Senate Standing Committee on Business, Professions and Economic Development

Okay, we are going to call to order the California State Senate Committee on Business, Professions, and Economic Development for Monday, July 7th. Thanks for being here. We have two authors. We don't quite have a quorum yet, but we will go ahead and start hearing from the Assembly Members since we have a pretty loaded agenda.

And whenever we do get a quorum, I will stop us, even if that's midstream, and establish that quorum so that we can go ahead and take votes. Until that time, let's go ahead and get started. Assemblymember Aguiar-Curry, I see you are first up on my agenda and then, Ms. Caloza, we will come to you next, okay?

Welcome, Assemblywoman. This is AB 8, cannabis and cannabinoids, industrial Hemp. When you're ready, go right ahead.

Thank you, Madam Chair and Members. Thank you to you and your staff for working on this complicated issue. I started working on hemp issues because of the 2018 Farm Bill, which left an unregulated industry. My previous legislation, AB 45, was the most strict hemp law in the country, when it was enacted in 2021.

It was the effort to legalize non-intoxicating hemp products like CBD. So, today, I'm here to make sure the law can be properly enforced and interpreted. As the hemp market grows, we are seeing more intoxicating hemp products sold outside of dispensaries without age limits, which should be illegal.

This Bill is another big undertaking, and it focuses on three issues. First, it will expand enforcement to better control the sale and distribution of illegal hemp products. This will give state agencies and local governments the tools they need to protect our kids from synthetic products.

Second, it will close loopholes that will allow intoxicating hemp products and make it clear that all synthetic THC is banned. Third, it integrates hemp into the legal cannabis supply chain. This will make sure all products with any level of THC are treated like cannabis, meaning full registration—regulation—and taxation.

This will bring new products under the Cannabis Excise Tax to maintain tax revenue. I will continue to work with stakeholders, state agencies, committees, as we address the concerns about the best way to implement these changes. With me, I have Amy Jenkins, on behalf of the California Cannabis Operators Association, and Ryan Sherman, with the California Narcotics Officers Association.

All right, thank you both for being here. You'll have two minutes each.

Thank you, Madam Chair and Members. Amy Jenkins, on behalf of the California Cannabis Operators Association, in strong support of the Bill.

As the author noted, AB 8 builds on the enforcement framework established under prior legislation that she authored that we were also very proud to work with her on. Unfortunately, since its enactment in 2021, we've seen a flood of highly intoxicating hemp products enter the California marketplace, products that were never contemplated under the original authorizing legislation.

AB 8 strengthens Public Health protections by cracking down on these high potency hemp products that are evading California State testing, taxation, and enforcement mechanisms. Let me be clear, these are not benign wellness products. These are powerful intoxicating products.

In a white paper titled the Great Hemp Hoax, we analyzed more than 100 hemp products purchased online and shipped in California after emergency rules were adopted to ban them. Our findings were deeply alarming. 95% contained prohibited synthetic cannabinoids, nearly half contained THCP, a compound estimated to be 30 times more intoxicating than THC.

Some had THC levels up to 32 times the legal limit of cannabis products and 91% of these products evaded taxes. This is a public health situation that needs to be immediately addressed. These products also evade child packaging, bypass worker safety and labor standards, and undermine California's equity goals. Let me also address the tax piece correctly.

Opponents have suggested that AB 8 would eliminate funding for critical Prop 64 programs. AB 8 does not seek to cut funding. It seek—seeks—to preserve these funds by stabilizing the tax base that supports them.

Lastly, I want to acknowledge that we are in ongoing conversations with small and craft cultivators and remain deeply committed to resolving their outstanding concerns. On behalf of CCOA and our hundreds of licensed operators across the supply chain, I urge and aye vote. Thank you.

Good morning, Madam Chair Members. Ryan Sherman with the California Narcotic Officers Association, in support of the Bill. We are concerned about public safety and public health concerns and the impact on our youth, and restricting intoxicating hemp products to authorize cannabis dispensaries, we believe, is the best approach.

Hemp-derived THC products have been widely available online, at grocery stores, gas stations, and other retail locations since passage of the 2018 Farm Bill.

These are highly intoxicated—Intoxicating—hemp products have surged by exploiting loopholes by measuring THC by weight rather than potency and as a result, many of these dubious hemp-based products contain higher amounts of intoxicating THC than legal products sold in state licensed cannabis dispensaries.

While our officers have not been quick to embrace the legalization of cannabis, we know better than most that a well regulated industry with state oversight is preferable to the dangerous and often deadly outcomes associated with international cartels and Black Market cannabis. AB 8 addresses many of our concerns by implementing the following. It prohibits the sale of synthetic cannabis products.

Bans inhalable cannabis products containing cannabinoids derived from hemp. Requires out of state hemp manufacturers to register with the state. Expands authority for agents to inspect, seize, and destroy unlawful cannabis products. AB 8 will better protect our youth, public safety, and health by requiring intoxicating hemp products to comply with the Medicinal and Adult Use Cannabis Regulation Safety Act.

For these reasons, we strongly support AB 8 and appreciate your aye vote. Thank you.

Great. Thank you so much. Is there anyone else in the room in support of AB 8? Please come forward.

Clifton Wilson, on behalf of the Marin County Board of Supervisors, in support. Thank you.

Board and Members. Jason Bryant, on behalf of the Cannabis Distribution Association. We're in support. Thank you.

Good morning. Shira Spector for Stone Advocacy, on behalf of the California District Attorneys Association, in support. Thank you.

Jordan Wells, on behalf of the California State Association of Counties, in support. Thank you.

Sarah de Cat, on behalf of the Rural County Representatives of California, in support.

Stephanie Jimenez, on behalf of Kiva Convections and Kiva Sales and Services, in strong support.

Sarah Arseneaux, on behalf of the California Cannabis Industry Association, in support. Thank you.

All right, anyone else in the room in support of AB 8 who'd like to come forward? Is there opposition of AB 8? Lead witnesses in opposition, two of you can come to the table if there is. All right, you will each have two minutes.

Great. Good morning, Senator Ashby, Members of the Committee, I'm Jim Keddie. I'm the Executive Director of Youth Forward, which is a Sacramento-based youth organization. I want to thank Majority Leader Aguiar-Curry for all of her work seeking to protect young people from these hemp products.

I have staff who work in our local Sacramento high schools, and we see these products all the time. We are here to express our opposition to one part of the Bill which has to do with the tax cut for the cannabis industry.

Our concern comes from the loss of revenue that will result from this tax cut for child care and for youth programs. We are in a very difficult time now, all of us who serve children and youth, due to the cutbacks that are coming from the Federal Government.

And now, we're looking to lose $180 million for child care, youth programs, the environment, and for local law enforcement, if this tax cut remains in the Bill. So, we have an opposed unless amended position. Thank you.

Thank you. And thank you for this opportunity. Good morning. My name is Leticia Aguilar, Pinelli Ville Pummel Nation, mother of three, born and raised in Sacramento. Also, CEO of the Native Sister Circle, the only organization in Sacramento solely dedicated to serving tribal girls.

I'm here today to show how Proposition 64 funding through Elevate Youth California has transformed our program and why this funding is vital for our most vulnerable population. Through lived experience, recognizing high addiction rates among tribal girls in urban areas, we started in 2018 as a volunteer run community group, holding weekly sessions in a donated space.

We then joined a coalition, the Sisterhood Collective, where we received a piece of our first Elevate Youth grant, which allowed us to grow from a small grassroots effort into a structured program.

With these funds, we created a safe space in Sacramento, a neighborhood deeply impacted by the war on drugs, where we provided education, empowerment, and cultural connection for youth. At the end of our initial three year grant, we were able to incorporate as a nonprofit and successfully secured our own Elevate Youth California grant.

The funding we have received has been vital for our programs, allowing us to hire staff and expand services to those impacted by the war on drugs. Our youth are now leaders mentoring new generations. Our multi-generation program teaches girls to combat addiction through advocacy, education, empowerment, and cultural pride.

Prop 64 funding has been lifesaving for these often invisible and overlooked tribal youth. Cutting or freezing this funding would undermine the purpose of Prop 64, break the promise made to voters, and harm the very youth these funds were meant to protect.

I would also like to note this is the only funding dedicated to correct the harm cannabis has done to tribal lands and our tribal youth. Our youth depend on this support and they are owed it. Thank you for your time and consideration.

Thank you very much for your testimony. Are there others in the room in opposition to this Bill? Ma'am, come forward. I know you wanted to speak. Mr. Keddie actually only used a minute, so if you want to take 30 seconds to express your concerns, go right ahead. The two of you—Mr. Keddie, you can sit, you can stay. Go right ahead.

Good morning, Madam Chair and Members. Sarah Nocedo on behalf of Origins Council representing 400 small independent cannabis businesses in rural areas of the state. We are in a continue to oppose unless amended position. We appreciate the May 23rd amendments.

We have a very detailed letter outlining some additional amendments that we're requesting and look forward to continuing working with the stakeholders in the author's office. Thank you.

All right, thank you.

Great. Madam Chair, Members of the Committee, Corey Brown with Resource Legacy Fund. We're also opposed unless amended. Two things we're asking to be changed. One is to remove the tax provision that takes $900 million away from the youth, child care, drug dependency, environmental restoration programs. Second is to create parity between hemp growers and cannabis growers.

The analysis correctly points out that that the Bill creates two different structures and for cultivation, the one thing it's missing is also making sure that the public health and environmental requirements, including what pesticides can be used, apply to hemp that is grown for creating intoxicating products. That's missing out of the Bill.

It's well discussed in the Committee analysis. With those two changes, we would change to support. Currently, we're in an opposed unless amended.

Okay, thank you. And before the next person steps forward, let me just say I let those two speak a little bit longer because they both wanted to be primary witnesses, and the primary witnesses did not take their full two minutes. Everybody else, we're just going to do me too testimony. All right? All right.

I have nothing else to add.

Go ahead.

