Senate Standing Committee on Health

The Senate Committee on Health will now come to order. Good afternoon. We have seven bills on the agenda with one of them on our proposed consent calendar. Item number seven, SB 1202, Weber Pierson with amends. We will begin as a subcommittee until a quorum has been established.

We will now start on file item five, SB1422. Senator Durazo. Senator Durazo, I would like to thank you for being here on time. And that's why we are going to be able to hear your bill first.

Alright. Thank you so much. Thank you Madam Chair and members. And I wanna start by acknowledging and appreciate the time that you, Madam Chair, have spent with me in our on all of our conversations. Members, SB1422 restores access to Medi-Cal for income eligible undocumented adults beginning 01/01/2027.

California has made real progress expanding health coverage, bringing us to the lowest uninsured rate in our state's history. As Medi-Cal expanded, counties were able to scale down indigent care programs, reducing local fiscal burdens, and stabilizing our safety net hospitals and clinics. The twenty twenty five, twenty six budget reversed that progress or it threatens to reverse that progress. It froze new enrollment for adults due only to their immigration status, and now we are seeing the consequences in real time.

People who relied on Medi-Cal are trying to enroll and being told they no longer qualify.

Others who are eligible are receiving denial notices. This freeze does not eliminate health needs. It shifts responsibility onto counties, already strained hospitals, and overcrowded emergency departments. The freeze creates a two tiered health care system by forcing undocumented individuals who do not have access to employer sponsored coverage into a county system of last resort if those programs are even available to them. That means fragmented access gaps in care and fewer real options to get treated.

This freeze exacerbates the poor health conditions that undocumented immigrants are already experiencing. And it does so by stripping access to care at a time when our communities, those same communities, are facing ongoing violent and traumatic attacks through ice raids. And we know exactly what that looks like. But what do I mean by worsening health conditions? Detecting diabetes at a routine doctor's visit becomes someone arriving at the emergency room in a diabetic coma.

Untreated high blood pressure becomes a stroke. Under federal law, emergency departments must treat everyone regardless of ability to pay. And emergency care can cost up to 10 times more than a physician's visit. So when people lose coverage, those costs don't go away. They are pushed onto counties, hospitals, and ultimately taxpayers.

California is already spending approximately 3 and a half billion dollars each year on preventable emergency care. Because of the enrollment freeze, hospitals will now seize see more patients without coverage, less reimbursement for the care they are already required to provide. That loss of revenue has real consequences. In light of HR 1 con hospitals, especially safety net hospitals, are being forced to cut services, freeze hiring, and in some cases, consider closing departments or facilities together, altogether.

And when those cuts happen, they hit the services communities rely on the most.

Emergency care, maternity care, and behavioral health. As a result, the impact is not limited to those who lost coverage. Everyone feels it. Longer wait times, fewer available services, and higher costs across the system. We cannot control those federal decisions, but the enrollment freeze is a state choice, and we should not compound the damage.

SP fourteen twenty two is a course correction. It restores a system where care happens earlier, costs less, and keeps our hospital and community stable. It's about dignity and fairness. It's about making our health care system work the way it's supposed to. I'm pleased to have the support of the emergency room physicians, public hospitals, and the people most impacted by this devastating policy.

Farm workers, caretakers, hotel and restaurant workers, childcare workers. I respectfully ask for your eye book. And my witnesses, madam chair, are David Campos, David, deputy county executive, County Of Santa Clara testifying, a cosponsor of the bill. And on behalf of the urban counties of California, Mar Velas, director of policy Latino Coalition for Healthy California cosponsor of the bill.

Thank you, Senator. You each have, two and a half minutes for your presentation. Thank you.

Thank you, Madam Chair, Doctor Weber Pierson, honorable members. My name is David Campos. I am deputy county executive for the County Of Santa Clara. The County Of Santa Clara is the sixth largest of the 58 counties, and we run the largest public hospital system in Northern California and second largest in the state of California.

This is a very critical issue for counties, which is why I'm proud to be here not only on behalf of Santa Clara but also, on behalf of the 14 counties that make up the urban counties, system.

We believe that what we are talking about is a shift of responsibility from the state to counties. And the reason we support and cosponsor SB1422 so strongly is that we believe that failure to do something to, cover, the undocumented population of this state means that counties will be left, addressing the burden on their own. The reality is that this population, in Santa Clara County we're talking about 70,000 residents, is not going away.

And I can tell you from my own experience, my family lived as undocumented people for many years, that what happens when you're undocumented and you're not covered by health insurance is that you leave things until the very last minute and you end up waiting until you have to go to the ER. And that means going to emergency rooms throughout the state where counties have to fit the bill.

And not only is that questionable from a moral standpoint, but financially and from, public health, it makes no sense to force people to delay basic care until the very last minute. We are here to ask for passage of SB1422 because it moves the state in the right direction. We have made a lot of strides as as California in covering, undocumented people and other, indigent people in the state by failing to provide coverage under the Medi-Cal, the state Medi-Cal system.

We are taking a step backward. And we're very grateful to Senator Durazo for this bill, and we respectfully request your support.

Thank you.

Good afternoon, Chair and Members. My name is Mar Velez. I am the policy director with the Latino Coalition for a Healthy California. Our mission is to protect Latino health through policy advocacy and to end health disparities among Latinos. And we are proud cosponsors of SB1422.

California has led the nation in expanding health coverage to all eligible Californians regardless of immigration status. Thanks to these expansions and the ACA, California reached its lowest uninsured rate of approximately six percent. However, due to the current freeze on Medi-Cal enrollment for undocumented Californians, that progress is now at risk. California must prioritize and protect health coverage for all Californians, Not only because this is within California's values, but also because health is a sound economic investment that secures the financial vitality and the health of all Californians.

With immigrants comprising roughly one third of all workers, in order for California to remain the fourth largest economy in the world, we must invest in the health of the people that power it.

Only miles away, the people who are working to put food on our tables are living the consequences of our state's actions. Farm workers are the backbone of California's over $310,000,000,000 agricultural industry, a core pillar of our economy. These workers, but also fathers, mothers, grandmothers face significant hazardous health challenges, including chronic diseases and heat stress. LCHCs Promotoras De Salud are hearing that immigrant farm workers are foregoing care. People who can no longer enroll are delaying life saving procedures.

Being able to enroll into Medi-Cal offered this population access to continuous care they need and deserve for their tremendous contributions to our state. But now, many undocumented individuals from all backgrounds and who live in every district in our state could be part of the 500,000 Californians who stand to lose health care coverage by 2028 because of this freeze. California must end the freeze and continue to champion health care access for everyone regardless of immigration status. For these reasons, I ask for your aye vote on SB1422.

Thank you. If there is anyone else in the audience that would like to register their bill, please come to the microphone, state your name, your organization, and your position only. Thank you.

Thank you, Chair Members. Cassidy Heckman on behalf of the California Association of Health Plans in support. Thank you.

Angel Renfrew on behalf of California Association of Alcohol and Drug Program Executives in strong support of this bill.

Thank you.

Kelly Brooks on behalf of the County Welfare Directors Association here in support. Thank you.

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

Nicette Short on behalf of Peach, representing Community Safety Net Hospitals, the Alliance of Catholic Healthcare and Adventist Health in support. Thank you.

Jesse Hernandez Reyes on behalf of the California Undocumented Higher Education Coalition in support.

Thank you.

Craig Pulsipher on behalf of Equality California in support.

Thank you.

Johnny Pineda on behalf of the Latino Coalition for Health California co-sponsored, Lideres Campesinas, TODEC, United for Restorative Good Justice, Regional Powerhouse Network, and, over 100 non profit organizations reflected on the on the analysis in support. Thank you.

Thank you.

Good afternoon, Chair Members. Connor Gussman on behalf of Teamsters California and Unite Here in support. Thank you.

Thank you.

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

Good afternoon. Rosa Bay on behalf of the East Bay Community Law Center here in support. Thank you.

Good afternoon. Sandra Pool on behalf of Western Center on Law and Poverty in support.

Thank you. Good afternoon. Vilma Bocanega on behalf of Hijas El Campo in support and in partnership with the HealthPro Coalition. These other organizations are also in support. Friends Committee of Legislation of California, California Committee Foundation, California School Based Health Alliance, Southeast Asia Resource Action Center, and Centro Vino Cebdio are also in support of this bill.

Thank you. Thank you.

Kevin Guzman of the California Medical Association in support.

Thank you. Trina Maraita, Hijas Al Campo and Health for All Coalition in support. Thank you.

Andrea Rivera on behalf of the California Association of Public Hospitals and Health Systems in support. Thank you.

Alexis Heaton here on behalf of California Coverage and Health Initiatives in support. Thank you.

Thank you. Christine Smith, Health Access California. Proud co-sponsor of the bill with the Health Brow Coalition.

Also adding Healthy Contra Costa, California Rural Legal Assistance Foundation, Survivors of Torture International, and Organizing Rooted in Abolition, Liberation, and Empowerment. All in support. Thank you. Thank you.

Hi. Chloe Amocia with the California Immigrant Policy Center, proud co-sponsor in support, also registering support for Multifaith Action Coalition, Vicioni Compromiso, Coalition for Humane Immigrant Rights - CHIRLA, Building Healthy Communities, Kern, all in support. Thanks. Thank you.

Good afternoon. Gina Bautista with United Way of California in support. Thank you.

Good afternoon. Brian Souza on behalf of APLA Health and Essential Access Help in support.

Thank you.

Good afternoon. Carol Gonzales on behalf of the Spanish Organized for Political Equality, Hope, and on behalf of our friends at Curacao and the Central American Resource Center in support.

Thank you. Jonathan Froxweig on behalf of San Francisco AIDS Foundation in support.

Thank you. Anna Alvarez on behalf of the National Council of Jewish Women California, AAPIs for Civic Empowerment, Alliance San Diego, Greenfield Walking Group, and Comunidades Alias Tomand Action in support. Thank you.

Good afternoon. Austin Smith on behalf of the International Rescue Committee and some more. Thank you.

Hello. Clint Carney on behalf of the San Diego Immigrant Rights Consortium and its members, Survivors of Torture International in support. Thank you.

Thank you. Nicole Wortelman on behalf of the Children's Partnership in support. Thank you.

Good afternoon. Andrea Mapisco on behalf of CPCA Advocates in support. Thank you. Thank you.

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

Thank you.

Good afternoon, Chair Members. Elmer Lazardi here on behalf of the California Federation of Labor Unions in support.

Thank you.

Chair Members, Marvin Pineda on behalf of Homeboy Industries, Children's Hospital of Los Angeles, Asian Law Alliance, California Human Development, Los Amigos de la Comunidad, First Aid Foundation, Calex Caboana Center, Social Equity LA, and Central Valley Opportunity Center in support. Thank you.

