Assembly Standing Committee on Health

Good afternoon, and welcome to the Assembly Health Committee's hearing on Tuesday, April 7. Before we we begin, I want to make sure everyone understands our committee procedures to ensure we maintain order and run a fair and efficient hearing with the goal of hearing as much from the public within the limits of our time. We seek to protect the rights of all who participate in the legislative process so that we can have effective deliberation on the critical issues facing California.

Rules of conduct by members of the public include no engaging in conduct that disrupts, disturbs, or otherwise impedes the orderly conduct of this hearing, engaging in personal attacks of members of this committee, authors, staff, or other witnesses, talking or loud noises from the audience. Please be aware that violations of these rules may subject you to removal or other enforcement processes.

If you are providing witness testimony at this hearing, all witnesses will be testifying in person. Main support and opposition will be allowed two main witnesses for a maximum of two minutes each. As a reminder, primary witnesses and support must be those accompanying the author or who otherwise have registered a support position with the committee. And the primary witness in opposition must have their opposition registered with the committee per the instructions on our website.

All other support and opposition can be stated at the standing mic when called upon to simply state your name, affiliation, and position.

All testimony comments are limited to the bill at hand. I would like to note the committee will be hearing two separate bills regarding AI and health care, AB1979 by Bonta and AB2575 by Ortega. We will hear these two bills back to back to accommodate a witness for their testimony and for a film crew to be able to set up with minimal distraction.

As special orders of business, today's hearing will begin with a special order of business to allow members of the committee to consider and for members of the public to express their opinions about AB2651. We realize that many people have traveled to Sacramento to voice their opinions and we want to hear from you.

But unfortunately, our time to hear this matter is not unlimited. We will dispense with the special order at shortly after 02:00 as the committee has 21 other bills to hear on other on the regular agenda. For housekeeping, I would like to note that speaker has appointed assembly member Rogers to be a substitute for assembly member Celeste Rodriguez for today's hearing. On consent, the following bills have been proposed for consent for today's hearing. Any member of the committee may remove a bill from the consent agenda.

The consent items include item number three, AB1773 by Rubio with a motion of do pass to appropriations. Item number four, AB1956 by Valencia with a motion of do pass to appropriations. Item number six, AB1985 by Berman with a motion of do pass as amended to higher education. Item number eight, AB2093, Bauer Kehlen with a motion of do pass to communications and conveyance.

Item number 10, AB2160, Celestia Rodriguez with a motion of do pass as amended to appropriations.

And item number 14 AB2391 by Arons with a motion of do pass as amended to higher education. With that, we will start as a subcommittee until we have quorum. And we will now begin with our special order item, AB2651 by Bonta. And our majority leader, Sisay Argeer Kuri, will, convene.

Good afternoon, everyone. Glad to see everyone here. Our first bill will be, AB2651 Bonta, inform parents healthy schools act. If the witnesses for, Miss Bonta are here. Assemblymember Bonta, whenever you're ready, please begin.

Thank you. Good afternoon, chair and members. AB2651 notifies parents when their child's school vaccination rate falls below the level required to achieve herd immunity. The herd immunity rate is the percentage of the population that must be immunized to prevent disease transmission and thus provide some protection even for those who lack immunity. This bill ensures that parents have the information they need to keep their children safe from preventable, communicable diseases.

AB2024 says in 2024, a study published in The Lancet estimated that vaccines have saved a hundred and fifty four million lives globally since 1974, comparable to a rate of six lives every minute. Of those saved lives, ninety five percent were children younger than five years old. Alarmingly, outbreaks are increasing. While measles was once eradicated in The United States, this year, 10 counties in California alone have reported a total of thirty four measles cases.

For 2024, 2025, twelve of the state's 58 counties, that's twenty one percent, reported that the percent of kindergarteners with all required immunizations was below ninety percent.

In addition to the dire health outcomes, preventing the spread of diseases is also costly. For instance, LA County approximates that its first three measles cases of 2026 cost $231,000. To ensure herd immunity, parents need school level vaccination rates. However, currently, to find this data, parents would need to be aware of the concept of herd immunity, make the time to find the reports themselves, then have the knowledge to interpret those reports.

Parents would also need to be do their own additional research across multiple sources to find recommended herd immunity thresholds.

These burdens constrain parents' ability to make informed decisions about school or childcare settings, particularly for families with young children or medically vulnerable individuals who rely on high vaccination coverage to reduce exposure risk. AB 2060, 2651 removes these burdens from parents who rightfully want to be able to make informed decisions. This bill requires schools to notify parents when their child's school vaccination rate falls below the herd immunity threshold established by the California Department of Public Health.

The notification uses data that is already collected and already public, so the bill does not publish any new type of information. In addition, by calculating rates for a school, no individual student can be identified.

CDPH also takes precautions for student de identification in smaller schools. Here to testify and support are two experts on the importance of children's health. Ian Kim, who is a family physician at Davis Community Clinic, an assistant clinical professor at UC Davis School of Medicine, and the vice president of the Sacramento Valley Academy Of Family Physicians, and Shireen Walker, who is a former president of current health advocates and current health advocate for the California Parent Teachers Association.

Welcome.

Thank you. Good afternoon, Chair and Members. As noted, my name is Doctor Ian Kim. I'm a family physician. I care for children and families here in the Sacramento region.

I'm also an educator at the UC Davis School of Medicine, and I'm a parent, here in Sacramento. On behalf of the California Academy of Family Physicians, we are a proud cosponsor of AB2651. We represent 11,000 family physicians as well as residents and medical students across the state. As a family physician, I care for patients across the lifespan from birth until patients take their last breath, and we receive specialized training in pediatrics in particular.

We provide comprehensive pediatric services such as well child visits and immunizations.

I have conversations every day in clinic with parents about vaccinating their children. Vaccine effectiveness depends on maintaining high vaccination rates. When vaccine rates drop even a little, diseases can quickly spread, putting children and entire communities at risk. We are seeing the consequences now as Assemblymember Bonta has noted. Just today, two new measles cases you may have heard have been announced in Sacramento County.

AB 2651 is a simple practical solution to ensure parents are notified when their child's school falls below critical herd immunity levels. Parents deserve to have clear timely information to make informed decisions about their child's health and safety. There's a saying that, you shouldn't have to touch fire to know that it's hot.

And I think that there are very good reasons for people to have skepticism or confusion about the importance and the safety of vaccines, and I hope that this bill and I expect this bill will contribute to more safety for the community. As a family physician and a parent, I'm dedicated to preventing illness.

I respectfully ask for your aye vote. Thank you.

Thank you very much. Our next witness, please. Remind everyone, you get two minutes.

Good afternoon. My name is Shereen Walter, past president and current health advocate from the California State PTA. And I'm here today on behalf of families and parents across California and also a proud cosponsor of AB2651. Parents wanna keep their children safe at school, but they can only make informed decisions when they have accurate, timely information.

Right now, families must search for school level vaccination data in complex California Department of Public Health reports or learn about issues indirectly, like the local news revealing that a school is being audited for low vaccination rates.

This bill offers a simple solution. It ensures that when vaccination rates at a school fall below the level needed to prevent the spread of diseases, parents are notified. That's it. It doesn't change existing vaccine requirements. It doesn't take away choice.

It simply provides transparency and gives families the information they need. We know that schools are places where illness can spread quickly, and high vaccination rates are critical to protecting not just individual children, but entire communities. Maintaining herd immunity is especially important for medically vulnerable children and those who cannot be vaccinated. Vaccines have saved millions of lives and remain one of the most effective tools we have to prevent serious disease and protect public health. When vaccination rates drop, the risk to our children increases.

Parents deserve to know when the risk changes in their child's school. This bill respects parents by keeping them informed and supports healthier, safer school communities. It's about transparency, safety, and informed decision making. On behalf of California State PTA and the families we represent, I respectfully ask for your aye vote.

Thank you very much. Others in support, if you would like to come to the microphone and we're gonna keep it nice and easy, You say your name and your organization.

Thank you very much. Vanessa Cajina on behalf of the California Academy of Family Physicians, proud co-sponsors here in support.

Angela Hill with the California Medical Association in strong support.

McClain Rozanski with the Alameda County Office of Education in support.

Farrah McDating on behalf of the County Health Executives Association of California in support.

Hi. Kelly McMillan, on behalf of the American Academy of Pediatrics, California, in support.

Thank you. Is there any others who would like to speak in support? Thank you. Prabhud Sidhu with the CSA, California Society of Anesthesiologists. Thanks.

Great. Thank you very much. Okay. We'll move on to witnesses in opposition. Again, we're allowing two witnesses at two minutes a piece.

And if you'd like to come up to the table.

We were told we could have our technical witness sit with them for answers. He's the only one capable of answering.

We have the two witnesses on that are here right now. Thank you.

And can we have our technical witness available?

Please begin.

Good morning, Chair and Members. My name is Karen Amagon. On behalf of Voice for Choice Advocacy, we are opposed to AB2651 unless it is amended. We support transparency in protecting vulnerable populations. However, after conversations with the author's office and committee staff, we remain concerned that this bill will create unintended harm without delivering meaningful public health benefit.

The CDPH school vaccine compliance data does not reflect what this bill suggests. It is a limited point in time snapshot based only on kindergarten and seventh grade collected at the beginning of the school year with no follow-up or updated data. Yet, it will be sent out to all parents as if it represents the entire school over time. A significant portion of students counted as not up to date are conditional entrants.

These include students completing vaccine schedules or waiting require required intervals as well as those facing barriers, such as homelessness, foster placement, military transitions, undocumented status, or limited access to timely care.

These students are compliant with the law, yet are counted in a way that suggests risk. In many cases, a school may be flagged based on just a few students who are often identifiable due to medical conditions, disabilities, or life circumstances, increasing the likelihood of bullying and discrimination. Transparency requires context. Percentages alone are not enough.

We respectfully ask that this bill be amended to exclude exempt and conditional students, use end of your data, clearly label grade level data, and target notifications only to those requiring their next dose.

Alternatively, consider an advisory approach directing parents to existing data with appropriate context or focus outreach on families who are truly behind. Without these changes, we believe AB2651 creates more harm than benefit. Thank you for your time and consideration.

Thank you very much. Next witness, please.

Good morning, Chair and Members. My name is Joshua Coleman, co-founder of V is for Vaccine, a public demonstration group focused on informed consent and medical choice. I'm here to address a serious concern with this bill. The requirement to notify parents when a school's vaccination rate falls below a state defined threshold signaling an increased risk of disease transmission. Now here's the concern.

In California, there is no philosophical exemption from vaccines. There is no religious religious exemption. The only option left is a narrowly granted medical exemption. Meaning, the only kids that can be permanently in school without all mandated and required vaccines are kids who have an IEP and kids who have a medical exemption. When the group is this small, anonymity doesn't really exist.

So when a school sends a notice home saying vaccination levels are below safe thresholds because of existing California law, it becomes obvious who is being referenced. There now is a very real risk to those medically vulnerable children, the very children these laws are claiming to protect to become the target of fear and anger or outright discrimination from other parents and even students. It doesn't take much for a child to be identified, singled out, or blamed.

