Existing law requires a county coroner to inquire into and determine the circumstances, manner, and cause of certain deaths. Existing law either requires or authorizes a county coroner, under certain circumstances, to perform, or cause to be performed, an autopsy on a decedent. Existing law requires a coroner or medical examiner who evaluates an individual who died, in the coroners or medical examiners expert opinion, as the result of an overdose as a contributing factor, to report the incident to the Overdose Detection Mapping Application Program, as specified.

This bill would authorize a county or regional group of counties to establish an interagency overdose fatality review team to assist local agencies in identifying and reviewing overdose fatalities, facilitate communication among the various persons and agencies involved in overdose fatalities, and integrate local overdose prevention efforts through strategic planning, data dissemination, and community collaboration. The bill would authorize the overdose fatality review team to be comprised of, among other persons, experts in the field of forensic pathology, coroners and medical examiners, county, local, state, and federal law enforcement, and public health staff, as specified. The bill would make confidential, among other things, an oral or written communication or a document shared within or produced by an overdose fatality review team related to an overdose fatality review, as specified. The bill would authorize an organization represented on an overdose fatality review team to share information in its possession concerning the decedent who is the subject of the review, information received from a person who was in contact with the decedent, or other information deemed by the organization to be pertinent to the review with other members of the team. The bill would require information gathered and recommendations made by an overdose fatality review team to be used by the county to develop education, prevention, and intervention strategies that will lead to improved coordination of treatment services and prevent future overdose deaths.

Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.

This bill would make legislative findings to that effect.

Existing law requires a county coroner to inquire into and determine the circumstances, manner, and cause of certain deaths. Existing law either requires or authorizes a county coroner, under certain circumstances, to perform, or cause to be performed, an autopsy on a decedent. Existing law requires a coroner or medical examiner who evaluates an individual who died, in the coroners or medical examiners expert opinion, as the result of an overdose as a contributing factor, to report the incident to the Overdose Detection Mapping Application Program, as specified.

This bill would authorize a county or regional group of counties to establish an interagency overdose fatality review team to assist local agencies in identifying and reviewing overdose fatalities, facilitate communication among the various persons and agencies involved in overdose fatalities, and integrate local overdose prevention efforts through strategic planning, data dissemination, and community collaboration. The bill would authorize the overdose fatality review team to be comprised of, among other persons, experts in the field of forensic pathology, coroners and medical examiners, county, local, state, and federal law enforcement, and public health staff, as specified. The bill would make confidential, among other things, an oral or written communication or a document shared within or produced by an overdose fatality review team related to an overdose fatality review, as specified. The bill would authorize an organization represented on an overdose fatality review team to share information in its possession concerning the decedent who is the subject of the review, information received from a person who was in contact with the decedent, or other information deemed by the organization to be pertinent to the review with other members of the team. The bill would require information gathered and recommendations made by an overdose fatality review team to be used by the county to develop education, prevention, and intervention strategies that will lead to improved coordination of treatment services and prevent future overdose deaths.

Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.

This bill would make legislative findings to that effect.

Existing law requires a county coroner to inquire into and determine the circumstances, manner, and cause of certain deaths. Existing law either requires or authorizes a county coroner, under certain circumstances, to perform, or cause to be performed, an autopsy on a decedent. Existing law requires a coroner or medical examiner who evaluates an individual who died, in the coroners or medical examiners expert opinion, as the result of an overdose as a contributing factor, to report the incident to the Overdose Detection Mapping Application Program, as specified.

This bill would authorize a county or regional group of counties to establish an interagency overdose fatality review team to assist local agencies in identifying and reviewing overdose fatalities, facilitate communication among the various persons and agencies involved in overdose fatalities, and integrate local overdose prevention efforts through strategic planning, data dissemination, and community collaboration. The bill would authorize the overdose fatality review team to be comprised of, among other persons, experts in the field of forensic pathology, coroners and medical examiners, county, local, state, and federal law enforcement, and public health staff, as specified. The bill would make confidential, among other things, an oral or written communication or a document shared within or produced by an overdose fatality review team related to an overdose fatality review, as specified. The bill would authorize an organization represented on an overdose fatality review team to share information in its possession concerning the decedent who is the subject of the review, information received from a person who was in contact with the decedent, or other information deemed by the organization to be pertinent to the review with other members of the team. The bill would require information gathered and recommendations made by an overdose fatality review team to be used by the county to develop education, prevention, and intervention strategies that will lead to improved coordination of treatment services and prevent future overdose deaths.

Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.

This bill would make legislative findings to that effect.

Existing law requires a county coroner to inquire into and determine the circumstances, manner, and cause of certain deaths. Existing law either requires or authorizes a county coroner, under certain circumstances, to perform, or cause to be performed, an autopsy on a decedent. Existing law requires a coroner or medical examiner who evaluates an individual who died, in the coroners or medical examiners expert opinion, as the result of an overdose as a contributing factor, to report the incident to the Overdose Detection Mapping Application Program, as specified.

This bill would authorize a county to establish an interagency overdose fatality review team to assist local agencies in identifying and reviewing overdose fatalities, facilitate communication among the various persons and agencies involved in overdose fatalities, and integrate local overdose prevention efforts through strategic planning, data dissemination, and community collaboration. The bill would authorize the overdose fatality review team to be comprised of, among other persons, experts in the field of forensic pathology, coroners and medical examiners, county, local, state, and federal law enforcement, and public health staff, as specified. The bill would make confidential, among other things, an oral or written communication or a document shared within or produced by an overdose fatality review team related to an overdose fatality review, as specified. The bill would authorize an organization represented on an overdose fatality review team to share information in its possession concerning the decedent who is the subject of the review, information received from a person who was in contact with the decedent, or other information deemed by the organization to be pertinent to the review with other members of the team. The bill would require information gathered and recommendations made by an overdose fatality review team to be used by the county to develop education, prevention, and intervention strategies that will lead to improved coordination of treatment services and prevent future overdose deaths.

Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.

This bill would make legislative findings to that effect.

Existing law requires a county coroner to inquire into and determine the circumstances, manner, and cause of certain deaths. Existing law either requires or authorizes a county coroner, under certain circumstances, to perform, or cause to be performed, an autopsy on a decedent. Existing law requires a coroner or medical examiner who evaluates an individual who died, in the coroners or medical examiners expert opinion, as the result of an overdose as a contributing factor, to report the incident to the Overdose Detection Mapping Application Program, as specified.

This bill would authorize a county to establish an interagency overdose fatality review team to assist local agencies in identifying and reviewing overdose fatalities, facilitate communication among the various persons and agencies involved in overdose fatalities, and integrate local overdose prevention efforts through strategic planning, data dissemination, and community collaboration. The bill would authorize the overdose fatality review team to be comprised of, among other persons, experts in the field of forensic pathology, coroners and medical examiners, county, state, and federal law enforcement, and public health staff, as specified. The bill would make confidential, among other things, an oral or written communication or a document shared within or produced by an overdose fatality review team related to an overdose fatality review, as specified. The bill would authorize an organization represented on an overdose fatality review team to share information in its possession concerning the decedent who is the subject of the review, information received from a person who was in contact with the decedent, or other information deemed by the organization to be pertinent to the review with other members of the team. The bill would require information gathered and recommendations made by an overdose fatality review team to be used by the county to develop education, prevention, and intervention strategies that will lead to improved coordination of treatment services and prevent future overdose deaths.

Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.

This bill would make legislative findings to that effect.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 2871

Author:(Maienschein)

As Amended Ver:August 14, 2024

Majority vote

SUMMARY

Authorizes a county to establish an interagency overdose fatality review team to assist local agencies in identifying and reviewing overdose fatalities, facilitate communication among persons and agencies involved in overdose fatalities, and integrate local overdose prevention efforts through strategic planning, data dissemination, and community collaboration.

Senate Amendments

1. Clarify that a county or regional group of counties may establish an interagency overdose fatality review team.
2. Permit overdose fatality review teams to share information and recommendations with overdose fatality review teams in other counties and state agencies for purposes of education, prevention, and intervention strategies that will lead to improved coordination of treatment services and prevent future overdose deaths.
3. Add experts in the field of forensic toxicology to the list of individuals who may be part of an overdose fatality review team.

COMMENTS

California is facing an overdose epidemic. According to a California Health Care Foundation report, 9% of Californians have met the criteria for a Substance Use Disorder (SUD) within the last year. While the health care system is moving toward acknowledging SUDs as a chronic illness, only about 10% of people with an SUD within the last year received treatment. Overdose deaths from both opioids and psychostimulants (such as amphetamines), are soaring. This issue, compounded by the increased availability of fentanyl, has resulted in a ten-fold increase in fentanyl related deaths between 2015 and 2019. The California Department of Public Health's Opioid Overdose Dashboard reported 7,385 deaths related to "any" opioid overdose in 2022, with 6,473 (87.7%) of those deaths fentanyl related.

1. Fentanyl. Fentanyl is a potent synthetic opioid drug approved by the United States Food and Drug Administration for use as an analgesic and anesthetic. It is approximately 50 times stronger than heroin and 100 times stronger than morphine. First developed in 1959, it was introduced in the 1960's as an intravenous anesthetic. Fentanyl is legally manufactured and distributed in the United States; however, there are two types of fentanyl: pharmaceutical fentanyl and illicitly manufactured fentanyl. Both are considered synthetic opioids. Pharmaceutical fentanyl is prescribed by doctors to treat severe pain, especially after surgery and for advanced-stage cancer. Most recently, cases of fentanyl-related overdoses are linked to illicitly manufactured fentanyl that is distributed through illegal drug markets for its heroin-like effect. It is often added to other drugs because of its extreme potency, which makes drugs cheaper, more powerful, more addictive, and more dangerous.
2. Existing Death Review Teams. Los Angeles County established the nation's first Child Death Review Team (CDRT) in 1978. A major role of CDRTs is to function as a case-investigating agency, providing in-depth analysis by many agencies on the possible causes of infant deaths in specific cases. California's CDRTs also assist in identifying agency and systems problems and developing recommendations to prevent future child deaths. According to the National Center for Fatality Review and Prevention, CDRTs have influenced state and local policy changes on issues ranging from child homicide sentencing, safely surrendered babies, children left alone in cars, child maltreatment reporting, data collection, and more.

Building on the success of CDRTs, in 1995 the California Legislature authorized counties to establish interagency Domestic Violence Death Review Teams to ensure that incidents of domestic violence and abuse are recognized and to develop recommendations for policies and protocols for community prevention and intervention initiatives. In 2001, the Legislature authorized counties to establish interagency elder death teams to examine deaths associated with suspected elder abuse and neglect, identify, and work towards the implementation of prevention strategies to protect our elder population. In 2010 the statute was expanded to allow the review teams to also assist in dependent adult death reviews. Most recently, in 2023 the Legislature authorized counties to establish homeless death review committees to identify the root causes of death of unhoused individuals and facilitate communication among persons and agencies involved in supporting the unhoused population. This bill builds upon these models to authorize overdose fatality review teams.

According to the Author

Confronting California's overdose epidemic will take collaboration across all sectors. The author argues that by providing the specific statutory authorization needed to create Overdose Fatality Review Teams, this bill will allow counties to look system-wide at individual deaths to find opportunities to increase safety and health in the future. The author states that other death review teams for children, domestic violence, and elder abuse have yielded tremendous results with opportunities for improvement identified and acted on at both the system-wide and individual levels. The author concludes that being able to implement drug fatality review teams would allow counties to maximize insights on how they can address the drug and opioid crisis locally for a growing crisis throughout the state.

Arguments in Support

The County of San Diego (County) is sponsoring this bill, stating that addressing California's drug fatality crisis will require a system-wide effort from local health, social service, and public safety agencies, nonprofits, community groups, and others who have expertise or work with people who are most at risk. The County continues that while overdose fatality reviews can currently be conducted to a limited degree, the ability to share information about individuals, much of which is confidential by law, is limited. The County argues that other death review teams for children, domestic violence, and elder abuse have yielded tremendous results. The County concludes by stating that this bill would unlock the ability for counties and other agencies to better work together to prevent and address future occurrences, as well as to improve coordination and effectiveness of interventions.

Arguments in Opposition

None on file.

FISCAL COMMENTS

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

VOTES:

ASM HEALTH: 16-0-0

YES: Bonta, Waldron, Aguiar-Curry, Arambula, Wendy Carrillo, Flora, Haney, Jones-Sawyer, Maienschein, McCarty, Joe Patterson, Rodriguez, Sanchez, Santiago, Schiavo, Weber

ASM PRIVACY AND CONSUMER PROTECTION: 11-0-0

YES: Bauer-Kahan, Joe Patterson, Bryan, Dixon, Hoover, Irwin, Lowenthal, Ortega, Ward, Wicks, Wilson

ASM APPROPRIATIONS: 15-0-0

YES: Wicks, Sanchez, Arambula, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Grayson, Haney, Hart, Jim Patterson, Pellerin, Ta, Villapudua

ASSEMBLY FLOOR: 71-0-9

YES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Juan Carrillo, Wendy Carrillo, Chen, Connolly, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Rendon, Reyes, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Robert Rivas

ABS, ABST OR NV: Calderon, Cervantes, Megan Dahle, Friedman, Gabriel, Holden, Mathis, Papan, Luz Rivas

SENATE FLOOR: 40-0-0

YES: Allen, Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Gonzalez, Grove, Hurtado, Jones, Laird, Limón, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk

UPDATED

VERSION: August 14, 2024

CONSULTANT: Riana King / HEALTH / (916) 319-2097 FN: 0004146

 THIRD READING  

Bill No: AB 2871

Author: Maienschein (D)

Amended: 8/14/24 in Senate

Vote: 21

SENATE PUBLIC SAFETY COMMITTEE: 5-0, 6/18/24

AYES: Wahab, Seyarto, Bradford, Skinner, Wiener

SENATE HEALTH COMMITTEE: 11-0, 7/3/24

AYES: Roth, Nguyen, Glazer, Gonzalez, Grove, Hurtado, Limón, Menjivar, Rubio, Smallwood-Cuevas, Wiener

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 71-0, 5/21/24 (Consent) - See last page for vote

SUBJECT: Overdose fatality review teams

SOURCE: San Diego County

DIGEST:

This bill allows counties to establish an interagency overdose fatality review team to assist local agencies in identifying and reviewing overdose fatalities, facilitate communication, and integrate local prevention efforts.