Thank you.

Good afternoon. Yasmin Paillet on behalf of Justice and Aging in support. Thank you.

Good afternoon, Chair and Members. Ed Little on behalf of Crime Survivors for Safety and Justice in support.

Thank you. Seeing no other individuals in the audience that would like to register their support. If there's anyone who would like to speak and lead opposition to this bill, this is the time to come forward. Seeing no one, if anyone would like to register their opposition to the bill, please come to the mic, state your name, your organization, and your position. Seeing none.

I will now turn it back to the committee. Senator Smallwood.

Thank you Madam Chair and, thank you so much to the author. I am thrilled to be a co author of this bill. I often say if the pandemic taught us anything, it's that disease does not discriminate and that everyone must have health care. It wasn't that long ago when just being near someone could cost you your

life. And thank goodness for the health care, the access, the treatments, the education of all Californians, we were able to make it out of the pandemic. And, if we don't recognize our history, we're damned to repeat it. And I think this is what this bill is saying is that we have to ensure, that all communities have access to health care, and when we have millions who are at risk, and will lose their health care, we know that puts so many more Californians, at risk.

And and I I understand that this is a serious issue, and I know the legislature is grappling with it in in terms of how do we fund it.

You know, where do those resources come. But it's, not a question of if. It's just a question of how. And I think this, this bill answers the, the unresoundingly, the if. And we must, protect all, Californians, particularly because this population, as labor chair, having worked in with vulnerable communities for for most of my, professional life, This is a hard working population of folks.

It is a group of Californians that are highly employed, but also employed in some of the most vulnerable, working conditions. And if we have Californians who are helping to drive our economy, who are helping to contribute to our safety nets, we have to find a way to ensure that they have access to all of our collective health care. And denying people their health care is not a viable option.

And so I'm happy to support this bill and I'm happy to move it when the time is right.

Thank you. Senator Perez?

Thank you. And, I too wanna express my support for SB1422 and thank the author, Senator Durazo, for authoring this bill and all of the, legislation that she's authored before this bill as well to expand this program. Now I want to make sure that we're having a full discussion about what the expansion of Medi-Cal has looked like through health for all, and read something actually from, the staff report.

And that is, that we saw the last budget bill that was passed in 2022 and the expansion of Medi-Cal, through health for all was fully implemented on 01/01/2024, making California the first state in the nation to cover all income eligible individuals regardless of immigration status and its Medicaid program. Now, I I highlight this because it's important to recognize that we defunded this very program after only a year of its full implementation throughout the state.

Now, the whole nexus, the whole idea and concept behind expanding Medi-Cal coverage to all individuals regardless of documentation status is for two very clear reasons. One, that Senator Smallwood Cuevas just acknowledged, which is that there's this very clear public health benefit. Right? We all benefit when our neighbors are healthy, when the people standing next to us are healthy. Disease does not discriminate.

And so it is very important, especially when we suddenly have a worldwide pandemic or other events like that, that we are taking care of everybody. In addition to that, there is also this anticipated tax benefit that you expect to receive as well. And that is that when somebody is ill, it is better for them to address that illness early on by seeing a primary care provider rather than waiting for that illness to exacerbate to the point when they need to be seen in an emergency room.

And when we do not provide people with adequate care, what ends up happening is those same patients that need care either wait and they do not see a doctor. And then by the time that they actually need care, it's now a necessity, and they have to go to the ER, which is incredibly expensive.

Now this is part of the reason why we saw a pilot program like this be launched in LA County back in 2013. I had the pleasure of working on that through the California Endowment, through Clinica Romero and several other partners that were working together to make sure that this program was successful. And they expanded it slowly over time similar to the way that the state did this as they saw not just the public health benefit, but the economic benefit of this.

And we saw as we folded in different age groups that while there was, an additional cost, right, to increasing the number of folks that were eligible, there was ultimately savings down the road. Now my frustration with what happened with the budget last year is that we defunded this program before we could even see any of those savings be realized.

And so the true kind of picture in terms of this program and the benefit, the public health benefit, the tax benefit, we didn't even get to see. Because by the time we got to full implementation, it was 01/01/2024. And by 2025, we took that funding away. We need to understand, and this is something that's very difficult.

I recognize as somebody that worked in public policy for many years and is now an elected official, it's very hard for government leaders to think past a two year and four year election cycle.

But the reality is that the economic impacts of the public health benefits of a program like this do not get to be realized in these short year to year terms. We have to allow for full implementation. And so I recognize in what you're going to hear is that this is too costly. It's too expensive. That it is too expensive to provide people with health care coverage.

And what I would argue to you is that it's more expensive to not do it. But we can't realize the economic benefits of a program like this unless we allow for its implementation. Yes, there are going to be some big costs. And yes, we saw those costs rise because people were enrolling into Medi-Cal. That's what we want.

We want folks to utilize that healthcare coverage and those healthcare services. So I share all of that because I think as we continue to have this discussion, and as these topics continue to get very politically hot for all sorts of reasons happening beyond this building, it's really important that we center ourselves in fact and in truth.

And if we are going to realize the true benefits of this, which is really seeing the impact, the great impact of providing health care to all residents here in California, we're going to have to let this program be implemented, and it's going to take a few years. That's not a bad thing. Not every single policy we pass, we're going to immediately see the benefits of within a single year.

And I know politically that's not convenient, but that is the reality. And that is how you get true impacts out of something like this. So I'm very proud to support your bill today, Senator Durazo. This is a great effort. It's been beautiful to watch this since, you know, it began as small pilot programs now be realized for the rest of the state.

And you know, look forward to continuing to support your efforts on this front.

Thank you. Seeing no other comments, we unfortunately just lost our quorum. Really want to thank you, Senator Durazo for all of your advocacy around this. You have been a very, very strong, hard fighter and a strong, consistent advocate in this area. You and I have had many conversations about this and I wanna thank you because a lot of times, people just don't think they need to have conversations.

But this is something that you truly believe to your core. And I believe that the vast majority, if not all, senators, legislators should want for people to have health care coverage. Not only insurance, but access. I talk about access all the time. Just because you have insurance doesn't mean that you have access to comprehensive health care.

And that is extremely important as well. We are in very challenging times, which is one of the reasons why perhaps the decision was made last year. You are a 100% correct. And I keep saying this myself. Just because of the cuts that we've made at the state, and unfortunately the things that we're seeing coming down from the Federal Government, people are not gonna stop getting sick.

They're going to continue to get sick. And unfortunately, they're going to have to seek care at this point as some of the places that provide some of the most expensive type of care. Every Californian should be able to access quality, affordable health care. Preventative care is what we really need to be focusing on. The reality is is that that does cost.

And the question is, do we as a state, as state legislators have the backbone to really start looking at pushing and passing through new sources of revenue that specifically support our health care system? If we don't, this will not work. I am committed to continuing to talk with you and work with you as we continue to hopefully talk about various sources of revenue, which I am a 100% in support of.

Because it's not only those that need insurance, it's those that are providing care in the hospital, outside of the hospital, our IHSS workers. Every component of our healthcare system needs assistance.

And we as a state need to get serious about finding new revenue strings to fund it. I support this bill and concept and will continue to work with you on it. I don't think you need my vote to get it out of committee. If you do, you know, you have it. But I really want for us as we are pushing this through to also be pushing those revenue streams.

Those new revenue streams that we have talked about, but this is the time to really get serious about. And with that, Senator Durazo, would you like to close?

Thank you again for, my colleagues, Senator, senators and, Madam Chair. Aye, I appreciate all of your the comments today, the conversations we've had leading up to to today's hearing. I also wanna thank very much everyone who came, everyone who's been supporting, everybody who's building more and expressing more support. Yes. We do have to look at cost.

That's part of our responsibility. Today, we're focused more on the on the policy, but, you know, in our minds, we know that we have to address this and I recognize there's an issue of of of cost. I I'm hoping that that issue of cost with our help will be dealt with and will be dealt with in a sincere way. I think we have the people around us to come up with the with the all the possibilities and the and the options. There's no doubt about it.

We've gotta give that as as you said, madam chair, the courage and the backbone to provide those sources of revenue for the people who need them. And that is all Californians. All Californians. It's not a small group that we could isolate, and not worry about on the side. They are part and parcel everything that happens in the state, what makes California so beautiful.

So, to me, I just, I urge you all to vote for this bill as we move forward. Not only with the content and the policy, but also with what it's gonna take to to keep to keep it working as our best healthcare system in the country. So with that, I respectfully ask for Yavor.

Thank you. And once we establish quorum, we'll be able to take that up. I strongly encourage any authors of any bills to come down. I will present, item number one, Senator Laird's bill.

Thank you Madam Chair. You are recognized when you are ready.

Good afternoon, committee members. Today, I am presenting Senate bill ten twenty three on behalf of Senator Laird. Senate bill ten twenty three increases access to critical HIV prevention medications called pre exposure prophylaxis or PrEP. PrEP is a highly effective at preventing HIV transmission and can be taken in the form of a daily pill or a log long injecting injection. Currently, the billing process for long acting injectable options can be administratively complex if health plans limit reimbursement to the medical benefit.

SB 1023 requires insurers that provide prep through the medical benefit to also provide prep through the pharmacy benefit pathway, which supports timely medication administration. Opening this billing pathway will support smaller community health care providers and make it easier for them to start providing and expanding prep services. SB 1023 will increase access to crucial HIV medication prevention when global health and LGBTQ rights are under active threat.

The bill is sponsored by the California Legislative LGBTQ Caucus, insurance commissioner Ricardo Lara, and the California Department of Insurance, San Francisco AIDS Foundation. Okay.

Equality California. APLA Health. And Los Angeles LGBTQ Center. With me to provide testimony is Jonathan Froxwite, Director of Health Justice Policy with the San Francisco AIDS Foundation. Thank you.

You're recognized for five minutes.

Thank you. Thank you, Chair. Again, my name is Jonathan Froxweig, Director of Health Justice Policy for San Francisco AIDS Foundation, which is a co sponsor of Senate Bill ten twenty three. In the last year for which data is available, almost five thousand Californians were newly diagnosed with HIV. That number was approximately the same the year before that and the year before.

Our state's progress on reducing new HIV infections has stalled out. Although HIV is now a manageable chronic condition, every person diagnosed with the disease must take medication for the rest of their life, manage side effects and complications, and cope with intense stigma. The s this cost not only individuals but also our health system. The estimated per patient lifetime cost associated with HIV is more than $850,000. PrEP is one of our most powerful tools for preventing HIV transmission.

