Senate Standing Committee on Business, Professions and Economic Development

The Senate Committee on Business, Professions and Economic Development will come to order. Good afternoon. And it is the afternoon. The Senate continues to welcome the public in person, as you know, via the teleconference service. For individuals wishing to provide public comment today, the participant number is 877-226-8216 and the access code is 6217161. 6217161. We're holding our committee hearing today in the 1021 O Street location. I'd ask that all members of this committee report to room 2100 so we can establish our quorum and begin the hearing.

We have nine bills on today's agenda, none on consent. We will establish a quorum when we have sufficient number of members to do so, and we will begin hearing bills when we have an author. So this is a call to authors. Senate Committee on Business, Professions and Economic Development. Senator Menjivar, would you like to present item number three, Senate Bill 373? Please come forward and proceed when ready.

Good morning. Welcome back. I'm here to present to you SB 373, and this is the Address Protection Act. This bill specifically is looking to create change for the Board of Behavioral Sciences and the Board of Psychology by limiting access to their personal home addresses. We saw during the pandemic that telehealth access was one of the number one way that our consumers were able to obtain mental health services. It was post-pandemic that we saw telehealth services really expand.

We're all talking about the workforce shortage that we have right now. This is one issue that is impacting a lot of our mental health therapists. Current law requires anyone who obtains a license under DCA to put their full address on their license. Right now, we're seeing individuals work from home more often than we saw before, providing mental health out of their private homes. You've probably heard stories regarding a client that perhaps has poor boundary issues.

Not everyone that seeks mental health has severe mental health illnesses, but there are some that have a poor understanding of boundaries. My wife is a licensed marriage family therapist. During the pandemic, she had to go fully remote and had to provide services out of our home. She had one individual who stepped, who crossed the line of boundaries and would reach out to her outside of their sessions when he got drunk and kept calling her.

If he had known, if he would have gone the step further, I would have had this individual come harass my wife at our house because our house address is on her license. I am glad that he did not take it a step further, but there are various cases of individuals that take it further.

Yes, you can put a PO box address instead of your private home, but that's an added financial burden that we're asking a workforce that we desperately need to address our social crises right now to take on. So what I'm asking through SB 373, is for licensees to only put their city, county, zip code, and state of where they live. A practice that is being done right now by 12 other boards, a practice that I think as relates to the Board of Behavioral Sciences and the Board of Psychology, is needed to ensure we protect the privacy of these individuals.

So, here with me to speak on testify in support of this bill is Angel Ortiz, a licensed marriage family therapist who is also the President of Sacramento Valley chapter of California Association of Marriage and Family Therapists, followed by John Drebinger, the senior advocate for policy and legislative affairs, California Council of Community Behavioral Health Agencies.

As they're approaching the, I guess, let's say, podium. Senator Menjivar, do you accept the amendments reflected?

Yes. Thank you so much. I will. I do appreciate the staff working with my staff on this, and I am accepting the committee amendments.

Thank you. Please proceed, sir.

Good afternoon, esteemed committee members. My name is Angel J. Ortiz. I am a licensed marriage and family therapist. I do 100% telehealth. This started before the pandemic, but after the pandemic took on a whole life of its own. I want to share a little bit of a personal story as support in support of SB 373 and why it is a very important piece of legislation. As an up and coming therapist, I had dreams of having my own home office, given my visual impairment and limited mobility.

I soon thought twice about that when I began to really get into the coursework and learn about co-occurring disorders, substance-induced psychosis, paranoid schizophrenia, and on down the line. So, as such, I immediately realized that I had to scrap that idea. This will then tie into why this bill is so important for our safety. For six years, up until about 2020, I was a forensic clinician. I worked with parolees and probationers, and these folks are, as you can imagine, not the most compliant.

And so, as such, there were times when I was at odds with them, their behavior, and reported certain behaviors in violation of their probation or parole to their agents, their POs, and as such, could have put myself into a very precarious situation had they known my home address. Thankfully, knock on wood, that didn't happen. But that threat remained in the back of my mind every day I went to work. I have maintained a PO box for I can't remember how many years it's been.

But as Senator Menjivar mentioned, it is a cost that we incur every year, every two years, on top of our liability insurance and everything else. And as an up and coming therapist, our salaries are not always commensurate with the cost of living. So as such, it is an added expense. But first and foremost, the main concern with this can and always will be our safety. At the heart of our profession is the therapeutic alliance.

We, as therapists, know that change within our clients comes from when they feel connected with us. However, as Senator Menjivar mentions, sometimes they don't understand boundaries, and that's one of the very reasons why they come to us for treatment. As such, if they had access to our personal home addresses, I can't imagine what that could possibly lead to and hope to never really experience what that's like. So, as such, I am offering my personal story in support of SB 373, for the safety of these very important mental health professionals in and around the State of California, and also from the perspective of a cost savings measure as well. I thank you for your time.

Thank you, sir. Next, please.

Good afternoon. Chair and Members of the Committee, my name is John Drevenger, senior advocate with CBHA, the California Council of Community Behavioral Health Agencies. CBHA represents behavioral health providers across the state who serve over 1 million Californians with vital behavioral health services. Our members experience firsthand the challenges associated with their address being publicly available. For example, psychotherapists often work with complex populations, including some that may leave them vulnerable to stalking and harassment.

Currently, the only option, as you've heard from folks today, is for licensees getting a PO box in order to avoid their personal information being publicly available. SB 373 offers a simple solution to address this issue while still allowing consumers to identify a provider on BreEze, verify their license status, and file a complaint if necessary. Importantly, this idea is not novel. As Senator Menjivar mentioned, several boards under the DCAA already operate in this fashion, and SB 373 helps bring the same protections to mental health providers. Thank you for your time and consideration of this important measure.

Thank you. Now, any other witnesses in room 2100 who would like to testify in support of the measure?

Good afternoon. Sumaya Nahar with Political Solutions on behalf of the California Association of Marriage and Family Therapists, one of the proud co-sponsors of the bill. Thank you.

Thank you, ma'am. Next, please.

Good afternoon. Chair and Members, Christoph Mair with the American Federation of State, County and Municipal Employees, in strong support of SB 373.

Thank you, sir. Any other witnesses in room 2100 who wish to testify in support of this measure? Seeing none, let's move to any lead witnesses in opposition to Senate Bill 373. Any witnesses in opposition? Any other witnesses in opposition in room 2100? Seeing none, let's move to witnesses waiting to testify via the teleconference service. Moderator, please prompt any such individuals waiting to testify either in support or opposition to Senate Bill 373. And we will begin with them.

Thank you. If you're in support of opposition of SB 373, you may press one and then zero. Again, that is one and then zero. And we will go to line 12. Your line is open.

Good afternoon. Rebecca Gonzales with the National Association of Social Workers California Chapter, in strong support of this bill and also a co-sponsor.

Thank you. Next we'll go to line nine. Your line is open.

Good afternoon. This is Jennifer Alley with the California Psychological Association in support.

Thank you. And Mr. Chair, we have no further support or opposition in queue.

Thank you. I'll bring the discussion now back to my colleagues on the dais. But before we do that, let's establish a quorum.

[Roll Call]

We have a quorum. Members, any questions, comments, concerns?

Mr. Chair, I would love to jump in. And I agree that those who practice psychology, social workers, and those in that field have got to maintain this sense of security. And if you cannot be secure in your home, what a shame. And I understand the work you do as law enforcement, they need to keep their confidentiality as well. Firefighters, nurses, a lot of people that are in the service-related industries. And who better to be protected than all of you? So I would like to make the motion to move it forward and agree that you should be protected. And thank you for bringing the bill forward.

Thank you, senator. Senator Niello.

Senator Menjivar, the medical board states that current law requires that health plans and insurers publish the provider's address currently. So how is this going to solve the problem, especially given that the practitioner can provide an email or a post office? I recognize what you said about a post office box, but they're really not that expensive. So it would seem that the remedy already exists. And with, given the medical board's letter, are you really achieving what you're trying to achieve?

Right. Thank you for that question. I think it's going to be really hard for us to judge what's expensive for a person or not given the added expenses that you have to do to the WiFi, your desk, the licensing every single year, the fees for that, it's a lot of money. So to ask a workforce that right now we're bleeding from to continue adding these expenses for us who are asking for social workers to be at every single hospital and attached to law enforcement, social workers to be mobile crisis and then not help in some way to reprive them of any of these expensive.

It's a little difficult for me to swallow, but when it comes to the addresses, the medical board was in opposition of this because the bill unintentionally included the entire medical board, which is why we accepted the committee amendments to, what's the word I'm looking for, extract them from this to move forward.

But there are other entities that do this, 12 boards, as I mentioned already, and it's more prevalent in this field because these are entities that work in their homes versus other doctors, physicians if you will. And there is a way, if they're looking for an address, to reach out email, should they request it to maintain a tracking to say this individual requested an email for what reason? They mentioned perhaps to require medical records for a lawsuit. There is actual, what's the word?

