Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human Services

The Senate Budget Subcommitee number three on Health and Human Service will come to order. Good morning, everyone. The Senate continues to welcome the public in person and via the teleconference for public comment. For individuals wishing to provide public comment, today's participant number is 187-726-8163 with today's access code 736-2834 as always, we are holding our committee hearings here in 1021 O Street. I ask the remaining members of the Subcommitee to be present here in room 1200 so we can establish our quorum and begin our hearing.

Perfect timing. Today we will be hearing budget proposals from two departments, Department of State hospitals and the Department of Public Health. So I would ask for Department of State hospitals if they can come on up along with LAO and DOF. We're going to begin with issue one, an overview of the Department of State Hospitals.

Okay, there we go. All right. Good morning, chair, Committee. My name is Stephanie Clendenin. I'm the Director for the Department of State Hospitals and the Department of State Hospitals manages the California State Hospital system. DSH's mission is to provide evaluation and treatment in a safe and responsible manner by leading innovation and excellence across a continuum of care and settings.

We operate five state hospitals located throughout California with over 6000 inpatient beds that include acute intermediate skilled nursing facility and residential recovery unit level beds. We also operate a conditional release program, otherwise known as CONREP. This is our system of community based services operated in partnership with county behavioral health departments, private and private providers. It's designed to transition patients back into the community following a forensic commitment to the Department.

We also have partnerships with county behavioral health programs, private providers and county sheriffs to provide community to provide competency restoration, community based restoration and diversion opportunities, and jail based treatment programs for individuals committed to the department as incompetent to stand trial. The individuals served by our system of care are mandated for mental health treatment by either a criminal or civil court. The majority of the individuals we serve are forensic commitments.

They have either committed or have been accused of committing crimes linked to their mental illness and come to us directly through the criminal courts or after they have completed a sentence with the California Department of Corrections and Rehabilitation. We serve six different types of patients, including individuals who have been found by a court to be incompetent to stand trial.

They have either been accused of committing a crime, but a court has determined that due to their mental illness, they are unable to understand the nature of the charges against them or assist their counsel in their defense. We also serve individuals who are found not guilty by reason of insanity. These individuals are ordered to the Department for Mental Health treatment for a period of time that's equivalent to what they would have received as a sentence if they had been found guilty.

We also serve current inmates from the California Department of Corrections and Rehabilitation who have serious mental illness who require inpatient hospitalization. We serve as the least restrictive level of treatment of inpatient care for CDCR's mental health delivery system.

We also serve individuals who have completed a sentence at CDCR for their crimes and have either been certified by the board of parole hearings to be an offender with a mental health disorder that still requires mental health treatment in an inpatient setting at the completion of their CDCR sentence, or those that have been determined by a court to meet the criteria for commitment as a sexually violent predator.

Finally, we also serve individuals conserved by a civil court under the Lantriman Petris Short act who require state hospital level of treatment. The 2023-24 Governor's Budget includes a total budget of 3.2 billion for the department operations, which is an increase of 35.5 million, or 1% from the 2022 Budget act and includes an additional 49.7 positions. The proposed budget augmentations generally include new investments to continue DSH's efforts towards enhancing the department's operations and delivery of services, and state hospital facility improvements.

The estimated caseload is projected to exceed 9000 patients by the end of fiscal year 23-24 with a total of 5468 across our state hospitals, 2772 in contracted programs and 1049 in our conditional release programs, both our non SBP and our SBP programs. I'm happy to take any questions.

Thank you so much. Appreciate that. This reminds me of a Senator you presented yesterday, a bill related to, and we heard testimony witnessed where a man talked about his son going constant contact 5150 and eventually was put into a state hospital just like this. And the need to have something to prevent individuals from going into your state. You mentioned that you're seeing potentially an increase. Do we have an insight, as we're seeing a large number of individuals going into the DSH program?

Yeah, we have seen a significant increase over the last several years and really over the last decade of individuals that are being referred to the department as incompetent to stand trial. These are the individuals that have been accused of a crime and have been found incompetent by the court and need restoration of competency in order to complete their due process.

When we did a study of the individuals in our system that had been treated through our system, we found that over 50% of them were individuals who were homeless at the time of their arrest. They were individuals that hadn't been accessing their mental health services. The majority of them had not accessed mental health services in the six months prior to arrest.

And the individuals had had multiple touches with law enforcement, and nearly half of them had had 15 or more prior arrests prior to the incident that brought them to the Department. So ultimately, what we are seeing is that individuals are cycling in and out of the criminal justice system and back into the conditions of homelessness after they are exiting the system.

So this administration, there's been a number of investments really towards this population with individuals with serious mental illness who have the Criminal Justice Involvement, really with many different efforts to try to reduce the impact for this population.

Another question, can you talk to us a little bit more regarding the wait times? I see there's been some improvements in that transfer. Any update, any additional update you could share with us?

Sure, I'm happy to. So there was a number of investments over multiple years now towards this population, the IST population for short. There's been multiple years of investments with a very sizable investment last year for additional solutions to try to address the waitlist. The waitlist, we had a continuing waitlist prior to the pandemic, but the pandemic really significantly impacted our waitlists and our operations at our state hospitals due to the infection control measures we had to put into place.

This time last year, in March of 2022, we had over 1900 individuals on the waitlist. Today we are at 1016. So we've seen a 48% reduction. And this really is largely due to our rapid implementation of the new IST solutions, as well as easing of pandemic infection control requirements on healthcare facilities, as well as we move through the pandemic. My apologies. If I can also add that our wait times have also improved. They have reduced.

Back in March of 2022, we were at around an average of 134 days for time to treatment. And currently at the end of February, we were at 69 days, which is a 49% reduction.

Yeah, just on the point that somebody going into the state hospital with oftentimes 40 contacts previously cycling in and out of our jails is sort of the definition of the loss of people's rights. So anyway, I thank you for your work sitting on the very back end of our failed mental health system.

And as you're saying, we're doing our best to try to improve things on the front end so it doesn't just accumulate and we spend millions and millions and millions of dollars for people who should never have ended up there. So hopefully one day we'll get back to state hospitals being able to be used for the purpose they were designed for and continue to shrink down as we continue to build out our community support. So thank you.

I wasn't going to ask anybody. I just want to make sure I'm clear on it. The waitlist. These are individuals who've already been found to be incompetent to stand trial and are awaiting time in the state hospital for restoration to competency.

That's correct.

And they sit in the county jails as opposed to doing something else. Is there some other option for those individuals other than state hospital?

Yes. So one of the solutions that we implemented in 2018, we received funding for a pilot project, the mental health diversion pilot program, as well as community based restoration. So we have opportunities in the community as well for individuals to receive treatment.

But it obviously depends on the crime for which they.

Are charged.

Correct.

Correct. And a court approval for both of those programs.

When our acute inpatient psychiatric capacity outside of the state hospitals is limited, too.

It is. But there has been funding for us to identify placements and beds within community and patient facilities as well. And this last year, we activated 78 beds within a community and patient facility here in Sacramento for the treatment of individuals that were found incompetent. So we are rapidly trying to implement as many solutions as we can to help bring down the waitlist.

Well, thank you. Thanks for explaining that. I appreciate your help and your efforts. Thank you, Madam Chair.

Thank you. Before we move forward, let's establish a quorum consultant if you can, please call the role.

[Roll Call] Quorum.

Perfect. Thank you so much. Seeing no further questions, we're going to move on to issue two, a program and caseload updates.

Thank you again. Stephanie Clendenin, Director for the Department of State Hospitals. And I'm a remiss because I did not introduce my two Chief Deputy directors in the last item. So I'm also joined by our Chief Deputy Director, Chris Edens, who is the Chief Deputy Director of program services, and Brent Houser, who is the Chief Deputy Director of operations. So, to start with our program and caseload updates, the first is the metropolitan state hospital increased secured bed capacity.

We are reflecting a one time savings of 11.2 million in fiscal year 22-23. This project originated with a capital outlay project in 2016. It added security, fencing and infrastructure to an existing patient building at our Metropolitan State Hospital so the bed capacity could be utilized to treat forensic patients. The construction project was completed, and two of the five inpatient units were activated prior to the pandemic for the treatment of individuals found in IST.

As of Governor's Budget, one unit is being used for Covid-19 isolation and the other two remaining units are housing the metropolitan skilled nursing facility patients, while the roofing project and repairs in the skilled nursing facility building are completed with estimated completion of July of 2023. The savings identified are related to personal services associated with the delay in activation of these beds for the treatment of forensic patients. For the enhanced treatment program, we are reporting a one time savings of $4.8 million in fiscal year 22-23.

AB 1340, back in 2014, authorized the Department to establish a pilot enhanced treatment program to treat patients who are at the highest risk of violence and cannot be safely treated in a standard treatment environment. The Enhanced Treatment Program provides enhanced treatment staffing security and incorporates admissions and treatment planning processes to identify and address a patient's violent risk factors.

The program is intended to provide treatment for patients with high violence risk with the goal of returning them to the standard treatment environment with supports to prevent future aggression. In the prior year budget acts, DSH was appropriated capital outlay funding to convert existing patient units into the enhanced treatment program. Units and resources were authorized to activate the units when they were completed. We previously completed the construction of the 13 bed unit at DSH Atascadero and activated that unit for enhanced patient treatment in September of 2021.

The second 10 bed unit that's going to be at DSH patent is underway. The construction is underway and as of Governor's Budget, we are experiencing a nine month activation delay for this unit, with construction scheduled to be completed in December of 2023 and unit activation is anticipated for March of 2024. Due to this delay, the savings reported is associated with personal services, savings. For the mission based review, court evaluations and reports, direct care nursing, protective services and treatment team and primary care.

In the 2023-24 Governor's Budget, we are reflecting a savings of 44.9 million in 22-23 savings of 24.1 million and 46.5 positions in 23-24 savings of 10.9 million and 46.5 positions in 24-25 and a savings of 10.9 million and 46.5 positions in 25-26. Several years ago, we initiated an effort to evaluate staffing practices across the state hospitals and reviewed four components. These were our hospital forensic departments, our 24 hours care nursing services, protective services, and treatment planning and delivery.

As part of our staffing study efforts and in collaboration with the Department of Finance Research and Analysis Unit through emission based review, workload and processes were examined and assessed for each of these components. As a result of this process, proposed staffing methodologies and position requests and adjustments were requested and authorized to be phased in over a number of years for these four components of the hospital staffing.

Savings reported are due to delays and challenges experienced in hiring positions that were authorized and a request to shift 46.5 positions associated with treatment team and primary care staffing study that were scheduled for phase in in fiscal year 23-24. We're proposing to shift them to 26-27 to allow time to recruit for the positions that have already been authorized, For the patient driven operating expense and equipment, we are requesting 20.5 million in ongoing to support the increase in patient driven support costs within the DSH system, which includes items such as clothing and personal supplies, food, laundry, medication, and outside medical expenses. We continued to utilize the methodology that was established in the Budget act of 2019 and the request is based on 21-22 actual expenditures and 23-24 projected census.

The request is as a result of a cost of cost increases nationwide for essential patient related basic necessities and services. For our conditional release program, for our non SVP patients, we are requesting 2.6 million or two positions in fiscal year 23-24 and ongoing in response to increased workload and costs for DSH and our contracted providers and evaluators, which is driven by the activation of new placement options established under CONREP's expanding continuum of care.

The CONREP program is DSH's system of community based services designed to transition individuals who were treated in the state hospitals back into the community. During the past several budget acts, we have been authorized to expand that continuum of care to provide additional treatment settings to increase the number of individuals who are able to transition from the state hospitals and meet their treatment and support needs.

This has included establishing a new conditional release program, forensic assertive community treatment regional program, expanding the statewide transitional residential program, and increasing the number of IMD beds in the CONREP program to help individuals transition from the state hospital, as well as to provide alternatives to a state hospital should an individual decompensate while participating in CONREP in the community. The projected CONREP caseload is 1020 CONREP clients in 22-23 and in 23-24.

The budget augmentation request includes specifically $277,000 for two DSH positions to support increased programmatic and administrative support 296,000 in fiscal year 23-24 and ongoing to support increases in personnel and operating costs for the step down transitional programs 177,000 in 23-24 and 228,000 in 24- 25 and ongoing to support an increased need in specialized evaluation services for our California Forensic Assessment Panel, which supports the service providers in the increased census resulting from the new programs.

This will increase the number of CFAP evaluators by three to a total of 12. We're also requesting 1.9 million in 23-24 and ongoing to support contracted service providers, increasing personnel and operating expense costs, and then for our conditional release programs for our SBP population. There is no change in funding requested related to caseload.

The anticipated caseload for fiscal year 22-23 is 27, which is consistent with the estimate presented at the 22-23 May revise. For the pilot Felony Mental Health Diversion program, which we spoke about a moment ago. There's no fiscal change requested in support of the felony mental health diversion pilot that was originally authorized in fiscal year 2018-19.

Under the pilot program, the Department was authorized to contract with counties to develop new or expand existing diversion programs to treat individuals with serious mental illness who have been found or have the potential to be found incompetent to send trial on felony charges.

We have contracted with 29 counties who have elected to divert more than 1100 individuals and as of September 30, which was the most recent, complete data due to the data reporting timelines from the counties, they had diverted 1060 individuals under this program. For IST solutions caseload program adjustments the budget adjustment reflected in this estimate item is specific to our jail based competency treatment programs and the one time infrastructure funding that's authorized in the fiscal year 22-23 budget to develop residential housing settings to support felony IST individuals participating in either the community based restoration or diversion programs.

We're requesting one position in fiscal year 23-24 and ongoing to support the shift in administrative workload from Clinicians to an office technician, which frees up the clinical staff to focus on patient care issues and provider oversight. Additionally, the Department reflects a net savings of 27.4 million in the current year and 3.1 million in the budget year and ongoing.

The primary driver of this savings is a reduction of the San Bernardino's jail based competency treatment program, reducing the capacity from 146 beds to 64 effective September 1, 2022. In addition, there are a number of offsets to the level of budget year savings in our jail based competency treatment program. This is related to 11 county programs that are pending activation.

Three programs were able to support an additional increase in beds above the original projection by 40 beds across these three programs and the bed rate increases anticipated for 20 of the participating counties. As of December 2022, there were 413 beds across 23 county JBCT programs. Related to the infrastructure funding for community based restoration and diversion programs, we're proposing provisional language that extends the encumbrance and expenditure period of the one time funding of 150,000,000 that was authorized for the 23-24 to June 30, 2028. Happy to take any questions on those updates.

