDENTS. OBSTETRIC
CLOSURES OCCUR TO MULTIPLE
FACTORS. IN 2022, THE GOVERNMENT
ACCOUNTABILITY OFFICE NOTED THAT
THERE WERE TWO MAJOR FACTORS AS
THE CAUSE. ONE, WE HAVE HEARD
MANY TIMES IS MEDICAID
REIMBURSEMENT RATES THAT DO NOT
COVER THE FULL COST OF CARE, NOR
THE FACILITIES. THE SECOND, FOR
THE CLOSURE IS A SHORTAGE OF
WORKFORCE AND DIFFICULTIES IN
RECRUITING AND RETAINING
PROVIDERS. CURRENT LAW REQUIRES
HOSPITALS TO NOTIFY THE
CALIFORNIA DEPARTMENT OF PUBLIC
HEALTH, AS WELL AS THE PUBLIC,
90 DAYS PRIOR TO THE PROPOSED
CLOSURE OF MATERNITY SERVICES.
THIS IS NOT ENOUGH TIME FOR THE
STATE TO INTERVENE IF POSSIBLE.
FOR THESE REASONS, AB 1895
REQUIRES HOSPITALS WITH
MATERNITY UNITS THAT ARE AT RISK
OF CLOSURE IN THE NEXT 12 MONTHS
TO REPORT SEVERAL DATA POINTS TO
THE CDPH, DEPARTMENT OF HEALTH
CARE SERVICES, DEPARTMENT OF
HEALTH CARE ACCESS AND
INFORMATION, AND THE CHAIRS OF
THE SENATE AND ASSEMBLY
COMMITTEES ON HEALTH, INCLUDING
THE NUMBER OF MEDICAL STAFF AND
EMPLOYEES WORKING IN THAT LABOR
AND DELIVERY UNIT. THE NUMBER OF
DELIVERIES PER MONTH OVER THE
LAST 12 MONTHS. THE NUMBER OF
PATIENTS SERVED IN THE LAST 12
MONTHS, AND THE HOSPITAL'S PRIOR
AND PROJECTED PERFORMANCE ON
FINANCIAL METRICS FROM THE PAST
12 MONTHS. ADDITIONALLY, HCCI,
IN CONJUNCTION WITH THE K¾T
PAGE, WILL BE REQUIRED TO
CONDUCT A COMMUNITY IMPACT
ASSESSMENT REGARDING THE
CLOSURE. THE COMMUNITY IMPACT
ASSESSMENT SHALL DETERMINE THE
THREE CLOSEST HOSPITALS OFFERING
MATERNITY SERVICES IN THE
GEOGRAPHIC AREA AND THEIR
DISTANCE FROM THE AT RISK
FACILITY. FINALLY THE HOSPITAL
WILL BE MANDATED TO PROVIDE
PUBLIC NOTICE TO THE OF THE
POTENTIAL CLOSURE, INCLUDING THE
RESULTS TO THE COMMUNITY IMPACT
REPORT AND THE PUBLIC SHALL BE
PERMITTED TO COMMENT ON THE
POTENTIAL CLOSURE FOR 60 DAYS
AFTER THE NOTICE IS GIVEN. THE
PUBLIC COMMENT PERIOD MUST
INCLUDE AT LEAST ONE NOTICE.
PUBLIC HEARING CONDUCTED BY THE
HOSPITAL. WITH MORE
NOTIFICATION, THE STATE MAY HAVE
THE OPPORTUNITY TO INTERVENE
WHEN POSSIBLE OR CONSIDERING
THESE FACTS. WHEN MAKING POLICY
AND BUDGET DECISIONS, WE
UNDERSTAND THAT THERE ARE A
COUPLE OF CONCERNS SURROUNDING
TRANSPARENCY AND POTENTIAL
DUPLICATE REPORTING. THE BILL
CURRENTLY STATES THAT THE
INFORMATION SENT TO THE STATE
THAT A MATERNITY WARD IS AT RISK
OF CLOSURE TO BE KEPT
CONFIDENTIAL. THIS WAS
ORIGINALLY INCLUDED BECAUSE WE
KNOW THAT IF THIS THAT THIS
INFORMATION IS MADE PUBLIC,
STAFF WILL LEAVE THEIR POSITIONS
AND PATIENTS WILL LIKELY NOT
WANT TO ESTABLISH CARE AT THAT
FACILITY. THUS, THE NOTIFICATION
WOULD BECOME A SELF-FULFILLING
PROPHECY, AND THAT MATERNITY
UNIT WILL BECOME MORE LIKELY TO
CLOSE. SECONDLY, WE KNOW THAT
THIS INFORMATION IS CURRENTLY
COLLECTED BY THE STATE AND WE
WILL CONTINUE TO WORK WITH STATE
STAKEHOLDERS ON HOW WE CAN
REDUCE THE BURDEN OF REPORTING
WHILE STILL RECEIVING THE
NECESSARY INFORMATION. I AM
COMMITTED TO WORKING ON THIS AS
WE CONTINUE TO MOVE FORWARD WITH
ME HERE TO TESTIFY TODAY IS RYAN
SPENCER ON BEHALF OF DOCTOR
SHILPA MATTHEW. SHE'S AN OB GYN
AND LEGISLATIVE COMMITTEE
CO-CHAIR FOR THE AMERICAN
COLLEGE OF OBSTETRICIANS AND
GYNECOLOGIST, AND SHANNON HOVIS,
DIRECTOR OF REPRODUCTIVE FREEDOM
FOR ALL. THANK YOU. BILL AGUILAR
CURRY. SECONDED BY HANEY. PLEASE
GO AHEAD. YOU'LL EACH HAVE TWO
MINUTES. THANK YOU, MADAM CHAIR.
RYAN SPENCER ON BEHALF OF THE
AMERICAN COLLEGE OF OB GYN'S
DISTRICT NINE, IN SUPPORT AND
SPONSORS OF THIS MEASURE, AS
DOCTOR WEBER MENTIONED, I'LL BE
SPEAKING ON BEHALF OF DOCTOR
MATTHEW, WHO HAD TO LEAVE.
UNFORTUNATELY, WE'RE IN THE
MIDST OF A CRISIS WHEN IT COMES
TO LABOR AND DELIVERY CARE. THIS
IS SIMULTANEOUSLY HAPPENED IN
CALIFORNIA AND THROUGHOUT THE
NATION, AND WE'VE BEEN
STRUGGLING WITH MATERNAL
MORBIDITY AND MORTALITY IN
HIGHER ACUITY BIRTHS AND HEALTH
DISPARITIES TO LONG. BUT THIS IS
A REALITY OF MODERN DAY LABOR
AND DELIVERY ON ANY GIVEN DAY, A
PROVIDER LIKE DOCTOR MATTHEW CAN
ENCOUNTER MANY SITUATIONS, SUCH
AS PATIENTS WITH PRE-ECLAMPSIA,
HEMORRHAGE, FETAL DISTRESS, OR
BABY SHOULDER GETTING STUCK
DURING BIRTH. SOMETIMES THESE
SITUATIONS REQUIRE EMERGENT
DELIVERY, WHERE EVERY MINUTE CAN
MEAN THE DIFFERENCE BETWEEN LIFE
AND DEATH. ADDITIONALLY,
PREDICTED LOW RISK BIRTHS CAN
TRANSITION TO HIGHER ACUITY
SITUATIONS IN A MATTER OF
MINUTES. WHAT IF YOU WERE A
PATIENT LIKE THIS AND LITERALLY
HAD NOWHERE TO GO? OR HAD TO
DRIVE HOURS UPON HOURS TO GET
CARE? WE HAVE TO FIND A WAY TO
END THIS CRISIS, AND WE BELIEVE
THIS BILL IS A STEP IN THAT
DIRECTION, AS IT PROVIDES A WAY
TO FORMALIZE THE COLLECTION OF
DATA ON THE HOSPITALS THAT ARE
CLOSING IN THE HOPES OF
ULTIMATELY INFORMING POTENTIAL
SOLUTIONS, ASSIST THE COMMUNITY
IN FINDING OTHER SERVICES IN THE
EVENT OF A CLOSURE AND, POSSIBLY
BEST CASE SCENARIO, PREVENT THE
CLOSURE FROM BEGINNING FROM
BEGINNING TO BEGIN WITH. IT FROM
HAPPENING TO BEGIN WITH. IN THE
END, A LABOR AND DELIVERY WARD
NOT ONLY PROVIDES CRUCIAL
MEDICAL SUPPORT, BUT ENSURES
THAT CHILDBIRTH IS NOT JUST A
MOMENT OF JOY, BUT ALSO ONE OF
SAFETY AND SECURITY. FINDING A
WAY TO STOP CLOSURES WILL BE A
WAY TO ENSURE ACCESSIBLE AND
INCLUSIVE CARE SO THAT
INDIVIDUALS, REGARDLESS OF
BACKGROUND OR CIRCUMSTANCE, HAVE
ACCESS TO THE SUPPORT THEY NEED
DURING THIS PIVOTAL MOMENT IN
THEIR LIVES. I ASK FOR YOUR I
VOTE. GOOD AFTERNOON CHAIR AND
MEMBERS. MY NAME IS SHANNON
OLIVERIO AND I'M THE DIRECTOR OF
REPRODUCTIVE FREEDOM FOR ALL
CALIFORNIA, FORMERLY NARAL,
REPRESENTING OUR MORE THAN
370,000 MEMBERS STATEWIDE. AND
HERE TODAY AS A CO-SPONSOR OF AB
1895. CALIFORNIA IS A PROUD
REPRODUCTIVE FREEDOM STATE,
WHICH IS WHY THE CURRENT TRENDS
AROUND LABOR AND DELIVERY CARE
AND MATERNAL MORTALITY RATES ARE
ESPECIALLY ALARMING. MATERNAL
MATERNITY WARDS ARE CLOSING,
LEAVING HUGE ACCESS DESERTS IN A
STATE AS LARGE AS CALIFORNIA.