A tracking evidence, if you will, to show that this is the individual who asked for the address. So it was a balance, and I'll close with this, there was a balance of consumer protection and then the privacy of the individual. And that balance we felt, or I feel the privacy outweighs any of the other unintended issues that you brought up right now.

Colleagues, any other questions? Senator, not a question, just a comment. I fully believe and support this concept, and I think the healthcare providers who work in this field absolutely need to be protected. I'm going to clearly support your bill. I would ask that as you move the bill forward, that perhaps you provide a little bit more clarity or at least the process to deal with the comment made by the Medical Board of California in opposition.

In other words, how do individuals obtain a copy of their medical records, or how do they serve legal documents? Where particularly with the, I suppose with medical records you could send an email and say, I'd like a copy of my medical records. With the legal process that I'm sure the Judiciary Committee may ask about, you actually have to affect personal service if it's an individual. And if you're a partnership or an LL limited liability company or a professional corporation, you may have to do a filing with either the secretary of the state, Secretary of State, or the county where your business address would be made available. But if you're not, you may not, and there may be some other way to affect service of process. But maybe you could take a look at that as you move the bill forward.

Thank you, Chair, for that comment and request. Yes, that's something that we are in communication with at the other 12 boards to see how they're doing it. And I do commit to continuing those conversations to have a more defined language in this bill on how people can approach that.

Perfect. Seeing no other questions. Senator Menjivary, it's been moved by Senator Archuleta. Ma'am, would you like to close?

I appreciate that conversation. Again, welcome back. We're jumping back in. I just respectfully ask for your aye vote on this.

Perfect. The motion is do pass as amended to Senate judiciary. Please call the roll.

[Roll Call]

Bill has seven votes, sufficient to get out, but we'll hold the roll open for absent members. Thank you, Senator. Madam pro tem, item number one, Senate Bill 385.

Well, thank you, Mr. Chairman and colleagues, for giving me the opportunity to present SB 385 last year with reproductive freedom. Facing unprecedented threats from the Supreme Court and other states, California took bold and aggressive action, enacting laws to enshrine the right to abortion and contraception into our California Constitution to strengthen legal protections for consumers and providers, expand the reproductive health workforce, and ensure access to affordable care. Unfortunately, this year we continue to see other states attack and erode access to abortions.

It's clear that we need to remain steadfast and do everything that we can to increase the number of trained providers available to Californians and those who need to come here for reproductive health care. And to that end, SB 385 will expand and modernize reproductive care training opportunities for physicians assistance. This builds off of the success of prior legislation, AB 154 from 2013 and SB 1375 from last year. AB 154 allowed qualifying nurse practitioners, certified nurse midwives, and physician's assistants to provide first-trimester abortions.

SB 1375 updated training standards and addressed workforce barriers for nurse practitioners and certified nurse midwives seeking to provide first-trimester abortion care. What SB 385 would do would apply the same training standards to physician assistance that SB 1375 did and that it established for the nurse practitioners and certified nurse midwives. Specifically, this bill would also better align abortion training to physician assistance scope of practice and provide multiple options for clinicians to get trained in abortion care.

SB 385 would further widen access to abortion services and healthcare by increasing the number of practitioners available, excuse me, to provide this critically needed care. Physician assistants play a critical role in providing reproductive health care by removing barriers to abortion training and allowing experienced providers. To utilize their full training and education, this bill will expand the number of qualified reproductive care practitioners, particularly in areas lacking access to care.

It lifts up a workforce of skilled physician assistants and provides them more opportunities to care for their patients. I would ask for an aye vote and Mr. Chair, here to testify in support today are Molly Robson with Planned Parenthood affiliates of California and Ryan Spencer on behalf of the American College of Obstetricians and Gynecologists.

Thank you. Please proceed. Yes, ma'am.

Hi, good afternoon. Chair Roth and members, Molly Robson with Planned Parenthood Affiliates of California. We represent the seven affiliates who offer sexual and reproductive health care through over 100 health centers here in California. Since 2014, physicians assistants have been providing abortion care within their scope of practice. However, barriers have existed for them to be adequately trained in abortion due to lack of trainers and training opportunities as the pro tem mentioned.

By updating the standards and requirements for PAS to be in line with that of other advanced practice clinicians, this bill will support the abortion workforce which desperately needs it right now. Improving training opportunities so that eligible clinicians can offer abortion services at a time when abortion access continues to be under serious attack and people are being forced to seek care here in California, we desperately need to improve our workforce.

Planned Parenthood is grateful for the leadership of Pro Tem Atkins and the Legislature for creating pathways and safeguards to ensure that California's abortion providers can continue meeting the needs of patients from across the country who have lost access to care and while continuing to support Californians. This bill supports the recommendations from the Future Abortion Council to address workforce barriers. As such, I respectfully urge your support today. Thank you.

Thank you. Next, please.

Thank you, Mr. Chair. Ryan Spencer, on behalf of the American College of OBYNs, District Nine, in support, I'd first like to thank the author for not only introducing this bill but for her leadership on this important issue of Reproductive Healthcare access in general. The bill and leadership are necessary even more today than it was just last week after Friday's confusing decision from a lower court related to FDA's approval. We have been and remain in an all-hands-on-deck situation in California.

ACOG has long supported the assistance of trained, advanced practice clinicians like PAs to perform or to assist physicians in providing important services related to reproductive health care, and this includes the ability to perform first-trimester abortions within their scope. SB 385 ensures PAs are sufficiently and adequately trained to perform first-trimester abortions safely and effectively. This bill will appropriately align their training with those of nurse practitioners and nurse midwives as proved last year, and nothing more. It's a simple yet very important bill with a very significant impact. Appreciate your time, welcome any questions, and ask for your aye vote. Thank you.

Thank you, sir. Any other witnesses here in room 2100 who wish to testify in support of this measure, please step forward. Name and affiliation, please?

Good afternoon, Mr. Chair and members. Bryce Docherty in support on behalf of the California Academy of Family Physicians. Thank you.

Thank you, sir. Any other witnesses here in room 2100 who wish to testify in support? Let's move to any lead witnesses in opposition to Senate Bill 385. Any lead witnesses in room 2100? Seeing none. Any other witnesses who wish to testify in opposition to Senate Bill 385? Let's move to witnesses waiting to testify via the teleconference service, then. Moderator, if you would please prompt any individuals waiting to testify in support or opposition to Senate Bill 385, we will begin with them.

Thank you. If you're in support or opposition of SB 385, you may press one and then zero. Again, that is one and zero for support or opposition of SB 385. We do have one. One moment for their line number.

And we will go to line 17. Your line is open.

Hi. This is Shannon Olivieri Hovis, on behalf of NARAL Pro-Choice, California, in support.

Thank you. Next, please.

Thank you. And Mr. Chair, we have no further support or opposition in queue.

Let's bring the matter back to my colleagues on the dais. Questions, comments, or concerns? Senator.

Thank you very much. I just want to thank Madam Pro Tem for bringing this bill forward. As was noted, it really is straightforward. I love that it is a bill about training additional people, that it is about access to resources. I am very happy to support, and when the time is appropriate, Chairman, I would very much like to move the item.

Thank you, Senator. Any other questions? Senator Eggman. Senator Niello.

Madam Pro Tem, I have one question. One of the witnesses referred to this, too. The bill specifies that 'nothing shall be interpreted as authorizing a physician assistant to perform abortion or aspiration techniques after the first trimester.' What is the significance or meaning for that provision?

Well, it probably refers to the scope of practice already that physicians assistants are under. They're different than nurse practitioners and certified nurse midwives because they work under a practice agreement. So we're just following along with what's already in existing practice for this particular scope of practice.

Not related to a state code or anything? Just their professional practice?

Well, I wouldn't say that, Senator. I want to be factual and correct, but that is my understanding, and I can certainly double check and get back to you with that information. But I want to make it clear the limits of the scope.

Any other questions, comments, or concerns, colleagues? Senator Atkins, would you like to close?

Thank you for your time, and I would respectfully ask for an aye vote.

Thank you. We have a motion. The bill has been moved by Senator Ashby. The motion is 'do pass to Senate Judiciary.' Please call the roll.

[Roll Call].

The vote is eight to one. Enough votes to move out. We'll hold the roll open for absent Members. Thank you, Senator. Okay. Item Number Two: Senate Bill 339. Senator Wiener. Proceed when ready.

Thank you, Mr. Chairman. Today I am presenting Senate Bill 339, which will update and make more effective a previous bill that I authored and that was passed into law in 2019. At the time, it was SB 159. This bill has to do with PrEP pre-exposure prophylaxis. For those who don't know, PrEP is really a revolutionary approach to preventing HIV. Taking one pill a day all but eliminates your risk of getting HIV. It lowers your risk dramatically more than using condoms.

People can still use condoms, but it is a transformational prevention tool around HIV. If everyone at risk of HIV on this planet were taking PrEP, if everyone had access, we would end the HIV pandemic. We could focus on those living with HIV and supporting them, and no one else would get HIV. It's that powerful. And yet, despite the power of this tool, so many people who are at risk are not taking it, either because they don't know about it, there are barriers.

