Assembly Standing Committee on Health

[Background]

Good afternoon. We will begin the hearing for California State Assembly Health Committee on June 11 at 135 today. Before we begin, I would like to make a statement on providing testimony at this hearing. All witnesses will be testifying in person. We will allow two main witnesses for a maximum of two minutes each.

If a single organization has more than one witness, one can be a main witness and further witnesses from that organization will give their name, organization, and position. Only additional testimony is limited to name, position, and organization. If you represent one. Today, we have substitutes for this hearing.

Assembly Members Lowenthal and Pellerin will be substituting for Assembly Members Schiavo and Weber, respectively. On consent, we have the following bills proposed for today's hearing. Any Member of the Committee may remove a Bill from consent. Item six, SB 1112 by Menjivar Item 10, SB 1320 by Wahab. Item 12, SB 1385 by Roth.

Item 13, SB 1442 by Ochoa Bogh. We will now move forward as a Subcommitee with item number two. Thank you, Mister Senator Cortese, for being here. SB 999. Please begin whenever you want.

Thank you, Madam Chair and Members, the interesting experience of trying to run my own Committee from here while I'm getting ready to present to you. I'm very pleased though to be here to present SB 999. This Bill will ensure that California is suffering from mental health conditions and substance use disorders can receive the appropriate level of treatment needed for a full and lasting recovery.

Utilization review is when a health plan or disability insurer approves, modifies or denies treatment based on what they consider medically necessary. Existing law requires health plans, disability insurers to use generally accepted standards of care when conducting utilization reviews.

However, despite existing law, some health plans and disability insurers still use inappropriate utilization review practices, evidently to avoid paying for care. As a result, medically necessary treatment days are often arbitrarily denied. Some reviewers have denial rates exceeding 95%.

SB 999 will remedy this by requiring that utilization review determinations are performed by a reviewer with appropriate training and relevant experience in the clinical specialty. The Bill requires reviewers to disclose their basis for a treatment denial, including a citation of the clinical guidelines that were followed.

The Bill also codifies the standard practice for reviewers to list their names and credentials on a treatment denial. This practice has been instrumental in helping us track trends in utilization review denials.

Finally, this Bill requires health plans and disability insurers to maintain telephone and direct communication access for utilization review during California business hours as some health plan regulators fail to address the issues outlined in this Bill on their own.

The passage of SB 999 is crucial to ensuring that all commercial health plans use qualified doctors to make accurate treatment determinations. By applying the appropriate clinical and utilization review criteria to mental health and substance use disorder treatment, we can save lives by combating overdose deaths and suicides.

SB 999 is co sponsored by the Kennedy Forum, the Steinberg Institute, Summit Estate Recovery center, the California Consortium of Addiction Programs and professionals, and the Santa Clara County Office of Education with us today to testify. We have John Drabinger of the Steinberg Institute and Joan Borsten of Summit Estate Recovery center.

And at the appropriate time, I would respectfully ask for your aye vote.

Thank you. You'll each have two minutes. Go ahead.

Thank you, Senator. Thank you, chair and Committee Members, I'm John Drebinger, senior advocate with the Steinberg Institute. I'm here today to address the denial of medically necessary covered mental health and substance use care. An alarming number of these claims are denied by health plan contracted utilization reviewers, putting patients at risk of overdose, financial hardship and suicide.

Some reviewers have denial rates of over 95% for behavioral health care. For many patients, this means waiting for treatment at a time when the risk of fentanyl overdose is higher than ever, or fighting for life saving mental health treatment while their condition worsens.

According to data from the Department of Managed Healthcare's 2023 Q4 report on independent medical reviews, the Department overturned 70.6% of mental health care denials, with an additional 9.2%, resulting in the plan reversing their original decision.

This means close to 80% of appeals are wrongful denials, and these are only for those who have the capacity to appeal their plan's decisions to regulators. High denial rates are often driven by plans contracting with untrained reviewers. Data from 38 state licensed treatment centers shows that reviewers with no training in addiction medicine are making determinations.

This extends to mental health, eating disorders, autism treatment and more. In 2020, we proudly co sponsored SB 855 Wiener, which aims to ensure mental illness and substance use are treated the same as physical illness. Unfortunately, despite these laws, high IMR overturn rates and and DMHC's investigation findings show plans remain noncompliant.

The Department of Insurance recently released their regulations for SB 855, which included standards similar to those proposed in SB 999. This Bill would help raise DMHC's rules to the same standards.

SB 999 ensures that utilization reviewers are trained in relevant standards of care, supporting this Bill means reducing the administrative burden of IMRsfor the state and most importantly, saving lives. We must ensure that coverage for medically necessary behavioral health care is not just a promise on paper, but a reality for all Californians. Thank you.

Please go ahead.

And I'm the Executive Director of Seminar State Recovery center, co sponsor of this Bill and I'm CEO of First Responders Recovery. Malibu. Summit State Recovery center is highly successful, and I'm proud to say that Newsweek has named us either the third or fourth best addiction treatment in California for four years running.

We're a smaller treatment center, so we're very careful what patients we put into our beds. We do a very detailed verification of benefits for our potential patients. Before we admit a client, a professional clinician does a detailed intake. Every potential intake must be approved by the clinical Director.

When SB 855 became law in 2021, it mandated the level of care and length of stay should be determined using ASAM criteria. Each of our doctors is an ASAM fellow. All our clinicians are trained in ASAM.

When we ask an insurance company for additional days, it's based on ASAM guidelines and we do not ask for days that are not prescribed by ASAM.

Despite this, our patients are often arbitrarily denied by unqualified doctors using one size fits all denial letters listing the same exact four reasons supposedly based on ASAM, but not according to ASAM specialists. Everyone gets the same denial letter, no matter what kind of substance they are addicted to or how many days of treatment they've completed.

All the changes is the patient's name and the ID number. Many providers also experience inappropriate peer to peer reviews. Our Clinicians have had messages left at 05:00 in the morning, California time, requesting information within 1 hour and threatening to deny care if the timelines are not complied with.

SB 999 will ensure that patients have timely access to life saving care by ensuring that peer to peer reviews are done correctly by experienced addiction doctors certified in ASAM, and that the peer to peer requests are made during California business hours.

On behalf of the addiction providers and patients we serve, I respectfully ask that you vote aye on SB 999.

Thank you. Are there any other witnesses in support? Please come forward. State your name, organization and position only.

Thank you. Vanessa Cajina, on behalf of the California Academy of Family Physicians here in support.

Jia Chen on behalf of the California Consortium of Addiction Programs and Professionals in support.

Symphoni Barbee on behalf of Planned Parenthood Affiliates of California in support.

Tom Tran, on behalf of the Ella Baker Center for Human Rights in Support.

Taylor Jackson with the California Primary Care Association, in support.

Melissa Cortese on behalf of autism speaks and on behalf of the Council of Autism Service Providers, in support.

Amanda Dickey on behalf of the Santa Clara County Superintendent, proud sponsor and in support.

Brandon Marche with the California Medical Association, in support.

Megan Loper on behalf of the California Hospital Association, in support.

Jessica Rand with the California Dental Association, in support.

Christine Smith, Health Access California, in support.

Jennifer Snyder with capital advocacy, on behalf of the California Life Sciences, in support,

Randall Hager on behalf of the Psychiatric Physicians Alliance of California, support.

Danny Offer with the National Alliance on Mental Illness, also known as NAMI California, in strong support. Thanks.

Danny Thirakul on behalf of Mental Health America of California, in support.

Andrea Chavez with American foundation for Suicide Prevention in support.

.... with the. California alliance of Child and Family Services, in support.

Elaine Peng, Mental Health Association for Chinese Community Support.

Tyler Rinde, on. Behalf of the California Psychological Association in support. Thank you.

Lisa Hayes, on behalf of the California Foundation for Independent Living Centers, in support.

Thank you. Thank you. Are there any witnesses in opposition? You'll each have two minutes. Please go ahead.

Good afternoon, Madam Chair, Members of the Committee, Jedd Hampton with California Association of Health Plans here regrettably in opposition to SB 999. First we do want to thank the author, the author's office, and his staff, as well as the Committee staff.

I think we've had a lot of really good, productive conversations on this Bill this year and really appreciate some of the more recent amendments that were taken to conform the Bill to existing statute.

Regulations here in California wanted to start off by again mentioning that, and we ultimately agree with the Senator and the sponsors that mental health is a key component to a person's overall wellbeing and that individuals should have access to important mental health care services.

However, we do have one remaining concern with the Bill that we have raised in that it would allow enrollees to access personal information and the credentials of the healthcare provider who is making the utilization determination.

We do believe that this could unnecessarily expose the provider performing the utilization review to inappropriate and potentially troubling communication from the enrollee should they disagree with the initial decision made by the provider.

Current law does provide a pathway for enrollees when they disagree with the utilization review decision, whereby an enrollee can file a grievance with the health plan regarding the decision, and also that health plan must receive review and resolve grievances within 72 hours when the enrollee faces an imminent threat or serious threat to their health.

We believe that the existing grievance process provides enrollees with a robust and timely process for resolving disputed decisions in a way that also protects the personal information and the clinical determination of that determining provider.

So we are committed to continuing our discussions with the author's office and the sponsors to ensure that our enrollees have access to quality mental health services. But again, we do have that remaining concern around the privacy of the initial reviewer.

We do think that that could be potentially troublesome moving forward, but again, look forward to working with the author's office on resolving that concern. Thank you.

Madam Chair Member Stephanie Watkins. On behalf of the Association of California Life and Health Insurance Companies, I'd like to echo my colleague's comments. We have had several really productive and thoughtful conversations with the author and sponsor and look forward to continuing those conversations if the Bill moves forward today.

