Senate Standing Committee on Health

Let's start with our first item. Item number one, AB 347, Assembly Member Ting, Household Product Safety. Welcome. Please begin when ready.

Thank you, Mr. Chair. First, let me just thank the committee, you, and your staff for your help on the bill. We are accepting the committee amendments today. AB 347 would require the Department of Toxic Substance Control to test, enforce, and ensure compliance with all existing laws regulating the use of PFAS chemicals in food packaging, juvenile products, and textiles.

It also asks CDPH to regulate the cosmetics, the cosmetics products that have been, the laws that have been passed to also regulate PFAS. As you know, we've passed a number of groundbreaking bills to look at PFAS and to make sure that PFAS gets out of certain products, the products that I'd listed. Yet there was no enforcement mechanism or no regulatory mechanism that was developed in any of those bills.

This bill will develop a regulatory regulatory framework so that we can ensure that the industry is complying with our state laws. We have been working very closely with DTSC, different stakeholders, industry stakeholders, and we continue to work through that process.

I know we are not completely quite there yet, and so we are committed to, during recess, to continue to work with all those stakeholders and continue to address the issue around, especially around cosmetics and the jurisdiction in that area. With me today are Avi Kar from NRDC and Bill Allayaud from Environmental Working Group. Excuse me.

Welcome. Please identify yourselves for the record and proceed when ready.

Good morning. My name is Avi Kar, and I'm a senior attorney with the Natural Resources Defense Council. Thank you for the opportunity to testify today. AB 347 would add enforcement for previously passed laws phasing out forever toxic PFAS chemicals and many concerns consumer product categories including textiles, food packaging, and juvenile products.

PFAS are a class of more than 14,000 chemicals used for a wide range of purposes. They're called forever chemicals because they are highly persistent and mobile in the environment, making them both difficult and expensive to remediate. PFAS have been linked to severe health problems, including cancer, hormone disruption and immune system disruption.

AB 347 will enhance enforcement and help ensure that consumers get the full benefit of the laws that have passed previously phasing out PFAS in products and that businesses that comply with the laws have an even playing field.

The bill would also authorize the DTSC to interpret and otherwise implement the laws, including addressing scope of products, and this will provide clarity and certainty for businesses.

AB 347 will help ensure the required support for regulated businesses, provide a central point of engagement, and will reduce the reliance on the author's office and sponsors. The bill also provides a funding mechanism to cover the agency's reasonable costs for implementing the chapter. And so we urge your aye vote on AB 347. Thank you.

Thank you, sir. Next please.

I'm Bill Allayaud with the Environmental Working Group. We're here to support the bill. Since this will be the last time I ever testify before this body because I'm retiring...

Oh, congratulations.

Thank you. At the end of the year. I thought, well, what could I say here? And I thought back to when Governor Davis was recalled. We had a party for him here, and we were thanking him for all the bills he signed into law. And he said, they don't mean anything unless you all follow up on them and make sure the agencies are doing their job.

So that's why I appreciate this bill by Mr. Ting. I worked on these PFAS bills, and if we don't look after them and the Legislature doesn't, then they just sit on the books. So that's what this bill does, is it makes sure that there is implementation of the good ideas we had and the good means we have to protect Californians' health. Thank you.

I agree with you. We do precious little to check on what we do and make sure it's fully implemented and correct that that needs correction. So thanks for pointing that out and congratulations on your career.

Thank you.

Other witnesses in support? Any witnesses in support? Take your time. Name, affiliation, and position, please.

Hi. Erica Parker with Californians Against Waste in support. Thank you.

Thank you for joining us. Any other witnesses in support? Seeing none. Any witnesses in opposition? I think you can just move over to your right. Thank you for joining us. Please identify yourselves for the record. Proceed when ready, and you all can flip a coin to decide who goes first.

Good morning, Members. Rob Spiegel, California Manufacturers and Technology Association. On behalf of my association, as well as a coalition of other businesses and industries, we are regrettably opposed unless amended to AB 347 as currently drafted.

First and foremost, CMTA and our coalition definitely appreciate the hard work of your committee staff in drafting the amendments and working with us on trying to help narrow the scope of AB 347 to actively address PFAS contamination, as well as enforcement for the state and for those bills that are covered under AB 347.

That being the textile products, AB 1817, AB 652, juvenile products, AB 1200 related to plant based food packaging and cookware, as well as, excuse me, as well as 2771 related to cosmetics.

So fundamentally, we still have, even with the committee amendments, significant problems. And now, I think, greater uncertainty surrounding the cosmetics provision, which my colleague will further address, but on a much more holistic or broader scale of where we are on the bill.

We agree that the bills and the orphan code issues surrounding all the previous legislation is a challenge not only for manufacturers to comply, but also to provide some certain certainty and clarity surrounding what are the rules of the game.

And with that, we at CMTA, as well as our coalition, do believe that 347 is a step in the right direction to provide some certainty of enforcement and predictability for the regulated community. The challenge that we have, though, is 347, While it may have provided the skeleton or the base of that enforcement, it doesn't really fully amplify or discuss what are those rules.

For example, in 347, we have situations involving like a SKU or a stock keeping unit, for example, The stock keeping units as part of this bill, these are unique to every individual retailer. So even if you are purchasing or providing a white t shirt, same company, same brand, same color, that SKU will be different between, let's say, a Target retailer and a Walmart retailer.

So how do we end up creating a situation in which a violation can be adequately determined across a whole section or a whole sector of these products? We don't really have what we would call a threshold or a statistically significant sample of a violation occurred on one t shirt.

Does that automatically presume then that every other element involving that t shirt or involving that product is also deemed in violation? With that, we still have concerns regarding the registration and testing elements, the notice of violation. We want to understand specifically where the violation occurred on from the manufacturer.

DTSC in this bill should be able to provide some of that information involving the threshold, involving the determination, the testing methods and accuracy surrounding that. We also have concerns still on enforcement and disclosure. What is, again, what are the rules of the game? As well as we still have concerns over testing capacity in the state.

And for all of these bills, we are quite literally talking about tens, if not hundreds of thousands of various consumer products that, at some point, at some point have to be tested and certified under the provisions of the bill. For these reasons, we still have significant ambiguity and concerns with AB 347.

We appreciate the work and the dialogue that we've had thus far, but for the reasons today and the reasons stated, we must still regrettably ask for your no vote, as we are opposed unless amended on the bill.

So let me ask a question. Obviously, testing capacity and the state's ability to do the job and funding for the state to do whatever the job is, those are issues that are beyond you, and those are issues that are in the sandbox here and the sandbox upstairs.

Other than those, have you suggested amendments to deal with the t shirt issue, the registration and testing, the notice of violation, the enforcement and disclosure? Because that's not us. That's you complaining. So do you have language that somebody has that I haven't seen?

Yes, sir. So when we first saw the language in June of what was introduced by the author, that was really our first opportunity as a coalition to look at kind of the work product. And so we have provided amendments to the author's office and others to kind of provide, I would call it, the meat or the substance to that regulatory framework.

I do believe that we are very close in some capacity to addressing those considerations and concerns. And what we are asking as an industry is to let us understand the rules, let us understand the environment of what DTSC is required to do.

So we provided, keeping with the transparency and accountability elements of what 347 provided, the industry asks of here's the rules of the game. Here's testing capacity. Here's how California should go through and essentially accredit laboratories beyond just DTSC. Because capacity is a challenge.

We don't believe that DTSC has the capacity to test everything, but whatever testing methods or methodologies are going to be used should be comparable or identical across every other private or accredited lab that's going to be doing a test on behalf of the State of California DTSC for these products.

Well, the phrase I think we're getting close, that's magic to my ears and to the ears of my colleagues who sit in these positions. So I would encourage you to keep working on that and hopefully come to a conclusion that's a successful one both for the author and for you.

But I will say that when you move into trying to suggest language about testing capacity, remember that's our sandbox. And if it doesn't exist, I guess this won't work. But what I would hope you would concentrate on are the issues that are in your sandbox as manufacturers having to do with the reports and the notices of violation and enforcement and disclosure.

Because those impact you and how you deal with various products that are in various retailers and how those are handled. I guess that's your t shirt example. So hopefully you'll, I'm going to give Mr. Ting an opportunity to respond, but hopefully you'll continue to work with him and see if you can come to some resolution. And ma'am, I haven't forgotten about you. You're next.

Just a quick response. I mean, we've been working very, very closely with industry on the amendments. EQ had asked us not to do amendments till after we get the bill to the floor. And so that's our intention to incorporate. We've already discussed many of the amendments that we were going to be incorporating on the floor. So that, that was the committee's request and so that's, we're going to honor that.

Right. And of course the other thing, when they do it, when there are multiple referrals of bills, while it's sometimes difficult for me, we try to stay on our own jurisdictional sandbox ourselves. So thank you for continuing to work on it. We'll see if we can come together. Yes ma'am.

Good morning, Mr. Chair and Committee Members. Mandy Isaacs Lee here on behalf of the Personal Care Products Council. I just want to thank you and the committee and even the author for countless conversations on this as we're trying to land this plane. But regrettably we're still in opposition to AB 347.

Our issue is what started off as a simple enforcement bill has turned into something that has introduced very significant policy issues in the second house in the final days before the policy committee deadlines. And my client, PCPC, was not a party to the year long conversations the author has had with DTSC and various parties.

In fact, we didn't even know that cosmetics was implicated until this bill went into print a few weeks ago. So working within the framework of the author's intent, which is to make this an enforcement bill for existing and future PFAS bans, we really pushed our members to find a capable regulator.

And we believe we found that in the CDPH, the Department of Public Health, under the Sherman Food, Drug, and Cosmetics Act. And we're thankful to the committee for, you know, suggesting that amendment. The Sherman Act, for what it's worth, just to be on record, has various provisions that hold cosmetic manufacturers accountable for adulterate cosmetics.

Manufacturers are subject to fines and penalties, even imprisonment, product recalls for violations of the act. So it's not insignificant. And so I just want to go back a little bit in history. In 2022, when we first negotiated the intentional PFAS ban for cosmetics, the cosmetics industry agreed to not intentionally add PFAS in our products.

And we remain committed to that. But the subtext of that agreement was that manufacturers would not be held liable for trace contaminants of PFAS found in the environment, found in the water. I know, Mr. Chair, we had a lot of conversations about that. Through the manufacturing and logistics process, there's potential for contamination as well.

And this law becomes effective on January 1, 2025. And yet here we are again, sort of subject to a last minute, very significant policy discussion that frankly we talked about in 2022 and decided to not go with the threshold. And it sort of reopens up a very carefully negotiated deal back in 2022.

So we continue to oppose 347 and, unfortunately, the committee amendments that authorizes CDPH to set a threshold for the following reasons. Number one is, as I previously stated, we're introducing significant policy by mandating the CDPH to set a threshold that, frankly, deserves more daylight than the final days before the second house policy committee deadline.

This is an enforcement bill. We found a very capable enforcement mechanism through the CDPH's Sherman Act, and I think we've achieved that intent. Number two is none of the other product categories are being relitigated. You know, they are simply being placed in 347 enforcement arm under the enforcement regime that 347 creates.

But with the threshold, we're reintroducing an issue that was hotly debated in 2022. And we decided in 2022 not to go with the threshold under the recognition that it's an incredibly complex policy discussion. And for those reasons, there wasn't a threshold in AB 2771. And now, arguably, some of the supporters that sit here that were a party to the discussions in 2022 are getting a second bite at the apple.

Number three, cosmetic manufacturers are committed to not intentionally adding PFAS, as stated earlier, but we cannot be held liable for trace contaminants that exist ubiquitously in the environment that are beyond our control. And the introduction of this idea of CDPH setting a threshold would do just that and create severe and untenable liability.

And the last thing that I'll close with is, you know, under the committee's suggested amendment, if manufacturers were to add PFAS into cosmetics, it would be considered an adulterated cosmetic. You know, we had discussions about putting it directly under the adulterated cosmetic provision.

The question becomes, once CDPH sets a threshold, whatever that threshold is, and let's say the threshold, the product is tested and the threshold is higher than whatever CDPH sets, what does that mean? Is there another provision that would enforce that? Is it super adulterated? How is that going to be enforced? There's no clarity in that.

And we find pause in that. And so I know we don't have a quorum right now, but the author has committed in the previous committee to address the cosmetics issue. But we still find ourselves at an impasse. And for those reasons, we'd ask for a no vote today.

Well, thank you for your comments. It's certainly not my intention to pick up trace elements of PFAS that are found in a cosmetic because the manufacturer plugs into a water system or the manufacturer has an ingredient that has trace elements that are there because it's an organic ingredient that picks PFAS up from the soil or the water and then perchance finds itself into a cosmetic product.

And in fact, the language talks about adulterated, which is true. And it also talks about it's adulterated if it contains an intentionally added PFAS. And it defines intentionally added chemicals that a manufacturer has intentionally added to a product or that are intentional breakdown products of an added chemical.

And talk about trace elements that are found because you plugged into some communities' water supply that... Somebody told me the other day that the threshold acceptable threshold for PFAS is .02 parts per million, which is pretty low.

So we shouldn't find a lot in the water supply unless we've got a larger problem. So that's my intent. I understand the disagreement as to who regulates it, and that will have to be worked out with the author and maybe we can help. I'm not going away yet. Not dead yet, until a little later in the fall.

And certainly, we'll be here in August when we revisit a lot of these issues. So I appreciate your comments. He's tied up over at the rail right now, but I'm going to ask the author, Assembly Member Ting, to continue to work with you, particularly the cosmetics folks, to you may have...

I know you can multitask, Assembly Member, so I'm sure you heard this. But I was commenting on the language, and it's certainly my intent that adulterated and intentional mean exactly what they sound like, which is you stick something in to a product that doesn't already have it, and you intentionally do so.

And that's what we intend with respect to the amendment. I know you'll work with the cosmetics industry to try to address their concerns, collective concerns, over the break, and come back, and we'll see if we can't tie the ribbon on this when we get back. Yes, ma'am.

Through the Chair. If I could just respond very quickly to that. We appreciate the Chair clarifying his intent. I think that the issue is that we use ingredients beyond just water. And I know we had a lot of conversations about water, but there are natural botanicals that we use as different ingredients that also could be contaminated because PFAS is everywhere in the environment.

And so the consideration is that we have various points at which the product can get contaminated. We are not intentionally adding the PFAS, but the manufacturing process, packaging, logistics, other ingredients aside from water that could present contaminants into the product that we don't want to be held liable...

And we may need to clarify that. But if you think about it, PFAS is everywhere, including in our bodies. So if that's the measuring stake, then the word intentional has no meaning. Because anything you add into your cosmetic product could have PFAS in it. So we need to fix. We need to think about that.

You've got some folks to your right, my left, who may have some thoughts on that. They know what I'm talking about, and I know the author does. So we'll go to work on this, ma'am. And also you're going to help with your language that is in your sandbox and not ours, and we'll see if we can't get a product that everybody, including the author, can be proud of.