Echoing the comments made before me by Resources Legacy Fund. This is Alex Loomer, on behalf of Pacific Forest Trust, the Environmental Protection Information Center, California Native Plant Society, Sonoma Land Trust, California Coastal Protection Network, Mojave Desert Land Trust, and Defenders of Wildlife, in oppose unless amended position. Thank you.

Thank you very much.

Good morning. Annalise Rivera, with California Trout and Trout Unlimited, in oppose unless amended position. Thank you.

Thank you.

Good morning, Madam Chair and Members. Karen Lang, on behalf of the Mendocino and Humboldt County Boards of Supervisors, in an opposed unless amended position consistent with Origins Council's position. Thank you.

All right, thank you very much. Anybody else in the room who is opposed to AB 8 or a tweener that feels they need to say something on the mic here? I know it's a tough Bill with a lot of components, so thanks for working with me on that actually. You guys did a great job.

We'll come back to the dais now colleagues. Comments? Senator Niello.

Question about the tax aspect of this. We have reduced the tax rate but increased the population of items being taxed. So, the 900 million relates to the reduction with regard to cannabis, but there's an increase with regard to bringing hemp into it. What's the aggregate impact?

We will be finding that out, I'm sure, in no time at all. But I think that there is—Amy may have the calculations on that—but I will say, before I go any farther, you know, the Bill subjects all hemp products to the Cannabis Excise Tax, which should maintain the amount of taxes collected.

So, that's what I do know. It'll help the community organizations that are receiving the funding, as was asked before. The license market is struggling. Even though sales increased, the revenue and taxes collected went down and this is unsustainable, and higher taxes should contribute to the costs that ultimately drive business out of license market and drive the taxes collected from it down. Amy, did you want to say something?

Just, I think you answered it well, Assemblywoman. I would just add to that, Senator, that the tax increase that just went up to 19% just happened last Tuesday. So, what we're simply asking for is to retain the 15%, beginning in 2028.

That's what this Bill would do and it would theoretically capture a lot more products and that's what we are assuming. And then, just to add to that, we have seen numerous consecutive drops to the tune of 30% since Q2 of 2021.

The Excise Tax is going down and will continue to go down if we continue to increase the price of these products.

I think we should note that the Bill requires studies for this particular reason. That's why we're doing this.

So, do I gather that the intent is for a revenue neutral impact on the total amount of tax being collected?

Well, that's what I would hope for, yes. But I also think that when we add more products to the supply chain that that might go up as well. So, that's why it's important to have a report so we can understand how that's going to impact other organizations as well.

Thanks.

Senator Smallwood-Cuevas.

Thank you for this presentation. And also, I wanted to just confirm, and I'm sorry I missed it, we're dealing with LA travel this morning, but can you say a little bit more about the conversations you've had and the amendments that I think you're working on, going into Appropriations?

You know, we have a fledgling business of cannabis retail, many of our social equity retailers in south LA, and I was glad to see the support that you have from them. But if you could say a little bit more about the amendments, it would be helpful for me to clarify for me.

Would you like to address some of those, Amy? We've taken, Senator, we've taken lots of amendments. We have been working in this realm for quite some time. As you can imagine, it is so complex and so, it can be confusing, and I think outsiders are trying to make it more confusing than this really is.

And I think once the information gets out, they're going, oh, okay, now I understand why this is important. You know, first of all, it'll always go back to me for safety. If I see one more kid sick or one more parent come into my office and tell me about what's happened about their kids getting illegal products.

It breaks my heart. So, this is just one of the starts, and we have to make sure we identify how we're going to deal with the tax. But let us remember, our jobs are about safety. And that's what really gets me really frustrated when people don't think we don't care. We care a lot.

And that's why we're doing testing and making sure that the products are safe for the communities and our constituents. So, I'm going to let Amy add a little bit onto that.

So, Senator, thank you for your question. We are continuing to work with craft cultivators and are in ongoing discussions. There are some additional amendments pending to try to address their concerns related to, to parity issues. I want to speak specifically about social equity.

Just very quickly, just to say that, you know, the other concern that we've always raised is this—the hemp industry does not have a social equity program, does not have worker protections.

And retailers, particularly retailers in LA are competing with a lot of businesses that are selling these products, products that are not obligated to essentially implement any of this programming. So, I think what the author is trying to say, and what we're striving for, is to create that parity.

And there will be some additional changes forthcoming to achieve that objective.

Thank you.

Actually, we'd have to have a question directed to you or the author. So, did you have a question directed at the opposition?

No, that was my question.

I think I did it. The author did a great job and so did her witness, so.

Okay. Okay. Any other questions related to? Senator Archuleta.

I would just like to commend you for getting all law enforcement throughout the State of California, it seems like, to support the Bill. And I noticed you got in my own district, Brea Police Association. You've gotten LA City Police and school police and quite a few school police.

And it seems like you were really going after the education side of all this and those educators who are concerned about our children and their safety. And I commend that. But also, I also commend the fact that the League of Cities have also weighed in—the League of California Cities—in support.

So, at the appropriate time, I will move the Bill, and I thank you for presenting it.

Thank you very much, Senator.

Okay, we are not quite there on a quorum yet. I think I need one more. So, if you are a Senator who serves on the Business, Professions, and Economic Development Committee, now would be a great time to show up in room 2100. I have a comment on this Bill as well.

And then, we will let the author and her, her panel go and we'll, we'll take it up. You have a motion, so we'll take it up later when we do have quorum.

Thank you very much.

Yeah. But I would just say this. First of all, this is not Rev and Tax. This is Business, Professions, and Economic Development.

This Bill will go. It should have passed this Committee to Rev and Tax, where I'm sure there will be a robust discussion around the tax implications. So, for those of you who came to discuss the tax implementation implications, I understand your concerns. It's not the purview of this Committee.

So, that's—it won't really be addressed in our analysis, nor would it be addressed in terms of the vote at this dais. Secondarily, this is not the Bill that you should be focused on if you're worried about the tax implications of marijuana or cannabis products in the Legislature this year.

There are other, other efforts in that regard that you might want to be really focused on. This actually is the—might be the Hail Mary for you in the sense that it expands that which is being taxed, as Senator Niello has so eloquently already laid out for the Committee.

So, you will get additional dollars thanks to Assemblywoman Aguiar-Curry, should this Bill pass and be signed into law, which is a high hurdle for—she's been carrying it for a while and, and working really hard on it.

So, I would just encourage you to pay attention to that analysis, in terms of the broadening of the scope of what is taxable, which is the key element of this Bill, rather than a reduction in the tax amount, which actually isn't even happening, it's just staying at the non-elevated amount.

So, that would be my 2 cents to you on the tax piece. I am a Member of the Rev and Tax Commission but not the Chair of it and I'm sure those will be discussed at a later date.

In terms of the Business, Professions, and Economic Development component to this, which Senator Smallwood-Cuevas dug into, this is really about us trying to create business and work and employment opportunities that we think are safe and productive for the State of California.

And so, kudos to Ms. Aguiar-Curry for really bringing follow up bills to try to continue to beat the drum of how do we keep this safe while we work with small providers across our state who are really interested in this field and this area.

So, I do think we're about to have a quorum here. Let me see if I can take—establish—that quorum and then we'll give you an opportunity to close.

That would be great. Thank you very much.

We'll be able to take a quick vote here. If you would call the roll.

[Roll Call]

Pretty sure the Bill passed during our roll call, but would you like an opportunity to close?

Members, I've been working on this issue for six years and it's constantly involving marketplace. This Bill, as I presented to you today, will make products and practices safer and makes it harder for criminals to sell illegal products.

This Bill balances the need to control the sale of illicit products with providing a pathway to good actors to sell non-intoxicating hemp, as well as in an unregulated space. This Bill also expands the amount of products subject to Cannabis Excise Tax and we expect to maintain tax revenue.

I've also taken amendments to protect small cannabis cultivators. Any hemp coming in the cannabis system is tested and quarantined and that hemp flower and inhalable products cannot be sold in California. But that does not mean that our work is done. I'll continue to work on this. I will promise you that.

Because it's for the kids, it's for our families. This Bill will support integration in a way that supports our legal hemp and cannabis industries, further empowers our regulators to attack illegal products, and protects our public health.

So, because at the end of the day, we need to make sure hemp products are well regulated and safe for all consumers. I commit to updating all of you on the Committee as those conversations progress, and I respectfully ask for your aye vote.

All right, thank you very much. Let's call the roll, for reals this time.

[Roll Call]

All right, that's y. We'll put it on call. We're missing a few Members. We'll come back to it later.

I appreciate everything you've done and helped on this Bill. Thank you very much.

All right, thank you all so much. All right, moving on. Ms. Caloza, Thank you. Okay, well, we're gonna take Ms. Caloza because I told her we would, and then we'll come back to Mr. Gallagher.

Hi.

Hi there. Welcome. When you are ready, AB 265.

Great. Good morning. Happy Monday, Chair Ashby and Senators. I'm here to present AB 265, the Small Business and Nonprofit Recovery Act, which establishes upon appropriation a state funded program administered by the Office of Small Business Advocate, to provide financial assistance to small businesses and nonprofit organizations impacted by declared states of emergency.

California is home to over 4 million small businesses and nonprofits which employ nearly half of California's workforce. With severe weather events such as the recent devastating wildfires in Southern California, decimating small businesses and nonprofits both economically and financially, it's important now more than ever that we ensure people's lives and livelihoods are secure.

I would also be remiss if I didn't mention that this week marks the six months since the wildfires in Southern California. And yet so many of our small businesses and nonprofits are still in dire need.

While federal disaster programs exist, many small businesses and nonprofits fail to qualify for these resources and face lengthy timelines that delay their recovery efforts. This gap leaves countless small businesses and nonprofits, especially those run and operated by minorities, women and underserved communities, without the necessary resources to recover and rebuild.

And so, colleagues, as you know, without this timely assistance, our businesses and nonprofits face permanent closure. And without this, so do our local communities, which would reduce the resilience of all of our neighborhoods across the state.

And with me today to testify are Susie Pryor, the Regional Director of the Central Small Business Development Centers, and Jennifer Fearing on behalf of Cal Nonprofits. And we will start with Ms. Pryor.

Great. You each have two minutes.