I think we do have that remaining concern about the privacy and safety of the reviewers.

And also I would be remiss if I didn't mention that CDI is currently promulgating their most recent version of their 855 regs, which we imagine will have a potential impact on the way this Bill is implemented as well as how the 855 originating statute is also implemented.

So with that, we look forward to continuing the conversations if the Bill moves forward today. But unfortunately, we're regrettably opposed.

Madam Chair Members. John Winger, on behalf of America's Health Insurance Plans to just echo the comments.

Thank you. Are there any other witnesses in opposition? Please come forward.

Seeing no other witnesses in opposition, I'll bring it back to the Committee for a comment or question. Pellerin, go ahead.

Thank you. I'm a proud co author of this Bill and I just want to thank the author for your leadership in this space. It is so absolutely imperative that we provide the necessary mental health treatment for people going through a crisis, whether it be substance use or behavioral health.

So thank you for showing leadership here. And with that, I would like to move the Bill.

We don't have a quorum quite yet, but we will note the motion when it's at the appropriate time. I want to also thank the author for bringing forward this Bill. I think it's very helpful to be able to support any kind of streamlining that we can do to the current process.

Ensuring that we have peer to peer discussions and the ability to use all the tools available to do us in an authorized and timely manner is very critical. Did want to just give you an opportunity and you can do so in your close to address the opposition's concerns.

About personal infos, information of the UR provider being divulged and what currently is our process, and respond to that.

Thank you, Madam Chair. And let me, before I forget, thank Senator Pellerin for her excellent Select Committee work, which I know has been touring around gathering information. Back to your question, and I appreciate the opportunity to address it. The Bill does not require the reviewer to disclose their contact information or any other sensitive information.

It's just name and credentials. And, you know, presumably those names are listed in. In registries somewhere anyway. But the idea is, without that minimal information, it becomes very, very difficult to continue to assemble, you know, the data and the outcomes that we're asserting here.

And one of the things that we ran into with the Bill early on, as you can imagine, is, what's the problem? What's broken? And, you know, show us the data, show us the denials. Show us where they're coming from.

Well, it's not fair, of course, to say, show us where they're coming from, and then say, but we don't want to really disclose who the reviewers are, so we. We are very sensitive.

I'm sure all of you are, especially in the line of work that we're in to, you know, exposing anyone to unnecessary communications or contacts or anything like that. So we've done everything we can just to reduce it down to simply name and credentials with that, if that satisfies the questions.

Madam Chair, I thank your Committee so much for the excellent work. We thank the opposition for working with us as well, and my team. Everyone's been working very, very hard on this, and I'd respectfully ask for your. aye vote.

Thank you for the presentation, and we will move on that Bill when we have a quorum.

Thank you.

We'll move on now. Back up in the file item order to SB 959, Menjivar. Thank you for joining us, Senator Menjivar. You can begin whenever you're ready. Please. I think put your mic on.

There we go. You're here, like, once a year, you know. You don't get used to it. Thank you, Madam Chair, Health Committee Members. In front of you, we have SB 959. We've seen across the country the various attacks, various anti-LGBTQ plus measures introduced in various states.

What I'm looking to do with SB 959 is to ensure, throughout the chaos, throughout the thick noise, that the TGI, the transgender, trans inclusive, gender diverse, and intersex people have a place that they can go to to find what available resources our beautiful State of California has to offer in relation to gender-affirming care, providers are going to be safe and affirming to them, entities that they can go to to get care.

We know that this population, especially the youth in this population, have one of the highest rates of suicide rates, and that can be correlated to the lack of access to be their true selves. So, with SB 959, we want to replicate what we already did with abortion services, where we have abortion.ca.gov.

We want to do the same for resources for our TGI population. Specifically, this website will have existing legal protections for patients and healthcare providers. It would have how to access health plan provider directories for gender-affirming care.

It will provide payment support resources, including coverage options and financial assistance programs, and support services, including transportation and family engagement support. Lastly, it will include references and links to additional related information and resources and Madam Chair, with your approval, I'd like to now turn over to my two testimonies to speak on this Bill.

Thank you. You'll each have two minutes.

Good afternoon, everyone. My name is Mahdi Roby. My pronouns are they/them, and I am with Trans Family Support Services and Trans Youth Liberation here in support of SB 959. I'm an intersex person, the I in TGI, who was born with variations in my sex characteristics, which refers to differences in chromosomes, hormones, internal reproductive anatomy, and external genitalia.

The intersex community is often overlooked and underrepresented, and far too many of us suffer the consequences. This has been my experience with accessing gender-affirming and TGI-inclusive medical care. Throughout my life. Going to the doctor has ranged from being a slightly uncomfortable to highly traumatic experience.

I've sat through entire appointments, being misgendered, subjected to microaggressions and tasteless jokes, asked unnecessary and inappropriate questions. Further, most doctors from primary care to endocrinology, have approached my treatment as a trial-and-error basis, with complete disregard to the damage caused simply because they had no training on bodies that exist outside of the binary.

I was seen as collateral, a learning opportunity, and an experiment to further their understanding, and not as a person myself. The first time I sought TGI-inclusive care, the only resources available were on social media or by word of mouth.

I was only able to find one list that had five doctors in my area who were labeled as TGI-friendly, but the resource was unreliable, and I was quick to learn that a doctor simply knowing TGI individuals exist is not the same as a doctor who is TGI competent and inclusive.

At 27, my distrust of doctors due to past experiences has put a strain on my health and well-being. Being intersex puts me at a high risk of developing cancer. But because of my medical trauma, it was only last year that I started to receive the preventative care I've needed since I was 18.

I'm not alone in this. Within the intersex community, health disparities due to improper treatment are high. To name a few, intersex people who lack access to adequate care are more likely to experience infertility, consecutive reproductive surgeries, reduced sexual function, permanent nerve damage, chronic pain, and more.

A guide like the one that SB 959 is proposing could have saved me and others like me from the mistreatment and malpractice we experienced from those who promised to do no harm.

We deserve access to quality care that is sensitive, informed, and specific to our needs and the ability to find those with the expertise, training, and awareness to provide it. For those of us within the intersex community, as well as the entirety of the TGI community, I urge you to vote yes on SB 959.

Thank you.

Good afternoon. Excuse me. Good afternoon, Chair and Members. Craig Pulsipher, on behalf of Equality California, proud co-sponsor of SB 959. First just want to acknowledge the work of this Committee and the Legislature to protect and improve access to healthcare for TGI Californians.

As the Senator noted, especially in this moment, where over 20 states have banned access to healthcare for trans youth, it's now more important than ever for California to be a leader in supporting and protecting the TGI community.

Last year, Equality California and Planned Parenthood convened a series of working groups of patients, healthcare providers, and advocates to discuss additional steps that California can take to improve access to trans Inclusive healthcare.

And in February of this year, we released a comprehensive report outlining several recommendations to continue California's leadership in this space, and SB 959 comes directly from those recommendations. Specifically, the working group members highlighted the need for more comprehensive and accurate information about how to access trans-inclusive healthcare.

TGI people, it was noted, frequently have trouble finding affirming providers and experience rampant discrimination and harassment in healthcare settings. TGI individuals often struggle to navigate the healthcare system, obtain financial assistance, and overcome the many bureaucratic obstacles to obtaining care.

At the same time, healthcare providers have shared that they often struggle to understand the evolving legal landscape as it relates to providing gender-affirming care to those in California, as well as to those in other states with healthcare bans in place.

SB 959 will help to address these challenges and importantly, the website will be developed with input from members of the TGI community to ensure that the resources are community-informed and it's an important measure to build on California's existing protections and ensure that all Californians can access the essential health care they need and respectfully urge your aye vote.

Thank you. Any other witnesses in support? Please come forward. State your name, organization, and position.

Madam Chair, and Members. Paul Yoder, on behalf of the California Academy of Child and Adolescent Psychiatry in support. Thank you.

Good afternoon. Symphoni Barbee, Planned Parenthood Affiliates of California, proud co-sponsor in support.

Nicole Moroles on behalf of Children Now in support.

Hello. Genesis Gonzalez on behalf of Lieutenant Governor Eleni Kounalakis in support. Thank you.

Erin Taylor with Political Solutions, on behalf of the California Commission on the Status of Women and Girls, in strong support.

Hi there. Faith Lee with Asian Americans Advancing Justice, Southern California. We're in support.

Danny Thirakul with Mental Health America of California and the California Youth Empowerment Network in support.

Brandon Marchy with the California Medical Association in support.

Thank you. Are there any primary witnesses in opposition? Any other witnesses to offer testimony? Seeing none, we will bring it back to the Committee for any questions or comments. We have some desire to move the bill when we have quorum, and we will certainly do that.

I wanted to thank Senate, you Senator for bringing forward this very important bill as was stated, and I really appreciate the testimony offered. It's absolutely critical that our LGBTQI, and particularly our trans inclusive, our TGI community, has the trans-inclusive healthcare available to them.

And something as basic as a website that has credible information that people can rely on, that has a holistic approach to healthcare is absolutely critical. So, thank you for closing this incredible gap that we have in our healthcare system as it stands. With that, would you like to close?

I think you had a beautiful close for me, Madam Chair. I appreciate those words. And with that, when appropriate, respectfully asking for an aye vote.

Thank you. We will move on now to our next item. Item number four, SB 1042, Roth.

Please go ahead, Chair. I think we need your mic on.