Just one question for me. I see the shift under the mission, treatment plan and primary care of those 40, somewhat 40 positions to the 26-27 year, and then I'm also seeing funding for other positions hiring, are you having difficulty hiring in one area versus the other, or is it all around?

So historically, we've had challenges with our state hospitals and hiring. Many of our hospitals are located in geographical areas that are tough to recruit and mental health providers into. But since the pandemic, we've definitely, like most healthcare entities across the nation, are experiencing challenges in hiring healthcare professionals. So many of these adjustments are related to that increased challenge that we've been experiencing over the last couple of years.

We have a number of efforts underway in which we're trying to increase our recruitment and retention efforts, and I ask that Chief Deputy Director Houser provide some additional information if you'd like to hear what we're working on.

Good morning. Brent Houser, Chief Deputy Director of operations happy to highlight a few of the initiatives we have going recognizing the challenges with recruitment and retention of our workforce. The first is in a few different domains. The first is on marketing and outreach. We currently are contracting with the HR consulting firm to reach a broader audience to demographics that we haven't reached out to before across our hard to fill and recruit positions such as psychiatry, nursing, food service technicians, psychology. Among some of those.

We also have a dedicated recruitment unit that is able to work with potential candidates to be able to walk them through the civil service hiring process, which at times can be challenging for individuals not familiar with the process. And one of our most successful initiatives relates to the partnerships we have with educational institutions.

Currently, we have partnerships with three community colleges for our psychiatric technician programs and really working with them to broaden our outreach and potentially increase the size of those cohorts so that we're able to establish the pipeline between the educational institutions and DSH serves as a clinical rotation spot. Another example will be heard, I believe, in issue number six on psychiatry workforce. We have a proposal. I'm happy to go into more detail during that issue. Thank you.

Thank you, colleagues. Any other questions? I'd like to turn to LAO and Department of Finance for any comment.

Department of Finance Nina Hoang, no further comments.

Will Owens, LAO, no comments on this item.

Great. Thank you. We're going to hold this item open and move on to issue three. Covid-19 Update.

Good morning again, Brent Houser speaking to issue number three. With the onset of the Covid-19 pandemic, DSH has executed a Covid-19 response plan across its system following CDPH, CDC and local public health Department guidance, and we do adjust this plan on an ongoing basis based on the nature of the COVID pandemic chellenges.

In 23-24, DSH is requesting 51.3 General Fund one time to continue to support infection control measures to protect the health and safety of our employees and our patients beyond the end of the state of emergency end date. Resources are needed to continue to support testing surge capacity, public health related personnel and PPE specific to testing funding would be used to procure tests and the associated materials congregate.

Living environments such as DSH have an increased risk of the rapid and transmission of Covid-19 as well as our patients being at high risk. For surge capacity, funding would allow the Department of State hospitals to continue to utilize the Norwalk alternative care site for another six months into the budget year, which has been a critical resource for the Department to respond to the pandemic for isolation space.

Another critical resource to fund an independent of the end of the state of emergency are our public health teams and those responsible for infection control will still be expected to administer vaccines, educate patients and staff on vaccines, track and monitor records and report on that, manage the inventory and conduct contact tracing and investigations within the hospital. The last major funding category is for PPE, such as gloves, gowns, surgical masks, n 95 mask fit testing and sanitation supplies. That concludes the presentation on issue number three and happy to take any questions.

Thank you. I don't have any questions. Senator Roth, Department of Finance and LAO any comment?

Department of Finance Nina Hoang nothing further to add.

Will Owens, LAO no concerns with this proposal, thank you.

We're going to hold this item open and move on to issue number four. Department of General Services statewide surcharge adjustments.

The Department of State Hospitals request $1.9 million in General Fund in 23-24 and ongoing to address ongoing increased costs due to the Department of General Services statewide surcharge the Department of General Services, also known as DGS, provides a variety of services to state departments, whether that be procurement management, state owned real estate, fleet oversight, and generally acts as a business manager for state departments. As such, DGS funds its operations through fees charged to client departments, DSH, among them.

The DSH appropriation for the statewide surcharge has not changed since the implementation of this fee structure. Although the fees have increased year over year, which is based on the number of authorized positions. Since the Department of State hospitals is a large Department and has grown in the number of positions over the years, as does the fees for the surcharge, currently, any increase in the surcharge and fees must be absorbed by the Department, which impacts the funding available for operating expenses and equipment and other departmental operations. Happy to take any questions.

I don't have any questions, seeing none LAO, Department of Finance.

Department of Finance nothing further to add.

No concerns with this proposal.

Thank you so much. We're going to hold the item open and move on to issue number five. Tele services, visitation and court hearings be.

Speaking to issue number five again. The Department of State hospitals request $2.1 million General Fund and 15 positions in fiscal year 23-24 and ongoing to establish permanent resources for managing teleservices for patient visitation and court hearings. Prior to the Covid-19 pandemic, televisitation services for family members, attorneys and other interested parties did not exist at the Department and telecort appearances were only offered by a small number of courts.

In terms of magnitude, in fiscal year 21-22 as a system, the monthly average of televisits was about just over 100 per hospital and telecourt appearances was 168 per hospital. During the Covid-19 pandemic, DSH did increase our reliance on video conferencing for virtual court appearances and establish the use of video equipment for patient visitations with family, friends and attorneys.

As in person, services incrementally continue to resume towards pre pandemic levels, a new demand to provide both modalities exist for the Department and is expected to increase across all locations. By continuing to provide these services virtually, DSH can maintain the continuity of care for patients as they will not need to discharge to the department and wait in jail to proceed with their court proceedings while this can be conducted at the department virtually

It is important to note that for Department to quickly implement telecort and tele services during the pandemic, staff were temporarily redirected from other unit areas and services that may have been suspended for restricted access due to the risk of transmitting Covid or worked overtime to support that workload.

As we continue to adjust to the changing nature of the pandemic and resume the full extent of pre Covid-19 services, staff will be required to cover their original assignments, which would leave the staffing void for DSH to fill, which is the purpose of this request. Happy to take any questions.

Yeah, I'll never say there's a silver lining to the pandemic. But we did see how daily operations one of the lessons learned was daily operations can be run in various manners. And I appreciate the Department taking realizing the benefits of removing barriers to access to services like this. So thank you for bringing this up. Great LAO Department of Finance.

Comment Department of Finance nothing further to add.

We have no concerns with this proposal.

Thank you. We're going to hold that item open, move on to issue number six.

I'll be presenting on issue number six as well. However, I am joined by Dr. Katherine Warburton, the DSH's statewide medical director. The Department quests a total of seven positions in fiscal year 23-24 an ongoing and General Fund of 6.5 million in 23-24 increasing to 8.3 million 27-28 and ongoing for the development and implementation of pipeline recruitment and retention initiatives to sustain and grow DSH's psychiatric workforce.

Specifically, this proposal requests resources to implement a four pronged approach to recruitment and retention of psychiatrists, the first being developing a new residency program modeled after the residency program we established at DSH Napa. However, this would be a residency program in Southern California through our DSH Patton State Hospital. This program would include cohorts of up to four residents per year and once fully implemented, we may have up to 20 residents in our system.

The second prong is adding funding for psychiatric fellowships across our five state hospitals. The third prong is adding funding for resident rotations across our five state hospitals. And just to speak to the residency programs, whether it's the program we're developing or sponsoring, fellowship or residency slots, these residents will provide a percentage of their time spending providing direct patient care, and the ultimate outcome being that they will train with us and hopefully stay with us and become employed by the Department.

It's been our experience that folks tend to stay where they train, and that's been a best practice that we're hoping to move forward with this proposal. The last part of this proposal is developing an office of continuing education and medical advancement within our clinical operations division to further develop DSH's existing educational and academic efforts to promote best practices and engage in research and knowledge sharing amongst DSH psychiatrists, which will result in increased collaboration and morale amongst our psychiatric staff.

There was a question in the agenda that I'd like to respond to and just repeating the question, it is how will these programs interact with the DSH Psychiatrist Loan repayment program adopted in the 2022 Budget act? And we see this proposal directly complementing the loan repayment program. These training programs as proposed in the Governor's Budget, introduce psychiatrists into our system and train the workforce to be able to have the skill set necessary to best serve our patient population.

The loan repayment program then incentivizes these newly trained psychiatrists to apply and stay within our system for a minimum of five years. That concludes presentation on issue number six. Happy to take any questions.

Thank you, Madam Chair. First, I want to compliment the administration on the fairly recent effort to robust up our training programs in mental health across the board, including psychiatry. They say that we need, if the stats are right, about 670 or so additional psychiatrists in the State of California to address the need. And that's only psychiatry. That's not licensed clinical social workers and all the other valued providers in this healthcare space.

Obviously, the pipeline is very, very long, not only for psychiatrists, but for social workers and others due to the clinical training hours that they have to complete in order to secure licensure and continue to provide service. I'm one of the ones over the years, and this is my 11th year here in this house, who spent a lot of time talking about primary care physicians, family medicine, internal medicine, because, of course, there was and remains a shortage of those as well, but really to some extent to the exclusion of focusing on the behavioral health field and psychiatrists and others. And I'm glad that the administration has taken the lead in focusing on that aspect of the health care delivery system.

I wonder, even as robust as these proposals are and the proposals that the governor's put forth in this budget in the last 25 million or whatever for additional psychiatric residencies, if we don't have to really do much, much more as the budget allows us, we need training sites. It's probably pretty difficult to have a psychiatric residency program in an acute care general hospital that's not licensed for mental health treatment. And our acute care inpatient psychiatric facilities are limited both in terms of beds and location.

So we're going to have to really work hard to figure this out and I think bolster up our budget appropriations as we can to add more and more residents to the pipeline. Because whether it's four or 20, when you divide 20 into 670, if that's the number, it's going to be a long time before we get the number of providers out in the system, given retirements and everything else that happen over the time, delivering services to those who most need it, most often our most vulnerable that we spend a lot of time working on here. So again, thank you to the administration. I don't have a question. I'm here to help in the limited time that I have left here, because I think this is a very important issue.

I'll just be very brief and also compliment the administration on leaning in on this. And just as somebody who's sitting on this budget, we also know there have been proposed cuts for pipeline and mental health training that I certainly won't be supporting. And I think we need more, not less. Thank you.

Thank you. Does DOF or LAO have any comment?

Nina Hoang, Department of Finance. Nothing further to add.

Will Owens, LAO we have no issues with this proposal.

Thank you. We're going to hold this issue open and move on to issue number seven. Brent, is it you again?

It is me again, although I will be joined by our chief information officer, Chad Corn, as well as our assistant Deputy Director of clinical operations on this particular proposal should there be any questions. The Department requests 21.5 million General Fund and 40 positions in 23-24 and 22.3 million General Fund and 58 positions ongoing to complete the remaining planning activities, complete the EHR solution procurement and initiate the activities needed for the transition into the implementation phase of the electronic health record system.

The Department has received resources via prior Budget act investments, which has successfully formed a business and clinical governance structure. We have standardized our business and clinical processes, collaboratively developed a procurement with the California Department of Technology, which includes a proof of concept procurement process, and we recently received stage three approval from the state's project approval lifecycle process. And last, we have evaluated and are underway in implementing and upgrading our wireless land infrastructure that's necessary to support electronic health records implementation across our system.

Specifically, this proposal allows the department to finish its planning efforts and initiate implementation by using these resources to add necessary functions across our clinical teams, including health informaticists, radiologists and laboratory specialist leads to ensure that representation for this project spans all clinical areas. Additionally, the resources also support our technology services division, given the level of complexity and volume of IT systems that will need to integrate and scale for this project to be successful.

Specific deliverables with the proposed investment of these resources will yield developing and implementing training process and plans with each hospital, specific locations, trainers and super users. It'll create a technical roadmap policy and procedures for onsite and cloud based it systems in preparation for the electronic health records vendor. And the reason why that's important, as we develop that roadmap and policies and procedures, we don't need to wait for the EHR vendor to be on board to do all the preparation work necessary.

We'll build EHR data standards, data management and cleansing and deploy data pipelines prior to the system integrator onboarding. And last, this proposal proposes to procure and configure end user devices and medical devices for the first pilot hospital, which will be DSH Colinga, happy to take any questions on the electronic health records proposal.

I don't have any questions. Colleagues. DOF, LAO, any comments?

Department of Finance Nina Hoang. No further comments.

Will Owens LAO we have no concerns for this proposal.

Well, you're going to get some oblique stretches there each time.

Thank you. We're going to hold this item open and move on to issue number eight as it relates to SB 1034.

Thank you. Hello Chair. Chris Edens, chief deputy director for Program Services. This is a budget change proposal on Senate Bill 1034. DSH is requesting 598,000 General Fund beginning in fiscal year 2324 and ongoing, to support two positions and contracted resources to support new workload resulting from the passage of Senate Bill 1034, which was effective January 1 of this year.

This bill primarily seeks to address issues around the difficult task of placing SBP, or sexually violent predator patients in the community through the department's conditional release program, also known as CONREP, where the individual would continue to receive treatment along with supervision and monitoring for some context. After the court has determined an SBP patient can be safely treated in the community and orders the individual's release, it takes an average of one year for the individual to transition to community placement.

However, that timeline continues to grow and we have seen patients who've waited more than two years the law and the courts guide where these individuals must be placed, which is typically in their county of domicile. The SBP CONREP program strives to do this. However, prior to Senate Bill 1034, no criteria existed to guide the courts as to when extraordinary circumstances are present which would allow a court to permit placement in another county outside of the individual's county of domicile.

Senate Bill 1034 requires the department to convene a committee of various county representatives who will be tasked with providing consultation and assistance to DSH, as well as our contracted service provider in the process of securing suitable housing for each SBP patient approved for conditional release. Additionally, for the court to make a finding of extraordinary circumstances, the bill requires the committed persons county of domicile to petition the court only after specific tasks are completed and specified criteria has been met.

The new requirements will result in an increased number of county stakeholder meetings, interagency coordination, court hearings, as well as drive additional tracking and court reporting. Happy to take any questions.

I don't have any questions. DOF, LAO.

Department of Finance Nina Hoang nothing further to add.

We have no concerns with us.

There you go, will. We're going to hold this item open and move on to issue number nine.

Good morning, longtime no see. Speaking to issue number nine, the Department proposes 847,000 General Fund in fiscal year 23-24 and ongoing to support 5.5 positions that were included in the 2021 budget act with limited term funding, which expires at the end of this fiscal year June 30, 2023. The department has sustained an increase in workload of court hearings at which DSH attorneys are required to appear and has sustained an increased workload in the Request Public Records Act request to which the department must respond.