This is not a question of if it will happen, but how often and how severely. Publicly signaling that a school is unsafe because of its IEP and medically exempt students risks stigmatizing disabled children and turning them into scapegoats.

Even without intent, this kind of public signaling can function like a modern day Scarlet Letter, where a small group of children becomes implicitly marked as the source of risk. This is not a position any child should be put in. Transparency is important, but it must never come at the expense of protecting students from discrimination and harm. Please protect our disabled and vulnerable children and vote no on this bill. Thank you.

Thank you very much. We'll move on to witnesses. The additional people that oppose that to testify, name, organization, position, please come to the microphone. Name, organization.

Brian Hooker, Children's Health Defense, chief scientific officer. I stand in opposition.

Thank you.

And Brian is available for questions. Tara Thornton, co-founder of Freedom Angels, also in strong opposition.

Thank you. Denise Aguilar, co-Co-

Sofia Carstens, Decentralized America, strong opposition.

Good afternoon, Members. Kasia Williams, California parent, affiliate with A Voice for Choice Advocacy asking for your no vote.

Thank you. Thank you.

Good morning. April Robinson with A Voice for Choice Advocacy and a mother of a special needs vaccine injured child in strong opposition unless amended. Thank you.

Thank you.

Good morning. Mikaela Swaney. I am with, Catalyst Legacy, and I'm the legislative analyst for CFRW, and I am in very strong opposition. Thank you. Thank you.

Julie Threed here from Butte County to advocate for the vaccine injured, me being one of them. Seven grandmother of seven. Florida doesn't do this. We don't need this. I strongly oppose.

Thank you.

Thank you.

Good afternoon. Vonnaletha Owens junior, retired state worker, former information officers too. California Department of Public Health, strongly opposed. Thank you.

Thank you.

Sorry. Kelly McMillan. I'm in support. I forgot a client. Children's Specialty Care Coalition in support.

Great. Thank you very much. Alright. Seeing no other opposition, I'd like to see if there's any questions from the members. Assemblymember Arons.

Thank you, Madam Chair. I wanna thank Chair Bonta for your leadership in authoring this really critical public health legislation, AB2651 to protect our California kids. In San Jose, where I represent, there are nine elementary schools who have reported an MMR rate of less than ninety five percent for their kindergarten students in the year 2025. That's a total of 460 students who attend these schools.

These families and these kids, and all of our kids in California students deserve to know if their kids might be at risk.

The rate of community immunity against measles is ninety five percent. In other words, if ninety five percent of people who are vaccinated against measles, even if the occasional cases spring up, we won't have an outbreak, and we're able to protect these kids. However, if we fall below ninety five percent, we know that measles moves very quickly. For example, there is an ongoing outbreak in South Carolina right now where kindergarten MMR coverage is about ninety two percent.

Now that seems like a high number, but it is below the threshold for community immunity.

And as a result, there are nine hundred and ninety seven confirmed cases of measles in South Carolina. The point of this bill is not to shame anyone. It is to make sure that parents know what the risk level is. As mentioned, this data is already publicly available, but it is difficult to find. We owe it to parents and more importantly, their children to make sure that they're that they get the information that they need.

So again, I wanna thank chair Bonta for authoring this bill and to keep fighting to help California parents be informed. As a former homeless student, as a former foster youth student, as someone who grew up with an IEP, I personally wanna thank the author for ensuring transparency in our public health decisions for our students. I'd love to be considered as a co author. Thank you.

Thank you. Are there any other questions? Okay. Seeing none. Assemblymember Bonta, would you like to close?

Thank you. I I spent six hours yesterday in the budget sub hearing on health where we are gonna make some very critical decisions about the future of our healthcare and the ability to be able to control some public health issues that we know will happen when people don't have care. And one of those concerns is that we will no longer have the resources that we need to ensure, particularly for people who are indigent, that they have the ability to get primary care, preventative care, including vaccinations.

We already have outbreaks here in the state of California. As Assemblymember Ahrens noted, it is of deep concern.

This bill is very simple. It seeks to be able to provide transparency to parents so that they can make informed decisions. And it also I just wanna reiterate, does not provide any additional information that isn't already available. It uses what CDPH already has available to be able to provide the noticing that we are requiring of of schools to be able to do. And and certainly doesn't provide any de identified it only provides de identified data.

No personal data or information about any individual child. With that, it is an important time for us to be able to step up in California to may be able to ensure we have the best public health that we can provide to our children in our schools. Our children come into our schools. They leave. They go home to their siblings who are newborns.

They go home to their elders who are immunocompromised. They go home to their family and friends who may not have been able to be vaccinated. We wanna make sure that our parents have that information so that they can make healthy decisions for their children. With that, I respectfully request your right will.

Thank you very much. Do you accept the amendments?

I do. Thank you.

Great. Thank you very much. I wanna thank you for raising this important issue. AB2651 strengthens transparency and communication between schools and families. By giving families accurate data, this bill empowers parents to make informed decisions.

It also protects medically vulnerable children and reduces misinformation. By providing parents with the vaccination thresholds, this bill strengthens herd immunity to protect our communities. In doing so, AB2651 improves health outcomes and reduces disparities and disease risk throughout our state. I recommend an aye vote. We do not have a quorum currently, and we'll take up the bill at that point. Thank you.

Thank you.

We are going to move on to A B item number 9, AB 2123 by Aiger Curry, Medical Debt Relief Act of 2026.

Chair Bonta, I appreciate us being able to be moved up in the file today. I'm blessed with having Fiona Ma here with me today. My buddy from years ago from another mother. Thank you, madam chair and members. I will be accepting the committee amendments today, which broaden eligible debt and strengthen oversight of the program.

Medical debt is a widespread issue in California affecting nearly 40% of our constituents. Even people with insurance struggle to pay off their health care bills. High deductibles, cost sharing, and claim denials can leave patients with thousands of dollars in unexpected charges. When this debt goes to collections, it can damage credit for years, making it harder to secure housing, employment, and loans. As a result, many Californians go without necessary care and struggle to afford basic resources.

Some local governments have stepped in to address this crisis. In 2024, Los Angeles County launched a pilot program that erased 36 363,000,000 in medical debt with just a $5,000,000 investment. They did this by purchasing medical debt on the secondary market for pennies on the dollar, making the program highly cost effective. For every dollar spent in LA, it was able to eliminate up to a $100 in medical debt for patients. AB 2123 builds on this proven model by creating a statewide medical debt relief fund.

This program will purchase and cancel qualifying medical debt for low and middle income Californians. It will prioritize those earning up to 400% of the federal poverty level or those with high debt burdens relative to their income. When debt relief recipients talk about this program, they don't just talk about dollars. They talk about finally being able to breathe again. That's the impact of AB 2123 can have for millions across California.

I wanna thank you. I respectfully ask your aye vote. And with me today is California straight state treasurer, Fiona Ma.

Thank you. Thank you, madam chair and members. I am the chair of the California Hospital Finance, Facilities Authority. And, a couple years ago, we issued 17 distressed hospital loans, to some of the hospitals, community hospitals, and rural hospitals who are either on the verge of bankruptcy or with just a couple of months of working capital left. And all of these hospitals are still facing financial strain.

And so this bill would not only help hospitals recover some of the the debt, but as the assemblywoman said, it would also bring peace of mind, help people's credit rating, and also allow them to move on with their lives. Many other states have are have either done this or in the process of doing it, including Rhode Island, Vermont, Connecticut, New Jersey, Illinois, and North Carolina. And we have a couple of excerpts.

Tanya, a single mother of three young children in North Carolina, was able to have her medical debt erased after surviving cancer, allowing her to focus on raising her kids instead of overwhelming bills. And then Alvin, who survived hurricane Katrina, carried medical debt for years tied to that hardship.

Through a debt relief program, that burden was finally lifted, giving him long time long overdue financial, relief. Right now, currently in California, there are 1,450 licensed debt collectors who are currently out there collecting the debt on, Californian. So this is not a new concept, but we are modeling this bill after a successful LA County pilot program that that had two tranches of of money that successfully relieved so many Californians debts.

So, you know, respectfully ask for your aye vote to help our fellow Californians who are still struggling, especially in the highest burdens affecting medical debt are ages 50 to 64 years old, and that is similar here in California.

Good afternoon, committee. My name is Patrick Henning. I'm the chief deputy treasurer for the state of California. I just wanted to highlight a couple of things. The National Library of Medicine that did a study recently, and they found about twenty six percent of households in The United States are experiencing medical debt.

And that was just a couple years ago. Those numbers only get higher. And I'd just like to say this, medical debt is not something that accumulates by choice. Nobody chooses to get sick, but yet are straddled with these high and expensive medical bills. For those and all the reasons you heard today, we respectfully ask for your arrival.

Thank you. Now we will move on to any witnesses in support to offer ME two. Please come forward stating your name, organization, and position only. Seeing none, we will move to any primary witnesses in opposition. Seeing none, any who would like to offer a Mitu in the hearing room?

In opposition, seeing none, we will bring it back to the committee for any questions or comments. Assembly member Caloza.

Thank you, Chair Bonta. I just wanted to, commend, our author, our majority leader for this bill, and our treasurer. Aye, previously got sick when I was in college and had it not been for the Affordable Care Act and having been covered under the ACA to stay on my insurance plan until after I graduated, I would be in hundreds of thousands of dollars of medical debt. And so it is completely an affordability issue for the millions of Californians right now who may be under crushing medical debt.

So would love to be considered added as a coauthor, and happy to move the bill when appropriate. But thank you for bringing this forward.

Thank you.

Seeing no other comments or questions from the committee, I wanna thank the majority leader for bringing this forward and treasurer Maff for being here. And the treasurer's office is always want to make sure that we have the best possible opportunity for Californians to not only just survive but thrive and really appreciate you bringing this forward. And majority leader for your leadership always. With that, would you like to close?

I would. First of all, I'd like to thank the treasurer for being here. Always appreciate her support and that her bringing some really good ideas and try to make things affordable for our communities and our constituents as well as transparent. The bill, uses a proven model to address a problem affecting millions for of Californians today. Many people have no real ability to repay these debts, which will continue to harm patients if we do nothing.

The Medical Debt Relief Act provides a path forward, giving families a real chance to recover. Thank you, and I respectfully ask for your eye vote when the time is appropriate.

Thank you so much. And I'm sure it will be given when it comes. With that, we will move on to item number two, AB 1570 by Wilson. Whenever you're ready, member.

Thank you, madam chair. Good afternoon, members. I'm proud to present or introduce AB 1570, a women's caucus priority bill. This measure is aimed to eliminate out of pocket costs from medically necessary diagnostic and supplemental breast imaging, such as breast MRI MRIs and ultrasounds, ensuring access to the full continuum of breast cancer screening and diagnosis without financial barriers.

What we say regularly, we know to be true, is that early detection saves lives, but only if patients can afford the follow-up care that comes after initial an initial screening.

