Assembly Standing Committee on Business and Professions

Good morning, everyone. Welcome to this morning's business and professions Committee hearing, which is our last scheduled hearing for Assembly bills. I'm going to speak very slowly through my introductory talking points, and I'm going to hope that my colleagues who have bills up today will show up by the time I'm done with these talking points. We have Bill yeah. Thank you, Assembly Member Dixon, for being here. So we can at least start as a Subcommitee.

We have 18 bills on today's agenda, including the following seven bills on consent. There you look at that, you throw a wish out into the world, and it happens. We have 18 bills on today's agenda, including the following seven bills on consent. AB 528 by Assembly Member Irwin, AB 1130 by myself, AB 1560 by Assembly Member Flora, and AB's 1257 and1262, 1263 and 1264, authored by this Committee.

For each bill being presented today, we'll be allowing primary witnesses here in the room today to speak for up to two minutes each, with up to two primary witnesses per side. Any additional witnesses will be limited to name position on the Bill and the organization they represent, if any. For those wishing to provide further comments, we are accepting written testimony through the position letter portal on the Committee's website. With that, we'll begin today's hearing.

Thank you very much, Mr. Chair and colleagues. Good morning. It's good to see each and every one of you. Thank you for allowing me to present today. I'm here to answer any questions and also would appreciate the aye support when you have reached a quorum and respectfully asked for

And I see my good friend Assemblymember Low is here to present agenda item number five. AB 996. Assembly Member Low ready when you are. And we are a Subcommitee, so we will not have motions or seconds yet.

I apologize. I'm going to need you to present for longer because we have no one else to present yet. So while we're filibustering until we get some other authors. Thank you, Assemblymember Low. I'm absolutely delighted to support this Bill today, and I'm sure it will get a motion in a second when the time comes.

. All right, that didn't last long, so I'm looking for others. If you're watching on TV, go find your Member and drag them to room 1100. Joy. Bill.

Thank you very much, Mr. Trent. Colleague

aye vote. Thank you.

All right. Thank you, chair and Committee Members. Today I'm presenting AB 1292, recognizing that for many California residents, distance nursing education is the best, if not the only, option for pursuing a nursing degree.

Zero, Assembly Vice Chair Flora, excuse me. It will be an honor and a privilege if you would present 1292 item agenda item number 12. Now I'm intimidated. You have a lot of people, so am I. You want us to take time, so here we go. Yeah, exactly. I jinxed myself.

Thank you, Mr. Chair. And Member, Chris Kahn, representing Nightingale Education Group, the parent company of Nightingale College. We're prepared to be very brief, or if you'd like us to be longer, we can.

Okay, great. Well, Nightingale College is a distance education college headquartered in Salt Lake City. Nightingale serves thousands of pre licensure nursing students throughout the country. As of May eigth, we'll be serving over 2000 California students with an incoming class of over 600 students. And that incoming class grows with every incoming class.

Unfortunately, California law does not allow for our California students to conduct their in person labs in California. AB 1292 seeks to remedy this by allowing our California residents who are enrolled in accredited distance nursing education programs to participate in clinical rotations and at California facilities conducted by a California licensed registered nurse. I'm going to just hold my testimony. I'm going to turn it over to my first witness, Chris Kahn, representing Nightingale Education group.

Brevity is beautiful.

As someone Flores said, this Bill is all about just giving these students a chance to do their clinical, on the ground placements in California. Right now, they are not able to do that. With me today is Mikel Schneider, who's the President of Nightingale College. He's here to answer any questions you may have about our program and what we do. I also have Ashley Jones from Generations Health to talk briefly about the interactions between healthcare facilities and these California students.

But first, we have two students here, one from San Diego, current students, one from San Diego, one who works at a facility or a hospital in Richmond, to talk about their experience and the hardships that they've had to have to go out of state to do their clinical placements in another state other than California. So, Ryan, do you want to kick it off?

And we usually have two primary witnesses per side, so why don't we split it up? Each of you, I apologize for this now, because you probably were told you'd have two minutes, but do 1 minute.

That's what we're doing, Mr. Chair. 1 minute each and then two minutes for our other witnesses that work?

All right, we'll do 1 minute each then. Yeah. All right. Thank you.

No, it's two minutes.

That's fine, Mr. Chairman. I speak fast anyways. Perfect. Good afternoon, Mr. Chairman, Members of the Committee. It's a true honor to speak here before you today. My name is Ryan Gettek.

I'm a senior at Nightingale College, and I'm also the military student ambassador in charge of 300 students at Nightingale. I'm also a California distance learner who I'm here to represent today. We need to realize that we live in a very different world than we did. Pre pandemic. According to National Council State board nursing, 100,000 nurses left during the pandemic.

And that number is going to continue to grow until 900k, or 1.0 fifth of the 4.5.0 million total rns intend to leave the workforce. We are at a dire crisis. When I applied to nursing school, I was fresh out of New York City, where I worked activated for Covid in the ICU as a medic with the army. And I was told when I got back here I would have to be on a waitlist, a lottery, or.

Because of the complexity of COVID I might not even get into nursing school, and I looked at two to three years for getting in. I began my journey at Nightingale, and that has thus proved good thus far. As we move forward in Nightingale, we have to travel. I myself have been to South Dakota, Utah, Nevada, and most recently to Pittsburgh. I was actually in Pittsburgh for 12 days.

This causes a strain on California students, and this also allows for outside recruitment of our future nurses in California as we get to Pittsburgh. As I got to Pittsburgh, I was actually recruited by a hospital in Pittsburgh to come work for them. This is not what we need to do to meet the shortage of nurses. Thanks. Thank you. Appreciate it.

Hi. I don't talk much, but I am a student. I just started Nightingale. I'm only on my third semester, so this was my first time traveling, and I think that was the hardest part for me. I am a single parent. I had to figure out two different locations for my three kids to go. And the cost of traveling put a strain on my household because I'm the only person at work.

I do work at a hospital in Richmond, and they were willing to let me do my clinicals there. But because of Nightingale not having the capacity to do the clinicals in California, it makes me have to travel.

Thank you very much. Appreciate that. So now I'm going to have to politely ask. Well, let me see. Are there any primary witnesses in opposition? Come on up. So I need one of you to vacate your chair to give a spot for the opposition. We got to be fair. Ready when you are. You have two minutes. Thanks.

Okay. Good morning, chair, Vice Chair and Members. I'm Marissa Clark from the Board of Registered Nursing. Our board Members discussed AB 1292 at their meeting last Thursday and voted to take an opposed position due to concerns about the bill's impact on public protection and clinical displacement. To be clear, students enrolled in out of state nursing programs can complete their clinicals in California, the school would just need to go through the exact same vetting process that is required for all other nursing programs in the state.

By becoming a board approved program, the Bill would instead essentially provide a carve out for out of state schools in which they could circumvent board oversight, and this could potentially place Californians at risk. Under current law, as was stated, a nursing student can only provide nursing services if they are enrolled in a board approved program. This requirement is in place for the sole purpose of public protection.

Every state has its own unique nursing practice act that sets a framework for how nurses are prepared and can practice in that state. Each state has different standards and rules related to nursing education, nursing discipline and nursing scope of practice. The board's program approval processes are vehicle for ensuring nursing programs and their students are operating in compliance with the laws that were established by the Legislature under California's Unique Nursing Practice act.

This includes reviewing whether school's curriculum meets the licensing standards of California, whether faculty have expertise in the content area they are teaching, and whether clinical placements are appropriate for the stated course objectives. Additionally, it ensures that students are adequately prepared to work alongside other healthcare personnel and provide care to patients based on the scope of practice of an RN in California. Lastly, California's approved pre licensed nursing programs are having a very hard time securing enough clinical placement slots for their current students.

Some have had to decrease enrollment numbers, skip enrollment cycles, or close their programs altogether. Without any type of board involvement, we cannot ensure that students enrolled in out of state programs from across the country will not be displacing current students in preapproved prelicensure nursing programs in impacted areas. For these reasons, we urge your no vote and very much appreciate the opportunity to speak today.

Thank you very much. So now we're going to have an opportunity for folks to add on in support or opposition to the Bill. Let's start with support. Is there anyone who wants to add on in support of the Bill providing your name, organization you're with, if any, and position on the Bill? Go ahead.

Good morning. Thank you. Thank you for the time for gathering today.

I apologize.

Zero, so sorry.

No worries.

My name is Ashley Jones. I'm Generations healthcare and I'm the regional retention and recruiting coordinator for the company.

In support of the Bill?

Yes, I am.

Thank you very much.

Thank you.

Thank you very much. I want to thank the author. I think that we need to do something we've never done before. We need to think outside the box. I hear so many students who are on these ridiculous long waiting lists to get into these are students in California. There's this whole thing that my former mayor, when I was on City Council, said, how can I feed my neighbor's kids if my own kids are going hungry? We should take care of Californians first.

Any additional witnesses want to add on in support of the Bill? Seeing none. Anyone want to add on in opposition to the Bill?

Good morning. John Chavan, California Nurses Association opposed.

Thank you very much. Any additional witnesses want to add on in support of the, in opposition to the Bill? Seeing none, I'm going to bring it back to colleagues. We're still a Subcommitee, but. Anybody have any questions or comments for the author? Mr. Gibson.

And I think by doing that is making sure I have a bill that we'll be hearing at some point. But we have a nursing shortage. We have out of state nurses. We have recruiting nurses from other countries coming in, and then we have students who want to become nurses to go in this field. We have nurses who are burnt out, who are leaving, who are retired, who just said, enough is enough with this pandemic, I want the hell out.

Thank you, Assembly Member Gibson, any additional questions or comments from Committee Members? Seeing none. Assembly Member Flora would you like to close? And I just want to confirm that you've taken the Committee's amendments.

But we're not filling these spaces and we are relying on a system that disenfranchised our own. And so I'll be supporting this bill today, and thank you very much for one stepping up and allowing and elevating this real issue that face California. And we really have to take a real look at it. And I think this is the beginning. Thank you.

Yes, absolutely. Thank you very much. And honestly, I'll just accept my colleague from LA's comments as my close. And I appreciate your comments. Thank you, sir.

That's my favorite close. Thank you for working with us on this Bill. I believe the accepted amendments tighten the bill quite a bit, but understand that there are still concerns that may need to be addressed.

The board's opposition came in past our deadline, so we did not have enough time to work that into the recommendation. I'll be supporting the Bill today, but hope that the author and sponsors will continue to work with the board and other opposition moving forward. And we are still a Subcommitee, but I'm sure it'll get a motion in a second when the time comes. Thank you very much. Appreciate it. So next up, I see Assembly Member Carillo with agenda item number one, AB 481. Ready whenever you are.

Thank you Mr. Chair and members, I am proud to present Assembly Bill 481, which will create new paths to becoming a registered dental assistant and expand the existing duties of dental assistants, both increasing the access to care and making the career ladder more attractive. Dental care, just like other healthcare fields, is facing workforce shortages that only got worse during the pandemic.

