Senate Standing Committee on Health

This is your 10 second warning. The Senate Committee on Health will begin in 10 seconds. Good afternoon. The Senate Committee on Health will come to order. I am your Chair, Richard Roth, and this is Senate Health. We continue to welcome the public to provide in person comment at the appropriate time. We're going to allow six minutes for testimony per side today, but don't feel obligated to use all that time if you don't need to. One bill was pulled from today's hearing, Senate Bill 999.

We have eight bills on today's agenda, with three of them being on our proposed consent calendar. Senate Bill 945, Senate Bill 1333, and Senate Bill 1112. At the appropriate point in time, we will call for the quorum. In the interim, we will continue to function as a Subcommitee, and I will put out the request for authors to report to the Senate hearing room for the Senate Health Committee to start presenting bills ASAP. Thanks.

For those of you wondering, we've had a telephone outage in the building, and so we're unable to summon Members by telephone. So hopefully they're watching on the television and they see me calling for them to come down and start this process.

Senator Menjivar, are you prepared to present Senate Bill 953, item number seven? Enough said, thank you. Okay, we're functioning as a Subcommitee still, but we're going to call item number seven, Senate Bill 953, Senator Menjivar, Medi-Cal menstrual products. Please proceed when ready.

Give me a second. Here we go. We will make do here. Hi. Good afternoon, fellow Committee Members. I'm here to talk to you about SB 953, a similar bill that I presented in this Committee last year. It is this year's period equity. Now, first, I accept the Committee's amendments as stated in the bill analysis on page four. So let's get into it. Let's talk about periods. Period equity is a public health issue.

It is crucial for the well being, mental, and physical health of menstruating people, especially our most vulnerable on Medi-Cal. Recognizing it as a health care necessity aligns with the broader public health goals preventing reproductive health issues, sepsis, cervical cancer, and ovarian cancer. This bill will help address the dangerous inequity of period poverty amongst Californians on Medi-Cal by requiring the Department of Healthcare Services seek the necessary federal waivers to implement Medi-Cal coverage for menstrual products.

This will then remove the financial burden from Medi-Cal recipients that sometimes is attached in purchasing these items. We have some federal precedent with this bill. In 2020, the Federal Government classified menstrual products as medical expenses. Then in 2023, our own state put out a report looking to address period poverty to address period poverty, and is asking Department of Health DHCS to examine potential options for submitting a waiver for reimbursement.

Now, the report asked the Department that they look into a way to include menstrual products as a reimbursement. My bill is stating that we should submit a waiver to have this be reimbursed under Medi-Cal. This wouldn't be the first thing that the state has asked for a waiver, a waiver that is often known as the 1115 waiver. We have asked for other waivers to address the whole person of an individual. A state as a whole is moving towards addressing the entire needs of the person.

Some examples of waivers that we've had for Medi-Cal are straight out of our CalAIM initiative, where we can now reimburse for housing navigation, housing down payments, and so forth. We are taking the same approach that the state has taken in other items to reimburse with this bill, SB 9553. Because I started early, I don't know if my witnesses. She is here. One witness is unable to be here. Mr. Chair, with your permission, I'd like to now turn to my witness.

Please proceed.

Good afternoon, Chair, Members. My name is Jennifer Robles. Oh, okay.

Yes, we have a new process here. We allow you to sit down. Welcome.

Thank you. Do I just push the button?

Yes, ma'am. Should be on. If you'd state your name again.

Yeah, I'll start over. Good afternoon, Chair, Members. My name is Jennifer Robles with Health Access California, the statewide Healthcare Consumer Advocacy Coalition. Despite California's previous efforts in tackling period poverty, it's essential to recognize the ongoing financial barriers that Californians face in affording period products.

SB 953, seeking to incorporate menstrual products as a covered benefit under Medi-Cal, helps close the disparity in menstrual inequity by relieving the financial strain on many low income menstruators, particularly as Medi-Cal has zero cost sharing or deductibles.

This legislation would provide benefits to a broad spectrum of Medi-Cal beneficiaries, spanning from children, teenagers, and adults earning less than $20,000 a year. Research suggests that marginalized and low income menstruators face increased health risks because of the inadequate availability of period products as they are compelled to weigh the cost against essentials like food. With multiple barriers already hindering their access to care, these health risks would only worsen their difficulties.

Health Access has long advocated for California to lead the way in innovative policies such as these to improve the health of our most vulnerable communities. And if our state programs covered basic menstrual products and thus relieve menstruators from this financial burden, California would bolster the ongoing national interest in recognizing that menstrual health is health care. Thank you. And Health Access is proud to support SB 953.

Thank you for joining us today. Are there any other support witnesses in room 1200? Please step forward.

Good afternoon. Linda Nguy with Western Center on Law and Poverty in support.

Thank you. Anyone else?

Craig Pulsipher, on behalf of Equality California in support.

Thank you for joining us. Next, please.

Joe Saenz on behalf of County Health Executives Association in support.

Thank you. Next.

Good afternoon, Chair, Members. Mari Lopez with the California Nurses Association in support.

Thank you. Any other witnesses in support? Seeing none. Let's turn to any witnesses in opposition. Any lead witnesses? Seeing none. Any other witnesses in opposition to this measure? Okay, let's bring the conversation back to my colleagues on the dais. Colleagues, any questions, comments, or concerns?

I just want to thank the author for bringing this forward. I know it's important for low income families, and when appropriate, I'd like to move it.

Thank you, Senator.

Thank you.

Any other questions, comments or concerns? Seeing none. Would you like to close?

Thank you, colleagues, for that robust conversation on my bill. This bill simply is doing the first step. We're just going to the Federal Government to request a waiver, plain and simple as that. Thank you again, and I respectfully ask for an aye vote.

Thank you very much, Senator. We do have a quorum, it looks like, so let's call for the quorum.

[Roll Call]

Okay, colleagues, we have a motion by Senator Rubio. The motion is do pass as amended and re-refer to the Committee on Appropriations. Please call the roll.

[Roll Call]

The vote is 5-0. We'll hold the roll open for absent Members. Thank you, Senator.

Senator Wahab, you have item number two, Senate Bill 980. Would you like to proceed? Please proceed when ready.

All right. Good afternoon, Mr. Chair and Members. I just want to start out by saying, I accept the Committee amendments, and thank you to your Committee staff for helping us with this bill. More specifically, the fact that it's already been more than six months that they've been working with me on this bill. So thank you. SB 980, better known as the Smile Act, is a bipartisan step toward fair and equitable access to dental services for all Californians. The Smile Act does two things.

First, it simply aligns statute to regulations for lab process crowns by lowering the statutory age of 21 to the age of 13, as listed in regulations. Second, and more importantly, this bill ensures dental implants are a covered benefit under the Medi-Cal Dental Program. In fact, one third of the state's population, which is roughly 13 million people, is enrolled in Medi-Cal. And in order to qualify for medical, a family must be at 138% of the poverty level.

According to the Centers for Disease Control and Prevention, there are disparities in equal access to oral health. For instance, the Medi-Cal Dental Program's current policy might allow for dental implants in very extreme cases, though prior authorization must be given as well as documented proof provided of an exceptional medical condition. Medi-Cal's dental provider handbook outlines these conditions as cancer of the mouth, severe loss of upper and lower jawbone, skeletal deformities, or traumatic destruction of the jaw, face, or head. That's what you need to qualify currently.

Aside from the extreme cases I just listed for you, dental implants are not a covered benefit in the Medi-Cal Dental Program. However, the program does cover the removal of teeth as well as existing dental implants, but patients do not have an option for replacing them. One of the consequences of not having a missing tooth replaced is permanent bone loss because the jaw is not getting the stimulation it needs to stay healthy.

Missing a tooth can lead to oral disease, poor nutrition, and is linked to systemic diseases like diabetes and coronary heart disease. According to the Center for Disease Control and Prevention, billions of dollars are lost in productivity in the United States each year due to oral disease, and millions more are spent on the consequences of ER and hospital visits due to its negative effect on overall health.