Senate Floor Amendments of 8/14/24 recommend more collaboration among overdose fatality review teams across different counties by suggesting that counties share information acquired by the review teams. Also adds forensic toxicology experts to recommended members.

ANALYSIS:

Existing law:

1. Defines “state summary criminal history information” as the master record of information complied by the Attorney General regarding the identification and criminal history of a person. (Penal Code §11105)
2. Defines “criminal offender record information” as records and data compiled by criminal justice agencies for purposes of identifying criminal offenders and of maintaining summaries of arrests, criminal proceedings and its results, and incarceration. (Penal Code §11075)
3. Defines “local summary criminal history information” as the master record of information compiled by any local criminal justice agency pertaining to the identification and criminal history of any person. (Penal Code §13300)
4. Requires probation officers to report and record antecedents, character, history, family environment, and offense of any person receiving a guilty verdict, this record shall be kept as a record of the court and can be accessed by specified an appointed or designated person or profession. (Penal Code §1203.10)
5. Provides, pursuant to the California Constitution, that all people have inalienable rights, including the right to pursue and obtain privacy. (Cal. Const., art. I, § 1)
6. States that the “right to privacy is a personal and fundamental right protected by Section 1 of Article I of the Constitution of California and by the United States Constitution and that all individuals have a right of privacy in information pertaining to them.” Further states these findings of the Legislature:
   1. The right to privacy is being threatened by the indiscriminate collection, maintenance, and dissemination of personal information and the lack of effective laws and legal remedies.
   2. The increasing use of computers and other sophisticated information technology has greatly magnified the potential risk to individual privacy that can occur from the maintenance of personal information.
   3. In order to protect the privacy of individuals, it is necessary that the maintenance and dissemination of personal information be subject to strict limits. (Civil Code §1798.1)
7. Establishes under federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which sets standards for the privacy of individually identifiable health information and security standards for the protection of electronic protected health information, including, through regulations, that a HIPAA-covered entity may not condition the provision of treatment, payment, enrollment in a health plan, or eligibility for benefits on the provision of an authorization, except under specified circumstances. Provides that if HIPAA’s provisions conflict with state law, the provision that is most protective of patient privacy prevails. (42 United Stated Code § 1320d, et seq.; Title 45 Code of Fed. Regs. Part 164.)
8. Prohibits, under the state Confidentiality of Medical Information Act (CMIA), a health care provider, a health care service plan, a contractor, a corporation and its subsidiaries and affiliates, or any business that offers software or hardware to consumers, including a mobile application or other related device, as defined, from intentionally sharing, selling, using for marketing, or otherwise using any medical information, as defined, for any purpose not necessary to provide health care services to a patient, except as expressly authorized by the patient, enrollee, or subscriber, as specified, or as otherwise required or authorized by law. States that a violation of these provisions that results in economic loss or personal injury to a patient is a crime. (Civil Code §56, et. seq.)
9. Defines, for purposes of the CMIA, medical information to mean any individually identifiable information, in electronic or physical form, in possession of or derived from a provider of health care, health care service plan, pharmaceutical company, or contractor regarding a patient’s medical history, mental health app information, mental or physical condition, or treatment. (Civil Code §56.05 (i))
10. Prohibits health care providers, health care service plans, or contractors, as defined, from sharing medical information without the patient’s written authorization, subject to certain exceptions. (Civil Code §56.10 (a))
11. Permits a county to establish an interagency domestic violence death review team to assist local agencies in identifying and reviewing domestic violence deaths and near deaths, including homicides and suicides, and facilitating communication among the various agencies involved in domestic violence cases. (Penal Code §11163.3)
12. Permits a county to establish a homeless death review committee to assist local agencies in identifying the root causes of death of homeless individuals and facilitating communication among persons who perform autopsies and the various persons and agencies involved in supporting the homeless population. (Penal Code §11163.72)
13. Permits a county to establish an interagency child death review team to assist local agencies in identifying and reviewing suspicious child deaths and facilitating communication among persons who perform autopsies and the various persons and agencies involved in child abuse or neglect cases. (Penal Code §11174.32)
14. Permits a county to establish an interagency elder and dependent adult death review team to assist local agencies in identifying and reviewing suspicious elder and dependent adult deaths and facilitating communication among persons who perform autopsies and the various persons and agencies involved in elder and dependent adult abuse or neglect cases. (Penal Code §11174.5)
15. Requires a coroner to inquire into and determine the circumstances, manner, and cause of all violent, sudden, or unusual deaths; unattended deaths; deaths due to drug addiction; deaths in prison or while under sentence; among various other circumstances. (Government Code §27491)
16. Requires coroners to inquire into and determine the circumstances, manner, and cause of various types of deaths, including, but not limited to those that appear to be violent, sudden, or unusual deaths; unattended deaths; and drug addiction. (Government Code §27491)
17. Requires the coroner in all cases in which a person has died under circumstances that afford a reasonable ground to suspect that the person’s death has been occasioned by the act of another by criminal means, the coroner, upon determining that those reasonable grounds exist, shall immediately notify the law enforcement agency having jurisdiction over the criminal investigation. (Government Code §27491.1)
18. Allows coroners or their appointed deputy to make inquiries into the circumstances, manner, and means of death. (Government Code §27491.2)

This bill:

1. Authorizes a county to establish an interagency overdose fatality review team to assist local agencies in identifying and reviewing overdose fatalities, facilitate communication among persons and agencies involved in overdose fatalities, and integrate local overdose prevention efforts through strategic planning, data dissemination, and community collaboration.
2. Authorizes a county to develop standardized protocols for postmortem examinations involving an overdose to assist coroners and other persons who perform postmortem examinations in determining whether drugs contributed to a death or were the actual cause of death.
3. Permits an overdose fatality review team to be comprised of, but not limited to, the following:
   1. Experts in the field of forensic pathology.
   2. Medical personnel with expertise in overdose fatalities.
   3. Coroners and medical examiners.
   4. District attorneys and city attorneys.
   5. County or local staff, including, but not limited to, all of the following:
      1. Behavioral health services staff;
      2. County counsel;
      3. Emergency medical services staff;
      4. Unhoused services staff;
      5. Medical care services staff;
      6. Medical examiner staff; and,
      7. Public health staff.
   6. County, state, local, and federal law enforcement personnel.
   7. Local drug trafficking experts.
   8. Public health or behavioral health experts.
      1. Drug treatment providers.
4. Representatives of local health plans, nonprofits, religious, or other organizations who work with individuals at high risk of overdose fatalities.
5. Local professional associations of persons described in this subdivision.
6. Requires an oral or written communication or a document shared within or produced by an overdose fatality review team to be confidential.
7. Requires an oral or written communication or a document provided by a third party to an overdose fatality review team, or between a third party and an overdose fatality review team, to be confidential.
8. Permits recommendations of an overdose fatality review team, upon the completion of a review, to be disclosed at the discretion of a majority of the members of the overdose fatality review team.

Comments

1. California’s Overdose Epidemic. California is facing an overdose epidemic. According to a California Health Care Foundation report, 9% of Californians have met the criteria for a Substance Use Disorder (SUD) within the last year. While the health care system is moving toward acknowledging SUDs as a chronic illness, only about 10% of people with an SUD within the last year received treatment. Overdose deaths from both opioids and psychostimulants (such as amphetamines), are soaring. This issue, compounded by the increased availability of fentanyl, has resulted in a ten-fold increase in fentanyl related deaths between 2015 and 2019. DPH’s Opioid Overdose Dashboard reported 7,385 deaths related to “any” opioid overdose in 2022, with 6,473 (87.7%) of those deaths fentanyl related.
2. County Postmortem Examinations. Post mortem examinations are conducted by a County’s coroner’s office in California. Specific county processes may differ but California law outlines circumstances that may trigger a coroner to conduct a postmortem evaluation to determine the cause and matter of a death. And if the cause and manner of death is determined to be a result of illegal activity, the coroner must report that information to the County Sherriff’s Department for further investigation and handling.
3. Existing Death Review Teams. Los Angeles County established the nation’s first Child Death Review Team (CDRT) in 1978. A major role of CDRTs is to function as a case-investigating agency, providing in-depth analysis by many agencies on the possible causes of infant deaths in specific cases. California’s CDRTs also assist in identifying agency and systems problems and developing recommendations to prevent future child deaths. According to the National Center for Fatality Review and Prevention, CDRTs have influenced state and local policy changes on issues ranging from child homicide sentencing, safely surrendered babies, children left alone in cars, child maltreatment reporting, data collection, and more.

Building on the success of CDRTs, in 1995 the California Legislature authorized counties to establish interagency Domestic Violence Death Review Teams to ensure that incidents of domestic violence and abuse are recognized and to develop recommendations for policies and protocols for community prevention and intervention initiatives. In 2001, the Legislature authorized counties to establish interagency elder death teams to examine deaths associated with suspected elder abuse and neglect, identify, and work towards the implementation of prevention strategies to protect our elder population. In 2010 the statute was expanded to allow the review teams to also assist in dependent adult death reviews. Most recently, in 2023 the Legislature authorized counties to establish homeless death review committees to identify the root causes of the deaths of unhoused individuals and facilitate communication among persons and agencies involved in supporting the unhoused population. This bill builds upon these models to authorize overdose fatality review teams.

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

SUPPORT: (Verified 8/14/24)

San Diego County (source)

Alameda County Board of Supervisors
California State Association of Counties
City and County of San Francisco
County Behavioral Health Directors Association of California
County Health Executives Association of California
County of Riverside
San Diego County District Attorney's Office
Urban Counties of California

OPPOSITION: (Verified 8/14/24)

None received

ARGUMENTS IN SUPPORT: According to San Diego County:

California’s drug fatality crisis is well-documented. The most recent available data indicates that over 11,000 Californians died from drug overdoses in 2022, more than double the number from 2018. Two-thirds of those deaths are from opioids and 60 percent are from fentanyl alone.

Addressing California’s drug fatality crisis will require a system-wide effort from local health, social service, and public safety agencies, nonprofits, community groups, and others who have expertise or work with people who are most at risk. While overdose fatality reviews can currently be conducted to a limited degree, the ability to share information about individuals, much of which is confidential by law, is limited. Other death review teams for children, domestic violence, and elder abuse have yielded tremendous results with opportunities for improvement identified and acted on at both the system-wide and individual levels. Being able to implement drug fatality review teams would allow counties to maximize insights on how they can address the drug and opioid crisis locally.

For counties interested in doing so, AB 2871 would provide the specific statutory authorization needed to create Overdose Fatality Review Teams. It would detail and protect processes and allow for greater sharing of confidential medical and other information needed to further identify issues and gaps in addressing the overdose fatality crisis. Finally, AB 2871 would require all confidential information shared among members of the review team to remain confidential.

The language in this legislation is based on the existing frameworks in law for child, domestic violence, and elder abuse fatality review teams, as well as the homeless adult and family multidisciplinary personnel teams, which allow the sharing within the review team of confidential information.

If signed into law, AB 2871 would unlock the ability for counties and other agencies to better work together to prevent and address future occurrences, as well as to improve coordination and effectiveness of interventions.

ASSEMBLY FLOOR: 71-0, 5/21/24

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Juan Carrillo, Wendy Carrillo, Chen, Connolly, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Rendon, Reyes, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Robert Rivas

NO VOTE RECORDED: Calderon, Cervantes, Megan Dahle, Friedman, Gabriel, Holden, Mathis, Papan, Luz Rivas

Prepared by: John Duncan / PUB. S. /

8/16/24 12:47:39

**** END ****

 THIRD READING  

Bill No: AB 2871

Author: Maienschein (D)

Amended: 4/24/24 in Assembly

Vote: 21

SENATE PUBLIC SAFETY COMMITTEE: 5-0, 6/18/24

AYES: Wahab, Seyarto, Bradford, Skinner, Wiener

SENATE HEALTH COMMITTEE: 11-0, 7/3/24

AYES: Roth, Nguyen, Glazer, Gonzalez, Grove, Hurtado, Limón, Menjivar, Rubio, Smallwood-Cuevas, Wiener

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 71-0, 5/21/24 (Consent) - See last page for vote

SUBJECT: Overdose fatality review teams

SOURCE: San Diego County

DIGEST:

This bill allows counties to establish an interagency overdose fatality review team to assist local agencies in identifying and reviewing overdose fatalities, facilitate communication, and integrate local prevention efforts.

