Senate Standing Committee on Health

The participant number is 877-226-8163 and the access code is 736-2834. We have nine bills on today's agenda. Three of those bills are on proposed consent, and those are SB 344 Rubio, SB 421 Limon, and SB 282 Eggman. So those bills are on the proposed consent calendar and when we establish a quorum, we can hopefully take those up. I will ask the secretary to call the role. Okay, secretary, please call the role.

[Roll Call]

Okay.

Since we do not have a quorum, I'd also take that roll call as a call for members to come on down if you heard your voice. So we'll start this committee as a subcommitee, but I do see our first author here, Senator Skinner. Senator Skinner is here presenting SB 59, having to do with menstrual products.

Thank you so much, Madam Chair and members, pleased to present SB 59. A lot of us in this room have a period story, and one that I won't recount mine because I'm still embarrassed about it. And of course, the first ones happened when I was pretty young, but they didn't stop just then. They went on. And why? Because either I was not prepared, I didn't know that I was going to get my period that particular day, or my flow is heavier. Any number of reasons.

So we go into bathrooms, and, of course, there's toilet paper. Everybody expects it. That's part of the sanitary provisions that we provide. Well, period products should be the same. And California has been incredible. We are now providing such products at our schools, at a variety of other places, we've ended the tax, but in our government buildings, they're not assured to be here.

And so what SB 59 does is expands the accessibility in menstrual products by ensuring that the restrooms in state buildings and state funded public spaces provide those products. And with that, I want to have my witnesses in support speak. And I have Tiffany Whiten from SEIU and Katie Van Deynze from health access.

Thank you very much. First witness. Please go ahead. Welcome.

Thank you. Good afternoon, Madam Chair and Senators. I'm Katie Van Deynze, a policy and legislative advocate with Health Access California, the statewide Healthcare Consumer Advocacy Coalition, and we're proud to support SB 59. SB 59 will make menstrual products more accessible by requiring free period products in bathrooms in state owned and state leased buildings and local government and hospitals that are funded by that have state funding. This will create inclusive spaces in public buildings where all menstruating people will have equitable access to these products.

SB 59 both removes the financial barrier to accessing these products in these buildings and ensures that if someone doesn't have a product, there is one available for free. While period products are essential products for menstruating people, not everyone can access them due to the cost. A 2022 study found that two thirds of low income women could not afford menstrual products in the last year, and half of those reporting had to choose between menstruating product and food.

Lack of access to menstrual products has serious consequences for people's ability to fully participate in their daily activities, their physical health and their emotional well being, and these consequences disproportionately impact low income people. Not having access to period products can mean that menstruating people have to improvise with a paper towel or something else, or even use a period product longer than advised, which can have serious health consequences. If people use tampons longer than advised.

This can lead to toxic shock syndrome, which can lead to fever shock, low blood pressure, skin rations, liver and kidney abnormalities, and this can be fatal. If someone has to improvise and use a rag, paper towels or reuse a menstrual product, this can increase risk for infection. SB 59 is an important bill to address menstrual inequity and ensure that when menstruating people go into these spaces, they have access and know that they have them free of charge. I respectfully ask for aye vote on SB 59. Thank you.

Thank you very much. Next person, please.

Thank you. Chair Eggman and members of the committee. Tiffany Whiten with SEIU California, representing members of the workforces of California safety net programs and many workers at our public hospitals. Our workers are there when people need help. Rain or shine, pandemic or recession aside, they are there to create a more healthier and equitable California. SEIU is committed to protecting our safety net and carrying out mandates that are placed on our public sector employees and protecting and advancing public health improvements.

And the significant majority of these workers are women, women of color. In fact, seven out of 10 SEIU members identify as women and 60% as women of color. SEIU continues to stay committed to gender equity in the workplace and, like this bill, acknowledges that not all menstruating persons identify as women. Transgender men, nonbinary and our gender nonconforming workforce may also menstruate and experience inequities resulting from lack of access to menstrual products.

And too many of our menstruating workforce are not more than a paycheck or two away from being on the other side of the line. We support SB 59 and thank the author for bringing this bill forward. SB 59 will not only ensure improved dignity and health for Californians our members are so proud to serve, but also because it will bring equity to our members of our workforce who menstruate.

Here in the Capitol, thanks to the leadership of pro tem Atkins and the janitorial professionals, capitol staff have access to free period products. That is great. It should be the standard in every state worker and every worker who is employed to provide services under a state funded program. It was the labor movement which led the fight for the right to a bathroom at work.

This is a continuation of that fight, a fight for an equitable bathroom at work where everyone is insured, all the free sanitary products they need. For these reasons, we are proud to support SB 59 and urge your aye vote. Thank you so much.

Thank you very much. Now would be the time for other people in support just to come to the microphone. Your name, organization and support.

Ryan Spencer on behalf of the American College of OBGYN's district nine in support.

Thank you. Okay. Seeing nobody else coming forward, we would take any people speaking in opposition today.

Committee members, my name is Sophia Lorey and I'm with California Family Council. At first glance, SB 59 appears to be a positive bill. How can anyone be against providing menstrual products in women's restrooms? Yet this bill also requires stateowned buildings to provide menstrual products in male restrooms. Pushing the lie that men can have a menstrual cycle and erasing the truth of what a woman is. This bill disregards the inherent dignity of women by attempting to obscure obvious biological distinctions between males and females.

Let's walk through basic biology. Only females have to endure monthly menstruation, where the lining of the uterus sheds, causing blood to flow from their uterus through their cervix and out of their vagina. Does a man have a uterus? No. Does a man have a cervix? No. Does a man have a vagina? No. Thus, males do not have a menstrual cycle. Let me repeat that. Males do not and cannot have a menstrual cycle. Your bill makes a mockery of this reality.

The author claims to be standing up for women, yet SB 59 erases women when it pretends our biology has nothing to do with our identity. This committee is made up of nine female members. Think of the hard fought battles women endured for the right to vote, to own property, to run for office, and to be treated legally as equal to men. We went from fighting for women's rights to now fighting for men's rights to feminine products.

You are being asked to affirm the idea that anyone can be a woman. Is that the legacy you want to leave your daughters and granddaughters? If you really want to be pro women, ask that this bill be amended to remove the requirement that men's bathrooms need feminine products, too. I urge a no vote on SB 59. Thank you.

Thank you very much. Anyone else speaking in opposition to this bill today? Seeing no other lead witnesses, would anyone like to come forward? Seeing none, we'll go to the phone lines now, please.

Greg Burr with the California Family Council in opposition. Thank you.

Brandon Campbell, Northern California Director of the Capital Connection for Independent Baptist Churches, in opposition.

Christine Campbell, in opposition.

All right, seeing no more line, we'll once again go to the phone lines. Anybody wishing to speak in support or opposition, now would be the time just to give your name, organization, and position moderator, can you please open the phone lines?

Thank you. If you wish to make a comment on SB 59, please press one, then zero at this time. We'll go to line 67. Please go ahead.

Chair and Members, Ms. with the California Commission on the Status Women and girls in strong support. Thank you.

Thank you. Next color, please.

Thank you. Line 72, please go ahead.

Andrea Rivera, on behalf of the California Pan Ethnic Health network in support.

Thank you. Next caller, please.

Thank you. Line 53, please go ahead.

Michelle Connor, Concerned Women for America, strong opposition to this bill. Thank you.

Thank you very much. Next caller, please.

Thank you. Line 75, please go ahead.

Hi, my name is Christina McKinney, strong opposition to this bill.

Thank you very much. Next caller, please.

Thank you. Line 70, please go ahead.

Hi, this is Kelly Mcmillan, and I'm calling on behalf of Parity for Pumps in support. Thank you.

Thank you. Next caller, please.

Thank you. Line 63, please go ahead.

Hi, my name is Sarah Kim, representing TV Next. And on behalf of thousands of followers of TV Next. I am in strong opposition of SB 59. Thank you.

Thank you very much. Next caller, please.

Thank you. Line 57, please go ahead.

Yes, good afternoon. Matthew McReynolds, deputy chief counsel of the Pacific Justice Institute Center for Public Policy in respectful opposition.

Thank you very much. Next caller, please.

Thank you. Line 49, please go ahead.

Hi, I'm Yun Hwang. I live in LA County. I strongly oppose this bill. Thank you.

Thank you very much. Next caller, please.

Thank you. Line 80, please go ahead.

Hi, my name is from San Bernardino, county, and I am in strong opposition of SB 59.

Thank you very much. Next caller, please.

Thank you. Line 77, please go ahead.

Sylvia Hernandez with the National Association of Social Workers, California Chapter, and we support this bill.

Thank you. Next caller, please.

Thank you. Line 82, please go ahead.

Penny Harrington from San Diego County, opposed unless amended.

Thank you very much. Next caller, please.

Thank you. I have no further comments. Thank you.

Thank you very much. Exhausted all the comments. It is now time to come back to members. Senator Wiener.

Thank you very much, Madam Chair. I want to thank the author for bringing this forward and all the supporters. It's a really important mill, and I'm happy to move the bill. I do just want to note with respect to some of the anti LGBTQ hate groups who testified today, and that's what they are, let's just be clear, and especially the one anti LGBTQ hate group that is now, I guess, portraying itself as having somehow fought for women's equality.

