Assembly Standing Committee on Business and Professions

But all the bills on our agenda today have a support recommendation from both sides of the aisle. As always, for each measure being presented today, we will be allowing primary witnesses here in the room today to speak for up to two minutes each, with 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 will begin today's hearing as a Subcommittee. Yeah, Subcommittee, because we don't have enough Members. So, staff, if you're watching, grab your Member, bring them to room 1100. And Senator Laird, it is an honor and a privilege.

We are ready when you are for agenda item number two, SB 540.

Thank you, Mr. Chair. And I just assume you say it's an honor and a privilege to every Senator.

Only to the best. Only to the best.

Thank you. My spouse at this point would say, what do you want?

Yeah, that's fair. That's smart. Yeah.

Okay. I'm presenting Senate Bill 540. I'd like to thank the consultant for the thoughtful analysis and working with my office. And I will be accepting the committee amendments that are on page eight of the analysis. This Bill will ensure warning labels on cannabis products keep up with evolving science, and new consumers are offered a brochure that includes steps for safe for cannabis use. The brochure will also be on display at the point of sale and available for other consumers upon request.

While there's no opposition listed in the analysis, I do want to thank the Youth Forward and Public Health Institute for working with my staff on this Bill. I had to move a little on the Bill, and so did they. And the product before the committee, I think, is balanced.

Ultimately, this Bill makes progress to ensure the Department of Cannabis Control is basing future warnings on evolving science and consumers have access to safe cannabis use information to the point of sale. The bills receive bipartisan support, has had no no votes, passed the Senate floor 40 to zero. And joining me to testify in support is Amy Jenkins on behalf of the California Cannabis Industry Association, who can help me answer technical questions, and at the appropriate time, I respectfully ask for an aye vote.

Thank you, Senator.

Good morning, Mr. Chairman and Members. Thank you for the opportunity. Amy Jenkins, on behalf of the California Cannabis Industry Association, one of the proud co sponsors of SB 540, a crucial Bill to address the evolving science surrounding cannabis product labeling and promoting responsible use.

As one of the leading trade associations, we have consistently supported policies that prioritize safe and responsible cannabis and have worked collaboratively with legislators and regulators to continue to develop our packaging and labeling protocols. Yet despite those efforts, concerns persist on the adequacy of current labeling requirements on informing consumers and preventing youth access. So SB 540 represents the legal cannabis industry's response to these concerns regarding consumer education.

It complements the ongoing policy discussions within the Department of Cannabis Control and the Department of Public Health, guaranteeing access to up to date safety information and educational materials for consumers across licensed jurisdictions. For all these reasons, we are proud to be co sponsoring this Bill today and request your support. Thank you.

Thank you very much.

Good morning, Mr. Chair and Members. Pamela Lopez on behalf of California Normal. California NORML is the state's largest consumer rights and cannabis safety advocate. Many of you are familiar with our work in politics to legalize cannabis for adult consumers. But long before cannabis was legal, California Normal was also the largest organization in California collecting information and data about cannabis to help cannabis consumers use cannabis as they choose and as they need for medicinal purposes or for responsible adult fun use to have a good time. We want to empower consumers to use cannabis as they see fit, and we believe that information is the key to doing that.

Whether you are a veteran who is a PTSD experiencer and is looking to take the edge off really extreme anxiety, or you are an adult who absolutely has the right to use cannabis for recreational purposes, we believe that. Updated labels and a system for updating labels on a regular basis and making sure that consumers have access to information is a fantastic way to ensure that the state of California is doing our level best to keep good. On the promise of Prop 64, which is that California consumers have access to safe, legal cannabis and have access to world class information about how they can use cannabis to best meet their needs. We're happy to support this Bill.

Thank you. Ms.. Lopez. Any primary witnesses in opposition? Seeing none. Anybody who wants to add on as a kind of a me too supporter of the Bill, please provide your name, organization you're with, if any, and position on the Bill.

Mr. Chair, Members Rand Martin on behalf of the Parent Company in support of this very helpful Bill. Thank you.

Thank you.

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

Thank you.

Honorable Chair and Members. Genine Coleman, representing Origins Council in very strong support.

Thank you.

Mr. Chair and Members, Eddie Franco, Director of Policy for Nabis, licensed distributor in California, as well as the Vice President of California Cannabis Industry Association. In very strong support. Thank you.