Good morning. Good morning Ms. Ashby and Members of the Committee. I'm Susie Pryor. I do proudly serve as the Regional Director of the Central California Small Business Development Center Network.

But I'm here today representing the entire California sbdc, a statewide network of technical assistance providers, and an integral program partner of the U.S. Small Business Administration and the Governor's Office of Business and Economic Development.

I'm here today for California small businesses that were affected by the disasters in Los Angeles this year, as well as the businesses that will be affected by a natural or man-made disaster in the future.

Small business is essential to California's economy, employing a large portion of our workforce in driving job creation and the innovation that California is known for globally.

It's for these reasons that the California SBDC is a proud sponsor of AB265 offered by Member Caloza. Because this Bill isn't just policy, it's a lifeline. It's a lifeline in the time of extreme emergency for a small business.

I know this. I live through this as a Member of the Kansas SBDC. On May 4, 2007 in Greensburg, Kansas, an E5 tornado, which is one of the strongest forces nature can produce, ripped through that town. It was a mile wide. It lasted for a terrifying 22 minutes.

When it was over, 95% of the town was gone. Homes, schools, hospitals, every single business wiped out entirely. And I walked those streets in the days that followed. And I saw families sifting through the rubble and small businesses asking not just how can we rebuild, but should we?

And that is where both the Kansas SBDC and the State of Kansas with its resources, stepped in. We didn't wait for someone else to figure it out. We mobilized immediately, setting up mobile offices and FEMA trailers and community centers and regional coffee shops anywhere we could find.

Honestly, we were there for those folks at the worst time of their lives. Without the help of both the SBDC and emergency state support, they would not have been able to rebuild.

In the end, Greensburg made national news as the first LEED Platinum certified city in the U.S. The town didn't just come back, it rebounded stronger and more resilient. Now working in California, AB 265 is California's statement. We will not wait till it's too late. We're ready to help. We are ready to act immediately.

Okay, thank you so much.

Ms. Fearing, go right ahead.

Thank you.

Good morning Chair Ashby and Members. Jennifer Fearing, the Sacramento advocate for Cal Nonprofits, a 10,000 member organization and a statewide policy alliance.

Cal Nonprofits urges your support for AB 265 to help nonprofits recover from a state of emergency to continue providing crucial services to communities. During the pandemic and the recent LA wildfires, nonprofits and governments alike greatly benefited from flexibility and greater access to resources.

By establishing a recovery grant program under this Bill, nonprofits can seek funding to recover from economic and operational disruptions caused by a state of emergency, ensuring the state's services supply chain is better supported - since we are in fact crucial state partners supporting vulnerable Californians.

New and sweeping Federal threats emerge every day targeting nonprofits on ideological grounds, including our 501c3 tax-exempt status. AB 265's definition of a qualified nonprofit referencing the state's nonprofit designation helps ensure eligibility for this program, even if a nonprofit's federal tax-exempt status is attacked.

AB265 supports a strengthened partnership between government and nonprofits at a truly critical time, and we urge your aye vote for AB 265.

All right, thank you very much. Are there others in the room in support of AB 265? If so, please come forward.

Good morning, Madam Chair. Chris Mckay here on behalf of the Los Angeles Area Chamber of Commerce in support of the Bill. Thank you.

Sarah Dukett on behalf of the Rural County Representatives of California and support.

Good morning. Jacob Brint on behalf of the California Retailers Association in support.

Russell Manning on behalf of California State Treasurer Fiona Ma in support.

Lawrence Gayden with the California Dental Association in support.

Good morning. Elise Borth on behalf of the California Community Foundation in support.

Good morning. Ben Triffo with League of California Cities in support.

Good morning. Claire Sullivan on behalf of the City of Thousand Oaks, in support. Thank you.

Chair and Members, Marlon Lara with the California Restaurant Association in support. Thank you.

Is there lead opposition for AB 265 in the room? If so, please come forward. Seeing none. Is there anyone in the room who is a tweener or would like to just state opposition for the record? Seeing none. We'll come back to the dais. Colleagues, are there comments? Moved by Senator Strickland. You have a comment, Senator Archuleta?

Yes. It's a great opportunity for small businesses. And I know in reference to fires and things of that nature, what about that small business that is impacted by a construction zone?

Because here in California, you know, we're all looking to rebuild some of our cities with housing and what have you and whatever construction goes on, it's a two or three year job and the businesses lose income. Would they be able to reach out to this Fund?

Thank you, Senator, for your question. You know, right now this is really tailored towards declared states of emergency and so interruptions due to construction at this moment wouldn't be eligible. That said, I think there is a tremendous amount of opportunity here in introducing this Bill.

As we talk about, you know, what type of work do small businesses face that causes interruption? I think LA County does a really great job. They have a Business Interruption Fund that's run by LA Metro that actually I used to help with when I was a Public Works Commissioner.

And I think there's definitely a future opportunity to look at a future program with what that looks like, especially as we continue to build housing and look at other projects in the L A area. And there's other ways in which businesses are getting interrupted. So we'd love to follow up with you and work on that.

Thank you. And again, the reason I bring it out, because we can't forget the small businesses that are affected not just by fires or floods or what have you, but there's other things that pulls them off their normal path of prosperity. And I think we should look to them as well. But thank you for bringing the Bill.

Thank you so much, Senator.

All right. Senator Smallwood-Cuevas.

I just want to thank the author for bringing the Bill. And we know this was a once in a generation disaster that hit our communities so hard, and we'll be hitting them for many years to come. I'm hopeful for this and I'm hopeful that the appropriations will come to implement this.

I know a lot of the small businesses and our economic development folks have been really doing deep analysis on how these dollars can be utilized. So the need has been articulated. This Bill helps to move it forward. So I'm happy to. I think we already have a second, but I'm happy to support the Bill today.

Thank you.

All right. Would you like an opportunity to close, Assemblywoman?

Thank you so much, Chair Ashby, and thank you to Ms. Fearing, to Ms. Pryor, and to the coalition of people who have come to really bring this Bill forward.

I understand that we're in really tough budget times, but this program is a step in the right direction to build the infrastructure that we need so that we stay ready not if, but when the next disaster strikes. And that's really what this is. It's about resilience.

It's about making sure that we're ready, and it's about making sure that we have the backs of our small businesses and our nonprofits just like they do ours. So respectfully ask for your aye vote.

All right, Very good. We will call the roll.

[ROLL CALL]

All right, that's eight to zero, but we are still missing a few members, so we're going to put you on call. Thank you for being here. Thank you to your witnesses. All right. Do we still have Assembly Member Gallagher? Yeah. Come on forward. Assembly Member Gallagher, I'm going to take care of one item of business while you're coming forward. Colleagues, we have a vote-only on AB 957. This is Ortega. We heard the bill last week. Would like to offer the author reconsideration.

So this is just a vote for the reconsideration of AB 957, which is a cigarette and tobacco product retail sale pharmacies bill, if there is a motion. All right. So moved by Senator Grayson. If you wouldn't mind calling the roll.

[Roll Call].

It's just for reconsideration. Yes.

[Roll Call]. Eight to zero.

I think that's eight/zero. We will continue to leave that one on call as well. Again, that is just for reconsideration on 957. Thank you, Mr. Gallagher. I appreciate you letting me get that item business out of the way. When you're ready.

Thank you, Madam Chair. Appreciate the opportunity to present to the Committee this morning. AB 254 would establish the California Ireland Trade Commission to advance bilateral trade and investment between California and Ireland. California and Ireland share deep cultural and economic ties and roots, creating a strong foundation for expanding collaboration and trade innovation and investment.

And I'd like to say actually maybe the Gallagher family played a little bit of role in this. You know, the family lore is that, you know, back in the late 1800s, my great great grandfather brought over draft horses from Ireland.

Now, I need to probably go back and fact check this a little bit, but he would bring over draft horses to sell them here in California because we needed that horsepower in the early, early days. But certainly we've come a long way since then.

And now relationships between Irish companies and Calif. Companies have been very strong in the areas of Fintech and Agritech and pharmaceutical. We have many California pharmaceutical companies who have headquarters in Ireland. And so in so many different sectors, construction, materials, housing.

There's been some great relationships forged there in California companies in Ireland and Irish companies investing here in California as well. And so we want to continue to build on that growth by establishing a formal Commission that will focus on promoting trade, initiating joint policy actions, facilitating business and academic exchanges, and encouraging mutual investment in infrastructure.

Members appointed by the Senate Pro Tem, the Assembly speaker and the Governor will ensure a diverse and expert panel fostering balanced discussions and dynamic trade strategies. The bill requires the Commission to submit annual reports to the Governor and Legislature with its findings and recommendations.

It also builds on existing efforts by requiring Go Biz to incorporate these recommendations into its international trade and investment strategy updates. As the world's fourth largest economy, California stands to gain significantly from deepening these trade ties with Ireland, especially as 25 states have already established similar commissions and another 25 are pursuing legislation to do so this year.

And I'll emphasize this as well, another reason why Ireland is such a great trading partner is because of access to the EU. But also, you know, the United States played a very big role in the peace process in Northern Ireland. And with, and with Northern Ireland also the ability to access the UK market.

So both of those markets, Ireland is really a key strategic gateway into those areas and to continuing to build on those trade partnerships.

So, and that was actually pointed out, and I want to point out we had a very nice letter from the Cahirlich of the Irish Senate, Mark Daly, that's in English, that's the speaker of the Irish Senate, actually sent us a nice letter supporting this legislation and very much wants to continue these relationships between our state and Ireland and so wanted to draw attention to that.

And of course, today I have with me Michal Smith, who's the Consul General for Ireland and the Western United States, who's prepared to testify in support as well. Thank you, Madam Chair.

When you're ready, you have two minutes. Thank you for joining us.

Madam Chair, distinguished Members of the Committee. That's a thank you in Irish. I'm very grateful to be here to speak in favor of AB 254 that reinforces the historic connections between California and Ireland and indeed looks forward with ambition to the future. Connections. They're long standing, those connections. They're profound.