ANALYSIS:

Senate Floor Amendments of 08/14/2024, the bill was amended to recommend more collaboration among overdose fatality review teams across different counties by suggesting that counties share information acquired by the review teams. Also adds forensic toxicology experts to recommended members.

Existing law:

Defines “state summary criminal history information” as the master record of information complied by the Attorney General regarding the identification and criminal history of a person (Penal Code §11105).

1. Defines “criminal offender record information” as records and data compiled by criminal justice agencies for purposes of identifying criminal offenders and of maintaining summaries of arrests, criminal proceedings and its results, and incarceration (Penal Code §11075).
2. Defines “local summary criminal history information” as the master record of information compiled by any local criminal justice agency pertaining to the identification and criminal history of any person (Penal Code §13300).
3. Requires probation officers to report and record antecedents, character, history, family environment, and offense of any person receiving a guilty verdict, this record shall be kept as a record of the court and can be accessed by specified an appointed or designated person or profession (Penal Code §1203.10).
4. Provides, pursuant to the California Constitution, that all people have inalienable rights, including the right to pursue and obtain privacy. (Cal. Const., art. I, § 1.)
5. States that the “right to privacy is a personal and fundamental right protected by Section 1 of Article I of the Constitution of California and by the United States Constitution and that all individuals have a right of privacy in information pertaining to them.” Further states these findings of the Legislature:
   1. The right to privacy is being threatened by the indiscriminate collection, maintenance, and dissemination of personal information and the lack of effective laws and legal remedies.
   2. The increasing use of computers and other sophisticated information technology has greatly magnified the potential risk to individual privacy that can occur from the maintenance of personal information.
   3. In order to protect the privacy of individuals, it is necessary that the maintenance and dissemination of personal information be subject to strict limits. (Civil Code §1798.1.)
6. Establishes under federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which sets standards for the privacy of individually identifiable health information and security standards for the protection of electronic protected health information, including, through regulations, that a HIPAA-covered entity may not condition the provision of treatment, payment, enrollment in a health plan, or eligibility for benefits on the provision of an authorization, except under specified circumstances. Provides that if HIPAA’s provisions conflict with state law, the provision that is most protective of patient privacy prevails. (42 U.S.C. § 1320d, et seq.; 45 Code Fed. Regs. Part 164.)
7. Prohibits, under the state Confidentiality of Medical Information Act (CMIA), a health care provider, a health care service plan, a contractor, a corporation and its subsidiaries and affiliates, or any business that offers software or hardware to consumers, including a mobile application or other related device, as defined, from intentionally sharing, selling, using for marketing, or otherwise using any medical information, as defined, for any purpose not necessary to provide health care services to a patient, except as expressly authorized by the patient, enrollee, or subscriber, as specified, or as otherwise required or authorized by law. States that a violation of these provisions that results in economic loss or personal injury to a patient is a crime. (Civil Code §56, et. seq.)
8. Defines, for purposes of the CMIA, medical information to mean any individually identifiable information, in electronic or physical form, in possession of or derived from a provider of health care, health care service plan, pharmaceutical company, or contractor regarding a patient’s medical history, mental health app information, mental or physical condition, or treatment. (Civil Code §56.05 (i).)
9. Prohibits health care providers, health care service plans, or contractors, as defined, from sharing medical information without the patient’s written authorization, subject to certain exceptions. (Civil Code §56.10 (a).)
10. Permits a county to establish an interagency domestic violence death review team to assist local agencies in identifying and reviewing domestic violence deaths and near deaths, including homicides and suicides, and facilitating communication among the various agencies involved in domestic violence cases. (Penal Code §11163.3)
11. Permits a county to establish a homeless death review committee to assist local agencies in identifying the root causes of death of homeless individuals and facilitating communication among persons who perform autopsies and the various persons and agencies involved in supporting the homeless population. (Penal Code §11163.72)
12. Permits a county to establish an interagency child death review team to assist local agencies in identifying and reviewing suspicious child deaths and facilitating communication among persons who perform autopsies and the various persons and agencies involved in child abuse or neglect cases. (Penal Code §11174.32)
13. Permits a county to establish an interagency elder and dependent adult death review team to assist local agencies in identifying and reviewing suspicious elder and dependent adult deaths and facilitating communication among persons who perform autopsies and the various persons and agencies involved in elder and dependent adult abuse or neglect cases. (Penal Code §11174.5)
14. Requires a coroner to inquire into and determine the circumstances, manner, and cause of all violent, sudden, or unusual deaths; unattended deaths; deaths due to drug addiction; deaths in prison or while under sentence; among various other circumstances. (Government Code §27491)
15. Requires coroners to inquire into and determine the circumstances, manner, and cause of various types of deaths, including, but not limited to those that appear to be violent, sudden, or unusual deaths; unattended deaths; and drug addiction. (Government Code §27491)
16. Requires the coroner in all cases in which a person has died under circumstances that afford a reasonable ground to suspect that the person’s death has been occasioned by the act of another by criminal means, the coroner, upon determining that those reasonable grounds exist, shall immediately notify the law enforcement agency having jurisdiction over the criminal investigation. (Government Code §27491.1)
17. Allows coroners or their appointed deputy to make inquiries into the circumstances, manner, and means of death. (Government Code §27491.2)

This bill:

1. Authorizes a county to establish an interagency overdose fatality review team to assist local agencies in identifying and reviewing overdose fatalities, facilitate communication among persons and agencies involved in overdose fatalities, and integrate local overdose prevention efforts through strategic planning, data dissemination, and community collaboration.
2. Authorizes a county to develop standardized protocols for postmortem examinations involving an overdose to assist coroners and other persons who perform postmortem examinations in determining whether drugs contributed to a death or were the actual cause of death.
3. Permits an overdose fatality review team to be comprised of, but not limited to, the following:
   1. Experts in the field of forensic pathology;
   2. Medical personnel with expertise in overdose fatalities;
   3. Coroners and medical examiners;
   4. District attorneys and city attorneys;
   5. County or local staff, including, but not limited to, all of the following:
      1. Behavioral health services staff;
      2. County counsel;
      3. Emergency medical services staff;
      4. Unhoused services staff;
      5. Medical care services staff;
      6. Medical examiner staff; and,
      7. Public health staff.
   6. County, state, local, and federal law enforcement personnel;
   7. Local drug trafficking experts;
   8. Public health or behavioral health experts;
      1. Drug treatment providers;
4. Representatives of local health plans, nonprofits, religious, or other organizations who work with individuals at high risk of overdose fatalities; and,
5. Local professional associations of persons described in this subdivision.
6. Requires an oral or written communication or a document shared within or produced by an overdose fatality review team to be confidential.
7. Requires an oral or written communication or a document provided by a third party to an overdose fatality review team, or between a third party and an overdose fatality review team, to be confidential.
8. Permits recommendations of an overdose fatality review team, upon the completion of a review, to be disclosed at the discretion of a majority of the members of the overdose fatality review team.

Comments

California’s Overdose Epidemic. California is facing an overdose epidemic. According to a California Health Care Foundation report, 9% of Californians have met the criteria for a Substance Use Disorder (SUD) within the last year. While the health care system is moving toward acknowledging SUDs as a chronic illness, only about 10% of people with an SUD within the last year received treatment. Overdose deaths from both opioids and psychostimulants (such as amphetamines), are soaring. This issue, compounded by the increased availability of fentanyl, has resulted in a ten-fold increase in fentanyl related deaths between 2015 and 2019. DPH’s Opioid Overdose Dashboard reported 7,385 deaths related to “any” opioid overdose in 2022, with 6,473 (87.7%) of those deaths fentanyl related.

County Postmortem Examinations. Post mortem examinations are conducted by a County’s coroner’s office in California. Specific county processes may differ but California law outlines circumstances that may trigger a coroner to conduct a postmortem evaluation to determine the cause and matter of a death. And if the cause and manner of death is determined to be a result of illegal activity, the coroner must report that information to the County Sherriff’s Department for further investigation and handling.

Existing Death Review Teams. Los Angeles County established the nation’s first Child Death Review Team (CDRT) in 1978. A major role of CDRTs is to function as a case-investigating agency, providing in-depth analysis by many agencies on the possible causes of infant deaths in specific cases. California’s CDRTs also assist in identifying agency and systems problems and developing recommendations to prevent future child deaths. According to the National Center for Fatality Review and Prevention, CDRTs have influenced state and local policy changes on issues ranging from child homicide sentencing, safely surrendered babies, children left alone in cars, child maltreatment reporting, data collection, and more.

Building on the success of CDRTs, in 1995 the California Legislature authorized counties to establish interagency Domestic Violence Death Review Teams to ensure that incidents of domestic violence and abuse are recognized and to develop recommendations for policies and protocols for community prevention and intervention initiatives. In 2001, the Legislature authorized counties to establish interagency elder death teams to examine deaths associated with suspected elder abuse and neglect, identify, and work towards the implementation of prevention strategies to protect our elder population. In 2010 the statute was expanded to allow the review teams to also assist in dependent adult death reviews. Most recently, in 2023 the Legislature authorized counties to establish homeless death review committees to identify the root causes of the deaths of unhoused individuals and facilitate communication among persons and agencies involved in supporting the unhoused population. This bill builds upon these models to authorize overdose fatality review teams.

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

SUPPORT: (Verified 8/14/24)

San Diego County (source)

Alameda County Board of Supervisors
California State Association of Counties
City and County of San Francisco
County Behavioral Health Directors Association of California
County Health Executives Association of California (CHEAC)
County of Riverside
San Diego County District Attorney's Office
Urban Counties of California (UCC)

OPPOSITION: (Verified 8/14/24)

None received

ARGUMENTS IN SUPPORT:

According to San Diego County:

California’s drug fatality crisis is well-documented. The most recent available data indicates that over 11,000 Californians died from drug overdoses in 2022, more than double the number from 2018. Two-thirds of those deaths are from opioids and 60 percent are from fentanyl alone.

Addressing California’s drug fatality crisis will require a system-wide effort from local health, social service, and public safety agencies, nonprofits, community groups, and others who have expertise or work with people who are most at risk. While overdose fatality reviews can currently be conducted to a limited degree, the ability to share information about individuals, much of which is confidential by law, is limited. Other death review teams for children, domestic violence, and elder abuse have yielded tremendous results with opportunities for improvement identified and acted on at both the system-wide and individual levels. Being able to implement drug fatality review teams would allow counties to maximize insights on how they can address the drug and opioid crisis locally.

For counties interested in doing so, AB 2871 would provide the specific statutory authorization needed to create Overdose Fatality Review Teams. It would detail and protect processes and allow for greater sharing of confidential medical and other information needed to further identify issues and gaps in addressing the overdose fatality crisis. Finally, AB 2871 would require all confidential information shared among members of the review team to remain confidential.

The language in this legislation is based on the existing frameworks in law for child, domestic violence, and elder abuse fatality review teams, as well as the homeless adult and family multidisciplinary personnel teams, which allow the sharing within the review team of confidential information.

If signed into law, AB 2871 would unlock the ability for counties and other agencies to better work together to prevent and address future occurrences, as well as to improve coordination and effectiveness of interventions.

ASSEMBLY FLOOR: 71-0, 5/21/24

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Juan Carrillo, Wendy Carrillo, Chen, Connolly, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Rendon, Reyes, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Robert Rivas

NO VOTE RECORDED: Calderon, Cervantes, Megan Dahle, Friedman, Gabriel, Holden, Mathis, Papan, Luz Rivas

Prepared by: John Duncan / PUB. S. /

8/14/24 16:48:48

**** END ****

 CONSENT  

Bill No: AB 2871

Author: Maienschein (D)

Amended: 4/24/24 in Assembly

Vote: 21

SENATE PUBLIC SAFETY COMMITTEE: 5-0, 6/18/24

AYES: Wahab, Seyarto, Bradford, Skinner, Wiener

SENATE HEALTH COMMITTEE: 11-0, 7/3/24

AYES: Roth, Nguyen, Glazer, Gonzalez, Grove, Hurtado, Limón, Menjivar, Rubio, Smallwood-Cuevas, Wiener

SENATE APPROPRIATIONS COMMITTEE: Senate Rule 28.8

ASSEMBLY FLOOR: 71-0, 5/21/24 (Consent) - See last page for vote

SUBJECT: Overdose fatality review teams

SOURCE: San Diego County

DIGEST:

This bill allows counties to establish an interagency overdose fatality review team to assist local agencies in identifying and reviewing overdose fatalities, facilitate communication, and integrate local prevention efforts.