AND SIMULTANEOUSLY, MATERNAL
MORTALITY RATES ARE ON THE RISE,
WITH THE DISPARITIES ONLY
GETTING WORSE AMONG BLACK WOMEN
AND PREGNANT PEOPLE. CHILDBIRTH
IS THE NUMBER ONE REASON THAT
PEOPLE ARE ADMITTED TO THE
HOSPITAL, AND HAVING GIVEN BIRTH
TWICE IN THE LAST THREE YEARS, I
KNOW FIRSTHAND THAT WHEN A
PERSON GOES INTO LABOR, THEY
NEED A SAFE PLACE TO DELIVER
THEIR BABY AND THE NEED IS
URGENT AND TIME SENSITIVE. YET
OUR ORGANIZATION HAS MEMBERS WHO
LIVE ON THE NORTH COAST AND
REPORT HAVING TO DRIVE TWO HOURS
TO THE CLOSEST HOSPITAL WITH
LABOR AND DELIVERY WARD. NEW
PARENTS TELL US STORIES OF
BARELY MAKING IT TO THE HOSPITAL
WITH BABIES BEING BORN IN TRIAGE
OR IN THE PARKING LOT IN
IMPERIAL COUNTY. ONLY ONE
HOSPITAL PROVIDING BIRTH AND
DELIVERY REMAINS. AND IT'S NOT
JUST DELIVERY CARE THAT IS
IMPACTED. THE DISTANCE ERECTS
BARRIERS FOR PEOPLE TO ACCESS
PRENATAL AND POSTNATAL CARE AS
WELL. TO MAKE MATTERS WORSE,
MORE THAN 1 IN 6 HOSPITALS IN
CALIFORNIA IS IN A RESTRICTIVE
HOSPITAL THAT IMPOSES SEVERE
LIMITATIONS ON REPRODUCTIVE
HEALTH CARE. AS LABOR AND
DELIVERY WARDS CLOSE, FEWER
OPTIONS REMAIN THAT GUARANTEE
COMPREHENSIVE REPRODUCTIVE CARE,
AND PREGNANT PEOPLE MAY BE
CONCERNED ABOUT GIVING BIRTH AT
A RESTRICTIVE HOSPITAL FOR FEAR
THAT IN THE EVENT OF AN
EMERGENCY, THEY MAY NOT GET THE
CARE THEY NEED. UNDER CURRENT
LAW, THERE IS NO PROCESS IN
PLACE TO TRY TO PREVENT THE
CLOSURE OF LABOR AND DELIVERY
WARDS BEFORE THEY OCCUR, BUT
THESE CLOSURES HAVE CERTAINLY
TRIGGERED SIGNIFICANT PUBLIC
OUTCRY AFTER THE FACT. THE
CLOSURE OF THE MATERNITY WARD AT
CENTINELA HOSPITAL IN INGLEWOOD,
AN AREA THAT ALREADY LACKS
SUFFICIENT SERVICES FOR
REPRODUCTIVE HEALTH CARE.
SHORTLY FOLLOWING THE DEATH OF
APRIL, VALENTINE IN CHILDBIRTH,
WAS MET WITH COMMUNITY OUTRAGE.
PETALUMA VALLEY HOSPITAL'S
MATERNITY WARD CLOSURE SPURRED
LOCAL PROTESTS. AB 1895 IS
ESSENTIAL TO UNDERSTAND WHICH
HOSPITAL, MATERNITY WARDS ARE AT
RISK OF CLOSURE, AND TO GIVE THE
STATE AND COMMUNITY AN
OPPORTUNITY TO INTERVENE TO
PROTECT ACCESS TO CARE. THANK
YOU, THANK YOU. ARE THERE ANY
OTHER ADDITIONAL WITNESSES IN
SUPPORT? CHAIR MEMBERS CATHY
MOSSBERG WITH THE LOCAL HEALTH
PLANS OF CALIFORNIA IN SUPPORT.
GOOD AFTERNOON, SYMPHONY BARBIE
WITH PLANNED PARENTHOOD
AFFILIATES OF CALIFORNIA IN
SUPPORT. VANESSA SHAHEEN, ON
BEHALF OF THE CALIFORNIA PAN
ETHNIC HEALTH NETWORK, IN
SUPPORT. ALEXIS RODRIGUEZ WITH
THE CALIFORNIA MEDICAL
ASSOCIATION IN SUPPORT. ONION
MOBILE WITH BLACK WOMEN FOR
WELLNESS ACTION PROJECT PROUD
CO-SPONSORS IN SUPPORT. THANK
YOU. DO YOU HAVE ANY WITNESSES
IN OPPOSITION TO THE BILL?
GOOD AFTERNOON. VANESSA GONZALEZ
WITH THE CALIFORNIA HOSPITAL
ASSOCIATION. AND SHE IS NOT
OPPOSED TO AB 1895. WE HAVE WE
DO HAVE SOME CONCERNS WITH THE
BILL, THOUGH, AND WE'VE BEEN
HAVING PRODUCTIVE CONVERSATIONS
WITH DOCTOR WEBER AND HER STAFF.
SO REALLY APPRECIATE HER TIME.
AS DOCTOR WEBER NOTED, THE, THE
FACTORS THAT ARE LEADING TO
LABOR AND DELIVERY CLOSURES ARE
WORKFORCE CHALLENGES, LOW
MEDI-CAL REIMBURSEMENT RATES, AS
WELL AS DECLINING BIRTH RATES.
WHILE WE UNDERSTAND THE INTENT
OF THE LEGISLATION IS TO PROVIDE
ADVANCE NOTICE TO THE STATE OF A
POTENTIAL LABOR AND DELIVERY
CLOSURE, AS DOCTOR WEBER NOTED,
WE ARE CONCERNED WITH THAT 12
MONTH NOTIFICATION WHILE THAT
NOTIFICATION IS INTENDED TO BE
PRIVATE, WE ARE CONCERNED THAT
THAT INFORMATION WILL BECOME
PUBLIC. AND OF COURSE, ONCE
STAFF LEAVES OR ONCE STAFF
LEARNS THAT THEIR LABOR AND
DELIVERY UNIT MAY BE CLOSING, OF
COURSE THEY START TO LEAVE. AND
THAT COULD EXACERBATE THE
CHALLENGES THAT HOSPITALS ARE
FACING, ALSO, WITH THAT 12 MONTH
NOTIFICATION, NOT ALL HOSPITALS
KNOW 12 MONTHS IN ADVANCE. SO
HOPING WE CONTINUE TO WORK. WE
CAN CONTINUE TO WORK ON THAT 12
MONTH NOTIFICATION. AND ALSO, AS
DOCTOR WEBER NOTED, A LOT OF THE
INFORMATION THAT IS THAT
HOSPITALS WOULD BE REQUIRED TO
REPORT, IS ALREADY INFORMATION
THAT HOSPITALS PROVIDE TO HØI ON
A QUARTERLY OR ANNUAL BASIS, AND
THAT INFORMATION IS ALREADY
PUBLICLY AVAILABLE. SO, YOU
KNOW, HOPING TO EXPLORE OPTIONS
TO DIRECT HØI TO ALREADY KIND OF
REPURPOSE THE INFORMATION THAT
THEY ALREADY HAVE TO TRY TO
ACHIEVE, THE SAME GOAL, SO WITH
THAT, I LOOK FORWARD TO
CONTINUING CONVERSATIONS WITH
THE AUTHOR AND THE CO-SPONSORS,
AND YEAH, THANK YOU. THANKS. ANY
OTHER WITNESSES IN OPPOSITION?
SEEING NONE, I'LL BRING IT BACK
TO THE COMMITTEE FOR QUESTIONS
OR COMMENTS. THANK YOU FOR
BRINGING THIS FORWARD. THERE'S
NOTHING WORSE THAN A MOTHER
BEING IN LABOR AND TRYING TO GET
TO A HOSPITAL. AND MINE WAS 75
MILES WHEN I DELIVERED MY FIRST
DAUGHTER, WHICH WAS TREACHEROUS,
ANOTHER FRIEND OF MINE HAD A
CHILD, AND WE HIS NAME IS JUSTIN
BECAUSE HE WAS JUST IN TIME.
I'LL BE SUPPORTING BILL. I WANT
TO THANK THE AUTHOR FOR BRINGING
FORWARD THIS BILL. WE'VE HAD
SEVERAL CONVERSATIONS ABOUT THIS
NEED TO MAKE SURE THAT OUR
HOSPITALS, HAVE LABOR AND
DELIVERY ROOMS THAT WE CAN COUNT
ON AND THERE ARE SEVERAL PARTS
OF OUR DISTRICT, AS YOU'VE
MENTIONED, OR OUR STATE THAT
YOU'VE MENTIONED, WHERE THERE'S
MORE THAN TWO HOURS DRIVE
BETWEEN ONE LABOR AND DELIVERY
UNIT TO ANOTHER. AND THAT'S
UNACCEPTABLE. BEALL IN THE AREA
OF TMI, AT LEAST TWO OF MY
CHILDREN WOULD HAVE BEEN BORN IN
A CAR, SO I WANT TO THANK THE
AUTHOR FOR BRINGING FORWARD THIS
BILL AND KNOW THAT YOU'LL
CONTINUE TO WORK WITH, H.R. ON
SOME OF THEIR CONCERNS WITH
THAT. WOULD YOU LIKE TO CLOSE?
