Senate Standing Committee on Rules

You. All right? We now would like to be able to call the Senate Rules Committee together here on March 6, 2024. Welcome to each of you who are here in room 2200 and to those who are watching online. We are grateful that you are participating here today. We're going to begin today's agenda with some administrative of items. But before we do, we'd like to be able to establish a quorum. Madam Secretary, can you please call the roll?

[Roll Call]

Thank you so much, Madam Secretary, a quorum has been established to the representatives who are here under Governor appointees. We are grateful. Thank you so much for being here on time and prepared. If it's okay with the three of you, and to this Committee, what we'd like to be able to do is take up some administrative items first. It will be rather quick. We'll be efficient with it. And then we'd like to be able to advance with our appointment presentations.

So, ladies and gentlemen, Committee, we'd like to be able to take up items. Governor appointees not required to appear would like to be able to take up separate votes. If it works for the Committee, we would like to be able to first take up item D. Then they'll be independent.

Then we'd like to be able to take up items two e through h. We would then like to take a separate vote on item two I. All right, so we have a motion and a motion on the floor. So is there any discussion on any of these items? And again, we'll take item D up first. Any conversation on item D. Hearing seeing none under Governor. Appointees not required to appear under Ms. Beasley for the Housing Partnership Corporation Board of Directors. Madam Secretary, can you please call the roll on item 2D?

[Roll Call] Five to zero.

All right, thank you so much. That is a 5-0 vote on those appointees. Ladies and gentlemen, Committee, we now would like to take up items two E through H. Each of these individuals are for Members on the Commission of the Status of Women and Girls. Is there any discussion on this item? We have a motion by the Vice Chair. Any additional discussion? Hearing seeing none. Madam Secretary, can you please call the roll and items two E through H?

[Roll Call] Three to zero.

That is a 3-0 vote. That motion passes. Members of Committee, we now would like to be able to take up our final item under those who are not required to appear. This is item two. I. Mr. Williams, Member of the State Park and Recreation Commission. Is there a motion on the floor? We have a motion by Senator Eggman. Any discussion? Heron? Seeing none, Madam Secretary. Can you please call the roll?

[Roll Call] Three to two.

That is a 3-2 vote. That motion on item two aye. Is approved. Thank you so much, Members, ladies and gentlemen, Committee, we now like to take up item three, which is reference of bills to Committee. Is there a motion to approve? Madam Vice Chair advances a motion. Any discussion by Committee hearing? Seeing none. Madam Secretary, can you please call the roll?

[Roll Call] Five to zero.

That is a 5-0 vote under Bill referrals. Ladies and gentlemen, Committee, we're now going to be moving on to floor acknowledgments. This is our final item before we return to Governor appointees, items four through eight. Items four through eight under floor acknowledgments, is there a motion to approve?

Quick question, please.

We have a motion by the Vice Chair. We do have a question in Members. Madam Vice Chair, you can affirm this item is non debatable, but we'll go to a question for Senator Jones.

Just a quick clarification on item number seven. Senator Laird's request for Gallery introductions. My understanding is we're supposed to have a list of names when we approve the motion. But I also heard that you might be working on the names.

Thank you so much. Please, Senator Laird

Yes, I do this every year, and it's just the annual leadership class for Morgan Hill. So I can get a list of the names of the people that are in the class.

Thank you.

Thank you so much. We have a motion.

Yeah, I just wanted to clarify that.

No, thank you so much, Senator Jones, we have a motion on the floor by the Vice Chair. Would like to be able to call the role on floor acknowledgments. Items four through eight. Madam Secretary, can you please call the roll?

[Roll Call] Five to zero.

That is a 5-0 vote. That motion is approved. Thank you so much, Members. Very grateful. We now are going to invite up Governor appointees required to appear. We are so incredibly grateful. Under item 1A and 1B. That we have Dr. Mahmood here today. If you could please come forward along with Dr. Thorp. They are coming forward as members of the Medical Board of California to each of the gentlemen who are advancing here to the dais.

You're going to have an opportunity to be able to provide one to two minutes for opening testimony to the Committee. We're then going to open it up to Committee Members to ask any questions and advance any comments in your opening. We would love it if you would introduce the guests who are with you here today or those who may be watching online. We're going to be keeping time of your opening. And I'm not at all trying to be rude.

I will give you a prompt when you get close to that time. We're going to first start with Dr. Mahmood. We are grateful that you're here. And I also want to say thank you so much for your service. Doctor, the floor is yours. Two minutes, sir.

Good afternoon, Senate Pro Tem, Committee Members really appreciate this opportunity. Thank you so much for giving me the second opportunity to be on the board. I do want to start with thanking my wife at home and my children at home. And I have my brother, Khalid Mahmoud here, and my almost 35-year-old friend, 35 far, 35 years friend, Jeff Albi. I am really thankful to them to be here. Just briefly, about me. I come from a very humbling background from a rural Pakistan, small village.

And I was the first kid from my family and from my village actually surrounding that area to go to medical school. And I am so humbled and so proud that I was able to make the career and come to California. All my life I have helped people, and that is what I have done all my life without any vested interest. And I was really thrilled. And four years ago, I got the opportunity to take my health to a bigger level, to help my patients.

My patients are about 80% minority patients, and there are so many challenges. And I think last four years, board has given me a lot of opportunity. I think a lot more work needs to be done to make sure the Californians are safe, secure, healthy in best possible way. And I'm here seeking your endorsement. Thank you, Doctor.

Thank you so much. We're really grateful into your family. Please thank them for attending. It's wonderful to have your brother here as well. Thank you so much, sir. We're now going to be opening the testimony up to Dr. Thorp again. Dr. Thorp, thank you so much for your service. The floor is yours. You have two minutes. Please advance.

Thank you. Senator Pro Tem, I appreciate the opportunity and Members of the Committee to have the opportunity to come and answer questions and to present myself as a candidate for the medical board. I want to thank the Governor for reappointing me for the medical board. And I want to thank my family, my wife Vicki, at home, and my four sons, Zach and Aaron Thorp, and Shane and Griffin Rogers, for their love and support. As always, I am a rural physician.