Although California has made strides in addressing the issues of equity among its most vulnerable communities, we still have a lot of work to do to effectively address the needs of these communities, especially the state's growing aging population, as I call it, the silver tsunami.

The Public Policy Institute of California tells us that California will experience an explosive growth in its aging population in the next 30 years, and by 2030, which is six years from now, one in every three Californians will be over the age of 50. This population makes up the communities that cannot afford to pay out of pocket for dental care or do not have private dental insurance. They are on fixed incomes. The Smile Act is a step toward ensuring fair and equitable access to dental services.

It saves millions in healthcare costs through its preventative and early intervention efforts and allows for a better quality of life for all Californians. With me today in support is Angela Gardner, board member of Healthy California Now and member of California Alliance for Retired Americans.

Ms. Gardner, welcome.

Can you hear me?

Yes, ma'am. Perfect.

Thank you, Senator Wahab. Good afternoon, Chair Roth and Members of the Committee. My name is Angela Gardner. I currently serve on the Board of Directors of the Healthy California Now Coalition, and I'm a proud member of the California Alliance for Retired Americans. As an advocate for healthcare reform for many years, my desire to achieve health equity is rooted in my own struggles to access and afford health care as a person with a disability.

In 2006, I had to stop working due to my disability, which made me forfeit my health care. During this transitional phase of my life, I returned home to live with my mother, who I still live with today. But despite the health care advances nationally at the time, I was unable to obtain dental coverage until 2014, when I was accepted into Medi-Cal nearly eight years later. For eight years, I went without any dental coverage and my oral health declined.

Medi-Cal's dental benefits have helped me in many ways. I've received teeth cleanings, fillings, and x rays and other services as covered benefits that I am grateful for. But as I get older, I may need more significant dental work, such as requiring implants, which is not a covered benefit under Medi-Cal.

SB 980 will give me the peace of mind of knowing that despite the gaps in dental coverage and care, dental implants will be a covered benefit for me and the millions of Californians who depend on Medi-Cal for their dental coverage, especially for seniors and people with disabilities. Above all, these experiences have taught me that oral health is truly the foundation of overall health. I respectfully ask this Committee to take a bold step forward to achieve health equity and expand access to affordable oral care by passing SB 980 today. Thank you.

Thank you for joining us. Are there any other support witnesses in the room? Support witnesses in support of this measure, SB 980. Yes, ma'am.

Good afternoon. Linda Nguy with Western Center on Law and Poverty in support.

Thank you for joining us. Next, please.

Katie Van Deynze with Health Access California in support. Thank you.

Thank you.

Hello. Monica Kirkland of Senior Services Coalition in support.

Thank you. Next, please.

Hello. Joe Saenz with County Health Executives Association in support.

Thank you.

Hello. Mel Assagai for the California Association of Orthodontists in support.

Thank you, sir.

Diana Madoshi, Placer County constituent, support of this bill.

Thank you for coming down.

Dan Wong from CARA. I'm from Sacramento, and I support SB 980.

Thank you, sir. Next, please.

I'm Ron Martin of the Fresno California Alliance of Retired Americans, and I support SB 980.

Thank you, sir. Yes, ma'am.

Arlene Harrison, retired Department of Human Assistance Medi-Cal worker, and I support the bill.

Thank you. Yes, ma'am.

Noel Felice Smith, I'm a retired registered nurse, and I support this bill.

Thank you for joining us. Next, please.

Hi, Patricia Chadwick with One Payer States, and I support this bill.

Thank you.

Randy Hicks, Californians for Disability Rights and CARA in strong support.

Thank you, sir. Next, please.

CT Weber, CARA, strong support.

Thank you.

Keith Imamoto, retiree from SEIU 721, in support.

Thanks.

Francis Coronado, retiree from Fresno County Probation and SEIU 521. And CARA, and I support this bill.

Thank you, ma'am. Next, please, sir.

James Hackett, retiree from Fresno County. I worked with the Department of Social Services for 31 years, and I support this bill.

Thank you for your service. Next, please.

Hi, my name is Richard. I'm with CARA, and I am in support.

Thanks.

Hi, good afternoon, Chair and Members. Brianna Pittman-Spencer with the California Dental Association. I'm here as a little bit of a tweener. We actually have a support if amended position. I really want to applaud the Senator for bringing this bill forward and the topic of Medi-Cal dental benefits, and particularly for her advocacy for seniors' oral health care. As written in our letter, we do have some concerns with the state's ability to actually implement a benefit as complicated and expensive as implants.

Just given sort of the status of the program and the challenge that they have and some of the administrative burdens that are in place on other less expensive, less complex procedures. In particular, as we mentioned, the crowns rate that exists now is so low that we only can assume the intent is to discourage utilization. That's definitely something we think really needs to be invested in. And if we were to do implants, we really would need to make sure that the rate was sufficient.

CDA really does strongly support the idea of looking at the Medi-Cal Dental Program and the benefit structure and making sure that it meets the oral health needs. I think, as the Senator said, we agree with everything, all of the voices that you heard. We need to make sure that our adults and our seniors who are on Medi-Cal are able to maintain their teeth going forward. There are a lot of holes in Medi-Cal's dental coverage in addition to the implants.

So things that replace teeth like bridges, partial dentures, the coverage is not great. And we really would like to see those things considered alongside implants or looking at this sort of comprehensively. So we have reached out to the Senator's office, and we would really like the opportunity to work on this and to look at Medi-Cal Dental because we think this is really important, particularly for adults. We've done a lot of work on kids. There's a lot of work left for adults and, in particular, our vulnerable seniors. Thank you.

Thank you, ma'am. Next, please.

Mr. Chair. Gary Cooper, represent the California Association of Oral and Maxillofacial Surgeons, and we have met with the Senator and her staff. We're a bit of a tweener as well. We're very concerned about the citizens that she is trying to help. But as you know, our doctors do most of the implant work, and we're very concerned about the expansion of implants if there are other types of things that can be done as opposed to implants.

But we've committed to the Senator that we will work with her and her staff. Even as of yesterday, I spoke with your staff, and we've committed that we will continue to work with you. And so at that point, we still remain neutral, but we will hope that the bill will move forward. Thank you.

Thank you, sir. Any other witnesses in support? Seeing none. Let's take any witnesses in opposition. First, lead opposition witnesses? Seeing none. Any opposition witnesses? I see none. So let's bring the discussion back to my colleagues on the dais. Colleagues, any questions, comments, or concerns? Senator Rubio, you look like you...

Hi. Thank you, Mr. Chair. Well, again, thank you for the author. And I did hear some of the concerns that the tweeners, not opposition but tweeners, expressed. And there's always a cost and concern in terms of administratively being able to put this forward. And I'm sure the author will continue to work on some of these issues, as I think she's already expressed. But I do think that.

I think besides the obvious issues already mentioned, for example, the permanent loss of bone, oral diseases, and just the potential of other health issues that come along with it, I like to also focus on the social, emotional aspect of it. I've seen some of my seniors at our senior centers somewhat withdraw as soon as they don't feel confident. And I think as our seniors become older, we want them to continue to be active and participate and be part of the senior community.

But when they're having issues, dental issues, or they lose their teeth and things like that, it really ruins their confidence. And again, if we want our seniors to be healthier and later in life, then we need to make sure that they have every opportunity to continue to be confident and participate fully in activities in our community. So I do want to move the bill forward, and I will be adding as a co-author. Thank you.

Thank you, Senator. Senator Menjivar.

Thank you, Mr. Chair. Senator, I have two questions. My first one is in the policy analysis, it spoke about ensuring there's some kind of language to utilize this as a last form of resort, that there were other options stated from some providers that could be better fit for that. Do you see some concern in utilizing this as a go straight to this procedure?