And the introduction of long acting injectable forms of prep has made this tool even more powerful. Unfortunately, the way many commercial insurers pay for injectable prep is preventing healthcare providers from prescribing these medications. These insurers only cover injectable prep under their medical benefit. Meaning they reimburse providers for the medication after the provider has administered it.

In practice, this means providers typically must purchase injectable prep at their own expense, store the drugs at their own risk, dedicate staff time to billing and appealing improper denials, and wait an average of twenty six days to be reimbursed.

These are clearly major barriers especially provide for providers in settings that lack resources. San Francisco AIDS Foundation is one of the largest prep prescribers in California, but we have to turn away patients seeking injectable prep if their insurer only covers the drug under their medical benefit. The Los Angeles LGBT Center cannot provide the injectable PrEP drug, Lincapavir, to commercially insured patients due to difficulties with medical benefit coverage.

This issue is repeating itself at clinics across the state, blocking the rollout of a highly promising HIV prevention strategy. SB 1023 will solve the problem by requiring commercial insurers that already cover injectable prep under their medical benefit to also cover it under their pharmacy benefit.

Because the bill only applies to insurers that already cover injectable prep, it does not expand prep coverage. It also does not increase insurers costs. We urge you to advance this simple solution and thus advance California's progress toward ending the HIV epidemic. Thank you.

Thank you. We'll now go to anyone else in the room that would like to express their support. Please state your name, your organization, and your position.

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

Good afternoon. Jim Wood, California Strategies here on behalf of the California Pharmacists Association in a support if if amended a position. We look forward to continuing to work with the author and the sponsors, going forward. Thank you.

Kevin Guzman with the California Medical Association in support.

Craig Puls from behalf of Equality California, a pride cosponsor in strong support.

Jennifer Snyder on behalf of California Life Sciences in support.

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

Brian Souza on behalf of APLA Health, a proud cosponsor and Essential Access Health in support. Thank you.

Miguel Bastidas with the California Department of Insurance here on behalf of insurance commissioner Ricardo Lara, proud cosponsor of the bill and strong support.

Thank you. We'll now move to any key witnesses in opposition. Please come forward. You will each have two and a half minutes and you're recognized when you're ready.

Thank you, chair and members. Cassie Heckman on behalf of the California Association of Health Plans. I wanna start by thanking the author, the sponsor, and his staff for engaging with us early on this issue. However, we remain concerned with the proposed legislation and respectfully have to oppose it today. SB 1023 mandates health plans cover certain anti retroviral drugs used for the prevention of HIV and AIDS has both a medical benefit and an outpatient prescription drug benefit.

As noted in the analysis, health plans are already required to cover these drugs without step therapy or prior authorization. Therefore, our primary concern is that SB 1023 sets a concerning precedent regarding a plan's ability to structure their own benefits. Benefit design structure is an area that has traditionally been within a plan's purview and is based on clinical care guidelines, actuarial considerations, and regulatory standards. Legislative mandates that change how plans structure their benefit design is not only costly, but creates confusion and reduces flexibility.

It also undermines their ability to design benefits in a manner that is clinically appropriate and responsive to patient needs.

Unfortunately, we have observed similar approaches in recent legislation which raises significant concerns for our members, particularly because health plans are already providing their enrollees with broad coverage for these drugs. Additionally, we are concerned about the provisions that expand existing law to drug products and drug devices because this would automatically prohibit newly approved and potentially costly treatments to prior authorization and step therapy when there could be an equally effective and more affordable treatment available.

I wanna thank the author and sponsor again for engagement with us on this issue, but due to the concerns stated, we must oppose it today. Thank you.

Good afternoon, chair members. Matt Akin. On behalf of the Association of California Life and Health Insurance Companies, also respectfully oppose the SB 23. I would like to align my comments with my colleague at cap and reiterate we are concerned with the precedent this bill would set regarding a plan or insurer's ability to structure their own benefit designs. Health plans and insurers distinguish between medical and pharmacy benefits based on how and where a drug is administered.

Generally, pharmacy benefits are from medications people self administer, while medical benefits cover drugs given by a provider in a excuse me, in a clinical setting like a hospital or a physician's office. This four bill would board that long standing distinction by requiring provider administered drugs to be treated as outpatient prescription drugs, even though they are not self administered and are delivered in clinical settings. This approach departs from established industry standards and would create unnecessary operational and administrative challenges.

We are also concerned with the bill's requirement to cover prep and out of network pharmacies in cases of a met of medical emergencies. PEP is appropriately considered emergency treatment and is already covered under existing emergency requirements.

Prep, however, is not an emergency service and we are concerned that treating it as such would be a significant new coverage mandate. For these reasons, we respectfully remain opposed, but we appreciate the conversations we've had so far with the author and sponsors and look forward to continued engagement if the bill moves forward today. Thank you.

Thank you. I'll now open it up to anyone else in the room that would like to express your opposition. Please say your name, your organization, and your position. Seeing none, we'll bring it back to the committee. No.

So I do need some I was hoping to get to support on this bill. I do need some some clarification, because as I understand, PrEP, it is currently and I'm hoping that the sponsor can can help me understand this. It when it's currently prescribed and administered, that happens within the provider's office.

So should this bill pass, the new process would be that, the patient would either have to go to the pharmacy, pick up the prescription, bring it back to the provider to be administered, or the provider would have to order it, wait for the pharmacy to bring it back. Is that is that accurate?

So you're correct that for injectable prep that's administered in a clinic in the provider's office. But this bill would not change how injectable prep is administered. It only affects the billing process. The drug would be shipped from a specialty pharmacy to the provider and be administered to the patient there, which is, if, when the drug is covered under the pharmacy benefit.

So from, the health plans, what is is my description accurate in terms of how a patient would access the treatment or prescription?

Yeah. That's my understanding as well. And I think our primary concern is, as I stated, the precedent that's being set in this bill. It it could start with one drug and then it can move to others. And my understanding from our plans is that this could create a bifurcated process where, you know, typically they go into a doctor's office.

It's a medical bill. And then you have a situation now where they're going into the doctor's office for a medical visit, but then there's an additional bill for the pharmacist or for the prescription drug. So then there would have to be some reconciliation on the back end that according to our plans, would would, you know, cost them and have some administrative burdens.

So I'm trying to decipher if it's administrative burdens. I think the whole purpose and intent should be offering an ease of care. And I'm not quite sure if this helps it or hurts it, which if it's simply administrative, I mean, you all figure out a lot of, you know, complex things very well. But I'm worried that it could postpone treatment, prolong treatment, for a patient. And that's what concerns me about the bill.

I'm I'm gonna lay off of it, and hopefully, you guys can work together to find a a middle ground. And when I see it, on hopefully on the floor, maybe I can get to a yes. But I just I need some clarification on that.

So if I can, interject and this isn't

Do you want my bill? Your clothes?

I just wanna address your Oh, okay. Perfect. Yeah. The issue of patients coming in and bringing their medications for to be injected is not something that is new. I have had patients that pick up their medication from, a pharmacy or get it somewhere else and they come into the clinic and my nurse will inject it.

So, whatever kind of administrative burden they're talking about, it's been done in the past. They can figure it out. I think one of the issues though is, about the ability for more people to be able to access this medication. When you look at, a medical benefit, the actual provider or clinic essentially has to put the money upfront before they can get the medication versus them getting the medication from a pharmacy benefit. Right?

And the patient can come in. And so the question is, especially in certain areas, providers may or may not be able to put up the funds, wait for reimbursement, and those kind of things. So it really actually does improve access. From my standpoint, it doesn't slow it.

Thank you. And would you like to close?

Oh, sure. On behalf of, Senator Laird, just respectfully ask for an aye vote on SB 1023. Thank you.

Thank you. We do not have a quorum, so we will now move We'll move to file item number three.

We are now on file item three, SB 1071. Senator Ochoa Bogh, you may begin when you are ready.

Thank you madam chair and members. Senate bill ten seventy one provides a legal path for families to amend a loved one's death certificate when a court has determined the death of a homicide, which will ensure California's public records accurately reflect those legal findings. Under current law, next of Kin may request certain corrections to a death certificate, including typographical errors or amendments to the cause of death with a physician's certification.

However, there is no process to amend the manner of death, even when a court of law has ruled a death a homicide. SB 1071 would allow a victim's next of Kin, after an appellate rights have been exhausted, to request an amendment so the official death certificate reflects the court's legal determination.

I'd like to make clear that SB 1071 does not allow any changes to the medical examiner's or the coroner's opinion on the manner of death, which will remain documented in the autopsy protocol or other medical documents that were produced at the time of death. It also it's also important to note that while the cause of death requires certification by the medical examiner or coroner, the manner of death does not require certification on the death certificate.

SB 1071 only allows an amendment to the manner of death on the state's official legal document recording a person's death and only after a legal determination of homicide. All medical opinions in medical records are preserved And all certified medical opinions on the death certificate are preserved. Joining me today are Ivy Fitzpatrick, chief deputy district attorney with Riverside County DA's office, and Candace Lightner, founder of We Save Lives and Mad and co founder of Not an Accident Campaign.

Thank you, Senator. You will have a total of five minutes for your presentation today.

Do I push? I know. You're good. Go ahead. Did it work?

Okay. Yeah. Hi. Thank you. I'm here today on behalf of thousands of victims and survivors of impaired driving and drug poisonings in California to thank you for hearing SB 1071, a bill that finally brings truth and honesty to our loved one's death certificates.

My daughter Carrie, right here, forever 13 was killed on 05/03/1980 while walking to a school carnival. She was hit from behind, thrown a 125 feet, and left in the road to die. In my grief, I tried to share her organs so another might life might be saved, but her body was so badly damaged that nothing was salvageable. Nothing.

I later learned the man who killed her was out on bail from another hit and run drunk driving crash the night before and had three prior drunk driving convictions in four years, yet still held a valid California driver's license.

Unfortunately, my daughter's story is not unique. Precious Rosenda Rose, Elizabeth Smiley, forever 14, was killed on 05/25/2024 also by a multiple repeat offender drunk driver who had signed the Watson advisement on his first and second convictions. He is now charged with murder, yet her death certificate also says accident. There are so many more heartbreaking stories. For decades, I have worked to remove the inaccurate inappropriate word accident from our language and our laws, launching the crash not accident campaign at We Save Lives.

Calling these deaths accidents misrepresents what happened, blurs the line between tragedy and wrongdoing, and helps negligent and reckless drivers evade full accountability. Imagine my shock when I saw my own daughter's death certificate and read accident under manner of death. Wrong. Carrie was killed in a drunk driving crime, a violent crime by a drunk driver, a criminal who was convicted of vehicular manslaughter, and they want to say under manner of death accident, it was a homicide.

SB 1071 gives families a way to correct this injustice.

