Assembly Standing Committee on Health

If you represent one, all testimony comments are limited to the bill at hand. We have a long agenda today, but we do have some items proposed for consent. The following bills are proposed for today's consent calendar. Any ember of the committee can remove a bill from consent. Item number seven, AB 424 by Assemblymember Brian. Item number 16, Assembly Bill 827 by Assemblymember Garcia. Item number 23, AB 1276, by Assemblymember McKinnor. Item number 26, AB 564, by Mr. Villapudua.

Item number 32, AB 1701 by Dr. Weber. The following bills have been removed from today's calendar. Item number five, AB 412, by Ms. Soria. Item number eight, AB 486 by Mr. Kalra. Item number 13, AB 657 by Dr. Jackson. Item number 15, AB 1751, by Mr. Gibson. Item number 19, AB 1316 by Ms. Irwin. And item number 24 AB 1338. So I don't really know how many that bills that leaves us, but there's still a bunch.

It's our custom to not start until we have a member representative from the other party here. So just hang out, play cards, whatever. So just for reference. So Mr. Haney has two bills before us and he will be presenting those bills. Three bills, two bills, whatever. Mr. Haney has some bills up before us, and then we're going to ask that Mr. Bennett come and present AB 1168.

It'll be out of order, but I think based on the audience, there might be a lot of people here interested in that particular bill. So we'll ask Mr. Bennett to come and present after Mr. Haney presents his bills. Thank you. Okay. Thank you. Our Vice Chair is here. You'll see that we are woefully short of a quorum. There is a lot going on today. There are multiple committee meetings. A lot of committee members are serving on multiple committees or presenting bills and other committees.

So you'll see a lot of people coming and going today. So with that, we're going to go ahead and move on to Mr. Haney you have before us. We're taking everything in file order today, except we're not when we're not, but right now we're going to do it in file order. Mr. Haney, you have AB 24.

Thank you, Mr. Chair and members. It's great to be in front of you all. First of all, I will be accepting the committee amendments today, and I thank you and your staff for working with us on this bill and for your leadership on this issue as well. AB 24 will require gas stations, libraries, bars and residential hotels to have opioid blocker nasal sprays, or what is commonly referred to as Narcan, on-site to prevent deaths from opioid overdoses.

It would apply only to counties that the Department of Public Health is determined to be in opioid overdose crisis and would be provided by the department. An opioid blocker works by binding to the same receptors in the brain that are activated when consuming opioids. After the spray is administered, the overdose can be completely reversed in 30 seconds and a life is saved. It's also easy to use.

I say this because I have personally administered Narcan after someone had overdosed on the sidewalk in front of my apartment in the Tenderloin in San Francisco. The difference between life or death when someone overdoses is how quickly Narcan can be accessed. And while I believe opioid blockers should ultimately be everywhere throughout the state, research shows that these are locations where people can commonly overdose. Right now, the state does provide opioid blockers to organizations that give them directly to opioid users.

However, your opioid users who are in the midst of an overdose cannot self-administer. For an opioid blocker to be effective, it requires someone near the person overdosing to have access to the medication. Also, there are no dangerous side effects from the medication. It is completely safe to use even if the person who received the medication is not having an opioid overdose. This is timely and necessary legislation because California is reaching new levels of the opioid crisis.

In 2021, there were 7000 overdose opioid related deaths in our state. These are sons, daughters, mothers, and fathers in every county and Assembly District in our state. Making sure that the most effective tool to prevent overdoses is easily accessible is critical to stopping deaths. AB 24 is one of the many bills this year that will confront the opioid crisis. It is not the only thing we must do.

We must get fentanyl off our streets and out of our communities and dramatically expand access to treatment and recovery. But there's absolutely no excuse to not make sure this life-saving intervention is available in the places where it can save a life. We have a responsibility to the families with loved ones who are struggling with addiction, as well as those who might accidentally ingest a deadly level of fentanyl. This would be a significant step in the right direction for our state and would absolutely save lives.

With me today, I have our expert witness, Dr. Paula Whiteman, an emergency room physician in Los Angeles, and I believe. Joining us is Rachel Ryan, owner of the oldest LGBTQ bar in San Francisco, the Stud.

Please, whenever you're ready.

My name is Paula Whiteman. I am an emergency physician practicing in Los Angeles County. Thank you all for allowing me to speak here today. As you know, we are in the midst of a public health crisis within the State of California and across the country with a record number of opioid deaths. Naloxone is a simple, easy-to-use, and effective medication. It comes in the form of a nasal spray that anyone can administer.

The medication binds to the same receptors in the brain used by opioids, causing a temporary reversal or blocking of the drug. Naloxone being distributed in public places would play a pivotal role in reducing these opioid overdose deaths. As an emergency physician, I have administered naloxone to patients experiencing an opioid overdose and have watched firsthand as a lifeless patient who has stopped breathing comes back to life within seconds of receiving the naloxone.

In addition to those experiences, I have co-authored a paper published in a well-respected peer review journal titled "Between Emergency Department Visits: The Role of Harm Reduction Programs in Mitigating the Harms Associated With Injection Drug Use", and I've also recently spoken at a national emergency medicine conference on educating other emergency medicine professionals about harm reduction strategies and the use of naloxone in the public space. The role of naloxone being distributed in public places would mitigate the harms associated with injection drug use.

It is a public health approach that aims to reduce harms associated with health risk behaviors and minimize the negative effects of drug use and promote health and social inclusion. Assemblymember Haney's AB 24 would implement a new approach to preventing overdose deaths by requiring opioid reversal, nasal sprays, and clear directions on how to use them in public spaces. Thank you for your time. I urge an aye vote.

Thank you very much. You had a second witness.

It appears she is in line, so we may have to move on without her unless she's walking in at this very moment.

Okay, we'll go through others and other testimony, and if she is able to make it in time, we'll give you that opportunity.

Thank you. Appreciate it.

Others in support. Just your name organization please.

Good afternoon Mr. Chair and members, Connie Delgado. On behalf of the California Emergency Nurses Association, in support.

Thank you.

Mr. Chair and members, Robert Harris On behalf of California Society of Addiction Medicine, in support.

Thank you.

Good afternoon, Priscilla Quiroz on behalf of the City of Santa Monica, in support.

Thank you.

Tara Gamboa-Eastman with the Steinberg Institute, in support.

Thank you.

Jim Lindbergh, Friends Committee on Legislation of California, in support.

Thank you. It looks like your witness has arrived.

There we go. Right on time.

Right on. Catch your breath. It's okay.

Sorry about that.

No problem.

Good afternoon. My name is Rachel Ryan, and I'm a co-owner and the general manager of the Stud Bar in San Francisco Soma neighborhood. We opened our bar in 1966, and we're the oldest queer bar in San Francisco. Over the last five years, we've seen the impact of the opioid crisis affecting both people in our nightlife community and our unhoused neighbors. It's a very common occurrence for us to see people with opioid addiction using fentanyl in the streets around our bar.

In 2018, the Stud was approached by the Drug Overdose Prevention Education project to become the first nightclub to publicly announce that we had Narcan on site. We put up posters around the bar letting people know that this was available and taught our staff how to identify an overdose. I've had personal experience with administering Narcan. I was at an event in 2021 where a man experienced an overdose from doing cocaine that he didn't know contained fentanyl.

When he collapsed, the people around him immediately recognized it as an overdose and started shouting for Narcan. I was one of several people there who were carrying Narcan in my purse. As someone dialed 911, we administered Narcan, and I held this man's head in my hands as another friend started CPR. Within a few minutes, he went from being nonresponsive and turning blue, from lack of oxygen to breathing on his own as the naloxone started to work.

By the time the paramedics arrived, he was awake and was able to walk himself to the ambulance. That man was incredibly lucky that he happened to be in a space that had Narcan. But we shouldn't be leaving people's survival up to luck. As a business owner, I can tell you that this bill will save lives. An opioid overdose is very distinctive and easy to recognize, and using naloxone nasal spray is incredibly easy. You just put it in the person's nose, push one plunger, and that's it.

I promise you that if we provide this important first aid tool to workers. They will make the choice to save people's lives. I respectfully urge you to vote for AB 24. Thank you so much.

Thank you very much. Is there opposition to the bill?

Thank you, Mr. Chair and members, Christina De Caro, representing the California Library Association, removing opposition today, sir. And we want to thank Judy Babcock of your staff and the Assemblymember for working with us so much on the amendments removing the penalties for libraries. Thank you very much.

Thank you.

Sarah Dukett on behalf of the Rural County Representatives of California, we oppose unless amended. We appreciate the committee amendments, and we're hopeful we can go neutral.

Okay. Thank you.

Thanks, Mr. Chair. Jean Hurst from the Urban counties of California, a similar situation at the Library Association and RCRC, appreciate everybody's work on this bill.

Great. Thank you. Anyone else? Okay. Seeing no one bring it back to the committee. Questions or comments? Well, I would just like to say thank you very much for bringing this bill forward from very early on your commitment to working on this issue, and look forward to working with you on your Select Committee as we move forward with that, as you move forward with that in the fall. I'm sorry. Hang on a second. I'll finish my comments and then we'll turn it over to her.

But thank you for bringing this important bill forward. And when we do have a quorum, I look forward to supporting the bill. So, Ms. Aguiar-Curry, thank you very much.

Sorry for my lateness. I appreciate the bill, Assemblymember, and I'm supportive of your intentions of the bill, and we're supporting it today. But I do ask that you consider an opportunity to cure for small businesses who may be unaware of this new requirement, perhaps a period of two weeks to comply before being subject to the penalties under the bill would protect those willing to comply once they've been made aware.

Sure. I think since there's not very many of us, that's probably the end of the comments. So would you like to close?

And thank you, Mr. Chair, for your support and your leadership as well, and your staff. And Ms. Aguiar-Curry, I believe that the bill has now been referred also to Judiciary Committee, and so we there are going to deal with some of the issues around liability, and I definitely take your comments around how to make sure that small businesses are able to deal with actually complying with the bill, and the intention is not to be punitive in that way.

So I appreciate that, and we'll definitely work on that. And again, I just want to thank you all, this committee, for your leadership on this issue, and this is one of the many things that we have to do. And I also want to recognize that I know there are many first responders in the room and healthcare professionals, and I want to thank them for their leadership and their life-saving interventions with the use of Narcan and others who are experiencing overdoses.

And with that, I respectfully ask for your aye vote.

Thank you. And when we have a quorum, we'll seek a motion and put it up for a vote. So thank you very much, Mr. Keaney, and thank you to your witnesses who can now catch a breath, or at least one of them can. Anyway, you have now before us AB 459.

Great. Thank you again, Mr. Chair, Members. And before I start, I want to accept the Committee's amendments. Today, AB 459 takes a critical step forward to hold our health care systems accountable for serving and improving the life outcomes of Californians living with mental illnesses and addiction issues. Unfortunately, despite all the investment in behavioral health initiatives, the statistics on mental illness and addiction in our state are troubling. Approximately one in six California adults experience mental illness and about one in 25 experience a serious mental illness.

People living with serious mental illness die 25 years younger than peers without mental illness, and drug overdose deaths nearly doubled in California over the last five years. As we look to transform our systems of care to better serve California- Californians living with mental illness and addiction, we have to have accountability and transparency. AB 459 brings both by requiring counties and health plans to set ambitious treatment goals and the state to monitor and publicly report their progress towards these goals in real time.

The bill will be divided into two phases. Phase one of this legislation takes stock of where we are and what data we need to track and understand in order to improve systems. It does so by asking the UC system to evaluate all existing data and make recommendations to an advisory group as to potential outcome measures for a statewide progress dashboard. This advisory group would include persons with lived experience and other key behavioral health stakeholders.

Phase two requires the counties and health plans to develop data driven and community informed self assessments based on the data and community input. Counties and health plans would then develop system improvement plans indicating which outcome measures that will target an anticipated improvement. Phase two also implements the creation of the statewide dashboard, which will be hosted and maintained by the UC system. Standard outcome measures will be tracked for every county and health plan. The three pillars of AB 459 are data transparency and community.

Without these, true transformation of our behavioral health system cannot happen. Too many people are needlessly suffering on our streets and our jails and our hospitals not getting the care they desperately need. It's time for investment. It's time for accountability, and it's time for results. Here to testify with me today is Dr. Tom Insel, a psychiatrist and neuroscientist and an expert on behavioral health. And also we have Tara Gamboa-Eastman from the Steinberg Institute, who is available to answer any technical questions the Committee may have.

Go ahead when you're ready.

Thank you very much. Thank you, Mr. Chair and Members of the Committee, for having me join in this testimony. I'll keep my remarks brief. My name is Dr. Tom Insel.

I'm the former Director of the National Institute of Mental Health during both Bush and Obama years, came to California, spent about a year as an advisor to Governor Newsom on behavioral health issues, when we had a chance to meet Mr. Chairman, and have served as the chair of the board of the Steinberg Institute, which is a proud sponsor of AB 459. I don't need to tell all of the Members of this Committee that in so many ways, our behavioral health system is in dire straits.

That spite of everything that we have done in the State of California, the investments we have made, the programs we've set up, the incredibly hard work of our county behavioral health agencies, we still see, unfortunately, really dire results. Some of this is due to the fragmented and underfunded nature of the health systems themselves. But I'm going to suggest to you that part of our challenge here is that we have not been focused enough on outcomes.

