Existing law requires the State Department of Public Health to establish a list of reportable communicable and noncommunicable diseases and conditions and specify the timeliness requirements related to the reporting of each disease and condition. Existing law requires the department to develop information about various communicable diseases, including hepatitis C and meningococcal disease, and to make the information available to the public. Existing law also supports research into the development of a vaccine to protect against valley fever (coccidioidomycosis).

This bill would establish the Valley Fever Education, Early Diagnosis, and Treatment Act. This bill would, among other things, require the department to conduct a valley fever awareness campaign to communicate with local health jurisdictions, providers, and the public about valley fever, as described. The bill would authorize the department to award grants or enter into contracts to perform activities related to the awareness campaign, as specified. Those provisions would become inoperative on January 1, 2021.

Existing law requires the State Department of Public Health to establish a list of reportable communicable and noncommunicable diseases and conditions and specify the timeliness requirements related to the reporting of each disease and condition. Existing law requires the department to develop information about various communicable diseases, including hepatitis C and meningococcal disease, and to make the information available to the public. Existing law also supports research into the development of a vaccine to protect against valley fever (coccidioidomycosis).

This bill would establish the Valley Fever Education, Early Diagnosis, and Treatment Act. This bill would, among other things, require the department to conduct a valley fever awareness campaign to communicate with local health jurisdictions, providers, and the public about valley fever, as described. The bill would authorize the department to award grants or enter into contracts to perform activities related to the awareness campaign, as specified. Those provisions would become inoperative on January 1, 2021.

Existing law requires the State Department of Public Health to establish a list of reportable communicable and noncommunicable diseases and conditions and specify the timeliness requirements related to the reporting of each disease and condition. Existing law requires the department to develop information about various communicable diseases, including hepatitis C and meningococcal disease, and to make the information available to the public. Existing law also supports research into the development of a vaccine to protect against valley fever (coccidioidomycosis).

This bill would establish the Valley Fever Education, Early Diagnosis, and Treatment Act. This bill would, among other things, require the department to conduct a valley fever awareness campaign to communicate with local health jurisdictions, providers, and the public about valley fever, as described. The bill would authorize the department to award grants or enter into contracts to perform activities related to the awareness campaign, as specified. Those provisions would become inoperative on January 1, 2021.

Existing law requires the State Department of Public Health to establish a list of reportable communicable and noncommunicable diseases and conditions and specify the timeliness requirements related to the reporting of each disease and condition. The department is also responsible for licensing and regulating health facilities, including primary health clinics and general acute care hospitals. Existing law requires the department to develop information about various communicable diseases, including hepatitis C and meningococcal disease, and to make the information available to the public. Existing law also supports research into the development of a vaccine to protect against valley fever (coccidioidomycosis).

Existing law requires the State Department of Public Health to establish a list of reportable communicable and noncommunicable diseases and conditions and specify the timeliness requirements related to the reporting of each disease and condition. The department is also responsible for licensing and regulating health facilities, including primary health clinics and general acute care hospitals. Existing law also supports research into the development of a vaccine to protect against valley fever (coccidioidomycosis).

This bill would establish the Valley Fever Education, Early Diagnosis, and Treatment Act. The bill would require the department and local public health officers, the California Conference of Local Health Officers, by July 1, 2019, to make available protocols and guidelines developed by the National Institutes of Health, the federal Centers for Disease Control and Prevention, and other appropriate professional health care organizations, for educating physicians and other health care providers, as specified, regarding the most recent scientific and medical information on valley fever etiology, transmission, diagnosis, surveillance, and treatment. By imposing new duties on local public health officers, the bill would create a state-mandated local program. The bill would require a health care provider who knows of or is in attendance on a case or suspected case of valley fever, to submit a report to the local health officer as required by a specified regulatory provision. The bill would require primary care clinics and general acute care hospitals to develop, adopt, and implement a written policy and procedure regarding required reporting to the local health officer.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

Existing law requires the State Department of Public Health to establish a list of reportable communicable and noncommunicable diseases and conditions and specify the timeliness requirements related to the reporting of each disease and condition. The department is also responsible for licensing and regulating health facilities, including primary health clinics and general acute care hospitals. Existing law also supports research into the development of a vaccine to protect against valley fever (coccidioidomycosis).

This bill would establish the Valley Fever Education, Early Diagnosis, and Treatment Act. The bill would require the department and local public health officers, by July 1, 2019, to make available protocols and guidelines developed by the National Institutes of Health, the federal Centers for Disease Control and Prevention, and other appropriate professional health care organizations, for educating physicians and other health care providers, as specified, regarding the most recent scientific and medical information on valley fever etiology, transmission, diagnosis, surveillance, and treatment. By imposing new duties on local public health officers, the bill would create a state-mandated local program. The bill would require a health care provider who knows of or is in attendance on a case or suspected case of valley fever, to submit a report to the local health officer as required by a specified regulatory provision. The bill would require primary care clinics and general acute care hospitals to develop, adopt, and implement a written policy and procedure regarding required reporting to the local health officer.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

The Medical Practice Act provides for the licensure and regulation of physicians and surgeons by the Medical Board of California. The act requires the board to adopt and administer standards for the continuing education of those licensees. The act, with certain exceptions, requires physicians and surgeons to complete a continuing education course in the subjects of pain management and the treatment of terminally ill and dying patients.

This bill would require a physician and surgeon to complete a continuing educational training course for the purpose of preventing, diagnosing, and treating Coccidioidomycosis infections, commonly known as Valley Fever, by January 1, 2020. This bill would require a physician and surgeon licensed on or after January 1, 2019, to complete that requirement within 2 years of his or her initial license. The bill would authorize the board to exempt physicians and surgeons by practice status category from the requirement for specified reasons.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 1790

Author:(Salas and Grayson)

As Amended Ver:August 23, 2018

Majority vote

Original Committee Reference: HEALTH

SUMMARY: Requires the Department of Public Health (DPH) to conduct a Valley Fever awareness campaign to communicate with local health jurisdictions, providers, and the public about Valley Fever, as specified.

The Senate amendments require DPH to conduct a Valley Fever awareness campaign and sunsets the provisions of this bill on January 1, 2021.

FISCAL EFFECT: According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, negligible state costs.

COMMENTS: Valley Fever is an infectious disease caused by a fungus, Coccidioides, which is found in arid soil and desert-like regions of California, the southwestern region of the U.S., parts of Mexico, Central America, and South America. Individuals and domestic animals can become infected with Valley Fever through breathing in the microscopic Coccidioides fungus spores. Anyone who lives, works, or visits areas with the contaminated soil is at risk for Valley Fever. It is important to note that individuals and/or animals infected with Valley Fever are not contagious. The majority of counties in California have reported cases of Valley Fever, but a large portion of Valley Fever cases are found in the California Central Valley. According to DPH, approximately 60% of infected individuals will not present any symptoms. However, for many individuals infected with Valley Fever they will present with flu-like symptoms which last from a few weeks to a few months. Approximately 5-10% of individuals infected will develop severe Valley Fever and may suffer life-long complications. In very rare cases Valley Fever can be fatal.

Valley Fever can mimic many common diseases, such as influenza or pneumonia. Therefore, patient cases are reported as suspected until laboratory results can confirm a patient has Valley Fever. Health care providers report suspected and confirmed cases to local health department (LHDs). LHDs are then mandated to report all cases of Valley Fever to DPH. Valley Fever cases are continuously reported by LHDs to DPH throughout the year, mainly through the statewide electronic disease reporting system, CalREDIE.

In response to the increase of Valley Fever cases, DPH recently convened a Valley Fever Workgroup (Workgroup). The purpose of the Workgroup is to improve understanding, standardize surveillance, and hold opportunities for communication between DPH and LHDs from endemic areas of Valley Fever. The Workgroup first met in October of 2017, and continues to meet monthly. It has four specific goals: to better understand how each local health jurisdiction is currently conducting surveillance of Valley Fever; develop a plan for systematic and standardized approach to Valley Fever surveillance in California; including the possibility of a revised case definition for disease monitoring that will facilitate more rapid reporting and case confirmation; discuss ways to increase public awareness of Valley Fever with the public and also medical providers; and, determine the need for new Valley Fever educational materials and additional tools for possible Valley Fever outbreaks.

Analysis Prepared by: Monica Montano / HEALTH / (916) 319-2097 FN: 0004983

 THIRD READING  

Bill No: AB 1790

Author:

: in the Senate

Vote:

SENATE HEALTH COMMITTEE: 8-0, 6/13/18

AYES: Pan, Nguyen, Hernandez, Leyva, Mitchell, Monning, Nielsen, Roth

NO VOTE RECORDED: Newman

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

SENATE HEALTH COMMITTEE: 9-0, 8/22/18 (Pursuant to Senate Rule 29.10)

AYES: Pan, Nguyen, Beall, Hernandez, Leyva, Mitchell, Monning, Nielsen, Roth

ASSEMBLY FLOOR: 73-0, 5/17/18 (Consent) - See last page for vote

SUBJECT:

SOURCE: Author

DIGEST:

1. This bill requires the Department of Public Health to conduct a valley fever awareness campaign to communicate with local health jurisdictions, providers, and the public about valley fever, as specified.

Senate Floor Amendments of 8/23/18 specify that funding for this purpose is provided under the Budget Act of 2018 (SB 840, Mitchell, Chapter 29, Statutes of 2018); and, sunset this bill’s provisions on January 1, 2021.