In 2023, I was diagnosed with breast cancer. I found it through a regular mammogram screening, And then I was called back and had to receive a physical examination as well as additional mammogram that looked at in a three d way, including a ultrasound and then a biopsy. Thankfully, through the coverage I had, I had no Adacop's expenses, so I had no thought to wait until I got paid again, or was I gonna choose between, feeding my family or getting medical care.

And many patients like myself, a mammogram is only just the first step. Additional imaging is often medically necessary to officially confirm or rule out cancer.

While screening mammograms are covered at no cost, follow-up diagnostic and supplemental imaging often come with significant out of pocket costs rising up to the hundreds and thousands. I have a friend right now who has not did her secondary, testing because the cost is $900 and she's waiting. And, of course, her friends wouldn't allow that, so she won't have to wait longer. But health care access looks different for different communities, impacting communities of color and lower socioeconomic communities differently than their white and wealthier counterparts.

Patients needing access to care may need to choose between paying rent for the month and taking care of groceries for the week versus timely supplemental care, forcing patients to delay or forego critical life saving care, which leads to a dangerous gap in the screening process.

No patient should have to choose between financial stability and life saving care. AB 1570 is a vital cost effective policy that improves outcomes and reduces long term health care costs. With me today is doctor Anne Darrow, assistant professor of clinical medicine, breast radiologist at UC Davis department of radiology, and Leslie Bradshaw, a volunteer advocate with Susan G Komen.

Welcome. Please start.

Good afternoon, madam chair and committee members. Thank you for the opportunity to testify in support of a AB 1570, and thank you, Assemblymember Wilson, for championing this important bill. My name is Leslie Bradshaw. I have advocated for women's health and early breast cancer detection for fifteen years, and I'm here today because this issue is deeply personal. I am extremely high risk for breast cancer.

With an eighty percent lifetime risk due to dense breast tissue, a BRCA2 gene mutation, and a sister who was diagnosed at the age of 41. Because of this, I chose to undergo a double mastectomy. The alternative was a lifetime of frequent mammograms, MRIs, and ultrasounds, often every six to twelve months with significant out of pocket costs for necessary supplemental screening. My daughter, who's 18, is in the row behind me here today.

She has a fifty percent chance of carrying the BRCA mutation and has a family history of breast cancer on both sides, placing her at extremely high risk.

She will need early and ongoing screening, and she could she should not face financial barriers for this in order to keep her life. I had choices, and I recognize my privilege. But everyone deserves equal access to medically necessary imaging. We have told women for years, get your annual mammogram. It's free, and it will save your life.

But when they're met with bills of over $1,000 for follow-up diagnostics, they may feel punished for doing the right thing and less likely to return. Diagnostic and supplemental imaging are not optional. They are required to complete the screening process. We can't allow cost to stand between patients and potentially life saving care. Thank you for your time, and I respectfully ask you to support AB 1570.

Thank you. Welcome.

Hi. Thank you, madam chair and members of the committee for this opportunity to speak in support of AB 1570. My name is doctor Anne Darrow. I am a breast radiologist. In my daily work, I interpret breast imaging, and I deliver diagnosis of breast cancer.

I strive to catch the disease before it becomes a death sentence. I'm a person that is also much more than just my work. I'm also a person who raised my younger siblings after losing my stepmom to metastatic breast cancer. I watched her die from a disease that had it been caught earlier, she likely would have survived. That loss shaped who I became, who I am today, and it is why I am here before you today.

I am asking you to support AB 1570. Here are the facts. One in eight women will be diagnosed with breast cancer in her lifetime. When caught early, survival is around ninety five percent. But late stage breast cancer that is diagnosed when it's already metastatic carries a five year survival rate of about thirty three percent or one in three.

My stepmom was in that group of people who die before surviving for more than five years with their family. This is the outcome, again, for about two of every three women who are diagnosed with metastatic breast cancer. The difference between those two outcomes, life and death, is often simply when we find the disease. Standard mammogram is a good tool, but it has limitations. And one of the main documented limitations is in detection of cancer in patients with dense breast tissue.

Forty three percent of women over the age of 40 have dense breast tissue. And in these women, a standard mammogram can miss cancer fifty percent of the time. It's like looking for a snowball in a snowstorm. Seventy one percent of breast cancers occur in women with dense breasts. So we already tell women when they have dense breast tissue, it's federal law, but we're not following up by covering the recommended next steps.

I urge you to support this bill. Thank you.

Thank you very much for your testimony. Very meaningful. Are there others in support that would like to come to the microphone and its name, organization, and position only? These are support.

Madam chair and members, Tim Madden representing the California Society of Plastic Surgeons in support.

Thank you, madam chair. Angela Pontes on behalf of Planned Parenthood Affiliates of California in support.

Kenneth Wilkerson on behalf of American Cancer Society Cancer Action Network in support.

Miss Snyder with CFT, a union of educators and classified professionals also in support.

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

Chair and committee members, Gilbert here with BioCom. Thanks.

Christine Smith, Health Access California in support.

Kevin Guzman with the California Medical Association in support.

Conor Sweeney with Susan G Komen. We're a proud sponsor of this bill, and we respectfully ask for your support. Thank you.

I'm Sweta Ganesan, a student doctor at UC Davis School of Medicine in support. Thank you.

Julia Bradshaw, a student at CK McClatchy High School, in support.

Crystal Quinns, on behalf of the California Commission on Status of Women and Girls, who we support.

Whitney Francis with the Western Center on Law and Poverty in support.

Carrie Sanders with the California Panethnic Health Network also in support.

Are there any others in support? Seeing none, I will move to witnesses in opposition.

Chair members, Olga Shiloh.

Would you like to sit here?

I'll just make brief comments here. Olga Shiloh, on behalf of the California Association of Health Plans, we share the author's commitment to early detection and timely follow-up care, and we recognize the and uncertainty that can come with abnormal screening result, and that is real. And importantly, as the author mentioned, preventative screening mammographs already covered without cost sharing, ensuring access to early detection.

Where we struggle with AB 1570 is not the goal, but the elimination of cost sharing for a broad range of supplemental and diagnostic imaging. Chaburb estimates that this, would increase premiums by nearly 94,000,000, annually at a time when health care affordability is already one of the biggest pressures Californians face.

We're also concerned about the precedent eliminating cost sharing for one category of diagnostic services while maintaining it for other raises questions of consistency and equity across the healthcare system, and invites more mandates that collectively compound to premium growth. We want to work with the author and the committee on solutions that help patients most, and thank you for your consideration.

Good afternoon, chair members. Matt Aiken on behalf of the Association of California Life and Health Insurance Companies. Respectfully also in opposition, we'd just like to align our comments with our colleague at Kat. Thank you.

Thank you. Are there any others in opposition? Alright. Seeing none, we'll move on to questions from the members. Any members have questions or comments?

I see none. Would you like to close?

Thank you. And I appreciate all those that came up and and and showed their support as well as those that have testified who have real life experience in their family and in their own help with this and a doctor who, you know, basically saves lives through diagnosis. And even opposition, and I understand their concerns, and I think the analysis prepared by the Health Committee, is is very thorough and and and not addressing those, but in bringing those to light.

And, of course, as a legislator, I'm always open to consideration any adjustments that need to be made to make this workable and get this across the finish line. As as, one of my witnesses noted, you know, it's personal.

For me, having gone through this and and recognizing the barriers that can be for so many women, I had a successful outcome. But there are people who were diagnosed at the same time as me who did not have as as successful as an outcome, And that's very real. And that's what so many women and including men face, because this is not just a a female disease. Any any being with breast, which is all human beings, are are faced could could be faced with cancer.

And like I said, I have someone real time who, just finding out has waited nine months to get the secondary supplemental screening to determine whether they have what the issue they found in their first, first test, whether that was real or not, whether it's cancer or not.

And so nine months of agonizing waiting, nine months of of being silent in shame because they couldn't afford the test. And that shouldn't happen in California and definitely not in in in this, great country. And so with that, when it's the appropriate time, I respectfully ask for a nigh vote.

Did you accept the amendments?

I did. Absolutely. You know what? You're right. I I thank the committee, but I forgot to thank committee for the amendments.

I just just have a quick comment. I wanna thank you for upcoming and bringing your daughter here today. The importance of education for our young ones and that it takes bravery to have these kind of difficult conversations as families. I've been there, done that. And so, thank you very much for coming and take I hope you got a picture when you're up at the microphone.

But thank you very much for testifying today, and doctor, thank you as well. Alright. We're gonna move to item 12, And that is. AB 2,201 Urner. Principal and remember whenever you're ready you can begin.

Bill's on call. And thank you very much for presenting. Thank you to your supporters here today. Alright. We're going to move on to item 16, AB2448.

Assembly member Berman, please join us.

Okay. That was okay.

I hope so too.

Well, this is a fishy one.

Oh.

Good afternoon, Assemblymember and witnesses. Please proceed when you're ready.

Thank you, Madam Majority leader and colleagues. I hope this bill has as much support as the last one. In the years since Roe was overturned, attacks on reproductive and gender affirming care have steadily intensified, threatening access to health care services for millions of Californians. As a result, it is critical that medical providers have access to technology that to protect sensitive medical information so that patients who have received reproductive and gender affirming care cannot be identified and targeted.

AB2448 would reinforce existing state law and require the implementation of this technology to protect the privacy and security of medical records.

All Californians deserve access to critical health care services without fear. I respectfully ask for an aye vote, and I'm joined today by Angela Pontes with Planned Parenthood Affiliates of California and Tiffany Brokaw with the attorney general's office.

Good afternoon.

Thank you, Sharon members. Angela Pontes on behalf of Planned Parenthood Affiliates of California. Representing the seven Planned Parenthood affiliates across the state. We are a proud cosponsor of this bill, and thank you to Assemblymember Berman and Bauer-Kahan for championing this policy. In 2023, following the Dobbs decision, California passed AB352 to strengthen privacy protections for sensitive health information, like abortion care.

By protecting sensitive medical records from being inappropriately shared outside of California without patient authorization, AB2448 follows up on this law by clarifying that electronic health records vendors must not only develop the technology, but also enable the technical capabilities needed for providers to protect their patients' data. Planned Parenthood health centers strongly believe that patients deserve access to health care without fear of legal or criminal consequences from data sharing.

And if an individual is uncertain about whether their medical information will be protected, they may hesitate to seek the care they need. AB2448 supports efforts currently underway by health technology companies and providers to better coordinate patient care and protect patient confidentiality at the same time. We ask for your aye vote.

Thank you. Good afternoon.

Good afternoon, Chair and Members. Tiffany Brokaw here on behalf of attorney general Rob Bonta who's proud to co-sponsor this bill. He thanks assembly member Berman and assembly member Bauer Kehane for carrying it. AB2448 would ensure that vendors of electronic health records are implementing operational safeguards, secure data so that health care providers have the technological capabilities to segregate and protect reproductive health health care information.

Across the country, increasing restrictions on reproductive health care have been accompanied by heightened concerns about the potential misuse of sensitive patient information.

While existing law requires certain entities to maintain policies and procedures to protect medical information, the next step is to ensure that these entities are implementing these protections. AB 2448 effectuates that next step, and it builds on California's commitment to advance and protect reproductive health care for those who seek and administer it. And for these reasons, we respectfully ask for an aye vote.