Victims deserve honesty. Families deserve records that reflect what really happened, not language that erases culpability. And as policy makers, you deserve accurate data because accurate data saves lives and inaccurate data costs them. I urge you, please vote Aye on SB 1071 for truth and for every family whose loved one was not lost in an accident by but killed by someone who chose to break the law. Thank you.

Good afternoon, Madam Chair, honorable committee members. My name is Ivy Fitzpatrick. I'm a Chief Deputy District Attorney at the Riverside County District Attorney's Office. In simplest terms, this bill would provide a mechanism to amend the manner of death on a death certificate after a final determination regarding the same. When a person dies and an autopsy is performed, there is both a cause and a manner of death listed on the death certificate.

Cause is the literal medical scientific cause of that person's death. And that cause of death is certified appropriately by a physician on the death certificate. Manner of death is much different. However, unlike cause, manner is not certified on the death certificate. And also unlike cause, manner is also not purely medical or scientific.

It is derived from the medical legal death investigation, death investigation, which is two, three days or so after the death, including the decedent's intent, as well as the actor's intent in causing the decedent's intent death, such as whether there were volitional harmful acts or intent to kill. The example of vehicular homicides demonstrates the problem that this bill seeks to solve. Currently, when a victim is killed by an impaired driver, the coroner typically classifies the manner of death at that time as an accident, not a homicide.

This is not altogether surprising because the coroner will not have all of the information necessary to rule at a homicide at the time of the autopsy given the early stage of the investigation. However, after the death investigation is complete, there's been a trial or in most situations with these appellate court has upheld the court's legal determination.

All due process has been afforded to the defendant, and there is a final legal determination of homicide. Legal determination of the manner of death which is homicide, not an accident. SB 1071 seeks to have the state's official legal document regarding a person's death and the death certificate reflect the legal determination of the manner of death.

Thank you.

For this re for this reasons, I ask for your aye vote respectfully.

Thank you. If there's anyone else in the audience that would like to register their support, please come to the microphone. State your name, your organization, and your position only. Thank you.

Good afternoon. I'm doctor Phil Moore Smiley. I represent not an accident campaign, but I really represent my daughter, Rose, who was murdered by a drunk driver before they took her lifeless body away that day. The man who killed her had been charged with murder, yet she was still categorized as an accident. Her death was not an accident.

Thank you.

Thank you. Just a reminder, your name, your organization, and your position, please. Thank you.

My name is Kelly Nalavaya with not an accident. My son was murdered on November 23. We ask for your aye vote on this bill for justice. Thank you.

No. It's okay.

Sorry.

My name is Carol Schweiger. I'm a founding member of the net not an accident campaign, and I'd like your support on SB 1071. Thank you. Thank you.

My name is Matt Capaluto. I'm here in support of this bill on behalf of the Organization Stop Drug Homicide, on behalf of the not an accident campaign, and on behalf of my daughter, Alexandra Capilouto, whose death certificate wrongfully states accident despite a man being held liable for her death and in prison today.

Thank you.

Thank you.

My name is Regina Leah Chavez. This is my beautiful girl. I'm also with the empower and resilience project in Placer County. My daughter, her case got the first murder conviction for fentanyl poisoning. I strongly, strongly support this bill, and I hope you all do too.

Thank you.

Good afternoon, Lieutenant Julio De Leon. I'm here on behalf of the Riverside County Sheriff's Office and, elective sheriff Chad Bianco in support.

Thank you.

Good afternoon. My name is Lorena Espino. My my daughter Brianna was murdered by fentanyl poisoning and a man was convicted. But yet her death certificate list her death as an accident. So I need this matter to be considered very urgent.

Thank you.

Thank you.

I'm Laura Didier, mother of Zach Didier Forever 17. We also have a conviction. I strongly support this bill. Thank you.

My name is Charmaine Apodaca on behalf of This Is Not An Accident. This is our son Keanu Apodaca. It was not an accident by fentanyl poisoning. I support the bill. Thank you.

Hi. My name is Carol Flores Wilson, and I am here in support of, representing my daughter, Melissa Wilson. This was not an accident, and I'm in strong, very, very strong support of this bill, SB 10 sorry, ten seventy one. This was not an accident. So thank you very much.

Thank you.

My name is Merica Cole and I'm in strong support of this bill. My son, was autistic and conserved but he was killed by carfentanyl in a drink form by somebody he knew. His death was not an accident. He was, it was homicide. So, please, I respectfully ask for your aye vote.

Thank you.

Good afternoon, madam chair, members. Ryan Sherman with the California Narcotic Officers Association, in strong support of the bill along with the other law enforcement associations listed in the analysis. Thank you.

Thank you.

Seeing no other, individuals that would like to speak in support of this bill, we will now move to lead witnesses in opposition. If you wish to speak, lead opposition in in opposition, please come to the table at this time. You have a total of five minutes and you may begin.

Thank you. Madam chair and members, Corey Salzillo on behalf of the California State Coroners Association, expressing sympathy to the families here today, obviously. And this is not, a reflection of any sort of judgment on, whether or not the, criminal acts that underlie all these awful cases, should be considered homicides in the eyes of the law. We appreciate the intent of the bill, to provide families with a mechanism to reflect the judicial outcomes in a particular case.

But this bill, fundamentally blurs the critical distinction between medical determinations and legal findings resulting in significant unintended consequences.

Death certification is a medical determination grounded in forensic science, professional expertise, and independent investigation. The manner of death, is determined by qualified medical examiner or coroner based on established principles and the totality of investigative findings at the time. A judicial verdict offered often rendered years later and under a different evidentiary standard serves a distinct legal purpose and should not retroactively, alter a medical certification.

The bill permits amendments to death certificates to the state registrar who's not medically or forensically trained and is not involved in the death investigation directly. This process by created by s p ten seventy one would override the independent judgment of the certifying official and undermine the scientific foundation of death certification.

Also, allowing legal outcomes to dictate changes in manner of death would compromise the accuracy and reliability of public health data. Death certificate information is used at local, state, and national levels including by the CDC to guide public health policy, allocate resources, and secure federal funding. Artificial alterations to manner of death classifications would introduce inconsistencies and distort critical datasets. Our system depends on maintaining a clear separation between forensic medical findings and judicial proceedings.

This bill moves in the opposite direction by conflating these roles, increasing the risk of perceived actual conflicts of interest and undermining public trust in the death investigation process.

Additionally, retroactively amending death certificates based on judicial outcomes could create discrepancies between autopsy reports and official records leading to confusion for families, legal entities, and financial institutions. There are already established protocols for reviewing and when appropriate amending death certificates. These decisions properly reside with the investigating medical legal agency. The outcome of a criminal prosecution is not and should not become a basis for altering a medical determination. The bottom line is that a court's abstract of judgment and a death certificate can and should exist independently.

I I'm I'm concerned that we're implying with this bill that truth and honesty are not hallmarks of what the physician medical examiner corner is working with in this. And again, the death certificate is not and it's not meant to be an indication of criminal culpability. It's a different standard and a different process. And homicide in a death certificate, that means death at the hands of another. It's a neutral determination.

And when a court says homicide, that's based on a different standard based on the introduction of facts and the finding of fact by a jury or a judge. So again, with sympathy to the proponents of this bill, we respectfully ask for your no vote. Thank you.

Thank you. If anyone else would like to register their opposition, please come to the microphone. State your name, your organization and your position. Seeing none, we'll bring it back to the committee. Senator Caballero.

Thank you, madam chair.

I wanna thank everybody for coming here today. Really appreciate the pain and the and the concern that that you've raised here. Let me ask a question of the opposition because I understand what you're talking about. But as I look at the form, what's being proposed here is a change. And change is always difficult.

And I get the the you want a what the form is is is stating are the facts that they find in regards in this instance in regards to someone who is deceased who comes in and the coroner is trying to figure out how how did they die. Right? So so the death caused by is is where the coroner looks at the details of the injury and makes a determination of what caused the death.

And I don't think anybody has any disagreement that that's, that should not be touched. What is being discussed here is the specific reason for why the deceased died the way they are.

And, accident is doesn't tell us much as we collect data. Because you don't know what kind of accident. Did they fall off a cliff? You know, were they hit by a car? And so, it's a category that is so broad that it really doesn't tell you much.

And if the space was big enough, it could say, vehicular homicide. In other words, the detail would be, could be articulated. And I get that a coroner can't make that kind of analysis because there isn't data in front of them to to to do that. If a court is making a determination, what is the problem with having the court issue an order as part of the homicide decision? Usually it's by plea or at jury trial.

That the death certificate should be amended to show that it was a vehicular homicide that was the real cause of death. And I'm looking at here because one says cause and one is Manner. Cause is the one above. And the other one is Manner. Manner.

That's right. Manner. I'm sorry. Thank you for that.

What's the problem with with that I guess if we're collecting data and this is what's important as part of this and then, and what's the problem with the data being specific so that we know how do we compare to other states and what laws do we need to change or what are the things that we need to, to, to, to, I guess I just have a hard, this is a document that we prepare, we, that is prepared as part of what will follow that individual for the rest of their lives.

I'm looking at going back into my family to figure out lineage and DNA and you know the death certificates and birth certificates are really principle when you look. And this stays with the family forever. What's the problem with if, if a court has reached a determination and, using that this requirement as a, to link it so that it can't be changed just because someone calls up and says, I want you to change it. The only way it gets changed is by a court order.

And the clerk, they can't do it all by themselves.

You said a number of objections and I'm just trying to get down to the one that I think is the biggest or the naughtiest problem is what really is the problem. I get it. The corners don't want anybody messing with their documents. But the only way you can do that would be with a court order. Through the chair.

Yeah. The problem is is that the death certificate is not intended to be the final legal explainer of what happened. It's just not that's just not what the document is. As you said, the the death certificate relays the cause and manner of death that causes the the the medical situation. Right?

You know, cardiac arrest or massive loss of blood, whatever the, you know, that the the doctor's gonna determine is the the physical reason why the person is no longer alive. The manner of death, the corner of the medical examiner is living limited to five choices. Suicide, homicide, natural, accident or undefined. And and that's the way it is and there have been discussions for decades about is that the appropriate list? Should it be expanded?

Should we have an additional category? Should we, you know and candidly that's a different discussion. But the the problem is is you've got a different finder of fact. Right? So you have a finder of fact in the beginning which is the corner of the medical examiner.

Saying based on my medical knowledge, my investigative skills, I'm making a determination that with the information I have before me that this was a death and let's take an example in a car accident. That there was an accident. I can't determine that there was a criminal level of culpability that raises this to a homicide. Was this at the hands of another or was this because of the circumstances?