Here we go. Thank you, Madam Chair. I want to thank you and your committee staff for all of your assistance with the bill. This bill requires all nursing programs in the State of California to report their clinical placement needs to the Board of Registered Nursing. The bill also requires licensed health facilities and clinics to report on clinical placement slots available for nursing students and do that report to the Department of Healthcare Access and Information, or HCAI.

The bill would also authorize the Board of Registered Nursing, at its option and upon request by a nursing school or program, to assist schools in finding clinical placement slots to meet those clinical placement needs of that particular school or program. That's optional at the board's decision. One of the major bottlenecks to growing capacity in our nursing programs is the challenge of locating and securing clinical placement slots necessary to provide clinical training required in order to obtain a nursing degree at our nursing schools.

Our California State Auditor in the 2020 report specifically recommended that the Board of Registered Nursing require nursing programs to annually update information about the clinical facilities they use for student placements. And of course, that would allow the board to identify clinical facilities that programs do not currently use for placements.

This bill does just that by collecting data on nursing programs' clinical placement needs and collecting that data from health facilities and clinics on their clinical placement slots, the board and HCAI would have the data necessary to better understand where clinical placement slots currently exist and where they can potentially be created, and the schools would be provided this information too, via a website.

You should have received a copy of amendments that I'm committed to take in the Assembly Business and Professions Committee, which is, of course, where this bill will head next if it is approved by this committee. And while I understand that you are voting on the bill currently in print, I also think it's important that the committee and its Members know what I intend for this bill should it move forward. These amendments do two things.

One, they remove the requirement that the board prioritize requests for assistance from public schools, and two, the amendments make some technical changes to the reporting requirements for health facilities and clinics. The changes include requiring them to report clinical placements affiliated with patient populations, rather than type of bed or unit, and aligning their reporting timeline with that of the school's to the Board of Registered Nursing.

These amendments may remove some or all of the opposition we will see, but I am committed to continue to work with the stakeholders on these issues to resolve any concerns. With that, I want to again thank you, Madam Chair and your committee staff, and also want to thank the hospitals, the nursing schools, public and private, and others for engagement on the bill. At the appropriate point in time, I respectfully ask for an aye vote.

Thank you. Assuming you don't have any witnesses, are there any other witnesses in support?

Good afternoon. Matt Lege on behalf of of SEIU California in support.

Thank you, Chair and Members. Ryan Pierini on behalf of the California Ambulatory Surgery Association in support.

Good afternoon, Chair and Members. Janice O'Malley with AFSCME California here in support.

Good afternoon. Vanessa Gonzalez with the California Hospital Association. And CHA does not currently have a position on the bill. However, would like to thank the Senator for working with us to address our concerns, and we look forward to seeing the amendments in print. Thank you.

Good afternoon, Madam Chair. Awet Kidane representing the California Children's Hospital Association. I want to thank the General for his diligent work and his staff. With those amendments that he mentioned, we are in a place of neutral, so thank you very much.

Thank you, Madam Chair and Members. Sarah Bridge on behalf of the Association of California Healthcare Districts. Again, want to echo the comments by my colleague from the children's hospitals. We removed our opposition. Thank you.

Good afternoon, Chair and Members. Alex Graves with the Association of Independent California Colleges and Universities. We, too, had been in an opposed and less amended position, but we'll also be moving to neutral with the amendments mentioned. Thank you.

Madam Chair, Matt Back representing the California Association of Private Postsecondary Schools. We, too, have an opposed position on the bill in print. We appreciate all the amendments. There is one issue we're still working with the author on. We are very cautiously optimistic we'll get there. And again, thank you for the amendments.

Thank you. Are there any other witnesses in, are there any witnesses in opposition? Seeing none. I'll bring it back to the committee for comment or question. We will get quorum. Senator Roth, thank you so much for bringing forward this bill. I know that we are both mutually working on an incredible workforce shortage, particularly within the healthcare sector, and allowing our student nurses and nursing schools to have accurate information about availability of clinical placements is absolutely a critical piece of that. So thank you for bringing forward this bill. Would you like to close?

Thank you, Madam Chair and Members. Thank you for your consideration.

Thank you.

We will move on now to item number eight, SB 11. Sorry, 1184 by Eggman. Whenever you're ready. Thank you, Senator. Use your microphone button, please.

Good afternoon. Today I am presenting SB 1184, which would help prevent the interruption of medically necessary treatment while preserving a patient's right to due process while in involuntary hold. And you all know I've done a lot of work in the mental health space this year. We're just doing some cleanup and some fine-tuning.

And this is one brought to us from the field itself. And this is when people go in on an involuntary hold, it's deemed that they are unable to make their medical decisions.

There's something called a Riese hearing that is held to see if the courts can then say, yes, this person needs to be medicated because they're not able to make those decisions themselves at this time. This simply says, because our court system doesn't always land up with a treatment time spent.

So right now, if someone goes from a three-day hold to a seven-day hold to a two-week hold to a month hold to another month hold, each time, if that person has not regained capacity, they have to go for another Riese hearing.

This just says if they're already on a Riese hearing and their confinement changes from one to another to allow that to stand until the courts can schedule a follow-up Riese hearing so the person does not decompensate while in treatment and begin to go backwards, thereby oftentimes necessitating an even longer stay.

So that is, in essence, what we're doing. And I can talk forever, but I will just say with me here today is Doctor Eric Chung and Randall Hagar to testify and support.

Thanks. You'll each have two minutes.

Thank you, Assembly Committee Members and chair. My name is Doctor Eric Chung. I'm the Chief Medical Officer of UCLA Psychiatric Hospital. I'm speaking as a member of the California State Association of Psychiatrists and as an ER and inpatient psychiatrist for the past 17 years.

SB 1184 fixes what I call the Riese gap, which is a significant disruption in medical care that causes treatment to be stopped in a patient who lacks capacity simply because they are moving from one phase of a hold to another. These medication stoppages typically last between one to four days as the patient simply waits for their capacity rehearing.

The Riese gap impacts the most seriously ill patients all across California. And I give you this case example. A young man with schizophrenia was admitted to our hospital on a 5150 hold after having suffered multiple skull fractures.

His core psychotic symptom was a delusion that he needed to save humanity by falling backwards and striking his head on the ground, attempting this daily. Sadly, he did not believe that he had schizophrenia and he refused medications. A Riese petition was granted.

With his 14-day hold, the patient started a medication, and he began to show signs of improvement. Then upon filing his 30-day hold and a new Riese petition. He fell into the Riese gap and his medication was stopped. As he waited three days for his capacity hearing, his psychosis worsened significantly.

His attempts to fall backwards and strike his head were more severe. He had volatile mood, nausea, headaches, and disrupted sleep. When the Riese was reinstated, we resumed the medication, but it was clear to all of us that he was starting over in his treatment.

The Riese gap causes undue medical harm to patients by worsening their illness, exposing them to risks from sudden discontinuation of medication, safety risks from agitated behaviors, and ultimately prolongs their hospitalization. I ask for your support for SB 1184 in the best interest of the health of our most vulnerable patients.

Madam Chair and Members of the Committee, Randall Hager, representing the Psychiatric Physicians Alliance of California. I could not have said it any better than Doctor Chung. Our guys are interested in the patient not deteriorating in treatment because of administrative delays that take place between one hold and another.

I would point out that Riese versus St. Mary's, which is the court case that this particular section of the law is based on, was decided long before we had a number of the new, newer holds that you see now in our statutes.

So, another 15-day hold, another 30-day hold, two 30-day holds. They were not anticipated, and there was not a finding in that, in that court case that determined how you go through those holes and what the termination needs to be.

So, really, in one sense, there is an administrative reconciling here of the Riese hearing procedure with all these recent enactments.

And again, I think the important thing to remember is that this measure is, I think, first and foremost, for my member, is a way of preventing the kinds of sudden deterioration that can result from an abrupt cessation in their intake of medications.

There's something called a rebound effect that can cause symptoms that are much greater than when the individual patient presented. And that's really something we all want to try to prevent. And we recommend this bill to you for those reasons. Thank you.

Thank you. Are there any other witnesses in support?

Madam Chair and Members. Paul Yoder on behalf of the city and County of San Francisco, in support. Thank you.

Thank you. Any witnesses in opposition? Are you primary witnesses in opposition? Please come to the table. Thank you. You'll each have two minutes. Go ahead. I think you need to put your mic on.

I haven't done this before. Thank you, Madam Chair. I'm Katherine Wolf, a doctoral student at Berkeley in the Sustainability and Health Equity and Disabled Ecologies Laboratories with a master's in public health from Yale. I conduct research on the geographic siting of psychiatric facilities in California.

But I am also here because of my personal experience with a mental disability and as a hospital and psychiatric ward inpatient. This bill claims to resolve treatment gaps, yet the bill sponsors cite no data and reference no research on why or if those gaps exist.

And as far as I know, they propose this bill with no input from people with mental disabilities. Imagine writing a bill about women without women. Imagine writing a bill about queer people without queer people. Yet we keep getting these bills about disabled people, specifically with mental disabilities without disabled people.

I think the reason is a form of discrimination that disability theorists call a loss of rhetoricity or epistemic injustice. More simply, once you have a diagnosis of mental illness, a lot of people no longer consider you a reliable witness of your own experience. Psychiatric patients are even the sole inpatient group excluded from federally mandated hospital experience surveys.

Speaking of rhetoric, the euphemisms. The only treatment that a Riese hearing authorizes is forced antipsychotic medication. That means if a patient refuses oral meds and physically resists, a group of staff can hold her, tie her face down on the bed, pull down her underwear, and force a needle into her butt.

Speaking personally, in two unrelated events, I have been sexually assaulted and I have been forcibly injected. The one that had the longer and worse impacts on my life was the forced injection because of the lack of recourse. I just had to live with it. Some don't live with it.

