Senate Standing Committee on Health

You didn't have to have a chance.

Good afternoon. The Senate Health Committee will come to order. I apologize for the delay. There was another Committee in here that had a long agenda, and they were clearing the agenda. I actually came in the back door, saw my colleagues, thought I'd been reassigned. I guess that's not the case. So this is the Health Committee. As you know, we welcome the public in person. And looks like several of you are here. We allow six minutes of testimony per side. Obviously, brevity is appreciated.

We do have nine bills on today's agenda. Two of them are going to be on our proposed consent calendar, item number five, Senate Bill 1428 and item number six, Senate Bill 1258, with amendments. Now that we have that out of the way, we're going to function as a Subcommitee. But we're going to start with item number one, Senate Bill 909, by Senator Umberg. It's my understanding Senator Newman will be presenting. Proceed when ready, sir.

Thank you. And, Mr. Chair, with your permission, I'm the second item. Mine is the second bill. If we could reverse those. One of my witnesses has to catch a flight.

We absolutely can.

Appreciate that.

We're reversing. Item number two, Senate Bill 1119 by Senator Newman, hospital seismic compliance.

And let me add, I saw you come in in the middle of the EQ meeting. I thought you handled that with grace and dignity when you left. Mr. Chair, Members, thank you for the opportunity to present SB 1119. Come on.

Which would authorize a limited number of narrow, case specific extensions of the 2025 seismic compliance deadlines mandated by AB 2190 for three hospitals, which are all part of the Providence Health group, each of which is actively in the process of working to achieve compliance per AB 2190.

More specifically, SB 1119 would authorize extensions of two additional years for Providence St. Jude Medical Center in Fullerton and Providence St. Joseph Hospital in Eureka, and an extension of one additional year for Providence Cedars-Sinai Tarzana Medical Center in Los Angeles County. As you'll recall, AB 2190 authored by Assembly Member Reyes in 2018, required all California hospitals to seismically protect their buildings to properly ensure the safety of patients and staff.

Under the provisions of the bill, the deadline for final seismic compliance for hospitals executing a replacement or retrofit plan was July 1, 2022 and for hospitals seeking extensions based on a rebate, that deadline is January 1, 2025.

As in so many other areas, the COVID-19 pandemic caused substantial changes in the financial priorities and conditions of hospitals all across the state, requiring many hospitals to focus on ensuring adequate capacity in patient care, in many cases at the expense of other priorities or mandates or ongoing work like the retrofit process. This was the case with respect to the three providence facilities covered by this bill without the extensions provided for by this legislation.

As a result of failing to meet the prescribed deadlines, these hospitals will lose their licensure and the communities they serve will lose access to vital care. Having said that, let me address the valid and very reasonable concerns expressed by the opposition. It is imperative, as we all agree, that staff and patients have the assurance that hospital facilities are safe and up to date in compliance with all prevailing seismic standards.

I want to assure you, as my witnesses will do, that the three hospitals covered in this legislation continue to work actively toward compliance and are in the midst of ongoing construction plans, all the while balancing that need with the operational costs and requirements of operating a hospital and adequately serving the needs of their patients.

The limited extensions provided for by this Bill are narrowly tailored to ensure that none of these three important area hospitals will be forced to close vital infrastructure while maintaining the requirements that this Legislature has rightfully placed on California hospitals. The Legislature has previously recognized that such extensions are reasonable and will allow for the completion of this type of essential infrastructure work while ensuring continuous patient care at each facility in communities where that care is desperately needed.

With me to testify to today is Laura Ramos, the CEO of Providence St. Jude Medical Center in Fullerton, and Ryan Barry, Executive Director of Construction Services for Providence, California. I am respectfully asking for your aye vote today.

Thank you, Senator. Please proceed.

Thank you. Good afternoon. My name is Laura Ramos and I am the Chief Executive of St. Jude Medical Center in Fullerton. I'm here today representing all three of our Providence ministries in need of a seismic extension as outlined in SB 1119. I want to express my sincere gratitude to Senator Josh Newman and the other co-authors for championing this legislation to ensure we can maintain critical access to care in communities across the state.

Founded by the sisters of Providence and Sisters of St. Joseph, Providence incorporates our mission of serving those who are poor and vulnerable into all elements of our work and decision making. Last year, Providence invested approximately $700 million into the communities we serve in the form of grants and service supporting mental health, access to housing, and access to medical care.

While we are steadfast in continuing to support the communities that we serve, we are in dire need of a limited extension to reach seismic compliance at our three hospital campuses, Providence St. Joseph in Eureka, Providence Cedars-Sinai in Tarzana and Providence St. Jude Medical center in Fullerton.

Work has been underway at these three ministries, but unfortunately, Providence, like many others in the hospital field, is still recovering financially from the pandemic and did not have the cash on hand to complete these requirements by the looming 2025 deadline. I am pleased to share that we are extremely close at the Tarzana campus. In fact, we just celebrated the grand opening of a new patient care tower last October. Again, we need just a short extension.

One year to allot is enough time to become fully compliant with the relocation of utilities at Tarzana. The St. Joseph campus in Eureka was paused during COVID, again, something other hospitals were forced to do in order to shift priorities to give care for patients in their communities. Upon resuming, it's apparent we are in need of two additional years to reach compliance at this campus. This campus is unique, as there are limited medical options in the rural community of Humboldt County.

Lastly, St. Jude, the campus I oversee, on average, we are exceeding 100% capacity every day. We are in planning and scoping stages and need the two year expansion to ensure we minimize any access impacts to this very impacted campus. For these three campuses, the reality is no construction team can complete the work by the deadline. We are in close contact with HCAI and unfortunately, HCAI is limited in their statutory authority to provide any further extensions, which is why I am here today seeking your support.

Faced with financial penalties and ultimate revocation of licensure if these seismic deadlines are not met, Providence needs your support to ensure we can become seismically compliant while maintaining access to care in both urban and rural communities that we serve. Thank you for your time.

Thank you. Next please, sir. Are you speaking?

I'm the technical assistant.

I think Mister Barry's here just for technical assistance.

We need a lot of technical assistance here. Are there any other support witnesses in the room? If so, please step up. Name, affiliation and position on the measure, please.

Good afternoon, Chair and Members, Alfredo Medina here on behalf of Cedars-Sinai, in support of the measure and for all the reasons already eloquently outlined by the author and the witnesses, we ask respectfully for an aye vote. Thank you.

Thank you, sir. Next please.

Clifton Wilson, on behalf of the Humboldt County Board of Supervisors in support. Thank you.

Thank you. Next.

Nicette Short, on behalf of the Alliance of Catholic Healthcare in support.

Next.

Vanessa Gonzalez with the California Hospital Association, representing over 400 hospitals and health systems in California, here in support.

Thank you, ma'am. Any other support witnesses here in the hearing room? Seeing none. Any opposition witnesses in the hearing room, lead or otherwise? There's one.

Good afternoon. Matt Lege, on behalf of SEIU California. We are not registered and opposed. We just have a concern position on this bill. These are hospitals that already got extensions to meet the 2020 extension.

And given the realities of what just happened in Taiwan and just really underscores that it really is not, if earthquakes are going to happen, it's a win. And so really just encourage continued thoughtfulness on this bill that I know the author and sponsor will have to make sure that we are coming into compliance to protect both workers and the services that communities need.

Just want to really stress that the extension on the 2025 extension is really so that they're laying that pathway to 2030 and how important that is. So with that, once again, not opposed. Just want to make sure that those hospitals are still getting to the 2030 compliance and meeting the 2020 standards as well. Thank you.

Thank you. Thanks for those comments. Any other witnesses in opposition? Seeing none. Let me bring it back to the dais, my colleagues, to offer any questions, comments, or concerns. Colleagues, anything? It's been well, at the appropriate time. I've got you down, Senator Nguyen. Any questions? Senator Menjivar.

Thank you so much. And maybe I missed this analysis. Senator, can you clarify? Because I heard from Providence that you're asking for specific different extensions for each campus, so they're not all grouped in. I heard towards that. It's just one year?

Correct.

Okay. I mean, I think so. It's important, right? That's the one hospital that was. It's in the valley where the Northridge earthquake happened, and which is why we have all these seismic rules. I'm glad to hear that's just one year.

I'm wondering, are these the only ones? I know there are two other Providences in my district that are within miles of the Tarzana hospital. Are those other locations in line to meet the deadlines?

Thank you guys for having us today. My name is Ryan Berry. I've been in the healthcare construction industry for over 25 years. So for the AB 2190 compliance, I believe you ever see Holy Cross and St. Joseph and Burbank? And they do not have any buildings on those campus that qualify for that bill.

And is it true that I know you shared the construction? I driven by the 101. I've seen the construction the past couple years. It looks beautiful. The campus looks great. That part of the construction was also in line to meet the seismic compliance?