Yeah. There has been a lot of conversation, as you've heard from, even folks that some would assume would be in opposition, but clearly they're not. Oral health is a priority for a lot of people. When we talk to, let's say, some of the providers and the oral surgeons and so forth. Before we get to the point of a legitimate implant, there are some steps that we could take, which we are considering. We're in the midst of a conversation, if you will, as to what that looks like.

Clearly, I'm not a dentist, right. So I don't know every single caveat, but for an implant, obviously, they have to go to an oral surgeon and have to see whether the bones can take it and so much more. And even before they have to replace or remove a tooth, there's potential procedures there. I think one of the biggest concerns that you've heard is that the reimbursement rate is just fairly too low. Right. And that's problematic. We want to be able to advocate for increased rates as well, but there are some smaller steps before that that we are looking into as well.

That was going to be my second part, as you and I have talked about this. Right. How can we better increase our Medi-Cal rates for an array of things. And having providers be participants of the Medi-Cal program under dental care is already very difficult, and I hope you and I will continue talking about how we can be creative in that sense, but happy to support your bill here.

Thank you. You want to add as a co-author?

Not as a Sub 3 chair.

I know right.

Gotta look at that money part.

Yeah.

Thank you, Senator. Any other questions, comments or concerns? Seeing none. The bill has been moved by Senator Rubio. The motion is do pass as amended rerefer to the Committee on Appropriations. Would you like to close, Senator Wahab?

I respectfully ask for an aye vote for the Smile Act as I'm smiling.

Nice presentation.

Thank you.

Please call the roll.

[Roll Call]

Vote is 7-0. We'll hold the roll open for absent Members. Before I call up our Chair emeritus, Senator Eggman, for her two bills, let's take the consent calendar. There are three bills on the proposed consent calendar, Senate Bill 945, Senate Bill 1333, and Senate Bill 1112. Is there a motion?

Move the bill.

Senator Rubio. Senator Menjivar. Senator Menjivar has moved the consent calendar. Please call the roll.

[Roll Call]

Vote is 7-0. We'll hold the roll open for absent Members.

Senator Eggman, welcome. You have two items.

Thank you. And hello, friends. I've missed you.

We miss you. Item number four.

Thank you to my Chair and Committee Members here. You've heard about this bill before, because it's been another one of my priorities. I've worked on and worked on and worked on it. We used to call it a bed registry, but we are now going to call it a bed solution. As you know, when people, our ERs are all packed up. People come in with a mental health issue.

They need to move to a different place, different level of care, and people are going through their paper and calling different places to see if they have a bed. A bed for a 75 year old suicidal female with health issues. Beds can be very specific versus somebody who's coming in with an overdose of oxy. So this would have all the beds that are available, do a whole inventory of them, and then have a registry where you have a patient before you have a client before you.

They need to be moved to a bed, and you'll be able to find something online on time where that next place will be. Really important issue. And I think it's one of the last pieces that we need to do to really ensure that our continuum of care is up and flowing as it should be, that people can move up and down the continuum of care as needed without having to search for hours and sometimes days to find a place that is willing to accept a person.

You still have to go through the whole intake process, but at least providers would then know where there was capacity to be able to send folks. With me today to testify is Randall Hagar, legislative advocate with the Psychiatric Physicians Association Alliance.

Please proceed, sir.

Thank you, Chairman Roth and Members of the Committee. Randall Hager, representing the Psychiatric Physicians Alliance in California. Excuse me, a little hoarse here. I've represented psychiatrists for over 20 years, and this has been a continuing problem, what to do with a patient when you're sitting there and there's no room at the end. As far as you know, in your immediate network of facilities, it's all 100% full. It's at capacity.

So it's amazing to me that at this point in time, with the technology that we have in this state, when you can actually pull up a ride from the airport to your hotel in about seven or eight minutes, or you can get a chocolate milkshake delivered to your doorstep, those kinds of algorithms and that kind of technology is out there, but we still can't find psychiatric beds when we need them. And they can, as Senator Eggman said, run the gamut.

Sometimes they're going to be drug and alcohol beds. Sometimes it's inpatient psychiatric beds. For those kinds of beds, we're talking about people who are very sick, who probably are in an acute crisis and they need to go, and they need to go now. And being able to download a PDF off the DHCS site, go through it page by page, do cold calling, is not an efficient process, and it certainly doesn't advantage the patient. So that's why we're here today. This is what this bill is about.

It will connect the right bed with the right patient at the right time. And I could give you more examples of that if you'd like to ask me questions about that later. We have real world examples, but I think I'll leave it at that and turn it over to my colleague here.

Thank you, sir. Please state your name for the record.

Thank you, Mr. Chair and Members. Danny Offer with the National Alliance on Mental Illness, also known as NAMI California. We're the statewide affiliate of the country's largest mental health advocacy organization. We have over 110,000 members and 58 affiliates, who include many people living with a serious mental illness, as well as their families and their supporters. We advocate on their behalf, providing education and support to our members, as well as the broader community.

Length of stay. Our loved ones who end up in the ER with a behavioral health crisis experience some of the longest lengths of stay out of anybody who ends up there. A national survey of over 6,000 ERs found that more than 70% of these ERs held a psych patient, not just for hours, but for days while trying to find a bed.

I know that often behavioral health crisis, just the term can seem a bit abstract, particularly when read off a piece of a paper by a guy with a nasal monotone. But imagine with me, if you're having the worst day of your life, you're scared, you might be hearing or seeing things. And now you're told that you need to wait here in this emergency room, and we don't know when we'll have a bed for you.

Our loved ones just can't wait that long. By developing a system to track bed availability, this bill will help our loved ones access care much quicker, where minutes really do count. And as Mr. Chair so astutely pointed out last year, in last year's iteration of this bill, we're lucky enough that we do have more beds coming online, thanks to the Behavioral Health Continuum Infrastructure Project as well as Prop One, should it pass. And it's imperative now more than ever that we're able to have a system in place to find these beds when they're needed. Thanks very much.

Thank you. Other witnesses in support of the measure?

Mr. Chairman and Members Paul Yoder, on behalf of the California State Association of Psychiatrists, another co-sponsor, urge your aye vote. Thank you.

Thank you. Thanks for attending. Next, please.

Good afternoon, Mr. Chairman, Members. Usha Mutschler, on behalf of the California State Sheriff's Association, in support of Senate Bill 1017. Thank you.

Thank you for attending. Next, please.

Thank you, Chairman, Members. Tim Madden, representing the California chapter of the American College of Emergency Physicians, in support.

Thank you. Yes, sir?

George Soares, California Medical Association, in support. Thank you.

Thank you, sir. Next, please.

John Drebinger with the Steinberg Institute in strong support.

Thank you, sir. Any other witnesses in support? Seeing none. Witnesses in opposition, first lead witnesses in opposition if there are any. Are you a lead witness, sir? We have room at the end, but that's okay. Welcome, sir. Please state your name for the record.

Good afternoon, Chair and Members. My name is Amar A. Cid and I'm here on behalf of the County Behavioral Health Directors Association of California, the leaders of the public behavioral health agencies that serve the mental health and substance use disorder needs of the Medi-Cal, uninsured, and underinsured populations. We respectfully have an opposed unless amended position on this bill.

While CBHDA commends the author for seeking to address the delays that those in psychiatric crisis too frequently experience when attempting to access vital services, we believe that any approach taken must be feasible, realistic, and guided by partnerships with stakeholders rather than punitive approaches. CBHDA appreciates the approach outlined in SB 1017, which includes conferring with stakeholders to inform the development of this database, recognizing how critical stakeholder buy-in is for ensuring effectiveness of a registry.

As the leaders of the public behavioral health agencies in California, we recommend an amendment which includes county behaviorial health as a part of the stakeholder buyin. CBHDA is also concerned with the punitive provisions in SB's 1017, which ultimately allow DHCs to assess a plan of correction or penalties against a facility for failing to submit data in a timely manner when the scope of the database has not yet been developed. This exposes our county behavioral health agencies and contracted providers to unknown liability.

