Assembly Standing Committee on Health

Good afternoon. We'd like to go ahead and get started with our hearing. So if you all find your seats out there, we'd appreciate that. Before we begin, I'd like to make a statement regarding providing testimony at this hearing. We seek to protect the rights of all who participate in the legislative process so that we can have an effective deliberation on the critical issues facing California. All witnesses will be testifying in person. We allow two main witnesses for a maximum of 3 minutes each.

Additional testimony will also be in person and limited to name, position and organization if you represent one. All testimony comments are limited to the bill at hand. We do have a proposed consent calendar for today's hearing. Any Member of the Committee may remove a bill from consent. That proposed consent calendar is item number five, AB 700, by Assembly Member Grayson. Item number 12, AB 1110 by Dr. Arambula, with amendments item number 13, AB 1233 by Vice Chair Waldron, removed from the calendar.

Calendar item number two, AB 412, was removed from today's agenda at the request of the author. So we do not have a quorum. So we will continue the hearing as a Subcommitee, and I'd like to invite Assembly Member Pacheco to come forward. You have item number one, AB 77. Welcome to the Health Committee. You have to hit the button so we can hear you, though.

Can you hear me now?

Perfect. Thank you.

It's a pleasure to be here before all of you. Mr. Chair and Committee Members, I have a very exciting bill. It is AB 77, and I want to thank you all for this opportunity to present. I want to start by thanking the Committee staff for all their hard work on this bill. And I wanted to mention that we will be accepting the Committee amendments.

I am pleased today to present AB 77, which would allow for the use of dire critical marks on vital documents, which include birth, death fetal, death certificates, and marriage licenses. It is not only important to spell a person's name properly, it is equally important to correctly pronounce a person's name without changing its meaning. This is important to maintain cultural identity and heritage. Given California's increasing diversity, it is important that cultural name pronunciations that deviate from the typical English language are represented and reflected in California law.

The passage of Proposition 63 and 1986, which declared English the official language of California, eliminated the use of diacritical marks on vital records. But prior to this, diacritical marks were permitted on vital records. This bill simply seeks to restore what was previously allowed. With me today to testify in support of this bill is Jaime Jarrín, MLB Hall of Fame Dodgers announcer who championed the hashtag Ponle Acento initiative to add diacritical marks to team jerseys. And I also have with me Nancy Chaires, mother of six year old Nicolás, who is present. And this is the inspiration of my bill. So I'm going to hand it on over to Jaime Jarrín.

Good afternoon, my name is Jaime Jarrín with tilde on the "i" in my last name. It is my pleasure to appear before you. It reminds me of my three years as the official announcer of the Senate of the National Congress of Ecuador. I recently retired after 64 years as the Spanish voice of the Dodgers. Since my arrival from Ecuador in 1955, I have witnessed a great change in the landscape of both sports and society in California.

I am here to express my total support to AB 77 Bill based on my experiences in baseball. There have been so many talented athletes from other countries who have played the sport called America's pastime. But there was a period when speaking Spanish in a major league clubhouse was discouraged by management. My dearest colleague Vince Kelly, who was considered the best baseball announcer of all time, used to come to my booth during a game to ask me, how do you pronounce this Hispanic name?

He just wanted to be right. It hurts my ears when the public announcer at the ballpark will mispronounce the player's name, saying Peréz instead of Pérez, Goméz instead of Gómez, Acuna for Acuña, or Pena for Peña. It was 2017 when the Major League Players Association sponsored a campaign called Ponle Acento in the major league's baseball. Every club was asked to include in the daily game notes a page with translation and proper spelling, including the "ñ" of the Latino, European, and Asian players.

Today, all major league baseball teams have interpreters and the players' jerseys have their names using diacritical critical marks and accents. Adding punctuation marks to the written word in Spanish expands the beautiful and melodic language, the same result as a musical composer giving the opportunity to add sharps and flats to musical notes. But beyond punctuation, it is the ultimate sign of respect: respect to the name, respect to the person, respect to the culture. Please accept my complete support of the Proposition AB 77 Legislation. Thank you. And thank you, Assembly Member Blanca Pacheco. It has been a great honor for me to be here with you today. Thank you very much.

Thank you very much. Please go ahead.

Thank you. Good afternoon. My name is Nancy Chaires Espinosa. In 2016, my son Nicolás made his debut into the world and I learned that the State of California would not allow me to give my son the name that his father and I had so lovingly and thoughtfully chosen for him. The state's denial of the tilde, just one type of diacritical mark in my son's name changes its pronunciation and strips it of its cultural heritage.

My grandfather attended segregated Mexican schools in this state, and he worked the fields from Calexico to Lakeport with my dad. My parents came of age at a time when students were often punished for speaking their home languages at school, and teachers would arbitrarily anglicize students' names for their own comfort. Today we know that acknowledgement of someone's name is the starting point for inclusion. Even if we can't pronounce a name correctly, how we respond to it matters.

Personally, I'm pretty bad at tonal languages, but I always try my best to get people's names right. It's important to make people feel seen and to send the message that shedding off parts of oneself is not the price of admission in our society, not in California, not anymore. Too often, we hear government institutions claiming that change is too hard, that the simple act of acknowledging non-english names and allowing people to use them is a burden not worth overcoming.

It sends the message that people from nonwestern European cultures are not worth respecting. You have all inherited the discriminatory practices in place today, but you also have the opportunity to ask yourself whether the prohibition of diacritical marks on the government documents that literally identify us reflects who we are as a state now and whether it aligns with the future that we're trying to build. AB 77 advances some of our most treasured ideals.

Freedom, self determination, parental rights, the vision of California for all, and the basic respect for people from the multitude of cultures that make this such a special place to live. I respectfully request your aye vote. And with the Chair's indulgence, I'd like to yield the balance of my time to my son, Nicolás.

My name is Nicolás with a tilde. I want to be able to write my name right.

Thank you. Thank you very much. Others in support, please come forward. Do we have opposition to the bill? Seeing no opposition. We'll bring it back to the Committee for questions or comments. Mr. Rodriguez.

I want to thank the author for bringing this important bill forward to preserve, remember, our cultural identity. So I want to thank you and thank your folks that came with you. Thank you, Mr. Jarrín, for joining us as well, and the others.

I'm glad you're bringing this bill forward. It's way overdue, and I look forward to making the motion to support it once we get the quorum and hopefully get it through and become law in the State of California. So thank you all for being here this morning or afternoon. Thank you.

Thank you. Ms. Weber--Dr. Weber?

Good afternoon. Thank you so much for the bill. Thank you for being here to give your presentations. As I was reading through the bill, help me if I missed it, but I'm not sure--did you limit the number of diacritical marks that you are trying to include?

No, they're not limited. It all depends on the spelling of a name.

Okay. Because one of the things I did notice in the analysis is that for some of the states that do allow it, they allow a certain number, not necessarily open to all. Do you know how many there are out there, diacritical marks?

No, I'm not aware of how many diacritical marks because it all depends on the language. So there's different types of diacritical marks. It could be the enye accent. So it just depends on the country. Germany has their own. Jewish community--they have their own. So no, it's not limited.

You know, I know that there is a concern about cost and the feasibility since it would be more of a local mandate and whether localities would be able to do that. That might be something that you would like to look into to see what other states that have it.

I know there's not a lot of states that allow it, but for those that do, you might want to kind of model it after them because that may help with some of the California Association of Clerks and Election Officials that have some concerns about this. And then also recognize the fact that those diacritical marks would still need to be removed because from a federal level they're not allowed.

And so when looking for something like a Social Security number, our localities would then need to remove them to send them off for their Social Security card. But thank you very much.

Correct. And there's currently seven states that allow it, which include Texas.

Yes, and Texas allows for.

Okay, thank you. And we are working with opposition too.

Mr. Fong, did you have a question? Anyone else? So I want to thank you, Assembly Member Pacheco, for bringing this forward and, Mr. Jarrín, thank you so much for being here. I've never been a Dodger fan, but today I make an exception.

I love it.

Hey, I'm a Giants fan. What canI say, you know? I think you can appreciate that I am a baseball fan and I'm a big fan of this bill. Mr. Jose Medina had a bill similar to this. I was enthusiastic supporter of that. And I think this is a really important bill for everybody who might be affected by the lack of a mark in critical documents. I would note that just for Dr. Weber, with regards to the Federal Government, they actually receive data, not the document.

So when they put things together, it's different than the actual diacritical marks included in that. I do recognize that some of the county clerks and have challenges with this as well. I don't mean to be too flippant, but I'm happy to send anybody a box of sharpies and if it helps to speed the process along while they get the computers to generate these marks, because I think it is important and I think it's long overdue. And I very much appreciate you bringing the bill forward. So thank you very much. Would you like to close?

I would love to. I just want to thank all of you, Mr. Chair, and the Committee Members for this opportunity to present. I want to also thank my amazing witnesses who testified and maybe one of our youngest witnesses to testify. So I appreciate your time and when the opportunity comes, I respectfully ask for your aye vote. Thank you.

Thank you. As you see, we're one short of a quorum here, unfortunately, because we'd love to be able to take this up. But thank you to yourself and your witnesses. Really appreciate.

Thank you very much.

Very much. Go ahead and move on. Mr. Alvarez, I'll wait a second. Whenever you're ready. Sir, you have AB 425.

I do. And I want to put on the record that I just got a good luck from a lifelong Dodgers fan for my San Diego Padres. So that was pretty cool.

Very good. You didn't say anything about the Giants on the way.

No, sorry. Thank you very much. I am Senator David Alvarez with a tilde on the first a in my last name and thank you Members for the opportunity to present this with you today. Thanks to the Committee staff for the communication with my office as we try to move forward this and obviously appreciate the work done and accept the amendments that have come from the Committee. AB 425 was inspired by one of my constituents.

