Senate Standing Committee on Health
- Richard Roth
Person
Senate Committee on health will come to order. This is the morning version of the Health Committee. Thank you all for being here. As you know, we do allow six minutes of testimony per side, so we'd like to move through the agenda. So if you don't need it, don't use it. We have 24 bills on the agenda. 10 of them are on proposed consent calendar. I will go through it now and hopefully I won't need to go through it again. [Consent Calendar] that's our consent calendar when we get to it.
- Richard Roth
Person
Let's start with our first item. Item number one, AB 347, Assembly Member Ting, Household Product Safety. Welcome. Please begin when ready.
- Philip Ting
Person
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.
- Philip Ting
Person
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.
- Philip Ting
Person
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.
- Philip Ting
Person
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.
- Richard Roth
Person
Welcome. Please identify yourselves for the record and proceed when ready.
- Avinash Kar
Person
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.
- Avinash Kar
Person
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.
- Avinash Kar
Person
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.
- Avinash Kar
Person
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.
- Avinash Kar
Person
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.
- Richard Roth
Person
Thank you, sir. Next please.
- Bill Allayaud
Person
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...
- Richard Roth
Person
Oh, congratulations.
- Bill Allayaud
Person
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.
- Bill Allayaud
Person
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.
- Richard Roth
Person
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.
- Bill Allayaud
Person
Thank you.
- Richard Roth
Person
Other witnesses in support? Any witnesses in support? Take your time. Name, affiliation, and position, please.
- Erica Parker
Person
Hi. Erica Parker with Californians Against Waste in support. Thank you.
- Richard Roth
Person
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.
- Robert Spiegel
Person
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.
- Robert Spiegel
Person
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.
- Robert Spiegel
Person
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.
- Robert Spiegel
Person
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.
- Robert Spiegel
Person
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.
- Robert Spiegel
Person
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.
- Robert Spiegel
Person
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.
- Robert Spiegel
Person
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.
- Robert Spiegel
Person
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.
- Robert Spiegel
Person
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.
- Robert Spiegel
Person
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.
- Robert Spiegel
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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?
- Robert Spiegel
Person
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.
- Robert Spiegel
Person
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.
- Robert Spiegel
Person
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.
- Robert Spiegel
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Philip Ting
Person
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.
- Richard Roth
Person
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.
- Mandy Lee
Person
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.
- Mandy Lee
Person
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.
- Mandy Lee
Person
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.
- Mandy Lee
Person
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.
- Mandy Lee
Person
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.
- Mandy Lee
Person
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.
- Mandy Lee
Person
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.
- Mandy Lee
Person
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.
- Mandy Lee
Person
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.
- Mandy Lee
Person
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.
- Mandy Lee
Person
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.
- Mandy Lee
Person
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.
- Mandy Lee
Person
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.
- Mandy Lee
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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...
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Mandy Lee
Person
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.
- Mandy Lee
Person
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...
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Philip Ting
Person
Yeah, we absolutely plan on spending the recess working this out. I feel pretty confident that we will be able to find a resolution.
- Richard Roth
Person
Perfect. Any other... I see them lining up. Any other opposition? Name, affiliation, and position on the measure, please.
- Adam Regele
Person
Good morning, Chair and Members. Adam Regele with the California Chamber of Commerce in respectful opposition unless amended. Thank you.
- Richard Roth
Person
Thank you. Yes, ma'am.
- Nicole Quinonez
Person
Good morning. Nicole Quinonez on behalf of the Household and Commercial Products Association, oppose unless amended. Thank you.
- Lauren De Valencia Y Sanchez
Person
Good morning. Lauren De Valencia representing the International Sleep Products Association, also opposed unless amended. Thanks.
- Faith Borges
Person
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
Person
Kevin Messner. I'm with the Association of Home Appliance Manufacturers, and we oppose unless amended.
- Tim Shestek
Person
Good morning, Mr. Chair. Tim Shestek with the American Chemistry Council, also oppose unless amended.
- Richard Roth
Person
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?
- Philip Ting
Person
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.
- Richard Roth
Person
Thank you. Apologize for the time we spent on this, but it's an important issue, and I appreciate your participation.
- Richard Roth
Person
Next item, Doctor Wood. Item number two. AB 815. Healthcare coverage provider credentials. Thank you for joining us. Proceed when ready.
- Jim Wood
Person
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.
- Jim Wood
Person
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.
- Jim Wood
Person
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.
- Brandon Marchy
Person
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.
- Brandon Marchy
Person
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.
- Brandon Marchy
Person
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.
- Brandon Marchy
Person
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.
- Brandon Marchy
Person
The credentialing process is conducted currently by each health plan and individual individually, each with its own set of criteria and extensive application process.
- Brandon Marchy
Person
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.
- Brandon Marchy
Person
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.
- Richard Roth
Person
Thank you for your testimony. Any other witnesses in support? Name, affiliation and position on the measure, please.
- Ryan Spencer
Person
Ryan Spencer with the American College of OB GYN Statistic Nine and the California Podiatric Medical Association in support. Thank you, sir. Next please.
- Christy Weiss
Person
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.
- Paul Yoder
Person
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.
- Kathleen Mossburg
Person
Chair Members, a bit of a tweener. Kathy Mossberg with the local health plans. With the latest amendments, we are neutral removing opposition.
- Richard Roth
Person
Thank you. We like that. Any other witnesses in support? How about witnesses in opposition? Any opposition? Witnesses, please come forward.
- Robert Brakens
Person
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.
- Robert Brakens
Person
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.
- Steffanie Watkins
Person
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.
- Richard Roth
Person
Thank you. Hopefully we can fix those. Any other witnesses in opposition? Seeing none. Doctor Wood.
- Jim Wood
Person
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.
- Jim Wood
Person
When you have a quorum.
- Richard Roth
Person
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.
- Evan Low
Person
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.
- Evan Low
Person
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.
- Evan Low
Person
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.
- Richard Roth
Person
Thank you. Welcome.
- Elizabeth Hawkins
Person
Thank you. Do I need to press anything or am I hearing I hear it?
- Richard Roth
Person
Just identify yourselves for the record.
- Elizabeth Hawkins
Person
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.
- Elizabeth Hawkins
Person
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
- Elizabeth Hawkins
Person
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.
- Elizabeth Hawkins
Person
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.
- Elizabeth Hawkins
Person
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.
- Elizabeth Hawkins
Person
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.
- Elizabeth Hawkins
Person
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.
- Elizabeth Hawkins
Person
AB 1577 is an important component to the solutions. Save nursing. Thank you and I respectfully ask for your aye vote.
- Richard Roth
Person
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.
- Janice O'Malley
Person
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.
- Richard Roth
Person
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.
- Sarah Bridge
Person
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.
- Sarah Bridge
Person
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.
- Sarah Bridge
Person
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.
- Sarah Bridge
Person
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.
- Sarah Bridge
Person
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.
- Sarah Bridge
Person
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.
- Sarah Bridge
Person
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.
- Richard Roth
Person
Thank you, ma'am. Next, please.
- Alex Graves
Person
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.
- Alex Graves
Person
Our institutions produced approximately 46% of the new BSN prepared nurses in the state.
- Alex Graves
Person
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.
- Alex Graves
Person
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.
- Alex Graves
Person
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.
- Alex Graves
Person
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
- Alex Graves
Person
But appreciate your time.
- Richard Roth
Person
Thank you. Any other witnesses in opposition, if any, name, affiliation and position on the measure only, please.
- Unidentified Speaker
Person
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.
- Richard Roth
Person
Thank you, ma'am. Okay, now let's turn to opposition.
- Christy Weiss
Person
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.
- Christy Weiss
Person
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.
- Christy Weiss
Person
So as we enter the final 60 days of the legislative process, we look forward to continuing to work with the author.
- Richard Roth
Person
Thank you. Next, please.
- Jen Chase
Person
Good morning, chair Members.
- Jen Chase
Person
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.
- Jen Chase
Person
Thank you.
- Richard Roth
Person
Thank you. Any of the witnesses in opposition.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Janet Nguyen
Person
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.
- Janet Nguyen
Person
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.
- Janet Nguyen
Person
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.
- Janet Nguyen
Person
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.
- Janet Nguyen
Person
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.
- Janet Nguyen
Person
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.
- Richard Roth
Person
And I'll be supporting it. Assemblymember Low, would you like to close?
- Evan Low
Person
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.
- Evan Low
Person
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.
- Evan Low
Person
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.
- Evan Low
Person
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.
- Evan Low
Person
But I appreciate the efforts, again, of the chair and look forward to the opportunity to get an aye vote at the appropriate time.
- Richard Roth
Person
As soon as we get a quorum, we'll take a motion and we'll do just that. Thank you.
- Evan Low
Person
Thank you very much.
- Richard Roth
Person
Thank you, ladies and gentlemen, for joining us. Okay, next item is item number four. AB 1895. Doctor Weber, thank you for joining us.
- Akilah Weber
Legislator
Ready?
- Richard Roth
Person
Proceed. When ready?
- Akilah Weber
Legislator
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.
- Akilah Weber
Legislator
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.
- Akilah Weber
Legislator
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.
- Akilah Weber
Legislator
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.
- Akilah Weber
Legislator
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.
- Akilah Weber
Legislator
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.
- Akilah Weber
Legislator
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.
- Akilah Weber
Legislator
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.
- Richard Roth
Person
Thank you both for joining us. Please identify yourselves for the record before you speak and proceed when ready.
- Sharee Wilburn
Person
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.
- Sharee Wilburn
Person
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.
- Sharee Wilburn
Person
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.
- Sharee Wilburn
Person
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.
- Sharee Wilburn
Person
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.
- Sharee Wilburn
Person
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.
- Sharee Wilburn
Person
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.
- Sharee Wilburn
Person
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.
- Richard Roth
Person
Thank you for joining us and thank you for your testimony. Doctor? g.
- Juliana Melo
Person
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.
- Juliana Melo
Person
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.
- Juliana Melo
Person
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.
- Juliana Melo
Person
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?
- Juliana Melo
Person
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.
- Juliana Melo
Person
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.
- Juliana Melo
Person
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.
- Richard Roth
Person
Thank you for your testimony. Thanks for joining us. Other witnesses in support, name, affiliation and position on the measure only, please.
- Kathleen Mossburg
Person
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.
- Richard Roth
Person
Thank you. Next, please.
- Genesis Gonzalez
Person
Good morning. Genesis Gonzalez, on behalf of Lieutenant Governor Eleni Kunalakis, in support. Thank you.
- Richard Roth
Person
Thank you. Next, please.
- Kimberly Robinson
Person
Good morning. Kim Robinson with Black Women for Wellness Action Project, a co-sponsor and strong support. Thank you.
- Vanessa Cajina
Person
Thank you. Vanessa Cajina, on behalf of the California Academy of Family Physicians and the California Pan Ethnic Health Network, both here in support.
- Richard Roth
Person
Thank you.
- Symphoni Barbee
Person
Good morning. Symphoni Barbee, on behalf of Planned Parenthood Affiliates of California and support, also noting support for Reproductive Freedom for All. Thank you.
- Richard Roth
Person
Thank you.
- Brandon Marchy
Person
Brandon Marchy with the California Medical Association in support.
- Ryan Spencer
Person
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 Lee
Person
Lan Lay, on behalf of Asian Americans Advancing Justice Southern California, in strong support.
- Timothy Madden
Person
Tim Madden, representing the California chapter of the American College of Emergency Physicians, in support.
- Kristy Wiese
Person
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.
- Kristy Wiese
Person
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.
- Kristy Wiese
Person
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
Person
Brianna Nelson, on behalf of TEACH, in strong support.
- Suzanne Goodman
Person
Suzanne Goodman, Doctor from Bixby Center for Global Reproductive Health, on behalf of myself and support.
- Matt Lege
Person
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.
- Matt Lege
Person
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.
- Matt Lege
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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?
- Akilah Weber
Legislator
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.
- Richard Roth
Person
We'll handle that.
- Akilah Weber
Legislator
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.
- Akilah Weber
Legislator
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.
- Akilah Weber
Legislator
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.
- Akilah Weber
Legislator
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.
- Akilah Weber
Legislator
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.
- Akilah Weber
Legislator
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.
- Akilah Weber
Legislator
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.
- Akilah Weber
Legislator
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.
- Akilah Weber
Legislator
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.
- Richard Roth
Person
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 -
- Akilah Weber
Legislator
But we know how to get in touch with you.
- Richard Roth
Person
- 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.
- Richard Roth
Person
And we can't wait for somebody to drive in, fly in, drop in, or whatever they need to be on the site.
- Richard Roth
Person
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.
- Richard Roth
Person
If you want an OBGYN to practice, to locate somewhere to practice, the OBGYN has to be able to earn a living.