And the lack of focus on outcomes results in needless human suffering, institutionalization, homelessness, incarceration, and, unfortunately, death. And as you just heard about AB 24, death is really a major issue in the behavioral health space. Report out today by the California Health Policies Institute shows over 1000% increase in fentanyl deaths since 2017. This has become the leading source of mortality in the State of California for people between the ages of 15 and 44, which is just simply extraordinary.

Right now, less than a third of Californians living with a mental health condition and approximately 10% of those living with a substance use disorder receive the care they need. So the problem I'll suggest to you, is that we simply lack our ability to measure and to be accountable for the kinds of outcomes we care about. AB 459 takes a critical step forward to hold our health care systems accountable for serving and improving the life outcomes of Californians living with mental illnesses and addiction issues.

It's really high time. It's been over 60 years since President Kennedy called all of us to this mission, and we have failed. And part of that failure is our lack of accountability. We don't manage what we don't measure, and the time has come to begin to do that. AB 459 provides the process for that. I respectfully ask for your aye vote and happy to remain to answer any questions you may have.

Thank you very much.

Tara Gamboa-Eastman with the Steinberg Institute, proud sponsors and just here to answer any questions if the Committee has any.

Thank you. Others in support? Please just your name and organization, if you represent one.

Katie Van Deynze with Health Access California in support. Thank you.

John Drebinger with the California Council of Community Behavioral Health Agencies in strong support.

Thank you.

Theresa Comstock with California Association of Local Behavioral Health Boards and Commissions in support.

Thank you.

Lauren Finke with the Kennedy Forum, in support.

Thank you. Anyone else? Is there opposition to the bill? Seeing no one to bring back to the Committee for questions or comments from the Committee. Ms. Waldron?

Thank you, Mr. Chair. I want to thank the author for bringing this bill forward. I've worked in the mental health and substance use space longer than I want to admit, even before I was in the Legislature with the opioid task force in San Diego. It's really needed that we unpack this and figure out where the shortfalls are, because we all see the outcomes and what the results have been. So it's really important that we do this so that we can be efficient and effective.

And as you mentioned, patient outcomes is always one of the things that we seem to overlook, and it's where the most suffering is. So I'm happy to support this bill when we have a chance, and thank you for bringing it forward.

I'd like to say thank you as well. I really do like your approach. I like the systematic approach, data transparency, community. I think it makes a lot of sense. And the fact that you're including so many people, so many entities in this is really critical. So as people may know, I'm a big believer in data. We think with good data we get an opportunity to make big changes. So when we do have a quorum, I'm happy to support the bill.

And should the bill pass out a Committee, I'd like to be added as a co-author, if you'd have me, of course.

Well, of course. Ms. Aguiar-Curry's saying, 'me, too. Me, too'.

And you're welcome to close.

Yes, and thank you so much. And thank you to our witnesses and sponsor. This is an issue we're going to have to work on for a long time to get this right. And so look forward to partnering with this Committee and all of you to get it done and to ensure that we get the results and have the transparency and data and accountability that we need.

I also want to acknowledge there were some recent concerns expressed around the membership of the advisory group and some different suggestions for membership, and we will work with those folks to address that input and try to get that right. So with that, at the right moment, we'd love to have your support on this bill.

Thank you. Thank you very much. Thank you to your witnesses. And you have also AB 1001.

All right, last one here. Thank you again, Mr. Chair and Members, and thank you again to your staff for your thoughtful work on this bill. And I accept the Committee amendments. AB 1001 establishes a minimum staffing requirement for mental health and addiction personnel at hospitals in order to ensure patients in need of services receive timely and appropriate care. California's healthcare system is becoming increasingly overwhelmed by the number of patients suffering from mental health and addiction services.

In 2020, patients with mental health and addiction diagnoses represented one third of all inpatient hospitalizations and one fifth of all emergency room department visits. However, hospitals are under prepared, understaffed, and lack appropriately trained and licensed staff to respond to patients experiencing emergency psychiatric or mental health and addiction crises. This places nurses and other healthcare workers and their patients in dangerous conditions. In California, there are more than 500,000 active licensed nurses, yet only 348,000 are working in the state.

Our hospital's inability to efficiently provide for care for patients in emergency departments is causing nurses to leave the profession, further straining the healthcare workforce. This lack of adequate staffing also causes patients with mental health and addiction needs to be inappropriately boarded in emergency departments or remain under observation status, leading to delays in receiving mental health care or addiction treatment, worse outcomes, and preventable errors.

This bill ensures that hospitals across the state are staffed with a four member behavioral health response personnel team to assist hospital patients experiencing a behavioral health crisis. This bill will also create the behavioral health emergency response and training fund, which would be financed through already existing behavioral health dollars. This fund would provide grants to newer existing programs that focus on training mental health and addiction personnel to work in hospitals.

With me today to testify is Ramona Malle from UC Davis ER registered nurse and Mari Lopez from the California Nurses Association.

Please go ahead.

Hello, my name is Ramona Mall. I'm a registered nurse in the emergency department at UC Davis Medical Center. I have worked in healthcare for 32 years. For the first 17 years, I was a licensed vocational nurse in behavioral health and for the last 16 years, I have been a registered nurse in the ED. During my work at UC Davis, I have witnessed firsthand how quickly seemingly minor psychiatric events can escalate into a full blown crisis.

In an overcrowded and understaffed environment where RNs and other workers do not have proper training and resources, we lack the capacity to provide the level of care that our patients deserve. At UC Davis, the largest public hospital in the region, approximately one third of our patients on any given day are experiencing issues with their mental health. Our staff of 200 plus registered nurses are required to complete only one training module in crisis intervention and prevention in their entire career at UC Davis.

By contrast, behavioral health nurses receive years of continued specialized training to provide a therapeutic hospital experience for their patients rather than a traumatic one. Patients who come to us in need of mental health treatment deserve a care team who are trained to safely and effectively address all of the aspects of the care they need. I'd like to share a story at this time. I was caring for a man who was twice my size who was on a psychiatric hold, a 5150.

As a result, he was held in isolation in the emergency room for three days. Aside from the occasional visit from the psychiatry team, it was up to the nurses to keep him calm and safe, armed only with our singular training and crisis intervention. Eventually, the patient became overwhelmed. He told me, I'm going to get out one way or the other. I looked to the ED provider for guidance, but she, too, lacked the unique training requirement to address the patient's needs.

He ended up eloping, further endangering himself and others. Nurses support AB 1001 because it guarantees that what should be common sense becomes law. When it passes, we will have the tools and resources we need to provide the care that the most vulnerable in our community so desperately need. Thank you for this opportunity.

Great. Thank you.

Good afternoon. Thank you Chairman Wood and Committee Members. My name is Mari Lopez, legislative advocate for the California Nurses Association and on behalf of the more than 100,000 registered nurses in our state, we are a proud sponsor of AB 1001 and thank Assembly Member Haney for authoring this important bill. California has made great gains in addressing behavioral health and continues to address the state's growing mental and behavioral health needs. Importantly, the hospital environment remains a major point of continuum of behavioral health care.

HCAI reports that one out of five emergency department visits and one out of three inpatient hospitalizations are patients with behavioral health issues. Some patients with mental health or substance use issues seek care through our hospitals and other patients in acute care settings sometimes have episodic, involuntary and unintended behavioral health responses to a hospital environment. Where they respond in a way that puts themselves, nurses and other healthcare workers at risk for violence and unsafe care conditions.

This bill would improve both patient and healthcare worker safety in California's hospitals. And under AB 1001, hospitals would be required to have a behavioral health team that's specifically trained and dedicated to responding to patients experiencing a behavioral health crisis, which would be dispatched throughout the hospital, across the hospital as needed.

And with the attention of a behavioral health team, hospitals could better ensure that patients receive the care that they need when the care that was needed in a timely fashion, which would help free up hospital beds and improve patient outcomes. A dedicated team of knowledge, with knowledge of programs, resources and information on behavioral health would play a key role in the state's continuum of behavioral health goals.

AB 1001 would also be instrumental in meeting California's goals in providing appropriate care to patients with mental health and substance use needs, and it would support nurses and other hospital staff as they provide care to your constituents. Thank you so very much for the time and the opportunity to speak to you all.

Great. Thank you very much. Others in support?

Hi, Theresa Comstock with California Association of Local Behavioral Health Boards and Commissions in support.

Thank you.

Mr. Chair and members, Sara Flocks, California Labor Federation, in support.

Thank you.

Mr. Chair and members, Tim Madden, representing the California Chapter of the American College of Emergency Physicians. We had been support if amended. We want to thank the author, his staff, sponsors, and the committee staff with their help, and we're moving to straight support. Thank you.

Thank you.

Hello Chair and members, Janice O'Malley with the American Federation of State County Municipal Employees in support.

Thank you.

Karen Moxley, critical care and recovery room nurse in support.

Thank you.

Jane Churchon, California Nurses Association, Neonatal ICU nurse in support.

Thank you. I see anyone else? See no one else. Is there opposition to the bill? Please come forward.

Good afternoon, chair and members.

Please push the button, if you don't mind. There. Thanks.

There we go. Are we on prime time? There we go. Good afternoon, chair and members. My name is Kirsten Barlow. I'm a vice president of policy at the California Hospital Association, where I bring nearly 20 years of expertise in behavioral health policy. We really thank the author's office and all of the committee staff who really engaged with us about concerns we have with the bill and are supportive of the amendments that are suggested in the analysis.

While those amendments are helpful, though, the bill still puts an overly prescriptive staffing requirement on hospitals, and we must regretfully oppose the Bill unless it's amended to address that aspect. Currently, California is facing a workforce shortage of nearly 500,000 allied health professionals and 40,000 RNs. The bill requires really a one size fits all approach for all areas of the hospital, not just the emergency room.

And it really gives us little flexibility to employ other innovative solutions that include, for example, using peer support specialists or substance use navigators, who really can provide lived experience perspective on how to deescalate a crisis. While the bill does include a training fund, it doesn't specify exactly where those funds would come from.

It also doesn't make those grants available to all types of hospitals, despite the fact that all types of hospitals right now, about 50% are operating in the red, given the COVID crisis that we're all still sort of emerging from. Lastly, we believe that efforts to reduce workplace violence in the hospital should acknowledge the whole patient population that we treat, not fuel the myth that people with mental illness are more violent and more dangerous than other patients.

As we know, violence can happen in any workplace, in any setting. The environment itself can be a stressful experience for any type of patient. And we know that workplace violence in a hospital can happen outside of people with a mental illness or people who have a 5150 involuntary hold. For these reasons, we strongly urge you to consider our concerns, and we must respectfully oppose AB 1001 unless it is amended. Thank you.

Thank you very much. Others in opposition see no one will bring it back to the committee. Any questions or comments from the committee? Dr. Weber.

Good afternoon. Assembly Member Haney. I want to thank you so much for bringing this bill forward, but also for accepting the amendments, because I did have a lot of concerns that have been addressed with the amendment. So thank you to the committee staff. I will be supporting it here. However, I do echo what was just stated by the opposition as far as the issue of workforce.

I was called at 04:00 a.m. This morning for a patient down in San Diego, and I was speaking with the doctor that called me, and we were talking about the lack of nursing for that particular clinic. One half day nurse or part time nurse for 4 physicians. It's real. And so, thinking outside of the box, having flexibility in order to be able to achieve what you're trying to achieve, I think is going to be important.

So I will support it today so that you can continue the conversations and keep this bill moving forward, because I do think that it is important, but I do think that there needs to be some kind of discussion and resolution that is presented to deal with the issue of workforce shortage with our nurses, with our other providers. So thank you.

Thank you. Just a couple of comments. First of all, so as a dentist, I'm pretty familiar with the carve out of certain parts of the body from the body as a whole. Patients often go to emergency departments with dental pain, and little or nothing can be done except get some pain relief and call your dentist in the morning. I do understand that dental care is provided differently, and emergency rooms are literally not equipped to provide such care.

That being said, we cannot do the same thing to individuals suffering from a mental health crisis. Yes, we need more beds. We also need appropriately trained individuals working in the hospital. And as you said, I believe a third of patients presenting in emergency rooms and some sort of behavioral health crisis rooms, whether they come in of their own volition or subject to an involuntary hold under the LPS system.

I do think that until we address the issue on patients on 5150 holds languishing in the ED, waiting for an assessment, which is a real problem, often languishing for hours because there isn't appropriate staff there to do the evaluations. And that is hugely challenging. We're still just kind of working around the edges, quite frankly. We need everyone to step up and do their part. The bill does enjoy a do pass recommendation. I thank you for working with us and the committee staff.

Would you like to close?

Yes. Well, first of all, I want to thank you again and your staff for working with us and for the amendments and for the committee's comments and for our witnesses who are here. I am absolutely. And we're committed to working with the Hospital Association and providers on some of the questions and issues that were brought forward. I do want to also, there are healthcare workers here and nurses, and I want to again acknowledge and thank them for their work.

I do want to say to Dr. Weber, I could not agree more. I think at the heart of this is the workforce issue. And so we wanted to both include the staffing standards and this workforce investment and funds and really say we need to do both of these things. And so I'm committed and I'm sure I'll have your partnership.