Senate Floor Amendments of 8/16/18 delete the previous provisions contained in this bill and instead require a valley fever public awareness campaign.

ANALYSIS: Existing law requires the Department of Public Health (DPH) to establish a list of reportable diseases and conditions to be reported to DPH by LHOs, clinical laboratories, and health care providers (valley fever is on this list). Requires DPH to specify the timeliness requirements related to the reporting of each disease and condition, and the mechanisms required for, and the content to be included in, reports made. [HSC §120130 and 17 CCR §2500, et seq.]

This bill:

Enacts the Valley Fever Education, Early Diagnosis, and Treatment Act and requires DPH to conduct a valley fever awareness campaign to communicate with local health jurisdictions, providers, and the public about valley fever. Requires the campaign to include, but not limited to:

Information about valley fever, such as the symptoms, diagnosis, and treatment, how a person may contract and reduce the risk of contracting the fungal infection, and the populations at risk; and,

Information about DPH’s activities related to valley fever, and how a person can access and receive additional information about the infection from DPH.

Permits DPH, as part of its administration of the campaign, to provide outreach to the general public; geographic regions where valley fever is more endemic; at-risk populations, as specified; health care providers, including providers who may diagnose or treat individuals for valley fever, and clinicians who work in either primary care or emergency room settings, hospitals, or in the arena of workers’ compensation insurance; health care professional associations or societies; health care employers; and, LHOs and health departments, as specified.

Requires DPH to perform an evaluation of the campaign following its conclusion and to make this report available to the public and post it its Web site.

Permits DPH to award grants or enter into contracts to perform the requirements of this bill, as specified.

Comments

1. Author’s statement. According to the author, timely diagnosis, early assessment, and proper treatment of valley fever infections are critical. If left untreated, valley fever can spread and result in lengthy, painful, and expensive treatments for patients, debilitating symptoms, and in the most severe cases can be fatal. Diagnosing and treating valley fever early and accurately can mean life or death. This bill – the Valley Fever Education, Early Diagnosis, and Treatment Act – will promote increased awareness among health care providers regarding valley fever and establish protocols and guidelines to help ensure early and accurate diagnoses and proper treatment.
2. Valley fever. According to the CDC, valley fever is caused by coccidioides, a fungus that lives in soil in the southwestern United States and parts of Mexico, Central America, and South America. Inhaling the airborne fungal spores can cause infection, but is not spread from person to person. Most people who are exposed to the fungus do not get sick, but some people develop flu-like symptoms that may last for weeks to months. In a very small proportion of people who get valley fever, the infection can spread from the lungs to the rest of the body and cause more severe conditions, such as meningitis or even death. While anyone in an endemic area is at risk, those working in occupations involving dirt and dust exposure may be at increased risk of infection. Several groups of people are at higher risk for developing the severe forms of valley fever, including African Americans, Asians, diabetics, and people with weak immune systems, including those with an organ transplant or who have HIV/AIDS.
3. California incidence. According to the CDC, between 1998 and 2016 the number of reported valley fever cases in California slowly climbed from 719 in 1998 to a peak in 2011 of 5,697. Those numbers were on the decline until 2016, when the number appeared to creep back up with 5,358 reported cases. Although most cases of valley fever are not associated with outbreaks, outbreaks linked to a common source do occasionally occur, particularly after events that disturb large amounts of soil. Past outbreaks have occurred in military trainees, archeological workers, solar farm workers, and in people exposed to earthquakes, and dust storms. The number of valley fever cases varies from year to year, and by season. Cases can be more common in the late summer and fall. Provisional cases include suspect, probable, and confirmed cases: suspect and probable cases may be confirmed later or excluded as official cases upon further investigation. According to DPH, the counties with the highest annual incidence rates statewide in 2016 included Kern (251.7 per 100,000), Kings (157.3 per 100,000), San Luis Obispo (82.8 per 100,000), Fresno (60.8 per 100,000),Tulare (45.3 per 100,000), Madera (31.5 per 100,000), and San Joaquin (25.3 per 100,000).
4. Budget action. The 2018-19 Budget Act included $2 million General Fund to pay for the public awareness campaign proposed under this bill. The budget also allocated $3 million GF to Kern County for valley fever research.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local: No

According to the Senate Appropriations Committee:

The Budget Act of 2018 includes one-time $2 million (General Fund) for encumbrance or expenditure, until June 30, 2020, for CDPH to implement a public awareness campaign related to valley fever. Fiscal costs of the bill are one-time $2 million (General Fund), as provided in CDPH’s provisional budget bill language, over the next two years. While there may be General Fund cost pressures associated with the potential for future public awareness campaigns, and in particular, the provisions related to provider education and outreach, the bill is tied to the 2018 Budget Act; any costs pressures are expected to be minor and time-limited due to the bill’s sunset provisions.

SUPPORT: (Verified 8/23/18)

Acton Town Council

Arvin Union School District

California Hospital Association

California State Association of Electrical Workers

California State Pipe Trades Council

City of Arvin

City of Delano

City of Hanford

City of McFarland

City of Wasco

GFWC California Federation of Women’s Clubs

Health Officers Association of California

Kern Health Systems

Kern Medical

Lamont Elementary School District

Rural County Representatives of California

Valley Children’s Healthcare

Valley Fever Americas Foundation

Western States Council of Sheet Metal Workers

OPPOSITION: (Verified 8/23/18)

None received

ASSEMBLY FLOOR: 73-0, 5/17/18

AYES: Acosta, Aguiar-Curry, Travis Allen, Arambula, Baker, Berman, Bigelow, Bloom, Bonta, Brough, Burke, Caballero, Calderon, Carrillo, Cervantes, Chau, Chávez, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dahle, Daly, Eggman, Flora, Fong, Frazier, Friedman, Gallagher, Eduardo Garcia, Gipson, Gloria, Gonzalez Fletcher, Gray, Grayson, Harper, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Mullin, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Quirk-Silva, Reyes, Rodriguez, Rubio, Salas, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon

NO VOTE RECORDED: Cristina Garcia, Melendez, Muratsuchi, Santiago, Steinorth

Prepared by:

8/24/18 16:20:18

 THIRD READING  

Bill No: AB 1790

Author:

: in the Senate

Vote:

SENATE HEALTH COMMITTEE: 8-0, 6/13/18

AYES: Pan, Nguyen, Hernandez, Leyva, Mitchell, Monning, Nielsen, Roth

NO VOTE RECORDED: Newman

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

SENATE HEALTH COMMITTEE: 9-0, 8/22/18 (Pursuant to Senate Rule 29.10)

AYES: Pan, Nguyen, Beall, Hernandez, Leyva, Mitchell, Monning, Nielsen, Roth

ASSEMBLY FLOOR: 73-0, 5/17/18 (Consent) - See last page for vote

SUBJECT:

SOURCE: Author

DIGEST:

1. This bill requires the Department of Public Health to conduct a valley fever awareness campaign to communicate with local health jurisdictions, providers, and the public about valley fever, as specified.

Senate Floor Amendments of 8/16/18 delete the previous provisions contained in this bill and instead require a valley fever public awareness campaign.

ANALYSIS: Existing law requires the Department of Public Health (DPH) to establish a list of reportable diseases and conditions to be reported to DPH by LHOs, clinical laboratories, and health care providers (valley fever is on this list). Requires DPH to specify the timeliness requirements related to the reporting of each disease and condition, and the mechanisms required for, and the content to be included in, reports made. [HSC §120130 and 17 CCR §2500, et seq.]

This bill:

Enacts the Valley Fever Education, Early Diagnosis, and Treatment Act and requires DPH to conduct a valley fever awareness campaign to communicate with local health jurisdictions, providers, and the public about valley fever. Requires the campaign to include, but not limited to:

Information about valley fever, such as the symptoms, diagnosis, and treatment, how a person may contract and reduce the risk of contracting the fungal infection, and the populations at risk; and,

Information about DPH’s activities related to valley fever, and how a person can access and receive additional information about the infection from DPH.

Permits DPH, as part of its administration of the campaign, to provide outreach to the general public; geographic regions where valley fever is more endemic; at-risk populations, as specified; health care providers, including providers who may diagnose or treat individuals for valley fever, and clinicians who work in either primary care or emergency room settings, hospitals, or in the arena of workers’ compensation insurance; health care professional associations or societies; health care employers; and, LHOs and health departments, as specified.

Requires DPH to perform an evaluation of the campaign following its conclusion and to make this report available to the public and post it its Web site.

Permits DPH to award grants or enter into contracts to perform the requirements of this bill, as specified.