Recent discharge from inpatient psychiatry is the biggest risk factor for suicide. That's not all from forced injections, but we know that coercion during hospitalization increases that risk and deters people from seeking future care.

This bill, by letting Riese decisions bleed into subsequent holds, increases the chance that medical staff will force needles into patients whom a hearing officer would have found to have capacity. That makes inpatient psychiatry less safe. And if the psychiatric system isn't safe, where are we supposed to go? Thank you.

Thank you. You'll have two minutes.

Hi. Good afternoon. My name's Clare Cortright. I'm the Policy Director for Cal Voices. We are a peer-run organization, so we're run by and for people with serious mental illness. I'm an attorney. I'm also a person who has defended countless patients on Riese involuntary petitions.

I think many of the issues here are probably more germane to the Judiciary Committee because we are talking about a landmark civil rights case and how this bill impacts that. But because this is the Health Committee, I'll leave the legal stuff brief, which is that my co-witness is correct. There is nothing to support this bill.

There's nothing to say that it's a systemic issue. What is in the law now was an enactment of this Legislature in 1991, a codification of the Riese Case. That case did address how long a Riese petition could remain in effect.

The two-week hold did have a second two-week hold, and the court did find that it could not carry through. There was a separate process for a 5260. It's called the second two-week hold. So, we're rolling back fundamental rights.

We're rolling back fundamental rights that are in part based in California's right to privacy in our constitution, the same thing that gives us a right to abortion. That being said, I think the human impact is the most important for the Health Committee. Our clients do regain capacity.

They have been medicated with medications that typically only take about two weeks to reach the greatest effectiveness. So, I've defended clients where the doctor was saying, this person lacks capacity. I would like to inject them with medications, and I won that hearing. The client did not lack capacity, and that's why the court originally got involved with Riese.

They said, competence is not a medical, clinical, or psychiatric concept. It's a legal one. That's why we have this recourse to have a neutral decision maker adjudicate the patient's rights. Thank you.

Thank you. Are there any other witnesses in opposition? State your name, organization and position.

Paul Simmons with California Peer Watch in opposition.

Danny Thirakul with Mental Health America of California, also on behalf of Disability Rights California and the ACLU in opposition.

Thank you. Seeing no other opposition, I will bring it back to the Committee for any questions or comments. Doctor Arambula?

Thank you, Madam Chair. I wanted to give the Senator, who many of us have a great deal of respect for, for your lived experience and time having provided care, an opportunity to respond to the opposition and some of the concerns that they brought up, as I believe many of us who are on the dais don't believe our current system is functioning and working well for so many people here in our great state. I'd love to hear your response.

Yeah. Thank you, Doctor Arambula. And as someone who's provided care in the ER, I know you understand the difficulties that impact not only that patient and family, but all the other patients and families that find themselves patients at the same time in a facility. Yeah, I'll say.

I will say over and over and over again, I believe voluntary is always best. Voluntary is always the right avenue if that works out. And sometimes that just doesn't work out.

And we find that we don't catch people early enough in their illness to be able to provide that early prevention intervention, although we're getting our systems up to hopefully be able to do that.

But we know that when someone devolves down to that point where they are unable to make their own decisions, that oftentimes that willingness to accept medication, they don't have that capacity to say yay or nay.

So, the Riese hearings were not, we did not have all the levels and holds, and I passed some of those new holds during our time here so that we wouldn't have to move right to conservatorship so that we would have other options.

And this just, and again, people always have, as soon as they retain capacity, they can always say no to medications. Right? It is ethical, it would not be ethical for a physician psychiatrist to continue to medicate somebody if they have capacity. So, if they have capacity, capacity returns, they will no longer medicate against their will.

This just says they can't get on the court calendar before the next hold starts, that they're able to maintain that Riese hearing for the next hearing, the next stay until the next Riese hearing can be produced, and or the patient returns to capacity by themselves.

And a patient devolving in a facility will often result in 5-point restraints, which nobody wants. Nobody wants to have to put somebody in restraints in a facility. That is the last thing you want, again, for that person, for the staff, and for the other people around them.

Thank you, Senator, for bringing forward this bill. I think for me, one of the challenges is that we're essentially addressing an administrative failure with a medical, a treatment plan.

So, existing law right now requires the capacity, requires capacity petitions to be heard within 24 hours and in a manner compatible with and the least disruptive of the treatment being provided to the person. So, really, there are gaps in the hearings. You mentioned them and your witnesses did as well.

Why not seek an administrative, a solution around the administrative hearings and limiting the time?

I would just say that our court systems, like all of our systems, are hugely impacted, and to try to supersede on top of that for a gap problem didn't seem reasonable. That's certainly something that we could take a look at, but it didn't seem like timely or reasonable.

But if it's okay, I'd like my witness to respond to that as well.

In my ideal world, a Riese petition would be filed today and would be heard today and decided today. But I think, practically speaking, it's too much to ask of courts for that to happen.

So, whether it's one day, one medication administration, or four days, we're putting the patient at risk for not taking the medication that is helping them to get better, and that's just medically not indicated.

I would further add, I think that there are some jurisdictions where there are a small county, small court. You schedule these things, unlike Mondays and Thursdays, and you have a hearing officer who does that.

And if something happens to the hearing officer, if the court is closed because of a bomb threat, there are many contingencies that could be brought to bear. It's not a complete solution to look to the courts to tighten up their procedures and to ensure that this happens in a timely way as the law says it should.

I do agree with Doctor Chung. You know, today, today and today, I think if we had our wishes, that would be the way we would go.

And do we have any supporting data to essentially give us a sense of the scope of this issue? How many individuals, and can you share that with us? I don't think that we've had an opportunity to review that.

Yes, I can share with you at least partial information. We're continuing to gather that because we know that it's of interest to your committee and to others. I can confirm for you that Los Angeles County has this problem. San Diego County has this problem.

Sacramento and Ventura and other counties like San Francisco have an entirely different process, which is an outlier in itself.

And we did a survey of our members as well, and San Francisco and San Diego as well as San Mateo counties came up as reporting frequent instances of this sort.

So, you did a survey of your members?

Yes. Yes. We have among our members medical directors of facilities who are very involved in the Riese hearings.

Yeah. I mean, I think my overall concern is that we are essentially addressing a judicial administrative challenge by potentially causing the civil liberties of individuals who are disabled and obviously need help to, that's being held in the balance. So, it's certainly a challenging decision for this Committee.

I certainly have the utmost respect and adoration, really, for the Senator and the work that you've done over the course of your career and certainly in the Legislature here.

And I know that this is one of those pieces that you definitely know needs to be in place in terms of ensuring that people get this help and support that they need in a timely manner. With that, we.

It goes to Judic. next.

It goes to Judic. next. And I think that there are some aspects of this that are, as the, as the opposition testimony offered, that are primarily in the Judic. space.

And so, with that, I'm going to be recommending an aye to pass it through this Committee and know that you will continue to work on this as it heads to Judiciary, because I think the issues are primarily more scope there.

But I'm definitely concerned with making sure that we have a robust data set and research basis to be able to make this public policy decision.

Fair enough.

Yeah. With that, would you like to close?

Just thank you. These are tough issues. That's why we get double referred to multiple committees, to be able to get as many eyes on it as we can to make sure we get it right for the benefit of all. I ask for your aye vote.

Thank you. When we have quorum, we will move forward with a motion for this bill. Thank you, Senator. We will move back up in the file item order to item number five, SB 1078 by Senator Min. Please begin whenever you're ready.

Members.

I'm here to present SB 1078, which would create an Office of language access within the California Health and Human Services Agency to provide oversight, accountability, and coordination across Cal HHS's departments and offices, ensuring that individuals with limited English proficiency have meaningful access to its programs and services.

For the nearly 6.4 million Californians with limited English proficiency, language barriers pose a significant challenge to their ability to have access to quality healthcare coverage and services. Studies show that the absence of culturally and linguistically appropriate healthcare services have significantly negative health outcomes for individuals, including longer hospital stays and higher likelihoods of hospital readmissions.

These avoidable clinical costs can be significantly reduced with improved interpreting and translation services. California has long recognized the importance of providing in language resources. Not all statutes and regulations have been implemented in an effective way. SB 1078 would ensure that implementation and monitoring of existing federal and state access language laws are done appropriately.

It would close an existing gap for those seeking a broad spectrum of health services, saving the state millions in avoidable costs, and bolstering the state's ability to meet statutory language requirements. I have with me to testify today Julia Liao from Asian Health Services and Doreena Wong from Asian Resources, Inc. To testify in support.

Please press the microphone button and welcome. You'll each have two minutes.

Good afternoon, Madam Chair and Assembly Health Committee Members. My name is Julia Liao, CEO at Asian Health Services, one of the co sponsors of the Bill and here to express full support of SB 1078. Asian Health Services is a federally qualified health center that provides medical, dental, and behavioral healthcare to 50,000 Low income patients.

We started 50 years ago because we saw the two key barriers to healthcare access was language and affordability, and that's why to this day, we serve all of our patients in 12 Asian languages, and research has shown that language accessibility is critical to reducing unnecessary ER hospital costs.

When California embarked on the broadest distribution of COVID vaccinations, we saw how language barriers hindered Asian community Members from accessing life saving vaccines. One couple who spoke only Vietnamese delayed getting their COVID vaccine by several weeks because they didn't understand the instructions in English for how and where to get a shot.

California's my turn vaccine website had Vietnamese translations full of errors and made comprehension extremely difficult. Max fascination sites promised translations for languages beyond Spanish, but our staff tried unsuccessfully for about 30 minutes to get an interpreter for Chinese, Vietnamese, and Korean languages and had to give up.