Yeah, we absolutely plan on spending the recess working this out. I feel pretty confident that we will be able to find a resolution.

Perfect. Any other... I see them lining up. Any other opposition? Name, affiliation, and position on the measure, please.

Good morning, Chair and Members. Adam Regele with the California Chamber of Commerce in respectful opposition unless amended. Thank you.

Thank you. Yes, ma'am.

Good morning. Nicole Quinonez on behalf of the Household and Commercial Products Association, oppose unless amended. Thank you.

Good morning. Lauren De Valencia representing the International Sleep Products Association, also opposed unless amended. Thanks.

Faith Borges on behalf of the Cookware Sustainability Alliance. We'd like to thank the committee for your thoughtful work on this bill and expect to be moving to neutral upon seeing the amendments in print.

Kevin Messner. I'm with the Association of Home Appliance Manufacturers, and we oppose unless amended.

Good morning, Mr. Chair. Tim Shestek with the American Chemistry Council, also oppose unless amended.

Thank you. Well, I'd bring it back to the dais, but there's only me. So, Assembly Member, it's your lucky day. Would you like to close?

You know, want, just again, thanks for your engagement, your committee's engagement. You know, we will spend the next few weeks having further conversation, hoping to land some resolution before we get through Appropriations.

Thank you. Apologize for the time we spent on this, but it's an important issue, and I appreciate your participation.

Next item, Doctor Wood. Item number two. AB 815. Healthcare coverage provider credentials. Thank you for joining us. Proceed when ready.

Good morning, Mister chair. And I'd say Members, but I can't. Me, myself and I. Yes, your honor. So first of all, thank you. Thank you and your Committee staff for your work on this Bill. Physician credentialing presents significant administrative challenges, much like prior authorizations and provider directories. As healthcare physicians often face varying criteria from different health plans.

AB 815 addresses these challenges by streamlining the credentialing process for physicians and health plans. AB 815 establishes a credentialing board responsible for developing a standard form to be used by all private health plans and insurers. This form sets forward standards to reduce redundancy and delays in the credentialing process rather than waste time in overly burdensome administrative processes.

AB 815 allows health plans to focus on ensuring enrollees have access to an adequate network of physicians and enables doctors to concentrate on delivering medical care. I'm accepting the Committee amendments and we are working with the stakeholders to address concerns. Here to testify in support is Brandon Marche, representing the California Medical Association. Welcome, sir.

Please proceed. Thank you, Mister chair. Mister chair of the Committee. My name is Brandon Marchy with the California Medical Association. I want to start by thanking the speaker Pro-tem for spearheading this effort, and also thank you and your committee staff for their diligent work on this. We greatly appreciate the amendments and their thoughtful consideration.

I have the best staff. I'm sorry? I said I have the best staff. Yes you do sir. The US Healthcare US Healthcare Industry administrative spending has reached $1 trillion in 2023. Therefore, it's time to bring operational efficiencies into the healthcare arena.

And starting with this credentialing process, AB 815815 brings together industry stakeholders to create and maintain a standardized credentialing form for all health plans and physicians to use in their own internal processes.

This standardized form will help to automate the process by allowing for auto population of confirmed physician information for more complete initial applications and more timely consideration of those applications. AB 815 is modeled after AB 2581 from 2022 and would also require health plans to consider a provider's credentialing application within 90 days of receipt.

The credentialing process is conducted currently by each health plan and individual individually, each with its own set of criteria and extensive application process.

After the application has been submitted, there is typically a long waiting period for health plans to review and approve physician credentialing application, causing delays in getting physicians contracted and into their communities providing care we have recently received complaints of credentialing delays of upwards of seven months after a physician has submitted an application.

AB 815 creates an important setting for the industry to work together to find solutions which reduce administrative spending and burden and get physicians into plan networks faster to deliver care to their communities. I respectfully request your. I vote.

Thank you for your testimony. Any other witnesses in support? Name, affiliation and position on the measure, please.

Ryan Spencer with the American College of OB GYN Statistic Nine and the California Podiatric Medical Association in support. Thank you, sir. Next please.

Good morning. Christy Wiese, on behalf of the Physician Association of, California, a group of small and independent physicians who really struggle with the length and delay that the credentialing process takes. We thank the author for bringing this important Bill forward. Thank you.

Next please, Mister chair Members Paul Yoder, on behalf of the California State Association of Psychiatrists in the California Academy of Child and Adolescent Psychiatry and support. Thanks for joining us. Yes ma'am.

Chair Members, a bit of a tweener. Kathy Mossberg with the local health plans. With the latest amendments, we are neutral removing opposition.

Thank you. We like that. Any other witnesses in support? How about witnesses in opposition? Any opposition? Witnesses, please come forward.

Hi. This is going to be very quick. We've been working together. We like that too. Good morning. Chair Robert Boykin with California Association of Health Plans. Thank you to you and your staff, as well as to the sponsor and to the author of the Bill.

You know, we look forward to this conversation moving forward, some very nice steps. The amendments have done a long way, have gone a long way to addressing some of our concerns and we look forward to conversation going forward. Thank you. Thank you. Yes ma'am.

Mister Chairman, Stephanie Watkins, on behalf of the Association of California Life and Health Insurance Companies, we too haven't opposed unless amended. We would like to thank the author, the sponsor and all the work that's been done on this. We do have some outstanding issues and would like to discuss those over the July break and going forward.

Thank you. Hopefully we can fix those. Any other witnesses in opposition? Seeing none. Doctor Wood.

Thank you Mister chair. As I sat here last week where we talked about provider directories, I started thinking that, you know, with this Bill, maybe this could be the framework for how we ultimately can deal with provider directories as well. Hope that's true. Hope that's true. But with that I respectfully ask your. I vote.

When you have a quorum.

As soon as we get a quorum, we'll take a motion. We'll do exactly that. Thanks for joining us. Thank you. Next item, item number three. AB 1577. Assemblymember Low, good to see you again.

Thank you very much Mister Chair, for allow me to present Assembly 1577, which of course you and I have respectively had a breadth of work on this issue with respect to clinical placements.

Thank you again for your work and your staff's work for helping to ensure that Assembly Bill 1577, before you provide transparency into why clinical placement slots are not being readily made available to community colleges and csus.

As you know, we are attempting to meet a critical need and this is a critical step in addressing the massive healthcare workforce crisis at hand. With me today, speak in favor of Assembly 1577 is Liz Hawkins from the United Nurses Association of. California.

Thank you. Welcome.

Thank you. Do I need to press anything or am I hearing I hear it?

Just identify yourselves for the record.

Good morning. My name is Elizabeth Hawkins. I'm a registered nurse and I'm also an Executive officer of United Nurses Association of California Union of Healthcare Professionals. And I'm a proud sponsor of Assemblyman Low's Bill AB 1577. For years, healthcare leaders have warned of an impending nursing shortage.

The recent pandemic starkly illuminated the crisis, exacerbated by short staffing, poor working conditions, widespread burnout and proliferation of the lucrative nurse travel industry. According to the US Bureau of Labor Statistics, an alarming 193,100 registered nurse job openings are projected annually through 2030, fueled by retirements and departures from the profession during the pandemic

California, like many other regions, bore the brunt of this shortage, with hospitals grappling and paying exorbitant fees to nurse registries to fill critical positions. Today, despite offering substantial recruiting incentives, California hospitals still face thousands of vacancies. This shortfall may escalate further as healthcare access expands to more individuals.

The ongoing dialogue about the nursing shortage demands urgent action from the State of California. It's imperative to implement a comprehensive plan to safeguard the nursing workforce by 2030. Delaying intervention is not an option. We must act decisively now to prevent further strain on our healthcare system and ensure quality of care for all.

AB 1577 is part of the solution one of the main hurdles facing nursing is the lack of clinical placement available to community college and CSU students. The lack of placement has led to longer waiting periods, especially at the JCs, where education is more affordable. This forces some students to enroll at expensive private schools.

Accepting a more costly education, AB 1577 encourages hospitals and healthcare facilities to expand their placements and most importantly, doing it without supplanting any current or future placement agreements in operation. AB 1577 also creates accountability by requiring hospitals and healthcare facilities to submit a declaration or lack of capacity to fulfill the requirement.

A very easy task, a drop in the bucket fine for failure to comply. It's time to prioritize the nursing infrastructure. California recently invested $300 million over a five year period to expand nursing programs at community colleges. Now we need clinical placements to be able to graduate these new nursing students.

AB 1577 is an important component to the solutions. Save nursing. Thank you and I respectfully ask for your aye vote.

Thank you for joining us and thank you for your support of this measure. Any other witnesses in support? Name, affiliation and position on the measure only, please.

Good morning. Janice O'Malley with AFSCME California here in co-sponsorship of the measure and appreciate the author's work on this and your work as well in clinical placements.

Thank you for joining us. Any other witnesses in support? Let's turn to witnesses in opposition. First, lead opposition, lead opposition. Witnesses may join us at the table. We'll take the others next. Welcome. Please identify yourselves for the record and proceed when ready.

Thank you, Mister chair Sarah Bridge, on behalf of the Association of California Healthcare Districts, we respectfully opposed to AB 1577. ACHD represents the state's 77 public health care districts that serve the state's most vulnerable and underserved populations.

District hospitals are at the center of the discussion on how to grow our clinical workforce, and we agree with the premise that the stat that the state lacks the necessary clinical placement slots to meet the overall need. However, AB 1577 arbitrarily prioritized specified educational institutions and penalizes hospitals who are unable to comply with the bill's provision.

Clinical placement slots are costly. They also require that staff qualified to teach be pulled out of rotation and or used more infrequently. Often, our district hospitals lack the funds and or staff to offer clinical placement slots at all.

With these limited resources, districts will partner with educational institutions that can train the workforce needed at that particular facility, often offering clinical placement slots for only that type of clinician, using the commonly referred to strategy of growing your own workforce to meet the unique community needs. This often means partnering with a community college.

However, it can also mean partnering with a variety of other institutions, making any prioritization language in the bill Problematic. We agree that we need more data and believe that the Committee has already addressed this issue in the Chairsville Senate Bill 1042 without the problematic prioritization requirements fines and costly database.

ACHG and other stakeholders were pleased to work through similar concerns on the Bill and are now neutral on that measure. We believe that it is the first and most appropriate step to addressing clinical placement shortages. I will remind the Committee that over half of the hospitals that received distressed hospital loans were public district hospitals.

We are now before the Committee highlighting yet another Bill that will put further strain on these already struggling facilities. I want to thank the Committee, author and sponsors for their continued work on this critical issue. However, for these reasons, we respectfully urge a no vote. Thank you.

Thank you, ma'am. Next, please.

Good morning, Mister Chair Alex Graves with the Association of Independent California Colleges and Universities here in opposition to AB 1577, AICC represents 89 private, nonprofit colleges and universities in the state, including roughly two dozen that offer nursing programs in academic year 2021/22.

Our institutions produced approximately 46% of the new BSN prepared nurses in the state.

The Committee analysis, I think, does an excellent job of providing an overview of the issues that nursing education programs see, whether it's clinical placement issues, not enough nursing faculty to do the supervision of nursing students, as well as the lack of good data on placement needs and placement availability.

We, too, remain concerned with this bill because it continues to include language that prioritizes resolution of placement needs based on the segment of higher education that a nursing program resides in.

We've consistently opposed such approaches because, again, clinical placements are incredibly valuable to all nursing programs, and we would welcome solutions that help increase the availability of placements for all programs. I would note that we, too are very supportive of efforts to tackle the clinical placement issue.

And like my colleague mentioned, we too have been very engaged on SB 1042 and are neutral on that language in print. We do believe that provides appropriate data to tackle this issue without again creating that prioritization based on the segment in which a program resides. So, for those reasons, we must be here in respectful opposition today

But appreciate your time.

Thank you. Any other witnesses in opposition, if any, name, affiliation and position on the measure only, please.

Sorry I missed the the support. So I'm actually a clinical instructor and I am the SEIU one to one RN Vice President and I wildly support this Bill.

Thank you, ma'am. Okay, now let's turn to opposition.

Little bit of a tweener here, Christy Weiss, on behalf of the California Hospital Association with a position of concerns, really appreciate the author and the staff's willingness to keep talking with us. Hospitals throughout the state provide thousands of placements for nursing students.

And I think, as everyone is aware, there are multiple proposals that are going through the Legislature right now that would address the placement process. Our concern is to make sure that there is coordination amongst all of those, as well as acknowledging the work that happens at the local level with the nursing consortiums.

So as we enter the final 60 days of the legislative process, we look forward to continuing to work with the author.

Thank you. Next, please.

Good morning, chair Members.

Jen Chase, on behalf of the University of California, we submitted a letter of concern similar to the concerns that AICCU outlined around the prioritization of certain segments over the others, as well as some of the comments that healthcare districts that, you know, we're going to be creating two different processes and we're doing a lot of work currently to already to have as many clinical slots as we can at our hospitals and clinics.

Thank you.

Thank you. Any of the witnesses in opposition.

Well, I don't know if my colleague wants to comment on this clinical placement bill. I'll let her raise her hand if she does, but I'll comment first.

Assemblymember Low, I just want to commend you for being a leader in this effort and many others in the health care field for most, if not all of my time up here, here in the California State Senate and your leadership on this effort in particular.

You know, there are folks referenced other bills, but you know, there are a variety of approaches to solving an issue and I think all of them have value and all of them should be considered generally and specifically that applies, I think, to this effort as well.

I said this yesterday in another hearing and it disappoints me when we have competition inside the healthcare arena. Competition that really doesn't belong in the healthcare arena. Healthcare is a team effort and that includes healthcare workforce education. There's no I and team.

And when we start competing and we start worrying about one sector or the other, without worrying about how the team succeeds and how many, how many goals we can put on the scoreboard as a team, then we really aren't functioning effectively, and the effort is probably not going to be as successful as it could be.

There's no question that we have a problem with clinical placements. There's no question that we have a problem with capacity in our healthcare workforce effort. And there's no question that solving this clinical placement issue is critical to dealing with our healthcare workforce shortage. And so, while there are a variety of approaches, we'll sort that out.

But at the end of the day, we have to ensure that we get a handle on this clinical placement issue, that we make sure that we identify every single potential clinical placement in the healthcare sandbox, and we fully utilize each and every one of those clinical placement slots to educate, in this case, the nursing workforce that we badly need.

So those are my comments on the issue. I don't know. I'll let Senator Nguyen, since she just arrived, ask a question if she cares to do so, or make a comment.

Thank you, Mister Chairman. I actually don't have any questions, more of a comment. Most of what the Chairman stated, I'm in agreement. This is, and I appreciate what you've been doing for many years now, trying to get us to where we need to be.