Yes, that's correct. So the only piece that's left is the existing tower that we just started to decommission in October. Yeah. Correct.

Okay. Thank you.

I guess I just have one question. Obviously, we're interested here in making sure that seismic retrofit occurs because it's a critical issue. I know you recognize that, too, in the hospital industry and those who spoke. We don't want another situation where hospitals collapse. And we also, even though they don't collapse, we want to make sure that hospitals are able to continue to provide healthcare to the patients that are in them following a major incident. And I know you're working toward that as well.

My only, and I'm glad I have you here, sir, for technical assistance on construction. My only question was the extensions. The latest one goes out to January of 2027, which is really only a little over two years away. And given construction and HCAI and all of that goes into your business, is that a long enough, a lengthy enough extension in order to get the job done? Given the fact that we're talking about design teams and general contractors and all of that?

Yeah. So it is. So in lieu of asking for a blanket extension, we asked for the extensions knowing that we had milestones to meet, assuming they were granted. And we already have general contractors hired or almost hired at every campus, and architects and design teams and their engineering teams are already on contracted as well.

I mean, did you build in contingency time for things that happen, particularly in your business, hospital business with hospital construction? So that should this bill move out, which I assume it will, and be signed, that what we see is finality and we won't see you back again?

We did. We took all that into account because we've had construction going and progress being made for the last several years. So really what we did is we built a schedule based on the unknowns as well, which accounts for the contingency and the schedules that we've asked for extensions.

But I think it's an excellent question and one that I did expect as well. I think that the timeframe that we are asking really, I hope, underscores our commitment to the prior comment that was made to seismic compliance.

Well, we certainly appreciate shorter rather than lengthier, because I think my perception is we give these long extensions and then out of sight, out of mind, and life in the hospital business takes over and things happen and then we see the same facilities back again. We're trying to limit that.

We're going to try to restructure, so we provide guidelines and milestones, much as what you apparently are doing, so that extensions are tied directly to the task that needs to be accomplished, ultimately getting the facility toward full compliance on both the non structural and the structural side. That is all I have in terms of questions. Senator Menjavar.

I just want to clarify, because even in the analysis, there has been a couple of points, Senator, and maybe I'll direct my question to Providence, where compliance milestones haven't even been met. So I'm just thinking in good faith, if they haven't even been met up to this point, how, you know, going back to the Chair's point, do you assume it will be completed by 2027?

So we took that into account when we built the schedules and asked for the one year and two year extensions. So we've outlined those milestones, which we'll work with HCAI in identifying if this bill does get extended.

We haven't met them.

We have.

But we will meet them now.

We will meet them now. So we've taken that into account as we built the new milestones into our schedule before.

We actually won't be here next year, but I will. Committee, or the next couple years, should y'all come back and ask for another extension. Okay, yeah.

Duly noted.

Yes.

Thank you, Senator Menjivar. Senator Newman will be here, too, so we can put him back at the podium when you ask.

Knock on Wood, sir.

Any other questions, comments, or concerns, colleagues? Anything? Seeing none. Let's establish a quorum first.

[Roll Call]

We have a quorum, Senator Newman. Would you like to close?

Thank you, Mister Chair. So thank you to my witnesses. As you've heard, the Providence hospitals that are covered by this bill are deliberately working toward meeting the compliance obligations. That's why there are different specifications for one and the other two that I know of. Two other bills that this Committee will hear on the same subject. So this is a problem that is not unique to Providence. It's fairly consistent across the board. But I know I speak for the witnesses and for the Providence chain generally.

They're very committed to doing the work, to render all of their facilities seismically safe. And when granted, this extension will let them do that. I respectfully ask for and I vote.

Thank you, sir. It's been moved by Senator Nguyen. The motion is to pass and re refer to the Committee on Appropriations. Please call the roll.

[Roll Call]

Six votes. We'll hold the row open for absent Members. Sir Newman, would you like to present?

Thank you.

Item number one, Senate Bill nine.

I would. Thank you, mister chair. And thank you. Mister Barry, I hope you make your flight. So thank you again, mister chair and committee members, I am actually presenting SB 909 on behalf of Senator Umberg, who was taken away for a family issue. SB 909 is a bill that strengthens our health care workforce by removing the maximum loan repayment limit of 105,000 for the Stephen M. Thompson Physician Corps loan repayment program.

California's Health and Human Services Agency designates 172 regions in the state as medically underserved areas, and that covers roughly 11 million Californians in those areas who live with a shortage of primary health care providers nearby. To combat this, the Stephen M. Thompson Physician Corps Loan Repayment Program provides physicians with up to $105,000 in loan debt forgiveness in exchange for three consecutive years of service in a medically underserved area.

Unfortunately, this limit of $105,000, which was established in the year 2002, is currently too Low to account for medical student debt trends. According to the Association of American Medical Colleges, the average medical student's debt has risen by over $150,000 in that timeframe, to an average of roughly $240,000 each. Accordingly, the financial incentive that may have worked in 2002 at the start of the program is obviously less effective today.

By removing this limit, SB 909 enables participating physicians to be eligible for repayment that better reflects modern debt averages, and doing so will bolster the incentives offered by the program, improving quality healthcare access in the communities that need it the most. Thank you for your consideration and on behalf of Senator Umberg for your aye vote today.

Thank you, Senator. Witnesses and support. If your lead, you may take the table. If not, your call.

Thank you, Chair Tim Madden, representing the California chapter of the American College of Emergency Physicians, the California Chapter of the American College of Cardiology, and the California Rheumatology Alliance, all in support for the reasons outlined by Senator Newman. Thank you.

Thank you, sir. Next, please.

I know that it's unusual to see me here on a health care bill, whatever, but Steve Pitt Thompson was very committed to this program. I owe, in many ways my professional, not my economic career, to Steve. The original program was actually authored by Marco Feyerbaugh, but the driving force for the program was Steve Peace, John Burton, and the White Lou Papen, because they represented underserved communities.

And with the way medical debt is now getting people to actually use this program is almost impossible given the current economic situation. So it's very critical. And I want to commend the pro tem for making this a priority to expand this program so all Californians have access to quality healthcare.

Thank you, sir. Next, please.

Mister chair and members of the committee, Brandon Marchy with the California Medical Association in support.

Thank you. Any other witnesses in support? Witnesses in opposition? Anyone in the room seeing none. Let's bring the matter back to my colleagues on the dais for questions, comments, or concerns. Colleagues, any questions, comments, or concerns? Who moved it? Senator Menjavar moved the bill seeing no other questions. Senator Newman, would you like to close.

On behalf of Senator Umberg, respectfully asking for your aye vote.

Please call the roll.

[Roll Call]

Thank you, members.

Bill has five votes. Will hold the roll open for absent members. Let's. Senator Durazo is here. Item number three. Senate Bill 1132. County health officers. Please proceed when ready, Senator.

Thank you, mister chair and members. SB 1132 clarifies the authority of county health officers to enter and inspect private detention facilities operating in our state. Existing law does not explicitly cover private detention facilities, including civil detention facilities used to detain immigrants. Today, there are six private facilities operating in our state that can hold as many as 7000 individuals at a time.

These facilities have now, until now, fallen into a gray area under our health and safety codes, so that while public health oversight laws empower inspections of publicly operated detention facilities and all private work furlough facilities, they do not explicitly cover private detention facilities. We want to change this and include explicit authorization for county health officials to enter and inspect these facilities whenever necessary. Private detention facilities operated by for profit companies often fail to meet minimum standards of health, safety, and sanitation.

Improving transparency in these facilities is not only good for public policy, but necessary for the safety of our state. In 2023, Cal OSHA entered and inspected one of these facilities following the passage of AB 263 that required private facilities to abide by workplace safety regulations. The inspection fined the private operator $100,000 for six violations of state code, failing to provide workers with effective information and training on hazardous materials. There must be accountability and oversight of these facilities.

With me, I have Ronald Coleman Baeza, managing policy Director to the California Pan Ethnic Health Network, to speak and support. And. Hamid, where's. Yes, you want to come up? Yazdan Panah, advocacy Director for the immigrant defense Advocates, to help answer questions.

Gentlemen, please proceed.

Good afternoon, mister chair and members. My name is Ronald Coleman Baeza, managing Director of Policy at the California Pan Ethnic Health Network CPEHN. I'm pleased to be here today to offer testimony in support of SB 1132. This bill concerns the public health oversight for private, for profit detention facilities that operate throughout our state. For profit detention facilities consistently fall short of the standards of care that should be in existence in congregate settings where human beings are jailed.

While California no longer has private jails or prisons, there are six private detention facilities in our state that are used for civil detention of immigrants. These facilities are privately owned and operated and have the capacity to house more than 7000 people at any given moment. Although the enforcement of immigration laws is a federal issue, the operation of immigrant detention facilities has historically delegated to state and local entities, particularly with respect to issues related to health and safety.