And really, as we go into the budget process, really making sure that this is prioritized and that we find every way possible to enhance that workforce because this cannot get done unless we address the workforce issues. I also would say that what we have here, as was stated, really is what we know to be common sense. As you said, chair, if we bring someone who has behavioral health needs into the hospital, there have to be professionally trained behavioral health staff there to provide for them.

That is a basic minimum. And the question is how we get there. We think that this bill is a way forward. And so with that, allowing us to continue to move it forward and to find a pathway forward to get it done is greatly appreciated. And thank you again, Mr. Chair, and at the right time would respectfully request an aye vote.

Great. Thank you very much, Mr. Haney, and thank you to your witnesses. Thank you. Okay. As I previously stated, we're going to go out of order here. We're going to have Mr. Bennett come forward. He's going to present AB 1168. And before you begin, Mr. Bennett, I'd like to make a few comments. I know it's a little unusual, but the committee learned this morning from stakeholders and that the committee amendments proposed have raised concerns about inadvertently broadening the bill.

I want to clarify that the intent of the amendments was to narrow the bill, protect patients, and not create undue disruption within the system. This is kind of illustrative of the challenge with this particular bill. This issue has been come before us many times, several times as recently as last year.

And one of the things that we struggle with is it takes a lot of explanation to explain the intent of this bill, but there takes very little explanation from the opposition as to why they don't like it. And so it appears that supporters and the opponents seem entrenched in their perspectives, which makes any progress exceptionally difficult.

My preference would be that both sides take a step back, spend some time trying to solve the issue in a more cooperative manner, and do this without the pressure of Committee deadlines. I realize that's not the preference of stakeholders. So we'll be hearing the bill today. I commend the author for trying to resolve this very complex and contentious issue.

Should the bill pass out of Health Committee today, my staff is committed to continuing to work with the stakeholders and the next policy committee to assure our amendments accomplish what was intended without the unintended consequences. So with that, please go ahead, Mr. Bennett.

Thank you very much, Mr. Chair. And I want to compliment you and your staff. I completely concur with your assessment.

This is an easy issue to have something inadvertently go wrong or be perceived as wrong, and your willingness to work with us, and hopefully one of the differences between this and certainly at least the last Bill that came in front of this Committee is we have endeavored to work with you from the very beginning and to try to let you know what the intent was and try to work with you and your staff in terms of what are possible solutions to address all the many concerns that people have out there.

So with that, I want to start by accepting the Committee's amendments and the intended amendments that are the modifications that you have coming that deal with the narrowing down of this, and also state my commitment to continue to engage the chair as this goes forward. This won't be a hide the ball kind of thing at all. We want to make sure that the chair and this Committee stays engaged and fully informed as this starts to move forward.

So moving forward, I'll be speaking to the Bill as proposed to be amended. AB 1168 is a very important Bill and it does three main things. It allows a narrow set of cities or fire districts to retain their authority over prehospital emergency services or 201 rights if they were providing service as part of a JPA. As of the end of 2022, it allows the City of Oxnard in my district to retain their 201 rights.

And it clarifies that going forward, entering a JPA does not automatically take away someone's 201 rights. I'd like to tell you that this is an easy Bill, but as you've identified, it certainly isn't. And we recognize that this is still a work in progress, and we continue to try to work with you on that.

I've worked hard with the sponsors, the supporters, Oxnard Fire Chief Hamilton, and we have tried to listen to the concerns of the opponents as carefully as we can, and we will continue to do this as this moves forward. We want to try to ensure that this Bill contains a real failsafe to avoid disrupting the existing system.

That failsafe that I certainly insisted upon before I was willing to move forward with this Bill requires that the city or fire district that is choosing to retain their 201 rights needs to cover the surrounding EMS area. So you don't have highly concentrated city areas where there are lots of fee for service, getting good service, and then rural areas potentially where there is not as much opportunity being left with inferior service.

So those cities or fire districts that choose to retain their rights, if they can't reach an agreement with the county, they have to cover all of the area that they are disrupting with their decision. We should not prohibit our cities and fire districts from retaining their 201 rights just because they join a JPA, particularly if they didn't even have a conversation in advance about that being the fact.

I want to make clear that although this Bill deals with 201 rights, it's not, as we said, the same as SB 443 that came in front of you last year. Unlike SB 443, this Bill does not deal with medical control of local EMS authorities over public agencies, and it does contain the failsafe that I just mentioned to avoid disruption of service.

Finally, if a locality with 201 rights had to service a surrounding area, the local EMS authorities and the state EMS agencies would still have oversight over those services, and the services would have to ensure that service is equal or a better level than what they pulled out of. I understand that there are many fundamental disagreements around this issue, and as you mentioned, Mr. Chair, fairly entrenched views.

I hope we can have an honest and calm dialogue as we continue to work to try to find ways to deal with the concerns of the opposition and mitigate those concerns. With me to testify today. I appreciate Oxnard Fire Chief Alexander Hamilton and Doug Subers on behalf of the California Professional Firefighters Association. Thank you, Chief.

Good afternoon, Chair and Health Committee Members. My name is Alex Hamilton and I'm the Fire Chief for the City of Oxnard, as well as the President of the Fire Chiefs Department of the League of Cities, which is sponsoring this measure. So this measure seeks to clarify the section 201 of the EMS act, which grandfathered in rights for entities that were delivering prehospital EMS services prior to the act becoming law. And I do appreciate that this is a pointy-headed issue, so I wanted.

To talk a little bit about our. Experience on the ground. So a couple of issues I wanted to address with this legislation is the fact that if you live in an area in Oxnard that has been designated by HUD as 50% low to moderate income area, you are twice as likely to wait for an ambulance. This rises to almost a three-to-one ratio for neighborhoods that are in a 75% low to moderate-income area.

After trying to work collaboratively with the Ventura County EMS agency on this issue over a number of years, the Oxnard City Council chose to leave the joint powers agreement that had governed ambulance service in Ventura County since the went out to an RFP and went out to bid. Ultimately, Falck Ambulance was the winner of that bid.

The alliance model that we had built was going to improve service delivery across our city, regardless of socioeconomic status, and was also going to improve the working conditions of the employees working for that ambulance company. One of the things that I wanted to touch on when it comes to system inequity is that the appellate court, in the ruling on the Oxnard versus County of Ventura case, accepted Oxnard's evidence of systemic inequities.

Or to put it another way, they ruled that systemic inequities in the ambulance service delivery in Ventura County is a fact. The second point I'd like to make is regarding an integrated system. In a truly integrated system that Oxnard is striving to realize, there would be a mix of ambulances and fire Department units providing adequate paramedic coverage across the jurisdiction, always ensuring a timely response. However, there is currently no integration or coordination between ambulance and fire units.

The ambulance company simply spreads their units as thinly as possible to maximize profits while trying to maintain their contractual compliance. In 2019, there was 1200 occasions where there was no ambulances available in the City of Oxnard, a City of over 200,000 people. And so, in closing, I would like to emphasize that the court did not rule on the 201 rights on Oxnard's 201 rights. Instead, they held that even if Oxnard had them, they were surrendered when we signed the joint powers agreement.

And so this Bill is, the goal of this Bill is to be narrowly tailored to further the intent of the EMS act and I thank you for your time today. Thank you.

Thank you, Mr. Chair and Members. Doug Subers on behalf of the California Professional Firefighters in strong support of AB 1168, CPF represents more than 34,000 professional firefighters and emergency medical services personnel statewide. We would like to thank Assemblymember Bennett for bringing this Bill forward to the Committee for their Engagement and work on this issue. This measure will create clarity around the provision of prehospital EMS services and rights to deliver those services.

The Oxnard decision has raised ambiguity and potential negative consequences, and we firmly believe it's appropriate for the Legislature to address this issue through AB 1168. In addition to addressing the City of Oxnard directly, this Bill will seek to ensure that jurisdictions that are providing prehospital EMS as a result of a joint exercise of powers agreement are not negatively impacted by the Oxnard decision should they have rights and seek to deliver services in the future.

Further, this measure will ensure statutory clarity for a fire Department to enter into a future agreement with a county to deliver prehospital EMS without losing their rights. Assemblymember Bennett noted in his comments that the measure contains a failsafe. Section two, Subdivision D, outlines the process that ensures that communities have continued access to EMS services should a city or fire district exercise rights under this Bill, CPF Members care deeply about their community and see EMS services as a vital portion of their work.

In many jurisdictions, CPF Members provide first response services where they are first on scene in a medical and emergency and begin rendering aid on a patient while waiting for an ambulance to transport that patient to a hospital. It is imperative that the system be efficient. Delays or inefficiencies impact the entire pre hospital EMS system and the working conditions of CPF Members. Finally, I would just like to address a few of the opposition points that are in the analysis noted on page seven or eight.

First, we reject any notion that EMS services are pursued by firefighters to somehow address or support pension costs. Our Members commit their life to service to their community, they bargain and pay for secure retirement, and our Members seek to deliver the best care to their communities and your constituents. So we disagree with any notion that a secure retirement is negative. Second, there is some discussion about fire department's efforts to carve out areas of geography and serve only certain constituents.

We think that the failsafe as described by Assemblymember Bennett will address that issue, that this would not be an effort to pick and choose certain communities. It was ensure that the entire community gets service. And finally, there is some suggestion that a Medi-Cal reimbursement rate for public providers is exorbitant. We disagree with that. It is exorbitant.

We don't think it's a race to the bottom, and we would just respectfully say that the recovery is borne by the local jurisdiction and the Federal Government, not the state. For these reasons, we respectfully request you aye vote. Thank you.

Thank you very much. Others in support.

Richard Pearce, Fire Chief of the Tiburon Fire District, representing fire districts of California. Support. Thank you.

Chair, Committee Members. Chris Tubbs, President of the California Fire Chiefs Association, in support.

Thank you. Thank you. Anyone else? Okay. Opposition to the Bill. I'm sorry.

Christie Foy, on behalf of the City of Oxnard, in strong support.

Okay, thank you. I'm sorry. You're part of the opposition. Okay, thank you. Are others in support? I'm sorry. I didn't mean to. Okay, whenever you're ready.

Good afternoon, Mr. Chair, Committee Members. My name is Daniel Shepherd. I'm a practicing Emergency Department physician, EMS specialist, and current Emergency Medical Services Medical Director for the Ventura County EMS Agency. Speaking you today in respectful opposition to AB 1168 on behalf of a broad coalition of counties. First, we believe AB 1168 will undermine and reverse over 40 years of EMS system planning and will compromise equitable delivery of prehospital medical care to our communities statewide.

Prior to the EMS act, regulation of EMS in California was fragmented and haphazard. Nothing required EMS providers to coordinate or integrate their services. The quality of care varied and was not equitable across jurisdictions. The EMS act promised and for 40 years has delivered a coordinated, integrated and readily available system of prehospital emergency medical care and specialty hospital resources for everyone in California, regardless of where one lives or their socioeconomic status.

The current California EMS system is built on a comprehensive, two-tiered system of governance across the entire spectrum of emergency medical services through both the state EMS authority and local emergency medical services agencies. LEMSA's LEMSA physician medical directors like myself provide objective oversight in the planning, implementation, and monitoring of the EMS system and advocate for the safety of our communities by focusing on patient needs through impartial assessment.

Impartial assessment of system performance in 1997, the California Supreme Court case involving the city and county San Bernardino affirmed the need for counties to manage their local EMS systems. Additionally, more recent cases in my County of Ventura and in the County of San Joaquin reaffirm the need for the coordination, integration, and availability of EMS services countywide.

Proponents have argued that this measure ensures cities or fire districts will retain their 201 rights if they enter or have entered into a joint powers agreement for the provision of ambulance service. Nothing currently precludes a JPA agreement from ensuring those administrative responsibilities could be maintained in the context of a JPA. The County of Ventura has administered EMS services in the City of Oxnard for over five decades and long before the enactment of the EMS act, with virtually no involvement by the city.

While the proposed amendments narrow the intent of the Bill, we still believe the result of AB 1168 will likely be widespread fragmentation of the organized, efficient and effective EMS system of today and a reversion to the disjointed state that existed prior to the implementation of the EMS act. We still believe cities and fire districts will be able to deem themselves till one entities moving forward, allowing them to leave existing agreements with counties at will.

Counties will then be forced to open up already complex ambulance contracting processes while scrambling to provide continued service to impacted residents. We foresee a reduction in quality of care and deepening of health disparities for rural communities and low-income or historically underserved populations. Mr. Chair, while we appreciate the proposed amendments, it still abrogates the Oxford versus Ventra ruling and does not alleviate broader county concerns for the reasons I outlined. California county strongly urge you to stand for our communities and vote no to AB 1168.

Thank you, sir.

Hello as I introduce myself to my patients. Hello, I'm Nathan, the paramedic on the ambulance. I have 17 years of Sonoma County EMS experience. I'm a field training officer and an AFSCME, a Local 4911 member, and most importantly to today, I am your EMS. I'm the guy in the back with you. Because of all of this, I must oppose Assembly Bill 1168. First, I must echo concerns about regional RFPs creating equity and measurable accountability across the region.

I am the person that is face-to-face with my patients. So the cost and quality of that care and service is deeply important to me because to my patients, I am the 911 system. It has been argued that this is improving on the model, but understand that is not what has been attempted. There is numerous avenues for that improvement is multiple disciplines working together led by a physician. This is because some people on this point. This is because some people have not gotten their way.

