Senate Standing Committee on Business, Professions and Economic Development

We'll wait on roll call till we get a few more folks here, and we will proceed with hearing some Members, and then we'll take motions when the time is appropriate. So, Senator Cortese, I saw you walk in. Are you ready to get us started? Senator Cortese, you have one Bill today, SB 1015. Go ahead with your opening statement whenever you're ready.

Well, thank you, Madam Chair and Senators. Thanks for allowing me to present SB 1015 to you today. SB 1015 will help California build an adequate nursing workforce that reflects the diversity of our state. It will increase transparency in the management of clinical education placements for nursing students. To become a registered nurse, a nursing student needs 500 hours of hands on clinical education. In 2022, a staggering 92 of California's 152 nursing programs were denied access to clinical placements for their students. Community colleges and state universities are acutely affected.

Senator Cortese, would you pull your mic a little bit closer to you there? Thank you.

The clinical impaction threatens our state's ability to keep the nursing profession accessible and affordable to diverse communities across California. Currently, it is unknown how nursing programs manage and coordinate clinical placements for their students at clinical sites. This bill gives the Board of Registered Nursing authority to collect and report information on how nursing programs manage their clinical placements, including how they coordinate with other nursing programs and clinical facilities. It also requires the board to study, develop, and recommend standards for clinical placements to all nursing programs.

SB 1015 takes the first steps to address the growing issue of an inequitable access to clinical placements for nursing students. As the state faces a nursing shortage, we must ensure equitable access to clinical education for both public and private nursing institutions. With us today to testify, we have Cathy Kennedy from the California Nurses Association and Eric Bakke from California State University. And at the appropriate time, I would respectfully ask for your aye vote.

Okay, great. Thank you. We'll go ahead and hear from your lead witnesses. Please state your name, organization, and you'll have a couple minutes here on the bill.

All right. Good morning. My name is Catherine Kennedy. I'm President of the California Nurses Association, representing over 100,000 registered nurses across the state, and CNA is a proud sponsor of SB 1015. I've been a registered nurse for well over 40 years and I also serve on HCAI's healthcare workforce education and training council.

Clinical education is an essential part of any nurse's education and it is critical that all of California's future nurses have clinical placement opportunities. Nursing schools report that the inability to secure clinical placements was the number two reasons for not enrolling more students. This bill is a common sense reform that will help ensure equity and transparency in clinical placement opportunities for all of California's nursing students.

It takes important first steps to address the problem of decreasing and inequitable access to clinical education placements, which has been an acute problem for our community college and CSU nursing programs. This bill would codify the Board of Registered Nursing requirements to collect, analyze and report clinical placement information, and this is consistent with the State Auditor's recommendation that the BRN collect information to assess clinical placement capacity.

The bill will also have the BRN's Nursing and Workforce Education Advisory Committee to analyze the issue and recommend standards to the BRN to ensure that equitable access to clinical placements occurs. In other words, this bill will help ensure California has the capacity to not only train enough nurses to to meet our state nursing workforce needs, but to also maintain safe staffing levels in our healthcare facilities.

If continued unchecked, CNA nurses fear this phenomenon will exacerbate an uneven playing field for public nursing education programs, and public nursing schools are vital in keeping the nursing profession affordable and accessible to all Californians. More BRN oversight on clinical placements will help ensure the nursing workforce reflects California's diverse patient populations. So CNA urges the Committee to vote yes on SB 1015. Thank you.

Great. Thank you for your testimony. Did you want to testify as well?

I do. Thank you. Good morning. Eric Bakke, Director of State Relations for the CSU Chancellor's office the CSU is the largest nursing program in the state, enrolling nearly 9,000 nursing students at the BSN, master's and doctoral level, producing nearly 3,000 nursing degrees each year. However, more can still be achieved as the state seeks to grow the number of nurses in California. The biggest barrier to increasing enrollment capacity in nursing programs is the limited number of clinical placements for nursing students.

As the analysis notes, students are required to have a combination of academic classroom preparation as well as clinical experience as part of their training, which is why the CSU is pleased to support Senate Bill 1015 by Senator Cortese, which would provide more information on clinical placements for students in nursing programs. The CSU believes that SB 1015 will continue to improve and support data collection on existing clinical placements and therefore facilitate opportunities to increase the number of clinical placements available for nursing students.

It's not possible to grow the number of nurses that we seek to enter into California's workforce until there is a corresponding increase to the available clinical placements. Any additional information on how to coordinate and possibly increase the number of clinical placements would be beneficial to the state, our students, and will inform future statewide policies and regulations. For those reasons, we ask for your support.

Great. Thank you very much for your testimony. Let's see if there's anyone else in the room who would like to, to support this bill. SB 1015, please come to the mic. We have reached the me too portion of the show, so your name and organization and position on the bill?

Elmer Lizardi, on behalf of the California Labor Federation, in support.

Great. Thank you. Anyone else in support of the bill? Seeing no one coming to the mic, we're going to move to opposition. If you are in opposition of SB 1015, please come forward. All right. Seeing no one in opposition, we will bring it back to the Members for discussion. Senator Niello?

Thank you, Madam Chair. Question in the staff report, it says that, in contrast, other approved nursing programs, says, particularly private nonprofit programs, continue to occur, secure the clinical placement slots. What are they doing differently? And obviously, it's not just the private nonprofits, but what are they doing differently that others are not?

Let me defer to the witnesses to respond to that, to the degree that they know on the private side.

Well, what we know, and again, this is what we need to find out for sure, is that when you have private, or profit nursing programs, they almost have, like, they get a partnership with a hospital. And so there is this partnership that allows their students to be able to place on into clinical placements on, you know, days like Monday through Friday, and then you have the public program scrambling, like weekends, where the nursing students would have to come so. Or there may not be any. So a lot of it is the partnership with these private nursing programs.

I would just simply add and kind of carry off what she said there. You know, for the CSU, it varies a little bit from our 20 campuses that offer nursing programs, but, you know, we do find ourselves scrambling to try to find those placements. We're limited in many cases to evenings or weekends. It doesn't necessarily always comport to the students availability and their time. So that's a challenge.