Thank you very much. We'll move on to other witnesses in support. Name, organization, position only. You can just come up to the microphone. Well, looks like oh, there's one.

That's right. Keshav Kumar with Lighthouse Public Affairs on behalf of Reproductive Freedom for All and our over 400,000 California members who could not be here in strong support and appreciation of the author.

Thank you very much. Alright. We'll move on to opposition. Is anyone in opposition? Seeing none.

Is there anyone here that would like to is there a tweener or anyone here? Seems like there's not. Alright. Would you like to close, mister oh, yeah. Is there any questions of the committee?

This is a quiet crowd today. Yeah. I got a lot of bills I know. Alright. Would you like to close, Assemblymember Berman?

I I appreciate the the brevity of my colleagues on the committee, and respectfully ask for I vote when the time comes.

The time is now.

Heck, yeah. Alright. It's You gotta perform faster than I did and be

It's been moved. I don't know. Would I get a second? Okay. We I will get a second.

Okay. Would you please please call for the role, please?

Item 16 AB2448. Motion is do passed privacy and consumer protection. [Roll call]

Bill's on call. Thank you very much for the presentation. We are looking for authors. And for those of you that are sitting in your office, if you could please make your way down here, we'd really appreciate it. Looks like I found somebody.

This is file number 7AB2034. Assemblymember, Addis, do you have your witnesses here yet? Okay. Good afternoon. Come join us at the table.

The table. Alright. Assemblymember, you can begin when you feel comfortable.

Thank you, Madam Chair and Members and staff, who has been sharing a lot of information with us and our advocates. Today, I'm here to present AB 2034, the Food Additive Safety and Transparency Act. This bill will strengthen California's ability to protect consumer health from harmful and dangerous food additives that make their way into our food or into our food supply.

This bill complements existing law to ensure greater transparency in the food industry by helping to identify hidden and potentially harmful chemicals entering our food supply. Before we dig in, we have heard concerns regarding implementation and feasibility, and I am committed to working with CDPH, with committee staff.

Both this committee and we're working with committee staff, should we get out of this committee. We're working with the ESTM Committee staff as well and stakeholders to refine the bill while maintaining the transparency and the focus on public health. So the problem is that consumers are exposed to dozens of chemicals through the food that we eat every day.

And at the federal level, the FDA is responsible for ensuring the safety of our food supply, including making sure that food additives, which are substances added to processed food that can be used to alter their sensory properties or increase their shelf life, are safe to consume. But food manufacturers can completely go around the FDA pre market review by self certifying that their additives are Generally Recognized as Safe, or GRAS.

And so there's a thousand GRAS substances that have entered the food supply, over a thousand, without FDA or public knowledge that are linked to really bad things, like heart and brain defects, infant leukemia, suppression of estrogen, and liver and kidney and intestinal toxicity.

So AB 2034 would address this basically by creating more transparency in labeling so that consumers understand what they're picking up off the shelf and by allowing some flexibility in terms of small businesses as well as businesses who use the voluntary process through the FDA to be able to certify their foods as being safe.

Joining me to testify in support is Thomas Galligan, principal scientist with the Center for Science in the Public Interest, and Nancy Buermeyer, the Director of Program and Policy for the Breast Cancer Prevention Partners.

Great. Thank you very much. You can proceed, either one of you.

Thank you. Good afternoon. I'm Thomas Galligan, principal scientist at the Center for Science in the Public Interest, or CSPI. I have a PhD in biomedical sciences with a focus on toxicology. CSPI is a national nonprofit that has been at the forefront of food safety nutrition and health for 55 years.

We accept no donations from government or industry. CSPI is proud to sponsor Assembly Bill 2034. As you just heard from Assembly Member Addis, this bill targets loopholes in federal laws that put Californians at risk from unsafe and poorly tested food chemicals.

I'd like to address some of the arguments that have been raised by the opposition. Importantly, AB 2034 does not duplicate AB 1264, which was passed last year. AB 1264 focused on ultra processed foods in schools. AB 1264 did not address the GRAS loophole or vague ingredient labeling.

This bill, AB 2034, does both of those things and does so for the entire food market, not just school foods. So simply put, AB 1264 will protect school children from harmful processed foods. AB 2034 will protect all Californians from unsafe chemicals.

Additionally, despite what the opposition has said, there should be little to no impact on food prices in for Californians. And that's because under federal law, food manufacturers have an ongoing obligation to ensure that their products are safe.

Even if companies choose to use GRAS ingredients without notifying the FDA, they are still required to prove those chemicals are safe using publicly available information. AB 2034 will require companies who skip the voluntary FDA process to share that information with the state instead.

The FDA process is entirely free. Chemicals that go through that voluntary process will be exempt from the state process. Finally, AB 2034 exempts small businesses. I therefore ask for your aye vote respectfully. Thank you.

Thank you very much. Next witness, please.

Good afternoon, Chair and Members. Thank you for the opportunity to testify, and thank you, Assembly Member Addis, for your leadership on AB 2034 to make our food safer. I'm here on behalf of Breast Cancer Prevention Partners, a science based organization working to prevent breast cancer by reducing exposure to harmful chemicals.

Nothing is more visceral to the public than the safety of the food we eat and especially what we feed our children. A February poll by the Pew Research Center found that nearly 80% of US adults are concerned about harmful chemicals in food and almost half are very concerned.

Americans depend on the FDA to safeguard our food supply. Unfortunately, it is failing us. Under the GRAS loophole, companies can add chemicals to food and food packaging without meaningful independent review or even telling the FDA.

Some examples include methyl and propylparaben, both hormone disruptors, and propylparaben has been shown to accelerate the growth of breast cancer cells. Flavor chemicals linked to cancer deemed GRAS by industry groups.

Partially hydrogenated oils or trans fats and butylated hydroxyanisole or BHA, a Prop 65 listed carcinogen. The FDA has removed the GRAS designation for some of these chemicals, but only after years of advocacy. And they should never have been allowed in the first place.

AB 2034 also brings much needed transparency to chemicals hidden under terms like natural flavors and spices. In 2020, this legislature passed SB 312, requiring disclosure of chemicals in fragrance and flavors and personal care products.

Today, Californians have more transparency about what's in their shampoo than what's in their food, even though many of the same chemicals are used in both. It's time to fix that inequity. In the face of federal inaction, California must once again lead to protect public health. I respectfully ask your aye vote.

Thank you very much. Are there other support witnesses here? And if you'd like to stand and give us your name, organization, position only.

Good afternoon. Lizzie Guansona here with the sponsor of the bill, CSPI. Also asked to share support for a number of organizations, including Rising Communities, FPEIS Foundation, Strategic Training Initiative for Prevention of Eating Disorders.

SF Bay Physicians for Social Responsibility, Clean Water Action, Bay Area Community Resources, CALPIRG, National Consumers League, and the United Parents and Students, as well as Dr. Girard from University of Michigan. Thank you.

Thank you.

Good afternoon, Chair and Members. Karen Amigon on behalf of Voice for Choice Advocacy, and we are in support of this bill. Thank you.

Thank you. Okay. Let's move on to opposition. Is there anyone opposing the bill? Please come on up to the table if you'd like. And you get two minutes a piece. Welcome.

Okay. Good afternoon, Chair Bonta and Members of the Committee. My name is Dr. James R. Coughlin. I'm a PhD trained at UC Davis toxicologist and an independent consultant with 47 years of experience in nutritional toxicology based in Orange County.

I work with food producers and manufacturers throughout California, the US, and globally on issues of ingredient safety and regulatory compliance. I have concerns that AB 2034 would duplicate rather than meaningful strengthen, meaningfully strengthen California's already robust food safety framework, raising three key issues.

First, while not perfect, the federal GRAS framework is currently under active review by the FDA. State action at this time risks creating duplication or potential conflict with forthcoming federal updates. Importantly, the scientific standard underlying GRAS established in the 1958 food additives amendment is the same standard applied to direct food additives.

GRAS determinations rely on panels of highly qualified independent scientists who must reach consensus based on publicly available evidence and well established scientific principles. This is a structured science based process grounded in long standing federal law.

Second, AB 2034, as currently drafted, would establish a new state level review and disclosure system that substantially overlaps with existing authorities. California already maintains one of the most comprehensive food safety systems in the world, including the Real Food Healthy Kids Act and more than four decades of proposition 65 implementation.

Agencies such as OEHHA routinely evaluate carcinogenicity and reproductive toxicity, making additional layers potentially duplicative rather than additive and potentially confusing for consumers. Third and final, the bill's proposed ingredient assessment and licensure framework does not clearly provide a pathway for manufacturers to respond to or to supplement the record.

Thank you very much.

Thank you. I respectfully urge your no vote.

Thank you.

Madam Chair and Members of the Committee. I'm Erin Raden here on behalf of the Consumer Brands Association. We represent the consumer packaged goods industry, which in California supports over 300,000 direct jobs, powers the economy with 22 billion in wages, and injects 48 billion into California's economy.

From facts upfront to digital disclosures like SmartLabel, CPG companies lead the way in delivering consumers the information they need in the format they want. AB 2034 is being marketed as a consumer transparency bill, but it is actually an ingredient review bill that simply layers on a second regulatory system, adding cost and bureaucracy, not protection.

And for those reasons, we must respectfully oppose. Last year, this body enacted AB 1264, the Real Food Healthy Kids Act, which established a comprehensive framework for evaluating and regulating food ingredients, including many of the same substances that AB 2034 targets. That program is just about to begin rulemaking and should be allowed to be implemented before another costly and conflicting review system is contemplated.

In addition, Prop 65 already mandates rigorous review and public warnings for chemicals linked to cancer and reproductive harm, and CDPH already has the authority under existing law to regulate, restrict, and ban unsafe food additives.

A new report by the Policy Navigation Group estimates implementation would cost California 34 million in its first three years with 15 million in ongoing costs thereafter. Previous economic impact studies have noted that a patchwork of state legislation like California's AB 2034 will also lead to an increase of 12% in grocery cost.

We welcome a dialogue with the author on consumer transparency and do not have any indication what the amendments will be, but we certainly do look forward to reviewing those and seeing if they impact any of these concerns.

But right now, AB 2034 does not increase consumer transparency. It is a grocery tax that establishes a duplicative California only ingredient review program, increasing costs for the state, businesses, and California families.

Thank you very much. Are there others that oppose the bill, would like to speak? Name, organization, position only. Just come up to the microphone.

Good morning, Madam Chair and Members. Jason Bryant on behalf of the National Confectioners Association. We're opposed. Thank you.

Good afternoon. Leticia Garcia with the California Retailers Association, also opposed. Thank you.

Nicole Quiñonez on behalf of CalChamber and the Food Ingredient Safety Coalition in opposition. Thank you.

Good morning. Anna Maubach with KSC on behalf of the California Grocers Association in opposition. Thank you.

Margie Lie, Samson Advisors, here on behalf of the California League of Food Producers as well as the Council for Responsible Nutrition, in respectful opposition.

Elizabeth Esquivel with the California Manufacturers and Technology Association, also in opposition.