Despite these requirements, oversight, accountability, and transparency has been difficult to enforce or obtain in private detention facilities. Part of the challenge has been that private facilities have operated under a gray area in California law. As it stands, county health officers are directed to inspect public detention facilities and private work furlough facilities. However, the facilities in question do not cleanly fit into either category, but are clearly facilities that do need to be accounted for as it relates to our public health oversight.

SB 1132 ensures that offices that detain individuals in California, including jails, prisons, and private detention facilities, are subject to public health oversight and transparency. This bill clarifies that county public health officials can inspect private detention facilities when necessary, but it does not impose an annual inspection requirement. The COVID-19 pandemic showcased the potential problems posed by these facilities, particularly when the Otay Mesa Detention Facility became the site of the largest outbreak of COVID-19 in any civil detention facility.

The outbreak spread to more than 200 individuals in the facility, not only those detained, but also to workers. Tragically, one man detained there lost their life during this COVID outbreak. Emails later obtained through a PR request included emails from public health officials to the warden asking for employees to be tested for COVID. The warden for the private facility responded they had no intention of testing their employees for COVID, and this is part of a pattern that operators believe that they are above the law.

In 2023, Cal OSHA levied $104,510 in fines against the private prison operator GEO group for willful and serious health violations after detained immigrant workers at the Golden State annex in Central California complained about unsafe conditions. This fine was the result of a single inspection, but it certainly documents the systemic issues present in all facilities.

SB 1132 empowers county health officials to conduct inspections of private detention facilities as necessary and when appropriate, and ensures that no facility in California is allowed to slip through the cracks any longer. Thank you.

Thank you, sir. Next, please. Perfect. There any other support witnesses in the hearing room? Support witnesses, please step up. Name, affiliation and position on the measure only, please. Thank you for coming.

Molly Robson with Planned Parenthood affiliates of California in support.

Thank you. Next, please.

Cynthia Valencia with the ACLU California Action in support.

Perfect. Thank you.

Chloe Steck with the California Immigrant Policy Center, proud co sponsor and in support.

Thank you. Next, please.

Jackie Gonzalez, policy director at Immigrant Defense Advocates. Proud co sponsor and support. Also here for our co sponsor, next gen policy. Thank you.

Thank you for joining us. Next, please.

April Newman with the California Collaborative for Immigrant Justice co sponsor and in strong support. Thank you.

Next, please.

Ana Linares with the California Collaborative for Immigrant Justice, co sponsor and here with a lot of support.

Thank you. Any other support witnesses in the hearing room? Seeing none, let's call for opposition witnesses, lead or otherwise. Any opposition witnesses in the hearing room seeing none. Let's bring the matter back to the dais and my colleagues for any questions, comments, or concerns. Questions, comments, or concerns.

Maybe just a comment.

Senator Rubio, I knew I could count on you.

Thank you. I'd like to keep you occupied. Just wanted to say thank you to the author. I think the information you share is very compelling, and I think it was overdue, so thank you for that. I just want to move the bill when appropriate, thank you.

Bill moved by Senator Rubio. Seeing no other questions or comments. Senator Durazo, would you like to close?

Just thank you all. Thank you. To our incredible organizations that do this every single day and ask for your aye vote thank you.

Bill has been moved by Senator Rubio. The motion is to pass and re refer to the Committee on Public Safety. Please call the roll.

[Roll Call]

Vote is four to one. We'll hold the row open for absent members. Thank you, Senator.

Thank you, mister chair.

Let's take the consent calendar. On the proposed consent calendar, Item Number Five: Senate Bill 1428 by Senator Atkins: health care coverage triggering events, and Item Number Six: Senate Bill 1258 by Senator Dahle: Medi-Cal unrecovered payments interest rate. It's been moved by Senator Menjivar. Please call the roll.

[Roll Call].

Vote is five/zero. We'll hold the roll open for absent Members on that one. Senator Limon, would you like to present Item Number Four: Senate Bill 1213 for Senator Atkins? Health care--

Senator Cortese is here.

Oh, I didn't see Senator Cortese. Oh, right there. I apologize, sir. I need glasses. Let's take Item Number Seven: Senate Bill 1300: Senator Cortese: health facility closure public notice. Proceed when ready, sir.

Thank you, Mr. Chair and Senators. I'm pleased to present SB 1300. The bill is sponsored by NAMI California. Let me begin by saying that I'm accepting the amendments that are being passed out to address the policy comment in the analysis. The amendments eliminate the requirements that HCAI certify the impact analysis and gives CDPH the ability to permit a closure without the extra 30 days notice if keeping the supplemental service open threatens the stability of the hospital as a whole. And hopefully I've stated that verbatim.

I want to thank the Committee staff for their work on the amendments. I mean that sincerely. This is an important bill, I believe, but one that we want to get exactly right. This bill will help communities prepare for closures of psychiatric units and maternity wards in hospitals. We purposely brought both of those things, even if they might seem somewhat incongruous in terms of types of health care. In my district alone, I've experienced closures of both a maternity ward and a psychiatric unit in less than five years.

These units closed despite the hospital as a whole remaining profitable. This problem isn't unique to my county. It extends across California. According to a recent CalMatters report, we've lost 27 maternity wards in the past three years alone. These closures result in maternity care deserts in predominantly low-income, oftentimes Latino communities, and rural communities as well. The negative impacts on families include decreased access to prenatal and postpartum care, increased travel distance, worsening maternal mortality rates, and increased emergency deliveries.

When a psychiatric unit closes, it places additional strain, of course, on our behavioral health system. California is already in a psychiatric bed shortage, which I think we're all familiar with--I know the Chair is--and that overburdens our emergency rooms, prolongs stays in correctional detention, and pushes people into homelessness. This is why it's important imperative for local communities to have an understanding of the impact that a psychiatric unit closure is going to have.

SB 1300 would require a health facility to provide 120-day public notice of the elimination of its inpatient psychiatric or maternity ward unit. It also requires a health facility to prepare a report that analyzes the impact of a closure on the surrounding community's health system. The report will allow the County Board of Supervisors to assess the closure's impact on the public health system and identify how best to mitigate the loss. Again, it will allow them to do so. There's no requirement that they do so.

Finally, the bill increases public transparency by strongly encouraging the County Board of Supervisors to post the report online and hold a public hearing to provide the community an overview of the impact report. Joining us today to testify, we have Michael Fitzgerald, President of the Zayante Group, and Frank Alioto, member of the Santa Clara County NAMI Legislative Committee and a parent of someone with a mental health condition. He asked us to share that. With that, I'll turn it back over to you, Mr. Chair. At the appropriate time, I'll respectfully ask for your aye vote.

Thank you, Senator. Gentleman, you may proceed.

Any person? Or we good?

We'll check it out here.

Okay. Michael Fitzgerald, President of Zayante Group, health care organization that consults with behavioral health and behavioral health issues. A past executive director for El Camino Hospital in Mountain View, was there for many years, comprehensive mental health services as part of a general care hospital, and that remains open. In fact, built a new facility. This impact of a closure that occurred in Santa Clara County, it wasn't just that we lost psychiatric beds.

We lost psychiatric beds that were part of general acute care hospital, and that's the places that are closing. These places take patients because they have an emergency department that other mental health facilities generally run by. For-profit organizations, freestanding psychiatric hospitals run by organizations such as UHS, Acadia, or Signature Health that are constantly in trouble with CMS. Very much high profit organizations that take psychiatric patients on a bulk basis.

They don't take patients with medical core mobilities, and they're not appropriate places for patients with new diagnosis or older adults or people that need access to other comprehensive services that only general acute care hospitals can provide. The problem is that these general acute care hospitals are closing these beds because the cost impact, cost of providing these services, even though they may be highly profitable in other areas of care. This bill is minor. It doesn't provide a whole lot, except for more time for community discussion.

That is important. In that 120-day period, it takes a long time. It did in this case. Just so you can understand, it's even closing, getting people together, talking about the issue. We need that more time. There'll be an argument made today by the opposition that'll say that it may impact closure quicker or that all the staff will leave.

This is not accurate in my experience, and I speak as someone who's been Executive Director at a hospital and has worked with CHA in the past as a past Chair, and have a lot of support for the Hospital Association, what they're trying to do. We need more legislative activity downstream so that we can--or down the road so we can effect this on an upstream rather than downstream basis, and try to support hospitals in making this decision initially.

Right now, it is what it is, and I think that additional time will be helpful to have that discussion in the community and try to have a better response. So thank you for your time.

Thank you, sir. Sir?

Can you hear me?

Yes, sir.

Okay. My name is Frank Alioto. I am the Legislative Chair for NAMI Santa Clara County, and I am here today. I'm also a member of the Santa Clara County Mental Health Committee, which reports to our Board of Supervisors.

