Assembly Standing Committee on Business and Professions

Good morning, everybody. Welcome to the first regular Bill hearing of the Assembly business and professions Committee for 2025. I'd once again like to welcome Members who are new to the Committee. Assembly Members Ahrens, Bauer Cahan, Caloza, Elhawary, Hadwick, Haney, Krell and Macedo. We have 15 bills on today's agenda. We had eight on consent.

But for every two minutes that we don't get an author here, I'm just gonna pull a random Bill off of consent. So it'll be a fun. Robbie's got a hat, we got some Bill numbers and we're just gonna see how this goes. So as of now, AB511 by selling Member Chen, AB516 by Assembly Member Kalra.

AB521 by a selling Member Carrillo. Maybe 529 by selling something. Member Aherns and ABs 559, 659 and 686 by myself, and AB 586 by Vice Chair Flora are all on consent.

I think for the Members on Committee who have bills on consent, if they don't show up, theirs will be the first to get pulled off of consent, starting with Vice Chair Flora. Because it's important to be a leader in the Legislature.

Mr. Chair, I just want to reflect that I'm here.

It has been duly noted that assemblymember Ahrern is here on time and his AB529 will stay on consent. Before we begin with today's agenda, I will remind everyone that the Assembly has rules to ensure we maintain order and run an efficient and fair hearing. I've already violated a couple of those.

We apply these rules consistently to all people who participate in our proceedings, regardless of the viewpoint they express. In order to facilitate the goal of hearing as much from the public. Within the limits of our time, we will not permit conduct that disrupts, disturbs, or otherwise impedes the orderly conduct of legislative proceedings.

For each measure being presented today, we will be allowing primary witnesses here in the room to speak for up to two minutes each, with up to two primary witnesses per side. Any additional witnesses will be limited to name position on the Bill and the organization they represent, if any.

For those wishing to provide further comments, we are accepting written testimony through the position letter portal on the Committee's website. With that, we will begin today's hearing. But we can't because we have no authors.

So in addition to the rule about pulling bills off of consent, and a little bit counterintuitive to that rule, if we don't get any authors, there we go Assembly Member. Flora, you were off the hook. You didn't know you were on it, but you're off it, so you're okay. Oh, he does have a non consent item. Beautiful.

Assembly Member Flora, you are up with agenda item 14, AB 1082. Coming in hot, ready to go. Nope. You can sit down down there. It's ironically, it's because you're the only author here to present a bill. So I went from being frustrated with you to being very happy with you very quickly.

You could never be frustrated with me.

It's true. Well, that's not true. That's for a different hearing, my friend.

Touche. All right, colleagues, Members. Thank you, Chair and Members. Got the right bill here? Yeah. Today I'm presenting AB 1082 that would allow California nursing students to enroll in out of state nursing programs to complete their clinical training here in California. Currently, these students are barred from doing so.

And we find that many of our nursing students who complete their clinical training in other states do not return home and stay in those other states. AB 1082 aims to support the education needs of these students while addressing the state's nursing shortage. And here testifying in support, Chris Kahn.

Good to see you.

Thank you. Thank you, Mr. Chair and Members. Chris Kahn representing Nightingale College. We're an online nursing school headquartered in Utah. Students from all over the country and currently 5000 California students. And this bill only impacts those 5000 California students.

Because of California law, these 5000 students are forced every semester to go out of state to do their clinical on the ground training. They have to find another state, they have to find a place to live, they have to find a facility in that other state to continue and conclude their nursing education.

The Nurse Practices Act did not envision online learning. And that's why we have what we think is an anomaly in this law and what we're trying to remedy here. It's a major hardship for our students, and that's why we continue to come back with this bill.

And we've been happy to have unanimous support by the Assembly in the past. But our students are made up of single parents and they're made up of family caregivers. And it's interesting that those caregivers and taking care of those family members is what gets them interested in nursing to begin with. So there's former military medics who... And all these folks choose online learning for a lot of those reasons and also because it's so hard to get into a California school.

The San Francisco Chronicle just published an Article that there's a UCLA and UC Irvine have a 1% acceptance rate in their programs. The CSU programs have single digits acceptance rates as well. So I'll just conclude with two quick things. When these students go out of state, they develop relationships with these out of state facilities. And when they graduate, they do everything to get them to go stay in those states and work in those states.

The irony is if they do decide to go back to California, the Board of Registered Nursing, after they pass the NCLEX, do license them. So they think enough of our program, they think enough of these students to license them as registered nurses in California. They're just not allowed to do these clinicals in the State of California. For those reasons, we ask for your aye vote.

Thank you very much. Any additional primary witnesses in support? Seeing none. Primary witnesses in opposition? Oh, let's do primary witnesses in opposition then we're going to do me toos for everybody. It's my first bill hearing of the year. I'm shaking off the rust. We're figuring this out. And you'll have two minutes each.

Hello, I am Loretta Melby or Lori Melby. I'm the Board's Executive Officer. I'm the person that he's talking negative about. And so the issue that is coming before us in the reason that we're taking an opposed position on this, our Board voted and we held a special board meeting so that we didn't run into this again where it went through the first couple houses without an opposed letter on file.

Is the reason our schools, their students that they are recruiting, the 5,000 students are not able to go to a California school is because we have very limited clinical placements. And so if you bring in 5,000 students doing clinical placements, it's just going to perpetuate this. Our schools will not be able to grow. Our California schools will close down because they won't have clinical placements.

So that's the conundrum that we're up against is the exact issue that these students are going out of state for because they cannot enroll in the California students. This bill would actually make it worse. And so that's why we are coming here to really kind of say this is an issue. The other thing is it's this is an accredited only school. There are two states in the entire nation that defer to accreditation. All the other states have Board of Nursing approval.

The Department of Education has just been closed, and we're not sure how that's going. And these accreditors, these nursing accreditors are approved by the Department of Education. So there will be no oversight for that. So that becomes problematic too because we don't have the oversight.

I met with these people about three years ago and said, hey, we have a pathway forward. You guys can become a California Board approved program. And that we would, we wouldn't have a two tiered system. They said that's not within their business plan. So there is a path forward for them.

They can become a California approved program, and we can have the oversight that we have with the rest of the schools and make an equal playing field. West Coast University is our largest nursing program in the State of California. They currently enroll less than the 5,000 students that this school is. Thank you.