While they are back to providing pre-pandemic levels of care, 87% of dental offices nationally reported that recruiting and hiring dental assistants was highly challenging. Additionally, recent data from the Dental Board of California shows that half of the state's 58 counties are experiencing a shortage of dental assistance. Currently, there are two ways to become a registered dental assistant, through an education program or on-the-job training.

However, affordable education programs are often hard to come by, and on-the-job training can take a year and a half to complete. AB 481 would create new pathways to register dental assistants licensure, allowing dental assistants to receive pay while training for RDA licensure. In addition to a pathway through regional occupation and adult occupation programs. These new pathways will help to diversify the dental workforce and reduce barriers to the licensure without any compromises on quality of care.

The bill also updates the duties and responsibilities of dental assistants to reflect new technologies used in the dental profession. California has three classifications for dental assistance, unlicensed dental assistance, registered dental assistance, and registered dental assistance in extended function. This scaffold of dental assisting professions create a career ladder that allows individuals to advance their skills, responsibility, and compensation of their career progress. This bill isn't about shutting anyone out. Workforce shortages mean that California needs an all of the above approach, and that is what this bill does.

It maintains the high standards of care and access that Californians expect by ensuring dental assistants are able to fully be trained and licensed quickly to meet workforce demands, while at the same time reinforcing the growth of opportunities in the dental assistant career ladder and diversification of the profession. Here to talk more on the need for the bill and answer any technical questions are Dr. Ariane Turley, immediate past President of the California Dental Association, and Mary McCune, policy Director for the California Dental Association.

Thank you very much. You'll each have two minutes.

Hi, my name is Mary McCune with the California Dental Association. I'm here for any technical questions, but I'm going to actually toss it over to Dr. Ariane Tarley.

Good morning. My name is Dr. Ariane Turley and I'm speaking on behalf of the California Dental Association bill sponsor of 481. I'm a general dentist practicing in Berkeley, and I'm also the Chief Dental Officer for La Clinica De La Rasa, which is a federally qualified health center.

Dentistry, like much of healthcare, is facing an ongoing workforce shortage, exacerbated by the pandemic, particularly amongst dental assistants. The duties and responsibilities of dental assistants are vital to the dental team and are often referred to as the right hand of the dentist. They are my right and left hands in my clinic. Currently, two pathways exist to become becoming licensed registered dental assistants education programs, which can cost upwards of 20,000 and on-the-job trained, which can be very lengthy, to complete.

AB 481 will create new pathways that include a preceptorship that allows. Sorry, I just lost my place.

It never works when we want it to. No worries.

Going to apologize. I'm going to do this off the top of my head because I just lost it off my screen. So basically, the preceptorship creates new pathways that will allow, with education for dental assistants to move from a dental assistant unlicensed position all the way to a registered dental assistant position. The workforce impact is huge in the state and we're seeing at all levels, it is even worse at the community health centers. I think that basically this allows us a pathway, a career pathway.

It also increases diversity in our workforce because it allows us to bring more people in. We're giving a lot of education to this. So I believe I would ask you to support this going forward because it will make a huge difference. We need boots on the ground now, not a year and a half from now. So I would ask for your support. Thank you.

Thank you very much. Any primary witnesses in opposition to the bill? Come on up. You'll have two minutes.

Good morning. My name is Melodi Randolph and I am with the California Association of Dental Assisting Teachers. I'm also representing the California Dental Assistance Association and the California Expanded Functions Association. And we have an opposed, unless amended, position on AB 481. I'd like to sincerely thank the author and the sponsor of the bill for engaging in robust dialogue in this bill, and we do appreciate the progress that has gone forward so far with this bill.

There's been a number of changes in the last couple of months and we've had good dialogue with them with this bill. However, we continue to have concerns in the following two areas. The first one is the eight-hour infection control course that is required of all unlicensed dental assistants. We are delighted that this bill will change the requirement to do this course prior to potential exposure to blood and OPAM. Right now, the current regulation states that they can do it within their first year of employment.

So we are delighted that they've made this change. However, they've made a change to the lab requirement of the course. It would remove the hands-on lab instruction by a qualified educator in the board-approved course and replace it with an option to watch, and I quote, no more than 2 hours of videos on infection control.

What will happen, therefore, is assistants will get the lecture part of the education and watch a video and then be trained by a dental assistant in the dental office who has been trained by a previous dental assistant who's been trained by a previous dental assistant. If you're familiar with the game of telephone, you know by the time it gets to the third or fourth person in line, the message has completely changed. So this is what would happen with infection control training.

There would be no actual physical training and evaluation of performance of proper and effective infection control procedures by a qualified educator in the board-approved course to ensure the safety of consumers of California. Our second issue is regarding the radiation safety certification course. Currently, the certification requirements require lecture, education, and a specified number of X-ray exposures in a lab setting and four patient full sets of X-rays under the direct supervision of a qualified instructor.

That's two minutes. So if you just wrap up very quickly, that'd be great.

Yes. So what this would do would change it so that there's no minimum requirement for lab instruction, and the clinical instruction would be under the general supervision of a dentist. And general supervision just means that the dentist doesn't even need to be in the facility. So really, no supervision when this assistant is taking X-rays on their patients for the first time.

Thank you very much.

Thank you.

Thank you. So now let's go to the public comment part of the hearing. Any members of the public who want to add on in support of the bill, please provide your name, organization you're with, if any, and position on the bill.

Gary Cooper, representing California Association of Oral and Maxillofacial Surgeons in support.

Thanks.

Mel Assagai, representing the California Association of Orthodontists, in support.

Thank you.

Good morning Chair and members. Dennis Cuevas Romero, representing the California Health Plus advocates, California community health centers, in support.

Thanks. Any members of the public who want to add on in opposition to the bill? Seeing none, we're going to bring it back to colleagues for questions or comments, any questions or comments from colleagues on the committee? Assemblymember Dixon.

Hi, just as we discussed in the previous bill, I mean, California has apparently has some serious issues with regard to professionals serving in the healthcare industry. And I'm pleased with the prior bill and with this bill to make it possible for more people to have a pathway. I like that word. To their professional goals. Ms. Carillo, if you could just reconcile the two professional organizations who serve the dentistry profession, one wants more professional oversight, and one is saying virtual is okay. How do we blend the two?

Thank you for the question Assemblymember, we had this bill last year, complications with exactly your question. We came back with the bill, have been working with the opposition to ensure that we have a pathway forward as Californians need access to dental care. When you continue to move the goalposts of what that's supposed to look like, then we're no longer negotiating in good faith.

And so at the end of the day, what we want to accomplish is the ability for all Californians to have access to health care when dentists don't have dental assistance. And when your argument is that if a dental assistant trains another dental assistant, that dental assistant is not going to have the same level of knowledge.

That to me is just an erroneous argument, but I will pass it on to Dr. Ariane Turley, who can speak a little bit more about how we get to a neutral place.

Thank you. I want to echo, Mr. Gibson your previous comments is thinking out of the box.

Basically, for a year and a half, COVID changed the world in terms of, there are things that we're doing today, including having outdoor restaurants in Berkeley, to be able to pass and eat on the street. Quite frankly, the entire time during COVID we taught dental school, dental assisting and dental hygiene instruction continued. And basically, we learned that you can learn on online education. And I would disagree with the comment because, quite frankly, you're approved to be able to do the x-ray certifications.

Right now, the students that are going through the x-ray certifications that I've put through, they come and do their x-rays in my office under my supervision, so it can be taught. You have the criteria. We all went through infection control. You check off the boxes, and then you certify that it's done. We all want our patients to be safe during COVID We have an incredible record in dentistry for not having patients get sick from COVID because of our infection control procedures.

So we want education. We are not diminishing anything. We're asking for more educational requirements. But we believe that this can be done in the office.

And then one final question. Thank you for that clarification. Bottom line, we have a shortage of dental professionals to teach to practice. Is that the situation in the State of California?

I'll give you an example. Right now, there's 30,000 licensed dentists in the State of California.

If I do the math simply and basically say that I need three dental assistants per dentist, and pediatric offices have up to 10 to 15. Basically, there are only 67,000 licensed RDAs in the State of California and I need 100,000. So the other piece of it is that we want the current dental assistants to become RDAs because what we are looking for as dentists is well-educated, licensed professionals to work with us because they are our right and left hands and they help us.

My ability to provide access to care in our clinics comes from my assistants working with me.

Okay. Thank you very much. I appreciate that clarification.

Thank you. Assemblymember Gibson.

Thank you very much. Thank the author for bringing this bill forward. I think it's a reasonable request. I think you are an answer to this shortage. As I said previously, when it comes down to nursing, I would like to be added as a co author of the bill. Thank you very much. And when we get a quorum, I would like to move it at the appropriate time.

Getting a jump start on things. I appreciate it. All right. Thank you, Mr. Gibson.

Any additional questions or comments from colleagues on the committee? Seeing none. Assemblymember, would you like to close?

Thank you, Mr. Chair and members appreciate the conversation. AB 481 is our second attempt to ensure that Californians have access to dental care. The state has done incredible work to increase access to MediCal recipients. However, what is the point of increasing access when at the end of the day, folks can't get access? Because we have a medical workforce shortage.

So we not only need to increase the access through policy, we need to do the work necessary that we are at the same time building the workforce that's going to create the access for all Californians. We have worked incredibly hard on this bill. This is our second attempt to make sure that we move forward. This bill will make the career ladder more attractive and diversify the profession, ensuring that Californians have access to the care they need that maintains the standards that they expect.

I'd like to thank the committee staff for working with my office, with our stakeholders and the Dental Board of California to ensure that this bill continue moves forward. And I respectfully request an aye vote. Thank you.

Thank you, Assemblymember, and thank you for working with us on this bill, as well as for agreeing to temporarily take out some of the controversial portions of the bill until the dental board can discuss those in May. I know there is still some disagreement on the infection control piece, as we heard, but would like to give the board an opportunity to review that as well. And with that acknowledgment, I'm happy to support the bill today.

And once we have a quorum, I'm sure I'll get a motion in a second. Thank you very much. I see Assemblymember Dr. Weber. Dr. Weber, if you'd like to present agenda item number three, AB 796. No. Are you signaling, Mr. Gibson? Yeah, signal to some of our colleagues to get down here in their chairs. Perfect.

Good morning, Chair and Members. I am here to present AB 796. I want to start by accepting the Committee amendments and appreciate the thoughtful conversations my staff have had with the Committee staff on this bill. AB 796 will create the Athletic Trainer Licensing Committee within the Medical board at the Department of Consumer Affairs to exercise registration, ensure national certification, and facilitate disciplinary functions relating to athletic trainers.

This bill would also prohibit a person from practicing as an athletic trainer or using certain titles or terms without being licensed by the Committee and it would define the practice of athletic training, specify requirements for registration and certification as an athletic trainer, and would require a certified and registered athletic trainer to practice only under the supervision of a physician or surgeon.