Good afternoon. Tricia Geringer with Agricultural Council of California, respectfully opposed.

Good afternoon. Katie Davey with the Dairy Institute of California in opposition.

Good afternoon. Shari McHugh representing the American Beverage Association in opposition. Thank you.

Dennis Albiani on behalf of the California Grain and Feed Association, California Seed Association, and the California Warehouse Association. We look forward to working on these amendments with the author as well. Thank you.

Randy Pollack on behalf of the American Chemistry Council in opposition.

Thank you very much. Anyone else? Seeing none. Are there any questions from the Members? We have a motion to move the bill and a second. Are there any questions to the bill? Yes.

I just wanted to thank the author for, you and I have, you know, worked together in a number of things, but I just wanna thank you for the conversations we've had. Two cities in my area would be greatly affected by this, over a 100 jobs.

And I know that you've committed to working with myself and other folks to make sure that we keep those jobs, not just in my district, but throughout California. I just really wanna thank the author for taking this issue on as well. Thank you.

Anyone else? Seeing none. I wanna thank you for bringing this bill forward, Assembly Member. This bill raises an important conversation about the Generally Recognized as Safe loophole. While there are conversations about closing the loophole at the federal level, our state legislature has a history of being ahead of the curve to ensure that ingredients in our food are safe.

I'm supportive of the overall goal of ensuring greater transparency regarding the ingredients in our food in order to allow consumers to make informed choices. This bill is going to Environmental Safety and Toxic Materials Committee, and I encourage the author to keep working on it.

To work with the stakeholders as this bill moves forward to address the opposition's concerns and ensure effective implementation. One idea is to narrow the scope of this bill to a database modeled after the California Safe Cosmetics database.

Which require companies to submit to DPH all of their products that contain GRAS and submit safety data to DPH. DPH could then create a database including this data. The author may wish to consider this approach in order to reduce costs and address implementation concerns. With that, would you like to close?

Thank you so much, Madam Chair. And I wanna thank the various Members that have reached out with their questions and concerns. And I've had a lot of robust conversations over the course of that. And also, you know, working with committees.

And working on how we might continue to improve the bill, as many bills through the legislature are improved through the committee process. So we're committed to doing that and just wanna thank everyone for the robust dialogue and respectfully ask for your aye vote.

Thank you very much. Secretary, please call the roll.

The motion is do pass to Environmental Safety and Toxic Materials Committee. [Roll Call]

That bill's on call. Thank you very much. We're gonna move to item number 22, AB 2598, Assembly Member Krell.

Good afternoon, Assemblymember Krell. You can start when you're comfortable about doing that.

Thanks so much. Good afternoon, everyone. Thanks for having me here to talk about Assembly Bill 2598 today. First off, I wanna accept the amendments and thank the committee staff for all of their hard work on this bill. I also wanna thank the surviving—I wanna thank the family members of, of loved ones who they lost.

That's the impetus for this bill. Jesse Peterson is one of those people who died, whose family members were looking for her, and whose remains were in a storage facility. With us here today, it's her mom, Ms. Kanji, who will be talking about the bill, along with Anthony Chicotel, Senior Staff Attorney with California Advocates for Nursing Home Reform. But really, this bill and this issue wouldn't have come to light if it hadn't been for family members who were searching for their loved ones.

So, I wanna back up and give you some background on this bill and explain why this is necessary to fill a gap that we currently have, in our law, something that was really shocking for me to learn about on KCRA news.

And that's that family members were dying in hospitals here in Sacramento. Their loved ones were not notified. Meanwhile, their loved ones were out looking for them. Some of them even filing missing persons reports, going to sheriff's offices, going to county offices, trying to figure out—even going to homeless encampments—trying to figure out where the person had gone. And, really, they had died in a hospital setting, and the hospital was not fulfilling its responsibility to notify next of kin.

So, what this bill does is it closes that gap. Not only does it require the hospital to notify the next of kin, which is already law, but it creates an enforcement mechanism. If the next of Kin cannot be located, it requires them to inform the Public Guardian's Office. But right now, there's a gap because when that—when that's happened, when there hasn't been notifications, the Department of Public Health hasn't really had enforcement power. They haven't really had teeth to do anything to fix the problem.

If you're wondering how bad of a problem this really is, KCRA's investigation revealed 180 cases where a loved one had died and the next of kin hadn't been notified and a death certificate hadn't been issued. And the time range for this is—all of these cases, the 180 cases I'm talking about—are over six months. One of them was over three years. So, that's the gap that we're trying to close with this bill.

Assembly B 2598 will give DPH clear authority, will require notification of next of kin, and will have real consequences, financial consequences if the next of kin is not notified, within that time frame.

So, here with me today is Ginger Kanji, family member of a patient whose death notification was significantly delayed, as well as Anthony Chicotel, Senior Staff Attorney at the California Advocates for Nursing Home Reform. Thank you.

Go ahead. Please start.

Good afternoon, chair, members. My name is Ginger Kanji. I'm the mother of Jessie Marie Peterson. Jessie Marie died on 04/08/2023, while in the care of Mercy San Juan Medical Center. She was 31 years old.

Our family was not informed of her death at the time despite the hospital having my contact information as her next of kin and them contacting me on multiple occasions prior to that. Mercy San Juan also did not report her death to the coroner and did not complete her death certificate for nearly a year. She was alone, stored in an off-site facility deep—decomposing—to the point she can no longer be identified by fingerprints or her tattoos, only a name bracelet they placed when she was admitted.

We searched for Jesse through that year filing missing person report, posting her information on the DOJ website, visited places she frequented, and showed her picture to house locations in hopes of finding where she was let—last seen.

No family should ever have to endure this. We couldn't have a proper burial for her or send her off with our well wishes; we couldn't have an open casket. No family should ever have to endure this. We're not the only family that this happened to.

My heart goes out to the families of Michael Gray, Tanya Walker, Charles Harvey, and more than 100 other families who were impacted by the same lack of accountability. This is not an isolated incident at Mercy San Juan; it's a systemic failure. AB 2598 is about making sure this never happens again. It's about accountability, timely notification, and basic human dignity for patients and their families.

I'm asking you on behalf of Jessie Marie, her sisters, and every family affected, please pass this bill. Thank you.

Thank you very much.

Good afternoon. I'm Tony Chicotel. I work for California Advocates for Nursing Home Reform. We provide free guidance and advocacy services for consumers of long-term care in California. Unfortunately, we don't get many calls about notification—delayed notification of death—but we do occasionally and from nursing homes.

We had one last year where a family was—a, a friend of a deceased nursing home resident called us and told us that the family hadn't been informed for over four months after the resident's death, the family had no idea that this had happened, and the funeral home was asking for $7,000 before they would release the body. That's illegal, but that's the kind of thing that we get when we don't have a clear statutory requirement for notification of death.

I was really surprised after the KCRA stories came out that we don't have a clear requirement. We have a requirement to notify the public administrator when there's no next of kin that are known, but there's no specific law that says you must notify next of kin.

So, this bill gets to that, which is really important. We also have a, a lack of enforcement mechanisms here. In the Mercy San Juan case, the Department of Public Health issued federal deficiencies for governing body and quality assessment. They didn't really have a good hook for failure to notify next of kin of death, at the state level. So, this bill, 2598, answers—fills these holes, these pretty significant holes that we have in the statutes right now.

So, definitely encourage your yes vote, please.

Thank you very much. Are there others that would like to be witness in support?

Good afternoon, madam chair and members. Trent Smith on behalf of the California State Association of Public Administrators, Public Conservators, and Public Guardians. We haven't yet adopted a formal support position, but we're well on our way to, to supporting the bill. We've had some very good conversations with the author's office, and then we have a couple more conversations later this week.

We're still looking for one more addition to the bill to require hospitals and health institutes to pass on whatever personal information they may have at the decedent so that the public administrator can carry on with trying to find the next of kin.

So, thank you. We urge your support.

Thank you very much. Are there any others that are here to support? Seeing none. Any witnesses in opposition? Seeing none.

Is there a Tweener here? Welcome.

Good afternoon. Vanessa Gonzalez with the California Hospital Association, and CHA does not have a position on the bill. However, we'd like to thank the author and committee staff for your willingness to address some technical and clarifying items, a couple more issues to work through, however, confident we'll get to a good place as the bill moves forward. Thank you.

Thank you very much. Members, do you have any questions, comments? We have Assemblymember Ahrens. Okay. Assemblymember Johnson.

Thank you. I wanna thank the author for bringing forward this bill and also your testimony. Thank you for being willing to share. I just have a clarifying question.

Can you give me some clarity on the definition of next of kin?

Yes. It would be the family member who's listed with the hospital.

Okay.

I know that there—I know you're working through some conversation. I think there's some clarity there, and I've had some folks reach out. And I am def—I'm in support. I wanna continue the conversation, just need some clarifying language in there for how what is considered next of kin in situations that are maybe not common.

But you have my support. Thank you very much.

Totally. Thanks so much. And I'm committed to continuing to work with the stakeholders.

Are there any other comments or questions? I wanna thank you for bringing this bill forward. You know, until sometimes it just kinda hits you in the face, you don't realize what has happened to our loved ones. And so, I wanna thank you for your testimony. I can't imagine how painful that has been for all of your family and yourself.

So, I would like to be a coauthor on the bill, and I thank you for bringing it forward. And with that, would you like to close?

Yes. Thanks so much. Happy to have you as a coauthor on the bill, as majority leader. I have deep appreciation for all of the family members that came to my office, that came to KCRA, that are here today in support of this bill.

Without their, you know, brave testimony and being willing to share painful aspects of their lives, we wouldn't be able to stop this harm from occurring in the future. So, with deep gratitude to them, I respectfully ask for your aye vote.

Thank you. Secretary, please call the roll.

[Roll Call]

That builds out. Thank you very much. I'm looking for authors. Thank you, everyone, for having patience. It's, a lot of Committee hearings today.

I think we'll go ahead and take up consent of a motion. So moved by Schiavo. Second by Addis. Secretary, please call the roll.

[Roll call]

Consent calendar's out. Members, if you're available, please come down. We'd like to have you present your bills. We're going to go ahead and do some add ons since we have some time here. Secretary.

Item one, AB2651. I need a motion. Motion by Addis. I need a second. Second by Rogers.

Secretary.

Item one, AB2651, Bonta. Motion is do pass as amended to education. [Roll call]

Bill's on call. Item two, AB1570, Wilson. I need a Secretary. Secretary, please call the roll.

Motion is do passes amended to Appropriations Committee. [Roll call]

That bill's on call. We'll move over to item add -ns for item seven AB2034, Addis.

[Roll call]

That bill's still on call. Okay. Item item nine, AB2123 by Aguiar-Curry. We did get a motion. We need a second.

Second by Addis. Secretary, please call the roll.

Item nine, AB 2123 motion as do passes amended to Banking and Finance Committee. [Roll call]

And item nine is on call. We have add ons for item 12, AB2201, Boerner.

[Roll call]

That bill is out. Oh, we missed you. Okay.

Adding on to item 12, AB2201 Sanchez.