Even here in California, when you get outside of particularly places like, even in San Francisco, honestly, there are people who should be on it who are not. And once you get outside of places like West LA or West Hollywood or San Francisco, it just drops dramatically. And particularly in communities of color, the access is way lower than it should be, and we have to change that.

And what we did with SB 159 is we said, similar to birth control, that pharmacists would be permitted to provide PrEP and PEP, which is what you take if you've been exposed without a prescription. People can go into their neighborhood pharmacy and they can get this medication. We were the first state in the country to enact that. However, in going through this Committee four years ago, we agreed to some restrictions on the bill.

We worked with the opponents and with the Committee at the time, and we put certain limitations on the bill, and we did that in good faith. Four years later, it's clear that one of those restrictions is not working and is a major impediment to the implementation of this bill. And by and large, pharmacies have not implemented this bill.

They have not opted in, and they're telling us, and we have data in talking to pharmacies and pharmacists, that the limitation in the bill, that a pharmacist can only dispense 60 days worth every two years, does not work, and that pharmacies don't want to deal with it. And so they're not. In addition, the other impediment that has been identified is that insurance companies are not reimbursing pharmacists for the time and effort in complying with the bill. So you can't just walk in and get the pills.

You have to have a negative HIV test. There are different steps that the pharmacist has to take to ensure that PrEP is appropriate for you and the pharmacies are not being reimbursed for that time. So this bill removes the 60 day limitation. It makes it 90 days, but you can go beyond the 90 days and requires health plans to reimburse for their time. I do want to say that even though we were the first, this is the great thing about state legislation.

After we passed SB 159, multiple other states, Utah, Colorado, and I'm forgetting one, multiple states followed our lead, but they did it without the 60 day limitation. And we actually prepared a chart looking at all these other states. None of them put the 60 day limitation in place, and they all either require reimbursement or are working towards requiring reimbursement, and they are succeeding in those states. So we worked in good faith in this Committee four years ago.

One piece of the amendments that we took is not working. We need to fix that today. If we can expand access to PrEP, we can just really tank new HIV infections and we'll be better off as a result. So I respectfully ask for your aye vote. And with me today to testify and support are Maria Lopez, who is the President of Mission Wellness Pharmacy, a community pharmacy in San Francisco, and Dr. Scott Hyman, who is the Medical Director of the San Francisco AIDS Foundation.

Thank you, Senator. Ms. Lopez.

Honorable Chair, Committee Members. My name is Maria Lopez, and as the Senator introduced, I am a pharmacist and lead program in PrEP. We serve a community pharmacy. We serve a diverse community. We're in the Hispanic Latino district of Mission in San Francisco, and we have experience establishing trust in those communities. I'm also a capacity building assistant consultant for HIV prevention, which is funded by the CDC and I hold a Voluntary Assistant Professor title.

Several community pharmacies offer longer and convenient hours than medical offices and are staffed by pharmacists who know the medications, maintain established relationships within the communities they serve, and have existing rapport with patients. And this is key to adherence. Based on published models, which mission wellness is one, pharmacists can safely and effectively provide PREP and PEP, which is why the CDC and federal partners support pharmacists providing PrEP and PEP. As the Senator mentioned, SB 159 was the first bill of nation.

It is the most restrictive. SB 339 will address these barriers. The 60 day supply limit is not in line with the CDC guidelines, which recommends 90 days of dispensing, and the once time supply every two years does nothing for California pharmacists to increase access to PrEP because there's a shortage of providers and patients cannot access ongoing PrEP. Lack of reimbursement does remain a major barrier for pharmacists.

And while our program in San Francisco has received limited support, the mere fact we cannot bill for services greatly hinders our ability to provide services for all patients who seek PrEp at our site. And we have even had to turn away patients due to this barrier. To be clear, we have approached insurance companies about payment for services and have repeatedly been told they do not have a mechanism to pay us.

Pharmacists have authority to order labs for medication management, and SB 339 outlines labs in accordance with the CDC guidelines. National Pharmacy School training standards require pharmacy students to interpret laboratory tests prior to graduation. This bill takes into account the varying levels of pharmacy settings. Some sites can provide 90 days while others can provide ongoing PrEP if they have the laboratory set up and follow up.

And I respectfully request your support of this important public health bill to ensure patient access to these life saving medications. Thank you.

Thank you.

And, Mr. Chairman, I reversed it. Dr. Hyman Scott. I said Scott Hyman. I'm biased to having Scott as a first name. So my apologies to the Doctor.

Okay, Doctor, step forward, please. It's all right. It's been happening to me since kindergarten. So good afternoon. Thank you to the Chairman and the Committee for allowing me to speak on behalf of this important bill. I'm an infectious disease trained physician. I also serve as the Medical Director of the San Francisco AIDS foundation. We have over 3000 patients who are currently on PrEP and we are one of the biggest PrEP providers in San Francisco. PrEP is highly effective and very safe.

There are data that actually show it's as safe as aspirin and that this is a medication that we should be expanding our access to improve the prevention that we know that this tool can allow us to have. We have ending the epidemic efforts in California nationally, and we are falling far short. Only 25% of people nationally are on PrEP who would have an indication. And we see stark racial ethnic disparities with lower rates among African Americans, Latinos, as well as individuals who are younger than 25.

And there are significant regional- There's actually a local analysis in California that looked at where PrEP was being implemented and it was implemented in the large cities, as Senator Wiener mentioned. But we're really missing in the rural areas. This bill focused on supporting pharmacists, which are a mainstay of our healthcare infrastructure. And actually a big part of one of the largest programs in San Francisco is completely run by pharmacists effectively.

And we have leaned on pharmacies to support vaccinations, contraception and other preventative tools, and that PrEP can easily be implemented and integrated into that. SB 1339 will address these key gaps that we have in expanding PrEP access to our communities that are most in need of this highly effective prevention intervention. It can be provided safely and effectively by pharmacists.

It's already been shown both in California and outside of California, and it really would allow us to reduce the hassle factor that our patients, when we've interviewed them around why they didn't start PrEP or why they stopped PrEP was all of the difficulty they had getting into providers, following up with providers, and getting their prescriptions refilled and their pharmacies always came out as a suggestion by the people who we talked to about this effort to make prep more accessible.

So thank you for your time and hope you support this bill, SB 339.

Thank you, Doctor. Any other witnesses in room 2100 who wish to testify in support of this measure, please step forward. Name, affiliation and position on the bill, please.

Chair Roth, Senators, Dean Grafilo, on behalf of the California Life Sciences, in support of SB 339. Thank you.

Thank you. Next, please.

Ryan Souza, on behalf of APLA Health and Essential Access Health, in support.

Thank you. Next, please.

Sarah Pollo Moo, on behalf of the California Retailers Association, in support.

Thank you. Next, please.

Craig Pulsipher, Equality California, proud co-sponsor in strong support.

Thank you. Next, please.

Michelle Rivas, California Pharmacist Association, co-sponsor, in support.

Thank you. Next, please.

Laura Thomas, San Francisco AIDS Foundation, co-sponsor in strong support. Thank you.

Thank you, ma'am. Now let's move to any lead witnesses in opposition to Senate Bill 339? Any opposition witnesses, please step forward.

Thank you, Mr. Chair. Ryan Spencer, on behalf of both the California Medical Association and the American College of OBGYN's District Nine, I'd first like to emphasize both CMA and ACOG's appreciation of the author's intent and his strong commitment to this issue as it has over the past years.

Expanding safe access to PrEP and PEP for individuals at the highest risk of HIV and acquisition's incredibly important. This is why ACOG supported CMA colleagues in 2019 as they worked on SB 159 that authorized pharmacists to dispense a limited supply of PrEP and PEP for a limited time without a prescription. This compromised bill provided appropriate safeguards, which included appropriate follow up care and a prescription to continue coverage of the medication.

Unfortunately, SB 339 now removes these important patient protections, seemingly allowing a pharmacist to continuously dispense both PREP and PEP in perpetuity without a patient ever seeing a qualified medical provider to receive a prescription. While pharmacists may be authorized to perform certain tests, their lack of medical training does not afford them the appropriate medical knowledge to interpret the results of such tests, and without appropriate follow up visit medical issues resulting from the drug, any drug may go detected and worsened over time.

Again, we fully support the author's goal and remain committed to working with him to find a balance to improve access, including expanding the timeline, but also maintain appropriate access and safety. But until then, unfortunately, both ACOG and CMA must respectfully oppose. Thank you.

Thank you, sir. Any other witnesses in room 2100 who wish to testify in opposition to Senate Bill 339, please step forward.

Seeing none, let's move to witnesses waiting to testify via the teleconference service. Moderator if you'd please prompt any such individuals waiting to testify, either in support or in opposition, we'll begin with them.

Thank you. In support or opposition, you may press one and then zero. Again, that is one and then zero. If you're in support or opposition, we will go to line 13. Your line is open.

Mr. Chair and Members, Silvia Solis Shaw here on behalf of the City and County of San Francisco, as well as the City of West Hollywood, both in strong support. Thank you.