I practiced in paradise, California for 40 years and currently live in Chico, California. After the campfire, we were relocated to Chico. I decided to be a physician when I was 12 years old, and I've been grateful for the opportunity and the privilege to serve as a physician through those years.

Patient care and patient solving patient problems has been the core of my practice for 40 years, and I am grateful to be able to have the opportunity to serve in that role of public protection for the last several years as an appointee of the Governor and hopefully for the next four years.

Thank you, Dr. Thorp. Thank you so much. Very grateful for both of you who are here. Ladies and gentlemen, Committee, we're going to open it up for questions and comments, and we'll be taking two separate votes on this at the appropriate time. First, we'll start with Dr. Mahmood and then go to Dr. Thorp at the appropriate time. But before we do, we'd like to be able to open it up to the Committee. We're going to start with Madam Vice Chair. Madam Vice Chair, the floor is yours.

Thank you, Mr. Pro Tem. Thank you both for being here. Appreciate it. I know it's not a tedious thing, but it's an honor to be appointed by the Governor and to come up here and take our questions. Some of the things that I want to ask both of you are significant concerns have been raised from stakeholders regarding to the Legislature about the medical board's complaint tracking system. Can you update us on the status of the board's proposed timeline for complaint tracking? These are complaints alleged against medical providers. Mr. Mahmood. Mahmood. Sorry.

Thank you so much. I think this is one of the core missions of medical board and should be that our prime goal is to have safety and security and well being of Californians. And nothing can improve until we hear complaints and just listening to complaint and not following up on them and not responding to them and those people who are aggrieved if they are not reassured what has been done, it is just not a real process.

I have been on medical board for four years and I talked to many stakeholders. I talked to consumers, and there's a concern. And board has come up with a complaint tracking system which is already in the process now we have to take an approval from two different agencies, and then after that we're going to kind of staff is going to adopt in a program and program after my discussion with the staff, program is hopefully going to be functional sometime by end of next year.

Thank you very much, Dr. Thorp, just unless you had something different, a second question I had on that is, why do you think it's taken so long to have this tracking system implemented?

Just to be clear, you mean why is it taken till 2024 to develop a complaint tracking system? Or why is it taking so long for the complaint tracking system to be implemented that was authorized in December of 2023?

So the first comment that you made, there's a lot of complaints that have gone on for the years, and now we have an over large number of complaints. And the response time has been based on the information that I have by stakeholders and others, that it's a very long delayed response time.

Correct. So I think there's two issues here. One of them is the length of the time that it takes for a complaint to go through the system. The other is the actual ability of the complainant to track their complaint through the system. And they are interrelated, but I think they're two different things. The board actually approved the complaint tracking system in December of 2023 as the result of public stakeholder meetings that were held in 2022-2023 to try to improve the communication with the board.

And the board was unanimously enthusiastic about that process. It's in the process now. And as Dr. Mahmood mentioned, it's going to take a little bit more work to get it actually up and running because it has various authorities to get authorized through, but it should be available and ready for primetime mid to late next year.

Great. Thank you. And the last question I had for you, Dr. Thorp, was, I understand that you took part in the task force to revise the board's guidelines on prescribing controlled substances. And I guess, in your opinion, how do these 2023 guidelines that you participated in bring balance from over prescribing opioids, which we have a lot of in workers compensation situations and things like over prescribing opioids with the needs, the patient need for pain reduction?

Previously, the guidelines that had been available, the 2014 guidelines from the medical board, and also the guidelines from the FDA as well, were, although they were guidelines, they were used as restrictive and prescriptive ways of prescribing. The task force took on the work of trying to look at this from the standpoint of patients who actually do need opioid prescriptions in the chronic pain population, and to try, to try to give the authority more back to the physician and the relationship of the physician and the patient.

The language is much more, how should I say it? It's not as prescriptive, and it's much more in the idea of trying to encourage, well, not encourage prescribing, but to encourage people to look at those people who need the medication carefully, laying out all of the parameters that need to be fulfilled for them to do so, and then to have the opportunity to prescribe without fearing the board disciplining them inappropriately.

Thank you.

Not inappropriately, but being able to prescribe without the fear of the board discipline.

Okay. Thank you. Thank you. Dr. Thorpe. Dr. Mahmood, did you have a comment on that?

Yeah, I would say that the major component on this was safety. Safety was not considered as a prime thing before, and the new guidelines go a lot on safety, safety of the consumers, safety of the patients, to keep an eye on that. So safety was the major consideration in this one. Thank you, Doctor. Thank you, Mr. Pro Tem.

Thank you so much, Madam Chair. Please. Senator Eggman.

Thank you, gentlemen, for being here today, and thank you for meeting with me earlier. I think for both you, Dr. Thorp, and Dr. Mahmood. And you mentioned this, right? I mean, just going back to the issue of opioids. Opioids, because you talked about when you first started practice, very rare, did you prescribe something? And then now the number has drastically. So what do we attribute that to? Do we attribute it to, I mean, the advancement of medicine and people just living longer with more pain, or what do we attribute that?

Well, in all honesty, Senator, we can attribute that to the Legislature. A number of years ago, the Legislature passed a document, a Bill called the patient pain Bill of rights. And legitimately so, there was probably under prescribing of pain medication in certain situations. That Bill actually mandated that physicians address chronic pain, address pain in any form. And at that time, pain as a discipline was not nearly as well understood as it is today. It was much more rudimentary.

And what we really knew was, you treat pain with pain medication, right. Well, patients would come in and ask for pain medication. It's very hard to tell if somebody's in pain. I can't tell if you're in pain. You can't tell if I'm in pain by just looking at you. Sometimes you can because somebody's in agony. But much of the time, it was very difficult to do that.