And it's still out. Item 16 for add-ons, AB2448, Bonta.

[Roll call]

That bill's out. Item 22, AB2598, Krell.

[Roll call]

That bill is out. Yeah. We're gonna go back to consent bill.

[Roll call]

Consent calendars out. Right. We're going to do item number 20, AB2551. Assemblymember, Assemblymember Elharwari. Welcome, Assemblymember.

As soon as you get comfortable, we'll go ahead and start.

Thank you so much, Madam Chair. Good afternoon, madam chair and members. I'm proud to present AB2551, a bill that will increase transparency regarding how many people must go out of network to access behavioral health care. Many Californians struggle to access behavioral health services. Communities of color report some of the lowest rates of mental health service use.

Californians who speak a language other than English, LGBTQI plus individuals, and black indigenous and people of color communities face additional barriers to equitable care. Part of the reason for this is that many consumers must go out of network to find providers who meet their cultural or linguistic needs. In doing so, they are forced to pay high out of pack pocket costs. Nationally, consumers spend about $15,000,000,000 out of pocket each year for mental health treatment.

Admittedly, as someone who prioritizes going to therapy every week with an LCSW who I can identify with, who I've built a rapport with after six years, and have also week after week, paid out of pocket.

I recognize that while I love her and she's amazing, I have to transition because of how much it costs and because we recognize that also at this point, I have to find someone in network in order to be able to continue to afford it. And so I'm in that transition period.

And so it's a v twenty five fifty one requires health plans and insurers to collect and publicly share data on how many people must go outside their network to get behavioral health care and the total expenditures these individuals pay out of pocket to receive such care. It also requires health plans and insurers to document why individuals went out of network in the first place.

For example, whether people are going out of network because they can't find care that is easy to navigate or that meets their cultural or language needs.

For these reasons, AB 2551 would increase transparency regarding behavioral health care access and hold health plans accountable for providing culturally competent care. This is about ensuring our constituents can access the behavioral health care they need without going out of network and paying thousands out of pocket. It's also about making sure that insurance actually works for the people it's meant to serve.

Joining me today is Omar Altamimi, senior legislative advocate with the California Pan Ethnic Health Health Network, and Kimberly Robinson, a community liaison with Black Women for Wellness.

Welcome.

Good afternoon, Chair and Members. My name is Omar Altamimi. I am the senior legislative advocate for CPEN, the California Pan Ethnic Health Network, a multicultural health policy organization dedicated to improving the health of communities of color in California. CPEN is a proud sponsor of AB2551, the Behavioral Health Affordability Act. The bill lays critical groundwork for improvement of behavioral health coverage and network advocacy for Californians covered by health insurance, particularly communities of color and those with limited English proficiency.

Despite strong federal and state mental health parity laws, access to behavioral health care is at a crisis point in California, with consumers increasingly forced to go out of network to access behavioral health care. This crisis is compounded for communities of color, including limited English proficiency and LGBTQIA plus communities who reported some of the lowest rates of utilization of mental health services and face additional barriers to equitable care as you'll hear from today's witness, Kim Robinson.

When consumers are unable to access in network care, they must wait for care, go without it, or go out of network and pay out of pocket. That means paying twice since this care should already cut be covered by their health plan and is already paid for with their premiums. This is unacceptable and only further exacerbates the unaffordability crisis and places undue hardship on families.

Among commercially insured people with moderately severe severe depression symptoms, nearly one in three said they went without care because of cost. Nationally, consumers pay $15,000,000,000 in out of pocket expenses for treatment for acts for mental health disorders. Individuals seeking mental health care are six times more likely to have to go out of network for care compared to other services. CPEN has heard numerous stories of individuals with health insurance not able to access care in a timely manner and having to pay for it themselves.

When health plan provider networks are not sufficient to meet patient needs, people suffer.

It's simply not acceptable for health plans to keep kicking the can down the road. Understanding how often, why, and how much is paid by health plan enrollees when they're forced to go out of network for their care should be a priority for all health plans as a critical way to understand the existing gaps in care. This is exactly what AB 2551 will do.

The bill turns invisible barriers into measurable data by requiring health plans, which already must conduct data collection and serve activities of all their enrollees each year to add questions related to the out of network use of behavioral health care. AB 2551 will also give insurance regulators.

Thank you.

And you can finish your last

I'll I'll yeah. For these reasons, I respectfully request an aye vote on this bill and pass it to our colleague, Kim Robinson.

Thank you.

Thank you. Good afternoon, Chair Bonta and members. My name is Kim Robinson, and I'm here today in support of AB2551, the Behavioral Health Affordability Act. During the COVID nineteen pandemic, we were told that telehealth would make assessing behavioral health care easier. In theory, care was supposed to be more accessible than ever.

But for many of us, especially black women and people with marginalized communities, that simply wasn't the reality. I had health insurance. I paid my monthly premiums like I was supposed to, but when I tried to find a behavioral health provider who was cultural comp culturally competent, someone who understood my lived experiences, I quickly realized that having insurance didn't actually guarantee access to the care that I needed.

While searching specifically for an African American African American woman who provided mental health care, I found that even though telehealth services were widely available, there was only one provider in my insurance network who fit that description. And she had an extensive waiting list. After nearly two months of searching, the only option provided to me by my insurance carrier was to attend group counseling.

That wasn't something that I was interested in engaging in, and so I was forced to use a provider who not only didn't look like me, but also wasn't equipped to properly address my mental health needs. After spending thirty minutes pouring out my heart and soul, instead of offering tools and guidance to help me cope with what I was dealing with, she offered me some literature to read and then the conversation shifted to her talking about her cat.

In that moment, I realized this was not someone who was going to be able to properly care for me. And honestly, the realization made me feel even more discouraged and depressed.

To make matters worse, my insurance only allowed me to process over again while still paying my insurance premiums the whole time. That meant I was essentially paying twice. Once for my insurance and then again with my time, energy, and sometimes out of pocket. One provider charged a $150 an hour. Trying to find care that actually worked for me was a job when it in it of itself.

Thank you so much. Can you final comment.

Yes. So for people like me and so many others across California navigating the same barriers, I respectfully ask for an aye vote on AB2551. Thank you.

Thank you so much. Are there any other witnesses in support to testify with your name, organization, and position only?

Good afternoon. Evan Fern with Disability Rights California in support.

Peter Hansell here on behalf of the AARP California. AARP is in support.

Good afternoon, Madam Chair. Malik Bynum with the County Behavioral Health Directors Association in support.

Nicole Wertleman on behalf of the Children's Partnership in support.

Nora Angeles with Children Now in support.

Katie Van Dines with Health Access California in support. Thank you.

Good afternoon, Chair Members. JP Hannah on behalf of the California Nurses Association in support.

Thank you. Are there any primary witnesses in opposition?

Thank you. You'll each have two minutes.

Madam chair members, Olga Shiloh on behalf of the California Association Health Plans. CAP appreciates the author's focus on improving access to behavioral health care, and we share the goal of making it easier for people to get timely, affordable care, especially when they are in crisis. However, at this time, we must respectfully oppose AB 2551.

We recently had an opportunity to have a good conversation with the sponsors about their goal with this bill, and we welcome that that opportunity to continue meeting with the author and and the stakeholders. While well intentioned, our primary concern is that the bill adds a new annual survey and reporting mandate on top of extensive behavioral health oversight that already exists, including parity requirements, network adequacy standards, timely access rules, and reporting to DMHC and CDI.

Implementing an annual survey program at scale would expend would be expensive and operationally complex. We are not convinced it would meaningfully, improve access. We also recognize that California faces a well documented shortage of behavioral health providers, particularly those willing to contract with plans and insurers. More broadly, the challenge we're trying to solve, thin networks and high out of network charges, are driven by the provider shortage and by market dynamics where some providers can remain out of network, set their own rates, and bill full charges.

Regrettably, this weekend's incentives to participate in networks and ultimately drives higher health care costs.

Kept welcome solutions that preserve timely access to care, protect consumers from excessive charges, and encourage providers to participate in networks. We appreciate the conversation and remain committed to working with the author, committee, and stakeholders on a constructive path forward. Thank you.

Good afternoon, chair and members. Matt Akin on behalf of the Association of California Life and Health Insurance Companies, also respectfully opposed AB 2551. I would like to align my comments with my colleague at CAP and reiterate that while we agree that California faces a shortage of behavioral health providers, we are concerned that this bill oversimplifies why patients seek out of network behavioral health care. In many cases, especially in PPO products, out of network use reflects plan design rather than a lack of access.

In closed network products, out of network care is only approved when specific criteria are met.

And when it is, member cost sharing is already capped at in network levels under SB 855 and it's implementing regulations. Outside of these circumstances, plans and insurers often have no visibility in out of network services or cost unless a claim is submitted, making it unclear how the bill survey and reporting requirements could be done accurately. Finally, we believe it is important to point out that out of network providers can set and collect full bill charges without the constraints of negotiated rates.

Regrettably, this only further weakens incentives for providers to participate in plan, ensure networks, and ultimately drives higher cost for consumers and employers. For these reasons, we respectfully remain opposed to AB 2551, but we do look forward to future conversations with the author and sponsors if the bill does move forward today. Thank you very much.

Thank you. Any additional witnesses in opposition who would like to offer a me too? Seeing none, I will bring it back to the committee for any questions or comments. Assembly member Addis.

I'm happy to move the bill if it hasn't been moved. And I just wanted to, thank the author and your witnesses for coming and, certainly respect the position of the opposition. But I would say in my county and, across the Central Coast, we're experiencing exactly this, which is that people have insurance, but they can't provide providers who will take that insurance largely because the rates are too low for them to be able to take that insurance.

And, I hear experience after experience where people had a a mental health professional or a therapist as it were. As you've as you've all kinda just described, they had somebody they were seeing that person.

They had a relationship with that person. And then all of a sudden, that person isn't able to take the insurance anymore and describes it as the insurance is no longer providing the rate that it wants provided. And so the therapist can no longer and these folks have to go to a lot of schooling. Many of them have student loans from going to their schooling.

They have to be able to get paid enough to be able to pay those loans back and make a living wage in a place like California that's very expensive.

And I would, add that on in a place like the Central Coast that's very expensive. And so I hear from constituents time and time and time again what a huge problem it is that they are, paying twice. As your witness has mentioned, they're paying for insurance, and then they can't find a provider who can afford to take the insurance.

So then they're paying the provider, and then they have a reduction in services because they can't afford to pay for the frequency of services that they once had when they had insurance. So for us on the Central Coast, this has become acute.

I hear from it more than most other issues that I hear for. And so I just wanna thank the author for bringing this forward and be be love if you're taking coauthors to be added as a coauthor.

Absolutely. Thank you. Assembly member Schiavo.

Thank you so much for bringing this forward, and I wanna echo the comments by assemblymember Addis. I think, you know, when you're talking I I agree with the opposition that, you know, providers are not willing to take insurance. We find this a lot, but that seems like a systemic problem within the insurance system.