They stretch back to the gold rush, to the digital age. Now, but even further than that, as we celebrate Independence Day over the weekend, we remember eight of the signatories of the Declaration of Independence were Irish born. And Irish people have helped build this great country.

And this great country has shaped a modern Irish state with, as Assemblymember Gallagher mentioned, the Good Friday Agreement. And indeed in strong economic reciprocity today, 2.4 million Californians are very proudly Irish American. Ireland itself ranks as one of the largest investors in California. Indeed, Ireland is the sixth largest investor in the United States.

The top 10 Irish companies employ 200,000 Americans in this country. And goods exported to Ireland keep 430,000 Americans in a job every day. So this is a two relationship built on trust, ambition. And AB 254 would help formalize that. It will formalize and underline a very deep, long standing friendship between California and Ireland. It's smart, it's strategic, and it's timely.

And I'd be very grateful for your support. Thank you.

All right. Thank you so much for your testimony. Are there others in the room in support of AB 254 who would like to come forward? Anyone in opposition of AB 254? Seeing no one. I will bring it back to the dais. All right, Moved by Senator Strickland. Comments from Senator Niello.

Thank you, Madam Chair. I'd just like to point out that when Ireland first won their Independence, for a long time the country was an economic basket case until it discovered competitive capitalism and has become a true economic power in Europe because of that, says the Italian. Okay, question.

Senator Dr. Webb Pierson.

Thank you. Thank you so much for this bill. As I was looking at it, I was just wondering, is this the only time something like this has been put in statute or have we created these kind of commissions, relationships and statute with other countries in the past?

Committee staff might know more. I believe. I believe the other Commission that we have established is with Mexico, California, Mexico Trade Commission. So I think this would be maybe the only other Commission that we've established. But I would say considering the long standing ties and the trade relationships, it would make sense to do so.

Okay. Yeah. No, I was just wondering because I just didn't know it. And I do understand that where we are now with what's happening at the Federal Government and a lot of our relationships being severed, that California will at times have to go alone.

And so we may end up seeing more of these coming up in statute with other countries.

But thank you so much, Senator Dr. Weber Pierson. There is one with Mexico and in my time here there have been more narrowly done ones that are specific to a topic like doctors or dentists or something. With several other countries that helps. Senator Smallwood-Cuevas, did you have a comment?

No, I just. My comment was along the same lines as the second good Senator from San Diego. Really glad to see this intentional effort. I think as Californians we see a lot of travel bans now against Americans in other countries.

It's really important that we do all that we can to show that California is a good business partner. We're open for business. We're ready to do business with the world. And that is important now more than ever. As we see our economy starting to contract as a result of some of these policies coming out of Washington.

So I'm happy to move the bill when the time is right.

Great. You have a couple of motions. Would you like an opportunity to close?

Thank you for the opportunity to present. And again, I think this would be a good Commission to establish for us in considering those trade relationships that we have and building on them. So respectfully ask for your Aye vote.

All right, we will call the roll.

Motion is due pass to Appropriations. [Roll Call]

I think that's 9 to 0, which is more than enough. But we'll still put you on call because we're missing a couple Members.

All right, thank you, Madam Chair.

All right, thank you for the bill and thank you for coming to see us today. Appreciate you very much. We're going to go to Rebecca Bauer-Kahan, Assembly woman on AB 432. Welcome to Business Professions Economic Development.

Thank you, Madam Chair and members, and I want to begin by thanking committee staff and the chair and in addition, Dr. Weber Pierson, for their dedication to this effort and their collaboration and work on the bill. I'm delighted to present AB 432, the Menopause Equity Act.

This bill was really born out of my own experience, but the experience of many of my peers as a 40-something-year-old woman. I, like many women, started to have symptoms I didn't understand and I didn't know that they were perimenopausal. I started to have brain fog that was frankly, frightening.

I didn't know what was happening with my brain, I didn't know why it was not working the way I wanted it to, and I didn't know where to go. So like many people, I went to my internist. Start there. She said I was fine. I said, no, I know I'm not fine.

I know there's something wrong in my body. So she sent me to another doctor. That doctor again said I was fine. I wasn't fine. And so then, having had hormonal problems throughout my life, I went to my OB, and I said, I think there's something going on. My brain isn't working. I'm in my mid-40s.

My mom was menopausal, fully menopausal by 50. I think maybe that's it. 'Oh, no, you're fine.' I wasn't fine. It wasn't until I was sitting at a brunch with girlfriends complaining about this story that one of my girlfriends recommended a doctor who'd been trained by the Menopause Society and said, go see him. I walked into his office and it was life-changing. He knew what was going on in my body.

He immediately started to describe to me what I was experiencing, which having been to three doctors prior to this in the Bay Area who all are incredible physicians in their own right, who told me I was fine when I knew I wasn't, was so amazing, and he prescribed medication for me, and it changed the course of my life over the past few years.

Now, my story is different than every other woman's story, but every woman who lives long enough will go through menopause. That's a fact. That's half the population, and the vast majority of us are not doctors.

So most women like me won't be able to diagnose what is happening in their body when it isn't one of the main symptoms. People often think of hot flashes, night sweats, but there are 32 known symptoms of menopause. It affects our entire body, our entire system, and we need to be able to walk into a doctor's office and have a doctor know that perhaps, perhaps that's what's going on. Even if they aren't the one who can diagnose it or treat it, they can send us to that right doctor.

Took me over a year to get into the office of a doctor who could actually diagnose and treat what was happening in my body to get me back to where I needed to be, and so this bill was born out of that experience, the conversations I've had with countless women from my mother's age.

My mother is now 80. She went through weeks of testing. She was hospitalized at Stanford Hospital for a week because her circulation wasn't working right. That was her symptom. Wasn't until she was at a party that she found out that maybe it was menopause.

That shouldn't be how women are finding out what's wrong with them and getting the treatment they need, and so the portion of the bill that's being heard here today relates to the training of physicians, making sure that they are getting the education necessary to know that this could be what is affecting the body system that the patient is describing.

As in print today, the bill mandates that doctors will take four hours of training over four years. I know, there's been a lot of conversation around that. The analysis--and again, gratitude to the committee for the analysis and the work.

The analysis indicates that we are trying to move the bill to an incentive-based program that would allow for doctors to get double credit if they opt in to up to four hours of menopause training. We are still ironing out the last details on that as it's a significant change that affects the Assembly committees as well, but I am committed to continuing to work to get this bill to a place where we can all support it, we can all make sure that women are getting the treatment that they deserve, and they don't have to spend the year like I did, really trying to get their bodies to function the way they deserve to.

And I should note that this isn't even just about my brain functioning in this moment in time. When our body systems aren't functioning properly, it can have long-term health impacts, and so to give women the length of life they deserve and to be as healthy as they need, this bill is critically important.

And so with me today in support of the bill are two incredible scientists by their own right. We have Dr. Emily Jacobs, who is a Ph.D. Director of the Ann Bowers Women's Brain Health Initiative at UCSB and Dr. Judy Mikacich--how'd I do?--who is a practicing OB/GYN and a Menopause Society specialist.

Ladies, welcome. You have two minutes each.

Yes, I'm Emily Jacobs. I am here to express my strong support of AB 432, which ensures equitable menopause and perimenopausal coverage. Menopause is not niche. It will affect half the population and women will live half of their lives in the perimenopause and post-menopause years, and while this is a normal part of the aging process, menopause is tied to a range of symptoms.

Why? Because ovaries secrete hormones that act on nearly every cell in the human body. When people think about ovarian hormones like estrogen and progesterone, they often think about reproduction, but these hormones have widespread effects throughout the body.

They impact the nervous system, the cardiovascular system, the skeletal system, the digestive system. There's really no part of the human body that is untouched by these hormones, and that's a feature, not a bug. Hormones are like a PA system that broadcasts information to the entire body.

That is also why menopause can bring on a whole host of symptoms, right? You feel hot, your brain feels fuzzy, you have trouble sleeping, you start to lose calcium in your bones. Menopause impacts almost every organ system in the body. There's been some concerns about requiring CME credits.

I'll just say this: we need physicians who are trained to recognize menopause as a critical window for preventative care. Relying on public awareness campaigns to educate women is not enough. We can and should empower providers. Menopause--to belabor the point--is not just an endocrine transition. It's a neurological transition. It's a cardiovascular transition. It's a metabolic and immunological transition.

And menopause is not a discrete event. It's a transition that can last for decades. Insomnia, heart palpitations, hot flashes, vaginal dryness, brain fog--women suffer in silence and yet there are excellent options to relieve these symptoms, but if patients don't know what questions to ask, and more importantly, if physicians aren't equipped with the knowledge to recognize a symptom as menopause, women pass through the system without getting the care they need.

According to a Johns Hopkins survey, about 20% of medical schools include menopause in their basic science curriculum, 20%, and for those that do, the courses are mostly an elective. So if you need the bumper sticker, here it is: women's bodies are not an elective. A module on menopause in grad school is not enough--

I need your final thought to wrap that up.

We need an impactful and enduring approach to improving menopause care, means we need physicians with up-to-date knowledge, knowledge that is rapidly advancing. Continuing education is critical to providing high-quality care for the women in California. And for integrated care, physicians need the most up-to-date information on how menopause impacts the body.

Thank you. We're going to go to the next witness. You have two minutes.

Hi, I'm Judy Mikacich. I'm an obstetrician, gynecologist in private practice at a group called Sacramento Women's Health, and also the Medical Director of Quality and Patient Safety for Women's Services at Sutter Medical Center, Sacramento. I've been taking care of women of all ages for over 25 years.

Several years ago, I became a certified menopause practitioner through what is now the Menopause Society, and since then, I have focused my clinical practice on the care of women in the perimenopause and menopausal periods.

I'm honored to be here today in strong support of AB 432 and applaud Assembly Member Bauer-Kahan for authoring this bill for the benefit of women in the State of California and hopefully for eventually across the country.

Women in the menopausal transition, which can last more than a decade, need our support and guidance as they navigate the many changes their bodies and minds experience. Estrogen receptors, as discussed, are on every tissue of the women's body, and loss of production results in numerous changes that women aren't necessarily ready for.