During the pandemic, individuals with LEP were three times more likely to test positive for the virus, and hospitalized patients were 35% more likely to suffer serious health outcomes compared with English speakers.

We've been really encouraged by the governor's September 2022 Executive order that directs Cal HHS to establish recommendations to improve language access to state government services and programs. Yet there's no mechanism or entity charged with oversight and accountability for the development and implementation of these language access plans.

As a result, it has been challenging for community Members to navigate and understand how the departments are providing equitable access to the wide array of state funded programs and services within calhs. We ask for your support of SB 1078, and thank you so much for your time.

Thank you. You'll have two minutes.

Good afternoon, chair Bonta and Committee Members. My name is Doreena Wong, and I'm the Policy Director at Asian Resources, Inc, or ARI. We ask for your support of SB 1078, which will improve language access for millions of limited English proficient Californians.

Since 1980, ARI has provided direct services and conducted advocacy for increased cultural and linguistic access for state and social services programs for over 30,000 Asian Americans, Native Hawaiians and Pacific Islanders, immigrants, and limited English speakers every year with offices in Sacramento and LA. Like AHS, we have seen firsthand the serious language barriers that our LEP clients experience.

For instance, we have seen long experienced long wait times, sometimes over an hour, especially when an interpreter is needed for medical renewals during the public health unwinding. This has resulted in medical terminations in the loss of health coverage for our clients.

As you heard, these kinds of barriers lead to health disparities and significant harm to LEP Members, which numerous studies have identified. The Bill would also improve communication and, as Senator Min indicated, reduce overall cost savings to the state. The Bill would also bolster the state's ability to meet its statutory requirements by codifying Cal HHS's language access policy.

Currently, there's no mechanism for requiring language access plans for coordinating its language services or enforcing its policies. So the Bill would create a centralized office that could issue corrective action plans.

It would also inform LEP communities about critical resources through a public website, and it would allow smaller language populations to request translated vital documents and increase accountability and transparency. So we urge the Committee to support SB 1078. Thank you. Thank you.

Are there any other witnesses in support?

Thank you very much. Vanessa Cajina, on behalf of the California Pan Ethnic Health Network here in support.

Taylor Jackson with the California Primary Care Association in strong support.

Mason Vega with the American alliance of Professional Translators and Interpreters in strong support.

Christine Smith, health access California, in support.

Yasmin Peled, Justice in aging in support.

Good afternoon. Cameron Sasai, on behalf of lead Filipino and strong support. Thank you.

Andrew Truman Kim with the Asian Pacific American Public affairs and the California AANHPI Advocacy Coalition here in support. Thank you.

Good afternoon. Madam Chair and Member {Inaudible] representing Chinese for affirmative action and strong support.

Good afternoon. Linda Wei with Western center on Law and poverty and support.

Malala Le, my name is Lisa Hafoca. I'm the President of the Otupu Oy OtU Fellinite Association, Otofa, Inc. In Sacramento in strong support of this Bill.

Good afternoon. Faith Lee with Asian Americans advancing justice, Southern California. We're in support. Thank you.

Good afternoon. Carolyn Wang Kong with Asian Pacific Fund in strong support.

Good afternoon. Thuy Do with the Southeast Asia Resource Action Center in strong support.

Good afternoon. I'm Jennifer Tran on behalf of the Oakland Vietnamese Chamber of Commerce, we are in strong support.

Ben Wong with Asian health services and strong support.

Good afternoon. I'm Lakshmi Malroutu of Asian Pacific Community Counselling. I'm also in support of this Bill. Thank you.

Hi. Thu Kwach with Asian Health services and the Progressive Vietnamese American organization in strong support.

Elaine Peng, Mental Health Association for Chinese Communities, very strong supported. Thank you.

Good afternoon. Vanessa Tehran with the Mixteco Indigena Community Organizing Project in strong support. Thank you.

Good afternoon. Mar Velez with the Latino Coalition for a Healthy California in strong support.

I'm Yawen laid, mental health associations for Chinese Community support.

Good afternoon. Mental Health Association for Chinese Communities for support.

My name Chong Minten MHACC. I support it. Thank you.

[Speaking non-english] 4 speakers

Good afternoon. Matthew Long with Korean Community Center of the East Bay and strong support.

Korean Community center of the East Bay [speaking non- english]

My name is Olian Nakim from Korean Community center of East Bay. In support. I have our community leaders behind me who are present to show their support.

My name is Young, forever Young, and then I'm living in Alameda, California.

I lived at Alameda County. My name is [inaudible].

Good afternoon. Andrew Mnor along with my colleagues at Asian Resources, Inc. in strong support.

[Speaking foreign language].

Natalie Tualemoso Ah Soon, Richmond Area Multi-Services and Regional Pacific Islander Task Force. I support.

... Regional Pacific Islander Task Force in the Bay Area. Totally support.

Thank you so much. Are there any other witnesses in opposition? Are there any witnesses in opposition? Seeing none, we will bring it back to the Committee for comment or questions. Assemblymember Carillo.

Thank you, Madam Chair. And thank you to the author. I wish I spoke Korean or Mandarin or Cantonese, some of the languages that I heard. But if you can translate to folks and just simply say, welcome, thank you for coming. All languages, all cultures, all people are welcomed in the people's house, and you should always feel like this is a space where you can be heard. Thank you. And thank you to the author for this Bill.

Thank you so much to the author for bringing forward this Bill. It's wonderful to see so many people from my district coming forward to support this Bill. Language barriers are something that we know pose incredibly significant challenges when it comes to the ability for Californians to know and feel that they have meaningful access to healthcare services.

And that's no more apparent than it is when we are dealing with issues of limited English proficiency. So thank you for bringing forward this Bill. This Bill ensures that we have access to linguistically appropriate services, which is, again, a basic need and right. I'm sure that you will continue to work with the Cal HHS to prevent any duplication of existing resources and streamline efforts to promote language access in line with the goals of this Bill as it moved forward with that. Would you like to close?

Certainly. We'll continue to work to make this Bill better, and I thank the assemblywoman from Los Angeles for her words of welcome. I respectfully ask for your aye vote.

Thank you. And we shall move the Bill when we have a quorum. We'll move on now to item number nine, SB 1230 Rubio. Do we want to put a comment here? Hi, Senator. Please begin whenever you're ready.

Good afternoon. Thank you, Madam Chair, Members of the Committee. Today I'm proud to present SB 1230, the Stop and Seize Illegal Tobacco Products Act. We're very clear about the health risks that tobacco causes and smoking, and that millions have died from the use of it. California has made great progress in reducing the use of tobacco products, so I could not be more proud of some of the policies that come out of this house, including adopting the recent ban on selling flavored tobacco products.

But these illegal tobacco products with flavor, designed to continue to target and appeal to our youth, continue to find their way into California. In particular, SB 1230 will strengthen enforcement of California's anti tobacco laws. And ensure that flavor vapes are kept off store shelves and out of the hands of our children and our young adults.

And that's what the goal is here today. My bill does this by authorizing employees of the California Department of Tax and Fee Administration. To seize and destroy any products, tobacco products, discovered during the regular inspections of tobacco retailers and warehouses.

The department already has the authority to seize and destroy tobacco products that fail to include the property state tax label. So this bill just simply is a cost effective way of getting the department to also remove flavored tobacco products from the market.

SB 1230 also includes a reasonable increase in the existing civil penalties imposed on retailers who break the law by continuing to sell labor tobacco products when they're not supposed to and by selling tobacco products to our youth, which is 21 and under. The fine amount hasn't changed in over 20 years.

And the modest increase goes a long way towards keeping students from these illegal flavored tobacco products. So the Stop and Seize Illegal Tobacco Products Act is sponsored by the Coalition of Public Health Organizations, including the American Lung Association and the Campaign for Tobacco-Free Kids. Again, we're just trying to go after bad actors.

And this bill has had no opposition. Joining me today to speak are two very impressive students with me. First, we have Ananya, trying to say your name correctly, Pinnamaneni. I think I got that right. And Amre Abumarkhieh. So both of them will speak on behalf of this bill. So, thank you, Madam Chair.

Thank you. You'll each have two minutes. Go ahead.

Good afternoon, Chair and Members. My name is Ananya Pinnamaneni. I'm a recent graduate of Dougherty Valley High School in San Ramon, California, and I'm speaking on behalf of the American Cancer Society Cancer Action Network. So, throughout high school, tobacco usage was a growing issue that I saw among my peers.

In fact, one of the bathrooms at my school was known as the vape bathroom because there was always a group of kids vaping in there. A survey was conducted by my school newspaper, asking students and faculty what percentage of students they believed use an e-cigarette or tobacco product at least once during their time in high school.

And the responses ranged from 31 to a shocking 70% of all students. Problematically, flavors are the main reason that so many youth are getting hooked onto these tobacco products in the first place. Some of my close friends have started using e-cigarettes. And they started with one flavor that maybe someone offered them at a party.

But now they want to try all of them. Pink lemonade, bubble gum, iced mango. The list goes on. It's become like trying ice cream flavors for them. They know that tobacco is bad for them. They've been taught this for years. Yet the flavors mask the harshness of tobacco products and make kids feel like it's just another harmless treat. Although California voters overwhelmingly voted to pass the law to end the sale of flavored tobacco products with Proposition 31, there are still gaps in the enforcement of this law, as can be seen through schools like mine.

Instead of kids consuming less tobacco, they're consuming even more. Clearly, more work is needed to end the availability of flavored tobacco products in California. That's why I'm here today to urge the passage of SB 1230. Students need to be focused on developing life skills, spending time with our family and friends, studying for our classes, and preparing for our future careers where we will be the ones taking charge of our societies.