You all put a call out to constituents I think, in the fall and you talk about the things that you do. And one of the things we ask constituents is do you have any ideas for a Bill? And I got a call from a high schooler as it relates to this Bill and I got on a zoom with them and the mother of the student and this was presented to me as something brand new.

I had no idea on this topic that I'm about to talk to you about and it was pretty clear very early on in the conversation that the student was passionate because of their personal experience. The student was someone that shared their story with me. She's suffering from depression and anxiety and suicidal thoughts and was under care of medical professionals and under medication. Unfortunately, none of the medication that was prescribed to her resolved her symptoms and in fact, it only seemed to get worse. She learned about.

Well, actually her mother learned about pharmacogenomic testing through a Facebook patient group and was fortunate enough to get the test. The results of that test helped her find the right medication for her. Now she's on a mission to increase awareness and access to the test that she has shared with us has saved her life. Pharmacogenomics, or most easily known as PGX for short, is the science of how a person's genes impact the way they metabolize medication.

Based on our genes, you could be a poor metabolizer, normal metabolizer, or ultra rapid metabolizer for medication, meaning individuals could receive too much or too little of a particular type of prescribed medication. In addition to my constituent story and the story we'll hear today, there are examples across many other conditions. While Medicare and commercial insurances cover this test, medical does not. AB 425 closes that gap, opening up a huge opportunity for savings, improved outcomes, and most importantly, better patient safety.

I want to take the moment to appreciate two Members of your Committee, in particular, Assemblywoman Aguira Curry and Assembly Member Rodriguez for being co authors, and certainly welcome others to join today. We have Christine Von Reesfield from people with empathy and Dr. Bani Tamras from UC San Francisco, which will be providing some testimony and support. And then we have Chantel Shenning with invite who's here to write any technical expertise on PGX testing itself. So pass it on to the witnesses, please.

Can you hear me?

Would you hold on 1 second? Here we have a quorum and it's a precious thing and we would hate for it to not be here. So, Madam Secretary, please call the role.[Roll Call] We have a quorum. Great. Please go ahead. Thank you.

Okay, are we ready for me?

We are now, I think.

Thank you. My name is Christine Von Raysfeld and I'm a resident of San Jose, but born and raised in the Bay Area and also a Member, a Committee Member for the DBSA, the Depression Bipolar Support Alliance. I'm here to speak to you about the importance of pharmacogenomics testing for medical patients as a patient who has suffered from the harmful side effects of medications. I understand the importance of a personalized treatment options.

I have a long history of illness and a list of medications to go along with it. I'd like to say that my health journey has been a series of unfortunate events. For most of my life, I never reacted well to medications. In 2002, after a lifetime of symptoms, I received a diagnosis of lupus. During that time, I was experiencing symptoms beyond my condition.

I was told that the symptoms were progression of my disease and were normal, but in reality, it was the way I metabolized the drugs that I was given. It turns out the three drugs used as standard of care caused significant damage. I was faced with three joint replacements, removal of dead bone from other joints, toxic encephalopathy, which is brain damage for those who don't know, and loss of night vision.

One of the most significant challenges I faced was a resistance to opioids due to being a rapid CyP metabolizer. This means that my liver processes medication quickly, which can lead to drug toxicity and limited efficacy. As a result, I was unable to find relief from my pain, even with high doses of opioids, which caused me to feel frustrated and hopeless. Regular opioid treatments are not effective for me.

With dilauded as one of the only compounds that actually helps with my pain, I'm often treated as a drug seeker because I know what I need. In 2018, I joined a Stanford humanwide precision medicine program where a PGX test was offered. We realized that out of the multiple compounds tested, I react differently to many. I'm a slow metabolizer when it comes to certain compounds, a rapid metabolizer, and others, with some having absolutely no impact.

Fortunately, as a part of my precision medicine initiative by Stanford, I was able to undergo pharmacogenomics, which allowed my doctors to identify my genetic variations and develop a personalized treatment plan. With the help of this testing, my doctors were able to prescribe medications that were tailored to my unique genetic makeup, which greatly reduced my risk of adverse effects and improved my overall quality of life.

Being a Medicare patient myself, I know firsthand how difficult it can be to access the care we need, especially when it comes to personalized medicine. However, I strongly believe that pharmacogenomics testing should be made available to all Medi Cal patients, as it has the potential to greatly improve health outcomes and reduce healthcare costs long term.

By investing in pharmacogenomics testing for medi Cal patients, we can help prevent harmful side effects, minimize the risk of drug toxicity, and ensure that patients receive the most effective treatments to reduce healthcare costs. By avoiding unnecessary hospitalizations and emergency room visits, I see a true need for PGX testing. Not only can it help patients attain the best care and treatment, it can save costs down the line.

For the rest of my life, I will be burdened with the side effects of the medications used to treat the symptoms of my disease, not even knowing the underlying cause. It is unethical and unhuman to not provide this resource to our populations. In conclusion, I urge you to consider the benefits of pharmacogenomics testing for medical patients. As someone who has experienced the negative effects of medication firsthand, I can attest to the importance of personalized medicine and the positive impact it can have on our patient lives.

By investing in pharmacogenomic testing, we can ensure that all Medi Cal patients receive the care they need and deserve. Thank you.

Thank you. Please go ahead.

Thank you. Good afternoon. My name is Bonnie Tamraz. I'm an associate Professor of clinical pharmacy from University of California, San Francisco. I have a pharmd, I'm a Doctor of pharmacy degree, and I also have a PhD in pharmaceutical sciences and pharmacogenetics. And I am a Member of a multidisciplinary team that we started about a year and a half ago at UCSF that has been working diligently in putting together the clinical pharmacogenetic program that we'd like to initiate.

And we are actually am proud to say that we're going live with our clinical pharmacogenetic program on May 9 of this year. And I'm here to speak, obviously, in the support of AB 425, and I'm here on my own behalf. So why did UCSF started thinking about this? Well, there exists a large and growing body of knowledge that's related to pharmacogenetics. FDA started inserting genetic information in the package insert of medications since in 2007.

And as of last year, there are at least 335 medications that have information about genetic markers in the package insert. And in the United States, we also have a consortium of experts in pharmacogenetics and medicine. The name of this consortium is called CPIC. It stands for clinical pharmacogenetic Implementation Consortium. This is a group of experts that reviews literature, and based on their evaluation, they come up with specific drug gene interaction recommendations for testing, and it's an NIH funded consortium, and it's originated in Stanford.

Their recommendations are divided into four different levels. There's level a, which when they say for medications that are level a, it means that if the genetic information is available, this information should be used for therapy selection. And then level b drugs are the ones that if they say, if the genetic information is available, this information could be used for prescription.

So we at UCSF are starting our program with medications that FDA recommends testing and also level a and some of level b. We have a list of 15 genes and 56 medications that's on our panel. These, incidentally, 99% of patients we know carry at least one variant that will impact one of these medications for sure. And then for these medications at UCSF, we looked when we know that over 118,000 patients were prescribed one of these medications in 2020. This effort has support.

So our effort that we're implementing has a lot of support across UCSF. Specialties from cardiology to psychology, primary care, positive care, Gyoncology, to just name a few. We are preemptively testing our patients with the goal that our electronic health record will trigger this comorbidity. For these 56 medications, then this is a one time test. Our patients will be tested once, but pharmacogenetic testing is evidence based. There is ample evidence in support of clinical benefits.

There was a recent study that looked at a 12 gene panel and time. Thank you.

Just finish up.

I'll just finish up. Okay.

I'm sorry.

Okay. So that's. Okay. Basically, this most recent study, which is really pioneering, and it shows that there was a 30% reduction in adverse drug reaction associated with use of pharmacogenetic testing. So, in California, or in General, there are all kinds of numbers out there, from 100,000 plus to over 200,000 people have experienced adverse drug reactions in the United States. These numbers vary. The adverse reactions are not certain, and it's limited by methodological considerations.

However, whatever the true number is, ADRs represent a significant public safety problem that is, for the most part, preventable. Death and illness resulted from the nonoptimized medication. Therapy cost about $528.4 billion annually. And this was based on a study that was published in 2018. And given the recent study that pharmacogenetic tests can result in a 30% decrease in adverse drug event, the wide use of PGX can have significant monetary and human benefits.

We look at National Highway Traffic Safety Administration reports that 23,824 passengers, car occupants were killed in 2020. And of these, 51% were not wearing seatbelts. Seatbelts saved an estimated 14,995 lives. By investing in this Bill, we are investing in an airbag or a seatbelt for medications. So by providing coverage for this test. We will save lives. Thank you.

Okay. Thank you. Others in support? Just your name and organization if you represent one.

Hi. Paul Simmons with the Depression and Bipolar. Support alliance of California, in strong support.

Anyone else? Is there opposition to the Bill? No one come forward. Bring it back to the Committee for questions or comments from the Committee. Question. Dr. Weber.

Thank you, Assembly Member Alvarez, for bringing this Bill forward. PGX is really the future, and hopefully, with implementation and more studies, we can make sure that we're treating people with the correct medication from the very beginning. I just had a quick question for you, though. Would this testing be triggered by a diagnosis or a drug? Because I've kind of heard two different things. So if I'm diagnosed with depression, would that trigger me to get this testing done?

Or is it because I've been diagnosed with Prozac that would trigger the testing seminar.

Weber. Dr. Weber, let me ask Chantel to help answer that.

I'm happy to. So, because a lot of these genes actually span across many disease states, really it's focused on if there is a medication that is currently prescribed or being considered that is in alignment with the guidelines. So FDA or CPIC? Because, for example, if you test someone for a specific disease condition or a specific. Yeah, let's use disease condition. That medication or that gene may actually impact a different type of condition.