- Richard Roth
Person
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.
- Akilah Weber
Legislator
Exactly.
- Richard Roth
Person
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.
- Richard Roth
Person
I'll be supporting it today.
- Akilah Weber
Legislator
Thank you.
- Richard Roth
Person
I should let you close if there's anything else you want to say.
- Akilah Weber
Legislator
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.
- Richard Roth
Person
We've got the best staff.
- Akilah Weber
Legislator
Yes.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Joe Patterson
Legislator
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.
- Joe Patterson
Legislator
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.
- Joe Patterson
Legislator
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.
- Joe Patterson
Legislator
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.
- Joe Patterson
Legislator
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.
- Joe Patterson
Legislator
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.
- Joe Patterson
Legislator
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?
- Joe Patterson
Legislator
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.
- Joe Patterson
Legislator
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.
- Joe Patterson
Legislator
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.
- Joe Patterson
Legislator
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.
- Joe Patterson
Legislator
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.
- Richard Roth
Person
And I assume you accept the amendments.
- Joe Patterson
Legislator
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.
- Richard Roth
Person
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.
- Natalie Cooper
Person
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.
- Natalie Cooper
Person
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.
- Natalie Cooper
Person
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.
- Natalie Cooper
Person
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.
- Natalie Cooper
Person
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.
- Natalie Cooper
Person
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.
- Natalie Cooper
Person
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.
- Natalie Cooper
Person
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.
- Natalie Cooper
Person
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.
- Natalie Cooper
Person
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.
- Natalie Cooper
Person
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.
- Natalie Cooper
Person
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.
- Natalie Cooper
Person
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.
- Natalie Cooper
Person
This simple yet effective change would restore access to the essential high quality care that is critical for these individuals.
- Natalie Cooper
Person
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.
- Natalie Cooper
Person
Please support AB 3156 and help safeguard the medical care of disabled individuals across California. Thank you for consideration and your yes vote.
- Richard Roth
Person
Thank you for joining us today. Very nice job on that. Okay, who wants to try to top that? No, go ahead, Chairman.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Richard Roth
Person
Thank you for being here. Yes, ma'am.
- Unidentified Speaker
Person
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.
- Richard Roth
Person
Well, thank you for taking the time to join us. Yeah, thank you. Excellent job. Thanks for having us.
- Richard Roth
Person
Any other witnesses in support? Name, affiliation and position on the measure, please?
- Vanessa Cajina
Person
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.
- Richard Roth
Person
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.
- Joe Patterson
Legislator
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.
- Joe Patterson
Legislator
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.
- Richard Roth
Person
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.
- Richard Roth
Person
So thank you, and as soon as we get a quorum, we'll take a motion and we'll take it up.
- Joe Patterson
Legislator
Great. Thank you very much.
- Richard Roth
Person
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.
- Rebecca Bauer-Kahan
Legislator
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.
- Rebecca Bauer-Kahan
Legislator
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.
- Rebecca Bauer-Kahan
Legislator
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.
- Rebecca Bauer-Kahan
Legislator
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.
- Rebecca Bauer-Kahan
Legislator
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.
- Rebecca Bauer-Kahan
Legislator
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.
- Rebecca Bauer-Kahan
Legislator
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.
- Richard Roth
Person
Please identify yourselves for the record before speaking.
- Ryan Spencer
Person
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.
- Ryan Spencer
Person
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.
- Ryan Spencer
Person
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.
- Ryan Spencer
Person
It addresses this critical gap by mandating coverage for these treatments, ensuring that all can receive the care they need, and they deserve.
- Ryan Spencer
Person
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.
- Ryan Spencer
Person
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.
- Richard Roth
Person
Thank you. Thanks for joining us.
- Richard Roth
Person
Yes, ma'am.
- Hannah Lee
Person
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.
- Hannah Lee
Person
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.
- Hannah Lee
Person
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.
- Hannah Lee
Person
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.
- Hannah Lee
Person
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.
- Hannah Lee
Person
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.
- Hannah Lee
Person
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.
- Richard Roth
Person
Thank you. Nice job. Any other witnesses in support, name, affiliation and position on the measure, please step up.
- Symphoni Barbee
Person
Symphoni Barbee, on behalf of Planned Parenthood Affiliates of California, in support. Thank you.
- Richard Roth
Person
Thanks for joining us. Yes, ma'am.
- Suzanne Goodman
Person
Suzanne Goodman, on behalf of the TEACH program, in support.
- Richard Roth
Person
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.
- Steffanie Watkins
Person
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.
- Steffanie Watkins
Person
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.
- Steffanie Watkins
Person
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.
- Steffanie Watkins
Person
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.
- Steffanie Watkins
Person
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.
- Steffanie Watkins
Person
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.
- Steffanie Watkins
Person
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.
- Steffanie Watkins
Person
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.
- Robert Boykin
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Rebecca Bauer-Kahan
Legislator
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.
- Rebecca Bauer-Kahan
Legislator
And what is currently happening is localized estrogen, which is safe for them, which is done through creams and gels, is denied.
- Rebecca Bauer-Kahan
Legislator
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.
- Rebecca Bauer-Kahan
Legislator
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.
- Richard Roth
Person
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.
- Richard Roth
Person
Proceed when ready. This is for those keeping track. This is item number 10, AB 20316. Assemblymember Gabriel, pupil nutrition. Please proceed when ready.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
And at the appropriate time would respectfully request your.
- Richard Roth
Person
I vote thank you. Thank you for joining us, Doctor. You must have enjoyed it so much last time you came back.
- Julianna Mello
Person
Yeah.
- Richard Roth
Person
Please identify yourselves for the record before you speak and fire when ready.
- Julianna Mello
Person
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.
- Julianna Mello
Person
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.
- Julianna Mello
Person
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.
- Julianna Mello
Person
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.
- Julianna Mello
Person
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.
- Julianna Mello
Person
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.
- Julianna Mello
Person
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.
- Richard Roth
Person
Thank you for joining us again. Yes, ma'am.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Richard Roth
Person
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.
- Brandon Marchy
Person
Mister Chair Brandon Marchy with the California Medical Association in support.
- Ryan Spencer
Person
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.
- Ryan Spencer
Person
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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
Good morning, chair Members. Kai Cooper, on behalf of breast cancer prevention partners and strong support. Thank you, ma'am.
- Richard Roth
Person
Now let's turn to witnesses in opposition. Lead witnesses in opposition. You feel free to come down to the table.
- Richard Roth
Person
Thank you, sir. Just identify yourself for the record and proceed when ready.
- James Coughlin
Person
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.
- James Coughlin
Person
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.
- James Coughlin
Person
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.
- James Coughlin
Person
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.
- James Coughlin
Person
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.
- James Coughlin
Person
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.
- James Coughlin
Person
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.
- James Coughlin
Person
We don't usually in my world of food safety, take strong actions against chemicals where we only believe there are potential effects.
- James Coughlin
Person
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.
- James Coughlin
Person
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.
- James Coughlin
Person
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.
- James Coughlin
Person
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.
- James Coughlin
Person
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.
- James Coughlin
Person
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.
- James Coughlin
Person
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.
- Richard Roth
Person
Thank you. Thank you for your testimony. It's an important issue. Yes, sir.
- Adam Regele
Person
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.
- Adam Regele
Person
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.
- Adam Regele
Person
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.
- Adam Regele
Person
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.
- Adam Regele
Person
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.
- Adam Regele
Person
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.
- Adam Regele
Person
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.
- Adam Regele
Person
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.
- Adam Regele
Person
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.
- Richard Roth
Person
Thank you. Any other opposition witnesses? Name, affiliation, position on the measure only, please.
- Unidentified Speaker
Person
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.
- Richard Roth
Person
Thank you. No problem. Next, please.
- Dennis Albiani
Person
Thank you. Dennis Albiani with the American Beverage Association. We continue to oppose. Thank you.
- Peter Kellison
Person
Peter Kellison, on behalf of the National Confectioners Association, in opposition.
- Richard Roth
Person
Thank you
- Margie Lie
Person
Margie Lie, on behalf of the California League of Food Producers and respectful opposition.
- Richard Roth
Person
Thank you.
- Robert Spiegel
Person
Rob Spiegel, California Manufacturers Technology Association, in opposition.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
The evidence is mixed. Maybe we shouldn't be doing this. We should rely on the FDA.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Jesse Gabriel
Legislator
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.
- Richard Roth
Person
Thank you. Assemblymember. As soon as we get a quorum, we'll take a motion and we will take a vote.
- Jesse Gabriel
Legislator
Thank you.
- Richard Roth
Person
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.
- Matt Haney
Legislator
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.
- Matt Haney
Legislator
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.
- Matt Haney
Legislator
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.
- Matt Haney
Legislator
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.
- Matt Haney
Legislator
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.
- Matt Haney
Legislator
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.
- Matt Haney
Legislator
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.
- Richard Roth
Person
Thank you for joining us. Please identify yourselves with the record before proceeding. Proceed when ready.
- Jeffrey Hom
Person
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.
- Jeffrey Hom
Person
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.
- Jeffrey Hom
Person
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.
- Jeffrey Hom
Person
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.
- Jeffrey Hom
Person
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.
- Jeffrey Hom
Person
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.
- Richard Roth
Person
Thank you. Next, please.
- Leslie Suen
Person
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.
- Leslie Suen
Person
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.
- Leslie Suen
Person
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.
- Leslie Suen
Person
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.
- Leslie Suen
Person
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.
- Leslie Suen
Person
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.
- Leslie Suen
Person
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.
- Leslie Suen
Person
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.
- Richard Roth
Person
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?
- Leslie Suen
Person
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.
- Leslie Suen
Person
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.
- Leslie Suen
Person
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.
- Richard Roth
Person
So when you dispense, because it's dispensing, right, methadone, is that dispensing act entered into CURES?
- Leslie Suen
Person
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.
- Richard Roth
Person
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?
- Richard Roth
Person
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?
- Leslie Suen
Person
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?
- Richard Roth
Person
And where is that reported?
- Leslie Suen
Person
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.
- Leslie Suen
Person
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.
- Richard Roth
Person
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?
- Jeffrey Hom
Person
That is correct.
- Richard Roth
Person
Does that occur?
- Jeffrey Hom
Person
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...
- Richard Roth
Person
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?
- Jeffrey Hom
Person
Correct.
- Richard Roth
Person
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?
- Richard Roth
Person
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?
- Jeffrey Hom
Person
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.
- Jeffrey Hom
Person
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.
- Jeffrey Hom
Person
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...
- Richard Roth
Person
And the number referred to substance abuse treatment providers. Because there's an end... You don't provide the substance abuse treatment generally.
- Jeffrey Hom
Person
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.
- Jeffrey Hom
Person
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.
- Jeffrey Hom
Person
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.
- Richard Roth
Person
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?
- Jeffrey Hom
Person
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.
- Richard Roth
Person
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.
- Leslie Suen
Person
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.
- Leslie Suen
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Jeffrey Hom
Person
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.
- Jeffrey Hom
Person
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.
- Richard Roth
Person
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.
- Leslie Suen
Person
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.
- Leslie Suen
Person
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...
- Richard Roth
Person
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.
- Paul Yoder
Person
Mr. Chairman and Members, Paul Yoder on behalf of the City and County of San Francisco and Mayor London Breed in support. Thank you.
- Richard Roth
Person
Thank you. Next, please.
- Leah Barros
Person
Leah Barros on behalf of California Hospital Association in support.
- Vanessa Cajina
Person
Vanessa Cajina on behalf of the California Pan-Ethnic Health Network here in support.
- Catherine Senderling-Mcdonald
Person
Cathy Senderling-McDonald for the County of Alameda in support.
- Richard Roth
Person
Thank you.
- Kelly Brooks-Lindsey
Person
Kelly Brooks on behalf of the California Association of Public Hospitals and Health Systems and the Santa Clara County Board of Supervisors in support.
- Richard Roth
Person
Thank you. Next, please.
- Dylan Stapleton
Person
Good morning. Dylan Stapleton on behalf of Lieutenant Governor Eleni Kounalakis in support. Thank you.
- Richard Roth
Person
Thank you.
- Symphoni Barbee
Person
Symphoni Barbee on behalf of Planned Parenthood Affiliates of California in support.
- Richard Roth
Person
Thank you.
- Geoffrey Neill
Person
Geoff Neill representing the County of San Diego, also in support.
- Richard Roth
Person
Thank you.
- Yarelie Magallon
Person
Yarelie Magallon with Political Solutions on behalf of the County of San Mateo in support.
- Richard Roth
Person
Thank you. Next, please.
- Jennifer Alley
Person
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.
- Jennifer Alley
Person
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.