I just don't think this is the right solution because now we're pitting a group of students against another group of students getting these slots.

I just think in the end we need to create more slots. These clinical facilities, we need more clinical facilities for more slots because there's no different than 10 students from the private school to 10 students from the public school. We actually want all 20 students. We don't want 10 only from either schools.

And so, I think, you know, this, I don't think is the solution. Why I appreciate what you're doing. I just think we here as a legislate, we got to come up with a solution. And it might have to be where we have to pay for these clinics, clinical facilities to open from the state side.

We have to encourage more of these hospitals to maybe hire nurses that will then just all they're going to do is help teach and have these clinical hours to be open. I don't know what the solution is.

I think we've all tried, but like I said, as much as I appreciate all your efforts, and I still do, I just don't think this is the right solution if you're going to pit one group of students against another. I think we need all of them at this point. So I will be opposing it today.

And I'll be supporting it. Assemblymember Low, would you like to close?

Thank you very much to Senator Nguyen. Senator Nguyen, I know that you have also traditionally given great respect to fellow colleagues and authors who have put a deep amount of work and effort in this capacity.

As previously was stated, Chair Roth and I have worked quite a bit outside of the legislative session to also make sure that we're meeting with stakeholders and addressing these issues. As you also similarly know, legislative proposals are not perfect in terms of addressing all of the different issues. But status quo is unacceptable.

And we have before us is a product to help address these issues, to address the barriers to entry, and also access points. Our public institutions also have lower costs. And when we address the barriers to entry, that is the endeavor that we hope to be able to address. And so that's what we have before you.

And I just want to reaffirm the importance of the hard work that is here before you today and Chair Roth and I and many stakeholders addressing these issues to best help on the access issue for the State of California. So, I heard loud and clear.

But I appreciate the efforts, again, of the chair and look forward to the opportunity to get an aye vote at the appropriate time.

As soon as we get a quorum, we'll take a motion and we'll do just that. Thank you.

Thank you very much.

Thank you, ladies and gentlemen, for joining us. Okay, next item is item number four. AB 1895. Doctor Weber, thank you for joining us.

Ready?

Proceed. When ready?

All right. Thank you. Good morning, Chair and members. I rise here to present AB 1895, a bill to provide the state with more advanced notification when a hospital expects challenges in their perinatal unit. We are unfortunately facing a maternal crisis in our state and around the country.

According to a recent CalMatters article, nearly 50 maternity wards have closed across California, with more than half shutting down in the last four years. This impacts every district up and down the state.

Earlier this year, Scripps Health in San Diego announced that it would be closing a maternity Ward in its Chula Vista location, and those patients would now have to drive all the way to the Hillcrest location.

Low birth volumes, financial distress, workforce shortages and insufficient Medi-Cal reimbursement rates may all be reasons why maternity wards need to shut down. Current law requires a hospital to notify the California Department of Public Health as well as the public 90 days prior to a proposed closure of maternity services.

Unfortunately, this is not enough time for the state to intervene. For these reasons, AB 1895 requires a hospital with a perinatal unit that expects challenges in the next six months that may result in a reduction or loss of perinatal services. To report several data points to the Department of Health access and information.

This report will outline the three closest hospitals offering perinatal services in the geographic area, their distance from the challenge facility, and whether these hospitals have any restrictions on the reproductive health services.

Finally, when a hospital announces an official closure of the unit, as mandated by the current law, AB 1895 requires a 60-day public comment period that includes at least one public hearing. This bill is sponsored by the American College of Obstetrician and Gynecologists, Black Women for Wellness, Reproductive Freedom for All, and the California Nurse Midwives Association.

Here with me to testify today is Doctor Juliana Melo, Board Certified OBGYN and Family Planning Specialist, and Sharee Wilburn, Perinatal Equity Initiative Committee Advisory Member. Thank you.

Thank you both for joining us. Please identify yourselves for the record before you speak and proceed when ready.

Good morning and thank you, Chair and committee members. My name is Sharee Wilburn. I am a program in health and equity program manager in Stockton, as well as a perinatal equity initiative. I'm original board member. I'm also an angel mother. I'm here today. Thank you for your attention to this matter, and it's of a profound importance.

I'm sorry. The health and well-being of black birthing women. This is not just a topic of discussion, but a state of emergency and a demand of our immediate attention and action. Imagine the joy of anticipating the outcome of expecting a child.

Now imagine that same joy overshadowed by the fear of uncertainties because your community lacks access to the care that supports positive birthing outcomes. This is a reality far too many for far too many black birthing women today, especially for the community that I serve in south Stockton.

It is a reality that has led to preventable tragedies, robbing families of their loved ones and leaving communities heartbroken. Consider this tragic case of Selena M., a mother who passed away this year from complications of childbirth due to preeclampsia. Her blood pressure was so high that her heart exploded.

Selena was one of my participants who was constantly dismissed. Her cries for help fell on deaf ears until it was too late. Her death was preventable, yet she is no longer here because her voice was ignored.

I want to highlight the impact of the lack of access for maternity awards and NICUs on our birthing experiences as black mamas or the mamas that you have worked with. You cannot stand - we cannot stand by as another black mother. Life is cut short because her pleas are ignored.

We must move beyond the balloon releases and the morning ceremonies of preventable deaths. We owe it to our women, their children, their families, and ensure that their voices are heard and respected in our communities. Let us commit today to eliminate the barriers that stand in the way of health equity for all, not just our black mamas.

But we will speak Selena's name because this was preventable. So, I urge an aye vote for the legislation as this is an important step towards addressing crisis maternity, war closures that we are facing in our community. Thank you.

Thank you for joining us and thank you for your testimony. Doctor? g.

Good morning, Mister Chair and members. I am Doctor Juliana Melo. I appreciate the opportunity to testify in support of AB 1895. I'm an OBGYN physician representing the American College of Obstetrics and Gynecology, District Nine, proud sponsors of this bill and as has been stated, we're in the midst of a crisis when it comes to labor and delivery care.

As the CalMatters analysis and other investigative reports have shown, more than 40 maternity wards have closed across the state since 2012. And this is simultaneously happening at a time where nationally we have been struggling with maternal morbidity and mortality, higher acuity births and health disparities. But this is the reality of modern-day labor and delivery.

On any given day, a physician like myself can encounter many situations such as patients with preeclampsia, life threatening bleeding, fetus with heart rate distress, or baby's shoulder getting stuck during childbirth. Sometimes these situations require emergence delivery where every minute can mean the difference between life and death.

And what if you're a patient like this and literally had nowhere to go or had to drive hours upon hours to get care?

We have to find a way to end this crisis, and we believe this bill is a step in that direction as it provides a way to formalize the collection of data, assist in the community in finding other services in the event of closure, and hopefully informing potential solutions and prevent future hospital closures.

In the end, labor and delivery not only provides crucial medical support, but it ensures childbirth is not just a moment of joy, but also one of safety and security.

Finding a way to stop closures will be a way to ensure accessible and inclusive care so that individuals, regardless of background or circumstance or zip code, have access to the support they need during this pivotal moment in their lives. I respectfully ask for your aye vote today for AB 1895.

Thank you for your testimony. Thanks for joining us. Other witnesses in support, name, affiliation and position on the measure only, please.

Chair and members, Kathy Mossberg, representing Local Health Plans of California, in support. Essential Access Health and First Five Association of California, both in support.

Thank you. Next, please.

Good morning. Genesis Gonzalez, on behalf of Lieutenant Governor Eleni Kunalakis, in support. Thank you.

Thank you. Next, please.

Good morning. Kim Robinson with Black Women for Wellness Action Project, a co-sponsor and strong support. Thank you.

Thank you. Vanessa Cajina, on behalf of the California Academy of Family Physicians and the California Pan Ethnic Health Network, both here in support.

Thank you.

Good morning. Symphoni Barbee, on behalf of Planned Parenthood Affiliates of California and support, also noting support for Reproductive Freedom for All. Thank you.

Thank you.

Brandon Marchy with the California Medical Association in support.

Ryan Spencer, also with the American College of OBGYN's District Nine, sponsor of the bill, and support. I've also been asked to register the support of the other sponsors, the California Nurse Midwives Association. Thank you.

Lan Lay, on behalf of Asian Americans Advancing Justice Southern California, in strong support.

Tim Madden, representing the California chapter of the American College of Emergency Physicians, in support.

Kristy Wiese, on behalf of the California Hospital Association. Again, a bit of a tweener today, CHA doesn't have a position on the bill, but just wants to acknowledge and thank the author for the provisions in the bill related to confidentiality.

Obviously, if a hospital is struggling and the staff find out that that, you know, is, the hospital may close or is at risk, the staff start leaving. And so, that exacerbates the situation that the hospital is struggling with.

So, it's a very fine line for hospitals to balance, and we just want to acknowledge the author's work on that and thank her.

Brianna Nelson, on behalf of TEACH, in strong support.

Suzanne Goodman, Doctor from Bixby Center for Global Reproductive Health, on behalf of myself and support.

Good morning. Matt Lege with SEIU. We don't have a position on the bill and have enjoyed really good conversations with the author's office.

We do have concerns on the sort of confidentiality and making sure that information is currently public, maintains public, and look forward to continuing to work with them on that, and then also just want to make sure that workers are considered as part of this process.

I know there's concerns about people leaving and there's ways that we've offered and would look forward to continuing working with the author on try to reframing that really around. How do we get help to make sure we're keeping these open and appreciate the author's work on this. Thank you.

Any other witnesses in support? Witnesses in opposition? Any seeing? None. Doctor Weber, you know, we're going to have to over the break, I think we're going to have to work on the implementation of the confidentiality provisions.

As you know, both how it works here, once reports get to the legislature, how it relates to the transparency rules that are on the books in terms of statutes and what we have to do to comply and the other considerations that some of the speakers mentioned. Obviously, it's a very important effort.

This is a critical issue in probably all regions of the state, but certainly in our underserved regions that needs to be addressed. And this seems to be a step in the right direction to get some data. I just have a couple questions.

You know, given the declining birth rate and the difficulty at the state level and in federal level too, I suppose, in pushing enough funding to healthcare facilities and healthcare providers to maintain critical services in many areas of the state, in particular in the Central Valley, in some areas of eastern Riverside County, probably some in San Diego County and other areas in the north, central and south of the state.

Is there an effort by organizations that you're familiar with to take a look at what additional steps need to be required in order to provide some level of OBGYN services in these underserved areas, other than maintaining a fully staffed maternity ward in hospitals that are around the corner or at least within reasonable commuting distance?

Right. That's a great question. Thank you so much for asking, Senator Roth. And I definitely look forward to sitting down and talking with you and picking your brain on how we can deal with the confidentiality issue.

We'll handle that.

Yeah. Yeah. And I was like, that's. You know, Senator Roth is the person I need to sit down and really talk with, because I understand the hospital's concern. We definitely don't want to create a self-fulfilling prophecy. The purpose of this bill is so that no maternity awards close. I don't want any - I mean, this has been a huge problem. And every time you turn around the corner, you hear about another maternity award closing. And so, the purpose of this bill is really so that the state can act as a partner with these hospitals, these labor and delivery units, to see what, if anything.

Because if it's an issue of low declining birth rate, and that's the only thing there. We can't force more people to have babies. But oftentimes, when you look at it, there are other factors that go into play.

And so, this bill is to really see how we, as a state, can support and help that unit to stay open, not to do something that would create people to leave or create panic within the community, so that what we're trying to have not happen does ultimately happen.

Now, to your question about other options, other models out there, there have been conversations about that. You know, I wanna echo my fellow colleague: as an OBGYN myself, one of the concerns that I have with some of those models is that when you have an obstetric emergency, you need to have the expertise there.

And, you know, for any medical student that's rotated on a labor and delivery ward or their OBGYN rotation, any resident, any OBGYN or even family medicine. Right. You know that pregnancy is a wonderful thing.

However, as a resident at Cook County in Chicago, I realize that that is probably the most dangerous state that anyone could possibly be in. Things take a turn very, very quickly. You can have a perfectly normal pregnancy. Everything's going great during the delivery, and then, boom, an abruption happens.

And you need to have that specialized OBGYN care, the OB anesthesiologist, or room ready to save the life of not only the mother, but the baby.

And so I think when we're talking about having different models to kind of come in and fill in the gap, we also have to be very mindful that you still need to be able to provide that urgent emergent obstetric care when necessary, and also ensure that we're not filling in the gap in these rural and low income communities disproportionately, who already are at risk because of other social determinants of health.

So, there are already high risk for preeclampsia already at high risk for shoulder because of the size of the baby, may already have decreased visits to their maternal ward. So, there are conversations, but again, that is also a balancing act, so that we're not putting certain people more at risk if and when those obstetric emergencies happen.

I completely agree with you. The good news is you'll be here, and the bad news for me is I won't be here to participate -

But we know how to get in touch with you.

- in the conversation. But I clearly agree that, you know, birthing centers are not necessarily the solution, because we do have situations where it absolutely requires the skills of a board-certified OBGYN physician to handle the emergency situation.

And we can't wait for somebody to drive in, fly in, drop in, or whatever they need to be on the site.

And so, I think it's going to explore what our regulations in California require in terms of healthcare facilities, how they're staffed, what changes we could make, how we, in some cases, subsidize, because that's if we have low birth rates.

If you want an OBGYN to practice, to locate somewhere to practice, the OBGYN has to be able to earn a living.

And so, we're going to have to address that as a state. It's going to require your talents, Doctor Weber, and the talents of many others like you to put the plan together to propose the rule changes and push them through.

Exactly.

And I'll be rooting from the sidelines for you, because I think this is one of the critical issues that we have in healthcare today, and it needs the full time and attention of all those with brains, and I'm not sure that's me, but all those with brains applying their full effort to get this thing solved, it's a step in the right direction.

I'll be supporting it today.

Thank you.

I should let you close if there's anything else you want to say.

Just really appreciate your support and also your staff support on this particular bill and look forward to continuing discussions on how we can tweak it to make it the best bill possible this year.

We've got the best staff.

Yes.

When we get a quorum, we'll take a motion and we'll do just that. Thank you for presenting. Thank you for joining us today.

Well, let's take item number 24. Assemblymember Patterson, thank you for joining us. Proceed when ready. Thank you for being. Thank you for being more than timely. We've got the full compliment today. Okay. So maybe good to see you again. Please proceed when ready, sir.

Great. Thank you so much. Mister chair and Senators, I'm here to present AB 3156. This is an issue that I've been working on since I've been elected, when immediately following being elected, I sat in a living room with a group of moms in my district who have children with developmental disabilities.

And essentially what's happening, to make a very long story short, is that as California transitions to managed Medi Cal, managed care, these individuals that utilize Regional Centers as well, ultimately are being forced to be put onto Medi Cal is their primary insurance coverage.

And obviously, with these individuals and their specialists that they have, they don't accept Medi-Cal. And so over the course of the last two years.