The 2021 Budget act provided permanent position authority for 5.5 positions and reflected another two years of funding from the 2019 Budget act, where the resources were originally approved for the legal division to address the increase in workload, including the number of hearings, court appearances and responses related to incompetent to stand trial population and associated litigation workload has sustained an even increase, which is the basis for continuing the funding to support the positions.

In calendar year 2021, the legal division has seen a 43% increase in the number of court appearances over calendar year 2020. Additionally, there has been an increase in the number of public records acts and subpoenas from 2020 to 2021. In 2020, DSH received over 730 Public Records Act requests and subpoenas compared to 2021. The department received over 834 Public Records Act and subpoenas at this time. Happy to take any questions, and I forgot to mention I'm joined by our chief counsel, Brent Reden.

Another Brent awesome. No questions from on my end. Department of Finance, LAO, any comment?

Department of Finance Nina Hoang. Nothing further to add.

We have no concerns with this proposal.

Great, Brent. We're going to hold this item open and move on to issue number 10. I'm in an extra good mood.

Good morning, JC Thompson here from the Department of State Hospitals, joined by my colleague Janna Lowder-Blanco. And we are here to address item 10, which is the Criminal Record Information Data Trailer Bill Language so, welfare and institutions code 4040 requires that DSH conduct research and evaluation studies which have an application to mental health policy and management issues.

So the proposed changes would amend penal code section 1115 to include the Department of State Hospitals as a named agency, having statutory authority to obtain access to the criminal offender information through the Department of Justice for the specific purposes of conducting research, program evaluation, data analytics, and legislative reporting on areas with important implications to mental health policy and management.

Additional changes to welfare and institutions Code 4046 would clarify DSH's ability to exchange criminal identification and information numbers with the California Department of Corrections and Rehabilitation. This data exchange promotes accurate record matching of data necessary to perform research. Happy to answer any questions you might have.

No questions on my end. DOF, LAO?

Department of Finance, Nina Hoang. Nothing further.

Add, we have no concerns with this proposal.

Great, thank you so much. We're going to hold that item open and move on to issue number 11.

I'm the deputy director of Administrative Services at Department of State Hospitals, and I'm joined by our Chief Operating Officer, Robert Horsley. So for item number 11, DSH requests 1.9 million in General Fund for the continuing central Utility plant replacement project for the working drawings phase. The 2022 budget act provided funding for the preliminary plans phase, and this request represents the next phase of this project.

The project will replace the existing central utility plant located at DSH Metropolitan that currently supplies steam and hot water, as well as central heating and chilled water for air conditioning to 32 patient housing and administrative buildings. The existing plant is more than 30 years old. The design is inefficient.

There's antiquated equipment, which makes future repairs and maintenance very challenging and costly because there's limited availability of parts and a shortage of specialized individuals with the expertise required to maintain this system for our DSH retained an architecture and engineering firm to complete a study to determine the best alternative for replacement of the aging and obsolete central utility plant.

The study identified a centralized option for providing new plant equipment that will significantly improve the efficiency and resiliency of the hot water and chilled water generation and distribution systems. This project will allow the hospital to move away from steam generation and will be replaced with hot water boilers and establish the infrastructure to further support this system at this time. That completes my overview, but I'm happy to address any questions.

Think antiquated is understatement? I see 1915?

1950.

So old yes, no comments or questions on my end. Any questions, Senators? Department of Finance, any comment or LAO?

Dominick Guidera, Department of Finance no concerns. Will Owens, Lao no concerns with this proposal.

Thank you so much. We're going to hold this item open and move on to issue number 12.

Thank you.

I'll be presenting this one as well. So DSH requests 536,000 in General Fund for the working drawing phase of the continuing DSH Metropolitan Fire Waterline Connection project. The 2022 Budget act provided funding for the preliminary plans phase, and this request reflects the next phase of this project. This project will provide the volume of water required for the fire sprinkler system to comply with current fire code requirements.

During the construction of the central kitchen, the state fire marshal found that the old existing water storage tanks did not meet the National Fire Protection Association requirements. Both the tank and outlet with antivortex plates were deemed out of compliance. The replacement of the existing northerly 750,000 gallon steel tank with a new 1 million gallon dedicated firewater storage tank will allow the hospital to Meet National Fire Protection Association fireflow requirements in the interim and to ensure safety.

The hospital buildings do have fire alarm systems and coverage on existing hydrants via firewatch. That concludes my presentation of this item, but happy to address any questions.

Thank you so much. No questions on my end. Department of Finance, LAO, any comments?

Nothing for we have no concerns with this proposal.

Thank you so much. We're going to move on to the last item in this department, issue number 13.

Thank you. DSH requests 1 million in General Fund for the working drawings phase to provide upgrades to the sewer connection system, the installation of screening system and connection to the city of Atascadero's wastewater treatment program. The 2022 Budget Act provided funding for the preliminary plans phase, and this request reflects the next phase in this project. Atascadero's existing wastewater treatment plant currently serves approximately 1100 patients and 2000 employees. No significant improvements to its sewer collection and wastewater treatment plant have taken place since its commissioning.

Also in the early 1950s, after a condition assessment and analysis of the new Central Coast Regional Water Quality Control Board order for waste discharge requirements, it was determined that this 70 year old wastewater treatment process will not comply with current mandates. Other deficiencies include improper flow rates, which are complicated by inadequate treatment capabilities. That completes my overview of this item, but happy to address any questions.

Thank you so much. I don't have any questions. Senator Eggman,

I just want to say that this is the last item, that it's nice to see all the people from the department as I sat in that chair. We're only on Zoom, so we got people back in person and that's nice.

Thank you. Department of Finance, LAO, any comments?

Dominic Guidera, Department of Finance, no concerns.

We have no concerns for this proposal.

Perfect. Thank you so much to Department of State Hospitals for your PCP presentations today. We're going to be moving on to the next department. Department of Public Health. I welcome the Administration to come up for the first issue, we're going to be welcoming someone on Zoom.

Hello, this is Linda Helen, Department of Public Health go ahead, go ahead.

Budget solution Public Health Regional Climate Planning reversion.

Thank you. Hello, Senators and chair. My name is Linda Helen. I manage the Climate Change and Health Equity Section at the California Department of Public Health Office of Health Equity. This budget solution is on a public health regional climate planning reversion.

This proposal would have provided $25 million in one time state General Fund expenditure authority to support local health departments, community based organizations and tribes to develop regional climate and health resilience plans to bolster the actions of resource limited local health departments and communities to more effectively prevent and reduce inequitable health impacts of climate change, including behavioral health risks.

It would have funded eight positions to provide technical assistance and support to the funded entities, and I will turn it over to the Department of Finance for further information.

Good morning, Madam Chair. Nick Mills, Department of Finance this reduction is consistent with the administration's overall approach to addressing budgetary problem through delays or reductions of some spending in the near term and where feasible. The Governor's Budget prioritizes ongoing commitments included in previous budgets in the climate change and health space. That includes 10 million General Fund ongoing for DPH's Climate and Health Surveillance program, which provides near real time notification for public health departments, first responders and community for emerging or intensified climate sensitive diseases.

We would also note that this is one of the investments that is, should there be sufficient General Fund in January 2024, the reduction would be restored.

Thank you. I have a question on this, Ms. Helen. These are grants that would have been really beneficial for my district. These are districts that the CBOs in my district would have applied for. I'm wondering, I understand we have to balance the budget. It wasn't utilized. It wasn't sent out. This makes sense, but I'm just wondering why we were in the situation in the first place to have that funding available to be clawed back.

We had not yet entered into any contracts and we were in the process of hiring staff and conducting community engagement. So the funding was still available, unspent. And as Department of Finance suggested, there are some other investments in climate health this year.

Thank you. Still a little concerned, seeing as this is something that's really beneficial, but I appreciate your response on that. Senator Eggman.

I would just echo the chair's remarks, and I know we've had a pandemic and things, but the money was there for a reason and it seems like it took a while to get off the ground. So then it's sitting around for someone to snatch.

Thank you. LAO, any comment?

Will Owens, LAO, we have no comments on this issue at this time.

Thank you. We're going to hold this item open and move on to issue number two as it relates to SB 1076.

Hi, good morning, Chair Menjivar, Senators Roth and Eggman, Committee Member Scott. Good to see you all. I'm Terry Sue Canale-Dahlman and I am the Deputy Director for the Center for Healthy Communities here to present issue number two to you. Lead poisoning is one of the most common environmental illnesses in California. Lead can lead to very harmful effects in a child's body, which may result to other lifelong learning, behavioral, reproductive, cardiovascular and other health problems.

Ingestion of lead contaminated house dust contributes almost 40% of the increase in blood lead levels in us children and creates hazards for our workers. CDPH is requesting one position and 615,000 out of General Fund for 23-24 and 24-25 and an additional 31 positions and 5.5 million from the Lead Related Construction Fund in 25-26 with ongoing 5.2 million starting in 26-27 to implement the residential lead based pace renovation, repair and painting program.

This is a brand new program for us and we anticipate certifying over 40,000 individuals and 5000 companies with accrediting over 150 training providers. In addition to having an audit and enforcement presence, CDPH would provide statewide educational materials to contractors and consumers and encourage multilingual training. We would conduct course audits of accredited training courses to minimize the potential of fraudulent certifications. We need to promulgate regulations and those will align with federal and state regulations, reducing confusion and simplifying training.

And we'll monitor compliance using audits, inspections and enforcement measures to deter violations. Open for questions

Now just to comment. Really excited about this. If the feds can do it, California will step in and take over. Any comments from my colleagues? LAO, any comment?

We have no concerns with this proposal.

Department of Finance?

Hick Bells, Department of Finance, nothing further to add.

I think we're back to Linda.

Great, we're going to hold this item open and move on to issue number three as it relates to AB 2238.

Hello, Linda Helen, Department of Public Health, Office of Health Equity again. And this Bill is the statewide extreme heat Ranking System, AB 2238. It requires the California Environmental Protection Agency, in coordination with the Integrated Climate Adaptation and Resiliency Program, ICARP, Department of Public Health and the Department of Insurance, to create a statewide extreme heat ranking system.

The Bill also requires the development of a public communications plan for the extreme heat ranking system statewide, guidance for local and tribal governments in preparing and planning for extreme heat events, and recommendations on locally relevant heat adaptation, preparedness and resilience measures. Department of Insurance will study past extreme heat events to determine the effectiveness of insurance coverages and evaluate insurance gaps among racial and socioeconomic groups and develop recommendations for insurance solutions for mitigating or adapting to heat risk.

CDPH is requesting $369,000 and two positions to implement this Bill. The CDPH role is to provide technical assistance and subject matter expertise to CAL EPA and other coordinating agencies during the development process of the extreme heat ranking system to provide technical assistance to ICARP in developing a public communication plan for the system, including outreach plans for reaching diverse and vulnerable populations most at risk for health impacts of extreme heat events.

We will also leverage existing partnerships with local health departments and tribal entities that we uniquely possess to provide input to the system and to help them be reached with the heat warnings. We will support ICARP in developing recommendations to local governments regarding heat adaptation, preparedness and resilience measures that can be linked to the extreme heat ranking system and identify how the ranking system aligns with other statewide extreme heat adaptation policies.

Thank you so much. I don't have any questions or comments. LAO, any comment?

We have no concerns with this proposal.

And specifically, the research scientists will conduct an analysis using historical Emergency Department data of the temperatures at which there have been health impacts and for which vulnerable populations experience the most disproportionate health impacts for every census tract in the state, and we will provide those results to the Office of Environmental Health Hazard Assessment at CAL EPA to develop the heat based health wording tool, or app.

Department of Finance?

Nick Mills, Department of Finance, nothing further to add.

Thank you, Linda. We're going to hold this item open and move on to issue number four as it relates to SB 855.

Hi, Terry Sue Canale Dahlman again, I'll be presenting issue number four. Drowning is a leading cause of unintentional injury related death among children aged one through four in California, childhood drowning prevention efforts require quality data.

However, existing data systems on childhood drowning either do not contain critical information on the drowning circumstances or are not collected consistently and completely across the state. CDPH is requesting a $1.8 million allocation to establish and administer a three year childhood drowning data collection pilot project. CDPH will collaborate with 5 to 10 counties, publish a standardized electronic form for the counties to use when reporting drowning statistics developed in consultation with our state advisory group and the National Center for Fatality Review and Prevention.

Thank you so much. I don't have any questions. Senator Eggman.

We'll submit a progress report and a final report to the Legislature, and we'll publish a California Water Safety Action Plan for children. Open for questions.

I'd just like to make the point. I live in an area that gets very hot, and so a lot of kids swim in places that they maybe shouldn't.

So when we look at the drowning, maybe also looking at the water quality, and I was thinking specifically of the delta where kids get in even when the algae bloom is high because it's so hot and often end up drowning. So I don't know if we can tie any of those things together about the water quality that kids are drowning in, as well as just the inability to swim. Thank you. Which is a key thing. Kids have to learn to swim.

Thank you, Senator. LAO, any comment?

We have no concerns with this proposal.

DOF, Department of Finance,

Nick Mills, Department of Finance. Nothing further to add.

Thank you so much. We're going to hold this item open and move on to Issue number five as it relates to AB 1632.

I'll be presenting this one as well. Some businesses lack available public restrooms for their customers, thereby leading to instances of people with medical conditions who require an immediate restroom being denied access to an available employee only restroom.

The Restroom Access Act expands access to business employee only restrooms facilities to those with eligible medical conditions when a public restroom is not available. CDPH is requesting nine positions and 1.4 million from the General Fund to create a new program to implement and provide oversight for the Restroom Access Act. CDPH would promulgate regulations, perform oversight and monitoring of investigations.

We would support the program implementation, provide statewide review of violation complaints, conduct investigations, collect fines, a civil liability penalty, up to $100 for each violation, conduct due process compliance, and establish and maintain a database to collect violation data for the purpose of conducting analysis and progress toward the shared program goals. Really, so that we're making sure that the businesses understand the new legal obligations. Questions?

Quick question related to the statewide data complaints, it would be on the website?

Thank you, Senator.

And then they would be able to.

No, this would be for our purposes to be able to. So, like, if you see an area where, say, there's a lot of businesses that are in non compliance, that means maybe they need more outreach to understand the law. So it's really for us to.

So there's no component for someone who goes into a business and they were denied after showing a card how they would file.

Right. The complaint form would be online.

Perfect.

I just wonder if there's some way in the future, not now, but to involve the local jurisdictions that have the ability to permit and inspect facilities to provide a notice at the time that somebody's perhaps opening a business in a new facility to make them aware of this particular requirement when they may not have a restroom in the plans that are approved for whatever reason. Does that make sense?