Athletic trainers are educated and trained to specialize in the prevention, assessment and intervention of emergency, acute and chronic issues such as concussions, heat illness and sudden cardiac arrest. The American Medical Association recognizes athletic trainers as an allied health care professional and are classified as such by the US Department of Health and Human Services. They are also assigned a National Provider Identifier, or NPI number, just like every other health professional, including myself.

In fact, the American Physical Therapy Association states that certified athletic trainer is qualified to supervise physical therapists for sports specialization certification because of their ability to educate on the acute injury illness management competency, which includes, "examination, evaluation, diagnosis, as well as prognosis, intervention, outcomes of the acutely injured or ill athlete". Athletic trainers are so important that 46 states have a licensure for athletic trainers. Hawaii requires registration and New York and South Carolina have certification title protection.

And then there's our great state that has nothing. But it's not just a health and safety issue, it's also a social justice issue. The Athletic Training Locations and Services project has created real time database of athletic training services in secondary schools. Let's review some of their data of CIF schools employment of certified athletic trainers. In San Francisco, there are 79% of certified athletic trainers. Across the way in Oakland, 0%. San Diego, where I represent, we have 63% of certified athletic trainers.

Los Angeles, 4.8. Sacramento, San Joaquin Valley, 16% have nationally certified athletic trainers. In CIF schools overall, and there's 1620, 63% have no nationally certified athletic trainers. Before I move on to my witnesses, I would like to address some of the concerns in the opposition letter. The first thing they say is a lack of necessity because there is no current crisis here in California. Well, first of all, I don't remember when we ever wait for a crisis to act.

And additionally, if there is no oversight, then you are unable to correctly assess what harm has been done. Second is that the scope of practice is ill defined in this bill that any person or patient can be treated by an athletic trainer. Well, if you read the bill, it clearly defines who can be an athletic trainer and who they can work on and what supervision they'll have. Additionally, they say that the broadness of this legislation puts public safety at risk. That's what we're doing right now.

We're putting public safety at risk because we have no oversight, no rules and no regulation. They also say that athletic trainers today work under the supervision of a physician, and that is not true because there is no requirement of that. They also go on to say that the conditions of this bill would allow an athletic trainer to assess and evaluate a patient's condition. Assessment and evaluation is not a diagnosis.

An assessment and evaluation is an acute recognition of what needs to be done. When a paramedic comes to you and you're having chest pain. They assess the fact that you need some oxygen. They assess the fact that you need to go to the emergency room. They do not diagnose a DVT or a heart attack. The athletic trainer who saved the life of Damar Hamlin went on the field and assessed the fact that his heart probably stopped and he needed some intervention.

He did not diagnose why that happened. Their other concern is that it's under the Occupational Therapy board, which has been taken care of in the amendments. It is under the Medical board because physicians are supervising these athletic trainers. And their last argument is also debunked. And that's also in the letter that hopefully you all received from the Athletic Trainers Association concerning the fact that other states do require that athletic trainers that practice in their state have some kind of licensure or certification.

So as a parent of two athletes myself, I want to ensure that the person caring for them is educated in proper techniques to minimize injury and is required to work with physicians and other healthcare professionals on follow up care. With me today, I have Kelci Stringer, founder of Korey Stringer Institute, and Dr. Cindy Chang, Chief Medical Officer for the Women's National Soccer League and Professor Emeritus at the University of California, San Francisco.

I'm also joined by Mr. Reggie Scott, Vice President of Sports Medicine and Performance for the Los Angeles Rams, who will help with any technical questions. Thank you.

Thank you very much and two minutes each.

Good morning, Mr. Chair and esteemed Committee Members. I am Kelci Stringer, the wife of former Minnesota Vikings all-Pro offensive tackle Korey Stringer and an advocate for improved safety in professional sports. I am here today to ask for your support of AB 796, which would license athletic trainers in the State of California. Tragically, my husband passed away due to complications of a heat stroke in August of 2001 while without the proper medical care and supervision of an athletic trainer.

This incident sparked my lifelong mission to ensure that proper medical care is always accessible to athletes. In 2010, I founded the Korey Stringer Institute alongside the partnership of the NFL and Gatorade. The Korey Stringer Institute serves the needs of athletes at all levels, youth, high school, college, professional and recreational athletes. The Team Up for Sports Safety Initiative, which is led by the Korey Stringer Institute, was established to drive changes in adoption of policies proven to reduce catastrophic sport injury in the secondary school level.

To accomplish this goal, the Korey Stringer Institute and the TUFSS Initiative, we travel state to state to meet with legislators to facilitate adoption of best practices nationwide. In 2017, our organization performed a study of state level implementation of evidence-based best practices for preventing and managing the leading causes of sudden death in secondary school athletics. The study ranked each state in terms of adoption of evidence-based best practices, and California was ranked last. That's right, last.

California's lack of licensure of athletic trainers, the only state in the nation to not license and regulate athletic trainers was one of the factors that earned California the low score of 30 out of 100. Now, just last night I was watching the local news here, and one of the top stories, aside from your local home invasion and robbery, was Sacramento Kings star player De'Aaron Fox.

He suffered a hand injury that makes him questionable to continue to play in the playoffs, which the Kings have not made in 16 years, and the fans are going crazy. Okay? Now imagine him not having a licensed, certified athletic trainer to properly care for him. So I challenge you to imagine any of your children or any young athlete being denied that right by the State of California to have anyone basically off the street to provide care for them.

So, as you see, AB 796 is a very important piece of the puzzle in ensuring athletes receive the best care possible. Having licensed athletic trainers on the sidelines would increase the level of medical care that athletes are entitled to and could prevent tragedies like my husband's from occurring again. So I strongly urge you to support AB 796. Thank you.

Thank you very much. Go ahead.

Thank you. Good morning, I'm Dr. Cindy Chang. 30 years ago, I became a board certified and licensed family physician and sports medicine physician. I've worked alongside athletic trainers at all levels from high schools to Cal Berkeley, Ohio State. Prior to that, Beijing Paralympics, London Olympics, Oakland Roots, San Francisco marathon, and now I'm the CMO of the National Women's Soccer League. The regulation of our athletic trainers is important to not just me, but to all residents of our state.

You've gotten a lot of letters supporting the athletic trainer profession, but I'd like to share examples of the adverse consequences that have occurred because of this lack of regulation. In October 2022, an athletic trainer in Bakersfield was charged with multiple felonies, including contacting and meeting a 15 year old minor with an intent to commit a sex act. He received his athletic training degree from Canada, was in Pennsylvania, and then worked as an athletic trainer in Arizona prior to being hired at Bakersfield.

Because he did not need to be licensed to practice in California, we had no regulatory body to investigate whether or not he had prior complaints, violations or suspensions of his license in these other states prior to coming to California. Also in October of 2022, six former high school football players sued the Colton School District and the school's former athletic trainer, alleging sexual assault, abuse and molestation between their ages of 14 and 17. She was not educated nor certified as an athletic trainer.

If she had been required to have a California license to work as an athletic trainer, she never would have had the opportunity to abuse these children in the training room and the locker room. With AB 796, even if one is educated and certified, parents and other members of the public would have an avenue to register complaints and our state could investigate and sanction illegal, unsafe or unethical behavior.

Why should any of us expect any less oversight of this important healthcare professional when one can call the Board of Barbering and Cosmetology if their hairdresser burns their scalp with hair dye?

That's two minutes. If you could wrap up, that'd be great.

I will. Thank you. I was given three so I'm going to talk fast now. Even small check inspectors are licensed by the California Borough of Automotive Repair. Our continued lack of regulation also conveys a lack of respect for the healthcare profession. And this is detrimental to attracting qualified athletic trainers to work here, to be educated and be educated here.

And if you could wrap up, that'd be great. It's two minutes per witness, not three minutes.

Yeah. Thank you so much. We need it. We've passed multiple state laws, health and safety laws about concussions. I've been here with all these passages, sudden cardiac arrest, heat illness, and we need athletic trainers in our state.

Thank you.

So thank you very much. This bill is essential-

Thank you.

-Towards providing public protection.

Thank you very much. I appreciate your testimony. We have a lot of bills today, so I'm going to need folks to stick closer to two minutes per witness.

Thank you.

Any primary witnesses in opposition to the bill? Perfect. You got a couple of spots up here.

Ready when you are. Thank you very much.

Thank you Mr. Chair and Members of the Committee for the Opportunity to testify before you today. I'm Chris Reed, a Doctor of physical therapy and certified athletic trainer. I am the chair of the California Physical Therapy Association's Government Affairs Committee, representing over 10,000 members statewide. I rise to speak in opposition to AB 796. And we're in opposition not because we disagree that athletic trainers should be regulated in the state.

We just believe that this is not the appropriate method of doing it. I want to first acknowledge the work done by the Committee and the proponents thus far.

While the amendments address concerns related to how athletic trainers are recognized in California, they do not adequately address the more concerning issues that we continue to have related to scope. The definition of an athlete in this bill is a person who is engaged in sports, games, recreation or exercise requiring physical strength, flexibility, range of motion, speed, stamina or agility.

This definition remains overly broad, allowing the athletic trainer to work with essentially anybody that moves, including a middle aged male that injures his knee while playing a game of tag in his backyard with his daughter. We believe that language similar to what is used in the majority of states, which ties the athlete to participation in organized sports, would better reflect the population athletic trainers are trained to work with.

We appreciate the inclusion of some specific elements that must be included in the practice agreements between the athletic trainer and supervising physician. However, they fall short in truly ensuring protection of the public by not delineating the appropriate settings an athletic trainer may work in. Furthermore, there are no time limits on how long an athletic trainer may treat an athlete without the involvement of a physician.

In order to truly provide protection of the public, we believe there needs to be further refinement of the elements relating to the practice settings and referral requirements. A further concern, this bill states that the physician or surgeon oversees the activities and accepts responsibility for the medical services provided by an athletic trainer, not the athletic training services, the medical services. This bill is not about protecting young athletes participating in high school or club sports.

It's not about stopping unqualified bad actors running around the state calling themselves athletic trainers. This bill is not even about the oversight of the delivery of athletic training services to athletes participating in organized sports. It is abundantly clear that this bill is about part about elevating athletic trainers above other healthcare professionals by creating a new physician extender model to deliver medical services to anybody that moves in any setting deemed appropriate.

We welcome further conversations with the author and the proponents of this bill and urge you to hold this bill in this Committee, to ensure those conversations continue to happen, I ask for you to vote no on AB 796.

Thank you very much. Next witness.

Good morning, Mr. Chair, and Members. Pat Whalen, Ellison Wilson Advocacy here on behalf of United Nurses Association of California Union's Healthcare Professionals, UNAC. We are in respectful opposition.

Real briefly, not to reiterate what my colleague just said with regard to the disturbing statistics offered by Dr. Weber about the number of athletic trainers in schools. That's bad. But this bill doesn't do anything about ensuring athletic trainers in schools, doesn't provide any funding, doesn't set any mandates or anything like that. Instead, it allows blowing off the barn door on scope for athletic trainers to treat anybody who moves, as the analysis notes at page 6 and 7.