I want to be clear that these same homophobic, transphobic organizations posing this bill today also oppose equality for women. How many of them are trying to get the ERA put into the constitution? They're fighting against women's reproductive health. So this whole notion that somehow it's pro women to be anti trans is absurd. And I want to thank the author and all of the supporters and sponsors for acknowledging that. Happy to move the bill.

Thank you very much. I do not believe we have a quorum yet, but noted. Senator Wahab.

Thank you. I also second the comments of Senator Wiener. And again, thank you, Senator Skinner, for bringing this forward. I think that one of the things that we can all talk about is that we have to lead by example, and this bill does that, number one and number two, at the same time that as much as people don't want to admit, there are realities there that we have to provide for everybody. And I think that this really does help move that forward when we talk about women's rights and women's issues. This bill exemplifies that. So again, I just really want to thank you for your leadership. I want to thank all the supporters for this. And I'm very excited to support this. Thank you.

Thank you very much, Senator Hurtado.

Thank you, Madam Chair. Just hearing the opposition testimony today, part of my concern coming into this hearing and in regards to this bill really was the hate that really and misinformation that comes out of some folks, some groups. And I really think about individuals that I'm worried. I'm worried about people being harmed. And so I'm happy to support the bill today. But I want us to really recognize that there is fear, there is hate out there. There is a lot of misinformation. And I think that we also need to work towards making sure that if there's any way kind of prevent any harm for individuals, that we do that as well. Thank you.

Thank you, Senator Rubio.

Thank you, Madam Chair. And I also want to comment the author, I'm a proud co author to your bill. And so I'm really glad that we're providing access for those that don't have access. And it makes me sad when we do hear misinformation and what comes across as uncollaborative and just hateful. So I hope that we move this forward and we could all agree that having these in restrooms as women is important. So thank you. Thank you, Madam Chair.

Thank you very much, Senator Skinner. I'd also like to say there was a women and girls group that took place in Stockton. I was there with former Assembly Member Christina Garcia when we first heard the young girls coming before us. And that kind of started some of the menstrual equity work that was done around that young girls coming forward and just talking about being in foster care and being in different places and not being able to go to school and using socks and newspapers and all kinds of things like that. And I am also, to echo Senator Wahab, glad that we're doing it ourselves. Oftentimes the state exempts ourselves in public buildings. And so this includes everybody.

And I would also say as somebody who's also, of course, has period issues like anybody else previously and also is somewhat gender fluid, going into a restroom can be a traumatic experience for people. And I don't think it helps any of us. And for those who come from a more spiritual place, I don't think it furthers your movement any to be dismissive of any of God's children. So we will wait until we have a quorum. But would you like to close?

Thank you so much. And I really appreciate my colleagues comments. And I appreciate the acknowledgment that, tragically, the main group that spoke in opposition, it is motivated by a terrible bias and hatred towards our trans population. But when they spoke, so much more came to my mind. Obviously, we have the issue of the rights of our trans brothers and sisters. However, we also have, anyone who has talked to medical professionals know that there is great variation in biology.

And there are people that have ambiguous genitalia and are equipped with a variety of organs that we don't consider would be in a "normal woman" or the "normal man." And yet these are people. They are normal. They are normal. But additionally, what occurred to me is my own daughters, one of her best friends in middle school and high school. And I'll use a different name, just Miriam. She looked like a boy. She was not a trans person. She still looks like a boy.

She would go to the female restroom and be told, you don't belong here. Get out of here. So very often, to avoid that, she would use the boy's room. Now, why should she not be able to get the product that she needs? The other thing that occurred to me is that in some of our older buildings, I think every one of us women know, whenever there's a big event and there's a huge crowd, and then there's the break, and you all have to go to the bathroom. There's lines at the women's room, and the men's room is empty, so we use it. So this artificial distinction with bathrooms makes no sense. We supply toilet paper. We should supply period products. And this is equity. Period. Thank you. I ask for your aye vote.

Thank you very much. And when we have a quorum, we already have a motion, and we'll take a vote on that. Thank you very much, Senator Skinner. Okay. I thought I saw Senator Portantino here.

Thank you.

Welcome.

Thank you, Madam Chair and Members presenting SB 257. And I will note that, in our next round of amendments, Senator Rubio is going to be added as a co-author. So I just wanted to let her know that that's in the works. SB 257 will help provide coverage for medically necessary diagnostic breast imaging without imposing a cost sharing.

This includes diagnostic breast imaging after an abnormal mammogram results and a diagnostic breast image for women with a genetic risk factor associated with breast cancer. Breast cancer is the second leading cause of death among women. However, early detection of breast cancer drastically increases survival rates, while mammography screening detects 80% to 90% of breast cancers in women who have not yet manifested physical symptoms, such screenings, cannot always adequately detect breast cancer.

Women who receive abnormal results on a breast cancer screening or who have genetic risk factors associated with breast cancer, including family history or known genetic mutation, often need to undergo a follow up testing to ensure that whatever the doctor doesn't like is adequately diagnosed. However, women are required to pay this out of pocket expense. So think about that. Your routine mammogram is covered, but the follow up image that your doctor prescribes and that it's medically necessary may not be covered.

So many women sit there with that decision. Should I wait till next year to see if it gets worse, or should I go out of pocket the $800? And we know that in that year bad things could happen. So to me, it makes no sense that the initial image would be covered, but the medically necessary, doctor-prescribed follow up isn't covered. And so this was brought to me by a constituent who faced this dilemma. And so we're back with this Bill.

Obviously, we have a number of folks who are here. Conor Sweeney from Susan G. Komen, Ryan Spencer from the American College of Obstetrics and Gynecology. Assemblymember Friedman is my joint author on the Bill, as others. And so at the appropriate time, would respectfully ask for an aye vote.

Thank you very much. We'll have first witness, please. And again, six minutes per side and extra credit for not taking the whole time.

Thank you, Madam Chair and Members of the Committee for the opportunity to testify this afternoon. My name is Conor Sweeney. I'm a State Policy and Advocacy Manager with Susan G. Komen. Komen is the nation's leading nonprofit breast cancer organization and proud sponsor of SB 257. Screening mammograms, as the Senator pointed out, are just the first step in diagnosing breast cancer.

Early detection would not be possible without diagnostic follow up imaging or supplemental imaging, which are required to either rule out breast cancer or confirm the need for a biopsy. Unfortunately, our organization often receives calls and emails from individuals who tell us they're unable to afford the out of pocket expenses for their recommended breast imaging.

Any patient who is delaying these imaging sessions for financial reasons runs the risk of seeing that cancer spread to other parts of the body, which makes it not only more deadly, but more expensive to treat. Matter of fact, breast cancer can be up to five times more expensive to treat once it is spread. So, as the Senator pointed out, it only makes sense to give equitable access to the entire screening continuum, not just the first step in the process.

We know that widespread availability of mammograms has shown us that increased access to screenings has driven an increase in early detection, but the same is not equally true across all demographics. Evidence has shown that commercially insured Black breast cancer patients are diagnosed at a later stage and have a higher mortality rate when compared to their white counterparts with the same insurance status.

Eliminating the out of pocket costs for diagnostic and supplemental imaging would further increase access, eliminate that disparity in others, and increase early detection of breast cancer across the board, even for variants that are more often detected during secondary screenings because they're harder to see during a standard mammogram. So respectfully ask for your aye vote on SB 257. Thank you again for the opportunity to comment.

Thank you very much. Mr. Spencer.

Thank you, Madam Chair, and I'll heed your words and not repeat the same words of the previous of my colleague from the previous testimony. Simply just state a few facts. Ryan Spencer on behalf of the American College of OBGYN's District IX. We are co-sponsors on the measure. And thank you Senator Portantino, for re-introducing this Bill.

Screen mammography enables early diagnosis and resulted in decreased cancer mortality in women of average risk, improving the five year survival rate from 75% in 1975 to 90% at present. Callbacks for false positives or inclusive results necessitate further imaging cause, anxiety, distress and financial burden. As my colleague mentioned, SB 974 would eliminate the cost share burden and reduce the barrier to care to complete the screening process. Simply put, please vote for the Bill. Thank you. Thank you very much.

Now is the time for anyone else in support of the Bill just to come forward with your name, organization and support.

Thank you Madam Chair. Tim Madden, representing the California Society of Plastic Surgeons in support.

Jennifer Snyder on behalf of the California Life Sciences in support.

Moira Topp on behalf of Biocom California in support

Andrea Kristen, as an individual, my sister in law just received a diagnosis of breast cancer, stage four. In support.

Carolyn Veal-Hunter, on behalf of AdvaMed, in support.

Matthew Peralta on behalf of the California Radiological Society, in support

Madam Chair, Members. Kathy Van Austin, on behalf of the American Association of University Women, California, in support.

Thank you very much. Now is the time for anybody in opposition. There is some opposition to this Bill, so have the lead person come forward, please. And again, six minutes per side.

Good afternoon, Madam Chair, Members of the Committee. Jedd Hampton with California Association of Health Plans. CAHP represents 43 licensed Knox-Keene health plans across the state, representing 28 million enrollees.

While we certainly agree that this Bill is well-intentioned, we are regrettably opposed to the Bill primarily based upon the cost impacts of the Bill. As noted in the CHBRP analysis on last year's SB 974, which is a substantially similar Bill, implementing this Bill would cost California premium payers approximately $117,000,000, and that would be a real intangible impact on individuals premiums here in California.