- Jennifer Alley
Person
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.
- Jennifer Alley
Person
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.
- Jennifer Alley
Person
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.
- Jennifer Alley
Person
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.
- Richard Roth
Person
Thank you. Any other witnesses? Okay, witnesses in opposition? Seeing none. Bring it back to the dais, colleagues. Senator Nguyen.
- Janet Nguyen
Person
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?
- Janet Nguyen
Person
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?
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Janet Nguyen
Person
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?
- Unidentified Speaker
Person
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.
- Janet Nguyen
Person
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?
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Janet Nguyen
Person
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.
- Janet Nguyen
Person
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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Janet Nguyen
Person
Go ahead, doc.
- Unidentified Speaker
Person
Thank you.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Janet Nguyen
Person
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?
- Unidentified Speaker
Person
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.
- Unidentified Speaker
Person
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.
- Janet Nguyen
Person
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.
- Janet Nguyen
Person
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.
- Janet Nguyen
Person
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.
- Janet Nguyen
Person
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.
- Janet Nguyen
Person
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?
- Janet Nguyen
Person
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.
- Janet Nguyen
Person
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.
- Richard Roth
Person
Thank you. And Senator Menjivar has got a question or comment in a second.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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?
- Richard Roth
Person
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.
- Caroline Menjivar
Legislator
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.
- Matt Haney
Legislator
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.
- Matt Haney
Legislator
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.
- Matt Haney
Legislator
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.
- Matt Haney
Legislator
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.
- Matt Haney
Legislator
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.
- Matt Haney
Legislator
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.
- Matt Haney
Legislator
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.
- Matt Haney
Legislator
So that's sort of where we ended up, where we are.
- Matt Haney
Legislator
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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.
- Richard Roth
Person
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?
- Matt Haney
Legislator
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.
- Richard Roth
Person
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.
- Matt Haney
Legislator
And I have 2893 for Ward. Where item 20.
- Richard Roth
Person
You mean you want more? Let me make sure we have a reporting requirement here somewhere.
- Richard Roth
Person
Item number 20. AB 2893 the supportive community residency program. And we'll continue to be supportive.
- Matt Haney
Legislator
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.
- Matt Haney
Legislator
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.
- Matt Haney
Legislator
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.
- Matt Haney
Legislator
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.
- Matt Haney
Legislator
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.
- Matt Haney
Legislator
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.
- Matt Haney
Legislator
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.
- Richard Roth
Person
Thank you for accepting the amendments. Assemblymember, please proceed when ready, sir. Identify yourself for the record.
- Louis Morante
Person
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.
- Louis Morante
Person
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.
- Louis Morante
Person
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.
- Louis Morante
Person
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.
- Richard Roth
Person
Thank you for joining us. Any other witnesses in support, please step forward. Name, affiliation and position on the measure.
- Symphony Barbee
Person
Hello, Symphony Barbee On behalf of Planned Parenthood Affiliates of California in support.
- Richard Roth
Person
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?
- Matt Haney
Legislator
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.
- Richard Roth
Person
We will do just that. Thank you.
- Richard Roth
Person
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.
- Cecilia Aguiar-Curry
Legislator
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.
- Cecilia Aguiar-Curry
Legislator
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.
- Cecilia Aguiar-Curry
Legislator
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.
- Cecilia Aguiar-Curry
Legislator
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.
- Cecilia Aguiar-Curry
Legislator
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.
- Richard Roth
Person
Thank you for joining us. Please proceed. Identify yourself for the record, though.
- Tiffany Devitt
Person
Thank you. Good morning, Chairman Roth, and esteem, well, missing Committee Members, but esteemed nonetheless. My name is.
- Richard Roth
Person
It's a busy time. They're all over the building.
- Tiffany Devitt
Person
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.
- Tiffany Devitt
Person
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.
- Tiffany Devitt
Person
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.
- Tiffany Devitt
Person
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.
- Tiffany Devitt
Person
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.
- Tiffany Devitt
Person
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.
- Tiffany Devitt
Person
We strongly support this Bill and commend the author for introducing it. Thank you.
- Richard Roth
Person
Thank you, ma'am.
- Amy Jenkins
Person
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.
- Amy Jenkins
Person
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.
- Amy Jenkins
Person
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.
- Amy Jenkins
Person
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.
- Richard Roth
Person
Thank you ma'am. Next please
- Amy Jenkins
Person
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.
- Amy Jenkins
Person
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.
- Richard Roth
Person
Thank you. Other witnesses in support. Name, affiliation, and position on the measure only please.
- Grace Koplin
Person
Good morning. Grace Koplin, on behalf of Kiva Confections and the California Cannabis Manufacturers Association, both in support.
- Richard Roth
Person
Thank you.
- Kristin Heidelbach
Person
Good morning. Kristin Heidelbach here on behalf of UFCW Western States Council proud co sponsors in support.
- Luis Sanchez
Person
Chair Members Luis Sanchez, on behalf of Weedmaps in support, thanks.
- Jolena Voorhis
Person
Mister chair. Julian Avoris, on behalf of the League of California Cities in support.
- Richard Roth
Person
Thank you very much sir.
- Sam Rodriguez
Person
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.
- Richard Roth
Person
Thank you. Yes ma'am.
- Pam Lopez
Person
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.
- Shant Apekian
Person
Good morning. Shant Apekian, on behalf of the Cannabis Distribution Association in support, thank you.
- Alex Loomer
Person
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.
- Richard Roth
Person
Yes sir.
- Ryan Sherman
Person
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.
- Ryan Sherman
Person
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.
- Richard Roth
Person
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.
- Rand Martin
Person
I know it well. Mister chair. Rand Martin, on behalf of the US Hemp Roundtable, I want to start off by saying that we agree with the objectives that the author is pursuing in this Bill.
- Rand Martin
Person
Please understand that there are other victims of people out there who have been manipulating the composition of some of these products to make them more intoxicating. And the Members of the US Hemp Roundtable are among those victims. We agree that we need to do something to tighten up the laws.
- Rand Martin
Person
You've said many times today, Mister chair, if we have problems with the laws, we need to come back and fix them so we can make them as perfect as we possibly can. And that's what we're seeking to do here. So things like strengthened enforcement and things like that are very important to us.
- Rand Martin
Person
We also agree with a milligram cap. In fact, AB 45, the author will recall, actually had authority given to the Department of Public Health to establish a milligram cap. They chose never to exercise that for reasons that remain unknown. But we have always recognized that a milligram cap is an appropriate thing to do. The question here is, what is that milligram cap?
- Rand Martin
Person
And whether we are going to come up with a number that is going to put people out of business, or are we going to come up with a number that will keep the good actors in the State of California, the people who have actually complied with both the spirit and the letter of the law that was enacted in AB 45, whether we can maintain their ability to provide benefits to the consumer population in California that relies on good hemp CBD products for their therapeutic benefit.
- Rand Martin
Person
We're also concerned secondarily with the issue of the number of servings per package. Right now, the law, the Bill says no more than five servings per package. That is a really small number when you consider some of the products that are hemp CBD products, for example, very popular are tinctures.
- Rand Martin
Person
If you had five servings in a bottle of tincture, the size of that bottle would be like this, which would be economically infeasible for a manufacturer to put together. We need a larger number, much like the cannabis industry has a larger number of servings per package.
- Rand Martin
Person
We appreciate the author who has said many times and again in her opening that she intends to continue to work with us. We look forward to that.
- Rand Martin
Person
We know it's not going to get resolved today, but we have plenty of time in the month of July to continue to talk about what is an appropriate level, science based level of THC in a hemp CBD product that does not cause intoxication, but also provides the therapeutic benefit to the consumers. Thank you, Mister chair.
- Richard Roth
Person
Thank you. Yes, sir.
- Ted Whitney
Person
My name is Ted Whitney. I am here with Rexis Biotech. We're a producer of naturally occurring THC, hemp derived Low dose drinks. We sell them in 21 states, including in California. We're currently on retail shelves throughout the state. We have a five milligram soda. We're thoroughly tested.
- Ted Whitney
Person
We comply with everything in AB 45, and our testing standards exceed that which we did when we were in the regulated market here in the state. I'm hopeful that. Well, I'm here in opposition of 2223 and I'm hopeful that we can find amendments that will provide for a Low dose path inside of the state.
- Ted Whitney
Person
We can derive fantastic tax revenue on the category. We can pay for enforcement. We can create a bifurcated market that works out great for all of our consumers in the state, offering harm reduction through drinks that provide better access to recreation and relief. I thank you very much for your work on this matter.
- Richard Roth
Person
Thank you, sir. Other witnesses in opposition. Name, affiliation and position only, please.
- Terence McHale
Person
Terry McHale, with Aaron Reed and Associates representing Cheech and Chong Global Holdings. Support unless opposed. Unless amended.
- Richard Roth
Person
Thank you, sir.
- Michael Ramirez
Person
Michael Ramirez. I'm an owner operator of Mars Consulting, Delta Beverage, which is a $52 million facility, the largest cannabis drink manufacturer in the country out of Los Angeles. And I'm also a board Member of the Cannabis Beverage Association, representing the majority of all hemp and cannabis drinks across the nation. Thank you for the author for this Bill.
- Michael Ramirez
Person
We believe in regulation. It needs to be stronger, but it needs to be wise. I think there's three major missing components. So with that, we stand opposed unless amended. Thank you.
- Kim Craig
Person
Kim Craig, with AHRQ Strategies on behalf of Cannon Bottle. Oppose unless amended.
- Chad Plotke
Person
Chad Plotke with Sun Med. We have over 400 locations through the U.S., the largest brick and mortar. We have 18 locations in California and we oppose.
- Richard Roth
Person
Thank you, sir. Next, please.
- Nathan Chessmore
Person
Hello. Nathan Chessmore. Opposed unless amended. We just own two local stores over here in Roseville and Lincoln. Thank you.
- Richard Roth
Person
Thank you, sir. Any other opposition witnesses? This will bring it back to the dais and my colleague. Colleagues. Any colleague. Any questions, comments, or concerns? And I see no hand being raised.
- Richard Roth
Person
So I guess it brings it back to me. You know, it occurs to me we're talking about we're attempting to integrate the cannabis and the hemp industries here as it pertains to THC. And we're talking about medicinal products and we're also talking about some low dose beverages.
- Richard Roth
Person
And I do think that there's probably a way to work this out. We do have time over our in district break in July, and of course, when we come back in August, I will be here for a short time after that.
- Richard Roth
Person
And I look forward to working with you on making myself and our staff, who are much smarter than I am, available to help with this if we can, and look forward to a successful effort and a completed product that is as perfect as we can possibly make it under the dome in the California State Legislature. So, having said that, Assemblymember, you may close.
- Cecilia Aguiar-Curry
Legislator
Thank you. One of the things that I've always done with any of my bills that I've run in this building, and I appreciate the, the comments you've made prior to me, is that what's the problem? How do you fix it? But the most important part of this is how do you implement it?
- Cecilia Aguiar-Curry
Legislator
And every year we go back and AB 45, we thought we had really had some tight reins around that, and there's always some loophole that someone's going to find. I'm going to assure you that I am not going to let this bill continue until we get these things ironed out.
- Cecilia Aguiar-Curry
Legislator
I appreciate the proponents of this and the opposition, because I think we're going to come to something that's going to be workable for all of us. With that, I respectfully ask for your aye vote.
- Richard Roth
Person
Thank you. And you all have an excellent author and I know she's going to work very hard to make this happen. As soon as we get a quorum, we'll take a motion and we will do just that. Thank you all for participating. Assemblymember Petrie-Norris. Item number 16. No. Item 15.
- Richard Roth
Person
AB 2490 Reproductive Health Emergency Preparedness Program. Proceed when ready. Thank you for joining us.
- Cottie Petrie-Norris
Legislator
Good afternoon Mr. Chair and members. Pleased to join you this morning or afternoon to present AB 2490 which will expand and improve access to reproductive health care in emergency departments across the state. I'd like to thank the chair and committee staff for your work on this bill, and I'll be accepting the proposed amendments today.
- Cottie Petrie-Norris
Legislator
For many pregnant Californians, emergency rooms are the most, and sometimes only accessible source of medical care due to a lack of health insurance and a growing shortage of primary care providers, OB gyns and Reproductive Health Clinics.
- Cottie Petrie-Norris
Legislator
Unfortunately, too many emergency departments in California and their staff are underprepared to ensure that patients are able to get quality miscarriage, contraception and abortion related care. The result of all of this is that it puts some of our most vulnerable patients at risk.
- Cottie Petrie-Norris
Legislator
AB 2490 will establish the Reproductive Health Emergency Preparedness Program in the Department of Health Care access to expand and improve reproductive health care in emergency rooms across the state. The premise of this bill is simple. It should not matter where you live in order to get good, safe reproductive healthcare in the State of California.