Comments

1. Author’s statement. According to the author, timely diagnosis, early assessment, and proper treatment of valley fever infections are critical. If left untreated, valley fever can spread and result in lengthy, painful, and expensive treatments for patients, debilitating symptoms, and in the most severe cases can be fatal. Diagnosing and treating valley fever early and accurately can mean life or death. This bill – the Valley Fever Education, Early Diagnosis, and Treatment Act – will promote increased awareness among health care providers regarding valley fever and establish protocols and guidelines to help ensure early and accurate diagnoses and proper treatment.
2. Valley fever. According to the CDC, valley fever is caused by coccidioides, a fungus that lives in soil in the southwestern United States and parts of Mexico, Central America, and South America. Inhaling the airborne fungal spores can cause infection, but is not spread from person to person. Most people who are exposed to the fungus do not get sick, but some people develop flu-like symptoms that may last for weeks to months. In a very small proportion of people who get valley fever, the infection can spread from the lungs to the rest of the body and cause more severe conditions, such as meningitis or even death. While anyone in an endemic area is at risk, those working in occupations involving dirt and dust exposure may be at increased risk of infection. Several groups of people are at higher risk for developing the severe forms of valley fever, including African Americans, Asians, diabetics, and people with weak immune systems, including those with an organ transplant or who have HIV/AIDS.
3. California incidence. According to the CDC, between 1998 and 2016 the number of reported valley fever cases in California slowly climbed from 719 in 1998 to a peak in 2011 of 5,697. Those numbers were on the decline until 2016, when the number appeared to creep back up with 5,358 reported cases. Although most cases of valley fever are not associated with outbreaks, outbreaks linked to a common source do occasionally occur, particularly after events that disturb large amounts of soil. Past outbreaks have occurred in military trainees, archeological workers, solar farm workers, and in people exposed to earthquakes, and dust storms. The number of valley fever cases varies from year to year, and by season. Cases can be more common in the late summer and fall. Provisional cases include suspect, probable, and confirmed cases: suspect and probable cases may be confirmed later or excluded as official cases upon further investigation. According to DPH, the counties with the highest annual incidence rates statewide in 2016 included Kern (251.7 per 100,000), Kings (157.3 per 100,000), San Luis Obispo (82.8 per 100,000), Fresno (60.8 per 100,000),Tulare (45.3 per 100,000), Madera (31.5 per 100,000), and San Joaquin (25.3 per 100,000).
4. Budget action. The 2018-19 Budget Act included $2 million General Fund to pay for the public awareness campaign proposed under this bill. The budget also allocated $3 million GF to Kern County for valley fever research.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local: No

According to the Senate Appropriation Committee:

The Budget Act of 2018 includes $2 million (General Fund) for encumbrance or expenditure, until June 30, 2020, for CDPH to implement a public awareness campaign related to valley fever. Using the estimate already developed in the budget, staff notes AB 1790 costs would be around $2 million (General Fund) for the advertisement, outreach, and contract costs, as well as for administrative workload to evaluate the efficacy of the campaign. AB 1790 does not specify a sunset date, so there may be ongoing costs for a public awareness campaign, which could create General Fund cost pressures.

SUPPORT: (Verified 8/22/18)

Acton Town Council

Arvin Union School District

California Hospital Association

California State Association of Electrical Workers

California State Pipe Trades Council

City of Arvin

City of Delano

City of Hanford

City of McFarland

City of Wasco

GFWC California Federation of Women’s Clubs

Health Officers Association of California

Kern Health Systems

Kern Medical

Lamont Elementary School District

Rural County Representatives of California

Valley Children’s Healthcare

Valley Fever Americas Foundation

Western States Council of Sheet Metal Workers

OPPOSITION: (Verified 8/22/18)

None received

ASSEMBLY FLOOR: 73-0, 5/17/18

AYES: Acosta, Aguiar-Curry, Travis Allen, Arambula, Baker, Berman, Bigelow, Bloom, Bonta, Brough, Burke, Caballero, Calderon, Carrillo, Cervantes, Chau, Chávez, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dahle, Daly, Eggman, Flora, Fong, Frazier, Friedman, Gallagher, Eduardo Garcia, Gipson, Gloria, Gonzalez Fletcher, Gray, Grayson, Harper, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Mullin, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Quirk-Silva, Reyes, Rodriguez, Rubio, Salas, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon

NO VOTE RECORDED: Cristina Garcia, Melendez, Muratsuchi, Santiago, Steinorth

Prepared by:

8/22/18 16:20:56

SENATE COMMITTEE ON HEALTH

Senator Dr. Richard Pan, Chair

BILL NO: AB 1790

PURSUANT TO SENATE RULE 29.10 (b)

SUBJECT: Valley Fever Education, Early Diagnosis, and Treatment Act

SUMMARY:

1. Requires the Department of Public Health to conduct a valley fever awareness campaign to communicate with local health jurisdictions, providers, and the public about valley fever, as specified.

Existing law: Requires the Department of Public Health (DPH) to establish a list of reportable diseases and conditions to be reported to DPH by LHOs, clinical laboratories, and health care providers (valley fever is on this list). Requires DPH to specify the timeliness requirements related to the reporting of each disease and condition, and the mechanisms required for, and the content to be included in, reports made. [HSC §120130 and 17 CCR §2500, et seq.]

This bill:

1. Enacts the Valley Fever Education, Early Diagnosis, and Treatment Act and requires DPH to conduct a valley fever awareness campaign to communicate with local health jurisdictions, providers, and the public about valley fever. Requires the campaign to include, but not limited to:
   1. Information about valley fever, such as the symptoms, diagnosis, and treatment, how a person may contract and reduce the risk of contracting the fungal infection, and the populations at risk; and,
   2. Information about DPH’s activities related to valley fever, and how a person can access and receive additional information about the infection from DPH.
2. Permits DPH, as part of its administration of the campaign, to provide outreach to the general public; geographic regions where valley fever is more endemic; at-risk populations, as specified; health care providers, including providers who may diagnose or treat individuals for valley fever, and clinicians who work in either primary care or emergency room settings, hospitals, or in the arena of workers’ compensation insurance; health care professional associations or societies; health care employers; and, LHOs and health departments, as specified.
3. Requires DPH to perform an evaluation of the campaign following its conclusion and to make this report available to the public and post it its Web site.
4. Permits DPH to award grants or enter into contracts to perform the requirements of this bill, as specified.

FISCAL EFFECT:

This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. Author’s statement. Timely diagnosis, early assessment, and proper treatment of valley fever infections are critical. If left untreated, valley fever can spread and result in lengthy, painful, and expensive treatments for patients, debilitating symptoms, and in the most severe cases can be fatal. Diagnosing and treating valley fever early and accurately can mean life or death. However, a lack of awareness among the public and among health care providers can result in delayed or missed diagnoses, leading to worse health outcomes and increased health costs. The Centers for Disease Control and Prevention (CDC) estimates that 150,000 cases go undiagnosed every year in the United States because many patients are not tested for valley fever. The CDC also estimates that of the thousands of patients that are diagnosed with valley fever, 60% to 80% are given one or more rounds of antibiotics before receiving a correct diagnosis and appropriate treatment, which in addition to putting the patient at increased risk of health complications from valley fever also puts patients at unnecessary risk of drug resistant infections by prescribing antibiotics when they are not needed. Studies have proven that those who know about valley fever and its symptoms are more likely to be tested and accurately diagnosed. Moreover, studies have repeatedly concluded that increased awareness and education among physicians and healthcare providers is necessary to reduce delays in diagnosis and missed diagnoses. This bill would help accomplish these goals by raising awareness of the symptoms, tests, and treatments for valley fever among the general public, local health officers and departments, and health care providers through a valley fever awareness campaign conducted by the DPH.
2. Background. According to the CDC, valley fever is caused by coccidioides, a fungus that lives in soil in the southwestern United States and parts of Mexico, Central America, and South America. Inhaling the airborne fungal spores can cause infection, but is not spread from person to person. Most people who are exposed to the fungus do not get sick, but some people develop flu-like symptoms that may last for weeks to months. In a very small proportion of people who get valley fever, the infection can spread from the lungs to the rest of the body and cause more severe conditions, such as meningitis or even death. While anyone in an endemic area is at risk, those working in occupations involving dirt and dust exposure may be at increased risk of infection. Several groups of people are at higher risk for developing the severe forms of valley fever, including African Americans, Asians, diabetics, and people with weak immune systems, including those with an organ transplant or who have HIV/AIDS.
3. Endemic areas. The CDC map below shows the approximate areas (called “endemic areas”) where coccidioides is known to live or is suspected to live in the U.S. and Mexico. Much of what is known about where the fungus lives in the southwestern U.S. is based on studies performed in the late 1940s and early 1950s. The map also shows the locations of several outbreaks and locations of valley fever cases acquired outside of the areas identified by skin testing. Coccidioides might also live in similar areas with hot, dry climates that are not shaded on the map.