Thank you, Chair Berman and Members of the Committee. I'm Carmen Comsti with the California Nurses Association, representing over 100,000 registered nurses in the state. We appreciate the author's willingness to hear concerns about the bill. However, we respectfully oppose.

The BRN plays a critical role in ensuring that nursing students receive quality education and training before entering California's healthcare workforce. But this bill would allow out of state distance education programs to operate in California unregulated and without ongoing BRN oversight.

We empathize with the students who've enrolled in these non-BRN approved distance nursing programs, but this bill simply is unnecessary because nothing is stopping these programs from seeking BRN approval in California today. If this bill were to pass, these programs could fall out of compliance with California standards.

But there would be no enforcement mechanism for the BRN to correct these efficiencies, including deficiencies in curriculum standards, faculty qualifications, pass rates for the RN licensing test, the NCLEX, and other complaints from students or patients. Equally concerning, the bill undermines the ability of California approved nursing programs to place their students in already limited clinical education slots.

The lack of clinical placements is particularly acute for our community college and CSU nursing programs. But AB 1082 would only exacerbate the problem of clinical impaction and undermine the BRN's recent efforts to address it. Without BRN approval and oversight, we are concerned that the bill will place both patients and nursing students in danger as a result of unregulated substandard nursing education. CNA respectfully opposes and urges your no vote. Thanks.

Thank you very much. Any people who want to add on it? Let's start in support of the bill and then we'll go into opposition. So any add ons in support?

Good morning. Justin Fanslau here on behalf of DaVita in support.

Thank you. Any members of the public who want to add on in opposition to the bill?

Good morning, Mr. Chair, Committee Members. Bryant Miramontes with the American Federation of State County Municipal Employees in respectful opposition.

Thank you.

Hi. Gina Finical, registered nurse here with Saddleback College, in opposition.

Thank you.

Eric Bakke with the California State University Chancellor's Office in opposition.

Thank you. See no additional witnesses. Bringing back to colleagues for questions or comments or motions or second. Oh, no motions or seconds yet. We don't have a quorum. We are one shy of a quorum. Any questions or comments for the author on his bill? Seeing none. Yes, please, Dr. Jackson.

Thank you very much, Mr. Chair. Obviously, there continues to seems to be some some additional concerns to be worked out if all if possible. Obviously, the, I'm willing to support this bill today in this Committee, but we probably need to still do some work. And so looking forward to those continued discussions and also looking forward to hearing for from those who are both in support and opposition as we if this bill gets to the floor.

Thank you, Dr. Jackson. Any additional questions or comments from colleagues? Vice Chair Flora, would you like to close?

Thank you, Mr. Chair, and I appreciate your time as well. I just want to clarify just a couple quick things. In the bill language it talks about there is no displacement of current students. So you know students that are enrolled in hospitals, there is no displacement. The school cannot pay for people to take their students as well.

Then on the oversight side of things, the BRN registers these nurses. They give them their license. And so if there's an issue with the curriculum, I think there's an opportunity that we can fix that as well. Otherwise they wouldn't be qualified nurses. They wouldn't get their license in the State of California. With that, I respectfully ask for your aye vote.

Thank you, Vice Chair Flora. We don't have a quorum yet, so we're not quite ready to hear motions and seconds. But when we do, I'll have an aye recommendation on the bill in Committee. I want to thank you for continuing to work with us on this bill. You've already included the Committee's recommended amendments in prior versions of this bill, which are intended to prevent competition with in state students for clinical placements.

But I do know that there are still concerns around the enforceability of those amendments. So I expect that you'll continue to work with the opposition as the bill moves forward, and we'll obviously be tracking it closely. And with that, I'll support the bill today. And we have a quorum, so let's just take a brief pause to establish a quorum and then we can take motions and seconds and vote. Madam Secretary, please call the roll.

[Roll Call]

Great, we have a quorum. With that, any motions or seconds? Have a motion and a second. Madam Secretary, please call the vote when you're ready.

On AB 1082, Flora, the motion is do pass to the Committee on Appropriations. [Roll Call]

That bill is on call with eight votes, and we're going to move on to the next authors. So I see Assembly Member Bonta is here. She's ahead on the file with AB 50 and AB 489. Dealer's choice as to which one you want to present first. AB 50? Great. So agenda item number one, AB 50.

Good morning Chair and Members. Thank you to the Chair and committee staff for their work on this bill. I accept the committee amendments. Despite FDA approval for over the counter or OTC use, Medi-Cal still requires a prescription for Opill, creating unnecessary barriers.

Prescription requirements cause delays, add administrative burdens and disproportionately impact low income individuals and those without regular access to a primary care provider. California pharmacists are already authorized to furnish self administered hormonal contraception including birth control pills, patches, vaginal rings and injections.

Existing laws such as SB 523 by Leva in 2022 ensure that OTC birth control methods must be covered without cost sharing or prescription. By passing AB 50, we can simplify the process for underserved individuals ensuring that they have the same level of access to contraception as those with private insurance.

Birth control is essential health care, allowing people to plan pregnancies, pursue education and participate fully in workforce. Let's prioritize health equity, preventative care and ensure that all Californians, regardless of income or insurance status, have the ability to make timely informed choices about their reproductive of health.

Here to speak in support of AB 50 is Sally Rafie, a Pharm MD and founder of Birth Control Pharmacist and Michelle Carreido, Pharm MD, a community based pharmacy resident.

Great. And you have two minutes each.

Hello? Okay. Sorry, it's my first time if you can't tell. Okay. Good morning. Hello. Business and Professions Committee Chair Mark Berman, Vice Chair Heath Flora and all the Committee Members. I am Dr. Michelle Carreido.

I'm a pharmacist from Safeway UCSF in full support of AB 50 authorizing pharmacists to furnish over the counter hormonal contraceptives. Under Senate Bill 493 pharmacists are recognized providers who are authorized to furnish oral contraceptives. As community based pharmacists, we aim to decrease barriers to access health care.

Over the counter contraceptives are available to many who can afford the cost. They are FDA approved, 98% effective with adherence, safe even in patients with hypertension and smoking history, including women that are breastfeeding. We identify and recognize the gap in care and accessibility for Medi-Cal patients. Too many people are unable to gain access due to cost.

To mitigate the burden of cost, we increase equitable access. AB 50 would allow pharmacists to furnish over the counter hormonal contraceptives without the barrier of protocols intended for prescription-strength hormonal contraceptives. A young lady, first generation college student, on a break to see her family came into the pharmacy to refill her birth control.