Thank you. Next, please.

Thank you. We'll go to line 12. Your line is open.

Good afternoon. Rebecca Gonzales with the National Association of Social Workers, California Chapter, in strong support.

Thank you. Next, please.

Thank you. Line 18, your line is open.

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

Thank you. Next, please.

And we have no further support or opposition in queue at this time.

Thank you, Moderator. Let's bring the matter back to my colleagues on the dais. Colleagues. Any questions? Comments? Questions? Senator Wahab moved the item. Senator Eggman, question?

So in the states, Utah, and what were the other two?

I'm sorry. It's Colorado, Nevada, Oregon, Utah.

Okay, so in states where there's not the 60 day. Have we seen higher usage in those states?

Yes. Just to be clear, in Colorado, Nevada and Utah, there are no time limitations. Oregon is basically the state that we're following with 90 days. But then it can be renewed, and we are seeing better success in those states. And I want to just emphasize, it's not that we've been moderately successful in California. We have been very unsuccessful. We tried the approach of limiting it. It didn't work.

Okay, and your contention is it doesn't work because it's too hard to keep track of a 60 day supply, if you've gave 10 or if you gave 20 in the course of the time limit?

It's challenging to track it, but also from the pharmacy's perspective, you can only give one time every few years. These pharmacists have to go through a training. The Board of Pharmacy implemented that. They have to set up systems. There's a lot of work that has to be done. If you can only give them basically a 60 day supply every two years as a pharmacy, it's going to be hard to justify doing that, which is why they really haven't. Plus the reimbursement issue.

Thank you.

Colleagues, any other questions? Comments? Seeing none. Senator Wiener, would you like to close?

I respectfully ask for an aye vote.

Thank you. We have a motion. The bill has been moved by Senator Wahab. The motion is due pass to Senate Health. Please call the roll.

[Roll call]

Bill has nine votes. Fishing it out, we'll hold the roll open for absent Members. Thank you, Senator.

Thank you, colleagues. Thank you.

Next item up: Item Number Four: Senate Bill 418. Senator Padilla. Proceed when ready.

Good morning, Mr. Chairman and colleagues. I'm here today to present Senate Bill 418, which would create the Prison Redevelopment Commission and direct the commission to provide California with a detailed strategy to convert closed prisons into local assets that are responsive to the needs and conditions of local communities.

As part of last year's state budget, the Department of Corrections and Rehabilitation was directed to close, among others, the Chuckawalla Valley State Prison in the City of Blythe, which is in my district. The budget calls for a resiliency plan to be developed for impacted employees, providing them with hiring preferences at state agencies and other forms of employment and economic assistance.

While this resiliency plan sought to address the immediate needs of the workforce that are impacted and affected by prison closures, it did not address the economic impacts specifically on the local community itself, concerns that could be driven and raised and highlighted by the community itself, or specific to the disposition of State Capitol facilities. Most of California's state prisons are located in rural, economically disadvantaged communities where prisons serve as essential economic drivers.

For example, in the City of Blythe, where CVSP is located, it has a bachelor's attainment rate of about 7.3 percent, compared to the state average of 36.3. And the median income in Blythe is almost half of the state median. By closing the state's prisons without developing detailed strategies in advance to repurpose these facilities and to mitigate the closures, the state is effectively eliminating the economic hub in these communities and not offering timely alternatives.

The state needs to come up with a detailed plan and specific recommendations that are community-driven so they can continue to serve as economic assets to these communities. This need is only intensified by the fact that the LAO anticipates that the state will need to close an additional five prisons within the next decade. SB 418 seeks to create a method which can build on existing efforts administratively, provide a common structure and transparency to bridge the gap between these closures and continued economic health of these communities.

Just recently, the State of New York, which has closed more than 20 prisons in the last 15 years, established their own Prison Redevelopment Commission, which was tasked with finding new and creative ways to repurpose vacant and often blighted correctional facilities that are no longer needed. The report that the commission was able to generate released with an entire toolkit of ideas that the state could broadly pursue as they look to help the areas impacted by closures.

By following some of this example, the State of California can ensure that communities affected by the closures can repurpose these sites to mitigate the negative impacts on local communities. With me today is Julian Cuevas, Director of Policy and Governmental Affairs with the Inland Empire Community Foundation, and Natasha Minsker with Policy Strategist--excuse me--with Smart Justice California.

Mr. Cuevas.

Great, thank you. Thank you, Mr. Chair. Thank you, Members. Julian Cuevas, Director of Policy and Governmental Affairs for the Inland Empire Community Foundation, and today I am here representing Inland Economic Growth and Opportunity, better known as IEGO, the IE's regional inclusive economic development coalition hosted by the Inland Empire Community Foundation.

As the Senator just mentioned, currently, most state prisons are located in inland California communities, which have been disproportionately affected by economic downturns. Prisons have served as principal economic engines for rural communities with approximately 40,000 employees across the State of California.

Given the economic effects prison closures would have, SB 418 would provide economic opportunities to help withstand the impacts on local economies. Creating a prison redevelopment commission will help turn prison development, redevelopment into economic drivers for these communities that mirror the state's goal to create an economy that works for all Californians. Creating this commission of 15 members with diverse expertise would help mitigate the negative impacts of these closures and create positive, lasting benefits to communities for generations to come.

As the Senator just mentioned, as we've seen in the New York Prison Redevelopment Commission Report, redeveloping California state prisons into community assets can serve the local populations in various ways, including affordable housing, job training centers, and opportunities for industry cluster development. For these reasons, IEGO supports SB 418 in order to help streamline the redevelopment process and bring about quicker solutions to our local communities. Happy to answer any questions, so thank you.

Thank you, sir. Next.

Good afternoon. Natasha Minsker, on behalf of Smart Justice California. Smart Justice California strongly supports prison closures. Projections are that we will soon have 20,000 vacant prison beds. The Legislative Analyst Office says that we can safely close five or seven prisons in addition to those that are already slated foreclosure. In other words, California can safely close almost one-third of our prisons. This would make available billions of dollars that we can spend on housing, health care, and education.

SB 418 is a smart bill because it recognizes that prison closure can be approached as an opportunity for economic revitalization and reinvention for the communities where these prisons are located. Modeled off of a successful effort in New York, SB 418 brings together state and local stakeholders to find ways to make prison facilities and the grounds that they sit on into creative community assets. SB 418 is a smart bill, and we urge an aye vote. Thank you.

Thank you, Ms. Minsker. Any other witnesses in Room 2100 in support of this measure? Seeing none, let's move to any lead witnesses in opposition to Senate Bill 418. Any other witnesses in opposition in Room 2100 who wish to testify in opposition to the measure? Seeing none, let's turn to witnesses on the teleconference service. Moderator, if you would please prompt any such individuals waiting to testify in support or opposition to this measure, we'll begin with them.

Thank you. For your support or opposition, you may press one and then zero. Again, that is one and then zero if you're in support or opposition. Mr. Chair, we have no one in queue.

Okay. Let's bring the discussion back to my colleagues on the dais. Colleagues, questions? Comments? Senator Niello.

Thank you, Mr. Chair. This kind of is reminiscent of the efforts to reuse closed military bases of several years ago. I was involved with that in Sacramento. The effort was quite successful here in our local area, and so it makes good sense.

The one question is, there isn't any funding in the bill, and so perhaps you're presuming that GO-Biz can handle it within their capabilities currently or would you be looking for things down the road?

Mr. Chairman, Senator, both. And we'll continue collaborating with the Department and stakeholders to be developing financial options as the bill moves.

Thank you, Senator. Senator Becker.

Thanks. I was just going to say this is exactly the kind of forward thinking policy I think we should be doing. I'd move the bill at the appropriate time.

Thank you. Any other questions, comments, concerns? Senator Smallwood-Cuevas.

Thank you so much for this bill, and I really appreciate the creative uses terminology coming from communities that have been devastated by the extraction of resources around the prison industrial complex. I'm glad to see that we're looking for ways to repair some of that harm by turning these into creative community assets. So I look forward to hearing more about this work, and thank you for carrying this bill.

Thank you. And Mr. Chairman and Senator, I would just say to close, I think it's important to put the community back in the driver's seat. As much as I applaud the Administration's efforts to include the directive in the budget process, the reality is many of these communities--for a variety of complex reasons that the Committee is well aware--receive little to no notice in advance of the closing announcements.

This maybe is an opportunity to provide a transparent structure to put communities back in the driver's seat about the disposition of these facilities. I respectfully ask for an aye vote.

Thank you, Senator. We have a motion. The bill has been moved by Senator Becker. The motion is 'do pass to Senate Public Health.' Please call the roll.

[Roll Call].

Good afternoon, Mr. Chair and Members. A few weeks ago, this Committee had an oversight hearing regarding cannabis regulation to hear about challenges, progress, and next steps. And one item that was mentioned throughout the various panels is how expensive and time consuming the application process is, specifically environmental review.

Bill has 10 votes, enough to get out. We'll hold the roll open for absent Members. Thank you, Senator. Senator De Laird, item number five, Senate Bill 5080.