It would also potentially divert resources away from much needed treatment and services. It is for these reasons CBHDA requests the removal of the punitive provisions in SB 1017. CBHDA thanks you for your time and for your consideration and for the aforementioned reasons, has an opposed unless amended position and looks forward to continued and further conversations with the author's office.

Thank you for joining us today. Sir, you're next. Please state your name for the record.

Randy Hicks, client. As well as good intention as this sounds, and finding more beds for people and getting them off the street, that's all well and good. As a client, I suggest we try outpatient. And I also believe that when you force treatment on the people, they're not necessarily going to take it.

And the other thing is you guys are guaranteeing that they're going to have a mental health issue when they could simply have a drug and alcohol issue. How about a little treatment for that? Instead of deciding that they're crazy, we're going to lock them up. They're crazy, we're going to put some more beds out there.

And that's what you guys are doing. We get more beds, put more people, lock them away, than having people come out and be on their own and have not forced treatment an outpatient. And the other thing is psychiatry is all well and good. Give them drugs. But sometimes psychology works, too. Sometimes it hurts us to talk to somebody. Okay. So as a client, I understand her. She's got well intentioned, yes, I understand what she's doing. And yes, we probably need more beds, but we should also look at other alternatives before we just lock them away.

Thank you for attending, sir. Thank you both for your testimony. Any other witnesses in opposition here in the hearing room, room 1200? Seeing none. Let's bring the conversation back to my colleagues on the dais. Colleagues, any questions, comments, or concerns? Senator Nguyen?

Senator, I just got a couple questions just for my understanding. So does this force a particular. Let me step back. So my concern is this, is that if one county doesn't have the facility, then it forces all the other counties to have to bear the burden. So if I'm a facility in, say, a county, I have plenty of beds because we've worked hard, we made sure we're in compliance, we're helping out.

And yes, I do have 25% of my facilities open, but another county decide, I'm not doing anything, I'm not going to have any beds, I'm not going to care. So I'm just going to send it to LA County or Orange County. I represent both. Does it force those county to have to accept or be in compliance with that or can they deny?

I appreciate that question. It's a really good question. Another, I think, benefit of having the bed solution is that then we have better tracking. Right. We think Prop One passed and part of that is really doing an evaluation of where there are resources. And so this will also lend to let us know where the beds are. And so if we get the report back that everybody in a certain county is having to travel to a different county, that is a real problem.

But right now we don't have any data about that. We just have anecdotal things. So the idea is to have every county have their resources built up for every level of care. We're not just talking about inpatient, but every level of care. And so people shouldn't have to go out of county. That's the whole point.

I think another part of being able to do this, both with the ease of getting somebody someplace, but also identifying where are the gaps in services and how do we go about filling that. But nobody's ever forced to take anybody.

Okay, that's my answer.

Nobody's forced to take anybody. But if you have 75% of bed openings, we're probably going to want to know why you're not using it.

No, I'm supportive of the idea and the data. We need the information. There's no doubt. I just don't want one county. You hear this a lot. My city is taking the burden for the other city, or my county is taking the burden for that county because they don't want to do it. And so that's just more of the concerns locally that they still have that local control.

Yeah, I think that's a great question and a great point.

Thank you.

And again, this helps us actually identify if there is a problem, because right now when you call someplace and you say, I have no beds, we don't really know if that's even true or not.

Yeah, perfect. Thank you.

Edification that there's no obligation created by this just because a bed is identified. The misinformation out there is that it creates an obligation because there's an opening you got to take to next patient who shows up. That's not true. What this is really about is identifying a place to make a phone call. And so you can connect as a provider to the hospital people, and you can talk about whether your patient fits and whether or not the receiving facility wants to take them.

Or has the capacity to take them at that time due to staffing or whatever other issues.

Thank you, Senator. Senator Menjivar.

Senator, I think two weeks ago we heard about just some of the difficulties in capturing some coding and billing through CalAIM. Do we anticipate some of those difficulties as we're collecting all that data from 58 counties?

We do in some respects, and that's why we're also looking at Sampsa's got how is the best way to do that? And so we're trying to incorporate all that with stakeholders. But there's always going to be some kind of issues, but we don't know what they are until we actually run into the issues that we have to be able to say, oh, here's a problem here with CalAIM. This is what we need to do to fix it.

Thank you, Senator. Any other questions, comments, concerns? Seeing none. Is there a motion for this bill? Senator Hurtado makes the motion. Senator, would you like to close?

Yes. Thank you very much. And again, thank you for hearing this. And I appreciate the counties coming forward, and I appreciate them working with us as we continue to move forward. As many of us know, one of the issues in doing something like this is that everybody has to participate. We've had that. We passed other policies and some whole big sections don't input into the data. And so it has been said, if you make a law without any penalties, it's just a suggestion.

So this is $100 a day for people who don't. But there is an appeal process. There is a how are you going to remedy process. It doesn't just move to fines right away. I think this is a really important issue to be able to really streamline all of our services. And I would ask for your aye vote.

Thank you. Please call the roll. It's been moved by Senator Hurtado and the motion is do pass and re refer to the Committee on Judiciary. Now we can call the roll. Thank you.

[Roll Call]

Bill has seven votes, seven to zero. Will hold the roll open for absent Members. Senator Eggman, number five, Senate Bill 1184.

Thank you very much, Members. This has to do with a Reese hearing. I don't know if everybody knows what a Reese hearing is, but when somebody is 5150 and brought in against their will, you have to have a court order, a judge say yes, this person is incapable of making their own decision. So we're going to be able to treat them with medication.

So currently, right now, if you go for a 5150 that Reese hearing is obtained and it is considered that it lasts through the 5250. If somebody has to stay that additional two weeks, we have found and professionals have found and brought this to us, that if people then have to go for a 30 day or the additional 30 day that oftentimes their treatment.

Then the medication is stopped being given because there's some, and it's supposed to be the Reese hearing is in effect until capacity is reached. But there has been some disagreements about that. So we think this law is important so that if the person is still incapacitated, that Reese holding holds over their entire time in treatment until they have restored capacity so that they don't go off medications and then decompensate before another Reese hearing is heard. For them to be able to be declared again.

There's always a process for appeal. There's always a process for the public defender. But we really think this helps people be able to most effectively restore themselves without having to take backward steps because of a simple technicality of a Reece hearing. And with me here today is Dr. Eric Chung and Randall Hagar.

Gentlemen, please proceed. Identify yourselves for the record first.

Hi. Good afternoon. Thank you, Chairman Roth. Thank you. Senator Eggman. Erick Cheung. I'm a psychiatrist, associate Professor of Psychiatry at UCLA and Chief Medical Officer of UCLA's Resnick Neuropsychiatric Hospital. SB 1184 fixes a critical gap in acute care treatment of psychiatric patients. We have seen this for decades as a problem that plays out in our hospitals across the state. First, to be clear about which patients we are talking about frequently, this applies to patients who have severe forms of psychosis, including schizophrenia.

They have first of all been involuntarily hospitalized under current law due to the acute severity of their illness. They have secondarily been clinically and judicially evaluated to lack capacity to make decisions about their psychiatric medication treatment due to the severe nature of their illness. The way the law currently exists creates artificial and negative clinical treatment interruptions. And there are five of them. I want to call to your attention. The first is obvious.

It is a likely worsening of their clinical status, meaning they become more psychotic when they are taken off their medications. They have potential adverse effects and risk of abrupt discontinuation of the medications, which can include nausea, sweating, insomnia, agitation, mood volatility, Catatonia, muscle rigidity, and potentially seizure. There is a possibility of increased patient and staff harm and safety risks when patients decompensate like this with agitated behavior or violence occurring in the hospital setting.