As a result, the demand for pain medication skyrocketed, and doctors were, frankly, overwhelmed with that demand and didn't really know what to do except to either resist it and face legal action or to try to figure out a way to comply. And that's really the source of that dramatic increase. On the other side of that, today we're seeing a dramatic desert in opioid prescribing because of the medical board actions, because of actions of the DEA, because of pharmacy activity as well.

So now if you're a chronic pain patient, it is almost impossible to find a Doctor who will prescribe pain medication for you. Opioid pain medication. And so these guidelines were built with the input of public, of special expert people who do chronic pain. These were built with those people's input to help us develop guidelines that are actually functional and safe and actually provide the ability for doctors to prescribe care within the guidelines and not fear discipline.

So you feel like it's correcting itself now?

It's a very slow process. We still have a lot of work to do, and I would say it's not corrected yet.

So do we err on the side of over-prescription or under at this time?

I would say we err on the side of underprescribing. The problem is that even though we're not prescribing as much, there are still many deaths related to overdose. But those deaths are really primarily related to fentanyl in the drug trade that occurs on the street, not from physicians overprescribing opioids as there was an issue.

And now there's a bigger protocol around different things that you can do just besides prescribing medications?

That's true.

Do you feel like people have integrated that into their practice and you're able to see that in complaints that come before the board?

We've seen a decrease in complaints for over prescribing. In my experience in my panel, I don't see them nearly as often as I did before.

Dr. Mahmood.

On your first part of question, why there has been more need for prescription drugs? It's many things. Not only that, biggest part of that is access to health care. Access to health care in the last 25-30 years has skyrocketed up. So people are aware of that.

Second thing is people are more aware that there's medications out there which are helpful, that led to more addiction, and that led to those people who are playing on these people getting more and more medication and getting them to the street. And I think at 1.0 it was really accelerating. And state and medical board worked on that. And we find people who are prescribing millions of pills in a year. And the other end, we find people who just give few.

That means some people are just overusing or abusing or doing a business and others are so scared to give because they think that their life should be. But the work for last few years has definitely improved and death from prescription drugs have trend down now for last several years, whereas death from the street drugs has gone up. We are very well aware, we have invited the national experts on pain to come and teach the board.

And I think there's still more need to go to the community and especially physician community to teach them and bring awareness. Nobody wants to live in a pain, but you just want to be sensitive, that you don't want to make them addicted. You just want to make them live in a real life. I have seen so many miserable cases, people who got addicted.

And if I may, Mr. Chair, and so do you feel like the medical board process at this point has a good process to be able to deal with it adequately?

Now the death certificate or drug death certificate follow up is really helping. And actually we are trending and following that that how many deaths are secondary drugs and how many are those prescription drugs and how many are those secondary street drugs? And we are moving in the right direction on that. Are we close to where we have to be? I don't think we are there, but I think we are in the right direction on prescription drugs at least.

And Mr. Chair, if I might, one more, just as we're talking about the Legislature entering into the medical field, there are some bills before us this year, and I'm just wondering about your feelings around the new drugs, around obesity. Right. Which of course has been a big issue with lending to a lot of health care issues. And on the other side, the over prescription perhaps of medication in order to deal with issues like that. Can you talk about your impressions about that new horizon that we're coming onto, potentially?

Honestly, you brought up such an interesting topic, and I was thinking last week when I was thinking about hearing that, I hope this thing comes up because it's skyrocketing right now.

And obviously a lot of people are getting help and people, it's just natural human desire to look, I'm not going to say like anyone in a normal weight or people have not a capacity to lose weight other ways, but what we've seen in our trend, there is in a competition going on pharmaceutical industry that is just not to help people just lose weight or something, but to keep more and more money.

We at some point have to set up in a guideline how and who can get it, or have people done other all measures and they can lose weight and they should do that. I am very sure if somebody doesn't bring it up, I'm going to bring up agenda to discussion the medical board, and this needs to be addressed. And honestly, you have brought up a very important issue which coming years can be a problem. Thank you for bringing.

I think the main issue with any treatment is or not the only issue, but certainly patient safety is clearly a significant concern in all these situations. These medications are effective. They certainly work very well for patients who have significant weight to lose. In my experience, we've been able to do them successfully. However, they can't be given without monitoring. They can't be given without appropriate oversight. And I think that's where there would be a problem if these medications were not given properly or with inappropriate oversight.

Okay. And just, Mr. Chair, if I might. We talked in my office just about some of the issues with, or the issue, I guess, of the very high profile physician who had been charged multiple times with assault, who was still able to practice without the public being informed of that, and just kind of the concerns around safety around that. If you could address that a little bit.

Yeah, well, I appreciate that question again, and a chance to maybe intensify my comment. Sexual misconduct is totally inappropriate in any situation, and the medical board takes that extremely seriously. We also have to live under the law that we are mandated in. And that's the main concern that we have is we're not the main concern, but the main limitation that we have is that we have to discipline based on what is evidence that's presented to us.

So it's not appropriate for in any circumstance, regardless of what the circumstance is. I certainly personally feel that, and the medical board feels that certainly is in agreement with that. But we do have to discipline based on what we are able to do legally based on the evidence.

Thank you. Dr. Mahmood.

There is no excuse for sexual misconduct in the society, period. But in a relationship between physician and a patient or physician and staff is much more gravious than that, even because the relationship of patient and physician is as sacred as parent and child. And in any circumstances, we should have a very low threshold to stop that, abandon that at the earliest possible.

I know there are challenges that we cannot act without lot of information, but we have the power to restrict them, and we should use that power to restrict them before any further damage happen. Because, as I said earlier, sexual misconduct or harassment is not only a bodily injury, it's a huge scar on the brain which might not heal rest of the life of the victim. And we need to stop it, and we should not have any excuse. And in my review of cases, I am extremely, extremely sensitive on that. And I have expressed that in our meetings.

And I understand about the sanctity of physician patient. But even if it's not your own child you're abusing, if it's somebody else's child, that is still something that feels like the public should be warned about.

Yes. Any sexual misconduct is not accepted because. We know abusing one just exactly is an indicator for abusing another. Very true. Very true.

Thank you.