Now a court can go back and say, look, we have legal standards for what constitutes a homicide and we can say with all the the facts that are presented by both sides, witness accounts, whatever the case may be, finder of fact will then say, in our opinion, this is this is a homicide.

This is a murder. This is a Watson murder. This is a vehicular manslaughter. This is a poisoning via fentanyl. And the court can say, this is a homicide.

But there's what we haven't heard is a sort of a and I'll try not to answer a question with a question, but what what is the necessity of those two documents saying exactly the same thing? They're not meant to be the same document.

No. I get it. So what what what would be the situation if a court makes a determination, sends it to the coroner, and the coroner has problems with the, the changing of the document and can communicate that to a court. I'm just trying to figure out. I I have a hard time understanding why we wouldn't wanna do it.

And I get the the different the different context. And maybe we need to expand the different categories so that we have a little bit more information. But, but I'm struggling to understand. You're struggling to understand why they'd want it and I'm trying to understand why. And I apologize I need to run but I'm trying to get

To the chair, I I understand the desire to have the the medical documents say, look, my my son or daughter was killed by a person. Right? This is a Watson murder. This was a a drunk driving, a fentanyl poisoning, whatever the case. I I get that.

The what I don't necessarily understand is why this sort of notion that these two documents have to reflect the same exact conclusion when they're not based on and they're not determined at the same point in time. The death certificate is understood to be this is what the doctor and the investigator's findings are at the time of death or, you know, very closely proximate to the time of death.

And that the abstract of judgment that says guilty of one eighty seven penal code homicide, that could be years and years down the line. So then a court comes back and says, you know, petition or ordering a change to the death certificate. So now you've got autopsy reports and medical finding and testing that everything that goes to accident or whatever the the case may be.

And then you've got an abstract of judgment that says homicide. And so now if the death certificate is then replaced, now you've got all of this stuff that sort of leads up to accident and then the death certificate says homicide. So you have this internal consistency on the front end of the medical documents. And that's that's part of the

Got it.

The concern on the part of the

And I my I guess my response to that is as long as they're not inconsistent then a change But

they are. They're necessarily gonna be inconsistent. Well,

it it's an accident. It is is just a an assumption based on a body coming in that looks pretty messed up. And the information that they pulled the individual out of a car. It's not based on anything else and that could be consistent with having been run over by by someone who's intoxicated. And that may even be in the police report that the the coroner looks at when they're doing the autopsy.

Because all of that information gets received by the coroner. So, so, that's I understand what where you're coming from and I do apologize. I need I need to run it.

If I may just really quickly respond, to Senator Caballero's question. Couple of things that was mentioned and I think it's it we need to clarify. First of all, there's two options right there with regards to and their differentiation being the cause of death, which is a medical interpretation certified by the coroner. The manner of death is not certified by the coroner. So we're not questioning the cause of death because they're working with what they have at the time.

What we want to have clarity on is the manner of that what was originally considered an accident based on the evidence at the time to be clear and reflect the truth of an outcome after investigations have been completed. Clarifying the manner of death which is not certified by the coroners or the medical examiners. So there has to be clear there's gotta be clarity. We're not changing anything that has been certified by an authority in place. We're just clarifying.

And, I usually don't I just need to ask a clarifying question because I now I'm confused about something. So you just stated that the manner of death is not certified by the coroner or the physician. Is it not on the death certificate?

I'll have my, extra Is the

manner of death on the death certificate?

Yes. If you read it If I believe you have the death certificate.

Yes. So So I'm confused to section Who signs the death certificate?

Right. So if we look to section, it says, well this is an older one but it'll say on there cause, I have a recent one, the recent death certificate. It says So, I have

So, I have this

one Nine is highlighted 29. Right here. It says

There's cause of death which is on Section 107. Do you see this on this? That's an older one, the one that is the copy of Carrie's. But this one, you can see the cause of death. And then if you go down here to the, it says, I certify the best of my knowledge that the death occurred at the hour, date, and place stated from the causes stated.

From the causes stated. It doesn't say, I certify the manner. It's very similar to the birth certificate. If we look at the birth certificate, the physician at the time of the birth, it says and I've probably and probably the doctor here knows

better than I do because I have my name for many births.

Time it date says date time place and it was a live birth. Right? Or something like that. It doesn't certify the name, the gender, the you know, all these sorts of things on there. Meaning, what what is actually at the certification line or those things.

So what we have before us is not an actual death certificate.

This is an older version of it. If you would like to see, madam chair, I can see the new one. Yeah. Okay. This is the modern.

Yeah. This is the plan.

I guess they've changed since I don't really know.

Sorry. I wasn't aware it changed so much. Can you bring it up? Yes. I can

bring it up.

Some If we look at Section 107 is if it's in a hospital right below that is I think it's 109 is the by the corner

manager. So he doesn't certify the manager.

Alright. But what I'm seeing here is that there is someone who certifies the cause of death on this one, but the coroner still certifies the manner of death.

It says on there, I certify what the certification language is is I certify the time I know I'm in front of you now. But time, place, something, and causes of death. So they're writing

I certify that in my opinion, death occurred at the hour, date, and place stated from the causes stated. Cause. Manner of death and then you check. So from my interpretation, whoever the coroner is is certifying the manner of death because they are signing under that. But I just I'm gonna turn it back over.

I just wanted to get, clarification on on that because if they weren't certifying it, then we're, you know, why were they signing it? But it looks from the new ones that they do actually certify the manner of death. But go ahead.

So thank you, madam chair. You kind of answered some of my questions here. But, one, I am a co author of the spirit bill. It's an it's it's a necessary for honesty, for truth, for dignity, for closure for families. We're gonna see I'm gonna see this bill again in judiciary.

So a lot of the legal questions, I'll I'll ask there. But I wanna Kinda focus on the health implications. And this, you know, the two most important government documents are birth certificate and a death certificate. And the certificate of death is does not belong to the coroner. It belongs to the individual.

It belongs to the people of the state of California and or the county. And I think it is so vitally important that we have the most accurate data that is gonna live live beyond today, tomorrow. It's gonna live beyond news articles. It's gonna live beyond family stories so that we better understand the health data and reason for deaths a hundred years from now. Two hundred years from now, if that's the case.

And having the most accurate information, even if that information needs to be updated after determination from a court is vitally important for our understanding of health needs in the state of California, which is why I'll be supporting this bill. I would like to ask, that, you I think we could probably make this better. There's probably a lot a bigger conversation to have. So I would ask that you continue to engage with the author to make sure that we're getting this right.

Senator Dorazo.

Yeah.

I've got lots of questions which I don't think can all be answered today. But I've always assumed that the death certificate was more along the lines of a medical document than anything else. And a lot of questions about what impact could this have if we merge them more. I think that's what you're asking to merge more of the the information.

What it could potential that it could have on the court or the legal proceedings, you know, when you when you change something that's been done in a certain way for so long.

How does that, you know, let let's just say that there are criminal proceedings or charges filed. How does this impact that that legal process if it's gonna be used if you're gonna use both of them at the same time or I I'm I know I'm probably asking this in a very confusing way because it's one, I've always just understood. One is one, it's medical and the other one, documents are legal court proceedings. And they have different purposes.

They have different, you know, they don't have this they're not looking for the same outcome.

So I'm I'm hesitant to make these changes because I don't know what all the impact is going to be way beyond just changing some words. This isn't just changing words. This is changing potential outcomes in that affect a lot of people. So it's just very unclear to me all those potential, impacts that it could have. And, I just don't have enough information in front of me to be able to make such a a solid, decision.

But I I I if if you were to get this, passed, there's gotta be a way of fixing it because it's it's not it's not clear enough that we should take the risks to move forward with it in my opinion.

Thank you, mister.

If I may. I think, you know, it's very well stated by our our sheriff in Riverside that spoke this morning that said, you know, we the only two documents that a family has will be the birth certificate and the death certificate of a child.

If I may. I think, you know, it's very well stated by our our sheriff in Riverside that spoke this morning that said, you know, we the only two documents that a family has will be the birth certificate and the death certificate of a child.

What we want to ensure is that there is clarity on the outcome manner in which a person died. Manner, which cannot be fully defined at the time of the initial inspection of a body. It's important on the on the basis that the manner of death on birth certificates is what we use in data in analyzing what is happening in our state.

It is that data reflected on the manner of death on birth certificates that we use to legislate, to create policy that keeps Californians safe. That's why it's important. Once again, there are five options and I will defer if the chair will allow. I will defer to my expert witness here. But there are only five ways in which a manner of death can occur right now.

Five manners in which the Coroner at the time with the initial body that it has before it can certify the cause of death. One of them being an accident. But that accident can be clarified, can be changed from an accident to a different manner of death only after it's been investigated. And that manner of death per this bill will only happen after all, what is the word? legal proceedings have been concluded.

So once that is completed, then we, through the courts, through an investigative process, a constitutional process, can we actually have clarity on that manner of death.

And our records in our state, including our family, should have clarity and truth and honesty on what that manner of death is. That's why it's important. It's important to have the ability to actually amend it, to have clarity of what has happened. And then also for our own purposes because this is what we use to literally gather data in our state that directs policy in public safety. I'm If I may just defer to if there's anything that I missed.

No. I think we're okay. Okay. So I do have a question for the opposition around data collection. You mentioned that there are five choices.

Are these five choices that California has chosen? Are these national five choices? What are what are we looking at here?

It's my understanding, Madam Chair, that it's that those five choices are generally accepted through the medical legal excuse me, the medical examiner profession. Those are national standards.

And that's important to me. As a provider, as someone that looks at data. Because if we're looking at data points, then they must be consistent. If we're changing ours and adding six, seven, eight categories, potentially, I'm just saying, which doesn't align with the other 49 states, then when we are looking at national data and the and the reason why this peaked is because you were talking about statistics from the Center for Disease Control.

And that they look at these things to determine national trends, not just state trends.

And so if we are going in a different direction, it's gonna be challenging for California to be able to be a part of any national data collection from a health standpoint. And that, is of concern for me.

I do want to mention that there are a number of other states interested now in doing this.

And I appreciate the interest. What I look for is movement, right? So if again, if it's not a national change, then the national data will be skewed. I thoroughly appreciate you bringing this bill forward.

I thought, to be quite honest, it was a lot more straightforward than what I am learning today, during the hearing. I wanna thank all of those who came to speak and support. It is not easy to come and share your story. And as a mother, my heart breaks with each and every one of your losses. I'm not sure what is going to happen with the bill today.

We don't have a still don't have a quorum, so we can't vote on it. But I feel like even if this isn't the method, there must be something that we can do to ensure that whatever the the coroner or the physician and that data set isn't disturbed. But we're still able to somehow provide that inform the updated accurate information for the families. So, appreciate you bringing the bill forward. Would allow for you to close and at the appropriate time, you know, we'll vote.