We would also like to point out that we feel that this Bill is one of, by our account, 23 bills that have been introduced this year in the Legislature that either mandate new benefits or alter existing benefit designs, primarily through the use of limiting utilization management and/or eliminating cost sharing for certain services. Regrettably, these types of bills do have real cost impacts on the healthcare delivery system as a whole, which is again the primary concern of our Bill.

As pointed out in the Governor's veto message of SB 974 last year, we do believe that the state should really weigh the potential benefits of all mandates with the comprehensive cost to the entire healthcare delivery system. So again, while we do believe that this Bill is well-intentioned, based upon the cost impact for premium payers in California, we are regrettably opposed. Thank you.

Thank you very much. Is there a second lead witness on this? No. So then would be the time for anybody just in opposition to come and state your name, your organization and your position.

Thank you. Madam Chair and Committee Members. Preston Young from the California Chamber of Commerce, here in opposition, respectfully, due to the employer premium impact the Bill will have. Thank you.

Thank you very much. Now we'll go to our phone lines. Now's the time for anybody in support or opposition to weigh in. So, simply, you want to state your name, organization and position. Moderator, are there any callers?

Thank you. If you wish to make a comment on SB 257, please press one, then zero at this time. Line 85, please go ahead.

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

Thank you, line 86, please go ahead.

Madam Chair, Members of the Committee, Brandon Marchy with the California Medical Association in strong support.

Thank you. Next caller, please.

Thank you. Line 87, please go ahead.

Thank you, Madam Chair. Meagan Subers, on behalf of the California Professional Firefighters in support.

Thank you. Line 71, please go ahead.

Hi, this is Gayaneh Pezeshkian, who brought this to Senator Portantino's attention, and I am in strong support.

Thank you.

Thank you. Line 77, please go ahead.

Sylvia Hernandez with the National Association of Social Workers, California Chapter, and we are in support.

Thank you. Next caller, please.

Thank you. I have no further comments. Thank you.

Thank you very much. Now would be the time. We'll bring it back to the Committee. Are there any Committee comments or questions? Go ahead, Senator.

Thanks so much. I appreciate the author's intent in bringing this up. Just a quick question. I saw that this was brought up previously and it was vetoed by the Governor, and it looks like it's really similar. What are your thoughts on it getting passed this time? What do you see changing here?

I think we're going to get a signature. That's what I'm hoping for. And we have had meetings with the Governor's Office on the nature of the veto message, in particular on whether this is a new or an existing benefit. We disagree with their analysis and we're making that argument.

Do we have any updates on the recommendation? It says that, and I don't even know what this stands for, but the USPSTF is currently in the process of updating the recommendations. Did that come out already?

We're going to have Komen comment on that.

Thank you for the question, Senator. I believe it was the US Preventive Services Task Force. The Governor called the Bill premature, stating that they were in the middle of updating their guidelines. We just don't really think that this is a Preventive Services issue. That refers to a screening when there is no symptom or cause for concern for breast cancer. But this is a diagnostic issue, so we just don't know that those recommendations will be relevant to this particular issue.

Thank you. Just those questions. I will be supporting the Bill, though.

Yeah. So the initial screening you could think of as preventive, but this is once the doctor sees something the doctor doesn't like, wanting to get more diagnosis of it. So it's not necessarily preventive. It's a further diagnosis of an aberration.

Thank you.

Thank you very much. Senator Rubio.

Thank you, Madam Chair. And I am going to be added as an author. And from someone who spent the last four years working on so many cancer policies, just this week alone, there's two people that I know personally, someone in particular in this building who was diagnosed, and this is something that touches everyone in one way or the other. And I know I'm very sympathetic to the plans and I continue to have conversations with the health plans on the cost. And I also recognize sometimes as the impact of, I believe they said 123 bills added on. I mean, I'm very sympathetic and I always bring them to the table and have discussions.

But this is something that I believe is going to cost more on the back end anyways if we don't give the opportunity to have early detection and break down barriers to ensure that these people don't get sicker. I still think that catching it on the front end really serves all of us best than waiting till it's too late or there's more cost on the back end. I'm proud to support it.

I think it's important and I think that we need to do what we can to keep people healthy and alive. So thank you for bringing this forward. With that, thank you, Madam Chair.

Thank you very much. And I'll also be supporting this today. But as my comments align somewhat with Senator Menjivar and perhaps we served on Budget, Health and Human Services and understand the balancing act that goes along with the Covered California Bronze Plan, so that whatever we say doesn't need a pre-offer.

This has to include for the Bronze Plan, which then continues to put costs at a very high rate for the poorest Californians. So while I'll be supporting this, and it's been held in approach before, I imagine it'll have a better outcome perhaps this year, and then we'll see when it gets to the Governor's desk. But Senator Menjivar. Senator Wahab.

We look alike. It's okay. So I really do appreciate both Senator Portantino and obviously yourself supporting this and bringing this forward. I know we always talk about cost, and we heard the opposition regarding cost. Everything costs something, right? But one of the things that this does, and I really want to kind of put this in focus for a lot of people here, is that preventative care and being ahead of a lot of things, actually, dollar per dollar is far more significant. In fact, prevention, earlier intervention, a lot of things like that, even when we're talking about homelessness and housing, saves actually roughly $7 on the back end.

Right? So this is incredibly important to kind of highlight as a preventative measure as well. And just something that can potentially save lives and capture things early on. So it's not harmful to not only families and individuals and patients, but also, hopefully, to a society that potentially lose loved ones. So thank you again.

Thank you very much. And I think while we have a quorum, we'll ask the Secretary to call the role so we can establish a quorum.

[Roll Call]

Thank you very much. And we'll go ahead and let. Would you like to close?

Absolutely. And I think the reason why we have routine mammograms is as a preventative measure to see what's happening. To me, it makes no sense that if you detect something of concern, that looking into that concern would not be a covered expense as well.

I mean, why have the first step if you're not going to have the second step, which then leads to the prevention, which leads to the early detection, which leads to saving the life and saving the money, dealing with it on the back end. So with that, I respectfully ask for an aye vote.

Thank you very much. There was already a motion on this Bill? Is there a motion? Okay, there was a motion by Senator Hurtado, and that motion is do pass and re-refer to the Committee on Appropriations. Secretary, please call the roll.

[Roll Call]

Okay, we're going to hold the roll open on that. Now, before we adopt the consent calendar, can we get a motion for the adoption of the Committee rules?

Okay, motion by Senator Hurtado on the adoption of rules. Secretary, call the role.

[Roll Call] 7-0.

7-0. We'll hold the roll open on that. Would I have a motion on the consent calendar, moved by Senator Gonzalez. And that again, consent calendar is SB 344 by Rubio, SB 421 Limon, and SB 282 Eggman and McGuire. Secretary, please call the roll.

[Roll Call]

Okay. We'll also hold that role open. Okay, I do not see another author here. So aye am going to hand the gavel to Senator Wiener, and I'll get up and present two bills.

I'm good. Yeah. Thanks. Appreciate it.

If it's all right with you, Mr. Acting Chair, I was going to start with SB 340.

Go ahead.

Just because we got late opposition on this, so I didn't really plan on presenting it, but here we go. So this has to do with glasses. This has to do with glasses covered under the medical system. And historically, we have had our prison industry make the glasses for us, which is a great thing that we want to do. We want to get people who are serving in prison a chance to work. But what we have found is oftentimes without good, healthy competition.

We're not saying that the prison industry cannot make those glasses anymore, but they'll bid just like everybody else to be able to get a contract to do that. One of the problems that we have is sometimes glasses take a long time to be delivered. And then if there's a problem, there's nobody to call to say, I need another pair, because it has to go back to the same system. So think about a kid who can't see.

I started wearing glasses when I was in elementary school, and I remember the day I walked out with my new glasses on. I read everything I could see. Bus stops. There was bus stops in those days, benches and everything. And it was like a magical experience for me. My grades picked up. I didn't have to sit in the front, not that I ever did, but it was a life changer for me.

So we want to be able to provide glasses as quickly as a doctor says is reasonable for people on Medi Cal. So it will expand at the source for allowing providers to better meet the needs of our patients. And I respectfully ask for your aye vote.

Thank you very much, lead witness.

Mr. Chairman, Terry Mchale with Aaron Reed and Associates, representing the California Optometric Association. I mean, there's good news and bad news with the prison system. Five years ago, we had had. We had 170,000 prisoners. This year, we have under 100,000. We're going to close five or six more prisons in the near future. And there's good news and bad news from this. We look at the firefighters, 227 fire crews. They could only fill 85 of them.

We're losing the prisoners that we use outside to fight fires, and we're losing the prisoners to do the prison industry authority work. The number one complaint that optometrists receive in the State of California deals with the fact that Medi Cal patients receive their glasses so much later than everyone else. And the optometrists take the hit on that, on all of those social know, the social programs. They deal with the complaints, and they have no resource, they have no recourse because they can't call the prison authority and find out why the delay exists. I'll just close it with this. This Bill is very fair to the prison industry authority. It says, if you can do the job as quickly as you say you can do it, then you're going to continue to have contracts and you're going to continue to work with optometrists. If you can't, it gives them options to go someplace else. It's a good bill for consumers. It's a good bill for the State of California. I ask for your aye vote.

Thank you very much. Is there any additional support testimony in the hearing room? Seeing none, we'll go to opposition. Is there any opposition? Please come forward.