ANALYSIS:

Existing law:

1. Defines “state summary criminal history information” as the master record of information complied by the Attorney General regarding the identification and criminal history of a person (Penal Code §11105).
2. Defines “criminal offender record information” as records and data compiled by criminal justice agencies for purposes of identifying criminal offenders and of maintaining summaries of arrests, criminal proceedings and its results, and incarceration (Penal Code §11075).
3. Defines “local summary criminal history information” as the master record of information compiled by any local criminal justice agency pertaining to the identification and criminal history of any person (Penal Code §13300).
4. Requires probation officers to report and record antecedents, character, history, family environment, and offense of any person receiving a guilty verdict, this record shall be kept as a record of the court and can be accessed by specified an appointed or designated person or profession (Penal Code §1203.10).
5. Provides, pursuant to the California Constitution, that all people have inalienable rights, including the right to pursue and obtain privacy. (Cal. Const., art. I, § 1.)
6. States that the “right to privacy is a personal and fundamental right protected by Section 1 of Article I of the Constitution of California and by the United States Constitution and that all individuals have a right of privacy in information pertaining to them.” Further states these findings of the Legislature:
   1. The right to privacy is being threatened by the indiscriminate collection, maintenance, and dissemination of personal information and the lack of effective laws and legal remedies.
   2. The increasing use of computers and other sophisticated information technology has greatly magnified the potential risk to individual privacy that can occur from the maintenance of personal information.
   3. In order to protect the privacy of individuals, it is necessary that the maintenance and dissemination of personal information be subject to strict limits. (Civil Code §1798.1.)
7. Establishes under federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which sets standards for the privacy of individually identifiable health information and security standards for the protection of electronic protected health information, including, through regulations, that a HIPAA-covered entity may not condition the provision of treatment, payment, enrollment in a health plan, or eligibility for benefits on the provision of an authorization, except under specified circumstances. Provides that if HIPAA’s provisions conflict with state law, the provision that is most protective of patient privacy prevails. (42 U.S.C. § 1320d, et seq.; 45 Code Fed. Regs. Part 164.)
8. Prohibits, under the state Confidentiality of Medical Information Act (CMIA), a health care provider, a health care service plan, a contractor, a corporation and its subsidiaries and affiliates, or any business that offers software or hardware to consumers, including a mobile application or other related device, as defined, from intentionally sharing, selling, using for marketing, or otherwise using any medical information, as defined, for any purpose not necessary to provide health care services to a patient, except as expressly authorized by the patient, enrollee, or subscriber, as specified, or as otherwise required or authorized by law. States that a violation of these provisions that results in economic loss or personal injury to a patient is a crime. (Civil Code §56, et. seq.)
9. Defines, for purposes of the CMIA, medical information to mean any individually identifiable information, in electronic or physical form, in possession of or derived from a provider of health care, health care service plan, pharmaceutical company, or contractor regarding a patient’s medical history, mental health app information, mental or physical condition, or treatment. (Civil Code §56.05 (i).)
10. Prohibits health care providers, health care service plans, or contractors, as defined, from sharing medical information without the patient’s written authorization, subject to certain exceptions. (Civil Code §56.10 (a).)
11. Permits a county to establish an interagency domestic violence death review team to assist local agencies in identifying and reviewing domestic violence deaths and near deaths, including homicides and suicides, and facilitating communication among the various agencies involved in domestic violence cases (Penal Code §11163.3).
12. Permits a county to establish a homeless death review committee to assist local agencies in identifying the root causes of death of homeless individuals and facilitating communication among persons who perform autopsies and the various persons and agencies involved in supporting the homeless population (Penal Code §11163.72).
13. Permits a county to establish an interagency child death review team to assist local agencies in identifying and reviewing suspicious child deaths and facilitating communication among persons who perform autopsies and the various persons and agencies involved in child abuse or neglect cases (Penal Code §11174.32).
14. Permits a county to establish an interagency elder and dependent adult death review team to assist local agencies in identifying and reviewing suspicious elder and dependent adult deaths and facilitating communication among persons who perform autopsies and the various persons and agencies involved in elder and dependent adult abuse or neglect cases (Penal Code §11174.5).
15. Requires a coroner to inquire into and determine the circumstances, manner, and cause of all violent, sudden, or unusual deaths; unattended deaths; deaths due to drug addiction; deaths in prison or while under sentence; among various other circumstances (Government Code §27491).
16. Requires coroners to inquire into and determine the circumstances, manner, and cause of various types of deaths, including, but not limited to those that appear to be violent, sudden, or unusual deaths; unattended deaths; and drug addiction (Government Code §27491).
17. Requires the coroner in all cases in which a person has died under circumstances that afford a reasonable ground to suspect that the person’s death has been occasioned by the act of another by criminal means, the coroner, upon determining that those reasonable grounds exist, shall immediately notify the law enforcement agency having jurisdiction over the criminal investigation (Government Code §27491.1).
18. Allows coroners or their appointed deputy to make inquiries into the circumstances, manner, and means of death (Government Code §27491.2).

This bill:

1. Authorizes a county to establish an interagency overdose fatality review team to assist local agencies in identifying and reviewing overdose fatalities, facilitate communication among persons and agencies involved in overdose fatalities, and integrate local overdose prevention efforts through strategic planning, data dissemination, and community collaboration.
2. Authorizes a county to develop standardized protocols for postmortem examinations involving an overdose to assist coroners and other persons who perform postmortem examinations in determining whether drugs contributed to a death or were the actual cause of death.
3. Permits an overdose fatality review team to be comprised of, but not limited to, the following:
   1. Experts in the field of forensic pathology;
   2. Medical personnel with expertise in overdose fatalities;
   3. Coroners and medical examiners;
   4. District attorneys and city attorneys;
   5. County or local staff, including, but not limited to, all of the following:
      1. Behavioral health services staff;
      2. County counsel;
      3. Emergency medical services staff;
      4. Unhoused services staff;
      5. Medical care services staff;
      6. Medical examiner staff; and,
      7. Public health staff.
   6. County, state, local, and federal law enforcement personnel;
   7. Local drug trafficking experts;
   8. Public health or behavioral health experts;
      1. Drug treatment providers;
4. Representatives of local health plans, nonprofits, religious, or other organizations who work with individuals at high risk of overdose fatalities; and,
5. Local professional associations of persons described in this subdivision.
6. Requires an oral or written communication or a document shared within or produced by an overdose fatality review team to be confidential.
7. Requires an oral or written communication or a document provided by a third party to an overdose fatality review team, or between a third party and an overdose fatality review team, to be confidential.
8. Permits recommendations of an overdose fatality review team, upon the completion of a review, to be disclosed at the discretion of a majority of the members of the overdose fatality review team.

Comments

California’s Overdose Epidemic. California is facing an overdose epidemic. According to a California Health Care Foundation report, 9% of Californians have met the criteria for a Substance Use Disorder (SUD) within the last year. While the health care system is moving toward acknowledging SUDs as a chronic illness, only about 10% of people with an SUD within the last year received treatment. Overdose deaths from both opioids and psychostimulants (such as amphetamines), are soaring. This issue, compounded by the increased availability of fentanyl, has resulted in a ten-fold increase in fentanyl related deaths between 2015 and 2019. DPH’s Opioid Overdose Dashboard reported 7,385 deaths related to “any” opioid overdose in 2022, with 6,473 (87.7%) of those deaths fentanyl related.

County Postmortem Examinations. Post mortem examinations are conducted by a County’s coroner’s office in California. Specific county processes may differ but California law outlines circumstances that may trigger a coroner to conduct a postmortem evaluation to determine the cause and matter of a death. And if the cause and manner of death is determined to be a result of illegal activity, the coroner must report that information to the County Sherriff’s Department for further investigation and handling.

Existing Death Review Teams. Los Angeles County established the nation’s first Child Death Review Team (CDRT) in 1978. A major role of CDRTs is to function as a case-investigating agency, providing in-depth analysis by many agencies on the possible causes of infant deaths in specific cases. California’s CDRTs also assist in identifying agency and systems problems and developing recommendations to prevent future child deaths. According to the National Center for Fatality Review and Prevention, CDRTs have influenced state and local policy changes on issues ranging from child homicide sentencing, safely surrendered babies, children left alone in cars, child maltreatment reporting, data collection, and more.

Building on the success of CDRTs, in 1995 the California Legislature authorized counties to establish interagency Domestic Violence Death Review Teams to ensure that incidents of domestic violence and abuse are recognized and to develop recommendations for policies and protocols for community prevention and intervention initiatives. In 2001, the Legislature authorized counties to establish interagency elder death teams to examine deaths associated with suspected elder abuse and neglect, identify, and work towards the implementation of prevention strategies to protect our elder population. In 2010 the statute was expanded to allow the review teams to also assist in dependent adult death reviews. Most recently, in 2023 the Legislature authorized counties to establish homeless death review committees to identify the root causes of the deaths of unhoused individuals and facilitate communication among persons and agencies involved in supporting the unhoused population. This bill builds upon these models to authorize overdose fatality review teams.

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

SUPPORT: (Verified 8/5/24)

San Diego County (source)

Alameda County Board of Supervisors
California State Association of Counties
City and County of San Francisco
County Behavioral Health Directors Association of California
County Health Executives Association of California (CHEAC)
County of Riverside
San Diego County District Attorney's Office
Urban Counties of California (UCC)

OPPOSITION: (Verified 8/5/24)

None received

ARGUMENTS IN SUPPORT:

According to San Diego County:

California’s drug fatality crisis is well-documented. The most recent available data indicates that over 11,000 Californians died from drug overdoses in 2022, more than double the number from 2018. Two-thirds of those deaths are from opioids and 60 percent are from fentanyl alone.

Addressing California’s drug fatality crisis will require a system-wide effort from local health, social service, and public safety agencies, nonprofits, community groups, and others who have expertise or work with people who are most at risk. While overdose fatality reviews can currently be conducted to a limited degree, the ability to share information about individuals, much of which is confidential by law, is limited. Other death review teams for children, domestic violence, and elder abuse have yielded tremendous results with opportunities for improvement identified and acted on at both the system-wide and individual levels. Being able to implement drug fatality review teams would allow counties to maximize insights on how they can address the drug and opioid crisis locally.

For counties interested in doing so, AB 2871 would provide the specific statutory authorization needed to create Overdose Fatality Review Teams. It would detail and protect processes and allow for greater sharing of confidential medical and other information needed to further identify issues and gaps in addressing the overdose fatality crisis. Finally, AB 2871 would require all confidential information shared among members of the review team to remain confidential.

The language in this legislation is based on the existing frameworks in law for child, domestic violence, and elder abuse fatality review teams, as well as the homeless adult and family multidisciplinary personnel teams, which allow the sharing within the review team of confidential information.

If signed into law, AB 2871 would unlock the ability for counties and other agencies to better work together to prevent and address future occurrences, as well as to improve coordination and effectiveness of interventions.

ASSEMBLY FLOOR: 71-0, 5/21/24

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Juan Carrillo, Wendy Carrillo, Chen, Connolly, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Rendon, Reyes, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Robert Rivas

NO VOTE RECORDED: Calderon, Cervantes, Megan Dahle, Friedman, Gabriel, Holden, Mathis, Papan, Luz Rivas

Prepared by: John Duncan / PUB. S. /

8/6/24 16:19:13

**** END ****

SENATE COMMITTEE ON HEALTH

Senator Richard Roth, Chair

BILL NO: AB 2871

SUBJECT: Overdose fatality review teams

SUMMARY:

Permits a county to establish an interagency overdose fatality review team to assist local agencies in identifying and reviewing overdose fatalities, facilitate communication among the various persons and agencies involved in overdose fatalities, and integrate local overdose prevention efforts. Makes information gathered over the course of investigations confidential and subject to disclosure requirements in federal law.

Existing federal law: Requires records of the identity, diagnosis, prognosis, or treatment of any patient maintained in connection with any program or activity relating to substance abuse education, prevention, training, treatment, rehabilitation, or research conducted, regulated, or directly or indirectly assisted by a federal agency to be confidential and be disclosed only after prior written consent of the patient. Includes the following definitions:

• 1. “Diagnosis” means any reference to an individual’s substance use disorder (SUD) or to a condition identified as having been caused by that SUD made for the purpose of treatment or referral for treatment;
  2. “Disclose” means to communicate any information identifying a patient as being or having been diagnosed with a SUD, having or having had a SUD, or being or having been referred for treatment of a SUD either directly, by reference to publicly available information, or through verification of such identification by another person; and,
  3. “Records” means any information, whether recorded or not, created by, received, or acquired by a Part 2 program (such as participating providers of the Medicare program, or those authorized to conduct maintenance treatment or withdrawal management) relating to a patient (e.g., diagnosis, treatment and referral for treatment information, billing information, emails, voice mails, and texts), and including patient identifying information. [42 USC §290dd-2, 42 CFR Part 2 §2.11]

Existing state law:

1. Establishes the California Department of Public Health (CDPH) to be vested with all the duties, powers, purposes, functions, responsibilities, and jurisdiction as they relate to public health, including administering the Substance and Addiction Prevention Branch (SAPB), which focuses on alcohol use research and harms prevention; problem gambling education, prevention, and treatment; overdose surveillance and prevention; and, cannabis surveillance and youth cannabis prevention. [HSC §131050]
2. Requires a coroner to inquire into and determine the circumstances, manner, and cause of certain deaths, including all violent, sudden, or unusual deaths, and deaths due to drug addiction, among other types of deaths. [GOV §27491]
3. Requires a coroner whose duty it is to investigate deaths to ascertain as many as possible of the facts. Requires a coroner to state on the death certificate the disease or condition directly leading to death, antecedent causes, other significant conditions contributing to death, other medical and health data, and the hour and day on which death occurred. [HSC §102855, 102860]
4. Requires a coroner or medical examiner who evaluates an individual who died, in their expert opinion, as the result of an overdose as a contributing factor, to report the incident to the Overdose Detection Mapping Application Program (ODMAP) managed by the Washington/Baltimore High Intensity Drug Trafficking Area program. [HSC §11758.04]
5. Prohibits health care providers, health plans, or contractors from sharing medical information without a patient’s written authorization, except in certain situations, such as in the course of an investigation by a medical examiner, forensic pathologist, or coroner’s office to identifying the decedent or locating next of kin, or when investigating deaths that may involve public health concerns, organ or tissue donation, child abuse, elder abuse, suicides, poisonings, accidents, sudden infant deaths, suspicious deaths, unknown deaths, or criminal deaths. [CIV §56.10(a) and (b)]
6. Permits a county to establish an interagency domestic violence death review team; a homeless death review committee; an interagency child death review team; and, an interagency elder and dependent adult death review team to assist in reviewing deaths in those populations. [PEN §11163.3, §11163.72, §11174.32, §11174.5]