But she was out of refills. Her next option was to purchase over the counter birth control, but she could not afford it. But furnishing it over the counter was not an option either. Since she was on a short break, she did not have the luxury of time to go through extra steps dictated by protocol.

So this young responsible college student under the current bill was unable to gain access to much needed medication because of the cost and unnecessary barriers of protocol of a drug that is already available over the counter.

And if you could wrap up, that'd be great. Thanks.

Yes. So this is just one example of what we see every day. People cannot afford their medication as low as a few cents. So please kindly support AB 50. Thank you for the entire Business and Professions Committee for this opportunity to testify.

Thank you.

Thank you.

Thank you for the opportunity to provide a statement of support for Assembly Bill 50 today. My name is Sally Rafie. I'm a pharmacist specialist at UC San Diego Health and founder of Birth Control Pharmacist. For 17 years now I've practiced as a pharmacist and contraception has always been part of the care that I provide.

Including most recently at a family owned community pharmacy when California granted pharmacists the ability to furnish contraceptives independently. While there have been many advances to expanding access to birth control, barriers still remain for many people. I was thrilled when the FDA approved the first over the counter contraceptive pill Opill.

While the price tag is affordable for some, we know that eliminating out of pocket costs for people really allows them to choose the birth control method they want to use. California's SB 523 requires health plans to cover over the counter birth control, but Medi-Cal specifically requires a prescription to cover any medication.

So if a patient comes to my pharmacy for Opill today and wants to use their Medi-Cal insurance, I have the necessary training to be able to issue that prescription. But only after the patient completes a self screening questionnaire with over 20 questions that are unnecessary for safe and effective use of over the counter birth control.

Additionally, I have to notify the patient's primary care provider that they came in for birth control. Now we know that about 1,500 pharmacies throughout the state are able to do this assuming that the trained pharmacist is there when the patient drops in. But that leaves about 5,000 pharmacies that cannot.

So AB 50 allows pharmacists to issue a prescription for the OTC birth control product without these unnecessary training requirements, patient questionnaires and notifications to other healthcare providers. California continues to lead the way by recognizing pharmacies and pharmacists as an essential access point for reproductive health services and products.

With this simple policy change, pharmacists will be able to help people use their health insurance to obtain over the counter birth control at no cost. This legislation will enable Californians to access safe and effective medications to maintain their health and achieve their life goals.

I urge you to support AB50 to allow equitable access to over the counter contraception for everyone in California. Thank you.

Thank you very much. Any additional witnesses in support of the bill?

Chair and Members. Kathleen Mossburg with Essential Access Health, proud co sponsor.

Thank you.

Good morning. Linda Nguy with Western Center On Law & Poverty in support.

Thank you.

Ryan Spencer on behalf of the American College of Ob-Gyn's, District 9 in support.

Thank you.

Christine Smith, Health Access California in support.

Thank you. Bless you.

Molly Maula on behalf of Planned Parenthood Affiliates of California in support.

Thank you.

Martin Radosevich on behalf of Reproductive Freedom for All California in support.

Thank you.

Any primary witnesses in opposition to the bill? Seeing none. Anybody who just wants to add on in opposition to the bill? Seeing none. Bringing back the colleagues for questions, comments, motions, seconds. We got two motions and a second. Any questions? Comments? Seeing none. We don't have to. Assembly Member Bonta, would you like to close?

Thank you so much. This is an essential health care access opportunity for us and I respectfully request your aye vote.

Thank you to Assemblymember Bonta for all your leadership to enhance access to care, especially reproductive care, which we all know needs protection. Happy to support the bill today as amended. Madam Secretary, please call the vote.

On AB 50 Bonta the motion is due pass as amended to the Committee on Health. [Roll Call]

That bill is out with 14 votes. Thank you very much. And now we'll move on to agenda item number three. AB 489.

Thank you chair and Members. I'm very pleased to present my Bill. AB 489. By now we're all familiar with the rapid rise of generative AI. This Bill is a straightforward, common sense, solution to address one particularly troubling and insidious practice and aspect of this technology.

AI systems misrepresenting themselves as health professionals, these systems have reached a point where they can produce natural sounding language and they are trained on a vast amount of data. On AI systems powerful capabilities can enable it to convincingly mimic a health professional.

Without proper safeguards in place, this capability can pose a danger to consumers in both healthcare and non healthcare settings. California law establishes strict standards for licensing and certification of health professionals. The Bill takes existing title protections in the law that would apply to people and it applies it to AI systems.

AB489 will draw a bright line and say an AI system cannot represent itself as a health professional, period. This will not only prohibit behavior we are seeing in the marketplace right now with chatbots claiming to be doctors, nurses or psychologists, but also hopefully deter future bad behavior by establishing a clear prohibition and the threat of enforcement.

Importantly, this Bill will also hold the developer or deployer of the technology accountable to ensure that technology does not violate the law.

This Bill has garnered a wide range of support because so many people in the health space are rightfully concerned about the impact the advice of an AI chatbot or an AI voice bot insisting it is a licensed health care professional could have on a child or teenager looking for mental health support or health advice.

Colleagues, this is ultimately a question of trust in an area as deeply personal as health care. Our constituents should be able to trust that, for example, when they're getting advice from a nurse, it's actually a licensed human nurse. With me, I am joined by my co-sponsors, SEIU California and the California Medical Association.

They will speak more to the urgency needed for this Bill.

Great. You have two minutes each.

Thank you. Good morning chairing members. My name is Dr. Karthik Sarma. I'm a practicing academic psychiatrist, a behavioral health AI researcher and a resident Member of SAU California's Committee of Interns and Residents.

I'm here representing the California Medical Association, one of the proud co sponsors of AB489 relating to the use of specific terms related to licensed or certified healthcare providers by AI systems.

We want to thank this Committee for hearing the Bill today, thank our co-sponsors, SEIU, and a special thank you to Member Banta for authoring this important measure. AI is a very hot topic and interest in healthcare, AI has grown rapidly over the last few years.

But the reality is, in the practice of medicine, we've been using AI for years to assist with diagnosis, with testing and for clinical documentation. I myself have been a healthcare AI researcher for more than a decade.

The physician community refers to artificial intelligence largely as augmented intelligence because we understand that today's AI technologies can enhance human intelligence, but they cannot replace it. We want to foster the use of AI in health care, but we want to guarantee that it's safe and ethical for our patients.