1. California incidence. According to the CDC, between 1998 and 2016 the number of reported valley fever cases in California slowly climbed from 719 in 1998 to a peak in 2011 of 5,697. Those numbers were on the decline until 2016, when the number appeared to creep back up with 5,358 reported cases. Although most cases of valley fever are not associated with outbreaks, outbreaks linked to a common source do occasionally occur, particularly after events that disturb large amounts of soil. Past outbreaks have occurred in military trainees, archeological workers, solar farm workers, and in people exposed to earthquakes, and dust storms. The number of valley fever cases varies from year to year, and by season. Cases can be more common in the late summer and fall. Provisional cases include suspect, probable, and confirmed cases: suspect and probable cases may be confirmed later or excluded as official cases upon further investigation. According to DPH, the counties with the highest annual incidence rates statewide in 2016 included Kern (251.7 per 100,000), Kings (157.3 per 100,000), San Luis Obispo (82.8 per 100,000), Fresno (60.8 per 100,000),Tulare (45.3 per 100,000), Madera (31.5 per 100,000), and San Joaquin (25.3 per 100,000).
2. Vaccine. Valley fever research has been going on since the 1930s and 40s, with not much progress towards a vaccine. According to a report published in October 2012 by the Reporting On Health collaborative (an initiative of The California Endowment Health Journalism Fellowships at the University of Southern California’s Annenberg School for Communication and Journalism), when a valley fever vaccine was evaluated in the late 1970s and early 1980s, and proved to be effective in mice and monkeys, hundreds of people signed up for the human clinical (Phase III) trials. However, patients complained of very sore arms and swelling at the injection site even at low doses. The shot was so painful people dropped out of the trial, and ultimately the vaccine did not show conclusive protection. In 1997, a Bakersfield-based committee worked with California State University, Bakersfield to select five U.S. scientists to develop a new vaccine with funding from the California HealthCare Foundation (CHCF) and the State of California. The project was launched with a $1.5 million grant from CHCF, $700,000 in state general funds, and a contribution of more than $100,000 from rotary clubs. With further contributions over the next decade from CHCF, the federal government, the state, the county of Kern and nonprofit groups, total funding reached about $16 million. However, funding dried up and the research stalled. DPH reports that it last received funding for valley fever in 2009-10 when $1 million in state funding was appropriated for valley fever vaccine development. Most of that funding, which was exhausted in 2010, was provided to an academic advisory group to coordinate vaccine research grants because DPH lacks technical expertise and capacity to monitor valley fever vaccine development projects.
3. Budget action. The 2018-19 Budget Act included $2 million General Fund to pay for the public awareness campaign proposed under this bill. The budget also allocated $3 million GF to Kern County for valley fever research.
4. Related legislation. AB 1787 (Salas) Places new reporting requirements on DPH related to valley fever surveillance, including: attributing late-reported data to the year of diagnosis in future data reporting; collecting cases by the state’s electronic data system by April 15 of each year; reporting to LHOs about any removal of discrepant data; and including an explanation for likely data changes between initial and final publication of data, and an explanation for discrepancies between data reported by an LHO and data reported by DPH. AB 1787 has been enrolled and presented to the Governor.

AB 1788 (Salas) permits DPH, for the purpose of reports confirming a case of valley fever, to use a laboratory criteria for diagnosis, with or without clinical criteria. AB 1788 has been enrolled and presented to the Governor.

AB 1789 (Salas) requires the Occupational Safety and Health Standards Board to adopt valley fever standards for state public works projects, as specified. AB 1789 was held on the Assembly Committee of Appropriations suspense file.

1. Prior legislation. AB 1279 (Salas of 2017) would have required DPH to develop and implement public outreach programs to educate the public about valley fever. AB 1279 was vetoed by the Governor, who stated:

“The department already provides fact sheets, brochures, posters and other educational materials to raise awareness of this disease. Expanding this program would necessitate additional resources which should be considered along with other funding requests as part of the budget process.”

SB 115 (Fuller of 2015) would have appropriated $1 million from the General Fund to DPH for purposes of valley fever vaccine research. SB 115 was held on the Senate Committee of Appropriations suspense file.

SB 1044 (Fuller of 2014), AB 1955 (Ashburn of 2002), SB 1027 (Ashburn of 2003) and SB 492 (Ashburn of 2005) were substantially similar to SB 115. SB 1044 was referred to Banking and Finance but never acted upon. AB 1955, SB 1027 and SB 492 were held on the Assembly Committee of Appropriations suspense file.

SUPPORT (Prior Version) AND OPPOSITION:

Support: Acton Town Council

Arvin Union School District

California Hospital Association

California State Association of Electrical Workers

California State Pipe Trades Council

City of Arvin

City of Delano

City of Hanford

City of McFarland

City of Wasco

GFWC California Federation of Women’s Clubs

Health Officers Association of California

Kern Health Systems

Kern Medical

Lamont Elementary School District

Rural County Representatives of California

Valley Children’s Healthcare

Valley Fever Americas Foundation

Western States Council of Sheet Metal Workers

Oppose: None Received

-- END --

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 1790

Author:(Salas and Grayson)

As Amended Ver:June 19, 2018

Majority vote

Original Committee Reference: B. & P.

SUMMARY: Establishes the Valley Fever Education, Early Diagnosis, and Treatment Act; makes findings and declarations; and requires the Department of Public Health (DPH) to work with the California Conference of Local Health Officers, by July 1, 2019, to make available specified protocols and guidelines developed by the National Institutes of Health, the federal Centers for Disease Control and Prevention, and other appropriate professional health care organizations, for educating physicians and specified health care providers regarding the most recent information on valley fever etiology, transmission, diagnosis, surveillance, and treatment.

The Senate amendments:

1. Deleted the requirement that a health care provider who knows of or is in attendance on a case or suspected case of valley fever, to submit a report to the local health officer as required by a specified regulatory provision.
2. Deleted the requirement that primary care clinics and general acute care hospitals develop, adopt, and implement a written policy and procedure regarding required reporting to the local health officer.

FISCAL EFFECT: According to the Senate Appropriations Committee, pursuant to Senate Rule 28.8, no significant state costs anticipated.

COMMENTS:

Purpose. This bill is sponsored by the author. According to the author, "[t]imely diagnosis, early assessment, and proper treatment of Valley Fever infections are critical. If left untreated, Valley Fever can spread and result in lengthy, painful, and expensive treatments for patients, along with debilitating symptoms of the disease. Diagnosing and treating Valley Fever early and accurately can mean life or death."

Background. According to the federal Centers for Disease Control (CDC), Valley fever is an infection caused by the fungus Coccidioides. The scientific name for Valley fever is "coccidioidomycosis," and it's also sometimes called "San Joaquin Valley fever" or "desert rheumatism." The term "Valley fever" usually refers to Coccidioides infection in the lungs, but the infection can spread to other parts of the body in severe cases.

The Coccidioides fungus has been known to live in the soil in the southwestern United States, parts of Mexico and Central and South America. The fungus was also recently found in south-central Washington. People can get Valley fever by breathing in the microscopic fungal spores from the air in these areas. About 10,000 U.S. cases are reported each year, mostly from Arizona and California.

Valley fever can be misdiagnosed because its symptoms are similar to those of other illnesses. Valley fever may also be underreported because many people who are exposed to Coccidioides have no symptoms (approximately 60%). Others may have flu-like symptoms that go away on their own after weeks to months.

For those with more severe symptoms (approximately 5% to 10% of cases), the treatment is usually three to six months of fluconazole or other antifungal medication. Those who have severe lung infections or infections that have spread (disseminated) to other parts of the body always need antifungal treatment and may need to stay in the hospital. For severe or disseminated infections, the course of treatment is usually longer than six months. Valley fever that develops into meningitis is fatal if it's not treated, so lifelong antifungal treatment is necessary for those cases.

While most people who have Valley fever make a full recovery, a small percentage of those infected develop long-term lung infections that can take several years to recover from. In very severe cases of Valley fever, the nervous system can be affected and there may be long-term damage. People who are at risk for severe Valley fever include people who have weakened immune systems, are pregnant, have diabetes, or who are Black or Filipino.

The CDC also notes that prevention is difficult. The only options for people who live in areas where the Coccidioides fungus is common involve avoiding breathing it in or otherwise allowing it to enter the body or taking medication. Some of the options include avoiding dusty places, using respirators or face masks, installing air filtration systems, cleaning wounds, or taking preventive antifungal medications at the direction of a healthcare provider.

Reporting of Valley fever. In states where the Coccidioides fungus is common (endemic), including California, health care providers and laboratories are required to report Valley fever cases to public health authorities. Local and state health departments collect information about Valley fever cases and then send the information to the CDC. Disease reporting helps government officials and healthcare providers understand why outbreaks occur and allows them to monitor trends in the number of Valley fever cases.

Continuing Medical Education (CME) for Physicians. The CDC has implemented an online CME program in collaboration with the Arizona Board of Regents on behalf of The University of Arizona Valley Fever Center for Excellence and the University of California Davis Coccidioidomycosis Serology Laboratory.

Analysis Prepared by: Vincent Chee / B. & P. / (916) 319-3301 FN: 0003716

 THIRD READING  

Bill No: AB 1790

Author:

:

Vote:

SENATE HEALTH COMMITTEE: 8-0, 6/13/18

AYES: Pan, Nguyen, Hernandez, Leyva, Mitchell, Monning, Nielsen, Roth

NO VOTE RECORDED: Newman

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 73-0, 5/17/18 (Consent) - See last page for vote

SUBJECT:

SOURCE: Author

DIGEST:

1. This bill (1) requires the Department of Public Health and the California Conference of Local Health Officers, by July 1, 2019, to work together to make available specified protocols and guidelines for educating physicians and other health care providers regarding the most recent scientific and medical information on valley fever etiology, transmission, diagnosis, surveillance, and treatment; (2) requires a health care provider, knowing of or in attendance on a case or suspected case of valley fever, to submit a report to the local health officer (LHO); and (3) requires a primary care clinic and a general acute care hospital to develop, adopt, and implement a written policy and procedure regarding required reporting to the LHO.