This bill:

1. Permits a county to establish an interagency overdose fatality review team (OFRT) to assist local agencies in identifying and reviewing overdose fatalities, facilitate communication among the various persons and agencies involved in overdose fatalities, and integrate local overdose prevention efforts through strategic planning, data dissemination, and community collaboration.
2. Permits an OFRT to be comprised of, but not limited to, all of the following:
   1. Experts in the field of forensic pathology;
   2. Medical personnel with expertise in overdose fatalities;
   3. Coroners and medical examiners;
   4. District attorneys and city attorneys;
   5. County or local staff, including, but not limited to: behavioral health services staff; county counsel; emergency medical services staff; unhoused services staff; medical care services staff; medical examiner staff; and, public health staff;
   6. County, local, state, and federal law enforcement personnel;
   7. Local drug trafficking experts;
   8. Public health or behavioral health experts;
   9. Drug treatment providers;
   10. Representatives of local health plans, nonprofits, religious, or other organizations who work with individuals at high risk of overdose fatalities; and,
   11. Local professional associations of any of these persons.
3. Permits a county to develop standardized protocols, which may establish written reporting procedures, including the proper designation of the cause and mode of death, for postmortem examinations involving an overdose to assist coroners and other persons who perform postmortem examinations in determining whether drugs contributed to a death or were the actual cause of death.
4. Provides that an oral or written communication or a document shared within or produced by an OFRT related to an overdose fatality review; provided by a third party to an OFRT; or between a third party and an OFRT is confidential and not subject to disclosure or discovery by a third party.
5. Permits recommendations of an OFRT, upon the completion of a review, to be disclosed at the discretion of a majority of the members of the OFRT. Permits an organization represented on an OFRT to share information in its possession concerning the decedent who is the subject of the review, information received from a person who was in contact with the decedent, or other information deemed by the organization to be pertinent to the review with other members of the OFRT. Makes this information confidential.
6. Requires a provider of health care or a covered entity (defined in federal law as a health plan, a health care clearinghouse, or a health care provider who transmits any health information in electronic form in specified situations) to provide to the OFRT members any information, including protected health information, and mental health records excluding psychotherapy notes, in its possession that is directly related to the review authorized under this bill. Requires information disclosed to include substance use disorder patient records only to the extent permitted by existing federal law cited above.
7. Permits additional information related to criminal history, criminal offender record information, and information provided to probation officers in the course of the performance of their duties to be disclosed only to the extent required for carrying out the reviews.
8. Requires information gathered, and recommendations made, by an OFRT to be used by the county to develop education, prevention, and intervention strategies that will lead to improved coordination of treatment services and prevent future overdose deaths.
9. Makes Legislative findings regarding the need to impose a limitation on the public’s right of access to the meetings of public bodies or the writings of public officials and agencies in order to protect the privacy of persons who have died due to a drug fatality, including confidential medical information, and to encourage the provision of comprehensive information about drug fatalities to the OFRT.

FISCAL EFFECT:

The Assembly Appropriations Committee determined this bill results in no costs to the state.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, confronting California’s overdose epidemic will take collaboration across all sectors. By providing the specific statutory authorization needed to create OFRTs, this proposal would allow counties to look system-wide at individual deaths to find opportunities to increase safety and health in the future. This authorization would increase the likelihood of implementation of OFRTs by counties. The bill would require all confidential information shared among members of the OFRT to remain confidential. Other death review teams for children, domestic violence, and elder abuse have yielded tremendous results with opportunities for improvement identified and acted on at both the system-wide and individual levels. Being able to implement OFRTs would allow counties to maximize insights on how they can address the drug and opioid crisis locally for a growing crisis throughout the state.
2. Prevalence of SUDs in California. A 2022 California Health Care Foundation (CHCF) publication, from the entitled “Substance Use in California: Prevalence and Treatment”, reported that substance use in California is widespread with over half of Californians over age 12 reporting using alcohol in the past month and 20% reporting using marijuana in the past year. According to the report, 9% of Californians have met the criteria for a SUD within the last year. While the health care system is moving toward acknowledging SUDs as a chronic illness, only about 10% of people with a SUD within the last year, received treatment. Overdose deaths from both opioids and psychostimulants (such as amphetamines), are rapidly increasing. According to the federal Centers for Disease Control and Prevention (CDC), for California, predicted cases for January 2024 were 12,504, which represents a 1.72% increase from the predicted 12,292 cases for January 2023. The CDC data represented the following drug categories: heroin; natural opioid analgesics, including morphine and codeine, and semisynthetic opioids, including drugs such as oxycodone, hydrocodone, hydromorphone, and oxymorphone; methadone, a synthetic opioid; synthetic opioid analgesics other than methadone, including drugs such as fentanyl and tramadol; cocaine; and psychostimulants with abuse potential, which includes methamphetamine. CDPH’s Opioid Overdose Dashboard reported 7,385 deaths related to any opioid overdose in 2022, with 6,473 (87.7%) of those deaths fentanyl related.
3. Benefits of death review teams. A report on the National Center for Fatality Review and Prevention, “The Coordination and Integration of Fatality Reviews: Improving Health and Safety Outcomes Across the Life Course,” states that unexpected and untimely deaths of infants, children, adolescents, and adults are opportunities to turn tragedies into lessons to prevent other deaths. Understanding the circumstances of and taking action to prevent these deaths is the work of fatality review programs, which help to uncover the reasons why each year in the U.S. at least half of the 55,000 children who die before age 19 die from preventable causes; at least 1,770 children die from child abuse and neglect, including approximately 1,000 infants; there are more than 1,800 domestic violence related homicides, of which 80% or more are women, representing approximately one-third of all female murders; and, 4% of all persons over the age of 60 experience abuse, neglect, and/or self- neglect, some dying from this maltreatment. The unifying feature of the different types of fatality reviews is that they are wide angle, multidisciplinary case studies conducted in a climate that promotes open discovery of information. Review teams obtain information on deaths from multiple sources for their discussions on the often extremely complex death events. Teams are comprised of individuals with expertise relevant to the deaths and from agencies and services representing death investigation, public health, medicine, law enforcement, social services, mental health, education, and many others. The teams examine records; discuss the events leading up to and causing the death; and, work to identify what could be done differently to prevent other deaths. They make recommendations to agencies and other decision makers for prevention activities and/or changes to service systems. The ultimate purpose of the reviews is catalyzing action for prevention rather than merely counting and calculating death rates.
4. Double referral. This bill was heard in the Senate Public Safety Committee on June 18, 2024, and passed with a 5-0 vote.
5. Related legislation. AB 1859 (Alanis) requires a coroner to test bodily fluid extracted during an autopsy to determine whether it contained any amount, including a trace amount, of xylazine. AB 1859 requires the coroner to report a positive result for xylazine to the CDPH and ODMAP. AB 1859 requires CDPH to post the number of positive results on its overdose surveillance dashboard. AB 1859 is pending in the Senate Appropriations Committee.
6. Prior legislation. AB 271 (Quirk-Silva, Chapter 135, Statutes of 2023) authorizes the establishment of county homeless death review committees for the purpose of gathering information to identify the root causes of death of homeless individuals and to determine strategies to improve coordination of services.

SB 863 (Min and Rubio, Chapter 986, Statutes of 2022) authorizes a county domestic violence death review team to assist local agencies in identifying and reviewing domestic violence near-death cases.

1. Support. Supporters, including the County of San Diego as sponsor, state that California’s drug fatality crisis is well-documented, and while overdose fatality reviews can currently be conducted to a limited degree, the ability to share information about individuals, much of which is confidential by law, is limited. Being able to implement OFRTs would allow counties to maximize insights on how they can address the drug and opioid crisis locally. This bill would detail and protect processes and allow for greater sharing of confidential medical and other information needed to further identify issues and gaps in addressing the overdose fatality crisis. The language in this legislation is based on the existing frameworks in law for child, domestic violence, and elder abuse fatality review teams, as well as the homeless adult and family multidisciplinary personnel teams, which allow the sharing within the review team of confidential information.
2. Support if amended. The County of Fresno reiterates supporters’ arguments for the need and benefits of OFRTs. However, they argue that preparation for these types of reviews would require additional staff time in gathering general information; summarizing general and medical information; organizing ongoing meetings; standardizing reports; establishing criteria for which cases to review; communicating with family to obtain missing information; and conducting additional forensic testing if information is missing. They state there is no mention of additional funding sources or establishing criteria for data assessment and would like to see this concern addressed.

SUPPORT AND OPPOSITION:

Support: County of San Diego (sponsor)

California State Association of Counties
City and County of San Francisco
County Behavioral Health Directors Association of California
County Health Executives Association of California

County of Alameda
County of Riverside

County of San Diego
Office of San Diego County District Attorney Summer Stephan

Rural County Representatives of California
Urban Counties of California

Oppose: None received

-- END --

SENATE COMMITTEE ON PUBLIC SAFETY

Senator Aisha Wahab, Chair

2023 - 2024 Regular

Bill No: AB 2871 Hearing Date: June 18, 2024

Subject: Overdose fatality review teams

HISTORY

Source: San Diego County

Prior Legislation: AB 271 (Quirk-Silva) Chapter 135, Statutes of 2023.

SB 863 (Min) Chapter 986, Statutes of 2022.

AB 2654 (Lackey, 2021) held in Assembly Appropriations.

AB 2660 (Maienschein, 2021) vetoed by Governor.

Support: California State Association of Counties; City and County of San Francisco; County Behavioral Health Directors Association of California; County Health Executives Association of California (CHEAC); County of Riverside; San Diego County District Attorney's Office; Urban Counties of California (UCC)

Opposition: None known

Assembly Floor Vote: 71 - 0

PURPOSE

The purpose of this bill is to allow counties to establish an interagency overdose fatality review team to assist local agencies in identifying and reviewing overdose fatalities, facilitate communication, and integrate local prevention efforts.

Existing law defines “state summary criminal history information” as the master record of information complied by the Attorney General regarding the identification and criminal history of a person (Penal Code §11105).

Existing law defines “criminal offender record information” as records and data compiled by criminal justice agencies for purposes of identifying criminal offenders and of maintaining summaries of arrests, criminal proceedings and its results, and incarceration (Penal Code §11075).

Existing law defines “local summary criminal history information” as the master record of information compiled by any local criminal justice agency pertaining to the identification and criminal history of any person (Penal Code §13300).

Existing law requires probation officers to report and record antecedents, character, history, family environment, and offense of any person receiving a guilty verdict, this record shall be kept as a record of the court and can be accessed by specified an appointed or designated person or profession (Penal Code §1203.10).

Existing law provides, pursuant to the California Constitution, that all people have inalienable rights, including the right to pursue and obtain privacy. (Cal. Const., art. I, § 1.)

Existing law states that the “right to privacy is a personal and fundamental right protected by Section 1 of Article I of the Constitution of California and by the United States Constitution and that all individuals have a right of privacy in information pertaining to them.” Further states these findings of the Legislature:

• The right to privacy is being threatened by the indiscriminate collection, maintenance, and dissemination of personal information and the lack of effective laws and legal remedies.
• The increasing use of computers and other sophisticated information technology has greatly magnified the potential risk to individual privacy that can occur from the maintenance of personal information.
• In order to protect the privacy of individuals, it is necessary that the maintenance and dissemination of personal information be subject to strict limits. (Civil Code §1798.1.)

Existing law establishes under federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which sets standards for the privacy of individually identifiable health information and security standards for the protection of electronic protected health information, including, through regulations, that a HIPAA-covered entity may not condition the provision of treatment, payment, enrollment in a health plan, or eligibility for benefits on the provision of an authorization, except under specified circumstances. Provides that if HIPAA’s provisions conflict with state law, the provision that is most protective of patient privacy prevails. (42 U.S.C. § 1320d, et seq.; 45 Code Fed. Regs. Part 164.)

Existing law prohibits, under the state Confidentiality of Medical Information Act (CMIA), a health care provider, a health care service plan, a contractor, a corporation and its subsidiaries and affiliates, or any business that offers software or hardware to consumers, including a mobile application or other related device, as defined, from intentionally sharing, selling, using for marketing, or otherwise using any medical information, as defined, for any purpose not necessary to provide health care services to a patient, except as expressly authorized by the patient, enrollee, or subscriber, as specified, or as otherwise required or authorized by law. States that a violation of these provisions that results in economic loss or personal injury to a patient is a crime. (Civil Code §56, et. seq.)

Existing law defines, for purposes of the CMIA, medical information to mean any individually identifiable information, in electronic or physical form, in possession of or derived from a provider of health care, health care service plan, pharmaceutical company, or contractor regarding a patient’s medical history, mental health app information, mental or physical condition, or treatment. (Civil Code §56.05 (i).)

Existing law prohibits health care providers, health care service plans, or contractors, as defined, from sharing medical information without the patient’s written authorization, subject to certain exceptions. (Civil Code §56.10 (a).)