Thank you.

Jerred Kiloh, President of the United Cannabis Business Association, the largest retail trade organization representing retailers in California in strong support.

Thank you. Anybody want to add on in opposition to the Bill, seeing none. Bring it back to colleagues for questions or comments on the Bill. It is that good of a Bill. Well, when the time comes, when we have a quorum, I'll be happy to recommend support. Thank you to the author for working with stakeholders to take meaningful yet implementable action to inform consumers about the health risks associated with cannabis use and for accepting the committee amendments. Thanks. And I have confidence in the bill's success when the time comes.

Thank you very much. I won't say anything to I apologize. I appreciate everybody that testified. And at the appropriate time, I respectfully asked for an aye vote.

Thank you, Senator. Oh, Senator Ochoa Bogh. You you're hiding in the back. Come on up. Agenda item number three, SB 612. Ready when you are.

Good morning.

It's a great day outside. I'd like to start by thanking the Committee Staff for their work on SB 612 and accept the committee amendments to fix a technical error in paragraph two of subdivision F of the Bill. Last year, I introduced SB 1453 to address the question of what type of authorization is needed for a Speech Language Pathologist, or SLP, to perform a flexible endoscopic evaluation of swallowing, commonly referred to as Fees, a one time authorization based on an SLP's competency, or an authorization required each time an SLP needs to perform the procedure.

The Bill clarified the issue, but didn't specify whether the new training provisions would be retroactive without guidance. The Speech Language Pathology and Audiology Board decided to apply SB 1453 new training requirements to all SLPs, even those who have been performing this procedure for many years. What this means is that SLPs who were performing Fees prior to 2023 are no longer able to perform the procedure without meeting additional training requirements, despite clear competency and experience.

SB 612 would clarify that the provisions of SB 1453 apply only to SLPs who received written verification of Fees competency on or after January 1, 2023. Joining me to testify in support is Marisa McGreg, chair of the Fees Task Force, and Dr. Susan Langmore, developer of the Fees procedure. Thank you.

Great. Thanks so much. Each of you have two minutes. Ready when you are. May you hit the little button. Perfect.

Thank you. We're on the clock? . Okay. Thank you, Senator Ochoa Bogh, for authoring the Bill. Thank you for allowing me to speak today. My name is Susan Langmore. I'm a PhD speech pathologist, licensed in California. I'm also currently Professor Emeritus at Boston University, where I was recently, but I worked at UCSF for many years in neurology and otolaryngology, and I live in California now.

Fiber optic endoscopes were first used by physicians in the 70s and 80s I simply took that technology and adapted it to evaluate swallowing and called it FEES. Fiber optic endoscopic evaluation of swallowing. Over the years, FEES has grown significantly, until today. It's one of our gold standard procedures done in every state. Why this growth? Well, it's not expensive and it's very useful. And it reveals a swallowing problem with a very simple tool, which I have brought.

So all this fuss is about this little thing. What you do is pass it through the nose of your patient to the back of the nose and then toggle the switch and look down at the throat. And you have with this tool a beautiful view of the airway and the food passage.

And sorry to interrupt, but the Vice Chair has just volunteered for in person demonstration.

I think that's a great idea. Then you'll all be sold. In any case. It's a very useful tool. You can take it to bedside rather than having the patient trek down to radiology, et cetera. It's very safe. Frequency of complications is less than 2%, usually about 1%, mostly just nosebleed.

If that's the case, our current Bill, SB 1453, passed in January of the past, just in January of this year, added a training requirement to the previous Bill, which has forced currently experienced, competent, certified speech language pathologists to have to undergo time consuming reverification if they want to continue to perform fees. So, as a result, fees as a service has been shut down in many clinics. SB 612 is intended to fix this.

Thank you very much. Please go ahead.

Am I on, perfect. Thank you. Thank you. Senator Ochoa Bogh, the Chair and the Committee Members. I'm Marissa McCray. I'm a speech pathologist, and I've used FEES as part of my scope of practice for over the past 15 years.

And I provide training and supervision to my fellow SLPs in the valuable use of this tool, which Dr. Langmore created for us. I'm currently serving as the chair of the cache of the California Speech Language Hearing Association's Fees Task Force. So, as you've heard, Dr. Susan Langmore developed fees back in 1988 with the goal of improving diagnostic and treatment capabilities, patient safety, and access to care.