ANALYSIS:

Existing law:

1. Requires the Department of Public Health (DPH) to establish a list of reportable diseases and conditions to be properly reported as required to DPH by LHOs. Requires DPH to specify the timeliness requirements related to the reporting of each disease and condition, and the mechanisms required for, and the content to be included in, reports made. Permits the list to include both communicable and noncommunicable diseases. Permits the list to be modified at any time by DPH, after consultation with the California Conference of Local Health Officers (CCLHO). [HSC §120130]
2. Requires DPH to establish a list of communicable diseases and conditions for which clinical laboratories are required submit a culture or a specimen to the local public health laboratory. Requires the list to set forth the conditions under which the culture and specimen is also required to be submitted to the State Public Health Laboratory. Permits the list to be modified at any time by DPH, in consultation with appropriate local public health stakeholders, including, but not limited to, LHOs and public health laboratory directors. [HSC §120130]
3. Requires every health care provider, knowing of or in attendance on a case or suspected case of any reportable diseases or conditions, to report to the LHO for the jurisdiction where the patient resides. Permits any individual having knowledge of a person who is suspected to be suffering from one of the diseases to make such a report to the LHO for the jurisdiction where the patient resides when there is no health care provider in attendance. Defines "health care provider" as a physician and surgeon, a veterinarian, a podiatrist, a nurse practitioner, a physician assistant, a registered nurse, a nurse midwife, a school nurse, an infection control practitioner, a medical examiner, a coroner, or a dentist. [17 CCR §2500, et seq.]
4. Requires an administrator of each health facility, clinic, or other setting where more than one health care provider may know of a case, a suspected case or an outbreak of disease within the facility, to establish and be responsible for administrative procedures to assure that reports are made to the LHO. [17 CCR §2500, et seq.]
5. Requires each clinical laboratory director, or the laboratory director's designee, an approved public health laboratory, or a veterinary laboratory, to report findings of specified communicable disease and conditions to the LHO of the local health jurisdiction where the health care provider who first submitted the specimen is located, except for acute HIV infection reporting (which has unique reporting requirements). Requires the laboratory, if the patient residence is unknown, to notify the LHO of the jurisdiction in which the health care provider is located. [17 CCR §2505, et seq.]

This bill:

1. Enacts the Valley Fever Education, Early Diagnosis, and Treatment Act and requires DPH and LHOs, by July 1, 2019, to work together to make available protocols and guidelines developed by the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and other appropriate professional health care organizations, for educating physicians and other health care providers, as specified, regarding the most recent scientific and medical information on valley fever etiology, transmission, diagnosis, surveillance, and treatment.
2. Permits the protocols and guidelines to include, but need not be limited to:
   1. Tracking and reporting of cases of valley fever by health care professionals and public health officials;
   2. Surveillance programs to determine the prevalence of valley fever in the population at large and in high-risk populations; and,
   3. Public education and outreach programs to raise awareness of valley fever, including programs targeted to reach high-risk individuals. Permits education programs to provide information and referrals on valley fever including, but not limited to, education materials developed by health-related companies, community-based or national advocacy organizations, counseling, patient support groups, and existing hotlines for consumers.

Comments

1. Author’s statement. According to the author, timely diagnosis, early assessment, and proper treatment of valley fever infections are critical. If left untreated, valley fever can spread and result in lengthy, painful, and expensive treatments for patients, debilitating symptoms, and in the most severe cases can be fatal. Diagnosing and treating valley fever early and accurately can mean life or death. This bill – the Valley Fever Education, Early Diagnosis, and Treatment Act – will promote increased awareness among health care providers regarding valley fever and establish protocols and guidelines to help ensure early and accurate diagnoses and proper treatment.
2. Valley fever. According to the CDC, valley fever is caused by coccidioides, a fungus that lives in soil in the southwestern United States and parts of Mexico, Central America, and South America. Inhaling the airborne fungal spores can cause infection, but is not spread from person to person. Most people who are exposed to the fungus do not get sick, but some people develop flu-like symptoms that may last for weeks to months. In a very small proportion of people who get valley fever, the infection can spread from the lungs to the rest of the body and cause more severe conditions, such as meningitis or even death. While anyone in an endemic area is at risk, those working in occupations involving dirt and dust exposure may be at increased risk of infection. Several groups of people are at higher risk for developing the severe forms of valley fever, including African Americans, Asians, diabetics, and people with weak immune systems, including those with an organ transplant or who have HIV/AIDS.
3. California incidence. According to the CDC, between 1998 and 2016 the number of reported valley fever cases in California slowly climbed from 719 in 1998 to a peak in 2011 of 5,697. Those numbers were on the decline until 2016, when the number appeared to creep back up with 5,358 reported cases. Although most cases of valley fever are not associated with outbreaks, outbreaks linked to a common source do occasionally occur, particularly after events that disturb large amounts of soil. Past outbreaks have occurred in military trainees, archeological workers, solar farm workers, and in people exposed to earthquakes, and dust storms. The number of valley fever cases varies from year to year, and by season. Cases can be more common in the late summer and fall. Provisional cases include suspect, probable, and confirmed cases: suspect and probable cases may be confirmed later or excluded as official cases upon further investigation. According to DPH, the counties with the highest annual incidence rates statewide in 2016 included Kern (251.7 per 100,000), Kings (157.3 per 100,000), San Luis Obispo (82.8 per 100,000), Fresno (60.8 per 100,000),Tulare (45.3 per 100,000), Madera (31.5 per 100,000), and San Joaquin (25.3 per 100,000).
4. Existing reporting mechanisms. According to DPH’s Web site, its Division of Communicable Disease Control (DCDC) works to promptly identify, prevent and control infectious diseases that pose a threat to public health. DPH works with LHOs to implement infectious disease control at the local level through the 61 legally-appointed physician LHOs in California, one from each of the 58 counties and three cities of Berkeley, Long Beach and Pasadena. DCDC identifies, prevents and controls infectious diseases that pose a threat to public health, including emerging and re-emerging infectious diseases, vaccine-preventable agents, bacterial toxins, bioterrorism, and pandemics. DCDC works with LHOs to identify and monitor reported cases of over 70 reportable diseases, including valley fever. These reportable diseases and conditions are reported by health care providers and laboratories to LHOs, who report this information to DPH. For most counties, local health department staff enter case information into the California Reportable Disease Information Exchange (CalREDIE), which is the statewide electronic disease reporting system. Basic patient identifying information is required for each case of valley fever; a longer Coccidioidomycosis Case Report Form with more information requested is available but is voluntary and not required.
5. Reporting valley fever. The California Code of Regulations (CCR) Title 17 requires that health care providers report cases of valley fever within seven calendar days to the LHO. Laboratories are required to report within one working day after the health care provider has been notified. According to DPH, LHOs may collect additional information from health care providers to determine whether a case meets standard case definitions, and then report cases to DPH. When LHOs enter data into CalREDIE, they initially mark them as “Suspect” if not enough information is available to confirm, and later change the classification to “Confirmed” if additional information shows that the case meets the standard definition. Both DPH and LHOs can review information in CalREDIE. For valley fever, LHOs receive reports of “Suspect” cases from local laboratories and health care providers, with most reports containing only minimal information. For example, valley fever cases reported by laboratories usually contain only the positive laboratory result(s), with no clinical information, such as signs or symptoms of illness. The national surveillance case definition for valley fever requires both laboratory and clinical criteria. For the clinical criteria to be met, the patient must have signs and symptoms consistent with valley fever.  In order to determine whether suspect cases actually meet the surveillance case definition, LHOs must follow up with health care providers or the patients and collect additional information. DPH states that because valley fever is a complex disease, it can be difficult to determine whether a positive laboratory result represents a false positive result, a recent infection, or an infection acquired in the past. Collecting additional patient clinical information helps determine whether the patient has valley fever currently or not. Some cases initially reported as “Suspect” are eventually not confirmed as valley fever cases. If the case meets the surveillance case definition of valley fever, it is counted for regular data reports. Currently, Kern and Los Angeles are two counties that report using laboratory criteria only.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

SUPPORT: (Verified 7/2/18)

Acton Town Council

Arvin Union School District

California Hospital Association

California State Association of Electrical Workers

California State Pipe Trades Council

City of Arvin

City of Delano

City of Hanford

City of McFarland

City of Wasco

GFWC California Federation of Women’s Clubs

Kern Health Systems

Kern Medical

Lamont Elementary School District

Rural County Representatives of California

Valley Children’s Healthcare

Valley Fever Americas Foundation

Western States Council of Sheet Metal Workers

OPPOSITION: (Verified 7/2/18)

None received

ARGUMENTS IN SUPPORT: Supporters state that according to the CDC, in addition to reported cases of valley fever, an estimated 150,000 more cases go unreported every year in the U.S., and unless physicians are trained to identify the likelihood of valley fever or specific tests are done, they are unable to diagnose the disease. Because of the difficulty inherent in distinguishing valley fever from other illnesses and a general lack of awareness, up to 90% of doctors do not order the simple blood test, according to the Valley Fever Center for Excellence. Timely diagnosis, early assessment, and proper treatment are critical. Supporters state that this bill will increase awareness and education about valley fever among physicians and help the thousands of patients that are misdiagnosed or undiagnosed every year.