Existing law permits a county to establish an interagency domestic violence death review team to assist local agencies in identifying and reviewing domestic violence deaths and near deaths, including homicides and suicides, and facilitating communication among the various agencies involved in domestic violence cases (Penal Code §11163.3).

Existing law permits a county to establish a homeless death review committee to assist local agencies in identifying the root causes of death of homeless individuals and facilitating communication among persons who perform autopsies and the various persons and agencies involved in supporting the homeless population (Penal Code §11163.72).

Existing law permits a county to establish an interagency child death review team to assist local agencies in identifying and reviewing suspicious child deaths and facilitating communication among persons who perform autopsies and the various persons and agencies involved in child abuse or neglect cases (Penal Code §11174.32).

Existing law permits a county to establish an interagency elder and dependent adult death review team to assist local agencies in identifying and reviewing suspicious elder and dependent adult deaths and facilitating communication among persons who perform autopsies and the various persons and agencies involved in elder and dependent adult abuse or neglect cases (Penal Code §11174.5).

Existing law requires a coroner to inquire into and determine the circumstances, manner, and cause of all violent, sudden, or unusual deaths; unattended deaths; deaths due to drug addiction; deaths in prison or while under sentence; among various other circumstances (Government Code §27491).

Existing law requires coroners to inquire into and determine the circumstances, manner, and cause of various types of deaths, including, but not limited to those that appear to be violent, sudden, or unusual deaths; unattended deaths; and drug addiction (Government Code §27491).

Existing law requires the coroner in all cases in which a person has died under circumstances that afford a reasonable ground to suspect that the person’s death has been occasioned by the act of another by criminal means, the coroner, upon determining that those reasonable grounds exist, shall immediately notify the law enforcement agency having jurisdiction over the criminal investigation (Government Code §27491.1).

Existing law allows coroners or their appointed deputy to make inquiries into the circumstances, manner, and means of death (Government Code §27491.2).

This bill authorizes a county to establish an interagency overdose fatality review team to assist local agencies in identifying and reviewing overdose fatalities, facilitate communication among persons and agencies involved in overdose fatalities, and integrate local overdose prevention efforts through strategic planning, data dissemination, and community collaboration.

This bill authorizes a county to develop standardized protocols for postmortem examinations involving an overdose to assist coroners and other persons who perform postmortem examinations in determining whether drugs contributed to a death or were the actual cause of death.

This bill permits an overdose fatality review team to be comprised of, but not limited to, the following:

• Experts in the field of forensic pathology;
• Medical personnel with expertise in overdose fatalities;
• Coroners and medical examiners;
• District attorneys and city attorneys;
• County or local staff, including, but not limited to, all of the following:
  • Behavioral health services staff;
  • County counsel;
  • Emergency medical services staff;
  • Unhoused services staff;
  • Medical care services staff;
  • Medical examiner staff; and,
  • Public health staff.
• County, state, local, and federal law enforcement personnel;
• Local drug trafficking experts;
• Public health or behavioral health experts;
• Drug treatment providers;
• Representatives of local health plans, nonprofits, religious, or other organizations who work with individuals at high risk of overdose fatalities; and,
• Local professional associations of persons described in this subdivision.

This bill requires an oral or written communication or a document shared within or produced by an overdose fatality review team to be confidential.

This bill requires an oral or written communication or a document provided by a third party to an overdose fatality review team, or between a third party and an overdose fatality review team, to be confidential.

This bill permits recommendations of an overdose fatality review team, upon the completion of a review, to be disclosed at the discretion of a majority of the members of the overdose fatality review team.

COMMENTS

1. Need for This Bill:

According to the Author:

Confronting California’s overdose epidemic will take collaboration across all sectors. By providing the specific statutory authorization needed to create Overdose Fatality Review Teams, this proposal would allow counties to look system-wide at individual deaths to find opportunities to increase safety and health in the future. This statutory authorization would increase the likelihood of implementation of opioid fatality reviews by counties. The bill would require all confidential information shared among members of the review team to remain confidential. Other death review teams for children, domestic violence, and elder abuse have yielded tremendous results with opportunities for improvement identified and acted on at both the system-wide and individual levels. Being able to implement drug fatality review teams would allow counties to maximize insights on how they can address the drug and opioid crisis locally for a growing crisis throughout the state.

1. California’s Overdose Epidemic

California is facing an overdose epidemic. According to a California Health Care Foundation report, 9% of Californians have met the criteria for a Substance Use Disorder (SUD) within the last year. While the health care system is moving toward acknowledging SUDs as a chronic illness, only about 10% of people with an SUD within the last year received treatment. Overdose deaths from both opioids and psychostimulants (such as amphetamines), are soaring. This issue, compounded by the increased availability of fentanyl, has resulted in a ten-fold increase in fentanyl related deaths between 2015 and 2019. DPH’s Opioid Overdose Dashboard reported 7,385 deaths related to “any” opioid overdose in 2022, with 6,473 (87.7%) of those deaths fentanyl related.

1. County Postmortem Examinations

Post mortem examinations are conducted by a County’s coroner’s office in California. Specific county processes may differ but California law outlines circumstances that may trigger a coroner to conduct a postmortem evaluation to determine the cause and matter of a death. And if the cause and manner of death is determined to be a result of illegal activity, the coroner must report that information to the County Sherriff’s Department for further investigation and handling.

1. Existing Death Review Teams

Los Angeles County established the nation’s first Child Death Review Team (CDRT) in 1978. A major role of CDRTs is to function as a case-investigating agency, providing in-depth analysis by many agencies on the possible causes of infant deaths in specific cases. California’s CDRTs also assist in identifying agency and systems problems and developing recommendations to prevent future child deaths. According to the National Center for Fatality Review and Prevention, CDRTs have influenced state and local policy changes on issues ranging from child homicide sentencing, safely surrendered babies, children left alone in cars, child maltreatment reporting, data collection, and more.

Building on the success of CDRTs, in 1995 the California Legislature authorized counties to establish interagency Domestic Violence Death Review Teams to ensure that incidents of domestic violence and abuse are recognized and to develop recommendations for policies and protocols for community prevention and intervention initiatives. In 2001, the Legislature authorized counties to establish interagency elder death teams to examine deaths associated with suspected elder abuse and neglect, identify, and work towards the implementation of prevention strategies to protect our elder population. In 2010 the statute was expanded to allow the review teams to also assist in dependent adult death reviews. Most recently, in 2023 the Legislature authorized counties to establish homeless death review committees to identify the root causes of the deaths of unhoused individuals and facilitate communication among persons and agencies involved in supporting the unhoused population. This bill builds upon these models to authorize overdose fatality review teams.

1. Argument in Support

According to San Diego County:

California’s drug fatality crisis is well-documented. The most recent available data indicates that over 11,000 Californians died from drug overdoses in 2022, more than double the number from 2018. Two-thirds of those deaths are from opioids and 60 percent are from fentanyl alone.

Addressing California’s drug fatality crisis will require a system-wide effort from local health, social service, and public safety agencies, nonprofits, community groups, and others who have expertise or work with people who are most at risk. While overdose fatality reviews can currently be conducted to a limited degree, the ability to share information about individuals, much of which is confidential by law, is limited. Other death review teams for children, domestic violence, and elder abuse have yielded tremendous results with opportunities for improvement identified and acted on at both the system-wide and individual levels. Being able to implement drug fatality review teams would allow counties to maximize insights on how they can address the drug and opioid crisis locally.

For counties interested in doing so, AB 2871 would provide the specific statutory authorization needed to create Overdose Fatality Review Teams. It would detail and protect processes and allow for greater sharing of confidential medical and other information needed to further identify issues and gaps in addressing the overdose fatality crisis. Finally, AB 2871 would require all confidential information shared among members of the review team to remain confidential.

The language in this legislation is based on the existing frameworks in law for child, domestic violence, and elder abuse fatality review teams, as well as the homeless adult and family multidisciplinary personnel teams, which allow the sharing within the review team of confidential information.

If signed into law, AB 2871 would unlock the ability for counties and other agencies to better work together to prevent and address future occurrences, as well as to improve coordination and effectiveness of interventions.

-- END –

Date of Hearing: May 15, 2024

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

ABPCA Bill Id:AB 2871

Author:(Maienschein) – As Amended Ver:April 24, 2024

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

SUMMARY:

This bill authorizes a county to establish an interagency overdose fatality review team.

Specifically, this bill:

1. Authorizes a county to establish an interagency overdose fatality review team to assist local agencies in identifying and reviewing overdose fatalities, facilitate communication among relevant persons and agencies, and integrate local overdose prevention efforts through strategic planning, data dissemination, and community collaboration.
2. Authorizes a county to develop standardized protocols for postmortem examinations involving an overdose to assist coroners and other persons who perform postmortem examinations in determining whether drugs contributed to, or were the actual cause of, death.
3. Provides that an overdose fatality review team may include coroners and medical examiners; district attorneys and city attorneys; county or local staff, including behavioral health services staff, county counsel, emergency medical services staff, unhoused services staff, public health staff, law enforcement personnel; and drug treatment providers; among others.
   
4. Provides that:
   
   1. Oral or written communications shared within or produced by an overdose fatality review team related to an overdose fatality review is confidential and not subject to disclosure or discovery by a third party.
      
   2. Recommendations of an overdose fatality review team, upon the completion of a review, may be disclosed at the discretion of a majority of the members of the overdose fatality review team.
      
   3. An organization represented on an overdose fatality review team may share information concerning the decedent who is the subject of the review, information received from a person who was in contact with the decedent, or other information deemed by the organization to be pertinent to the review with other members of the team.
      
   4. Information shared by an organization with other members of a team is confidential.
      
5. Requires a health care provider to provide to the county overdose fatality review team any information, excluding psychotherapy notes, that is directly related to the review, and to include substance use disorder patient records only to the extent permissible.
   
6. Provides for the disclosure of additional information, including specified criminal history and probation information.
   
7. Requires a county to use information gathered, and recommendations made, by an overdose fatality review team to develop education, prevention, and intervention strategies that will lead to improved coordination of treatment services and prevent future overdose deaths.
   
8. States legislative findings that to protect the privacy of a person who has died due to a drug overdose, including confidential medical information, and to encourage the provision of comprehensive information about drug fatalities to the review teams, it is necessary to limit general access to information regarding those persons and the meetings of public bodies. 

FISCAL EFFECT:

No state costs.

COMMENTS:

1. Purpose. This bill is sponsored by San Diego County. According to the author:

Confronting California’s overdose epidemic will take collaboration across all sectors. By providing the specific statutory authorization needed to create Overdose Fatality Review Teams, this proposal would allow counties to look system-wide at individual deaths to find opportunities to increase safety and health in the future. This statutory authorization would increase the likelihood of implementation of opioid fatality reviews by counties. The bill would require all confidential information shared among members of the review team to remain confidential. Other death review teams for children, domestic violence, and elder abuse have yielded tremendous results with opportunities for improvement identified and acted on at both the system-wide and individual levels. Being able to implement drug fatality review teams would allow counties to maximize insights on how they can address the drug and opioid crisis locally for a growing crisis throughout the state.

1. Death Review Teams. According to the Assembly Privacy and Consumer Protection Committee analysis of this bill, Los Angeles County established the nation’s first child death review team (CDRT) in 1978. A major role of a CDRT is to function as a case-investigating agency, providing in-depth analysis on the possible causes of infant deaths in specific cases. California’s CDRTs also assist in identifying agency and systems problems and developing recommendations to prevent future child deaths. According to the National Center for Fatality Review and Prevention, CDRTs have influenced state and local policy changes on issues ranging from child homicide sentencing, safely surrendered babies, children left alone in cars, child maltreatment reporting, data collection, and more.
   
   Building on the success of CDRTs, in 1995 the Legislature authorized counties to establish interagency domestic violence death review teams to ensure that incidents of domestic violence and abuse are recognized and to develop recommendations for policies and protocols for community prevention and intervention initiatives. In 2001, the Legislature authorized counties to establish elder death review teams and in 2010 the statute was expanded to allow the review teams to also assist in dependent adult death reviews. In 2023 the Legislature authorized counties to establish homeless death review committees to identify the root causes of the deaths of unhoused individuals and facilitate communication among persons and agencies involved in supporting the unhoused population.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing: April 16, 2024

ASSEMBLY COMMITTEE ON PRIVACY AND CONSUMER PROTECTION

Rebecca Bauer-Kahan, Chair

ABPCA Bill Id:AB 2871 (

Author:Maienschein) – As Introduced Ver:February 15, 2024

AS PROPOSED TO BE AMENDED

SUBJECT: Overdose fatality review teams

SYNOPSIS

California is facing an overdose epidemic. According to a California Health Care Foundation report, 9% of Californians have met the criteria for a Substance Use Disorder (SUD) within the last year. While the health care system is moving toward acknowledging SUDs as a chronic illness, only about 10% of people with an SUD within the last year received treatment. Overdose deaths from both opioids and psychostimulants (such as amphetamines), are soaring. This issue, compounded by the increased availability of fentanyl, has resulted in a ten-fold increase in fentanyl related deaths between 2015 and 2019.The Department of Public Health’s (DPH) Opioid Overdose Dashboard reported 7,385 deaths related to “any” opioid overdose in 2022, with 6,473 (87.7%) of those deaths fentanyl related.