And then we also anecdotally hear stories of placement, number of hours being used by for profits, which is concerning in terms of, as Senator Cortese mentioned, 500 hours is the requirement, but we're hearing stories of longer 1,000-1,500 hours for those placements which locks up available opportunities for some public. So this type of information and this reporting will help sunshine a lot of that activity. So we can make sure that there's a fair and equitable distribution of placements throughout the state.

Why the partnerships and why can't other? And obviously it's based upon the wording here, it's not just for-profits. There are others evidently also that I'm not sure if it's partnerships in that case or not, but what's keeping other public entities from forming the same partnerships?

I would just simply add its money. I think anecdotally there's information to suggest that some for-profits are paying hospitals to incentivize them. There's really no incentive for hospitals to create this space for nurses to participate.

It's burdensome, it's challenging, scheduling is difficult, but we don't have those types of resources as a public entity. And so for-profits want to move through students, through their program. So they create partnerships in a way that helps make it easier for hospitals to work with them. And it puts a challenge on our ability to provide those spaces. So this type of information that's being asked will sunshine that, so that we can try to understand how much of that is really a problem.

Is it a bigger issue than we know of right now? Is it a smaller issue than we can work? But at least it's going to sunshine the information so we can make sure we have the right policies in the State of California.

The one concern that I'd have is that the study is conducted in a fashion that the conclusion is already known based upon the testimony that may be the case.

If the reason for the clinical compaction is a, quote, uneven playing field created by resources on one end and not as much on the other, then that would appear to be a foregone conclusion before the study is made. And my concern is that we level the playing field by mandating that hospitals can't do that or otherwise attempting to disadvantage the for-profit entities to then advantage the nonprofit. I get the problem with the solution, the problem that exists, but I'd be really concerned about the direction that the solution would go.

If I may, through the chair respond to that. It's a great point. And I think the most important thing, most important response relative to the bill as it's in print, is that it is clearly a study. It will come back to the Legislature. I think if we really knew exactly what was going on, it would have been able to put a fixed time for response. We actually left that open.

There's faith, though, that it will come back, regardless of what it ends up affirming or not, that it'll come back soon enough, because the Nursing Education and Workforce Advisory Committee, which typically just meets two times a year and would therefore have a hard time doing probably anything other than picking up on anecdotal advice, actually created a Subcommitee for this purpose that we'll be meeting monthly, you know, to take the deep dive in. So it may end up that what we're hearing anecdotally isn't the problem.

I think the fundamental issue, which I know you understand fully as a Senator and as a Legislator, if we don't get the study back that begins to identify where it's really broken, it's going to be tough to run any legislation to fix it, even if we think we know what the issue is, because, you know, all the way down the line through Committee consultants and every other part of the process, we would otherwise continue to be asked, how do you know?

How do you know for sure? How do you get beyond anecdotal? So this is step one. Get the data back. Get the information back. Get a bona fide study back from. From the board itself and its Subcommitee. We don't have to accept it. You know, we don't have to swallow the whole thing. We'll have a chance as a Legislature to come back and debate what they came up with and see if we believe it or not. But this is the first step.

So I think, you know, more than an ounce of skepticism here is in order. But I think the study and the bill will deliver on the promise that skepticism is a good thing going into something like this.

Okay, Senator Cortese and Niello-

Sure. And then I'm going to take roll after that so that we can hit a quorum. Go ahead.

One additional point.

Okay. The data is good. What we do with the data and any bias that might exist is also important. And I will tell you, when I worked with then Assemblyman Portantino on private postsecondary regulation for that, there was, in the discussion, there was a definite bias against for profit institutions, for weaknesses or criticisms that, frankly, existed almost equally in state institutions. But it wasn't discussed there. It was discussed as something to be guarded against in the development of those regulations.

There is a bias against for-profit education institutions that isn't outwardly stated. I am outwardly outwardly stating it now. And if that bias overtakes the interpretation of the data, I'm doubly skeptical.

Well, fair enough. And, you know, like I said, however the study comes back in whatever condition it comes back in relative to that issue, I'll be more than happy before ever introducing another bill if I'm asked to sit down with you, Senator, and, and talk about how to collaborate on that and make sure that it's an unbiased implementation bill going forward. But again, we're safe here in the sense that this is not the implementation bill, it's just the study.

All right. Thank you very much for that clarification. I'm going to ask if we can do a roll call here and establish a quorum.

[Roll Call]

Great. Senator Archuleta.

Thank you, Madam Chair. Obviously, and I guess this goes to your representative, Senator, you must have had some surveys conducted, some information, some background that you've discovered that there's an equity inequity here. But, you know, I'm totally for 150% for the fact that we need more nurses, but we need them from across the communities. We need to level the playing field. I've got that.

So can you share some of the data that you may have found, that you found that it was so necessary that we have to bring this up? And obviously, you wouldn't have done it if you didn't find the information. Can you share that with us a little bit?

Sure. You know, I've been working as a nurse for 44 years, and I started off at American River College, community college. And back then we didn't have the, there were private institutions in nursing. But now what we're seeing is that because it is so hard for people that may not have the funds to go to nursing programs, the public, the community college and the CSUs are more affordable than the for profit nursing programs that we're seeing now.

And what ends up happening is that because, again, as my colleague was saying, there's not the monies there in public colleges to increase capacity of nursing students. Because, again, you want to make sure that the nurses that you do have, students that you do have, are able to get through their clinical placements so that they can move on to take the board and then work as a registered nurse.

And that's really limited because, again, we don't have, you know, the community colleges and the CSUs don't have the money, whereas you have private institutions that charge an enormous amount of money. I've seen one community, an ADN program down in Southern California that charges over $40,000 a year for their two year program. That's a lot of money. So then they absolutely need to make sure that those nursing students are able to get through so that they can turn around and take their NCLEX exam.

So, you know, for the public institutions, that's something that's, you know, we're talking about. It's not really an equal playing field if there is those collaborations. And again, this is a study just to see if what we're seeing is true, because we have now nurses that went through a program, a private nursing program that are in a hospital, and they're having to sign a contract to say, we're going to put you through a preceptor program and you have to stay for three years.

And if you do not stay for those three years, you're going to pay back that preceptor program funds that we use to put you, to train you to work in our facility. So it becomes this again. Now you have a nurse that has this huge debt, and they have to stay in that hospital because they went through a private program.