I'm here today, though not as members of those two organizations, but I'm here as a parent, and I can't tell you how difficult it is to find a place for a mentally incompetent person when places are closing on short notice. I mean, even 120 days is generally not enough time.

These--I think the real issue, or one of the real issues here, is the closure of mental health facilities and the loss of beds by hospitals and organizations that run from--or profitable, and decide that they are going to, you know, cut beds or cut services to enhance their bottom line. At the time that Good Samaritan Hospital in Los Gatos, a privately-owned hospital, was closing a critical care psychiatric facility, the website is bragging, their corporate website is bragging about near record income and near record profitability.

And if you dug further, you got a CEO who's making 34 million dollars a year, and they're closing an 18-bed critical care psychiatric unit in Los Gatos and San Jose, California. I'm a former CEO of a publicly-traded company on Nasdaq, and I got to tell you, this is immoral to me, and the State of California needs to step up and protect us from these things happening.

That's my two cents as a private citizen. We've got more closures coming up right now scheduled. I mean, Regional is closing, and as was mentioned earlier, it's going to put a particular hardship to get to Valley Medical Center from the east side, which is highly Hispanic and not necessarily the wealthiest part of the Silicon Valley, and it's going to take--once that closes, you're going to have a critical care psychiatric patient who needs instant help.

It's going to add eight to 15 minutes, depending on traffic, to get that person to the emergency ward at Valley Medical. And I have to tell you, people who are familiar with that end of the business critical care and moving it to emergency wards, eight to 15 minutes is the difference between life and death, all right? So that's what these closures mean.

And I think that notice and extending notice notification by 30 days is the minimum that can be done to help families so they can look for other options for their loved ones and their children. Thank you.

Thank you both. Thank you, sir, particularly, for coming to offer testimony. It's a critical issue.

Can I make one other comment? And this is just quickly. This is a personal opinion. When I go to a website and I look at a corporation, a hospital corporation that is printing money and bragging about, you know, the success, and they deprive care from those people who are so desperate and needy, I'm telling you, to me and my benedictine education, okay, that borders on a crime against humanity. That's how upset I am. Thank you.

We appreciate you coming to testify today. Are there any other support witnesses in the hearing room? Please step forward. Name, affiliation, and position on the measure, please.

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

Thank you, ma'am. Next, please.

Danny Offer with the National Alliance on Mental Illness, also known as NAMI California. We're the sponsor of this bill. Ask your support. Thanks.

Thank you for joining us today. Yes, ma'am.

Sandra Poole with Western Center on Law and Poverty, in support.

Thank you. Next, please, sir.

David Campos, on behalf of the County of Santa Clara, in support.

Thank you. Sir?

Daniel Pearl, on behalf of the American Federation of State, County and Municipal Employees, in strong support.

Thank you, sir. Next, please.

Molly Robson with Planned Parenthood Affiliates of California. We're in support.

Thank you for joining us. Yes.

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

Thank you. Any other support witnesses? Let's turn to witnesses in opposition, if any, in the hearing room. Opposition witnesses, please step forward. If you'd like, please join us at the table. We'll figure this out. The mic's on this end over here.

Hi. Good afternoon, Chair Roth and Members. My name is Kirsten Barlow. I'm here with the California Hospital Association. We, unfortunately here, are today to share our opposition to the bill as it's currently written. And while we appreciate amendments that were developed by the Committee, we think there's still some more work to do and have been trying to have some conversations with NAMI California to see if there are some ways that we might, as the bill moves forward, find some things that would address our concerns.

We do want to say that we do share the Senator and NAMI's concerns about ensuring access to inpatient psychiatric care and labor and delivery services. But while it might sound like a simple policy to just add 30 extra days of public notice before a hospital has to make the tough decision to close a service, this will not actually prevent those services from ultimately closing, and in some cases, could even make the situation worse.

Hospital staff react the same way any one of us would if we found out our job might be in danger and they begin to leave essentially immediately to look for other work. As a result, hospitals sometimes end up needing to start to ramp down the number of patients they can accept in that unit or even close the service down altogether, way before the 90 days is even hit today.

And while we again appreciate the hard work of the Chair and the Committee on the Amendments, there are still some concerns that we have. For example, allowing a hospital to close its service 90 days after providing notice could be helpful. But really, by doing so, the author or the Committee is sort of acknowledging that giving that longer period of 120 probably means that staff will leave, and you might actually need to close down sooner.

Additionally, there's a provision that would allow us hospital to, to have some flexibility if the Department of Public Health has cited it for not providing safe care. Hospitals simply would not take on more patients if their staff were insufficient. We wouldn't need to get to that point to be cited before taking action. Additionally, there are some pieces of the impact analysis that we find are problematic. In particular, asking a hospital to estimate the effect of closing a service on the county is problematic for several reasons.

In some cases, it's being because the information we wouldn't have, frankly, in terms of what's the county going to do if this service goes away, what additional costs would it incur to replace the beds, for example, that are lost?

The other difficulty, I think, with mentioning the county specifically is that it kind of reaffirms the pressure we've all collectively placed on counties in our state to solve the public behavioral health crisis and doesn't really reflect the fact that many of these patients have private insurance, and it's not the county's role nor authority to sort of step in and do anything in particular about making inpatient psych or labor and delivery available to the broader community.

In the few hospitals that have closed inpatient psychiatric care in the last decade, they've mostly cited workforce challenges and Medicaid reimbursement problems. And so, again, providing 30 extra days of notice, I think we acknowledge, would not necessarily solve the problem of protecting or preserving beds. But we are very interested in working with NAMI and the author on some of the kind of real policy solutions that, as Mr. Fitzgerald said, get further ahead of that from happening in the first place.

For example, addressing the Medicaid reimbursement rates is something that we're aware Department of Healthcare Services is starting to work on, and we're supporting their efforts in that arena. We also think that we have not really raised our expectations enough for health plans and counties to show they have an adequate access to those services. So, for example, our county mental health departments are asked to provide proof, essentially to the state that they've made sufficient outpatient mental health care available to Medi-Cal beneficiaries.

We've not asked them to prove they can provide inpatient psychiatric care, which is part of why we have 24 counties out of 58 with zero inpatient psychiatric beds today. So we think that there are other solutions that sort of get to the underlying issue here and hope to be able to work through those issues with the author and sponsorship. And with that, I will turn to my colleague.

Thank you.

Good afternoon, Chair and Committee Members. My name is Jim Suver, and I'm the CEO of Ridgecrest Regional Hospital. Thank you for allowing me to discuss my concerns in opposition to SB 1300 today. While we have background, Ridgecrest is a small, critical access hospital. We are community, nonprofit based. We have a capacity of 25 beds. Recently, I had to make the agonizing decision to close our labor and delivery program.

Ridge Crest delivered its last baby on February 29, so unfortunately, I am all too familiar with the closure process. I should also let the Committee know that our day's cash on hand is now at 25 days, and after that, there is no more cash in my facility to keep operations. While providing additional notification as well intended, I'm afraid it's going to have the opposite effect and will actually force hospitals to close services longer. Longer or sooner?

Longer notice periods and impact analysis requiring hospitals to provide information that they have no access to will not stop service closures. We should be working to address the underlying challenges that are causing closures to stop them from happening in the first place, rather than further requirements once the hospital has determined that they are going to close the service.

In my hospital's case, we knew that the labor and delivery unit was at risk and we deliberated for almost two years, repeatedly postponing making a decision while we conducted extensive analysis of demographics, engaged community and policy leaders, and advocated for increased reimbursement rates and incorporated input from our medical staff leaders. Exasperating the problem is a declining birth rate in our community, which further stresses financial, labor and delivery program as well as makes quality more of a challenge.

Meanwhile, increasing costs due to staffing challenges in both the nursing and physician fields created more financial distress. Ultimately, the decision became clear. Close our labor and delivery program or consider downgrading our emergency Department, which would have had potentially deadly impact to our community residents. Our board deliberated over both potential actions very carefully. We cannot address the challenges that patients and providers are facing when maintaining and increasing access if we don't hold all stakeholders accountable. By ensuring reimbursement rates for both commercial and government payers covers cost.

Requiring adequate networks, considering time and distance standards could help rural providers meet the needs of our communities. Fixing these problems requires buy in and ownership from all involved, not just those of us that are on the front lines struggling to maintain services. None of these challenges that my hospital continues to face are addressed in its SB 1300 and it's unlikely to benefit patients as service curtailment, is likely to come even sooner.

In my hospital's case, if I had the advance notice requirement, I would have made the decision to close the labor unit sooner due to concerns about, frankly, running out of cash. I delayed the decision as long as I could up until the day I had to give the official 90 day notice, hoping that there were some increases going to occur to the reimbursement rates, but unfortunately, that did not happen.