Healthcare AI used properly can allow us to improve the quality of our care, but when used improperly, it can have devastating results.

Indeed, recent investigations by journalists have uncovered examples of unproven AI systems claiming to be physicians or other health care professionals, systems providing advice that is unsafe or dangerous, and in one case, even a system that allegedly encouraged the young man with mental illness to end his own life.

AB489 is a key step to ensuring that AI in health care is used safely and ethically. By ensuring that AI systems do not misrepresent themselves as health care providers. Physicians go through over a decade of education and training that leads to becoming a licensed physician.

As a result, patients trust highly trained physicians and other licensed health care professionals who for accurate diagnosis and treatment plans. Allowing for an AI system to claim physician status could be dangerously misleading.

By helping patients understand who or what they are talking to, this Bill will protect the public from misrepresentation and build trust with our healthcare system and with innovative technology like AI. As such, I respectfully request an aye vote on AB49. Thank you all and I'm very happy to answer any questions. Thank you.

Good morning. Matt La Jay, proud co sponsor of this measure with CMA and I'm here on behalf of SEIU California. We represent thousands of different types of healthcare workers with various training, education experiences and we want to make sure that continues to be recognized and we don't have AI chatbots trying to represent themselves.

That they have done that. Education, training, unpaid hours, all the work. That goes into actually becoming a healthcare worker. So this is a Bill simply to ensure that that happens.

And so want to just spend the rest of my time really thanking the Assembly Member for taking this on, thanking the chair and his staff for helping us really think through this problem. So thank you very much and respectfully ask your aye vote.

Thank you. Anybody who wants to add on in support of the Bill, half of the hearing room.

Good morning MJ Diaz on behalf of Kaiser Permanente in support.

Good morning Mr. Chair Malik Bynum with the County Behavioral Health Directors Association in strong support.

Good morning. Lizzie Kutzona here on behalf of the California Academy of Child and Adolescent Psychiatry in support. Thank you.

Thank you. Clifton Wilson on behalf of the California. State Association of Psychiatrists in support. Thank you.

Good morning Chair and Members. Tyler Rinde with the California Psychological Association and on behalf of the Steinberg Institute as well in support. Thank you.

Samaya Nahara here on behalf of the California Association of Marriage and Family Therapist also in support.

Thank you.

Morning, Chair Tim Madden representing the California chapter at the America College of Emergency Physicians and the California Society of Plastic Surgeons in support.

Lawrence Gayden on behalf of the California Dental Association and in support.

Ryan Spencer on behalf of the, American College of OB GYN's District 9 and the California Radiological Society in support.

Thank you. Any primary witnesses in opposition to the Bill? Seeing none. Anybody who just wants to add on in opposition to the Bill? Still seeing none. Mr. Chair, I move the Bill got a motion. Got a second and a third and a fourth, I think. Any questions or comments? Yes, some Member Pellerin thank you.

Thank you. Chair. I think this is a great Bill, assembly member Vonta. AI can definitely bring advantages in the healthcare space, but as will all emerging technology. There is opportunity for harm. I especially worry how a vulnerable teenager, for example, could be dealing with a mental health crisis. They go online thinking they are communicating.

With a licensed health provider. The reality is they were duped by a bot and an online platform, and any advice that would result from that interaction can only do harm to that child. So I want to thank you very. Much for bringing this great Bill forward and I'd be honored to be added as a co-author.

Thank you. Any additional questions? Comments? Member Bonta, would you like to close?

A quick search of the character AI website for mental health shows a mental health helper with 6 million chats and a character called mental health Doctor that boasts 1 million chats, a therapy, mental health advice bot, and characters represented as psychiatrist, psychologist and mental health professional, all with tens of thousands of chats. This issue is very real.

It's current. We have people who have already been suffering by the existence of misrepresentation in this space. And while I know that there is much regulation and balance that needs to be struck in this particular area, I know that we shouldn't represent bots as humans and licensed practitioners. With that, I respectfully request your aye vote.

Thank you, Assembly member Bonta. This is a common sense way to add some much needed protections for patients as we continue to see new AI technologies enter the healthcare space. So I'm happy to support the Bill and if you'll have me, would love to be added as a co-author. Thank you. With that, Madam Secretary, please call the Vote.

On AB 489 Banta the motion is do pass to the Committee on Privacy and Consumer Protection.

[Roll Call]

That Bill is out with 14 votes. Thank you, Chair. Thank you. Next we're gonna move on to Assembly Member Rubio with agenda item number two. AB481.

Thank you, Mr. Chair and Members for giving me the opportunity to present AB 481. I accept the committee amendments. Just off the top, AB 481 allows federally qualified lab personnel under the CLEE, CLIA, the Clinical Laboratory Improvement of Amendment, amendments to assist licensed laboratory personnel with specific tasks to address lab staffing shortages and improve turnaround time for patients.

By expanding the allowable tasks for the lab assistance, AB 481 insurance ensures California is better prepared to handle general medical tests, public health emergencies such as pandemics or outbreaks benefiting all residents.

We saw an example during the COVID 19 pandemic under BPC Section 1206.7, which suspended California licensing requirements for testing personnel performing COVID 19 testing if they met the federal CLIA requirements for high complexity testing.

AB 481 mirrors this approach while balancing the needs for expanded support roles with stringent supervision to uphold the state's commitment to high quality health care delivery. Thank you to the committee and specifically Vincent Chi, the committee consultant, for working extensively on this bill to help us address many of the opposition's concerns.

I appreciate the dialogue with the opposition and I have accepted all seven committee amendments. With me today in support of this bill is Tim Tubman, President Elect of the California Click- Clinical Laboratory Association and Molly Maula representing Quest Diagnostic.

Great. You have two minutes each.

Hello. Good morning. Tim Tubman, licensed Genetic Molecular Biologist Scientist and the incoming President of the California Clinical Laboratory Association, CCLA. CCLA is a trade association representing both small and large laboratories across California. CCLA is actively involved in a voice for the clinical labs and legislative and regulatory matters.

CCLA is pleased to co sponsor and support AB 481 by Assemblymember Rubio. The clinical lab workforce shortage has existed for well over a decade and continues to intensify as laboratory scientists in this industry retire without any adequate pipeline to replace them.

CCLA continues to support efforts to fund and increase training for the next generation of scientists, but we need to look for additional pathways that immediately address the laboratory's needs and to help ensure quality healthcare for California patients.