Good afternoon. I will say Chairman, Madam Chair and members of the Committee. My name is Mac Jenkins. I am a retired chief probation officer. I've retired out of San Diego, county, and I've worked for more than 40 years in the criminal justice system here in the State of California. I'm also a past President of the Chief Probation Officers Association, and I am a member of the Council on Criminal Justice and Behavioral Health. And I am also a board Member with Cal PIA.

So as this is the Senate Health Committee, I'm going to expect that this committee is familiar with the term social determinants of health. I also would hope that this committee is familiar with social determinants of health as it relates to individuals who are impacted by the justice system.

What we know from research and from practice about social determinants of health for individuals who are impacted by the justice system is that they must be addressed effectively to change the behaviors that have led to the criminal justice involvement in the first place. Among the things that are captured in social determinants of health, homelessness falls there, illiteracy falls there, employability or a history of unemployability also falls there.

Now, the mission and purpose of the prison industry authority is to provide job training skills to an incarcerated population to reduce the likelihood, or I can say it another way, to give them skills so that they can make changes in their behavior that will reduce the likelihood that they will engage in the behaviors that led to their incarceration in the first place.

Now, I'm also going to expect that this committee, as well as the entire California Legislature, is, well, interested in seeing the prison system do something more than simply incarcerate individuals who come there. So the mission of PIA is to do exactly what I described. And we're at a point now where we not only, PIA has achieved that mission, we have empirical support that shows it.

We recently received, partnered with the University of California, Irvine, with Dr. Susan Turner, who is a nationally renowned criminal justice researcher who produced, evaluated the impact of Cal PIA programs and found, after studying at least about 8000 individuals who were released from California prisons that had participated in the CALPIA programs, that their recidivism rate three years after leaving was at about 15%. And I may be wrong in this figure, but I understand the CDCR's recidivism rate is something north of 60%.

So that means 85% of the individuals who participated in the Cal PIA programs stayed free from incarceration for three years after their release. Now, the import of 340 on what Cal PIA does is that it would eliminate the opportunity for those individuals who work in the Cal PIA optical program. And that is about 420 positions.

So I urge this Committee to vote against the bill because what it would do is it would remove that opportunity from those 420 individuals and thus retard not only the prison system's effort to provide rehabilitative services to this population, but it would certainly retard that effort for Cal PIA. I respectfully urge your no vote.

Thank you. Is there any additional opposition? Please come forward.

Good afternoon, Mr. Chairman and Members of the Committee. My name is Dr. Armand Agakanyan. I'm a Member of the Burbank Board of Education. I'm also an appointee of the speaker to the Cal PIA. And I'm also Director at East Los Angeles College, which is home to the largest formerly incarcerated population in California. I hope that this committee can look at the former bill that was introduced last year, 1089, which is not being reintroduced now.

That was Senator Weiner's bill, and it's pretty much the same thing. And really look into what this bill is about. The concerns that the Senator brought up in terms of service and time had to do with a very short period during COVID. That supply chain was a concern of everyone. So to argue that the services are not there and not delivered on timely matter does not work.

Second of all, this committee decided to go into the lens area because some of you may know it's a very niche area. It's not like you go to a community college or a place and get a job, get a machine that's worth millions of dollars and get certified in this. These individuals, the minute they come out of this program, certified, there are jobs waiting for them.

And I want to debunk all these rumors out there that only one factory in other state provides jobs in this area or these individuals don't have. I am a witness to what this program does. Our own college, where some of these laptops that are refurbished by the prisoners were given to formerly incarcerated students at East LA College. I'm talking about 420 laptops. These students would have dropped out of college had they not received this.

Another thing that I want to mention, everyone here, is that this is going to cost. It's going to increase the cost almost to double, to triple. So do we want to go from taking 420 jobs from our currently incarcerated individuals, training them to go out there with jobs that are ready to go and give power and authority to a lobby that obviously is not happy about the fact that they're not getting a fair share of this apparently in their business?

And if you look more into it, there is more to this. It's not as simple as delivery time and the services not being provided. I think we should invest more in these programs. And you want to look at some of the success stories. I can't mention names, but I will give you one scenario. I'm sorry. So again, please, opposition against this. It's the same 1089. It's just being reintroduced.

Thank you very much. Is there any additional opposition in the hearing room? Okay. Seeing none, we will move to the phone lines. Will you please queue up any public testimony via phone?

Thank you. If you wish to make a comment on SB 340, please press one, then zero at this time.

I have no comments in queue.

Okay, thank you. We'll bring it back to the Committee. Colleagues, any questions or comments on this Bill? We have a motion by Senator Hurtado. Anything else? Okay, Senator, you may close.

Thank you very much. I am not against the prison industry, but I don't think it's the job of Medi Cal and that we should compromise children's eyesight for rehabilitation. And I believe there are about 1500 other programs under PIA, as the opposition referred, to hiring people that had refurbished computers. There's a lot of things that people can do. And again, the PIA can still bid on these contracts. With that, let's all see a little bit better. And I respectfully ask for your aye vote.

Okay. And the motion was by Senator Hurtado and that is to pass and re-refer to the Committee on Public Safety. And we'll call the roll.

[Roll Call]

Okay, that is a vote. We'll put it on call for absent Members. Thank you. We'll now go to Item number 7, SB 43, also by Senator Eggman.

Thank you very much. Now, this is a Bill you may have heard a little bit about. And when you try to take on a big issue, it's kind of hard to know where to start. So I thought I would just provide a little bit of background. Historically in our country, we locked people up. We locked people up for all kinds of reasons that we shouldn't have.

I will also say the first national survey of how many people were living with serious and persistent mental health issues was in 1880. It was about 100,000. And we asked where were those people? About 50% of them were in almshouses, institutions. The rest were mostly in the community with about 0.07, less than 1%, in our correctional facilities. We know that landscape has changed drastically. So in the 1960s things began to change.

Right? Senator, President Kennedy, probably with some experience with his sister, said, this is wrong. We shouldn't just be institutionalizing people without any recourse. And I wholeheartedly agree with that. In 1967, Lanterman–Petris Act was passed. And later President Reagan signed that into law. And to say that we should be able to put people in the least restrictive care in order to meet their needs. And I continue to support that, tenant. I'm a social worker. Right.

We meet the person where they are. But I will say the landscape is very different now than it is in 1967 because all of those community supports that we said were going to come didn't come. So now we have and we can say whatever we like to say, but there always are going to be those amongst us who are going to need different levels of care. I've made the remark and I don't mean to relive it all, but my spouse has brain cancer.

She's got a tumor in her brain stem. I would wish that wasn't true. But I can't live in the world that I wish. I live in the world that I live in where she needs a lot of wraparound care. I see a lot of folks on our streets and you all do too, who need more help than is currently being provided to them.

And also just to back up a little bit to talk about what we have done, because this is going to be a, talking about a Bill that is going to redefine what it says to say, "you're gravely disabled," because as you know, right now, it's the ability to provide food, clothing, shelter, that is interpreted in all kinds of different ways.

If your plan is to stand in the middle of the street and eat what someone else has thrown on the ground, that can be an okay plan for you to be released, right? I don't think that's okay. So in the last couple of years we have, I did last year, that would actually ask us to get more data on people we put on holds. The last couple of years we have put more than $12.0 billion into standing up and expanding our behavioral health system.

We have put in billions of dollars to stand up a treatment program for children from zero to 25 that will be able to have through a platform, get a mental health evaluation wherever they are. So we have done a lot last year, as you know, we worked on the CARE Court, which would say, "let's try to keep people out of being conserved and get them help before that with wraparound care, housing involved." And as you know, we put a lot of money into our workforce.

So there's those who say you can't redefine what it means to be gravely disabled until we have all of those things in place. Well, we are working on that infrastructure. It is continuing to be implemented around the state. And when we passed the CARE Court last year, people said, "well, you're putting people on court." Well, this is civil court. Right?

And it is an agreement between the counties, the court systems and the individual. But what happens if that person is non-compliant? And as we know and as we see every single day, we have gaping holes in our safety net, and it allows people to fall onto our sidewalks with a horrible splat. In this storm we've been having right now, people will die. When we had our heat wave this last summer, people died.

So this Bill says that we are going to redefine grave disability with criteria that matches our SAMHSA diagnosis or criteria that says, "if you are through your mental health issues, your substance abuse issues, if you are in grave danger, and that includes the continuing deterioration, if you don't receive help, that you will continue to deteriorate, that you may be held and then thereby treated."

Now, what am I talking about when I say that? People may be familiar with the story of Mark Rippee, who lived on the streets for over 20 years in Solano County. He lived, often camped, in front of the County Services building. I went out and I met with him there. His family was trying to get him treatment, but some would say it was health. Some would say he had a brain injury, some would say it was mental health issues and he could not get any help.

He ended up dying of an infection. Right? Because if you can't even acknowledge that you have something which is called Anosognosia, that you can't even acknowledge that you have a disease, something is wrong, then that tells us that you cannot then take care of your physical and mental health. Right? Is voluntary services best? Of course, we all agree voluntary is best. I don't know about you, but I was walking to an event the other day, right down O Street. Was it O Street?

And there was a young man, feces all over the back of him, pants hanging down, open sores all over his face, in a spastic state in the middle of the street, screaming and talking with people who were not there. Now, if I were to walk up and offer that person voluntary care, I don't think they would accept. Right? He was not in a condition. He was not having a conversation with me. And I was thinking back, and it's coming up on Easter time.