And, and the problem is that, in addition to, you know, the things that, assembly member Addis was talking about, the the the low pay being a part of it, I've also heard about the incredible amount of paperwork about, you know, a a number of issues when it comes to verifying your information, having to verify your information with insurance companies on a regular basis, and then being told you haven't verified it when you have, and it's, you know, a a part time job just to make sure you stay on the insurance list.

If you are a a actually taking insurance, which I I know is becoming less and less common.

And in the middle of a a mental health crisis for people not to be able to get therapy through their insurance that they're paying for is a is a a disservice to say the least. So so I hope you know, we we shouldn't have to do these bills is partly what I'm trying to say.

You could just fix it and, you know, and and do a better job of making sure that people are getting what they deserve to be paid, making sure that it's an easier system for the providers, because it's a little bit carton horse, I think, situation when you're talking about this issue. And I'd love if we didn't have to do any of these bills, and, you know, and and it was just available for folks when they need it.

So, hopefully, there is reflection on how it can be a more streamlined process and supportive process for providers to be able to come into the insurance system as well.

Assembly member Patterson?

Great. Thank you. You know, I'm gonna support this bill today largely because I, you know, I agree with my colleagues that there, you know, there are limited numbers of providers that will accept the insurance or that, you know, actually just provide this service at all. And if we're gonna get people, you know, like, off the street and things like that, we actually need to, you know, increase. But I do wanna say, however, know, it's not just private insurance that underpays providers.

Medical has for generations as grossly underpaid providers, and it's hard to find providers to do anything, particularly help those with disabilities, including mental health issues. So so I don't just blame, you know, the private insurance. I think we have a systemic issue, you know, that we have to we have to figure out. But, I look forward to supporting the bill today. Thank you.

Seeing no other comments or questions from the committee, assembly member, you can close. I respectfully ask for your aye vote. Thank you. Thank you so much. We have a motion by Addis.

Is there a second? By Caloza. With that secretary, please call the roll.

[Roll Call]

That bill is out. Thank you, assembly member. We are gonna move on now to item number 21, AB 2575 by Ortega. Thank you, assembly member, whenever you are ready. Please, press the button for the mic.

Sorry. Okay. Thank you. Thank you, madam chair and members, for the opportunity to represent AB 2575 today. First, I'd like to thank the committee staff for their work, and I accept the proposed amendments listed in the analysis.

AB 2575 is built around a simple principle. In health care, artificial intelligence should only support clinical judgment, not replace it. AI may offer promise, but in real world settings, these tools can still get it wrong. AI, they can generate false alarms or miss serious conditions. For example, a nurse was forced to take a blood sample after receiving an erroneous alert for sepsis, adding to the patient's bill.

In another instance, a nurse followed protocol suggested by the algorithm and diagnosed a patient with something benign. That patient died with severe respiratory and renal failure. AI can also reflect the same biases that already exist in the data they were trained on. One algorithm assigned black patients a lower likelihood of adverse health outcomes than white patients who were at the same risk. This because the tool used health care cost as a proxy for health needs.

Because the system historically spent less money on treating black patients, the AI model codified and recreated this discrimination. Knowing these faults, our frontline health care workers find themselves in an impossible double bind. Their employers are using these tools and making workers follow their output. But if the AI is wrong and the patient is harmed, it is the workers and not the AI who face liability. Follow the machine, get blamed.

Override the machine, risk retaliation. When an AI tool goes awry because of a developer's or an employer's failure to develop safeguard, someone can try to hold them liable. But developers and employers can use a legal legal loophole called superseding cause by pointing the finger at health care workers for failing to catch the AI's mistake. When they win using this loophole, they face zero liability, even if their negligence caused harm. To address this, AB 2575 has three key provisions.

First, the bill prohibits employers from retaliating against a health care worker for using their professional judgment to either override or follow an AI recommendation. Second, this bill requires AI tools to carry a nutrition fact label that lets healthcare workers know the risk and intended uses of the tools they use. Third, it prevents a developer or employer from using this superseding cause loophole to shift blame to a healthcare worker to avoid liability for their mistakes made in patient care.

The purpose of a by AB 2575 is not to stifle innovation. We're using it. We use it in everyday, items that we hold, our phones. I know when I've gone to the doctor, I've been asked if my notes if AI can transcribe my notes. So, it's there. It's happening. The concern is that it's moving really fast.

So fast that we are trying to play catch up when it comes to accountability, when it comes to transparency, and when it comes to patient safety. Aye, for one, do not want an AI tool to determine whether I need, some kind of medication or some kind of treatment. I want that ultimate decision to be made by my healthcare providers.

And if my healthcare provider decides that that AI that they're being asked to use is making the wrong call, then I don't want my healthcare provider to be retaliated against. That is the purpose of AB 2575.

And I'm not alone in this. A poll from last year showed that while many Americans are turning to AI for answers on some medical questions, we've I'm sure many of us have used some of those sites ourselves. The vast majority, 79%, don't think that it can be trusted. Not yet. So AB 2575 helps empower health care workers to speak up and advocate for their patients.

Testifying in support today is board president of the California Nurses Association, Kathy Kennedy. Also with me today is Sarah Flocks from the California Labor Federation. And I also have Deborah Raji, an AI researcher at UC Berkeley, and Carmen Kos Kamsti from the California Nurses Association in the back for our technical witness to help answer any questions.

Thank you. Your primary witnesses will have two minutes each. Please go ahead.

Good afternoon, madam chair and members. My name is Catherine Kennedy, Kennedy, president of California Nurses Association and cosponsor of AB 2575. A B2575 addresses a reality many nurses and other health care workers are confronting today. Our employers are telling us that we must use artificial intelligent AI systems without basic information about these tools, such as clear protections to object or override them without fear of retaliation. As nurses, we are asking multiple questions such as what is the tool doing?

What is its intended use? What data is it using? What are its risk and limitations? How well does it work or not? And we are not getting any answers.

So when employers expect nurses to rely on this technology that we cannot meaningfully evaluate, object to, or override, then it puts our patient's safety at risk. In response, AB 2575 would put three common sense guardrails in its place when AI systems are used in patient care. Transparency, override protection of health care workers, and accountability for the developers and health facilities that deploy these systems.

After forty six years as a bedside RN, I know safe patient care is never just about what's on the screen or on the chart. It is about the uniqueness of the person.

And as an RN, I am constantly assessing, listening, observing, and evaluating. So patient care is more than just executing the prediction that technology generates. For example, in the emergency department, ED, an AI triage tool estimates a patient's severity of illness and assign the patient a low priority score based on the information entered in the system when asked specific questions about their condition or their symptoms.

Now if you have an actual triage nurse, that person would immediately observe, touch, or even notice an odor of the patient's condition or they may be pale, their skin is cool. All of those things make a difference.

It's not Last last comment. So my last comment is this. AI tools that our employers are asking us to use in patient care is something that we just we need to be able to override it, and I respectfully ask your aye vote. Thank you.

Madam chair, members, Sara Flocks from the California Federation of Labor Unions. And we are a proud cosponsor of this bill. It is part of a large package of bills we have to establish worker technology rights as the new labor standards for the twenty first century. And the goal of all of those bills is to ensure that human workers and human expertise is in control of AI tools and not being replaced by them.

And the opposition coalition to this bill wrote in their one of their letters that, quote, we have a shared obligation and commitment to ensure that these AI tools are developed and deployed responsibly, equitably, and transparently.

Well, that is great because what AB 2575 does is codify the conditions and guardrails that are necessary to make sure we meet those AI goals and to ensure that any benefits of this technology, since these are much touted benefits that we are going to get, that those accrue to workers, to patients, and to the public, and not just to the tech developers or the employers who are using those tools.

We need actual laws and not just commitments to make sure that that happens. So this bill puts in place three key parameters, conditions necessary for that that we have across our bills. The first is advanced notification. Workers need to know what tools are being used and the information that is going into them and coming out of them.

The committee did an excellent, excellent analysis. And starting on page eight, there are a number of examples. The author gave one of them of where the information of the algorithms that were used, the inputs, the potential risk, all a a health care professional needs that information to use their professional judgment. That is one. Two is the freedom to be free from retaliation, and the second is ensuring fair accountability.

That is what is needed to codify to make sure humans are in command. We urge your aye vote.

Thank you. Are there any others in support who would like to offer a me too? Your name, affiliation, and position on the bill.

Good afternoon, madam chair and members. Roxanne Gould representing the American Nurses Association of California in strong support. Thank you.

Good afternoon, chair and members. Omar Altaimimi with the California Pan Ethnic Health Network in support.

Good afternoon, chair and members. Connor Gussman on behalf of Teamsters California and the engineers and scientists of California in proud support. Thank you.

Good afternoon. Alia Griffing with the American Federation of State County Municipal Employees in support.

Good afternoon, madam chair, members of the committee. Navnit Puryear on behalf of the California School Employees Association in support.

Thank you. Mitch Steiger with CFT, a union of educators and classified professionals also in support.

Jennifer Robles with Health Access California in support.

Eric Paredes with the California Faculty Association in support.

Shafi Hanna with California Nurses Association, proud to sponsor this measure.

Whitney Francis with Western Center on Law and Poverty in support.

Ramon Costeblanc, California Alliance of Retired Americans in support.

Shirley Toy, member of California Nurses Association, strong support.

Pamela Morales, registered nurse Nurse and member of California Nurses Association in support.

Cathy Dennis active bedside registered nurse director on the California Board of Nurses. Please vote yes on this for me and my members. Thank you.

Thank you. We will now move to any primary witnesses in opposition. Please come forward. You'll each have two minutes. Thank you.

Thank you, chair and members. Alexis Rodriguez, with the California Chamber of Commerce here in opposition to AB 2575. AB 2575 seeks to impose numerous notification and disclosure requirements on health care facilities using AI tools and systems. This bill will negatively impact those tools that are already safely and effectively used in health care every day. AI tools and systems have the ability to improve the early detection of life threatening conditions.

AI is already helping Clinicians detect sepsis sooner, improve the accuracy of, cancer screenings, assist with screening patients' medication orders, and more. To be clear, Cal Chamber believes that AI in health care should not replace providers. It's there to support them and the practice of medicine. Medical professionals can and should use their professional judgment when using these tools. With that said, AB 2575 would impose liability on health care entities and AI developers whenever there is harm resulting from a professional using these tools.

If a patient is harmed, there should be a thorough investigation on who or which tool is truly at fault. Strict liability on the health care facility and developer will only discourage the use of AI in the clinical setting and dissuade innovation and creativity of future tools. We share the goal of responsible AI use in health care, but, unfortunately, AB 2575 only moves us in the wrong direction. For these reasons, we respectfully urge no vote. Thank you.

Good afternoon, chair and members. George Sorries with the California Medical Association here representing over 50,000 physicians and medical students in California. We're here in opposition to AB 2575 by Assemblymember Ortega. This bill would put numerous new reporting documentation and notification requirements on physician practices that are using artificial intelligence tools to help deliver safe and effective patient care. This bill is overly broad and risk creating unintended consequences that could ultimately harm the very patients it seeks to protect.