Fifty-seven million women in the U.S. report symptoms which include difficulty in concentration, sleep disruption, headaches, as well as hot flashes and weight gain, all of which can be addressed with proper treatment. Though effective remedies definitely exist, 73% of women do not receive treatment.

Most importantly, I think it's estimated that lost working time due to menopause symptoms cost women $1.8 billion every year. Even among OB/GYN residencies charged with training doctors to provide comprehensive women's healthcare, 80% do not specifically address the needs of women in midlife.

As a result, many women do not feel that their doctors are comfortable treating perimenopause and menopause. Across the country, there are only 1,300 certified menopause practitioners trained specifically in menopause treatment in the country.

I support this bill wholeheartedly and hope that this will be just the beginning of a wave of advancing provider education and better care of women looking forward to restoring their health and well-being which is totally realistic with evidence-based individualized care.

All right, thank you very much for your comments. Are there others in the room in support of AB 432? If so, please come forward. This is just #MeToo testimony, so your name, organization, and position on the bill.

Madam Chair and members, Nico Molina, on behalf of Bayer, in support. Thank you.

Katherine Squire, on behalf of the California Commission on the Status of Women and Girls, in support. Thank you.

All right, is there anyone in the room in opposition to AB 432? Come on forward.

All right, you have two minutes each.

Thank you. Chair, Members of the Committee, my name is Angela Hill, and I'm with the California Medical Association. We are opposed unless the CME mandate is amended or removed. I'd like to thank the author for her hard work over the weekend, as well as the staff on the Committee and with the author's office and otherwise.

I know many people have been taking meetings with us and hearing our concerns with the bill as it's currently drafted, which is overly broad and would capture physicians from HIV AIDS specialists to people who are doing Parkinson's disease, things that we really don't think should be captured in an ongoing mandate. So we really appreciate all the conversations.

If the amendments, as they're described in the analysis, are adopted, we will would remove our opposition. So we do hope that those are taken. And we want to thank Dr. Weber Pearson, the chair and the author for all of their work. And I'm happy to answer any questions.

All right, thank you very much.

Good morning, Madam Chair Members. Aaron Bone with the Medical Board of California. We also have an opposed, unless amended position related to removal of the CME mandate. The board believes that physicians should be responsible themselves to determine what types of continuing education courses that are most appropriate for them and for their unique and diverse patients.

If a physician finds themselves in a situation where they are unable to practice competently in whatever field, then they should refer their patient to another provider.

Ultimately, if a patient believes that their physician failed to treat them appropriately on this or any other topic, then we encourage that patient to file a complaint and that the board will take appropriate disciplinary action. Similar to cma, the amendments described in the analysis would remove the board's opposition. As it is, that would remove the mandate.

We would then need to evaluate the novel approach to how CME would be handled with the double credit that would be offered, and the board will be discussing that at our board meeting next month. Thank you.

All right, thank you very much. These guys left you a minute. Do you want to push your concerns?

Go right ahead, Ryan Spencer.

They're separate and different than what they've already stated.

Go ahead, Ryan Spencer at the American College of OGYNs. And they are very similar to what. Comments are made by my colleagues right here. And if that amendment is adopted in analysis, we would gladly remove our opposition. Thank you, Madam Chair.

All right, thank you very much. Now we're on to me-too testimony. So if you oppose, name, organization, position on the bill.

Thank you very much. Vanessa Kahina, on behalf of the California Academy of Family Physicians here in an opposed unless amended position would be removing our opposition if these amendments are included.

All right, thank you very much, Madam Chair Members.

Tim Madden, representing the California Chapter of the American College of Cardiology with an opposed unless amended position for all the reasons stated. Thank you.

You would also be removing your opposition if the amends were taken?

Yes, that's correct. Thank you.

All right, anyone else in the room who wants to speak on AB 432, in favor or in opposition? If not, we'll bring it back to the dice. I don't do this often, but I am going to lead off on this dialogue and thank the author. It is her intent to take these amends.

We've spoken about it at length. She did the hard work and met with Dr. Weber Pearson, who, of course, is our Senate Doctor that we all really lean on a lot to explain these issues to us. And the two of them have done, I think, an excellent job.

I'm actually excited about the idea of double credit for this. I think it is a good incentive that will encourage people to learn what these two ladies know and are screaming from the rooftops.

As a woman very close in age to the Assembly woman, I will tell you it would be great if more doctors understood into the young women in the audience, right? Yes. More fun to come for you, but it is important. It does affect every part of your life.

And it would be really great to have doctors understand that when you go in to meet with them. And I think this bill strikes exactly the right balance with the amends. It has my support today. We should also note this is a women's caucus priority for obvious reasons.

The women's caucus really wants to see women's health care be a priority. And we want to do it in a way that's respectful to the doctors, which is why we lean so heavily on Dr. Weber Pearson.

But we also want to do it in a way that people across the State of California receive the best health care in the world. That's really our goal. And obviously we have the Clinicians. We just need to make sure that the information is out there. We have great advocates in this space.

What I heard in this hearing is that you wouldn't have any opposition once these amendments are taken. I know it is your intent to take these amendments. Sometimes when we work on a bill all the way up to the finish line, we can't get those amendments in. In this Committee, it is her intent.

Luckily, the next Committee chairperson is here, who is also, by the way, quietly in the background, been working on this as well and deserves also a ton of credit, is a huge champion in the women's caucus as well. And I believe we'll pick this up. This would be just like a seamless relay.

I will hand her the baton and I'm sure she'll take it from here. But it is our intent to put these in play. We do need to play nice with the Assembly. They have a few questions and concerns.

Our Committee will stay involved and will help Senator Mengavar, Chair Mengavar's Committee, get these amends in place, as is the intent of this Committee to do so. But unfortunately, we don't have them quite in print yet. So I wanted to explain that to my colleagues.

It is a strong and hearty yes from me with the intention to work with Ms. Menjivar's Committee to be sure that these amendments are put in place for everyone. Dr. Weber Pierson.

Thank you, Madam Chair. I want to thank the Committee, want to thank the author. We were finally able to have a conversation this last weekend to hopefully come to a resolution. So, you know, we'll keep working together with that. You know, menopause, perimenopause, premature ovarian insufficiency.

There are a lot of things that happen to a woman's body, and I say it affects all individuals with XX chromosomes and functional ovaries. So that's not all women. Right. But it's a lot of them.

In my field and my specialty, I actually deal with those who are diagnosed with premature ovarian insufficiency, which occurs when they're 12, 13, 14, 15 years old. Right. Their ovaries stop working. And so how someone presents and what their symptoms are vary. Not one size that fits all.

As you stated, it's not like the cold or the flu. When you come in and you say this is exactly what you have, the treatment varies per person, per symptoms, per their body, which is one of the reasons why we have specialists and one of the reasons why they now have their own menopause society.

I know when I was doing my adult practice, I relied heavily on Dr. Catherine McCauley. She was our menopause specialist at UCSD and a very active Member of the menopause society.

But I do believe that the basics of menopause should be something that a lot of physicians know about, but this is something that should be taught in medical schools. It should be taught in the residency programs. And so if we're going to put a mandate on something, it should be done by their accrediting body.

That basically states this is what you need to learn in order to be a practicing physician in this particular area. And I mentioned this to you, Assemblyman Bauer-Kahan.

For us to do this, for California legislators to impose this mandate, it's basically stating that we as legislators know more than those who practice and study and manage patients on a daily basis and their societies that basically tell them what they should have in order to be a practicing neurologist, cardiologist, OBGYN.

I'm going to talk about the issues with the mandate first because that's what we're voting on. Right one. As has been stated, it is extremely broad. Even though in Assembly BNP they narrowed it down to certain specialties. Even within those specialties, you have subspecialties of people who see or wouldn't diagnose or definitely wouldn't treat menopause.

You have neurology as a specialty because people come in with brain fog. But even within neurology, you have neurologists that have, that specialize in epilepsy or seizure disorder. You have neurologists that specialize in neurocritical care. They only see patients in the icu. To make them take this course is unreasonable.

You have cardiologists, but even within cardiology you have multiple specialties. You have echocardiologists that just look at echocardiograms all day. You have interventional cardiologists that actually go in to place the stents and stuff, that don't necessarily see or manage patients or diagnose or treat menopause. And that's not why someone would particularly come to them.

Even in my specialty as a board certified OBGYN, I did a fellowship in pediatric and adolescent gynecology. I see adults, but I don't see them at the age that they're going through menopause.

But this bill as is, would capture me as well, along with people who do family planning that focus their practices on, you know, contraception and terminations, medical and surgical who don't manage or see patients in this area. It is extremely broad. It's also, in my opinion, unenforceable. I have no idea how the medical board would do this.

It's this thing over four years, a certain number of CME hours, yet we have to, you know, recertify every two years and show our cme. I have, I have no clue how you all would do this. It's also an added expense for providers. A mandate is an added expense.

We have one of the highest expenses in order to have a California medical license in the country and now you're staying on top of that. We must pay more money for this extra course. And we all know this because we take courses that we're mandated.

Mandating going to a course is not necessarily going to change someone's comfort level in screening, diagnosing, nor treating menopause, especially if they see patients so infrequently. If I see one or two patients a year, it's not going to change my ability to necessarily be able to diagnose it right away or treat it right away.

Mandates oftentimes send wrong messages. Like I said, you know, we do a lot of mandates in this state, some of which we are now starting to roll back because we what we've seen is that it hasn't improved the lives or given the outcomes that we're necessarily looking for.

And so that's why when I spoke with you, I said, you know, instead of sending the message that California knows more than physicians, by doing this mandate, we can send the message that California cares about menopause, cares about women's health, by incentivizing physicians to learn more about it.

And incentivizing them would be by increasing the amount of hours they got, double the amount of CME hours for the courses. That sends a totally different message.

And it also allows for those who see patients in this area or who want to learn more about this area, the opportunity to go and take these courses instead of forcing people who may never or rarely see anyone with these issues.