YES. I WANT TO THANK THE CHAIR
AND THE COMMITTEE FOR THOUGHTFUL
CONVERSATIONS, ALONG WITH OUR
SPONSORS AND ALSO C.H.A, BUT,
YOU KNOW, WE HAVE SPENT MANY,
MANY HOURS, DISCUSSING AND
DEBATING IN THIS COMMITTEE AND
OTHERS ABOUT THE IMPORTANCE OF
CLOSING THE GAP IN RELATION TO
MATERNAL AND FETAL OUTCOME OF
BLACK AND BROWN AND INDIGENOUS
WOMEN AND CHILDREN. WE HAVE ALSO
SPENT MANY HOURS DISCUSSING THE
DAMAGE AND DEVASTATION THAT
OCCURS TO COMMUNITIES WHEN THEIR
HOSPITALS AND LABOR AND DELIVERY
UNITS CLOSE, AND WE CANNOT
CONTINUE TO JUST DISCUSS THESE
ISSUES AND NOT IMPLEMENT
POLICIES TO PREVENT OR MITIGATE
THE HARMS AND THE CONTINUED
DISPARITIES. I ACKNOWLEDGE THE
CONCERNS DATED TODAY AND WILL
CONTINUE TO WORK WITH THEM TO
ADDRESS THESE CONCERNS. BUT
THERE ARE A FEW THINGS THAT WE
MUST RECOGNIZE FIRST, WHAT WE
HAVE IN PLACE RIGHT NOW WITH THE
90 DAY NOTICE, IS CLEARLY NOT
SUFFICIENT TIME FOR THE STATE TO
BE ABLE TO INTERVENE. OTHERWISE
WE WOULD HAVE BEEN DOING SO.
SECOND, WHEN WE CLOSE LABOR AND
DELIVERY UNITS, WE PLACE
PATIENTS AT RISK OF DELIVERING
IN PLACES OR AT PLACES THAT DO
NOT HAVE ADEQUATELY TRAINED
STAFF, NOR THE EQUIPMENT TO
PROPERLY HANDLE. IF THERE IS AN
AN OBSTETRIC EMERGENCY, AS WAS
THE LEAD AS WAS ALLUDED TO. AND
THIRD, WE TALK A LOT ABOUT COST
HERE AND THE COST OF HEALTH CARE
. WELL, WHEN WE CLOSE LABOR AND
DELIVERY UNITS, WE ACTUALLY
OFTENTIMES INCREASE THE COST OF
HEALTH CARE BECAUSE WE AS
OB-GYNS END UP ADMITTING
PATIENTS TO HOSPITALS WHEN
THEY'RE NOT ACTUALLY IN LABOR,
BECAUSE WE ARE CONCERNED ABOUT
THE FACT THAT THEY LIVE TOO FAR
AWAY, TO ACTUALLY GET BACK IN
TIME FOR WHEN THEY DO GO INTO
LABOR. AND WHAT THAT CAUSES IS
NOT ONLY PROLONGED HOSPITAL
STAYS, WE END UP INDUCING PEOPLE
WHO DON'T NEED TO BE INDUCED. WE
THEN HAVE FAILED INDUCTIONS. WE
RUN, WE RUN INTO
CHORIOAMNIONITIS. WE END UP WITH
UNNECESSARY C-SECTIONS AND
POSTPARTUM HEMORRHAGE. AND I
COULD HONESTLY GO ON, ALL
BECAUSE THAT PARTICULAR
INDIVIDUAL LIVED TOO FAR AWAY
AND WE DIDN'T WANT THEM TO RISK
DELIVERING AT HOME OR IN A CAR.
AND SO WE END UP ADMITTING THEM
EARLY. AB 1895 ALLOWS A STATE TO
HAVE THE ABILITY TO GET THE
INFORMATION IN TIME TO SEE IF WE
CAN INTERVENE AND CORRECT THE
PARTICULAR SITUATION. THÀNH. AND
IT ALLOWS US TO PARTNER WITH OUR
HOSPITALS. SO THAT WE CAN KEEP
THEIR UNITS OPEN AND OUR
COMMUNITY SAFE, HEALTHY AND WITH
THE HEALTH CARE ACCESS THAT ALL
DESERVE. AND WITH THAT, I
RESPECTFULLY ASK FOR AN AYE VOTE
ON AB 1895. THANK YOU, THANK
YOU. I BELIEVE WE HAVE A MOTION
AND A SECOND. THE MEASURE IS TO
PASS TO APPROPRIATIONS. PLEASE
CALL THE ROLL ONTO AYE. ONTO.
AYE. WALDRON. WALDRON. AYE. AGAR
KURI. AGUIAR-CURRY. AYE.
ARAMBULA. ARAMBULA AYE. WENDY.
CARILLO. LARA HANEY. HANEY. AYE.
JONES-SAWYER. JONES-SAWYER AYE.
MAIENSCHEIN. MAIENSCHEIN. AYE.
MCCARTY MCCARTY. AYE. JO.
PATTERSON. RODRIGUEZ RODRIGUEZ.
AYE. SANCHEZ. SANCHEZ. NÓ.
SANTIAGO SHABO. AYE. WEBER.
WEBER AYE. THAT MEASURE HAS 11
VOTES TO ONE AND IS OUT OF
COMMITTEE. THANK YOU. WE'LL MOVE
ON TO ITEM FIVE AB 2063
MAIENSCHEIN.
THANK YOU. THANK YOU VERY MUCH,
MADAM CHAIR AND MEMBERS. OH,
GOOD. I'M HERE TO PRESENT AB
2063, WHICH WOULD EXTEND THE
SUNSET DATE OF A CRITICAL PILOT
PROGRAM ACCOUNTING FOR THE
DELAYED IMPLEMENTATION BROUGHT
OUT BY THE PANDEMIC. THE PILOT
PROGRAM COMBINES RISK BEARING
PROVIDERS WITH SELF-FUNDED
EMPLOYER PLANS THAT UTILIZE RISK
BASED OR CAPITATED PAYMENT
MECHANISMS, INSTEAD OF FEE FOR
SERVICE COMPENSATION TO REDUCE
HEALTH CARE COSTS. THE BILL
WOULD EXTEND THE PILOT PROGRAM
INITIALLY SET TO OPERATE UNTIL
DECEMBER 21ST, 2025, TO CONTINUE
UNTIL DECEMBER 31ST, 2027, AS
WELL AS THE DEADLINE FOR
REPORTING FINDINGS TO THE
LEGISLATURE FROM JANUARY ONE,
2027 TO JANUARY 1ST, 2029. THIS
EXTENSION IS VITAL FOR
SUCCESSFULLY EVALUATING THE
PROGRAM'S IMPACT ON SERVICE
SPEED, HEALTH CARE COSTS, AND
PATIENT OUTCOMES BY GRANTING
THIS EXTENSION, WE ENSURE THAT
THE PROGRAM HAS AMPLE TIME TO
FULFILL ITS OBJECTIVES. DESPITE
THE SETBACKS BROUGHT ON BY THE
PANDEMIC. I URGE YOUR SUPPORT
FOR AB 2063 AS IT REPRESENTS A
COMMITMENT TO IMPROVING HEALTH
CARE COVERAGE AND ADDRESSING THE
EVOLVING NEEDS OF OUR
COMMUNITIES DURING THESE
CHALLENGING TIMES. I
RESPECTFULLY REQUEST AN AYE VOTE
AND WITH ME HERE TO TESTIFY IN
SUPPORT IS LAURA JOSH, THE
GENERAL MANAGER OF CALIFORNIA
SCHOOLS VIVA AND BILL BARCELONA
WITH AMERICANS, WITH AMERICA'S
PHYSICIAN GROUPS. THANKS SO
MUCH. YOU HAVE TWO MINUTES,
CHAIR BONTA AND DISTINGUISHED
MEMBERS OF THE SUBCOMMITTEE. I'M
LAURA JOSH, THE GENERAL MANAGER
OF CALIFORNIA SCHOOLS VIVA, A
NONPROFIT TRUST FOUNDED IN 1993
THROUGH A PARTNERSHIP OF SCHOOL
SUPERINTENDENTS AND LABOR
REPRESENTATIVES TO ADDRESS
RISING HEALTH CARE COSTS FOR
SCHOOL DISTRICT EMPLOYEES
STATEWIDE. BY LAW, VIVA FUNDS
CAN ONLY BE USED FOR OUR TRUST
MEMBERS. UNLIKE OTHER HEALTH
PLANS, NO ONE IS PROFITING.