And if it doesn't get out of committee today, would love to sit down and talk with you about some other potential options.

Okay. So on that matter of death just for clarity, we're not adding categories to the manner of death. That is not the intent of the bill. It's not to add categories, Ma'am. What we're trying to do is when one of those options state an accident and it is determined legally that it was not an accident, the family has the ability to amend that original statement of an accident into homicide, which is already one of the five already manners of death within that certificate.

So we're not adding anything. We're not changing anything from the original examination. All we wanna do is that when one of those five, which includes an accident, is determined legally that it was in fact not an accident, the families have the ability to amend and reflect the updated, accurate reflection of that manner of death. Which, quite frankly, our corners would have no idea that would be the case at the time because not all evidence was there. So that is important to note.

Accurate death certificate data, And by the way, we would be leading the nation on this effort. It's not something and then once and the response that we that the organization has received as far as ensuring that people are aware because I think most people, just as an FYI, the average person, when they think of the death certificate, they think that it reflects the actual manner of death.

As a matter of fact, the majority of folks that I have spoken with about this bill or have read about this bill are absolutely shocked that it that's not the case. So we all assume that it does that, but it actually doesn't which is why we want to make sure that we are able to literally modify that original misinterpretation or not misinterpretation but just I guess misinterpretation. That's the only word I can think of.

Mislabeled. Thank you. Mislabeled, end.

So very much important to delineate that. So accurate death certificate data does more than just provide closure to families. The information is transmitted to the state registrar and the California Department of Public Health, Where it forms the basis for certified death certificates and state wide vital statistics. This is why it's so important.

Those statistics directly inform public health research, guide criminal justice policy decisions, and shape state what data systems that lawmakers and agencies rely on when addressing. In this case, such an example, impaired driving and other preventable deaths.

This bill is about truth and justice for victims and their families. Drunk and impaired driving deaths are up in California. And death certificates should accurately categorize these deaths as homicides, not accidents. I respectfully ask for an aye vote.

Thank you, Senator. Unfortunately, as I stated, we still do not have a quorum. Once we have a quorum, I believe the motion has been made. Yes. And so we'll be able to take it up at that time. Thank you.

Thank you, madam chair.

Alright. So we will now move back and file order to file number two, SB 1057 by Senator Becker. Senator Becker, you may begin when you're ready.

Thank you. Good afternoon, Chair and members. First, I would say this bill comes out of our experience of a friend of mine. SB 1057 represents a common sense shift towards a short of justice in the healthcare sector. This bill modernizes the certification process for a certified nurse assistants and home health aids.

It moves the states away from a rigid automatic denial system for individuals with criminal records and works towards discretionary rehabilitation first model. By prioritizing current character and proven rehabilitation over past mistakes, California can build a stronger, equitable, and sustainable workforce. Currently, California is facing a massive shortage of frontline caregivers by removing, permanent barriers for qualified rehabilitated individuals. This bill expands the labor pool for nursing homes and home health agencies without compromising safety.

Rather than a blanket ban, SB 1057 requires Department of Public Health perform an individualized assessment based on three specific factors.

One, the actual nature and gravity of the offense. Two, the amount of time it is a lapsed since conviction. And three, concrete evidence of rehabilitation such as recent work history and character references. For the bill lines, healthcare licensing with our states broader fair chance employment goals. Except, if the judicial system has recognized individuals rehabilitation, our licensing board should do the same.

Supporting this bill means supporting the dignity of our workers and most importantly the quality of care for California seniors and those with disabilities. With today, with me today to testify in support is Ed Little with Californians for Safety and Justice. Thank you.

Thank you. You have a total of five minutes.

Thank you.

Good afternoon, Chair and Committee members. My name is Ed Little, and I'm the Government Affairs Manager with Californians for Safety and Justice and proud cosponsor of SB 1057. Californians living with past convictions face lasting barriers to sustainable work, safe housing, education and other opportunities to succeed. This bill would increase access to direct care workers, jobs for people with past records by aligning Department of Public Health Certification Standards related to conviction history with those of other healing professions under existing law.

AB 2138 passed by the legislature in 2018 established critical protections and greatly improved access to licensure for people with records, including for registered and vocational nurses, physicians and surgeons, clinical social workers, and more.

However, under existing law today, people seeking certifications for similar patient care roles such as certified nursing assistants and home health aids are not afforded the same protections. This bill seeks to close that gap. This bill is a critical step toward not only ensuring fair opportunity for people with past records to pursue meaningful career, caregiving careers, but also addressing California's direct care workforce shortages.

Extending accepted standards and practices for considering conviction history and other health care giving fields to CNA and home health aid certifications will help achieve these goals. For these reasons, we ask for your aye vote on SB 1057. Thank you.

Thank you. If there's anyone else in the audience that would like to register, they their support, please come to the microphone, state your name, your organization, and your position. Seeing none, if anyone would like to speak as a lead witness in opposition, this is your time to come forward. Seeing none, if anyone would like to register their opposition, please come to the microphone. State your name, your organization, and your position.

Hi. Sorry. Support. Andrea Maviska on behalf of CPCA Advocates in support of the bill. Thank you.

Seeing no further individuals that would like to speak, we'll bring it back to committee. Not seeing any questions or comments. Senator Becker, would you like to close?

Well, thank you. I think, you know you can see this was a bill that we wrote in in conjunction with our, some of the organizations mentioned because stressing a specific problem that I've, you know, I've again, I've seen myself and hoping that today we can move this forward and continue to move forward in the process and accomplish the goals which are to allow people who have been through rehabilitation to serve in these capacities that are much needed.

So with that, I respectfully ask for an aye vote.

Thank you, Senator Becker. And once we get a quorum, we'll be able to take this up.

Okay. Thank you.

We will now move to file item number four, SB 1088 by Senator Blake Spear.

Senator, you are recognized when you are ready.

Okay. Thank you. Thank you, chair and colleagues. I am pleased to author SB 1088, which is sponsored by the Coalition for Compassionate Care of California. This bill will help ensure people receive the medical treatment they desire at the end of their lives or when they are no longer able to express their wishes.

As a former Wills, Trust, and Estate Planning Attorney, I worked with clients who care deeply about charting their own exit, and I've seen firsthand the deep significance of advanced planning. Advanced care planning is the process where a person declares and documents the type of care and medical treatment that they want and that they don't want should they become incapacitated. There are three legal tools for communicating one's care preferences.

Advanced health care directives, pre hospital do not resuscitates or DNRs, and physician orders for life sustaining treatment, which is otherwise known as a POLST. Advanced health care directives allow a person to designate someone to make medical decisions on their behalf and explain what medical treatment should be done if they lose decision making abilities as a health care agent.

However, an advanced health care directive expresses preferences. These are not medical orders. The instructions can be vague, and providers and the designated decision maker may view them as general guidance rather than clear and compelling instructions. The other two two tools are the prehospital do not resuscitate DNR and and the POLST. While a DNR limits resuscitation attempts following cardiopulmonary arrest, a POLST allows a patient to decline interventions like CPR, ventilators, and feeding tubes during any life threatening emergency.

Both prehospital DNRs and pulse are highly specific, standardized, and signed by a medical provider, making them binding medical orders that other health care providers are required to follow. SB 1088 aligns the three planning tools and makes important modernization updates. First, in recognition that physician assistants and nurse practitioners can sign a pulse, it updates the name of pulse to be port portable orders listing scope of treatment and allows those providers to also sign a hospital DNR.

It also clarifies that POLST and prehospital DNR forms are entirely voluntary and that care cannot be conditioned on completing one. It clarifies who can sign a POLST on behalf of an incapacitated patient, which is a health care agent, a conservator, or a surrogate.

It creates a presumption of validity for a POLST executed in another state. And it allows electronic signatures to be used to facilitate electronic completion, storage, and retrieval of pulse forms. These are modern and reasonable reforms that help people plan for the end of for their end of lives. With me I have Jennifer Moore Ballantine on behalf of the Coalition for Compassionate Care of California.

Thank you very much. Madam chair and committee members, my name is Jennifer Ballantine, CEO of the Coalition for Compassionate Care of California. CCCC introduced the POLST program to enhance California's advanced care planning toolkit in 2009. Since then, we have supported the program and sponsored several bills to improve access to POLST and develop a statewide electronic registry. In 2024, we undertook a statewide survey to assess the quality of POLST processes.

The survey amounted to a test of POLST knowledge and practice and we received more than 3,600 responses across the spectrum of care settings and healthcare disciplines. The results of that survey highlighted a number of persistent lapses in POLST use, several of which originated in gaps or confusions in the POLST DNR statute. So this bill is narrowly focused to address those issues.

Notably less than 1% of respondents to the survey, a quarter of whom were emergency service personnel, could correctly identify the operational differences between POLST and the pre hospital DNR, including which form can be signed by which healthcare providers. Allowing NPs and PAs to sign the pre hospital DNR will eliminate this confusion and create consistency between the forms.

Less than 4% of respondents could correctly identify who would be authorized to sign a POLST or DNR for an already incapacitated patient. Clarifying who under what authority can sign a POLST or DNR will help providers correctly identify authorized signers of of the POLST and exclude those not authorized to sign. We frequently hear reports of POLST being required for for admission to nursing facilities. This is contrary to the standard that any advanced care planning document must be voluntary.

In the POLST survey, barely half of skilled nursing facility personnel correctly understood that the use of POLST is voluntary.

Explicitly stating this crucial principle in the the

Many health systems already use electronic medical health records and yet the POLST DNR statute does not define nor authorize electronic signature of the form. This amendment will bring the law into alignment with current practice and eliminate confusion on an essential feature of the forms validity. Finally, visitors and temporary residents in California should have confidence that their documented wishes will be honored by our healthcare systems. Existing law allows recognition of advanced healthcare directives from other states.

We believe the same should hold for POLST and pre hospital DNRs.

Thank you for your attention and your support of the bill. I'm happy to answer any questions.

Thank you. If there are any members of the audience that would like to come and register your support for this bill, please come to the mic. State your name, your organization, and your position.

Nissette Short on behalf of the Alliance of Catholic Healthcare and Support. Thank you.

Madam chair and members, Monica Miller on behalf of Alzheimer's San Diego, Alzheimer's Orange County, and Alzheimer's Los Angeles in support. Thank you.

Thank you.

Yvonne Chung on behalf of the California Association of Health Facilities. We are the Trade Association for Skilled Nursing Facilities in support.

Thank you.

Natalie Pita on behalf of the California Academy of Family Physicians in support.

Thank you. Alright. If there's anyone in the audience that would like to speak and lead opposition, please come forward now. This, to the table. This is your time.