Thank you very much. And thanks for the time was spent as short as it was. And I think this is interesting because I think this is true for Senator Grove.

This is our second time with you, and we, how do I say it, had a rather spirited hearing the first time you were here, and I did have two takeaways about each of you personally, about Dr. Mahmood, your humble beginnings, but also, Dr. Thorp, about your entire practice being burned out by the paradise fire and how you managed to reopen within a matter of days in another location and continue to serve people. And I remember both of those from our first hearing.

And I also saw that you had your quarterly meeting to strengthen your outreach in Bakersfield last summer, and I hope you appreciated everything that Bakersfield has to offer while you were there. The thing I wanted to ask to follow up on the questions here is that that animated hearing before came after the LA Times story and of physicians that did rather egregious things, and some of them were returned to service after that.

And a few of them, according to the LA Times, continued to do it or did it again. And so I really appreciate the complaint, tracking the outreach, the different things that have been implemented. How do you, in looking at that, sort of convince the public that those aren't just processes, they are actually going to lead to addressing the concerns that the public has or were raised in that article? And I don't know which order we're going in. Just start maybe with Dr. Thorp.

Thank you. Thank you, Senator Laird. And it was a pleasure to meet with you again today, too. So I think that's always the challenge, right? Is when we do change processes, that it's not just perfunctory, but that it actually has meaning and that actually changes and improves patient protection. And I think the proof is in the pudding, basically. I think the only way that for us to restore confidence is through that ongoing communication that we get on every item on the agenda. We get public comment.

But also I think the public stakeholder meetings are very helpful. We had a number of public stakeholder meetings when we revised the opioid guidelines. And I think those focused public stakeholder meetings are very helpful, like that opioid task force, because we get people who are very concerned about that particular issue and we get very constructive comments, and it did result in a product that they could see and that actually did change the way we do things. So I think that our goal, I know my role.

I've been educated over the last few years, recognizing the importance of the public input and the public stakeholder input into each of those processes and how important these things like the complaint tracking unit, the complainant liaison unit, the complainant being able to make a comment before their case is closed, all of those are very, they help to build trust that we're actually paying attention to what the public says. So I think that's the way we make it work.

I appreciate that very much. Dr. Mahmood.

That particular article, actually, as I told you earlier, I am from Southern California, and that particular article not only brought up a very important issue, but it really increased the vacuum or gap between public and medical board, because the biggest challenge medical board right now has is trust of public and confidence of public. It is not exactly because medical board is not doing its job, it's because we are not being seen as doing the job.

That whole thing had happened before I was even on the medical board. But we are very vigilant. We're not only waiting for somebody to report it, just like complainant or some hospital, any other medical board. I think we are going farther now. If something comes in a media report, big news, credible news, we should act on that. Whenever I go on deliberation in the panel meeting, I'm very reluctant to give people a leverage if there is some character or behavior like that.

We do believe in rehabilitation, but certain rehabilitation and given the chance, can hurt more people. We have to have a very stingy supervision and chaperone thing on those things. And we have been, and I'm confident nothing else has risen since then. And we have been really on at least the panel I working has risen up to the thing where we would lose any loophole. I cannot guarantee that nothing will happen again, but we are very sensitive and I assure you that we'll be very careful.

And we also need to interact with watchdogs. We need to interact with the consumer dogs and all those people who help patients or complainants or victims that get their input and encourage them to let us know without any hesitation or without any reluctance that this is what is happening, so we can have a preemptive action before anything bad happen again. So we are sensitive and we are going to work on this.

Well, my last question is a follow up. And the follow up is, do you believe that the perception of the medical board is changing because of these activities and this outreach? Given the fact that that article is now three years ago, and I think the lively hearing we had is a similar time, do you feel that there's change being felt by the public or stakeholders.

So there are several things. One, the burning issue is this legitimacy of process of complaint process. That is one of the bigger things because a lot of people have complaints about that. Not that we are not, board is not following. And honestly, I talked to many staff members who are involved and I would admit here they are overworked, but they are working diligently.

But there is always a need for newer things because we are evolving and need to find better ways to bring and media reports, the complaint process and some people not getting according to the public thing as much discipline as they think and they don't know the whole thing. And sometimes we are tied because what comes to us is a little different. But in spite of all those things, I think we need to work more on creating more trust and confidence between medical board and public. That is really very important. That can only happen with a transparent and just process, not just talk.

Thank you. And Dr. Thorp, anything to add on that?

I'm not sure I have anything more to add, except to say that trust is something that has to be earned. And we have put these processes, or even the processes are taking longer than we would like them to take to get implemented. And once they get implemented, it's going to take some time before people say, oh, that actually is better, that's actually working better.

So to say that the trust is restored in the medical board today, I don't think so. I think we have work to do still and getting these processes working functional, operationally successful, that's going to be part of our role in rebuilding trust.

Great. Thank you. I appreciate both your responses.

Thank you so much. Senator Laird. Before we turn it over, for those in support and opposition, we'd like to be able to see if there's any additional comments from the Rules Committee at this time. Hearing. Seeing none, we now would like to be able to open up public comments on the appointment of both Dr. Mahmood and Dr. Thorp. We welcome any individual to be able to step forward. If you could please state your first and last name along with the organization. We're looking at support. We're looking at support right now. Good afternoon. It's good to see you.

How are you? George Soros with the California Medical Association in support both.

Thank you. Soros. Thank you so much for being here. We're really grateful. Those who are in room 2200, we invite you to be able to come forward to the podium. Any individual would like to be able to speak in support of the doctors. Please advance at this time. This is going to be last call. Last call hearing. Seeing no one stand, we're now going to be going to opposition. Anyone wishing to testify in opposition may now come forward and speak. We welcome you to the podium.

Last call hearing, seeing none. We're now going to be bringing it back to Committee. Before we look for two separate motions on this issue on these appointees, we'd like to see if there's any additional comments or questions from the Committee hearing. Seeing none. Thank you, doctors, both, for your service to the State of California. To the patients of the State of California, of course, to the people of the Golden State. We are grateful that both of you are here today.