- Cottie Petrie-Norris
Legislator
Pleased to be joined today by two witnesses, Alena Chavez on behalf of TEACH, and Doctor Suzanne Goodman. Goodman, thank you.
- Richard Roth
Person
Welcome. Thanks for joining us. Please identify yourselves for the record before speaking. Proceed when ready.
- Alena Chavez
Person
Good morning Chair Roth and members of the committee. Thank you for having me today. My name is Alena Chavez and I'm the program manager for TEACH, which stands for Training and Early Abortion for Comprehensive Healthcare. And we are proud co sponsors of AB 2490.
- Alena Chavez
Person
TEACH ensures physicians and advanced practice clinicians have the skills needed to provide comprehensive reproductive health care, including abortion. For emergency physicians. There is an obvious gap where such training hasn't been systematically offered to them.
- Alena Chavez
Person
Reproductive healthcare is completely within their scope of practice and this training will ensure that the standard of care is available to those most marginalized. Further, emergency physicians cannot continue to rely on referring patients to OBs.
- Alena Chavez
Person
Given maternity ward and labor and delivery units closures in rural areas, emergency room physicians will increasingly become a primary source of healthcare in rural and medically underserved communities.
- Alena Chavez
Person
In California, 67% of abortions are done through the abortion pill regimen, and we are witnessing an increase of people self managing their own abortions, especially with the rise of telehealth prescription. People using abortion pills may only have contact with the provider in the ED if they have questions, concerns or fear of complications.
- Alena Chavez
Person
All in all, this training is desired by EDs in California so they can provide this essential healthcare and all they really need are the resources to be able to do so. That is why I'm here today. Respectfully asking for your aye vote on AB 2490. Thank you for your time.
- Richard Roth
Person
Thank you. Next please.
- Suzanne Goodman
Person
Chair and members, thank you for having me today. I am Doctor Suzanne Goodman, a UCSF clinical professor, an emergency and family physician as well as an abortion provider and co founder of the TEACH program.
- Suzanne Goodman
Person
As an emergency room doctor, I've worked part time for 25 years in a rural critical access emergency room that just closed three months ago on the coast, leaving yet another isolated rural community struggling to get the care they need. As an ER physician, I've had so many patients present with complications of early pregnancy, such as bleeding.
- Suzanne Goodman
Person
I saw one young pregnant mother of three presenting with bleeding and a threatened miscarriage. Even though I have the skills, I was unable to offer definitive management options due to ER policies, lack of trained staff, basic medications and equipment.
- Suzanne Goodman
Person
I could only offer watch and wait care with a referral to the county hospital, which usually takes weeks and essentially leaves patients bleeding in pain and many back in another emergency room requiring a procedure that I could have readily provided. Many ER docs across the state find themselves in a similar situation.
- Suzanne Goodman
Person
The ER is the primary source of care for many of my pregnant patients, especially those that are low income and BIPOC. Getting them to specialty clinics causes care fragmentation, wasted time, repeat tests and exams, lack of privacy, and significantly increased costs to both the patient and the healthcare system. Worse, patients get frustrated.
- Suzanne Goodman
Person
Waiting can end up in crisis pregnancy centers, or what we think of as fake clinics where they never get definitive management. Miscarriage related care accounts for over 900,000 emergency department visits in the United States each year.
- Suzanne Goodman
Person
Options for miscarriage management include expectant management, which, as I mentioned, is watchful waiting, medication management and uterine aspiration, all of which can be safely and effectively initiated in the emergency room. The Dobbs Supreme Court decision has greatly limited the availability of care for early pregnancy complications and abortion related care for many us patients in California.
- Suzanne Goodman
Person
As you've heard, over 40 labor and delivery units have closed in California since 2012, with over half in the last four years. The rural shortage of perinatal and obstetric docs has worsened since Dobbs. In restrictive environments, ers desperately need this training and capacity.
- Suzanne Goodman
Person
The Reproductive Health Emergency Preparedness program proposed in this bill will prepare those emergency departments opting in to obtain training, medications and materials needed to manage evidence based treatment for pregnancy loss, miscarriage and abortion. I strongly urge you to support this bill. Thank you so much for your time.
- Richard Roth
Person
Thank you very much. Other witnesses in support. Name, affiliation and position on the measure only, please.
- Symphoni Barbee
Person
Symphoni Barbee on behalf of Planned Parenthood Affiliates of California, in support.
- Richard Roth
Person
Thank you. Next, please.
- Ryan Spencer
Person
Ryan Spencer on behalf of the American College of OB/GYNs, District 9, in support.
- Brandon Marchy
Person
Brandon Marchy with the California Medical Association, in support.
- Grace Glaser
Person
Grace Glaser, on behalf of VALOR US, proud co sponsor and in support.
- Richard Roth
Person
Thank you.
- Vanessa Cajina
Person
Vanessa Cajina on behalf of the California Academy of Family Physicians, here in support. Thank you.
- Timothy Madden
Person
Tim Madden, representing the California Chapter at the American College of Emergency Physicians, in support.
- Martin Radosevich
Person
Martin Radosevich, on behalf of Reproductive Freedom for All California, co sponsors.
- Kathleen Mossburg
Person
Kathy Mossburg, Essential Access Health, in support. Thank you.
- Beth Malinowski
Person
Beth Malinowski, [Unintelligible] in support.
- Danna Stapleton
Person
Good afternoon. Danna Stapleton, on behalf of Lieutenant Governor Eleni Kounalakis, in support. Thank you.
- Kimberly Robinson
Person
Good afternoon. Kimberly Robinson with Black Women for Wellness Action Project, a co sponsor, in support. As well as representing the California Women's Foundation, also in support.
- Richard Roth
Person
Thank you. Next, please.
- Brianna Nelson
Person
Brianna Nelson, on behalf of TEACH, co sponsors of AB 2490 in strong support.
- Richard Roth
Person
Thank you. Any other support? Witnesses turn to witnesses in opposition. Any other opposition witnesses? Any opposition witnesses seeing none. Let's bring it back to the dais. Colleague, any questions, comments, concerns?
- Lola Smallwood-Cuevas
Legislator
No, I just want to thank the author for this important bill. It's just so unfortunate that our ERs are the point of contact for basic care. Just as a testament to how we need to continue to work to offer accessible care for all that is continual and a safety net for all communities.
- Lola Smallwood-Cuevas
Legislator
And happy to move the bill when the time is right.
- Cottie Petrie-Norris
Legislator
Thank you, Senator.
- Richard Roth
Person
Thank you, assembly member, would you like to close?
- Cottie Petrie-Norris
Legislator
I will simply ask for an aye vote at the appropriate time. Thank you so much, Senator.
- Richard Roth
Person
Because we get a quorum, we'll take a motion and we'll do just that. Thank you all for being here. Thank you for presenting. Next item, item number 17, AB 2670. Assembly Member, Schiavo Awareness Campaign, Abortion Services thank you for coming. Please proceed when ready.
- Pilar Schiavo
Legislator
Thank you so much, Mister chair, Committee Members, we are all aware of the crisis facing abortion rights. You are just talking a little bit about it. And we know that the important role that California is playing to ensure that people across the state and the country are able to find the care that they need and deserve.
- Pilar Schiavo
Legislator
However, many Californians don't know where to access accurate and trusted information, where they can seek reproductive health care when they need it. In fact, there are many who are actually deceiving people across our state about where they can access medically accurate and comprehensive care.
- Pilar Schiavo
Legislator
Crisis pregnancy centers, or often called fake clinics, are centers that use known deceptive practices, target vulnerable populations to draw them in for care by claiming that they provide comprehensive services when they often have no licensed medical staff on site and many are not medical clinics, as well as no capacity or willingness to provide abortions or even refer people to abortion care.
- Pilar Schiavo
Legislator
Across California, fake clinics actually outnumber abortion clinics by 20%, making it more likely for people seeking abortion care to find these clinics rather than ones that actually provide accurate information and comprehensive healthcare, including abortion care.
- Pilar Schiavo
Legislator
These fake clinics shame, intentionally mislead and lie to women about their reproductive health care options in order to block them from accessing abortion care, and are often confusing to people in our community.
- Pilar Schiavo
Legislator
In the worst cases, being met with shame and fear and being Fed misinformation about abortions during this time can lead to higher rates of infertility, depression and suicide.
- Pilar Schiavo
Legislator
In an attempt to ensure that people know where they can get accurate information about where to access abortion care, AB 2670 will prompt the launch of a public awareness campaign to communicate the facts about pregnancy care and abortion services through Abortion CA.Gov Comma, a website that we've created here in California.
- Pilar Schiavo
Legislator
When women need access to healthcare, it's critical that the information that they get is timely, factual, and provides the best and providers that have your best interest in mind, not an agenda to discourage you from seeking abortion care.
- Pilar Schiavo
Legislator
With AB 2670, factual information will be delivered to the General public as well as those in the healthcare space to ensure anyone seeking abortion care knows where to get medically accurate, comprehensive and unbiased information. We know this is essential.
- Pilar Schiavo
Legislator
Rest assured, states across the country continue to face more extreme bans and we know that California will remain a beacon of hope.
- Pilar Schiavo
Legislator
I actually visited the crisis pregnancy center in my district and have a whole stack of information that was given out there, and one of the flyers that I took away was this confused man learning about do condoms make sex safe?
- Pilar Schiavo
Legislator
The truth is, it says even if you use a condom, every time you have sex, you're still putting yourself at risk. So this is just one example of the kind of information that they're putting out and lots of confusion about whether or not using a condom is effective.
- Pilar Schiavo
Legislator
Just basic sexual health information being misrepresented, and you can imagine how that works when it comes to people at a very vulnerable moment seeking abortion care. So today I have symphony Barbey, legislative advocate with Planned Parenthood to testify as well. And also Doctor Goodman. Doctor Goodman who has to leave soon.
- Pilar Schiavo
Legislator
So I'm trying to be quick curriculum Director at Teach for abortion and comprehensive healthcare.
- Richard Roth
Person
Thank you for joining us. Please proceed. Thank you very much. Again.
- Kelly Pfeifer
Person
Is that on?
- Richard Roth
Person
Yes, ma'am.
- Kelly Pfeifer
Person
Great. Again, chair and Members, thank you for having me today. I'm actually reading a statement today from my colleague, Doctor Kelly Pfeiffer. So she says, I have been an abortion provider for over 25 years, and I currently practice in rural California, Arizona and Kansas.
- Kelly Pfeifer
Person
I also run an independent abortion clinic in Kansas that serves people who travel from banned states seeking care. Every day in clinic, I see people for whom the news of an undesired pregnancy was a catastrophe. Many panic, fearful that they won't be able to get the help they need.
- Kelly Pfeifer
Person
Most are parents and know what it takes to be a parent. They find their way to a clinic through the Internet, but many times they get put on a Detour through the misleading information that they find there. I have seen many patients harmed by fake clinics which delayed their care.
- Kelly Pfeifer
Person
Many of these clinics are not medical clinics are not staffed by licensed providers, and they have given false information, including fake ultrasounds, in any other part of medicine. When I get a test result from another center, I trust it.
- Kelly Pfeifer
Person
But when patients bring in their ultrasound films, I have to repeat them because patients are given false results, told they are too far along to get an abortion when they are still early, all in the interest of preventing patients from getting the care they seek.
- Kelly Pfeifer
Person
My patients have no idea that their personal and private health information is not private, that these places can share their private data with whomever they and whatever they want. One of my patients went to one of these clinics for an ultrasound, assuming it was private.
- Kelly Pfeifer
Person
And the next day, she got a call on her cell phone from an anti abortion activist trying to persuade her to change her mind. I see patients weeping because they fear they will never be able to have a baby again. Abortions do not cause infertility or cancer or mental illness. These myths have been repeatedly disproven.
- Kelly Pfeifer
Person
But patients are told these lies when they think they're getting legitimate health care. In fake clinics, people get false information that affects them profoundly, and there are no consequences. Californians deserve to be informed. They have the right to medical care without being tricked.
- Kelly Pfeifer
Person
Please support AB 2670 so patients can search the Internet and get results that they can trust. Thank you again for your time.
- Richard Roth
Person
Thanks for joining us. Yes, ma'am.
- Symphoni Barbee
Person
Good afternoon. My name is Symphoni Barbee with Planned Parenthood affiliates of California, representing the seven affiliates who operate over 100 health centers providing comprehensive sexual and reproductive health care to patients across the state. And we are proud to be here in support of AB 2672 Years Ago, the Supreme Court overturned Roe v.