And she has met that goal last year. Cash is sponsored, SB 1453, with Senator Ochoa Bogh, with the goal of improving access to care by expanding the health care settings where fees could be performed. And this was a crucial measure that met the medical needs of Californians, and this committee was very integral to the success of that Bill.

So very much. Thank you. And as Senator Ochoa Bogh outlined, the change to the supervision requirement to receive verification of competency, based on the amendments proposed by the SLP board changed a few things for us. And it's important to note that the change to that verification process were not in response to any incidents regarding patient safety, as to our knowledge, there have been none. The legal board's counsel interpreted SB 1453 when they applied it retroactively. And what that did is result in the nullification of competencies for many SLPs and the cessation of comprehensive swallowing assessments for many Californians.

For example, here in Greater Sacramento, at Mercy San Juan Hospital, SLPs who had attended Dr. Langmore's course and met the previous statutory requirements were successfully using FEES. However, based on that interpretation, the program was basically halted at the onset of that. That's happening also at other facilities across the state.

So attempting to meet that new statutory requirement has actually created some unnecessary and costly delays to patient care, and it ultimately had no impact on improving patient safety or quality of care. So, as stated, SB 612 is a simple, yet critical cleanup measure that allows competent and proficient SLPs who hold written verification of competency prior to January 1, 2023, to resume the full standard of care that they've been providing to Californians. So we respectfully ask for an aye vote. Thank you so much for your time.

Thank you very much. Any primary witnesses in opposition. Or tweeners if we have a tweener. No Tweeners. Maybe a tweener. Thinking about it, making the decision on the way up to the mic, flip a coin.

I don't want to use that terms. So George Soares of the California Medical Association, respectfully in a support if amended position. We're just looking for some clarity on the training standards for SLPs and physicians who supervise on these. And I look forward to continuing to work with the author in her office and the committee. Thank you, everyone. Thank you very much.

We're going to take a quick break to establish a quorum. Madam Secretary, please call the role.

Berman Aye. Here. Flora. Alanis, Alvarez. Present. Bains Bonnta Chen Dixon Gibson Grayson Irwin Jackson Lee Lowenthal McCarty McKinnor Nguyen, Patterson Ting. Great.

We have a quorum. We will now be accepting motions and seconds as well. We got a motion. Got a motion. Got a second. Thank you very much. Any people want to add on in support of the Bill, please provide your name, organization you're with, if any, and position on the Bill.

Great. Thank you, MJ. Diaz. On behalf of Kaiser Permanente in support, thank you.

Cherise Burns, Assistant Executive Officer for the Speech Language Pathology Audiology and Hearing Aid Dispensing Board. And we appreciate the amendments taken and the technical one as well, so that it's all good. And I also appreciate the clarification that it was our legal counsel's interpretation, and so we went ahead and implemented. This is how we got here. Thank you for helping clean it up. And I think we also are somewhat supportive of the training requirements as well for SLPs that will supervise. So whatever we work out in the medium term, we'll continue to work with all stakeholders.

Thank you very much. Thank you. Thanks.

Thank you, Senator. Thank you, committee. Thank you, Chair Berman. I voted for you in the last election. I'm in your district. So my name is Anne Carney. I'm a speech pathologist.

That's enough out of you. That's all you need. Shouldn't you be in the back doing the human test? Yeah.

So I've been a speech pathologist for over 30 years. The last 20 years I've been in the Department of Otolaryngology at Stanford. I'm strongly in favor of this Bill. Please pass it. Thank you.

Thank you very much. Disregard the vice chair's comments. Anybody want to add on in opposition to the Bill? Seeing none.

We've got a motion in a second. Any questions or comments from colleagues? Yes, Dr. Bains?

I just wanted to thank you so much, so much for this Bill. Super important work. I mean, as a physician, making sure we have enough speech pathologists, specifically in rural areas we lack so badly, especially with kids with developmental disabilities and intellectual disabilities and kids in General.

We're having a lot of kids. We're not catching autism screens in clinics right now. We're not getting the resources out to kids. So whatever we can do. I would love to be a co author on this Bill. Thank you.

Thank you, Dr. Bains. Any additional questions or comments? Seeing none. Senator, would you like to close?