Similar to existing fatality review teams that study deaths caused by intimate partner violence, child abuse, or an unexpected death of someone who was homeless, the purpose of this bill is to allow a county to establish interagency working groups to review overdose fatalities and make recommendations for preventing future fatalities. In order to facilitate the needed information sharing, the bill establishes that information shared within or produced by the review team is confidential as to not reveal a decedent’s personal information to the public.

As the bill came to this committee, it proposed eliminating all current privacy and confidentiality laws related to the sharing of information about a deceased person and their history in order to allow for the broad sharing of sensitive personal information among the team members, including, but not limited to, state, local and federal law enforcement, district attorneys, drug trafficking experts, and representatives from local nonprofits, religious organizations and others who work with individuals at high risk of overdose fatalities. Among the laws these teams would have been exempt from were attorney-client, doctor-patient, and psychotherapist-patient privileged communications. In addition, the bill waived the privacy provisions in the Confidentiality of Medical Information Act and the Lanterman-Petris-Short Act as it relates to the rights of individuals who are either voluntarily or involuntarily receiving behavioral health treatment.

This sweeping authority to gather and share large amounts of sensitive and privileged personal information, without first obtaining consent from the person’s next of kin or ensuring that the information is protected, would have gone against the general policy direction of this Committee. The proposed Committee amendments are designed to ensure that all privacy protections remain in place.

This bill is sponsored by the County of San Diego and supported by the County Health Executives Association of California and the Urban Counties of California. There is no opposition. This bill passed the Health Committee on a 16-0 vote.

SUMMARY: Authorizes a county to establish an interagency overdose fatality review team to assist local agencies in identifying and reviewing overdose fatalities, facilitate communication among persons and agencies involved in overdose fatalities, and integrate local overdose prevention efforts through strategic planning, data dissemination, and community collaboration. Specifically, this bill:

1. Authorizes a county to develop standardized protocols for postmortem examinations involving an overdose to assist coroners and other persons who perform postmortem examinations in determining whether drugs contributed to a death or were the actual cause of death.
2. Permits an overdose fatality review team to be comprised of, but not limited to, the following:
   1. Experts in the field of forensic pathology.
   2. Medical personnel with expertise in overdose fatalities.
   3. Coroners and medical examiners.
   4. District attorneys and city attorneys.
   5. County or local staff, including, but not limited to, all of the following:
      1. Behavioral health services staff.
      2. County counsel.
      3. Emergency medical services staff.
      4. Unhoused services staff.
      5. Medical care services staff.
      6. Medical examiner staff.
      7. Public health staff.
   6. Local, county, state, and federal law enforcement personnel.
   7. Local drug trafficking experts.
   8. Public health or behavioral health experts.
   9. Drug treatment providers.
   10. Representatives of local health plans, nonprofits, religious, or other organizations who work with individuals at high risk of overdose fatalities.
   11. Local professional associations of persons described in this subdivision.
3. Requires an oral or written communication or a document shared within or produced by an overdose fatality review team to be confidential.
4. Requires an oral or written communication or a document provided by a third party to an overdose fatality review team, or between a third party and an overdose fatality review team, to be confidential.
5. Permits recommendations of an overdose fatality review team, upon the completion of a review, to be disclosed at the discretion of a majority of the members of the overdose fatality review team.
6. Permits an organization represented on an overdose fatality review team to share information in its possession concerning the decedent who is the subject of review, information received from a person who was in contact with the decedent, or other information deemed by the organization to be pertinent to the review with other members of the team. Requires information shared by an organization to be confidential.
7. Permits an overdose fatality review team to request information, as specified. Permits written and oral information, as specified, to be disclosed to an overdose fatality review team.
8. Requires information gathered, and recommendations made, by an overdose fatality review team to be used by the county to develop education, prevention, and intervention strategies that will lead to improved coordination of treatment services and prevent future overdose deaths.
9. Requires overdose fatality review teams to follow all state and federal privacy and data minimization laws.
10. States legislative findings that in order to protect the privacy of persons who have died due to a drug fatality, including confidential medical information, and to encourage the provision of comprehensive information about drug fatalities to the review teams, it is necessary to limit general access to information regarding those persons.

EXISTING LAW:

1. Provides, pursuant to the California Constitution, that all people have inalienable rights, including the right to pursue and obtain privacy. (Cal. Const., art. I, § 1.)
2. States that the “right to privacy is a personal and fundamental right protected by Section 1 of Article I of the Constitution of California and by the United States Constitution and that all individuals have a right of privacy in information pertaining to them.” Further states these findings of the Legislature:
   1. The right to privacy is being threatened by the indiscriminate collection, maintenance, and dissemination of personal information and the lack of effective laws and legal remedies.
   2. The increasing use of computers and other sophisticated information technology has greatly magnified the potential risk to individual privacy that can occur from the maintenance of personal information.
   3. In order to protect the privacy of individuals, it is necessary that the maintenance and dissemination of personal information be subject to strict limits. (Civ. Code § 1798.1.)
3. Establishes under federal law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which sets standards for the privacy of individually identifiable health information and security standards for the protection of electronic protected health information, including, through regulations, that a HIPAA-covered entity may not condition the provision of treatment, payment, enrollment in a health plan, or eligibility for benefits on the provision of an authorization, except under specified circumstances. Provides that if HIPAA’s provisions conflict with state law, the provision that is most protective of patient privacy prevails. (42 U.S.C. § 1320d, et seq.; 45 Code Fed. Regs. Part 164.)
4. Prohibits, under the state Confidentiality of Medical Information Act (CMIA), a health care provider, a health care service plan, a contractor, a corporation and its subsidiaries and affiliates, or any business that offers software or hardware to consumers, including a mobile application or other related device, as defined, from intentionally sharing, selling, using for marketing, or otherwise using any medical information, as defined, for any purpose not necessary to provide health care services to a patient, except as expressly authorized by the patient, enrollee, or subscriber, as specified, or as otherwise required or authorized by law. States that a violation of these provisions that results in economic loss or personal injury to a patient is a crime. (Civ. Code § 56, et. seq.)
5. Defines, for purposes of the CMIA, medical information to mean any individually identifiable information, in electronic or physical form, in possession of or derived from a provider of health care, health care service plan, pharmaceutical company, or contractor regarding a patient’s medical history, mental health app information, mental or physical condition, or treatment. (Civ. Code § 56.05(i).)
6. Prohibits health care providers, health care service plans, or contractors, as defined, from sharing medical information without the patient’s written authorization, subject to certain exceptions. (Civ. Code § 56.10(a).)
7. Permits a county to establish an interagency domestic violence death review team to assist local agencies in identifying and reviewing domestic violence deaths and near deaths, including homicides and suicides, and facilitating communication among the various agencies involved in domestic violence cases. (Pen. Code § 11163.3.)
8. Permits a county to establish a homeless death review committee to assist local agencies in identifying the root causes of death of homeless individuals and facilitating communication among persons who perform autopsies and the various persons and agencies involved in supporting the homeless population. (Pen. Code § 11163.72.)
9. Permits a county to establish an interagency child death review team to assist local agencies in identifying and reviewing suspicious child deaths and facilitating communication among persons who perform autopsies and the various persons and agencies involved in child abuse or neglect cases. (Pen. Code § 11174.32.)
10. Permits a county to establish an interagency elder and dependent adult death review team to assist local agencies in identifying and reviewing suspicious elder and dependent adult deaths and facilitating communication among persons who perform autopsies and the various persons and agencies involved in elder and dependent adult abuse or neglect cases. (Pen. Code § 1174.5.)

FISCAL EFFECT: As currently in print, this bill is keyed fiscal.

COMMENTS:

1) Need for this bill. According to the Health Committee analysis of this bill, California is facing an overdose epidemic. A California Health Care Foundation report states that 9% of Californians have met the criteria for a Substance Use Disorder (SUD) within the last year. While the health care system is moving toward acknowledging SUDs as a chronic illness, only about 10% of people with an SUD within the last year received treatment. Overdose deaths from both opioids and psychostimulants (such as amphetamines), are soaring. This issue, compounded by the increased availability of fentanyl, has resulted in a ten-fold increase in fentanyl related deaths between 2015 and 2019. The Department of Public Health’s (DPH) Opioid Overdose Dashboard reported 7,385 deaths related to “any” opioid overdose in 2022, with 6,473 (87.7%) of those deaths fentanyl related.

The author argues there is currently a lack of statutory authorization and protection for counties that want to conduct opioid fatality reviews while protecting confidential medical record information, confidential law enforcement information, pending investigative information, and information from health/behavioral health plans. This information is needed to further identify issues and gaps in addressing the opioid crisis.

Similar to existing fatality review teams, the purpose of this bill is to allow a county to establish those interagency working groups to review overdose fatalities and make recommendations for preventing future fatalities. In order to facilitate the needed information sharing, the author notes, and the bill establishes that information shared within or produced by the review team is confidential as to not reveal a decedent’s personal information to the public.

2) Author’s statement. According to the author:

Confronting California’s overdose epidemic will take collaboration across all sectors. By providing the specific statutory authorization needed to create Overdose Fatality Review Teams, this proposal would allow counties to look system-wide at individual deaths to find opportunities to increase safety and health in the future. This statutory authorization would increase the likelihood of implementation of opioid fatality reviews by counties. The bill would require all confidential information shared among members of the review team to remain confidential. Other death review teams for children, domestic violence, and elder abuse have yielded tremendous results with opportunities for improvement identified and acted on at both the system-wide and individual levels. Being able to implement drug fatality review teams would allow counties to maximize insights on how they can address the drug and opioid crisis locally for a growing crisis throughout the state.

3) Existing Death Review Teams. Los Angeles County established the nation’s first Child Death Review Team (CDRT) in 1978. A major role of CDRTs is to function as a case-investigating agency, providing in-depth analysis by many agencies on the possible causes of infant deaths in specific cases. California’s CDRTs also assist in identifying agency and systems problems and developing recommendations to prevent future child deaths. According to the National Center for Fatality Review and Prevention, CDRTs have influenced state and local policy changes on issues ranging from child homicide sentencing, safely surrendered babies, children left alone in cars, child maltreatment reporting, data collection, and more.

Building on the success of CDRTs, in 1995 the California Legislature authorized counties to establish interagency Domestic Violence Death Review Teams to ensure that incidents of domestic violence and abuse are recognized and to develop recommendations for policies and protocols for community prevention and intervention initiatives. In 2001, the Legislature authorized counties to establish interagency elder death teams to examine deaths associated with suspected elder abuse and neglect, identify, and work towards the implementation of prevention strategies to protect our elder population. In 2010 the statute was expanded to allow the review teams to also assist in dependent adult death reviews. Most recently, in 2023 the Legislature authorized counties to establish homeless death review committees to identify the root causes of the deaths of unhoused individuals and facilitate communication among persons and agencies involved in supporting the unhoused population. This bill builds upon these models to authorize overdose fatality review teams.

4) Analysis. The primary question before this Committee is whether or not the benefits of establishing overdose fatality review teams that include non-covered entities, such as law enforcement, require the elimination of individuals’ privacy rights in order to accomplish the policy goals of this proposed legislation. For two reasons, this does not appear to be the case. First, privacy interests do not simply cease at death. The release of sensitive or privileged information of the dead may harm the reputation and dignity the dead and the psychological well-being of their surviving loved ones. Second, team members can still share information and discuss cases without violating established privacy protections. In the event that there is information that is needed that the team does not have access to, the team is free to reach out to the decedent’s next of kin to request consent to review that information.

As the bill came to this committee, it proposed eliminating all current privacy and confidentiality laws related to the sharing of information about a deceased person and their history in order to allow for the broad sharing of sensitive personal information among the team members, including, but not limited to, state, local and federal law enforcement, district attorneys, drug trafficking experts, and representatives from local nonprofits, religious organizations and others who work with individuals at high risk of overdose fatalities. Among the laws eliminated would have been attorney-client, doctor-patient, and psychotherapist-patient privileged communications. In addition, the bill waived the privacy provisions in the Confidentiality of Medical Information Act and the Lanterman-Petris-Short Act as it relates to the rights of individuals who are either voluntarily or involuntarily receiving behavioral health treatment.^[1]

This sweeping authority to gather and share large amounts of sensitive and privileged personal information, without first obtaining consent from the person’s next of kin or ensuring that the information is protected, would have gone against the general policy direction of this Committee. The proposed Committee amendments, spelled out in detail in the following section, are designed to ensure that all privacy protections remain in place.

5) Proposed Committee amendments. The following amendments remove the sections of the bill that could have compromised the individual and their family’s right to privacy:

11679. (a) (1) Consistent with paragraph (9) of subdivision (b) of Section 56.10 of the Civil Code, a provider of health care, as defined in Section 56.05 of the Civil Code, or a covered entity, as defined in Section 160.103 of Title 45 of the Code of Federal Regulations, shall provide to the members of the county overdose fatality review team any information, including protected health information, and mental health records excluding psychotherapy notes, in its possession that is directly related to the review authorized under 11675 about the individual involved in the case. The provision of information under this paragraph is a disclosure required by law, which may be made only to the extent permitted under subdivision (a) of Section 164.512 of Title 45 of the Code of Federal Regulations. The information disclosed shall include substance use disorder patient records only to the extent permitted by Part 2 (commencing with Section 2.1) of Title 42 of the Code of Federal Regulations.

(1) Written and oral information may be disclosed to an overdose fatality review team established pursuant to this division. The team may make a request in writing for the information sought and a person with information of the kind described in paragraph (3) may rely on the request in determining whether information may be disclosed to the team.