So when I was working on my doctoral degree in social work and social welfare, social research, I worked in a hospital, because when I was teaching, I never wanted to be teaching classes and pulling up examples from a long time ago. So I was working a night shift in an emergency room, and a patient came in who was incredibly malnourished, had stabbed herself in her hands and in her side. So she was both in physical emergency as well as a mental emergency.

So when I did the assessment on her, and I would try to talk to the family, the family said she had been locked in her room for 40 days. They hadn't hardly get her to eat or drink. She was malnourished and again living in a state of disarray. So we ended up holding that person against their will and treating their physical symptoms. When I woke up the next morning, I realized it was Easter, and I said, "oh, Jesus Christ."

She had been reenacting a Christ symbol, right? The crucifixion had been reenacted. And she actually thought, because she kept telling me, "it'll be okay. It's all going to be okay." So that is not somebody who's going to actively go get help on their own, because they don't even acknowledge, if you think you're Jesus, you don't think that you need help for the most part. So we do not live--and I've said many times, I am the only thing in my house still working, except my stove since 1967, right? Our landscape has changed. We know our prisons and we know our jails are the places that people go. We know they end up dead. They end up in our hospitals. They end up crowding in our emergency rooms. It's time to do something, Members. We've been talking about this for a really long time. And it's time to finally make our laws match the reality that we see. We meet people where they are.

And if they're so sick that they can't provide for their care, that's not okay. And we owe it to them. We owe it to the public, and we just owe it to doing the right thing. With me today, I have Psychiatric Association as well as NAMI here to testify.

Thank you very much. We'll have our two lead witnesses please come forward. You'll each have two minutes? Three minutes each.

Hello, everyone. My name is Aaron Meyer and I'm representing the California State Association of Psychiatrists as a proud co-sponsor of this Bill. I am grateful for Senator Eggman's leadership in addressing the state of our mental health system. And today I am relieved that help is on the way. This modernized language on "grave disability" will support patients and their families, and it will save lives.

By modernizing language on "grave disability," our laws will more closely approximate what we are seeing, and it will help support a holistic evaluation of a struggling patient. I am hopeful that by integrating medical conditions into our understanding of grave disability, we will address the 15 to 20 year life expectancy gap facing people living with schizophrenia. Adding language on serious harm will acknowledge the importance of assessing a person's functional Independence.

Our understanding of mental disorders has evolved, as Senator Eggman said, since the LPS Act was enacted in 1967. Substance use disorders have been a part of the Diagnostic and Statistical Manual of Mental Disorders since 1980. I personally have witnessed people predictably and preventatively die from severe substance use disorders.

Senate Bill 43 shifts away from our current approach of incarcerating people who are unable or unwilling to engage and treats people with substance use disorders similar to other mental disorders. Incorporating insight into an understanding of grave disability is necessary. Some people are able to grapple with the ambivalence of treatment. Others are not. Similar to people with severe depression or schizophrenia, people with substance use disorders can lack understanding into their diagnosis and the ongoing need for support despite life-threatening consequences.

Senate Bill 43 acknowledges that autonomy does not extend to a point of deliberate indifference. Conservatorships are denied due to our antiquated definition of grave disability. A young man with more than 10 hospitalizations for heart failure was denied conservatorship because his grave disability was due to a stimulant use disorder. Senate Bill 43 could help him receive a heart transplant. Conservatorships are prematurely terminated due to our antiquated definition of grave disability. One man died alone on the street mere weeks after termination of his conservatorship.

He wanted to see his mother before he died, and he did not get that chance. I am haunted by that. Senate Bill 43 could have saved his life. Thank you for caring about the most vulnerable members of our society. I am happy to answer any questions, and I am happy to provide more examples. Thank you.

Thank you. Next.

Good afternoon, Mr. Chair and Members, Senator. I'm Brian Lundgren on behalf of the National Alliance on Mental Illness California, a co-sponsor of SB 43, we ask for your passage of this legislation. Three years ago, NAMI surveyed the community for input on the LPS Act, including their experiences with access and thoughts of the "gravely disabled" definition. We received over 1300 responses, many of which expressed their frustration at how hard it is to get treatment for their loved ones or for themselves.

I also ask for your support not just as a representative of NAMI and a family members across California, but also as a father of a son who is living with a serious mental illness. My son was affected with a serious mental illness at the age of 15 with substance abuse. We thought he was healthy. He was an athlete, he was a skier. He was everything that you would want in a son.

But from this age until he turned 23, he was placed on involuntary hold, known as 5150, 5152, nine times. He was enrolled in 17 treatment centers, including one out of state. He was treated by 24 mental health and drug professionals. He experimented and used nearly every and any drug, legal and illegal, he could get his hands on. He was arrested over 10 times.

He was prevented from being conserved three times. He committed a crime which eventually put him into a state hospital for 13 years. At the peak of his illness, as Senator Eggman mentioned about personalities, he had three. He was Tupac Shakur, he was John Gotti, and he was a Navy SEAL. All interchanged, depending upon the day. My son's mental health journey was long, painful, and death-defying.

If an updated criteria for "gravely disabled" were in place at the time of my son's first break, there's a very high likelihood that his journey would have been swifter, less threatening and painful, and he could much sooner have begun living a full life again with his rights intact. So on behalf of the National Alliance of Mental Illness, California family members, and my son, we respectfully ask for your aye vote on this important Bill. Thank you.

Thank you very much. Is there any additional support public comment in the room? Please state your name, affiliation, if any, and the fact of your support.

Madam Chair, Members of the Committee. Randall Hagar, representing the Psychiatric Physicians Alliance of California. I'm also a family member with a son with schizophrenia. We urge your strong support for this legislation.

Thank you. Chair and Members. Moira Topp, on behalf of the Big City Mayors Coalition. This is the coalition of the 13 largest cities mayors. We offer our support and our co-sponsorship of this important Bill.

Good afternoon, Senators. Cliff Costa, on behalf of Govern for California, in strong support. Thank you.

Madam Chair, Members of the Committee. Brandon Marchy with the California Medical Association, in support.

Good afternoon, Chair Members. Priscilla Quiroz on behalf of the California Academy of Child and Adolescent Psychiatry in the City of Santa Monica, in support. Thank you.

Good afternoon. Stephanie Estrada on behalf of the City of San Jose Mayor Mahan, in support.

Izzy Swindler on behalf of the Sutter County Board of Supervisors, in support if amended position. They've submitted a letter for the Committee's consideration. Thank you.

Madam Chair Members Andrew Antwih, with Shaw Yoder Antwih Schmelzer & Lange on behalf of Los Angeles Mayor Karen Bass, in support. Thank the author.

Thank you. Any additional public comment and support in the hearing room? Seeing none, we'll now move to opposition. Our lead witnesses. Who are the lead witnesses?

Disability rights.

Okay. And three minutes, please.

Thank you, Senator. Mr. Chair, Deb Roth with Disability Rights California. We are the agency designated under federal law to protect and advocate for the rights of people with disabilities. We appreciate the Senator's desire to improve mental health in California, but strongly disagree with the approach. We had a meeting with the Senator yesterday. We appreciate that she met with us.

However, we think that expanding the definition of "gravely disabled" to make it easier to involuntarily detain people undermines the very purpose of the Lanterman–Petris–Short Act, and fails to address the very real needs of Californians living with mental health disabilities, especially those who are unhoused. It's really sad that this is what it has come to. The author believes the current standard isn't enough. This proposal, if it is enacted, is going to create chaos.

And if you look at some of the language in the Bill, there are adjectives added to pretty much every section of the definition. So, for example, if someone is not adequately or appropriately clothed, then that can make them gravely disabled. And we think that that is just wrong. This Bill will subject more patients to the trauma of involuntary detention and treatment and commitment, which will undermine trust in the behavioral health system.

And as you'll hear from another witness, traumatizing the very people you're trying to help doesn't make sense. Also, Black and Brown people are disproportionately unhoused and also more likely to be diagnosed and misdiagnosed with serious mental health disorder. An analysis of discharge data showed that Black and Latinx Californians are at least 50% more likely to be placed on a 5150 hold. There are so many initiatives, more than 15 programs or statutes recently enacted.

The infrastructure to serve all of these people is not there, and it will be time before it gets there. In the meantime, this Bill would take a standard that an audit from just a couple of years ago in the state, from the State Auditor said the standards are okay. What we need is to build out the infrastructure. And now there's these 15 or so programs, billions of dollars, as the Senator mentioned, that are going to be thrown out at all of this.

And it takes time to untangle it, to figure it out. And in the meantime, we would respectfully request that the state not use vast resources to contribute to involuntary care that could otherwise be used for a cost-effective and humane services with supportive housing. Also, the hearsay provision adds to the problem by saying, "you don't need to have the treating practitioner there to testify in conservatorship proceedings. That's okay. We've got medical records. We've got an expert witness. That's good enough."

You're about to take someone's rights away legally, and that's okay under this Bill. As I said, the existing standards in the Bill are things like satisfying the need for nourishment. Who's going to make that determination? So, respectfully, we ask you, please do not go in that direction. Thank you very much.

Thank you. The second lead witness.

Hi, good morning. My name is Clare Cortright. I'm an attorney and a Policy Director with Cal Voices, which is a peer-run organization, and I have lived experience of bipolar I disorder with psychosis. On behalf of myself and my community, we oppose SB 43 and expanding the population of people who will be subject to involuntary processes because it expands what we find harmful. I have been involuntarily hospitalized during my first break in 2009.