Thank you. Thank you. And you will both have a combined five minutes.

Thank you madam chair. Roxanne Gould representing the California Association of Clinical Nurse Specialists. We apologize to the Senator for our late opposition when we discovered the bill was going to be on consent. We just we felt it was, rather urgent that we not send a message to future committees that the bill is is ready. And our our objective is that clinical nurse specialists should be included in the bill.

That, there are more than 3,000 clinical nurse specialists in California. They have a minimum of masters. Most have a doctorate. And they have nearly four years of training after that specialty. And in fact, those clinical nurse specialists train many of the nurse practitioners that actually currently are authorized to sign in the POLST.

Hi. Thank you. So my name is Colleen Vega. I'm a clinical nurse specialist and I serve as a lead of anti practice provider at a large academic center in the Bay Area. In this role, I provide direct care to patients overseeing and mentoring clinical nurse specialists, nurse practitioners and physician assistants. I'm here today to advocate for the expansion of the authorized signatures on the pulse for clinical nurse specialists.

So our objective is not with the bill as it stands. We think the bill is, would be better if we would include those 3,000 clinical nurse specialists as authorized signatories to the POLST.

Like other practice, advanced practice providers, including nurse practitioners, clinical nurse specialists practice under the standardized procedures and are prepared through graduate study level of occasion. They present possess extensive clinical expertise in areas such as critical care, oncology, geriatrics, and palliative care. CNS's are licensed, regulated professionals who assess, diagnose, and manage complex patient conditions. In both the rural and academic settings, CNS's lead correlate coordination, care treatment decisions, and facilitate facilitate deeply personal discussions about patient's goals of care.

In my academic role, I also train and, educate nurse practitioners and physician assistants who are authorized to sign PULSE, but I am not.

Unfortunately, under this constitute right now, even with the s P ten eighty eight, I would not be able to sign a PULSE with a patient who I have connection with and treating. This creates unnecessary barriers for patients, particularly those in undeserved or rural communities where access to authorized providers may be limited, leading to more delays and documentations of the patient wishes or worse resulting in care that does not align with the wishes of the patient.

There are many ways that we think that this can be accomplished by adding clinical nurse specialists to this bill. First, it improves access, which I think is what we're hopeful for this bill. But improving it, if I can't sign the bill, even though a patient can, I'd have to find someone to be able to sign the bill who had not been having those conversations with the patient.

Second, enhances continuity of care. CNS's often develop long standing relationships with patients and families, placing them in ideal position to have meaningful conversations about end of life preferences and ensuring that their wishes are accurately documented. And third, it strengthens our work fit our heart, health based workforce recognizing CNSs as authorized pulse signatures acknowledges their expertise and aligns with the California with growing number of states that are empowering, advanced pastors nurses, to fork at the full extent of their license and training.

As our population of adult patients with chronic illnesses continue to grow, we'll need more healthcare providers like CNS's to provide centered care and facilitate patients end of wishes through the completion of pulse. Adding CNS's, compliments the collaborative and team based approach that defines modern health care.

It ensures that qualified professionals can act in the best interest of their patients without unnecessary administrative constraints. We appreciate that the bill SB 1088 looks to improve access for patients completing the pulse, but we think that we can go further than that and by including CNS's as authorized signatures. We appreciate you taking the time to hear us out about this.

Thank you. If there's anyone else in the audience that would like to register their opposition, please come to the microphone, state your name, your organization, and your position. Seeing none, I'll bring it back to the committee. Seeing no questions, Senator Blakespare, would you like to close? Oh.

I just wanted to ask about the CNS's concerns. Yeah. What what Yeah.

I I mean, so so essentially, this is not a scope of practice bill. I mean, what we're doing here is we're modernizing the pulse with, very specific things. Like, for example, a pulse from out of state is recognized in this state. If there are two dates, the more recent date is the one that's valid.

You know, a number of very specific things related to the pulse itself, but we're not this is not a scope of practice bill where we're getting involved in a dispute among California Medical Association, PAs, NPs, clinical nurse specialists about what who should be doing what within medicine.

And I think I I very much appreciate the testimony and the reality that they are dealing with the same patient population and they have a trusted relationship. But simply stated, that would be a different bill. And it would be also, to be honest, a different fight around, you know, what kind of, disputes are we doing with this bill. And what we're trying to do is modernize the pulse, and it's narrowly tailored to be within that lane, not to be expanding the scope of practice.

Thank you. Yep.

Seeing no other questions or, comments, Wanna thank you, Senator Blake Spear for bringing this bill forward. Appreciate the fact of you trying to keep it within this lane. If it was a scope of practice bill, it would not be something that we would be hearing or dealing with in this particular committee anyway. But if you would like to close, this is your time.

Alright. Well thank you. And I respectfully ask for your eye vote.

Thank you. We still don't have a quorum. But when we do We're close. We'll take it up. So, members of the Health Committee, we are now hearing our last health bill.

Would really appreciate for members to come down so we can establish a quorum and we can start voting on these bills.

We will now move to file item number six, SB 869 by Senator Weber Pierson. Senator, you are recognized when you're ready.

Thank you. Good afternoon, Members of the committee. I am here to present SB 869. And we'll be accepting the committee amendments.

Senator, I'm gonna pause you right there so we can establish quorum. Secretary, do you please call?

[Roll Call]

Senator, we have established quorum.

Thank you. Okay. Well, good afternoon, Members of the committee. I am here to present SB 869, and will be accepting committee amendments, and would like to thank committee staff for their work on this bill.

Every day, millions of Californians walk into restaurants and food facilities and order beverages without realizing just how much added sugar they're consuming.

It is estimated that about half of all adults and two thirds of all youth here in The United States consume sugar sweetened beverages every single day.

These decisions are made quickly at a counter, at a drive through, on a digital screen. And in those moments, consumers deserve clear, easy to understand information about what they're taking into their bodies.

We have known for many years about the link between excessive added sugar consumption and diabetes. In fact, in many communities, having diabetes is referred to as having the sugar.

We also know that the rates of type two diabetes in adult and children and prediabetes in both groups has risen over the last few decades.

But what research is also showing is that excessive added sugar consumption is directly linked to obesity, heart disease, other chronic illnesses.

And recently, studies have shown that excessive added sugar can double your risk of developing dementia or Alzheimer's disease. Sugary drinks are one of the largest sources of added sugar in the American diet.

This drink, my staff purchased at a popular chain coffee restaurant this morning. It has a 163 grams of sugar. The daily recommended allowance for adults is no more than 50 grams.

And for kids between the age of two and 18, it is no more than 25 milligrams of added sugar. When people purchase these drinks, they have no idea how much sugar they're consuming.

SB 869 addresses this gap by requiring large chain restaurants to display a clear, easy to recognize added sugar icon next to beverages that exceed 50% of the daily recommended limit for adults of sugar.

And that icon will be labeled on the menu at the point of purchase. As I just stated, this would only apply to large chain restaurants, meaning those that have more than 20 locations.

Before I introduce my witnesses who will speak in support of this bill, I would like to address some of the concerns from the opposition.

One of their concerns that they list in their letter is that they already provide nutritional information on food and drinks. That is true.

But tell me, when was the last time you went into a coffee shop, or you went to a restaurant and you looked at the menu, and it told you right there how much sugar you would be consuming? You can't tell me.

Because the reality is is that this nutritional information is hidden in an app hoping that you have it or online hoping that you have access to it. But it is not readily available when you're purchasing that item.

They also talk about the fact that if we did this, it would add to crowding the menu. And I state that a superscript icon of a sugar cube does not crowd a menu any more than a v next to a vegan dish, a v e g next to a vegetarian dish,

a g f next to a gluten free dish. Nor does this tiny script at the bottom that would say contains more than 50% of daily recommended sugar differ from what we already have.

They also mentioned the fact that they've worked a lot with their kids meals and ensure that the default beverage is not the sugary one. And for that, I say thank you.

That does not mean that that child or that parent for that child cannot order a sugary drink. And that right now, when they look at the menu, they won't know whether or not that sugary drink has an excessive amount of added sugars.

Additionally, many adults and children don't order off of kids' meals. They also talk about the fact that we have caused more difficulty because of the crushing wage increases that specifically target restaurants,

because we passed a law requiring them to provide a livable wage.

Although I didn't wanna bring cost into this, let's not forget about the high cost to our healthcare system impacting everyone when we treat these conditions that are caused or exacerbated by high added sugar intake, many of which could be prevented.

Finally, they mentioned the fact that we recently passed a bill that they supported, to allow for, allergen, food allergen labeling, which will go into effect in July.

This bill, my bill, SB 869, is not scheduled to go into effect until January 2028, giving them a whole year and a half. And I appreciate the fact that they acknowledge the seriousness of food allergens.

Because that impacts around six to ten percent of The US population. And that transparency is important. But let's take that six percent and multiply it or double it by two. That's twelve percent. Twelve percent of The US population with diabetes.

Let's take that six percent and multiply it by seven. Over forty two percent of The US population has obesity. And if you include those who are considered overweight in The US population, we're talking up to seventy percent.

All of these are serious conditions that can be prevented or mitigated by having readily available information to make healthier choices.

California has long been a leader in public health, and this bill continues that legacy by prioritizing transparency, empowering consumers, and taking practical steps towards addressing chronic disease.

You know, we often say that we are what we eat. And the truth is, in addition to that, we are what we drink.

With me today, serving as a witness is Christine Fallabel with the American Diabetes Association and Dr. Jay, an emergency room physician and local American Heart Association volunteer. Thank you.

Thank you. You're both recognized for two and a half minutes.

Good afternoon, Madam Chair and Members of the committee. Thank you for taking the time to hear such an important issue today. My name is Christine Fallabel.

I'm the Director of State Government Affairs for the American Diabetes Association. I'm here today to speak in support of Senate Bill 869, and the ADA is a proud cosponsor.

For too long, we've asked people to make better choices without giving them the tools or the truth that they need to actually do that.

Sugary beverages are one of the clearest examples of this gap. They're marketed as refreshing, energizing, and even healthy at times.

But what's often missing is simple, honest transparency about how these drinks impact our bodies, especially for communities already facing higher rates of chronic conditions like type two diabetes and obesity.

And this is where Senate Bill 869 comes in. This bill is not about taking choices away.

It's about making those choices real and transparent. When a parent picks up a a drink for their child, they deserve to understand what they're giving them.

When kids visit a coffee shop after school, they deserve to know what exactly they're drinking and how it will impact them.

When someone is trying to manage their weight, their blood sugar, or or their overall health, they shouldn't have to decode labels or rely on guesswork or even ask a busy barista to find an old nutrition label in the back corners of their business.