I must also point out a clear contradiction in this Bill. Section two e states that this Bill will not modify, affect, or limit the role of the Medical Director. That is not achievable. When section 2d authorizes departments to remove themselves from RFPs, those are mutually exclusive and cannot coexist. I have to also highlight the loss of regional billing will severely restrict EMS union's abilities to negotiate livable contracts affecting over 70% of California's EMTs and paramedics.

That is an attack on bargaining on a scale we have never seen. I ask you to deeply consider how would you want your EMS ran by the desires and opinions of one person. Without enforcement, largely accountable. We must have region-wide LEMSA, physician led, science-driven EMS accountable and enforceable care and service and that the people providing that care are represented and compensated fairly. And we do not see the amendments as presented as having a positive effect on that. Thank you very much.

Thank you. Others in opposition, just your name and organization if you represent one, please.

Shelly Hudelson, I am the Labor National Representative for The International Association of EMTs and Paramedics and we oppose. Thank you.

Jocelyn Paulson. I'm President of AFSCME Local 4911 representing EMTs and paramedics throughout the State of California and we oppose. Thank you, Members.

Janice O'Malley with AFSCME, California. We appreciate the Committee's work on the Bill. Yet even with the chair's suggested amendments we still believe that 1168 will lead to a fractured emergency services system and ultimately neglects the impacts to the EMS workforce. Therefore, we remain opposed. Thank you.

Thank you. Just your name and organization. I mean, please.

Adrian Soto, EMT, Member of TEMPSA, I oppose.

Thank you.

My name is Stephen Stone, I'm a member of TEMPSA and I oppose 1168.

Thank you.

Latifah Alexander with the Association of California Healthcare Districts in opposition.

Thank you.

Good afternoon. Lindsay Gullahorn, on behalf of San Bernardino County, respectfully opposed. Thanks.

Thank you.

Thank you, Chair and Members Jonathan Feldman, on behalf of the 911 Ambulance Alliance, opposition.

Thank you.

Good afternoon. Brian Henricksen with Global Medical Response, here in opposition. Thank you.

Good afternoon. David Magnino, representing Sacramento county, opposed, and also representing the Emergency Medical Service Administrators Association of California, opposed.

Thank you.

Good afternoon. Jeremy Shoemaker, American Medical Response, Riverside County, opposed.

Thank you.

Good afternoon. Chris Grogan with the Pray and McKayli on behalf of Covalent Health, in opposition.

Thank you.

Good afternoon. Jean Hurst here today on behalf of The Urban counties of California and the Ventura County Board of Supervisors, in opposition.

Thank you.

Sarah Dukett on behalf of the Rural County Representatives of California and in opposition.

Good afternoon. Michael Cohen, Medic Ambulance, in opposition.

Mr. Chair and Members Betsy Armstrong, on behalf of the County Health Executives Association, representing local health departments, in respectful opposition.

Thank you.

Aaron Vaughn, EMT, Medic Ambulance. We oppose.

Thank you.

Lisa Curly, Medic Ambulance and I oppose.

Thank you.

Hello. Steven Buckner with Medic Ambulance. I oppose this.

Thank you.

Catherine Houston, United Steel Workers District 12, in opposition. Thank you.

Thank you.

Good afternoon. I'm Mike Hesslinger, Regional Director for AMR, in Monterey, Santa Cruz, and San Bernardo counties, and I ask that you strongly oppose. Thank you.

Thank you.

Hi there. Todd Day, Rural Metro Santa Clara County, opposed.

Thank you.

On behalf of San Mateo County Board of Supervisors, in opposition.

Thank you.

Hi. Katrina Garcia, paramedic, American Medical Response from San Joking County, and I oppose.

Thank you.

Hi, I'm Aaron with AMR, Tipa Local Two, and I'm President. I oppose.

Thank you.

Good afternoon. Nicole Henderson, Global Medical Response. I oppose.

Thank you.

Carl Spore, representing the EMS Medical Directors Association of California. We oppose.

Thank you.

Kim Freeman, Bi-county Ambulance and Tuolumne County EMS Agency, opposed.

Thank you.

Good afternoon. Brian Hajik, American medical response. San Joaquin County, stand opposed.

Thank you.

Katie Andrews, Tuolumne County EMS Agency, opposed.

Thank you.

Elizabeth Lickland, paramedic with San Joaquin county, in opposition.

Thank you.

Tiffany Riddle, paramedic for San Joaquin County, in opposition. Also, we'd like you to remember that we, too, dedicate our lives.

Thank you.

Elias Estrada, EMT, San Jose County American Medical Response, opposed.

Thank you.

Hi. Rachel Blucher, on behalf of the counties of Contra Costa and Yolo, in opposition.

Thank you.

Good afternoon. James Trinkera, AMR San Joaquin County and I oppose.

Thank you.

Eric Rice, paramedic supervisor, San Joaquin County AMR. We oppose.

Thank you.

Good afternoon. Brian Shapina, Chief Shop Steward of San Joaquin County. We oppose.

I hope you all left somebody in San Joaquin county.

Good afternoon. Gabriel Cruz, with American Medical Response, in opposition.

Thank you.

Good afternoon. Jill Vincent with American Medical Response, opposed.

Thank you.

Ryan Sack, AMR. I oppose.

Thank you.

Chad Newland, American Medical Response opposed.

Thank you.

Danielle Lance, GMR, opposed.

Thank you.

Good afternoon. Douglas Brim, Yolo County EMS Agency administrator, representing Yolo County EMS Agency and opposed.

Thank you.

Good afternoon. Mike Romo, San Bernardino County AMR. I oppose.

Thank you.

Heather Watts, San Bernardino County AMR, opposed.

Thank you.

Diana McCaferty, AMR San Bernardino County and I oppose.

Thank you.

Mark Beldon, American Medical Response Shasta County, opposed.

Thank you.

Tyler Herd, representing 4911. I oppose.

Thank you.

Madison Wyan, paramedic, Local 4911. I oppose.

Thank you.

Richard Lemon, AMR Shasta County, respectfully opposed.

Thank you.

Michael Lysen, paramedic, AMR Shasta County, opposed.

Thank you.

Leslie McCoy, Shasta County. I oppose.

Thank you.

Jeff Meisner, labor representative for United EMS Workers, in opposition.

Thank you.

Fergie Bradley, AMR San Francisco I oppose.

Thank you.

Lee Alameda, TEMSA United Steel Workers International Union Local 12911, representing Members from Los Angeles to San Francisco. We oppose.

Thank you.

Sam Adeluna, paramedic, Riverside County AMr and United EMS Workers. I oppose.

Good afternoon. My name is Jennifer Curles. I am a paramedic for Stanislaus County, also Chief Steward. We oppose.

Thank you.

Rod Brohard, American Medical Response. I oppose.

Thank you.

Good afternoon. Cassie Medeiros, AMR for City and County of San Francisco and we oppose.

Thank you.

Good afternoon. Michelle Franklin, Clinical Manager, Rural Metro California. We oppose.

Thank you.

Daryl McCranahan with Rural Metro Ambulance in Santa Clara County. I oppose.

Thank you.

Jason Chan with City Ambulance of Eureka and Vice President of the California Ambulance Association. We are opposed.

Thank you.

Jacob Frummer with Sonoma Life Support, opposed.

Greg Jitsey, Sonoma Life Support, opposed.

Thank you.

Suzanne Cisna, Santa Clara County. I am a registered nurse and I oppose.

Thank you.

Malcolm Graham, AMR Hemet, Riverside County, opposed.

Thank you.

Susan Nelson, AMR, paramedic and Hemet in Riverside County opposed.

Thank you.

Garland Carpenter, Paramedic Field Training Officer, Riverside County. I oppose.

Thank you.

Nick Graham, AMR Hemet, Riverside County. I oppose.

Thank you.

Ambrose Stevens, AMR, Sonoma Life Support. I oppose.

Thank you.

Johnny Crystalinas with Alpha One Ambulance. I'm a paramedic and Emergency EMS Interfacility Transport Manager, and we're in opposition.

Thank you.

Good afternoon. Ken Liebman, American Medical Response, Los Angeles County, opposed.

Thank you.

Daniel Iniguez with Global Medical Response in Stanislaus County, opposed.

Thank you.

Good afternoon. David O'Gain, AMR, Riverside, Southern California. We oppose.

Thank you.

Good afternoon. Peter Goyhanich, Sonoma Life Support. I urge you to reject this Assembly Bill.

Thank you.

Good afternoon. Alex Hazte, Rural Metro, Santa Clara and I oppose.

Thank you.

Afternoon. Melissa Lionelli, Sonoma Life Support, in opposition.

Thank you.

Katerina McNulty, Sonoma Life Support, opposed.

Rachel Fanning, San Diego AMR CCT, RN, Union President, in opposition.

Thank you.

Julie Bell, AMR San Diego, in opposition.

Ben Miller, AMR San Diego, in opposition.

Teresa Rios, Monterey County EMS Agency Director, we oppose.

Thank you.

Good afternoon. Joe Chidley, American Medical Response. I oppose.

Good afternoon. Esequiel Hernales, American Medical Response, San Mateo County, strongly opposed.

Thank you.

Terrence Flores, AMR San Mateo County, opposed.

Thank you.

Good afternoon. Deanna Sanchez, AMR San Mateo County. We oppose.

Sean Rogoff, AMR Napa County, in opposition

Thank you.

Jesus Guerrero, Alameda County and I oppose.

Thank you.

Good afternoon. Jo Leonadera with the California State Association of Counties, in opposition.

Thank you.

Good afternoon, Mr. Chairman. Michael Oliveri, AMR Alameda County, opposed.

Thank you.

Jason Bond, Napa County AMR. I oppose.

Thank you.

Nicole Hicks, AMR Napa, opposed.

Thank you.

Richard Long, AMR Napa. I oppose.

Thank you.

Kevin Mercer, AMR San Diego, and Imperial County, in opposition.

Thank you.

Brandon Walls, Imperial County AMR, opposed.

Thank you.

Paul Forney, AMR San Diego County, opposed

Thank you.

Tom R. Joe, Alpha One Ambulance, Chief Executive Officer, opposed.

Thank you.

Mark Mendenhall, AMR Sacramento, opposed.

Thank you.

Paul Maxwell, Imperial County and San Diego County AMR, opposed.

Thank you.

Michael Jones, Alpha One Ambulance, Chief Administrative Officer, opposed.

Thank you.

Nick Koibian, Alpha One Ambulance, opposed.

Thank you.

Matt Burrell, Chief Operations Officer, Alpha One Ambulance, opposed

Thank you.

Mike Ryder, EMT, opposed.

Thank you.

Noemi Nava, NHIIAP, AMR, opposed.

Thank you.

Michael Rice, Vice President, GMR, opposed.

Thank you.

Arlene Sacamonians, AMR Placer, Sacramento, and Yolo, opposed.

Thank you.

Sean Walters, Paramedic, San Diego County AMR. I oppose.

Thank you.

Paul McKee, San Diego Emergency Medical Services Association also opposed.

Thank you.

NICK Hooker, AMR Placer, Sac, and Yolo Counties, opposed.

Thank you.

Michael Strechia, AMR Placer, opposed.

Thank you.

Mike Sanders, AMR Gold Coast, and Ventura County and I oppose.

Thank you.

Good afternoon. Charles Arval, on behalf of AMR Ventura County and Local UMSP 1, opposed.

Thank you.

Ivan Mendez, Imperial County AMR, and Union President. I oppose.

Thank you.

Jeffrey Winter, Operations Manager for Gold Coast Ambulance currently serving the City of Oxnard, opposed.

Thank you.

Good afternoon. Jeffrey Schultz, Operations Manager, AMR Ventura County, strongly opposed.

Thank you.

Susanna Silva, AMR San Diego. I oppose.

Thank you.

Claudia Rempel, AMR San Diego, in opposition.

Thank you.

Good afternoon, Mr. Chair. Sean Sullivan, Life West, opposed.

Thank you.

Good afternoon, Mr. Chair. And Members Karen Lange, on behalf of the county boards of supervisors in the counties of Kern, Merced, Napa, Nevada, Placer, Shasta, Stanislaus, and Tulare, all in opposition. Thank you.

Thank you.

Mike Noon, the EMS Administrators of California, opposed.

Thank you.

Gagandeep Greywall, Emergency Medical Directors Association of California, opposed.

Thank you.

Berto Hernandez, Paramedic, Chapter President, United Local EMSW 4911, opposed.

Thank you.

Mr. Chair and Members Sean Henschel, regrettably still opposed on behalf of American Medical Response. Thank you.

Thank you.

John Poland, representing the Sierra Sacramento Valley EMS Agency, in opposition.

Thank you.

Good afternoon. Sean Vincent, representing the Napa County EMS Agency, in opposition.

Okay, thank you.

Good afternoon. Marshall Bennett, representing Contra Costa County in opposition.

Thank you. Anyone else? Seeing no one. Bring it back to the Committee. Questions or comments? Mr. Rodriguez, I assume you have a question or comment.

Yes, I have several questions, comments. Don't know where to begin yet. First of all, before I begin, I really want to thank all the EMS workers, whether you work for a private or public agency, my hats off to you guys for what you do day in and day out protecting Californians. As some of you may or may not know, I've been an EMT for over 34 years now. So I worked a lot in Southern California, particularly the L.A. County area.