Yeah, we could certainly do that as part of our outreach to businesses because we have planned outreach to businesses and we could put that on our website.

We do it with respect. In fact, we're planning to upgrade our notice, do it with respect to ADA compliance. On the access issues, there's a notice that's delivered to business owners at the point of the transaction in local jurisdictions, which is the building Department or the Planning Department. We might want to do the same thing with this as well.

Not that they need to put a restroom in, but to notify them that if they have a restroom that's not open to the public, they need to comply with this particular statute.

Yeah, that makes sense.

Thank you, Senator Roth, LAO, any comment?

Will Owens LAO, We have no comments on this issue.

Department of Finance?

Department of Finance, nothing further to add.

Thank you so much. We're going to hold this item open and move on to issue number six.

Good morning. My name is Richard Olney. I'm the Division Chief for the Genetic Disease screening program. And first I'll be talking about our estimate as a brief background. GDSP's special Fund, or the Genetic Disease Testing Fund. GDTF is primarily supported by two major programs, the mandatory California Newborn Screening program, or NBS program, and our statewide voluntary California Prenatal Screening program, also known as the PNS program.

In September 2022, DDSP launched a redesigned PNS program by making cell free DNA screening, also known as CFDNA or NIPT, available for down syndrome and other conditions. This major change has affected our estimated revenues and expenditures.

Our total budget expenditures for 2023-24 are projected at about $184,000,000, which represents an increase of about 11 million, primarily as a result of increases related to our 2023-24 BCP, which I'll be talking about in a minute, and also accounting for a full year of CFDNA prenatal screening costs.

Our combined NBS and PNS revenue projections for 23-24 are $179,000,000, which is an increase of almost 5 million, primarily due to changes in projectable, billable caseload for a full year of CFDNA screening and the new fee structure for prenatal screening, with separate billing for CFDNA and neuro-tube defect screening, and resulting increases in billable caseloads. Before moving on to discuss the BCP, are there any questions about the estimate?

No questions. No Richard, no questions.

Okay, thank you. I'll move on to issue seven then.

Oh before LAO did you have any?

We have no comments on the estimate.

Department of Finance.

Nick Mills, Department of Finance. Nothing further to add.

Great. We're going to hold that item open. Richard, you can move on to issue number seven.

Thank you. So issue seven is the California Newborn Screening Expansion, BCP. Just as brief background about the expansion. In August 2022, newborn screening for a condition known as MPS-2 was added to the federal Recommended Uniform Screening Panel, or RUSP. And in January 2023, another condition, GAMP Deficiency, was added to the federal RUSP. GDSP has a statutory obligation to begin screening within two years after conditions are added to the RUSP.

So our deadline for adding MPS-2 to the California NBS panel is August 2024, and for GAMP Deficiency is January 2025. So for this BCP, we're requesting $3.5 million for implementation costs in 2023-2024 as well as future ongoing funding. Both of these new disorders will require laboratory developed testing at the CDPH Richmond Laboratory campus, as well as follow up.

So first, new equipment, reagents and consumables will need to be procured, and secondly, our information systems will need to be updated to accommodate results reporting and special care center reports about screen positive children. We have requested four permanent positions to implement and continue routine screening and follow up for MPS-2 and GAMP Deficiency, which has projected state operation costs of 1.2 million in 202324 and ongoing costs after that. Do you have any questions?

No questions on my end, LAO?.

We have no concerns with this proposal.

Department of Finance?

Nick Mills, Department of Finance. Nothing further to add.

Great. Thank you, sir. We're going to hold the item open and move on to issue number eight, Women, Infants and Children Program. WIC, joining us on Zoom, William Welch.

Good morning, as you said, my name is William Welch. I'm the Assistant Division Chief of operations for the WIC division, and I'll be sitting in for Chris Sullivan, WIC's Division Chief, who is out of the office. And I'm also joined by Catherine Lopez, Assistant Division Chief of Services. Should there be any questions? Thank you for the opportunity to provide a brief overview of the WIC November estimate package. The Subcommitee has requested a response to the following two items.

Number one, please provide a brief overview of the caseload and expenditure changes for the WIC program and number two, please provide an update on participation in the program as a percent of eligible individuals in the state. For item number one, WIC estimates an increase in expenditures of more than $200 million in current and budget years, with about half of the increase due to the extension of the fruits and vegetables benefit increase and half due to increases in inflation and participation.

This increase brings total expenditures for food to $921,000,000 in current year and $944,000,000 in budget year. Food expenditures are covered by federal revenue and formula rebate revenue. The fruits and vegetable benefit increase was initiated in the summer of 2020 as a temporary measure and has been extended with each federal budget approval. USDA released proposed regulatory changes in November 2022 that would make the increase permanent. The November estimate includes projections of more than 940,000 WIC participants each month, which is a small increase over the previous estimate.

In response to the second question regarding the percentage of eligible individuals in the state in January of this year, USDA released its latest WIC program reach coverage report. Using data from 2020, USDA estimated that nationally, WICC served 50% of its eligible population in 2020, while California served 65% of its eligible population. No other state has a higher WIC coverage rate or higher number of WIC participants than California. I note that this report USDA made modifications to its methodology and they updated their estimates for prior years.

We will modify our language accordingly in the May revision. Thank you again for the opportunity to respond to the Subcommittee's questions on WICC's November estimate package. Does the Subcommitee have any additional questions?

Thank you. Mr. Welch. I don't have any comments. Senator? LAO, any comment?

Will Owens LAO, we have no comments on the estimate.

Department of Finance?

Nick Mills, Department of Finance. Nothing further to add.

Perfect. Thank you. We're going to hold that item open and move on to issue number nine as it relates to AB 351.

No, no questions on this, Senators? LAO, any comment?

Good morning. I'm Miren Klein. I'm the acting Deputy Director for the Center for Environmental Health. And I'm going to be talking about AB 351.

So this is a General Fund increase request of 357,000 in one position in 23-24 to implement AB 351, which requires CDPH to adopt rules and regulations prescribing the standards for human reduction chambers to ensure the destruction of pathogenic microorganisms. We will also need to contract with a subject matter expert for the areas of efficacy for testing for humans, for human reduction chambers in microbiology, composting, soil science and hazardous materials. Happy to take any questions you may have.

Department of Finance?

We have no concerns with this proposal.

Selena Noreli, Department of Finance, nothing further to add.

Great. Thank you so much. We're going to hold this item open and move on to the next issue, issue number 10, as it relates to AB 2298. Welcome back.

Okay, that's me also, so this is a General Fund increase of 193,000 in one position in fiscal year 23-24 to implement the provisions of AB 2298 to adopt new regulations for wave basins related to sanitation and safety that may be based on public swimming pools requirements. But consider the unique characteristics of a wave basin.

And wave basins are a new type of water recreational venue that pose some unique public health challenges due to the volume of the water, the chemical disinfection, dispersion, the magnitude of the wave action, and the size of a typical wave basin, which can have a capacity of 7 million gallons. Happy to answer any questions you may have.

Definitely not, but when I heard of this, I put it on my to do list to visit one of these. Senators, any comments? Questions? LAO, any comments?

We have no concerns with this proposal.

Department of Finance?

Selena Noreli, Department of Finance, nothing further to add.

Thank you. We're going to hold this item open and move on to issue number 11 as it relates to AB 1704.

So that's me also, so this is a one time General Fund increase of 425,000 in fiscal year 23-24 to implement the provisions of AB 1704 which require CDPH to issue a new limited podiatric radiography permit.

This will allow a medical assistant to perform x rays only of the foot and the ankle area in a podiatric office setting. This request is to configure our existing licensing database for this new permit type. And happy to answer any questions?

No questions. Senators, any questions on this one? LAO, any comment?

No concerns with this proposal.

Department of Finance,

Selena Noreli, Department of Finance, nothing further to add.

Great, thank you. We're going to hold the item open and move on to issue number 12. We're going to go back to zoom. Oh no, we have some people here. Never mind.

Hi, good morning. My name is Cassie Dunham. I'm the Deputy Director of Center for Healthcare Quality at Department of Public Health and I'm joined here with my colleague Michelle Bell, who is our Division Chief over our internal operations. So, general overview of the Center for Healthcare Quality we have the responsibility for regulatory oversight of licensed healthcare facilities and healthcare professionals in assessing the safety, effectiveness, and healthcare quality for all Californians.

The center fulfills this role by conducting periodic inspections and complaint investigations at healthcare facilities and provider agencies to determine compliance with applicable state and federal laws and regulations. The program is organized into 14 district offices and includes a partnership with Los Angeles County, which operates under a contract with the center. The Center for Healthcare Quality licenses and certifies over 14,000 healthcare facilities and agencies in California in 30 different licensure and certification categories.

In addition, the center oversees the certification of nurse assistants, home health aides, and hemodialysis technicians, as well as the licensing of nursing home administrators. The center also hosts the Healthcare Associated Infections program, which oversees the prevention, surveillance, and reporting of healthcare associated infections and antimicrobial resistance in California hospitals and other healthcare facilities. The majority of the center is funded by the State Department of Public Health Licensing and Certification Fund, which is supported by licensing fees collected from regulated healthcare facilities and providers throughout California.

The US Department of Health and Human Services Centers for Medicare and Medicaid Services also awards federal grant monies to the center to certify that facilities accepting Medicare and Medicaid payments meet federal requirements. Additional funding includes reimbursements associated with interagency agreements with Department of Healthcare Services and General Fund, which supports survey activities in state owned and operated facilities. I'd like to speak now briefly to the center's performance over the past year.

The centralized application branch, which reviews, analyzes, and evaluates request for facility licensure and or certification or processes other license associated transactions submitted by facility providers. As of quarter two of 22-23 the branch had received over 7,500 applications and processed nearly 6,000 of those. The branch processed over 1,000 applications requiring an onsite licensure survey within that same time frame.

In quarter two, 72 percent of applications requiring a licensing survey were completed within 45 days, which is the highest rate since prior to Covid-19 as of December 2022, 80% of long term care complaints are being completed within the 60 day mandatory required time frame. While final January 2023 data is not yet available, current progress indicates a compliance rate of roughly 85%. 79% in September, October, and November of 2022, which is up 61% in quarter two of fiscal year 21-22.

In the period since July 11, 2022 through December 2022, the center investigated and completed and closed 6,586 complaints. The center has completed 81% of its backlogged complaints that existed as of July 11, 2022. The center has reduced the net backlog by approximately 10,000 complaints since April of 2021. Only 933 long term care complaints remain in our backlog, meaning older than 60 days as of March 17,2023.

During calendar year 2022, the center completed just over 47,000 unique onsite inspections and investigations and continues its efforts to reestablish routine survey cycles while prioritizing attention on resolving the remaining backlog. As of February 23, 2023 the center's overall vacancy rate is 16.4%, which includes a 15.9% vacancy rate for our health facility evaluator nurses, which is an increase of roughly 13 percentage points since the beginning of the pandemic in 2020.

Los Angeles County our partners in Los Angeles County, their surveyor vacancy rate is 27%, which is an increase of 19% since fiscal year 19-20. This combined increase is due in part to newly authorized positions, but also because of increased retirements and separations. The center's nurse surveyors play an essential role in the center's activities. To address this critical issue, the recruitment, outreach, and onboarding unit within the center has implemented new recruitment efforts.

The surveyor shortage is not limited to California but is also affecting other states across the nation. It has become increasingly challenging to compete for registered nurses given the exponentially increasing demand and salaries in direct healthcare settings and among this limited clinical workforce.

Added to the demanding nature of the survey and investigative activities that the center is responsible for, the center is exploring opportunities to diversify the classification makeup of our field operations surveyors to include professionals who might not be registered nurses but can complement the nurse skill sets and allow our nurse surveyors to focus on elements of the job that require their clinical expertise. The center has made significant progress towards restoring normal operations as the state continues to recover from the public health emergency.

While staffing challenges are likely to remain given the nationwide nursing shortage, the center is developing and implementing strategies to adapt and to continue delivering critical licensing and certification services. Ongoing recruitment activities include utilizing social media platforms such as Indeed and LinkedIn to attract candidates as well as proactively contacting qualified potential applicants, increasing engagement, and guiding potential candidates through the complex state hiring process. CDPH recently completed a health facility evaluator nurse series recruitment campaign, with interviews occurring now.

And in addition, our LA County partners recently held two job fairs and made offers to more than 40 candidates for their nurse surveyor positions, which will significantly reduce the vacancy rate for LA County. I'll pause now for any questions.

No, just a quick comment. I appreciate the effort we're making to get higher and higher in removing those cases off the backlog. 82% of the complaints are being met within the time frame, which is great. Looking forward to that percentage growing. Senators, any comments or questions on your end? LAO, any comment?

Will Owens, LAO, we have no comments on the estimate.

Department of Finance,

Nick Mills, Department of Finance. Nothing further to add.

Great. Thank you so much.

We're going to hold the item open and move on to issue number 13.

Okay, issue 13. Facilitating projects to benefit nursing home residents. CHTQ is requesting an increase in local assistance expenditure authority.

Your name?

Oh, sorry. Michelle Bell. I'm the internal Operations Division Chief at CHCQ. We're requesting an increase in local assistance expenditure authority of 5 million in 23-24, 5 million in 24-25 and 3 million in 25-26 for the Federal Health Facility Citation penalties account.

CDPH has also requested provisional language to extend expenditure encumbrance authority through June 30 of 2027. CMP funds are penalties that are collected from nursing homes who are found to not be in compliance with federal regulations. The funds are then reinvested to support projects that protect or improve the quality of life of nursing home residents. This funding will allow CDPH to execute contracts for current and future multi-year projects in a timely manner.

I don't have any questions or comments. Senators? LAO, any comments?

We have no concerns with this proposal.

Nick Mills, Department of Finance. Nothing further to add.

Department of Finance.

Great. Thank you so much for that. We're going to hold that item open and move on to issue number 14 as it relates to AB 1502.

Okay. Skilled nursing facilities, change of ownership and change of management application requirements. CHCQ is requesting expenditure authority of 286,000 in 23-24, 24-25, and 25-26 from Fund 3098 to provide resources to implement the provisions of AB 1502.

This Bill revises the license, application review and approval process for SNFs, and CHCQ estimates that the Bill will increase current processing times for change of ownership and change of management applications, and as such, we're requesting two limited term AGPAs to perform this additional workload. However, it is possible that application volumes may decrease over time, but if application volume remains consistent, we may submit a BCP in the future for permanent authority.

Great. Thank you. No questions on my end, seeing none. LAO, any comment?