I would ask that we focus on necessary financial support to hospitals for obstetrical programs, especially unreimbursed standby expenses to stop the ever growing maternal care deserts occurring in our state. Changing notice periods and collecting additional information does not address the underlying challenges that are leading to closures. Thank you very much and very happy to answer any questions.

Thank you, sir. Any other opposition witnesses in the hearing room? Seeing none, I'll bring the conversation back to the dais and my colleagues for questions, comments, and concerns. I do want to note one issue or point, and that is there were some amendments proposed with the author, which the author has agreed to accept.

And one in particular gives CDPH the ability to allow a hospital to close the maternity, psyche and psyche, or psychiatric unit without waiting for this additional 30 days if it finds that the closure and the notice period rather will threaten the hospital as a whole, sort of mirroring the language that currently exists for emergency departments where the stability of the hospital as a whole is threatened.

So you already have a 90 day notice period that's required, and this is to add 30 to go to 120, and the 30 can be erased by CDPH if it finds that the additional notice period will threaten the stability of the hospital. We can debate the original 90 days, but that's not the issue here. The issue is the additional 30 days. Obviously, this is a delicate situation. Those of you who are small hospitals in rural areas or small hospitals in urban areas doesn't seem to be.

There's a difference in some cases that are on the cusp of financial disaster. That's an issue that's much broader than this bill that we are going to have to grapple with in the state, hopefully soon, with a more robust budget. It deals with reimbursement rates for Medi-Cal and various procedures. It deals for a whole host of issues, including seismic, that we're currently grappling with. But again, that's not this particular bill.

It seems to me that an additional notice period, aside from the financial distressed hospitals, an additional notice period could cause some issues for hospitals with respect to staffing. But I'm wondering if the opportunity for further public discussion and investigation of options during that 30 days might be worth the additional notice period to hospitals. It we also have transition and continuity of care, and in particular in the mental health field.

I don't know when a hospital that is one of a few in an area shuts down an acute care inpatient psychiatric unit, what people who need that unit do, and that's an issue we're going to have to grapple with in this state and in this building fairly quickly. We have a behavioral health bond that there was a variety of opinions on that I'd be interested to take a poll in this room to see who supported and opposed, but we can't ask those questions.

But hopefully that additional money, once it rolls out, will enable, will support additional bed capacity and support those that have tried to maintain capacity over time and rather difficult conditions. So I just wanted to note the amendment. The rest was commentary. So I'm going to turn to my colleagues for questions, comments or concerns. I'm sure Senator Grove has some. Senator Grove.

Thank you, Mr. Chair, my apologies. I have a dual Committee duty. I was in Rules. Rules just adjourned. And I made my way down to the first floor. I believe is second floor for Rules. I do have comments and the reason I'm making these comments is because, you know, one of your opposition witnesses is one of my presidents of a hospital that we have in a very rural community that is the life split to the China Lake Naval Air Warfare Center.

Which is a south side China Sea Protector, which is beneficial to all of us in the state including constituents in everybody's district that's standing there and on the dais. It's a financially distressed hospital. And I hate that we still are putting band aids on the real situation because the situation is definitely we need to increase Medi-Cal rates. We keep increasing small percentages, making negotiations with health plans and other organizations who can offset some of the cost. And these are all just minimal band aids.

If even band aids on situations that are dastardly not substantial enough to fix the real problem that we have. But on the flip side, we're increasing costs by a 30 day notice. We're not addressing the seismic issue that's coming up like a whirlwind. They have to start planning now for the time limit for seismic. We're not addressing the dollar 25 increase in wages for every person in a hospital. We keep adding expenses up to here. Fixing a band aid to this level.

And you're putting financially distressed hospitals in a position where they can't provide adequate healthcare specifically to our rural communities. And I despise, with every bit of my being this response that I get from some of my colleagues. For instance, like we'll just go to the next hospital. Well, the next hospital from Jim's hospital in Ridgecrest, Mr. Suver's hospital is 55 to 60 miles away. But think about it. It's not like traveling down I-5.

You're traveling down a canyon road with a 50 foot drop to a river on one side. And a two lane road and a canyon wall on the other side. In very windy conditions. It's not in the same circumstances that you deal with in a large metropolis area. This is a rural hospital. And it also has a ability to affect our recruitment for our naval air warfare center where we expect the best of the best to show up and protect us from cybersecurity issues.

From, you know, it's the largest research and development arm in the United States military. And I just say all that we can't afford to let this hospital fail. And I have huge concerns over that.

So I'm going to oppose the bill today because I can't just see adding another, another brick wall to a hospital that's already struggling to keep their doors open is under the list of financially distressed hospitals, has addressed the maternity word issue, is either going to, and I apologize for not being here for the entire testimony. Standby emergency room? Have you done that already? Are you thinking about doing that?

It's on our trigger list. If our financials do not improve, we will downgrade from a basic to a standby.

So basic standby emergency room. Think about recruiting somebody and the services that that rural community will get when you can't even take your kid to the hospital for a broken arm for an emergency or something like that. Not to mention cardio care, cardiovascular care, and pulmonary care. I just, I challenge all my colleagues to understand that rural California doesn't operate like you.

I don't have a foundation like my colleague in San Francisco where you can just set up a foundation and some millionaire billionaire can give you millions of dollars in the foundation to make offset. I don't have those people in my district. I have hardworking white collar jobs, research and development jobs, especially in this area, school teachers, and they deserve adequate and substantial medical care.

And I just think adding these continuous mandates and extended cost on hospitals that are already financially to stretch, which we tried to address last year with the loan program, is not a good thing for all of us in the state. So I respectfully oppose the bill today.

Thank you. Thank you, Senator. Any other questions, Colleagues, comments, concerns? Senator Menjivar has moved the bill. Senator Cortese, would you like to close?

Thank you again, Mr. Chair. I really appreciate your preparedness, not that you need to hear that from me. Your mastery of each of these topics that come before you in Health Committee and before us as a Senate. I'm very happy that we've been able to create an opportunity today for folks to talk about issues that really don't have anything directly to do with the bill.

But I think it's a perfect example of what we are trying to do with the bill in terms of creating public hearing processes where issues like this that are driving decisions to close psych units and to close maternity units, come to public hearing at the behest of each county, each of the 58 counties, not just mine, but each of the 58 counties, including Kern and others.

Those boards of supervisors, which are subdivisions of the State of California, direct subdivisions of our government, which have the same rights to hold public hearings as we do right here, would have the opportunity to hear testimony like this, very compelling testimony like this from the opposition witnesses in their local county without having to drive 2, 4, or 5, or get on an airplane from Los Angeles and come to Sacramento. That's what should be happening. Instead, we have an opaque situation where these units are closed.

The counties don't have direct jurisdiction over the hospitals, but moreover, they don't even have the opportunity by statute to call a hearing to invite people in to ask them what the hell happened, what happened? Can we have you come in and tell us in a public hearing so our constituents, black, white, brown and other, can come forward and hear what just happened? Why would we stop that from happening in Kern or Silicon Valley or any county, any of the 58 counties in California?

That's all this bill does. And that's why the support witnesses said, my support witnesses said, this is really a very simple bill. It doesn't do much. It creates a public hearing opportunity at the local level to deal with issues that are, I agree with you, Senators, absolutely vital to the survival of our constituents in my county, Silicon Valley. And imagine it's like this.

Having visited Los Angeles a few times in Los Angeles County, when you close down a maternity unit on one side of the valley, especially on the side of the valley, which is dominated by people of color, and you tell them that you now have to commute in high traffic situations at peak hours to go to maternity unit, that, oh, by the way, we own as a hospital system all the way across the valley, it's just as difficult as getting across Kern County.

It may be more difficult without a helicopter. It takes sometimes an hour and 15 minutes, an hour and 30 minutes to get 12 miles across our valley in a car. That's what I think one of our colleagues who is in the Committee room yesterday talking about reparations, would call modern day redlining. That's modern day redlining. And that's why some people feel that that's immoral. When you close down a psych unit, we know what the impact of that is. I know that.

I think most of our colleagues here know that. But to have, in effect, an obstacle in our statutory scheme that disallows, again, one of our own subdivisions of government, county government, to call a hearing and find out exactly what happened and perhaps bring to bear some remedies, perhaps bring to bear some help, some county grants, some county assistance, some lobbying efforts at the State of California, why we would cut that off, I have no idea. I respectfully ask for your aye vote.

Thank you, Senator. The bill, SB 1300 item number seven has been moved by Senator Menjivar. The motion is do pass as amended and re refer to the Committee on Appropriations. We are ready to call the roll. Please call the roll.

[Roll Call]

The vote is five to one. We'll hold the row open for absent Members. Thank you, Senator.

Thank you all.

Senator Menjivar, you - oh, Senator Limon. Shifting gears, Senator Limon is presenting item number four, Senate Bill 1213 for Senator Atkins's healthcare programs, cancer.