The Bill would provide much needed efficiency to California's cannabis licensing system, in turn strengthening the regulated market. An efficient, well coordinated regulatory system is our greatest tool to combat illicit cultivation and the egregious environmental harm that it can inflict upon our natural resources. Thank you for the opportunity to testify in support of SB 508. Today we ask for your support. Thank you, sir. Any other witnesses here in room 2100 who wish to testify in support of this measure?

The environmental review is critical and should be completed, but as mentioned before the Committee, the process is expensive and time consuming and duplicative. This Bill aims to streamline the review and approval process of annual cannabis licenses by eliminating a redundant CEQA review by the Department of Cannabis Control after a local jurisdiction has completed a site specific review. So to be clear, right now, two CEQA reviews are required. This Bill would reduce it to one. It's not wiping away the review.

It's taking it from doing it twice to doing it once. I authored a similar Bill last year, SB 1148, which passed this Committee with unanimous bipartisan support. But since this problem remains as a barrier to entry, I'm here once again to make an attempt to address it. We have seen various bills update the legal cannabis framework because it's imperative to make a regulated system work.

One indicator of the illicit market's threat to the illegal and regulated market and the environment is the millions of dollars, almost $134,000,000, that are allocated in the state budget and past budgets to clean up and remediate the environmental impacts created by illegal cannabis cultivation. For myself individually, one of the reasons I supported the initiative was as resources secretary, some of the agencies were involved, and I recall one in northeast Mendocino county where there was illegal pesticides, illegal diversion of water, guns were on the property.

There were a whole host of things that just were detrimental to the Members of the public and not good public policy. And having a regulated industry really would address those issues, and what it's really about is making the regulation work so people come in and actually use it.

Currently, there's no registered opposition, but myself and my staff have been meeting with last year's opposing groups and hope that we will be able to work together to bring applicants into a regulated system and to address any remaining issues. Here to speak in support of the Bill is Mark Smith, on behalf of the Origins Council. I respectfully ask for an aye. Thank you, Senator. Mr. Smith.

Yes, Mr. Chair and Members. Mark Smith, on behalf of Origins Council, we represent 800 licensed small and independent cannabis businesses in rural producing counties throughout California. So mostly legacy farmers who have been involved in the production of cannabis through its history in the State of California. California's legalization framework places significant weight on local control. This has necessitated that industry work in partnership with jurisdictional governments to help develop local cannabis programs and land use policies.

The regional partner organizations of Origins Council have worked with their local governments to help develop over a dozen land use ordinances for commercial cannabis cultivation over the past seven years. In 2021, we undertook a technical analysis to study the functional interplay between CEQA, state licensing and local land use regulation for cannabis. That report can be found on our website.

I won't go into details about it now, but the report findings indicate that the current system is duplicative, inefficient, and anomalous to normal sequo process flow, which is significantly challenging. Implementation under normal process flow CEQA review for local projects are generally under the purview of a local government, SB 508 seeks to better align the cannabis framework with normal CEQA process flow. SB 508 furthers this critical multiyear effort of the state to remove duplicative licensing requirements and enhance coordination between the state and local cannabis regulating agencies.

Yes, Mr. Chairman. And Members Amy Jenkins, on behalf of the California Cannabis Industry Association, in strong support. Thank you.

Thank you. Next, please.

Good afternoon, Mr. Chair and Members. Pamela Lopez, on behalf of STIIZY, one of the largest vertically integrated cannabis companies in California, also owned by people of color, and California normal, the state's largest human rights organization for cannabis, in support.

Thank you. Any other witnesses in support? Let's move to any lead witnesses in opposition to Senate Bill 508? Any lead witnesses in opposition? Seeing none. Any other witnesses in opposition to this measure here in room 2100? Seeing none. Let's move to the teleconference service. Moderator, if you would, please prompt any individuals waiting to testify in support or opposition to Senate Bill 508 we will begin with them.

Thank you. If you're in support or opposition, you may press one, then zero again. That is one, and then zero. If you're in support or opposition. Mr. Chair, we have no one in queue at this time.

Thank you. Moderator. Bring the matter back to my colleagues on the dais. Colleagues, any questions or comments? Move the Bill. Bill's been moved by Senator Eggman. Let me just check. Any other questions or comments. Okay, Senator Laird, would you like to close?

Thank you, sir. The motion is do passed to Senate environmental quality. Please call the roll. [Roll Call]

I respectfully ask for an aye vote and appreciate the testimony from in the room.

Bill has 11 votes, enough to move out. We'll hold the roll open for absent Members. Senator, you have Item Number Six: Senate Bill 540.

Thank you very much, Mr. Chair. Senate Bill 540 enacts a comprehensive cannabis consumer education, legislation intended to keep consumers and patients safe. Specifically, it directs the Department of Cannabis Control to evaluate its existing cannabis product labeling requirements based on evolving science, as well as develop a brochure to promote responsible adult use and deter youth access.

While existing law sets strict standards for cannabis packaging and labeling, including specific cautionary statements, concerns persist over whether these requirements are sufficient to inform consumers and defer youth access, particularly as science continues to evolve regarding the risks and benefits. This bill therefore directs the Department of Cannabis Control, in consultation with the Department of Public Health, to reevaluate its existing cannabis labeling requirements beginning in 2025 and every five years thereafter.

It also establishes a stakeholder process in coordination with the Department of Public Health to develop a brochure that will be made available to consumers on responsible use. These stakeholders would include, among others, medical experts, youth services representatives, and public universities. My office and the bill's sponsors are in continued dialogue with all stakeholders to address outstanding concerns. But I want to point out some specific changes that I'm prepared to make to the bill to address issues raised by the opposition, assuming it's approved by this Committee today.

First, I would amend the bill to require the Department of Cannabis Control to assess the existing labeling requirements on or before July 1st, 2025, and every five years thereafter beginning July 1st, 2030. I'm hopeful that this change will resolve some of the concerns that have been raised. Second, concerning the Advisory Committee, I will be modifying the language to allow other stakeholders to participate in the process at the direction of the Department of Cannabis Control and the Department of Public Health.

Lastly, I am very sensitive to concerns that have been expressed pertaining to the distribution of the brochure, which is currently upon request. I'm working with the industry to strengthen that language to better inform consumers, while not generating additional paper waste in the industry.

For instance, there's a consensus that the brochure should be prominently displayed. I'm also exploring how we ensure that customers who are having cannabis delivered have access to this information. Joining me today to testify in support is Amy Jenkins, on behalf of the California Cannabis Industry Association. I respectfully ask for your aye vote.

Ms. Jenkins, please proceed.

Thank you, Mr. Chairman, Committee Members. Amy Jenkins, on behalf of the California Cannabis Industry Association, which represents several hundred licensed cannabis operators and ancillary companies across California. I want to thank the author for introducing this bill.

There's been a lot of conversation, as some of you know, about our existing labeling and brochure requirements. So this is our proactive effort to attempt to address those concerns. As the leading trade association, we've actually been in this dialogue for some time.

We have a long history of supporting policies that promote safe and responsible cannabis consumption, and we have been proactively working to develop comprehensive laws aimed at curbing youth access, establishing appropriate standards for the manufacturing and labeling of all cannabis products, and implementing enforcement protocols to uphold California's commercial cannabis laws and regulations.

And we have also partnered with the Department and its predecessor, the Bureau, as well as the Department of Public Health to pursue public awareness campaigns that inform cannabis consumers about how to identify licensed cannabis businesses and products and the importance of consuming legal products. But nonetheless, as the Senator noted, our efforts to continue to support the integrity of the market need to continue to be fine-tuned.

So we're very appreciative of the Senator's work and collaboration, and we feel this represents a good step forward with this new brochure, which will require a five-year rereview as well as with our labeling requirements. And we urge your support for this measure today. Thank you very much.

Thank you. Any other witnesses in support here in Room 2100, please step forward. Name, affiliation, and position on the bill, please.

Pamela Lopez, on behalf of California NORML, the state's consumer safety and human rights organization, in support.

Thank you. Next, please.

Alicia Priego, on behalf of the California Cannabis Manufacturers Association and also Kiva Confections, in support.

Thank you. Next, please.

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

Thank you, sir. Any other witnesses here in Room 2100, please--

Mr. Chair and Members, Mark Smith, on behalf of Origins Council, in support.

Thank you. Any other witnesses in support here in Room 2100? Seeing none, let's move on to lead witnesses in opposition to Senate Bill 540. Any opposition witnesses to Senate Bill 540?

Mr. Chair?

Yes, ma'am.

Dr. Lynn Silver, the Public Health Institute. Our position is to oppose unless amended. We appreciate the intent of the author and the openness of the Committee to amendments, and some of the amendments you just mentioned, Mr. Laird, and also the wise passage last year by this Committee of the Cannabis Right Know act. However, we are deeply concerned that the Bill, as currently proposed, will delay, rather than support actually informing consumers about serious mental health and other risks from today's turbocharged cannabis products.