AB 481 provides additional capacity and improves workflow in the laboratories by allowing qualified, trained, unlicensed personnel to assist in analysis of samples under supervision of licensed personnel with specific tasks associated with clinical testing. This assistance will free up licensed personnel to better utilize their time doing critical work befitting their license.

The bill helps the laboratories deliver timely and accurate results that physicians, patients need to ensure appropriate care. CCLA appreciates your favorable consideration of this bill and I'm available to answer any technical questions.

Thank you.

Good morning, Chair and Members Molly Maula with Edelstein, Gilbert, Robson and Smith representing Quest Diagnostics. Quest is one of the largest clinical laboratories in the state with 400 patient service centers and 17 regional and rapid response labs. Diagnostic testing accounts for 70% of health care decisions.

Delays in access to results of lab testing due to the workforce shortage in clinical labs impacts physicians and patients ability to make important health care decisions. AB 481 seeks to mitigate the effects of the workforce shortage and increase capacity for licensed personnel.

This bill is an immediate remedy for to address the workforce shortage, though it's not the only remedy. And I want to thank Assemblymember Rubio and her staff, Erica, as well as Vince from the committee for their work on this bill. Respectfully urge your aye vote. Thank you.

Thank you very much. Any additional witnesses who want to add on in support of the bill?

Good morning, Mr. Chair and Members. Missy Johnson with Nielsen Merksamer here on behalf of Myriad Genetics in support.

Thank you.

Ryan Spencer on behalf of the California Society of Pathologists in support.

Thank you. Any primary witnesses in opposition to the bill. Come on up. You've got two minutes each.

Good morning. Matt Lege with SEIU California. First just want to thank the committee staff and the chair and the author for their diligent work on this. This is a bill that, similar to a previous bill that we had some concerns with. And so we're, you know, carrying those concerns forward for SEIU..

Primarily our concern is we want to make sure that the unlicensed personnel have some sort of state certification or training.

There is what we see in our labs and the thousands of lab workers that we have, they have some basic certification and training, which includes a phlebotomy certification that ensures that you have some of the basic things that you need to work in a lab and ensure there's no errors.

Because really, as the supporters said, lab testing is such a critical part of health care. And getting it wrong also has such an important impact on care in terms of misdiagnosis, having to repeat some of those exams or those diagnostic procedures to make sure that you're getting the tissue out.

That can be incredibly time consuming, painful and costly to the system. And so we want to make sure the training is checked on the front end.

The second piece, and this I think is also appropriately called out in the analysis, is the need to make sure that there continues to be more work around the supervision and control pieces of the bill to make sure that someone can step in if they see something's being done wrong.

And then finally, I just want to really call out the lack of the other addition of this certification is the need to do CEUs, Continuing Education Units to stay up to date with technology.

And then finally I'll close and just highlight that this is leaving a lot up to employers that are large employers that have a financial incentive to try to do things as efficiently as possible and then also leading a lot up to the federal government.

California, we have routinely stepped up and had higher standards to ensure we're putting patients first and consumers first. And so for those reasons, we're respectfully opposed unless amended and look forward to continue conversations with author.

Thank you. Any additional witnesses who want to add on in opposition to the bill.

Good morning, chair and Members. Jp Hanna, on behalf of the California Nurses Association, we also have an opposed unless amended.

Thank you. Bringing back the colleagues questions, comments. We have a motion we don't have a second. We now have two seconds. Senator Pellerin.

Thank you, Chair. This bill reflects how health care shortages are being felt across lots of different sectors. And I appreciate your taking these amendments today as they do address some good issues raised by labor.

I hope all parties can continue to actively engage in discussions, and I'll be taking a closer look at the bill when it gets to the floor. But thank you so much.

Thank you. Any additional questions? Comments? Seeing none. Assemblymember Rubio, would you. Would you like to close?

Thank you, Mr. Chair and Members, I respectfully asked for an aye vote.

Thank you to the author, to the sponsors, and to the opposition for working with the committee on this Issue. Again, we understand the opposition concern. The opposition's concerns. So the recommended and now accepted amendments aim to limit the tasks that can be performed as well as move the needle on training and supervision requirements.

I know the amendments don't fully address these concerns, particularly around standardization and ratios, where the underlying concern is business interests competing with quality control. However, today's recommendation is only meant to be the start of the conversation, with the expectation that the author and sponsors will continue to work through the concerns as the bill moves forward.

And so I'm happy to support the bill today. Madam Secretary, please call the vote.

On AB 481 Blanca Rubio. The motion is do pass as amended to the Committee on Appropriations. [ROLL CALL]

That bill's out with 12 votes. Thank you. I just want to commend the committee. We are cruising through this hearing and I appreciate the efficiency with which we're doing it. Assemblymember Lee. Ha ha ha. That's debatable. Assemblymember Lee, you've got two bills, agenda item 10 and agenda item 13.

Dealer's choice as to which one you would like to lead with.

I'll start with the animal shelter Bill. AB631.

All right. Gen item number 10.

All right. Thank you, Mr. Chair and Committee Members. I have two. Animal welfare. oh, there he is. I have two animal welfare bills before the Committee today. AB631 is about animal shelter data collection. I like to start by accepting the Committee's amendments.

This Bill requires animal shelters to post data on their websites on the number of animals taken in, the source of intake and the outcomes of all animals. This data is important to get an accurate picture of animals entering exiting shelters and their outcomes.

Californians care for the welfare of shelter animals and our official state pet is the shelter pet. According to data from 2023 cities and counties invest approximately $378 million to operate state animal shelters. As such, it's critical we have the data to properly optimize resources, best informed policy and help pets find their forever homes.

The Bill will ensure we have the information necessary to direct funding more efficiently to shelters and make informed policy decisions. I'll be respectfully asking for I vote and today I'm pleased to be joined by my witness in support, Nicholas Sackett, Director of Legislative affairs at the Social Compassion in Legislation. Thank you.

Got a bipartisan motion in second two minutes, sir.

Great. Thank you. Chair Members Nickolaus Sackett, Social Compassion in Legislation Our group was founded in 2007 with the primary mission to reduce the pet overpopulation crisis in our shelters. Our state and local governments spend over 400 million annually in operating animal care and control.

That figure does not include the millions spent by nonprofits, foundations who rescue animals and provide medical care and support of our shelters. From 1995 through 2016, CDPH collected and made publicly available all the categories of data required under this Bill.