So this Bill is really difficult for me in some points because I get it where you're coming from on both sides. I have good friends on both sides, either firefighters or in the public EMS agencies. But I just wanted to touch base on some of the comments that were made on both sides on the support and opposition. I'll just start with the opposition really quick. I know, I'm sorry, Doctor, I didn't catch your name.

But you talked about this 40 years of EMS in the industry, right? That we've had all these laws and things done, and really, it doesn't seem like there's a big deal in changing things because things seem to work well in. I forgot what county? Santa Barbara County? I forgot where it was. Right?

In Ventura County. I work in both, but yeah.

And I think, yeah, I guess you're true to a degree that maybe some counties do a better job than others in providing service, really, at the end of the day, because they're very dynamic. The rural settings or the urban settings. So I think because it's been such a long time, over 40 years, I think there has to be some changes on the way we provide service.

To me, at the end of the day, whether it's a private or public ambulance responding to any emergency in California, that they be there in their contracted response times, whether it's the eight minutes, 10 minutes, whatever it is. But I think now we're living in a different age. Right? I think the pandemic has really moved us in a different direction, providing, in this case, emergency care to our communities throughout California. So 40 years, it's been a long time.

I think we reevaluate policies and procedures moving forward. And once again, like I said, some counties do a better job than others. And that leads me to believe that the next question is for folks on the support side. Chief from Oxnard, you said in your comments the reasons you guys had this issue because there was over, I think, 1900 times an ambulance wasn't available. Do we know why an ambulance wasn't available to respond to those calls?

Apologies. Committee Member Rodriguez, generally, those ambulances were moved out of the ASA Six Area, which is in the City of Oxnard, to cover other areas of the county. And it was 1200 times in 2019.

And that was in one full year?

Correct.

So that was obviously in violation of the contract agreements.

The contract doesn't cover absences within an EOA, but it does contribute to those late responses that we were having, because we're often having ambulances come in from outside the area, and so obviously, they're not making their eight-minute compliance. And we see that most definitively in, like I said, the poorest areas of our city.

And would there be a reason why, if anybody can answer why in these disadvantaged communities we're having long response times? Could anybody answer that question?

I don't have a good answer for that question other than those ambulances are getting moved to, they're moved to other areas of the county where arguably there's better reimbursements. But I don't have a good answer. I'd just be speculating.

And that just comes to my question why we're living in a day and age, and it doesn't matter where you live, that that ambulance should be there per that contracted agreement. So maybe for the firefighters here, I know we talked a little bit about the origins of the Bill, but really, what was the intent of the Bill? Is it to improve emergency response or outcomes of patients at the end of the day, moving this Bill forward?

I guess I'll take that. Thank you, Assembly Member. I think, from the CPF's perspective, this measure has created ambiguity in whether or not these jurisdictions that entered a JPA have their rights, or if they're going to go into a JPA in the future, will they have their rights? From the CPF's perspective, this is all about patient care. Whether the service would be being provided by a public provider or a private provider, like every one of your constituents deserves high-quality EMS services should they call 911 and need them.

And I think our focus here is to create that clarity. And in places where there could be a partnership between a jurisdiction that currently has their 201 rights and a broader area of the county to work together to improve service, we think that should be done. We do think this Bill provides that clarity for those people moving forward.

And I would just note that we are not aware of any case law that suggests you can write into a contract that this doesn't affect your 201 rights. As this Committee knows, there are multiple bills that work on various policy issues around EMS services. And oftentimes you will see a provision that references rights under 1797.201 and 1797.204 and that is just to make it clear that the Legislature is saying that we are not trying to. Doing an activity is not intended to interrupt those rights.

Okay. Also have a couple more questions for you, Doug. On that note, in this area, like what's happening in Oxnard and maybe others, that this would impact. What type of impact will this have on the private EMS workforce out there that's currently there if we do that change?

So the only example that I could speak to, and maybe I will defer this to Chief Hamilton, that was when the City of Oxnard did attempt to exercise their rights. Prior to the litigation, they were going to work with an existing private provider to deliver the service. Should this Bill become law and someone in the future exercise their rights that are in a current JPA, I would be speculating about who's going to deliver that service.

Could it be a public private partnership or could it be just a public agency? I would only be speculating there, and then going forward, it would be largely dependent upon an agreement between a city and the county for the delivery of services. Would it be to supplement existing providers or in lieu of. I mean, it would just be dependent on the circumstances. The one that we're aware of relative to this Bill is certainly the City of Oxnard and the County of Ventura.

Yeah, because I'm hearing from a lot of the folks on the opposition that if this Bill to go through, that pretty much is going to shut the door to the private sector EMS, because there'll no longer be a need for them because the departments will do their own. So it just kind of makes, if there's any clarifications in that, because once again, this Bill is only narrowed down to 10 JPAs. Really.

This isn't a statewide mandate, correct?

That's certainly the intention of the Bill, Assembly Member, is to address those JPAs that we have found to be where fire is providing EMS. There are 62 total that are referenced in the analysis, and about 10 of those, our assessment, are the ones that do ambulance services. We have then tried to go through each of those and determine who would have 201 rights, because that is another key portion of the Bill.

But the intent here is not to generate a massively broad application, I think, of the provisions here, and I think the Chair and Committee staff were working on amendments to attempt to make that clear, and I think that is the intention there to narrow it down to the universe that we know.

Chief, do you had a question? Follow up?

Yeah, just a quick follow up. I will say that I'm a strong proponent of the public private alliance. I think there is absolutely a role for private providers to play in the emergency medical response arena.

But to your question about the pay and working conditions, what we had dictated in our contract with Falcon Ambulance under that alliance model was that EMTs would receive an increase in their pay of 21% and paramedics would have an increase of 32% in their pay of what the pay was at that time. Additionally, their working conditions would be improved because there'd be none of the non-emergency intra-facility transports that the current 911 units have to do.

And they often have to do these in the middle of the night when the 911 responses slow down. Separately, we were dictating better equipment on those ambulances, things like power lift cots, so that they can save the EMTs' and paramedics' backs. And so we were very conscious of making sure that the working conditions were going to be improved for those EMTs and paramedics through our alliance with Falcon Ambulance.

Okay, one last question, probably for the firefighters. Will fire districts or cities that assert their 201 rights self-regulate their goals, or LEMSAs continue to ensure the response rates in current standards?

Thank you, Assembly Member. It's certainly my understanding that any fire agency that would be delivering EMS services in a LEMSA would be subject to the rules and regulations that a LEMSA has regarding medical protocols and et cetera. A Department could certainly act within its service system to determine, I guess, where units are allocated. You have strategically located firehouses already in communities, so I think there would certainly be the oversight from the LEMSA, and we don't see this Bill undermining that.

And then it would be dependent on the situation, I think.

Okay, that'd be my last question for now. Unless somebody has a question.

I'm sorry to be out of turn. May I add some answers to your.

Go ahead.

Through the chair?

Thank you. So I want to be clear. I can't speak to the specific experience in Oxnard County. I don't serve that area. But you had asked a question initially about response times and level zero, or there being no ambulances available and what might contribute to that. So I think if you have the experience in EMS, you know that pretty much every system has things that influence the amount of available ambulances and at any given moment.

Okay. Yes.

And there was a concern about delayed response times in particular areas. I think that in the environment around an RFP that has contractual language for response times that are mandated and enforceable, if that's not occurring or if that's not adequately serving the community, to make an effort to enforce that language or strengthen that language, I think is definitely potentially something that's important.

Again, I can't speak to the specifics of Oxnard, but to take the step of removing an agency from the RFP that then suddenly does not have response time requirements that are only existent inside of an RFP, I think is the opposite move towards addressing concerns around response times. Right? So I think that's one element to response times. And you had also asked a question about medical direction.

And I think the conversation of response times and medical direction have been interesting hand in hand in this Bill, because the statement is made that this Bill does not limit the role of a Medical Director. The Bill talks a lot about response times negatively impacting patient care.

And in an environment where a Department removes themselves from an RFP and there is no enforceable response time requirements, I do see that as limiting the role of a Medical Director to enforce language that was previously existing, that now has been removed because there is no more RFP. So hopefully that answers, zero, and then I also wanted to speak to the impact on the workforce you had asked about.

So I think we can all understand that the pooling of resources in a region creates more services and more available resources for both the community members as well as unions. Right? And I think that as they've talked about, to remove themselves from a Bill, remove themselves from an RFP, it only has to be certain counties or certain cities that have the financial means to do so. So in the context of the workers' rights and the limitation on the workforce. If the most lucrative cities in a region have the financial resources to remove themselves, and then they do that, the abandoned ones are presumably the ones that don't have those resources.

And so to have the union be able to negotiate equivalent contracts becomes much more difficult, because down to this analogy. But the meat on the bone has already been removed and is serving a particular city as opposed to the county. So I hope that that provides some context for your question, from my perspective.

Doctor, did you have a question?

Yes, thank you, Assembly Member Rodriguez, through the Chair. I think, obviously, we don't want to relitigate the case in Oxnard, but it's safe to say that Ventura County has a much different perspective of the data. I'm ethically obligated to make sure the system is as functional as possible, and I would never create a system or allow a system to continue that was neglecting certain areas of the county.

When we read the data, we found areas of the county with very high income areas or wealthy areas that had longer response times than Oxnard. And I think so that kind of goes against the narrative that they were targeting certain areas. And we have an exclusive system, so the ambulance provider is getting the transport either way. So it doesn't really benefit them to just focus on one area and neglect another. And the EMS Act is 40 years old, but the systems are not.

We are constantly innovating, and as new techniques develop, as new methods of deployment and sort of response, we're always thinking about doing EMS assessments and trying to improve the system we provide to our communities. And that's where the competitive procurement process is important, because the bidders can give their vision for the city or for the county, and the counties can analyze that and find the best option for the county and we can move forward.

Okay, thank you. Once again, I'm just talking about how there's a need in some areas to make some changes, right. If the system is working great the way it is, leave it alone. But if there's other areas where we're having some issues with response times or the delivery service by whether it's the private or the public agency, there has to be changes. We can't continue kicking the can down the road like they say. This Bill came to us last year.

Unfortunately, it came towards to the end. We really couldn't have any discussions and the Bill didn't move. It's back here today where now we can have some discussions about it moving the Bill along, because definitely there is a need for some type of changes. Right? And everybody's going to learn to, we're not going to be able to get everything, but we're going to learn to agree and disagree and hopefully come to a better understanding. How do we provide EMS services across the state?

And once again, you should not be waiting for ambulances in these disadvantaged communities. As one of the references, we talk about why this Bill came forward. It may be just a staffing issue, whether it's the private agencies or the public agencies, but we should not once again, delay the responses to our communities in the state.

Once again, this Bill has me very torn about both sides, but I think this is a very important that we need to continue having this discussion and hopefully getting in a better place with everybody and really ultimately making sure that those ambulances are responding appropriately, as they should. So I know we don't have a quorum yet, but I'll probably be looking to support this Bill to continue that discussion because I think it goes to another Committee after this one.

And with that in my comments, I'm sure Chair, you might have something to say as well. Thank you.

Thank you, Mr. Rodriguez. So a question to the chief from Oxnard. Excuse me. You mentioned something about interfacility transports. Could you repeat what you said? You said something about negotiations regarding.

So one of the things that. It was in reference to improving the working conditions of the paramedics and EMTs through the alliance that we had with Falcon Ambulance. In the current system, 911 ambulances are occasionally pulled away from 911 response to do these non-emergency intra-facility transfers, and often those transfers will occur in the middle of the night. So an EMT or a paramedic that's been working on an ambulance all day running 911 responses is then asked to do a non-emergency transfer during the night.

The day after that, the City of Oxnard council voted to leave the JPA. We had a full arrest call in a lower socioeconomic area, and the ambulance assigned to that area was down in Los Angeles running an IFT call at the time, resulting in a late response from the next nearest ambulance. This is an example of what happens on the ground for us when they do these non-emergency IFT transfers.

So don't some of those IFT transfers come from hospitals to go to, like, skilled nursing facilities or other areas which then free up hospital emergency rooms and beds?

Absolutely. And there is absolutely a role for IFT ambulances to play, but I don't like the idea of moving ambulances that are dedicated for 911 response away from 911 response. I would way prefer have those units available to respond to emergencies and have other ambulances available to do IFT responses because you're absolutely right, they play a critical role in the system. They do need to move patients out of the hospital so that the hospitals can accept more patients.

Okay. Just these, these things just add to the complexity of this entire subject and which is really challenging. So I do not envy you, Mr. Bennett. You're sitting between a county on one side that's in opposition, a city on the other side that's in support of this Bill. You're in a no-win situation, so God bless you for that. But at the end of the day, we have healthcare districts in opposition, counties in opposition, labor in opposition.

I didn't know Steel Workers actually represented EMS folks as well. We have a Medical Director in opposition. We have a city in support. We have CPF in support. Just a couple of other comments. Those are just observations. So I would say, and my friend Mr. Rodriguez and I honor his work and all the years and everybody who provides life-saving services here. In my district, the north coast, it's 300 plus miles from north to south. I have one of the largest districts in the state.

If we had eight minute response time in every part of my district, I don't know how many ambulances we'd have. We'd have a whole lot of them. We will never be able to achieve that kind of response in my district because of the nature of the geographic centers and the rugged nature of the district in general. My concern with the Bill from the beginning has been what I continue to worry about is further fragmentation of an already challenged system here.