Cause I introduced this Bill sort of as a placeholder as we tried to work this out with DHCs over the last two years, and DHCs has indicated to us that it is not their intent for them to obviously lose access to their primary insurance or their primary providers.

And so, over the last two years, we've met with DHCs multiple times, including the Director, and we've had some very good and Frank conversations. And in addition to that, my staff has probably spent 100 plus hours working on individual cases for constituents, not only in my district, but throughout the state.

Actually, unfortunately, the downside is I'm not aware of a single success story of one of these individuals with a developmental disability who utilizes a Regional Center actually being able to keep their primary coverage. And so that's obviously very problematic with me. Now, our original intent was to basically, okay, we're kind of tired of dealing with this.

Let's just exempt them from this managed care program. And I understand that's not the desire, and that would add some complexities, but what we're trying to do is just say, hey, look, DHCs, can you please work this out and make sure that they can continue to keep their primary care?

Because these are specialists, these are people that are trained on the disabilities that they have, and it's a very unique and specific kind of Doctor that they need that. Unfortunately, they don't take Medi Cal for a lot of reasons we're aware of.

But so, like I said, the one thing, the reason why I think that this is really important, and my most recent discussion with DHCs, and again, the Director has been very great and gracious with me is that it seemed that there was some blame put on the providers. And this is very complex system. But what I.

All of these cases that come to me, they all have different providers, they all have different health plans. So it's not actually. It cannot possibly be all of their faults collectively. There's a problem with the way that the billing happens, and so we're just trying to solve this problem. I think this is a good.

If we can get DHCs to fix it on their own, especially through this legislation. That is my goal. At the end of the day, I just want to make sure that they can continue with their health insurance and continue to get the services that they've had forever.

With that, I do have some witnesses here to testify and support. We have Natalie Cooper, who's a constituent of mine. She's joined with Sue Samuel, also a constituent of mine, and also Jim Frazier of Arc of California.

And I assume you accept the amendments.

Yes, I do accept the amendments. Thank you. By the way, thank you for the work and the communications with the staff and the consultants. It's been a really good experience. I appreciate that.

Okay, please identify yourselves for the record before you speak. I'll let you determine the order. I guess it's you, ma'am, so you're on.

My name is Natalie Cooper and I'm here to express my strong support for AB 3156, a Bill designed to safeguard the medical care rights of our most vulnerable populations by allowing them to use their primary insurance instead of being restricted to managed care medi Cal providers. The current law.

Under the existing legislation, disabled individuals who are clients of the Regional Center and have other primary insurance, so that's insurance funded by their parents, most likely must still use managed medical to access other services, such as IHSS, which is a generic service that we are mandated to use, and others.

This has led to numerous challenges for families with medically complex individuals who qualify for Regional Center services as they are forced into a limited pool of managed care providers, often resulting in the loss of continuity of care and access to necessary specialists. My friend Dylan Big D, who has autism, is significantly impacted by this current law.

Dylan is fortunate enough to have health insurance through Tricare for life, thanks to his dad, granddad, and great granddad, who were all combat fighter pilots with over 80 years of military experience and more than 300 combat missions. Their dedication and service provide Dylan with excellent insurance coverage and as an. And that coverage continues as an incapacity.

Sorry, incapacitated adult. However, due to the implementation of calaim and managed Medi Cal, Dylan cannot use his tricare and is forced out of his superior coverage. My son Collin suffers from an exceedingly rare and complex genetic disorder with only four documented cases known at this time.

This disorder includes twisting of his upper spine, joint contractures, limited functional use of his hands, seizures, cortical visual impairment, and extreme anxiety. The uncertainty and severity of his condition, necessity, except severity of his condition, necessitate access to top tier medical specialists.

Previously, our family managed to budget for high deductible PPO plan to ensure Collin could see the best doctors for his condition. However, the rollout of calaim drastically altered our situation. Despite obtaining letters from specialists underscoring the critical need for continuity of care and the detrimental impact of losing providers under managed medical, our exemption was denied.

Within four weeks, we lost access to specialists who had been crucial in managing Collins debilitating anxiety, a provider with whom he had finally connected. After trying at least a dozen others, the managed medi Cal system has proven to be insufficient.

There are little to no providers enrolled in the managed medical care plan in our county, leaving us without timely quality care. Continuity of care became impossible as many providers are unwilling to accept the Low reimbursement rates offered by managed Medicare plans.

Our primary insurance plans, once a lifeline, are now useless as we are forced to use only providers who are also enrolled in managed Medi Cal plans. The reality is that different insurance plans do not work together as promised by dhCs.

Dylan was turned away and denied care from a team of providers that took over a decade to assemble. The UC Davis Mind Institute, arguably the leader in autism research and care, will not take anyone with managed Medi Cal as a secondary insurance, regardless of primary coverage or other health insurance, but they did accept fee for service.

Medi Cal as a secondary. AB 3156 offers a Low cost solution to this problem. This Bill would allow disabled individuals like Dylan Collin and countless others to continue to use their primary insurance.

It will require dhcs to focus more on the needs of the population by soliciting stakeholder input through existing Medi Cal managed care plan Advisory Committee and take any necessary any necessary steps through additional plan or provider guidance, enforcement, or consumer outreach and education where necessary to address the issues raised.

This simple yet effective change would restore access to the essential high quality care that is critical for these individuals.

Passing AB 3156 will protect the health and well being of our most vulnerable citizens, including my friend Dylan, my son Colin, and countless other individuals with developmental disabilities who have primary health coverage but are the victims of the current system shortcoming. Let's fix this issue to ensure that no more families have to endure what we have faced.

Please support AB 3156 and help safeguard the medical care of disabled individuals across California. Thank you for consideration and your yes vote.

Thank you for joining us today. Very nice job on that. Okay, who wants to try to top that? No, go ahead, Chairman.

That's you, Assembly Member. Thank you, Mister chair and Members, it's a privilege to be here today to support these mama bears in their efforts for their children. What I would say. And also thank the Assembly Member and his staff for championing this cause. Also, after reading the staff analysis on this, I can't add to it.

Your staff and the Committee gets it. Absolute necessity that we continue to support these families in a manner that they used to have. And then when Calaim came in front of us, they got the rug pulled out from underneath them.

I don't know the situation, what works and what doesn't work in a manner, but we need to have a living document when we have calaim and flexibility to be able to adjust to this predicament. When Calium was put together, it really, in my opinion, focused on the mental health and homeless.

And all of a sudden we just kind of gathered up the developmentally disabled community and brought it forward with it. And it kind of seems to me that we're stepping over a dollar to pick up a dime when private insurance will pick up these specialists and no question, and saving the state money.

But when we do this managed care component, we are leaving out the health of the individual that we're supposed to be providing for through the Letterman act.

And so in one case, I would think that we are violating the civil rights of these individuals when we don't give them the equal access to care that they deserve, that others have. And so with that, I just respectfully ask for. I vote and I'm proud to sit here with these mama bears.

Thank you for being here. Yes, ma'am.

Oh, I'm Sue Natalie and I combined the speech so when she was speaking about Dylan, who lost all his doctors on May 2. That's my son. So, he's just the first example of, I think, that we know about in the State of California that lost all the health coverage because of CalAIM.

Well, thank you for taking the time to join us. Yeah, thank you. Excellent job. Thanks for having us.

Any other witnesses in support? Name, affiliation and position on the measure, please?

Vanessa Cajina, on behalf of the California Academy of Family Physicians here in support. Thank you. Hi. I'm Susan Hald, and I have a loved one with developmental disability also in support.

Thank you for joining us. Any other witnesses in support? About witnesses in opposition? Any witnesses in opposition? Seeing none. Let's bring the matter back to the dais. Colleagues, any questions, comments, or concerns? Seeing none. Assemblymember, thank you for bringing this forward. Nice job. You may close.

Great. Well, thank you so much. I would gladly not send this Bill to the Governor should it get out of appropriations, if dhCs, you know, we can resolve these internally. This is, I think, just a backstop and kind of concerned about the cost to, you know, put together a workgroup and report back to the Legislature.

But we'll take that up in appropriations. But really appreciate the consideration. And I'm always open to ideas or suggestions on how we can improve this for our disabled community.

Well, as you know, perfection is a word that's not often found in our dictionary here. So it's important to have individuals such as yourself to bring bills forward to fix what we've done in the past and make it as perfect as we possibly can.

So thank you, and as soon as we get a quorum, we'll take a motion and we'll take it up.

Great. Thank you very much.

Vote it out. Thank you for joining us. Thanks. Okay, I see Assemblymember Bauer-Kahan. So, let's call up item number 14, AB 2467. Assemblymember Gabriel, may I go forward? I apologize for not seeing you. I'm sure he would. He's the consummate gentleman. Please proceed when ready.

Mister Chair and Senator. Senators, I want to start by thanking the committee staff for their incredible work on this and their dedication to making the bill stronger for every woman in California. I'm proud to present AB 2467.

It is a first of its kind bill with expansive, mandated health coverage for those experiencing perimenopause and menopause related symptoms. The bill was created in part due to conversations we, as a legislature, had during hearings of the Select Committee on Reproductive Health, including a joint hearing with you, Mister Chair.

Thank you for your participation in hosting that hearing. We're in the year 2024, and women's health in relation to menopause is both understudied and underfunded. It is unacceptable.

In a study by bonafide on the state of menopause, only one third of women between the ages of 40 and 64 said their health care provider has ever talked to them about what to expect while going through menopause. In comparison, issues affecting men of the same age are widely considered medically necessary conversations that happen every single day.

Doctors are working hastily to make sure that men's symptoms are given the right treatment and women are trained to tough out the symptoms of menopause. As one of the leading states in the nation for healthcare, we're led half of our constituency down.

Every woman who lives long enough will experience menopause and deserves the treatment that will help them alleviate their symptoms and live longer and healthier lives. There are proven treatment options out there that women simply don't know exist or are not covered by their health care provider by their insurance plan.

The stigma needs to be broken and these treatments need to be at the forefront of women's menopause healthcare journey. With me to testify today is Ryan Spencer, representing the American College of Obstetricians and Gynecologists, and we have a statement from Lourdes Ione, our other witness, that my amazing staffer Hannah will read.

Please identify yourselves for the record before speaking.

Chair and members, Ryan Spencer on behalf of the American College of OBGYN's District Nine supporters of AB 2467. First, we'd like to thank the author for her leadership on the issue of menopause. She's been a strong voice and ACOG commends her for making it a policy priority.

Nearly 6000 women in the United States reach menopause every day, constituting up to 40% of their lives, with approximately 80% of those experiencing symptoms that disrupt their daily lives. Despite the availability effective treatments for these symptoms, individuals may struggle to access treatments due to lack of insurance coverage.

Hormone therapy, non-hormonal therapy and other medical interventions can prohibitively be expensive without insurance support. AB 2467 is a very important bill that ensure coverage of treatments deemed medically necessary for perimenopause and menopause symptoms. It recognizes the significant health challenges faced by individuals experiencing menopause and seeks to improve their access to necessary medical care.

It addresses this critical gap by mandating coverage for these treatments, ensuring that all can receive the care they need, and they deserve.

Ensuring comprehensive and flexible insurance coverage for menopause treatments is not just about improving individuals' quality of life, it is a public health imperative as untreated menopausal symptoms can lead to long term health complications and is essential to accommodate the diverse needs of individuals undergoing menopause and reduce associated health risks.

AB 2467 aligns with ACOGs commitment to gender equality and healthcare equity and acknowledges the unique health challenges faced by women, ensures they receive the care they need and like I said before, they deserve. For all these reasons, ACOG is pleased to support AB 2467 and urges your vote as well. Thank you.

Thank you. Thanks for joining us.

Yes, ma'am.

Hello. Good morning, Chair and members, Hannah Lee, on behalf of Lourdes Ione, and I will be reading her testimony. Good afternoon and thank you to Assemblymember Bauer-Kahan for championing this issue. My name is Lordes Ione. As the Governmental Affairs Manager and House Lobbyist for San Diego Gas and Electric.

I am a long-term member of this amazing capital community. In the 1900's, 1997, as a college graduate, I started my first job in the assembly as a receptionist for then Assemblymember and Budget Chair Denise Moreno Ducheny. In fact - sorry - menopause is a natural process, but it feels awful.

It's a mental and emotional roller coaster with wild swings. I'm irritable. I'm sad with no warning or reason. Physically, it's draining. I'm losing sleep, muscle mass, energy, hair and stamina. I sometimes don't feel like myself anymore. It's the most unnatural way to go through a natural process. Then I learn about hormonal treatment for menopausal women.

Progesterone for sleep, estrogen to ease menopausal symptoms, testosterone to maintain muscle energy and stamina. Yay, science and medicine save the day; boo, insurance policies obstruct my way. Yes, obstruct. My insurance company will not cover testosterone cost. Reason one, not medically necessary, their doctor said. I appeal and they deny me again.

Reason two, I am not male, their doctor said. I am confused by their doctors since they are not my doctors, and I am now forced to pay $450 per month to use testosterone as part of my menopausal care. Women produce estrogen, progesterone, and testosterone.

Testosterone is produced in similar quantities in women than in men, of course, but it's there and it's necessary. I'm not looking to win a bodybuilding competition. I'm just hoping to have the energy to get up and come to work in the morning without wanting to yell at people.

And I want to feel like myself again so that I may continue to contribute to this incredible community. Thank you for your time and attention. I respectfully request your aye vote on AB 2467.

Thank you. Nice job. Any other witnesses in support, name, affiliation and position on the measure, please step up.

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

Thanks for joining us. Yes, ma'am.

Suzanne Goodman, on behalf of the TEACH program, in support.

Thank you. Any other witnesses in support? Any witnesses in opposition? I think what we're going to have to do is. Well, you may be able to stay there. We need a couple mics though. Joel - oh, he's going to do it for you. You know the rules. We need you to identify yourselves and flip a coin. Yes, ma'am.

Mister Chair and members, Stephanie Watkins, on behalf of the Association of California Life and Health Insurance Companies, regrettably here in opposition. I would like to thank the author. I know that there's been a lot of work with committee on this bill.

Unfortunately, while we were minutes away from removing our opposition on an earlier iteration of the bill coming out of the assembly, the bill imprint today gives us great pause.

I think one of the biggest issues, as you'll look in reference to A, is the bill requires an inclusive but not limited to opens the door to go far beyond, I think, what we saw in the bill coming out of the assembly.

I think our concerns are, and it's been noted by Chaburb that this sort of opens the door to a much greater potential cost that was previously analyzed. I think we'd also have significant concerns about removing utilization management related to each formulation and associated method.

In addition to granting medical necessity standard to be determined solely by the providers, that gives us some pause. We also believe that the Bill removes any ability that we would be able to place quantitative limits on the Bill, on any sort of disease or diagnosis.