And to all those who have turned out in support of the doctors. Ladies and gentlemen, Committee, we would now would like to be able to take up item one a. One a. We have a motion by Vice Chair Grove. A motion by Vice Chair Grove. On item 1A, Dr. Mahmood for the medical board of California. Madam Secretary, if you can please call the roll?

[Roll Call] Five to zero.

Thank you so much, ladies and gentlemen. Committee, that is a 5-0 vote. Thank you so much, Doctor. We're now going to be moving forward with a motion to approve Dr. Thorp. Item 1B Is there a motion on the floor? We have a motion by Madam Vice Chair. Any last-minute discussion hearing? Seeing none. Madam Secretary, if you can please call the roll.

[Roll Call] Five to zero.

Congratulations. Dr. Thorp, as well. We are grateful, gentlemen, that both of you are here today. Thank you so much. Thank you. We're going to give it just a moment while folks clear out of our first appointees. As that is happening, we are now going to be taking up item 1C, the potential appointment of Joseph Eto as a Member of the Independent System Operator Governing Board. Good afternoon, Board Member. Thank you so much for being with us here today.

Thank you for your patience as we are having a discussion here on our previous panel. First and foremost, Mr. Board Member, we are going to provide one to two minutes for your opening testimony. We appreciate your service, sir. We're then going to open it up to Committee Members to be able to ask questions and, of course, any comments that they may have in your opening. We welcome you thinking or acknowledging any guests that you may have here in the Committee room or online.

And then what we'd like to be able to do is open it up for questions and comments and of course, I'll give you a three second warning when you hit two minutes. Mr. Eto, thank you again for taking the time to be here. The floor is yours, sir.

Thank you, Mr. Pro Tem, Vice Chair, Grove Senators Eggman Jones and Laird. I'm honored to be able to introduce myself to you all and talk about the work that we do at the ISO. I do not have any guests with me here in person, but I would like to acknowledge my wife Liza and my son Ben and my daughter Georgia. They are the reason I'm able to do the things that I do, and I am grateful for their support in those endeavors.

I'm a third generation Californian. I was born in Southern California, raised in the Santa Clara Valley before it became known as the Silicon Valley. I went to Berkeley to go to college and effectively never left.

I went directly from graduate school to work at the Lawrence Berkeley National Laboratory, which is the Department of Energy Facility that's located on the hill above the campus where I had a 40-year career working on public interest issues surrounding electricity reliability, energy conservation, integrated resource planning, and specifically integration of variable renewable generation. I've published extensively in these areas, and I draw on those experiences in my work for the ISO.

I would like to talk a bit about my priorities very briefly for my tenure should you approve me as a Governor at the Board of the ISO. My first priority and my highest priority is keeping the lights on. It really is job number one of our organization. It's foundational to the well being of our population and the vibrancy of our economy. Without a reliable power system, all of the policies that we're interested in pursuing really are going to be much, much more difficult to accomplish.

Just real quick, we have about 30 seconds. Would it be all right with the Committee if we extend Mr. Eto's time by two minutes? Would that be all right with the Committee? Just want to make sure that folks are comfortable with that, please. I did not mean to interrupt, sir. The floor is yours for additional two minutes.

Thank you, Mr. Pro Tem, for the extra time, I do really appreciate that. I will draw on my engineering expertise, my work on blackouts, my work on advanced grid technologies to improve reliability, many of them that I demonstrated at the California ISO, many of which are employed by the ISO to this day, to view all of my decisions from the perspective, first and foremost of, is this going to hurt or is this going to help reliability?

I think everything needs to come back to that from the standpoint of what we do here at the ISO. My second priority is to ensure that we play the critical role that we have to play in achieving our state's clean energy goals. These are goals that I support wholeheartedly. They have really been at the core of the public interest research and analysis that I've conducted throughout my career at the Lawrence Berkeley National Laboratory.

And again, I am honored to have the opportunity to try to put those lessons to work in supporting the objectives of our state. Our role at the ISO in that regard is twofold. One, we must plan the transmission system that is going to be required to bring that clean energy to our customers, to the population. And second, we must interconnect the resources that are the sources of that clean energy.

Those are our two principal jobs at the ISO with respect to the pursuit of those policy goals. We have to do that, of course, in conjunction with other agencies, particularly the California Energy Commission and the California Public Utilities Commission. We've recently signed an MOU with them that greatly improves our ability to deliver on that role. And I'll be happy through the question and answer to talk about some of those activities.

My final priority is to pursue the above in a way that we can afford and specifically to ensure that we pay no more than we need to pay to achieve these ends. We're going to pursue it in two ways. One is to make sure that we're right, sizing and building only the most cost effective transmission system that we need to meet our objectives. The transmission system is a means to an end. It's not the end. The end is clean energy.

The end is reliability delivered to the electricity users of our state. The second way we pursue that is through the operation of regional wholesale markets for electricity that allow us to cooperate with our neighbors in a way that we can both benefit by ensuring the cleanest energy at the lowest cost can be used and applied, and in the same time benefit the reliability of the power system.

I'll be happy to talk about some of the economic benefits of regional cooperation that we've been able to accomplish 5 billion in the last seven years. But I believe the reliability benefits will trump all of those, and I'll be happy to talk about those as well. With that, let me conclude my opening remarks. Thank you again for the extra time.

No, thank you so much. As a board member, I know we'll get into more discussion. I really appreciate that. Thank you so much. We're going to go to Senator Laird first.

Senator Laird, thank you very much. I appreciate the chance to meet, however abbreviated it ended up being. I want to pick up on what you said about transmission, and to make a semi snarky comment, you said it means not an end, but if it's not there, it's an end, it'll be a dead end. And so the real question is that we have so much stuff that can come online and such limited transmission, and yet transmission is what is going to make the grid work.

And so how do you act as a facilitator and how do you prioritize what's there when there appears to be much more energy coming online than there is the ability to transmission, to move it around?