We have no concerns with the proposal.

Department of Finance.

Nick Mills, Department of Finance. Nothing further to add.

Perfect. Thank you so much, Michelle. We're going to hold the item open, move on to issue 15 as it relates to AB 2673

Hospice facility licensure and oversight, CHDQ is requesting three positions in 23-24 and ongoing, and 926,000 in 23-24, 759,000 in 24-25, and 698,000 in 25-26, and 615,000 in 26-27 and ongoing from Fund 3098 to implement the provisions of this Bill, which affect hospice facilities licensing requirements in California. AB 2673 increases CHCQ's regulatory oversight over hospices.

The Bill requires more stringent review of hospice applications, and as such, CDPH is requesting the funding equivalent of two limited term AGPAs for one year in the centralized applications branch to continue this additional workload. It's anticipated that the enforcement of AB 2673 provisions will lead to a decline in the volume of hospice applications over time. This Bill requires CDPH to adopt emergency regulations to implement the recommendations of the CSA hospice audit, and we're requesting one limited term AGPA for that workload.

And finally, the Bill establishes a complaint process for hospices, and we're requesting three permanent, full time health facility evaluator nurse positions to perform this workload.

Thank you so much. I know this is work that we really, really need to put a limelight on this situation, so I'm looking forward to getting anyone committing fraud or treating our individuals badly out of here. Senators, any comments or questions? LAO, any comment?

We have no concerns with this proposal.

Department of Finance.

Perfect, thank you. We're going to hold the item open, move on to the last issue with this Department. It's issue 16 related to SB 107.

Nick Mills Department of Finance, nothing further to add.

Gender affirming health care, CHTQ requests expenditure authority of 321,000 in 23-24, 24-25, and 25-26 from Fund 3098 to provide resources to implement the provisions of this Bill.

SB 107 may increase medical breach complaints by up to 5%, according to our estimates, and as such, we're requesting funding equivalent of two limited term special investigators for three years in order to perform this potential additional workload. However, if CDPH experiences a significant increase in this estimated workload, we may submit a BCP in the future for permanent position authority.

Perfect. No questions on my end. No questions. LAO, any comment?

No concerns with this proposal.

Department Finance, any comments?

Nick Mills, Department of Finance, nothing further to add.

Perfect. Thank you so much to the Department for their BCP and overview presentation today. Next we're going to listen to issue 17 and these are proposals for investments. The Subcommitee received five proposals that had a Senator sponsor. And first we're going to be hearing from Laura Thompson, who's going to Laura, who will not be presenting. Is there a Laura Thompson here to present on the overdose prevention and treatment navigation

Laura Thompson is walking from the parking lot now, I can present, if it's urgent,

Hi. Thank you, Madam Chair. Senators, Megan Subers, on behalf of the California Professional Firefighters CPF, along with Assembly member Grayson, Assembly Member Robert Rivas and I would like to thank Senator Dodd for bringing it forward.

I will come back to that. We're going to move on to the next proposal here. Then if Megan Subers is here, Megan will present on the California Firefighter Cancer Prevention and Research program. Up here, please. Hi, Megan.

On the Senate side are requesting $20,000,000, 1 time to be allocated to the California Department of Public Health to work with fire scope under the California Office of Emergency Services to establish a California Firefighter Cancer Research and Prevention program. The grants would be allocated from CDPH to the UC system to eligible institutions that could apply to CDPH to conduct research for this purpose.

Cancer is the leading cause of death among firefighters in the United States, and our firefighters are exposed to known, many known and suspected carcinogens in the line of duty. In June of 2022, the International Agency for Research on Cancer classified occupational exposure as a firefighter as a group one known human carcinogen. This indicates that a large body of scientific evidence has demonstrated a casual association between working as a firefighter and the development of cancer.

Here in California, firefighters have worked diligently for years to reduce exposures to carcinogens. Many things that were adopted by this Legislature to protect firefighters in updating their personal protective equipment, eliminating the use of toxic flame retardants, phasing out the use of firefighting foams that contain PFAS. However, the biomedical research community does not have a thorough understanding of the exposures and biological mechanisms that cause the elevated incidence of cancer among firefighters.

Building off of research conducted in other states, this program will be focused on California firefighters who have unique risks and exposures, which will be key to developing data driven driven interventions designed to reduce toxic exposures and reduce the rates of cancer in firefighters and improve treatment outcomes.

This funding will be used to provide grants to eligible UCs use the fire service community based participatory research model to recruit fire departments and firefighters to participate, and this amount of funding will also allow the program to be conducted over, ideally, a five year period so we can track the changes in their DNA methylation over that period of time and be able to come to some useful conclusions and impact this research for firefighters in California.

And so at the appropriate time, we would urge your support for this request. Thank you.

Megan, when do we anticipate if this were to go through, we could have some data on this?

So, good question. The study that's been conducted in the State of Arizona, it focuses on a very small cohort of firefighters right now, but ideally, they could do blood draws or urine samples in year one, year three, and year five.

And so between one and year three, you could likely have, based on the experts that I've talked to, you could have some data between year one and year three. And then ideally after year five, when you can do sort of that second go around with your same cohort of firefighters, you could have some real, identifiable conclusions.

Senators, any questions? LAO, any comment on this?

We have no comments on this proposal.

Department of Finance, any comment?

Nick Mills. Department of Finance. Finance has not evaluated this proposal, so we have no position on it at this time.

Great. Thank you, Megan. I'm going to hold that item open. Did Laura make it? Okay, we're going to move on to the third item. I'd like to over Zoom, welcome Allison Kurian to present California Cancer Registry.

Thank you, Chair, Members of the Committee. My name is Allison Kurian. I am a Professor of medicine and epidemiology at Stanford University and a practicing oncologist specializing in breast cancer treatment.

I am pleased to testify today and discuss the importance of protecting funding for the California Cancer Registry, or CCR, which is mandated by law to track every new cancer that occurs in California. The CCR is a population based cancer registry, and together with the National SEER program to which it contributes, is described as the eyes with which we see the cancer problem.

Without it, we would be blind to how a major cause of illness and death has affected the people of California and the nation for the last 50 years. The CCR serves as a vital backbone that anchors other data sources for cancer research. The CCR is exceptional in that it leaves no one out, whatever their age, race, ethnicity, gender, income, education, or other characteristics. Every patient's cancer journey is recorded.

I lead a project based on extracting data from electronic medical records, linking them to CCR data, and using advanced technologies, including artificial intelligence. This has led to high impact research, such as our recent finding that LGTBQ patients have higher mortality from breast cancer. The CCR is essential to understand whether the nation's investment in new treatments, vaccines, and genetic technologies is working for everyone.

My work with the cancer registry has revealed racial, ethnic, and income disparities in which patients receive and benefit from precision oncology advances and has helped us to target these disparities for improvement. The CCR is also crucial to help us understand how to find cancer early. I have used CCR data to identify which women benefit from novel breast cancer screening approaches such as magnetic resonance imaging, and this has led to a change in the national screening guidelines.

These are just some examples of the ways the CCR has contributed toward our victories in the fight against cancer. But today, this vital resource is under threat. State funding for the CCR has been on a steady decline due to declining revenues from Proposition 99 and lack of state investment in the upcoming fiscal year. The allocation of the tobacco tax revenue that funds the CCR is forecasted to have a shortfall of just under $1 million.

This cut comes on top of prior funding reductions that have resulted in flat funding to the three regional registries for a decade and increased funding pressures resulting from the implementation of electronic pathology reporting. Unless funding for the CCR is protected, California will be unable to maintain its 20% institutional cost share for the Federal SEER program, and California Cancer registry in its current form would come to an end. The negative impact on my work and that of other cancer scientists would be incalculable.

The CCR is truly the envy of cancer scientists around the country and the world, and it is also critically important to eliminating gaps in health equity. With the appropriate ongoing funding, we can sustain and strengthen the cancer registry, implementing changes that would provide real time data for researchers and clinical trials. Thus, I urge the Senate Budget Committee to take action to protect California's vital tool in our fight against cancer in this year's state budget. Thank you very much for this opportunity to testify.

Thank you so much for that thorough background. I don't have any comments or questions. Senators? does LAO have any comment?

We haven't evaluated this proposal, so we have no comments at this time.

Department of Fonance?

It's not evaluated this proposal, so we have no position on it at this time.

Thank you so much. We're going to leave that item open and see if Laura, okay, we're going to go on to the next one.

And I'd like to welcome up Ronald Coleman, who's going to be presenting on Health Equity and Racial Justice Fund.

The Health Equity and Racial Justice Fund is supported by over 200 organizations, and it's been prioritized and included in the Legislature's budget priorities for the last two years. We continue to urge Governor Newsom's support as it's critical for us to ensure that we have a grant program in place that will resource local work to address health inequities and improve health outcomes, while also addressing racism.

At its roots, the co-sponsors of the fund strongly support current investments in place for our local public health infrastructure and its workforce. However, community investments are a critical missing component to ensuring Californians have a comprehensive public health infrastructure to meet their needs. Communities of color and other low income and marginalized populations bore the brunt of the pandemic, both in sickness and in economic impacts.

Our communities continue to suffer higher rates of job and income loss, have higher rates of being unhoused, and are plagued with food insecurity. The history and legacy of racism, which persists, has resulted in an unfair burden of largely preventable, preexisting health conditions such as heart disease and diabetes. Our proposal would allow for health equity projects to be funded that focus on a wide range of issues that include, but are not limited to, food security, wide ranging health education, community violence, youth criminal justice, and environmental justice.

Projects funded from the Racial Justice Innovation Program would seek to transform behaviors, institutions, and systems that disproportionately harm historically marginalized communities and create barriers to opportunity. Projects could build community infrastructure for community engagement within governmental institutions or provide community-led equity, inclusion and cultural competency trainings for healthcare and public health stakeholders. Community-based organizations were key to serving constituents in each and every one of your districts before the pandemic, certainly ramped up to meet the need during the pandemic to reach communities the government could not, and will continue to attempt to reduce disparities and improve health outcomes in the future.

Philanthropic investments are not enough to meet the need, and the state has a responsibility to work to target and reduce inequities. So what are we going to do differently this year to ensure we get the Governor's support?

We've tightened up our proposal to ensure potential grantees of the fund will collaborate and coordinate on the ground with local public health jurisdictions and counties who are also tackling projects in our communities to target the social determinants of health. Community partnerships with counties and public health departments will strengthen our public health infrastructure generally.

This year, we've also worked to improve metrics related to the deliverables and outcomes for funding projects that would be overseen by an Advisory Committee administered by the Department of Public Health Office of Health Equity. Outcomes and deliverables will be quantifiable and results will be measured with clear objectives and goals. Lastly, we understand that it's quite a difficult year to get the Health Equity and Racial Justice Fund fully funded.

And while we respectfully urge the Legislature to invest 25 million in fiscal year 23-24 and fiscal year 24-25, our communities also respectfully demand creation of the framework for the Health Equity and Racial Justice Fund. This year, for the third year, we're presenting a fully cooked proposal which has been vetted by the Legislature, has received TA from the Department of Public Health's Office of Health Equity, and strongly supported by diverse and racial ethnic communities across the state.

We must ensure a program is in place to receive philanthropic dollars or future state funding to meet the pressing community needs. We thank our champion, Senator Eggman, and we urge the Legislature's continued support of the California Health Equity and Racial Justice Fund to ensure California has a strong, comprehensive public health infrastructure that includes and resources community led projects. Thank you.

Thank you. Senator Eggman, would you like to add anything to that?

No, just to thank them for their continued work and we'll see if we can get it done this year.

Perfect. No questions. I know we talked about this.

Great. We're going to hold that item open and I see Laura Thompson has made it. Do I say your name right? Thomas, sorry about that. Laura, you're here to present on the overdose prevention and treatment navigation?

Yes, that's correct. First of all, my apologies for being late. It was a fast drive from San Francisco, but not fast enough. So you're going way ahead of yourselves today. Chair Senators, thank you so much for hearing this proposal. It comes to you from the National Harm Reduction Coalition, the California Association of Syringe Exchange Providers, the San Francisco AIDS Foundation, which I represent, and other organizations interested in preventing overdose fatalities here in California. My name is Laura Thomas.

I'm the Senior Director of HIV and Harm Reduction Policy at the San Francisco AIDS Foundation. We are asking for $61 million in one time funding to be spent over four years for harm reduction programs around the state to be able to continue to provide essential overdose prevention services, infectious disease prevention services, linkage to care and treatment services that they have been providing for the last three years.

In 2019, the California Legislature created a pilot program to provide funding for all of the syringe access and harm reduction programs around the state. That program has been wildly successful beyond, I think, any of our original ideas, and we have substantial research at this point showing that the organizations that were funded under this California Harm Reduction initiative were able to reach thousands of people around the state who'd not previously been reached.

And in particular, and in light of the extraordinary overdose crisis that California is facing, these programs have served as the backbone of our overdose prevention programs around the state. What we know is that the California State funded Naloxone Distribution program distributes naloxone around the state.

The cherry funded harm reduction programs were only 8% of the total programs that were funded, but received 30% of the naloxone distributed through that program and reported a full 60% of the overdose reversals around the state that are credited to that program. So these small, scrappy programs are punching way above their weight when it comes to actually stopping overdose fatalities in this state. The original pilot program is currently scheduled to end with general fund dollars at the end of June of this year.

The state office of AIDS has found some funding to continue the programs through the end of the calendar year, end of December. But without additional funding, these programs will end, and with it, the ability to ensure that naloxone is getting into the hands of people most likely to be at the scene of an overdose and most suited to reverse overdoses.

So this is a workforce initiative, this is a public health initiative, and at its core, this is the best overdose prevention program that we have going in the state right now.

Thank you so much. I don't have any questions for you. Senator Roth, go ahead.

Not a question, just a comment. You know we've spent a lot of time, it seems to me, over the last few years on this issue, fentanyl in particular, for good reason. And I just want to thank you for what you do. It requires both the private sector and the public sector to step forward. It's a team effort, and I appreciate your success in the past. I anticipate your continued success in the future, and I just want to thank you for it.

Yes, thank you very much and, you know, I've been-- as some of you know, I've been working on overdose prevention in this building. Thank you, Senator Eggman, for your enormous leadership on this issue. And being able to have some state funding into these programs has made such an incredible difference particularly in bringing programs to parts of the state that never had syringe access before.

I think there are programs in all of your districts and, you know, one of our original initiatives or intentions behind this was to bring some geographic equity to the State of California where previously if you lived in San Francisco or Oakland or Los Angeles, you had access to these services. But if you lived in Lake County, you know, we had somebody who was out of the goodness of her heart running these services out of literally the trunk of her car.