The potential negative impact of use of restraints, seclusions and physical holds and ironically, involuntary injected medication when they go off medications due to the gap in the Reese process. This likely prolongs the length of stay of inpatient involuntary hospitalization. Or on the flip side, it can lead to premature discharge. If hospitals and physicians are frustrated by the process and end the involuntary hold. There's little to no clinical value for patients in detaining them involuntarily in a hospital when they lack capacity without providing them treatment.

Patients do retain rights. They have the right to file to win their probable cause hearing at each. Phase of the hold. They have the right to file a writ at each phase of the hold. And as was mentioned by Senator Eggman, psychiatrist and the medical staff must restore the ability for a patient to make decisions about their care when they have regained capacity, which is what we really hope for. We are devoted to best patient care, and we would do this with no other condition in medicine, in acute care setting.

To start a medication for a patient who's incapacitated, stop it for a period of five or six days, waiting for something to happen, restarting it for another 17 days and stopping it again, we simply would not do that in medicine. This is also about resource consumption. During this entire gap period of treatment, we are providing 24/7 nursing and support care in the hospital, but no treatment is being rendered.

Physicians and hospitals must devote additional resources to engaging in the core processes which can be used otherwise for patient care. And as I mentioned before, this gap likely lengthens inpatient stays and is not in the best interest of patients. There are plenty of other patients waiting in emergency departments all across the state who need hospitalization while we are wasting this precious time. Thank you.

Thank you, sir.

Mr. Chairman, Members of the Committee, Randall Hagar again, for Psychiatric Physicians Alliance of California. Just going to embroider a little bit around the edges. That was excellent testimony from a rural expert. I actually learned about this from him. And so I will just say that we have a real issue on our streets today where people have been untreated with severe mental illnesses like schizophrenia, out on the streets for months, if not years.

And it's sort of axiomatic that the longer that you go with your untreated illness, the longer and harder it's going to be to bring yourself into some sort of a stability with the help of your doctors. So what we're talking about here is maybe avoiding three hearings in 45 days in order to continue medication. As we know administratively. Things happen, there may be gaps. And you've had a description of what happens when people are allowed to miss their medications, particularly people with psychotic disorders.

And so this Bill is really about that as much as anything else, but it's really also a need to make sure that in the quickest and the surest way possible that patients are able to step onto the road towards their recovery. And that's why we bring this Bill forward. We want to incentivize that in facilities and throughout the state. And with that, I'll answer any questions.

Thank you for your testimony. Any other support witnesses in the hearing room?

Mr. Chairman and Members Paul Yoder, on behalf of the California State Association of Psychiatrists, the sponsor of this Bill, really appreciate Dr. Chung coming up to testify here as a witness to you in person. Urge your, aye vote.

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

Thank you. Any other support witnesses in the hearing room seeing none. Any opposition witnesses in the hearing room? If there are any lead opposition witnesses who've been identified, please step forward. We'll take your testimony first. You're welcome to join us at the lead. Opposition witnesses are welcome to join us at the table. Just two, please. Thank you very much. Sit wherever you are comfortable and identify yourselves for the record before you start.

Thank you, chair Members. My name is Samuel Jain and I'm with Disability Rights California and I'm a senior mental health policy attorney. We are the federally designated protection advocacy system for the State of California. I'll note that we did see the Committee amendments. They do alleviate our concerns about vague language that could be interpreted to allow one involuntary medication order to last indefinitely.

However, we are concerned that another hold was added to the Bill which would explicitly lengthen the duration a single involuntary medication order could last. We are still opposed to this Bill, and we have serious concerns. It would eliminate due process rights for patients which allow them to contest involuntary medication orders. So under current law, these rights align with the right to contest involuntary detention.

For example, if you get placed on a new involuntary hold, you have the right to contest that new hold, and the facility needs to obtain a new court order in order to administer involuntary medications. This Bill would decouple these rights and allow one involuntary medication order to last the duration of an involuntary detention. Patients can have very good reasons for refusing psychiatric medications. These are powerful, mind altering drugs that can have extreme side effects.

For example, one study found that between 15 and 30% of patients over the age of 45 developed a condition called tardive Dyskinesia after just one year of treatment from psychiatric medications. This condition is a severe and permanent movement disorder. One argument that we've heard from the author and from the proponents in support of this Bill is that current law creates a treatment gap which can disrupt medication titration. I'll note that this is not an actual issue in practice.

If a facility plans to place a patient on a new hold and continue a Reese, they will time the filing of the new hold with the Reese petition on a day when the Reese petition can be heard by the court. This practice eliminates any gap in involuntary medication treatment that would otherwise occur, and it's a widely utilized practice throughout the state. These hearings are critical in determining whether patients have sufficient reasons to refuse psychiatric medication, such as serious medical complications. We urge this Committee not to roll back these important due process protections. We ask for your no vote on SB 1184.

Thank you. Thank you for joining us, ma'am. You are next.

Hello, chair and Members, my name is Rachel Bhagwat and I'm a legislative advocate with ACLU California Action. The ACLU opposes SB 1184 because it takes away, as Sam mentioned, due process protections during a scary medical process with no reasonable justification. When a person is taken for an involuntary psych hold, it's well understood that you can't just hold them indefinitely because people should only have their civil rights deprived as long as it's absolutely necessary.

And that's why there are interim hearings and such between different consecutive holds to create checkpoints along the way where a person could prove they're no longer a danger to themselves or others. Similarly, what this Bill covers is a separate set of hearings that determine whether a person is mentally well enough during an involuntary hold to make their own medical decisions, like if a Doctor can override them refusing psychiatric medications if a short term forced medication order is placed.

Under current law, a person is entitled multiple opportunities along the way to prove if they've regained the ability to make their own decisions. This Bill would eliminate those checkpoints and would make it so. As Sam mentioned, a single involuntary medication order could last, as I read it, about 47 days in the current text, or 77 with the potential amendments circulated without a person being entitled to those standard legal protections along the way. ACLU is not here to contest the idea of involuntary medication.

What we're opposing is the idea that through seven or 11 weeks of forced drugs, taking away someone's right to get the chance to prove whether they've recovered or still need forced antipsychotics so that nobody ends up in one flew over the cuckoo's nest checkpoint hearings and petitions are due process, and it's really concerning to see the fact sheet for the Bill describe due process as redundant.

Also, it says that the Bill is needed to reduce administrative burden on psychiatrists with great concern and empathy for the capacity and staffing issues in our mental health facilities and even in the courts, ACLU has to emphasize that those issues, capacity, staffing, it's not constitutional to just remove legal protections in order to fix them. I urge you to reject the premise of this Bill. Thank you.

Thank you for joining us. Any other opposition witnesses, please step forward.

Randy Hicks, client opposed. Thank you, sir. Any other opposition witnesses? Okay, seeing none. Let's bring the conversation back to my colleagues on the dais. Colleagues, any questions, comments or concerns? Senator Nguyen?

I just have a question. Madam Senator, with the proposed amendment, what is the longest time the initial medication order can stay in effect?

I believe we're talking about 72 days. Is that correct with the initial, correct with the amendment that's going forward right now. And again, that's the longest. But as soon as somebody's capacity is restored, then that order goes aboard.

Perfect. Thank you.

Any other questions? Senator Grove, comment?

Thank you, Mr. Chair. I just have a comment. I know this is a really tough Bill, and I know that I understand both sides of the argument, but I can tell you that I've talked to parents of adult children that have said, showed me photographs. This is my son when we required him to take medication, and he's working at Albertson's and he's the manager of the meat Department, and his life is normal, and his wife and his kids are happy.

And then when he doesn't, he's on the street, they're trying to find him, make sure he's safe, make contact. And it is a very hard thing for, I think, not only parents, but family Members. And I think the limited scope that you put in this, again, I'm not for things like this, but because of the limited scope. And I drive down Twelveth street and I see naked people in the street that don't even know they're on the street. Right? They don't even know they're there.