I knew something was very wrong, so I tried to get help. I was told to wait three weeks for an outpatient appointment or go to an ER. I had to go to an ER. I hadn't slept in four days. Access to timely outpatient care in lieu of hospitalization has not improved. I was placed on two holds for which I did not meet criteria.

I experienced such extreme stress that my blood pressure spiked to a dangerous level, and I had to take medications to prevent a heart attack. I was angry, I was scared, and I was converted from a person seeking treatment to a person who wasn't going to cooperate. Please understand that the state's good intentions in using force, in any judgment that is necessary and ethical, does not alter how the person experiences that force. I experienced it as profoundly harmful. Force drove me out of treatment and underground.

I swore off psychiatry, and for the next eight years, I grew sicker and sicker. I was gravely disabled for years. Had I been met with yet more force, especially under a lowered standard for grave disability, the result would have been the same: avoidance of the system I needed to help me. Involuntary processes are flawed. They're time-limited, and they fail to do the needful thing: to get people to accept treatment voluntarily. To be well for more than a hospitalization, to be well for a lifetime, I needed to self-bind to voluntary treatment. Eventually, in my own time and in my own way, I did. And I did that with the help of a peer support worker who built trust with me by validating my very bad experience with hospitalization. If our foundational assumption here is that we cannot help people without the use of force that they find harmful, that needs to be examined.

We should seek instead to move a little closer to the original statement of ethics in medicine, which is first, do no harm. And if I have a few moments, I'd like to add lib. Psychiatric holds don't allow for forced medical treatment. We don't have the facilities for substance use disorder. Being able to detain people for substance use disorder has always been part of the LPS. The problem is the facilities don't exist.

If you're throwing thousands of more people into scarce LPS beds, you're going to have a real problem. As Deb also mentioned, I've been a patient rights advocate in Sacramento, Yolo, San Joaquin, and Santa Clara counties. I've represented thousands of patients in these hearings. The complexity of the criteria that you are potentially enacting here is going to break your system day one. You're talking about a system that is under-resourced, a system where timeframes matter, and it will be a problem. Thank you.

Thank you so much. Okay, additional opposition testimony. Please state your name, affiliation, if any, and the fact of your opposition.

Linda Nguy with Western Center on Law and Poverty, respectfully oppose.

Laurie Hallmark, attorney and consumer. I oppose.

Any additional opposition in the room? Okay. Seeing none. I'm sorry, were you wanting to come forward? Were you a 'tweener, perhaps? Okay, come forward, please.

Thank you. Mr. Chair and Members, Jolie Onodera with the California State Association of Counties, representing all 58 counties. I'd like to thank the author for her continued efforts on this issue. And we too have joined in the strong urgency of doing something that will help those who are suffering with serious mental illness and substance use disorder.

With regard to capacity, I would like to note that the public guardians and public conservators do not receive state funding for the work that they do for the existing caseload.

Even before, we would contemplate the expanded nature of this Bill and that there's currently an inadequate supply of facilities for these placements. We would like to thank the author for supporting the California Association of Public Administrators, Public Guardians, and Public Conservators Budget Request for ongoing funding for this measure, and look forward to continued discussions with the author on this measure.

Thank you very much. Okay, we will now move to the phone lines. Will the Moderator please queue up any remote public comment?

Thank you. If you wish to make a comment on SB 43, please press one, then zero at this time. Line 68, please go ahead.

Hi, good afternoon. Sharon Gonsalves on behalf of Mayor Karen Goh and the City of Bakersfield and the City of Carlsbad in support. Thank you.

Thank you. Line 96, please go ahead.

Hello. Caroline Princioni on behalf.

Thank you, line 69, please go ahead.

Naomi Ramirez on behalf of the California Behavioral Health Planning Council, in opposition.

Thank you. Line 95, please go ahead.

Stacie Hiramoto, professional social worker representing REMHDCO, the Racial and Ethnic Mental Health Disparities Coalition. We oppose.

Thank you. Line 79, please go ahead.

Alicia Benavidez Lewis on behalf of Policy Alliance Council in opposition, appreciate the author's office for having met with us yesterday.

Thank you. Line 92, please go ahead.

Andrea Rivera on behalf of the California Pan-Ethnic Health Network, in opposition.

Thank you. Line 58, please go ahead.

John Vanover on behalf of DBSA California, the Depression and Bipolar Support Alliance, in strong opposition.

Thank you. Line 74, please go ahead.

Good afternoon. Kira Ross, on behalf of Mayor Lincoln and the City of Stockton, in support of the Bill.

Thank you. Line 51, please go ahead.

Susan Sindelar on behalf of the California Public Defenders Association, which has submitted a letter to the Committee and opposes this Bill unless it is amended.

Thank you. Line 52, please go ahead.

Hello, Danny Jericho, on behalf of Mental Health America of California and California Youth Empowerment Network, in strong opposition.

Thank you. Line 101, please go ahead.

Allison Monroe, representing Families Advocating for the Seriously Mentally Ill, in strong support.

Thank you. Line 83, please go ahead.

My name is Lynne Gibbs. I'm an ambassador at the Treatment Advocacy Center. I chair the NAMI Santa Barbara County Public Policy Committee. I host an Association of California advocates for Treatment, and I represent a local Santa Barbara advocacy group called Families Act. We are in strong support of SB 43.

Thank you. Line 99, please go ahead.

Hi, my name is Teresa Pasquini. I am a California ambassador for Treatment Advocacy Center. I am also proud NAMI Member and mostly the proud mom of an adult son who has been 5150'ed 40 times, and on a conservatorship for 21 years. I am in strong support of this Bill and am grateful, grateful to this author. Thank you.

Thank you. Line 103, please go ahead.

Good afternoon. Héctor Hernández-Delgado with the National Health Program in opposition of SB 43. Thank you.

Thank you. Line 102, please go ahead.

Hi, this is Rebecca Basson with the Law Foundation of Silicon Valley and Santa Clara County Patient's Rights. We'd like to urge strong no on this Bill. Thank you.

Thank you. Line 98, please go ahead.

Good afternoon. Tony Chicotel, Senior Staff Attorney for California Advocates for Nursing Home Reform, in opposition.

Thank you. Line 55, please go ahead.

Hello, my name is Dr. Katie Wilson. I'm a psychiatrist in our Northern California. I want to strongly support this, and I want to make sure people know that Anosognosia, which is lack of awareness of illness, affects almost 50% of patients with severe mental illness. This is a neurological symptom in which people are not able to be aware that they are ill. So these are the folks that we really need to find novel ways to help. And this Bill would definitely help. Thank you.

Thank you. Line 105, please go ahead.

Hello, my name is Katherine Wolf. I'm a doctoral student at the University of California at Berkeley and a member of the Sustainability and Health Equity Lab and the Disabled Ecologies Lab. I am disturbed by the lack of input from those with lived experience, and I urge a strong no on this Bill.

Thank you. I have no further comments. Thank you.

Thank you very much. We'll bring it back to the Committee. Colleagues, are there any questions or comments on this Bill? Senator Wahab?

Thank you, Senator Eggman, I really do appreciate you bringing this Bill forward. I have heard a significant amount of opposition in regards to this Bill as well. And, you know, I think you and I have had conversations about tackling mental health, as well as a wide number of other problems, including homelessness and substance abuse and much more. We know the current definition and interpretation of "gravely disabled" does not accurately reflect the realities we know about in communities and on the street.

I really want to highlight specifically that there's always something called "in theory" versus "in practice." And yes, we want people to have autonomy over themselves and their livelihoods and much more. But at the same time, we also know that communities and those individuals, as well as the people around them are deeply affected by what is going on.

There are individuals that are literally spending years, a significant amount of money, time, effort, energy, emotional strain, and much more to take care of their loved ones that are dealing with issues, and at a certain point in time, they will call it quits. That's the honest truth. We are seeing people who are in the streets that are struggling, and to your examples, even, and examples that we've all seen that are problematic to society, and that's not a good quality of life.

Number one, it's problematic for our community, for public health, for public safety, for so many different reasons. And we continue to see the struggles of community members that cycle in and out of hospitalization, shelters and jails without getting access to medications and treatments. So I understand SB 43 seeks to address the shortcoming, however, ongoing chronic underinvestment in public and private treatment resources, housing, caretaking is a concern.

The likelihood of millions of individuals who likely need expensive and long-term--possibly lifelong--care is absorbed into the healthcare system is even greater concern. So the definition of "gravely disabled" being expanded to include mental health and substance use disorder obviously will just exacerbate that particular concern.

We know that, and I'm hoping whether we talk about it in future amendments or in another Bill, which I'm happy to work on as well, should be made guaranteed that we have sustained and dedicated state resources that go above and beyond the current investments to humanely meet the needs of the population impacted by the expanded definition. I do just want to highlight, people talk about this issue in a very clinical way often, and we tend to talk about it in a very policy-driven way.

But I really just want to recognize when we see individuals struggling or in the street or dealing with things, I really want to highlight that there's an individual, for example, in my city that sits at the Starbucks that I go to every day, that throws feces at individuals and is 5150 pretty regularly released very shortly after, the mental health hospital that we have in that particular county. There's only one for the entire county, right?

And that is not going to solidify any or meet the needs of that individual or anybody in that particular county for long-term needs. And I asked specifically what happened to this individual, what is the issues and things like that? And this person was, quote unquote, living their life and perfectly fine, but then eventually had a traumatic brain injury that could literally happen to any one of our loved ones in a car accident, in a football accident, in a biking accident, whatever the case is.