So if you start with mental health, for example, there's also gene drug implications for maybe GI or cancer that needs to be taken into considered. So it's a one time test that spans across many conditions based on the gene and the medications. I'm sorry, why would someone be offered this test right now with this Bill? Is it because they got a diagnosis of something or is it because they were prescribed a specific medication? Medication. Okay, thank you.

Anyone else? Okay, bring it back to the author. We have a motion by Mr. Rodriguez, a second by Mr. Flora. The motion is due pass as amended to appropriations. You did accept the. And so would you like to close?

Yeah, I would just say because I know she's following the young woman who brought this to our attention. Her goal was to elevate this topic and make more of us aware of it. I know certainly I have, and many people that I know in my circles have become aware of this important tool, and that's already a win, but obviously, appreciate your. I vote so that more patients can actually have access to this. Thank you.

Thank you very much, Mr. Alvarez. Madam Secretary. So the motion is do pass as amended, to appropriations. Madam Secretary, please call the roll. [Roll Call] That's 8 - 0. Your Bill is out. We will leave the roll open for others to add on. Thank you very much. Thank you.

So, Assembly Member Schiavo. You have AB 464. Whenever you're ready.

Thank you so much, Mr. Chair, Members. AB 464 is especially an important bill to me because, as you may not know, I co-founded an organization working on homelessness and did outreach for over a year every Sunday to encampments where the number one thing that people asked for when I spoke with them, aside from housing and food, was an ID, help getting an ID. And so one of the things that we know is that you can't get a job, you can't get housing, you can't really get on your feet if you don't have an ID. And so housing insecurity takes many forms.

It could be getting behind on the rent, couch surfing, moving between multiple shelters. Some individuals may live in their vehicles or makeshift tents, and some may have housing today and lose it tomorrow. As a result, it's not uncommon for identification to be lost, stolen, or destroyed.

Given the burdens of living in such unstable circumstances, it can be very challenging to recover vital documents, such as personal identification, driver's licenses, and other paperwork. When an individual is seeking employment, enrolling in school, applying for assistance or health care, or applying for housing, identification documents of this sort are, in most instances, a requirement.

AB 464 will reduce administrative barriers for low-income individuals, and it does so by exempting individuals based on their income or qualifications for certain public assistance from having to pay fees otherwise required for copies of vital records for California State ID card or for a driver's license renewal. Current law requires a cumbersome process that requires homeless individuals to reach out to and otherwise be connected with a third party to verify their status as homeless or in order to access replacement documents of this sort.

AB 464 seeks to make this process somewhat easier by expanding eligibility to anyone who qualifies for one of the public assistance programs articulated in the bill. AB 464 will eliminate fees for any individual who income qualifies for public assistance as defined in the Welfare and Institutions Code for certified copies of birth certificates, death records, marriage or marriage disillusion records, as well as driver's licenses and state ID cards.

This approach simplifies the cumbersome process for individuals whose lives are already challenged and complicated to give the tools that they need to get on their feet. Here with me today is Kat Calvin, who is with Project ID and the sponsor of the bill and an expert witness to speak on the bill as well.

Hello. My name is Kat Calvin. I am the CEO of the Project ID Action Fund. I'm going to start by telling you about Nicole. Nicole was one of my clients. She's a single mother of four living in Section Eight housing in Los Angeles. Nicole came to us because she needed birth certificates for herself and for two of her children to enroll them in school, but she couldn't afford the fees. Unfortunately, all that we had to offer her was an affidavit of homelessness to get free birth certificates. But Nicole didn't want to sign those, and we didn't want to give them to her because we didn't want to lie to the state. She wasn't unhoused.

She just was poor. Millions of Californians are in this predicament. They're living in poverty, but they have housing for now. For them, the cost of vital documents and IDs are out of reach. But they're not eligible for the vouchers for free IDs and affidavits for free birth certificates that are available to the homeless. Even those, however, have to be distributed by official homeless services providers.

You have to have a wet signature, and in most counties, you can only go to certain clerks on certain days of the week to get them. Approximately 2.7 million adults in California do not have photo ID, and 1.9 million do not have access to birth or citizenship records. And an outsized percentage of those are people of color. These Californians still need IDs and vital documents for jobs, for health care, for benefits, and so much more.

And without those IDs and vital documents, the housing that they currently have is in serious jeopardy. It's difficult to maintain housing when you can't work. California benefits when its citizens are working, healthy, and educated. And the very small cost of vital documents and IDs is vastly outweighed by the economic and social benefits of a thriving, contributing citizenry and when we are working to prevent more homelessness across the state. And that's why we're respectfully asking for your aye votes today. Thank you.

Thank you. Others in support.

Sandra Poole, Western Center for Law and Poverty and support.

Thank you. Anyone else? Is there opposition to the bill? Seeing no opposition. We'll bring it back to the committee for a question. We have a motion by Ms. Aguiar-Curry, a second by Ms. Weber. Any questions for the committee? Mr. Patterson?

Yeah, I just wanted to comment on this bill a little bit. Nobody's going to listen to this. This isn't public record or anything. My mom's a waitress, single, two kids. We grew up not having very much, and my mom was on WIC for a while. So, I'm definitely sympathetic to the need for this. I know there are other bills that coming through this year, maybe even today, that consider giving free documents to certain individuals.

I think I do have some concerns about it is slightly piecemeal on certain groups of people that might get exemptions from paying these records. And so I kind of have mixed feelings on it. I mean, I really do appreciate what you're trying to accomplish because. Yeah, paying $18 or whatever for a record or $35 for a driver's license or whatever the fees are, that really does matter. I mean, that's a lot of baby formula.

So I am kind of sympathetic, or I am very sympathetic towards this. I think we kind of need a global conversation on who should be paying for driver's licenses and birth records and things like that because I think we can argue perhaps that there are several other groups out there that shouldn't pay this. And I also am somewhat concerned about the fiscal impacts as well. I do think this is a very big issue, and I like that you're bringing this discussion forward.

As I sit here right now. I don't even know how I'm going to vote in a couple of minutes here, but it's a great discussion to have. There are a lot of things that maybe people who are going through difficult times should maybe get - there should be a safety net for and this is one small thing, but this is a very big discussion. We have another bill on this topic, actually in this committee coming up, so I want to make sure I'm consistent, by the way.

So thank you.

Thank you.

Anyone else? May I respond? Is that okay?

Yeah, you may actually close.

Oh, okay.

Well, I'll do both then. As someone who also, my mom when I was younger, was a waitress, and I've had enjoyed the government cheese grilled sandwiches myself at a certain point in my childhood. It's hard when you're struggling, right? And that can make a big difference in terms of what is existing right now. An ID, a state ID, and a driver's license: there's already a program that makes it free for unhoused folks. They have to go through getting a voucher. It's very cumbersome.

We'd like it to be free at the point of service so there's not these extra barriers. But that already exists for folks. And that's actually the most utilized program there is, one that reduces the cost for low-income folks, and that is very underutilized. I think over the last year, the DMV said that there were 120,000 vouchers issued for folks who are experiencing homelessness and only 30,000 for people who are low-income. So we haven't seen a huge takeup -

- and that makes me feel like it's not going to be something that breaks the bank. And if you're going from $6 to $0, specifically around the ID, it's not a huge leap. We understand that there are some counties that already make these available for free for folks who are low-income. So in some counties, there won't be a big difference. And I think a lot of people, unfortunately, don't know about programs like this.

Not that we think that's a good thing, but take-up obviously has an impact on what the budget impact is going to be.

So we think that this is an important policy, though, because ultimately, if you want people to get on their feet, if you want them to pay taxes, if you want them to have stable housing and not need more and more public assistance, then this is an important resource for them to be able to do that and get on their feet and get stabilized so that they can contribute to our state and move forward in their lives. And so that's why we think it's an important bill.

And I hope I can convince you for a yes vote, but I would appreciate an aye vote. And thank you so much.

Thank you very much. Your bill does enjoy do pass recommendation. We have a motion from Ms. Aguiar-Curry, a second from Dr. Weber. Motion is due pass to transportation, so I'm going to ask the secretary to call the roll.

[Roll Call]

You have five votes. We'll leave the bill on call. We've got a lot of members not here. Thank you. It looks like. Next up, Ms. McKinnor, you have AB 974. Please push the button up there if you don't mind. Thank you.

Good afternoon. Thank you, Chair and Members. I'm here today to present AB 974, which would ensure all incarcerated people have access to a fee exempt copy of their birth certificate. Last year, the Legislature passed SB 629 to establish an imprisonment program for people to receive a California ID upon their release. An ID is needed in order to access housing, employment, enroll in educational programs, receive Medicare, medical care, and sign up for public benefits, among other things.

Existing law states that in order to get a California identification card while incarcerated, an applicant must be able to show proof of their full name, date of birth, Social Security number, legal presence in the US, and California residency. A birth certificate is typically the form of proof most people use, but individuals who do not have access to their birth certificate while incarcerated do not qualify for the new ID program.

That is why I am introducing AB 974, which would require a local registrar, state registrar, or county recorder to provide a birth certificate fee waiver to incarcerated people. Additionally, it directs the California Department of Public Health to develop an affidavit for certification of incarcerated status. With this bill, incarcerated individuals will be prepared with the necessary tools to be successful and have a better chance at re-entry.

In Committee with me to testify in support is June Lee, a system impacted person and advocate, and Gail Yin with the Los Angeles Regional Re-Entry Partnership.

Good afternoon, my name is June Lee. I am a re-entry coordinator for organization called Ahimsa Collective. We do a lot of restorative justice work. I also used to work for Root and Rebound as an in-prison program coordinator and so I am going to speak on this bill from my lived experience. I did over 21 years. I came home. Luckily, I came home, got a second chance in 2010.