The lady in the Costco parking lot, she doesn't even know she's in the Costco parking lot. And if we could get her on the medication that she needs so she could be self aware and go back to what would be a normal life, maybe at her home, then I'm all in. And so I appreciate, number one, veteran to veteran and your work in this area for, I would say, 30 years at least. And I thank you for bringing this forward.

Thank you very much.

Thank you, Senator. Colleagues, any other questions or comments? Senator Menjivar?

Senator, or maybe this question might be for the expert, but not saying you're not the expert. No, 100 said you're right. How much time are we giving a patient to be able to prove that they're capable?

Yeah. I would defer to Dr. Chung as he works with this every day.

Just to be sure that I understand your question, Senator, is it a question about how long does it take for a patient to regain capacity?

No, because I think that would be hard to answer--

What does capacity look like?

But in addressing sometimes--the concerns that we're just going to be shoving treatment down a patient's throat constantly without really giving an ability for that patient to prove that they no longer need to be on medication, is there a standardized timeline of how much we have to wait before determining if that patient needs more medication or not?

Well, let me answer it this way. The treatment of schizophrenia, particularly with oral medications, is customarily a daily treatment in the acute setting. So every day a medication is indicated to begin to chip away at the severity of the psychotic illness. The timeframe of improvement can be very gradual. Unfortunately, it can be very slow for individuals who have reached this point where they have been brought in involuntarily and then lack capacity to make decisions over their treatment.

In best-case scenario, they will regain that capacity early, before you even hit a 30-day or a second 30-day hold, but in many cases they do not and they remain too ill to make that decision, too ill to leave the hospital, and have continued to be evaluated by court hearing officers to be able to be detained in the hospital. They haven't been able to state the reason why they should be able to leave the hospital and prevail on their PC hearing, probable cause hearing.

And if they call for a writ, they have a second chance to be able to prove in front of a judge why they should be able to be released from the hospital. That would discontinue all treatment entirely and they would be able to leave.

And the patient themselves is the one that goes and attempts to prove that point?

With an advocate. With a court-appointed advocate or anyone of their choice.

Okay, thank you.

And as one of the lead opposition people pointed out, there is a process already to go to say if you still need to be held, right? What we're doing is saying you had to have to go through the second process to say, should your Riese hearing still continue, that being found that you're still incapable of having capacity should be enough. You shouldn't have to do both every single time, like somebody's going to be held another two weeks without medication, which then, of course, causes disruption for the whole unit.

Okay.

Thank you.

Would it be okay if I reply to that? Because that was my comment.

I'll allow it.

I apologize.

Sure.

Senator Menjivar, I think you're asking really important questions, and I just want to highlight that from a different perspective, the separateness of--it's important to understand the significance of the separateness of these two sets of hearings because I don't believe that it follows that just because you've been found to need to stay in the hospital longer, that you should automatically, and it doesn't really follow kind of the constitutional precedent on this either.

It doesn't follow that you should be found to be incapable to refuse psychiatric medication. The standard for keeping someone in the hospital under involuntary hold is typically danger to self and others, right? As opposed to I could be a danger to myself and others, that doesn't mean that I am in a mental place where I shouldn't be able to make my own medical decisions. And so it's just not that binary.

It's not like if a person is found to be able to make their own medical decisions, it doesn't mean, oh, they go off medication. It means that if a psychiatrist is making a claim about what their med regimen should be, it's whether the person has an ability to say, 'yes, no, or could I try something different?' Obviously, there can be that conversation, right?

But as someone who takes significant psychiatric medication, sometimes I've had situations where I have experienced side effects that made me feel like this wasn't the best course of meds and the psychiatrist wasn't listening to me and wasn't taking that seriously, right?

So I just want to separate out those two issues and just share that this idea that because a person is being held, they therefore shouldn't need another hearing to determine whether they can refuse psychiatric meds. It's a little bit dicey, both constitutionally and in practice when you've gone through this, right? So I just want to share that.

Okay, and again, we're not talking about people who are seeing their psychiatrist on an outpatient basis and going in for the adjustment. We're talking about people who have been found to be incapacitated. So I think that is the distinction, and I think using examples like 'One Flew Over the Cuckoo's Nest' is a little bit inflammatory. We're not talking about going back in time. We're talking about trying to provide the services that people need right now.

And I know the ACLU was also opposed to SB 43 that we did last year. That will also expand the definition of what it means to be gravely disabled and to be able to make your own health care decisions.

Before I turn to Senator Rubio, I'm just curious, I mean, is the standard really different? I mean, there has to be a legal standard here. We're dealing with the law, and we're dealing with decisions that the court makes with advice and assistance by mental health professionals in this context and the constitution and the constitutional rights that individuals have.

So can one be incapacitated to the point where they have to be detained involuntarily in a mental health facility and still have the capacity to decide whether or not they want to take their medication?

That's a really good question, Chair Roth, and the answer is yes, the rights are different. There's actually a different evidentiary standard. So the evidentiary standard to be held in a psychiatric facility is probable cause. Courts have held that the right to refuse medication is actually more protected than the right to one's liberty because psychiatric medication is such an invasive thing. Not only does it compromise bodily autonomy, it also compromises one's mind. They're very powerful medications. So it is a different evidentiary standard.

And courts have held that the right to refuse medication is actually more protective. You have more rights in that space than you do to be involuntarily.

But in a practical context, we actually have cases and decisions where the courts have held an individual involuntarily in a facility but ruled that the person has the right not to take medication?

Yes. I am a former Patients' Rights Advocate. I've represented hundreds of individuals in these petitions, and we win these hearings for people who are involuntarily detained but have the right--the court determines that they still have the right to refuse medication. So it's a different legal standard. It's a higher evidentiary standard. And this bill rolling back those rights, so not eliminating these due process protections is really concerning.

But in the case where someone is held and is being forced to take medication involuntarily, and individuals such as yourself or your organization feel that that's inappropriate or a local advocate, rights advocate, would they not have access to the courts via a motion to have the court reconsider the issue?

Yes. So what this bill would do is--

Consider the issue.

This bill would eliminate due process protections. So currently, if you're in a facility, you would have the right to contest an involuntary medication order during the duration of that detention--let's say, for example, I think about five times. So this bill would make it so that it would eliminate three of those five times. So you would only have the right to contest that involuntary medication order in the initial hearing, and then you would have the right to file an appeal.

So it makes it so that you have less rights to contest involuntary medication orders than you do to contest your confinement, even though courts have held the opposite.

Well, doesn't this bill only impact the timing of hearings that we set? We can't interfere with someone's constitutional right. So if someone has a constitutional right, can't you go to court and file a motion and have a judge hear the case?

You have one right to an appeal, both for the involuntary detention and for the Riese petition. So what this bill does is it rolls back additional protections that you have to contest the involuntary medication order. All this bill does, it doesn't get people off the streets, it eliminates due process protections for people to contest these orders.

I don't want to belabor this. I'm not sure I understand that if it's a true constitutional right. I'm sure someone ought to be able to figure out a way to get into court to challenge the constitutionality of what the government or some government agency is doing vis-á-vis the person being impacted, but I'm going to call on Senator Rubio to ask her a question. Senator Rubio.

Thank you, Mr. Chair. I think my concern question, it's along the lines of the Chair, because you're saying that it eliminates due process, so I'm just going to turn it over to the author to go down. And what I'm hearing is eliminating due process. Can you go over and highlight the rights and how we come to this that doesn't violate just eliminating due process completely because that's kind of what I hear when I hear the last statement.

And people always have the right to file habeas corpus. Without right does not disappear in any form. What this does, if a person has not been restored to capacity, it allows not to have another Riese hearing. And again, this is the physician who's treating that person, saying they still don't have the capacity. We all just heard a case--somebody was held for like three months and then just discharged with no aftercare.