I think I would point out in two at least one option, each formulation of an associated Member method of Administration for the non hormonal medication for each menopause symptom. As it was previously stated, the symptoms for menopause can be quite broad.

We're sort of uncertain about how that would be interpreted and how we would have on our formularies coverage for every single solitary symptom. We think that that could potentially have a great significant cost and one that hasn't been previously analyzed.

So for those reasons, we would like to continue conversations if the Bill moves forward today, we'd also suggest that maybe Chaburp look at this iteration of the Bill to consider what those potential costs would be to the healthcare sector. Thank you.

Yes, sir. Robert Boykin with the California Association of Health Plans. Good morning again in opposition to this Bill, and I'd just like to echo. The comments of ACLA earlier. Thank you.

We're going to take some opposition. Other opposition? Is there any other opposition? Name, affiliation, position? We're seeing none. So, Member, thank you for taking the amendments you did, which are in print. From my understanding, there are some other amendments under conversation. I appreciate you continuing the conversation. I understand the concerns on the plans.

They need to know sort of what they're looking at in order to decide. You know, we've got premiums involved. And Shabirb, my understanding, is already taking a look at the, the amendments that aren't in print, figuring out the Bill in print, I guess correcting myself, actually, the brains are correcting me.

But I appreciate your continuing to work on this and see if we can't come to a resolution. It's a very, very important issue, as I mentioned during the hearing of, affects all of us, regardless of our gender, those of us who have spouses or loved ones or daughters.

It's an issue that we really need to grapple with and get a handle on. So, colleagues, any questions, comments, concerns? I don't see hands flying up. So I guess, Assembly Members, your lucky day. You get to close.

Thank you, Senator. And I do continue to appreciate your allyship and strong support on the issue of menopausal care, and we will continue to work. One of the issues just to address that was brought up is that often women, especially women who have risk of breast cancer, can't have systemic estrogen.

And what is currently happening is localized estrogen, which is safe for them, which is done through creams and gels, is denied.

And so part of what we're trying to do with the formulations is ensure that women can get the specific care they need, but are happy to continue those conversations and really appreciate the poise that the plants have taken along the way of being supportive of the effort.

And I know that they have a lot of women in their ranks who will need this care as well. So I appreciate that. Thank you.

Thank you very much. Thank you all for joining us. We got a quorum. We'll take a motion and we will vote, assuming Member Haiti. I need to ask your patience, because I jumped over Assemblymember Gabriel, who was here before you got here, and he was kind enough to defer to some Member barkayan. So, Mister Gabriel, step up.

Proceed when ready. This is for those keeping track. This is item number 10, AB 20316. Assemblymember Gabriel, pupil nutrition. Please proceed when ready.

All right. Thank you very much Mister chair and Members, for allowing me to present AB 20316. And thank you, Assemblymember Haney, for your graciousness. I will be accepting Committee amendments to strike titanium dioxide from the Bill.

AB 2316 is a bipartisan Bill that would prohibit schools from serving foods containing additive links to hyperactivity and neurobehavioral problems in children. Given these longstanding concerns in 2019, the Legislature directed the California Office of Environmental Health Hazard Assessment, known as OEHA, to conduct an independent and thorough scientific examination into the impact of synthetic food dyes on children.

In 2021, after an exhaustive review, OEHA issued a report with clear findings. Most importantly, the State of California concluded that, quote, consumption of synthetic food dyes can result in hyperactivity and other neurobehavioral problems in some children.

The report also found that current FDA approval of synthetic food dyes is based on 35 to 70 year old studies that were not designed to detect the type of behavioral effects that have been observed in children and that newer studies indicate that current FDA guidelines may not adequately protect children.

The conclusions reached by the State of California about the harm caused by these chemicals is consistent with that of many other nations around the world, many of which have banned, restricted, or required these coloring agents to include strict warning labeling requirements.

To be clear, this Bill will not result in a ban on any foods in California, nor will it result in any products coming off the shelf.

On the contrary, it will simply encourage companies to make very minor modifications to food sold in our schools to remove harmful chemicals and replace them with safer, alternative ingredients they already use in Europe and so many other nations around the world.

This simple change can make a huge difference, particularly for our students who struggle with adhd and other learning issues. As anyone who has watched a child struggle knows, it makes no sense to provide them with therapies and interventions in the classroom and then expose them to chemicals at lunch that will further exacerbate their challenge.

Finally, it's important to understand that more than 95% of the products served in schools are already free from these chemicals and that our number of school districts around the state, including Los Angeles Unified and Tahoe Truckee, have already stopped serving foods that include these harmful additives.

We have worked with stakeholders in opposition and have previously accepted amendments to delay implementation to give industry and districts time to comply and renegotiate contracts. Today, we are accepting amendments to remove titanium dioxide, which should remove the opposition from the Dairy Institute, the Ag council, and the American Chemistry Council.

This common sense measure is supported by doctors, nurses, teachers, school administrators, and cancer prevention organizations. It is sponsored by the State Superintendent of Public Instruction, Tony Thurmond, and supported by the La County Office of Education, CTA, CFT, the California Medical Association, California environmental voters, and more than 70 other organizations.

I'm very pleased today to have with me here to testify in support of the Bill, Doctor Juliana Mello, a board certified Ob GYN, and Kat Sultan Murad, a registered dietitian, nutritionist, and the food service Director for Tahoe Truckee Unified School District, which has already removed artificial dyes from their schoolfold. Thank you.

And at the appropriate time would respectfully request your.

I vote thank you. Thank you for joining us, Doctor. You must have enjoyed it so much last time you came back.

Yeah.

Please identify yourselves for the record before you speak and fire when ready.

All right. Thank you for the opportunity to testify in support of AB 20316. My name is Doctor Juliana Mello. I'm speaking on behalf of myself. I am both a physician and more importantly, a mother. I have two young sons, one who just finished first grade right here in Sacramento City Unified, and one who's a preschooler.

As a mother, I take great care to ensure my kids have access to nutritious foods that support their well being and development, both physically and mentally. In our home, we work hard to avoid foods that don't offer nutritious value and have been shown to cause harm. This is why I'm speaking to you today.

The overwhelming evidence shows that synthetic food dyes are making it harder for some of our kids to learn. Oeha's unprecedented, systematic, peer reviewed assessment looked at human evidence of what happens when kids eat dyes.

Animal studies of what happens to their brains and behavior, and all available evidence, including how dyes interact with the brain and brain signals that affect behavior. California State scientists conclusively determined that some kids suffer from behavioral effects after consuming synthetic food dyes.

The toxicological studies that the FDA relied upon to review these dyes and establish acceptable levels in the 1960s, seventies and eighties were not capable of detecting their effects on behavior in our kids brains. However, OIHA combined clinical studies of kids behavior and modern animal studies to conclude that these dyes can cause neural behavioral problems in some children.

Despite OEHA's comprehensive assessment, the FDA has no plans to reconsider the safety of synthetic food dyes and is not required to do so. This is why it's so important for California to act now.

Let's do what California State scientists say is best for our kids, parents and teachers, and end the use of unnecessary toxic chemicals in foods offered at school. I respectfully ask for your aye vote.

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

Good morning. Thank you Mister chair, Members of the Committee, thank you for your time and consideration for this Bill. I am a registered dietitian and school food service Director with 22 years in school nutrition programs.

With the last 13 years at Tahoe Truckee Unified, we serve 4100 students across 12 schools and across 723 miles covering placer, Nevada and El Dorado counties.

At Chaho Truckee School Food service 13 years ago, we rid our school meal programs and any competitive foods of dyes and colors and other artificial ingredients that we know are harmful to children. We have not experienced any negative fiscal impact on our programs. Participation has not declined.

To the contrary, and very thankful to free meals for all students. We see student participation almost rise threefold in the last four years for our district. In terms of school nutrition leaders, we are tasked with providing nutritious meals with wholesome, fresh meals for students that strive to achieve academic learning.

Focus and attendance for students every day throughout a child's k 12 journey, they learn about the benefits of eating a wholesome diet throughout the day, how to read nutrition labels, how to look within ingredients, and how it most importantly impacts their health, not just now and in the future.

Modeling and offering what's best for children on school campuses during the school day is important for academic achievement. What we offer in the cafeteria is an extension of the classroom. We are definitely a learning lab. Those 1215 minutes that students come in, we offer them healthy choices and they walk away ready to learn.

Comparatively, only 3% of ingredients found in school meal programs contain these dyes. Only 4% of 11,000 ingredients provided on the tray outside of the competitive meal program had these dyes. There are alternatives available. We provide that at Tahoe Truckee Unified.

There are many other school districts, both here in California and across the nation, that have been dye free. New York public schools are examples. Since the sixties have been dye free with artificial flavors removed from all of their meal programs. They serve about a million children every day.

I'm also a mother to a wonderful eight year old autistic boy who has developmental delays and struggles intellectually. He was nonverbal until age five and with his intellectual delays, he definitely has behavioral challenges. We avoid these dyes at home.

I see a direct impact when he gets his hand on certain food items that do have these dyes in them. Especially, he has a very limited diet due to food insensitivities.

In addition to our wellness policy at TTSD, we support not using any of these foods for rewards, especially during the school day and for any type of fundraising. I really appreciate your time and your efforts to hear our testimony and I hope that you will support AB 20316. Thank you.

Well, we appreciate your time and the fact that you came to testify, so thank you. Other witnesses in support name, affiliation and position on the measure only, please.

Mister Chair Brandon Marchy with the California Medical Association in support.

Thank you. Ryan Spencer with Environmental Working group, co-sponsors, measure and support. If you don't mind a couple organizations, I've asked me to also register support as well.

Cleanerthforkids.org, comma Northcounty Equity and Justice, equal echo cess to sustainability, peeps, North County Climate Change alliance, environmental Health Trust, facts family advocating for chemical and toxic safety, clean water action, and the California nurses for environmental Health and justice. Thank you. Thank you, sir. Yes, sir.

Good morning. Matt Lager with SEIU in support. Thank you, sir. Next. Hello. Sam Nasher on behalf of the Los Angeles County Office of Office of Education support. Thank you. Kristen Zelhart, I'm with eat real in full support. Thank you. Chris Myers with the California School Employees Association and support. Thank you. Good to see you. Thank you.

Good morning, chair Members. Kai Cooper, on behalf of breast cancer prevention partners and strong support. Thank you, ma'am.

Now let's turn to witnesses in opposition. Lead witnesses in opposition. You feel free to come down to the table.

Thank you, sir. Just identify yourself for the record and proceed when ready.

Thank you. Chairman Roth, I'm here today representing the Consumer Brands Association. I'm Doctor James R. Coughlin, a PhD in nutritional toxicology. I received my master's in food science and technology, my PhD in agricultural and environmental chemistry and postdoctoral training in environmental toxicology. Right down the interstate there. UC Davis in the seventies.

I'm also a resident of Orange County. For the past 33 years, I've been engaged specifically in these color related activities here in California.

Since the Legislature first funded the OEHHA Risk assessment and review, I had the opportunity to view the September 2019, 2 Day symposium, and I've also reviewed the OEHHA report from 2021 and the subsequent review paper that Miller published in 2022.

With my experience around the world, I'm also very familiar with the evaluations that have been performed over many decades by various national and international bodies. Us FDA, Jakva, the European Food Safety Authority have done evaluations over many years and they have concluded that there is no causal relationship. And I want to make a strong point of that.

There is no causal relationship that's been established between dietary exposure to these colors and any health concerns for children and other age groups. In addition, these other agencies I'm talking about have decided not to Institute risk management policies. They didn't think they were warranted.

I do disagree with OEHHA's report and the Miller subsequent report that was published in 2022. Their conclusions that these associations have been observed in studies that they reviewed, I don't believe they are evidence of a causal relationship between the colors and adverse neurobehavioral effects.

The conclusions of both reports say that an Association, not causality, may exist, but I believe this is based on insufficient scientific evidence. Even the titles of both reports, the Miller Report and the OEHHA report, the first word in the titles of the reports are potential effects.

We don't usually in my world of food safety, take strong actions against chemicals where we only believe there are potential effects.

So the discrepancies that I've looked at in OEHHA's report and in Miller's conclusions, and those of expert food safety bodies around the world raise serious questions to me about the validity and merit of OEHHA's investigations, assessment and conclusions. Let me mention just a couple of these severe limitations that I consider that are severe limitations.

Miller reviewed 25 randomized controlled trials that examined the effects of colors on various neural behavioral outcomes. Again, these studies provided no conclusive evidence that any of the colors have been shown to cause these adverse neurobehavioral effects.

In addition, the studies provided no scientific evidence that eliminating these colors from the diets of children would have a successful means of reducing or eliminating the observed effects.

And in fact, the Miller review paper, which was seven of the authors, who were seven of the 15 authors of the OEHHA report, they did not conclude that these synthetic colors should be banned for consumption by children. And the last sentence in their abstract. A very important part, part of every published paper is the abstract quote.

There is a need to reevaluate exposure in children and for additional research to provide a more complete database for establishing adis protective of neurobehavioral effects. So the results summarized in these two reports, I've looked at all of them. They do not demonstrate any large magnitude effects. The studies, most of them were small in nature.

There was inconsistency across the studies. And very important to us in the world of toxicology is there doesn't seem to be a dose response relationship between the chemicals increasing the dose and increasing the effects.

So finally, considering the many limitations and the influence of many confounding factors on the health outcomes that were reviewed in both reports, I believe it would be scientifically unfounded and unnecessary to consider banning these synthetic colors in foods and beverages destined for California school kids, mainly because it seems to be based on insufficient scientific evidence of a causative relationship. Thank you.

Thank you. Thank you for your testimony. It's an important issue. Yes, sir.

Good morning, chair Members Adam Wrigley with the California Chamber of Commerce, in respectful opposition to AB 2316. I want to begin by thanking the chair and Committee consultant and the author for striking Titanium dioxide from the Bill. Regrettably, we still have significant concerns with the Bill.

As noted by Doctor Coughlin, we don't agree with the science that supports circumventing FDA to pass bans on these colors. Our members take very strong pride in making sure our products taste good, look good, and most importantly, meet California's stringent nutritional standards.

To accomplish this, our food producers spend a tremendous amount of time and resources ensuring that we have the best available science to dictate how products are made. That's why this Bill is troubling for us.

Because, as cited, the OEHHA relies on 27 studies, 24 of which are now 30 years or older, to come to the conclusion that certain dyes may be exacerbating hyperactivity in young children. The FDA, for example, contrasts that by reviewing 33 studies, some of which are notably overlapped with the OEHA report.

And they conclude the exact opposite, that there is no causal relationship, as Doctor Coughlin articulated, between artificial food colors and adverse neurobehavioral effects in children. Further, the 2021 gentry study found that available animal and mechanistic studies that OEHHA rely upon lack consistent evidence of neurobehavioral effects.