Before I came home, I knew that my success to transition from prison to my community was about preparing myself. I did my parole plans. I found a place to live before I left. I actually had two jobs available for me before I came home. And then I made plan A, B, and C, and even D. So I did all these things because I wanted to come back and be a returning citizen, having a job, paying taxes, and giving back to my community.

What I wish I had before I left was my birth certificate. This really put an obstacle in my path, but it didn't stop me. But it stopped me for about two months, because without that birth certificate, people didn't know who I was. I couldn't get an ID. I couldn't go to the DMV to get an ID. It stopped me from getting those jobs, but it didn't stop me.

Today I am so thankful that I am a coordinator that helps people coming back home after doing 10 to 40 years. And right now I'm working with a man that where this is stopping him. His birth certificate is stopping him. I've been working with him for almost a month, and without that birth certificate, that he did the footwork to fill out the application. But it takes time, and even with COVID it takes even more time. I'm thankful today that he has gotten--we've done the footwork.

We walked through it. He's gotten his ID. I just helped him find a job. But we're the lucky ones. I had support. There's people coming back home that do not have the support. And everything takes like--people have to know who you are to get housing, to get a job, to come back home. We want to be community members giving back. And that's why I'm here to support this bill today, because I know it's important. I know it's important. Thank you.

Thank you.

Good afternoon, Chair, Members. My name is Gail Yen. I'm the California Policy Director with Root and Rebound. We're a legal service nonprofit that provides supports for formerly incarcerated people coming home. As June has mentioned, we also have an imprisonment program where we provide supports for folks who are coming home and help plan their reentry, including signing up for public services or public benefits, but also helping them get their IDs and birth certificates so that they can get their IDs when they come home. Just here to also answer any technical questions that you guys may have.

Thank you, other supporters?

Kat Calvin, Project ID Action Fund in strong support.

Thank you. Is there any opposition to the bill? Seeing no one. Will bring back to the Committee for questions or comments. Mr. Villapudua?

Well, first of all, I want to thank the author for bringing this forward, and if I can be added as a co-author. And I want to thank the witness for speaking. I think we really need to do more.

I think it was last year we passed something that was where they needed to make sure before they leave, too, is to have an ID, right? The birth certificate is great even having the ID, because it is so hard when you get released that you got to go out through this vicious circle, right, to go to get a job. They're looking for all that. They need all that. And when you don't have that, you don't have those tools. Guess what?

There's a percentage of folks that will probably end up going down the wrong path. And it's not sometimes their fault. It's just that they didn't have the tools. So I think providing this is one tool of being released that they need. And I just want to thank the author for this. Thank you very much.

Thank you. Any other questions? Mr. Patterson?

Thanks. Well, hey, I try to be as inconsistently consistent as possible. You know, we considered, not a similar bill, but just literally the last bill. And I have similar feelings. I will say that I've had this conversation with a friend of mine who spent some time in prison, and I know that there are a lot of things we can be doing better.

The vast majority of people are going to be getting out of prison, and we can be doing a much better job at preparing them to re-enter society and be successful. And congratulations, by the way. I think that's amazing. I do feel very similar in terms of the last bill that I think this is really a conversation we should have in this state, a broader conversation about who should be paying the fee for birth certificates and documents that are really necessary to survive for everybody.

So I think, again, I'm going to try to be consistent on this bill, and I think I'm going to be not voting. But once the fiscal analysis comes out and things like that, and I can sort of weigh that in after the next Committee, maybe on the floor, I'll have a different opinion at that point. But I want to see people who are in prison and are coming out to be successful. I think it benefits everybody. So I appreciate you bringing this bill and getting the conversation going. So thank you.

Mr. Rodriguez.

Also want to thank the author for bringing this bill forward. I too had a friend who was incarcerated for many years, and he had a lot of issues transitioning out. So this is the first step on helping our folks coming out and transition back into life. So, once again, I thank the author for bringing this board and your witnesses and testifying support. Thank you all and wishing you well. Thank you.

Anyone else? The Bill has a do pass recommendation. The motion would be do pass to Appropriations. Mr. Rodriguez made the motion. It was second by Ms. Aguiar-Curry. Would you like to close, Ms. Mckinnor?

Thank you. And I respectfully ask for your aye vote.

Thank you. With that, Madam Secretary, please call the roll.

[Roll Call]

You have six votes. We'll leave the bill on call.

Thank you.

Thank you.

Thank you.

Dr. Weber, would you like to present. You have AB 1241.

Good afternoon.

Good afternoon, Chair and members. I want to start by thanking the chair and the Committee staff for the work on this bill leading up to this hearing. I'm here to present AB 1241, which would ensure that there is one standard of care, regardless of income or medical eligibility, for individuals to access connected care and would make health care more accessible for all.

Specifically, this bill will remove the requirement in current law for the telehealth practitioner to schedule an appointment with another practitioner on behalf of the patient. Current language that the legislature adopted last year requires a warm handoff for telehealth practitioners who are referring a patient to specialized care in clinical settings. This means that a telehealth practitioner would need to make direct contact with this specialist and ensure an appointment for follow-up care is made.

Many health plans contract for providers, and those practitioners do not share the same scheduling systems as the specialized care providers. Thus, the current law would make it impossible for them to continue providing telehealth services to our medical patients in California. Statistics show that one in four Californians live in an area that is experiencing a shortage of primary care providers. AB 1241 attempts to relieve healthcare provider shortages.

This bill would increase access to telehealth services in urban and rural communities where healthcare delivery can be diminished due to a lack of health facilities or transportation to get there. Telehealth assures that regardless of your income status, you have access to a California-licensed telehealth practitioner. Should a patient need to see an in-person provider, the telehealth practitioner can refer the patient to a new provider.

AB 1241 eliminates the unintentional barrier placed on our medical patients by creating a way for providers to satisfy the new requirements without sacrificing patient protections or lowering the quality of health care that patients receive. This bill has support from the California Retired Teachers Association, Californians for Accessible Connected Care, California Hispanic Chamber of Commerce, National Diversity Coalition, Special Needs Network, and the American Telemedicine Association. With me here to testify, I have Jordan See, Director of Government Affairs for Teladoc Health.

Good afternoon. My name is Jordan See, and I'm the Director of Government Affairs for Teladoc Health. I'm here today to express support for Assembly Bill 1241. Today, in California, Teladoc Health is contracted through five of the state's managed care organizations and is an eligible benefit for over 2 million medical beneficiaries with access to at least one of our healthcare services.

Beginning January 1, 2024, California licensed providers in the medical program who wish to offer telehealth services will be subject to requirements that are far more restrictive than those required for the same care given to patients under commercial health plans. Teledoc Health, like the majority of healthcare providers in California, is not part of a closed healthcare system and has no access or visibility into scheduling for physicians and other healthcare providers outside of Teladoc Health.

Assembly Bill 1241 offers a simple amendment to clarify that the current referral and facilitation arrangement, codified last year, would not create a requirement for medical telehealth providers to schedule an appointment with a different provider on behalf of a patient, nor there would be an expectation for a MEDI Health provider to be responsible for maintaining an integrated scheduling system that is not currently feasible in California today.

Teladoc Health firmly believes that Medicare patients deserve to have as many healthcare choices and receive the same healthcare as commercial health plan patients enjoy today. It remains our goal to provide Californians with safe, high-quality, and convenient health care, especially for those in underserved and unserved areas. Thank you for your time to share Teladoc Health's perspective on this important piece of legislation, and I'll be glad to answer any questions the committee may have.

Okay, thank you. Others in support of the bill? Actually any opposition to the bill? This is a very quiet audience today. Bring it back to the committee for questions or comments.

I love telehealth. It's my heart and soul. Thank you for bringing this bill forward. We always need to clean up. We always need to look at it each year a little bit differently. And I appreciate the change that you've made on this, and thank you very much. And I'll be supporting the Bill today, if I'm not already the co-author.

Make sure I am and thank anyone else. Thank you, Dr. Weber, for bringing this forward. I have a few comments. Been working on this area as well for quite a while. Department of Healthcare Services underwent a public stakeholder process in the fall of 2021 and updated the policies to reflect stakeholder input and final legislative negotiations. So, the current law, which this bill clarifies, reflects these agreements. As the chair of the committee here, I want to state on the record my support for telehealth.

We've seen through the pandemic and continuing on that telehealth is critical to increasing access, particularly in rural districts like mine and some of our fellow colleagues here. But I also believe that telehealth is not a standalone service disconnected from a person's normal source of care but a modality providers can use to deliver care. Care offered through telehealth should be coordinated with a normal source of care and not create more fragmentation.

So, for instance, if during a telehealth appointment, it becomes necessary to instead have the person come in in person, for the provider will say, "Please come into the clinic," or the telehealth provider doesn't provide in-person care, that they have a relationship with somebody in the community that can assist that patient, then the patient will have a handoff to somebody. My concern is that if there is no connection at all, we talked about provider networks last week.

We can't just be giving a list of providers to people and saying, well, we've diagnosed this. Here's a list of providers. Good luck. And so that's one of the challenges. We don't want them to be stuck in the patients, to be stuck in the middle, having to bridge a gap between the telehealth provider and the person who might be providing care in person. So, the bill strikes a good balance by maintaining these important patient protections by making it easier for providers to comply with this requirement.

It clarifies. The requirement does not mean that telehealth providers actually have to schedule an appointment for the patient and then provision in-person care and that the provision of in-person care or warm handoff doesn't occur in every case. We expect additional guidance coming from the Department of Healthcare Services on this requirement, but this helps clarify the legislative intent around that provision, which I believe is the intention of the bill.

So, I want to thank you for working on this with us to amend the bill prior to the hearing, and I'm happy to support the Bill today. We do have a motion by Ms. Aguiar-Curry, a second by Mr. Villapudua. Would you like to close, Dr. Weber?