THERE IS NO DISTRIBUTION OF
EARNINGS, AND ALL OF OUR EXCESS
RESERVES CANNOT BE RETURNED TO
THE EMPLOYERS. TODAY, WE SERVE
OVER 160,000 MEMBERS ACROSS
CALIFORNIA, WITH A COMMITMENT TO
HIGH QUALITY AND LOWER COST AND
PATIENT CENTRIC HEALTH CARE,
SERVING TEACHERS, CUSTODIANS,
BUS DRIVERS AND THE OTHER MANY
DIVERSE EMPLOYEES WHO DIRECTLY
SERVE OUR COMMUNITIES. VBA'S
FUNDAMENTAL BELIEF IS THAT
HEALTH CARE BENEFITS ARE ONLY
USEFUL IF EMPLOYEES AND THEIR
FAMILIES CAN AFFORD TO ACCESS
THE CARE THEY NEED, WHEN THEY
NEED IT. WE WERE HONORED TO BE
SELECTED TO BUILD THE FIRST OF
ITS KIND DIRECT CONTRACTING
PILOT, MADE POSSIBLE BY AB 1124,
SPEARHEADED BY ASSEMBLY MEMBER
MAIENSCHEIN, WE SUCCESSFULLY
LAUNCHED A COMPREHENSIVE PROGRAM
WITH EXTENSIVE MEMBER
PROTECTIONS ON JANUARY 1ST, 2024
TO ALMOST 5000 VIVA MEMBERS AND
FAMILIES. OUR PILOT PROGRAM
DEMONSTRATED SAVINGS IN OUR
FIRST YEAR, SIGNALING THE POWER
OF SELF-FUNDED AND RISK BASED
CONTRACTS TO ALIGN INCENTIVES
THAT PRODUCE BETTER HEALTH
OUTCOMES AND AT A REDUCED COST.
IN ADDITION, MEMBERS
SATISFACTION HAS BEEN HIGH, WITH
NO MEMBER COMPLAINTS RECEIVED IN
THE FIRST QUARTER OF OPERATION.
OUR ANTICIPATED LAUNCH DATE WAS
DELAYED BY TWO YEARS DUE TO THE
COVID 19 PANDEMIC. TODAY WE SEEK
A TWO YEAR EXTENSION THROUGH AB
2063 TO ENSURE CONTINUITY AND
ALLOW FOR A REASONABLE TIMELINE
TO PROPERLY EVALUATE THE IMPACT
OF THIS IMPORTANT PILOT. BY
GRANTING THIS EXTENSION, WE WILL
AVOID DISRUPTING MEMBER CARE AND
ALLOW EVALUATION OF COST
SAVINGS, PATIENT OUTCOME AND
ENROLLEE SATISFACTION. WE
SUPPORT THIS BILL AND
RESPECTFULLY REQUEST YOUR AYE
VOTE. THANK YOU, THANK YOU. YOU
HAVE TWO MINUTES, MADAM CHAIR,
AND MEMBERS OF THE COMMITTEE,
BILL BARCELONA WITH AMERICA'S
PHYSICIAN GROUPS. APG IS ALSO A
PROUD CO-SPONSOR, AND WE'RE
GRATEFUL TO THE AUTHOR FOR
STICKING WITH US DURING THE
PANDEMIC AND WORKING THROUGH
THIS. THE PURPOSE OF THIS PILOT
IS TO GENERATE DATA, IMPORTANT
DATA THAT CAN BE STUDIED BY THE
DEPARTMENT OF MANAGED HEALTH
CARE AND THEN REPORTED TO THE
LEGISLATURE ON HOW DIRECT
CONTRACTING CAN WORK IN A
SELF-FUNDED ENVIRONMENT SIMILAR
TO HOW WE'VE DONE IT FOR YEARS
IN CALIFORNIA. IN THE FULLY
INSURED, KNOX KANE REGULATED
ENVIRONMENT. AND THAT'S WHY IT'S
IMPORTANT, BECAUSE AS, OUR MAIN
PRIORITY NOW WITH THE
DEVELOPMENT AND IMPLEMENTATION
OF THE OFFICE OF HEALTH CARE
AFFORDABILITY HAS BEEN TO FOCUS
ON HOW WE CAN GENERATE BETTER
ACCESS, IMPROVE QUALITY AT LOWER
TOTAL COST OF CARE IN THE STATE
OF CALIFORNIA FOR A 39 MILLION
RESIDENTS. AND SO THAT IS WHY WE
RESPECTFULLY URGE YOUR AYE VOTE
TODAY TO CONTINUE THIS PILOT FOR
AN ADDITIONAL TWO YEARS TO
GENERATE THAT DATA. THANK YOU,
THANK YOU. ANY ADDITIONAL
WITNESSES IN SUPPORT? THANK YOU.
MITCH STEIGER WITH CFT, A UNION
OF EDUCATORS AND CLASSIFIED
PROFESSIONALS ALSO IN SUPPORT.
ANY WITNESSES IN OPPOSITION.
GOOD EVENING, CHAIR. AND MEMBERS
OF THE COMMITTEE, ROBERT BOYKIN
WITH THE CALIFORNIA ASSOCIATION
OF HEALTH PLANS. WE GREATLY
APPRECIATE THE AUTHOR'S OFFICE.
SORRY. REGRETTABLY, IN
OPPOSITION TO AB 2063. OH, THERE
WE GO AGAIN. IT HAPPENED TWICE.
I KNOW, WE GREATLY APPRECIATE
THE AUTHOR'S OFFICE AND THEIR
EFFORTS TO PROMOTE INNOVATION IN
HEALTH CARE. HOWEVER, WE
CONTINUALLY TO BE CONCERNED
ABOUT ALLOWING NEW RISK BEARING
ARRANGEMENTS FOR PROVIDERS
OUTSIDE THE SCOPE OF A NOXS
KEEN, FULLY LICENSED HEALTH
PLAN. CALIFORNIA'S NOXS KEEN
LICENSE HEALTH PLANS ARE TIGHTLY
REGULATED AND COMPLY WITH A WIDE
ARRAY OF REQUIREMENTS THAT
PROTECT THE MARKET, AND HEALTH
CARE SERVICE CUSTOMERS AMONG
OTHER THINGS. FULLY LICENSED
HEALTH PLANS MUST MEET STRINGENT
SOLVENCY REQUIREMENTS, ENSURE
TIMELY ACCESS TO CARE, IMPLEMENT
CUSTOMER GRIEVANCES, AND
PARTICIPATE IN INDEPENDENT
MEDICAL REVIEWS. WE FEEL THIS
BILL WILL ALLOW AN ARRANGEMENT
THAT DOES NOT PROVIDE THE
IMPORTANT CONSUMER PROTECTIONS
THAT A LICENSED HEALTH PLAN,
MUST EXTEND THEIR ENROLLEES. WE
WERE OPPOSED TO THE ORIGINAL
BILL, AB 1124, THAT ENACTED THE
PILOT PROGRAM AND CONTINUE TO
HAVE THE SAME CONCERNS LISTED IN
OUR IN OUR LETTER AND IN THE
ANALYSIS. FOR THAT REASON, WE
ASK YOU TO VOTE NO ON EXTENDING
THE PILOT PROGRAM. THANK YOU FOR
YOUR TIME TODAY. THANK YOU. ANY
OTHERS IN OPPOSITION? STEPHANIE
WATKINS, ON BEHALF OF THE
ASSOCIATION OF CALIFORNIA LIFE
AND HEALTH INSURANCE COMPANIES,
ALSO IN OPPOSITION. THANK YOU.
I'LL BRING IT BACK TO THE
COMMITTEE FOR COMMENT. I'LL
START OFF WITH, SAYING THANK YOU
TO THE AUTHOR FOR BRINGING THIS
FORWARD. I THINK YOU'VE TOUCHED
ON THE CHALLENGE THAT WE HAD
WITH, DELAYED IMPLEMENTATION.
AND I THINK THIS IS A VERY
THOUGHTFUL, NARROW BILL THAT
ALLOWS US TO BE ABLE TO MOVE
FORWARD WITH LEGISLATION AND
INTENTION THAT WE PASSED
PREVIOUSLY. AND WITH THAT,
SEEING NO OTHER COMMENTS FROM
THE COMMITTEE, YOU MAY CLOSE.
YEAH. IN CLOSING, THIS IS A
POLICY THAT WE AS A LEGISLATURE
PASSED SEVERAL YEARS AGO. SO
IT'S A POLICY THAT WE ALL
COLLECTIVELY AGREED WE WANTED TO
SEE TAKE IN TO ITS CONCLUSION.
THE PANDEMIC INTERRUPTED THAT.
SO THIS IS JUST TO MAKE SURE
THAT WE CAN SEE THE FRUITS OF
THE LEGISLATION THAT WE PASSED.
SO WITH THAT, I'D RESPECTFULLY
REQUEST AN AYE VOTE. DO WE HAVE
A MOTION SO MOVED BY CHEVELLE,
SECONDED BY AGUIAR-CURRY. PLEASE
CALL THE ROLL AS Dð MOTION IS
DUE. PASS TO APPROPRIATIONS ONTO
A ONTO A WALDRON EDGAR CURRY
EDGAR CURRY I ARAMBULA ARAMBULA
I WENDY CARILLO WENDY CARILLO I
FLORA HANEY. HANEY I JOHN
SAWYER. JOHN SAWYER I
MAIENSCHEIN MAIENSCHEIN I
MCCARTY. MCCARTY I JOE PATTERSON
. RODRIGUEZ. RODRIGUEZ I SANCHEZ
. SANCHEZ I SANTIAGO. BROUGH.