Physicians across California are already facing an unsustainable level of administrative workload. Studies consistently show that doctors spend nearly as much time on documentation and compliance as they do on patient care, which routinely leads to professional burnout. The bill's language restricting the use of technologies that may replace or limit professional judgment is vague and open to wide interpretation. In current medical practice, physicians routinely rely on clinical decision support tools, many of which incorporate AI to assist, not replace physician decision making.

These tools help identify early warning signs of serious conditions, reduce medication errors, improve diagnostic accuracy, and assist in clinical note taking.

Under this bill, physician practices will be hesitant to use these tools. Out of concern, they could be seen as limiting physician judgment even when they are clearly beneficial. This bill risks discouraging innovation in patient care. California has long been a leader in both health care and technological advancements. This measure would have detrimental impact on the responsible development and implementation of new tools that improve efficiency and patient outcomes.

Additionally, this bill introduces legal and operational uncertainty for physicians. The concept of professional judgment is already well established through medical standards of care and overseen by state licensing boards. This ambiguity may lead to increased administrative burden and defensive practices that detract from patient care. At a time when California is grappling with physician shortages, burnouts, federal funding cuts to health care, and access to care challenges, we should be reducing unnecessary administrative burdens, not expanding them. This bill would only add to those issues.

Every additional minute spent on administrative task is a minute taken away from direct patient care. We fully support and always have supported appropriate oversight.

Thank you.

For these reasons, we respectfully ask for a no vote. Thank you.

Thank you. Others in opposition, please come to the mic to offer your name, affiliation, and position on the bill.

Madam chair, member Shawn Wenger on behalf of Advanced Medical Technology Association, ADVAMED in opposition.

Madam chair, Mark Farouk on behalf of the California Hospital Association in opposition.

Madam chair and members, ... on behalf of Kaiser Permanente in opposition.

Nicette Short on behalf of Adventist Health in opposition.

Olga Shiloh on behalf of the California Association of Health Plans also in opposition.

Jennifer Snyder, on behalf of the California Life Sciences, in opposition.

Jason Schmelzer, on behalf of TechNet, in respectful opposition.

Matt Aiken, on behalf of the Association of California Life and Health Insurance Companies, in opposition.

Thank you, chair and members. Ryan Perini on behalf of ATA Action, the advocacy arm of the American Telemedicine Association in respect for opposition. Thank you.

Ryan Spencer with the California Radiological Society, the California Society Pathologist, and OCHIN in opposition. Thank you.

Gilbert Lara here on behalf of BioCom in opposition. Thanks.

Madam chair, members, Dennis Cuevas Romero, on behalf of the California Primary Care Association, advocates in respectful opposition.

Thank you. With that, we'll bring it back to the committee for any questions or comments. Some, majority leader.

Thank you very much, and I'm sorry that we didn't get to touch base today, miss Ortega. I appreciate the the work on this bill so far. I I appreciate the intent to ensure AI is used safely in health care and to protect patients as well as providers. AI is already improving care, reducing provider burnout, allowing more time with patients, and I see that with some of my doctor friends right now. This has alleviated some of the work, workload for them.

I appreciate the committee amendments to limit notifications that could lead to burnout. But as drafted, I'm concerned that the bill may be too broad and could limit proven tools that support, patient care. I've also have concerns with the employer retaliation liability provisions that need more clarity to avoid unintended consequences. I'm supporting the bill today, and I encourage the author to keep working with stakeholders to address these concerns to strike the right balance. Thank you very much, and I'll support it for today.

Assemblymember Rogers.

Thank you so much, chair. And I wanna thank the author as well for bringing this forward. I think you know I'm the husband of a nurse, and I can appreciate that you're bringing a bill that is really focused on protecting workers as we enter into this new environment.

But I also wanna bring it back to sort of the 50,000 foot view, which is this is very downstream from a bigger issue that the legislature needs to grapple with, which is broadly around liability related to to AI and who is liable when AI goes wrong or when it's used as a tool and and nothing happens.

We have seen small issues, whether it be from autonomous vehicles and liability related to that to enormous issues like Grok deciding that it was going to put out illegal and inappropriate underage pictures.

And we have not yet come to a clear decision on how to assess liability when the tool itself is the problem and the outcome. We don't wanna stifle the innovation. I'm sure we'll be able to to move forward in that space. But I do appreciate this bill looks at what has consistently happened up to this point, which is shifting the blame away from the tool and onto the practitioner, and I'll be supporting your bill today.

I just wanted to see if, miss Raji had a comment about the liability issue, oh, broadly raised by Assemblymember Rogers.

Good afternoon, everyone. I think what Assemblymember Rogers brought up was really important. The bill, makes sure that any worker in the loop who is being a a human reviewer of AI does not unintentionally or for whatever reason become a scapegoat for the problems that happen with AI. Unlike what opposition said, this is not about strict liability. This is about preventing, an affirmative defense from being used to put workers, in front of, liability on AI harm to patients.

It's simply saying that we wanna make sure that there can be accountability and that workers are not being the ones blamed.

Yeah. Just to add a bit to that, I think there's current ambiguity under the current system in which, you know, the law is built around human decision makers and what it means for human decision makers to make the wrong call. And so when you introduce an an AI system that might have some degree of autonomy in decision making, it becomes ambiguous.

And so part of the function of this bill and related bills is to clarify that ambiguity, to make it clear sort of who is ultimately in charge, which is the human decision maker, who should be in charge, which is the human decision maker. I also wanted to briefly comment on an earlier point, around, you know, the feasibility of this bill, in in terms of in practical and technical terms.

A lot of the, technical infrastructure required for these bills, you know, AI inventories, notification, the integration of features into electronic health record systems, are requirements that are also being discussed at the level of the FDA and ONC and other regulators at the federal level. And so a lot of, you know, AI vendors, for example, will have to think about integrating some of these transparency features moving forward, and a lot of health systems will have to think about integrating these type this type of AI transparency infrastructure.

And so, you know, this is not far from existing requirements or requirements that these stakeholders will have to consider anyways.

Assembly member Schiavo.

Thank you so much for this bill. Thanks for being here today. I know the opposition mentioned that, they did they agreed that AI should not replace workers, health care workers, and that it should support them, and then went on to say that there should be if something negative happens to a patient, that there should be a full investigation. You know, my concern after working for thirteen years with nurses and hearing lots of stories is that sometimes that's too late. You can't just investigate.

And so I'd be curious to hear what Miss Kennedy thinks about just waiting to investigate later if there's a problem that comes up.

Well, there always is a problem. And so, you know, it really we should be able to override if we see something. Because I I I mentioned the uniqueness of each individual person. So when you have an algorithm that may say set in stone exactly what we're supposed to do for this particular patient, it doesn't it doesn't allow for that individuality, that uniqueness that sometimes not sometimes. A lot of the times a nurse may pick up that the algorithm itself doesn't pick up.

So when you when you override it, when you say, no, I don't think so, not for this particular person.

So for example, if it if it's if the algorithm states that the patient really needs fluids, IV fluids, but yet you have somebody sitting in front of you that may be a dialysis patient and you have to limit the amount of fluids, but yet their blood pressure is going down, you're gonna stop for a second and say, I'm not gonna put two liters of fluid in this patient. I'm gonna talk to the physician, override it, and not go any further.

So that's what I'm talking about is the opportunity to look at something, look at the patient. This doesn't meet I mean, this in my mind, I would have stopped.

But sometimes you're not allowed to because you have the employer or your manager saying, just do it. That's what

Right. And And it'll be too late. Too late. Exactly.

And, you know, what some of the things that I've heard from working with nurses for so long, including you, is that there was some discussion around this even around telehealth and some of the challenges around telehealth that how important it is, as a nurse to be able to see a patient directly, to see the color of their skin, to see if they're clammy, to be able to touch and feel the skin, and that those are things that are really important indicators.

And, obviously, computers also can't necessarily do those things, at least not at this point. And so, you know, having I I can't imagine anyone feels comfortable with AI making decisions without some kind of human override. Like, this just seems incredibly common sense to me.

And and so, you know, can you talk a little bit about some of those things that are so important for nurses to be able to see, smell, feel, touch that that would be important indicators that may be different than an AI algorithm is giving you?

You know, like I said, I I think that we're not anti technology at all because as as the the assembly woman stated is that we see this in our everyday life. However, I think what's important is that when we're the we're the last person before, you know, we we are the ones that are in front of the patient day in and day out.

And if we see that the algorithm is stating for us to do something where we clinically have seen in in experience I've worked as a registered nurse for forty six years. There are many times when a doctor has asked me to do something. And because I've seen something in the past that was a bad outcome, I would stop and we would have a discussion to talk about that and say, no, not in this case.

And a lot of times when you have, like, newer nurses that are maybe less experienced and are very you know, they are they see the algorithms and, you know, they they feel that they need to do what the algorithm states as opposed to stopping and pausing for a minute. I think that it can have some significant and severe consequences. The concern also is that sometimes you're pressured. You know, that's it's it's almost like people look at us like we just do task.

Nursing is is an art and a science.

It's more than just task. It's about looking at who's front who's in front of you. You have the algorithm that states that you need to do certain things. But yet as a nurse, you're looking at that individual to say, no. And so at that point, you know, we should be able to override it, have a talk with the physician to say, come to the bedside, look at what I'm seeing.

And and that I'm concerned about having been at the bedside for such a long time. And with the introduction of AI into health care at a very, very fast pace, I'm extremely concerned because it's almost become second nature. I mean, we we begin to look at it and maybe even believe it. And so you really you really and it's been untested.

And I I fear that, you know, we're we're using our patients as guinea pigs instead of really really looking at what it is that we're really bringing into health care without it being untested and unregulated.

And so I'm extremely concerned about that. I hope that answers the question. Yeah.

So Thank you. And just, if you could clarify from CMA some of the concerns. I mean, one of the things that I've noticed, just as a patient myself Is that there's certainly a a number of benefits to AI. Right?

The even though it's a little Creepy, AI taking the notes when you go to the doctor's office now, I feel like the doctor is able to look me in the eye more and focus on the patient care piece and not have to be in front of the screen and taking notes constantly, to chart things, which I appreciate.

I am hoping that those notes are reviewed by the physician before they go into my chart for accuracy and making sure that they are. But, I mean so that seems like an important human interaction, right, and and override essentially. Right? You can approve or not or correct charts. But what are some examples of this kind of overwhelming paperwork that you're talking about?

Yeah. So so I appreciate the question. On the note taking, absolutely, physicians are always, you know, trained and taught to review it before the final submission to it is extremely important, and I and I know the profession takes it very serious as well as other folks part of the care team.

As far as the the the other kind of burdens and notifications that related to the bill is that, you know, it's it's left really ambiguous and there is is a anytime that these tools are used, I know there's some amendments that we're still going through. Right?

And, you know, those are kind of highlighted or summarized in the analysis. But, you know, anytime that a tool would be used, it would then be on either the physician, the or the health facility, or the clinic to then notify the the employer or the employee, I'm sorry, that this tool is being used. And we feel that that is overly broad and and it's too much information that will detract away from patient care.

Now that's not to say that we don't value folks being properly trained and the and the tools being properly trained, but, you know, we think that it will bog down an already cluttered system.