Typically this Committee, when evaluating regulating a profession, there's five levels going from just modifying existing law, updating enforcement all the way up to the fifth level of licensure, which is what this bill does. We're going from zero to sixty. Your Committee has a long established history of saying we would reserve that fifth level for the situations where there is an obvious need to protect patients or a clear risk of harm to people. We don't have any evidence of that.

And we're going right to the maximum level and establishing licensure for those reasons we oppose. Thank you.

Thank you very much. Any additional Members of the public who want to add on? I see there are a lot. I'm going to ask everybody to follow the Committee rules. Please provide your name, organization you're with, if any, your position on the bill, please do not, what do we call it? Editorialize much? Thank you.

Good morning. My name is Kathy Dieringer from the, I am the President of the National Athletic Trainers' Association in support of licensure for athletic trainers.

Thank you.

Good morning. Deanna Kuykendall, also from the National Athletic Trainers Association in support of licensure for athletic trainers.

Thank you very much.

Good morning. John Chavan, California Nurses Association opposed.

Thank you. Okay, I guess we're going to take support and opposition at the same time. Why not? Come one, come all.

Hello. Tom Abdenour, retired athletic trainer from San Diego State University and the Golden State Warriors in full support of athletic training licensure.

I thought I recognized that name. Good to see you, sir. Thank you.

Hello. Nick Harvey with the California Athletic Trainers Association in support.

Thank you.

Ron Nocetti, Executive Director of the California Interscholastic Federation, or CIF, in support.

Thank you.

Matt Quijano, certified athletic trainer with the California Athletic Trainers Association in full support of licensure.

Thank you.

Gina Biviano, manager of athletic trainers at UCSF Sports Medicine, and we all support.

Thank you.

Suzy Ghattas. I am with the California Athletic Trainers Association. I am full support of this bill.

Thank you.

Good morning. Lindsay Gullahorn, on behalf of the Occupational Therapy Association of California, respectfully opposed.

Thank you.

I am Ryan Lacey. I am an athletic trainer certified in California, and I support this bill.

Thank you.

Good morning. April Johnson, certified athletic trainer in Fresno. Support this Bill.

Thank you.

Hello, my name is Francisco Gamboa, representing Fresno, California, certified athletic trainer, and I support this bill.

Thank you.

Jamie DeRollo. I have my doctorate in athletic training, and I am in full support of this. From Modesto Junior College.

Thank you.

Dr. Holly Brown, an athletic trainer for over 20 years at Sacred Heart Preparatory in Atherton, California, and I fully support this bill.

Thank you.

Michael Kaufman, from Sacramento City College, certified athletic trainer, in full support of this bill.

Thank you.

Jay Nacionales, certified athletic trainer, sports performance coordinator of Jesuit High School, Sacramento. Full support of this bill. Thank you.

Good morning. My name is Camille Lu. I'm an athletic trainer at UCSF Medical Center, and I support this bill.

Thank you.

Hi, I'm Justine Lee. I'm a certified athletic trainer from Oakland, California, and I am in full support of licensure for athletic trainers.

Thank you.

Hi, I'm Sandy Noah. I'm a student of athletic training, and I am in full support.

Thank you.

I'm Dr. TK Koesterer. I'm a member of the managing board of the California Athletic Trainers Association and an athletic training education program director at the University of Pacific, and I support this bill.

Thank you.

I'm Sienna Santoyo. I'm a Fresno State masters of athletic training student. I'm in support of this bill.

Thank you.

Alex Salmeron, masters of athletic training student, in full support of this bill.

Thank you.

Jason McCamey, Meticulous Medical employer of an athletic trainer in full support of licensure.

Thank you.

My name is Mike Chisar. I'm a physical therapist and athletic trainer and in support of licensure for athletic training in this bill.

Thank you.

Dr. Manny Romero, former athletic trainer for the Sacramento Kings, former athletic trainer for the Los Angeles Lakers, currently the clinical education director for the University of the Pacific Masters of Science in Athletic Training Program. Full support of this bill.

Thank you.

Lisa Varnum, University of California Davis, sports medicine. We are in full support.

Thank you.

Matt Davey, head athletic trainer, Sacramento State. And I support this bill.

Thank you.

Enrique Becerra, certified athletic trainer at Sacramento State University, and I'm in full support of this bill.

Thank you.

Tina Tubbs, associate athletic Director of Student Athlete Health, Wellness and Performance from Sacramento State, and I support this bill.

Thank you.

Sarah Lyons, senior associate director of athletic training at Stanford University and I'm in full support of this bill.

Thank you.

MJ Yost, master of athletic training student at Oklahoma State, currently with Stanford University, and I support this bill.

Thank you.

Brandon Padilla, head athletic trainer at Jessup University in Rockland, California. I support this bill.

Thank you.

Genesis Sahagun, certified athletic trainer at Jessup University and I support this bill.

Thank you.

Grant Klotzbuecher, certified athletic trainer at Jessup University and I'm in full support of this bill.

Thank you.

Maryah Cohen, certified athletic trainer for Premise Health and I am full support of this bill.

Thank you.

Carly Mangini, certified athletic trainer with premise health in full support.

Thank you.

Melissa Cortez, on behalf of the San Francisco 49ers, in support of this bill.

Thank you,

Chris Pond, director of sports medicine and wellness at the University of the Pacific, in support of this bill.

Thank you.

Silvio Ferrari, on behalf of the National Football League, in support.

Thank you.

Mr. Chairman, Committee. Ahmed Kadani, representing the Los Angeles Rams, proudly supporting this bill.

Thank you. Any additional Members of the public who want to add on in support or opposition to the bill? The hearing room is going to be empty after this bill. Want to bring it back to colleagues? Any questions or comments? Yes. Assembly Member Mckinnor.

Good morning. Thank you, Assembly Member. Thank you, Dr. Weber. I appreciate you bringing this bill forward. My son Nicholas played sports through high school and college. He broke two toes, his noes, he lost his tooth. I needed somebody there that know what they were doing because he has a limp right now, because one of those toes, it didn't heal well. And so I thank you for bringing this Bill forward for our children. Thank you.

Thank you, Senator Mckinnor. Any additional questions or comments from colleagues? We're still short of a quorum. We were short one Member. I think now we're short two. But, Dr. Weber, would you like to close?

I would. Thank you very much. First, I want to address again some of the opposition's comments. I'm not sure if they've read the current version of the bill, but this is a certification and not a licensure. So when you're talking about going from zero to five or zero to 100 or whatever, we are doing the proper steps.

Additionally, making sure that there is certification and title protection would protect our kids in school because someone could not claim to be an athletic trainer unless they actually had gone through the committee, shown that they had national certification, and then thus had oversight. Did you want me to stop for a minute?

That'd be fantastic. I appreciate you. We're going to quickly get a quorum. Quickly establish a quorum. Madam Secretary, please call the role.

[Roll Call]

Great, we have a quorum. Please continue with your close, Dr. Weber.

Thanks. All right, so the opposition has mentioned in the opposition letter that various legislators for the past 20 years have been trying to get this done. Fifteen times bills have been introduced in many different forms to create licensure or certification for athletic trainers. And fifteen times this state has failed to ensure the safety of our most vulnerable Californians, our youth. Every other state in this nation, including Washington, DC, has declared that there are no scope of practice issues.

Yet for some reason, we want to cling to that false belief. In actuality, by defining and certifying and regulating athletic trainers in California, we are providing scope protection for all other allied health professionals in addition to protecting the health and safety of our children. And I will conclude with the results from the Corey Stringer Institute, who looked at every state to determine who has the best policies and implementation of evidence based best practices in high school sports for safety.

And I always find this interesting because recently some people like to compare California to Florida. Well, Florida ranked number one in state high school sports and safety policies with a score of 86. As was stated, we ranked 51 out of 51 with the score of 30. So, Members, I ask that we finally join our other 49 states in Washington, DC in declaring that our student athletes lives are worth protecting.

Please stop allowing people to refer to us as they do right now when it comes to athletic training and the safety of our students as the Wild, Wild West. And we can do this by first creating certification for athletic trainers. And for this reason, I respectfully ask for your aye vote. Thank you.

Thank you, Dr. Weber. And Dr. Weber, you alluded to this, but I want to make sure that everyone's on the same page that with the amendments the author has accepted today, the bill no longer requires a license for athletic trainers. I agree a license is the highest barrier to entry and should be our last resort. What the amended bill will require is registration with the medical board and protect the title athletic trainer for those with active certification.

This balances the author's intent to protect athletes while addressing the concerns we have heard today about the downsides of full licensure, and I want to thank the author, the sponsors, the opposition for working with us on the bill. We agree that some level of regulation is needed, particularly for interstate travel complications. The Committee does not agree that full licensure is needed at this time, so the amendments are intended to reduce the cost burdens on the profession.

To address the concerns from opposition, we're clarifying the relationship between a physician and an athletic trainer under a practice agreement, as well as removing the Committee from under the occupational therapy board, as was alluded to. While we did not have enough time to address all of the concerns regarding definitions and settings, we fully expect that those conversations will continue as the process unfolds.

And with that, I'm happy to support the bill today, and we'll definitely continue to monitor the bill's progress as it moves through the legislative process on the various concerns. And with that, we're looking for a motion and a second. Have a motion and a second. Madam Secretary, please call a vote.

AB 796 Weber. The motion is due pass as amended, to the Committee on Appropriations. [Roll Call]

We'll keep the roll open for absent Members. Thank you very much, everybody. I appreciate you all. And I think we're going to come to authors on the committee if we have any. And we do. Mr. Lowenthal, agenda item number four, AB 814. Excuse me, Eddie. Assemblymember Garcia with agenda item 14, AB 1396.

Thank you, Mr. Chair. Good morning. AB 1396, a bill regarding doctors and dentists from the Mexico program. Got a motion and a bipartisan second respectfully ask for your aye vote.

That's a great call. Any primary witnesses in support of the bill?

Arnold Torres, representing Community Health Centers and the Central Coast Health Network. Thank you again, all of you.

Thank you. Any primary witnesses in opposition to the bill? Seeing none. Any members of the public who want to add on in support of the bill? Seeing none. Any members of the public who want to add on in opposition to the bill? Seeing none. Going to bring it back to colleagues for questions or comments?

Seeing none. Assembly Member Garcia, would you like to close? None. Thank you, Mr. Garcia. I was happy to support this bill when you presented it a few weeks ago. I'm happy to support it again today. And with that, Madam Secretary, please call the vote.

AB 1396 Garcia. The motion is do passed to the Committee on Appropriations. [Roll Call]

We'll leave that roll open for absent Members. Thank you. So we're going to now go members of the committee in file order but with a little deviation in a second but first agenda item number four. Assemblymember Lowenthal, AB 814. Assemblymember Lowenthal, ready when you are.