And I didn't look at it specifically, but I would guess that their medication wasn't continued because they were never able to return to capacity and then eventually just released. So again, we are not--and we can continue to work on if we need to make it more clear about habeas corpus. We're not trying to interfere with that at all, just the automatic that requires it that sometimes can't get on the docket, and then people go for days without having their medication.

And then again, the consequence of that is to go backwards. The consequence of that is to decompensate further and then need longer to stay in order to get capacity back.

Well, and I guess, to be clear, what I'm hearing you say, which is counter to what he's saying is that the right is still there, but the other part for me is restoring to that capacity, and that is, I imagine, there's professionals looking at this individual and seeing what their capacity is. So it's not, they're just automatically saying, 'let's do it.' They're seeing if they are restored to capacity. If not, then that's when this kicks in, right? So I know it's a little confusing, but just for my clarity, I see the author's point.

I'd like to provide some context that might help if I could, please. Okay, sure. So there is a continuous daily evaluation for capacity, right? Start with that. 45 days, 12 days, whatever. That's the context.

The other is that there are multiple opportunities of due process. So you have probable cause hearings, you have certification hearings, you've got the Riese hearing, and then you've got the writ hearing. So all we're doing is altering one of those hearings. The other options are still available.

The way you explain it to me right now, I can see, because again, if you just hear--and with all due respect--I hear that. I feel like all rights are out the window, but the way you explain it, there's multiple opportunities, right? There's a real big conflict for me in particular because we see--I had a very affluent woman come to me to say that her mother was on the street and they needed help.

And there's always this conflict where you want people to have their rights, but then, on the other hand, you can't help these individuals that are on the street or they're sick or perhaps not being able to take care of themselves, and we don't have these type of bills in place. So with that, I just want to move the bill when it's appropriate. Thank you.

Thank you, Senator Rubio. Colleagues, any other questions, comments, or concerns? Seeing none, Senator, would you like to close?

Thank you, Mr. Chair, and I appreciate the conversation, and I appreciate the ongoing opposition from Disability Rights and ACLU, and I get it, and I think that's a healthy conversation we need to continue to have, but I do believe that we need to be able to provide treatment in the best way that we can in order to get people back into a place where they can make their own decisions. Again, this is always to move people to a lower level of care.

It is not to continue to hold people, it's to move them to a lower level of care so they can be restored to capacity and go on about their lives, and I respectfully ask for your aye vote.

Thank you, Senator. Senator Rubio has moved the bill. The motion is 'do pass as amended. Re-refer to the Committee on Judiciary.' Please call the roll.

[Roll Call].

Thank you, Members.

Vote is eight to zero. We'll hold the roll open for absent Members. Thank you all for participating. Our final item this afternoon is item number nine, Senate Bill 957, Senator Wiener, data collection. Sir, please proceed when ready.

Thank you very much, Mr. Chair, you and your staff for working with us on this bill. Presenting Senate Bill 957, which seeks to address a very significant gap in our healthcare system relating to LGBTQ people, which is a profound lack of data collection. I'm going to be perfectly honest with you, colleagues. I really wish that I could have used this bill vehicle for something else. I wish I did not have to introduce this bill.

The California Department of Public Health should be just automatically collecting this data, and it's frankly disappointing that I had to introduce this bill after I introduced another bill in 2020 that was passed and after former Assembly Member Chu passed a law a number of years ago. It's been very clear that this Legislature wants data collection on sexual orientation and gender identity so that we can have a full picture of the needs and the disparities relating to LGBTQ community. And sadly, that simply hasn't happened.

And so we asked for an audit of CDPH on this issue several years ago. That audit came back with some very clear deficiencies in the lion's share of CDPH forms. It does not ask for voluntary information about a person's sexual orientation and gender identity. We know that CDPH is largely not collecting this data from other entities like county health departments, and so we simply do not have the complete picture of the health and health disparities relating to LGBTQ people.

And this is a matter of life and death. It's not just information for the sake of information. When you think about early in the pandemic, when we were still learning about the virus, we knew that black people were much more likely to die of COVID We knew that Latino people were much more likely to be infected by COVID. We knew that older people were much more likely to become severely ill and to die than younger people were.

And the question is, how did we know these things? We didn't just magically know these things. It wasn't anecdotal. It was because in our healthcare system, we very consistently asked people, it's all voluntary. None of this is mandatory. But most people answer, what is your gender? What is your age? What is your race? And that data allowed us to know quickly who was most at risk of COVID. And we don't have that information for LGBTQ people because we do not ask it, and we don't ask.

And I'm going to be honest with you, it's because too many people in our healthcare system, there still is this perception that is so dated and old that your sexual orientation, whether you're gay or lesbian or trans or bi, it's somehow a dirty little secret. It's quote unquote private. And so we can't possibly ask anyone for that. Maybe that was the attitude many years ago. That should not be the attitude today.

Again, no one is required to answer, just like you don't have to say what your race is or you don't have to answer any of that, but we should be asking the question. And most people will provide that data, and it will allow us to focus resources, to focus educational campaigns, to address any kinds of disparities or shortcomings. And so this bill fully implements the state auditors audit recommendations. This will, I think, finally put a stop to these deficiencies. And I respectfully ask for your aye vote. With me today to testify is Craig Pulsipher, the Legislative Director with Equality California and Eve Banas from the Sacramento LGBT Center.

Mr. Pulsipher, please proceed.

Good afternoon, Chair and Members. Craig Pulsipher, on behalf of Equality California, proud co-sponsor and appreciate Senator Wiener bringing this bill forward to make sure that CDPH is collecting accurate and complete data to improve programs and services for LGBTQ people.

Efforts to collect SOGI data have been underway for quite some time, but as the Senator noted, the urgency behind collecting this data was really made clear during the COVID pandemic, when members of the community were especially vulnerable to the impacts of COVID and SOGI data was not being routinely collected.

Most recently in 2022, SOGI data collection became even more critical during the mpox outbreak, when the vast majority of cases were among gay and bisexual men, and accurate data was essential to effectively target vaccines and other resources to this community. Unfortunately, despite previous legislation mandating that CDPH and other state departments collect voluntary SOGI data, when collecting other demographic data. The Auditor's report revealed that there are still glaring issues related to the collection and reporting of this data, both within CDPH and among the providers and labs they work with.

Notably, the report found that CDPH collects complete SOGI data on a very small number of forms, only 17 out of 129. Last week, CDPH shared in a budget Subcommitee hearing that it's working diligently to implement the recommendations from this report. SB 957 will help to ensure that the Department follows through on that stated commitment.

And importantly, the bill will require CDPH to provide an annual report to the Legislature and to the public about its progress in implementing the recommendations from the audit, including the steps it's taking to improve programs and services for LGBTQ people. And again, thank the Senator for his work on this issue over the past several years, and respectfully request your aye vote.

Thank you, sir. Ms. Banas.

Good afternoon, Mr. Chair and Members. My name is Eve Banas and I'm with the Sacramento LGBT Community Center. Happy to be here today to show my support for Senate Bill 957, which seeks to improve the collection of sexual orientation and gender identity data. At the center, we often hear firsthand accounts about the lack of affirming resources available to LGBT community members.

LGBT people are often left to rely on each other for support, information, and care to make up for a lack of available resources for them. This lack of support can be attributed to many things, including pervasive stigma, misinformation, and an incomplete understanding of the needs of LGBTQ plus community members. LGBTQ plus people should not have to fill in these gaps by themselves, and one important way to address these issues is by prioritizing better sexual orientation and gender identity data collection.

The LGBT community experiences extensive health disparities. This includes heightened rates of anxiety, depression, certain types of cancer, substance use, STIs, cardiovascular disease, and disability overall. To reduce these health disparities, we need to understand community members' unique experiences and needs, and particularly those who have multiple marginalized identities. And to do this, we need complete SOGI data. If we do not prioritize this type of data, we risk perpetuating the same problems that have been impacting LGBT communities for generations.