CHAU. VÚI. WEBBER WEBBER I. THAT
MEASURE IS OUT WITH A VOTE OF 12
TO 0. THANK YOU. WE'LL MOVE ON
TO OUR LAST ITEM TO BE HEARD AT
THIS HEARING. ITEM NUMBER 16, AB
2466. WHILE ASSEMBLY MEMBER
CARRILLO IS HEADING TOWARDS THE
PRESENTATION COMMITTEE MEMBERS,
SHOULD YOU CHOOSE AND LIKE TO
VOTE, NOW WOULD BE THE TIME TO
COME DOWN. WHENEVER YOU'RE
READY. THANK YOU, MADAM CHAIR
AND MEMBERS, FIRST LET ME BEGIN
BY ACCEPTING THE COMMITTEE
AMENDMENTS. THANK YOU TO THE
STAFF FOR WORKING WITH US TO
MOVE THIS BILL FORWARD. I'M
PROUD TO PRESENT AB 2466, WHICH
WILL ADOPT A NUMBER, ADOPT A
NUMBER OF MEASURES AIMED AT
IMPROVING BEHAVIORAL HEALTH
APPOINTMENT WAIT TIMES FOR YOUNG
PEOPLE ON MEDI-CAL. ON NOVEMBER
28TH, 2023, THE CALIFORNIA STATE
AUDITOR RELEASED A REPORT
HIGHLIGHTING THE CHALLENGES THAT
CHILDREN AND YOUTH FACE WHEN
ACCESSING BEHAVIORAL HEALTH
CARE. THE REPORT FOUND A CLEAR
NEED FOR THE DEPARTMENT OF
HEALTH CARE SERVICES TO MONITOR
HEALTH PLAN COMPLIANCE WITH
TIMELY ACCESS STANDARDS AND LAW.
THE HEALTH PLANS NOT MEETING
THOSE STANDARDS FUELS LONG
STANDING DISPARITIES IN ACCESS
AND MENTAL HEALTH OUTCOMES FOR
CALIFORNIA'S LOW INCOME YOUTH OF
COLOR, A POPULATION WHO ARE
PRIMARILY ENROLLED IN MEDI-CAL
FOR MEDI-CAL YOUTH, THE AUDITOR
FOUND THAT HEALTH PLANS WERE
LARGELY UNABLE TO MEET THE
STATE'S 48 HOUR URGENT
APPOINTMENT STANDARD WITH A
MEDIUM WAIT TIME OF 13 DAYS
ACROSS. MEDI-CAL MANAGE AND CARE
PLANS. ADDITIONALLY, THE
DEPARTMENT OF HEALTH CARE
SERVICES HAS NOT SET ANY MINIMUM
THRESHOLD FOR HOW MANY PROVIDERS
A HEALTH PLAN MUST HAVE FOR
SERVICES WITH TIMELY ACCESS
STANDARDS. THE INFORMATION IN
THE STATE AUDITOR'S REPORT, MUST
BE A RECKONING. IT IS
UNACCEPTABLE THAT YOUNG PEOPLE
IN COMMUNITIES ACROSS CALIFORNIA
ARE UNABLE TO RECEIVE THE CARE
THEY NEED AND WHEN THEY NEED IT.
IN CALIFORNIA, THE LOWEST INCOME
CHILDREN OR LOW INCOME CHILDREN
ACROSS MANY COMMUNITIES ARE THE
ONES MOST LIKELY ENROLLED ON
MEDI-CAL. THEY EXPERIENCE THE
HIGHEST RATES OF SERIOUS
EMOTIONAL DISTURBANCE,
EXPERIENCED THE GREATEST RACIAL
AND ETHNIC DISPARITIES IN TERMS
OF OUTCOMES LIKE SUICIDE, AND
HAVE THE MOST BARRIERS TO
ACCESSING SERVICES. THESE
RESULTS SHOW THAT ENSURING
MEDI-CAL COVERED BEHAVIORAL
HEALTH SERVICES MEET TIMELY
ACCESS STANDARDS IS CRITICAL TO
ADDRESSING THE LARGEST UNMET
NEEDS. THIS LEGISLATION WILL
ALSO IMPROVE DCS OVERSIGHT OF
ALL SERVICES THAT MANAGE CARE
PLANS PROVIDE TO CALIFORNIANS.
ON MEDI-CAL. HERE. TO ADDRESS
MORE ON THE BILL IS ASHLEY
VERCHER, A MOM FROM PLACER
COUNTY, AND ANGELA VASQUEZ, A
MENTAL HEALTH POLICY DIRECTOR AT
THE CHILDREN'S PARTNERSHIP WHO
HAS BEEN WAITING ALL DAY TO
TESTIFY. AND FROM MY DISTRICT,
WELCOME. THANKS SO MUCH. I HAVE
NO PREPARED STATEMENT TODAY AND
DEFER TO MY FRIEND ASHLEY.
HELLO. I'M HERE TO TALK ABOUT MY
EXPERIENCE WITH MEDI-CAL. MY
SON, WHEN MY SON WAS 18 MONTHS
OLD, HE STARTED DISPLAYING SIGNS
THAT HE WAS ON THE AUTISM
SPECTRUM. I TRIED TO GET MY SON
ASSESSED THROUGH HIS PRIMARY
CARE PROVIDER, BUT BECAUSE OF
THE WAITLIST FOR BEHAVIORAL
HEALTH SERVICES, I HAD HIM
ASSESSED THROUGH ALTA CALIFORNIA
REGIONAL CENTER, BUT HE STILL
DID NOT RECEIVE SERVICES BETWEEN
AGES TWO AND THREE AND BETWEEN
AGES TWO AND FIVE. I CONTINUED
TO REQUEST BEHAVIORAL HEALTH
SERVICES FOR MY SON, BUT I
EXPERIENCED MULTIPLE DENIALS AND
DELAYS AND HE NEVER HAD
CONSISTENT ACCESS TO CARE.
THROUGHOUT THIS TIME, FAST
FORWARD TO 2020, WHEN MY SON WAS
FIVE YEARS OLD AND STARTED
KINDERGARTEN AND STILL DID NOT
HAVE ACCESS TO ANY MENTAL AND
BEHAVIORAL HEALTH SERVICES, HE
HAD TO ATTEND SCHOOL VIRTUALLY
FROM A SMALL HOME BASED CHILD
CARE CENTER. THE PROVIDER AT
THIS CHILD CARE CENTER
PHYSICALLY ABUSED MY SON BECAUSE
HE COULD NOT BECAUSE SHE COULD
NOT HANDLE HIS NEEDS AND HE DID
NOT HAVE ANY SUPPORTS, SERVICES,
SUPPORTIVE SERVICES IN PLACE TO
HELP MANAGE BEHAVIORS, HIS
BEHAVIORS. NOW, I TRIED TO
ACCESS MENTAL HEALTH SERVICES SO
MY SON COULD PROCESS THE TRAUMA
THAT HE EXPERIENCED. SINCE
KAISER DID NOT HAVE AVAILABLE
CLINICIANS, THEY MADE AN OUTSIDE
REFERRAL, WHICH CAUSED ANOTHER
DELAY IN ACCESSING SERVICES.
AFTER A FEW MONTHS OF SEEING
THIS CLINICIAN, MY SON'S
SERVICES WERE TERMINATED DUE TO
THE THERAPIST NOT RECEIVING
PAYMENT BECAUSE OF INSURANCE
CODING BARRIERS. BECAUSE KAISER
DID NOT HAVE ANOTHER APPROPRIATE
THERAPIST IN ITS NETWORK, I HAD
TO I HAD TO THEN FIND A NEW
THERAPIST WHO WAS OUT, WHO WAS
OUT OF POCKET TO BE ABLE TO GET
MY SON SERVICES THAT HE NEEDED,
ESPECIALLY DUE TO HIS SUICIDAL
IDEATIONS FROM WHAT HE
EXPERIENCED. AGAIN, I WAS LEFT
WITH MY LEFT ON MY OWN TO FIND
ANOTHER THERAPIST. IN ADDITION
TO CONTINUING TO NAVIGATE THE
CRISIS IN DAILY ELOPEMENTS WHILE
TRYING TO GET MY SON TO THE
CORRECT THE CORRECT DIAGNOSES
AND SUPPORTS. DUE TO THESE
DELAYS, MY SON STILL DID NOT
HAVE ANY SERVICES IN PLACE WHEN
IN-PERSON SCHOOLING RESUMED
AFTER COVID. ONCE THIS HAPPENED,
HE STARTED TO ELOPE FROM THE
SCHOOL, CAMPUS AND OTHER
LOCATIONS IN THE COMMUNITY. LAW
ENFORCEMENT, AS WELL AS THE
PLACER COUNTY BEHAVIORAL HEALTH
MOBILE CRISIS TEAM, WERE CALLED
OUT MANY TIMES TO SUPPORT HIS
NEEDS AND TO HELP KEEP HIM SAFE
DURING THE SIX MONTH PROCESS OF
TRYING TO GET MY SON CONNECTED
TO ONGOING MENTAL HEALTH
SERVICES, EVERY TIME THE MOBILE
CRISIS TEAM RESPONDED TO
PARTICULAR SITUATION, THE
COUNTY'S BEHAVIORAL HEALTH TEAM
CLOSED THE REFERRAL AND DID NOT
PROVIDE ANY ADDITIONAL
COORDINATION FOR SERVICES AT
THAT TIME, EVEN THOUGH WE WERE
STILL WAITING TO GET HIM
CONNECTED TO BEHAVIORAL HEALTH
SERVICES FROM KAISER. FINALLY
KAISER AGREED TO ASSESS MY SON'S
NEED FOR BEHAVIORAL HEALTH
SERVICES. AT FIRST, THEY
DIAGNOSED MY SON WITH ADHD. I
THEN HAD TO ADVOCATE FOR MY SON
TO ALSO GET ASSESSED FOR AUTISM
SPECTRUM BASED ON HIS BEHAVIORS.
IT TOOK OVER SIX MONTHS FROM
THAT TIME FOR MY SON, TIME. MY
SON STARTED SEEING THE CRISIS
THERAPIST TO RECEIVE THE ADHD
DIAGNOSIS. SINCE THEIR
ASSESSMENT, SCORING MACHINE WAS
DOWN AND I WAS TOLD THAT THERE
WAS NO OTHER WAY TO ASSESS HIM.