Thank you, Mr. Chair and committee Members, for your comments. SB 612 will ensure that SLPs who are performing fees before the beginning of this year are still able to perform them. I respectfully ask for an aye vote.

Thank you, Senator. I'm happy to support this Bill today to ensure that trained speech language pathologists can continue performing fees procedures, especially on Vice Chair Flora. And I know my staff would be happy to help facilitate and support ongoing conversations to address outstanding concerns stemming from last year's Bill. Thanks so much, Madam Secretary. Please call the vote.

SB 612 Ochoa Bogh. The motion is do pass as amended. Berman aye. Berman. aye Flora. Flora. aye Alanis. Alvarez. Alvarez. aye Bains. Bains aye Bonta. Chen Chen. aye Dixon. Dixon. aye Gibson. Grayson. Grayson. aye Irwin. Irwin. aye Jackson. Jackson. aye, Lee Lee. aye Lowenthal. Aye. Lowenthal. aye McCarthy. McKinner. McKinnor. aye Nguyen. Patterson. Patterson. aye Ting. SB 612 Ochoa Bogh. The motion is do pass as amended. Alanis? Alanis, aye Nguyen aye

Congratulations, Senator. That Bill is out. I saw Senator Allen back for round two.

Agenda item number four that has a support support recommendation with a bipartisan motion and second. Ready when you are, sir.

I just know how interested this committee is in cannabis issues and had such a good time talking to you guys last week that I want to come back for more. Appreciate the good work of the committee on this. So our existing law requires the state to establish a unique identification program for cannabis to track product from seed to seed, from seed to sale.

Sorry. It's a track and trace system, and it's intended to prevent diversion to an unlicensed market and minimize public health and safety risks in the event of a product recall. Now, law also specifies that a unique identifier must be visible and affixed by cultivators to the base of each plant, usually in the form of a single use plastic tag.

This requirement creates a lot of labor and operational costs for the legitimate cultivators, and then, of course, also millions of pounds of needless plastic waste, something like 43 million plastic tags at a cost of $15 million just last year alone. And that's only going to grow. Now, the thing is that it's a totally unnecessary aspect of our system.

All individual plant tags are immediately discarded upon harvest, and then the product is batched with these single package tags for the track and trace program, and products only ever traced back to the batch, and the individual plant is never identified. The same batching system is used by the California Farm Bureau, the US. Department of Agriculture, to track produce in the case of product recalls, for other types of things.

So this Bill will provide some more flexibility Department of Cannabis Control to regulate how the plants are identified, to ensure effective enforcement by inspectors and compliance with the law by cultivators while minimizing wasteful and expensive single use tags. So I have with me here today Tiffany Devitt, who's the Director of Regulatory Affairs at CannaCraft, and then Jordan Wells with the National Stewardship Action Council.

Thanks so much, ready when you are. You have two minutes each.

Great, thank you. Good morning, Mr. Chairman and Assembly Members. I'm Tiffany Devitt and I represent Canacraft, which is a vertically integrated cannabis company with a licensed farm in Lake County. This is an individual plastic tag. As the Senator mentioned, our industry is required to zip tag one of these to every single cannabis plant in the state. And they can only be used once on one plant, and then they're thrown away during the summer plantings.

That means that we bring in huge temporary crews to do the back-breaking work of zip-tying one of these to every plant in temperatures that are often over 100 degrees during the fall harvest. We bring those temporary crews back to remove these tags, put them in garbage bags, and haul them off to a landfill. As important as that human toll is, is the environmental Bill.

The Senator mentioned that over the past five years, the state has used almost a quarter billion of these tags, which has generated well over a million pounds of plastic waste. The biggest tragedy here is these tags do nothing to prevent diversion. And what I mean by that is, the only time you don't have to worry about a plant being diverted is when it is in the ground, because it cannot walk away on its own.

And yet, that is the only time these tags are on the plant, because as soon as you harvest it, you put it into a big batch, assign a harvest tag, and these are in the garbage. I respectfully ask that you support this common sense Bill, which will save the state tens of millions of dollars a year, significantly reduce the cannabis industry's environmental footprint, while improving the operational efficiency of our farms and the working conditions of our employees. And it will do that without diminishing the integrity of your track and trace system. Thank you.

Thank you.