Thank you, Mr. Chair and Members, I'm pleased to present AB 814, which expands healthcare options for those seeking physical rehabilitation for their animals. Specifically, this measure creates a pathway for licensed physical therapists with advanced training in animal rehabilitation to treat animals only if certain conditions are met. I'd like to start by accepting the Committee amendments and thank the Committee staff for all of their work on this bill.

Look, the entire country is facing a shortage of veterinarians, and access to veterinary care is a growing challenge for consumers. A series of studies published by Mars Veterinary Health in 2022 revealed the following. Pet care appointments increased by 6.5% in 2021. Nearly 2000 Baby Boomer veterinarians are retiring each year. The number of US veterinarians is increasing just 2.7% annually. More than 40,000 new veterinarians are needed to meet projected demand in 2030.

The current pace of veterinarian graduates will leave a 16% shortfall over the next 10 years. It would take more than 30 years of graduates to meet the 10 year need for credentialed veterinarian technicians. Based on current US education capacity, over 75 million pets in the United States may not have access to veterinary care by 2030 without intervention.

The studies also indicated that many veterinarian teams are feeling overworked and overwhelmed, and that because of the underlying veterinarian workforce shortages, growth in demand for specialty services and specialists has significantly outpaced general growth in demand for companion animal veterinarian services. California is no exception when it comes to this veterinarian shortage and availability of care. There are veterinary practices in the state that specialize in Animal Physical Rehabilitation or APR, and some practices may not focus exclusively on APR, but do offer rehabilitation services.

That being said, not every practice in the state offers animal physical rehabilitation, and there is growing demand for these and other specialized services throughout the state and country. The American College of Veterinary Sports Medicine and Rehabilitation, which was developed to meet the unique needs of athletic and working animals, as well as all animals in need of rehabilitation, currently lists only 14 diplomats or providers in California, four of whom are located in Davis, California.

The American Association of Rehabilitation Veterinarians lists just 23 rehabilitation professionals in the entire State of California. Of the 37 practices and providers listed who specialize in animal physical rehabilitation, the majority are concentrated in either Northern California in the Sacramento and Bay Area, or in Southern California in the LA or San Diego regions. I will not suggest that this list of providers is exhausted, but it shows that there is not an overabundance of specialized providers in the state.

California's current total population is estimated at 39 million residents and 13,217,586 households, according to the most recent census data, and it's estimated that approximately 40.1% of those households own pets, which is close to 5.3 million households with pets in our state. As we face this ongoing shortage, we should be looking at options to help alleviate the burden that many veterinary practices are experiencing and providing all services to consumers and animal patients.

AB 814 will not solve the veterinary shortage, but it provides veterinarians with an additional option for animal physical rehabilitative treatment when deemed appropriate. Under AB 814, the supervising veterinarian who has referred an animal to a physical therapist for APR is responsible for making all decisions relating to the diagnosis, treatment, management, and future disposition of the animal patient. Prior to treatment by a PT, an animal must be referred by a licensed veterinarian who has an established veterinary-client-patient-relationship, VCPR.

Referrals to a licensed physical therapist are completely optional and at the discretion of a referring veterinarian under the provisions of this bill. Additionally, a referral would only be authorized after a veterinarian has conducted a thorough medical examination and determined that physical rehabilitation would be a beneficial and safe treatment option. Referrals would be limited to only those physical therapists who are certified in animal rehabilitation and work on a registered animal physical rehabilitation premise that meets state health and safety standards or in a mobile arranged setting.

Finally, when making a referral to a licensed PT, the veterinarian would have the choice of providing either direct or indirect supervision over the treatment that a PT is providing to an animal. This bill is designed to provide more options for treatment to veterinarians throughout the state.

If, for instance, a veterinarian does not specialize or otherwise offer APR within their practice and there are no other practices offering those services in the region, an authorized physical therapist would be an excellent option for referral if deemed appropriate by the veterinarian. I want to make clear the following: this bill does not authorize direct access for physical therapists to provide physical rehabilitation to animals without the referral from a veterinarian.

If a veterinarian already specializes in APR or otherwise provides APR services, they're not required and do not need to refer an animal to physical therapists for treatment under this bill. If an animal has a chronic or underlying condition or is not suitable for APR treatment by a physical therapist, a veterinarian is not required and does not need to refer an animal to a physical therapist for treatment under this bill.

If a veterinarian simply does not want to refer an animal to a physical therapist for treatment, they're not required to do and do not need to refer an animal to a physical therapist for treatment under this bill. Finally, I remain committed to working with the opposition to this bill to see if we can find workable solutions to their concerns. I'm pleased to be joined by Karen Atlas and Tracy Walker, representing the Animal Physical Therapy Coalition, who will be testifying in support of this bill today.

Thank you for the exhaustive presentation. I can't imagine there's anything more to say, but if there is, do you have two minutes each? Ready when you are. Thank you very much.

Thank you Chair Berman and the Committee Members, for your thoughtful consideration and time for AB 814. My name is Karen Atlas and I am the President of the Animal Physical Therapy Coalition. We are a coalition comprised of veterinarians, physical therapists, vet techs, registered vet techs, consumers, educators, and law enforcement and search and rescue handlers. Basically, we are a coalition of all stakeholders.

We have now come together after 15 years of dialogue and debate and have arrived at a common sense solution for the ongoing problem of accessing animal physical therapy. California has an access to care crisis for animal health care. There simply are not enough veterinarians for all the animals in need. In addition, this Committee and its center counterparts have identified animal rehab as an area that needed resolution in the last two sunset reviews of the Veterinary Medical Board. AB 814 is that resolution.

As amended, AB 814 allows a veterinarian, after they have examined, diagnosed, determined that animal rehab is appropriate and safe, would be able to refer their animal patient to a qualified animal physical therapist. The referring vet would also determine the level of supervision, whether that be direct supervision where the vet is on site at all times, or indirect supervision whereby the veterinarian can be on an off site location. AB 814 increases safe access to animal physical therapy.

How do we know that this model is safe? Because other states have demonstrated success authorizing animal PTs to care for animals. Seven other states have an indirect supervision with referral model and well over 70 years of combined experience with this framework. According to these state board authorities, there have been no complaints of harm or negligence against a physical therapist trained on animals. So this model is proven safe and-

If you could wrap up, that'd be great. Thank you.

AB 814 will increase interprofessional collaboration between veterinarians and physical therapists. It will increase safe access to care so more animals can be helped and elevate the quality of that care and how it is delivered. This is long overdue and we ask for your aye vote today. Thank you.

Thank you very much. Go ahead.

Morning. My name is Tracy Walker and I'm here to provide my perspective and personal experience with animal physical therapists. Prior to my injury, I worked in law enforcement with Santa Barbara County Sheriff's Office as a crisis intervention deputy. I was also a member of the department's mounted enforcement unit, off highway vehicle unit, a field training officer, and a search and rescue coordinator. I started my law enforcement career in 2012 with Los Angeles County Sheriff's Office.

In addition to working in law enforcement, I also volunteered my time with the California Rescue Dog Association, it's also known as CARDA, as a human remains detection dog handler, I've been with CARDA since 2009. These skills have been utilized within my department as well as other departments for criminal cases. My eldest dog, Mojo, was working as a human remains detection dog, but her arthritis was affecting her ability to work as much as we both desired.

Despite Mojo's eagerness, I had to limit her working time to ensure her ability to get up the following morning. When I was told about animal PT services in my community, I was not initially sold on the potential benefits, but based on my good friend's recommendation, I gave it a try. The results were they were pretty incredible. Mojo was able to move and do things she hadn't been able to do in quite a while.

Had I not utilized these services, Mojo would not have been able to assist during the Montecito Mudslide in 2018 in searching for victims. Mojo has since retired and she is currently 14 years old, but still able to run around and play. I'm certain without the skilled treatment provided by an animal physical therapist, Mojo would certainly be suffering from a significant amount of pain from her arthritic hips back, as well as her narrowed spinal column.

During the Montecito Mudslides in 2018 and the campfire in 2019, our search and rescue teams received animal PT services to care for the working dogs involved in searching for the victims of these horrendous natural disasters. These services are essential for working dogs in California, whether they be military, search and rescue, apprehension or drug detection dogs. These dogs are highly trained and serve the people of California and they need more access to rehab care so they can be utilized to their highest potential.

And if you could wrap up, that'd be great.

Yes, sir. This measure will not only benefit animals, but also the communities suffering from these natural disasters. They'll be able to stay out for longer periods, return soon after the breaks, after the specialized care of the animal PT. I know I'm not alone when I ask for your aye vote today. Thank you.

Thank you very much. Any primary witnesses in opposition to the bill? You'll have two minutes each. Go ahead.

Good morning, Mr. Chairman and Members. I'm Dr. Keith Rode, a small animal veterinarian in Woodland and President of the California Veterinary Medical Association. The CVMA is opposed to this measure, along with several other veterinary medical associations. At least 20 years ago, chiropractors wanted to perform work on animals. We sat down as a group, the CVMA, the Chiropractic Association, the Veterinary Medical Board, and the Chiropractic Board.

We hammered out an agreement that is contained in our code of regulations that says a chiropractor may perform work on an animal as long as it is under direct supervision by a veterinarian. Direct supervision means that the treatment is taking place at a licensed veterinary premise, and the veterinarian is on the premise in the event that something bad happens, and we can administer aid. That agreement has worked well for more than two decades. This bill would treat human physical therapists completely differently.

It says that a human physical therapist can operate independently from a veterinarian at an offsite location where a veterinarian may not be within miles to render aid. The sponsor has repeatedly said that this bill contains supervision. I want to be crystal clear. You've heard about direct and indirect, but this bill contains zero supervision by a veterinarian.

Zero supervision because once an animal gets referred out of a veterinarian's office, the chances of the veterinarian getting to see the animal again during the course of its therapy are essentially zero. And to make matters worse, there will be no veterinarians on-site in the physical therapist's office to respond to an emergency when one occurs.

The veterinary profession is deeply insulted that a human healthcare practitioner thinks that they have and should have the ability to expand their scope to practicing veterinary medicine with zero veterinary supervision despite them having no training on animals as part of their formal licensing curriculum. Would the same concept even be considered if we, as veterinarians, decided that we wanted to work on human beings?

We support California's current law, which requires physical therapists to work on animals under direct veterinary supervision, which still allows for the desired increased access to care for their services. We feel that this provides the protection that California's consumers and animals deserve, and we hope that you will agree. Thank you for your time.

Thank you very much. Go ahead.

Good morning. Chair Berman and Members, my name is Kathy Bowler, and I've been a member of the Veterinary Medical Board for almost nine years now, and I'm the immediate past president. I'm here today representing the board in our unanimous opposition to AB 814, as it was presented to us last week. I call your attention to our letter of opposition, which details several of our concerns, but I'd like to specifically speak to some of the consumer and animal patient protection issues this morning.

Currently, the individuals promoting this legislation, as you've heard, can administer APR treatment at veterinary premises under the direction of a licensed veterinarian. While these licensed human physical therapists have an extensive education on the human body and have passed a rigorous licensing exam, there's no such core education allowing them to provide this type of veterinary care to our pets.