So I'm just, you know, anecdotally, this is what we're seeing, what we're hearing, and so this is the reason why I think that this is important for the BRN to be able to collect that data and really see what's going on, because a lot of the kids that want to go to school don't have the funds, and where can they go?

They start off at the community college or in the CSU system, and we really want those folks to be able to stay in California and go to the programs here in our state instead of having to go to Nevada or where else to go to nursing school because we don't have the capacity. I hope that makes sense.

And I'm assuming that by bringing this study forward, when it's completed, it'll show the inequities, it'll show exactly what you're talking about. But we can't unless we find and complete the study with that, I will move it at appropriate times.

All right. Thank you very much, Senator Menjivar.

Thank you, Madam Chair. Senator Cortese thank you so much for bringing this bill. You spoke about stories that are personal to me. I have a cousin about seven years ago, waiting list after waiting list after waiting list at a Pierce College in Southern California because they had no more space for her until she ended up switching her career because she had no ability to pay for a private school.

I have another cousin who is in her first year at a private nursing school who took out thousands and thousands of dollars at a loan because she wanted to be a nurse and she couldn't wait for the public programs. And I know how important it is for individuals who want to be in this career. Another, my sister in law also had to pay for this private school and shared some similar stories that you brought up today. So thankful for you to bring this up, and I'm happy to support this bill.

Go ahead. Senator Alvarado-Gil,

Thank you Chair. Senator Cortese, thank you for bringing this up. I noticed in the, for this bill, the study, you outlined a minimum of topics that would be included in this study. I would just like to emphasize that as I look at some of the gaps in workforce across my district, particularly in rural and mountain regions, access to schools, nursing programs is limited, as are the opportunities for those placements.

So I'm wondering, as you look at the minimum, including that ability to create standards or strategies for recruitment and placement in those rural areas that are, we don't have a lot of density of higher education institutions, so it's not outlined in here. But I do think that this is going to be a comprehensive study bill that you're putting forward, and I'd love to see some data and facts about the rural communities.

Yeah. Through the chair. I'd be happy to continue to pursue the issue of rural versus urban, as we've seen with the hospital system and so forth. Seems like every Committee I go into these days is, is kind of pivoting off that discussion, so understand the need for it.

I don't know if we could do that informally or if we need to put something in the bill, but we will look into that going forward and if we need to, you know, amend some language in just to make sure it's covered.

Thank you. I'll leave it to you to ensure that it's complete.

Thank you.

Thank you. Senator Cortese, would you like to close?

Yeah. Thank you. And as Senator Archuleta's question and appreciate the willingness to make the motion, the Board of Registered Nursing does an annual survey. It's told us that we have this problem, a numerical problem that we talked about. It's really what we know at this point. And with that big of a gap, 92 versus 152, it just calls for let's go find out why that's happening.

And we're more than happy to try to discriminate between, for informational purposes, data purposes, rural versus urban, and so forth. But with that, appreciate all the help looking at this from the Committee and the discussion today. And I'd respectfully ask for your aye vote.

Great. Thank you, Senator Cortese. This motion is do passed to Senate Committee on appropriations. Let's call the roll.

[Roll Call]

Okay, that is 10 aye's, no no's. We'll put it on call. Thank you, Senator Cortese.

Thank you all. Appreciate it.

Next up, I'd like to do consent, if that's okay, with my colleagues, so we can get that taken care of. We have one item on consent today. This is Senator Ochoa Boghs Bill SB 1468, moved by Senator Nguyen.

[Roll Call]

Okay, that is also 10 to nothing. We'll leave that on call as well.

We'll leave that on call as well. That's consent. And we're gonna move now to Senator Smallwood Cuevas. Are you prepared? Great. And as you make your way up there to the podium, I will introduce your Bill. She is presenting one Bill to us today, SB 1067, when you are ready. Senator Smallwood-Cuevas, welcome to your witnesses.

Thank you so much, Madam Chair. And good afternoon, colleagues. I am pleased to present SB 1067. And this would create an expedited licensure application process at the Healing Arts Board boards, which regulate the licensure and regulation of medical professionals for healthcare providers who can demonstrate that they intend to practice in medically underserved areas. So you all know I represent south central Los Angeles, where we have some of the highest health disparities, some of the highest mortality rate disparities, and too often, many times, these are preventable diseases. If people could just get care, their lives would be saved.

And so I appreciate the Committee's work with me on this Bill and making it stronger, and we'll continue to work with you to fine tune and narrow around some of the suggestions that have been made. But clinics in my district serve more than 277,000 patients each year, with about 81% of these patients living under 200% of the federal poverty rate. These clinics and healthcare professionals are invaluable to the health and welfare of my district and so many others.

Decreased access to health care has contributed to the disparities, as I mentioned, and we have to do all that we can to ensure that we are bringing and delivering strong care and expediting the numbers of professionals that we need to come into our communities. But despite serving our most vulnerable communities, we see many of these same providers have reported high vacancy rates, prolonged periods to fill staff vacancies for key positions like physicians, dentists, nurse practitioners.

We just heard about the shortage in our nursing sector and the need for deeper study. Clinics throughout the state have experienced an average wait times of 26, 26 weeks to fill a vacancy for a physician, and that is life or death when we think about the needs. There's also 18 weeks to fill a vacancy for dentists or for nurse practitioners. Wait times in the licensure process is just one of the factors contributing to our medical workforce shortages.

These shortages undermine quality care and timely access, further exacerbating the suffering, quite frankly, in our communities, expediting licenses for practitioners who plan to serve in our most vulnerable populations is a valuable incentive to work, and particularly to work in communities in the most need. Recently, the Medical Board of California and this Committee was very involved in this process, established their own expedition licensing process for applications for practitioners serving in medically underserved areas.

SB 1067 is modeled after this process to directly benefit California's communities with high need for accessing quality health care. Joining us today to provide testimony is Doctor Hakeem Adeniyi. Thank you so much for that. And chief clinical officer at Sacramento Native American Healthcare Center, which is located here in downtown Sacramento. And Sarah Gavin, who is the chief behavioral community health officer at the Communicare Ole Health center, which serves Yolo, Napa and Solano counties. They are here also to testify as Taylor Jackson with CPCA advocates. If there are technical questions, who is a sponsor on this Bill? I'll turn it over to my witnesses.