Thank you, Senator Allen. Chair and Members. I am Jordan Wells, Director of Advocacy and Communications at the National Stewardship Action Council, a nonprofit that advocates for a circular and equitable economy. We strongly support SB 622, which will reduce unnecessary single use plastic currently being produced by California's cannabis cultivation system that does nothing to prevent diversion. The single-use plastic plant tags that currently are required on cannabis plants contaminate the composting system, and composters must ask cannabis cultivators to remove them. This is akin to how composters and their local government partners must ask consumers to remove the plastic stickers from fruit before they are put into the composting stream.

Eliminating the mandate to use the redundant and unnecessary single use plastic plant tags will not only reduce plastic waste and operational costs, but it will also help keep the composting stream clean and free of plastic pollution. California is a leader in reducing single use plastics, as exemplified by the legislature's enactment of policy such as SB 54. SB 622 is a plastic waste reduction policy that does not compromise the integrity of the state's Track and Trace Program. I want to thank Senator Allen for his leadership, and I respectfully ask for your aye vote. Thank you

Thank you very much. Any primary witnesses in opposition? Seeing none. Anybody want to add on in support of the Bill?

Good morning, Mr. Chairman. Alberto Torrico, on behalf of the Joint Labor Management Cannabis Committee for San Diego and Imperial Counties. In support.

Thank you, Mr. Chairman. Members Rand Martin, on behalf of the parent company, in strong support. Thank you.

Amy Jenkins, on behalf of the. California Cannabis Industry Association and Spark in strong support.

Thank you.

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

Thank you.

Pamela Lopez, on behalf of California NORML, in support.

Thank you.

Kristin Heidelbach, on behalf of UFCW Western States Council. In support.

Thank you.

Good morning. Janine Coleman, representing Origins Council. And we have 800 licensed small cannabis farmers that we represent in very strong support.

Eddie Franco, Director of Policy at Nabis in support. Thank you. Thank you very much.

Any witnesses who want to add on in opposition to the Bill? Seeing none. Bring it back to colleagues for any questions or comments. Vice Chair Flora.

Thank you, Mr. Chair. I'm just curious, have you thought about using these unique Identifiers on food that's prepared at a consumption site?

How long have you been preparing that question?

All the whole testament. So excited.

The bad news, Senator, is we're going to be waiting for Senator Dodd for 15 minutes. We got a couple of questions. Alanis has a question.

Thank you, Senator. I think it's a great Bill. If there's room for a co author, I'd like to be part of this. It just makes sense. I wonder at what point somebody thought that was a good idea to add it to the plant that doesn't even get yanked out or it gets harvested as it's in the ground. So those are very good points. And, yeah, I was going to ask the same thing that somebody, Member Flora was going to ask, but it's okay.

Assembly Member Alvarez.

All right. I have a real question. It's more my lack of knowledge of the inspection process, because that's obviously why this was initially, I think, thought it was a good idea. I think your Bill makes a ton of sense. I guess the question I would ask is, is there any risk or what was the potential risk that maybe you thought about as you were preparing this legislation? And this could be to anybody at the table of what this could removing this tag could cause in terms of making sure that this is regulated and that the Department actually focus on inspecting, which I personally believe there's more work to be done to make sure that the black market really is eliminated for those who are doing this the right way. As the folks who you are representing, So can you tell me about how this will not jeopardize those efforts?

Yeah, that's an excellent question and thank you for asking it. So I'm going to get real with you all and tell you a little bit about how product is diverted. I'm not personally doing this, but it's ubiquitous in the industry. One of the ways product is diverted is a cultivator will go in and they will top the plants early in the harvest season. And they'll top the plants, take those materials, usually sell them so that they have enough money to do the actual full harvest. Now, the reason why the tags aren't helpful in that scenario is because the tags are still on the plant.

Now, metric, as a system of track and trace, it requires that the cultivator log it if they have manicured the plant, meaning we have to document each transition, the planting, the flowering, the manicuring, harvesting, et cetera. So the tags don't help with that. What would help with that is those onsite inspections where the agents just come in, they walk the field and they see, hey, those look like they've been topped.

Does metrics say that you've manicured them? The second and more common way that plants are diverted out of the legal system into the illicit market is through burner distribution licenses. And I'm sure you guys have heard about those. Those are basically licenses that people have and they kind of burn through them, hence the expression, and only use them to kind of provide cover.