Well, thank you very much. I would like to close just by once again thanking the Chair and the committee. We are all very well aware of the importance of telehealth. It has really been a game changer to breaking down a lot of barriers to access that we have had up and down the state and actually throughout this country. To have the requirement that the provider on telehealth actually schedule the appointment for the patient is more than just a bit.

I, prior to coming here, I actually worked at two separate hospitals within the San Diego area, completely two different electric medical record systems. Did not speak to each other. So, if we can't do it within the same city, then I don't know how we would expect that of someone who's providing care via telehealth. So I appreciate it.

And I just want to reiterate that this bill is about eliminating barriers to care that is necessary to ensure that telehealth care remains an option for all Californians, just not those who have commercial insurance. And I respectfully request an aye vote. Thank you.

Thank you very much, Dr. Weber. And clarification, my hearing isn't as good these days. So, the motion was by Ms. Aguiar-Curry. The second was by Mr. Boerner Horvath. And it was very close, though. Pardon? I thought that's what I said. Did I? Apparently, I can't speak as well as here. I'm scared of what might be next. But anyway. Okay, we do have a motion. We do have a second. I'm not going to repeat the names. The motion is do pass to appropriations, ma'am.

Secretary, please quickly call the roll.

[Roll Call]

You have seven. We're almost there. We'll leave the Bill on call. Thank you. Ms. Addis, you have AB 839. Excuse me. Thank you.

Good afternoon.

Microphone.

Thank you. How's this?

Perfect. Thank you.

Okay. Good afternoon, honorable Chair. Thank you for having us and members of the committee. I also want to thank committee staff who helped us with some amendments, my staff, and our witness who is here today and then say a very special happy birthday to Assemblymember Waldron. I hope you get to celebrate today, but I am here today to ask for your aye vote on Assembly Bill 839.

This bill was developed with significant input from committee staff and we did take all committee staff recommended amendments. We're talking about residential care facilities for the elderly, which are an incredibly important part of our state's health system, supplying housing and care to individuals over 60 years of age. These facilities are generally seen as an intermediary between independent living and 24-hour supervised care, providing personalized care assistance, room and board, among other services to seniors.

California, like many other states, has an aging population and by 2030 we are expected to have over 10.8 million individuals over the age of 60 and qualifying for what's called RCFE or residential care facility for the elderly support. By 2060, it is projected that adults over age 60 will make up 30% of our state's total population. So as you can see, care facilities such as RCFEs are going to become more and more impactful as California's demographics continue to shift.

In sharp contrast to the growing need for senior care, there's a harsh reality that many RCFEs face, which is staffing shortages exacerbated by the COVID-19 pandemic, which has led to other problems, especially for those smaller nonprofit RCFEs. So what AB 839 would do would directly support these nonprofit facilities by opening access to lower interest rate, tax-exempt financing through a program that already exists, which is the California Health Facilities Financing Authority. And to be clear, the CHFFA only funds nonprofit care facilities.

So this bill is a very modest change that will have a profound impact on RCFEs by reducing borrowing costs and allowing them to invest those funds in areas of dire need. AB 839 would add at a maximum 239 nonprofits that could qualify for this funding. But what we know is that some of these facilities, some of the nonprofit facilities already are getting the funding, so we expect the number to be a little bit less, so not putting a burden on the CHFFA program. And I do have a witness here, Amber King with Leading Age California. Would like to turn it over to her testimony.

Thank you.

Thank you, Mr. Chair and members. Amber King with Leading Age California, representing nonprofit providers of care and affordable housing for older adults throughout the state. We also represent skilled nursing facilities, residential care facilities, home and community-based care, home health, and hospice care throughout the state. We are proud to sponsor AB 839, which would allow nonprofit RCFEs to take advantage of the California Health Facilities Financing Authority and their tax-exempt bond program.

As the Assembly member mentioned, the demographics of older adults is rapidly changing throughout the state. When CHFFA was originally created in 1979, the delivery of care of older adults was much different than it is today, and how older adults are wishing to receive care and how they're wishing to age. Independence and dignity is a key driver of that change.

While skilled nursing facilities are an integral part of the healthcare delivery system, we are seeing more and more of our nonprofit provider members downsizing their skilled nursing care and increasing their capacity for assisted living and in particular, memory care, which we're seeing a stronger demand for more recently, as older adults are choosing to receive their care in their home for as long as possible and delaying their move to the more clinical health setting.

AB 839 additionally furthers goal one, housing for all ages and stages of the master plan for aging, which aims to allow older adults to live where they choose, as they age in communities that are age, disability, and dementia friendly. AB 839 will reduce borrowing costs to create more assisted living and memory care to meet the needs of our growing older adult population. And with that, I would urge your aye vote. Thank you.

Thank you very much. So, we have a motion by Mr. Villapudua, second by Ms. Waldron. I just want to make sure I get that one right. Okay. Others in support of the bill? Is there any opposition to the bill? Seeing none. We'll bring back to the committee. Questions or comments from the committee? Seeing none. Would you like to close, Ms. Addis?

There we go. Thank you so much for your time, and I respectfully ask for your aye vote on AB 839.

Thank you very much. The bill does enjoy a do pass recommendation. We have a motion by Mr. Villapudua, a second by Ms. Waldron. Madam Secretary, please. It's do pass as amended to appropriations. So thank you for accepting the amendments. Madam Secretary, please call the roll.

[Roll Call]

You have six votes. We'll leave the bill on call.

Thank you.

Thank you. Yes. Okay. Seeing no other authors, I'm going to turn this over to our Vice Chair, and I'm going to present my bill.

AB 1092. Chairman Wood, start when you're ready.

Thank you very much, Madam Chair and members. AB 1092 builds on my prior legislation, AB 595, to ensure health plans acquiring a physician group is subject to regulatory review. This bill authorizes the Department of Managed Healthcare Director to review competition in healthcare systems or healthcare providers and to provide this information to the attorney general. To clarify, this bill does not expand attorney general authority other than what is an existing law, and merely authorizes the department of managed healthcare to share information with the attorney general. We are in discussions with the health plans to clarify these provisions. With me in support is Health Access California, and I respectfully ask for your aye vote.

Good afternoon, Madam Chair and members. I'm Katie Van Deynze, a policy and legislative advocate with Health Access California, the statewide healthcare consumer advocacy coalition. Health Access proudly supports AB 1092, which will ensure that when health plans merge or acquire other entities like physician groups, there's a review for the impacts of the mergers on consumers to prevent any negative impacts.

Health access sponsored AB 595 by Dr. Wood, which the Legislature passed in 2018 to approve or deny health plan mergers or approve mergers with conditions to protect consumers. AB 595 required that when two health plans merged or another entity acquired a health plan, that they seek approval from the department. And under the law, the department reviews the merger for the impacts on consumers, purchasers, costs, quality, and competition, and holds a public meeting on the merger.

AB 1092 closes a critical gap in this oversight by requiring that when a health plan acquires another entity, there is that same review. Since the passage of AP 595, we've seen an increasing trend of health plans buying physician groups, and there is not existing oversight over these kinds of mergers. For example, Optum, a medical group owned by UnitedHealthcare, recently bought two of the largest physician entities in Southern California. UnitedHealthcare is now one of the largest employers of physicians in America and is growing.

Like health plan mergers, eliminating or lessening competition among providers and insurers and plans can lead to increasing costs for consumers and less competition for quality and types of services offered. That is why requiring that all kinds of health plan mergers have this oversight is critical to protecting quality and affordable health care. The Legislature and this committee have prioritized containing health care costs, and AB 1092 is an important measure to do just that. I respectfully ask for your aye vote on AB 1092. Thank you.

Beth Capell with Health Access, here to answer any questions. Thank you.

Thank you. Are there other witnesses in support of the bill? Please come forward. Name and organization.

Good afternoon. Andrea Rivera on behalf of the California Pan-Ethnic Health Network, in support.

Sandra Poole at Western Center for Law and Poverty, in support.

Good afternoon. Beth Malinowski with SEIU California, in support.

Christoph Mair with the American Federation of State, County, and Municipal Employees, in support.

Thank you. Seeing no other witnesses in support, I'll call up witnesses in opposition. Two witnesses, three minutes each.

Thank you, Madam Chair and members, Nick Louizos with the California Association of Health Plans, and we are respectfully opposed to this bill in its current form. By way of background, this bill, AB 1092, revisits Chairman Wood's AB 595 from 2018, which we opposed at the time because it gave the Department of Managed Healthcare authority to impose new requirements on health plan transactions, including government regulators, giving government regulators more leverage to demand expensive undertakings from our members when they seek approval for a transaction.

One of the reasons we objected to AB 595 was because it specifically codified this practice by allowing conditional approval only if certain contingencies are met by the plans, in other words, undertakings in the form of financial contributions to various groups and initiatives. AB 1092 now adds new contingencies to that language, which, while well-meaning from our perspective, are ill-defined and difficult to attain because they, from our perspective at least, ignore undercurrents in the healthcare market. Other provisions of the bill raise additional concerns.

Current law already requires that proposed transactions by plans be approved by the DMHC, and provisions in this bill involve the attorney general. We had a conversation with the author's staff and the sponsors yesterday, so we're seeking more clarification about what the role of the attorney general would be with the added language in this bill. Additionally, we should add that the newly created Office of Healthcare Affordability aims to take a comprehensive approach to addressing rising healthcare costs.

And, of course, Chairman Wood was a champion of the Office of Healthcare Affordability. As part of its mission, the office is required to monitor the impact of consolidations in the healthcare market and promote competitive markets in a manner that is supportive of the AG and DMHC's current efforts. So, from our perspective, it's not entirely clear why these added provisions are needed.

And so I'll just close by saying we know that the author of the Chair is a champion of cost containment and affordability, and we certainly appreciate that. We do disagree with the direction of this proposed bill, but we understand that ensuring a healthy marketplace is very important. So we've had some initial discussions. If there's an openness to resolving some language concerns that we have, we look forward to having further conversations down the line. Thank you.