And the difference that this funding has been able to make is people have been able to hire staff, they've been able to do this full time, they've been able to reach communities, reach parts of the state, whether it's, you know, Plumas County, San Bernardino, parts of San Diego that were never reached before just throughout the entire state. So it's been a very cost effective investment in services.

Well, I appreciate you making that drive for 15 minutes. I know this is very important, so thank you so much for that.

Of course I'm always happy to come up here. I just thought it was going to be later in the day.

We are going faster than usual.

That's good. Sign of a good chair. Any other questions?

No, that's all.

Thank you very much.

We're going to hold the item open and we're going to listen to our last proposal for investment. I welcome on Zoom Dr. Diane Nugent and Mary Brown to present on sickle cell disease network transitional funding.

Good afternoon Madam Chair, and thank you for having us. I'm Mary Brown, President and CEO of the Sickle Cell Disease Foundation. We are a community based organization that's been in existence since 1957. Additionally, the Sickle Cell Disease foundation works with the Department of Public Health's Newborn Screening program and have been providing hemoglobin trait follow up counseling services since 1992. Today, I'm advocating for the 6000+ adults living with this life threatening chronic illness.

Life expectancy for a person with sickle cell disease in California is 20 years shorter than sickle cell disease mortality in the greater United States. Being a native of California, I knew we could do better. And in 2019, $15 million was appropriated to establish five comprehensive sickle cell adult clinics. Today we brag that we have opened 12 clinics around the Golden State.

We were recently informed that a 30 year old young woman was sent home to die because her liver had been destroyed due to an iron overload. She was not recommended for a liver transplant. However, the network got busy and within a week of her receiving a death sentence, she received a liver and is currently in rehab doing very well, the care these patients receive are life changing. They renew hope, and they offer more than the prospect of waking up every day in a struggle to live.

Therefore, I strongly support a one time appropriation of $11 million in fiscal year 2023-24 to bridge the gap to ensure the integration of Networking California for Sickle Cell Disease into CalAIM. Thank you. Dr. Nugent?

Thank you, Mary. And thank you, Madam Chair and Senators. Like Mary, I'm a fourth generation Californian, and I've been taking care of sickle cell patients for 30 years now, and I'm very proud of that. We were one of the first states to do newborn screening for sickle cell.

We identify children with sickle cell from the moment that they're born and get them into the greatest care, our CCS centers, and we keep them there for 18, 21, sometimes up to 25 years, because we know when they leave, they have nowhere to go. And it's a huge investment for the state to identify these kids. It's the most common genetic disease that we screen for to take care of them, and only to have them go to a world where there's no adult clinics.

And in 2018, Mary and I, we are part of the CDC grants that are awarded here in California. We were identified as having the shortest survival, as Mary stated, and we got sick of just looking at data and we said, we have to act. So SB 74, the state, invested for us to build five clinics in three years. I'm proud to say that each year, four clinics were established. We finished signing on the last clinic, which will be open at Arrowhead Regional next month.

These centers provide preventive care. Pain and anemia are only the superficial signs of progressive total body organ failure. Brain, kidneys, and throughout. If they just-- Adults need the same preventive care that children do, and if we do that, they have a chance to live full lives, pain free, productive, wonderful members of our community, contributing to art, science, all of these things. But right now, this young woman was 29.

She had been in pediatric care, but for five years was being seen by someone who just gave her blood and pain medications, let her become iron overloaded, and basically sent her home to die. Totally wrong. And yet, that's what every child that transitions from our clinic has to face in our state. Until we got these clinics started. In the first year, the first 38 patients that we had, the CDC documented that we saved one million dollars in length of stay, hospitalization, ER utilization, EMT utilization.

This applies to our military families as well. They now have a resource to go to, and we're up to 1000 patients, but our goal is 4000 to scale up. We're caught in a donut hole because CalAIM application is just coming up now. So we just need some dollars for transition to a sustainable model so that our patients can get preventative care, decrease death and morbidity, improve and empower our patients to get their treatment in the ambulatory setting and to drive down cost.

In a year where we're totally short, we think we'll be able to show a $50 million savings return on investment in these clinics in this year alone with the clinics that are now up and running. So thank you for your consideration. Thanks for giving us this rope hold to make our way through over to sustainability. It's a partnership completely with the community to address the socioeconomic problems and we can't do it without the clinic, can't do it without the community. And that's what Networking California is.

And just thank you for your belief in us and for caring for this underserved population in our state.

Thank you so much, Dr. Mary, for that presentation. I don't have any questions for you. Senators, do you have any? Great. I appreciate you joining us. Have a great rest of your day. We're going to hold that item open and that is all the items we have on agenda. We're going to now move on to providing public comment for anyone who wishes to provide a public comment. As a reminder, today's participant number is 1 (877) 226-8163, access code 7362834. We'll begin with people here in person, room 1200.

Please proceed.

Good afternoon, Craig Pulsipher on behalf of Equality California in support of item 16 related to implementation of SB 107 around gender affirming care and the stakeholder proposal for overdose prevention and treatment navigation.

Hi, my name is Wendy Bloom and I'm providing public comment on behalf of the HERJ Fund and the communities we serve. I've been a registered nurse at UCSF Benioff Children's Hospital in Oakland for 36 years and I know firsthand, as a frontline healthcare worker in inner city pediatric hospital, the multiple ways we are not serving. We're not able to meet the needs of all of our at risk families, many whom are immigrants and families of color.

I know this is a challenging budget year, but please prioritize the communities that need the extra financial support to remain healthy. Investing in prevention and other community health services with many of our partners through the HERJ Fund will be a wise, financial and forward thinking decision. The COVID pandemic has taught us how critically important it is to have accessible, welcoming and fully funded community based healthcare organizations. Thank you so much.

Thank you.

Hi, my name is Shilo Jama. I'm here on the Harm Reduction Initiative. I'm a survivor of an overdose and when I had an overdose at 17, if I would have died, you would not have been able to see the adult here. Today I'm the Executive Director of Safer Alternatives through networking Education, the Needle exchange program in Sacramento that goes and delivers Narcan and other supplies to encampments and our life saving things. We've saved thousands and thousands of people. And Rachel Anderson, our founder, has recently passed. Please don't let her work go away.

Thank you so much.

Hi, my name is Kristen Van Dilde Young. I also work for Safer Alternatives through networking and education, which is a harm reduction organization located right here in Sacramento. I run our medication assisted treatment program, which includes medication like buprenorphine or suboxone that treats opioid use disorder. Our clinic is Low barrier due to this funding.

This means we utilize telehealth communication, which allows us to reach much larger network of folks who are seeking services, patients who may not be able to find transportation to come to our location, things of that nature. Thanks to grants and funding, we are a free clinic, which means patients do not have to pay to be part of our program. We serve in large majority marginalized populations, including black, indigenous, people of color, Low income and unemployed folks, and people experiencing homelessness.

Without this funding, we would not be able to operate as a free clinic. Our doctors specialize in addiction medicine, which is imperative to patients who have faced stigma in other medical environments and creates an environment where patients feel safe and instills trust between patients and physicians. And above all else, our program saves lives and without access to our Low barrier treatment, Members of our community would continue to die at alarming rates. Thank you so much for your time.

Hello. My name is Anna Vasarev and I'm here to provide public comment on behalf of the Public Health Institute. We are proud to be one of the over 200 organizations statewide that supports the creation of the Health Equity and Racial Justice Fund.

We thank the California Legislator and our champion, Senator Dalamantes Egment, for being strong supporters of the Fund for the past two years and urge that you include the establishment of the Fund for future appropriation in your budget. This year, we asked for an initial appropriation of $50 million over two years to pilot the fund's implementation. Each year we spend billions of dollars treating preventable diseases, but have not succeeded in changing the way that community in changing the community conditions that drive them.

Black, Latinx, Native Hawaiian, Pacific Islander, Asian American, Native American, and other Low income populations bore the brunt of the pandemic, largely due to long standing structural inequities in addressing health disparities. However, cbos play a vital role in breaking down the traditional walls of health care. They were critical partners in increasing Covid-19 testing, contact tracing, and vaccination in communities of color. For all of these above reasons, please support the creation of the health Equity and Racial Justice Fund. Thank you.

Good afternoon, chair and Members, Kathleen Soriano with the University of Southern California. We are pleased to support ongoing funding for the California Cancer Registry, which was discussed as a proposed investment. USC is one of the three regional registries that works directly with the CCR, servicing Los Angeles County, providing critical support on local instances of disease. USC supports all efforts to ensure ongoing support for from the state General Fund to protect the registry and respectfully disagrees with any proposed cuts.

Ongoing funding for the registry will protect and strengthen the cancer registry and help maintain ongoing federal funding that is vital to the program's ongoing survival. We look forward to continuing working with the Legislature and the Department of Public Health on this important issue, and we urge your support at the appropriate time. Thank you.

Thank you so much. Hello. My name is Elizabeth Loseva. I'm a registered nurse, Riverside Community Hospital. Patients in the ICU, they require our patients that we see have life threatening injuries and suffer trauma and require constant monitoring. My patients needs constant monitoring, and when things change, patient situations, their health status declines quickly in the ICU and they become unstable. A critical patient if I start with two patients and I'm in ratio, and one of my patients, situation changes quickly, which oftentimes happens.

We need staff, additional staff to pivot for that critical change. In my unit, I had an instance where I was caring for two patients. I started my shift with a 19 year old who rear ended a back end of a semi and suffered severe head trauma. And we were monitoring pressures in his head. To increase in the pressures could lead to permanent brain damage. My other patient initially was stable, 67 year old female, and his condition declined and required more of my attention.

We didn't have the staff to pair him as one patient to one nurse. And at that moment, I was put in a situation where I need to decide, who do I give my most attention to in this critical moment? And I focused on the 19 year old kid to try to give the best care I could to prevent any brain damage with high pressures. We monitor pressures in the head with head injuries, and his was critical levels.

And as a result of my attention being focused mainly on him, my elderly patient went into respiratory distress, meaning she was having issues breathing and required emergent intervention, which she ended up being intubated and perhaps could have been changed if we had more staff to intervene. It's very important with these changes that there's adequate staff, especially in critical times.

And so my point is that we have safeguards, measures in place to safeguard our, our nurse to patient ratios, and we have the enforcement mechanisms they already exist into law, but the law is meaningless if we don't have this enforcement. So we need CDPH to enforce our nurse to patient ratio laws. Thank you for your service.

Good morning. Afternoon. Now, I'm Joyce Powell. I'm a registered nurse at Providence St. Joseph's in Burbank. I have over 20 years experience there. And earlier today we heard that La County had a 27% vacancy rate for its nurse evaluators. And having difficulty finding experience and competent RN pool to choose from, I'm here to ask that the CDPH and their nurse evaluators have what they need to hold the hospitals accountable. ER is a gateway to the hospital. When we're understaffed, as we often are, it creates an avalanche of pressure on departments throughout the whole hospital. Our patients arrive in all sorts of conditions, some of them quite severe.

It's our job, my job, to start the process of determining what kind of care they need and where they must go and who else needs to be involved. But when we're not able to take our time and properly execute and evaluate all the steps and tests, that process is slowed and other staff and their patients are negatively impacted. The work that gets done in the emergency Department also involves bringing in staff from other units.

For example, a patient who arrives in the emergency room who is septic can take over an hour to stabilize. We may need to call in other rns from other departments to help us even find an iv with an ultrasound. Doing so can mean a matter of life and death. If there isn't enough ancillary staff to transport patients, like moving a 200 pound individual from a gurney to a CT scan, it's a matter of life and death.

There aren't enough specialists to conduct the highly technical work or other patient care is delayed. Backups due to understaffing in the ER pour out into the hospital lobby. There's a chaotic mixture of seriously ill or injured patients wait alongside with those of minor problems. This is a terrible situation, one of which I've witnessed many times. Patient conditions have deteriorated or worse yet, they've lost consciousness in their waiting room seat.

Others with kidney stones have writhed in pain while waiting to be seen with the pressure put on the nurse to determine, is this a stone or a dissecting aortic dissection? It's a life and death situation and we need to make those decisions. These scenes, which play out in the full view of visitors, family Members and nonmedical staff, create enormous anxiety for all the patient who has cut his finger off.

With a kitchen knife might not be as critical as the one next to him who is showing signs of a stroke. But he doesn't know that he is simply in pain and wants to be seen as soon as possible. The buildup of fear, frustration, and anxiety is what leads to workplace violence perpetrated against healthcare workers. As an ER nurse of many years, I know and accept a certain level of uncertainty, even chaos in the ER. It's the nature of the job.

The problems we face today, however, are fixable. We need hospitals and the California Department of Public Health to support us by monitoring acuities and enforcing safe staffing throughout our hospitals.

Hello. My name is Anna Seja. I am a Member of the SEIU. I am here today to ask CDPH to enforce nurse to patient ratios. I am an ICU nurse in Kern Medical in Bakersfield.

I have been a nurse there for seven years. I love what I do, but it's really tough to see a lot of my coworkers who are continuing to be burnt out from the lack of proper staffing and ratios. I've seen a lot of older nurses quit, leave the bedside because they just cannot handle it, dealing with things from the pandemic. I am in charge of training new nurses, and I see that they're not well supported.

And being out of ratio just isn't something that could be solved if we are held to those standards. It's very unsafe when we're out of racial all the time because who suffers? Our patients. And as nurses, our main job is to advocate for our patients. Me and my colleagues have called CDPHD many times, too many times to count. I have not seen any fines in my hospital.

So hospitals are continuing to violate nurse to patient ratios, and we need CDPH to hold them accountable to help protect our patients, prevent burnout, and sustain our healthcare system. Thank you.

Hello and Happy Thursday, government officials. My name is Bronze Courtney. I represent an agency called HepAC, also known as the HIV Education and Prevention Project of Alameda County. We are a Black-led organization in the City of Oakland and does work in Contra Costa County. We do non clinical setting work. So we go out to the trenches, the encampments, and we provide harm reduction services. One of those services is called the Black Drug Users Health Hub, where we get people linked to medication assistance treatment.

The California Harm Reduction Initiative is vital to us providing these services in the black community, which, as the data shows, is detrimental. Right. Our black folks are dying in Oakland. Due to overdose and all kinds of other comorbidities.

So please continue funding for the California Harm Reduction initiative so that we can continue to work in the black community to make sure folks get linked to mat, get linked to HIV, primary care, and get all the services that require them to stay healthy, alive, and able to thrive within the black community. Thank you so much, and please keep this funding going.