We can't be caught up in defending ourselves from those who are trying to exploit us by selling illegal tobacco products, which is why it is so important for the California Department of Tax and Fee Administration to have the authority to protect us. It is vital that action is taken on this matter right now to prevent even more future generations from falling victim to these cycles of addiction. Thank you.

Thank you. You'll have two minutes.

Good afternoon. My name is Amre Abumarkhieh, and I'm thankful for the opportunity to voice youth concerns and show my support for SB 1230. I recently graduated from Granite Bay High School in Placer County of Northern California, and I will be attending Yale University in the fall.

I'm actively engaged in tobacco prevention efforts within my community and beyond. I've served as the Chair of the Placer County Youth Commission's Substance Abuse Prevention Subcommittee, and I've led a policy oriented project in which we developed a fully online, self driven course to serve as an alternative to suspension for students caught vaping on campus.

I've also been a youth board member for the California Youth Advocacy Network, through which I have collaborated with youth from across California and designing a policy handbook for tobacco retailers to prevent negligence. We also recently hosted our annual Youth Quest event at the Capitol to celebrate coalitions around California fighting for a tobacco-free future.

So what's my story? Inhaling smoke has become second nature for me, but not of my own accord. From a young age, car rides with my dad always meant his cigarette smoke would be blowing into my face, and sometimes even the cigarette ash. I've always tried to get him to simply quit his 34 year old addiction, but I realized there was much more to it than what appears on the surface. I learned that his addiction was rooted in a complex interplay of misinformation, social norms, and manipulative marketing tactics.

It turned out that in his twenties, smoking was popular among folk his age and was marketed as such. So when his friend had pressured him into trying a cigarette, there was no reason why not. As a result of my dad's bad decision, my entire family shares a part of the consequences via secondhand smoke. But this consequence is not just exclusive to my family, it applies to our youth at large. In reality, the smoke I inhaled at home was the same smoke I had to endure on my school campus. Only at school, the smoke carries an artificial scent and flavor.

Every time I enter the school restrooms, I am met with the sight of students huddled together sharing a vape, along with the remnant smell of artificial flavors that they leave behind. I sometimes even see it in the hallways between classrooms, and I'm also aware that students will often leave in the middle of class to vape in the restrooms.

Go ahead and finish your thoughts.

Not only does this inhibit these students learning, but it also affects everyone else on campus, regardless of whether they personally choose to smoke or not. Granite Bay High School, my high school, is located in an affluent area, meaning our school has access to a plethora of resources to help students quit tobacco.

And, yes, these approaches are necessary and effective. However, the most productive approach is targeting the root. And the root, or at least a big part of it, is all the devious marketing tactics of the tobacco industry, including the flavors and bright colors, which are intended to entice and target none other than young people themselves.

If we don't get these flavored or otherwise illegal tobacco products off the shelves today, this cycle of addiction will only perpetuate, which leads to more and more lifelong smokers like my dad. The ultimate goal of my advocacy is to live in a world where no one is robbed of a smoke-free life. And that's why I urge the committee to vote aye on SB 1230. Thank you for your time.

Thank you. Are there any other witnesses in support?

Good afternoon. Silvia Solis Shaw here on behalf of the American Heart Association, one of the co-sponsors of the measure, in support. Thank you.

Nora Lynn with Children Now in support.

Jessica Moran with the California Dental Association in support.

Joe Saenz with the County Health Executives Association, representing local health departments, in support.

Brandon Marchy with the California Medical Association in support.

Tim Gibbs, Campaign for Tobacco-Free Kids, in support.

Thank you. Are there any other witness... Are there any witnesses in opposition? Seeing none in the room. I'll bring it back to the committee. I want to thank... Oh, Mr. Jones-Sawyer, please go ahead.

And I want to thank you for bringing this forward because as I look at my family and my grandfather and father who smoked and smoked Camels with no filter. So what you're smoking is a lot different. But they got hooked because when they were drafted into the service, the military was, and the tobacco companies were giving servicemen cigarettes for free, which they knew would hook them to a lifelong habit of cigarette smoking. That same insidious practice is being practiced now only at a more sophisticated scale with vapes and other things.

And so I thank you for bringing this forward because I think we gotta stop it at the beginning, especially at the young age of 18 and 17 year olds, because that habit never went away. And my stepfather passed away of cancer. It was so bad, he was smoking cigarettes through his throat. And so that's how nicotine, we talk about a lot of different drugs, but nicotine and other smoke flavored tobacco could be just as addictive to a point, not only where it kills you, but you just can't stop. So I thank you for bringing this forward.

Thank you. I want to thank the author for bringing this forward, and certainly I want to thank your witnesses. Ms. Pinnamaneni, I apologize if I didn't say that correctly, and Amre as well, for bringing forward the testimony that you've offered. It's most important for us to hear from youth and to hear that in your schools there's active vaping, as I know there are in my children's schools as well, is devastating to hear. And I think the author has put forward part of our legislative package that will ensure that we curtail such free access to terrible tobacco. So thank you so much. Senator, would you like to close?

Yes, thank you. Well, first of all, thank you for listening to our testimony here. I've been working on this for quite a while. As a teacher, I always have to share that smoking goes on like in the libraries. Now, we have also these flavors that you can't smell or see, and so they're being disguised in so many ways that parents can't tell, teachers can't tell, and it's something that we need to do to stop the tobacco industry from doing this to our kids and hooking the next generation of smokers. So with that, I respectfully ask for an aye vote. Thank you.

Thank you. And I'm sure you will have it when we have a quorum. With that, we will move on to our next item, which is item number seven, SB 1119, Senator Newman. We are going to pause to call the roll, Senator Newman, to establish quorum.

[Roll Call]

We have a quorum at 2:55. I want to thank Assembly Members Lowenthal and Pellerin for your substitutions today. With that, Senator Newman, please go ahead.

Thank you, Madam Chair. Madam Chair and Members, thank you for the opportunity to present SB 1119, which would authorize a limited number of narrow, case specific extensions of the seismic compliance deadlines mandated by AB 2190 for three hospitals which are part of the Providence Health Group, each of which is actively working to achieve compliance.

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. This Bill, passed out of the Senate Health Committee and the Senate Floor with no no votes.

As you recall, AB 2190 authored by Assemblymember Reyes in 2018, requires 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. For hospitals seeking extensions based on a rebuild plan, that deadline is January 1, 2025.

As you're aware, the Covid-19 pandemic had a massive impact on the financial conditions and planning capacities of hospitals across the state, in many cases forcing hospitals to shift critical resources in order to ensure adequate capacity and patient care, often unavoidably at the expense of other priorities or mandates.

This was precisely the case with respect to the three providence facilities covered by this Bill. Without the extensions provided for in 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 reasonable concerns expressed by the opposition. It is imperative, as we all agree, that staff and patients have the assurance that California hospital facilities are safe and up to date in compliance with prevailing seismic standards.

Each of the three hospitals covered in this legislation are currently working actively toward compliance and are in the midst of ongoing construction plans, all the while balancing those demands with the operational costs and requirements of operating a hospital and adequately serving patient needs. The limited extensions provided for in this Bill will ensure that none of these three important area hospitals will be forced to close vital infrastructure while also maintaining the requirements that this Legislature has rightfully placed on California's hospitals.

It's important to note that the Legislature has previously recognized that such extensions may be reasonable to allow for the completion of this type of essential infrastructure work while ensuring continuous patient care in communities where there is a desperate need for that care and where an interruption of that care would have massively negative and potentially catastrophic consequences.

With me to testify today is Rachel Selleck, Chief Government Affairs Officer for Providence California, and Ryan Berry, Executive Director of Construction Services for Providence California. I am respectfully asking for your aye vote this afternoon.

Good afternoon. My name is Rachel Selleck. Thank you, Senator Newman, for the introduction and for championing this issue on behalf of the communities we serve. Providence is a not for profit health system. We have 17 hospitals across California and our mission is really to serve the poor and vulnerable.

Approximately 30% of our patient population is, in fact, on Medi-Cal. With that said, as Senator Newman graciously introduced, we sit before you today seeking your support for a time seismic compliance extension, not for 2030 compliance, but rather for the 2025 looming deadline for those three site specific campuses, Tarzana, St. Jude in Fullerton, and St.

Joseph in Eureka. I'd like to defer the remainder of my time to Ryan Berry, who's our construction leader for California overseeing all 17 of our hospitals, to speak to the progress at each of these facilities, as well as provide assurances that no further extension will be required should this be granted through this legislation.

Good afternoon. My name is Ryan Berry and I'm the Providence's Executive Director of Construction with accountability for construction services across all 17 hospitals in California. As Rachel referenced, I'm here today to provide further detail around the need for these time specific extensions, how these years were selected, and discuss how we will ensure compliance if these extensions are granted. Work has been underway at these three campuses. Existing construction timelines inform the requested extensions specific to each campus.

At the Tarzana campus, we opened a new patient tower last fall, which brings us to extremely close to compliance. All that remains is a relocation of utilities, which we are confident can be completed by the requested one year extension to 2026 for this campus. At St. Joseph's in Eureka, construction progress was paused during COVID and began last year. Progress slowed in recent months as we are actively trying to maintain an impacted service in this rural community. Should we be forced to close the non seismically compliant buildings by the current 2025 deadline.