AFTER FIVE YEARS OF MANY DELAYS
AND SEVERAL FAILED ATTEMPTS TO
SELF-REFER TO HIM FOR SERVICES,
I FINALLY DECIDED TO SWITCH TO
ANTHEM. MEDI-CAL WHICH THEN
CREATED ADDITIONAL DELAYS AS WE
NEEDED TO NOW REESTABLISH CARE
WITH A NEW PEDIATRICIAN, TRY AND
TRANSFER ALL OF HIS MEDICAL
RECORDS, AND NAVIGATE A NEW
NETWORK OF PROVIDERS. DUE TO ALL
OF THESE DELAYS, MY SON DID NOT
GET DIAGNOSED WITH AUTISM UNTIL
HE WAS ALMOST SEVEN, AND SOON
AFTER THAT I HAD TO STOP WORKING
TO SUPPORT HIS NEEDS. AFTER NINE
MONTHS OF BEING PLACED ON A
WAITLIST FOR ABA THERAPY, A
PROVIDER CALLED US AND HAD SPACE
AVAILABLE. HOWEVER, AFTER DOING
THE PAPERWORK, WE WERE TOLD THAT
THEY DID NOT TAKE ANTHEM
MEDI-CAL, BUT THAT THEY TAKE
KAISER MEDI-CAL. SO AGAIN,
SERVICES WERE DELAYED BECAUSE WE
HAD TO GO THROUGH THE PROCESS OF
RETURNING TO KAISER FOR ABA
TREATMENT. TODAY IS MY SON'S
NINTH BIRTHDAY AND THE CURRENT
TIME. AFTER 5.5 MONTHS, I AM
STILL WAITING TO GET MY SON
CONNECTED TO THERAPEUTIC
SUPPORT, AND I'M IN THE MIDDLE
OF THE GRIEVANCE PROCESS. I'VE
ALSO CONNECTED WITH KAISER'S
ENHANCED CARE MANAGEMENT
SERVICES AND HAVE BEEN WAITING
ALMOST TWO MONTHS FOR ADDITIONAL
SUPPORT THROUGH THIS PROGRAM TO
BE ABLE TO GET MY SON ACCESS TO
THE MENTAL HEALTH SERVICES THAT
HE NEEDS. AS YOU HAVE HEARD FROM
OUR STORY, IF MY SON HAD TIMELY
ACCESS TO THE BEHAVIORAL AND
MENTAL HEALTH SERVICES THAT HE
NEEDED, HE WOULD HAVE BEEN ABLE
TO ACCESS EARLY INTERVENTION
SERVICES WHEN HE WAS YOUNGER AND
WOULD STILL HAVE BEEN ELIGIBLE
FOR WHICH HE WOULD HAVE GREATLY
BENEFITED FROM AND MAY NOT HAVE
EXPERIENCED THE AMOUNT OF TRAUMA
THAT HE HAS HAD TO ENDURE. THESE
DELAYS PREVENTED HIM FROM
RECEIVING TIMELY AND ACCURATE
DIAGNOSES, RESULTING IN BARRIERS
TO ACCESSING OTHER SERVICES SUCH
AS IN-HOME SUPPORTIVE SERVICES
AND SOCIAL SECURITY BENEFITS,
WHICH ALMOST CAUSED US TO BECOME
HOMELESS. THESE DELAYS HAVE ALSO
PREVENTED MY SON FROM GETTING A
TIMELY AND COMPREHENSIVE IEP AND
ACCESSING THE EDUCATIONAL
SUPPORTS HE NEEDS. SINCE IT IS
NOT CLEAR TO ME AS A PARENT
WHETHER MY MEDI-CAL HEALTH PLAN
OR THE SCHOOL HAS A
RESPONSIBILITY TO PROVIDE OR
ARRANGE FOR MY CHILD'S CARE AS
NEEDED SERVICES AND WHICH
PROVIDER SHOULD BE COORDINATING
HIS CARE. THANK YOU. THANK YOU
SO MUCH FOR YOUR TESTIMONY. BILL
MOVED BY DOCTOR ARAMBULA,
SECONDED BY RODRIGUEZ. ANY
ADDITIONAL SUPPORT THOUGHT FOR
THE BILL? GOOD AFTERNOON, LINDA
WEI WITH WESTERN CENTER ON LAW
AND POVERTY IN SUPPORT. AT BEST,
ON BEHALF OF THE CALIFORNIA
ALLIANCE OF CHILD AND FAMILY
SERVICES IN SUPPORT. SYMPHONY
BARBIE, ON BEHALF OF PLANNED
PARENTHOOD. AFFILIATES OF
CALIFORNIA IN SUPPORT. TRENT
MURPHY WITH THE CALIFORNIA
ASSOCIATION OF ALCOHOL AND DRUG
PROGRAM EXECUTIVES AND SUPPORT.
KIM LEWIS, ON BEHALF OF CHILDREN
NOW IN SUPPORT. CHRISTINE SMITH,
HEALTH ACCESS AND SUPPORT.
MARVIN PINEDA, ON BEHALF OF THE
LEUKEMIA AND LYMPHOMA SOCIETY IN
SUPPORT. THANK YOU. ANY
WITNESSES IN OPPOSITION
?
YOU'LL EACH HAVE TWO MINUTES.
THANK YOU, GOOD AFTERNOON, MADAM
CHAIR AND COMMITTEE MEMBERS.
KATIE, ANDREW WITH LOCAL HEALTH
PLANS. CALIFORNIA IN OPPOSITION
TO AB 2466. LPCC APPRECIATES THE
BILL'S INTENT TO ENSURE TIMELY
ACCESS TO MEDI-CAL MEMBERS AND
LOCAL PLANS. SHARE THIS
COMMITMENT. HOWEVER, WE BELIEVE
THIS BILL IS PREMATURE AND THAT
IT CIRCUMVENTS THE CURRENT AND
PLANNED ACTIONS OF THE
DEPARTMENT OF HEALTH CARE
SERVICES IS UNDERTAKING TO
ADDRESS THE RECOMMENDATIONS
WITHIN THE STATE AUDITOR'S
REPORT THAT THIS BILL AIMS TO
ADDRESS, INCLUDING ASSESSING THE
FEASIBILITY OF IMPLEMENTING A
SECRET SHOPPER APPROACH WITHIN
TIMELY ACCESS SURVEYS AND
MONITORING PROCESSES FOR NEW AND
EXISTING PATIENTS. ADDITIONALLY,
DCFS HAS ALREADY BEGUN TO WORK
WITH THE DEPARTMENT OF MANAGED
HEALTH CARE ON A LION COMPLIANCE
THRESHOLDS ACROSS MANAGED CARE
DELIVERY SYSTEMS. WHILE
ACKNOWLEDGING THE GOALS OF THIS
BILL TO IMPROVE TIMELY ACCESS,
WE REGRETTABLY MUST OPPOSE AB
2466 AT THIS TIME, BUT LOOK
FORWARD TO CONTINUING TO WORK
WITH THE AUTHOR AND CO-SPONSORS
ON THE BILL. THANK YOU. GOOD
AFTERNOON, MADAM MÁS. GOOD
EVENING, MADAM CHAIR. MEMBERS OF
THE COMMITTEE, JED HAMPTON WITH
THE CALIFORNIA ASSOCIATION OF
HEALTH PLANS, IN THE INTEREST OF
TIME, AND THIS BEING THE LAST
BILL, WE WOULD LIKE TO ALIGN OUR
COMMENTS WITH MY COLLEAGUE FROM
THE LOCAL HEALTH PLANS,
CALIFORNIA. WE APPRECIATE THE
AUTHOR AND HER STAFF, YOU KNOW,
MEETING WITH US AND AS WELL AS
ENGAGING WITH THE COMMITTEE ON
THIS BILL, LOOK FORWARD TO
HAVING FUTURE CONVERSATIONS
AROUND SOME OF THE CONCERNS THAT
MY COLLEAGUE OUTLINED. THANK YOU
. I'LL BRING ANY OTHER
OPPOSITION. I'LL BRING IT BACK
TO THE COMMITTEE FOR COMMENT OR
QUESTION. DOCTOR WEBER, GOOD
EVENING EVERYONE. FIRST, I
REALLY WANT TO THANK YOU FOR
STICKING AROUND ALL THIS TIME TO
PROVIDE YOUR TESTIMONY. I KNOW
IT'S BEEN A VERY LONG, LONG DAY,
AND I ALSO WANT TO APOLOGIZE FOR
THE DELAY THAT YOU AND YOUR SON
HAVE HAD OVER ALL OF THESE YEARS
. IT'S ONE OF THE REASONS YOUR
STORY IS ONE OF THE REASONS WHY
I ASKED FOR THE AUDIT REPORT IN
THE FIRST PLACE. AND SO I JUST,
YOU KNOW, IT IS IT IS
UNFORTUNATE. IT SHOULD NEVER
HAPPEN HERE IN THIS STATE. BUT I
REALLY APPRECIATE YOU COMING AND
TELLING YOUR STORY. WE
UNDERSTAND THAT WHEN THE AUDIT
REPORT WAS RELEASED AND I MET
WITH, DCS, THEY DID STATE THAT
THEY WOULD BE IMPLEMENTING MANY
OF THE FINDINGS WITHIN THE AUDIT
REPORT. SO I LOOK FORWARD TO
THAT, TO SEE WHAT THEY ARE ABLE
TO DO. AND THE ONLY THING THAT I
WOULD JUST KIND OF CAUTION TO
THE AUTHOR, IF THIS BILL DOES,
YOU KNOW, MOVE FORWARD. AND IF
THE GOVERNOR DOES SIGN THIS IS
TO JUST KIND OF KEEP AN EYE ON
THE IMPLEMENTATION OF IT, ONE OF
THE THINGS THAT I GET CONCERNED
ABOUT WHEN WE START PUTTING
REQUIREMENTS AS WE SHOULD, IS
THAT THOSE DON'T TRICKLE DOWN TO
THE PROVIDERS. IF YOU WANT TO
END UP, YOU KNOW, BEING ABLE TO
SEE PATIENTS WITHIN OUR NETWORK,
YOU MUST SEE A CERTAIN NUMBER OF
PATIENTS AND A CERTAIN NUMBER OF
TIMES SO THAT WE CAN MEET OUR
METRICS, BECAUSE THEN WHAT THAT
TRICKLES DOWN TO IS NOT ONLY ARE
YOU DOUBLE BOOKING, BUT YOU'RE
TRIPLE BOOKING IN ORDER TO
MAINTAIN THE ACCESS PER SE, SO
THAT THE NUMBERS ARE DOWN AND
YOU DON'T HAVE TO WAIT TEN DAYS.