- Symphoni Barbee
Person
Wade, stripping away access to abortion and related care for millions of people across the country. At the same time, California led by investing in sexual and reproductive healthcare, improving access to practical support, and created abortion.ca.Gov, a comprehensive resource and website to help people get the information that they need to access abortion in California.
- Symphoni Barbee
Person
This resource has been critical in the years post ops. AB 2670 will require the Department of Public Health to develop an awareness campaign to help publicize abortion CA.Gov and help combat misinformation around access to abortion and reproductive health care.
- Symphoni Barbee
Person
While California has made substantial progress meeting the needs of patients, there are intentional misinformation campaigns out there designed to confuse and intentionally mislead people when it comes to their reproductive health care options.
- Symphoni Barbee
Person
AB 2670 promotes comprehensive access and information related to sexual and reproductive health care to further California's commitment as a reproductive freedom state, and I respectfully urge your I vote today.
- Richard Roth
Person
Thank you. Thank you for joining us. Other witnesses in support name affiliation position on the measure only please.
- Martin Radosevich
Person
Martin Radosevich on behalf of Reproductive Freedom for All in support.
- Richard Roth
Person
Thank you. Yes, ma'am.
- Kimberly Robinson
Person
Kim Robinson with Black Women for Wellness Action Project in support.
- Richard Roth
Person
Thank you.
- Brianna Nelson
Person
Brianna Nelson on behalf of Teach in strong support.
- Richard Roth
Person
Thank you. Any other witnesses in support of this measure? Witnesses in opposition? Seeing no witnesses in opposition. Bring the matter back to the desk. Colleague questions? Comments?
- Lola Smallwood-Cuevas
Legislator
I just want to thank the author for this important Bill and making sure we have the right information for our populations, particularly our youth and our vulnerable populations. And with that, I am happy to move the vote when the time is right. Thank you.
- Richard Roth
Person
Thank you, ma'am. Assemblymember, you may close.
- Pilar Schiavo
Legislator
Thank you. Really appreciate your support and or request your support. And, you know, we can see what an important issue this is. I was just in an event last weekend talking about this Bill to a crowd of folks and no one knew about abortion.ca,.gov, and these are pretty politically-involved people who had no idea about it.
- Pilar Schiavo
Legislator
So I think it's really, really important that we've created this great resource that can make sure that people have factual information. We have to make sure people actually know about it. So thank you so much. Respectfully ask an aye vote when the time is right.
- Richard Roth
Person
As soon as we get a quorum, we'll take a motion and we will do just that. Thanks for presenting. Thank you for joining us. Okay, next item, item number 22. Assembly Bill 2975. Assemblymember Gipson, I see you here. Occupational safety and health standards workplace violence prevention plan. Proceed when ready.
- Mike Gipson
Legislator
Thank you very much, Mister Chairman and Members. Thank you for allowing me to present this simple direct Bill. Assembly Bill 2975 I want to thank the Committee, the chair, as well as the Committee staff for helping. I will be accepting the amendments as was suggested.
- Mike Gipson
Legislator
This Bill seeks to improve hospital safety by requiring weapons detections screenings at selected hospital entrances to be conducted by a trained personnel. Healthcare workers are on the front line on a daily basis, providing patient cares, often facing with families, as well as families who are in crisis dealing with their loved ones.
- Mike Gipson
Legislator
According to the Bureau of Labor Statistics, healthcare workers are five times more likely to suffer, to suffer workplace violence, injuries, more than any other workers in the United States. And that is absolutely glaring. And it's on the uptick. On a daily basis, this issue of workplace violence adds health care workers stress and burnout.
- Mike Gipson
Legislator
And we've seen that even during the pandemic, a lot of our healthcare frontline warriors left. The profession was traumatized not only because of that, but also safety was an issue as well. Assembly Bill 2975 proposed to enhance and require safety measures for hospitals by.
- Mike Gipson
Legislator
Requiring common sense measures such as weapons detection, screenings at selective entrances to ensure that hospitals remain safe, a safe place for healing and not violence.
- Mike Gipson
Legislator
With me to provide supporting testimonies will be Miss Monique Nicole Hernandez, a registered nurse at the Riverside Community hospitals, and Matt with the government of affairs advocate for SEIU, who also self introduced as well.
- Richard Roth
Person
Thank you. Welcome. Thank you for joining us. Please identify yourselves for the record before speaking and fire when ready.
- Monique Hernandez
Person
All right. Good afternoon. My name is Monique Nicole Hernandez and I am a registered nurse at Riverside Community Hospital. I am also the Vice President of SEIU. One to one RN. Metal detectors are a basic safety measure that should be in place in every hospital, but there is no statewide policy or standard on metal detectors.
- Monique Hernandez
Person
So many of us in healthcare feel very unsafe at work. In January this past year, a group of men attempted to enter a four bedroom room at my hospital after another nurse had already asked them to leave the Premises. I had to physically block them from entering the room with my body.
- Monique Hernandez
Person
The men said they had gotten lost on their way out through to one of the other main entrances. When they left the way I instructed, the patient they were after came out from hiding in the bathroom, his own words, and the patient informed me the Shorter one had a gun.
- Monique Hernandez
Person
Apparently the patient had owed them money and had received a death threat after arriving at the hospital. He knew to hide. But like me and the three other patients in this room and my colleagues, we had no idea we were in danger. After that incident, nothing changed.
- Monique Hernandez
Person
The men had, after all, abided by all the hospitals security policies. They signed themselves in. No further measures were taken to protect our patients or us.
- Monique Hernandez
Person
Stories like mine are happening all over the State of California, where you and your loved ones go to receive care and heal, because it's up to the hospitals to decide the level of security they employ or not.
- Monique Hernandez
Person
Today, even hospitals that have metal detectors, they could lose them at any time because keeping them is solely up to the hospitals. Being a nurse is stressful enough without the fear of having to deal with violence on our mind. Our patients deserve our total attention.
- Monique Hernandez
Person
I was lucky to go home this day in January, but this is not lost on me. No one should rely on luck to make it home from work, period. It's a troubling trend right now in hospitals, where hospitals compromise nurse safety as a cost saving measure.
- Monique Hernandez
Person
Instead of investing in comprehensive security protocols, some hospitals choose minimal measures that leave staff and patients vulnerable. All Californians deserve quality health care, and they also deserve a safe health care. We need AB 2975 the secure hospitals for all Bill. Thank you.
- Matt Lege
Person
Thank you for coming and for presenting. Yes, sir.
- Matt Lege
Person
Good afternoon. Matt Lugar, on behalf of SEIU California, proud sponsor of the Bill, and want to thank both the author and the chair and the Committee staff for the work on the Bill and the labor Committee as well. This is one that we worked hard on.
- Matt Lege
Person
So for this Bill, we do really see this as a step forward to try to improve the safety for our workforce. Unfortunately, during the pandemic, there was a recent study that was done that found despite the drop in both patient volume and visitor volume, the incidence of violence continued.
- Matt Lege
Person
And so it's a really, it's a rising issue in our hospitals and want to make sure that we're trying to prevent the worst consequences of workplace violence, which is when a knife or another weapon is included. So for those reasons, that's why we're supporting the Bill.
- Matt Lege
Person
Look forward to continued conversations with the California Hospital Association and other opposition as we, you know, work to try to craft something that is both workable but is also going to address the safety and do want to appreciate the tenor that they bring to the conversation around making sure that, you know, it's something that they can do while also making sure that their workers are safe.
- Matt Lege
Person
So with that, I just respectfully request your aye vote when you're ready.
- Richard Roth
Person
Thank you for all that. Obviously, this is a very important issue. We need to take care of those who take care of us, and we also need to make sure that whatever we do, as with anything else we do up here, is workable.
- Richard Roth
Person
And I want to thank you and SEIU for working with us, with the Committee staff and with those who are on the other side of this issue to try to craft something that is doable while we protect those who need protection. So other supporters, anyone else in support? Name, affiliation, position on the measure?
- Elmer Lizardi
Person
Good afternoon, chair Members. Helmer Lazardi, on behalf of the California Labor Federation, in support.
- Richard Roth
Person
Thank you. Anyone else? How about opposition? Lead opposition witnesses first. Come on down. You know the rules. Name, identify yourselves for the record, please, and then proceed when ready.
- Christy Weiss
Person
Good morning or good afternoon. Christy Weiss, on behalf of the California Hospital Association and CHA is here today in an opposed, unless amended position, really want to thank and acknowledge the work of the author, the sponsor and the Committee.
- Christy Weiss
Person
And, you know, this is a hard one because we, too, consider the greatest priority to be the safety of the employees at the hospital, the patients at the hospital, and everyone who goes in and out of hospitals. So we are very aligned on the goal. The challenge for us is as is often the case.
- Christy Weiss
Person
The devil is in the details here. With over 400 hospitals throughout the State of different sizes and configurations, you know, we need the flexibility to figure out, where do metal detectors go? Is a metal detector the best and most appropriate, you know, system to have at that hospital?
- Christy Weiss
Person
We really appreciate the Committee's amendment to accommodate our rural hospitals and allow them to use the, to include the use of wands.
- Christy Weiss
Person
We'd like to see that for all of the hospitals, because, really, what we find is the challenge with the Bill is the language, as is too prescriptive in terms of where the metal detectors have to go, you know, kind of what can be used within those systems.
- Christy Weiss
Person
So we're hopeful that we can continue these conversations and work through some of these issues, get to a place where there's greater flexibility for the hospitals. And, you know, again, we have a long history of working with Cal OSHA to come up with standards, so we are comfortable with that framework and that paradigm.
- Christy Weiss
Person
We just really want greater flexibility in terms of how we create the systems. The unintended consequence that none of us wants to see is that a system is in place that creates log jams or delays for folks getting into the hospitals.
- Christy Weiss
Person
And so, you know, again, we'll continue to work with the author and the sponsor to try to work through some of those issues.
- Sarah Bridge
Person
Thank you. Mister chair and Committee Member Sarah Bridge, on behalf of the Association of California Healthcare Districts, really want to hear opposed to the Bill. I want to echo the comments of my colleague from the Hospital Association.
- Sarah Bridge
Person
I want to say that we were pleased to see the Committee suggest amendments around the rural hospitals allowing them to use hand only metal detectors. Agree that that should be an option for other hospitals. However, we understand that our rural hospitals have particular spatial and financial challenges that other hospitals do not.
- Sarah Bridge
Person
Our remaining concerns are around potential liability for the hospitals. In particular, hospitals are federally required to deliver care. We have no ability to turn away patients seeking hospital and emergency services because they refuse to go through a metal detector. So want clear standards on what constitutes a weapon, how to return those weapons.
- Sarah Bridge
Person
Additionally, we have concerns around storing weapons and engaging law enforcement when appropriate. We are encouraged by the direction the Bill is moving. We again share in the sentiment, the intent, and the goal behind the Bill to keep our patients and a workforce safe. However, at this time, we are still respectfully opposed unless further amended. Thank you.
- Richard Roth
Person
Thank you. Any other witnesses in opposition?
- Kelly Brooks-Lindsey
Person
Kelly Brooks. I'm here on behalf of the California Association of Public Hospitals. We have a concerns position, and we remain concerned with the storage provisions as well, thanks.
- Richard Roth
Person
Anyone else in opposition? Well, I'll say this. This is a very important measure. We need to have some protections in place. Obviously, the OSHA standard. I mean, I used to do this work. The OSHA standards board is there for a reason. Normally the California Code of Regulations sets out with more specificity what we normally put in statute. However, that takes time.
- Richard Roth
Person
And so as you work through this process, if the Bill passes out of the Committee and onto the floor and off the floor, perhaps during that process, you can provide some language that the standards board could issue more specific rules and deal with the issue of where we actually place this equipment in hospitals to take into account variations in size and all of the rest.
- Richard Roth
Person
But from my perspective, it seems to me we need to get some rules in place and then figure out how to modify them to make them workable.
- Richard Roth
Person
If we can't do it in the Bill itself, to have language to allow the standards board to do it and then make sure we make them, make the rules workable for hospitals at the same time as we provide protections, badly needed protections for workers.
- Richard Roth
Person
I'm sure you can work out issues about when you notify law enforcement and whether you confiscate weapons or notify law enforcement, whether you store them in certain cases, you know, the law is pretty clear. Even those who are authorized to carry a firearms with a CCW are not allowed to have them on hospital property.
- Richard Roth
Person
And so those who do haven't read the book.
- Christy Weiss
Person
Yes, thank you for that, Senator. And that would very much be our preference to work with Cal OSHA to come up with the standards. The challenge that we have is some of the language that Cha uses as being too prescriptive would go into the statute.
- Christy Weiss
Person
That would be the framework that Cal OSHA would have to work kind of underneath.
- Richard Roth
Person
Well, unless the statute says otherwise.