Thank you. Are there other witnesses in opposition? Name, organization and position only. Seeing none. I'll bring it to the committee for any questions or comments. Return it to Chairman Wood for a close.

Thank you, madam Vice Chair. My door is always open to work with stakeholders in opposition to a bill. I think AB 595 proved its worth in a recent merger of health plans. And I will say that, in general, the merger of health plans is not a frequent occurrence, but what we're seeing now is much more frequent, and that is the acquisition by a health plan of physician provider groups, and that is of concern. We will continue to work with the opposition on this. I'm always looking for high-quality, high-access, and patient-centered healthcare. This bill is no exception to that. So I respectfully ask for your aye vote.

Thank you. We do have a motion. Do pass, as amended, to appropriations. Madam Secretary, please call the roll.

[Roll Call]

Five to one. We'll put it on call.

Mr. Muratsuchi.

Thank you very much. Mr. Chairman, if I may proceed?

Please do. Please.

Thank you to the Members of the Committee. I'm here to present AB 899, which your excellent want to thank your excellent staff report, very comprehensive summary of the state of trying to make sure that infant formula, baby foods sold not only in the State of California but across the country, a national effort to try to raise standards to protect our babies. As the summer indicates, this requires basically three things.

One is requiring in state or out of state manufacturers of infant formula or baby food sold or distributed in the state to, number one, test their infant formula or baby food products for toxic heavy metals, especially lead, mercury, cadmium and arsenic. Number two, post on their website the name and level of toxic heavy metals in the final infant formula or baby food product. And three, include a label on the product that has been tested.

This bill idea actually came from one of my former Committee staff, Susan Chan. We celebrated her new motherhood last year and she discovered and brought to my attention the issue that I'm sure many mothers and fathers in this building, as well as all Californians who are new parents are discovering, which is the very uncertain situation in terms of the documented evidence of toxic heavy metals in infant formula and baby food being sold.

The Committee report summarizes the congressional Subcommitee that issued the report, which I wanted to just read, and highlights that according to the congressional Subcommitee, commercial baby foods are tainted with significant levels of toxic heavy metals, including arsenic, lead, cadmium, and mercury. Exposure to toxic heavy metals causes permanent decreases in IQ, diminished future economic productivity, and increased risk of future criminal and antisocial behavior in children. Toxic heavy metals endanger infant neurological development and long term brain function.

The Subcommitee goes on to find that internal company standards currently permit dangerously high levels of toxic heavy metals. And documents revealed that the manufacturers often sold foods that exceeded the Food and Drug Administration levels. So we clearly have a national problem here.

While the FDA and Congress are looking into this issue, this is an opportunity for California to once again take the lead and to spur Congress and the rest of the country as the world's fourth largest economy, to bend the market, to spur the market, to ensure that we are protecting babies from these heavy, toxic metals. Here to testify in support of this bill is Susan Little with the Environmental Working Group, who is working on this not only here in California, but also in our nation's capital.

Good afternoon. Thank you. As the Assemblymember mentioned, my name is Susan Little. I'm a senior advocate with the environmental Working Group and I'd first like to thank the Assemblymember for authoring 899 which will inform parents about the heavy metals lurking in the food that they feed their infants. To date, this information has been largely a mystery.

The presence of high levels of lead, mercury, arsenic, and cadmium and baby food has only been brought to light as a result of third party testing and acts of Congress. These disclosures have demonstrated that alarmingly high levels of toxic metals are present. The presence of these toxic metals in baby food should cause us all concern, because the ingestion of even low levels of these metals, which build up over time in children's bodies, can cause infants and toddlers grave health effects.

Lead, as we know, is especially damaging to babies. It's a neurotoxin, damages the nervous system, and even low levels of lead exposure can cause lifelong learning and behavioral difficulties. Lead is also a carcinogen, can damage kidneys and cause high blood pressure. Chronic exposure to cadmium can cause kidney, liver, and bone damage. Children are more susceptible to the effects of low doses of cadmium over time. And like lead, cadmium causes developmental and behavioral problems. Mercury is another neurotoxin and when consumed by children, can cause blindness.

Brain, lung, and kidney damage, harm the immune system and create digestive problems. Arsenic can also lower IQ, impair brain development, cause cancer, growth and breathing problems, and hurt the immune system. None of these metals should be present in baby food or fed to children. Even at low levels, baby food manufacturers should test their products for these toxins and transparently disclose levels to consumers. Amazingly, such protections are not currently required.

AB 899 will close this gap and give Californians the information they need to protect their infants from toxic metals that can impair their development and harm their life outcomes. We'd urge your support for this bill. Thank you.

Thank you very much. Others in support. Is there anyone in opposition to the bill? No. We'll bring it back to the Committee for questions or comments. Mr. Flora?

Thank you, Mr. Chair. Thank you, colleague, for bringing this forward. I just had a couple just questions, and you said it sort of in your statements that the FDA has not actually set a level yet. Is that correct?

That is correct. Okay.

So if the feds have not looked at this and set a level and we disclose this information, what are the parents supposed to do with that? What are the other alternatives?

Thank you. Thank you, Mr. Flora. So the FDA is currently reviewing and taking public comments as the Committee report indicates, a draft action plan on lead and baby food. But in the meantime, they have issued the recommendation that manufacturers should disclose the amount of heavy metals that exist in these products. And while the FDA has not formally landed on the guidelines in terms of what levels of these heavy metals are.

In fact, dangerous and how dangerous are they, they have issued the recommendation for the sake of consumer awareness, with the general guidance that obviously, the less toxic heavy metals, the better it is for their baby. So this is what we are proposing. The first step. We're certainly open to working with this Committee as well as with any concerns.

I know that there were some concerns highlighted in the Committee analysis, and one proposal was to try to align this with any subsequent recommendations that may be forthcoming from the FDA. On the last page of the Committee analysis, the author may wish to consider requiring the posting only where the FDA has adopted guidance. I mean, those are considerations that we're certainly open to. But in the meantime, I think know mothers, fathers, all parents should have the right to know what toxic heavy metals are in the food that they're feeding their babies.

And I appreciate that, and I would certainly agree with you. I think parents deserve that right to know. I also think it's important that parents understand the information that they're given. And if there's no guidelines set and we just throw out a bunch of information that could create an unnecessary concern that may or may not be there at certain levels. And right now, we just came through a bit of a formula shortage that we all are very aware of.

And so to create a hysteria about this with really no guidelines, I think might be a little bit premature. But I certainly respect the intent of the bill. I am going to be laying off of it today, but I do think it's probably wise. California we do like to lead, but on this particular issue, I think we should let the FDA, the professionals, take a look at this, set the guidelines, and then we come in behind them. So thank you.

Thank you.

Any other questions? Mr. Villapudua.

So was it mentioned that there is testing going on right now? There is testing, there is testing going on, yes. Okay. And part of this bill will be, is it testing in bulk? Is it, each can?

As the Health Committee analysis indicates, the Subcommitee has found that the final products have included foods that exceeded the FDA's recommended levels. The congressional Subcommitee recommended that baby food manufacturers should be required by the FDA to test their finished products for toxic heavy metals, not just their ingredients. So we're trying to focus on the finished products. The concern is that much of the testing to date has focused on the input ingredients, but not on the final product. What consumers are actually consuming and so this bill would be to require to test for samples, not every product, but samples of the final product.

Got it. Good. Yeah. Again, I don't want any bad finished product coming out, but as long as there's no delays. Right. As my colleague mentioned, we just came off a year not having enough out there. And that was kind of displayed all over the social media. Right on TV, too. So I'll be voting for this today.

Thank you. And just to clarify, Mr. Villapudua, nothing in this bill seeks to ban or limit the consumption or the availability of these infant formulas or baby food. It is merely a transparency measure to give consumers that information.

Thanks, sir.

Thank you.

Ms. Weber, or Dr. Weber, excuse me.

I want to thank the author for bringing this bill know. Transparency is important, especially when we're dealing with our young infants. And even though we may not have the specific data, at least giving parents that knowledge, and this is not something that is uncommon here in California. With Prop 65, we started putting labels that things may have certain ingredients or certain products that may lead to cancer.

And I don't think that that has caused mass hysteria because I think that's been an effect for probably like 30 years. But it is good to know and it's really good to give people the opportunity to make the choice if they want to purchase something or if they want to consume something, even if we don't have all of the information out there. So I definitely appreciate that. I've given these types of foods to my children when they were younger and I wish I had known about this information. So thank you. And I'd love to sign on as a co author.

Well, thank you very much, Dr. Weber. As a physician, I especially appreciate your support for this bill.

Thank you. Anyone else? I want to thank you, Mr. Maratsuchi, for bringing this bill forward. You certainly sparked a lot of conversation with our Committee consultants as we analyze the bill. And just for the record, to Mr. Flora's question about shouldn't we be waiting? We've done this before with cosmetics, and that was your bill. So this is not unprecedented that we're looking at this as a possibility moving forward.

We're also asking for testing by manufacturers. And I think at some point we'd like to see the FDA do a little bit of this testing as well. Transparency can change behavior. I think that when people know what's in something, they can then make a conscious decision whether they want to purchase it or consume that. I am personally really appalled to think that there might be high lead, levels of lead and other heavy metals in what we're feeding to our infant that I wish I could say.

I was optimistic that the FDA would be on this immediately and really working on it. The Federal Government moves very slowly, and the FDA moves very slowly. And so I do appreciate your desire to shine a light on this. And maybe by shining a light on this, the Federal Government will actually accelerate their efforts to get to a place where we can have least disclosure, what safe levels can be, and ensure that we're actually giving our infant children the safest possible food. So I'm happy to support your bill today. Would you like to close?

I respectfully ask for your aye vote.