NOW YOU'VE GOT TO WAIT FIVE
DAYS, BUT NOW YOU HAVE LESS TIME
WITH EACH OF THE PATIENTS. SO I
WOULD JUST, YOU KNOW, REQUEST
THAT IF THIS GOES THROUGH AND
THE GOVERNOR SIGNS IT, THAT YOU
JUST KIND OF KEEP AN EYE ON THE
ACTUAL IMPLEMENTATION THÀNH AND
LISTEN TO WHAT THE PROVIDERS SAY
ON THE GROUND TO ENSURE THAT
IT'S NOT ULTIMATELY IMPACTING
THEIR WORKLOAD, WHICH ULTIMATELY
THEN IMPACTS THE CARE THAT
THEY'RE ABLE TO PROVIDE FOR
PATIENTS AND THEIR FAMILIES. SO
THANK YOU. I ALSO WANT TO THANK
THE AUTHOR FOR BRINGING FORWARD
THIS BILL TO MOVE FROM. IT'S A
VERY GOOD DEMONSTRATION OF
GOVERNMENT AND THE LEGISLATURE
WORKING FROM THE SENSE OF
SENSIBILITY OF FOCUSING ON
OVERSIGHT WITH THE INITIAL
REQUEST FOR THE AUDIT THAT
DOCTOR WEBBER FOCUSED ON
BUILDING UPON THAT IN ORDER TO
BE ABLE TO REALLY ESTABLISH A
ROADMAP, TO BE ABLE TO MOVE
FORWARD FROM THOSE AUDITOR
RECOMMENDATIONS, AND ALSO BEING
IN CONVERSATION AS THIS BILL
MOVES FORWARD WITH DHS TO ENSURE
THAT, THERE IS PARITY IN TERMS
OF WHAT THOSE RECOMMENDATIONS
ARE AND WHAT THIS BILL
ULTIMATELY PROVIDES. AND I ALSO
WANT TO THANK THE WITNESS FOR
NOT ONLY BEING HERE FOR SUCH A
LONG DAY, BUT SHARING, SHARING
YOUR STORY IN A WAY THAT WE CAN
ALL HEAR IT. I THINK MANY OF US
UP HERE WOULD HAVE BEEN YELLING
AND SCREAMING BASED ON THE
EXPERIENCE THAT YOU'VE HAD. AND
SO I WANT TO THANK YOU FOR YOUR
ADVOCACY AND REALLY TESTIFYING.
IT MEANS A LOT WITH THAT.
ASSEMBLYMAN CARRILLO, WOULD YOU
LIKE TO CLOSE, THANK YOU, MADAM
CHAIR. AND, MANY THANKS TO MY
COLLEAGUE FROM SAN DIEGO FOR,
REQUESTING THE AUDIT TO BEGIN
WITH, AND I THINK I'M REALLY
GRATEFUL THAT SOME OF THOSE
IMPLEMENTATIONS AND SUGGESTIONS
ARE GOING TO BE MOVING FORWARD.
I THINK IN THIS COMMITTEE IN
PARTICULAR, I'VE PRESENTED AND
HAVE SEEN MANY OTHERS PRESENT.
LEGISLATION RELATED TO HEALTH
CARE ACCESS AS WELL AS THE
WORKFORCE NEEDED TO BE ABLE TO
ADDRESS ALL OF THE CONCERNS THAT
ARE FELT. AND I THINK WHEN WE
LOOK AT, THE PATIENTS THAT ARE
IN THE MOST NEED, THEY'RE OFTEN
IN VULNERABLE DISENFRANCHIZED
COMMUNITIES ON MEDI-CAL, WHICH
WE ALREADY KNOW DOES NOT HAVE
THE RESOURCES THAT THEY NEED AS
PROVIDERS. AND CERTAINLY,
REALLY, YOUR TESTIMONY, MISS
WALKER IS AN EXAMPLE OF HOW EASY
IT IS TO FALL INTO THE CRACKS
AND LOOPHOLES OF JUST THE
BUREAUCRACY THAT IS HEALTH CARE.
AND SO I KNOW THAT WITH WORKING
WITH, STAKEHOLDERS AND
OPPOSITION TODAY, THEY SHARE THE
SAME, GOAL IN ENSURING THAT
THEIR PATIENTS HAVE COVERAGE.
AND SO I REALLY LOOK FORWARD TO
CONTINUING THE CONVERSATION AND
MOST IMPORTANTLY, WORKING ON
POLICIES THAT, AT THE END OF THE
DAY, HELP PEOPLE AND TO CREATE
THE WORKFORCE NECESSARY FOR OUR
STATE. SO WITH THAT, I
RESPECTFULLY REQUEST AND I VOTE
THE MOTION IS. MOTION IS DO
PASS, AS AMENDED TO
APPROPRIATIONS. PLEASE CALL THE
ROLL MONTA I MONTA I WALDEN
WALDEN I AGUIAR-CURRY AGUIRRE I
ARAMBULA ARAMBULA I WENDY
CARILLO WENDY CARILLO I FLORA
LARA NOT VOTING HANEY. HANEY I
JOAN SAWYER JOHN SAWYER I
MAINTAIN MAY SHINE I MCCARTY
MCCARTY I JOE PATTERSON. NO.
PATTERSON. NOT VOTING. RODRIGUEZ
RODRIGUEZ I SANCHEZ. SANCHEZ NOT
VOTING. SANTIAGO. SANTIAGO I
CHAVO CHAVO I WEBBER. WEBER I.
THAT MEASURES OUT 13 TO 0. THANK
YOU. WE WILL CONCLUDE OUR
BUSINESS BY ENSURING THAT WE RUN
THROUGH THE ENTIRE HEARING AGAIN
WITHOUT THE PRESENTATIONS, TO
MAKE SURE THAT PEOPLE HAVE THE
OPPORTUNITY TO VOTE. WE'LL START
WITH ITEM NUMBER ONE, AB 1799.
THIS NEEDS A MOTION MOVED BY
AGUIAR-CURRY, SECONDED BY DOCTOR
WEBER. THE MOTION IS Dð. PASS TO
APPROPRIATIONS. PLEASE CALL THE
ROLL. BONTA. AYE, AYE. WALDRON.
AGUIAR-CURRY. AGUIAR-CURRY. AYE.
ARAMBULA. ARAMBULA AYE. WENDY.
CARILLO. WENDY. CARILLO. AYE.
FLORA. LARA. NO HANEY. HANEY.
AYE. JONES-SAWYER. JONES-SAWYER
AYE. MAIENSCHEIN. MAIENSCHEIN.
AYE. MCCARTY. MCCARTY AYE.
PATTERSON. PATTERSON. NO.
RODRIGUEZ RODRIGUEZ. AYE.
SANCHEZ. SANCHEZ. NO. SANTIAGO
SANTIAGO. AYE. CHAVO CHAU. AYE.
WEBER. WEBER. AYE. THAT MEASURE
IS OUT. 12.23. ITEM NUMBER TWO
AB 1895. WEBER FOR ADD ONS.
WENDY CARILLO. WENDY CARILLO.
AYE. FLORA LARA NOT VOTING. JOE
PATTERSON. NO. PATTERSON. NOT
VOTING. SANTIAGO SANTIAGO. AYE
1301 VOTE IS NOW 13 TO 1 ON THAT
MEASURE. ITEM NUMBER THREE AB
1936. CERVANTES IS A WAS ON
CONSENT. ITEM NUMBER FOUR AB,
THEN AB 1975 BONTA FOR ADD ONS.
LARA LARA. NO MAIENSCHEIN. AYE
MCCARTY MCCARTY I JOE.
PATTERSON. PATTERSON. AYE.
RODRIGUEZ RODRIGUEZ. AYE.
SANCHEZ. SANCHEZ. NOT VOTING.
SANTIAGO. SANTIAGO. AYE. VOTE
NOW 14 TO 1 ON THAT MEASURE.
ITEM NUMBER FIVE, AB 2063
MAIENSCHEIN FOR ADD ONS. WALDRON
LARA. LARA. AYE JOE. PATTERSON.
SO. PATTERSON. AYE. SANTIAGO
SANTIAGO. AYE.
AND THERE'S NOW 15 TO 0. ITEM
NUMBER SIX, AB 2066 REYES FOR
ADD ONS. LARA LARA NØ
MAIENSCHEIN. WEINSTEIN. AYE.
MCCARTY. MCCARTY. IJO PATTERSON.