And so I want to thank the author so much for listening to me for taking this suggestion, agreeing to do this amendment. You know, I know that for whatever reason, there are now issues with Assembly BNP on this. I have no idea why, as you can see, all of those who are opposed would come off.

There is a difference between CME requirements for our licensure within California versus the CME requirements that we must do to maintain our own board certification. So I don't know if there's a concern about the fact that people wouldn't take courses in their own area. We have to do that anyway in order to maintain our board certification.

I have to take my ob GYN focused things every year in order for me to maintain my board certification. So I'm not quite sure what their concern is.

But I believe that the proposed amendment strikes the right balance to say that California cares hopefully can serve as a model for other states without looping in every physician that may never, ever manage or treat or diagnose menopause.

And so I want to thank you for Being open to those, I commit to continuing to work with you to get Assembly DNP to agree to these amendments because it really does strike the right balance and it puts us in the right, on the right path. So thank you very much for that.

Thank you, Senator.

Thank you again, Dr. Weber. You can all see now why we lean so heavily on her. Okay, two. Two more on this side and then one on the other. We're going to go Senator Menjivar and then Senator Smallwood-Cuevas, and then we'll come to you, Senator Niello.

Thank you. Thank you, Madam Chair. We chat over the weekend. I don't think I have any outstanding questions for you. I appreciate your time. I have a couple questions. The opposition. You mentioned a point regarding having physicians take courses that are within their space and so forth. Maybe, Angela, you have the answer for this.

How many physicians currently take CMEs on menopause?

Aaron Bone with the Medical Board of California. I don't have that information with me, Senator. Unfortunately.

Yeah. Angela Hill. So this is a question I do recall being asked in the first House. So right now that's information that, to my knowledge, is not collected at the state level related to any topic of Cme, of tracking. I can't speak for the medical board. I imagine that would be a very costly endeavor.

But it's not currently collected at the state level as a data point for menopause or any other subject.

Okay, thank you. And then how many CMEs exist that teach on menopause?

That's a good question, Senator. Unfortunately, I don't have that information either. In terms of how many courses are out there on the marketplace, there could be quite a few. The American Medical Association, the California Medical Association are some of the authorized providers of Cme.

So how many courses does CMA offer on menopause?

We currently do not offer a CME course on menopause. We have communicated to the author's office that as an ins, we were inspired by this bill. And as an accredited body, we are taking the steps to begin offering that course.

I can also follow up with you on the number of courses that we've personally provided to the author's office as well. Regarding. We went and we searched through all of the accredited CME courses and pulled everything that touches on menopause. I don't remember offhand how many courses there were, but I can give you that number.

There was a hearty amount. I didn't analyze it in comparison to other conditions, for example, but I can follow up.

I think Miskihis might have a number for you. Go ahead.

Thank you very much. Only speaking for the California Academy of Family Physicians and also Vanessa Kahina on behalf of Cafp, given that our Members. Treat people from birth to end of. Life, this is a really critical topic for many of our Members. We provide menopause training sessions in all of our accredited training courses.

I will follow up with extensive data on that. But they do have very high uptake. In them and are provided at every single practice forum.

All right, thank you, Ms. Mahina. Go ahead. Doctor, did you want to. I just want to answer her question from. Well, Ryan from OBG, from ACOG. Every year we have to read a certain number of articles in order to maintain our board certification and to get our CMEs.

And every year there are multiple articles for us to read and questions to ask for our test on menopause. I've done mine this year and chose to do menopause articles just for my own my own knowledge. But you have to. There is no specific number because every subspecialty has their own CME courses and requirements.

So OB GYN has many courses and tests that we have to take on menopause.

Right. And it seems like, you know, you mentioned there's a lot of courses that mention menopause. Every single that was just mentioned embeds menopause. I guess I was wondering, are there courses specific to just menopause? Because, you know, women's health can be in geriatric. It can be embedded in a lot of different topics.

Do we actually have topics just on menopause? It was one of my questions, is there a platform or not a platform? Is there enough where physicians have the ability to go and take these courses for the double credit that's being proposed by the Assembly Member, was my question, because I think it's.

I agree with what Dr. Weber Pearson mentioned on the social services side. We have to take CES as well, and we get to choose which CES to take every two years, depending on what population we work with. Some are mandated, required, but then you get to choose. They're not always. You're in front of a laptop.

It's not as informative as you want, but you get to go to conferences and get credits like that. The conversations I had with the Assembly is like, is there flexibility? Is there other ways you can get some not points or credit, but for a conference and so forth outside of the CMEs? And is there flexibility with that?

Because I do agree that it shouldn't be so rigid on how we approach the training. But I also Wanted to make sure there is. I'm just using the word platform, but it's not a platform, but there is a base that people, physicians can go to and actually pull that training.

And are all physicians as great as Dr. Weber Pearson because they work in this space? Are they going to do this training? Because we do have to recognize that we're falling short in this space where 51% of the population, potentially 51% of the population, are going to go through this.

And are our physicians prepared to treat this, given the fact that this body has had a lot of or has had informational hearings on this? And all the information we get is that we're falling short. But I'm glad there's flexibility now. I appreciate that it moved away from a mandate, so thank you for that.

I just wanted to make sure that we're investing on the back end so we are providing opportunities for our physicians to take that training.

Senator, Smallwood-Cuevas, please.

No, I really appreciate the conversation. And. I'm glad that there's been some deeper conversation based on expertise and understanding because I would hate to have folks opposing menopause training. I would. Just on the face of that, I would, that is, I would be very disheartened to see that.

So I'm glad that we're getting into the weeds and we're getting to the specificity. I also want to just say how important laws are in the space of making sure that our medical boards and associations are treating their patients, our constituents, fairly, legally.

I know the Civil Rights act had a lot to do with how my grandmother and mother get seen, get heard. And knowledge is power, particularly when we look at issues of racial disparity and health.

And that was to my question of both of these great Senators and their expertise, but also love and care for women in this topic. You know, Black women face some of the highest disparities in treatment, and because of that, oftentimes see some of the most severe cases of menopause just go undiagnosed and untreated.

I'm curious, in terms of the curriculi that is available, how are we looking at making sure that our medical profession, professionals are able to diagnose, to treat and to really care for this population in this particular space. I know we often talk about maternal health and all of the concerns that are related to that.

Certainly we know black women are experiencing some of those most traumatic experiences of not being heard when they come with their cases and issues related to menopause.

Maybe there could be some conversation in the research to look at the breadth of what is offered, and particularly those who are working in underserved or diverse communities have access to that information.

So I will put that question to you, but it sounds like there's more work being done to really ascertain what's out there and what's available to patients. Go ahead.

And if I may, we actually, as was mentioned by Senator Menjivar, we had a series of four informational hearings on menopause last year.

And kudos to, by the way, the amazing black women who are advocating for black women in this space who appeared at many of those hearings to raise exactly the disparities that you mentioned.

Because I want to address one thing that Dr. Weber Pierson said that's really important that I just want to correct, which is I've never thought I know more than the doctors, and I don't. What I do think is that I'm a lawyer.

And I agree with you that I think where we have populations that our institutions are ignoring, that's when policy steps in.

And the fight that this bill has been and the lack of research, the lack of education, the lack of care in this space just reminds us that aging women are one of those populations that institutions are not going to run to care for on their own. And that's why policy is so important. And I agree.

I'm glad we found a really great path forward. But I do think that's why I believe deeply that policy in this space is so critical. And you heard from CMA that it was policy that sort of pushed them to start to work on providing the CMEs in this space.

We heard from Dr. Patel, who has testified on this bill, who runs the UCLA Menopause Clinic, that now she's being asked to provide more and more CMEs in this space. I do think this has started a conversation around how we do that.

And as to your question about racial disparities, there is some incredible research out of Stanford on black women and their menopausal journey.

There are different rates of surgically induced menopause in black women for reasons that I won't go into because I'm not a doctor and wouldn't reiterate them properly, but making sure that those women are getting the care they need. And so one of the things this bill is a piece of what I've done on menopause.

But another piece that my office has been spearheading is looking into our UCs, our research institutions and their research dollars. Where are those going? And the question we asked was, how much is being spent on research around midlife women in the menopause transition.

Of all the dollars spent in research at the UCs, I believe that we should be getting share of that where 51% of the population is under Menjivar's point. And in addition to that, how much is going into the racial disparities on top of. Let's research this and let's also look at the racial disparities.

And I actually have to credit. You see, the numbers we've gotten so far were actually pleasantly surprising. So I'm happy to share that with your office if you want to take a look at it.

But it's another piece of this puzzle that I think is not in the bill but is critically important to what you're saying is the underlying research that will go into the training. Because we want all of our trainings to be evidence based on.

So we're saying we don't have that training at this point. But this is going to come. We're expecting that through the other bills that you're doing. In this bill, there will be sort of a creation of curriculum that will speak specifically to how menopause is impacting these communities that are underrepresented.

I mean, we should keep our eye on that for sure. Right now it's not there. I mean there's very little overall. And so we need to build up and then make sure we're focused on them. But you know, I will let the experts speak if they want to speak on this.

And I know that our Doctor does these trainings, I think so if she wants to speak.

Hi. Okay, hold on. Okay, go ahead, lean into your mic there. And when it's up to the Assembly woman, she called on you so you can answer that question. It's actually up to the chair so. I can get more precise to finish her thoughts. So you go ahead.

Yeah.

We. We did talk earlier today about getting. The each of the UC medical school, schools to set up these sorts of programs, UCLA being the first, but to spread it out to others. And that would take a while. It is not in. In the base level medical education. We know that it could be.

That's that would come over time. But certainly something like this would help. Drive that as mentioned.

Okay. Angela, I'm sorry, did you want to add a component to that as well?

Thank you. Yeah. I just wanted to clarify at least from CMA's perspective. We do, we do agree that this has sparked a conversation and we're happy to begin the work as an accredited body to offer a course on Menopause. And there are already courses on menopause and that include menopause.

I'm happy to also provide that to your office as well. But at least from CMA's perspective, we're not going to be offering anything further than that. So cma, CME course.

No, I appreciate it. And I hope as the course, these courses come online for the CMEs that we do look at how this condition impacts women from different communities.