And they conclude, quote, the evidence is insufficient for a neurobehavioral quantitative risk assessment. In other words, the evidence lacks the strength to be relied upon for neurobehavioral quantitative risk assessment, end quote. There is substantial disagreement among scientific opinions on whether these colors have any impact on hyperactivity in children.

Nevertheless, even if you take a precautionary principle and adopt OEHHAs perspective, this Bill still exceeds the own the science that OEHHA relies upon. For example, not a single one of the studies that OEHHA relies upon tests children over the age of 15. And yet this Bill applies all the way through high school.

The Harley study from 1978, they look at three through 12 year olds. Pollock and Warner, 1992 through 15 year olds. McCann 2007, through only three year olds and 8 and 9 year olds were studied. Row and Row, 1994. Goyette 1978 Stevenson 2010. All only looked at young children.

So while we strongly disagree with any policy banning these FDA approved colors and urgent no vote today, we must emphasize that AB 2316 should at the very least be further amended to be consistent with the very science that OEHHA and the sponsors and the author is relying upon. And for those reasons, we must respectfully oppose. Thank you.

Thank you. Any other opposition witnesses? Name, affiliation, position on the measure only, please.

Mister chair Members, I'm coming in out of order, actually in the support category. Office of Cat Taylor and Foodsafe, LLC. Appreciate the Committee's indulgence.

Thank you. No problem. Next, please.

Thank you. Dennis Albiani with the American Beverage Association. We continue to oppose. Thank you.

Peter Kellison, on behalf of the National Confectioners Association, in opposition.

Thank you

Margie Lie, on behalf of the California League of Food Producers and respectful opposition.

Thank you.

Rob Spiegel, California Manufacturers Technology Association, in opposition.

Thank you. We bring the matter back to the dais, colleagues, any questions, comments, concerns? Then I'll say something. You know, I'm. I appreciate all the testimony, particularly those of you at the table here. I'm aware of the State of the Science and the scientific studies and the fact that we seem to be on the sidelines watching a.

A battle of the scientific studies. I am concerned and would certainly appreciate, have appreciated having more certainty in the scientific results presented. But I'm also acutely aware of the fact that this is different than what happens at home under parental supervision or what happens outside of the school setting.

We're talking hear about what happens inside of our California schools where we require, generally, in one way or another, kids to attend, and where we provide food products to kids while they are in this controlled environment, generally outside the supervision of their parents or any of the rest of us, other than the teachers and the hardworking aides and other professional staff that work in the school settings.

And I think in that circumstance, I think as legislators, we need to pay particular attention and even be more careful than we would normally be where there is any suggestion that food products provided to young people in school settings may have adverse effect on them.

And so while I, had there been a little bit more certainty, I might have been inclined to take a different position. I'm just not in a position to guess wrong. And so I'll be supporting the measure today, and we'll see what happens when we get a quorum and we take a motion.

But with all of that, Assembly Member, I appreciate, you know, what I think of your hard work and your professionalism, so I'll let you close.

Thank you. Thank you very much, Senator. And I, too, have really enjoyed the thoughtful conversations and the thought provoking conversations and appreciate the spirit in which you've approached this.

If you might indulge me, I just want to say a few things about the OEHHA report since, since the opposition talked about that, and then maybe just make a broader point that I think is worth noting. So here's what the OEHHA report said. This is what Aweha says about its own report.

It says this report is the product of a two year, multifaceted evaluation of seven synthetic food dyes that have been approved by the FDA. OEHHA extensively reviewed existing studies on the effects of these dyes in both humans and laboratory animals. It goes on to talk about all of the evidence that they collected from the human studies.

And it says these studies demonstrate clearly that some children are likely to be more adversely affected by synthetic food dyes than others. Animal studies indicate synthetic food dyes affect activity, memory and learning, cause changes in the neurotransmitters in the brain, and cause microscopic changes in brain structure.

Then go on to talk about how, in preparing this, they collaborated with scientists at UC Berkeley and UC Davis, that they actually invited the public to submit information on this, that they conducted a symposium to have discussion from researchers, academia, and industry and government. So they actually invited industry to be collaborators there.

And then they took a drafter version of the report, and they released it for comment by Members of the public. And they also had external peer review by experts identified by the University of California Office of the President.

So what I see from OEHHA here is a very thorough, very patient, very extensive, very comprehensive survey of the scientific literature and the scientific research. It's not surprising to me that the opposition could find maybe one or two people that would come up here and contest that science.

But I think what you see from OEHHA is, for them, it's a settled question. They feel very comfortable and very clear about what the research and the evidence demonstrates to us here today. The additional data pointed out to that is that other jurisdictions have already reached the same result.

This is a lighter touch approach than they have in Europe. In Europe, they have either banned these food dyes entirely from any foods that are allowed to be sold in commerce, or they have required manufacturers to put a label on the product that says, warning, this can harm your kids. That's literally what is required from that.

So I think, to me, this is a very, very light touch approach. I think the burden on industry at this point is I don't understand what the burden might be. We're giving them more than three years to come into compliance here.

There's no dispute here that there is less than 5% of the foods served in our schools have any of these dyes. They are non essential ingredients. They are not required for any products. You've heard that major urban districts like Los Angeles unified have done this. Rural districts like Tahoe Truckee have done this.

So I think this is well within our ability to do. And I appreciate what you said here, Senator, that, you know, when we're faced with some. You know, when we're faced with some choices, to come down on the side of protecting kids is the right way to go if it makes you feel better.

Last year, as you remember, we had a conversation about the California Food Safety act, where California became the first state in the nation to ban four chemicals to get ahead of the FDA. And we had this conversation with a lot of the same opposition who came in and made the same arguments. The science is mixed.

The evidence is mixed. Maybe we shouldn't be doing this. We should rely on the FDA.

I'm proud to report that since we passed that Bill, and actually, just earlier this week, the FDA announced that brominated vegetable oil BVO, one of the chemicals in the California Food Safety act, will no longer be allowed to be used in foods sold in the United States of America.

And I'm very confident and understand from people in Washington DC, it is because California took that action that the FDA felt compelled to step up. But let me share with you how far we are behind the rest of the world. The UK banned BVO in 1970, more than 50 years ago. India banned it in 1990.

The EU banned it in 2008, and Japan in 2010. And yet, despite all of this, these very same opposition witnesses came in and really made exactly the same argument to us. The science is mixed, the data is mixed. Let the AFDA do its thing.

And it's only because California stepped up to the plate and did that, that we were able to put that pressure on the FDA to ultimately reach the conclusion and bring us into line with the rest of the world.

As you and I have talked about, for reasons that have been shocking to me, the United States is really a global outlier. And I will conclude by sort of thinking about the testimony of these two witnesses.

I approached this first and foremost as a parent, as the father of three young kids, of a four year old, a six year old and an eight year old. I had always assumed that there was someone in Washington DC watching our back that was protecting my kids.

And it was frankly shocking for me to uncover how far behind the rest of the world the United States is when it comes to food safety. And for me, this is a settled question.

There's been back and forth, and that's the reason the Legislature put money in the budget and said, let's ask people who don't have an economic interest in this, who don't have a dog in the fight, you guys take a look at it. And that's what the experts at the UC did. That's what the folks at Oeha did.

And I think they left us with a very, very clear understanding of the harms here to our kids. And so on behalf of our kids, would respectfully request, an aye vote.

Thank you. Assemblymember. As soon as we get a quorum, we'll take a motion and we will take a vote.

Thank you.

Thank you for presenting, thank you all for joining us and for your testimony. Excellent job. Next item, item number seven, AB 2115, Assembly Member Haney. Thank you, sir, for your patience. Proceed when ready.

Thank you, Mr. Chair and Members. As we know, we have a devastating, deadly opioid overdose epidemic that is ravaging our state. We're now losing over 11,000 people a year to drug overdose. Thankfully, there's a treatment for addiction to opioids, which is responsible for taking most of those lives. Methadone is the most effective, proven treatment for people with opioid addiction. It helps them change their lives and transition to sobriety and normalcy.

It works by easing the debilitating symptoms of opioid withdrawal for people who have, who want to quit drugs like heroin and fentanyl. It also reduces the likelihood of dying of an opioid overdose by more than 50%. Yet fewer than one in 10 people in the US who with opioid addiction are currently enrolled in the treatment. And as I said, thousands of are dying each year.

During the Covid-19 pandemic, the federal government relaxed many methadone restrictions to make sure that we could get more people onto methadone and off of these deadly drugs and increase patient access. In April of 2024, the Biden Administration, recognizing that reducing treatment barrier saves lives, adopted the Covid-19 rules and made them permanent.

However, California continues to have outdated methadone policies that are more restrictive than federal regulations and are actually more restrictive than most states in the country. As a result, many people cannot access methadone who need to. These intense requirements, like standing in line every day to receive a single dose of methadone, often dissuade patients from pursuing care.

They have to spend far too much time getting enrolled and staying enrolled that other aspects of their recovery, like finding a job and stable housing, is interrupted. I'll also say that one of the things that we're seeing in urban areas, particularly in my City of San Francisco, is people are having to line up every day for methadone.

And the result is that drug dealers often prey on them by surrounding those clinics and trying to get them back onto these illegal drugs. In order to confront this opioid epidemic, we have to get people onto medications that can save their lives, that can help them. Methadone is the best way to do that.

And by making sure that patients can easily access treatment and remove ambiguity, we will prevent unnecessary deaths and we will help many tens of thousands of Californians. With me today in support of the bill is Dr. Jeffrey Hom from the San Francisco Department of Public Health and Dr. Leslie Suen, an Assistant Professor of Medicine at the University of California, San Francisco.

Thank you for joining us. Please identify yourselves with the record before proceeding. Proceed when ready.

Great. Good morning, Chair Roth, Vice Chair Nguyen, Members of the Health Committee. Thank you for the opportunity to testify in support of AB 2115. My name is Jeffrey Hom, and I'm a senior physician in behavioral health in the San Francisco Department of Public Health, where I help lead our overdose prevention efforts.

As you know, overdoses remain a profound public health crisis nationally and in California. During the first 4 hours of this hearing alone, five more Californians will die of an overdose. While deaths are often the most highlighted manifestation of our overdose crisis, hundreds of thousands of Californians live with and often struggle with opioid use disorder.

Fortunately, like other chronic illnesses, opioid use disorder can be effectively treated with medications. Methadone is the most well studied of these and reduces the risk of dying by 50%. Despite this, fewer than 5% of the nearly 1 million Californians with opioid use disorder receive treatment with methadone.

We must increase access if we are to turn this crisis around and save lives. AB 2115 will help do this. This bill will allow for clinicians to provide 72 hours of methadone to patients to treat acute withdrawal symptoms while referring them to an opioid treatment program. AB 2115 simply aligns outdated California law with federal law, which was recently updated to meet the needs of people with opioid use disorder.

Other jurisdictions have successfully implemented this federal law. It is not untested, but instead has been shown to be an effective way to get patients this life saving medication as a bridge to an opioid treatment program. That is what this bill will do. As a physician, I have seen the tragic health consequences of severe opioid use disorder.

But I've also seen how well people do when given the right supports. Recovery is possible, but we must ensure people across California have every opportunity to start this medication. And so I respectfully ask you support AB 2115. Thank you, and I'm happy to take any questions later.

Thank you. Next, please.

Thank you. Good morning, Esteemed Chair Roth, Vice Chair Nguyen, and Esteemed Members of the Committee. Thank you for the opportunity to speak with you today. My name is Dr. Leslie Suen. I'm an Assistant Professor of Medicine at the University of California, San Francisco.

I am an addiction medicine physician and primary care doctor providing substance use treatment in San Francisco. And I also work as a health services researcher in addiction policy at UCSF. I'm speaking on behalf of myself today in support of AB 2115. Methadone is our nation's oldest medication for opioid use disorder, with over five decades of evidence showing reduction in deaths, drug use, crime, and improving rates of recovery.

Methadone is also the most highly regulated medication in our country. In fact, California is the most restrictive state, one of the most restrictive states when it comes to methadone regulation. Many patients have actually nicknamed methadone liquid handcuffs because of how disruptive being on methadone is to their daily lives.

For example, under current state California regulations, patients enrolled in methadone are required to visit the clinic every day for months to be observed while taking their medication, often commuting several hours each way. During the Covid-19 pandemic, the federal government loosened restrictions to allow patients to shelter in place at home. This included patients allowing them to receive doses of methadone that they could take home instead of having to come to the clinic every day.

Research from our top national agencies, including the CDC and the National Institutes of Health, have revealed that with loosening restrictions, patients were more likely to be retained in treatment and reported improved quality of care without increases of concerns around diversion or increases in overdose from methadone. Based on these data, the federal government codified these exemptions into law earlier this year.

However, we as physicians in California still must abide by these state restrictions from the pre-Covid era, preventing our ability to provide up to date care. If passed, 2115 would codify these new federal regulations into California state law, allowing substance use treatment providers like myself to follow federal guidelines on methadone treatment and reduce barriers to accessing care.

Individuals would be able to receive more doses of methadone to take home when they enter treatment and obtain stability, avoiding disruption to other parts of the recovery like obtaining a job or getting into housing. Further, individuals will not be kicked out of treatment for declining to participate in counseling, and AB 2115 would also ease pathways into enrolling into methadone treatment and reducing administrative burdens on methadone clinic staff.

By updating our state laws to follow a federal guidelines, our AB 2115 would allow us to, as substance use treatment providers, to follow the evidence, reduce barriers to treatment, and thereby improving our ability to address overdose deaths in this country and our state. Thank you inviting for me to testify, and I look forward to your yes vote.

Well good. Let me deviate from my normal practice and just ask a question at this point and then we can take the other supporters and any opposition. How well do you think we're doing in terms of tracking process? In other words, monitoring those who actually cross the bridge to treatment. And where would I go to find that tracking?

So, in our State of California, as me, as a physician, every time I prescribe a controlled substance, I have to I am required to check our prescription data monitoring database, also known as CURES. CURES database keeps track of all prescriptions for controlled substances from clinics, hospitals, emergency departments.

And as a physician, I have to check it every single time. And so the point of CURES is to prevent diversion, improve safety, prevent adverse events for patients, so that I am not prescribing a controlled substance for someone who may not, it may not be appropriate for. And so there are data tracking systems.

I also understand that our California Departments of Public Health also track data statewide, especially around controlled substances. So there are many layers of protection. And in addition, around the 72 hours rule specifically, in Section one, AB 2115, there are specific regulations and handrails that have been in place from the DEA. And so a lot of the safety and the guardrails have already been put in place at the federal level.

So when you dispense, because it's dispensing, right, methadone, is that dispensing act entered into CURES?

Yes. So it would be. Under this bill, 72 hours methadone, because it's dispensed from hospitals and clinics, or, sorry, in clinics specifically, it would be entered into CURES.