We have seen a 75% increase in emergency room visits associated with cannabis use, increases in psychosis of young people, and other issues. So, as currently proposed, it requires a flyer that will not actually be given to anyone unless they know to ask for it. I appreciate your openness to changing that aspect. It also does not require the Department of Cannabis Control to add missing warnings on mental health, which are completely absent at this time.

And it includes, on a scientific Advisory Committee, people who stand to directly profit from the sale of cannabis, which is another request that we made. We would not do that with a pharmaceutical product, for example, and we should not do that with cannabis.

So, basically, together with youth forward, we provided modest amendments to the Bill, similar to what emerged from Assembly BNP last year, that the flyer with key information actually be given, at least to new consumers, that mental health warnings be required to be added, because these are some of the most significant problems we're seeing in our hospitals and clinics. In addition, we appreciate that you will require that review to occur. Thank you for making that change.

And then we ask that the scientific Advisory Committee be made up of scientists, but exempt from conflicts of interest, and not with representation of the industry, as is typical in any scientific review Committee. It's a lot less than you passed last year, but that would make the Bill enough to actually help inform consumers and keep them safer. And so we ask for these amendments to the Bill. Thank you.

Thank you for your testimony. Any other witnesses in opposition to this measure? Name affiliation position. Chairman Roth, Members of the Committee. I'm Jim Ketty. I'm the Executive Director of Youth Forward. Youth Forward is a Sacramento based nonprofit organization that works on children, youth and young adult issues statewide. We have a particular focus on substance use disorder prevention and do work on a regular basis with the Department of Healthcare Services. On that topic, I serve on the Prop 64 Advisory Commission with dhCs.

I won't reiterate what Dr. Silver has stated. We are supporting the proposed amendments to the Bill. I also want to express our appreciation to Senator Laird for taking leadership on this very critical issue I guess the 1.0 I would like to make is just to remind everyone that we legalized cannabis in California seven years ago. And since that time, there has been significant changes in cannabis products. We've seen the emergence of marketing and much more kind of aggressive promotion of cannabis in the state.

And I do think it's really important that we take time to reassess and to provide consumers with up to date information as we've learned more about health risks for pregnant women and certainly the mental health risks that Dr. Silver mentioned. So thank you. Thank you, sir. Any other opposition witnesses in room 2100 seeing none. Let's move to the teleconference service. Moderator if you would, please prompt any individuals waiting to testify either in support or opposition to this measure, we'll begin with them.

Thank you. If you're in support or opposition, you may press one and then zero. Again. That is one and then zero. If you're in support or opposition.

We'll. Go to line 27. Your line is open.

Good afternoon, Mr. Chair and Members Jason Bryant, on behalf of the Cannabis Distribution Association, in support. Thank you. Thank you. Next, please.

Thank you, Mr. Chair. We have no further opposition or support in queue.

Thank you, colleagues. Questions, comments? Senator Ashby?

Thank you. Senator Laird. I wanted to speak on this item for a couple of reasons. One, because I am following in big shoes from Dr. Pan, and I know he carried the last iteration of this Bill, and it had a little bit more aggressive language. And I'm hearing that from the advocates today, some of whom are my backyard. So I want you to know that in my mind, I love that you started today with moving forward and taking some recommendations. That's really good.

And I'm hoping that in the process that you'll move even farther. I'm not really one for saying stop now when something is a work in progress. I'd rather give you all the opportunity in the world to move forward. My hope, though, is that this will be a little bit more aggressive by the time I get to see it again on the Senate Floor. I don't love that the Committee is seeing something that's less than what the Committee approved before from Senator Pan.

But I do love that you are not letting the conversation go away, because it's a really important conversation. And I know you're here speaking in opposition and that you're a little bit outnumbered, but keep talking because I think it's really important and meaningful. And I do think you're helping him make good progress on this and ultimately getting us to a place where we better inform people of the health risks. I happen to also be married to an ER trauma nurse.

And so I'm pretty familiar with some of the numbers that you all have shared. And I think it's really important that we get good information in the hands of consumers. So thank you, Senator Laird. I'll be supporting you today.

Thank you, Senator. Next, Senator Niello, followed by Senator Becker.

Thank you, Mr. Chair. Senator Laird, many times I vote against a measure that's sort of a work in process. I will not be today, but I'm going to echo the comments made by my friend Senator Ashby from a little bit different perspective, and that is the voters in the state approved the legal use, legal recreational use of cannabis. And at the outset, you described the brochure as being steps for the safer use of cannabis.

We're headed in a more elaborate direction, but nonetheless, to have the approval of the voters and safe use of cannabis, a lot of people can think, well, it's fine to use it. There are no risks, which there are, of course, with substances, tobacco, alcohol, et cetera. And so I support the concerns of those who stated in opposition, unless amended, that there be given adequate coverage in information that's disseminated about the risks that exist for cannabis use.

And I trust that, because I know you, Senator Laird, I trust that you'll be pursuing that in good faith. So I will support the Bill. Thank you, sir. Senator Becker?

Yeah. I'll just add on to say, first of all, thank you for taking this up. I'm really glad you're working on it. And I apologize. I missed a minute. Apologize for repetitive on anything. But number one, I would hope that we could do this before Jen, I know you're says up to January 2025.

I hope we could do this much sooner because I think it is a really important Bill and an important document you'll be producing. And just to say that anecdotally, I've heard from Fred, what you hear all the time now is that the strains that are available now are not the strains of 20, 30 years ago, and it's just much more powerful. And I don't think a lot of people realize that.

And I've just heard anecdotally from number of friends who've had, especially with young men, have had really bad psychotic episodes as a result of a lot of use. So I do think we need to step up our warnings. And I appreciate you taking this on, and I'll just echo the comments of my colleagues. Thank you, Senator Becker. Senator Laird, but you'd like to close.

Thank you. Very much. And I appreciate the testimony, and I appreciate the comments here and a few things.

One of the reasons it's January 1, 2025 is it goes into effect on January 1, 2024 and you need time to do it. That is really the reason for that date. And what we are trying to do here is strike a balance. And the amendments that I have either taken or pledged to take really work hard to move more to that balance in who serves on the stakeholder group. So it includes more of the medical community and other people that were referenced.

And we took some of the amendments on the distribution because we don't want this to be something where thousands of, they're given mandatorily to everybody, thousands of them are thrown away, but that you don't have to work to know it's there, that you actually can figure it out and it can happen, and people can access this information without having to ask for it. So we'll continue to consider things, but I feel like this is not the work in progress it was when I introduced it.

I think we are really starting to address these issues and refine it, but I will continue to work with anybody that has concerns, and I respectfully ask for an aye vote. Thank you, Senator. Do we have a motion on the Bill? Motion by Senator Dodd. The motion is do passed to Senate appropriations. Please call the roll.

[Roll Call]

Bill has 11 votes, enough to get out. We'll hold the roll open for absent Members. Thank you, sir. Thank you very much. So we have three items left. We're going to start with item number seven. Senator Ochoa-Bogh. I doubt that we're going to finish before we have to recess for Senate Floor session at a little bit before two, but we're going to try. Senator Bog, the floor is yours. This is SB 612.

Thank you, Mr. Chair. And Members, I would first like to thank the chair and Committee staff for their work on this Bill. Not close enough. Is that better? I apologize. I'm happy to take the proposed author's amendments noted in the analysis, which we believe address the clarity issues raised by staff. Thank you for that. SB 612 would clarify that the provisions of SB 1453, which I authored last year, apply only to speech language pathologists who are licensed on or after January 1, 2023.

The accepted author's amendments clarify that SLP licensed prior to January 12023 are to be held to the same training requirements as they were before SB 1453 was enacted. Questions had previously arisen over whether the authorization needed for a SLP to perform a flexible endoscopic evaluation of swallowing, commonly referred to as fees procedure, was a one time authorization based on the SLP's competency or required each time an SLP had to perform the procedure.

SB 1453 from last year clarified this issue but did not specify whether the new training provisions were retroactive. Recently, the speech Language Pathology and Audiology Board announced they interpreted SB 1453 in such a way that they would apply the bill's new language bill's new training requirements to all slps. This means that slps who were performed performing fees prior to 2023 may no longer be able to perform them without meeting additional training requirements, despite clear competency and experience.

To be clear, SB 612 does not decrease the training standards of slps. After SB 1453, slps have to receive written verification that they perform 25 of the same procedures. The only difference is the clarification of who is supervising these 25 procedures. Joining me to testify in support is Lisa M. Evangelista and Dr. Jennifer Kisner. On behalf of the California Speech Language Hearing Association, please step forward.

State your name for the record.

Jennifer Kisner thank you, Senator Ochoabo, chair Roth, and Committee Members. My name is Jennifer Kisner. I've been a speech pathologist for over 25 years, and I currently work as a clinical specialist in the head and neck oncology clinic at Stanford Healthcare. I'm board certified in swallowing and swallowing disorders, and I'm here today on behalf of the California Speech Language Hearing Association. I sit on the Fees Task force and on the Casha Advocacy Committee.