All right, go ahead to the witnesses.

Madam Chair and Members, good morning. My name is Hakeem. I'm a UCSF trained family and community medicine physician and as mentioned, I serve as the chief clinical officer at Sacramento Native American Health Center and FQHC, or federally qualified health center, located in Sacramento, South Sacramento and Del Paso Heights of a neighborhood in Sacramento. I've been serving in the community for the past 15 years and have worked at for the past four and a half years, starting just a couple months prior to the pandemic.

I also get the benefit of serving as the chair of the California Primary Care Association's peer network for supporting black communities. So community health is all that I know. Having worked at and recruited clinical staff for FQHCs in San Francisco, Vallejo, Yuba City, Marysville, and now Sacramento, I'm intimately aware of the workforce shortages and I've. I'm here just to stress the importance of SB 1067 and how it can help us close the gaps.

The Institute for Healthcare Improvement IHI is an organization whose mission is to improve health and healthcare worldwide, and they have a quintuple aim that highlights five sections. The need to improve the patient experience, improve population health, reduce healthcare costs, improve care team well being, and advance health equity. By prioritizing the recruitment of healthcare professionals in community health centers, SB 1067 can help us achieve each of these goals. One, improving the patient experience.

Health plans often require us to establish care with all of our patients within 90 to 120 days, and if they've been in the hospital within seven days. But it often takes up to six months for healthcare professionals to get the license to practice. This is a huge misalignment and counterproductive for our patients. Expediting the licensing process allows patients to get the care when they want it and where they want it, which will undoubtedly improve their patient experience. Number two, improving population health.

Our Zip codes are better predictors of our health outcomes than our genetic code. With up to 60% of our health solely determined by where we live, getting more Clinicians into these Zip codes to address our patients various clinical needs can help improve the health of their overall community.

Okay, I want to make sure all of your witnesses have an opportunity to speak. Do you have a final wrap up?

I'll say the last part. So, ultimately, the reason why we're doing all this is, one, to make sure that the mom who has a suspicious mass on their mammogram can get care. Two, that the elder who wants to spend time with their grandkids is able to get care for their lung condition and three, for the abuelita to have the medications to prevent her stroke. Thank you.

Thank you very much. And thank you for the good work you're doing all across the region. We appreciate you. Welcome.

Good morning, madam Chairwoman and Members. My name is Sarah Gavin. I am the chief behavioral and community health officer at CommuniCare+OLE. We are an FQHC serving more than 55,000 patients across three counties such Yolo, Solano and Napa counties. I am also a licensed marriage and family therapist and a licensed professional clinical counselor with almost 20 years of clinical experience in underserved areas.

And I've been with CommuniCare+OLE as an FQHC since 2007, and I'm here today to also respectfully urge your support of SB 1067. As the Senator said, there's a healthcare workforce shortage in our state. Historically, this shortage has disproportionately affected underserved public populations who access safety net services from FQHCs, community clinics and rural health centers. And of course, during the COVID-19 pandemic, the workforce shortage worsened when burnout contributed to mass resignation in healthcare.

And as said in a recent survey, our community health centers report high vacancy rates, prolonged periods of time to fill staff vacancies for key life saving positions. And I will say anecdotally, many health centers are facing vacancies that go on for months, if not years. And part of this is because of the backlog and the challenges with the Healing Arts board, who license physicians assistants, behavioral health practitioner nurses and other healthcare providers in California.

They have lengthy backlogs for processing applications for licensure, which prevents providers from joining the healthcare workforce in a timely manner. This has left us all in an untenable and challenging position when it comes to recruiting. I want to speak to behavioral health, specifically. The administrative delays in processing applications force us to make a difficult choice.

We can either hire Clinicians before the application is processed and cover their salaries while we wait and before we can Bill for services before they can see patients, which is sometimes months later. Or we can wait to hire Clinicians until their paperwork is approved, which often means losing those candidates to employers who can afford to pay salaries without billing.

Neither option is financially sustainable for us, and I would say, most importantly, the situation creates substantial barriers to care in addressing our urgent behavioral health needs in our communities, we have clinicians who could see patients respond to crisis, reduce suffering now, but instead we have to wait months while the licensing agencies process the paperwork. Okay, got a final thought on there? Yes. Just supporting taking action in expediting this process for agencies in medically underserved areas and support your aye vote in SB 1067 thank you.

Thank you. Are you here for technical support or you want to. All right, then. We have reached the part where if you are here to agree and you can come forward and meet to testimony support the Bill, just give us your name and your organization, your position on the Bill.

Good morning, Chair Members. Rebecca Alcantar, on behalf of Altamed, in strong support of the Bill, and we really believe this will address the disparities and the provider shortage that we're seeing across the state. Thank you.

Thank you.

Good morning. Dan Seeman, on behalf of Wellspace Health, serving Sacramento County, El Dorado, Placer, and Amador counties, in support.

Squinakoy Virginia Hedrick, on behalf of the California Pan Ethnic Health Network in support.

Good morning. Nanette Starr, California Consortium for Urban Indian Health and in support. Thank you.

Okay. Anybody else here in support of SB 1067? If not, then we will move to opposition. If you are here in opposition of SB 1067, please feel free to come forward. Okay. Seeing no one, we will bring it back to the Members for discussion. Senator Niello?

Thank you, Madam Chair. I agree with what you're trying to do here completely. My problem is that we already have three classes that qualify for an expedited process and a couple more proposed this year. If they all pass, we have six exceptions. And the problem is, the more priorities you have, the less you have any priorities. They all compete with each other.

There's also the small issue of if a person commits to a certain practice and then doesn't complete that commitment, I don't know how you enforce that, but the issue we have is the problem that we have is the processing, and we're attempting to address the effects of the problem without addressing the problem itself. And it would seem to me much more effective to try to figure out why we have the problem of processing and fix it.

Now, it probably means resources, and I realize in today's budget, that's a challenge, but I don't know how many resources it would be. But unless we address what the problem is, others will continue to come forward with what they believe are classes of applicants that also should be given an expedited review. And I don't see where that really gets us anywhere.