ASSEMBLY FLOOR: 73-0, 5/17/18

AYES: Acosta, Aguiar-Curry, Travis Allen, Arambula, Baker, Berman, Bigelow, Bloom, Bonta, Brough, Burke, Caballero, Calderon, Carrillo, Cervantes, Chau, Chávez, Chen, Chiu, Choi, Chu, Cooley, Cooper, Cunningham, Dahle, Daly, Eggman, Flora, Fong, Frazier, Friedman, Gallagher, Eduardo Garcia, Gipson, Gloria, Gonzalez Fletcher, Gray, Grayson, Harper, Holden, Irwin, Jones-Sawyer, Kalra, Kamlager-Dove, Kiley, Lackey, Levine, Limón, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Mullin, Nazarian, Obernolte, O'Donnell, Patterson, Quirk, Quirk-Silva, Reyes, Rodriguez, Rubio, Salas, Mark Stone, Thurmond, Ting, Voepel, Waldron, Weber, Wood, Rendon

NO VOTE RECORDED: Cristina Garcia, Melendez, Muratsuchi, Santiago, Steinorth

Prepared by:

7/3/18 16:05:20

**** END ****

SENATE COMMITTEE ON HEALTH

Senator Dr. Richard Pan, Chair

BILL NO: AB 1790

SUBJECT: Valley Fever Education, Early Diagnosis, and Treatment Act

SUMMARY:

1. Requires the Department of Public Health and local health officers (LHOs), by July 1, 2019, to work together to make available specified protocols and guidelines for educating physicians and other health care providers regarding the most recent scientific and medical information on valley fever etiology, transmission, diagnosis, surveillance, and treatment. Requires a health care provider, knowing of or in attendance on a case or suspected case of valley fever, to submit a report to the LHO, as required under existing law. Requires a primary care clinic and a general acute care hospital to develop, adopt, and implement a written policy and procedure regarding required reporting to the LHO.

Existing law:

1. Requires the Department of Public Health (DPH) to establish a list of reportable diseases and conditions to be properly reported as required to DPH by LHOs. Requires DPH to specify the timeliness requirements related to the reporting of each disease and condition, and the mechanisms required for, and the content to be included in, reports made. Permits the list to include both communicable and noncommunicable diseases. Permits the list to be modified at any time by DPH, after consultation with the California Conference of Local Health Officers (CCLHO). [HSC §120130]
2. Requires DPH to establish a list of communicable diseases and conditions for which clinical laboratories are required submit a culture or a specimen to the local public health laboratory. Requires the list to set forth the conditions under which the culture and specimen is also required to be submitted to the State Public Health Laboratory. Permits the list to be modified at any time by DPH, in consultation with appropriate local public health stakeholders, including, but not limited to, LHOs and public health laboratory directors. [HSC §120130]
3. Requires, through regulation, every health care provider, knowing of or in attendance on a case or suspected case of any reportable diseases or conditions, to report to the LHO for the jurisdiction where the patient resides. Permits any individual having knowledge of a person who is suspected to be suffering from one of the diseases to make such a report to the LHO for the jurisdiction where the patient resides when there is no health care provider in attendance. Defines "health care provider" as a physician and surgeon, a veterinarian, a podiatrist, a nurse practitioner, a physician assistant, a registered nurse, a nurse midwife, a school nurse, an infection control practitioner, a medical examiner, a coroner, or a dentist. [17 CCR §2500, et seq.]
4. Requires, through regulation, an administrator of each health facility, clinic, or other setting where more than one health care provider may know of a case, a suspected case or an outbreak of disease within the facility, to establish and be responsible for administrative procedures to assure that reports are made to the LHO. [17 CCR §2500, et seq.]
5. Requires, through regulation, each clinical laboratory director, or the laboratory director's designee, an approved public health laboratory, or a veterinary laboratory, to report findings of specified communicable disease and conditions to the LHO of the local health jurisdiction where the health care provider who first submitted the specimen is located, except for acute HIV infection reporting (which has unique reporting requirements). Requires the laboratory, if the patient residence is unknown, to notify the LHO of the jurisdiction in which the health care provider is located. [17 CCR §2505, et seq.]

This bill:

1. Enacts the Valley Fever Education, Early Diagnosis, and Treatment Act and requires DPH and LHOs, by July 1, 2019, to work together to make available protocols and guidelines developed by the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and other appropriate professional health care organizations, for educating physicians and other health care providers, as specified, regarding the most recent scientific and medical information on valley fever etiology, transmission, diagnosis, surveillance, and treatment.
2. Permits the protocols and guidelines to include, but need not be limited to:
   1. Tracking and reporting of cases of valley fever by health care professionals and public health officials;
   2. Surveillance programs to determine the prevalence of valley fever in the population at large and in high-risk populations; and,
   3. Public education and outreach programs to raise awareness of valley fever, including programs targeted to reach high-risk individuals. Permits education programs to provide information and referrals on valley fever including, but not limited to, education materials developed by health-related companies, community-based or national advocacy organizations, counseling, patient support groups, and existing hotlines for consumers.
3. Requires a health care provider, knowing of or in attendance on a case or suspected case of valley fever, to submit a report to the LHO, as required under existing law in 3) above. Requires a primary care clinic and a general acute care hospital to develop, adopt, and implement a written policy and procedure regarding required reporting to LHO.

FISCAL EFFECT:

According to the Assembly Appropriations Committee, negligible costs. This bill may have minor costs to local health departments, but it is unlikely there would be significant state-reimbursable mandate costs associated with the requirement for local public health officers to work with the state to make available protocols and guidelines, given the flexibility in meeting the requirement. Reporting requirements are duplicative of existing regulations, and thus should not result in increased costs.

COMMENTS:

1. Author’s statement. According to the author, timely diagnosis, early assessment, and proper treatment of valley fever infections are critical. If left untreated, valley fever can spread and result in lengthy, painful, and expensive treatments for patients, debilitating symptoms, and in the most severe cases can be fatal. Diagnosing and treating valley fever early and accurately can mean life or death. This bill – the Valley Fever Education, Early Diagnosis, and Treatment Act – will promote increased awareness among health care providers regarding valley fever and establish protocols and guidelines to help ensure early and accurate diagnoses and proper treatment.
2. Background. According to the CDC, valley fever is caused by coccidioides, a fungus that lives in soil in the southwestern United States and parts of Mexico, Central America, and South America. Inhaling the airborne fungal spores can cause infection, but is not spread from person to person. Most people who are exposed to the fungus do not get sick, but some people develop flu-like symptoms that may last for weeks to months. In a very small proportion of people who get valley fever, the infection can spread from the lungs to the rest of the body and cause more severe conditions, such as meningitis or even death. While anyone in an endemic area is at risk, those working in occupations involving dirt and dust exposure may be at increased risk of infection. Several groups of people are at higher risk for developing the severe forms of valley fever, including African Americans, Asians, diabetics, and people with weak immune systems, including those with an organ transplant or who have HIV/AIDS.
3. Endemic areas. The CDC map below shows the approximate areas (called “endemic areas”) where coccidioides is known to live or is suspected to live in the U.S. and Mexico. Much of what is known about where the fungus lives in the southwestern U.S. is based on studies performed in the late 1940s and early 1950s. The map also shows the locations of several outbreaks and locations of valley fever cases acquired outside of the areas identified by skin testing. Coccidioides might also live in similar areas with hot, dry climates that are not shaded on the map.