- Christy Weiss
Person
Right. And those are the amendments that we're hoping.
- Richard Roth
Person
But, you know, at the end of the day, we need to have some sort of weapons detection device in place where the public enters the facility to screen out firearms, to screen out knives that are in violation of California law because there's a rule against that and all of the rest before those people get access to the facility, access to staff and access to patients.
- Richard Roth
Person
So, and the problem with the standards board process, it takes a while, and sometimes it takes a long while. And between now and the long while, we have a whole bunch of people who potentially are at risk, and we need to make sure that whatever is in the Bill protects them. So those are my comments on it.
- Richard Roth
Person
But let me turn it back to my colleagues on the dais. Colleagues, any questions, comments, concerns?
- Lola Smallwood-Cuevas
Legislator
No, I just want to thank the author for bringing this forward. We have this discussion in Labor Committee and it's just a sad day in California when we have to put medical detectors at a hospital because of how prevalent weapons and guns are, particularly in our community.
- Lola Smallwood-Cuevas
Legislator
And it is the balancing act of making sure that our workers, our frontline workers that we rely on so much are safe. Really appreciate your story and I'm grateful that you got home on that day. But balancing it also with the families and visitors who are coming into the hospitals.
- Lola Smallwood-Cuevas
Legislator
We know when law enforcement gets involved, it can be a very, very challenging situation because of institutional racism and barriers and profiling. So I appreciate you working with labor Committee and I'm happy to support the Bill when the time is right.
- Richard Roth
Person
Senator Grove.
- Shannon Grove
Legislator
Thank you, Mister chair. I have deep respect for the author. There's a melee off the Bill today, and the only reason is because I want to make sure that working with the opposition, there's several hospitals in my district and Good Samaritan has three exits and three entrances. I think dignity health has 16.
- Shannon Grove
Legislator
So, and I think that there is, we do have an obligation to make sure that employees and patients are safe, but we also have a balancing act and we need to make sure that hospitals have the ability to do that where the liability falls and those kinds of things.
- Shannon Grove
Legislator
And I know you're a person that will work with opposition to solve some of these problems. I've worked with you for years, even in the Assembly, and so I trust you work out these issues. So I'll Reserve my right to vote for, for this Bill if it comes to the floor.
- Mike Gipson
Legislator
Thank you very much. So, Member Gibson, would you like to close very briefly? I appreciate the robust conversation and thank each Senator for your commentary regarding this. I was, just, as the dialogue ensued and took place, I was thinking about the state capitol back in the sixties when Willie Brown was the speaker.
- Mike Gipson
Legislator
I remember very vividly in that Capitol across the street where people brought guns into the Capitol. Today we don't. I remember also going back in memory Harvey Milk. If in fact there was metal detectors in the Board of Supervisors, would he still be with us today?
- Mike Gipson
Legislator
I even come back to the present time where we're in today where having conversations with nurses, where we've had employees in hospitals have disputes among each other, where weapons was also brought into the workplace. I often go back to just the present time when walking in this building.
- Mike Gipson
Legislator
There's a metal detector coming into this building, not only for those protections of those people who are here, but also for lawmakers as well. When you, when I leave this place tomorrow, I will be going to the airport, and through that airport, there's TSA.
- Mike Gipson
Legislator
I will be going through a detective, a detection process, a metal detector, not only through my bags, but also on my person to making. We don't.
- Mike Gipson
Legislator
What I'm trying to simply say is we don't live in a time in the sixties, we live in different times today where we have to also implement measures that speaks to our day and time that we're living in right now. Safety is an issue.
- Mike Gipson
Legislator
The articulation from Vice President Hernandez again brings home the point that we cannot wait. We have to make sure that we protect our frontline workers. And even the Chairman said as well, we have to protect those frontline workers because those are the ones who are caring for ourselves, our family Members and alike.
- Mike Gipson
Legislator
And the best way to do that is in a very thoughtful way, coming together, having this robust conversation, trying to find the balance with both sides to make sure that we protect those frontline workers as well as those patients seeking care. And I hope with the wisdom that's in this body that you will render your aye vote in support of 2975. Thank you very much for your time.
- Richard Roth
Person
Nice presentation. You know, unfortunately, the hospitals are the place where people in conflict wind up. And whether it's a domestic dispute or a business dispute or something that's not quite lawful, and it's a dispute, those folks, some of them wind up in the hospital. And sometimes people want to continue the dispute once they're in the hospital.
- Richard Roth
Person
And we need to make sure that we can, we make an attempt to stop that before it occurs. So thank you, sir, for the presentation. Thank you all for your testimony. We'll be available over our district break and into August. I'm not dead yet. I'll be around in August.
- Richard Roth
Person
If you need our help here to put this thing together a little bit better, to try to achieve something closer to perfection, we'll be here to do it. Thank you.
- Mike Gipson
Legislator
Thank you.
- Richard Roth
Person
Item number 23, AB 3047, Assemblymember McCarty, youth athletics. Proceed when ready.
- Kevin McCarty
Person
Thank you, Mr. Chair. Is this your last Bill?
- Richard Roth
Person
This is the last Bill.
- Kevin McCarty
Person
This is your last ever Health Committee hearing?
- Richard Roth
Person
Well, I would like to say that, but I'm not going to jinx myself.
- Kevin McCarty
Person
Well, if it is, congratulations.
- Richard Roth
Person
Thank you.
- Kevin McCarty
Person
Yes. This is a topic that I'm very committed to, focusing on the health of our youngest athletes in California, specifically related to youth tackle football. I grew up playing football here in Sacramento in the hot weather, just like this summer, I played tackle football and flag football.
- Kevin McCarty
Person
And, you know, years later, now we're learning that tackle football has a severe impact on our youth. We're going to hear from our witnesses and our Neurology Association in a bit. More and more research is coming out. You know, frankly, parents are voting with their feet. They're picking other options like flag football and soccer.
- Kevin McCarty
Person
Now flag football is an Olympic sport. The NFL plays in the Pro Bowl. It's a high school sport for girls now. So it is an alternative to protecting our youngest kids. And more and more research shows that just like smoking, the earlier you start smoking, the greater your risk to get cancer later in life.
- Kevin McCarty
Person
And, you know, cumulative hits to the brain are really impactful and research shows that kids that play youth tackle football under 12 are 15 times more likely to have head impacts than flag football. It's not just CTE and concussions.
- Kevin McCarty
Person
It's the little sub-concussive hits over and over when you're taking, when you're doing a practice little drills over and over, not a big concussion, but the little hits over and over have the greatest impact as our researchers will show you. So we're not always experts on this because you can't find out unless the person dies.
- Kevin McCarty
Person
That's why you hear these tragedies of kids that have CTE. One kid here in California last year put his family on the phone, told them he was going to commit suicide, and shot himself in the heart so they could study the brain. Athletes like Junior Seau, the legend, San Diego Charger and Oceanside, the same thing.
- Kevin McCarty
Person
So this is the only thing you find when somebody dies. So the impacts are severe for our youngest kids in California. We could certainly have an opportunity, California, to provide better rules of the game for kids that play in high school. There's a great debate as far as what an entry level should be.
- Kevin McCarty
Person
One thing that we decided that we wanted to do, we talked about this a couple years ago and the Administration encouraged us to work on this again this year, as opposed to setting a date for when you would start playing this, is to have us do some more research.
- Kevin McCarty
Person
And this would direct our surgeon general to convene a commission to study the risks and brain injury impacts related to youth tackle football. With me are two distinguished witnesses. I ask you to listen to them and respectfully ask for your aye vote. Thank you.
- Richard Roth
Person
Thank you, sir. Please identify yourselves for the record. Proceed when ready.
- Sarah Tolentin
Person
Perfect. Hello, my name is Sarah Tolentin. I'm from Pleasanton, California, and I am here today as a child of a parent diagnosed with CTE. I come from a football family. My dad played Division 1 football for the University of Florida. My brother played for Oklahoma State, and I was a Division 1 rower at the University of Miami.
- Sarah Tolentin
Person
While I love sports and the invaluable lessons they teach, football also took my father away from me. My dad was a man of remarkable achievements. He was the first in his family to graduate from college, something that would not have been possible without football.
- Sarah Tolentin
Person
He earned his MBA and dedicated his life to advancing scientific discovery, supporting the work of four Nobel laureates. Yet, by the end of his life, he could barely hold a conversation and couldn't keep a job at a local grocery store. The family he was so proud of, he was estranged from.
- Sarah Tolentin
Person
My dad died at the age of 59 alone in his apartment. And thanks to CTE, I lost my dad years before his actual death. Before things got as bad as they did, my dad asked us to donate his brain for concussion research to benefit other athletes and their families.
- Sarah Tolentin
Person
As a clinical psychology doctoral student, I have dedicated my dissertation to learning from other surviving family members of CTE. Every single family member, their stories are hauntingly similar. The sport they loved destroyed their lives. Every single family member I have spoken to has wished that they and their loved one had known the risks.
- Sarah Tolentin
Person
While some still would have played football, the right to make that informed choice was taken from them. I am here today to urge you to study safer practices for football and consider establishing a minimum age for youth tackle football. Advocating for AB 3047 is not about taking away football or its values, but about ensuring informed consent.
- Sarah Tolentin
Person
History has shown us the importance of reevaluating what we once thought was safe, like how cigarettes were once physician-tested and approved. These tragedies are not isolated. Repetitive head impacts are to blame. The pain my family endured was preventable. CTE is preventable. Tackle football can wait. Thank you for your time.
- Richard Roth
Person
Thank you for joining us and for your testimony. Yes, sir.
- Steven Cattolica
Person
Good afternoon. My name is Steve Cattolica. I represent the California Neurology Society and their President, Stella Legarda, who could not be here today. We've provided the Legislature with volumes and volumes of statistics and studies starting back well into last year. And so I'm not going to go recite those once again.
- Steven Cattolica
Person
But I do want to mention that the lack of knowledge that parents have needs to be filled. We were told that with the original version of this Bill, and so the current version is going to fulfill that task. It's so important and I can only talk to my personal experience and, similar to Sarah's, my father played football at Cal in the thirties and he played rugby.
- Steven Cattolica
Person
They didn't have helmets. And unfortunately, in the early 1980s, he was one of the very first brains that was analyzed because he died of dementia. My mom didn't know what to do. His brothers were brutal on him because of his loss of faculties.
- Steven Cattolica
Person
They didn't understand it. Nobody did. And if we can do anything to keep that from happening, and that's not to say that football needs to be outlawed. None of that. But if we can do it better and we can know more about it, we should. And this Bill will take us a long way towards that. So thank you very much for your time.
- Richard Roth
Person
Thank you for joining us today. Witnesses in support? Name, affiliation, position on the measure, please.
- Vanessa Cajina
Person
Thank you. Vanessa Cajina on behalf of the California Academy of Family Physicians here in support.
- Richard Roth
Person
Thank you. Next, any other witnesses in support? Witnesses in opposition? Sir, come on down.
- Ron White
Person
Good morning. But it's clearly afternoon now, so I say thank you to the Committee. I understand you have a really busy agenda, and you'll probably appreciate that I will keep my remarks brief as it's a long day and I respect the work you're doing up here. Great. Thank you.
- Ron White
Person
My name is Ron White, and I am the President of the California Youth Football Alliance, representing thousands of youth football participants statewide. We respectfully become before you today in staunch opposition to Assembly Bill 3047 as written for the past six years. And I said hello to Assemblymember Mccarty on the way in because we've had constant conversation.
- Ron White
Person
We have traveled to the Capitol from all corners of the state to stand up for the rights of parents, players, and communities and will continue to do that. Really important for this testimony.
- Ron White
Person
During that time, we have also played a critical role in establishing the most comprehensive youth tackle football safety legislation in the country, the California Youth Football act. To date, it is the only piece of legislation of its kind in the nation and will soon be modeled in other states. I think that's really key for this conversation.
- Ron White
Person
We oppose AB 3047 as it focuses solely on a single youth sport in California, youth tackle football, and does not mention nor reference countless other contact sports or activities statewide, such as soccer, wrestling, basketball, junior boxing, mma, rugby, flag football, lacrosse, motocross, and many other sports. Nothing listed.
- Ron White
Person
During today's proceedings, you may hear medical opinions offered by the author and those testifying in support of AB 3047.
- Ron White
Person
It is critically important to note that those opinions are not shared unilaterally by the medical community, as clearly demonstrated in multiple studies, including a study released just in the past 30 days by the Harvard University School of Public Health, which found, and I quote I no significant relationships between first playing tackle football before the age of 12 and adverse outcomes later in life.
- Ron White
Person
We have provided countless comprehensive studies in this area, including research listed in the Lancet and other peer review, excuse me, peer reviewed publications demonstrating significantly different outcomes as you tackle football and science are constantly evolving.