And my question then points to what some would call a warm handoff from the point where, as a clinician, you're dispensing a 72 hours dose or doses of methadone, what tracking shows that you've provided, which I assume is a requirement, a warm handoff to a substance abuse treatment provider? And where would I go to find that?

And how successful are we doing, those of you who are in this business, how successful are you in providing the warm handoff? And what tracking is there that extends after that to determine whether or not the individual actually makes it to substance abuse treatment?

These are wonderful questions. So thank you, Chair. I will defer the second part of the question to Dr. Hom, as one of the leaders of the Department of Public Health. But to your first question, if I understand, the question is around how well do we do warm handoffs to our colleagues in substance use treatment clinics? Is that correct?

And where is that reported?

Gotcha. So it is documented in our medical record. We have to document, first that we check CURES. It also is recorded in our medical records often, you know, what the result of our check was. We also document our handoffs to other providers. Oftentimes, however, as people who work in clinics or emergency departments and hospitals, we work during many hours of the day, well into the night. And many substance use treatment clinics, including narcotic treatment programs, are only open during mornings and often close by 2:00 PM.

And so if we are taking care of a patient from the hours of 2 to 5:00 PM, which we often do as regular business hours, we may not be able to actively do a warm handoff and call the clinic just due to the business of nature business hours. And so as you can see, there are many, many barriers for people even accessing treatment, even for people, for providers of myself to even do those warm handoffs, but everything that we do do is required to be documented in the medical record.

And it wouldn't necessarily need to be the actual physician who's doing the dispensing to provide the warm handoff. It could be someone inside your organization with permitted access to the medical record to do that, correct?

That is correct.

Does that occur?

Yes. I mean, as Dr. Suen mentioned here, that as referrals are made and as warm handoffs do occur, that documentation does exist within the referring provider's chart. So...

So where... So, but the medical records are obviously protected by HIPAA. And we wouldn't need to have specific, personally identified data to determine the success or failure of this program. There ought to be a way to track, from the point of dispensing to the point of link up with a substance abuse treatment provider, the success or failure of this program, because the program doesn't start and stop with the dispensing of the methadone, right?

Correct.

So how do we... You know, I have an interest in this, and I wasn't able to achieve any agreement on language. But how would we do this to, to determine the success or failure of this program?

Shouldn't there be some reporting requirement somewhere, however cleansed of personally identifiable data, to determine when a physician has an individual who needs methadone for purposes of breaking the link and moving towards substance abuse treatment? Shouldn't we have a reporting process that shows us that we're actually making connection with these individuals?

Absolutely. So thank you, Chair. I appreciate these questions, and I think something that Dr. Suen and I have sort of thought a lot about. I will say that we support this idea of a reporting requirement. This is very important to us, both as physicians and as sort of health services researchers. As you heard mentioned. We believe that the correct place to store these data is the CURES database. Under AB 2115, Section 1C, which does refer to the Health and Safety Code 11165.

Does require that physicians and other clinicians who are providing these doses of methadone, just as with other controlled substances, would be reporting into the state's prescription drug monitoring program known as CURES, which has existed since 2003 and managed by the California Department of Justice and made permanent as a permanent program in 2003.

And the data that are captured here include the number of unique patients who are receiving medication through a program, the number of repeat visits, the number of doses dispensed in total. And so as of right now, we can sort of look and say numbers...

And the number referred to substance abuse treatment providers. Because there's an end... You don't provide the substance abuse treatment generally.

Absolutely. So the way that 2115 is sort of written is that by providers providing 72 hours worth of methadone, that data can be pulled from CURES to sort of see, oh, these were the number of, in aggregate, to your point, these are the number of individuals who received a prescription for 72 hours methadone, which can then be followed to see which percent.

What number of individuals did follow up at an opioid treatment program? In the same way that we use CURES data, as well as looking at other controlled substances to follow treatment. For example, with buprenorphine, we can tell you right away that in San Francisco County, for example, in 2012, 2529 individuals received buprenorphine.

We can then sort of look to see what individuals were retained in care over time. And CURES is the database that we believe is the most appropriate one because it's available to specialty providers as well as non-specialty providers for whom 2115 is most applicable in providing treatment.

And how do we find out the last piece? Is it because if someone has transitioned to a substance abuse treatment provider, there'll be prescriptions that are entered into CURES that you can track by name?

So CURES, CURES as it exists, is the one data system that all providers in California who work with any degree of sort of prescribing of controlled substances do have access to.

So someone could track a person by name through CURES to find out that they were at a substance abuse treatment facility and received prescriptions for something there? I'm just trying to... How do I, if I come to you with an addiction, and you dispense 72 hours of methadone to me, and you enter that in CURES and you refer me to XYZ substance abuse... I apologize, folks. But refer me to XYZ substance abuse treatment facility, how can anybody tell that, assuming they're authorized to access CURES? Am I asking... I'm not a healthcare provider. So.

No, this is a wonderful question. So I just wanted to clarify that because there are so many protections around methadone treatment in general, especially around 42 CFR Part 2, that in order for someone to even access whether someone is actually linked to a narcotic treatment program, there are many many, many layers of protection, so much so that many narcotic treatment programs actually don't even report to CURES because CURES does not, would not fulfill or is blocked by 42 CFR Part 2.

And so the only way that we as healthcare providers can actually track someone's linkage is very, through multiple onerous ways of getting multiple consents from the patient in the moment that only lasts for three months at a time. And so in order to track people actually entering into a narcotic treatment program, that will require a lot of revamping and a lot of additional restructuring of how we track our substance use treatment programs across the state.

That's very helpful. What it tells me is that this would require a different system somehow to be utilized that does not involve the personal identifying information. Because I'm not necessarily interested in whether I, I'm interested, but it's not necessarily significant from a policy perspective to know whether I was referred, whether I successfully completed.

But in the aggregate, we need to know that if we're dispensing methadone, how effective are we in getting people to substance abuse treatment and getting them through treatment successfully? Does that make sense? Doctor, you're in the business. As a policymaker, how would I decide whether this program is effective under the current circumstances? By the number of people that are still on the street.

So, one thing I also want to clarify, so thank you for these points, that it is a really important thing. And I would sort of again reiterate that we do believe in the importance of a reporting requirement. Both of us have spent time in one of, at least one of our methadone clinics in San Francisco. And as part of our normal clinical practice, when we're admitting someone, we do check the CURES database.

In doing so, we would be able to see, prior to us dispensing our first dose of methadone from an OTP, we would be able to see in that moment if the person did receive 72 hours of methadone prior to reaching our practice. So as a clinician, if I am sitting in front of a person who is new to my practice, I can look at the CURES database and say, oh, they received 72 hours of methadone prior to me dispensing that first dose from an OTP.

What report do I... So I'm not a healthcare provider. I don't have access to any of these systems, never will, don't have access to anybody's medical records. Shouldn't. What report do I pull off the shelf to find out how effective this methadone program is in terms of getting people into treatment and successfully through the process? Because I can't access CURES.

I think one thing that I would probably rely on is probably our Medicaid database, when we know that many of our patients who are on methadone belong to safety net systems and do have Medicaid insurance. And so through Medicaid, narcotic treatment programs do have to build for services through the Medicaid insurance.

And so we, as many healthcare researchers do, can track Medicaid claims data over time and see that a person has linked from receiving Medicaid service through a hospital of 72 hours of methadone and then can actually see at a population data level that they have continued to link through other...

This is obviously more complicated than I'm going to be able to work through in the four weeks that I have left in this business. But I thank you for tolerating me, those of you in the audience and the author, for tolerating my questions. I do think this is an area where we need to focus. We're dealing with support, so are there any supporters? Name, affiliation, and position on the measure, please.

Mr. Chairman and Members, Paul Yoder on behalf of the City and County of San Francisco and Mayor London Breed in support. Thank you.

Thank you. Next, please.

Leah Barros on behalf of California Hospital Association in support.

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

Cathy Senderling-McDonald for the County of Alameda in support.

Thank you.

Kelly Brooks on behalf of the California Association of Public Hospitals and Health Systems and the Santa Clara County Board of Supervisors in support.

Thank you. Next, please.

Good morning. Dylan Stapleton on behalf of Lieutenant Governor Eleni Kounalakis in support. Thank you.

Thank you.

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

Thank you.

Geoff Neill representing the County of San Diego, also in support.

Thank you.

Yarelie Magallon with Political Solutions on behalf of the County of San Mateo in support.

Thank you. Next, please.

Good morning, Chair and Members of the Committee. I'm Jennifer Alley. I'm the Executive Director for the California Opioid Maintenance Provider Organization. We actually have a concerns position on the bill. If I could add a few comments, please, I would appreciate it.

So, first of all, I'd like to thank the author and his staff and the committee and staff for the thoughtful discussions and work that we've done. We've made a lot of improvements in the bill since it was introduced. And, you know, we really just rolled up our sleeves. You know, COMP fully supports increasing access to opioid use disorder medications.

But we have had some safety and some questions about the bill. Specifically, right now we're looking at a bill that will create a new and untested program in California. And we think that it's critical to evaluate the safety and efficacy of this approach.

As such, we're requesting data be reported into existing SUD systems that the state already has, such as CalOMS DATAR. Specifically, the number of patients receiving medication under the program, the number of repeat visits by patients. So somebody that received a 72 hours dose and then went back, was unsuccessful in entering their treatment that may have gone back to the clinic for a second 72 hours dose.

The number of doses dispensed to a patient in total, so that they go three times, four times, five times, once, and the number of admissions to treatment and community programs. We think it's critical to determine how this approach to opioid use disorder in the community works. And again, we'd like to thank the author and staff for their comments.

And if we don't, you know, if we can't get an understanding on how effective, safe, or unsafe this approach to treatment could be, then we recommend considering simply a pilot program limited to San Francisco before we go statewide. Thank you, and I'm happy to answer any questions.

Thank you. Any other witnesses? Okay, witnesses in opposition? Seeing none. Bring it back to the dais, colleagues. Senator Nguyen.

Thank you, Mr. Chair. I have a few questions. One is this is only for clinic that's registered with the Board of Pharmacy. So it's not like anybody, any physicians, or any that can just go out and subscribe these medications. Can you help me understand?

One is, do you know how many of these clinics are allowed in the state? And second is what are the criteria for these, for folks or clinics or facilities to become registered with the Board of Pharmacy? Like what's the criteria the pharmacy would allow, would approve such a clinic?

Thank you, Vice Chair. I don't have the exact numbers on hand. I'm happy to get back to you about some of those numbers if we can obtain them from the board of pharmacy.

But you're correct that this Bill, as written AB 2115 only pertains to those that both are licensed by the board of pharmacy as well as have a license from the Drug Enforcement Administration.

So it is not the sort of the picture of freestanding sort of clinics that exist and operate, and outside of having a very specific license by those two agencies. But I am sorry, I do not have the numbers.

No worries. So is it safe to say that every county facility should, or every county, their healthcare facility should have a clinic or two?

I think, you know, given that every county in California has been affected by the overdose crisis and is seeing escalating levels of overdose deaths, especially through the dominance of fentanyl in the drug supply, not only in opioids, but many, many other drugs that are particularly devastating our communities, particularly among young adults? I would say yes.

Okay, then my next question is the comment that was just made, is there an issue, do you have an issue in being able to include in the sud system the data of making sure that we know how many people are getting the doses, how many of them are potential repeat, how many doses that individual is getting weekly, monthly, et cetera?

So just to clarify, so the 72 hours section one part of AB 2115 this is only supposed to be a one time episode from a clinic to provide a link before they linkage to treatment.

Other states have already implemented this ruling, including in states like Massachusetts, Colorado, Oregon, and then also Washington, as well as at Johns Hopkins in Maryland.

And so many research from other states have already found that in places in clinics that did implement 72 hours methadone, that hundreds and hundreds of patients have been able to link over into subsequent substance use treatment programs.

And then also of the many hundreds of people that they have assessed, only less than 5% even had two repeat episodes. And so we know from experience from other states that it's very unlikely that people will have multiple, multiple episodes. And as already discussed with Doctor hamm, this data is tracked through cures.

And so the number of doses, the dosages that people receive, the number of episodes is already tracked through the data systems. And to add additional data systems that would also track. This may seem redundant and somewhat wasteful.

Okay, but are retracting. I'm not saying identify the individual, but are we tracking what cures that, you know, X patient has had two doses of these 72 hours or three doses.

I mean, so it's not just like, you know, a thousand doses that has been given or a thousand people received, but we don't know how many actual individual.. Okay. And does that, can you, Mister chair, can I ask a question? Sure, audience. Sure.

Well, the cures database doesn't allow for easily allow for searching based on a county or a city to determine the impact. Right. Because it's physician and patient.

So when you want to look and evaluate a program's effectiveness overall, I don't know how that's done through cures, which is very limited on who can access the data and how it can be evaluated. Right. You have to go through the Department of Justice. There's a very specific form you have to be approved. Right.

So it's just not part, part of the existing public health system that we've been building for years that includes not just ntps, but a variety of substance use disorder providers that all report information as they're required to when they receive federal funding, to file that information on their programs, their number of patients, what they're doing, their outcomes, and that type of thing.

It's important to know how public money is spent. Right. And so if you don't report the data, then you don't know that. And so this is a new program outside of this. And just for clarification, the other states that have implemented this have done it through a hospital system, which is a little bit different than a clinic.

And so it's just kind of the federal, you know, the 72 hours rule says hospitals or physicians, it doesn't say clinics. And so from that perspective, from our read on it, it is a newer type of system that's doing it. And so that's, again, why we think the data is so critical.

Don't not want it to happen, just want to make sure that we have the information moving forward and so that it's effective and safe. Thank you. Thank you.

Go ahead, doc.

Thank you.

I do want to point out that there are, there are, there is a process to access QRS data. There are safeguards that are built in place, as Doctor Nguyen has also sort of alluded to.

But I do want to sort of call attention to health and safety code 11,165 C two, section a, which does say that, you know, these data can be provided to public, private, or private entities as approved by the Department of Justice for educational, peer review, statistical, or research purposes.

If patient information, including information that may identify the patient, is not compromised. And this is why CDPH, the California Department of Public Health, has put on their dashboard the number of individuals who are filling a prescription for buprenorphine, the number of doses of buprenorphine dispense for the treatment of opioid use disorder.

Those data can also be available to both CDPH, other departmental, other state agencies to sort of look, to sort of see how many individuals are receiving more than one prescription. Researchers in San Francisco have done this for buprenorphine. As again an example, 1850 people in 2023 received more than one prescription for buprenorphine.

So extending this to include methadone would be the same process. It is available through cures. It is a process to apply for it and to justify the need for it. But it does exist in that system.

But as a public Member, can I get access to that information through cure? Are you saying like as a public citizen, lay citizen, as Senator, or is Janet Nguyen, I wanted that data, can I get access to it?

I think, well, to speak to Doctor Hamm's example, we would have to create those reporting systems through, for example, California Department of, you know, CDPH.