And as I said, my preference would be for supporters and opposition to get into a room and work this out in a way that we could come to some agreement that maybe merits a legislative proposal or maybe not. But what I would say is that this is the first committee and I want this conversation to continue. And that I believe that is in light of the fact that it doesn't appear we're going to get everybody in a room to really work this out.

And maybe you can, Mr. Bennett, I hope you can. But we need this discussion to continue going forward. And so when there is a quorum, I will recommend an Aye vote to keep the conversation going. But I will remind you that if the Bill does make it through both houses and it doesn't come back in a format that suits the concerns of the Committee, this Committee does have the last say. So with that, would you like to close?

I would normally like to close with just a respectful request for an Aye vote, but I don't think that's appropriate in this situation. So if you will indulge me to make some comments, I would appreciate it. Number one, again, I recognize and I appreciate the sincerity of your comments as you go forward in terms of what your goal is, which is we don't want to fragment the system. And I appreciate Assembly Member Rodriguez being here and asking those thoughtful questions.

And Assembly Member Aguilar, this is a Big Committee, and there's three of you here, and there are many other Committee Members that I wish could hear this. The first thing I'd just like to say is, it was good for me to be here today because it was good for me to hear the fear that I'm hearing from people out there. If, in fact, I thought this was going to destroy my union, it was going to destroy my working conditions, I would be fearful about this.

And whenever change is made, when you do public policy, it is easy to have the portrayal of some part of a Bill and portray it in a way that escalates the fear or doesn't. And I'm not saying it's wrong to escalate the fear. That's just a fact. People link this, then this means this, and then this means regionally you can't Bill, and then therefore you lose the ability. Those are all logical questions to be asked.

And that's why, as I was approached about this Bill, I appreciated the challenge of saying, I think that I'm in a unique position to be able to try to bring that same conversation that you're talking about together. And so let me share something that is important, I think, for everybody to know. I served on the Ventura City Council and cities generally and hasn't been pointed out, but the League of Cities is the sponsor of this Bill.

While you've identified many people who are in opposition, you have cities across the state that many of them are overwhelmingly in favor of this change. And that's been the case for decades, that there's been this tension between cities and counties.

While I was on a City Council new to the City Council, didn't know very much, but I advocated, and I believe that having our firefighters, who have been transitioning more and more from just fire suppression to more and more medical calls and stuff, that it just made sense for them to be more involved in this. And I actually moved this forward unbeknownst about all of the things as a new City Council Member that was going on with the county and the EMS Act, et cetera.

Not long after that, the County of Ventura overrode the decision of the City of Ventura. That I actually came for presented. And I became a county supervisor for 20 years. And for 20 years I was a big advocate of EMS and a coordinated system. And I had learned from that experience that what I had created in the City of Ventura, unintentionally, was a truly fragmented system. The City of Ventura was just going to pull out and not pay attention to the unincorporated areas.

So I became a strong advocate for the EMS system. And I completely believe and support the doctor when he says, I'm not trying to discriminate with anybody when I'm managing the system, I'm trying to just do it. It's just difficult. And Ventura County is a classic example. It is a semi-rural county. We have very hard-to-reach areas like you have in your area. Some of those are enclaves of very high-income people, but hard to get ambulance service to.

And some of them are enclaves of very low-income, disadvantaged people, also geographically just very difficult to provide ambulance service to. And so as this came forward, I thought, I know this issue and I don't want to break the system up. I don't want to have this engender, undue fear in everybody that we're unraveling the whole thing.

So as the doctor spoke, what I heard was a comparison between what could happen if we unravel the system, a comparison between what was happening before we had a system and now. And I'm sure you don't want to go back there, and I'm sure I don't want to go back there. And I firmly believe that's what we'll come up with is something that does not take us back there.

But as Assembly Member Rodriguez said, after 40 years and after the experiences I've had on both sides of this, I do think that particularly with the recent ruling by the judge, it calls into question, is there a need for clarification after 40 years and a judge's ruling that says cities that didn't even know they were giving up their 201 rights gave them up?

Well, that seems like an appropriate time for us to have this conversation, and I hope we can have it in a way that does not cause the fear to go up, but is recognized by both the opponents and the supporters that we're trying to get to a place that clarifies those 201 rights, that clarifies that judge's decision, that allows for appropriate modifications, that allows for places where fire districts are really primed to potentially enhance the service of pre-hospital delivery and all of that, to have those fire districts where they're able to do that, be able to work with private ambulance, whatever system seems to work, but take advantage of that and have that conversation and have this Bill, as you said, be narrowly limited.

So there's two things I really appreciate. One, the failsafe, we will not leave the unincorporated areas right next to a city behind. And the reference that when they get out, they won't have any response times is not the Bill that I'm hoping is going to come out of this. The intention here is that they will still have to meet all the requirements that the EMS system puts on them, that the LE, whatever you call that leaf lesmus system, what's that? LEPIS system puts on? Right.

That they will have to have response times, they will have to have all this, they will be monitored. So by narrowing this, by having it limited, with the attempt that the Committee is trying to do, by having them recognize that they're pushing for a limited Bill, not the Bill they did last year, where they just wanted to wipe out the system, have it apply countywide, I think this is an appropriate time for us to continue to have that conversation.

And finally, the way I envision it, just in clarity with the Chair, because we will have more conversations on this, I am sure if this passes out of this Committee, is that the intention is a city and their fire district, assuming in this situation would have to negotiate with the County of Ventura, we want out, what's the right way for us to get out?

Maybe the County of Ventura will say, well, you just go ahead, go on, because we can actually do the rest around you better without you. All right, that could happen. Or they'd say, no, you've got to take all of this stuff because we can't do that properly. But there's going to be a negotiation. There's going to be this healthy collaboration about what the best system is.

And maybe after 40 years, we may find that that enhanced conversation between cities and counties will lead to a better system in a few areas, and we can all learn something from that to decide whether there should be more or less or whatever. And if you're terrified that this might ultimately change the system, yes, you will then not want to have any change.

But if you have confidence that you're providing good service already, that if the elected representatives of the people that you're serving are comfortable with what you're doing, you ought to have confidence that we should be able to find an appropriate combination here that works for everybody. Thank you for indulging me with that. And with that, I would respectfully ask for an Aye vote whenever you have a quorum here.

Okay.

And I genuinely look forward to talking to anybody in the opposition that wants to talk about where we go. Thank you.

Great. Thank you, Mr. Bennett. I want to thank the witnesses. I want to thank everybody who traveled here to be here today for this discussion. This is the first committee. There will be additional discussion going forward, and I look forward to those discussions. Like I said, when we have a quorum, the Bill will enjoy a do pass recommendation. Thank you, Mr. Bennett. Thank you to the witnesses. We'll wait just a minute to let people move out if they'd like to.

Okay, Ms. Bauer-Cahan, are you ready? Whenever you're ready.

Thank you, Mr. Chair.

We promise us to be slightly shorter than the last one. We're here to present AB 352, a Bill to further protect reproductive rights by preventing information on abortion from crossing state lines. This Bill came to me a year ago in the midst of the post Roe work we were doing.

A Doctor in my district who provides abortions in the hardest to reach parts of California and beyond, in border states where people have to leave their own states to go access abortion came, and she had been in one of those border states and noticed that the electronic medical records were crossing state lines, and she was able to see every single thing that was happening in another state.

And she realized that for those patients crossing state lines, taking the time and effort and at times risk to go receive that health care, the information was seamlessly shared back to their home state, risking both criminal and civil penalties depending on what the state has done at this point.

So as our further efforts continue to protect those accessing safe and legal abortions here in California, we are bringing this Bill forward to protect the privacy of our patients, to ensure that they have access to that safe and equitable health care, including abortion, and in so doing are protected from those records going out of state and them facing that liability. With me today is Lisa Matsubara, Vice President of policy with Planned Parenthood, and Dr. Michelle Gomez, a family medicine physician and abortion provider.

Please.

Good afternoon, Chair Wood and Members. I'm grateful to be here in support of AB 352. My name is Dr. Michelle Gomez, and I'm a family medicine physician and volunteer clinical faculty with UCSF School of Medicine in California. I've been providing and teaching both primary care and abortion for 20 years, and I'm here today because I'm deeply concerned for my patients and my colleagues. First and foremost, abortion is safe, effective, and a common procedure with Low complication rates.

Decades of studies support the safety and efficacy of abortion procedures, including medication abortion. When patients seek this care in California, we must do all we can to protect their confidentiality, particularly if that patient is traveling to California for care and must return back to their home state where abortion may be banned or criminalized.

While the exchange of electronic medical information is valuable in making sure providers have essential information to provide appropriate care in states where abortion is criminalized, the exchange of information may expose patients to prosecutions and other state actions that are harmful to them. Let me give you two examples from my own experience. I have patients who live in Texas who come to me for abortion care in California.

In one case, a Texas patient returned home to Texas, continued to experience bleeding, and sought follow up care in the emergency room that day, I got a notification through my electronic medical record that the patient was seen in a Texas ed. I could see the whole visit, and it occurred to me that the provider that saw the patient in the Texas Ed could also see her entire visit with me, that the Texas Doctor could see that this patient had had an abortion in California.

The chart also showed that the patient was referred to an OBGYN in Texas who could also see that she'd had an abortion in California. At a time when Texas law is trying to punish providers, patients, and those who help patients under the state's abortion ban, I wondered how many other people, nurses, social workers, billing people, etcetera, had access to that information through the patient's medical record.

Under Texas law, I could be punished with life in prison and or a $100,000 fine just for helping a patient do what she felt was best for her own body and her family's future. Also, under Texas law, anyone close to my patient who may have known what she was doing could be sued for $10,000 and serve up to five years in prison for aiding and abetting her.

I also have a colleague who reported that a patient who traveled to her for care from a state with an abortion ban went back to their home state, where information in their medical record related to the abortion care they received resulted in a report to Child Protective Services. This patient is now dealing with the ramifications of being accused of being an unfit mother. As a mother myself, I cannot even imagine that heartbreak and fear.

Other providers have also shared that they've resorted to using paper records rather than the electronic health records for out of state patients to better protect their confidentiality, a move that makes it harder to reconcile the patient's medical charts and may expose providers to other forms of legal liability. This is urgent. We do not want to wait until someone is harmed before we do something in California to protect abortion patients and providers. These are real lives with real consequences.

And California has the opportunity to continue to be a leader in the fight for reproductive freedom and protect patient privacy. Thank you.

Good afternoon, Chair Wood and Members. My name is Lisa Matsubara. I'm the General counsel and VP of policy at Planned Parenthood affiliates of California, representing the seven Planned Parenthood affiliates throughout the state who operate over 100 health centers in California and provide over 1.3 million patient visits annually. I'm here today in support of AB 352.

For Planned Parenthood health centers, confidentiality is at the core of its role as a trusted healthcare provider, and patients should be able to access sensitive services, including abortion care, with dignity, compassion, and without fear of having their private information widely shared. The importance of confidentiality is even more important in today's legal landscape following the Supreme Court's decision in Dobbs that overturned the protections in Roe and now allow states to criminalize abortion.

As of today, 13 states ban abortion at all stages of pregnancy and five states have implemented previability bans, with several states also considering legislation that further restricts access. While I recognize the importance of the exchange of health information in caring for patients, we are now facing an unprecedented scenario where information that is a part of a patient's care in one state, when shared through an electronic health record system in another state, may put the patients and their providers that provided that care at risk.

A recent report by If/When/How showed that among people who are investigated or arrested for allegedly ending their own pregnancy or helping someone else do so, almost 40% of them came to the attention of law enforcement when they were reported by their healthcare providers. No patient should fear that their medical records would be used as evidence against them. And we must ensure that people who get care in California are not risking their lives and freedom when they return home.

AB 352 will provide further protections for medical records and make sure that California is a haven for reproductive health care. Thank you.

Thank you. Others in support? It's just your name and organization. If you represent one.

Good afternoon, Martin Radosevich, on behalf of CNMA and NARAL Pro Choice California in support.

Thank you.

Good afternoon. Chao Jun Liu with the Electronic Frontier Foundation in strong support. Thank you.

Alexis Rodriguez with the California Medical Association in support.

Thank you.

Ryan Spencer, on behalf of the American College of OBGYN's District Nine, we are co sponsors on the measure in support.

Thank you.

Taylor Jackson with California Health Plus advocates. Representing California's community health centers in strong support.

Thank you.

Veronica Villalobos Cruz with the California Latinas For Reproductive Justice and support.

Thank you.

Good afternoon. Onyemma Obiekea with Black Women for Wellness Action Project in strong support. Thank you.

Thank you.

Lucy Quacinella, on behalf of Maternal and Child Health Access, in strong support.

Thank you.

Mr. Chair and Members. Bryce Doherty, on behalf of the California Academy of Family Physicians and support.

Thank you. Anyone else? Okay, seeing no one, is there opposition to the Bill? Seeing no opposition, we'll bring it back to the Committee for questions or comments. Any questions? Ms. Aguiar-Curry?

I don't know how to say right now, it's been so upsetting the past couple of weeks. It goes from bad to worse. And I really want to thank you, Assembly woman, for taking this on. It's risky. People give us a bad time about things in this realm of talking about women's freedoms and reproductive work. And I'm really proud that you've taken this on and that your supporters here and sponsors realize and have brought it to our attention of what's happening in the inequities.