So, given all of this, the Sacramento LGBT Community Center strongly recommends Senate Bill 957, and we urge you to support this important legislation. Queer and trans folks need us to do better, and we believe that Senate Bill 957 is a much needed solution to address these existing health disparities. So thank you so much for your consideration.

Thank you for joining us. Any other support witnesses here in the hearing room in support, please?

Randy Hicks, a member of the LGBTQ community and citizen of this state, in strong support.

Thank you, sir. Next, please.

Nicole Morales on behalf of Children Now in strong support.

Thank you. Next, please.

Jennifer Robles with Health Access California, in support.

Thanks for joining us. Next, please.

Chair, Members. Anna M. Smith with the American Cancer Society, Cancer Action Network also in support.

Thank you. Sir, next please.

Good afternoon. Ryan Souza with the San Francisco AIDS Foundation and APLA Health in support.

Thanks for joining us, sir. Next, please.

Good afternoon. Whitney Francis with the Western Center on Law and Poverty in support.

Thanks, Ms. Francis. Next, please.

Denita Stromgrun, volunteer with AARP California, in support.

Thank you. Any other witnesses in support? Okay, seeing none. Let's start with lead opposition witnesses. Any opposition witnesses? Lead opposition? Other opposition? Okay, seeing none. Let's bring the discussion back to my colleagues on the dais. Colleagues, any questions, comments, concerns? Senator Menjivar?

Just a comment. The Chair and I just last week were talking about this in sub three and the Senator who's bringing this forward, I want to thank you so much because you're so right. The excuse we got from the Department was privacy laws. Privacy laws, privacy laws. And that's the only excuse for this demographic. Not for race, not for sex. Everything else can be captured except SOGI. And a small little story.

When I was a little staffer in the City of LA during COVID I saw your bill pass from 2020 or something like that, and I was pushing the City of LA like, hey, this bill passed statewide. Why aren't we doing this? I would get the same pushback. We can't ask that question. We can't ask that question. So I'm sorry you had to take up a spot in your bill package on this, but I also thank you for taking up a spot on this issue. So with that, Mr. Chair, when appropriate, I'd like to move the bill.

Thank you, Senator. Any other comments, questions, or concerns by my colleagues on the dais?

I have a question, Mr. Chair. Thank you. Is there an enforcement piece here? This is how many years in the making? What is the opportunity to have some accountability on this?

Yeah, I've learned in now, my 8th year in this body that getting a bill signed into law is only step one. We all have to sort of really monitor implementation and make sure departments are implementing. And our LGBTQ caucus met early on with CDPH to express our serious concern about the lack of data collection. So we've been monitoring it. I think they're not necessarily violating the law. But they are certainly doing, at best, the bare minimum.

This bill will finally require them to just do it comprehensively, and they say they want to do that. And again, I'm not trying to disparage a lot of great people at the Department of Public Health. It's just that for whatever reason, the agency has not sort of occupied the field here and just gotten it done. And I would have hoped we didn't need a bill, but we do, and this, hopefully, will be the end of it.

Thank you for your work on this. I'm happy to support.

Thank you, Senator.

Colleagues, final call for questions. Okay, the bill has been moved by Senator Menjivar. Senator Wiener, would you like to close?

Respectfully ask for an aye vote.

This is item number nine, Senate Bill 957. The motion is by Senator Menjivar. It's do pass to refer to the Commission on Committee on Judiciary. Please call the roll.

[Roll Call]

Did you call me?

I did, yes. You were first.

Okay. The vote is eight to one. We'll keep the roll open for absent Members. Thank you very much. Thanks for joining us. I'm going to start at the top with the consent. Yeah, I'm just going to do one, which is consent item, and just go one through nine.

For those who weren't here, we're going to open the roll to make sure that we have you captured. We're going to start with Item number 1 in the Consent Calendar. And the Consent Calendar has three items on it. Item number 1, Senate Bill 945; Item number 6, Senate Bill 1333; and Item number 8, Senate Bill 1112. The current vote is 7-0. Chair voting aye. Please call the roll.

[Roll Call].

Vote is 9-0. We'll keep the roll open for absent Members. Next is Item number 2, Senate Bill 980 by Senator Wahab. Current vote is 7-0. Chair voting aye. Please call the roll.

[Roll Call]

Current vote is 9-0. We'll hold the roll open for absent Members. Next item is Item number 4, Senate Bill 1017 by Senator Eggman. Current vote is 7-0. Chair voting aye.

[Roll Call].

Current vote is 9-0. We'll hold the roll open for absent Members. Next item is Item number 5, Senate Bill 1184 by Senator Eggman. Current vote is 8-0. Chair voting aye. Please call the roll.

[Roll Call].

Vote is 11-0. That matter is out. Next item: Item number 7, SB 953 by Senator Menjivar. Current vote is 5-0. Chair voting aye. Please call a roll.

[Roll Call].

Do we know whether the other people are coming back?

Current vote is nine to zero. We'll hold the roll open for absent Members. And the last item: Item number 9, Senate Bill 957 by Senator Wiener. The current vote is 8-1. Chair voting aye. Please call the roll.

[Roll Call].

Current vote is 9-1. We'll hold the roll open for absent Members. Thank you all.

Let's call the roll on the Consent Calendar again. Item number 1. Consent Calendar consists of three bills: Senate Bill 945, Item number 1; Item number 6, Senate Bill 1333; And Item number 8, Senate Bill 1112. Current vote on the Consent Calendar is 9-0. Chair voting aye. Please call the roll.

[Roll Call].

Current vote is 10-0. We'll hold the roll open for absent Members.

Do we want to get Senator Glazer?

What is he missing?

He's missing Item 2, 980. And, he's missing a couple, and Item 4, 1017.

Okay, Senator Glazer, we're going to call the roll for you on the open items. The next one is Item number 2, Senate Bill 980 by Senator Wahab. Current vote is 9-0. Chair voting aye. Please call the roll.

[Roll Call].

Current vote is 10-0. We'll hold the roll open for absent Members. Next item is Item number 4, SB 1017 by Senator Eggman. Current vote is 9-0. Chair voting aye.

[Roll Call].

Current vote 10-0. We'll hold the roll open for absent Members. Next item: Item number 5, Senate Bill 1184 by Senator Eggman. Current vote is--that's out. Okay.

Glazer's on everything else.

Okay, that's it for you, Senator Glazer.

We let her know again, sir. Senator Grove.

We're just waiting, just Grove is all. She needs to vote on Consent and.

Okay, she's on her way. She says she's on her way.

Yeah, a few of them.

Well, I have to close them out anyway. Yeah, except for.

She should be here momentarily, sir. Thank you.

No, it's okay. We're just going to roll through. We're going to open the file on all of the items except for the one that's out. So we're going to first take the Consent Calendar, starting with Item number 1. There are three items on the Consent Calendar: SB 945, Item number 1; Item 6, Senate Bill 1333; and Item number 8, Senate Bill 1112. Current vote is 10-0. Chair, voting aye. Please call the roll.

[Roll Call].

Vote is 11-0. That matter, that item, which is a Consent Calendar, is out. Next is Item number 2, Senate Bill 980 by Senator Wahab. Current vote is 10-0. Chair voting aye. Please call the roll.

[Roll Call].

Current vote, 11-0. That item is out. Next item is Item number 4, Senate Bill 1017 by Senator Eggman. Current vote is 10-0. Chair voting aye. Please call the roll.

[Roll Call].

Vote is 11-0. That item is out. Item number 5 is out, Senate Bill 1184. Next item, Item number 7, Senate Bill 953 by Senator Menjivar. Current vote is 9-0. Chair voting aye. Please call the roll.

[Roll Call].

Final vote is 9-0. That item is out. And the final item is Item number 9, Senate Bill 957 by Senator Wiener. Current vote is 9-1. Chair voting aye.

[Roll Call].

Final vote is 9-2. That item is out. And this concludes the Senate Committee on Health hearing for today, which is March 20, 2024. We are adjourned.