As a major consumer of all types of veterinary services, including animal physical therapy, I truly appreciate and am so grateful for the exhaustive and extensive foundational curriculum that veterinarians must graduate with and then go on to pass a rigorous, high-stakes exam in order to be licensed in the US and Canada. Again, there are no such accredited educational or testing equivalent for these individuals, and there are vast anatomic, physiologic, and behavioral differences between humans and animals, not to mention between animal species or even breeds.

So for this reason and many others, after many hearings over the years, both in person and written testimony on both sides of the issue, the Veterinary Medical Board still believes that our mission to protect the public is best served with the current regulation allowing this work to be performed under the direct supervision of a veterinarian. Our board President, Dr. Christina Bradbury, and Executive Officer Jessica Seiferman are also here and can answer questions on various concerns with the implementation of this legislation or other specific veterinary issues.

Thank you very much for your time.

Thank you very much. Any additional witnesses who want to add on? Members of the public who want to add on in support of the bill, provide your name, organization you're with, if any, and position on the bill.

Good morning, Mr. Chairman and Members. Carl London, here on behalf of the California Physical Therapy Association, in support of this bill. Thank you.

Thank you very much.

Chris Reed, Chair of the Government Affairs Committee for the California Physical Therapy Association, also in support. Thank you.

My name is Shorty Rossi, and this is my service animal, Ares. For the past 22 years, I have founded and am the President of Shorty's Pit Bull Rescue, which saves thousands, and also president and founder of Hercules Hercules's Clinic, where we provide a free spay and neuter program to people who can't afford it. Without physical therapy for the hundreds of our dogs, this dog right here wouldn't be able to help me climb upstairs. Thank you. I'm in support of this bill.

Thank you very much.

Howard Potter, bulldog owner and rescuer, in favor of the bill.

Thank you very much. Any members of the public who want to add on in opposition to the bill. Seeing none, going to bring it back to colleagues for questions or comments, motions and seconds. Do I have any questions or comments, or motions?

Actually, Mr. Chair, I have a question. I'm sorry. I have a question.

Sorry. Assemblymember Ngyuen.

Thank you. I'm a big pet lover, and I understand that there are concerns because there is a lack of professionals in all fields whatsoever. And I know we're trying to find ways to address that issue. I do have a concern, though, and I think the opposition brought up a good point, that if we're allowing now for physical therapy to happen if you did humans for a pet, my concern is that, is that going to be the reverse?

And we're also going to now allow those that are physical therapy for pets be able to do for humans. I have concerns in the sense of how do we know that they're fully, properly trained. Thank you for also clarifying the fact that this needs to be a referral from a veterinarian to somebody that is trained. That clarified a lot for me because I had some concerns about their different training, different structures and whatnot, and what happens if it does more harm.

And I don't know if you can address some of the concerns that the opposition brought up earlier as well, too.

GV airs with the Animal Physical Therapy Coalition representing them, and they are not here to testify but to answer questions. No, the training that exists is rigorous. It is not only training in education but also in training in experience at it, too. There has been no instances where any harm has been noted by those states that do it. There's been no instances of harm that has been noted here in California. And so we understand, we believe that it is safe.

As far as the issue of whether veterinarians could practice on humans? Well, that's not an issue that we're dealing with, and that's not an issue that is at hand at this point. This is an issue where these people, these physical therapists are highly trained in physical therapy, although additionally, or initially it's in humans, they have additional training with animals. That's a difference maker as far as they're being able to be able to do it without direct supervision. With chiropractors, chiropractors have -

- I'm not going to try to pit one against the other, but chiropractors have no animal, have no animal training in their curriculum at all, and there's none required under the board regulations. So that's a difference maker. That's a difference maker in this discipline and in this practice.

Could I jump in really quickly? Assembly Member, I want you to consider my district. I represent four cities: Long Beach, Carson, Signal Hill, and Avalon, Catalina Island. In Catalina Island, there isn't veterinary care available, and the ability for seniors or others to be able to get off the island, seek care, is very challenging. And so I think, as I mentioned earlier, we have a nuanced situation where we have concentrated care in certain areas of the state and not other places.

This is already happening right now and would not happen in any circumstances without the referral of the veterinarian themselves.

And. I'm sorry, one more question, please. Sorry, I know we're beating this. So just to clarify, the only way would be a referral from a veterinarian in order. Okay. And the veterinarian would have to understand the referral, obviously, that they're making, that this person is qualified, well able to be able to. Okay, perfect. Thank you.

Thank you. I know we have a motion from Assembly Member Mckinnor. Looking for a second from. Got a second from Assembly Member Lee, I believe. Any additional questions or comments from colleagues seeing none. Assembly Member Lowenthal, would you like to close?

Just want to reiterate once again that we certainly will work with the opposition on this, and anybody has any concerns otherwise, we very much would like to do so and respectfully ask for your aye vote.

Thank you. Assembly Member. I want to thank the author, sponsors. Am I on the right one? I am. And opposition for working with us on this bill. I know there is still conceptual opposition to the bill, but the amendments will at least strengthen the veterinarian's role and clarify that the board will decide the needed education or training and with the accepted amendments. I'll support the bill to allow for ongoing conversations with the opposition in the hopes that there is room for agreement with that.

Madam Secretary, please call the vote.

AB 814 Lowenthal. The motion is do pass as amended, to the Committee on Appropriations. [Roll Call]

We'll leave that roll open for absent Members. Thank you very much. And with that, we're going to move on to agenda item number seven, Assemblymember Holden, which is going to be presented by Assemblymember Mckinnor. Sorry, Mr. Gibson, for the disappointment.

Thank you chair and.

And is your mic on?

Hello.

There it is.

Thanks.

There it is.

This is a Bill aimed at addressing the issue of employees being misclassified as independent contractors in the construction industry. Before going on to further the Bill, I would like to state that on behalf of Assemblymember Holden, I accept the amendments outlined in the analysis and thank the consultant for her tireless work on this Bill.

Despite efforts from the Labor Commissioner, the labor movement, and high road contractors to adhere to labor law, the problem of misclassification remains rampant in the industry, with low road contractors putting their profits above employee benefits like workers compensation, insurance and rest breaks. The misuse of independent contractors allows these low road contractors to underbid law abiding contractors and ignores state labor law requirements, creating unsafe workplaces for employees and leaving workers responsible for finding remedies to be paid properly.

AB 1204 seeks to limit the number of independent contractors working under a single subcontract, helps to curb employee misclassification and ensure accurate certified payroll reports while decreasing the likelihood of project abandonment. The Bill does not affect legitimate subcontracting relationships where employers properly classify themselves as such and their workers as employees. By enacting AB 1204, California will join other states in setting clear standards and limits for the use of independent contractors in the construction industry.

Today I have with me Jeremy Smith with the State Building and Construction Trade Council of California and Bob Jerome with the International Union of Painters and Allied Trades, who would share how employee misclassification has affected their lives.

Thank you very much. Two minutes per witness. The Bill has a motion and a second.

Thank you, Assemblymember - Mr. Chair. I understand the motion and a second. I'll be very brief. We are still living in a space where there are low road contractors that misclassify employees. It's still happening out there. It is rampant. AB 1204 will help quell this situation and lead to safer workplaces and workers getting the wages and benefits that they deserve. We urge your aye vote today. Thank you.

Thank you very much.

Mr. Chairman and Members. Bob Jerome, on behalf of the International Union of Painters and Allied Trades, Northern California District Council 16 and Southern California District Council 36. We have finishing crafts in our union. We have floor layers, carpet layers, floor covers, drywall, drywall tapers, drywall mudders. We have about 40 different classifications of employees that are quite often misclassified by subcontractors that are seeking work.

This Bill limits the number of subcontractors to a job in a certain craft, and we've seen this for years, just a different method of an underground economy in California. So we just like to have everything above board and have everybody receive the health and welfare and payments that they deserve for the work that they're performing. Thank you.

Thank you very much. Any primary witnesses in opposition to the Bill? Seeing none. Any members of the public who want to add on in support to the Bill? Me too. Support name, organization, position? Nope. Any Members of the public want to add on in opposition to the Bill? Seeing none. Going to bring it back to colleagues for questions or comments. Vice Chair, floor.

Thank you for bringing this Bill forward and to the building trades just have one quick clarification. If you have a contractor that is a signatory to three different labor groups that wouldn't, whether it's like the laborers, the masons, or whatever, would this Bill affect them?

No, I think that would fall under in the amendments, that would fall under a valid collective bargaining agreement.

Perfect. Thank you.

Thank you, Mr. Vice Chair. Mr. Patterson?

Yes. What kind of projects mean, obviously, you know, there could be big ones and things like that, but an individual, let's say building a house or something, or going through that, I'm just wondering how this would impact kind of smaller individual projects like that.

Well, I think that specialty contractors tend to work not only on smaller projects, but large projects. And unfortunately, the residential housing market is probably the biggest offender in the underground economy. We would hope that it would affect it in a way that would make sure employees are taken care of and they either actually have a bona fide employee-employer relationship with their specialty contractor, or they are lucky enough to be in a union and be under a collective bargaining agreement.

Would you mind illustrating in that example, the residential housing market, exactly what happens now and then if this Bill becomes law, what would change there?

Well, a General contractor.

I read picture stories. Sorry. So, trying to illustrate it for me. Thank you.

A General contractor gets a job, he or she then performs some of the work themselves. But most of the time they hire subcontractors. In the Bill, in the parlance of the Bill, a subcontractor is also a specialty contractor in this sense. The general contractor doesn't have the employees on staff or the expertise, him or herself to do glazing, for example, or painting or tile laying. I'm just using the painters crafts as an example because he's here.

But there's lots of smaller contractors that exist in the world that that's all they do. All they do is carpet. All they do is tile. Those men or women are hired, and then they employ their workers in this space. What the Bill is trying to get at is when that first subcontractor or specialty contractor then decides to hire another one. Another one of them, right. Another contractor that does their craft, and then that person hires a third.

This is what happens in much of the construction industry. And unfortunately, in the residential market, most of those contractors are ones who tend to not want to play by the rules. And I should have mentioned this earlier, underbid because they aren't going to be having to pay workers compensation. They're not planning to pay workers compensation.

They have to pay it, but they're planning not to pay it, or Unemployment Insurance or health and welfare, and they then are able to underbid good contractors who do follow the law. Mr. Grayson is on this Committee. He is one of those. If he were here, he could probably talk to you about this. So we want to not only protect workers in this space, we want to make sure we protect good contractors, good employers who do choose to follow the state's labor laws.

We also. Assemblymember, we believe this is good consumer protection Bill for the, especially the homeowner who ends up a lot of times having work done by an unlicensed contractor, a contractor who doesn't pay the wages. And then what happens is that employee that's not treated right or not receiving the compensation they deserve will come back to the homeowner, and then the homeowner has to result to going to the Contractor State License Board and filing a complaint against the General. So we believe this is strengthening consumer protection as well. I also want to note, Mr. Chairman, that I want to thank your staff for all of the work that she put in, Kaitlin Curry, over the last couple of weeks with our team.