And so I want to thank you for bringing it forward, and I'd like to be a co author of the Bill.

Thank you. Dr. Weber.

Thank you. Thank you to the sponsors for this Bill. It is definitely needed. And I'm sorry, I was at another Committee. So I just want to make sure that I am clear that this is just for people who are requesting information out of state. Correct?

Do you want to address how it works?

Yes. The restrictions in sharing information is in response to requests from out of state.

Okay, perfect. And the only other thing that I would say, and maybe this was mentioned, is really figuring out when the particular patient would be consenting for this. Is it a one time consent or is it, I'm consenting to release this test versus I've got a consent to release the five tests that I have at different times. So is this information put in a pool of sensitive material? Because we have that right now with some of our electronic medical records, there's a pool of sensitive material.

And so if I'm consenting, it's really for all of that, or is it just one piece of that? So I know the discussions will continue, but that's going to be an important thing to kind of figure out to make sure that this is as successful as we'd all like it to be. But thank you.

Anyone else? Just a question. And first of all, look, I'm in support of the Bill, and when we do have a quorum, I'm going to recommend an aye vote. I do have a question and thinking, just as a medical provider, if a woman has a complication out of state, like your patient you talked about in Texas, and obviously the sensitivity about why there's a medical complication, how do we ensure that the patient is getting the appropriate care and that there is a diagnosis to support that?

Because if we don't have the information, then how do we know you're treating the right condition? Because the patient's not going to want to say anything. And what if the patient's unconscious? Maybe that's rare. That's probably extremely rare, but it is a possibility. If you've lost enough blood, you could be unconscious. So help me understand that we're not inadvertently creating a situation where someone doesn't get the appropriate care and they have a complication that could be avoided.

Absolutely. That's a great question. And of course, our primary concern is always for our patient safety. Fortunately, abortions are extremely safe. They're actually safer than carrying a pregnancy to term. So just for that perspective, it's probably 14 times more dangerous to carry a pregnancy to term in the United States than it is to have an abortion.

But right, sometimes there will be complications, and bleeding is one of the most common complications. Fortunately, it doesn't tend to be enough bleeding where people are unconscious. I don't have exact numbers for you, but I can tell you it's extremely rare that patients need a transfusion after a medication abortion, for example, which is what more than half up abortions are now. It's about one in 500 cases where patients need a transfusion. So it's extremely rare, less than 1% of the time. Are there significant complications.

However, if there is a complication that takes a patient to the emergency department, there is no difference between bleeding from an abortion or bleeding from a miscarriage. So that patient could still use it is a form of a miscarriage.

Right. The pregnancy is not continuing. So they could say that they were pregnant, they're having bleeding. They don't know why. It's up to them to share what they want to share. But there is nothing about bleeding from an abortion that would need them to talk about that. The treatment would be exactly the same. I would also say that in most cases, because it's uncomplicated, a first trimester, uncomplicated abortion is not relevant. Past medical history, it's like having an IUD placed.

So they certainly don't need that information unless there's a complication. I hope that answers your question.

Yeah. Thank you, and I appreciate that. Just kind of a follow up question. Is the information redacted or is it just not included? Because if you're submitting a report that's redacted, it's kind of a clue as to what the heck is going on or what has happened for this patient. So explain that to me, if you don't mind, please.

So I think in response to Assembly Member Weber's, there are some details on the implementation side that I think were pointed out in the Committee analysis that we are going to be addressing. But this Bill also has a provision in it that would require electronic health record systems in California to create certain technological capabilities to properly segregate the information.

And if I may, as Dr. Weber mentioned, this is not the first time that this type of practice is happening. Right? Substance abuse, for example. Patients can withhold that, and it isn't shared through electronic medical records. So the concept here is not a new one. We're just applying it to new areas.

Great. Okay. Thank you. Any other questions? Thank you. The Bill does enjoy do pass recommendation, and when we get a quorum, we're getting closer slowly, but anyway. So would you like to close?

Yeah. Thank you, Mr. Chair and Members, for your support and also for all that we've done as a Legislature. I think in the past week or two weeks, we saw a foreign state criminalize assisting a youth in accessing abortion out of state. Right?

So imagine the scenario where a young child, sexually assaulted, gets pregnant. Mom decides to take that child out of state to access abortion services safely and legally, and the medical records then are shown in state, and that parent is criminalized under human trafficking laws. That's what we're talking about here.

And people have a right to access safe and legal health care, and we want them to do it here in California, and we want them not to have the negative consequences that other states are trying to put on what is health care. So thank you. And I respectfully ask for your aye vote.

Okay. Thank you. When we have a quorum, we'll. We'll seek a motion and hopefully move your bill on. Thank you so much. Mr. Carrillo. Okay, we have Assembly Bill 503 whenever you're ready, sir.

Thank you, Mr. Chair. Thank you for allowing me to present Assembly Bill 503. And before I begin, I would like to respectfully accept the committee's amendments and thank the chair and consultant for all their hard work on this bill. AB 503 seeks to develop additional opportunities to register individuals as organ and tissue donors with the goal of increasing registration rates to save more lives.

Committee amendments specify that additional questions asking applicants if they would like to enroll will be limited to the online application known as a single, streamlined application. Committee amendments also specify that the questions be optional and not a required part of the application. Currently, more than 104,000 individuals across the country are waiting for life saving organ or tissue transplants. Nearly a fifth of these individuals are in California. All of these people in need of transplant nationwide, 17 of them die each day without one.

Because of this, organ and tissue donation is a vital process for improving and even saving the lives of Californians. Donate Life California is responsible for managing the state's organ, eye, and tissue donor registry, and prior to 2004, no registry had existed for those who wish to give consent to be an organ and or a tissue donor. Many of you probably recall being asked if you wanted to become an organ donor at the DMV.

This has been made possible through Donate Life California's partnership with the Department of Motor Vehicles, which began in 2006. To date, over 18.5 million individuals have expressed their intent to donate with registry, with over 98% of those coming through the donors of the DMV. Still, we need to do better. Roughly 90% support organ donation, but only 60% are actually signed up as donors. Since 2006, more than 600,000 lives have been saved or healed through organ and tissue donation because of the registry. This bill serves as the natural next step toward that goal. Joining me to testify in support and answer questions is Mr. Jim Martin, CEO of Donate Life California, and Lacey Felder, an organ recipient.

Push the button there, please.

Good afternoon Chair and committee members. Jim Martin, Donate Life California CEO. Thanks for the opportunity to testify on AB 503. As Assemblymember Carrillo stated, we're the nonprofit, state-authorized, organized tissue registry for the State of California and we were established in 2006 in partnership with the California DMV to register as many donors as we possibly could. In the 17 years since inception, we've had a great relationship with the DMV, resulting in the 18.6 million registered Californians.

There are 20,000 Californians that are currently on the national waiting list. Of those, 46% are from the Hispanic Latino community, 21% are from the white non-Hispanic community, 20% are from the Asian community and 10% are from the black non-Hispanic community. One person's donation gifts can save up to eight lives and improve the lives of over 75 others. While our partnership with the DMV has been amazing, we feel it's imperative really to shift the conversation into the public healthcare domain similar to any other end-of-life decision and or advanced directive.

The increased frequency and repetition of the organ donation registration question on the healthcare registration forms is a huge first step in reframing organ donation and transplant as a public health issue, and we believe 503 is the mechanism to make this important and substantive change. AP 503 provides a critical opportunity to increase the number of registered donors in California and the bill requires the application for insurance affordability programs to include a checkbox.

All individuals can therefore give their consent to enroll in the donate life organ and tissue donor registry. We believe this bill will significantly impact the number of those registered in California. And we appreciate the efforts of Assemblymember Carrillo in introducing this important legislation. Urge your support. Thank you.

Thank you. Please go ahead.

Good afternoon, Mr. Chair and members. My name is Lacey Felder, and I am honored to say that I am the program manager at Donate Life California. When I was 10 months old, my parents were told that I was in heart failure. I had caught a virus that attacked my heart, and a heart transplant was the only option for me to live. I'm humbled and proud to be able to stand before you today because a family said yes to organ donation. My donor's name was James.

He was 22 months old, and he was in a tragic accident right here in Sacramento. Last October. I celebrated 32 years with baby James's heart, and I live each and every day for James and his family. The most challenging aspect of advocating for organ donation as a recipient is the fact that we look like normal people. You can't see the hundreds of inches of scars or the straight gratitude that we feel for simply living.

My journey hasn't been an easy one and became even harder when I was diagnosed with kidney failure in high school. I'm so lucky that my brother Tyson, my hero, stepped up and donated his kidney to me in 2006. Because of Tyson and baby James, I have been the first person in my family to graduate college. And most recently, I got to marry the love of my life. And we are now on the journey of starting a family through surrogacy.

Organ donation doesn't just save lives, it transforms them. It creates memories, experiences, and milestones that we never even knew were possible. I'm going to be honest. When writing this testimony, I really struggled in finding the words to capture what this moment means to me. Walking past the Capitol fills my heart with pain and gratitude.

Not just because baby James passed away right near here, but because the last time I was here testifying, I was eight years old, sharing the incredible impact we could have if we started the Donate Life California donor registry. We now have over 18.6 million Californians registered, but unfortunately, that's only about half of our population in the State of California.

I've made it my life's mission to honor baby James every single day and help give the 20,000 people waiting for an organ in California the same chance as me. By supporting AB 503. I know the lives saved will be worth it, and it will give even more Californians the opportunity to say yes to transforming lives like mine. Thank you so much for this opportunity to share my story and remember live life to the fullest. We don't all get a second chance at it. Thank you.

Thank you. Others in support, please.

Hi, Kristy Foy, on behalf of the California Dialysis Council, in strong support.

Good afternoon. Sandra Poole with Western Center on Law and Poverty, in support.

Thank you.

Kelli Boehm for Health Net of California, in support.

Thank you. Anyone else? No one. Is there any opposition to the bill? Seeing no one, we'll bring it back to the committee for questions or comments. Any questions or comments? I'd just like to say thank you, Mr. Carrillo, for bringing this bill forward. It does enjoy a do pass recommendation. I want to thank your witnesses. Lacey, thank you so much for sharing your story with us today. When we do get a quorum, we'll ask for a motion. Mr. Carrillo, would you like to close?

I really was not prepared for that testament. I really got to. Well, the visibility is a common sense measure that would help save more lives through organ and tissue donation by expanding opportunities to sign up with that, I respectfully urge, I vote. And I thank you.

Thank you. Assemblymember Calderon.

Whenever you're ready.

Good afternoon, Chair and members. Assembly Bill 586 would add climate change or environmental remediation devices to the list of community supports under the CalAIM initiative. CalAIM currently lists 14 community supports that provide nonclinical interventions, target the social determinants of health, and reduce health disparities. CalAIM currently lacks community support services that directly address climate change and environmental health impacts. Extreme heat and poor air quality are linked to negative health outcomes, especially among vulnerable populations who bear the disproportionate burden of climate change impacts.

These are the same populations who are likely enrolled in Medi-Cal and who would benefit from CalAIM community supports. AB 586 addresses these gaps by covering devices such as air conditioners, electric heat pumps, and backup power sources to mitigate the impacts of extreme weather conditions caused by climate change. AB 586 also promotes environmental justice by protecting the health of marginalized communities in our state and reducing strains on our healthcare system. With me in support of AB 586 is Amir Rashid with the County Behavioral Health Directors Association and Dennis Cuevas-Romero with California Health Advocates.

Good afternoon Chair and members, and thank you for your time today. My name is Amer Rashid and I'm here on behalf of the County Behavioral Health Directors Association of California. CBHDA is comprised of the leaders of the public health, excuse me, public behavioral health agencies that serve the mental health and substance use disorder needs of uninsured and underinsured Californians.

And it is because of that work and the populations that we serve that we strongly support AB 586 community support are services through CalAIM that are designed to address the social drivers of health going well beyond services offered in traditional medical settings. These services aim to recognize complex and unmet whole-person needs which impact physical health.

AB 586 will add climate change remediation to the list of community supports covered through CalAIM, and this expansion of community supports is becoming more imperative as already vulnerable populations of Californians are impacted by increasing heatwaves, air pollution, and other extreme weather events, which have been happening at a growing frequency across the state. In the past decade, California has experienced more frequent and intense heat events, wildfires, droughts, reduced air quality, and atmospheric storms, which have all outpaced historical records.

The Center for Disease Control and Prevention has noted that these extreme weather events impact some of California's most vulnerable populations, such as children, pregnant people, older adults, persons with disabilities, and communities of color. These impacts can look like temperature related death and illness, air quality health impact, vectorborne disease and waterrelated illnesses, and a number of mental health impacts.

With the passage of AB 586, we can adequately recognize and address the health implications of climate change to best support the health and well being of Californians, which ultimately is the intent and goal of CalAIM community support services. By passing AB 586 and ensuring climate change and environmental remediation devices are included in CalAIM community support services, we not only make CalAIM even more efficacious but by extension, also make Californians healthier. It is for these reasons, we respectfully request your ivo and thank you for your time today.

Thank you. Please.