While this data was for rabies control, it also gave policymakers and others an estimate of the pet overpopulation problem. In 2016, the department's report showed that we euthanized over 158,000 dogs and cats combined. But since 2017, the Department stopped collecting this important data, making it extremely difficult to know where we are with this problem.

Some of you may have noticed a spike in the number of bills introduced in this Legislature to help tackle the pet overpopulation issue. We applaud the attention to the problem. Californians care about what is happening in our state's shelters.

With this data, this Legislature, local governments, the shelter and rescue communities and the public will have metrics to evaluate the progress or lack thereof in getting the overpopulation problem under control. Lastly, this information would be critical in the event of a future zoonotic disease outbreak.

Understanding how many animals are entering, exiting our shelters and under what circumstances stray, adopt it, euthanize, etc. Will be helpful in any future disease outbreak response. With that, I urge your I vote. Thank you.

Thank you very much. Any additional witnesses who want to add on in support of the Bill?

Clifton Wilson, on behalf of the California Animal Welfare Association with the position of support if amended. But we look forward to working with you through anything. Thank you.

Thank you.

Good morning. Jennifer Fearing, on behalf of San Diego Humane Society and with the amendment suggested in the analysis, we would be pleased to support the Bill. Thank you.

Wonderful.

Jim Jensvold. I'm with Democrats for Protection of Animals. And we support the Bill.

Thank you. Any primary witnesses in opposition to the Bill? Seeing none. Any folks want to add on in opposition to the Bill? Seeing none. We've got a motion in a second. Questions or comments? Assembly Member Macedo.

Good morning. Just a quick question. As far as how would this be implemented for. For shelters or organizations that do not have websites? Would we then require them to have websites? Would they be exempt from this rule? How would that be handled?

That's a great question. We are still trying to work out how we would do that. Whether it's just simply exempting them from the requirement, but ensuring that they make it publicly available upon request. Request.

Possibly looking at if the shelter is connected to obviously a local jurisdiction that if the shelter doesn't have their own website that they could possibly post on that jurisdiction's website. These are things that we're considering and we'll definitely be working on it in the next Committee because we know there will be a cost attached.

I appreciate you guys recognizing that the area I come from, we are not geared with as many resources as other places. So we just want to make sure we can have resources like these shelters. Available without added costs that could inhibit them from providing. Providing services very much needed to our community. Thank you.

Thank you.

Thank you very much. Any other questions or comments? Seeing none. Assembly Member Lee, would you like to close?

Respectfully ask for your aye vote.

It's my favorite close. Thank you, Assemblymember Lee, with the amendment to reduce the frequency of the reporting requirement, I'm happy to support this Bill today. Madam Secretary, please call a vote.

On AB 631. Lee. The motion is do pass as amended to the Committee on Appropriations. Berman.

Aye.

Berman, aye. Flora. Flora aye. Ahrens. Aarons aye. Alanise. Elanise aye. Baines. Baines aye. Bauer-Kahan. Caloza. Caloza aye. Chen. Chen aye. Elhawary. Hadwick. Haney. Irwin. Irwin aye. Jackson. Jackson aye. Krell. Krell aye. Lowenthal. Lowenthal aye. Macedo. Macedo aye. Nguyen. Nguyen aye. Pellerin. Pellerin aye.

That Bill is out with 14 votes. Next up, agenda item 13. Yes.

So, good morning, Mr. Chair and colleagues. I only have one witness today. Unfortunately, my cat could not come today. Unfortunately. So, we only have the human witness.

Your cat, who was invited, who was invited to participate.

He was invited. It's true. The Chair did offer, but he was not ready for primetime yet. So, good morning, Mr. Chair, colleagues. This Bill, AB 867, is a policy that I believe is long overdue. Cat declawing is a serious surgery, with a cat's final toe joint being removed, or its tendons being severed.

And I believe that when it is performed for any reason other than the health of the cat, then I believe it is cruel and inhumane. And behind me, is a diagram showing you what the declawing procedure is like.

So, the equivalent is not just taking out, say, the toe—the nail—of a cat, but it is taking off as, essentially, our equivalent of our first toe or finger joint. So, done for cosmetic reasons, it is pretty cruel.

This Bill would prohibit cat declawing surgeries from being done in California, unless a licensed veterinarian is performing it for medical purpose, for the health of the cat, and not the convenience of the cat's human parent.

As it is noted in the Committee Staff's excellent analysis, there has been a number of bills introduced over the years, with the same goal as this Bill. And three years ago, the Committee passed a bill, which I was joint author on, and then the full Assembly passed it with 60 votes and a bipartisan vote.

This is a commonsense Bill that says that a permanent, disfiguring surgery cannot be performed on cats for any other reason, other than the health of the actual patient, the cat. And with me today in support is Dr. Jennifer Conrad.

Good morning, Chair Berman, and distinguished Members of the Committee. My name is Jennifer Conrad. I work for the Paw Project, the world's largest nonprofit dedicated to ending declawing, and I am a veterinarian licensed in California. I'm here to ask you to understand that cat declawing is—should really be called cat de-knuckling.

It is the amputation of the last bone in a cat's toe. It's the equivalent of taking this cigar cutter and cutting off every one of my last phalanxes on my hand.

It's non-therapeutic surgery that has no benefit to the animal, is so predictably painful that it has been used in clinical trials to test the efficacy of new pain medication. This is the last phalanx of a declawed lion, and you can see that they actually amputate the bone. You might hear that declawing is rare.

A 2024 Poll, that was conducted by Humane World for Animals, found that 22% of American cats are declawed. 22%. That is not rare. This number has been corroborated by the Veterinary Literature, coming in with the range of 21 to 24% of American cats declawed.

You might also hear that it's a last resort, that it's only performed after all humane alternatives have been exhausted. Well, again, not true. 76% of declaw surgeries are performed on kittens 8 months old or less.

The other last resort idea that you might hear is that it's better that a cat get declawed than rather end up in the pound, where it's likely to be killed.

Well, that again, is not true, because if someone is intolerant of a cat scratching, they're going to really be intolerant and give up their cat when they find out that, that these cats don't use the litter box because it hurts their amputated toe nubs, and they also begin to bite to protect themselves.

Thank you very much. If you could wrap up, that'd be great.

Okay. I, I just want you to know that there's no reason to declaw a cat—doesn't protect human health. And the veterinary profession has failed to protect—to police—itself on this issue. So, I respectfully urge your "Aye" vote.