- Ron White
Person
As written, AB 3047 in its current state seeks, via proposed study, to establish a minimum age of play for youth tackle football, knowing there is no such legislative nor clinical precedent in this area for youth sports and or activities of any kind in California.
- Ron White
Person
It was stated in a recent informational hearing by proponents of this Bill that, quote, science cannot tell us the right age to play or not to play youth tackle football.
- Ron White
Person
We, along with many medical experts, agree as causation is not correlation in the bill's analysis, the author is quoted saying, there is no real way to safely play youth tackle football. We adamantly disagree. As the current version of youth tackle football being played today, it is the safest version in this country's history.
- Ron White
Person
And California is now, and I say this proudly, now, leading the nation through the California Football act. It is vital when informing public policy with significant risk of negative unintended consequences. We examine this process with clinical clarity. AB 3047 alienates constituents in attempts to unravel the work of the California Legislature via Assembly Bill one.
- Ron White
Person
Excuse me, AB one. And we do not see, and this is important for this AB 3047 as a companion Bill to the California Youth Football act. Not at all.
- Ron White
Person
As Californians, we have a real opportunity to educate and inform the public via AB one, the California Youth Football act, and respectfully, resources should be allocated in that direction and not on a discriminatory single support study Bill that is in front of you today.
- Ron White
Person
With all that being said, for those reasons outlined, we respectfully ask for a no vote on AB 3047.
- Richard Roth
Person
Thank you, sir. Any other witnesses in opposition? Seeing none, I'll bring the matter back to the dais. Colleagues, any questions, comments, concerns? Senator Menjavar, thank you so much.
- Caroline Menjivar
Legislator
And I don't know if the sponsors or the author would like to answer these questions. The analysis by this Committee had really conflicting information regarding the need. I mean, there's various studies that show that there is no correlation for, regardless of what age you start playing tackle football. I mean, there's mixed reviews with professional NFL players.
- Caroline Menjivar
Legislator
And then I also think about this on the, for low income communities, right. This is an opportunity for kids to be active, to stay out of drugs, or be at promised risk youth.
- Caroline Menjivar
Legislator
So I feel like in pushing this, and I'm okay with the Commission part, but the part that it's asking to come up with the minimum age to play tackle sports that requires a parent or a guardian to approve, I think goes a little far, in my opinion.
- Caroline Menjivar
Legislator
So I'm just wondering, since there's not enough outstanding studies, the need for bringing forward a Commission that is going to come up with the minimum age.
- Richard Roth
Person
Please.
- Kevin McCarty
Person
The second one. First, you weren't here when I started, but I grew up in this hot area, Sacramento, and played tackle football and pop Warner and soccer as a kid. And I can tell you that Pop Warner is way more expensive than flag football and soccer. So there all are alternatives.
- Kevin McCarty
Person
If you Google right now, football opportunities, there are way more flag football opportunities than there are tackles. So there are ways for kids to get involved at a safer age. I mean, parents are voting with their feet. There are way more flag opportunities now.
- Kevin McCarty
Person
Now, as you know, flag is a high school sport for girls, an Olympic sport. The NFL is doing flag for a reason, because there's inherent risks. You know, NFL players in droves are saying we should wait. You know, Tom Brady, the best ever, didn't play high school, didn't play football teams in high school.
- Kevin McCarty
Person
We have one Member of the Legislature who played in the NFL, not me, Avellino Valencia. And he is a joint author of this. So he believes that we should focus on this because there are inherent risks and that you can wait. There are other options. But your bigger question.
- Kevin McCarty
Person
There is no evidence to smoking gun evidence to this, because this is a disease. You don't find out until someone's dead. This is a disease. You don't find out until someone is dead to study their brain. It's not like tobacco research 40 years ago when it was a crystal clear point in time.
- Kevin McCarty
Person
Okay, this doesn't make sense for our youngest kids. What we said, you wait till you're 18. So what we're doing isn't a making a decision. There was an idea I did have that we would actually set a policy. This asks our state surgeon General to evaluate whether or not there should be a minimum age.
- Kevin McCarty
Person
Maybe the minimum age he comes back with or he or she comes back with says it's four years old, which they wouldn't be a minimum age. So, you know, it's not setting what it would be. It's asking the question, should there be one?
- Kevin McCarty
Person
And I think this helps, you know, answer the issues as far as, you know, what is best for the tens of thousands of kids across California. Do you want to expand upon that?
- Unidentified Speaker
Person
Yeah. Thank you. I would echo the assemblyman's comments, and, in fact, the original version of this Bill was a little draconian in the sense that it did try to draw a line. The request from the football folks was to provide the opportunity for a parent to make their own decision.
- Unidentified Speaker
Person
And in order to do that, we all acknowledge that there was a dearth of information available. The surgeon General will help us backfill that information and allow parents to make an informed decision. There's no question that flag football is a great alternative. It's much less expensive.
- Unidentified Speaker
Person
So if you're talking about making things available for kids, that's exactly the right answer. There's an ad here that puts almost a $600 price tag on just the equipment alone, little on anything else.
- Unidentified Speaker
Person
And if you take that $600 and put it against a couple extra fields and some other people that can supervise the activity, I think you come out ahead. So the point that we needed to try to make was we weren't trying to, and maybe we came at it ham handedly trying to draw a line.
- Unidentified Speaker
Person
But by the same token, parents do have a right and they should make an informed decision. And I will tell you, as I did with my father's experience and yours as well, you don't know, and you can't do anything about things that you don't know. So the more we know, the better off we're going to be.
- Richard Roth
Person
Perfect. Please proceed.
- Caroline Menjivar
Legislator
Can you talk to me about. Because there are conflicting studies, conflicting studies. The Commission, is this a Commission? What is your intent here? What studies are they going to be looking at? Guard rows, that it's not one sided just because it's just very conflicting information.
- Kevin McCarty
Person
Well, if you look at the actual Bill on just a short Bill, two page Bill on Section two, it says, the surgeon General shall convene a Commission, and it says, who should be on there? And it says, consist of selected Members, should include, not be limited to people in youth, sports, public health, neuroscience, pediatricians.
- Kevin McCarty
Person
So, you know, we're trying to get people from all sides to look at the issue and come up with more clarity and advice for our youth and for our families throughout California.
- Unidentified Speaker
Person
Is it okay if I answer this a little bit in regard to the conflicting study? I am a clinical psychology doctoral student, writing my dissertation, interviewing family members. And part of writing a successful dissertation is examining both sides.
- Unidentified Speaker
Person
So even though I may want to answer one question, I do need to look at both sides of the coin. While there may be limited, conflicting data, I also encourage you to look at the funding behind the data that is conflicting. These studies are out there. They exist.
- Unidentified Speaker
Person
And if the big question is, you know, if this conflicting data is out there, why should we do things? That's exactly why we're calling for this, for you all to investigate this further.
- Unidentified Speaker
Person
So it's not either side just coming at this, but saying, like, hey, have an objective view of this because families are being affected and this is a health risk.
- Ron White
Person
Can I respond to that as well? I can wait. Certainly.
- Richard Roth
Person
Sure. I just want to note, I'm looking at the Bill, and the Bill asks this particular Commission, led by the surgeon General, a healthcare provider, to provide recommendations. That's what these are. This isn't recommendations based on the study that's conducted. And it's not, as you've heard from previous bills.
- Richard Roth
Person
Here we have the battle of scientific studies all the time, and someone has to sit down and try to sort through them and then make recommendations as to what should be.
- Richard Roth
Person
And in this particular case, the language talks about, you know, an appropriate minimum age for participation, which very, I'm sure that you have, that the people that are running football leagues and the like have minimum ages for participation. Sure. Certainly.
- Richard Roth
Person
And it may very well be that the surgeon General and the Commission's recommendation coincides completely with the current recommendation, with the current minimum age that you have for participation in your leagues. We don't know. Right. But that's why we have a Commission and a surgeon General to take a look at this.
- Richard Roth
Person
If the Bill had been prescriptive and had set minimum age of 16, then I guess we would be having a different conversation. But this is just sort of, we call them a study Bill. Sure, I'm familiar, but yes, you may respond.
- Ron White
Person
So I appreciate that. And I think that that is an absolute fair response. But we have two concerns with this Bill. And prior to the concerns, I want to make a statement. In 2022, a similar Bill was ran, and through the wisdom of Governor Newsom, that Bill was vetoed.
- Ron White
Person
And two things that were cited in that veto was the fiscal impact. And I think we're all aware as a state where we're at fiscally now, and what's really being ignored in this conversation, not from you folks, but just overall with the author, is the California Youth Football act. He cited both of those.
- Ron White
Person
We have an off ramp, we have a mechanism, and it's the only piece of legislation in the country. And resources, respectfully, should be put in that category. The two issues, and we are opposing this Bill as written for this one reason.
- Ron White
Person
If this Bill would have been introduced early on instead of a banned Bill, and that's what we'll call this, because when you set a minimum age or you attempt to do that going back to 2018, then you're cutting off a segment of the population that's the historical chronological of that.
- Ron White
Person
So we're concerned because this is a six year journey in this process, the youth tackle football community went to work, rolled up its sleeves, and through the wisdom and help of Assemblyman Cooper, we drafted a piece of legislation that is groundbreaking. That's number one. And it seems to be ignored in this conversation.
- Ron White
Person
Number two, our concern is the limited scope and the way that the study Bill is being rolled out. If we felt that this was a fair and equitable Bill, respectfully to everyone here, I would be flanked at this table with folks from junior rugby, boxing, any contact sport in the state.
- Ron White
Person
We're alone once again with the microscope on youth tackle football. Science is unsettled. And respectfully to the folks to my left, what they've shared here is heartbreaking. And I wear a lot of hats, but as a father, that's the most important that I wear.
- Ron White
Person
But I would say to them and everybody here that sport is not this sport. I've spent three and a half decades as an advocate for youth tackle football, helping grow the sport, helping evolve the sport. And I heard a Committee Member, Menjivar, say, what is the unintended consequence? What's the impact?
- Ron White
Person
I can also tell you when we potentially start removing programs and services, the unintended negative impact could be through the roof. And I don't just say that as a football person. I say that as a retired state peace officer. Sir.
- Richard Roth
Person
Yes, sir, I'm giving you time to speak.
- Ron White
Person
Thank you.
- Richard Roth
Person
But I want to interrupt and rude, but remember, this is a recommendation. If it comes back here, nothing happens unless this Legislature or the follow on legislatures that will come and somebody else sitting in this chair decide it should happen.
- Richard Roth
Person
So I want to make sure that we stay focused what this Bill is and remember what it is not. My colleagues may choose not to support it, may choose to vote no, stay off the Bill. That's what this process is all about, because we all have different constituencies, and it's not what we think.
- Richard Roth
Person
It's what our constituents think that matters. But I just want to make sure that we don't cause alarm for folks who are listening to the hearing who may not have access to the Bill and haven't read it. Thank you.
- Richard Roth
Person
May not have access to the analysis and haven't read it, and they think that we're doing something here to prevent their son or daughter from participating in a school football game or a league football game somewhere that is not this Bill. And if there's somebody here who thinks differently, please speak up now.
- Ron White
Person
No, thank you. I appreciate that point. I certainly appreciate you making that point. And I appreciate you reference the word alarm, but there is some alarm. And I appreciate the fact that you're lining out what this Bill will or will not do.
- Ron White
Person
But I want to say again, for the record, respectfully, that if this was perceived, at least from the tackle football community, as a fair and equitable Bill, we would be flanked with multiple other sports in this state instead of there being a continuous microscope on youth tackle football.
- Ron White
Person
And the irony of that, and this is pertinent to the Bill, the irony of that for us from our position, is we're the group that's rolling up our sleeves.
- Ron White
Person
We're the group that went to work with California legislators because we acknowledge that we can do better and we are better, and we have an off ramp and a mechanism. And I feel as if that is a really crucial part of this conversation, that we're missing segments of the population that are not represented here, respectfully.
- Richard Roth
Person
Okay, where are we? Senator Menjivar, colleagues, any other questions? Comments? Who? Senator Limon please jump in.
- Monique Limón
Legislator
Thank you. And I just want to make a comment, because I've actually watched the evolution of this subject matter in the Legislature. And when I served in the State Assembly, this issue came up, and it was a very different Bill, very different Bill to the one that is in front of us. That is just a recommendation.
- Monique Limón
Legislator
And I remember having conversations with you about that Bill. And so I want to recognize that this Bill didn't come out of anywhere, that the first version of what was introduced was very different.
- Monique Limón
Legislator
And to get a group of experts to come together to provide recommendations, particularly in light of the original issue, the original Bill feels like the right step to move forward.