Thank you, Chairman and members. I have more of a voice today than I did yesterday. I'm here today to present SB 1213 on behalf of Senator Atkins, which would expand access to breast and cervical cancer screenings, diagnostic services, and treatment for lower-income Californians. Other than skin cancer. Breast cancer is the most common cancer for women in the United States and the second leading cause of cancer death in women.

The American Cancer Society estimates that there will be about 13,820 new cases of cervical cancer in 2024, and about 4360 women will die from this disease. Detecting and treating breast and cervical cancer early can save lives and improve health outcomes. Currently, many lower-income women who are uninsured or underinsured with an income of above 200% of the federal poverty level and who are not eligible for Medi-Cal are unable to afford or purchase insurance, and undocumented individuals are not eligible for subsidies to reduce premiums.

To ensure that lower-income Californians get the treatment they need, our Every Woman Counts program provides free breast and cervical cancer screenings to eligible Californians, and the Breast and Cervical Cancer Treatment program provides treatment benefits to eligible Californians diagnosed with breast or cervical cancer.

SB 1213 would increase the eligibility threshold for the Every Woman Counts program and the breast and cervical cancer treatment programs from 200% of the federal poverty level to 300% of the federal poverty level, meaning more women would be able to access life-saving medical care. Here to testify and support are Autumn Odgen-Smith from the American Cancer Action Network and Connor Sweeney with the Susan G. Komen Foundation, as well as Courtney Quinn from the Albie Aware Breast Cancer Foundation.

Please proceed.

Thank you, Chair members. I'm Autumn Ogden-Smith with the American Cancer Society Cancer Action Network. Here is a proud co-sponsor of this bill. Every Woman Counts, and the breast and cervical cancer treatment programs are critical lifeline to women in California who are uninsured and underinsured. Since the Affordable Care Act, California has been at the forefront of achieving universal coverage through a variety of expansions and subsidies.

Expanding Every Woman Counts in the BCCTP to 300% will bring us in alignment with 80% of other states and will, more importantly, take a modest next step in providing access to cancer care treatment to the women who need it the most. As California moves forward towards universal coverage, it is critical that we take the next step in ensuring that more people have access to critical cancer care. Thank you. I ask for your aye vote.

Thank you, ma'am. Sir.

Thank you, Mister Chair and members. Connor Sweeney, with the Susan G. Komen Foundation, is also a proud cosponsor of this bill. Every Woman Counts in the breast and cervical cancer treatment program has a strong track record of saving lives by providing free cancer screenings and treatment, providing public education, outreach, patient navigation, and care coordination for those diagnosed with cancer through EWC. EWC provides thousands of screenings to women every single year and places a special emphasis on women who are less likely to be screened for cancer, including those with low income and, who are without access to affordable health coverage options, and those from racial and ethnic minority groups. But despite their strong track record of success in this critical mission, EWC and the treatment program are only able to provide these services to Californians making up to 200% of the federal poverty level, which is just $30,120.

This is, in fact, among some of the lowest coverage levels for these types of programs in the US. Patients with incomes higher than this bar are unable to get access to these treatment and screening programs. They're ineligible for Medi-Cal benefits. And yet, at the same time, those folks may be without full health care coverage through their employer, or they may be enrolled in a high deductible health plan with annual deductibles as high as $10,000.

By allowing these programs to cover Californians up to 300% of the federal poverty level, or $45,180, would ensure those additional Californians are able to get screened and, if necessary, treated for breast or cervical cancer without delay or financial hardship. When it comes to treating cancer to maximize a patient's chances of survival, every second counts. Yet, there are still many women out there who will delay or completely skip these critical health services because they can't afford it.

This bill will reduce the number of Californians who lose their life, livelihood, or life savings to this terrible disease. Thank you again for the opportunity to comment.

We respectfully ask for your aye vote.

Thank you, sir. Next.

My name is Courtney Quinn. I am a breast cancer survivor and the Executive Director for the All Be Aware of Breast Cancer Foundation. We're the largest nonprofit organization dedicated solely to breast cancer in the greater Sacramento area as our reach is more than 2.5 million individuals in the month of October alone. As Breast Cancer Awareness Month, we're often the first point of contact when somebody locally realizes that they need a mammogram or they've discover a lump.

So, as a breast cancer survivor, I have the honor of telling you about some stories of some individuals who've been saved from Every Woman Counts, and the CCTP program and why they're now cancer survivors and some are not cancer survivors. They just now know they're completely healthy and no longer have that health concern. So first story I'm going to share is we received a phone call from an individual who had never had a mammogram. She didn't have insurance.

I shared about the Every Woman Counts program, and I stated the income eligible eligibility. She let out a huge sigh and said, I make $100 more every single month, so I'm not eligible. So, how do I get a mammogram? And because I told her that because she lived in the greater Sacramento area, our organization would pay for her screening. But that's sadly not true for many of the individuals that live in the areas you represent.

So, I checked with the local hospital, and I checked to see how much the current out-of-pocket costs for an individual needing a screening mammogram are. It's more than $750. So, if you're an individual making minimum wage pre-tax, you'd have to work 47 hours to pay for this exam. So that's part of the importance of why we want to see this passed.

The second story I'll share is there was a small business owner who had emergency insurance only when she found her lump as a business. As her business was struggling, she was barely able to pay the emergency insurance premiums. So she was eligible for every woman counts. Her lump was indeed breast cancer. And she's alive today because of Every Woman Counts in the BCCTP program.

And then the other one I'm going to share with you is imagine being this individual who is having a bloody discharge from her nipple, and she doesn't know what's happening with her body, and she's fearful it's cancer, and she doesn't have the financial means to pay the thousands of dollars for a breast MRI. Fortunately, she lives in the State of California, where the state receives federal funds to pay for this breast MRI and the treatment that she needed.

So, the State of California can turn to the Federal Government for these funds. Whereas these individuals often have no one to turn to. So, on behalf of our organization's breast and cervical cancer survivors and those that will be saved by this legislation, I asked for an aye vote, sorry, on Senate Bill 1213.

Thank you very, very much. Others in support of this measure. Name, affiliation, and position on the bill, please.

Mister Chair and members of the committee, Brandon Marchy, with the California Medical Association in support.

Thank you, sir. Next please.

Mister Chair and members. Chad Mayes with Capitol Advocacy, City of Hope, and also California Life Sciences in support.

Welcome back. Thank you. Next please.

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

Next please.

Matt Lege with SEIU, California, in support.

Thank you. Next, please.

Mark Farouk, California Hospital Association, in support.

Thank you, sir. Yes, ma'am.

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

Thanks. Next.

Molly Robson, Planned Parenthood Affiliates of California, in support.

Thank you. Next please.

Ryan Spencer with the American College of OB GYNs District Nine in support.

Thank you, Mister Spencer. Next please.

Chris Myers with the California School Employees Association and support.

Josh Gauger with the County Health Executives Association of California in support.

Mister chair and members, my name is Fred Noteware, representing Stanford Healthcare in support.

Thank you, sir. Next, please.

Cheri Andrew, two time breast cancer survivor and volunteer with Albie Aware Breast Cancer Foundation in support.

Thank you. Thanks for what you do. Yes, please.

Melissa Manzo, with Albie Aware Breast Cancer Foundation in support.

Thank you. Yes, sir. Doug Carson, founder of the Albie Aware Breast Cancer Foundation, in support.

Thank you. Any other witnesses in support? Now let's turn to witnesses in opposition. If there are any witnesses in opposition, please step forward. Seeing none, let's bring the matter back to the dais and my colleagues for questions, comments, and concerns. Any. Senator Rubio.

Well, first, I want to thank. I know that we've had the opportunity to work a lot on issues of cancer. And, I mean, it almost affects everyone in one way or the other. You know, I have a lot of family members, and that's why I've worked on several pieces of legislation. I think this is so important. There's always this misconception, you know, that it's so easy to get coverage.

I mean, I just remember going back to horror stories when I was a teacher, and even as teachers, we had coverage, and we had to struggle to give, like, our sick leave to teachers or who had cancer. And it just seems like a never ending story. So this is just very basic, you know, something that struck me as when you just talked about the 300%, right, which is $45,000.

It's just. It just seems incredible. I can't imagine, you know, who can afford anything with that kind of salary, especially with the family. And so I know our author is not here, and thank you for presenting the bill, but we just have to do it. It is extremely important that we support women and I. Because I've worked on issues of cancer, you know, you hear the stories where women just keep waiting and waiting, and it's too late.

And the impact, it's not only just for them, their families, or communities, and everyone that gathers and tries to support them. So just thank you for bringing this forward, and I strongly support it. I want to move the bill, but thank you for presenting the bill as well. Appreciate you.

Any other questions, comments or concerns? Colleagues seeing none. Senator Limon, would you like to close?