(2) An individual or agency that has information governed by this division is not required to disclose that information.

(3b) The following additional information, may be disclosed only to the extent required for carrying out the reviews authorized by pursuant to this division, may be disclosed:

(A) Notwithstanding Section 56.10 of the Civil Code, medical information.

(B) Notwithstanding Section 5328 of the Welfare and Institutions Code, mental health information.

(C1) State summary criminal history information, as defined in Section 11105 of the Penal Code, criminal offender record information, as defined in Section 11075 of the Penal Code, and local summary criminal history information, as defined in Section 13300 of the Penal Code.

(D2) Information provided to probation officers in the course of the performance of their duties, including, but not limited to, the duty to prepare reports pursuant to Section 1203.10 of the Penal Code, as well as the information on which these reports are based.

(E) Notwithstanding Section 12300 of the Welfare and Institutions Code, records relating to in-home supportive services, unless disclosure is prohibited by federal law.

(b) Written and oral information may be disclosed under this section notwithstanding Sections 2263, 2918, 4982, and 6068 of the Business and Professions Code, the lawyer-client privilege protected by Article 3 (commencing with Section 950) of Chapter 4 of Division 8 of the Evidence Code, the physician-patient privilege protected by Article 6 (commencing with Section 990) of Chapter 4 of Division 8 of the Evidence Code, and the psychotherapist-patient privilege protected by Article 7 (commencing with Section 1010) of Chapter 4 of Division 8 of the Evidence Code.

6) Related legislation. AB 271 (Quirk-Silva, Chap. 135, Stats. 2023) was a similar bill that allows counties to establish “homeless death review committees” in order better understand the root causes of death among people experiencing homelessness. That bill was not heard by this Committee.

SB 863 (Min, Chap. 986, Stats 2022) authorizes a county domestic violence death review team to assist local agencies in identifying and reviewing domestic violence near-death cases, as defined.

AB 2654 (Lackey, 2021) would have reconvened the State Child Death Review Council by removing the requirement that funds are appropriated for it in the Budget Act in order to be operative. AB 2654 was held in the Assembly Appropriations Committee.

AB 2660 (Maienschein, 2021) would have required each county to establish an interagency child death review team no later than January 1, 2024. AB 2660 was vetoed by the Governor.

ARGUMENTS IN SUPPORT: According to the sponsors, the County of San Diego:

California’s drug fatality crisis is well-documented. The most recent available data indicates that over 11,000 Californians died from drug overdoses in 2022, more than double the number from 2018. Two-thirds of those deaths are from opioids and 60 percent are from fentanyl alone.

Addressing California’s drug fatality crisis will require a system-wide effort from local health, social service, and public safety agencies, nonprofits, community groups, and others who have expertise or work with people who are most at risk. While overdose fatality reviews can currently be conducted to a limited degree, the ability to share information about individuals, much of which is confidential by law, is limited. Other death review teams for children, domestic violence, and elder abuse have yielded tremendous results with opportunities for improvement identified and acted on at both the system-wide and individual levels. Being able to implement drug fatality review teams would allow counties to maximize insights on how they can address the drug and opioid crisis locally.

AB 2871 would provide the specific statutory authorization needed to create Overdose Fatality Review Teams. It would detail and protect processes and allow for greater sharing of confidential medical and other information needed to further identify issues and gaps in addressing the overdose fatality crisis. Finally, AB 2871 would require all confidential information shared among members of the review team to remain confidential.

REGISTERED SUPPORT / OPPOSITION:

Support

County Health Executives Association of California (CHEAC)
County of San Diego (sponsor)
San Diego County District Attorney's Office
Urban Counties of California (UCC)

Support if Amended

County of Fresno

Opposition

None on file.

Analysis Prepared by: Julie Salley / P. & C.P. / (916) 319-2200

1. The Lanterman-Petris-Short Act (Welf. & Inst. Code §§ 5000, et seq). ↑

Date of Hearing: April 9, 2024

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

ABPCA Bill Id:AB 2871 (

Author:(Maienschein) – As Introduced Ver:February 15, 2024

SUBJECT: Overdose fatality review teams.

SUMMARY: Authorizes a county to establish an interagency overdose fatality review team to assist local agencies in identifying and reviewing overdose fatalities, facilitate communication among persons and agencies involved in overdose fatalities, and integrate local overdose prevention efforts through strategic planning, data dissemination, and community collaboration. Specifically, this bill:

1. Authorizes a county to establish an interagency overdose fatality review team to assist local agencies in identifying and reviewing overdose fatalities, facilitate communication among persons and agencies involved in overdose fatalities, and integrate local overdose prevention efforts through strategic planning, data dissemination, and community collaboration.
2. Authorizes a county to develop standardized protocols for postmortem examinations involving an overdose to assist coroners and other persons who perform postmortem examinations in determining whether drugs contributed to a death or were the actual cause of death.
3. Permits an overdose fatality review team to be comprised of, but not limited to, the following:
   1. Experts in the field of forensic pathology;
   2. Medical personnel with expertise in overdose fatalities;
   3. Coroners and medical examiners;
   4. District attorneys and city attorneys;
   5. County or local staff, including, but not limited to, all of the following:
      1. Behavioral health services staff;
      2. County counsel;
      3. Emergency medical services staff;
      4. Unhoused services staff;
      5. Medical care services staff;
      6. Medical examiner staff; and,
      7. Public health staff.
   6. County, state, and federal law enforcement personnel;
   7. Local drug trafficking experts;
   8. Public health or behavioral health experts;
   9. Drug treatment providers;
   10. Representatives of local health plans, nonprofits, religious, or other organizations who work with individuals at high risk of overdose fatalities; and,
   11. Local professional associations of persons described in this subdivision.
4. Requires an oral or written communication or a document shared within or produced by an overdose fatality review team to be confidential.
5. Requires an oral or written communication or a document provided by a third party to an overdose fatality review team, or between a third party and an overdose fatality review team, to be confidential.
6. Permits recommendations of an overdose fatality review team, upon the completion of a review, to be disclosed at the discretion of a majority of the members of the overdose fatality review team.
7. Permits an organization represented on an overdose fatality review team to share information in its possession concerning the decedent who is the subject of review, information received from a person who was in contact with the decedent, or other information deemed by the organization to be pertinent to the review with other members of the team. Requires information shared by an organization to be confidential.
8. Permits an overdose fatality review team to request information, as specified. Permits written and oral information, as specified, to be disclosed to an overdose fatality review team.
9. Requires information gathered, and recommendations made, by an overdose fatality review team to be used by the county to develop education, prevention, and intervention strategies that will lead to improved coordination of treatment services and prevent future overdose deaths.
10. States legislative findings that in order to protect the privacy of persons who have died due to a drug fatality, including confidential medical information, and to encourage the provision of comprehensive information about drug fatalities to the review teams, it is necessary to limit general access to information regarding those persons.

EXISTING LAW:

1. Permits a county to establish an interagency domestic violence death review team to assist local agencies in identifying and reviewing domestic violence deaths and near deaths, including homicides and suicides, and facilitating communication among the various agencies involved in domestic violence cases. [Penal Code (PEN) §11163.3]
2. Permits a county to establish a homeless death review committee to assist local agencies in identifying the root causes of death of homeless individuals and facilitating communication among persons who perform autopsies and the various persons and agencies involved in supporting the homeless population. [PEN §11163.72]
3. Permits a county to establish an interagency child death review team to assist local agencies in identifying and reviewing suspicious child deaths and facilitating communication among persons who perform autopsies and the various persons and agencies involved in child abuse or neglect cases. [PEN §11174.32]
4. Permits a county to establish an interagency elder and dependent adult death review team to assist local agencies in identifying and reviewing suspicious elder and dependent adult deaths and facilitating communication among persons who perform autopsies and the various persons and agencies involved in elder and dependent adult abuse or neglect cases. [PEN §1174.5]

FISCAL EFFECT: Unknown. This bill has not yet been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, confronting California’s overdose epidemic will take collaboration across all sectors. The author argues that by providing the specific statutory authorization needed to create Overdose Fatality Review Teams, this bill will allow counties to look system-wide at individual deaths to find opportunities to increase safety and health in the future. The author states that other death review teams for children, domestic violence, and elder abuse have yielded tremendous results with opportunities for improvement identified and acted on at both the system-wide and individual levels. The author concludes that being able to implement drug fatality review teams would allow counties to maximize insights on how they can address the drug and opioid crisis locally for a growing crisis throughout the state.
2. BACKGROUND. California is facing an overdose epidemic. According to a California Health Care Foundation report, 9% of Californians have met the criteria for a Substance Use Disorder (SUD) within the last year. While the health care system is moving toward acknowledging SUDs as a chronic illness, only about 10% of people with an SUD within the last year received treatment. Overdose deaths from both opioids and psychostimulants (such as amphetamines), are soaring. This issue, compounded by the increased availability of fentanyl, has resulted in a ten-fold increase in fentanyl related deaths between 2015 and 2019. DPH’s Opioid Overdose Dashboard reported 7,385 deaths related to “any” opioid overdose in 2022, with 6,473 (87.7%) of those deaths fentanyl related.
   1. Fentanyl. Fentanyl is a potent synthetic opioid drug approved by the FDA for use as an analgesic and anesthetic. It is approximately 50 times stronger than heroin and 100 times stronger than morphine. First developed in 1959, it was introduced in the 1960’s as an intravenous anesthetic. Fentanyl is legally manufactured and distributed in the United States; however, there are two types of fentanyl: pharmaceutical fentanyl and illicitly manufactured fentanyl. Both are considered synthetic opioids. Pharmaceutical fentanyl is prescribed by doctors to treat severe pain, especially after surgery and for advanced-stage cancer. Most recently, cases of fentanyl-related overdoses are linked to illicitly manufactured fentanyl that is distributed through illegal drug markets for its heroin-like effect. It is often added to other drugs because of its extreme potency, which makes drugs cheaper, more powerful, more addictive, and more dangerous.
   2. Existing Death Review Teams. Los Angeles County established the nation’s first Child Death Review Team (CDRT) in 1978. A major role of CDRTs is to function as a case-investigating agency, providing in-depth analysis by many agencies on the possible causes of infant deaths in specific cases. California’s CDRTs also assist in identifying agency and systems problems and developing recommendations to prevent future child deaths. According to the National Center for Fatality Review and Prevention, CDRTs have influenced state and local policy changes on issues ranging from child homicide sentencing, safely surrendered babies, children left alone in cars, child maltreatment reporting, data collection, and more.

Building on the success of CDRTs, in 1995 the California Legislature authorized counties to establish interagency Domestic Violence Death Review Teams to ensure that incidents of domestic violence and abuse are recognized and to develop recommendations for policies and protocols for community prevention and intervention initiatives. In 2001, the Legislature authorized counties to establish interagency elder death teams to examine deaths associated with suspected elder abuse and neglect, identify, and work towards the implementation of prevention strategies to protect our elder population. In 2010 the statute was expanded to allow the review teams to also assist in dependent adult death reviews. Most recently, in 2023 the Legislature authorized counties to establish homeless death review committees to identify the root causes of death of unhoused individuals and facilitate communication among persons and agencies involved in supporting the unhoused population. This bill builds upon these models to authorize overdose fatality review teams.

1. SUPPORT. The County of San Diego (County) is sponsoring this bill, stating that addressing California’s drug fatality crisis will require a system-wide effort from local health, social service, and public safety agencies, nonprofits, community groups, and others who have expertise or work with people who are most at risk. The County continues that while overdose fatality reviews can currently be conducted to a limited degree, the ability to share information about individuals, much of which is confidential by law, is limited. The County argues that other death review teams for children, domestic violence, and elder abuse have yielded tremendous results. The County concludes by stating that this bill would unlock the ability for counties and other agencies to better work together to prevent and address future occurrences, as well as to improve coordination and effectiveness of interventions.
2. SUPPORT IF AMENDED. The County of Fresno supports this bill if amended, stating that preparation for these types of review would require additional staff time in gathering general information; summarizing general and medical information; organization of ongoing meetings; standardizing reports; establish criteria for which cases to review; communication with family to obtain missing information; and conduct additional forensic testing if information is missing. The County of Fresno continues that there is no mention of additional funding sources or establishing criteria for data assessment in this bill.
3. PREVIOUS LEGISLATION.
   1. AB 271 (Quirk-Silva), Chapter 135, Statutes of 2023, authorizes counties to establish homeless death review committees.
   2. SB 863 (Min), Chapter 986, Statutes of 2022, authorizes a county domestic violence death review team to assist local agencies in identifying and reviewing domestic violence near-death cases, as defined.
   3. AB 2654 (Lackey) of 2021 would have reconvened the State Child Death Review Council by removing the requirement that funds are appropriated for it in the Budget Act in order to be operative. AB 2654 was held in the Assembly Appropriations Committee.
   4. AB 2660 (Maienschein) of 2021 would have required each county to establish an interagency child death review team no later than January 1, 2024. AB 2660 was vetoed by the Governor.
4. DOUBLE REFERRAL. This bill is double referred, upon passage of this Committee it will be referred to the Assembly Committee on Privacy and Consumer Protection.

REGISTERED SUPPORT / OPPOSITION:

Support

County of San Diego (sponsor)

County Health Executives Association of California

Rural County Representatives of California

San Diego County District Attorney’s Office

Opposition

None on file.

Analysis Prepared by: Riana King / HEALTH / (916) 319-2097