I think that particularly those who are serving in those communities, black and brown communities, I think that is culturally relevant and competency, builds competency in our medical profession to, to have that kind of a curriculum available.

And I want to just give a shout out to black women for Wellness Action Project, which is in my district for their great research. They do a lot of participatory research. They do a lot of education and training to really lift up these issues and can be a great partner.

And I think as you all are thinking about how to put these kinds of trainings together.

All right, thank you, Senator Niello.

Thank you, Madam Chair. I am neither a physician nor obviously a woman, but I am a long time opponent of a lot of mandates that this Legislature imposes as a citizen, as a local elected official, as a business person. Senator Wilbert Person made a comment about mandates and a question.

When you recognize the shortcoming in the profession and by the way, as a patient, you're a consumer of healthcare services and it certainly is appropriate for you to point out where you think there's a shortcoming.

Did you meet with the medical board and with the CMA to discuss with them what they intended to do about what you saw as a shortcoming in the system?

Yeah, we've had, I mean as Angela.

At the outset before you introduced the Legislation, I mean this bill.

Well, so last year I did a bill that this is building upon, so and it didn't include, I don't know if you sat on health at the time last year, that one was just heard in the Health Committee because it was narrower in scope. It didn't include the continuing education.

And throughout that work it became apparent that this was a piece of that was to be added. As you heard, we've had many conversations and I do want to give with both the board and the NCMA and ACOG and others.

You heard, you know, there are many different groups in the room and I do want to give CMA credit for the, you know, we did talk. One of the first questions I asked is you are a CME provider. What are you providing?

And that's when Angela and her colleagues started to talk about, you know, this is something that needs to be in our curriculum. And I don't. I don't know the exact process, but I know the process is underway. And she has kept us updated on that. And, and to me, that's wonderful.

And I want to give absolute credit to them. I don't want to diminish that, but I want to make sure that, you know, and I. I don't think I misspeaking when I say, when they offer that under current. The current system, people will opt in or they won't opt in. I mean, that's the way it functions.

And so, you know, as a consumer of these goods, I wanted to make sure that not only do they offer it, which they're now doing without me mandating, I'm not mandating that they offer it. That's not the bill.

You know, that the doctors who would be seeing these patients in a frontline way would be educated through these courses.

Well, as it turns out, it creates a conversation that's very productive, and that's good. I have a concern about the double credit because that opens the avenue for this to be utilized for any other particular need that somebody else might see that isn't adequately addressed with regard to continuing education or basic education.

And it seems to me the ultimate solution to this is that medical schools offer courses in this, and hopefully this will lead to that being done as opposed to relying upon the incentive of double credits, which is just not going to be applicable to some doctors.

And also, as I said, opens the door to other specific conditions that people other than you, legislators other than you might believe are important enough to also offer the double credit and attempt legislation in that effort. I'd be concerned about that in the future, and I will wait to see how the amendments play out.

But at this point, I'll lay off.

Okay, one last comment from me, and then we'll give you the opportunity to close. We do have colleagues, nine more bills on the agenda, so we want to move through. Not to say that this one isn't super important. It is. And I know there's been a lot of conversation.

I just want to reiterate that while these amendments are not in print today, it is the intent of this Committee to work with the Assembly Business and Professions Committee, as well as whose Chairman has entered the room. Conveniently long timing.

And to work with the next Senate Committee, whose Chairwoman is also in the room, to make it very clear that we're expecting this set of amendments to come into play. We do have the authority to pull it back to this Committee. And I would just remind the Committee Members of that.

If you predicate your vote today on those amendments and they aren't satisfied, we could call this item back to our Committee. So with that, you have an eye recommendation for from me, Would you like an opportunity to close?

Thank you, Madam Chair. And I just want to address Senator Elo's point very quickly, which is the slippery slope point. I think it's important to note that we do actually require CME for palliative and geriatric care.

So there was precedent for what was in the bill, the requirement itself, and I had an incredibly hard time moving that forward. So it makes me think that slippery slopes are not as real as one would fear. And I think that to call. You know, I want to clarify.

This isn't a cond that is, you know, experienced by some portion of the population that is small. This is experienced by every woman who lives long enough. And it affects most of our system. And so it feels unique in its application.

And why I'm not as concerned as you may be on that, although I respect the concern and I appreciate you continuing to watch the bill. But with that, I just, you know, really want to thank this Committee, thank Dr. Weber Pierson for her time. Thank the chair, as always, for her dedication to women and girls.

I want to thank the health chair, who I know has been in conversations with me, as you heard, and will continue to work on the bill.

And since I have him in the room, also the Assembly BNP chair, who I appreciate, you know, is also a huge advocate for women and girls and say that, you know, this is really important.

It's important to me, but it's important to all the women that each of us represent because we will experience this and it will affect our bodies, and it will do so in different ways. But we need to be able to walk into our healthcare providers and have them treat us to the fullest ability of their training.

And this will allow them to do that even better than they did yesterday. Respect Faster. I vote.

All right, let's call the roll. Do I have a motion moved by Senator Cuevas?

[Roll call]

That's seven to zero. We'll leave it on call and you all bring it back up. And we have a few more Members here. Thank you, Assemblywoman Bauer-Kahan. We have our Assemblymember Berman here. We're gonna take up his bill.

I did. I did. Good job.

Mr. Berman, welcome.

Thank you.

Senate side. We are happy to see you. This is ABC. I was just looking to make sure. That's the only bill we have.

It is nice to be here only presenting one bill.

That's. That's weird. Okay. Yeah, let's do it. When you are ready, sir.

Thank you, Madam Chair. AB 408 is a bill sponsored by the Medical Board of California to allow for the creation of a physician health and wellness program that aligns with nationally recognized best practices for protecting patients and connecting doctors with the help that they need to continue practicing safely.

While evidence shows that health and wellness programs encourage practitioners to receive care for substance use disorder and other conditions by reducing stigma and promoting treatment, the Medical Board has not offered a program for its licensees in nearly 18 years.

AB 408 allows the board to establish a program that addresses issues with the prior diversion program while not changing any requirements for physicians who have harmed a patient or committed serious misconduct. Fundamentally, this bill is about protecting patients by encouraging doctors to seek and receive care before their condition impacts their practice, meaning before they harm a patient.

I'd like to thank Chair Ashby for engaging with me on this bill and for including my author's amendments in the analysis which were drafted to address stakeholder concerns. While the Committee has not recommended any further amendments at this time, I am fully committed to continuing to work with any remaining opposition to the bill.

And with me today in support of the bill are Reji Varghese, Executive Director of the medical board, and Dr. Shannon Udovic-Constant, President of the California Medical Association.

Great. Thank you. So you have four minutes combined. Is one of you here as technical expertise? Okay, great. So two minutes each then. Great. When you're ready.

Thank you, Madam Chair and Members of the Committee. My name is Reji Varghese and I'm the Executive Director of the Medical Board of California. I would first like to thank Mr. Berman for partnering with us on this bill.

I joined the board in 2020 and prior to that served the Oklahoma Medical Board for more than three decades, most recently as Deputy Director there in Oklahoma. I worked very closely with the Oklahoma Health Professionals Program, which is ohpp.

And so first hand how early intervention and addressing a physician impairment is a great success that helps to protect the public from an impaired clinician and help to rehabilitate them. Right now, the board's only tool to address the physician's health condition that may impair their ability to practice safely is to go through the disciplinary process.

This is a relative reactive approach. After the Board receives a complaint which often occurs after a patient is harmed, it can take years to investigate and prosecute a physician at a five to six figure cost. This approach sadly misses the opportunity to prevent patient harm from happening further.

During an 18 month public process where we explored our existing authority in this area and after working with experts operating similar programs in other states, the Board developed a proposal that's containing AB408. This Bill authorized a program that prioritizes early intervention for these health issues by offering confidential evidence based service before a provider becomes a risk.

If the Board learns that a licensee has a health issue but has not harmed their patient or engaged in sexual misconduct, we could refer them to the program in lieu of discipline where their compliance and progress will be monitored.

AB408 includes meaningful guardrails so we can discipline those who fail to comply with the program and are unsafe to practice. This program would be overseen by the Board but operated by an external group of experts.

Existing law recognizes that a substance use disorder is both a health and public safety problem and in the Medical Practice act the Board is charged to, when possible, attempt to rehabilitate our licensees. We believe the bill strikes the right balance to promote safe patient care. On behalf of the Board, I respectfully request your aye vote.

With me is Carrie Webb, our staff counsel to help answer questions.

Thank you for being here. Go right ahead.

Good morning, Madam Chair and Members of the Committee. I'm Dr. Shannon Udovic-Constant. I'm the President of the California Medical Association and I'm pleased to join you in support of AB 408.

The physician health and Wellness program authorized through this legislation would be a critical addition to the resources available in California to address physician health and wellness in order to maintain a healthy and robust physician workforce to meet all the health care needs of all Californians.

Physicians are not different from other people and other health care professionals in that they are human and can get sick just like anyone else. Physicians who are struggling with health problems that are not putting patients at risk should not be worried about seeking professional help because of risk to their medical license.

Physician health programs serve as confidential, supportive resources for physicians who may be at risk of impairment due to a health condition. This legislation addresses problems upstream. California is one of only three states currently without a physician health program and it's foregoing the patient safety benefits of this important resource.

The Federation of State Medical Boards passed policy in 2021 establishing that, quote, early detection, evaluation, treatment and monitoring of a physician with an impairing illness enhances the board's ability to protect the public, end quote.

The federation refers state medical boards to the federation of state physician health Programs guidelines as a model for how to structure programs and the provisions of AB408 incorporate these best practice principles from those physician health program guidelines. In my role as President of cma, I've had the privilege of meeting with physicians from across the state.

In that work, I've talked with physicians who report that their practices and sometimes even lives have been saved by participation in a physician health program. We physicians get into this work because we want to help people.

And sometimes physicians feel like they don't have a place to turn when they need the help and that shouldn't be the case. It's better for everyone if there's a non punitive place to turn. Evaluation of other states physician health programs has shown them to be incredibly effective. AB 408 is modeled on what we've learned from these existing successes.