- Monique Limón
Legislator
And I just want to recognize that because this is interesting and also complicated to me to hear some of the same arguments that were being used on a different Bill used today, when this Bill has made a lot of changes or this topic has made a lot of changes.
- Monique Limón
Legislator
And so I asked myself, will there ever be a time where as long as we talk about tackle football, these arguments won't be made? And, you know, I've been here eight years, and I hear the same arguments no matter what the Bill is.
- Monique Limón
Legislator
But the Bill is actually very, very, very different, very different than what was introduced in the Legislature years back before the 2022 Bill. So, just to be clear, before the 2022 Bill, you know, I will be supporting the Bill.
- Monique Limón
Legislator
I also think that we've come a long way to bring, and I agree with bringing folks together that are experts in this space to provide recommendations about what should or should not be considered. A recommendation is not a law. And so I'm happy to move the Bill when appropriate and when we have quorum.
- Richard Roth
Person
Thank you, Senator Limon. Listen, I want to be clear. Big supporter of team sports, youth team sports, team sports in school. I've spent a lot of time in the military.
- Richard Roth
Person
We used to call that a team sport, sort of, but it requires teamwork, organization, focus, the ability to play well in the sandbox, all the things that what you do and others just like you do with young people, we just need to make sure that, you know, it's as safe as possible.
- Richard Roth
Person
I will note that one of the other requirements of the Bill is, in addition to having to analyzing scientific data and coming up with some various recommendations, is to also recommend the best practices for minimizing any risks that are identified through this process.
- Richard Roth
Person
So there's a lot of good that can come out of this Commission that's going to be presented back to those who are sitting here. Won't be me, to think about what to do, if anything. And it could very well come out entirely, the outcome could be entirely different than the outcome that you're predicting.
- Richard Roth
Person
We'll just see how this process goes. Seeing no other hands up, Assemblymember, have at it.
- Kevin McCarty
Person
Yeah, this is a certainly a topic you could get a lot of debate tomorrow at the 4 July parades around California, taking away fireworks or apple pie. You know, this is, there's conflicting opinions on this. And you have research from people in academia and science, and you have research that sometimes is paid by the industry.
- Kevin McCarty
Person
And people question that. You know, just like years ago, we heard from the tobacco industry that cigarettes with filters will be safe. Like we realized, no, that wasn't true. So this is an opportunity to kind of peel the layers of it off and have some independent analysis as far as what's best for California.
- Kevin McCarty
Person
I will say that, yeah, we are in a budget situation, and I did propose last year the legislation that would have had a policy for an age. And the Administration asked us to step back and ask us to go forward with the Bill so we can have a more thoughtful discussion what we're doing just now.
- Kevin McCarty
Person
So certainly the finances of California will dictate where we go next. But I think this is a fair approach and you laid it out great. Mister Chairman, as far as being open to ideas and where we go from here. And with that, respectfully ask for your. aye vote.
- Richard Roth
Person
Thank you. As soon as we get a quorum, we'll take a motion and we will take a vote. I do want to thank you all for taking your time to come down here and participate and for your testimony. We really appreciate it on both sides. Thank you very much.
- Richard Roth
Person
And I think we will be in a recess for 10 minutes. I will ask the sergeants to call the members so we can get a quorum and we can take a vote.
- Kevin McCarty
Person
Thank you.
- Richard Roth
Person
Okay, the Senate Health Committee will be back in session after our relatively short recess. Let's establish a quorum.
- Committee Secretary
Person
[Roll Call].
- Richard Roth
Person
Okay, we have a quorum. Let's take up the consent calendar. There are 10 items on the proposed consent calendar. Does any member need me to read them? Everybody know what the consent calendar is? Okay, we need a motion on the consent calendar. Senator Nguyen moved the motion. Moved the consent calendar. Please call the roll.
- Committee Secretary
Person
[Roll Call].
- Richard Roth
Person
Vote on the consent calendar is nine-zero. We'll hold the roll open for absent members. Let's then continue. We'll skip over item number one for the moment. Let's continue with item number two, AB 815 Assemblymember Wood, healthcare coverage provider credentials. The motion do pass as amended re-refer to Committee on Appropriations. Is there a motion? By Senator Gonzalez. Please call the roll.
- Committee Secretary
Person
[Roll Call].
- Richard Roth
Person
Vote eight to one. We will hold the roll open for absent members. Moving to item number three, AB 1577 Assemblymember Low, general acute care hospitals. Motion do pass, re-refer the Committee on Appropriations. Is there a motion? By Senator Smallwood-Cuevas. Please call the roll.
- Committee Secretary
Person
[Roll Call].
- Richard Roth
Person
Vote is eight to two. We'll hold the roll open for absent members. We move to item number four, AB 1895 Assemblymember Weber, public health maternity ward closures. Motion do pass and re-refer the Committee on Appropriations. Is there a motion? By Senator Limon. Please call the roll.
- Committee Secretary
Person
[Roll Call].
- Richard Roth
Person
Who changed what? Is it eight to two?
- Lola Smallwood-Cuevas
Legislator
Yes. Eight to two.
- Richard Roth
Person
Vote is eight to two. We will hold the roll open for absent members. Next item. Item number seven, AB 2115 Assemblymember Haney, controlled substances clinics. Motion do pass, re-refer to the Committee on Appropriations. Is there a motion? By Senator Rubio. Please call the roll.
- Committee Secretary
Person
[Roll Call].
- Richard Roth
Person
Vote is eight to zero. We'll hold her open for absent members. Next item. Item number nine, Assembly Bill 2223 Assemblymember Aguiar-Curry, cannabis industrial hemp. Motion is do pass, re-refer the Committee on Appropriations. Is there a motion?
- Unidentified Speaker
Person
Mr Chair, did she take amendments?
- Richard Roth
Person
No. Is there a motion? By Senator Gonzalez. There's a motion. Please call the roll.
- Committee Secretary
Person
[Roll Call].
- Richard Roth
Person
Vote is ten, zero. We'll hold the roll open for absent members. Next item is item number ten, AB 2316 Assemblymember Gabriel, pupil nutrition. Motion do pass as amended and re-refer the Committee on Appropriations. Is there a motion? Is there a motion? Senator Gonzalez makes the motion. Please call the roll.
- Committee Secretary
Person
[Roll Call].
- Richard Roth
Person
Vote is seven, zero. We'll hold the roll open for absent members. Next item. Item number 14, AB 2467 Assemblymember Bauer-Khan, healthcare coverage for menopause. Motion do pass, re-refer the Committee on Appropriations. Is there a motion? Senator Rubio makes the motion. Please call the roll.
- Committee Secretary
Person
[Roll Call].
- Richard Roth
Person
Vote nine, zero. We'll hold the roll open for absent members. Item number 15, AB 2490 Assemblymember Petrie-Norris, reproductive health emergency preparedness program. Motion do pass as amended and re-refer to the Committee on Appropriations. Senator Smallwood-Cuevas, would you like to make a motion? Senator Smallwood-Cuevas had made the motion earlier. She just confirmed it during the time we could make a motion. Please call the roll.
- Committee Secretary
Person
[Roll Call].
- Richard Roth
Person
Vote is nine to two. That measure is out. Next item. Item number 17, AB 2670 by Assemblymembers Shiavo and Holden, awareness campaign abortion services. Motion do pass and re-refer the Committee on Appropriations. Is there a motion? Assemblymember Smallwood-Cuevas makes the motion. Please call the roll.
- Committee Secretary
Person
[Roll Call].
- Richard Roth
Person
That's it, right?
- Committee Secretary
Person
Yes.
- Richard Roth
Person
Vote is nine to two. That measure is out. Next item. Item number 20, AB 2893 Assemblymembers Ward and Haney, supportive community residency program. Motion do pass as amended, re-refer to the Committee on Appropriations. Is there a motion? Ladies and gentlemen, anyone wants to move this? Senator Limon made the motion. Please call the roll.
- Committee Secretary
Person
[Roll Call].
- Richard Roth
Person
Vote is nine, zero. That matter is out. Next item. Item number 22, AB 2975 Assemblymember Gipson, occupational safety and health standards workplace violence prevention plan. Motion do pass as amended, re-refer the Committee on Appropriations. Is there a motion? By Senator Menjivar? Hurtado. Excuse me. Please call the roll.
- Committee Secretary
Person
[Roll Call].
- Richard Roth
Person
Is that everybody?
- Committee Secretary
Person
It's everybody.
- Richard Roth
Person
Vote is nine, zero. That matter is out. Next item. Item number 23, AB 3047 by Assemblymember McCarty, youth athletics. Motion do pass and re-refer the Committee on Appropriations. Senator Limon, would you like to move this? Senator Limon moves it. Please call the roll.
- Committee Secretary
Person
[Roll Call].
- Richard Roth
Person
Eight to zero. That's it, right? Vote is eight to zero. That matter is out. Item number 24, AB 3156 by Assemblymembers Patterson and Nguyen, it has moved by Senator Nguyen. Medi-Cal managed care plans. Motion is do pass as amended and re-refer to the Committee on Appropriations. Please call the roll.
- Committee Secretary
Person
[Roll Call].
- Richard Roth
Person
Vote is eleven, zero. That matter is out. Give me a minute here.
- Richard Roth
Person
Okay? Okay. Well, let's take up item number one, AB 347, Assemblymember Ting, household product safety, toxic substances testing, and enforcement. The motion is do pass as amended, re-refer to the Committee on Appropriations. But what we will be voting on, with respect to the mock up, we are going to remove Health and Safety Code Section 1-11673B, starting on or about January 1, 2026.
- Richard Roth
Person
The Department shall adopt regulations that set an enforcement threshold. That subsection will be removed from what we're voting on. Everybody understand? Okay. Is there a motion as amended? Senator Rubio has made the motion as I've outlined. Please call the roll.
- Committee Secretary
Person
[Roll Call].
- Richard Roth
Person
So that's out. Yes. Vote is nine, zero. That matter is out. Next item is item. Let's take up the consent calendar. Anybody need the consent calendar read? Okay, call the roll on the consent calendar. The current vote is nine, zero. Chair voting aye.
- Committee Secretary
Person
[Roll Call].
- Richard Roth
Person
Vote is eleven, zero. Consent calendar is out. Going back to item number two, AB 815 Assemblymember Wood, health care coverage provider credentials. Motion is do pass as amended, re-refer the Committee on Appropriations. Current vote, eight to one. Chair voting aye. Please open the roll.
- Committee Secretary
Person
[Roll Call].
- Richard Roth
Person
Current vote, nine to one, that matter is out. Next item. Item number three, AB 1577 Assemblymember Low, general acute care hospitals. Motion is do pass, re-refer the Committee on Appropriations. Current vote, eight to two, Chair voting aye. Please open the roll.
- Committee Secretary
Person
[Roll Call].
- Richard Roth
Person
Vote is nine to two. That matter is out. Item number four, Assembly Bill 1895 by Assemblymember Weber, public health maternity ward closures. Motion is do pass, re-refer the Committee on Appropriations. Current vote, eight to two. Chair voting aye. Please open the roll.
- Committee Secretary
Person
[Roll Call].
- Richard Roth
Person
Vote nine to two. That matter is out. Item number seven, AB 20115 Assemblymember Haney, controlled substances clinics. Motion is do pass, re-refer the Committee on Appropriations. Current vote, eight to zero. Chair voting aye. Please open the roll.
- Committee Secretary
Person
[Roll Call].
- Richard Roth
Person
Vote is nine, zero. That matter is out. Next item. Item number nine, AB 2223 Assemblymember Aguiar-Curry, cannabis industrial hemp. Current vote is ten, zero. Chair voting aye. Motion is do pass, re-refer the Committee on Appropriations.
- Committee Secretary
Person
[Roll Call].
- Richard Roth
Person
Vote is eleven, zero. That matter is out. Next item, item number 10, AB 2316 Assemblymember Gabriel, pupil nutrition. Motion is do pass as amended, re-refer the Committee on Appropriations. Current vote, seven, zero. Chair voting aye. Please open the roll.
- Committee Secretary
Person
[Roll Call].
- Richard Roth
Person
Vote is eight to zero. That matter is out. Next item. Item number 14, Assembly Bill 2467 by Assemblymember Bauer-Khan, healthcare coverage for menopause. Motion is do pass, re-refer the Committee on Appropriations. Current vote, nine to zero. Chair voting aye. Please open the roll.
- Committee Secretary
Person
[Roll Call].
- Richard Roth
Person
Final vote nine, zero. That matter is out. Next item. Item number 15, that one's out, 17 is out, 20 is out, 22 is out, 23 is out, and 24 is out. And that concludes the agenda for today's Health Committee hearing. Thank you very much. Great work.
No Bills Identified
Speakers
Legislator