I think that is a very appropriate question. Transmission is a means, but without the means, as you say, we don't have the ends and we have to build a lot of transmission. We have a lot of new generation that needs to come on. We need to onboard on the order of 7000 generation every year in order to meet our clean energy targets. In order for those 7000 difference, we have to be able to deliver that energy to the folks that use electricity.

And that's going to be through the expansion of the transmission system. We have several things that we're doing, several specific things that we're doing to that, and I'll enumerate them right now. First and foremost, we have staffed up. We have 116 staff in our planning group. We have a total population at the ISO 700. So 7th of them are working on these planning topics.

We've kind of come out of the COVID era to have a full complement of staff to undertake the large lift that we have ahead of us. Second, I mentioned this MOU that was recently signed between the PUC and the Energy Commission and the ISO. This allows us to tightly synchronize our planning processes so that we don't waste any time in this planning process. We draw on that memo in several ways.

The first and most tangible way is that we annually prepare a 10 year look ahead transmission plan and we're updating this every year looking ahead. The projects that we identify in that plan are those that we view. Those are the highest priorities for meeting these clean energy targets. I would like to thank you.

I think the Legislature for AB 1373, which confers on the need assessment that we conduct a rebuttal presumption of need that really greatly facilitates the CPCN process that's necessary and previously was again sort of a drag on getting projects approved and built. There are some other issues that need to be addressed in transmission, such as permitting and site. They're beyond the scope of what we do with the ISO. We're keenly interested in seeing those processes move forward.

We acknowledge again the work of the Legislature in trying to streamline the CEQA and NEPA process. All that stuff is going to. We don't have a moment to lose. And so any place where we can cut down the historic eight to 10-year lag in building transmission, to cut it in half, if we can, or even further, is essential for being able to onboard this new generation in a timely fashion.

Let me offer one final area that is really coming before the board in a couple of months. Many of you have heard about the interconnection queue process. This is the process by which this new generation applies. And we have to do extensive studies to ensure that they can be integrated reliably. Well, historically we had about 150 projects coming in a year. Two years ago, we had approximately, I believe it was close to 300 projects come in. And last year we had 500 projects come in.

We now have more projects in the queue than we can accommodate beyond our targets for 2045. So in addition to the workload issue, we need to sort of figure out how to go through that in a way that is fair and equitable to all participants, but that really prioritizes the state's needs first so that we get the best projects online as soon as possible. The MOU has been critical in this process.

We now look to the CPUC to identify the areas of the state where they have designated preferred resources to be built. So this will be solar in the central valley, offshore wind in your region, sir. Offshore wind in your region, down by Diablo Canyon, out-of-state solar and wind, lots of solar, as we've talked about in your district. And so these are the resource-rich areas that we can now target in our interconnection processes. So if you want a site in that area, you're going to be at the front of the line. Those are the projects that we want to go through first.

And let me just do exactly what I did in our meeting, which is you just outlined all the processes and all the goals and everything. How do you actually make sure it happens? How do you actually make sure there's transmission that happens? And how do you make sure it's fair to those competing interests? Because you said in the meeting in here, you have to make choices. It's like, what are those choices? Who wins and who loses? How are you going to do that when you actually apply everything you just said in your answer?

It's going to be a lot of hard work, and it's going to require the cooperation, support of our market participants and stakeholders. And the way that we are pursuing that is through a very open process to identify specific development metrics for projects that all parties can agree to about. This is a project that is in the right place. This is a project that has moved through the stages of development in a timely manner. These are the projects that are going to be ripe first.

These are the ones that you want to interconnect first. Because this is going to be a process of winners and losers. It's very important that all stakeholders have the opportunity to weigh in on exactly what those.

Excuse me for interrupting, but I think when you say it's a process of winners and losers, and we're five people up here that represent the winners and the losers, we are anxious to understand how that will work because so many times in hearings we hear winners and losers and then we realize we just made a decision for all our constituents in one area to be a loser. And so it's very important for us to understand what the process is and what the relative weights are so that we can make an assessment about them.

Surely I cannot speak to the specifics of the metrics that we are proposing. We're going to be reviewing them very shortly at the end of this stakeholder process. But I do want to emphasize this stakeholder process. Who are the folks who will be the winners and losers? They are involved in an open and very transparent discussion with our staff that has been going on for a year now to try to fine tune these things to something that we can all accept.

So that should someone become a loser, they understand why and they were part of the process that decided on those rules. That is extremely important to the decision making that we do at the ISO, because at the end of the day, we're being asked at the board to look at the way in which the stakeholders interested in, balanced and assess that against the goals that we have as a state to meet with these processes and decide whether that is fair, that's the decision that we make.

Obviously, there's going to need to be a bunch of conversation on that.

And if it's okay, Mr. Chair, I had another second question, different subject, and that is having to do. We talked about it in the meeting. One of the interesting things about that day in September when it was so hot in 2022 was the Governor deciding to put out a flex alert where it happened so fast, I'm not sure.

Okay.

He communicated with CalISO, and CalISO couldn't understand why in the middle of this crisis, the usage was ratcheting down and so I heard from a lot of people, lay people mostly see Flex Alerts work really trying to affect demand works. And yet I hear coming back that that's the last thing we ever want to do. That if it does work, it works one time a year and you better not use it again. What's your reflection as a CalISO board member on that process and what we should or shouldn't do?

Flex alert is a very, very important tool in our reliability tool chest that we use when the system is under stress. I would like to distinguish that from the governor's Office of Emergency Services setting out a wireless alert at the very last minute. That is an extreme measure. I am pleased to know that Californians are sensitive to and responsive to a call for help when asked. But it is a measure that I would only want to use very reluctantly.

And my work at the ISO really is to sort of fill out the tool chest with the many, many other means that we have to preserve reliability when the system is under stress. I'd like to list a few of the things that we're working on specifically. The first is to onboard a lot of new resources and specifically energy storage through batteries. In the last three years, we have increased the capacity of battery on the system 30 fold. We've gone from 200 over 7000 batteries.