PATTERSON. NØ. RODRIGUEZ
RODRIGUEZ. AYE SANTIAGO.
SANTIAGO. AYE. MEASURE NOW IS 13
TO 3. ITEM NUMBER SEVEN ON
CONSENT. ITEM NUMBER EIGHT AB
2098. GARCIA, FOR ADD ONS LARA
LARA. AYE. MAIENSCHEIN
WEINSTEIN. AYE. MCCARTY MCCARTY.
AYE. JOE. PATTERSON. JOE.
PATTERSON. AYE. RODRIGUEZ
RODRIGUEZ. AYE. SANTIAGO.
SANTIAGO AYE. 1670. MEASURE NOW
HAS 16 VOTES TO ZERO. ITEM
NUMBER NINE, AB 2105 IS ON CALL.
I'LL LIFT THE CALL. PLEASE CALL
THE ROLL. LARA NOT VOTING.
HANEY. HANEY. AYE. MANCINI
MAIENSCHEIN. AYE. MCCARTY.
MCCARTY. AYE. PATTERSON NO.
PATTERSON. NOT VOTING.
RODRIGUEZ. RODRIGUEZ AYE.
SANTIAGO. SANTIAGO. AYE. WEBER
WEBER. AYE. ASKING THAT MEASURES
OUT 14 VOTES TO ZERO, ITEMS TEN
THROUGH 14 ARE ON CONSENT. ITEM
NUMBER 15, AB 2449 IS ON CALL TO
. I'LL LIFT THE CALL ARAMBULA.
ARAMBULA. AYE. LARA LARA. AYE
HANEY. HANEY. AYE. MAINCHAIN.
MAINCHAIN AYE. MCCARTY. MCCARTY.
IJO. PATTERSON JOE. PATTERSON.
AYE. RODRIGUEZ. RODRIGUEZ. AYE.
SANCHEZ SANCHEZ. AYE. SANTIAGO.
SANTIAGO. AYE. WEBER WEBER. NOT
VOTING. THAT MEASURES OUT 15 TO
0. ITEM NUMBER 16 AB 2466. ADD
ONS. I HOPE EVERYBODY WE HAVE
EVERYONE ON THAT ONE ITEM NUMBER
17 AB 2490 PETRIE-NORRIS,
MEASURES ON CALL. I'M LIFTING
THE CALL. ARAMBULA. ARAMBULA.
AYE. LARA LARA NÓ HANEY. HANEY.
I MAIENSCHEIN MAIENSCHEIN. AYE.
MCCARTY MCCARTY. AYE. JOE.
PATTERSON. JOE. PATTERSON. NO
RODRIGUEZ. RODRIGUEZ. AYE.
SANCHEZ. SANCHEZ NO. SANTIAGO
SANTIAGO. AYE WEBER. WEBER. AYE.
PERFORMANCE MEASURES. NOW. 12
VOTES TO FOUR AND OUT OF
COMMITTEE, 18 AND 19 ARE ON
CONSENT. ITEM NUMBER 20, AB
2775. GIBSON FOR ADD ONS. OH,
SORRY, IS ON CALL. I WILL LIFT
THE CALL. ARAMBULA ARAMBULA.
AYE. LARA LARA. AYE HANEY.
HANEY. AYE. MAIENSCHEIN
WEINSTEIN. AYE. MCCARTY.
MCCARTY. IJO. PATTERSON NØ.
PATTERSON. AYE. RODRIGUEZ.
RODRIGUEZ. AYE SANCHEZ. SANCHEZ.
AYE. SANTIAGO. SANTIAGO AYE.
SABO SABO. AYE. 16 ZERO. THAT
MEASURES OUT 16 TO 0. ITEM
NUMBER 21 AB 2859 IS ON CALL.
I'M LIFTING THE CALL. ARAMBULA
ARAMBULA. AYE. LARA LARA. AYE.
HANEY. HANEY. AYE. MANCINI
MASON. AYE. MCCARTY MCCARTY.
AYE. JOE. PATTERSON. JOE.
PATTERSON. AYE. RODRIGUEZ
RODRIGUEZ. AYE. SANCHEZ SANCHEZ.
AYE. SANTIAGO. SANTIAGO. AYE. 16
ZERO. THAT MEASURES OUT 16 ZERO.
ITEM 22 AB 2866. NEEDS A MOTION
SO MOVED BY AGUIAR-CURRY,
SECONDED BY DOCTOR ARAMBULA.
PLEASE CALL THE ROLL. THE MOTION
IS DUE. PASS TO APPROPRIATIONS,
PLEASE CALL THE ROLL ONTO AYE.
ONTO. AYE. WALDRON AGUIAR-CURRY.
AGUIAR-CURRY. AYE. ARAMBULA
ARAMBULA. AYE. WENDY. CARILLO.
WENDY. CARILLO. AYE LARA. LARA.
AYE. HANEY. HANEY. AYE.
JONES-SAWYER JOHN. SAWYER. AYE.
MAIENSCHEIN. MAIN SHRINE. AYE.
MCCARTY. MCCARTY. AYE. JOE.
PATTERSON JOE. PATTERSON. AYE.
RODRIGUEZ. RODRIGUEZ. AYE.
SANCHEZ SANCHEZ. AYE. SANTIAGO.
SANTIAGO AYE. SHABU SHABU. AYE.
WEBER WEBER. AYE. 15 ZERO.
MEASURES OUT. 15 ZERO. ITEM
NUMBER 23, AB 2956 IS ON CALL.
I'LL LIFT THE CALL. ARAMBULA.
ARAMBULA. AYE. LARA LARA NOT
VOTING. HANEY HANEY. AYE.
WEINSTEIN MAIENSCHEIN. AYE.
MCCARTY. MCCARTY. AYE. JOE.
PATTERSON JOE. PATTERSON. NOT
VOTING. RODRIGUEZ RODRIGUEZ.
AYE. SANCHEZ SANCHEZ. NOT
VOTING. SANTIAGO SANTIAGO. AYE.
CHAVO CHAU. AYE. WEBER. WEBER.
AYE. 13 ZERO. THAT MEASURES OUT.
13 TO 0. ITEM NUMBER 24, AB 2960
LI. THAT MEASURES ON CALL. I'M
LIFTING THE CALL. ARAMBULA
ARAMBULA. AYE LARA LARA. NO
HANEY. HANEY. I MANCINI. MAIN
SHRINE. NOT VOTING. MCCARTY
MCCARTY. NOT VOTING. JOE.
PATTERSON. JOE. PATTERSON NO.
RODRIGUEZ. RODRIGUEZ NOT VOTING.
SANCHEZ SANCHEZ. NO. SANTIAGO
SANTIAGO. NOT VOTING. FIVE. THAT
MEASURE FAILS. PASSAGE, ASSEMBLY
MEMBER LEE IS NOTICED.
RECONSIDERATION. WITHOUT
OBJECTION. AND BY UNANIMOUS
CONSENT. WE'RE MOVING FORWARD
WITH RECONSIDERATION ON THAT
BILL. ITEM NUMBER 25, AB 2995,
THROUGH ITEM NUMBER 27 ARE ON
CONSENT. ITEM NUMBER 28. I NEED
A MOTION SO MOVED BY
AGUIAR-CURRY, SECONDED BY DOCTOR
ARAMBULA. PLEASE CALL THE ROLL.
AYE. MOTION. DO PASS TO
APPROPRIATION. ONTO. AYE. ONTO.
AYE. WALDRON AGUIAR-CURRY.
AGUIAR-CURRY. AYE. ARAMBULA
ARAMBULA. AYE. WENDY. CARILLO.
AB 3268. PELLERIN AYE. WENDY.
CARILLO. AYE. LARA LARA. AYE.
HANEY HANEY. AYE. JOHN. SAWYER.
JOHN. SAWYER. AYE MAIENSCHEIN.
MAIENSCHEIN. AYE. MCCARTY
MCCARTY. AYE. JOE. PATTERSON NÓ.
PATTERSON. NØ. RODRIGUEZ.
RODRIGUEZ. AYE. SANCHEZ SANCHEZ.
NOT VOTING. SANTIAGO SANTIAGO.
AYE. CHAVO BROUGH. AYE. WEBER.
WEBER. AYE AYE. 13 ZERO. SORRY.
13 ONE THAT MEASURES OUT. 13 129
ON CONSENT. ITEM 30 AB 3275
ARAMBULA ARAMBULA. AYE. WENDY
CARILLO WENDY CARRILLO. AYE.
FLORA LARA. AYE JOE. PATTERSON.
PATTERSON. AYE. SANCHEZ SANCHEZ.
AYE. SANTIAGO. SANTIAGO. AYE
CHAVO. SABO. AYE. 16 ZERO. THAT
MEASURES OUT. 16 ZERO. WE'LL NOW
MOVE TO CONSENT. I'VE ALREADY
INDICATED THE ITEMS ON CONSENT
CALENDAR. PLEASE CALL. LIFT THE
CALL. OPEN THE ROLL. OR FOR ADD
ONS I SHOULD SAY LARA LARA. AYE.
MAIENSCHEIN MAIENSCHEIN. AYE.
MCCARTY MCCARTY. AYE. JOE
PATTERSON. JOE. PATTERSON. AYE.
RODRIGUEZ. RODRIGUEZ. AYE.
SANTIAGO SANTIAGO. AYE. 16 ZERO.
CONSENT CALENDAR IS OUT 16 TO 0.
THAT CONCLUDES OUR HEARING FOR
THE ASSEMBLY ON HEALTH. PLEASE
HAVE A HEALTHY NIGHT