So fees, or flexible endoscopic evaluation of swallowing is an objective tool that allows us to make important clinical decisions regarding safety and efficiency of a person's swallow function, which is really complex. Fees is a safe procedure that can be formed, performed with patients who have neurological disorders, structural postoperative changes, or trauma to their swallow muscles and function.

Fees allows the clinician to actually see inside the throat using a small diameter scope while a person is swallowing different consistencies of food and liquid mixed with a color contrast for optimal viewing. This assessment was developed by Susan Langmore, who is a speech pathologist and researcher back in 1989 and is currently performed by speech pathologists across the country and around the world.

The Centers for Medicare made a separate CPT code for fees back in the early 90s, which really shows the importance of patients having this clinical tool. Last year, this Committee passed SB 1453 by Senator Otoa Bogue, a measure that, among other provisions, clarified the range of medical health settings in which fees can be performed to best meet a patient's medical needs. SB 1453 also made changes to statutory requirements about supervision of slps.

They're practicing passing flexible scopes that is part of, but not the whole fees assessment. So Cacha supports SB 612, as amended, because it clarifies that licensed speech pathologists who have received training and verification and have been performing fees for years or even decades, in some cases, can continue to perform this important assessment.

To help guide our treatment, slps are required to maintain written verification of their confidence to perform passing the scope and kasha thanks, Senator, for introducing this important measure and ask for your support, and I'm happy to answer any questions.

Thank you. Next, please.

Thank you. Senator Ochoa - Bogh, Chair Roth, and Committee Members I'm Dr. Lisa Vangelista and I'm the Director of Speech Pathology at the University of California, Davis Medical Center. I serve on the board of directors for the American Board of Swallowing and Swallowing Disorders and the California speech, Language, and hearing Association's feast Task Force and advocacy committees. 10 million Americans are evaluated for swallowing difficulties each year.

Patients with neurological insults, cancers, pulmonary diseases, and normal aging benefit from the expeditious evaluation of swallowing impairments that could result in deleterious health outcomes. The fiber optic endoscopic evaluation of swallowing or fees, has been a staple in swallowing diagnostics since 1988 and an instrument that I've utilized in my practice for the past 14 years. The fees examination is a Low risk procedure that allows for visualization of the swallowing apparatus by passing a camera within a small scope from the noes into the throat.

In real time, speech pathologists can determine impairments in swallowing function and develop a plan of care that results in improved physical wellbeing and quality of life for patients. It should be noted in the past 35 years that fees has been performed by speech pathologists. There is not a single adverse event that has been reported or documented. On January 12023 Senate Bill 1453 went into effect.

While the aim of SB 1453 was to clarify provisions under which speech pathologists could perform these, it changed statutory supervision requirements and at present has restricted access to swallowing diagnostics for patients in California. Casa supports SB 612, as amended, because it clarifies that licensed speech pathologists who received training, verification, and conducted fees as part of their clinical practice, can continue to perform this important assessment and treatment instrument.

The passage of SB 612 would allow competent and proficient speech pathologists to resume providing fees to patients in need. Casha. Thanks Senator Ochoa Bogue for introducing this important measure and asked for your support. I'm happy to answer any questions.

Thank you, ma'am. I'm going to ask you to keep it very short, ma'am.

It'll be very short.

Otherwise you'll be coming back.

No problem.

Thank you.

Marissa McRae, speech language pathologist. I work at Mercy San Juan Medical center here in Sacramento. I'm also in charge of the Casha fees task force, and I'm in strong support of this Bill.

Thank you, Mr. Chair. Actually, it's not opposition. It's more between her first. We're actually working with the Senator right now, Ryan Spencer.

Thank you for coming. Next, please. Is that it? Any other support witnesses in room 2100? Let's move to any lead opposition? Witnesses in opposition to Senate Bill 612? Any lead opposition? Yes, sir.

On behalf of the California Medical Association, we're working with the sender right now to try to improve the training standards of those who actually will be training the slps on fees to make sure that's appropriate. So I continue to work with her. So I'll give you a heads up. That's what's happening. Thank you. Perfect. Any other opposition witnesses or other in room 2100? Seeing none, let's move to the teleconference service.

Moderator, if you would, please prompt any witnesses waiting on the teleconference service to testify either in support or opposition, we will hear from them.

Thank you. For in support or opposition, you may press one and then zero. Again. That is one and then zero. If you're in opposition or support in one moment while we gather their line numbers. Thank you. We will go to line 31. Your line is open. Please go ahead. Thank you. And thank you, chairperson. My name is Dr. Maggie Kuhn, and I'm the medical Director of the Department of Otolaryngology and had a neck surgery at University of California, Davis in strong support of SB 612.

Thank you. Next, please.

Thank you. Next, we'll go to line 31. Your line is open.

My name is James Garber. I am the nurse practice manager for the ear noes throat clinic at UC Davis Health, and I am in strong support of Senate Bill 612. Thank you. Next, please.

Thank you. Next, we'll go to line 14. Your line is open. Please go ahead, Amanda. For Zachary's health and the cashless use passport. I'm in support.

Thank you. Next, please.

Thank you. Line 30, your line is open.

Hello. My name is Anne Carney. I'm an SLP in the Department of otolaryngology at Stanford University. I am in strong favor of the Bill.

Thank you. Next, please.

Thank you. We'll go to line 29. Your line is open.

This is Dana Farahus. I'm the chief of speech pathology at UC Davies Medical Center for Inpatient Services and in strong support of. Next, please.

Thank you. We'll go to line 19. Your line is open.

Hello, my name is Lisa Blumenfeld. I'm the Director of speech language pathology at the University of California, San Diego. And I'm in strong support.

Thank you. Next.

Thank you. Line 25, your line is open. Hello, my name is Susana Rodriguez. 15 years experience with SLP experience. Seven years for fees on behalf of cashface task force. I'm strongly in support of this Bill.

Thank you.

Next, line 26, your line is open. Hello, my name is Melanie Vira. I've been a speech pathologist for 16 years in the State of California. I'm currently with dignity health, and I'm in strong support of this Bill.

Thank you. Next, please.

Thank you. Next. We'll go to line 32. Your line is open. Hi, I'm Casey Rumble. I'm a speech pathologist at Mercy San Juan. I am in support.

Thank you. Next, please.

Thank you. We'll go to line 10. Your line is open. This is Rebecca Lottie, a speech pathology manager at UCLA, in support. Thank you.

Thank you. Next.

Thank you. We will go to line 35. Line 35, your line is open. This is Jessica Piatrowski from UC Davis Center for Voice and swallowing on behalf in support of this Bill. Thank you.

Thank you. Next, please.

One moment, please, and we will go to line 36. Your line is open. Line 36, your line is open. Hi, this is Leah Chapman. I'm a speech pathologist at UC Davis, and I am in support of this.

Thank you. Next, please.

Thank you, Mr. Chair. We have no further support or opposition. Thank you.

Okay, let's bring the matter back to the dais and my colleagues. Questions, comments? I move the Bill.

Okay.

The Bill has been moved by Senator Niello, Senator Alvarado-Gil

Senator Ohoa-Bogh, I just want to thank you for continuing to be a strong advocate for people with different abilities and bringing forward a Bill to move us forward in excellence in healthcare. Thank you.

Any other questions? Seeing none. Senator, would you like to close?

We have a motion. The Bill has been moved by Senator Niello. The motion is do pass as amended to the Senate Floor. Please call the roll.

I respectfully ask for an aye vote.

[Roll Call]

Bill has 12 votes, enough to get out. We'll hold the roll open for absent Members. Thank you, Senator. At this point, we are going to recess as we have to move our way over to the Senate Floor. We will resume as the Senate business, professions and economic development 15 minutes after the close of Senate session.

Thank you, Mr. President and Members. I'm happy to take the proposed amendments noted in the Committee analysis. I appreciate the Committee's staff willingness to engage on this matter. As proposed to be amended, SB 778 is a technical measure to improve the Call Before You Dig Law. Current law generally requires an individual or entity planning to perform an excavation to inform one of the two regional notification centers so that operators of any underground utilities in the area can mark their underground lines.

The law is intended to prevent excavators from damaging underground utilities. It's also intended to protect from injury those working around potentially dangerous underground lines. The provisions contained in SB 778 originated from the California Common Ground Alliance, a state chapter of a national organization dedicated to excavation safety. The group, which consists of utilities, utilitied locating companies and excavators, identified several shortcomings with California's 811 law, and these are the issues addressed in the bill.

In short, all of the changes contained in SB 778 are clarifications and codifications of either existing law or existing practice. Here to testify in support and answer any technical questions is Todd Bloomstine, representing the sponsor, the Underground Service Alert of Southern California, known as DigAlert.

Sir, please proceed when ready.

Thank you, Mr. Chair and Members. Todd Bloomstine, representing the sponsors, the Underground Service Alert of Southern California, commonly called DigAlert, as well as the Southern California Contractors Association. This area of the law, the nexus for this area of the law occurred in 1976 when an excavator struck a gas line in Los Angeles. It killed nine people, injured 14, and burned down almost an entire city block. Through this law, when it was developed in 1976, it's seen numerous changes over the decades.