So my response to that is, we've already done an expedited process through the CMA board last. Senator Smoldkovs. Hold on. Is her mic on, you guys, we can't hear her very well. So there's been one expedited. Can you hear me now? Is that good? There's been one expedited process that we looked at last year that was approved for physicians. This is about healing arts. This would extend to dentists. It would extend to nurses, nurse practitioners. So, you know, I can't speak to other bills.

I can only speak to the Bill that we have here. And I think it's important for us to recognize that the problem we're trying to solve is not processing. The problem we're trying to solve is communities that are disproportionately sicker than others, disproportionately underserved, disproportionately, lack of access to care, being able to be prioritized first through an expedited process. So that is the problem that this Bill seeks to solve.

You know, I think we have to, I'm not one for trying to solve a problem that doesn't exist. So the process doesn't exist as a problem. The problem is really trying to care for underserved communities, and that's what this Bill does.

But why do you have to have an expedited process?

Because we need to get providers into these communities as quickly as possible.

And I agree with that. But the reason that you need an expedited process is because the process is otherwise too slow. And evidence is with now at the end of this session, if the other proposals are successful, we'll have six exceptions for the expedited process. Then we need to prioritize which one of those is more important, I guess, but that's chasing your tail.

I can't speak to those bills. I can only speak to my bills.

I get it. They exist.

So I hear your concern, and I think we crossed that bridge when we get there. Now, the bridge is how do we get care to these communities as quickly as possible? And you know this, at this point, we have physicians with an expedited process. We think the other healing arts providers also need to have the process.

And if this becomes an issue, I'm happy to look at this issue once we look at what happens at the end of this session and into next year, and then we will address, should there be a process issue, we will address it. But this Bill is just saying that the process provided to physicians should be provided to other healing arts boards.

Thank you, Senator, for bringing this forward. You know, obviously there's a great need to serve the underserved and especially in the medical field. And we have great organizations like Ultamed who's been doing this for years and years, and they too are trying to find ways to bring people within the community, getting them in schools, whether it be doctors, and even to the point they've asked to go into Mexico to ask doctors to come in and test and study and finish up here.

So, I mean, there's such a dire need for the underserved, no doubt. But my concern is how do you at the end, ask them to stay and, you know, they're not going to walk away after a year. I mean, is there a commitment? I guess that's my question. If there's a commitment, how do you cement that commitment to make it long lasting? Because that's what we're looking for. Not someone just come in and come out, but to actually serve the community.

I'm happy to have one of our witnesses answer that technical question.

Thank you. Senator Archuleta and I might have our providers add on, but something we've really discovered is once folks get into community health and have the experience of working with folks with the most need, they are much more likely to stay long term. And that's one of the great things about this legislation, is it also really incentivizes folks to come into our facilities.

We may not be able to compete dollar for dollar with some of the folks in the healthcare space who can pay more, but something like this really incentivizes folks to work in community health. And once they have the experience of working with these communities, what we find is folks tend to stay. So that hasn't been a big concern of ours. And I don't know if the other folks want to add on to that.

Just to add to that, I think many of us are bleeding hearts. So once we get there, we want to continue to be there. I know myself, I could go literally anywhere if I wanted to, but there's no way that I would, because I know that we're serving a population that really needs us. In Sacramento county itself, around 70% of all black people and people of the African diaspora are Medi Cal.

So just looking at that, if we're unable to meet the needs there, we clearly are demonstrating a health equity issue. Additionally, in terms of the questions around resources, I'm a frugal person by nature. In terms of reducing healthcare costs, around 50% to 50% of all emergency room visits are avoidable. An average visit in an emergency room is $2,960. For me, if I see the patient, it's $196. Generally, across the state, that's 7% of the cost.

I'm pretty sure we can use some of that money to meet the needs in terms of helping to expedite, making sure that we have the resources to do the credentialing. That's a pretty big difference.

And obviously we've discovered there's so many things that are still there. Medi Cal, Medicare, getting the professionals to stay in the communities. That's one. God bless you for doing that, by the way. But that's something that's really important to me. I think that this will open the door. Now, let's be clear. This is not giving an advantage. It's just taking that application and saying, okay, this one is ready to serve in the underserved communities. Let's go ahead and take a look at that. And because there's plenty of others. Is that correct?

Yes, I think that's correct. And just looking at it from a social justice standpoint, we often look at the fence. Right now our goal is to take the fence down, not to give another step.

Very good. And I'll be ready to move the Bill at appropriate time.

Thank you, Senator Archuleta. Senator Glazier

Just wanted to thank the Senator for her work in this area and focus. I'm happy to move the Bill to at the appropriate time.

Okay. Seeing no additional comments, Senator Smallwood-Cuevas, would you like to close?

I want to say thank you for all of the great discussion today. And like I said, we will continue to work with Committee on this Bill. And this is a dollar and cents. This saves us in the long run until we have universal healthcare. We've got to create the incentives that bring our capacity, our skilled providers, our healing hearts providers into the most underserved communities. Because in the end, it saves lives and it does save dollars and cents, as the good Doctor said. And with that, I ask for your. aye vote.

Okay, just 22 comments from me. First of all, Senator, Small, thank you for working with staff on just logistics of the Bill. The overarching idea of the Bill is obviously important. So thank you for working with them. And I know you, so I know you'll keep working on it all the way across the finish line.

And then just one point of privilege. One of the best things about being in Sacramento is that I get to see the all star lineups in every category every once in a while. So to the three of you who are also some of you, my friends, thank you very much for what you do in this city and in this community every day, we're really grateful. And to see you here fighting for the next is very meaningful to my heart. So thank you very much.

On that note, we have at least one motion maybe two over here from Senator Archuleta and Glazier. Can we call the roll? [Roll Call] Wilk. I. Okay that. Sorry. That's nine yeses, no nos. We will keep that open on call. Thank you, Senator. Thank you. And thank you to your witnesses. Have a great week. All right, moving on. We have had one item removed. Just to make sure you know, Senator Dodd, it looks like the author has pulled SB 1206. So we will put that back on on a future agenda, and we will move to the final item, which is me. So I'm going to hand this over to you, my.

At this time, we're going to be hearing item five, SB 1498. Madam Chair, whenever you're ready.