Good afternoon, Mr. Chair Members. Dennis Cuevas-Romero with the California Health Plus Advocates, advocacy affiliate of the California Primary Care Association. We represent 1300 health centers up and down the state here to support AB 586. We provide care to 7.7 million patients in the State of California. And as the speaker previously mentioned, climate change is a big driver of health issues, particularly with wildfires in the rural north.

As recently as last year, some of the patients at our health centers were struggling with the lack of air filtration in their homes, and it's really driving the chronic care conditions in our health centers. So for those reasons, California Health Plus Advocates are in strong support of the bill.

Thank you very much. Others in support.

Sandra Poole, Western Center on Law and Poverty, in support.

Thank you.

Molly Robson and with Planned Parenthood Affiliates of California, we're in support.

Great. Thank you. Anyone else seeing? No one. Is there opposition to the bill? See no one, we'll bring back to the committee for questions or comments. Any questions or comments from the committee? Seeing none, the bill does enjoy a do pass recommendation. We're one shy of a quorum. We're getting closer. Would you like to close, Ms. Calderon?

Thank you, Mr. Chair. I respectfully ask for an aye vote at the appropriate time.

Perfect. Thank you. Thank you. We'll do that. You have another bill?

Item number 17, AB 904.

Yes, sir.

Yes, I have one witness.

Perfect.

Assembly Bill 904 requires private healthcare plans to develop a maternal and infant health equity program by January 1, 2025. This program aims to reduce racial inequities and birthing outcomes through the use of doulas. The bill also requires private health plans to convene a doula stakeholder group to examine the implementation of these programs. California faces stark racial disparities in birthing outcomes. Black, indigenous, and people of color are more likely to die of pregnancy or birth-related complications.

Research shows that doula services can prevent negative birthing outcomes like preterm births and cesarean sections by providing support throughout pregnancy and childbirth. The medical program started covering doula benefits on January 12023. However, they are not yet covered by private health plans. Some commercial health plans, like Blue Shield of California and Healthnet, have sponsored doula pilot programs throughout the state with participants reporting positive health outcomes. AB 904 would make California one of the first states to expand access to doula services for people insured through private health plans. With me in support of AB 904 is Kairis Chiaji on behalf of Birthing Project USA.

Good afternoon, Chair Wood and members. As a veteran community and professional doula who has spent the last two and a half decades providing family advocacy and peer support, as well as direct support and education during pregnancy, labor, birth, and 12 months postpartum, I am excited for a future with less infant and maternal loss, more trauma prevention, and deconstructing distrust of maternity care and birth settings in our state.

Combating disparities in birth outcomes by acting as a bridge between community and health care is ancient wisdom, and integrating this wisdom into the healthcare system as standardized care empowers, protects, and saves the lives of birthing people. Birthing Project USA was founded in Sacramento 35 years ago. Currently, the Center for Community Health and Well-Being is the home of Her Health First. Through that, I've had the privilege of training community doulas for over 20 years.

Using a SisterFriends social support model, Birthing Project USA has supported and guided thousands of pregnant people through the landmines of our current maternal health crisis and has touched the lives of over 13,000 babies. I personally have attended 56 births and assisted over 77 families in the last two years, which has resulted in significantly reduced hospital stays during the pandemic lessened fear, stress and anxiety associated with childbirth.

Identifying and addressing potential problems early and connecting families to resources that address their needs outside of a dual scope of work. In the past year, 96% of my 28 births were full term, 100% born at healthy weights, a reflection of social support's ability to reduce preterm delivery. While these wins highlight the joys of birth work, there are times when birth work can be challenging.

A couple I worked with lost their first baby in utero and had to deliver their full term daughter two days after she passed away. Coaching grieving parents through a silent labor, building a support team that felt and functioned like family, holding space for faith and medicine to coexist goes beyond prescriptions and copays.

The training, the experience, and the skill that it takes to connect a grieving family to perinatal loss resources while continuing to hold and build hope for their future children puts the heart of doulas on full display. That kind of care doesn't end with shift changes. Now that doula services are covered by Medi-Cal, AB 904 will enable birth workers to continue nurturing parents who use private health plans through childbirth in ways that preserve and promote bodily autonomy, birthing equity, justice, and joy. This bill will also help lay the foundation for private health plans to integrate doulas into their coverage services. And it is for this reason that I respectfully request your aye vote. Thank you.

Thank you. Thank you very much. Others in support.

Sandra Poole, Western Center on Law and Poverty, in support.

Thank you.

Molly Robeson, Planned Parenthood Affiliates of California, in support.

Thank you.

Erin Evans, on behalf of the California Nurse Midwives Association and NARAL Pro Choice California, in support.

Thank you.

Onyemma Obiekea with Black Women for Wellness Action project, in support. Thank you.

Thank you. Is there opposition to the bill? Seeing no one. We'll bring back to the committee. Questions or comments from the committee? Dr. Weber.

Thank you, Assemblymember, for bringing this bill forward. A couple of questions. So this bill establishes a working group, correct?

Yes.

Okay. One of the things that I would recommend is to consider, because when you're talking about a lot of the inequities, and I see the requirement that for the working group, 80% be practicing doulas and at least 75% be doulas that provide services to Medi-Cal enrollees, you may also want to think about talking about the background or the ethnic background or the cultural backgrounds of the people who will be on this working group to make sure that whatever recommendations that come forward are actually inclusive of everyone that would be utilizing doula services.

So, just something I thought about and the other thing I just looked at, and I'll be bringing this up with another bill, is postpartum. Postpartum does not mean one year following the end of a pregnancy. You can talk about the perinatal period, which does include pregnancy, and then delivery, and then one year after. But when we talk about postpartum, it's generally six weeks after delivery. Some people may kind of sparse it out into different definitions. The most it would go up is eight months.

But generally we say postpartum is six weeks. So, like, you go for your postpartum check, that's generally about six weeks after you deliver. And I just want to make sure that we are making those terms clear and accurate and they align with what we talk about in the medical field. And it's not just your bill. There's another bill later on, and I just happen to see that. So you might want to kind of look at that, and either use the perinatal period or one year post-pregnancy. But postpartum is not generally a year after you deliver. Thank you.

Thank you, Assemblywoman. I really appreciate that. And we will work on that. They're good suggestions. Thank you.

Thank you. Any other questions or comments? The bill does enjoy a do pass recommendation. When we get a quorum, there'll be a motion, I suspect. Would you like to close?

Thank you, Mr. Chair. Yes, I respectfully ask for an aye vote at the appropriate time.

Great. Thank you. Thanks very much. Ms. Schiavo.

Good afternoon. Thank you, Mr. Chair and Members. I wanted to first just say thank you to the staff for their feedback, and we'll be taking the recommendations and want to thank you for the opportunity to present on AB 608, which is truly a health equity bill designed to support Medi-Cal families that too often fall through the cracks on our health care system by extending perinatal services from 60 days to the full year of birth.

This provides nurturing, supportive, and culturally-competent postpartum care to new moms, parents, and babies when they need it most in that first year of life and parenthood. As a mom myself, I know that the first year after pregnancy is challenging for moms and babies.

For me, when my daughter got to be a year old, I felt like we needed a whole extra celebration just for keeping her alive that first year because they scare you so much about what can happen to your baby in the first year, and it can be really overwhelming for parents, and so having support is critical. The first year can be difficult to maintain mental or physical health for some families, and many on Medi-Cal also experience food or housing insecurity.

AB 608 extends the ability of comprehensive perinatal health workers to help address these critical needs through a comprehensive approach to care that supports families in their homes and in their communities. Perinatal health workers screen for behavioral, mental, and physical health issues, connect patients with social services, promote preventative care, and foster stronger parent-child bonds. Unfortunately, assessments and visits from perinatal health workers are currently only covered for 60 days postpartum for Medi-Cal enrollees.

Today, only one in four Medi-Cal children receive child well visits in the first 15 months. And what's incredibly heartbreaking is that research shows that death by suicide is more likely to occur in late term postpartum period of time for moms and parents.

AB 608 would expand coverage for visits of perinatal workers for the full year of postpartum and allows workers to meet patients where they're at, in their communities and in their homes. By extending these culturally-competent perinatal services outside of the hospital, California can better support parents and children, recognizing the hurdles of low-income families that they're seeking when they're seeking out care. Every child deserves a healthy start in life, and AB 608 ensures they get just that.

And finally, I want to introduce our sponsor, Lucy Quacinella, who is a consultant for Maternal and Child Health Access, and also Shannon Shaw-Pace, who's Executive Director of Her Health First, who are here to share testimony about--in support of AB 608 as well. Thank you.

Thank you. Lucy Quacinella. Lucy Quacinella, on behalf of Maternal and Child Health Access, cosponsor of this measure, along with the March of Dimes and the Children's Partnership. MCHA's home visitors who meet with low-income families in Los Angeles counties who have newborns or infants and MCHA's health navigators assist over a thousand individuals a month. We also collaborate extensively throughout the state with similar programs in the Central Valley.

Right now we're doing a lot of work in remote rural areas in the north, including in Sonoma and Napa counties. We find a great unmet need after a birth, a stillbirth, or a miscarriage for health education, which CPSP provides for assistance with breastfeeding support, which providers indicate is best provided through the CPSP benefit. It's the easiest way to get reimbursement for that kind of support, and with newborn care, as the Assembly Member mentioned.

We also find an incredibly great need for assistance with social needs, things like food insecurity, housing insecurity, not having a regular place to sleep, being homeless, having to move, losing a job, or not having practical or emotional support. These factors, including the last one, not having practical or emotional support, are documented factors in negative health impacts in the perinatal period. The California Department of Public Health has data supporting what we see in the field.

Medi-Cal consumers bear a disproportionate burden of these kinds of impacts in the perinatal period, and the Covid Pandemic has only made these kinds of harms even worse. In our experience, the need for services doesn't appear at the end of the 60-day perinatal period. It extends throughout that year, and it impacts not just individuals who have a live birth, but also those who miscarry or have a stillbirth.

So we believe very strongly that it's time to align Medi-Cal CPSP's benefit with the new 12-month post pregnancy eligibility period. As the Assembly Member mentioned, mental health is a major issue in our state, unfortunately, and the CDPH data indicate that of maternal suicides in California, 85 percent had one or more psychosocial stressors documented near the time of birth. These are the kinds of stressors that CPSP is designed to identify early. My colleague Shannon Shaw-Pace here will explain how her program works with these protocols to improve maternal and child health. Thank you.

Good afternoon. My name is Shannon Shaw-Pace. I'm a maternal health consultant currently working with federally-qualified health centers throughout Merced, Modesto, and the larger Central Valley to support the expansion of their CPSP services. And here in Sacramento, I'm the Executive Director of Her Health First, a local-based agency committed to decreasing the disproportionate African American maternal and infant mortality rates.

Our pillar program, Black Mothers United, funded by First 5 Sacramento for over nine years, is modeled on CPSP and the lived experiences of Black birthing people in our county. Led by key staff Kenya Fagbemi and Leona Spivey, who are seasoned doulas and comprehensive perinatal health workers with a combined 45 plus years of experience, our team of pregnancy coaches provide comprehensive perinatal education and social supports throughout their pregnancies and postpartum periods.

Our ability to meet clients where they are at outside of the clinic allows our team to build relationships based on trust, centering the unique needs of the pregnant client every step of the way. Leveraging CPSP tools like the initial assessment, steps to take, and the individualized care plan, we have developed a robust database, and through independent evaluation, we have seen the following statistically significant outcomes. Reported nutritional deficiencies decreased from 20 percent at program intake to six percent at follow up.

Maternal anxiety and depression as indicated by the PHQ-9 assessment was rated moderate or high in 30 percent of our clients prior to entering our program and decreased to 11 percent after program completion. Higher dosage of service was statistically shown to predict healthy birth weights and babies born at full term and most worthy of celebration, our program has had zero infant deaths for the past three consecutive years.

As you consider AB 608, it is key to note that the early, low interventions that BMU-- Black Mothers United provides based on the CPSP model are key preventions for higher levels of care. Our Black Mothers United pregnancy coaches--again, leveraging the CPSP model--do coordinate with our clients' OB care team despite not being directly under the supervision of licensed medical providers.

AB 608 would not only allow reimbursements for CPHW services--I'm sorry; for CPSP services provided away from a medical site, but also allow CBOs such as our program not to have to be under supervision of a licensed provider.

And please note that this more flexible approach has already been adopted by the state for community health workers, and Black Mothers United do make referrals to behavioral health services and providers when the trimester and postpartum assessments indicate that level of care is needed. And in fact, we find that our clients feel more comfortable having their pregnancy coaches providing a warm handoff to behavioral health services. It's been incredible to see the strides that we continue to make with the expansions of so many new Medi-Cal benefits.

However, the important services should be seen as enhancements to an existing program that has been shown to have a profound impact on maternal and infant health outcomes. And when considering ways to address the harrowing maternal and infant death crisis, perhaps a key part of that solution is right here in front of us: CPSP. Thank you.

Thank you very much. Others in support?

Jim Lindburg, Friends Committee on Legislation of California, in support.

Thank you.

Sandra Poole, Western Center on Law and Poverty, in support.

Thank you.

Nicole Wordelman, on behalf of the Children's Partnership, proud cosponsor in support.

Thank you.

Annette Aguilar with Health Access California, in support.

Thank you.

Taylor Jackson with California Health Plus Advocates, in strong support.

Thank you.

Molly Sheahan with the California Catholic Conference, in support. Thanks.

Thank you.