The provisions in SB 778, as proposed to be amended, are all operational changes, essentially, not really public policy. For this reason, we'd ask for your support. Thank you, Mr. Chair.

Thank you, sir. Let's move to any other support witnesses here in room 2100. Any other support witnesses, please step forward. Name, affiliation and position on the measure, please.

Hi. Good afternoon. I'm Jessica Gauger with the California Association of Sanitation Agencies. I'm pleased to report that with the amendments taken, today in Committee, we're going to move to a neutral position. So just appreciate the author and her sponsoring staff for working with us.

Excellent. Next, please.

Yeah. Thank you, Mr. Chair and Members. Jason Ikerd, on behalf of the Los Angeles County Sanitation Districts, ditto what Jessica said. Just want to add, appreciate the author working with us. Appreciate the work of your staff as well. Thank you.

Thank you for your work. Okay, let's move to any opposition witnesses, lead or otherwise. Any opposition witnesses in room 2100. Seeing none. Let's now move to witnesses waiting to testify via the teleconference service. Moderator, if you would please prompt any individuals waiting to testify in support or opposition of this measure, we will begin with them.

Thank you. If you're in support or opposition, you may press one and then zero. Again, that is one and then zero for any support or opposition. Mr. Chair, we have no one queuing up at this time.

Thank you very much. Back to my colleagues on the dais. Colleagues, any comments or questions? Seeing none, is there a motion on the bill?

Wilk moved.

Moved by Senator Wilk. Senator, would you like to close?

This bill will enhance the protections of those excavating around underground utilities and will also protect the infrastructure itself. I respectfully ask for an aye vote.

Okay, nice job. The motion is due pass as amended to Senate Governance and Finance. Please call the roll.

[Roll Call]

Bill has eight votes, enough to get out. We'll hold the roll open for absent Members. Senator Dodd, our last item on the agenda, Senate Bill 630.

Thank you, Mr. Chairman and Members. I'm presenting SB 360, which would authorize the state contractor's license board CSLB to require applicants to provide an email address upon application and renewal, and would provide that a contractor's failure to complete terms of probation would result in a license ravocation. Currently, the CSLB could spend $300,000 each time they mail information to their 285,000 licensees about industry bulletins or notices about meetings that require licensee input.

The CSLB has started relying on email as a means to communicate with licensees. Unfortunately, licensees must request to be added to their system to receive information via email. Relatively few have taken the time to do that. This Bill would require applicants and licensees to provide their email addresses when available.

Also, the current CSLB process for addressing a contractor who has failed to meet the terms of disciplinary action involves rehearing the case to reimpose the previously imposed discipline this Bill would authorize through a process for automatic revocation of a license for a contractor who has failed to meet the terms of their disciplinary hearing. With me today is Giafana Lamar, chief of legislation for the contractor state license Board. Respectfully ask for your eye vote.

Thank you. Please proceed.

Thank you Committee chair and Committee Members. Thank you, Senator Dodd. My name is Yofana Lamar from the contractor state License Board. By authorizing the CSLB to require email addresses, SB 630 would enable CSLB to communicate with its licensee population of more than 280,000 in a manner that is Low cost, timely, and environmentally responsible. SB 630 would also standardize how disciplinary cases are resolved when probationary conditions are not met. Probationary terms are placed on a license in lieu of revocation after an administrative hearing.

Therefore, it makes sense to revoke the license when those terms are not met. CSLB is authorized to reimpose revocation in certain cases, such as when a licensee fails to pay restitution. However, when a contractor is ordered to complete coursework or retake an examination, CSLB does not have that authority. SB 630 would codify existing authority and regulation and standardize how failure to complete probationary terms are resolved.

Authorizing CSLB to reimpose revocation for failing to meet terms of probation would strengthen consumer protection by providing an incentive to comply with all probationary conditions while also reducing costs associated with disciplinary proceedings. Thank you, Senator Dodd, and thank you for your time and consideration. I would appreciate your support.

Thank you.

Thank you for your testimony. Any other witnesses here in room 2100 who wish to testify in support of this measure? Senate Bill 630 name, affiliation and position, please, sir.

Thank you Senators. Good to see you again. Thank you all Members, for listening to this presentation on a very sensible Bill. In this era of fast communications, email is the way to go. And if we have more than a quarter million licensees and applicants to communicate with, particularly when it may affect their license to practice emails, is sensible. As I said, expedient and otherwise efficacious. No cost so very much support the Bill. Thank you, Senator Dodd.

Thank you, sir. Any other witnesses in support? Seeing none, let's turn to any witnesses in opposition to Senate Bill 630. Any opposition? Witnesses in room 2100? Okay, seeing none, let's move to witnesses on the teleconference service. Moderator if you would, please prompt any individuals waiting to testify in either support or opposition to Senate Bill 630? We will move on with them. Moderator.

Thank you. If you're in support or opposition, you may press one and then zero. That is one and then zero for any opposition or support. Mr. Chair, we have no one queuing up at the time.

Thank you. Moderator bring the matter back to the dais. Any questions or comments from my colleagues. Senator Wahab?

Thank you. Senator Dodd, thank you for bringing this forward. I think that it's very important that we start actually taking a look at how we are making things more efficient in the State of California. And this is a very simple request and surprising that it hasn't been done in the last two decades. But other than that, I would like to move this.

Thank you, Senator. The Bill has been moved by Senator Wahab. Senator Dodd, would you like to close?

Respectfully ask for your aye vote.

The motion is do passed to Senate judiciary. Please call the roll.[Roll Call]

Nine. Right. Bill has nine votes. Fish to get out. We'll hold the roll open for absent Members. We're going. We're going to open the roll starting with item number. Start with one. We're going to start with item number one, Senate Bill 385. The vote is. Current vote is eight to one. Chair voting aye.

Motion is due. Pass the Senate Judiciary Committee. Current vote, eight to one [Roll Call]

Current vote, 9-3. Hold the roll open for absent Members. Next item. File item number two. SB 339. Current vote, nine to zero. Chair voting aye.

Motion is due pass to the Senate Health Committee, nine to zero. [Roll call]

Current vote is 12-0. We'll hold the roll open for absent Members. File item number three, Senate Bill 373. Current vote is 7-0. Chair voting aye.

Motion is due pass as amended to Senate Judiciary Committee. [Roll call]

Current vote, 12-0. We'll hold them all open for absent Members. Next item, item number four, Senate Bill 418. Current vote, 10-0. Chair voting aye.

Motion is due pass to Senate Public Safety Committee. [Roll call]

Current vote, 11-0. Hold the roll open for absent Members. Next item. File item number five, Senate Bill 540. Current vote, 11-0. Chair voting aye.

SB 508. Motion is due passed to Senate Environmental Quality Committee. Current vote, 11 to zero. [Roll call]

Current vote, 11-0. We'll hold the roll open for absent Members. Item number six, Senate Bill 540.

Motion is due passed to Senate Appropriations Committee. Current vote, 11 to zero. [Roll call]

Current vote, 13-0. That matter is out. Item number seven. Item number seven, Senate Bill 612. Current vote is 12-0.

Motion is due pass as amended to the Senate Floor. [Roll call]

Current vote, 13-0. That matter is out. File item number eight, Senate Bill 778. Current vote is eight to zero, with chair voting aye.

Motion is due passed as amended to the Senate Governance and Finance Committee. [Roll call]

Current vote is 11-0. Hold the roll open for absent Members. File item number nine, Senate Bill 630. Current vote is 9-0. Chair voting aye.

Motion is due pass to the Senate Judiciary Committee. [Roll call]

Current vote, 11-0. Will hold the roll open for absent Members. We're going to go back through the roll, starting with file item number one. Senate Bill 385. Current vote is nine to three. Chair voting aye.

[Roll call]

10 to three. That bill is out. File item number two, Senate Bill 339. Current vote is 12 to zero.

[Roll call]

13 to zero. That bill is out. File item number three, Senate Bill 373. Current vote is 12 to zero.

[Roll call]

13-0. That bill is out. File item number four, Senate Bill 418. Current vote, 11 to zero.

[Roll call]

Current vote is 12-0. That bill is out. File item number five, Senate Bill 508. Current vote is 11-0.

[Roll call]

Current vote is 12-0. That bill is out. File item number six, Senate Bill 540. That bill is out. File item number seven. That bill is out. File item number eight, Senate Bill 778. Current vote is 11 to zero.

[Roll call]

Current vote is 12-0. We'll hold the roll open for absent Members. File item number nine, Senate Bill 630. Current vote is 11 to zero.

[Roll call]

Current vote is 12-0. We'll hold the roll open for the absent Member.

Let's open up the roll for the absent Member. Item number eight, Senate Bill 778.

[Roll call]

12-0. That measure is out. Item number nine, Senate Bill 630.

[Roll call]

12-0. That matter is out. The Senate Business, Professions and Economic Development Committee Hearing is now adjourned at 03:40 p.m.