Transparency levels the playing field. It replaces confusion with clarity and empowers people to make decisions that align with their health goals. We know that small daily choices add up.

A single beverage may not seem like much, but over time, it can significantly impact someone's health trajectory. Studies show that adding even one twelve ounce sugary drink daily increases the risk of developing type two diabetes by roughly 25%.

Senate Bill 869 is a step toward respect for consumers, for families, and for communities. It acknowledges that people can make good decisions when they're given honest information, and we're asking for that transparency.

With transparency comes trust and better health outcomes for all Californians. We support Senate Bill 869 and encourage you to vote yes. Thank you for your time and consideration.

Good afternoon, Madam Chair and Members of the committee. My name is Arthur Jay, and I'm an emergency medicine physician at one of the local, hospitals, and I volunteer at the American Heart Association.

Thank you for the opportunity for me to speak to you today regarding Senate Bill 869 and the importance of offering clear icons to stand to standard beverage menu items that contain high level of sugars.

By introducing these standards, SB 869, it takes an important step towards improving the dietary environment of Californians and protecting them from early risk factors to type one diabetes, type two diabetes, obesity, and cardiovascular disease.

I mean, as a physician who cares for patients with diabetes, I see every day how challenging this disease can be.

Many of my patients are really trying to do their best, yet still frustrated and overwhelmed by trying to manage their own health. If I was in their position, I would feel exactly the same way.

Without transparency, patients have a harder time making informed decisions about their health. Restaurants are a frequent source of food in American families in The United States,

with the average family eating out four to five times a week. But best but restaurants' foods can have high levels of salts and sugar, including sugary drinks.

And sugary drinks are the highest rec highest instigator of sugar in the diet. Some of them have more than the 50 grams of sugar in a single serving.

Consuming too many drinks, sugary drinks can lead to heart disease, dental caries, and type two diabetes including obesity. Personally, my mother has diabetes, and I've seen firsthand the highs and lows that come with managing this disease.

It's not just about the treatment. It's about the daily decisions that and challenges that come with trying to stay healthy. This bill does not restrict choice.

It simply ensures transparency, giving consumers consumers like me, my mother, my patients, and all of our families the information they need to control their own health.

Californians deserve to have a clear and easy to read understanding of the information in front of them at time of purchase. For these reasons, we respectfully ask you to vote aye on the on SB 869.

Thank you for your opportunity to speak.

Thank you. We'll now move to anyone else in the room that would like to express their support. Please state your name, your organization, and your position.

Thank you, Chair and Members. Keshav Kumar with Lighthouse Public Affairs on behalf of the California Academy of Registered Nutrition and Dietetics.

We are the largest association of registered dietitians in the state, and we are strongly in support and appreciate the author's work.

Kevin Guzman with the California Medical Association in support.

My name is Dr. Sreeda Sethathi. I'm with District 8 and part of CMA and I fully support this.

Now, I'm Dr. John Maa. I'm the Chair of the California American Heart Association Advocacy Committee and Strong Support.

Good afternoon. My name is Dr. Devon Fordyce. I am a clinical education specialist as well as a professor of nursing as well as an actual on the committee volunteer. I as well very much support this bill. Thank you so much.

Thank you. We'll now move to any key witnesses in opposition that like to come forward. And if we could have, to make some room here, please. Thank you. You're recognized when you're ready for five minutes.

Thank you. I'm Matt Sutton with the California Restaurant Association and, we are unfortunately in respectful opposition. The Chair has laid out some of our arguments and I'd just like to take a minute or two just to expand upon some of those.

We of course take the issue of nutrition and sugar, seriously and we believe we've been a productive partner in this building on that for quite a long time. Myself primarily.

The CRA Harabedian an industry leader on a lot of these disclosure fronts. It was mentioned, that the restaurants in the scope of this labeling mandate are already subject to menu labeling laws.

We actually went out on a limb and worked with then Senator Alex Padilla, of course now US Senator Alex Padilla, on the initial menu labeling law that became later adopted by the Federal Government and and is now a model for the nation.

As the Chair mentioned, it does include some disclosure of sugar, but not the disclosure of sugar that's sought after in this bill. In 2018, we again worked with, the Senate on further disclosure.

I'm sorry. Not disclosure, but replacing, sugar sweetened beverages in kids' meals. This committee, of course, deliberated the allergen menu labeling law from last year that Senator Menjivar,

did so well in navigating through the legislature and working with us. Now we find ourselves three months out from the effective date of that bill with restaurants finalizing their menus to be compliant with that July 1.

And we have a new menu labeling on menu labeling mandate. So that's that's sort of the the cumulative effect that our members are a little fatigued over on the menu labeling front.

It is indeed costly to replace menus, menu boards, drive through boards, and all of the menu resources. That is not our primary concern.

Our primary concern is that we as you can see, we're already adding new disclosures when we're three months out from the effective date of the last disclosure mandate. So these are coming quick and fast and these are hard to deal with.

No doubt. So again, I think we'd be happy to continue to have discussions about disclosure methods, appropriate disclosure methods.

But, that that's what our base is feeling, when it comes to the impacted restaurants that are affected by this bill and the predecessors. So it's a lot. It's a lot quickly.

And, there's a number of different ways to disclose this type of information to folks. And I would argue that more and more, especially since the pandemic, so much has changed in the restaurant space in terms of electronics and technology

and disclosure. QR codes. All these things that I don't think they're as buried as people, allege. And I think they are incredible resources for restaurant patrons.

And I think there's a probably a healthy discussion about, appropriate ways to disclose. But we do object to this proposal and we do object to the on menu mandate. Thank you.

Thank you. Now, would love to open up to the audience. Anyone else who is here in opposition, please state your name, your organization, and your position.

Well, to clarify, we're tweeners. We have concerns. So Dennis Albian, on behalf of American Beverage Association. One of our issues, and we mentioned this with the with the staff and the Member is the the warning icon that some

beverages with sugar would be uniquely harmful versus other things. So that's a issue that that remains, as well as the information, and how to best articulate that information. Thank you.

Thank you. We will now move it to the committee. Senator Durazo?

Well, I wanna say it makes a big difference to me when I see specific information about what's, you know, in in the food I'm about to I'm about to eat. And this is about chain restaurants. Right?

So this is chain restaurants, many of which are low income communities or sell, you know, less expensive food, which is which is fine except that's where we really need to, I think, make sure and focus being on the information that's needed.

And at least it gives us an opportunity to look at the menu and say, this is how much sugar, this is how many calories, this is how much fat.

I mean, all these things that are just bad for our health. I do hear you, sir, from the restaurant association. You know, the continuous thing.

So maybe there maybe that's room for a working group or something to say, what are the things that we should take on and sort of do a a package of how to do them so that you're not continuously doing them. Or time time when it's implemented.

I'm just throwing out those seem to be specific things you're not saying you never ever wanna do it, But how it's impacting, the restaurants. I'm sympathetic, to that.

But it makes a huge difference whether in a restaurant or you're seeing the menu up on the top. I know I've caught myself many times saying, okay. That looks really good.

And then, boom. I see what it what it contains and it holds me back from buying certain things. I'm hiding my Pepsi right here. But there's no sugar. Further record.

But, I do think that we have to watch out. We were just discussing the Senator and I about what was it like many decades ago when we did a lot more cooking at home because we didn't need everybody in the household working.

Now we have to eat out more, which is a good thing. I'm not opposed to it. I just there's, you know, the culture of eating has changed tremendously. And if you're if you have if you earn enough income to eat in nicer restaurants,

you don't have to worry about this as much. But I think the lower the income level, then we have to watch out for those and that's where we have the worst, I think percentages of diabetes and and other illnesses.

So, you know, I'm supportive but I'm sympathetic. I don't know, what or if anything more should be done but with this particular bill. But those are just my thoughts for now. Thank you to the author. Thank you.

Cheers, Senator Durazo. Senator Smallwood-Cuevas.

Thank you, very much, Madam Chair. And I want Vice Chair. And I wanna thank, the author for bringing this bill forward. I really appreciate the intent of this bill.

And, you know, the more you know, the more you know. And, the way science is moving, we're learning a lot. And it's important for having partnership. Right?

Because these are the same consumers who are going to purchase, and that's not gonna stop anytime soon. They will just have more choices.

And, and those are the the businesses that will benefit, from those consumer and consumer choices. So I just I think that this is about partnership.

And that raises a a question for me because one of the things that I have seen about, my time here in the state legislature is that we do create these regulations and then it costs to actually deliver in terms of implementation.

And so often that cost is shifted to the consumer. And we are, in a time where affordability is a real issue. And so my question is, as we think about the implementation of this, how do we ensure that we can work with industry to not,

pass on additional costs for making sure that folks are informed and healthy? And, and I and I wonder is there, you know, do do you have any thoughts about that as the author on this?

Because we wanna address issues, and I have family that have struggled with diabetes and other conditions in my family.

And I'm so grateful now that we have this information, that is easily accessible to everyone and certainly even to the point of purchase.

But how do we ensure that we aren't fixing our problem here and creating another problem in terms of people being able to afford all of this, amazing, food and drink and the things that we wanna consume.

Right. Thank you so much for that question. And so, want to point out once again that this bill would not go into effect until January 2028. And so that gives, again, the restaurants over a year and a half to prepare,

if this bill is passed and signed into law. And, you know, one of the things that you know about restaurants, we all go to restaurants, we all go to coffee shops, is that they are constantly changing their menu.

And when you go to a restaurant and they have paper menus, or even if they're laminated, they're still changing them.

You know, it's sometimes seasonal things that are on there, sometimes things that they're removing for a variety of different reasons.

And so, to think that a menu that a restaurant has is permanent and does not change is not consistent with reality. And when they do change, they're not passing those costs onto the consumers.

And again, don't would hate to start talking about cost with the bill that deals with health, but the cost to our healthcare system and our healthcare structure, with the vast number of people getting diabetes, high blood pressure, our youth

getting diabetes, obesity. I remember when I was in medical school, which was not, you know, I'm not young, but it wasn't that long ago. Type two diabetes was not something that we talked about in children. That was an adult condition.

Now the number of children that have type two diabetes is skyrocket. It's actually doubled over the last two decades. And so when we're talking about cost, and we have been grappling with the cost of our health care, grappling with the

cost of new medications. Do we cover GLP ones? What do we do? These are things that have a very, very minuscule cost in comparison to the cost that we are having to put out as a result of what,

excessive added sugar is doing to our bodies, our families, our communities, our state, and quite frankly, this nation.

Thank you, Senator. Did you Senator Grove. Thank you.

Thank you. Madam Vice Chair and Madam Chair for the bill that you're bringing forward. I do have a couple of questions. I just, I was wanting to address the concerns that you have,