Thank you very much. Thanks for your patience. Let's see if we could get through this last one quickly, and I can give you guys the rest of your Monday back here. All right. SB 1498 provides a necessary enforcement tool to address the illegal marketing of cannabis and cannabis products that are attractive to children. Current law specifies rules that licensees must adhere to for the advertising of cannabis, including prohibiting advertising that is attractive to young people.

While illegal, some cannabis operators choose to willfully violate these prohibitions by continuing to advertise content that is attractive to children. This leaves the promise of Proposition 64 to protect youth from exposure to cannabis advertising that is attractive to children. Unfulfilled, the Bill allows parents and guardians of minors to take existing private right of action against cannabis businesses. In in violation of these cannabis advertising laws protecting youth, a parent or guardian must demonstrate that they notified the licensee of the noncompliant advertisement before taking legal action.

Then, if a cannabis business fails to remove or fix the advertisement that is attractive to children, a court could award a plaintiff sum or all of the injunctive relief, civil penalties, and reasonable attorney fees and costs. SB 1498 is a Bill that simply seeks to keep our children safe and ensure that Prop 64 is implemented as intended and promised to the voters of the State of California. I respectfully ask for your. I vote.

Thank you. At this time, do you have any, is there any sponsors or lead witnesses?

Not sure if we have a lead witness here today.

Are there others who would like to testify in support of SB 1498? See none. Anyone here who would like to oppose SB 1498? Please come forward.

Madam Chairman, chair and Senators, I am not opposed. Amy Jenkins, on behalf of the California Cannabis Industry Association, we actually support what the Senator is trying to do. We look forward to speaking with her. We have some amendments we might want to propose that would incorporate intoxicating hemp products as well as illicit products to achieve the objectives that she is trying to accomplish with her Bill. So look forward to further discussions. Thank you.

Happy to work with her.

Thank you. And bring it back to Committee. Senator Eggman, thank you.

Thank you for bringing this forward. And I'm assuming you're still working on this?

Yes. Working with the Department, working with Committee staff. Yes, we are.

Okay. Just because there's a. I mean, there's a lot of. Any time you do a private rite of action, right. It makes people nervous. And this seems to be very broad, like, how do you define. I mean, how do you define what's attractive to a child? And then, so, I mean, the way I read this, I'm driving down the street, I don't like a cannabis sign that I see on the freeway. I go to the shop and I say, I don't like that sign. I think my kids like it. Take it down or I'm gonna sue you.

Yeah. You know, it's probably not clear in this Bill, but that is actually already defined. What this Bill does is allow a parent or a guardian to do what our state agency can already do. The truth is that our state agency is inundated and can't quite do all of these causes of actions on their own, thus creating the private right of action. What is identified as advertising for that is aimed at children has already been defined.

All this does is allow that private right of action then for parents or guardians to be able to be a part of that enforcement too. And it also has a notice requirement on the front end of it. So if a parent or guardian wanted to sue an agency or a company that they believed were advertising towards their children or were in violation of the existing rules, they'd have to give them notice first. They have an opportunity to correct, and then if they didn't do that, then they could bring forward the right of action.

And what does that process, I mean, what does the process look like? Like take it down? Or is there.

Sure, they could take it down. Yeah. So let's say it's a Billboard. Like you said, they took the Billboard down. I think that would be seen as a corrective action. If there was packaging. They'd have to change the packaging. If they were choosing a location. Like school. Like in front of a school. Say Billboard's facing only a school. That's the audience. Say they bought a little League sign and they put it out in the left field of the Little League. Okay. Gotta take that down.

So it just probably depends on what. What it is about the advertising. That is it the time, place, manner, content. What is it about that advertising that is creating the appearance that it is focused on children.

Okay. And then that's. Then that is documented in.

That is already an existing law that the Department can see that. Say that again.

If somebody sees that, then what is, what does that process look like? I guess. And then what is.

Well, first of all, you'd have to have a harm, so you'd have to feel like your child was negatively impacted by that. That creates the right of action. And then you'd have to notify the agency, they have to have a chance to correct. And then you could bring forward a case as a parent. By the way, this doesn't change the fact that the Department can still proceed with actions. It just adds, gives parents the same right to do so.

And if you, if you believed that your child was negatively impacted and then you brought forward this ruling, told the agency or the company, hey, you were advertising, you put Strawberry shortcake on this and you put it near at the lower racks or whatever and you're advertising towards children. I saw your ad on Minecraft, whatever online, you would give notice to the company, to the agency that's doing it, whatever corporation it is. And if they don't correct that, take them down. They're still advertising.

You're still seeing that there's still Strawberry shortcake on the packaging. Then you could bring forward your private right of action as a parent and then you would sue. And then as I listed off the things that the court could respond to the remedies would be an injunctive relief, which is you got to stop. That's the court telling you you got to stop. Now the civil penalties of 5000 per violation and then of course attorney fees costs.

I mean, I'll stop. I have a lot of questions about this. So I mean, I understand it's probably work in process and I know it's double referred and so I'll be, yes.

It goes from here back to rules where I think it will be sent to Judish.

I guess I just have a lot of like why not then just talk to the Department who's already in charge of it. Why create this whole other anyway? So I have a lot of questions.

Sure. I'm happy to also sit down with you. The answer to that last part of the question, and really the whole point of the Bill is that the Department doesn't have the resources to follow through on all of the actions that need.

So we're going to put it in parents hands.

I'm sorry.

So we're going to put it in parents hands like a citizen's arrest.

It gives parents an opportunity to be involved in that process. Yes. Would be one more form of enforcement. Yes. Okay. Yes.

Senator Glazer.

Yeah. Thank you, Senator. As we have talked about, I have in plea agreement what you're trying to do. I mean, absolutely 200%. I've never been a fan of private right to action, but I would say in defense of your Bill that you do lay out, you know, a cure process. And I think that's really important. I think that's one of the, when we see abuses out there, they don't typically allow for that cure.

And certainly facilities for the handicapped is a classic private right of action abuse that has happened out there. So I want to just give you props for that process that you've outlined in the Bill. There was a. And you put some limitations on how much 5000 per violation to try to not create this lawyer mill that just goes after companies that may be doing the right thing, but they can make a case that somehow they're doing the wrong thing.