Now, in that case, a cultivator may sell their materials to a burner distribution license, knowingly or not knowingly, because we don't have visibility into where those materials are going. So the plant tags don't help in that scenario either, because as we discussed previously, the materials are already in a batch. They're not associated with individual plants.

With regard to the kind of evolution of metric, there are certainly ways to improve that system. I do know that once we had to waste out a bunch of plants because we had a pathogen on the farm, the DCC came and said, we just want to see the plants you wasted and make sure you're not dropping them out the system. So there are those checks and balances in place.

They could be improved. You could build algorithms and symmetrics so that it threw up a flag. If someone's yield was way lower than our actual, if they reported a very low yield, you could build an algorithm.

So if the distributor is taking in a lot of biomass, and it's not getting to retail that triggers it. But those are improvements in metric that have absolutely nothing to do with the tag. So outside thank you. Very well explained. Outside of removing the tag, though, the legislation also authorizes Department to potentially put forward new regulations.

Would it be regulations like the ones you're describing? Or what has a Department shared what they would be looking at doing alternatively?

Okay, so I can't speak for the Department. Obviously, I would assume that they're looking into some of those algorithmic improvements. With regard to metric, I will say that metric has a digital tag already. So this is the physical tag. There's a digital corollary that I don't believe the state is planning on getting rid of. So from a practical standpoint, if an enforcement agent or inspector comes to my farm and I say, okay, I have ten rows, they each have 200 plants.

All they have to do is walk one row, count 200 plants, look in Metric, and see that I've assigned 1000 tags to that farm. So between now and some future date is the DCC Evolves, the Metric system. All of the safeguards that the physical tags provide, the digital tags also provide it. You won't be losing that under this proposal.

One last question. After the cultivation, when the batches are gathered, does the batch get identified with all the plants that were used? Obviously not in a physical way, because these get tossed, but in some digital way. So the digital tags kind of roll. It's a transition. So, for example, within the cultivation kind of lifecycle, initially, the plants are assigned a package tag for, like, 20 clones, and then you bring them onto the farm and you switch that to a plant tag, and then you take them off the farm and you switch that to a batch tag.

So it gets increasingly difficult to track back to the specific clone that you bought. The data is there. Not particularly useful.

But it is a sign on this metric system. From source.

Got it. Thank you very much. Appreciate the answer to those questions. Great. Any additional questions or comments from colleagues? Seeing none sender. Would you like to close? Yeah,

I appreciate the good questions. I'm learning a bit, too, through this. And thank you for recognizing what we're trying to do here. There's just a lot of unnecessary labor and waste associated with the current with the status quo, and and this will create more flexibility in a way that doesn't harm our broader policy goals. And so appreciate your your support for this important measure.

Thank you, Senator. And I applaud your continued efforts to reduce plastics waste in California, and I'm happy to support the Bill today. Madam Secretary, perfect timing as well. Madam Secretary, please call the vote.

SB 622 Allen. The motion is do pass to the Committee on Appropriations. Berman aye. Berman. Aye flora. Flora. Aye Alanise. Aye, Alanise. Aye Alvarez aye. Alvarez. Aye Baines. Baines Aye Bonta. Chen Chen. Aye Dixon Gibson. Grayson Grayson. Aye Irwin. Jackson. Jackson. Aye Lee. Lee. Aye Lowenthal. Lowenthal. Aye McCarthy. McKinnon. McKinnon. Aye Nguyen. Nguyen. Aye Patterson. Patterson. Aye Ting.

Congratulations. That Bill is out. Thank you very much, Senator Dodd. Agenda item number five, SB 667. Have a motion. Have a bipartisan motion and second.

Senator Dodd, ready when you are.

Sounds like a signal.

Not at all, sir.

Mr. Chair and Members, SB 667 builds upon the recent efforts by the Legislature to expand access to women's health care across the state by removing redundant requirements, ensuring certified nurse midwives can practice to the full extent of their scope and training. Respectfully ask for your aye vote.

Thank you, Senator. And if you have primary witnesses in support.

Yes, I do. Holly Smith, policy Chair for the Certified Nurse Midwives Association, and Dr. Annette Feinberg.

GreatYou have two minutes each.