1. California incidence. According to the CDC, between 1998 and 2016 the number of reported valley fever cases in California slowly climbed from 719 in 1998 to a peak in 2011 of 5,697. Those numbers were on the decline until 2016, when the number appeared to creep back up with 5,358 reported cases. Although most cases of valley fever are not associated with outbreaks, outbreaks linked to a common source do occasionally occur, particularly after events that disturb large amounts of soil. Past outbreaks have occurred in military trainees, archeological workers, solar farm workers, and in people exposed to earthquakes, and dust storms. The number of valley fever cases varies from year to year, and by season. Cases can be more common in the late summer and fall. Provisional cases include suspect, probable, and confirmed cases: suspect and probable cases may be confirmed later or excluded as official cases upon further investigation. According to DPH, the counties with the highest annual incidence rates statewide in 2016 included Kern (251.7 per 100,000), Kings (157.3 per 100,000), San Luis Obispo (82.8 per 100,000), Fresno (60.8 per 100,000),Tulare (45.3 per 100,000), Madera (31.5 per 100,000), and San Joaquin (25.3 per 100,000).
2. Vaccine. Valley fever research has been going on since the 1930s and 40s, with not much progress towards a vaccine. According to a report published in October 2012 by the Reporting On Health collaborative (an initiative of The California Endowment Health Journalism Fellowships at the University of Southern California’s Annenberg School for Communication and Journalism), when a valley fever vaccine was evaluated in the late 1970s and early 1980s, and proved to be effective in mice and monkeys, hundreds of people signed up for the human clinical (Phase III) trials. However, patients complained of very sore arms and swelling at the injection site even at low doses. The shot was so painful people dropped out of the trial, and ultimately the vaccine did not show conclusive protection. In 1997, a Bakersfield-based committee worked with California State University, Bakersfield to select five U.S. scientists to develop a new vaccine with funding from the California HealthCare Foundation (CHCF) and the State of California. The project was launched with a $1.5 million grant from CHCF, $700,000 in state general funds, and a contribution of more than $100,000 from rotary clubs. With further contributions over the next decade from CHCF, the federal government, the state, the county of Kern and nonprofit groups, total funding reached about $16 million. However, funding dried up and the research stalled. DPH reports that it last received funding for valley fever in 2009-10 when $1 million in state funding was appropriated for valley fever vaccine development. Most of that funding was provided to an academic advisory group to coordinate vaccine research grants because DPH lacks technical expertise and capacity to monitor valley fever vaccine development projects. That funding was exhausted in 2010 and DPH is no longer involved in any research for a valley fever vaccine.
3. Existing reporting mechanisms. According to DPH’s website, its Division of Communicable Disease Control (DCDC) works to promptly identify, prevent and control infectious diseases that pose a threat to public health. DPH works with LHOs to implement infectious disease control at the local level through the 61 legally-appointed physician LHOs in California, one from each of the 58 counties and three cities of Berkeley, Long Beach and Pasadena. DCDC identifies, prevents and controls infectious diseases that pose a threat to public health, including emerging and re-emerging infectious diseases, vaccine-preventable agents, bacterial toxins, bioterrorism, and pandemics. DCDC works with LHOs to identify and monitor reported cases of over 70 reportable diseases, including valley fever. These reportable diseases and conditions are reported by health care providers and laboratories to LHOs, who report this information to DPH. For most counties, local health department staff enter case information into the California Reportable Disease Information Exchange (CalREDIE), which is the statewide electronic disease reporting system. Basic patient identifying information is required for each case of valley fever; a longer Coccidioidomycosis Case Report Form with more information requested is available but is voluntary and not required.
4. Reporting valley fever. The California Code of Regulations (CCR) Title 17 requires that health care providers report cases of valley fever within seven calendar days to the LHO. Laboratories are required to report within one working day after the health care provider has been notified. According to DPH, LHOs may collect additional information from health care providers to determine whether a case meets standard case definitions, and then report cases to DPH. When LHOs enter data into CalREDIE, they initially mark them as “Suspect” if not enough information is available to confirm, and later change the classification to “Confirmed” if additional information shows that the case meets the standard definition. Both DPH and LHOs can review information in CalREDIE. For valley fever, LHOs receive reports of “Suspect” cases from local laboratories and health care providers, with most reports containing only minimal information. For example, valley fever cases reported by laboratories usually contain only the positive laboratory result(s), with no clinical information, such as signs or symptoms of illness. The national surveillance case definition for valley fever requires both laboratory and clinical criteria. For the clinical criteria to be met, the patient must have signs and symptoms consistent with valley fever.  In order to determine whether suspect cases actually meet the surveillance case definition, LHOs must follow up with health care providers or the patients and collect additional information. DPH states that because valley fever is a complex disease, it can be difficult to determine whether a positive laboratory result represents a false positive result, a recent infection, or an infection acquired in the past. Collecting additional patient clinical information helps determine whether the patient has valley fever currently or not. Some cases initially reported as “Suspect” are eventually not confirmed as valley fever cases. If the case meets the surveillance case definition of valley fever, it is counted for regular data reports. Currently, Kern and Los Angeles are two counties that report using laboratory criteria only.
5. Related legislation. AB 1787 (Salas) Places new reporting requirements on DPH related to valley fever surveillance, including: attributing late-reported data to the year of diagnosis in future data reporting; collecting cases by the state’s electronic data system by April 15 of each year; reporting to LHOs about any removal of discrepant data; and including an explanation for likely data changes between initial and final publication of data, and an explanation for discrepancies between data reported by an LHO and data reported by DPH. AB 1787 is set to be heard on June 13, 2018 in this Committee.

AB 1788 (Salas) permits DPH, for the purpose of reports confirming a case of valley fever, to use a laboratory criteria for diagnosis, with or without clinical criteria. AB 1788 is set to be heard on June 13, 2018 in this Committee.

AB 1789 (Salas) requires the Occupational Safety and Health Standards Board to adopt valley fever standards for state public works projects, as specified. AB 1789 was held on the Assembly Committee of Appropriations suspense file.

1. Prior legislation. AB 1279 (Salas of 2017) would have required DPH to develop and implement public outreach programs to educate the public about valley fever. AB 1279 was vetoed by the Governor, who stated, “The department already provides fact sheets, brochures, posters and other educational materials to raise awareness of this disease. Expanding this program would necessitate additional resources which should be considered along with other funding requests as part of the budget process.”

SB 115 (Fuller of 2015) would have appropriated $1 million from the General Fund to DPH for purposes of valley fever vaccine research. SB 115 was held on the Senate Committee of Appropriations suspense file.

SB 1044 (Fuller of 2014), AB 1955 (Ashburn of 2002), SB 1027 (Ashburn of 2003) and SB 492 (Ashburn of 2005) were substantially similar to SB 115. SB 1044 was referred to Banking and Finance but never acted upon. AB 1955, SB 1027 and SB 492 were held on the Assembly Committee of Appropriations suspense file.

1. Support. Supporters state that according to the CDC, in addition to reported cases of valley fever, an estimated 150,000 more cases go unreported every year in the U.S., and unless physicians are trained to identify the likelihood of valley fever or specific tests are done, they are unable to diagnose the disease. Because of the difficulty inherent in distinguishing valley fever from other illnesses and a general lack of awareness, up to 90% of doctors do not order the simple blood test, according to the Valley Fever Center for Excellence. Timely diagnosis, early assessment, and proper treatment are critical. Supporters state that this bill will increase awareness and education about valley fever among physicians and help the thousands of patients that are misdiagnosed or undiagnosed every year.
2. Oppose unless amended. The Health Officers Association of California (HOAC) requests amendments to remove language that is duplicative of the requirements under existing law that providers report valley fever to LHOs and that health facilities develop reporting guidelines because they are concerned by the distinction of valley fever in statute pertaining to reportable diseases. HOAC additionally suggests a clarifying amendment to delete the reference to LHOs in the development of protocols for provider education and instead reference the CCLHO. HOAC states that this language would clarify that DPH and a collective body of LHOs, through CCLHO, will partner to help educate clinicians.

SUPPORT AND OPPOSITION:

Support: Acton Town Council

Arvin Union School District

California Hospital Association

California State Association of Electrical Workers

California State Pipe Trades Council

City of Arvin

City of Delano

City of Hanford

City of McFarland

City of Wasco

GFWC California Federation of Women’s Clubs

Kern Health Systems

Kern Medical

Lamont Elementary School District

Rural County Representatives of California

Valley Children’s Healthcare

Valley Fever Americas Foundation

Western States Council of Sheet Metal Workers

Oppose: Health Officers Association of California (unless amended)

-- END --

Date of Hearing: May 9, 2018

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez Fletcher, Chair

ABPCA Bill Id:AB 1790

Author:(Salas and Fong) – As Amended Ver:April 30, 2018

Urgency: No State Mandated Local Program: Yes Reimbursable: Yes

SUMMARY:

This bill contains a number of provisions intended to enhance awareness of coccidioidomycosis (valley fever). Specifically, this bill:

1. Requires the California Department of Public Health (CDPH) and local public health officers to work together to make available protocols and guidelines regarding the most recent scientific and medical information on valley fever, as specified.
2. Requires a health care provider to report a case or suspected case of valley fever to the local health officer.
3. Requires primary health clinics and hospitals to develop, adopt, and implement a written policy and procedure regarding required reporting to the local health officer.

FISCAL EFFECT:

Negligible. This bill may have a minor costs to local health departments, but it is unlikely there would be significant state-reimbursable mandate costs associated with the requirement for local public health officers to work with the state to make available protocols and guidelines, given the flexibility in meeting the requirement. Reporting requirements are duplicative of existing regulations, and thus should not result in increased costs.

COMMENTS:

1. Purpose. This author-sponsored bill is intended to encourage early detection, diagnosis, and treatment of valley fever.
2. Background. Valley fever is a flu-like infection caused by a fungus found in the American southwest and northern Mexico. Most cases in California are in the southern Central Valley and Central Coast. People can get valley fever by breathing in microscopic fungal spores from the air, although most people who breathe in the spores don’t get sick. Most who do get sick recover on their own within weeks to months, but some people will need antifungal medication and certain populations are at risk of severe illness.

State public health regulations require each local health officer to report at least weekly the number of cases for each condition specified on the "reportable conditions" list maintained by CDPH. This list already includes coccidioidomycosis (valley fever).

1. Related Legislation. AB 1788 (Salas), pending referral in the Senate, allows CDPH to use laboratory criteria to confirm cases of valley fever, with or without clinical criteria.

AB 1787 (Salas) , pending referral in the Senate, requires the California Department of Public Health (CDPH) to establish a March 31 annual deadline for a local health officer to report to the department all cases of coccidioidomycosis (valley fever) reported to the local health officer during the previous calendar year.

AB 1789 (Salas), pending on this committee’s Suspense File, requires the Division of Occupational Safety and Health (Cal/OSHA) to develop occupational safety and health standards for state public works projects to prevent and control valley fever.

1. Staff Comments. The author may wish to more clearly define the role of CDPH versus local health departments in making available protocols and guidelines. In addition, the bill indicates that a public outreach and education campaign is part of protocols and guidelines regarding the most recent scientific and medical information on valley fever, which does not appear fully accurate. The author may wish to consider revising this section for clarity. Finally, the requirement for a provider to report cases of valley fever to local health authorities is duplicative of existing regulations.

Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081

Date of Hearing:

ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS

Evan Low, Chair

ABPCA Bill Id:AB 1790

Author:(Salas) – As Amended Ver:April 19, 2018

SUBJECT: Valley Fever Education, Early Diagnosis, and Treatment Act.

SUMMARY: Establishes the Valley Fever Education, Early Diagnosis, and Treatment Act to raise awareness of the symptoms, tests, and treatments for valley fever among the general public, primary health care providers, and health care providers who care for persons at higher risk for getting valley fever.