Thank you.

Mr. Chairman and Members. Gary Cooper representing the Paw Project, and Dr. Conrad has very succinctly and eloquently portrayed what the Paw Project has been about for the last 25 years. I respectfully asked for an "Aye" vote on AB 867. Thank you.

Thank you very much. Any additional witnesses who want to add on, in support of the Bill?

Good morning, Chair and Members of the Committee. Sosan Madanat, at W Strategies, here on behalf of Animal Legal Defense Fund, a proud co-sponsor of the Bill, in support. Thank you.

Thank you.

Good morning. Lizzie Cootsona, here on behalf of Humane World for Animals, formerly known as the Humane Society of the United States. Proud co-sponsor. Thank you.

Thank you.

Good morning, again. Jennifer Fearing on behalf of San Diego Humane Society. In support.

Thank you.

Jim Jensvold, representing the membership of Democrats for the Protection of Animals. We support. Thank you.

Nicholas Sackett, Social Compassion and Legislation, in support.

Thank you very much. Any primary witnesses in opposition to the Bill?

Good morning, Mr. Chair and Members. I'm Christina DiCaro. I'm the lobbyist for the California Veterinary Medical Association. Please excuse my cold. We are opposed to AB 867. Over the past two decades, the veterinary profession has determined that the need to declaw a cat as a preventive measure is no longer the professional standard. The CVMA has a formal position statement that reinforces that forward thinking.

In fact, large veterinary corporations and some small mom and pop veterinary practices have banned the procedures in their practices entirely. When we speak to many veterinarians in our association, they note that they have not done a declaw procedure in many, many years. And if they did, it was because their human client owner was on a blood thinner and could not risk being scratched by their cat.

Where we take issue with this measure is that whether you disagree or agree with the idea of declawing, the bill regulates a surgical procedure that falls within the recognized definition and scope of veterinary medicine. We think that's a concerning precedent. And if surgery is regulated by the Legislature for veterinarians, where does that stop for human medicine? There is also language in the bill that would require veterinarians to file paperwork with the Veterinary Medical Board if they do perform a declaw, even if it's for a therapeutic purpose.

And we suspect that the only reason this language is in the bill is so that animal activists can obtain this information, the names of veterinarians through a public records request, and target our hard working professionals. We're hopeful that the bill can be amended to address this matter as well as several of the other issues we have highlighted in our letter as AB 867 moves through the process this year. Thank you very much.

Thank you. Any additional witnesses who want to add on in opposition to the bill? Seeing none. Got a motion. Got a second. Any questions or comments? Assembly Member Lowenthal.

I want to thank you for bringing forward this important legislation. I have a very important question to ask you. Have you ever considered declawing the Department of Finance or the third House?

Oh, every day. Only every day.

Thank you.

Thank you, Mr. Pro Tem.

Assembly Member Caloza.

Thank you, Chair Berman. I just wanted to thank the author for his work on this bill. I am also a proud cat owner and, you know, that thought of declawing my cat kind of makes my stomach churn. And so thanks to the coalition that you've brought together and working to make sure that we have practices that really work to more treatment all of our animals, especially our cats, more humanely. So just wanted to voice my support of the bill. Thanks.

Thank you. Assembly Member, would you like to close?

As a proud cat parent, I ask that you consider saving our cat's knuckles and their first digits, and I respectfully ask for your aye vote. Thank you.

Thank you to the author and to the sponsors and supporters of this bill, who I know have been trying to get this done for a long time. I've got a couple of cat puns here. This bill is meow-velous. And I'm happy to have a do paws recommendation on the bill today and hope that this is the year the bill gets to the finish line. Madam Secretary, please call the vote.

On AB 867, Lee, the motion is do pass to the Committee on Appropriations. [Roll Call]

That bill is out with 11 votes. Thank you. We got a little. We got some cat fighting going on on the dais. Yeah, a little frisky. So while we're waiting for our last author, why don't we start with the adoption of the committee rules, which apparently is a thing that I didn't see.

Is that in my talking points? Okay. Can I get a motion in a second for the committee rules? We got a motion. We've got a second. Thank you very much. Madam Secretary, please call the vote on the committee rules.

The motion is that the committee rules be adopted. [CALLING OF VOTE]

Great. The committee rules are adopted with 14 votes. Now let's move on to the consent calendar. Can I get a motion second for consent? Got a motion and a second. Thank you very much. Madam Secretary, please call the vote on the consent calendar.

On the consent Calendar, file item 4, AB 511 Chen. The motion is due. Pass to the Committee on Appropriations. File Item 5. AB 516 Callra. The motion is due. Pass to the Committee on Appropriations. File Item 6, AB 521 Carrillo. The motion motion is due. Pass to the Committee On Judiciary. File item 7, AB 529 Ahrens.

The motion is do passed to the Committee on Appropriations. File Item 8, AB 559. Berman. The motion is do pass to the Committee on Judiciary. A file item 9, AB 586 Flora. The motion is do passed to the Committee on Judiciary. File item 11, AB 659 Berman. The motion is do pass to the Committee on Appropriations. File item 12,

AB 686 Berman. The motion is do pass to the Committee on Appropriations. [CALLING OF VOTE]

Consent calendar is out with 14 votes. Now let's. Why don't we start from the top and let members. Well, I guess let's start with a bill that's on call and then we can go to the adding on to bills that have already passed out.

On AB 1082 Flora. The motion was do passed to the Committee on Appropriations. [CALLING OF VOTE]

That bill is out with 12 votes. And now, Madam Secretary, when you at your leisure just let's take it from the top.

On AB 481. Blanca Rubio. Chen? Chen not voting.

Just want to thank everybody for getting here on time and sticking with us through this morning's hearing. We have one more Bill. Agenda Item 15, AB 1307 by Assembly Member Avia Farias, Avila Farias.

Farias to the Assembly Member staff, please go find your Member, bring them down to room 1100 of the swing space or just come down with some talking points. And I would bring be happy to present the Bill which I have an aye of recommendation on.

And the Vice Chair will move it for a bipartisan motion and second so that everybody else can get on with their day. Thank you.

I'm waiting for my witness. Oh, you're right there.

We have agenda item 15, AB 1307, ready when you are.