We are confident we can proceed with becoming compliant within the requested two years, extending the deadline to 2027 for this campus. At St. Jude, similar to other campuses, architects and contractors have been hired and work is underway. We have preliminary plans in place to relocate impacted services and require the requested two year extension, extending the deadline to 2027 for this campus to minimize impacts to access. Additionally, by bringing this hospital into the AB 2190 program, we can work with HCAI on formalizing construction milestones which will enhance transparency.

As mentioned earlier, work is underway at these campuses and these requested extensions were intentional, driven by construction milestones. I meet monthly with HCAI to keep them informed of progress and should we be afforded these extensions, we will continue to collaborate with them on appropriate milestones to ensure compliance within the requested timeframes. Providence needs your support to ensure we can become seismically compliant while maintaining access to care in both the urban and rural communities we serve. Thank you for your consideration today.

Thank you. Are there any other witnesses in support? Please come forward. State your name, position and organization.

David Bolog in support thank you.

Dylan Elliott, on behalf of Humboldt County in support. Appreciate the author's work.

Vanessa Gonzalez with the California Hospital Association here in support. Thank you.

Alfredo Medina here on behalf of Cedars-Sinai. Here in support.

Good afternoon. Moira Topp, on behalf of Orange County Business Council in support.

Nissette Short, on behalf of the alliance of Catholic Health Care, in support.

Thank you. Are there any witnesses in opposition?

Good afternoon. Matt Leje on behalf of SEIU California. We're not an opposition on this Bill. We do have concerns and just appreciate the work that the author and sponsor are doing. These are buildings that are not yet at the 2020 seismic standard, meaning that there's a substantial risk to collapse. And so that, of course, is very concerning for the workers and patients that we serve. Of course we want to maintain access to care.

It's sort of that balance of just making sure that this is respectfully the last time, to make sure we're on track, to make sure that we're meeting seismic compliance, because really, every patient in our community is counting on hospitals to be there when there's a major earthquake or emergency, and so appreciate the Committee's work on that. And thank you very much.

Thank you. Any other witnesses in opposition? Seeing none. I'll bring it back to the Committee for questions or comments. Mister Jones-Sawyer.

This has been an ongoing discussion ever since I've been here, and I'm probably now, the senior Member, having been here almost 12 years, and it is frustrating. One of the things I can offer, as the former Emergency Preparedness Coordinator for the City of Los Angeles, where I did the seismic retrofit for police stations, fire stations and libraries for the City of Los Angeles. So I also know how difficult it is to do rebar, doing unreinforced masonry if you have one of those buildings.

How to actually do the seismic retrofit, that's needed. To give me comfort, especially if it gets out of this Committee and it gets to a point where it gets to our floor, if at all. If you could show me your construction schedule, what you plan to do, I can actually give some constructive suggestions on making sure that you meet this deadline, because I was under the same kind of gun as you were when we got the seismic bond money to actually get it done, and we were required in our bond to get it done by a certain time.

And we experienced some of the same, probably some of the same problems you had with the costs rising over time with steel and material and other things. And so what I'm doing is offering my help, but also letting you know, if it's kind of squirrely, I may speak up later. If it gets up later on, when it gets, if it gets out of this Committee and onto the floor.

Thank you for your comments and happy to provide those. Thank you.

I think perhaps I'll ask a little bit more of a direct question to Providence at this point, because I do share my colleague's concerns and the concerns of the opposition. You're addressing 2020 deadlines guidance. How confident are you that your hospitals will meet the updated seismic compliance deadlines in this Bill? And I'd like a percentage.

We are 100% comfortable that we will make these deadlines. Like the Bill states, we only requested for the times we needed for each, each campus, which is why we didn't come in with a blanket to your extension. Just one year in Tarzana, two years at St. Joseph's in Eureka, and then St. Jude in Fullerton.

Thank you. I certainly appreciate that 100% confidence level. And I want to appreciate the author for bringing forward this Bill. I do have individual hospital, this hospital system that we are concerned with. Ultimately, we need to manage the importance of ensuring that our community hospitals remain open and available and that service is provided.

But it is equally important that the patients and workers are safe within those structures. The Legislature is certainly continuing to work on this issue, and we will definitely be monitoring the progress of these particular hospitals as we think address seismic issues in this cycle. Actually, with that, Senator, would you like to close?

I do appreciate your comments. Your comments are almost my close. So, you know, 100% is good, right? But these are, as noted, these are time certain extensions with a very firm Commission on completion without the need for additional extensions. I appreciate Assemblymember Jones-Sawyer using the technical term squirrely. We will endeavor not to have that happen. And so I'm looking forward to your favorable consideration and to completing this project. Thank you.

Thank you. The motion is due passed to Appropriations. Secretary. Oh, can I have a motion. Moved by Curry, seconded by Waldron. Motion is due passed to Appropriations. Please call the roll.

[Roll Call].

That measures out 10 to zero. Thank you.

Thank you, Madam Chair. Thank you, Members.

Thank you. We will move on now to item number 11, SB 1369 by Senator Limon. Please go ahead and press the mic. It's great to see you.

Thank you, Chair. Thank you, Members. I would like to thank the Committee and also the opposition for working with the office on the bill. I will be accepting the amendments outlined in the analysis. Dental plans will often contract with third parties to issue provider payments to dental practices with virtual credit cards.

However, accepting this form of payment charges the dental office processing fees 2-5% of the total payment amount, in addition to the standard merchant transaction fee for processing the payment through their credit card terminal.

This leaves providers with two options, either process the virtual credit cards and accept high fees, or spend administrative time continuously opting out of the cards when accepting their payment. Providers should not need to pay should not need to pay to get paid for their services.

This bill ensures that dental offices have the option to use virtual credit cards, receive notifications of any fees associated with payments, and get information about alternative payments. SB 1369 ensures dentists receive complete payments for their services. Today with me, we have Jessica Moran, Legislative Advocate for the California Dental Association, speaking in support of the Bill.

Good afternoon, Chair and Members. Jessica Moran with the California Dental Association. Here as the sponsors of SB 1369. The shift to electronic payments was meant to streamline and modernize the healthcare delivery system, but instead has created a space in the market where providers are paying up to 10% in processing fees just to access their contracted payments.

SB 1369 will create a streamlined process for providers to choose to opt into receiving virtual credit cards. The bill will also allow for increased transparency on behalf of the dental plans by requiring them to notify providers of any fees associated with potential payment methods, empowering the payment the dentist to enroll in a payment model that works best for their office.

Under current practices, dental plans through their contracted vendors have made virtual credit cards the default payment method, despite having other non-fee-based payment options available, such as mailed check or electronic funds transfers.

In addition to the predatory processing fees associated with the funds of these virtual cards, dental office staff spend several hours on the phone requesting to opt out of receiving these services, only to find out that opting out doesn't really do anything as they are often sent another card in the next billing cycle.

Although the opposition were unable to remove their opposition in this bill, we really appreciate the conversations that we've had to make sure this bill has been operable, including providing them with a three-month delayed invocation and moving away from a wet signature to authorize enrollment and allowing dentists to use an e-signature or checking a box online to confirm their authorization.

With SB 1369, California could get some of the strongest guardrails in the country for use of virtual credit cards. I respectfully ask your aye vote. Thank you.

Thank you. Are there any other witnesses in support? Please come forward. State your name, organization and position.

Madam Chair and Members of the Committee, Stephanie Roberson on behalf of the Association of Dental Support Organizations in support of this bill. Thank you.

Mel Assagai for the California Association of Orthodontists in support.

Chris Grogan on behalf of Children's Choice Dental Care in support. Thank you.

Thank you. Any witnesses in opposition?

You know, we have learned on the dental plan side of the concerns that the dentists have with these types of payments. What the plans here is that from many of their contracted dentists, they prefer this form of payment because it is the fastest, it is the fastest way for them to get paid. So, you know, from the plan perspective, as many dentists as there are who don't like it, we also hear from dentists who do like it. Even in light of that we're working, we've kind of reached agreement on the policy. The challenge is, as all of you know and can appreciate, the mechanisms and the ways in which health plans pay providers and providers receive payment are very complex.

There was recently a Bill, a similar Bill that was passed and signed into law in Florida. And so what we're trying to do is to really work through these last few implementation issues and ideally get to a place where, you know, it's not often that we say we want California to be like Florida, but when you're talking about creating a paradigm that plans will have to deal with across the country, we're hopeful that we can continue our conversations and get to a place where the language is aligned. And we've worked through these last remaining issues. But unfortunately, we're still opposed as we sit here today.

Any other opposition, please come forward. State your name, organization and position.

Thank you. Madam Chair and Members, Faith Conley with Sun Life, which is a subsidiary of DentaQuest. I just wanted to thank the author very much for working on this issue. We are still in opposed position, but look forward to working with you.

Seeing no other opposition, I will bring it back to Committee for comment or question. Moved by Doctor Arambula, seconded by Pellerin. Thank you to the author for bringing this forward. I did have one question. So the up to 10% processing fees that were mentioned in the testimony, who is the recipient of those funds? Because it's essentially kind of coming off of the top of what the provider should be getting.

The recipient of those funds would be the virtual credit card company who the dental plans contract with.

Is it the case that the dental plan gets a portion of those funds?

I do not know. I do know, though, that there was an article from ProPublica that came out last year that said that virtual credit card companies do profit share with health insurance plans. I'm not sure if that is equivalent on the dental side.

Do you have a response?

Sure. So the dental plans, like other payers do, contract with third party administrators to administer payments to make sure that they're the most efficient. It's our understanding from our plans that we've spoken with about this Bill that they do not receive a portion of those fees, that those fees are third party fees, the entities that's processing the payments between the dentist and between the plan.

You know, again, what we've heard is that in some cases, some dentists feel that that fee is worth paying because they get paid more quickly. But again, we are working with CDA, and to make it more simplistic, if the dentists want to opt out, if they don't want to receive that, that they're able to.