And families can only work so hard to provide 24 hour care when they're also needing to meet the demands of their other children or loved ones, their job requirements and much more. So I really want to highlight that that's really the image behind this Bill, is trying to provide a little bit more help to those families that really do care about their loved ones but can't compete with the demands on their time elsewhere. So I fully support this Bill.

I appreciate you taking this, obviously risk and people being upset about it. But I also want to say that practice and policy are two different things and we need to kind of address both. So thank you.

Thank you.

Thank you. Any additional questions or comments?

I'll move, yeah.

Motion by Senator Wahab. First of all, I want to thank Senator Eggman for her continued leadership on this issue. Having done a few conservatorship bills with some different Committee structure in both houses, it was very, very challenging. I think we have a real path to get some true reform done this year.

And I'm very sensitive to people's concerns about, we absolutely should never go back to the way it was 50 years, 60 years ago when people were simply being warehoused because they had a mental health condition, people who absolutely did not need to be institutionalized, who were, and we know the abuses that can happen. But that's not what this Bill does, because the reality is we went too far in the other direction where we have people who are literally unraveling and dying on our streets.

And it's not progressive, it's not compassionate to just let that happen in the name of voluntary treatment. And we all have seen this. There are people in my community who I see day in and day out on the streets. Our city people have tried to get them help. It's not working and they need help. I think it's also important to understand that being in a conservatorship does not need to mean that you're in a locked facility. In fact, it usually wouldn't be in a locked facility.

We have some folks who are conserved in San Francisco who are in supportive housing and we don't have enough supportive housing. We need more of that. We need more beds and so forth. But this is a flexible tool that will save lives. And so I'm happy to support this Bill and I'm proud to be a principal co-author. So we do have a motion. And Senator, you may close.

Thank you very much. And I want to thank both the supporters and the opposition. All of the voices are important and I'm glad the opposition are still, all still alive because there are so many who can't speak for themselves because they have died with their rights on. And I also want to say that this Bill does nothing to change due process.

So if you go in on a 5150 hold, that is a 72 hour hold, it can be reevaluated for a two week hold. It could be reevaluated for a 30 day hold. I did a Bill last year to be able to see you can have another 30 day hold. It could go to a six month and then it can go to a conservatorship and then it must be renewed every year. So the due process does not change.

It is only the criteria that we're applying to the person because as if we've heard people say, people go in and go right back out over and over and over again. And to folks who say this is going to affect Black and Brown people, it is our Black and Brown people who are dying on the streets and are in our prisons and in our state hospitals and are in our county jails, and that is not the place for people to get treatment.

Our state hospitals are full of people who are found unable to stand trial. So they have committed multiple crimes, finally a serious one, and then have to go into a state hospital and lose all of their rights, or state prison and lose all of their rights because we couldn't treat them on the front end. There was a recent study that came out about how the sickest of our mentally ill folks who are in state prisons are moved from one prison to another.

And people asked me to do a hearing on that because we've got to do something about that. Well, we can't do something about that until we do the things on the front end and actually get people the care they need before they're required to go in and out and in and out of our system, desperately falling back out through the cracks. Again, I invite you to look outside, walk around these streets, and I don't know about the rest of you, but I have kids.

And it is so hard to be able to tell your child why there's nothing we can do for that naked lady on the street, with sores all over her body. And I think when we're living in this kind of environment we're living in right now, where there's this anger and this tenor that is untenable for me, as somebody who likes to try to move things forward in a positive direction.

I think us actually being able to tackle really big, hard issues gives hope to everybody else, that we can actually find ways to come together and provide the help that people need and the public should demand of us. It's time for this change to take place. And I respectfully ask for your aye vote.

Okay. Thank you. We have a motion by Senator Wahab, and that motion is do pass as amended and re-referred to the Committee on Judiciary. We'll call the role.

[Roll Call]

Okay, that has 10 votes. We'll put it on call for absent Members, and I will hand the gavel back to Senator Eggman.

And I see Senator Becker here. Please. Senator Becker is presenting SB 570 having to do with prenatal screenings.

Thank you, Madam Chair. I also thank you for your leadership on the previous issue, if that's appropriate. I'm here today to present SB 570. This Bill would restore a pregnant person's ability, in consultation with their doctor, to utilize all available prenatal screening services. This will allow them to make the most informed decisions about their health and the health of their newborn as possible.

Specifically, this Bill prohibits the state from limiting access to genetic screening through rule, regulation, or contract when genetic screening is recommended or ordered by a pregnant individual's prenatal provider. While the fixed proposed in my Bill is simple, making sure pregnant Californians maintain a choice and access in their prenatal screening options and have those screenings covered by insurance or MediCal the same as it was before. This change is absolutely essential to address unfortunate access issues that recent CDPH changes have created.

Unfortunately, in late 2022, CDPH implemented major changes that limit the state's prenatal screening program to testing for just trisony 21, 18 and 13. If pregnant individuals wish to access the additional screening they previously would have enjoyed as recommended by their provider, they must now undergo a complicated and confusing two-path process of screening. This is an unnecessary new barrier, and it means the vast majority of pregnant people will not have access to full panel screening and the important information it provides.

This is about medical care being decided by medical care providers rather than an arbitrary line in the sand. Lastly, I want to thank the Committee for working with me and stakeholders to draft amendments that we will be taking per the policy comment in the analysis. I've asked the sergeant to distribute copies, which I believe was just done, of these amendments, to the Committee. And with me today, fortunate to have in support our colleague, Assembly Member Dr. Weber, a principal co-author, and board-certified OBGYN.

She's also the founder and past Director of the Pediatric and Adolescent Gynecology Division at Radies Children's Hospital in San Diego.

Dr. Weber.

Good afternoon, Chair and Members. Thank you so much for allowing me to come into your house to testify. As a principal co-author of SB 570, I could not overstate the importance of this Bill.

I speak today not only as a board-certified OBGYN who has ordered these tests many, many times, but also as a fellow Legislator who has stood side by side with many of you, as we have asserted that the doctor-patient relationship is important, sacred, and in most cases, not something that the government should dictate or limit. I have also stood by many of you, as we have argued, the importance of improving access to health care and not to place barriers and obstacles.

This Bill, SB 570, aligns with what we declare as core values of healthcare in California, respect for the doctor-patient relationship and expansion of access for our patients. This Bill will expand this critical testing to all pregnant Californians and allow women to receive the full gamut of testing at the lab and the location that they choose. This Bill is intended to ensure the health and safety of all of our pregnant residents, as well as our future unborn residents of California.

SB 570 gives pregnant Californians a choice and access in their prenatal screening, rather than forcing these individuals to enroll in the PNS Program to receive the care that we all know they need and limiting what lab they can actually go to to receive it. Thank you so much for your time and consideration. I respectfully ask for an aye vote on SB 570. Thank you.

Thank you very much, Dr. Weber.

Thank you. We have one more witness as well. Thank you.

Hello. I'm Dr. Krishna Singh I'm a triple board-certified physician in the specialties of obstetrics and gynecology, maternal-fetal medicine, and medical genetics and genomics. The current cell-free DNA test permitted by the state program includes reporting only on three chromosomes despite recommendations by the American College of Medical Genetics and Genomics to include at least five. Their test is not the established standard of care for results, and it results in misdiagnoses, delays in care, and increased costs.

Go ahead.

When a patient has this test, it's possible that the laboratory identifies an unexpected abnormality other than the three that are specified. In these cases, the laboratory is advised by the state program to report only that the test results are indeterminate. The laboratory may have information available about the chromosomes of origin or suspected abnormality. Is it fetal or maternal? But this information cannot be included in their results under the current program. Additional information might be important for helping clinicians to guide patients on next steps.

A clinician might call the laboratory to ask for further information, but contracted laboratories might not have incentive to spend time on phone calls to review results with various providers. This is among the issues limiting a patient's care within the program.

A pregnant person and her obstetric provider should be able to determine which test best fits their circumstances. It should not be restricted to a state-assigned laboratory test. Patients should have the option to have laboratory tests that are being used throughout the other 49 states and the world for obtaining information during their pregnancy.

Thank you very much. Other people speaking in support. Now would be the time to come forward and just provide your name, association, and position.

Alexis Rodriguez, with the California Medical Association, in support. Thanks.

Good afternoon, Madam Chair. John Valencia, appearing, on behalf of Illumina, Incorporated, a global leader in human genomics headquartered in San Diego, right across from Assembly Member Weber's district, in support of the Bill.

Thank you. Person, please.

Madam Chair and Senators, Adam Keigwin, on behalf of Natera, in support.

Thank you. Next person.

Jennifer Snyder on behalf of the California Life Sciences, in support.

Thank you.

Lyla Ree, a genetic counselor, urge support.

Thank you.

Libby Sanchez, on behalf of BillionToOne, in support. Thank you.

Thank you.

Ryan Spencer on behalf of the American College of OBGYN's District Nine, in support.

Thank you. Anybody in opposition to this Bill today? Seeing none, we'll go to our phone lines. And at this time Operator, if we open the phone lines and this is the time for anybody in support or opposition to please just state your name, your organization, and your position.

Thank you. If you wish to make a comment on SB 570, please press one, then zero at this time. It'll be just one moment for our first commentary. Line 88, please go ahead.

Kristi Foy on behalf of the California Clinical Laboratory Association, in strong support.

Thank you. Next caller, please.