So, in your view, at the job site, this is a way that some contractors are getting around doing the, paying the wages that would otherwise be maybe mandated in the contract or whatnot?

That's correct.

So if there's a painter and the painter gets the contract, this only applies when there are two or more subcontractors under that painter?

That is the goal of the amendments, yes. Hopefully that's clear. But that's our goal.

I know. That's why I say the pictures work really well for me. So I'm just illustrating it out. Okay. Well, I'm going to think about this. I'm the Vice Chair of Housing, and I think making it so we can build homes is important, but it is an important component, obviously, making sure people want to build homes and so I'm kind of interested in this. I think depending on what my vote is today or no matter what it is should more information become available, obviously, I obviously would reserve my rights as that sort of moves forward through the process. But I really appreciate you illustrating this for me. So thank you.

You're welcome.

Thank you, Assembly Member, any additional questions or comments from the Committee? Do we have a motion in a second yet? We do have a motion in a second. Assemblymember Mckinnor, would you like to close?

I respectfully ask for your aye vote.

Thank you very much. Thank you, Assemblymember Mckinnor, for presenting this Bill on behalf of Assemblymember Holden. Thanks to the proponents for working with the Committee and with the amendments, I'm happy to support the Bill today. Madam Secretary, please call the vote.

AB 124. Holden. The motion is do pass as amended, to the Committee on Appropriations. [Roll Call].

Thank you very much. We'll leave that bill open for absent members.

Thank you, Vice Chair, for taking over for a couple of minutes while I can present.

Good luck, sir. All right. I see. Mr. Waldron. Assemblywoman Waldron, we are ready when you are. Assemblywoman Waldron presenting AB 1741. We are ready when you are.

Thank you, Mr. Chair and members of the committee. I'm here today to present AB 1741. I am accepting the committee amendments and want to thank the chair and committee consultant Vince Chien and the committee for working diligently with us on the amendments which respond to every concern outlined by the opposition. The clinical lab industry is facing a workforce shortage especially with clinical laboratory scientists.

The state has recognized this problem with the California Department of Public Health establishing a workgroup that was tasked to understand that specific problem and proposed solutions. This shortage impacts patient diagnostics and delays treatment opportunities. Among the subcommittee's recommendations was to update California licensing requirements to allow unlicensed personnel that meet federal standards to assist licensed personnel in laboratories. This allows laboratories to meet high testing demand while maintaining access to accurate care.

These changes will help address workforce shortages in labs, improve testing capacity, address delays in patient care, and create new jobs in the industry. I commit to continue working with the opposition on their concerns should the bill move forward today. Here to testify in support and answer any questions are representatives from Quest Diagnostics Mike Robeson and Tim Tubman as well as Kristi Foy who is here with the Clinical Laboratory Association in case there are any specific questions.

Thank you so much. We'll take two minutes per witness, please.

Mike Robeson here on behalf of Quest Diagnostics. And I'll try to be very quick. As the assemblywoman noted, this bill is aiming to address workforce shortages in the clinical lab industry. Quest Diagnostics is the largest clinical lab in the state and I think in the know. Quite simply, this bill clears up some vague and conflicting language between the existing statute and regulations that are at the lab field services at the Department of Public Health ensures that unlicensed personnel can do routine tasks under supervision.

And while the licensed staff, the clinical lab scientists, are able to do the jobs, the analytical jobs, that are more appropriate for their status and license. And again, I want to thank Vince Chien, your Committee consultant. He worked very diligently on finding some tightening this bill up. There's three and a half pages of amendments in your analysis and I really appreciate his efforts. So thank you.

Tim Tubman, Quest Diagnostics. I'm here really for technical questions on the bill, but to add to Mike's testimony there, we do have CLIA in place, which is a federal guideline that does ensure all the levels of appropriate controls are in place to maintain quality in a laboratory. And this law would clarify the language that puts that supervision in place.

Thank you. Kristi Foy here on behalf of the California Clinical Laboratory Association in strong support. This bill will address those critical workforce shortages of clinical laboratory personnel. It will set up a key road to licensure for California laboratory personnel and establish important supervision standards to help meet testing demands while maintaining accurate, high quality testing. CCLA is pleased to see this bill move forward and for those reasons, we're happy to support. Thank you so much.

Thank you so much. Anyone else in support of AB 1741? Name an organization, please support seeing none. Anyone in opposition? Sorry, I do it different than the chair. Anyone to opposition to AB 1741? Come on up.

Thank you, Mr. Chair Members. Matt Broad here on behalf of the Teamsters and Engineers and Scientists of California, two unions that represent clinical lab scientists and medical lab techs across the state. I think, first of all, I'd like to thank the committee. We've come a long way in terms of this bill of addressing some of our concerns. With any bill, I think your main question is, what problem are we trying to solve? Are we trying to get more people into the industry?

If so, I think we're kind of at a philosophical loggerheads. We would prefer to sort of skill people up so they can do more work in a lab opposed to deskilling and allowing unlicensed personnel to do more in the lab with this specific bill. At this point, we're really concerned about the kind of broad and nebulous authority for unlicensed personnel to perform preventative maintenance within a lab on machines, which falls kind of squarely within the ambit of a clinical lab scientist's scope.

So we look forward to continuing working with the author's office and sponsors on maybe clarifying that further. With me today is Sandra Pedro Nava, who is a clinical lab scientist at Kaiser Roseville. She's going to talk a little bit more about the preventative maintenance issue. Thank you.

Wow. How about now? So, just so I graduated from Sac State with a bachelor's degree in biology, concentration and chemistry, and minor in chemistry and concentration and clinical lab sciences. So, preventative minutes can range from a wide variety, from cleaning the outside of the analyzer to actually replacing tubing and calibrating the analyzers that affect patient results. And patient results is what doctors use to take care of the patient, how they treat them clinically.

So, in my opinion, I feel like an unlicensed personnel does not have the knowledge of, when dealing with the analyzer, as to what chemical reactions are going on. Having a degree in chemistry, it's like you understand why it's so important that everything in the analyzer is working properly. It's not just about going in there, touching it and just saying, okay, it's fixed. Preventative maintenance is done.

But we have to make sure that the analyzer is working properly because this is what the doctors are using to treat the patients, the results that the analyzer is producing. We also have engineers that come in and do preventative maintenance on the analyzers. They're very skilled personnel, so are as we are. And I don't believe, like having an unlicensed person doing preventive maintenance is going to solve the issue of work, of shortage in the lab.

Thank you so much for that. Anyone else in opposition to AB 1741? Name an organization, please. Seeing none, we'll bring it back to the Committee. Any questions from the Committee Members? Seeing none, someone. Would you like to close?

Thank you, Mr. Chair. Delaying patient care is hurting people and healthcare access. This bill simply implements a recommendation from the Department of Public Health to address the critical workforce shortage in testing labs that is not going away. The goal is to streamline moving unlicensed personnel into licensure. I think that's something we can all agree on. And I thank you and ask you for your support on this bill so we can continue to work on this critical issue. And as I said, I commit to work with the opposition as we move forward. Thank you.

Thank you so much for that. We have a motion. Do we have a second on this bill? Thank you very much, Madam Secretary. Please call the roll.

AB 1741. Waldron. The motion is do pass as amended, to the Committee on Appropriations. [Roll Call]

We'll leave that roll open for absent Members to add on. Thank you so much. Moving on to AB 1518 Friedman, Assemblywoman Friedman.

Hello, Mr. Chair and Members, I got the message. I want to first thank the Committee and the chair for working on this very important piece of legislation. This bill is about helping make sure that people understand the role of service animals. What is and is not a service animal, and what they are entitled to do and be, and particularly to make sure that we understand when animals are not legal service animals and not entitled to be in restaurants or in stores.

And this is for the protection of actual service animals because unfortunately, sometimes animals that are not trained the way that a service animal is trained are being passed off as service animals or called emotional support animals, which does not entitle them the same access. And there have been cases where those animals have attacked actual service animals and really caused problems.

So AB 1518 would require the Department of Consumer Affairs to inform places of business through a statewide educational campaign on the problems faced by qualified service dog users. It would authorize DCA to solicit donations from private sources, including service dog schools, to help create this content and really to help to educate our business community and our community. Now, we've talked to Cal Chamber and other business groups about the bill. They have no issues.

Testifying in support this afternoon is Amanda Wolf, instructor and field representative from Canine Companions, and Judy Wilkinson, former President of the California Council of the Blind. The Bill has no opposition and I would request an aye vote. Thank you.

Thank you so much. We'll do two minutes per witness, please. Thank you.

Good morning. My name is Amanda Wolf and I'm representing Canine Companions in support of AB 1518. I've worked at Canine Companions for nearly 10 years as a member of our professional training staff, training over 100 service dogs and supporting over 1000 service dog users now as a field representative in Sacramento. As an instructor, I've invested thousands of hours in training the highest quality service dogs for our clients with disabilities.

And too often I hear about incidences where service dogs are denied access to public places due to ignorance or bias. Someone claiming a pet was a service dog left a bad taste in the mouth of a business owner. What's worse, service dogs I've trained have been forced out of their careers after being attacked and harassed by poorly trained dogs in places where pets are not permitted. And I am only one trainer, and I know so many service dog professionals hear these devastating stories.

In fact, a recent white paper published by Canine Companions, 93.2% of our 1500 service dog users reported encountering poorly trained dogs in public places. 79% had a dog bite, snap, vocalize, lunge at, or distract their working service dogs. I know education of business owners in the general public is key to reducing the negative impact on people with disabilities who rely on service dogs for independence. AB 1518 is the answer, and it will make a difference providing this much needed education on awareness.

On behalf of canine companions and our co sponsors, I implore you to support AB 1518. And I believe I should have a few extra seconds, which I will be giving to one of our graduates, Barry Schlesinger.

Hello, I'm Barry Schlesinger. I am in support of AB 1518. I am a five time support dog user.

Thank you so much for that. Next witness in support.

Good morning. I'm Judy Wilkinson, immediate past President of the California Council of the Blind and a member of one of our state chapters, the Golden State Guide Dog Handlers. I'm also a retired professor of English. I was an original faculty member of Skyline Community College in the San Mateo district. So I'm all about education and that my guide dog, Echo and I are here to talk about the Department of Consumer Affairs educational campaign to educate businesses about both their responsibilities and, yes, their rights as businesses.

They do have responsibilities to let service animals in. They have rights. They can exclude any handler and service animal who behaves inappropriately. We are all supposed to handle, have our animals under our control at all times when they are in a business, and a business has the right to send us away if we are not obeying the rules. Too many dogs are allowed in now who are not following the rules.

We need to educate businesses about that, and we need to do it in a timely manner. You will have the support of the service animal schools, who, with advocacy organizations, will determine what goes into this campaign. And also, you can apparently hit them up for some money, too. So with that I will thank you so much. And Echo and I urge your support of this bill.