EXISTING LAW:

1. Establishes the California Department of Public Health (CPDH) within the California Health and Human Services Agency to administer and implement numerous programs relating to, among other things, infectious disease control and prevention, food safety, environmental health, laboratory services, patient safety, emergency preparedness, chronic disease prevention and health promotion, family health, health equity, and vital records and statistics. (Health and Safety Code (HSC) §§ 131000-131231)
2. Provides for the licensure of health facilities, including primary health clinics and general acute care hospitals by the CDPH, and requires primary health clinics and general acute care hospitals to develop and implement various policies and procedures, including security and safety assessments for health facilities screening patients for spousal or partner abuse. (HSC §§ 1200-1211, 1250-1339.59)
3. Requires the CDPH to establish a list of reportable communicable and noncommunicable diseases and conditions and specifies the timeliness requirements related to the reporting of each disease and condition. (HSC §§ 120100-122450)

THIS BILL:

1. Establishes the Valley Fever Education, Early Diagnosis, and Treatment Act.
2. Makes the following findings and declarations:
   1. Valley fever, also called coccidioidomycosis, is a lung infection caused by a fungus that lives in the soil. Approximately 10,000 cases are reported each year, mostly from California and bordering states.
   2. Valley fever is a serious, costly illness. According to the Centers for Disease Control and Prevention, nearly 75 percent of people with valley fever miss work or school. As many as 40 percent of people who get valley fever need to stay in the hospital.
   3. People get valley fever by breathing in microscopic fungal spores from the air in areas where the fungus lives. Anyone who lives in or travels to these areas can get valley fever, but some people are at higher risk for developing valley fever, such as older adults, people who have weakened immune systems, pregnant women, people with diabetes, people who are Black or Filipino, and people who have jobs that expose them to dust, such as agricultural or construction workers.
   4. The symptoms of valley fever are similar to those of other common illnesses, so patients may have delays in getting diagnosed and treated. The initial symptoms may appear one to three weeks after exposure. They tend to resemble those of the flu, and can range from minor to severe, including fever, cough, chest pain, chills, night sweats, headache, fatigue, joint aches, and a red, spotty rash.
   5. In areas with valley fever, it is difficult to completely avoid exposure to the fungus because it is in the environment. There is no vaccine to prevent infection. Knowing about valley fever is one of the most important ways to avoid delays in diagnosis and treatment.
   6. It is the intent of the Legislature to raise awareness of the symptoms, tests, and treatments for valley fever among the general public, primary health care providers, and health care providers who care for persons at higher risk for getting valley fever.
3. Requires the CDPH and local public health officers, by July 1, 2019, to make available protocols and guidelines developed by the National Institutes of Health, the federal Centers for Disease Control and Prevention, and other appropriate professional health care organizations, for educating physicians and other health care providers, as specified, regarding the most recent scientific and medical information on valley fever etiology, transmission, diagnosis, surveillance, and treatment.
4. Specifies that the CDPH's Valley fever protocols and guidelines may include, but need not be limited to, all of the following:
   1. Tracking and reporting of cases of valley fever by health care professionals and public health officials.
   2. Surveillance programs to determine the prevalence of valley fever in the population at large and in high-risk populations.
   3. Public education and outreach programs to raise awareness of valley fever, including programs targeted to reach high-risk individuals. Education programs may provide information and referrals on valley fever including, but not limited to, education materials developed by health-related companies, community-based or national advocacy organizations, counseling, patient support groups, and existing hotlines for consumers.
5. Require a health care provider who knows of or is in attendance on a case or suspected case of valley fever, to submit a report to the local health officer as required by a specified regulatory provision.
6. Requires primary care clinics and general acute care hospitals to develop, adopt, and implement a written policy and procedure regarding required reporting to the local health officer.

FISCAL EFFECT: Unknown. This bill is keyed fiscal by Legislative Counsel.

COMMENTS:

Purpose. This bill is sponsored by the author. According to the author, "[t]imely diagnosis, early assessment, and proper treatment of Valley Fever infections are critical. If left untreated, Valley Fever can spread and result in lengthy, painful, and expensive treatments for patients, along with debilitating symptoms of the disease. Diagnosing and treating Valley Fever early and accurately can mean life or death."

Background. According to the federal Centers for Disease Control (CDC), Valley fever is an infection caused by the fungus Coccidioides. The scientific name for Valley fever is “coccidioidomycosis,” and it’s also sometimes called “San Joaquin Valley fever” or “desert rheumatism.” The term “Valley fever” usually refers to Coccidioides infection in the lungs, but the infection can spread to other parts of the body in severe cases.

The Coccidioides fungus has been known to live in the soil in the southwestern United States, parts of Mexico and Central and South America. The fungus was also recently found in south-central Washington. People can get Valley fever by breathing in the microscopic fungal spores from the air in these areas. About 10,000 U.S. cases are reported each year, mostly from Arizona and California.

Valley fever can be misdiagnosed because its symptoms are similar to those of other illnesses. Valley fever may also be underreported because many people who are exposed to Coccidioides have no symptoms (approximately 60%). Others may have flu-like symptoms that go away on their own after weeks to months.

For those with more severe symptoms (approximately 5% to 10% of cases), the treatment is usually 3 to 6 months of fluconazole or other antifungal medication. Those who have severe lung infections or infections that have spread (disseminated) to other parts of the body always need antifungal treatment and may need to stay in the hospital. For severe or disseminated infections, the course of treatment is usually longer than 6 months. Valley fever that develops into meningitis is fatal if it’s not treated, so lifelong antifungal treatment is necessary for those cases.

While most people who have Valley fever make a full recovery, a small percentage of those infected develop long-term lung infections that can take several years to recover from. In very severe cases of Valley fever, the nervous system can be affected and there may be long-term damage. People who are at risk for severe Valley fever include people who have weakened immune systems, are pregnant, have diabetes, or who are Black or Filipino.

The CDC also notes that prevention is difficult. The only options for people who live in areas where the Coccidioides fungus is common involve avoiding breathing it in or otherwise allowing it to enter the body or taking medication. Some of the options include avoiding dusty places, using respirators or face masks, installing air filtration systems, cleaning wounds, or taking preventive antifungal medications at the direction of a healthcare provider.

Reporting of Valley fever. In states where the Coccidioides fungus is common (endemic), including California, health care providers and laboratories are required to report Valley fever cases to public health authorities. Local and state health departments collect information about Valley fever cases and then send the information to the CDC. Disease reporting helps government officials and healthcare providers understand why outbreaks occur and allows them to monitor trends in the number of Valley fever cases.

Continuing Medical Education (CME) for Physicians. The CDC has implemented an online CME program in collaboration with the Arizona Board of Regents on behalf of The University of Arizona Valley Fever Center for Excellence and the University of California Davis Coccidioidomycosis Serology Laboratory.

Current Related Legislation. AB 1787 (Salas) of the current Legislative Session sets reporting deadlines for local health officers to report to the CDPH cases of Valley fever, requires the CDPH the collect specified data on Valley fever, and establishes requirements for the collection and publication of the data. STATUS: This bill is pending referral in the Senate Committee on Rules.

AB 1788 (Salas) of the current Legislative Session authorizes the CDPH, for the purpose of reports confirming a case of Valley fever, to use a laboratory criteria for diagnosis, with or without clinical criteria. STATUS: This bill is pending referral in the Senate Committee on Rules.

AB 1789 (Salas) of the current Legislative Session requires the Division of Occupational Safety and Health (Cal/OSHA) within the Department of Industrial Relations to adopt occupational safety and health standards for state public works projects to prevent and control Valley fever. STATUS: This bill is pending on the Assembly Committee on Appropriations suspense file.

Prior Related Legislation. AB 1279 (Salas) of 2017 would have required the CDPH to develop and distribute materials increasing awareness of Valley Fever. NOTE: This bill was vetoed by Governor Brown, who stated that the CDPH "already provides fact sheets, brochures, posters and other educational materials to raise awareness of this disease. Expanding this program would necessitate additional resources which should be considered along with other funding requests as part of the budget process."

SB 361 (Hill), Chapter 764, Statutes of 2015, required Skilled Nursing Facilities (SNFs), by January 1, 2017, to adopt and implement an antimicrobial stewardship policy that is consistent with antimicrobial stewardship guidelines developed by the CDC, the federal Centers for Medicare and Medicaid Services, the Society for Healthcare Epidemiology of America, or similar recognized professional organizations and required, on or after January 1, 2018, a licensed veterinarian who renews his or her license to complete a minimum of one credit hour of continuing education on the judicious use of medically important antimicrobial drugs, as defined, every four years as part of his or her continuing education requirements.

SB 1311 (Hill), Chapter 843, Statutes of 2014, requires all general acute-care hospitals to adopt and implement an antimicrobial stewardship policy that includes a process to evaluate the judicious use of antibiotics.

SB 158 (Florez), Chapter 294, Statutes of 2008, establishes an infection surveillance, prevention, and control program within the CDPH to provide oversight of hospital prevention and reporting of general acute care health-care-associated infection (HAIs), expands the responsibilities of the CDPH’s HAI Advisory Committee, and requires all hospitals to institute a patient safety plan for the purpose of improving the health and safety of patients and reducing preventable patient safety events.

AMENDMENTS:

Add Assemblymember Grayson as a joint author.

REGISTERED SUPPORT:

Arvin Union School District
City of Arvin
City of Hanford
City of McFarland
City of Wasco
Lamont Elementary School District
Valley Fever Americas Foundation

REGISTERED OPPOSITION:

None on file

Analysis Prepared by: Vincent Chee / B. & P. / (916) 319-3301