One of my questions on the $5,000 per violation is whether or not if somebody puts up a billboard, as we were hearing as an example, and that's a 5000 per violation. Example. What if they had 100 billboards in California? Would that be 100 times that? 5000? And then therefore, it's not really kind of a modest, you know, reimbursement to some collection of folks.

Great question. I don't know the answer. I'd have to look into it for you.

Okay. And then the. Because it says in the Bill that in connection with the same or substantially similar advertising or marketing. So that's a, that's a question that goes to that.

Would that be considered, well, the finest per violation. So at the heart of your question is what constitutes one violation versus would it be 10 violations of. There were 10 billboards. And I mean, honestly, if you're a lawyer, you could put that together whichever way that you wanted to. But if we wanted to add some additional clarity when we get to Judish on that, we certainly can.

Yeah. Okay. And then as we exchange texts over the weekend, I mean, you know, one of the, one of the ways to avoid this type of remedy is to empower other public agencies. I mean, these agencies that aren't doing their work. Well, that's a problem. And frankly, it's something that we should be right on top of.

And they should be called to account for not enforcing the law in places like this, and their budget should be withheld if they're not going to prioritize them the way they should be to make sure the kids aren't exposed to these types of dangerous products for them. But my question was, really?

So we have an Attorney General, we have district attorneys, we have city attorneys that come to us here in the Capitol every year to say, give us more authority in enforcing public law because we don't see it happening and we want that power. Please give it to us. So have you given some thought as another alternative to doing what you are trying to accomplish?

And what I agree with of expanding the power of our city attorneys and district attorneys, because I think they would love to find those examples and from a public representation point of view, not a private interest, make the case.

So, as I committed to you over the weekend, first of all, a couple questions wrapped up in your question there. I know I don't have to explain this to you, so please don't take it as that, but more just putting it on the record in a year with a $60 billion shortfall, I wish that we could just grow the Department, give them the resources that they need. It's the same argument that was made to Senator small cuevas on the last item.

It would be ideal for us to just right size every Department so they could deal with every single thing that comes their way. That is not an opportunity, not this year, and it hasn't been in the past so far. And the amount of responsibilities that have been laid on this particular Department are pretty significant. Which leads to the next half of your question, which is then why not city attorneys, DAs and the AG? There's nothing preventing the AG from getting involved now.

We could singularly pull him out and add him, which is potentially something that could happen in judicious. Well, I'm not sure this is within the purview of city attorneys. Having worked closely with a very large city attorney Department, I'm not sure this would be something that they would have the expertise to enforce, but maybe potentially something I'm willing to look at as we move forward with the Bill as well. As I also told you in our text exchange.

Thank you.

I have little to no sympathy for cannabis organizations that are marketing to children.

Indeed. And I agree with that. And I do think that district attorneys would love the opportunity to enforce if we gave it to them, and I think that's a remedy. I appreciate your consideration.

Definitely one we can look at.

Okay. Senator Niello.

Thank you, Madam Chair. I agree with the things that Senator Glazier said. I like what you're doing, and I can't remember any time that I have supported a private right of action. I have been universally opposed to that. But acknowledging that mindless consistency is the hobgoblin of weak minds, I can support it here. But now I'm not an attorney. You are. But you mentioned in answering Senator Egman's question that first you have to prove harm. You don't, and private right of action.

All you have to prove is that there's a violation of a regulation. There doesn't have to be any injury, which is a fundamental premise of our legal system, which is why I hate the private right of action. But that being the case, I am learning to hate the Proposition that legalized Marijuana more and more and more as time goes on. It is an impossible Proposition that has created more problems than it has created any benefits.

That point aside, there is no doubt that there are legal, more so illegal illicit sellers of Marijuana that do attempt to attract, make their product attractive to children. It is absolutely wrong. And so for a parent to seek redress on that, they'd have to wait until the kid started smoking a joint and then sue on the basis of that happening because of the advertising. Why wait till then? I can see the logic of it. There are obviously detailed problems here.

I trust that you will be working on that. But one other that I'd like to add to the mix. In the Bill, it says that any civil penalties awarded will be split between the plaintiff and the General Fund. I don't understand why any of it would go to the General Fund, and I would prefer that all to go to the plaintiff

or to the cannabis oversight.

Or to the cannabis oversight, rather than just General funding. Be more specific with the allocation.

Beg your pardon?

If that's the case, then be more specific.

We'll take a look at that, too.

Because enforcement is one of the things that I hate about the Proposition, too. There's just things that aren't enforceable. But that's why I'm able to oversee my otherwise consistency on private right of action. And I agree with what you're trying to do. I know you'll continue to work with some of the other issues.

Yeah, I appreciate that.

Senator Alvarado Gil.

Thank you, Senator Ashby. I'm also kind of dissecting your Bill here. The question that I have, maybe Senator Niello kind of touched on this, but for me, it's not clear that a parent or guardian of a minor child is that they would have to bring action on behalf of their own minor child or just being a parent.

No, no. On behalf of their own child. Okay. All right.

So that, for me, wasn't clear. And then are they essentially exercising their right as a parent or guardian on behalf of their child to bring a private right of action so that their child.

Having their own child is what gives them standing? Yeah.

Okay. But the money is for the parents to recover damages, or is it?

Well, it's a really small amount of money. It's primarily going to end up being lawyers fees so that people have the ability to pay for if they bring forward the suit that they're going to get reasonable fees and response. And like I said on the civil penalties piece, it's only $5,000. So, you know, we can take a look at where that money goes. I've heard from a couple people now that they want to know where that money would go.

More specifically, meaning not into the General Fund. Some people want it to go entirely to the victims. Some people want it to go entirely to cannabis enforcement. I'm committed to taking a look at that, talking to the Department a little bit more about that piece. But, yeah, in terms of standing, it would be being the parent of a child who's negatively impacted by the advertising.

So if the, if the parent has multiple children, can they bring multiple suits?

Excellent question. I'll have to, again, that's. Your question is the same as Senator Glazier's about what constitutes a violation. Meaning is two kids a violation or 100 violations? And so we'll take a look at that, too. Again, this goes to, well, it goes to rules, and then rules is going to send it to Jiu Jish, and we can take a look at some of the, clearing those things up right now.

Some of this is already codified in what the Department does and just gives the parent the same right of action that the Department already has. So I need to take a look at whether or not the Department has already identified that children in one household would constitute one violation.