Good afternoon. Hi, my name is Liane. I'm the co Executive Director of Harm Reduction Services, which is a small nonprofit here in Sacramento county. I'm also speaking regarding the CHRI funding. We have 12 staff, and last year we gave out 21,000 doses of naloxone. We have 1934 reported reversals from last year alone. We could have easily given out twice that amount of naloxone. There's that need in our community.

We also provide other services like case management and testing and syringe access and safer sex supplies and all of that stuff. And we host a weekly free medical clinic that provides reproductive care as well as primary care to our folks. We also refer folks into Matt. Last year, we referred 200 people into medication assisted treatment for opiate use disorder.

So I ask that you continue the CHRI funding and that you expand it because there's so much more work to do and there's so much more need in California. We really need it. Thank you so much.

Hello, I'm Kenneth Beasley. I'm also from harm reduction services here in Sacramento and just here to support you all continuing the funding of CHRI program. I know exactly what a fentanyl overdose looks like. I personally reversed an overdose using naloxone from a harm reduction program. As a matter of fact, I reversed many people who have overdose right in front of me and friends.

But many people are afraid to call 911 because they don't want to go to jail or see someone else go to jail. Emergency rooms are a terrible place for drug users at times as well. Medical staff are overworked, and when they run into cops there, they're treated in a way that's unkind and not respectful sometimes. Some are nice, but some can be terrible. In emergency rooms, it's important that we have naloxone and get it out to the people out there where they're at.

You know what I mean? Out there in the camps and whatever. So they know, because they're the first ones to get there. And there's been, like my coworkers, Liane said, that there has been. We've overturned thousands of reported overdose being overturned, and we need to have that out there in the community where people got. We need to continue to CHRI. Please continue to CHRI funding and make sure that these people out on the front lines are able to have naloxone where they're at.

And like I said, we passed out 21,000 doses last year. And like Liane said, we could have did twice that easily. And the number of lives that have been saved because of that are in 1000. And so please continue to CHRI Grant, and we appreciate your work. Y'all do.

Thank you so much.

Good afternoon. My name is Philip Lassiter. I appreciate the opportunity to speak on behalf of the overdose prevention initiative. I am a manager with the San Francisco AIDS Foundation Syringe Access services program, primarily involved with the mobile sites that we have throughout our city in beautiful San Francisco. But rather than come to you with the perspective of a provider, I would like to offer the perspective of someone who used drugs for 26 years.

So I am living proof of the importance and legitimacy of harm reduction services and overdose prevention services. This initiative will extend the life expectancy of people like me, enabling us to move forward into a life full of opportunities and possibilities. So please help us to continue to offer evidence supported life saving services. Thank you.

Thank you so much.

Good afternoon. Glenn Backes for the National Harm Reduction Coalition. In brief, the naloxone distribution program by DHCs distributed over 2 million doses and reported 130,000 reversals from those doses. Harm reduction programs accounting for 59% or 78,000 reversals. These small, scrappy programs are going into homeless encampments, into SRO hotels, into motels, and delivering the services that are needed.

And they're bringing people out of encampments, off the street, out of hotels, into drug treatment, mental health care, medical care, doing HIV and hepatitis C testing and screening, and providing HIV and hepatitis C prevention materials. They are your best, most cost effective in this moment of a humanitarian crisis. The fentanyl and homeless crisis is nothing less than a humanitarian crisis. Please support these programs that are incredibly effective. Thank you.

Thank you for allowing me to speak again. This is another issue that is near and dear to my heart. I didn't know was on the agenda. Like I said, Wendy Bloom, registered nurse at Children's Hospital in Oakland, and I've had the privilege of caring for sickle cell anemia patients my whole career. I actually have unfortunate that we have a very specialized clinic at CHo that serves adults as well as children with sickle cell anemia, and it makes a huge difference in their life. They're a very underserved population. They need services hugely. So I'm speaking in support of you funding the sickle cell anemia clinics. Thank you.

Thank you so much. See no more in person comments Moderator.

Madam Chair, if I could just make one point just it being social work months that you made today, just like to point out the work of Glenn Backes, who is one of our lobbyists, but also an MSW, a Member of our tribe. Thank you so much.

Seeing no further public comment moderator if you could please queue the individuals waiting to provide comment over the teleconference and you could let me know how many we have in queue.

Thank you, Madam Chair. Currently we have 19 in queue, ladies and gentlemen. To comment, if you have not already done so, please press one, then zero.

If we could kindly limit our comments to no more than a minute.

More than a minute. First we'll go to line number 28. Go ahead, please.

Hi chair Members Kathy Mossberg speaking on two of the proposals for investment. Representing both APLA Health and California Hepatitis alliance, we wish to voice our support for the overdose prevention and treatment navigation item. These dollars will build on a successful pilot and are urgently needed.

Without continued and expanded investment in these programs that provide Low barrier overdose prevention and other healthcare services at harm reduction sites, California's overdose crisis will continue and representing the Public Health Institute, PHI supports the request to provide the California Cancer registry with $6.5 million of much needed funding.

As noted by Dr. Curian, the registry is a vital part of California's cancer surveillance system, and the research it provides is critical to if we want to find cancer cases earlier in disease stage and ultimately work to eliminate them. Due to declining resources from Prop 99 revenues that are continued that continue to forecast to fall year over year, we need the state to step in and provide General Fund Dollars to maintain this much needed program.

We encourage this Committee to support these additional resources and hope to work with this Committee to ensure these programs are funded in the final budget. Thanks for your time today. Thank you so much.

Next caller, next is line 44. Please go ahead.

Thank you. Chair and Committee Members Eliana Bender, representing Glide, a social service provider in San Francisco. I'm calling to support the request to Fund overdose prevention, outreach and treatment. Navigation Glide Harm Reduction Program is the recipient of the California Harm Reduction Initiative, or CHRI, which is ending this year and needs to be continued in a different form through this funding request, our program helps people access medically assisted drug treatment, the most effective means of helping a person reduce or stop using fentanyl, heroin or other opiates.

Our team also gets naloxone directly into the hands of people who use drugs because they are the people who need it the most and who are most effective at reversing overdoses. We urge you to not let these grants lapse. Programs across the state, on the front lines of the overdose crisis, desperately need this funding to continue saving lives. Thank you. Thank you so much. Next caller.

Line 54, please go ahead.

Good afternoon, Madam Chair Members. My name is Oussama Moukeddem and I serve as the Director of state policy for Public Health Advocates. I'm here today as a part of the over 200 organizations expressing support for the health Equity and Racial Justice Fund. This multi year initiative was born during the Covid-19 pandemic out of the pressing need to meet communities where they're at oftentimes hard to reach for our state agencies in order to get them the resources they need to live healthy lives during crises.

Through the $50 million investment over two years, the Fund, along with its accompanying infrastructure, was carefully crafted to implement upstream solutions to racial and health inequities that are faced by underrepresented communities in California, which are often not accounted for in our response. This would be done by solidifying the partnership between state agencies and trusted and culturally competent community based organizations which could help us reach these communities and get them the resources they need to challenge the public health issues they face, ultimately saving countless lives.

Many lives were lost during the pandemic purely because information and resources didn't reach their communities fast enough. Despite the speed at which community based organizations stepped up to the plate to advocate for resources for their communities, our lack of infrastructure and emergency response created a reactive, not preventative approach. The Health Equity and Racial Justice Fund is the preventative approach and investment in our infrastructure.

We realize that we're in an uncertain financial times as a state, but as someone who grew up in a Low income, underrepresented community during the last recession, I guarantee you that these communities will suffer the consequences for a much longer time than our state budget if we don't make this upstream preventative investment now. Thank you so much for your time and I urge you to support this Fund.

Thank you so much.

Next caller, line 36, please go ahead.

Hi, my name is Marlene Espinoza, and I'm calling on behalf of the Sickle Cell foundation to support the $1 million budget asked to sustain the comprehensive and life saving care being provided to adults with sickle cell through the network in California for sickle cell care. Thank you.

Line 33, please go ahead.

Hello, my name is Jessica Smith. I'm calling on behalf of National Harm Reduction Coalition to support the request to Fund overdose prevention outreach and treatment navigation the funding will support the workforce best suited to distribute naloxone and fentanyl test strips and address overdose in our state, which is those who work at harm reduction and CERN services programs. Sops are one of the only services that people who use drugs trust as they are Low barrier and free of judgment and stigma.

People who use drugs are on the front lines of addressing the overdose crisis and need to be equipped with the tools and resources like naloxone test strips, overdose prevention education and treatment options to keep saving lives. As a Ta provider for the California Harm Reduction Initiative grant, I've seen firsthand the way that the 37 funded programs have improved and expanded overdose prevention services and treatment. Navigation several programs hired staff for the first time. They served the hardest to reach drug users in the state.

They created culturally responsive services such as the Black Drug Users Health Hub in Oakland and an indigenous mat program on the Hoopa reservation in Humboldt County. Humboldt County is where I live and they achieved all of this during COVID The funding will ensure that these programs can continue to address our state's overdose crisis in a compassionate and cost effective way, so we really hope that this funding can continue. Thank you. Thank you.

Line 38, please go ahead.

Hello, my name is Mar Velez with the Latino Coalition for our Healthy California. Our mission is to protect and advance the health of Latinos in our state, and that is why LCHC strongly supports the Health Equity and Racial Justice Fund, which will address the social determinants of health through community led projects. Specifically, it will provide resources to community based organizations, clinics and tribal organizations that are working to improve the health and wellness of our state's most underserved communities.

Cbos are the pulse of our community and our ask of 50 million over two years will ensure that local communities are given support to advance health equity locally and outro systemic racism within our state. We thank the Legislature for being a strong supporter of the health equity and Racial Justice Fund for the last two years and urge you to again include it in your budget to advance positive health outcomes. Thank you so much. Thank you.

Line 35, please go ahead.

Greetings. My name is Tana Lepule and I'm the Director of Native Hawaiian and Pacific Islander affairs at the Asia Pacific Partners for Empowerment, advocacy and leadership. Or appeal for short. I'm calling on behalf of appeal in support of the Health Equity Racial Justice Fund. As we all saw during the Covid-19 pandemic, immunity based organizations are indispensable partners in identifying the most pressing health equity and racial justice issues in our communities and developing solutions to address them.

We know our neighbors, our distinct needs. We are fluent in every language spoken in California and know how to implement effective solutions that will work at the local level, serving as frontline voices in cities, counties and to our beautiful state. Honor the great partnerships, lives lost and survivors that have come out of this pandemic and advanced the Health Equity Justice Fund our community.

Thank the Legislator again for their support over the past two years and urge you to again included in the budget and advance positive health outcomes. Thank you very much for your presence.

Thank you so much.

Line 43, please go ahead.

Hi, my name is Amy Lieberman. I'm calling from Los Angeles and I'm calling to support the request to Fund harm reduction initiatives. I volunteered a harm reduction program that works directly with folks who are unhoused in downtown LA and the grants from the state have helped increase the staff, including hiring some of our participants, the people who really know best what needs to be done and where.

It's great that the state is going to continue funding naloxone, but I don't see where they're getting the funding to actually get the naloxone to the people who need it most, the people who are using drugs and are best equipped to respond at the scene of an overdose emergency. Please continue the CHRI funding. Thank you.

Line 55, please go ahead.

Good afternoon, Madam Chair and Members. This is Jamie Morgan with the American Heart Association in support of item 17, the Health Equity and Racial Justice Fund. This golden and innovative Fund would provide direct resources to clinics, community based and tribal organizations to address the most urgent health and racial justice issues in their communities.

This funding would mean organizations could take action to address health inequities at the local level by tackling nutrition security, housing security, health promoting environments and the social determinants of health and reduce the unequaled burden of the leading causes of death and illness, like heart disease and stroke in children and adults. Thank you for your time and we urge your support of this Fund. Thank you.

Line 60, please go ahead.

Good afternoon, Tiffany Phan on behalf of Vertex Pharmaceuticals, we want to express our support under issue 17, the Sickle Cell Disease Network. Transitional funding the funding is vital to serve the sickle cell disease community in our state and will result in a great cost savings for the state in emergency health for cost. Thank you.

Line 14, please go ahead.

Hello, my name is Graschelle Hipolito. I'm calling on behalf of Little Manila rising in Stockton, California, in support of the Health Equity and Racial Justice Fund that is well supported by over 200 organizations that advance health equity agendas for the state's most underserved communities.

We urge you to again include this Fund in your budget to sustain programs for cbos doing the work on the ground directly immersed in the community, such as our organization Covid-19 testing and vaccination sites, free and accessible holistic health clinics that bring culturally responsive and collective healing to minority groups, as well as our environmental justice nurse that provides at home asthma mitigation and air quality sensors in neighborhoods disproportionately affected by pollutants and victims of redlining and environmental racism in Stockton.

Thank you to the Legislature for supporting the herdge Fund for the last two years and for the opportunity to voice our support today. Thank you.

Line 61, please go ahead.

Good afternoon, Madam Chair and Members. My name is Vanessa Teran, policy Director, calling on behalf of the Mixteco Indigena Community organizing project located in the California Central coast. I'm calling in support of the Health Equity and Racial Justice Fund. Our organization empowers indigenous community Members, often those historically marginalized and disenfranchised, to raise their voices in advance programs and policies that address, adjust and preventable inequities.

We really want to thank the Legislator for being a strong supporter of the Fund for the past few years, and we want to urge you to include it in your budget again to advance positive health outcomes. Thank you so much. Thank you.

Line 62, please go ahead.

Andrea Rivera, on behalf of the Having Our Say Network. Having our say is a network of over 35 community based and grassroots organizations across the State of California. Having our say has prioritized the health Equity and Racial Justice Fund and we appreciate the leadership of Senator Eggman on this issue.

The Fund is a bold and innovative program that is supported by over 200 organizations across the state that would dedicate $50 million over two years to community based organizations, community clinics and tribal organizations so that they can continue to do the work to improve the health and well being of our state's most historically excluded communities through community informed health solutions.

We thank the Legislature for being a strong supporter of the Health Equity and Racial Justice Fund for the past two years, and we urge you to again include it in your budget to advance positive health outcomes for all Californians. Thank you. Thank you.

Line 48, please go ahead.

Sorry. Line 48, please start again. Please start again, line 48.

Hello, good afternoon. My name is Maddie Ribble and I am calling on behalf of the Children's Partnership, a statewide organization working to advance child health equity in California, and I'm calling today in support of the Health Equity and Racial Justice Fund budget request. We know that as a result of persistent structural racism, children of color in California disproportionately face barriers to good health, from lack of access to healthy and affordable foods, to exposure to violence, to exposure to harmful environmental pollutants, to name only a few.