Thank you so much. Anyone else in support of AB 1518? Seeing none. Anyone in opposition? Thank goodness. All right, seeing no opposition, bring it back to the Committee. Any questions from the Committee Members? Seeing none. We have a motion and a second. Assemblywoman, would you like to close?

I'll just take the moment to educate. We did work on this last year, but there is no such thing in the law as an emotional support animal. They're not allowed to be in places where other pets are not allowed. You as a human being, can get a prescription from a doctor to keep a pet in your home as emotional support, but that animal doesn't have any special rights occurred to it the way that a service animal does

This is to reduce that conflict and that lack of understanding by the public and by business owners. I would certainly request an aye vote. Thank you.

Thank you so much. Madam Secretary, please call the roll.

AB 1518 Friedman. The motion is due passed to the Committee on Appropriations. [Roll call]

We'll leave that roll open for absent members. Thank you, Assembly Member. Next up, I believe we have Assembly Member Gipson with AB 1328, agenda item number 13. Got a motion and a second, and a chair aye reco, and a Republican aye reco. Things are looking up, Mr. Gibson.

I appreciate that. Thank you very much, Mr. Chair. Again, I want to introduce and thank you very much for the moving the bill. I have two witnesses. Just let me say this is Assembly Bill 1328, which allows California to enter into an interstate cosmetology compact. My two witnesses will self introduce a representative from the California Board of Barbering and Cosmetology and the National Center for Interstate Compact.

All right. Kristy Underwood. I'm the Executive officer with the State Board of Barbering and Cosmetology. Our board is in support of the bill.

Thank you very much,

Chair Berman, members of this committee, my name is Dan Logsdon. I am the Director of the National Center for Interstate Compacts at the Council of State governments, and I'm here to answer any technical questions you may have.

I don't anticipate any. Appreciate it. Any questions or comments from colleagues? I think everyone's ready to move the bill along. We've got a motion in a second. Definitely. Member Gipson, would you like to close?

Respectfully ask for an aye vote.

Thank you very much chair in a different context, but thank you to Mr. Gipson both for authoring this bill and for your representation of California on the Council of State governments. You do a very good job of representing California on the Council of State governments. Happy to support the bill today. Thank you very much, Madam Secretary. Please call the vote.

AB 1328 Gipson the motion is do pass to the Committee on appropriations. [Roll Call] AB 1328 Gibson the motion is do pass to the Committee on appropriations. [Roll Call]

Leave that roll open for absent members. I have lost track so I don't know which bills we have left. Assemblymember Nguyen agenda item 17 AB 1646.

Good morning, Chair and Members. On November 11, 2022, California overwhelmingly passed Prop One to protect the rights to safe, legal abortion. And furthermore, the Accreditation Council for Graduate Medical Education re-firmed its long standing requirement that OBGYN residency programs make training available. How do the two relate, Mr. Chair, you ask? I can tell you this. What that did was that allowed medical residents to be able to be fully and properly trained.

What we're seeing happening now is states all across the country are banning abortion, making it really difficult for medical residents to be fully and properly trained. AB 1646 will allow this provision ensure that medical residents can participate in not only guest rotation and approved postgraduate training programs but also in ACGME-certified training sites like health clinics, community clinics, public health centers, and other health facilities in California, allowing them to be able to fulfill their hours and become properly and fully trained.

With me today is Kristen Simonson, Director of Programs and Operations from Ryan Residency Training Program, and Dr. Tania Basu, Director of Abortion and Sedation Services at Planned Parenthood Northern California.

Have a motion to second. Two minutes per witness. Ready whenever you are.

Good morning, Chair Berman and Members. My name is Kristen Simonson, and I'm the Director of Programs and Operations for the Ryan Residency Training Program. The Ryan Program is a national initiative to integrate and enhance family planning training for obstetrics and gynecology residents. I'm here today in support of Assembly Bill 1646, which will allow for medical residents to participate in guest rotations in California. Nearly all OBGYNs have patients that need abortion care, making it a critical skill that they must be trained to provide.

These same skills are essential for managing pregnancy loss, pregnancy complications, and many other common obstetric and gynecologic cases. These skills are in jeopardy for thousands of OBGYN residents since the Supreme Court overturned Roe v. Wade. We need to find ways for future physicians to get hands-on training to ensure that people in all states get the skilled care they deserve.

Approximately one third of OBGYN residency programs in the United States are either in a state with very restrictive abortion bans, have no abortion providers, limit abortion care after six weeks, or face an uncertain future for abortion access as they await outcomes of court cases. Approximately one third of future OBGYNs will potentially graduate without the skills they need to provide full spectrum reproductive health care. This has enormous implications for their future patients and the communities they will serve.

The Ryan Program started a project to help our programs in restrictive states partner with other programs so residents can receive the abortion training they need. Since March 2020, we have worked with 17 programs in restrictive states who are now sending their residents to California, New York, Massachusetts, and Illinois to receive abortion training. Over 50 programs are still looking for training partnerships, and that number will likely only increase.

The process of setting up out-of-state training partnerships is complex and time-consuming, and there currently is more demand for training partnerships than available partners nationwide. Assembly Bill 1646 would help to address both these obstacles by facilitating easier training relationships and increase California's ability and capacity to create partnerships and host residents. It's an important step to help fix a complex problem, and I urge your support.

Thank you very much.

Thank you. Good morning, Chair Berman and Members of the Committee. My name is Dr. Tanya Basu, and I'm a board-certified obstetrician, gynecologist, and complex family planning specialist. I'm also the Director of Abortion and Sedation services for Planned Parenthood Northern California and a voluntary clinical Professor of OBGYN at the University of California, San Francisco. I am here today in strong support of Assembly Bill 1646, which will allow medical resident physicians to participate in guest rotations in California.

Training in abortion care is essential to the provision of health care to pregnant people across this country. Soon after Roe fell, I was approached by medical students who matched an OBGYN in severely restricted states. These future doctors were concerned regarding their ability to gain the skills to safely provide abortion, asking if they can return to train with me -

- in California. As a reproductive freedom state, we are in the best position to provide the support to trainees coming from states where they can be prosecuted for performing a procedure that is an essential part of health care. Recently, I was on call on labor and delivery, caring for a patient who was 20 weeks pregnant with severely high blood pressures, causing liver and kidney failure. She had a condition called severe preeclampsia, and if she remained pregnant, she could suffer strokes and even die.

The evening I was on call, her health status quickly deteriorated. After much discussion with the specialists on the team, she decided to undergo procedural abortion of this much desired pregnancy in order to save her life and to be present for her three year old child. That night, the resident and I were able to safely provide the care she needed, and within hours after the procedure, her blood pressure stabilized and her health rapidly approved.

The residents reflect on how, if I wasn't there to both provide the care and to supervise the resident through it, they would have had to perform a much larger surgery, which could have increased her risk of complications, including prolonged hospitalization and loss of her uterus. If we do not train the next generation of providers appropriately, the health of many pregnant people and the well-being of families will be greatly impacted, ultimately further increasing maternal mortality in our country.

In California, we have several training programs, many of which partner with Planned Parenthood affiliates to train resident physicians in procedural abortion. Doctors who are trained during residency are more likely to perform these procedures in their practice, which is used commonly for management of pregnancy complications, like the very one I described.

And if you could wrap up.

Please help maintain this essential procedural skill within the practice of high-quality, evidence-based medicine; please support AB 1646. Thank you.

Thank you very much. Any primary witnesses in opposition to the bill? Any folks of the public who want to add on in support of the bill, please provide your name, organization you're with, if any, and position on the bill.

Oli Ropes and Planned Parenthood Affiliates of California were sponsored in strong support.

Thank you. Any members of the public who want to add on in opposition to the bill? Seeing none and we've got a motion in a second, I believe. Bring it back to colleagues for questions or comments. Any questions or comments?

Matt Lege, on behalf of SCIU California in support.

Good bill.

That's two words that say so much. Senator Member Wynn, would you like to close.

Respectfully ask for your aye vote.

Thank you.

Thank you. Thank you for bringing this bill forward. It's critically important that we do everything in our power to preserve access to essential reproductive healthcare services, and I am proud to support this bill today. Madam Secretary, please call the vote.

AB 1646 Nguyen, the motion is to pass as amended to the Committee on Appropriations. [Roll Call].

Congrats. That's the first bill that's out so far today. We'll keep the roll open for absent Members and we have a motion on the consent calendar. I have a second on the consent calendar, from Gipson and Flora. Madam Secretary, please call the vote on the consent calendar.

On the consent calendar. [Roll call]

Consent calendar's out. We'll leave the roll open for absent Members. It's all good. So why don't we start from the top? Some bills will need motions and seconds because we were only a subcommitee when the bills were presented. But let's start with agenda item number one, please. Got a motion and a second.

AB 481, Wendy Carrillo. The motion is due pass to the Committee on Appropriations. [Roll call]

That bill's out. We'll leave it open for absent Members.

AB 796 Weber. [Roll call]

That bill is out.

AB 814 Lowenthal. The motion is due pass as amended to the Committee on Appropriations. [Roll call]

That bill's out.

AB 996 Low.

We need a motion, a second for- Have a motion and a second on agenda item five. AB 996 Low.

The motion is due passed to the Committee on Appropriations. [Roll call]

That bill's out.

AB 1204 Holden. The motion is due pass as amended to the Committee on Appropriations. [Roll call]

That bill's out. We need a motion and second for 1292. Heath, you want to move your bill? Heath moves the bill. We have a second. Thank you.

AB 1292 Flora. The motion is due pass as amended to the Committee on Appropriations. [Roll call]

AB 1328. Gipson. The motion was due passed to the Committee on Appropriations. [Roll call]

That bill's out.

On AB 1396 Garcia. The motion was due passed to the Committee on Appropriations. [Roll call]

That bill's out.

On AB 1518 Friedman. The motion was due passed to the Committee on Appropriations. [Roll call]

That bill is out.

On AB 1646 Nguyen, the motion was due pass as amended to the Committee on Appropriations. [Roll call]

AB 1741 Waldron. [Roll call]

That bill is out. I assume we're going to run it from the top because folks have been coming in and out, so we're just going to take it from the top.

On the consent calendar. [Roll call]

On AB 481 Wendy Carrillo. [Roll call] On AB 481. [Roll call]

On AB 796 Weber. [Roll call]

On AB 814 Lowenthal. [Roll call]

On consent [Roll call]

AB 481 Wendy Carrillo. [Roll call]

AB 796 Weber. [Roll call]

AB 814 Lowenthal. [Roll call]

AB 996 Low. [Roll call]

AB 124 Holden. [Roll call]

AB 1292 Flora. [Roll call]

AB 1328 Gipson. [Roll call]

AB 1396 Garcia. [Roll call]

AB 1518 Friedman. [Roll call]

AB 1646 Nguyen. [Roll call]

AB 1741 Waldron. [Roll call]

And with that, we're adjourned.