What I need you to programs your. Final so I ask CMA asks the physicians of California ask for your aye vote. Thank you.

Thank you. Sorry about that. All right, are there others in the room in support of AB 408? Please come forward. State your name, organization and position on the bill.

Hello. Matt Lajay, with SEIU California in support.

Good morning. Shira Spector, with Stone Advocacy on behalf of the California Orthopedic Association and support. Support. Thank you.

Good morning. Edwin Kim, with the Federation of State Physician Health Programs in support.

Good morning. George Osborne, for the Union of American Physicians and Dentists in support.

Clifton Wilson, on behalf of the California State Association of Psychiatrists as well as. The California Academy of Child and Adolescent Psychiatry. Thank you. Both in support.

Lawrence Gaydon, with the California Dental Association, support.

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

Michaela Spencer, on behalf of the California Society of Pathologists in support.

Cheryl Marcell, California Society of Addiction Medicine in support.

Okay, are there those in opposition to 408 in the room? Please come forward. All right, you can both come forward and I'm going to need one of you to take a seat and you can come back up later if we need be. Thank you. Sorry. All right.

All right. He's going to need to sit in that seat, so you're going to have to sit down, ma'am, and give him that chair. Great. Okay. All right. When you're ready, sir, you can start and then we'll give her a chance to get organized with her pictures and things so she can. Go right ahead.

Good morning, chair and committee. My name is Marcus Friedman, Administrative Director for the Consumer Protection Policy Center at the University of San Diego School of Law. CPPC is a nonpartisan nonprofit academic and advocacy center at USD School of Law. We've examined and critiqued California's regulatory agencies for over 40 years.

The Medical Board of California is a government enforcement agency. Last year's audit revealed serious enforcement issues when it comes to investigations, disciplinary orders, and funding for the program. There are systemic problems with the timeline and cost of enforcement actions that need to be addressed by this Legislature to protect patients.

Instead, the board focuses on this treatment program for doctors. The board's previous treatment program had failed five audits with primary concerns on oversight and funding before it was unanimously terminated by the board. Today, the board faces staffing and budgetary concerns without the added responsibility of this program.

The board claims it has learned from its past failures but it is in no position to take on this responsibility at the expense of patient harm. The board hopes at best to treat between 0.1 and 0.2% of the licensing population. At the same time, there are many court-approved treatment centers throughout California for doctors to voluntarily enroll.

CPPC also raises antitrust concerns as the current structure of the program leaves the board vulnerable to antitrust challenges. However, CPPC has proposed an alternate solution that would help shield the decisions made for the rehabilitating physicians from antitrust arguments, specifically, a reformed complaint process that leaves the decision out of the board's purview. A board-supervised treatment program is unnecessary and the board should focus on existing systemic failures instead. We ask for your no vote at this time.

All right, thank you very much. Ma'am, you have two minutes, okay?

You want to go?

No, no. It's you. It's you, but you only have two minutes, so I'll let you know when you're at the end of that, okay?

I've done this before.

All right, good. Then you're all set to go. When you're ready.

Can you hold that up for me? I'm getting there. I'm getting there.

You're doing great.

I need my glasses. Oops. Oh, crap. Really? Tina Minasian. I'm a survivor of a doctor who battled an addiction to alcohol. I was a victim in 2002 of the California Medical Board's Diversion Program that allowed doctors with drug and alcohol addiction to keep using and hiding it from their patients. The author is saying that with this new legislation, they have a guardrail so the harms of the past doesn't happen again, but the uniform standards approved by the Legislator a decade ago already addresses this.

These standards require board oversight of the doctor, of the doctors in the program, and consequences for failure, and every other healthcare board must follow. These standards are set in place to protect people like me, but this bill eliminates them.

My doctor had a well-documented history of alcohol abuse, yet I was never informed, there was no warning, no disclosure, no transparency, and I paid the price with excruciating surgery complications and permanent harm. I didn't know the doctor I chose was secretly enrolled in the program meant to help impaired physicians, but it was a system designed to protect him, not me.

AB 408 would protect doctors from informing their patients of their participation in the new diversion program, even if they relapsed, like my doctor repeatedly did. Your paramount priority should be patient protection. If it was your mother, father, brother, sister, daughter, son, or grandchild, would you allow them to be operated on by a doctor with a drug or alcohol problem?

Thank you, ma'am. Do you want to give us a final thought? Wrap up?

Yes. Patients could live with this program if the uniform standards applied, but they don't. If you pass AB 408 and any patient is hurt or killed by a doctor in your new diversion program, their blood is in your hands.

So I urge you to vote no on AB 408.

Okay--

Thank you very much for your testimony. Appreciate it. Okay. All right, so is there anyone else in the room in opposition to AB 408? If so, please come forward to the mic now. Seeing no one, we're going to come back to the dais.

I'm going to, again, comment on this one first and then open it up to my colleagues. I think folks know, or hopefully they figured out by now, that Assembly Member Berman and I try really hard to work together because the Business and Professions component, which is in both his committee and this one, are tough.

They're tough areas in which to legislate and we have to do a lot of bills, sunset review bills, cleanups to sunset review bills, and a lot of scope discussions, and so 99.9% of the time we agree, and where we don't agree, we try to give each other a lot of grace and room. This is the first time since we have both been in these positions that we do not agree on a bill, and I want to continue to give him all the grace in the world, which is why you, colleagues, received a none reco and not some other recommendation from me. I want you all to vote your conscience.

I know you all have individual relationships as well and work hard on this board and have lots of varying degrees of information and experience in these areas yourselves, but I need to state right away that this was presented to me a year ago by the medical community when we were doing a sunset cleanup bill last year for the Medical Board and I did not support it then and so we didn't see it because we took it out of the bill.

I was the author of that bill, but we switch back and forth, and so the Assembly sometimes starts and sometimes the Senate starts. And in this instance, I struggle with this bill for really three, potentially four reasons.

First of all, it is an in lieu program, meaning--and it says in Section 2344 sub a--in lieu of disciplinary action, you may be referred to this, which would be different if you were coming in voluntarily and saying, I have an issue before you've gotten into any kind of problem, but this is in lieu, so that means you could already be seeking, seeing, facing discipline of some kind, and in lieu, you could do this. Now, it is not unprecedented for us in California to have diversion-type programs. In fact, they are quite frequent.

However, this is not a true diversion program because a diversion program as set up in law generally has some some form of consequence that is stayed pending successful completion of a diversion program. This bill does not do that. It does not require successful completion of the program.

It uses the term 'may,' so you may move forward with something else, the board may have another consequence, they also may not. It doesn't say 'shall,' so it doesn't force some triggering incident. For example, if you committed petty theft in the State of California, it was the first time you ever did so, you'd be eligible for diversion.

However, you would have to plead guilty to that petty theft and then when you finish the diversion program, the crime is wiped off of your record and it's all over with, but if you fail the diversion program, it automatically triggers the conviction and whatever the stayed consequences were.

This doesn't do that because of the 'may' component. The law--the bill also refers to the participants as voluntary throughout, which means that you could have been facing discipline, and then in lieu of that discipline, you take this on but you're still deemed voluntarily participating in that program, which I think is a bit troubling given the notion that it would be in lieu of discipline.

And then just last, there isn't a duration or window, meaning you could be a repeat person in this program. It's not like once every five years or so long as you're not practicing or something like that. There's no start and finish timeline that gives us a reasonable assurance that the Medical Board would then take action on somebody's license. So these are my concerns.

I have shared them with Mr. Berman, but if we were to make all these changes, which he notes that we, we did not offer amends--that's true--because if we made all these amends, we'd be back to pretty much what current law is. So instead, I, we made the deal that he would come and make his case to this group and you, we can all vote on it and democracy prevails and then it will move forward.

It is--if it moves forward out of this committee, it goes to Judiciary, where many of the issues that you discussed came up. I didn't discuss the Judiciary concerns today because this isn't Judiciary. I am on Judiciary as well as several other members on this board, and I would discuss that at that point, but from a Business Profession standpoint, from the licensure component, from the oversight component, from the Medical Board, these are my concerns today.

I may have some additional or varying ones from a Judiciary standpoint, but this is why I will not be supporting the bill today, but again, leave it open to my colleagues to vote their conscience and to work with the author in whatever ways they would like if the bill moves forward.

Madam Chair, if I may?

Yes, you may. Of course.

Thank you so much. I appreciate you sharing those concerns with me and the specifics of those concerns around 7:00 p.m. last night. I have not had time, obviously, in between then and now to address the specifics of the concerns that you raised. I do just want to note the hypothetical that you mentioned about somebody being found guilty of some misconduct and then being diverted to a program. That's not what this bill does.

This bill says that before there's any investigation, before there's any guilt found on behalf of the medical practitioner, they have the opportunity to go into this type of a program. So that's very different.

That was my point is that it's very different.

Okay, perfect. So, sorry--I just wanted to make that point.

Okay, just one last point on that. It's true that I did lay these out for you last night pretty late after we talked for quite a while, but we've been in discussions over this bill for a few weeks so I told you I had concerns about the bill, and last year, I took this component out of our sunset review because I had concerns.

I'm not sure if you knew that. That is fair that you may not have, but our staff certainly did on both sides, so--but it is, it is a fair criticism. I tried very hard to remain open to how to move forward.

That is my exact point, though, that this is in lieu. In your, in the bill, the language reads, 'in lieu of disciplinary action, a referral may occur.' That's true. That's very different is my point, is that in other components of the law, you--there's actually a trigger if you're going to do something in lieu of a disciplinary action, and in this one, there, there is not. Okay. Other comments? Dr. Weber Pierson, then Smallwood-Cuevas, then Menjivar.

Thank you. Thank you, chair. I want to thank the author for bringing this forward. I want to thank all of those who come to speak in support or against this particular bill.

So in conversations and, you know, just with me reading the bill and the analysis, I think it's confusing for some people because it talks about this being voluntary and occurring prior to patient harm, and yet there's those words like in lieu of discipline, right, and so I was wondering if you could potentially elaborate on that.