I just want to thank the author for bringing this forward, but also for giving me the opportunity to present on it. Because in the audience, we have students here from Oxnard College that are witnessing their very first bill being presented, and here in the capitol for the first time. With that, I respectfully ask for an aye vote.

And students have an excellent author to watch. So there you go. The bill has been moved by Senator Rubio. The motion is do pass, and we refer to the Committee on Appropriations. Please call the roll.

[Roll Call]

The vote count is 7-0. We'll hold the row open for absent members. Thank you. Next item. Senator Menjavar, looks like you're up to bat with two or with just one? One. Item number eight. You didn't know I was giving you another one. Item number eight. Senate Bill 959, trans inclusive care Resources and support services. Proceed when ready.

Thank you, Mister chair and committee members, I am the only one that stands between us getting out of here.

Actually, Senator Gonzalez.

Just kidding. Then I would take my time, Mister chair. We'll be taking the committee amendments as noted on page 5 and 6 of analysis. Thank you so much to the committee staff for the beautiful analysis. SB 959 will establish a website resource for transgender, gender diverse, and intersex people and their families to access reliable information about access to trans inclusive healthcare, existing legal protections for patients and healthcare providers, and other available support services.

We have all witnessed the significant rise in anti trans hate across the country, fueled by legislation, restrictive health policies, and misinformation. And despite our state's strong laws protecting TGI people's access to essential health care, TGI people and youth especially, continue to have significant difficulty finding providers for routine care. Identifying healthcare providers who offer gender affirming care within their health plan can be even harder.

These access issues exacerbate existing health disparities among TGI Californians, who are more likely to experience chronic health conditions and experience higher rates of health concerns related to HIV, substance use, mental illness, and sexual physical violence. That is, why should SB 959 pass? California HHS would recreate this website that will showcase a couple of things. It's going to show existing legal protections for patients and healthcare providers. It's going to show how to access health plan provider directories for gender affirming care.

It will showcase payment support resources, including coverage options and financial assistance programs, support services, including transportation and family engagement support, and additionally, it will have references and links to other related information and resources. There are too many TGI individuals who, unfortunately, are losing their life, either through suicide, bullying, mental health, and so forth.

I do not want to hear another name like we've heard of next Benedict, who died earlier this year, a 16 year old transgender, indigenous, non binary individual, Alex Taylor Franco, who died also earlier this year, a 21 year old trans man who was shot and killed in Utah, or Ariana Mitchell, a 17 year old black trans girl. There are many barriers that still exist to ensure that the TGI population feels secure and safe.

And this is one of the things, a small effort that we can make to ensure that they can have a focal point where they can pull all the available resources that the great State of California has to that mister chair, I'd like to then now turn over to two witnesses who are here to speak in support of this bill. Kathie Moehlig and Eve Banas butchered it.

Please proceed.

Good afternoon. My name is Kathie Moehlig, she/her my pronouns. I'm the founder and Executive Director of Trans Family Support Services and Trans Youth Liberation. We have served over 5000 Trans individuals and their families. First and foremost, this bill is essential to acknowledge the longstanding discrimination and prejudice that the TGI community has endured with the health care system. Far too often, TGI individuals have faced discrimination from medical and mental health professionals, leading to disparities in care and adverse health outcomes.

This discrimination not only undermines the trust between patients and healthcare providers, but perpetuates a cycle of marginalization and neglect. Moreover, one of the overwhelming challenges TGI individuals is the difficulty in finding healthcare providers who are adequately trained and knowledgeable about their healthcare needs. Many providers lack the necessary expertise or cultural competence to provide affirming and inclusive care for transgender patients. This lack of training and awareness contributes to significant barriers in accessing essential healthcare services.

In addition to these challenges, we can't ignore, as we've already heard, the alarming rise of anti Trans rhetoric and movements that seek to undermine the rights and dignity of all TGI individuals. Across the country, and here in California, we have witnessed a disturbing trend of legislation targeting these rights. This hostile environment not only exacerbates the mental health challenges faced by the TGI community, but also reinforces the stigma and discrimination they experience in the healthcare setting.

SB 959 seeks to address these challenges and as you heard, this website will serve as a centralized resource hub where the public can access up to date information about Trans Inclusive Healthcare Services and support resources by the state. The importance of this website cannot be overstated. It will serve as a lifeline to TGI individuals, offering critical information on healthcare providers, support groups, legal resources, and more.

This initiative aligns with California's longstanding commitment to equity, diversity and inclusion in healthcare, ensuring that all residents, regardless of gender identity, have equal access to quality care and support services. On behalf of the TGI community that we serve across California, I urge you to support this important legislation and take a stand for health and well being of all Californians.

Thank you. Next, please.

Good afternoon, chair Roth and members of the committee. My name is Eve Banas with the Sacramento LGBT Community Center. Happy to be here today to speak in support of Senate Bill 959. As we've heard, we have seen a startling rise in anti lgbtq legislation across the country, with a significant portion targeting trans-gender, nonconforming, and intersex folks. In addition to this hostile policy landscape, TGI folks experience heightened rates of chronic health issues, substance use, mental illness, sexual violence, unemployment, housing discrimination, and the list goes on.

This greater ill health is unfortunately paired with significant barriers to quality affirming care. Many of the community members who come to the Sacramento LGBT Community Center do so because they have struggled to find other affirming resources, resources that they need to live happy and healthy lives. To address this issue, the center offers many resources, including free STI, HIV screenings, mental health services, harm reduction support, respite employment resources, and safe community spaces.

This support is absolutely essential to TGI folks, but unfortunately, it is inaccessible to many TGI Californians. To address this lack of accessible resources, SB 959 will create a website detailing accurate information that will connect TGI people and their families to life saving care. The Sacramento LGBT community center believes that Senate Bill 959 is much needed, and we urge you to support this policy. I respectfully urge you to vote yes on Senate Bill 959. Thank you.

Thank you. Thanks for joining us. Any other witnesses in support of this measure? Name, affiliation, and position on the measure only, please. Yes, ma'am.

Good afternoon. Symphoni Barbee, on behalf of Planned Parenthood, affiliates of California proud co sponsor and support. Thank you.

Thank you. Next, please.

Craig Pulsipher for Equality California proud co sponsor, strong support. Thank you.

Nicole Morales, on behalf of Children Now in support.

Thank you. Next, please.

Brandon Marchy with the California Medical Association in support.

Thank you. Welcome back. Yes, ma'am.

Doctor Darcy Totten with the California Commission on the Status of Women and Girls and strong support.

Thank you. Any other witnesses in support in the hearing room? How about witnesses in opposition, lead or otherwise? Any witnesses in opposition? Seeing none. We'll bring the matter back to the dais and my colleagues for any questions, comments, and concerns. Any questions, comments or concerns.

Thank the author for bringing the bill, and I'm happy to move it.

Thank you. Senator Smallwood-Cuevas. No other questions Senator, would you like to close? Nice job. Were there other questions?

I'm sorry. Yes, I guess. Thank you. Thank you. So I'm trying to create balance here. Do I think that obviously everyone, including my people in Ridgecrest, deserve adequate healthcare and any TGI kids, wherever they're at? Right. I don't care where they're at. In California, my district. Your district. I guess the issue that I have. I'm gonna borrow this from my colleagues. I'm going to borrow my colleague's Ipad here. I understood. It's just a website.

Just a website.

That's what that bill does.

Yes.

Okay. But I guess the issue or the sentence that brings us to a place where it's the question, I guess, that we're asking or I'm asking. I'm not asking on behalf of my colleague. It says here, it says it's going to provide TGI individuals and families accessing transclusive healthcare. This is right off your bill.

Support services and state including, but not limited general description of Trans Inclusive Healthcare, which is fine information on how to access directories, but it says of providers for providing gender affirming care services. Is that two minors? So is there puberty blockers? Is there surgery? Is there all those things included in that that they would be referred to as a minor?

We're not being specific on the exact procedure. It's more on who's accepting and who can go, where the individual can go seek gender affirming care. So correct me if I'm wrong, it's not gonna. The website's not gonna have. This is where you go for hormone treatment. This is where you go for this. This is where you go for that. It's just overarching.

What do you mean by overarching?

Just gender affirming care as a whole. Like, these are the providers that accept you as an individual. These are the providers that you can go in and have a conversation related to what you look at as gender affirming care.

Is it for minors or not for minors? Family.

And the website is not going to ask, are you 18 years or older to access this website? This website would be just like the abortion.ca.gov website that we have right now. That is a website accessible by anyone. So we do not have any parental controls in terms of ages. Anyone would be able to go there. Just also reminding you not remind. Just also noting that in California we do have certain laws already in place. This isn't looking to change any single law related to what age an individual can seek. X, Y and Z care. And those laws are not being touched or addressed in this bill.

It's just a website.

Just a website.

Okay. And there is. There's no direction to specific providers or there is a direction for specific providers.