Thank you. Line 94, please go ahead.

Hi, this is Molly Robson with Planned Parenthood Affiliates of California, in support.

Thank you. Next caller, please.

Thank you. I have no further comments. Thank you.

Thank you. Is it time to bring the measure back to the Committee? We have a motion. And I'll just say thank you for bringing this forward. Also, nice to have a star witness and a co-author at the same time. Double dutian. And to our other physician who's triply certified. Wow. Would you like to close, Senator?

I thank my co author, and I especially asked for an Aye vote.

Okay. Thank you. And that motion is do pass as amended and re-refer to the Committee on Appropriations. Secretary, please call the roll.

[Roll call]. Nine.

That is nine zero, and we'll hold that roll open. Thank you very much.

Wahab, Aye. Sorry.

And I believe Senator Wiener is going to present for Senator Stern. How about while he's getting himself together, we do a roll call on the consent calendar just one more time?

We never got over the consent items.

It's like 567.

Again on the consent calendar. That's SB 344, Rubio. SB 421, Limon. SB 282, Egwen Mcguire.

[Roll call]. 11 zero.

11 zero. We'll hold that open a little while longer. Okay. Senator Wiener for Stern.

Thank you very much, Madam Chair. Today I'm presenting SB 302 on behalf of Senator Stern, and we will be amending to add me as a co-author of the Bill. SB 302 will expand the existing Ryan's Law to allow more patients the option to utilize cannabis to manage various health conditions while in a health facility. As written, the Bill will expand the current definition of patients eligible under SB 988 to include individuals who are at least 65 years of age who struggle with a chronic disease.

So expand it beyond folks who have a terminal illness. The National Council on Aging reports that nearly 95% of people over 65 have one chronic condition and nearly 80% have two or more. Patients using medical cannabis to treat a variety of chronic illnesses currently have unfettered access outside of healthcare settings. However, elderly patients who are inside a medical facility are not afforded the same right, and many could benefit dramatically.

The majority of medical cannabis use in elderly populations is aimed towards appetite stimulation, dementia-related agitation suppression, and pain relief. The pharmaceutical alternatives to alleviate these symptoms can be far more detrimental in the long term than the use of cannabis. A 2017 UC Berkeley study reported that 97% of a statewide sample of medical cannabis users agreed that they are able to decrease the amount of opioids that they consume when they also use cannabis, and 81% said it was more effective at treating their condition.

California's elderly deserve all viable and effective options to treat chronic disease in any medical setting. Respectfully ask for an Aye vote. With me here to testify today are Tiffany Whiten with SEIU California and Sean Kiernan with Weed for Warriors.

Welcome back, Tiffany.

Thank you, Madam Chair and Members. Tiffany Whiten with SEIU California, representing 700,000 Members, many of which work across various healthcare settings. Our workers are there when people need help. They are proud to serve the elderly, persons with disabilities, and the terminally ill. They see our community Members in pain, and they see them as they age. They see them as they work and maintain dignity and control in activities of daily living that you or I may take for granted.

This legislation, SB 302, can be seen as a part of a fuller vision that we see and a vision that we believe the Legislature holds, too. All persons, regardless of their age, disability or stage in life, should have equal access to health care, equal access to the treatments and supports they need to be successful in their daily lives. Research increasingly shows the power of cannabis to meet medical needs.

It is why this Legislature thoughtfully passed SB 311, Ryan's Law, and why SB 302 looks to expand on that approach. At the heart of SB 302 is allowing our grandparents, our parents, our community elders who are over 65 and suffer from chronic illness and living in medically assisted facilities to be allowed to make the choice to use cannabis. Chronic illness can be physically and emotionally debilitating.

Our workers know that many of the conditions that can be improved by cannabis consumption, like pain relief and appetite stimulation, can have a significant effect on quality of life and someone's ability to live. We often say that when someone lives should not. Where somebody lives should not impact the access to the care that they have. This holds true here, too.

There are many reasons why someone may be able to age in the home they've lived in for decades, or why they may be choosing to age or forced to transition to a medically assisted facility. When a person lives, where a person lives should not impact their ability to access and use cannabis for medical purposes, and it certainly should not disrupt a treatment plan that already includes cannabis.

This Bill allows cannabis use by those 65 and over with chronic illness and medical assisted facilities, and creates health equity for our aging population. For these reasons, we respectfully request your Aye vote. Thank you.

Thank you very much. Next witness, please.

Hello. Thank you very much, Madam Speaker. My name is Sean Kiernan. I'm CEO of the Weed for Warriors. We are the largest veteran cannabis organization in the world, represented in 50 states and other countries. This is a huge issue we deal with weekly, with not only our veterans, but their parents. And it goes beyond that, but we don't need to get into it. And that's really about. It's a body sovereignty issue. This isn't even a cannabis issue. This is a body sovereignty and a dignity issue.

And the lovely speaker before me touched on the science. I'm going to give you an anecdotal example. SB 34, we give cannabis to veterans and patients. We just did an event in Wildemar, California. Exhibit. If you don't know him, he's the MTVA. He's a rapper. He came in, and he's been very supportive of us, and he said, you know in an interview you can see on YouTube, on our channel, his dad was a veteran, hated cannabis. It was a big issue between these two.

And it wasn't until he had a terminal illness that he took a gummy. And he said the way his dad acted, he was able to connect with him like never before. Because when he's on the opiates and all the other medicines, he's a zombie. He's angry. And the dignity given to that family and that last year and that body sovereignty to choose cannabis. The unfortunate thing is so many people put in these homes don't have kids to come give them that medicine, and their doctors won't. Why?

Because of insurance and other nonsense. They're not against it. And so let's give that dignity of body sovereignty to everybody, whether it's my dad or my mom or my ability as their caregiver to choose that. Please vote Aye. It's a very simple step, and this is a much bigger problem than what this will address. But this is a simple step forward, and I hope we get a yes. Thank you, Senator Wiener.

Thank you very much. Other people here in the room in support, just name an organization.

Pamela Lopez with K Street Consulting on behalf of California NORML.

Quentin Lebec on behalf of California Health Coalition Advocacy, in support.

Thank you. Anybody speaking in opposition to the Bill today? Seeing none. Let's open up the phone lines and have people speaking in both support and opposition. Just your name, organization, and position. Moderator?

Thank you. Thank you. If you wish to make a comment on SB 302, please press one, then zero at this time.

There's some rule.

I have no comments in queue.

Thank you very much. Now would be the time we bring it back to Committee Members. Comments? We have a movement. A motion. There we go. Senator Wahab.

Hi, there. Do we have any understanding of how, if this is utilized, how this potentially affects other individuals in, let's say, facilities or any type of language around that?

If you're talking about smoking, I don't believe that this covers smoking. This is about edibles.

Just edibles. Okay.

So there wouldn't be a secondhand smoke issue.

Okay. All right. I appreciate it. Thank you.

And I will say, Senator Waha, that was my question, too, but just edibles. Okay. Thank you very much. And, yeah, pain should. People should be able to take care of their pain as they see fit. So thank you for your motion, Senator Glazer. And this is do pass as amended and re-refer to the Committee on Judiciary. Secretary, please call the roll.

[Roll call].

That is 10 zero. We'll hold that open for absent Members. Okay. Senator Skinner presented before, but we didn't get a motion for that. Senator Menjivar moves to Senator Skinner's Menstrual Product Accessibility Act. Secretary, please call the role.

[Roll call]. Nine one.

It's nine, one. We'll hold that open. Okay, let's move down the list, then. For Senator Portantino, SB 257. Secretary, please call the roll.

[Roll Call]

Okay, we'll again hold that roll open, and hopefully the sergeants have called absent members to come on down. Okay, how about SB 570, Becker?

[Roll Call]

Okay, how about ten, zero? We'll hold it open. SB 340, Eggman.

[Roll Call]

All right, that bill is out.

She's not coming back.

She's not coming back. Okay. Welcome, Senator Limon. Let's run through the lineup again. So measure's on consent. Secretary, please call the roll.

[Roll Call]

That's twelve, zero. That bill is out. SB 59, Skinner. Secretary, please call the roll.

[Roll Call]

All right. Ten, one. It's nine, zero. We'll hold that open for a few more minutes. Okay. SB 257, Portantino. Secretary, please call the roll.

[Roll Call]

Twelve, zero. That bill is out. SB 302, Stern.

[Roll Call]

Eleven, zero. Hold it open just one more minute. SB 570, Becker.

[Roll Call]

All right, eleven, zero. And SB 43, Eggman.

[Roll Call]

Eleven, zero. We'll leave that roll open a few more minutes. Oh, and let's do the consent calendar.

[Roll Call]

Twelve, zero. That bill is out.

Okay, we're going to lift the call on the adoption of committee rules.

[Roll Call]

We'll close that out. Okay. Welcome, Senator. Thank you for making it back. What do we need Senator Hurtado on?

I need Senator Hurtado on SB 59.

SB 59, Senator Skinner.

[Roll Call]

SB 257, Portantino. Okay. That bill is out ten, one. SB 257.

[Roll Call]

Twelve, zero. That bill is out. SB 302, Stern.

[Roll Call]

Twelve, zero. That bill is out. SB 570, Becker.

[Roll Call]

SB 340, Eggman. SB 43, Eggman.

[Roll Call]

Twelve, zero. That bill is out. And that concludes our committee hearing for today, and this hearing is closed.

Thank you, Madam Chair.