Those batteries are a key reason why we did not have any flex alerts this past summer. We had calm weather, we had good hydro. But having that ability to shift the solar from the middle of the day to the evening when we need it has been critical to taking stress off our system. The second tool in our toolbox, quite frankly, is our regional markets. We are now able to move power seamlessly across the west to where it is needed.

So that power that we are offloading when we have too much solar in the middle of the day to help our neighbors that are having stress conditions comes right back to us in the evening when we have our stress conditions and their systems have eased off a bit. And we do that in more or less an automated fashion through these regional markets. This has really been a terrific, terrific outcome for us.

The third way that we're trying to address the third tool in our toolbox is really to improve our own procedures. We are at the end of a three year grid modernization activity that's going to revamp our control room. It's going to put in the latest weather forecasting tools and a whole host of automated and more sophisticated procedures so that we can sort of anticipate better and automate our operators actions in responding to relieving these stress situations.

I'm also very much in favor of programs that we've initiated to look at emergency demand response. So unlike the flexlit, we're asking folks voluntarily to save energy. We are paying folks, we are contracting with them in advance, and we are paying them when they are called to provide that demand relief when we need it under these emergency conditions. We're also working very closely with DWR on some of the emergency generation programs that they have underway.

Again, the goal and reliability is what we call defense, and we want to have multiple, multiple techniques, not just calling for help and asking folks to voluntarily curtail electricity use at the last minute, but a whole host of steps that we were able to deploy and minimize those extreme measures.

Thank you very much. I appreciate the responses to the questions.

Please, Madam Vice Chair.

Thank you, Mr. Chair. I don't have questions. I do have comment. A comment. We don't agree on the end use of transition and policy, but I appreciate your skill and your intellect and your intelligence to be able to navigate this process. And I am very comfortable with you at the ISO that you are going to keep the lights on and you are going to do it in a way that does not bankrupt every Californian, and you're going to work.

We had an extensive conversation yesterday about ISOs and their responsibility in making sure transmission lines were available. I expressed to you that we have the capacity in Kern with how much percent?

I got to write that down. Excuse me. I'm preparing to give her speech. I'm preparing to give her speech at the end of her service. So I have to get all these facts correct.

53% of the renewable energy comes from Kern County out of 58 counties, and we have energy to share. But the transmission lines that we are not allowed to use for ISOs because they're concerned of earthquakes and things like that. And believe me, if we have an earthquake that's going to disturb those second and third transmission or those second transmission lines, we have more problems than transmission lines. So I appreciate the hour or so that you spent with me yesterday.

I have full confidence that you are going to make good decisions in the ISO and you are going to do everything you can to make sure that we have deliverable power for a rate that Californians can afford. So I just want to make that statement and express why I'm not asking questions. Thank you.

Thank you for your support.

Thank you so much, Madam Vice Chair. Very grateful. Any additional questions, if it's all right with the Committee, just have a few questions. And again, Mr. Eto, really grateful for your time and jumping in on the details of this here today. And I'm grateful for the opportunity to have had time to be able to sit down with you as well.

I'd like to just talk about regionalization real quick, and this is an issue that obviously has been swirling around the state, swirling around the Legislature, and would like to talk about ensuring that California, if we ever go down this road, is able to be able to protect our clean energy goals, and especially if we're one or two at the table versus controlling our own destiny. And can you talk to us about what that would look like? And as a Board Member, being able to protect those goals that we have established?

Let me start by saying that I support these goals wholeheartedly, as I've sought to indicate. I've spent most, the majority of my career pursuing those goals in different ways. So I believe in them, and I'm grateful for the opportunity to continue my public service by serving on the board and advancing those goals. Those goals are after keeping the lights on my priority, and I am going to be looking at the decisions we make from the standpoint of preserving those goals.

Regionalization, regional cooperation is what I like to use as the term, is the least cost way of achieving those goals, diversifying the portfolio that we draw from. Because when the sun is shining in the southwest and it's not shining in the Central Valley, we can utilize that solar energy.

When the wind is blowing in Wyoming and Idaho and the wind is not blowing in the Tehachapis, we can utilize that wind power so we are more cost-effectively able to meet our clean energy goals through regional cooperation. The way that we protect our interests in these discussions about regional cooperation is to be proactive in those discussions.

I think our EDAM and our energy imbalance market and our extended day ahead market are tangible examples of how we demonstrate the value of that cooperation to our partners and to ourselves. The energy imbalance market has already yielded $5 billion of savings for all of the western participants. We get about a third of that. That is money that we would otherwise have to be paying to be in pursuing our clean energy goals that we are, in fact gaining from the trade with our neighbors.

The EDAM that FERC just approves for us, the extended day ahead market, which is sort of an enhancement on that energy imbalance market, is just going to further those benefits toward us. Again with the objective. And let me just clarify, we have extremely strong protections in the way that these markets are set up so that we know the color of every electron that's crossing the border into our state.

And that's how we protect our goals, by benefiting from trade and ensuring that that trade is fair and honest in terms of paying for and getting the clean energy that we seek.

Thank you so much, Board Member. I'd like to be able to transition and piggyback onto where Senator Laird was discussing in regards to transmission. Look, I think the bottom line, and I think we are in agreement that we need to get more transmission on faster. And I know that under current legislation, there is work that's happened between Caliso, California Energy Commission and Public Utilities Commission on how to be able to expedite.

And I think that transmission project, these are my words, the expediting plan would be due back to this Legislature in December. I believe that each of the three agencies, and this is more of a comment, but truly, I think where we are, our achilles heel, especially when we're talking about offshore wind, is the ability to get that power off the sea and into the rest of the grid. Right.

And it's because, and I'll just speak for our neck of the woods, whether you're going west to east to reading out of Humboldt or north to south from Humboldt into Sonoma county, those transmission lines are going to need enhanced upgrades, most likely in the billions of dollars. So I think that is our biggest challenge that we have and why we need to move with speed and grace to be able to get it done. And I don't know if you have any comments about my comment, if you'd like to be able to just chime in on your own personal opinion on that.