Thank you. I'm actually in search of a motion at this point, a motion by Dr. Weber, and that was by Ms. Waldron. Second. A second by Vice Chair Waldron. So the motion is do pass to environmental safety and toxics. Madam Secretary, please call the roll.

[Roll Call].

That's seven votes. We'll leave that bill on call, Mr. Muratsuchi. Ms. Irwin, would you like to come forward? While you're coming forward, I'm happy to entertain a motion on the Consent Calendar. Motion by Ms. Aguiar-Curry, I believe.

Second by Dr. Weber. Or vice versa. Ms. Boerner Horvath, excuse me. Madam Secretary, the Consent Calendar includes item number five, AB 700, by Mr. Grayson, item number 12, AB 1110 by Dr. Arambula, and AB 13, Item 13, AB 1233, by Vice Chair Waldron. So please call the roll on the Consent Calendar.

[Roll Call]

So, the Consent Calendar is approved with eight votes, and we'll leave the roll open for others to add on. Ms. Irwin, you have AB 1117. Please push the button. Thank you.

I think you heard a good afternoon already. Last year, I authored AB 2673 which implemented the recommendations made by the State Auditor to address significant fraud in the hospice industry. Recently, it was brought to my attention that some hospice providers have identified a loophole in state law that allows bad actors to continue defrauding the state. Certain fraudulent hospice providers currently hold multiple licenses, but only certify one license with Medicare for building.

The fraudulent providers then bill Medicare for services provided to fictional patients up until fraud is detected and an investigation is open. Once under investigation, the provider will abandon that license and certify his next license to begin the whole process all over again. AB 1117 addresses this fraud by requiring licensees to be certified within 12 months of receipt from the Department of Public Health. As an additional safeguard, licensees must submit patient data to HCAI on an ongoing basis. If reporting data ceases, the licensee must forfeit their license. With me to testify in support is Peter Kellison, representing the California Hospice and Palliative Care Association.

Thank you, Mr. Chair and Members. Peter Kellison on behalf of the California Hospice and Palliative Care Association. Want to thank the author and your staff for once again working with us on this issue to try to reduce fraud in the hospice system that provides care to the terminally ill and those needing palliative care. The author has summarized the issue. Essentially, this bill requires hospice providers to use their license to, substantiate that the license is being used to serve patients, or lose it. Happy to answer any questions if needed.

Motion by Mr. Flora, second by Ms. Aguiar-Curry. I got that right. Others in support of the bill? Seeing no one. Is there any opposition to the bill? No one. Bring it back to the Committee. Questions or comments from the Committee? None. We have a motion by Mr. Flora, a second by Ms. Aguiar-Curry. Motion is do pass to Appropriations. Would you like to close, Ms. Irwin.

I appreciate the bipartisan motion. Respectfully ask for your aye vote.

Thank you. Thank you. So the motion is do pass to Appropriations. Madam Secretary, please call the roll.

[Roll Call]

Your bill has eight votes. It's out. We'll leave the bill on, we'll leave the roll open for others to add on. Thank you very much.

Thank you very much.

We have a couple of bills left. Looking for Dr. Jackson, Ms. Sanchez to come and present bills, please. We have... Oh, yeah, let's go ahead. We have several bills on call here, so let's go to the top of the order, and we will open the roll on item number one.

Oh, I'm sorry. We did not have a quorum. So, looking for a motion on item number one, AB 77 by Ms. Pacheco. A motion by Ms. Aguiar-Curry. A second by Mr. Flora. The motion is do pass as amended to Appropriations. Madam Secretary, please call the roll.

[Roll Call]

That's 8-0. That bill is out. Item number three, AB 425 by Mr. Alvarez. Please open the roll and call the absent Member. Let's lift the call. This was not on call? Okay, then open the roll. Call the absent Members. Sorry.

[Roll Call]

That's 11-0. Item number four, AB 464 by Ms. Schiavo. Please lift the call and call the absent Members.

[Roll Call]

That's seven. That bill is still on call. The Consent Calendar. Please lift the call and call the absent Members on the Consent Calendar.

[Roll Call]

That's 9-0. Please lift the call. Call the absent Members on AB 839, item number six.

[Roll Call]

That's 8-0. That bill is out. Please open the roll, call the absent Members of AB 899. Oh, it was on call. Excuse me. Okay, please lift the call, call the absent Members.

[Roll Call]

Now that one is out. Please lift the call on item number eight, AB 974 by Ms. McKinnor.

[Roll Call]

That has nine votes. That bill is out. Item number 10, AB 1117 by Ms. Irwin. Please open the roll. Call the absent Members.

[Roll Call]

That's 10. Item number 14, AB 1241 by Dr. Weber. Please lift the call. Call the absent Members.

[Roll Call]

That's 11 votes. Item number 15, AB 1092 by Wood. Please lift the call. Call the absent Members.

[Roll Call]

That bill has eight votes. It's out. We'll leave the roll open for others to add on. Okay, we have word that our authors are on their way, so hang tight. Oh, I'm sorry. That was quick. Okay, please come forward. Come on up to the desk. Whenever you're ready. You have to push the button on the mic there. Thanks.

I'm learning. Thank you, Mr. Chair and Members. I want to thank the Committee and staff and stakeholders for working with us on this measure. AB 1696 is a straightforward Bill that helps our government agencies better protect state and federal funding from being exploited by bad actors in the recovery residence industry. Recovery residences are an important source of support for individuals undergoing treatment for substance abuse. Residences that allow nationally standards of quality are safe and effective in helping these individuals.

However, the generally unregulated nature of recovery residences industry has left the door open for bad actors to take advantage of vulnerable people. These are residents that are overcrowded, unsafe, predatory, and destructive to their residents and to neighbors around them. AB 1696, the very common sense Bill that simply says if a government entity in California contracts with a recovery residence, the residence owner must submit proof that their residence maintains a standard of practice that helps keep their residence and neighbor safe.

We should not allow any state or federal funding to be funneled into the pockets of bad actors looking to make a quick buck at the expense of residents who are suffering. We must ensure that these funds support programs that provide a safe quality of life. For these reasons, I urge your support on this measure. Testifying with me today is Sherry Daley with the California Consortium of Addiction programs and professionals and Leslie Huber, who has personal experience with recovery residence housing.

Thank you, honorable chair and Members, Sherry Daley with the California Consortium of Addiction programs and professionals. CCAP is California's affiliate organization for the National alliance for Recovery Residences, which sets standards for this type of housing. As such, we certify residences that meet safety and quality benchmarks, inspect homes, respond to complaints against them, and train owners and operators on how to establish new homes or improve the quality of existing homes.

It is our mission to improve access to this housing type and to ensure that participants are safe and their needs in early recovery are being met in several states. All public funding dedicated to this housing type and all referrals made to it from state regulated entities are tied to certification. This has been proven to be an effective means to raise quality and Ward off bad actors because it incentivizes good practices by reserving contract opportunities and referrals to legitimate providers.

It also creates a public private partnership where owner operators who harm consumers or defraud funders can be eliminated from the system. California is poised to invest almost $1 billion in behavioral health bridge housing. This raises concerns that unscrupulous and fraudulent operators will wreak havoc in an already untenable and unregulated market. Although much needs to be done to move the needle toward tying quality to funding, this Bill addresses four immediate needs for moving in that direction. First, to improve residents safety, the Bill does two things.

It mandates that contracted homes supply overdose reversal medication and ensures someone in the home knows how to access it and administer it. It also requires that contracted entities have in place a policy to address medication used by the residents who stay in these homes. To promote ethical behavior, the Bill requires contractors to sign the NAR code of ethics and to produced documentation that demonstrates that the owner of the property has given permission for it to be used for recovery residents housing.

With just these four contract requirements, California can begin to move toward healthier homes, longer lasting recovery for residents, and happier neighborhoods. We urge your aye vote on this measure. Thank you.

For any successful recovery, it's essential that there is support available in an environment that is properly equipped with tools and training for life beyond affliction. Early sobriety can bring relief, excitement, freedom, energy. But there is a lot more to work through. Fear, anxiety, shame, lack of confidence, broken relationships, financial hurdles, and the monumental task of reframing the wires of our brain to think and act differently in a wellprepared, sober residence.

There is no stigma when surrounded by peers who are united in their recovery and who all strive for accountability. There's an opportunity to learn how to grow back into authenticity and revisit the foundations of building and mending meaningful and healthy relationships. There's a peace that comes knowing there are people further on in their journey who have made it their mission to guide you and arm you with the tools to take on your journey, too.

There's the utmost importance of the quality and procedures in residences as well. There is utmost importance that the quality and procedures in residences are well regulated and structured. People do still use drugs through recovery, whether we want them to or not. And having a reversal medication on hand if someone relapses while away from the residence is highly important.

If I didn't feel safe, if I still had access to drugs, or if there was a lack of staff training or knowledge, I don't think I would have been successful in my sober residency. Because these environments harbor people who are struggling with crisis. It can be a dangerous place, costing lives. Everyone deserves a fighting chance and a safe place to start their journey. Thank you for your consideration, and I urge your I vote on this life saving measure.

Thank you. Others in support? No one. Is there anyone in opposition to the Bill? No one will bring it back to the Committee. Questions or comments from the Committee? Seeing none. We have a motion by Mr. Via Pudwa, a second by Mr. Rodriguez. I think I got that right. A motion is do passed to appropriations. Would you like to close?

AB 1696 is a reasonable measure that helps ensure that state and federal funding is not used to Prop up or incentivize the entrance of bad actors into the recovery residence industry. I respectfully ask for your aye vote on this measure.

Thank you very much, Madam Secretary. Please. The motion is do pass to appropriations. Please call the roll.

Wood.