Do you think it's a little unfortunate that an individual provider is needing to make a choice between 10% of the payment and the speed of payment? So thank you for bringing forward this Bill. Senator Limón, would you like to close?

Well, I think, Madam Chair, you just closed for me, and this is the need. You've expressed why there is a need for this Bill, because there is that choice. And, look, this is an option that will still remain for dental providers. Right? Like, they will be able to choose this method if they would like, and if this works for their practice, the idea is that it's not just forced on them and they don't have another way to receive the payment. So with that, I'd respectfully ask for an aye vote.

Thank you. We have a motion and a second. The motion is due passed as amended to Appropriations. Please call the roll.

[Roll Call].

We lightly say 12 to zero. The measure passes. Thank you so much, Senator Limon. We are waiting for our last author for item number three, SB 1016 Gonzalez. In the meantime, we will take a vote. We will kind of just dispense with the bills that we have already heard, starting with item one, SB 959 by Menjivar.

I need a motion in a second. Moved by Arambula, seconded by Pelerin. Secretary, please call the roll.

Do pass to judiciary. [Roll Call]

That measure is out with a vote of 10 to three. We'll move on to item number two. Already heard SB 999 by Cortese I need a motion. Miotion by Aguiar Curry. Seconded by Pelerin. The motion is do pass to appropriations. Please call the roll.

[Roll Call]

That measures out 12 to one. We are going to now pause and go back to our last item, item number three, SB 1016 by Senator Gonzalez, who will get our most respectful attention. That was more for the Committee than for you. Please proceed.

Good afternoon, Madam Chair and Members. I'm here to present SB 1016, which will help uncover trends and disparities that that are often hidden in aggregated health data for Latinos and indigenous Mesoamericans. Latinos make up 40% of California's population. However, the Latino community, there are several ethnic groups that have diverse health outcomes.

These distinctions hide in the monolithic term of Latino, which leads to less detailed and nuanced information. So SB 1016 will address these shortcomings by requiring the Department of Health to collect and release disaggregated data for specified Latino subgroups, including Mexican, Salvadoran, Guatemalan, and each major Mesoamerican indigenous nation and others. Testifying in support of this measure. Today I have Vanessa Terán with Mixteco Indigena Community Organizing Project, which is called MICOP and Mar Velez with the Latino Coalition for a Healthy California. I respectfully ask for an aye vote.

Thank you. Moved by Aguiar-Curry, seconded by Sanchez. Please go ahead. You'll each have two minutes.

Hello. Good afternoon. Chair and Members of the Committee. Vanessa Terán, Policy Director with the Mixteco Indigena Community Organizing Project. MICOP is a proud sponsor of SB 1016. Co sponsor. Indigenous communities across the central coast of California face significant health disparities, as demonstrated by the groundbreaking local study gathered by the San Luis Obispo County Indigenous Mexican Enumeration and Demographic Study, which is funded by the county San Luis Obispo Public Health Department and co led by MICOP and other partners. Accurate data collection is essential for addressing disparities.

Our research revealed that 87% of indigenous people speak Mixteco at home, and nearly half of respondents, 46%, preferred written health information in Spanish or in both Spanish and an indigenous language, 24%. When asked about the preferred indigenous language, respondents self identify their preferences. The study also found that 85% of indigenous adults in the county do not have health insurance, creating further barriers to healthcare access. These barriers stem from unique health risks caused by poor housing and economic conditions.

By gathering detailed demographic data on major diseases, leading causes of death, pregnancy and housing and mental health, epidemiologic data can better illustrate the challenges faced byMesoamerican or Latinx communities. In terms of mental health, participants reported stress and sadness and anger, but rarely miss work.

A more precise understanding of the unique context affecting indigenous people's mental health status will enable us to provide more effective care to these indigenous populations. It is crucial to have public health data that tracks specific health data points across indigenous languages, race, ethnicity. Disaggregating this data will help us better understand diseases, historical racism, and the further invisibilization of indigenous people, ultimately leading to the development of future practices that prioritize the health and well being of all Californians.

SB 1016 is a testament to the importance of funding data equity for indigenous communities, further transforming our current data from non existence or inadequate to a beacon of hope for health equity. I respectfully ask for an aye vote for SB 1016. Thank you.

Thank you. You'll have two minutes.

Good afternoon. My name is Mar Velez, Director of Policy with the Latino Coalition for Healthy California. I just want to echo my colleagues comments and just add that SB 1016 is the first step in achieving data equity and data justice for our communities, and I respectfully ask for your aye vote.

Thank you. Any other witnesses from support please come forward. State your name, organization, and position.

Craig Pulsipher, on behalf of Equality California, in support.

Vanessa Cajina on behalf of the California Pan-Ethnic Health Network, here in support.

Jhonny Pineda on behalf of Union a de Migrantes Guatemaltecos Los Angeles in support. Thank you.

Faith Lee with Asian Americans Advancing Justice Southern California. Were in strong support.

Nora Lynn with Children Now in support.

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

Hello. Matt Lege with SEIU California in support.

Good afternoon, Chair and Members Jonathan Munoz, on behalf of First 5 California, in strong support. And we thank the Senator for her leadership on this.

Jennifer Snyder with Capital Advocacy on behalf of the California Life Sciences in support.

Good afternoon. Alejandro Solis on behalf of the Mexican American Opportunity Foundation and Los Amigos de la Comunidad in support. Thank you.

Good afternoon, Madam Chair and Committee Members. Doreena Wong from Asian Resources, Inc. In strong support of SB 1016.

Elaine Peng, Mental Health Association for Chinese Communities. We are very strongly support this Bill. Thank you.

Yawen Lei, Mental Health Association for Chinese Communities. In support.

My name Chung Minh Tian. I'm from MHACC. I support it. Thank you.

Hello. Good afternoon. I'm Mental Health Association for Chinese Communities. In support.

[Speaking foreign language].

My name is Alina Kim with Korean Community Center of East Bay and support.

I'm Matthew Long with Korean Community Center of the East Bay, and I strongly support.

Good afternoon. Pysay Phinith from Korean Community Center of the East Bay in strong support.

Hi, my name is Nicole Soong. I'm from KCCEB. I'm in support of the Bill. Thank you.

Victor Lau with KCCEB in support.

Austin Rams speaking on behalf of Roots for Change, California Certified Organic Farmers, California for Pesticide Reform, Community Alliance with Family Farmers and Pesticide Action Network in support. Thank you.

Hello. My name is Jalen Joyce, and I'm here representing California Food and Farming Network, Central California Environmental Justice Network, CBDIO, Central Coast Alliance United for a Sustainable Economy and United Food and Commercial Workers Western States Council. Thank you. We are in support.

Thank you. Any other witnesses in, any witnesses in opposition? Seeing none. I will bring it back to the Committee for comment or questions. Moved by Pellerin. Oh, it's been already been a motion and seconded. Senator, I want to thank you for bringing forward this Bill. We had a prior Bill brought by Senator Min. Also around kind of recognition of language and the robustness of our ability in California to have a very diverse language community and appreciate that you are seeking a very simple thing, which is more data for us to be able to make informed decisions on with this legislation in a way that wholly represents all of California. So thank you for doing that. Would you like to close?

I just want to thank our witnesses. They've been on the front lines doing this really good work. So on behalf of them, I respectfully ask for an aye vote. Thank you.

Thank you. We have a motion and a second. The motion is due passed to Appropriations. Please call the roll.

[Roll Call]. 15 to zero.

That measure passes 15 to zero. Thank you. We will go back now to completing our vote for item number four, SB 1042 by Roth. The motion is do pass to business and professions. Aguiar Curry. Seconded by Pelerin. Please call it all.

[Roll Call]

That measure passes 14 to one. We'll move on to SB 1078, item number five, moved by pelerin, seconded by urambula. The motion is do pass to human services. Please call the roll.

[Roll Call]

That measures out 15 to zero. We'll move on now to the consent calendar we've previously read in what the consent items are. Moved by our ambulance, seconded by Pellerin. Secretary, please call the roll for consent.

[Roll Call]

That consents out 15-0, we'll move on to item seven, SB 1119 for add ons.

[Roll Call]

Measures now 14 to zero. Still out. Item number eight, SB 1184, moved by aguirre Curry. Seconded by Carrillo. Motion is do pass to Judiciary. Please call the roll.

[Roll Call]

That measures out 16 to zero. We'll move on to item nine, SB 1230 by Rubio. Motion is do pass to governmental government relations.

Governmental.

Governmental. Oh, my gosh. Governmental Organization. Can I have a motion moved by Carrillo and seconded by Arambula? Please call the roll.

[Roll Call]

That measures out 16 to zero. Item number 10 was on consent. We'll move on to item number 11, SB 1369 for add ons.

[Roll Call]

That measures out 160. Items number 12 and 13 were on consent. If you were here for the whole thing, you voted. We will now continue with the roll for add ons. Going back to item number one for add ons.

[Roll Call]

Now 13 to three. Item number two, SB 999.

[Roll Call]

5-0 item three, SB 1016.

[Roll Call]

Now 16-0. Item number four, SB 1042.

[Roll Call]

It is now 15 to one. Item number five, SB 1078.

[Roll Call]

It's now 16-0. Item number six, SB 1112. Oh, it's on consent. Item number seven, SB 1119.

[Roll Call]

Item seven, SB 1119.

[Roll Call]

That is now 15 to zero. Item number eight, SB 1184. Item number nine, SB 1230. All the rest. With that, we'll conclude the hearing for Assembly Health Committee on June 11.