There will be a directory, yes.

A directory, yes. Okay.

But we. If I'm not mistaken, we'll be protecting the names of providers. There's no actual names of providers on this website. Yes.

So I know there's a difference of opinion between all of us. You know, people have all of it. Well, I mean, just. There's a difference of opinion with. With legislators.

Right.

So I guess my thing is, is that if I had a child that was going through gender identity or gender care issues and my. My choice for my 14 year old or 15 year old, whatever the age, under age 18. And I was. I don't want to say accepting and loving and you always support your children, but I would, as a parent, I could see that I would not want my child to have surgery.

Things that would detriment, that could possibly harm them physically in the future. So I guess my thing is that. Is that going to do that? Is this website going to direct a child without parental consent to go and have a surgery done, and then the child's in the hospital and you find out about it that way? Is that?

And please correct me if I'm wrong on this. I try as much as I would turn to my witness, I want to try as much as be able to respond to that question myself. Currently, right now, those who seek to be placed on XYZ under the age of 18 are doing that with parental consent.

There is no doctor in the State of California. There is no Doctor anywhere in our country that will be providing any kind of gender affirming care to a minor without parental consent.

That's what I needed to know.

It does not happen.

Okay. Thank you, ma'am. Sorry.

No.

Thank you for the question. Any other questions? Bill has been moved by Senator Smallwood-Cuevas. The motion is to pass as amended and re refer to the Committee on Appropriations. Please call the roll.

[Roll Call]

Well, let me just clarify. She didn't vote, did she?

No, she didn't vote.

So it wasn't a change. It was a no vote. I'm sorry.

So the vote is seven ayes and one no will hold the roll open for absent members.

Thank you.

Thank you, Senator. Senator Gonzalez, item number nine, SB 1131, if you are ready, Medi Cal-providers, please proceed.

Thank you. Good afternoon, Mr. Chair and Members. I want to begin by accepting the Committee amendments described on pages four through five of the analysis and would like to thank the Committee for their help. I'm here to present SB 1131, which will ensure access to essential family planning services for low income Californians across the state.

Since 1997, California has been providing family planning services such as contraception, pregnancy testing, STI and HIV testing to low income individuals at no cost through family planning, access care and treatment program, also known as the Family Pact. In order for a health clinic to provide these services in their community, the clinic must be certified, excuse me, by a designated healthcare professional.

Despite a healthcare workforce shortage, the state continues to limit who can certify clinics for family pact services to only physicians, certified nurse midwives, or certified nurse practitioners. SB 1131 will address this shortcoming in the law by expanding who can certify a clinic to include physician assistants, requiring at least six months for a provider to complete program orientation after enrollment, and requiring DHCS to offer trainings virtually and on a monthly basis. These changes are critical, of course, to ensuring that every Californian across the state has access.

Testifying to in support of the measure today, I have Kelby Lind with Planned Parenthood Affiliates of California, and Jeremy Meis, a physician assistant at Wellspace Health. I respectfully ask for an aye vote.

Thank you, Senator. Please proceed.

Mr. Chairman, Members, good afternoon. My name is Jeremy Meis, President Elect of the California Academy of Physician Associates. After training at UC Davis Family Nurse Practitioner and PA program, I've been practicing adult primary care locally for the last 12 years. I'm currently the associate medical director of primary care at Wellspace Health, federally qualified network of health centers providing a variety of services to underserved populations.

I'm here today in support of SB 1131, which seeks to improve the Family Planning, Access, Care and Treatment program, also known as Familypact. Familypact is a lifeline to essential services for over 1 million Californians. Many of the patients I serve utilize family pact and are unhoused, uninsured, impoverished, undocumented, and disenfranchised.

While free access to FDA approved contraception is the bread and butter of the Family Pact program, the program also provides other crucial services, such as screening for STI's for men, women, and minors, and cervical cancer screening for females. Any indicated follow up testing and treatment is covered. Should any of these screenings come back positive. These services catch early asymptomatic illness, limit spread in vulnerable populations, and it's not an overstatement to say that they save lives.

It's also important to note that many of the clinics providing Familypact services are federally qualified, requiring that they refuse service to no one. When a patient has no insurance, federally qualified clinics provide services on a sliding fee scale. This entails a nominal, perhaps $10 fee for those able to pay it, while the services are offered for free for anyone without a source of income. The Familypact program allows FQHCs to serve more patients while sustaining our clinics.

Mr. Chair, Members, this is a good program, but due to a handful of the program's practices, including current policy not permitting PAs like me to certify the clinic, many health centers across the state that treat these underserved populations can't do so under the Familypact program as they are unable to become certified. This means that patients either have to forgo needed care or pay out of pocket.

By passing this legislation, lives of Californians will be saved, needless suffering avoided, and the motivating aim of enacting the Familypact program fulfilled. Thank you.

Thank you. Next, please.

Good afternoon, Chair Roth and Members of the Committee. My name is Kelby Lind and I'm the Vice President of Regulatory Affairs for Planned Parenthood Affiliates of California, representing seven affiliates that provide comprehensive sexual and reproductive healthcare on behalf of the family program throughout California. We are proud co-sponsors of Senate Bill 1131 and I want to begin by thanking the author for her dedication and leadership on family planning services. Planned Parenthood is the state's largest Familypact provider with half a million annual visits.

Through the program, Familypact provides critical coverage for Californians who need affordable family planning services, particularly patients who have confidentiality concerns or whose family income exceeds the Medi-Cal limit. Planned Parenthood supports the intended purpose of the Familypact site certifier program to ensure that all family pack providers are up to date on the policies and benefits of the Familypact program.

However, there is a need for clarification and updates, so the program reflects how the Familypact providers provide care and facilities, their ability to provide the necessary oversight as required. We share the state's goal of improving and maintaining program integrity, ensuring clinical quality and compliance with the Familypact standards, and maintaining access to time sensitive family planning services for patients. Planned Parenthood prioritizes providing the highest quality of care to all patients, including Familypact patients.

This bill will clarify and streamline the Familypact program, improve requirements to sustain and expand the program for future years, and reduce healthcare disparities for Familypact patients across the state. The Familypact program is critical. Critical to Planned Parenthood's patient population. And that is why Planned Parenthood is a proud sponsor of AB 1131. And I respectfully urge your aye vote. Thank you.

Thank you. Are there any other witnesses in support in the hearing room? Witnesses in support. Name, affiliation, and position on the measure, please.

Thank you, Mr. Chair and Members. I'm Erin Evans on behalf of Reproductive Freedom for All, formerly NARAL Pro Choice California, in support.

Thank you. Thanks for joining us. Yes, please.

Chair, Members. Kathy Mossberg, with Essential Access Health in strong support.

Thank you. Any other support witnesses? Seeing none, let's turn to opposition. Witnesses in opposition? Seeing none. Let's bring the matter back to the dais and my colleagues for questions, comments, and concerns. I see no hands. Senator Menjivar has moved the bill. The motion is do pass as amended and re-refer to the Committee on Appropriations. But, Senator Gonzalez, you may close.

I just want to thank our witnesses, Mr. Meis and Mr. Lind, for their testimony. And I respectfully ask for an aye vote.

Okay. Please call the roll.

[Roll Call]

Bill has eight votes. Hold the roll open for absent Members. We're going to open the roll on items that we've heard today, starting with item number one. Senate colleagues are not here. Please come down to the hearing room. Start with item number one, Senate Bill 909, Senator Umberg. The roll is 5-0. Chair voting aye. Please call the roll.

[Roll call]

The vote is 10-0. That item is out. Item number two, Senate Bill 1119. Current vote is 6-0. Chair voting aye. Please call the roll.

[Roll call]

That vote is 9-0. That matter is out. Item number three, Senate Bill 1132. Current vote is four to one. Chair voting aye. Please call the roll.

[Roll call]

Current vote is eight to one. That matter is out. Next item, item number 4, 1213. Current vote is seven to zero. Chair voting aye. Please call the roll.

[Roll call]

Current vote is 10-0. That matter is out. The consent calendar, items number 5 and 6. Item five, Senate Bill 1428. and item number six, Senate Bill 1258. Current vote is five to zero. Please call the roll.

[Roll call]

Current vote 10-0. Those matters are out. Item number seven, Senate Bill 1300 by Senator Cortese. Current vote is five to one. Chair voting aye. Please call the roll.

[Roll call]

Current vote is eight to two. That matter is out. Item number eight, Senate Bill 959. Current vote is seven to one. Chair voting aye. Please call the roll.

[Roll call]

Current vote is eight to one. That matter is out. And our final matter. Item number nine, Senate Bill 1131. Current vote is eight to zero. Chair voting aye. Please call the roll.

[Roll call]

Vote is eight to zero. That matter is out. And that concludes the hearing of the Senate Committee on Health for April 3, 2024. We are adjourned.