Absolutely. You are absolutely correct. And I have great concern around the challenges of building transmission in this state. We know it's a very difficult Proposition. People don't like to see it. It costs a lot of money, yet we need it. I wanted to sort of reflect on one aspect of the MOU. We have tangible proof that that MOU among our three agencies is working. In the last transmission plan that we approved last year, we approved 46 projects totaling about $7 billion in spending.

That's more than twice the amount that was approved in the prior year. So that's a direct cause and effect. We integrated these processes. We immediately were able to sort of make a quantum step forward in the planning process in terms of which projects we want. Speaking to the north coast offshore wind, which we are counting on in meeting these clean energy targets, I reviewed the plan after we had our discussion. We are looking at 1600 transmission to bring in the 10 year plan.

We're looking at the alternatives right now for the plan that will be coming before me in a couple of months. We're going to be looking at every possible way of getting that power on board at the time that offshore wind is developed. We're looking at reconductoring, we're looking at new transmission paths. We have the gamut of alternatives in front of us. We're trying to find the most cost effective way and the quickest way to get that power to where it needs to be.

And again, I want to thank the Legislature for helping us in the downstream part of that, the permitting siding, which is also a huge hold up for the construction of those projects.

Yeah, and this is an issue that obviously, Senator Laird is championing others in this Legislature of trying to be able to get it done sooner. I think where there are some that would like to be able to go is very similar to what we've done with offshore wind in combining environmental documents, for example. Right. Where we combine two eirs, both local and state, into one, and negotiations with the feds to be able to combine the federal document with Bohem, with CEQA.

So I think that could be a recipe for some success there. I think the awkward piece of where you're at, and please push back on, Mr. Board Member, you have a foot in state land, and you also have a foot with the feds. And I say that because ultimately, FERC is the one that's going to determine, making sure that you're working with, ensure that you have enough resources to be able to build out that clean energy grid.

And so I just would like to be able to ask, how would you see prioritizing those clean energy projects that are in the queue? Right. So we know, for example, there is great demand within Senator Grove's district, especially within Kern, of large commercial grade solar. We know that there's great demand on the central coast. We know for offshore wind. We know that there's great demand for geothermal in areas of the Salton Sea as well as up on the north coast.

So how would you see CalISO prioritizing projects that are currently in the queue that would both, number one, hit our long-term needs plus advance those clean energy goals?

Addressing that issue is at the heart of the connection process enhancements that we have spent a year and a half discussing in multiple, multiple stakeholder workshops, specifically to hammer out exactly what will be a fair process that all parties can agree to or at least tolerate to prioritize projects, recognizing that there are resources in many parts of the state, and we need to develop those that are the most ready, that are going the most to our clean energy goals, the soonest.

And having a transparent and open process to establish what those measurements, what those metrics are, is, to my mind, the fairest approach that we can take to ensuring that everybody's interests are heard and respected and accommodated and aligned with pursuit of our state's clean energy goals.

Yeah. And I'll just do a quick follow up and then see if there's any additional questions or comments from the Committee. Is that, look, I think that we have established these massive goals, rightfully so, and shame on us if we can't hit them. And the only way that we're going to be able to meet these goals is ensuring that we have a modern transmission grid up and running.

And again, I know you have a foot into the feds and a foot into the state, and please push back on me. I think where Caliso has an ability to impact positive changes, prioritizing those clean energy projects that are currently in the queue, and then obviously working with FERC to be able to line up those resources that we are so dependent on the feds to be able to help fund. Would that be fair assessment?

Fair assessment, sir.

Yeah. And so I think that's the big piece, I think, and I don't want to speak for folks up here of a priority, at least based off of the policy that's been passed by this Legislature as well as by the Governor. And again, Mr. Board Member, I appreciate the seriousness that you've taken the hearing, and I do want to say that I'm grateful on that. I would like to now see if there's any additional comments or questions that are coming from the Committee hearing.

Seeing none, we now would like to be able to open it up for public comment. We're going to start with those who are in the public and wishing to speak in support. If you don't mind, please approaching the podium, if you could, please state your first and last name along with your organization that you're with. We welcome you. How you doing?

Thanks. Hi, Mike Robeson here on behalf of the California Municipal Utilities Association in support.

Good afternoon. Nico Molina, on behalf of the NRDC Action Fund in support.

Thank you so much. Nice to see Mr. Robeson.

Thank you.

Good afternoon. Howard Kwan with Northern California Power Agency in support.

Thank you. Mr. Kwan.

Hi, good afternoon. Sara Fitzsimon with the Independent Energy Producers Association, also known as IEP, here in support.

Thank you so much. Thanks for being here.

Good afternoon. Tiffany Fan, in support on behalf of three entities. First, Intersect Power. Secondly, the California Efficiency and Demand Management Council. Last, MCE serving customers in Contra Costa, Marin, Napa, and Solano counties. All in support. Thank you.

Thank you so much, Ms. Van appreciate that. We'd like to be able to see if there's any additional individuals here wishing to speak in support. We're going to do last call for support. Hearing seeing none. Ladies and gentlemen, here in the Committee room, we'd like to be able to welcome anyone who would like to speak in opposition. If you could please advance at this time. Those in opposition? Last call hearing seeing no one stand.

We're now going to bring it back to Committee to be able to see if there's any additional questions or comments from the Committee at this time. Thank you so much. We have a motion by Madam Vice Chair to be able to move Mr. Eto to the floor. The motion has been made. Madam Secretary, can you please call the roll?

[Roll Call] Five to zero.

That is a 5-0 vote. Mr. Eto, congratulations. Thank you so much. ISO staff, who is also here today. Thank you so much. It's good to see you. I appreciate you being here.

Ladies and gentlemen, Committee, this concludes today's public portion of the agenda. We are grateful for all the feedback that we have heard today. We are going to be moving the Senate Rules Committee into Executive session. We're going to take about a two-minute break, allow folks to be able to exit the room, and then will advance our Executive Committee. Thank you so much all, for joining us here today. We're going to take a two minute break.