Chair Berman and Committee, thank you for having me today. My name is Holly Smith, and I have been a nurse midwife for 23 years. And I'm the Health Policy Chair of the California Nurse Midwives Association. SB 1237, authored by Senator Dodd in 2020, was a landmark Bill. In fact, it was the first major Bill to pass for CNM since 1974. The intent was to create independent practice for nurse midwives in California so that CNMs could fill geographic access gaps, improve outcomes for birthing people who need it most, and to help close the racial disparity gap from eternal mortality and morbidity in California.

And thanks to this committee and the Legislature as a whole, I have never been prouder to say the decision to enact SB 1237 is working. I field regular calls from nurse midwives from out of state, for example, who want to move here and support the California workforce now that California supports them. New graduates who are willing to move to a low resource setting and establish their own private practice.

CNMs, who own community birth practices, who are thrilled that they can actually scale up their practice rather than shutting down because they could no longer afford or simply couldn't find a physician supervisor. But now, in our third year since enactment of the law, we have had ample time to hear from our Members about remaining barriers. I have personally heard from Members in the North Bay, Sacramento Area, Central Coast, LA, Antelope Valley, San Diego, and the Inland Empire who are trying to utilize the new law, but are running into unique challenges.

For example, CNMs can only send someone out on disability during limited times at the end of pregnancy. But there are clear examples of very normal events during the course of pregnancy that require some temporary time off work, like nausea and vomiting. For example, when a CNM cannot certify disability for something within their scope, this puts the burden on the patient to find a doctor.

Explain the issue again to someone new, pay an additional copay, or find childcare in the process. This doesn't make sense, and SB 667 corrects this. Another example to collaborate on the care of a moderate risk patient, meaning a patient outside of the defined low risk scope, CNMs and physicians have to sign two agreements.

This is confusing to CNMs and doctors alike. The Bill keeps all the same safeguards from SB 1237, but does so through one signed, mutually agreed upon policy and protocol, and allows CNMs and physicians to consult and collaborate even when they aren't in the same practice. Finally, to see patients and make appropriate treatment and care management decisions, CNMs need the ability to interpret a small number of laboratory tests that are within our scope. In fact, SB 1237 did in fact address this to some degree. And

If you could sorry, if you just wrap up, that'd be fantastic. That's the best wrap up ever. Thanks. Not yet.

Okay. I've been a practicing OBGYN for 25 years in collaboration with Certified Nurse midwives. In the last year, I returned to UC Berkeley to earn a master's in Public Health in maternal child health. I strongly support the provisions of SB 667, which expand nurse midwives ability to provide care for common gynecologic conditions within their scope and training.

All of the midwives I've worked with in both private practice and as part of a Federally Qualified Health Center, do this. It's part of their education and training, and they consult, as do I, when needed. I do not need to be in the same practice as those I consult with to provide excellent care.

There's a significant shortage of providers with these skills, and I'm certain that the shortage is only going to worsen with time. It's also an unnecessary inconvenience and burden to both patients and Obstetricians to require duplicate services when a patient needs disability authorized for routine situations. In my experience, the midwives are not more or less likely to provide disability authorizations than Obstetricians.

In my experience, low risk women receive excellent care when care is provided by midwives, and newer studies show that these outcomes are sustained even when midwives care for moderate risk women. Involving Obstetricians when necessary for high risk consultations or transfer of care is precisely the model that provides excellent care patient outcomes. Care for midwives is particularly important in the labor process, and studies show that supportive care of midwives in labor reduces the complications and rate of Caesareans.

Let me try to summarize this here. Midwifery care can improve access and support maternal morbidity and mortality for women in General, and I can assure you that everybody who's actually studying this and looking at this is in agreement, and we're on the right side of history here. I urge you to support SB 667.

This Bill simply cleans up the policy implications left over from SB 1237 in 2020, ensuring that women who seek nurse midwifery care get the full benefit of. Their care without unnecessary roadblocks. Your vote will help to expand access in pregnancy and gynecologic care for California women. Thank you.

Thank you very much. Any primary witnesses in opposition to the Bill? Seeing none. Anyone want to add on in support of the Bill? Please provide your name, organization you're with, if any, and position on the Bill.

Thank you. Mr. Chair and Members, I've been asked to express support on behalf of Black Women for Wellness Action Project, another co sponsor of the legislation, as well as narrow pro choice California in support. Thank you.