I guess my concern is and I know this is not your intent, but the utilization of a child as a proposal or a means to then open up.

It's definitely not enough money for it to be a lucrative opportunity. That's something that I think Senator Niello and Senator Glazier and Senator Eggman all sort of touched on. We want to avoid. I don't, I actually don't often vote on private rights of action either to im judige. Don't love them. But the problem that I am seeking to address here is that our Department doesn't have the ability to enforce this rule, and they need some help.

And so we started off broadly looking at who all could have standing, narrowed that in. And because I am actually of a like mind here with my colleague Senator Niello and Senator Glazier, I added the right to cure because I think that's really important. Otherwise you end up having problems that we see in other areas where lawyers are making a living off of just going around suing everybody. That is, this is not enough money to justify that, which is part of why, why the fee is so low.

I appreciate that. I think what it. To me, it spells lucrative practice for attorneys, unscrupulous attorneys, to, again, use children as a Prop to catalyze.

I don't think they would do that at a $5,000 per violation. It's too low.

But they get reasonable attorney fees and costs.

They do. So that would be. That'd be a wash for them. They're not going to be able to make a big profit off of that.

Yeah, but again, if that's. If that's what they dedicate themselves to.

It's like. I mean, I'm just throwing things out. Cause I'm trying to understand your.

Right.

Yeah, absolutely.

And then the other thing that comes to mind for me, are there similar laws in existence that deal with other vices like alcohol, tobacco, gambling, that your Bill is modeled after, or would this be the first time a private right of action for parents?

It's not the first time for a private right of action for parents. I am not an expert on all of those areas of law. I'd have to ask the Judiciary Committee for a little bit of help there.

But this Bill is modeled after what the Department is already doing and then extends it to parents in order to help the Department meet the goal of Prop 64, which is the promise made to our, you know, California citizens that we won't allow cannabis organizations to advertise to our children, which is, as Senator Niello said, it is happening a lot. And so we're lacking in enforcement in this area, which is why the Bill is coming forward.

I know it's a tough one, and you're the First Committee to hear it, and I appreciate all of you with the questions, I really do, because it's helpful. I think this Bill has a long trajectory. It's got to go back to rules, and it's going to go back to Judish. It's got a long road ahead of it.

And my commitment to you is to continue working really hard on it and see if I can get some help from some strong Committee staff along the way like I did here in BMP, and make sure that it's as solid as it can be before you see it again.

Yeah, I acknowledge it's a tough one, I think, because we have so many other vice industries that are targeting and marketing to children, and we in this Committee have heard those bills over and over again, limiting tobacco flavors, vaping flavors, cartoon characters, and things on packaging. So this, to me, is kind of. It's monumental as a private right of action, and I tend to stay away from those as well.

I'm just trying to see how are we opening a Pandora's box in terms of utilizing children as props for private rights of action when it comes to vices. If and then in agreement with some of my colleagues of why not give the agencies that are funded and purposeful to do these jobs?

That, yeah, would love to do that, but no resources to do so, no ability to do that right now. And in speaking with the Department, this is something that would be really helpful to them. And so I guess my ask if. Is that the last question? Okay. All right.

Senator Dodd.

Yes. First, I feel absolutely privileged to be at a Committee hearing where Senator Niello has made history.

Me, too.

It's amazing, really. But I will. And I agree with Senator Niello in his points he made as Senator Eggman and Senator Glazer. I think just in hearing this conversation today, you might want to even consider putting a time deadline on it so that there is some consistency there. And as the chair of go, I'll tell you, this has nothing to do with this Bill. But just as an editorial, if there's any problems with any restaurants or any liquor stores with.

In reference to booze selling to underage children, there is hell to pay. And it's the same thing with gambling and the gambling Commission. And I'm telling you, we ought to have some sort of oversight hearing with this Department. The fact that this Department does not have resources to go out and police a law that we have already on the books is just, you know, I'm blown away by that. And I wasn't planning on saying anything. I'm going to support your Bill.

I like the fact that you did the right to cure and the other things that we've heard today. But some way, somehow, we are missing the boat here in terms of what this Department should be doing. When we set it up, or it wasn't us that set it up, it was the initiative that set it up. We all thought that this was going to be overseen and regulated just as liquor was, and it's no joke.

And so I'm hoping that we, as an institution, can do something about it without prejudice with your Bill at all.

I'm really glad you decided to speak today. Cause I think that's really important. You're totally right. This Bill is trying to get where we have gotten as a society with alcohol and gambling, trying really hard to protect kids from the dangers of cannabis. And you're right. We're failing right now. And you're also right that a hearing is a really good idea.

So maybe when we get through this busy time here with bills, maybe we can come back around on that, because I know, as Senator Alvarado-Gil said, there have been numerous bills that have come through here, and most of them didn't make it, actually, on advertising and trying to address this issue with children.

So we haven't gotten there yet, Senator Dodd, where you have NGO, and we need to get there so that we can take care of kids, so that we can meet that promise of Prop 64.

Well, let me just put it this way. Thank you for that comment. This was in this place way before I became the chair of go. Yeah, it's been historically. Thank you.

We need to get there.

Any other comments, questions, colleagues? There is a motion. Would you like to close?

Yeah, I guess I would just say in close. I asked my colleagues to give this Bill a shot to go through the process. Thank you really deeply for all of your comments today. It would be very helpful to me. I will use all of them to continue working on this Bill. And now I'm considering an oversight hearing that I wasn't even thinking about before. So thank you, Senator Dodd, I do think we need to do more to protect kids from the dangers of cannabis. And I know that the vast majority of you would agree with me on that, and I would urge an aye vote.

Thank you. With that, there is a motion by Senator Archuleta. The motion is do passed to the Senate Committee on rules. Please call the roll.

[Roll Call]

Welk. Okay, that is seven to nothing. We'll leave that one on call as well. Thank you, colleagues, for that robust discussion. That's it for our agenda. So, for those of you who have voted on all the items, thank you for being here. We will now ask give a couple minutes for our colleagues to come back who need to vote on the items that we still have outstanding, and then we will lift the call. All right, let's lift the call now for the Senators who are here.

[Roll Call]

Okay, then we are all set. Thank you for coming back. That's it for Business, Professions and Economic Development.