In order to solve these problems, it's essential that we invest in the community-rooted and community-led organizations that best know the challenges and the solutions for their own communities. That is exactly what the Health Equity and Racial Justice Fund will do, and it's past time that we put this approach front and center in our public health infrastructure. We greatly appreciate the Legislature's support for this fund over the last two years, and we urge you to continue support in this year's budget. Thank you very much.

Thank you.

Line 63, please go ahead.

Hi, my name is Raven Hoopes. I'm calling in from Redding, California up in very northern Shasta County. I'm calling to support the request to fund overdose prevention, outreach, and treatment. Navigation I work at a clinic up here with a harm reduction program. We assist people in accessing and also provide life-saving services and resources. Specifically speaking on naloxone, our community is mostly rural with a very large geographic region.

Without our outreach and navigation team directly reaching into these hidden communities, several hundreds of people in Northern California will suffer and many will die. There are not very many services up here, especially ones that people trust, and our folks are getting in directly where people are not getting reached. Without this funding, that doesn't happen. So please do not let these grants lapse. We are on the front line of the overdose crisis and this funding will ensure that we can continue to save lives in California. Thank you.

Thank you so much.

Line 21, please go ahead.

Hello, my name is Stephanie Harris Mercado, physician assistant in the Central Valley, and I'm calling on behalf of the UCSF Fresno Adult Sickle Cell Clinic in support of the 11 million budget. Ask to sustain the comprehensive and life-saving care provided to adults with sickle cell disease through networking California for sickle cell care. Thank you.

Thank you so much.

Line 64, please go ahead.

Hi, my name is Edith from Riverside, California. I'm calling to support the request to fund overdose prevention, outreach, and treatment navigation. I work with Inland Empire Harm Reduction. We're a small harm reduction service with only four staff, one part-time, three full-time. In 2022, we distributed 12,500 plus doses of naloxone that resulted in 470 reported of reversals, not just the numbers, most likely higher. We can do much more with your support.

We can need funding for staff to shoot naloxone fentanyl test strips and provide overdose prevention education. We also need navigators to support people who are interested in entering treatment. We need the funding and we're underfunded as it is. I think 46% of CDC recommendations. Thank you.

Thank you.

Line 50, please. Go ahead.

Hello, my name is Rachel Bhagwat and I'm the deputy director at the California Alliance of Academics and Communities for Public Health Equity, or the alliance, which is a program of the Public Health Institute. We're testifying in support of the creation and proposed appropriation towards the Health Equity and Racial Justice Fund. The alliance is a statewide partnership between community leaders and academic experts from California universities, schools, and programs of public health.

We and our academic partners work with countless organizations who profoundly impact their neighbors' health on shoestring budgets. Those organizations and leaders have unique insights into the solutions that work on a local level, especially programs that support the health of California's most vulnerable groups. Creating additional, flexible, and sustained funding in partnership with local government could move the needle on health equity in the way that we failed to do for decades. Thank you for your continued support of this fund, and we urge you to keep pushing and include it in your budget again this year. Thank you so much.

Thank you.

Line 45, please. Go ahead.

Hello chair Members Autumn Ogden-Smith with the American Cancer Society Cancer Action Network, speaking on issue 17, the California Cancer Registry proposal for investment. The California Cancer Registry is a critical source of data and research that contributes to the advanced knowledge, enable scientific discoveries, and develop policy initiatives that help with the implementing interventions in the fight against cancer. Appropriate, ongoing funding is the only way that we can ensure this important work continues, and for these reasons, we urge your support of funding the California Cancer Registry in this budget.

Thanks.

Line 41, please go ahead.

Hello, my name is Sarah Perez and I'm calling on behalf of Ventura County. We are part of the Having Our Say Coalition and we are calling in support of the Health Equity and Racial Justice Fund. So we have spent billions of dollars trying to treat diseases, but have not succeeded in changing community conditions that drive them. This approach will continue to perpetrate health disparities until we are willing to challenge a status quo that is not working for people of color or underserved communities.

We also want to increase culturally linguistic appropriate, community based crisis responses and care options as alternatives to politicizing and other crucial responses. Thank you so much for the Legislature for being a strong supporter of the Health Equity and Racial Justice Fund for the past two years, and we urge you again to include it in your budget to advance positive health outcomes. Thank you.

Thank you.

Line 53, please go ahead. Five, three.

Hi, my name is Audrey Chavez, she/her/ella. I'm from Bakersfield, California. I'm with Bakersfield's AIDS Project, one of county's syringe exchange programs. We are three years old. We want to say thank you. We want to say thank you for having this funding for overdose prevention and for treatment, and we want to encourage you and implore you to continue it as well as to augment it. We have been part of an AIDS service organization. This is our 30th year.

We served on the AIDS advisory board here locally for 25 years until it dissipated. And needle exchange was always on that agenda until three years ago when we just went out of the area, partnered with other syringe exchange programs and brought it here. It is amazing. It is amazing to see this population understand and know that they have a voice that they deserve.

Thank you so much for calling in. Thank you.

Line 12, please go ahead.

Good afternoon, Chair. My name is Meron Agonafer, the policy and legislative affairs manager with California Black Health Network. I'm calling in support of issue 17, the Health Equity and Racial Justice Fund, and the $11 million funding request for clinics for adults with sickle cell disease. From the outset, on behalf of over 200 CBOs, I would like to thank Senator Eggman for championing the Health Equity Racial Justice Fund and the California Legislature for supporting the creation of the fund for the past two years.

CBHN is proud to be one of the sponsors for creating this fund. We urge the Legislator to approve the request for an initial appropriation of 50 million over two years. This is an important initiative to directly fund CBOs that serves marginalized communities and communities of color. Also on behalf of CBHN, I urge the legislators to support the 11 million funding requests for clinics for adults with sickle cell disease. We want to thank CDPH.

Thank you so much for calling in.

Line 47, please go ahead.

Hello, my name is Carol Newark, calling from the Harm Reduction Institute in Santa Ana. I'm calling to support the request to fund overdose prevention, outreach, and treatment. Navigation I serve as the executive director for the Harm Reduction program that helps people access medically assisted drug treatment, the most effective means of helping a person reduce or stop using fentanyl, heroin, or other opiates. We receive absolutely zero financial support from our city and county to do this life-saving work.

The grants that we have received from the state have helped us stay open so that we can get naloxone directly into the hands of the people who need it the most and also those who are the most effective at reducing overdoses, and that's people who use drugs. We teach people how to use naloxone and how to provide overdose prevention education to others. Please do not let these grants lapse. We are on the front lines of the overdose crisis, and we in Orange County desperately need this funding to ensure that we can continue to help save lives. Thank you.

Thank you.

Line 27, please go ahead.

Hello, my name is Scott Suckow. I'm the executive director of the Liver Coalition. On behalf of the Liver Coalition, I'm calling in support of the 11 million funding request for adults with sickle cell disease. Sickle cell disease or its treatments, including blood transfusions, can increase the risk of liver damage from iron overload and hepatitis because of network in California for sickle cell care, just this year, a sickle cell patient in San Diego was connected with a doctor who was able to provide a life-saving liver transplant. Without this network, this patient, who was only 30 years old, wouldn't be here today.

The Liver Coalition thanks CDPH for their previous support and dedicated a 5 million for the clinics in the last budget cycle. And we are in support of the additional 11 million in sustained funding to ensure networking California for sickle cell care continue improving health outcomes for adults living with sickle cell disease by ensuring its long-term standing within CalAIM under DHC.

Thank you so much for calling in. Thank you.

Line 18, please go ahead.

Hello, my name is Patrice Ragin and I'm calling on behalf of the Sickle Cell Disease Foundation in support of the 11 million budget asked to sustain the comprehensive and life-saving care being provided to adults with sickle cell disease through networking California for sickle cell care. Thank you for your time.

Thank you.

Line 32, please go ahead.

Hello, my name is Laurie and I'm calling from Santa Rosa in Sonoma County, and I'm calling in support to request to fund overdose prevention and outreach treatment. Navigation we are a harm reduction organization that serves our whole county as well as other surrounding counties. Please. This life-saving funding has helped so many people and some of the most people who are the most vulnerable. We don't want to lose other family members, friends or community Members. So please continue the support with the funding for harm reduction programs. Thank you.

Thank you.

Line 66, please go ahead.

Good afternoon, this is Jim Lindburg on behalf of the Friends Committee on Legislation of California. We're a nonpartisan, Quaker-based lobby founded in 1952. We are in the midst of a tragic public health crisis with regards to fentanyl overdoses that desperately calls for a sustained public health approach. As the proposal in item 17 builds upon a successful pilot program, we strongly urge that the Legislature adopt the proposed $61 million expenditure to support overdose prevention and response and drug treatment. Thank you.

Line 26, please go ahead.

Hello, my name is Mohammed Sani Bukari, MD, medical hematology and oncologist. I'm calling on behalf of UCSF Fresno Adult Sickle Cell Clinic in support of 11 million budget request to help sustain the comprehensive and life-saving care being provided to adults living with sickle cell disease through the network in California for sickle cell care. Thank you.

Line 56, please go ahead.

Hello, my name is Portia Langdon and I am calling on behalf of the Sickle Cell Disease Foundation, in support of the 11 million budget asked to sustain the comprehensive and life saving care being provided to adults with sickle cell disease through networking California for sickle cell care. Thank you for your time.

Line 65, please go ahead. Line 65. 65 airlines open. Go ahead. Please check and see. You might be muted on your end. Check your mute button. 65 not responding. Line 57, line 57, please go ahead.

Good afternoon, everyone. I am Stacey Dee from the Sidewalk Project, a small harm reduction program working directly on the street of Los Angeles's Skid Row with unhoused and drug-using participants. We are calling in support of funding for the California Harm Reduction Initiative. As with it, we have been able to distribute thousands of doses in naloxone and have saved over a thousand lives this last year alone. We offer navigation to medically assisted treatment and are on the front lines of the overdose crisis saving lives. Please continue the vital funding of harm reduction programs in California. Thank you so much.

Line 40, please go ahead.

Hello, my name is Emily Pomerantz, calling from the Harm Reduction Institute in Santa Ana, Orange County. I'm calling to support the request to fund overdose prevention, outreach and treatment. Navigation our small harm reduction program, with a total staff of four, distributed over 26160 doses of naloxone that resulted in 3400 reversals. We can do much, much more with your support. We need funding to staff to distribute naloxone fentanyl test strips and provide overdose prevention education.

We also receive no additional funding from the city or county and rely solely on the grant funding from cheery from the state. In order to serve our community, we also need navigators to support people who are interested in entering treatment. Our small team have been a vital part in ensuring our folks are able to seek treatment in Orange County.

We've been a voice for the unhoused community, and with the support of cheery funding, we have been able to contribute to multiple narcan trainings throughout our county and to many other organizations in the county who do not have access to Narcan. The cheery grant has helped us increase our hours and locations and the number of people we serve. Our organization gets naloxone directly into the hands of the people who need it the most and who are most effective at reversing overdoses, people who use drugs. Thank you.

Line 67, please go ahead.

Hello, my name is Gladys Menard Henry. I am the mother of the 30-year-old that a month ago was being sent home on hospice to die due to liver failure. She spent two months in UCLA until I reached out into the Sickle Cell Foundation. Within 2 hours of notifying them, the life trajectory of my daughter changed completely. She now has a new liver. She's thriving in acute rehab and will be discharged in a week.

I'm calling on behalf of the Sickle Cell Foundation in support of the 11 million budget. Ask to sustain the comprehensive and life-saving care provided to adults with sickle cell disease through networking California for sickle cell care. They literally saved my daughter's life, and I am looking at her right now, this beautiful 30-year-old that would have died a month ago if it not for these people. Thank you for your time.

Thank you so much.

Line 71, please go ahead. And 71, your lines open? Check and see that you're not muted. 71 not responding. Line 72, go ahead, please.

Hello, my name is Elly Jalayer, and I am the harm reduction program manager here at Bienestar Human Services in East Los Angeles. I'm calling to support the request to Fund overdose prevention, outreach, and treatment navigation. We help people access medically assisted drug treatment, the most effective means of helping a person reduce or stop using fentanyl, heroin, or other opiates. The grants Bienestar received from the California Harm Reduction Initiative have helped us increase our hours, locations, and the number of people we serve.

We get naloxone directly into the hands of the people who need it the most and who are most effective at reversing overdoses, people who use drugs. We teach people how to use naloxone and teach folks, how to provide overdose prevention education to others. Please don't let these grants lapse. We're on the front lines in the battlefield of the overdose crisis, and this funding will help ensure that we continue to help save lives. Thank you.

Thank you. We'll take five more minutes of public comment. Five more minutes. So if you could please limit your comments. That was not for me.

Line 74, please. Go ahead. And 74, your lines open. Go ahead, please.

Hi, I'm Deborah Green and I'm the assistant camp director for Camp Crescent Moon, a summer camp for children with sickle cell disease. For the past 30 years, I've seen children with sickle cell disease grow into adults with sickle cell disease who did not have access to specialty care. I'm calling on behalf of the Sickle Cell Disease Foundation in support of sustaining a comprehensive health care for adults with sickle cell disease through the network in California for sickle cell care. Comprehensive health care through the sickle cell network has proven to save money and has saved lives of Californians living with sickle cell disease. Thank you.

Thank you.

And line 75, please. Go ahead.

Hi, everyone. Yes, my name is Barrot Lambdin. I'm an implementation scientist at RTI International and a fellow there as well. And I wanted to just speak quickly about some research that we've done looking at the impact of the pilot California Harm Reduction Initiative and put in my support for the overdose prevention, treatment, and outreach navigation initiative as well. So we carried out a national survey of certain services programs throughout the United States that were a part of the program.

What we observed in that research was that programs that received direct funding from the State of California at a 75% higher levels of naloxone distribution, 73% higher levels of syringe distribution, nearly 100% higher levels of fentanyl test strip distribution were almost three times as likely to offer buprenorphine treatment to their participants. What we know from the research is that these types of initiatives have major impacts on the delivery of life-saving interventions for our fellow Californians, and I strongly support this initiative.

Thank you.

Madam Chair. There are no additional callers in queue.

Great. Seeing no more further public comment, we have come to the conclusion of our agenda. If you did not get an opportunity to come in person or call for a public comment, as a reminder, you are still able to write it in by visiting our website and write it into the Budget and Fiscal Review Committee. With that, we have concluded our agenda. I'll see you in two weeks. Budget Subcommittee on Health and Human Services has adjourned.