Thank you very much.

Good morning. Roxanne Gould, representing the American Nurses Association of California in support. Thank you.

Good you. Any folks you want to add on in opposition to the Bill? Seeing none. And we've got a motion in second.

Assembly Member. Grayson. Thank you, Mr. Chair.

Thank you, Mr. Chair. Senator Dodd, thank you for your work on this prior and would like to be added as a co author.

Thank you. Mr. Grayson, any additional comments or questions from colleagues? Seeing none.

Senator, would you like to close?

Respectfully, ask for aan aye vote?

Thank you very much. Senator, thank you for your continued work on this really important issue. And thanks for working with us on the Bill. I completely agree there were areas that could be clarified. I take the completely out because it's not really properly placed. I agree that there were areas that could be clarified, and I'm happy to support the Bill today. Madam Secretary, please call the vote.

SB 667. The motion is due passed to the Committee on Appropriations. Berman aye. Berman. Aye, Flora. Flora. Aye, Alanise. Aye, Alanis. Aye, Alvarez. Alvarez. Aye, Bains. Bains. Aye, Bonta Chen. Chen. Aye, Dixon Dixon. Aye, Gibson. Gibson. Aye, Grayson Grayson. Aye, Irwin Jackson. Jackson. Aye, Lee Lee. Aye, Lowenthal Lowenthal. Aye, McCarthy McKinnor. McKinnor. Aye, Nguyen Nguyen. Aye, Patterson Patterson. Aye, Ting.

That Bill is out. Thank you. Senator, I've got a motion on agenda item number two, SB 540, which was heard when we were a Subcommittee. Got a second? Madam Secretary, please call the vote on agenda item number two, SB 540 by Senator Laird.

SB 540. Laird the motion is do pass as amended to the Committee on Appropriations. Berman aye. Berman. aye Flora. Flora. aye Alanis. Aye. Alanis aye Alvarez. Aye. Alvarez. aye Bains Bains. aye Bonta Chen. Chen. aye Dixon Dixon. aye Gibson. Gibson. aye Grayson Grayson. aye Irwin Jackson. Jackson. aye Lee Lee. aye Lowenthal. Lowenthal. aye McCarty McKinnon McKinner. aye Nguyen, Nguyen. aye Patterson Patterson. aye Ting.

That bill is out. Can I get a motion on consent? Got a motion in a couple of seconds. Madam Secretary, please call the vote on consent calendar.

On the consent calendar. Berman aye. Berman. Aye Flora. Flora. Aye Alanise. Aye. Elinese? Aye alvarez. Aye. Alvarez. Aye Baines Baines. Aye Bonta Chen. Chen. Aye Dixon Dixon. Aye Gibson. Gibson. Aye Grayson Grayson. Aye Irwin Irwin. Aye Jackson. Jackson. Aye Lee Lee. Aye Lowenthal. Lowenthal. Aye McCarthy McKinnor. McKinnor. Aye Nguyen Nguyen Aye Patterson Patterson. Aye Ting.

Consent Calendar is out. Madam Secretary, please just run through the bills for colleagues who are absent.

SB 540 Laird Irwin Irwin. Aye SB 612, Ochoa Bogh. Gipson. Gibson. Aye SB 622 Allen Gipson. Gipson. Aye Dixon. Dixon, Aye Irwin Irwin. Aye SB 67, Dodd Irwin. Irwin Aye.

Thank you, everybody. See you in two weeks. We're going to keep the hearing open for a couple of colleagues who are stuck in other committees.

A casual looking Mr. McCarthy is here. Madam Secretary, please run through the votes for Member McCarty.

On consent. McCarty. McCarthy. aye. SB 540 Laird. McCarty. McCarty. aye. SB 612 McCarty. McCarty aye. SB 622 Allen McCarty. McCarty aye. SB 667 Dodd McCarty. McCarty aye.

Not at all. Madam Secretary. Please run through the role of bills that have support, support recommendations, and are all already out. For Assembly Member Bonta

On consent. Bonta aye. Bonta aye SB 540 Laird. Bonta aye Bonta aye SB 612 Ochoa Bogh. Bonta SB 622 Allen Bonta aye Bonta aye SB 667 Dodd Bonta aye. Bonta aye.

Meetings confirmed. The meeting is adjourned. Thanks.