And it would have to kind of go through different levels of making sure that the data is secure and people who are accessing are, you know, that the data doesn't fall into the wrong hands.

So no is your answer. So someone like me, a public member, wants to get access to the data. Look, I voted yes on this and B and P, but now I'm questioning because we all know these individuals needs help and we want to be there. We want to help. So I have no reason why not to today.

But I'm hearing concerns is that, you know, we need the data because ultimately us doing this is to help these individuals to get into a program to get help. Once they get help, that's the result, right? We want them to get help because the 72 hours emergency is literally what it is. It's an emergency.

It shouldn't be abused, it shouldn't be repeated. It shouldn't be someone who goes, you know what? I'm going to go again because I need it, because I can't find it on the street, right? So we need these data.

And if the public can't get that data, and we can't even get a data that says, say, you know, I represent majority of the cities in Orange County and three cities in Los Angeles. If I wanted the data in Orange County, I wanted to be able to say, okay, Orange County, you have given out.

You've given out 1000 doses this month. And those thousand doses, there's only, there are literally 999 of them individuals. So one did twice that month. And of the thousand, all 1000 went into a treatment program. And I also agree with the chairs, like, what happens to them after the treatment program?

Did they get out of the treatment and actually head into the right direction or they went back into the system again. So I think data helps us and by, I don't want data that has any individuals names or anything identifying anybody in particular.

I think, though, is that the more data we have publicly, it gives us policymakers an opportunity to be able to find the pathway to success and not just a last, you know, a 72 hours option.

Thank you. And Senator Menjivar has got a question or comment in a second.

I think the issue is, as policy makers, we want to, we would like to know if those who are dispensing methadone and a particular facility or group of facilities, what your track record is for getting people into substance abuse treatment cures doesn't really provide that. To answer that colleague, Senator Nguyen's question, I've looked at the section.

DOJ will make a determination as to whether to release data to the public or entities. But it's research, education, it's a defined set of categories. And of course, the personal identifying data has to be redacted, but a defined set of categories of entities that are entitled to access cures other than physician providers, pharmacists and the like.

So I don't know that cures is the solution. Obviously, we don't have it in the Bill. Doesn't change what I'm going to do on the Bill.

But I do think at some point, those of you who are going to be around here need to take a look at this, because as policymakers, we should be able to evaluate whether the program, the 72 hours dispensing program, is effective or are we just dispensing methadone? To dispense methadone?

I realize you have good intentions, but unless there's a follow on by somebody, whether it's the person dispensing or someone else on the health facility staff, I don't know how effective the program is. But let me turn to my much smarter, harder working colleague, Senator Menjavar.

I know we've been asking the sponsors all these questions. Assemblymember I'd like to give you an opportunity on your thoughts regarding adding the data collection part, ensuring that you yourself can come back and review how successful it's been or not.

No, absolutely. And I appreciate the dialogue. And I think it is incredibly important, as we heard, to be able to assess whether this is effective.

Of course, when a Doctor or a physician is making the medical decision to prescribe a medication, that is first and foremost a medical decision that they're making with certain ethical and professional requirements with that, and then from there, the hope and the intention is that people continue that medication, and if they're continuing to come back and abusing the system, that is something that the doctors would be able to see, the hospitals would be able to see, and because of that, likely would not continue to do that.

I think we do need to make sure that we assess this program and that we have the adequate levels of data to do that.

It's my understanding from talking to the public health agencies, to the state, to the doctors, to the hospitals, that they believe that the best way to do that for us is through cures, and that creating an additional system of reporting actually would be not only potentially burdensome, but actually less accurate in many ways.

And so there was a lot of resistance to doing the amendment that was requested. In fact, most of our supporters said that they would be in opposition if we took that amendment. So it put us in a very challenging position here.

And I really appreciated the chair for asking these questions and for leaning on us to make sure that we follow this issue as this Bill hopefully moves forward, that we are looking at how to make sure it's successful, how to make sure the reporting is appropriate, that we follow up on this, and that we continue the conversation about how best to do this.

I, as you did, went to the experts and said, well, could we do this amendment on reporting that they've asked for? And all the folks who run their hospitals and our doctors and everything said, no, this is not the way to do it. This would actually create huge problems for us.

So that's sort of where we ended up, where we are.

But I think the intentions to have the right level of reporting and data and all of that, that the chair and the Vice Chair have spoken about is something I fully support, will continue to work on with everyone involved to make sure that we get right and make sure that this program is successful.

Well, let me just say this. I'm going to obviously support this. I think I supported it before and have continued to. I can almost assure you that cures does not provide the data that I'm asking for.

If I want to find out whether a clinic or a group of clinics, what your percentage of success rate is after dispensing a 72 hours dose of methadone in terms of getting people into a substance abuse treatment facility that is not going to cures.

If I were to gain access to cures, I would not be able to determine that data, given the fact that the identifying information from the patient is redacted.

And unless DHCs or some other government agency gets involved and does the number crunching, and maybe a government agency with full access to cures can do that and connect the dots. Maybe. But it's not going to happen for somebody like me with no authorized access fully to cures.

And so for those who say cures is a solution, I say bunk. I won't be here to engage in that conversation. My colleagues will be.

I hope we have a much more robust conversation because as policymakers we ought to be able to determine whether the folks that are dispensing 72 hours doses of methadone at their facilities are effective in moving people from the methadone 72 hours program into a substance abuse treatment program. I do apologize for spending so much time on this.

I commend the author for bringing it forward. I'll leave it to those who are going to be around to continue the conversation. May I? Is that your close Assemblymember?

That is my close. And I really do appreciate the engagement on this and you have Mike commitment on it to continue to work on it. And I think you've raised some very important issues and greatly appreciate your engagement on this. And with that, at the appropriate time, would respectfully ask for your aye vote and the opportunity to move forward.

As soon as we get a quorum down here, we'll take a motion and we'll do exactly that. Thank you very, very much for taking time out of your schedules to present. I apologize if I belabored the issue or badgered you with questions, but I appreciate your responses.

And I have 2893 for Ward. Where item 20.

You mean you want more? Let me make sure we have a reporting requirement here somewhere.

Item number 20. AB 2893 the supportive community residency program. And we'll continue to be supportive.

Thank you Mister chair and Members. I'm here to present AB 2893 which I am a proud joint author with Assemblymember Ward and will be accepting the Committee amendments.

This is really about getting people the right type of help that will put them in a situation where they can recover from addiction and to live safely in that recovery.

Right now we have a housing first policy that is out of step with the Federal Government's housing first policy, similar in some ways to the Bill that I just presented.

There are many thousands of people in our state who are ready to live in a drug free recovery environment, a strictly sober environment where the staff and the other residents there are committed to a path of sobriety. Right now, unfortunately, current law does not allow for any state funding to be spent on drug free recovery housing.

The lack of options forces people to live in housing that isn't best suited for their individual sobriety journey, and it can put them at a higher risk of overdose and falling back into homelessness. This is not saying that everybody should be put into that environment.

It's about having options, and there are many people who want that option, and yet the state is not supporting it. This Bill will ensure that California continues to provide options for harm reduction and also responds to our homelessness and addiction crisis by allowing up to 10% of state funding to go towards drug free recovery housing.

It also establish a state certification process for recovery housing through the Department of Health Care Services. It has received broad bipartisan support, and with me to testify in support of the Bill is Jason. We're up. Just Louis Moranti from the Bay Area Council.

Thank you for accepting the amendments. Assemblymember, please proceed when ready, sir. Identify yourself for the record.

Good morning, Mister chair. My name is Louis Morante. I represent the Bay Area Council on housing issues and I'm proud here to be a supporter of this Bill. The Bay Area Council is one of its sponsors.

I'm going to abridge my comments in the interest of your time, but I'm very proud to say that we work with a broad swath of our Members in the Bay Area to come up with this Bill, including the Salvation Army and many other homelessness services providers.

According to the US Department of Housing and Urban Development, the services provided by supportive community residences can and should be a component of any continuum of care. California's existing housing first law prohibits the state from funding SCR projects, and it is therefore out of conformity with federal best practices on the topic.

AB 2893 would bring California into conformity with federal guidance by allowing up to 10% of state grants with individual counties to support supportive community residence projects and would require the Department of Healthcare Services to establish criteria for certifying supportive community residents. For these reasons, I strongly urge your yes vote today. Thank you.

Thank you for joining us. Any other witnesses in support, please step forward. Name, affiliation and position on the measure.

Hello, Symphony Barbee On behalf of Planned Parenthood Affiliates of California in support.

Thank you, ma'am. Any other witnesses in support? Witnesses in opposition. It's your lucky day, Assemblymember. Given the last time. Would you like colleagues, any questions? Would you like to close?

Thank you. And thank you again, Mister chair. And respectfully, at the right time, when there's a quorum, I ask for your aye vote, thank you so much for the amendments and for your engagement on this as well.

We will do just that. Thank you.

Nice presentation. Thank you, Madame Majority leader. I see you there. Thank you for your patience. This is item number nine, AB 2223 cannabis industrial hemp. Proceed when ready.

Okay? Thank you, Mister chair and Senators. First, I would like to thank you and your staff for your work on this complex issue. I started working on hemp issues because the 2018 farm Bill unleashed a largely unregulated industry.

My first successful legislation was AB 45, which was the strictest hemp law in the country when it was enacted in 2021. But today, I am here to make sure that that law can be properly enforced and interpreted.

As the hemp market grows, we're seeing more intoxicating hemp products that are sold outside of dispensaries without age limits, which should be illegal. This Bill is another huge undertaking that takes on three issues. One is expands enforcement to crack down on illegal hemp products.

It's closing loopholes that will allow intoxicating hemp products, and it's making sure all intoxicants are in the cannabis supply chain, meaning full registration, full regulation, and taxation. I will continue to work with the stakeholders and state agencies and committees as we address the concerns about the best way to implement these changes.

With me, I have Amy Jenkins, on behalf of the California Cannabis Industry Association, and Tiffany Devitt, on behalf of the Joint Labor Management Council.

Thank you for joining us. Please proceed. Identify yourself for the record, though.

Thank you. Good morning, Chairman Roth, and esteem, well, missing Committee Members, but esteemed nonetheless. My name is.

It's a busy time. They're all over the building.

Indeed. My name is Tiffany Devitt, and I'm here on behalf of the San Diego Imperial County's joint labor management Committee, which is a partnership between cannabis labor and cannabis employers. I'm here to express our strong support for AB 2223.

Central to this legislation is a really important principle, which is that medical and recreational cannabis belong in the regulated medical and recreational cannabis marketplace, regardless of whether the THC was sourced from cannabis or hemp. Here's why. Hemp products with NeTHC, as we know, are vulnerable to misuse abuse.

The regulated cannabis market has countless measures in place to protect consumers, patients, and the broader community. The hemp market, on the other hand, is a wild west. It's characterized by frequently adulterated, mislabeled, highly impairing products that are triggering an increase in youth hospitalizations.

Full spectrum medicinal cannabis products with high ratios of CBD D to THC have been a cornerstone of the regulated cannabis market from day one. I understand and have great sympathy for patients today who are using hemp because medical cannabis is expensive.

AB 2223 does, in fact, address this to a degree, by allowing licensed cannabis manufacturers to use lower cost CBD hemp inputs. But what's important that we all understand is that the vast majority of THC hemp products are not medical and they are not wellness products.

Brands with names like knocked out sauce, El Chapo extracts, and I'll just say, f'ed up, rather than disrespect the Committee and say the actual name. Those brands are not selling medical products. They're selling hyper impairing, often synthetic cannabis that's unregulated, untaxed, and untested, put in California's public health and safety in danger.

We strongly support this Bill and commend the author for introducing it. Thank you.

Thank you, ma'am.

Good morning, Mister Chairman. Amy Jenkins on behalf of the California Cannabis Industry Association, I want to thank the good work of Committee staff and the author for moving this important legislation forward.

I will try not to echo the comments made by my colleague, but just simply say the proliferation of these products has created a significant public health risk. We see a direct correlation between the use of these products, or the proliferation of them, and youth access and youth hospitalizations. So this is a significant public health risk.

I'll also note, as my colleague indicated, the influx of synthetic cannabinoid products is also causing a lot of concern. Those products often exceed potency levels found in regulated cannabis, leading to acute intoxation and other serious side effects.

So the lack of regulation and oversight has allowed this widespread availability, and we would like to see some serious safeguards put in place to preserve and protect the integrity of the legal cannabis industry, which is struggling to continue to operate successfully in the state.

Thank you ma'am. Next please

We have a well regulated system, we have high testing standards, and we have strong protocols, and we believe this Bill is essential to protecting that market and also protecting public health and safety. So I'll just close by saying that there's a lot of misinformation out there, claims about Impairment Thresholds, and the interaction between CBD and THC.

And we are both collectively happy to answer any questions that might come up, and thank you for your time today. We urge your aye vote.

Thank you. Other witnesses in support. Name, affiliation, and position on the measure only please.

Good morning. Grace Koplin, on behalf of Kiva Confections and the California Cannabis Manufacturers Association, both in support.

Thank you.

Good morning. Kristin Heidelbach here on behalf of UFCW Western States Council proud co sponsors in support.

Chair Members Luis Sanchez, on behalf of Weedmaps in support, thanks.

Mister chair. Julian Avoris, on behalf of the League of California Cities in support.

Thank you very much sir.

Good morning Mister Chairman, Members of the Committee, Sam Rodriguez, on behalf of good farmers, great neighbors based in Santa Barbara county in support. And we also want to recognize the great work of the Committee staff and also the author of staff Marika, it's been exemplary. Thank you Mister Chairman.

Thank you. Yes ma'am.

Good morning. Pam Lopez, on behalf of California Normal, very happy to be in support and also requesting amendments for a two year phase in to accommodate high CBD hemp tinctures.

Good morning. Shant Apekian, on behalf of the Cannabis Distribution Association in support, thank you.

Good morning. Alex Loomer with Resources Legacy Fund in a supportive amend position to include the environmental protections that are embedded in Prop 64. We really appreciate the author's leadership on this and appreciate working with staff and we'll continue those conversations. Thank you.

Yes sir.

Good morning, Mister chair. Ryan Sherman with the Riverside Sheriff's Association, California Narcotic Officers Association, California Reserve Peace Officers Association, Deputy Sheriff's Association of Placer county, and the police officer associations of the following cities.

Arcadia, Burbank, Claremont, Corona, Culver City, Fullerton, Murrieta, Newport Beach, Nevada, Palos Verdes, Pomona, Riverside, Santa Ana, Upland, the LA School Police Association, La School Police Management Association and California Coalition of School safety professionals, all in support of AB 223 to protect our consumers and our youth. Thank you.

Thank you. Any others? Okay, let's turn to opposition first. Lead opposition. Join us at the table if you'd like, and then we'll take the rest. You know the drill, identify yourselves for the record and fire when ready.