Okay. Well, good morning, everyone. Thank you, Chair and Members, thank you for the opportunity to present AB 1307. I want to start by respectfully accepting the Committee's amendments. AB 1307 establishes a pilot program allowing 30 qualified dentists from Mexico to practice in areas with limited access up to three years.

Despite having one of the largest dentist workforce in the country, California continues to face major access gaps to dental care. Over 2.7 million Californians, mostly in rural low income Latino communities, live in areas with very limited access to dental care. There are a total of 174 federally qualified health care centers throughout the state.

The Dental Board released a report finding that 532 areas are experiencing dental professional shortage. In some of these areas. I know you can't see this, but I will pass this or send it to your staff are concentrated in Northern California and obviously Southern California.

AB 1307 addresses the inequity by allowing credentialed dentists from Mexico's institutions to serve in underserved communities. Modeled after the successful pilot program for physicians, foreign trained dentists face high barriers under current law which Requires completion of U.S. based programs and even allow them to qualify abroad.

The California Dental Association has expressed concern about the credential review, but we are engaged in ongoing conversations with the California Dental Board to meet their standards. AB 1307 is a cost neutral, equity driven solution that increases access to care without lowering standards.

Here with me for testimony is Arnold Torres who will be speaking in support on behalf of the La Chemica De Salud Del Valle, the sponsor of the Bill.

Great. You have two minutes.

It's on. There you go. I want to thank the Committee consultant for writing an absolutely excellent history of everything that we've done on this issue. I want to thank this Committee for passing every Bill that we have brought before you on the doctors.

We just distributed to you the last year evaluation of the doctors program which basically tells you the program demonstrated significant success in addressing health care disparities for underserved population. Expanding, refining the program will further strengthen California's health care workforce. We recommend the program be expanded and continued. This Committee passed the 2860 last year unanimously. It got through.

We now will have over 155 doctors working in these areas. This legislation on the dentist is patterned exactly off the model that we've done with the doctors. We will be working with the Dental Board to make sure that we address all of their concerns in the most effective manner. We want to underscore to you as well is that this will not cost the General Fund any money.

We, as we did with the doctors, we went out and got funding from foundations in Mexico as well as in the United States Fund anything that needed to be done, especially the two year evaluation that we do of the dentist.

The other thing to remember in closing the federally qualified health centers in this state do their own peer reviews. So they are the only institution that actually monitor their doctors and their dentist and any medical provider in their four walled area to make sure that they're complying with all existing standards.

I would say to you that we have in this Bill a secondary peer review that will be done by a UC dental school. So we are adding another layer, two layers in which right now dentists don't have even one layer that practice dentistry in private practice.

I would also close with telling you that of the Members on this Committee, you have at least 10 of you who will have dentists and doctors in your districts. I would say virtually everyone, the exception of Mr. Lowenthal, Ms. Caloza, Mr. Flora is comodicen estalleno of doctors and dentists.

You have a bunch, as you well know, in your district, but almost every one of you, Mr. Jackson, you will have at least 10 doctors and dentists in your County of Riverside that have already asked. The clinics have already made the request. Those doctors are now being recruited.

The dentists will be recruited as well as now psychiatrists, which is what the legislation we did last year allowed. I thank this Committee, Mr. Berman, for your patience and for your absolute great support and again, a great Committee analysis. We cannot thank you enough. Mr. Chair, I move the Bill.

Thank you very much. I hear a bipartisan motion. And second. Any additional witnesses who want to add on in support of the Bill? Seeing none. Any witnesses who want to come and add on or come and speak in opposition to the Bill?

Lawrence Gaydon with the California Dental Association with an opposed unless amended position. Confident that the work the sponsors are putting in with the dental board will get us to a place of neutral. Thank you.

Great. Thank you very much. Any additional witnesses in opposition? Seeing none. Bring it back to colleagues. We've got the motion and the second and the Haney. Any comments, any questions? Yeah, Vice Chair Flora.

Thank you to my colleague for bringing this forward. For a long time, Central Valley has, you know, we've struggled with access and we've struggled with availability. And so I think this is just another great Bill to kind of try to in some desperate way deal with that.

So I appreciate you bringing this forward and happy to support it today.

So thank you very much, Mr. Flora. Thank you. Any additional questions or comments? Yes, Dr. Bains.

Can you hear me now? Okay. Thank you so much for this Bill. Speaking of access, I think we all are a little alarmed with Medicaid cuts that might be coming, especially in the Central Valley. I'm sitting here in my scrubs today because I worked a late night shift, took a flight early morning to come in.

I'm really worried about what's going to happen to the Central Valley when people neglect access to health care being important. So thank you for bringing this Bill forward. Love to be added as a co author and thank you for the importance of supporting healthcare, especially in the Central Valley.

Thank you, Dr. Baines, and for all you do in your community. Any additional questions? Comments? Seeing none. Would you like to close?

I respectfully asked for an aye vote to help close the dental care gap in the most vulnerable communities of California. Thank you Chairman and colleagues here for hearing our Bill today.

I want to thank the author and want to make it very clear that this Committee is deeply concerned about increasing access to dental care in all of California, especially in areas with large immigrant communities who need culturally and linguistically, linguistically competent care.

I'm happy to support solutions like this one and want to again thank the author and her tenacious sponsors for bringing these bills forward. With that, Madam Secretary, please call the vote.

On AB 1307. Avila Farias. The motion is do pass as amended to the Committee on appropriations. Berman. Berman aye. Flora. Flora aye. Ahrens. Ahrens aye. Alanis. Alanis aye. Bains. Bains aye. Bauer-Kahan Caloza. Caloza aye. Chen. Chen aye. Elhawary. Hadwick. Haney Haney aye. Irwin. Irwin aye. Jackson. Jackson aye. Krell. Krell aye. Lowenthal.

Lowenthal aye. Macedo. Macedo aye. Nguyen. Nguyen aye. Pellerin. Pellerin aye. Hadwick. Hadwick aye.

Bill is out with their 15 or 16 votes. 16 votes. Thank you very much. Thank you. Thank you everybody. We are going to open the roll for colleagues to add on and. Yeah, let's do that. Thanks. Madam Secretary.

[Roll Call]

Yeah, yeah, yeah. All right, thanks, everybody. We're gonna keep the hearing open until 11 to let absent Members come add on. Vice Chair No, you can take off.

Perfect timing? I hear you got some things going on this morning. Madam Secretary, Please, from the start, from the top. For folks to add on.

[Roll Call]

With that, the hearings adjourned.