Wood, aye. Waldron. Waldron aye. Aguiar-Curry. Aguiar-Curry aye. Arambula. Boerner Horvath. Boerner Horvath aye. Carrillo. Flora. Flora aye. Vince Fong. Maienschein. Maienschein aye. McCarthy. McCarthy aye. Joe Patterson. Joe Patterson aye. Rodriguez. Rodriguez aye. Santiago. Santiago aye. Villapudua. Villapudua aye. Weber. Weber aye.

Aye.

You have 12 votes. The Bill is out. We'll leave the roll open for others to add on. Thank you, Dr. Jackson. I'm sorry. Excuse me, Dr. Jackson, you have the final Bill of the day.

Thank you very much, Mr.

Chair. And Members, I would like to open up by saying that we are accepting the Committee amendments. And I thank the Committee and the staff for their work with my office on this measure. I present to you AB 1079, which would create a hate crimes intervention unit within the California Department of Public Health and establish the California Ad Council within the California Civil Rights Department. In 2021, California saw a horrifying surge in hate crimes, reaching numbers unseen since the aftermath of the terrorist attacks of September 11.

In 2021, there were 1763 bias events, a 32.6% increase from 2020, the highest number reported since 2001. Antiblack hate crimes, the most frequent of all hate crimes, both now and since the United States began tracking hate crimes in 1991, increased by 12.5%. Antiasian hate crime events skyrocketed yet again, arising by 177.5%. Hate crimes motivated by sexual orientation bias rose by nearly 50%, alongside historic increases in hate violence against our Jewish brothers and sisters.

In fact, California had the 6th most incidents of white supremacist propaganda distribution in the country, nearly doubling 2021 numbers. California was second in the country in white supremacist events and third in incidents of white supremacist propaganda distribution on colleges, University, and k through 12 school campuses. While there are serious efforts to combat hate crimes from the California Department of Justice and through other community investments, there have been little effort through a public health lens.

On a statewide level, racism is a public health crisis in California, with 37 declarations by our local governments or governing bodies, the highest nationwide. These declarations, however, do not outpace the harm caused by the unprecedented spike in hate crimes. To halt the growing tide of bigotry, hate dogmatic ideology, California must go on the offense against bigotry, hate, and xenophobia. With AB 1079 and other measures like it, it will be the first genuinely antiracist state.

Joining me today in support is a representative from the Bill sponsor the Antidefamation League. Mr. Cliff Berg.

Thank you. I would like to thank the author and good afternoon Chairman Wood, Vice Chairman Waldron, and Members of the Committee on Health. My name is Cliff Berg. I am here on behalf of the Jewish Public Affairs Council. On behalf of our Member organization, the Antidefamation League, ADl. We'd like first to thank Assemblyman Member Jackson for sponsoring this Bill.

Founded in 1913, ADL is a leading anti hate and civil rights organization whose mission is to stop the defamation of the Jewish people and secure justice and fair treatment to all. ADL is a leading advocate on hate crime legislation and hate crime prevention. In 1981, we developed model legislation, and today we provide victim support, increase community awareness, and conduct trainings on how to identify hate crimes. Hate crimes are message crimes.

They are uniquely harmful and deeply personal, both to the targeted individual and to the community who share that individual's characteristics. As we develop policy solutions to address hate crimes, it is essential to take a community and victim centered approach. Although traditional hate crime laws have typically focused on penalty enhancements, that is only one piece of the puzzle. Addressing and preventing bias motivated requires a holistic, multipronged approach.

That is why ADL is proud to support AB 1079, which would establish a hate crimes intervention unit to develop research based strategies to address hate, and the California Ad Council to create a media advocating against discrimination. AB 1079 recognizes hate is not only as a public safety issue, but also a public health issue. Because hate and bias can deny access to resources, dignity, and impact quality of life. This approach focuses our efforts on education, community building, and victimcentered approaches.

Although California is home to many diverse communities, the true impact and scope of hate in the Golden State is often underestimated. According to the newly released FBI data, in 2021, reported hate crime incidents across the country increased to 10,840 incidents, the highest level recorded in more than two decades. In California, we saw an over 33% increase in reported hate crimes, the highest since 2001.

A hate crimes intervention unit would help implement a holistic, community based approach to address this troubling rise in hate crime incidents in our state. We urge you to support AB 1079.

Thank you very much. Others in support.

Andrea Rivera on behalf of the California Panethnic Health Network in support.

Thank you. Anyone else? Is there any opposition to the Bill? None. We'll bring it back to the Committee. Questions or comments of the author? From the Committee we have no questions. We have a motion by Mr. Rodriguez, a second by Dr. Arambula. The motion is do pass as amended to judiciary would you like to close, Dr. Jackson?

Thank you very much, Committee Members. As you know, the issues of racism, hate and xenophobia continue to climb. We're in another upward trajectory when it comes to that. And therefore, it is our goal to ensure that we create systemic efforts to ensure that, ongoing for future generations, we create the mechanism necessary to continue to combat these issues. I respectfully ask for an aye vote.

Thank you very much, Madam Secretary. Please call the roll.

Wood.

Wood. Aye. Waldron. Waldron. Aye. Aguiar Curry. Aguiar Curry. Aye. Arambula. Rambula. Aye. Boerner Horvath. Boerner Horvath. Aye. Carrillo. Flora. Flora aye. Vince Fong. Vince Fong. Aye. Maienschein. Maienschein. Aye. Mccarty. Mccarthy aye. Joe Patterson. Joe Patterson. Not voting. Rodriguez. Rodriguez. Aye. Santiago. Santiago aye. Villapudua. Villapudua aye. Weber. Weber aye.

Aye.

Know, Mr. Flora, you had a vote change you wanted. And then we'll go to the top of the order for vote change. AB839. Addis from not voting to I. So vote change. AB 839. Addis. Not voting to I.

Flora not voting to aye.

Perfect. Okay, thank you. That makes it 90. So we'll go to the top of the order and open the roll for Members who haven't voted. So hang on a second, we're conferring here. Yeah. Eight, three. Okay, we'll go to the top of the order. Item number one. AB. 77 by Assembly Member Pacheco. Please open the roll and call the absent Members.

Arambula. Arambula aye. Carillo. Vince Fong. Vince Fong aye. McCarty. McCarty aye. Joe Patterson. Joe Patterson aye. Rodriguez. Rodriguez aye. Santiago. Santiago aye. 14.

That's 14 0. Item number three. AB, 425 by Assembly Member Alvarez. Please open the roll. Call the absent Members.

Arambula. Arambula aye. Carrillo. McCarty. McCarty aye. Santiago. Santiago aye. 14 0.

That's 14 0. Item number four, AB. 464 by Assembly Member Schiavo. Please lift the call. Call the absent Members.

Arambula. Arambula aye. Carillo. Vince Fong. Vince Fong. Not voting. McCarty. McCarty aye. Joe Patterson. I'm sorry. Not voting. Santiago, Santiago aye. 10.

That has 10 votes. The consent calendar is items number five. AB, 700 by Mr. Grayson. Item number 12, AB. 1110 by Dr. Rambula. And item number 13, AB. 1233 by Vice Chair Waldron. Please open the roll. Call the absent Members.

Arambula. Arambula aye. Carrillo. Vince Fong. Vince Fong aye. McCarty. McCarty aye. Joe Patterson.

No, this was the consent calendar.

Joe Patterson aye. Santiago. Santiago aye.

That's 140. Item number six, AB 839 by Assembly Member Addis. Please open the roll call.

The absent Members Arambula. Arambula aye. Carrillo.

Vince Fong. Vince Fong aye. McCarty. McCarty aye. Joe Patterson.

Aye.

Joe Patterson aye. Santiago. Santiago aye.

That's 140. Item number seven, AB 899 by Mr. Muratsucci. Please open the roll call the absent Members.

Arambula, Arambula aye. Carrillo. Vince Fong. Vince Fong not voting. McCarty. McCarty aye. Joe Patterson. Joe Patterson no. Santiago. Santiago aye. 11 to one.

That vote is 11 to one. Item number eight, AB 974 by Ms. McKinnor. Please open the roll call the absent Members.

Arambula. Arambula aye. Carrillo. Vince Fong. Vince Fong aye. McCarty. McCarty aye. Joe Patterson. Joe Patterson aye.

Okay, that's 13 0. Item number nine, AB 1079 by Dr. Jackson. Please open the roll call the absent Members.

Carrillo.

That was it. 14. Okay, that vote is 13 0. Item number 10, AB 1117 by Ms. Erwin. Please open the roll call the absent Members.

Arabula. Arambula aye. Carrillo.

Vince Fong. Vince Fong aye. McCarty. McCarty aye. Joe Patterson. Joe Patterson aye. 14 0.

That's 14 0. Item number 11, AB 690. Hang on, hang on. We got it. No, it was 1117. 1117. Yeah, I think we're okay now. Item number 11, AB 1696 by Assembly Member Sanchez. Please open the roll call the absent Members.

Arambula. Arambula aye. Carrillo. Vince Fong. Vince Fong aye 140.

That's 140. Item number 14, AB 1241 by Dr. Weber. Please open the roll call the absent Members.

Arambula. Arambula aye. Carrillo. Vince Fong. Vince Fong aye. McCarty. McCarty aye. 14 0.

That's 14 0. And item number 15, AB 1092 by Wood. Please open the roll call.

The absent Members Arambula. Arambula aye. Vince Fong. Vince Fong no. McCarty, McCarty aye. Joe Patterson. Joe Patterson no, it's not voting.

I just want to give you that. Okay, so believe we have a vote changed by Mr. Patterson, AB 974. So it would change from I to not voting.

Joe Patterson aye to not voting. 120.

Thank you. Okay, hang on a second. We got a. Yeah. Okay. So, unfortunately, Ms. Carrillo will not be able to make the hearing. So with that, we will go ahead and conclude the business. Meeting adjourn.