Assembly Standing Committee on Business and Professions

Good good good morning, everybody. It is now 09:07. We have no authors. We have no Republican Assembly members, so we have no ability to start a hearing. So if we can get one Republican Assembly member, Joe Patterson, I'm looking at you, And if we could get one Senator to come present their bill, our options are senators Umberg, Weber doctor Weber Pearson, Ochoa Bogue, Niello, Maguire, or Richardson, we'll have a hearing.

If we can't get we don't need a Republican Assembly member. So if we can just get a Senator to present their bill, then we'll start the hearing. If we can't get a Senator to come and present their bill by 09:15, we'll adjourn the hearing. So it's seven minutes from now. Thank you.

Senator Richardson gets the prize. Don't we all right now? Don't we all? Thank you, Senator. We so, actually, as we're coming up, I this is my mistake.

I didn't dispense with all the formalities. Good morning, everyone. Welcome to this morning's meeting of the Assembly Business and Professions Committee. Thank you to Assemblymember Patterson for joining us on the committee for purposes of today's hearing, subbing in for vice Chair Johnson. There are total seven bills on today's agenda and no bills on consent.

Before we begin with today's agenda, I wanna remind everyone that the Assembly has rules to ensure we maintain order and run an efficient and fair hearing. We apply these rules consistently to all people who participate in our proceedings regardless of the viewpoint they express. In order to facilitate the goal of hearing as much from the public within the limits of our time, we will not permit conduct that disrupts, disturbs, or otherwise impedes the orderly conduct of legislative proceedings.

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

For those wishing to provide for their comments, we are accepting written testimony through the position letter portal on the committee's website. With that, happy to start today's hearing. Senator Richardson, thank you for joining us. We don't have a quorum yet, but we look forward to hearing your presentation.

Thank you, Mister chairman and members and staff. Let me start off by painting a picture for you. When a cemetery is abandoned, the people interned and the property I'm sorry. I have to start off your morning with talking about cemeteries, but here we are. Anyway, when a cemetery is abandoned and people are interned and the property is subject to vandalism and theft, desecration of those burial plots, action needs to be taken, and it needs to be taken by us.

In my district, just, this has happened over the last couple years. But even in January, I had a cemetery where, the volunteers had dogs there to help guard the cemeteries because they continued to be broken into. And the people who broke into it this time actually killed two of the dogs and stabbed the rest of them. So this is a problem that when cemeteries are abandoned and they're left without care and without caretakers, unfortunately, horrible things do happen.

There are a 187 private cemeteries in the state of California that are subject to abandonment.

These cemeteries that have already been abandoned are due to the fact that once a cemetery is full, it is no longer, profitable because it does not generate sales, and internments, therefore, are not profitable. Further, the endowments paid in the past years are no longer sufficient to cover ongoing expenses. So if a person was, unfortunately, buried back in the fifties, sixties, seventies, eighties, What they paid in endowments at that time does not cover, the care of a cemetery in today's, cost.

When cemeteries lose owners, they also are losing protection. Abandoned cemeteries quickly become public nuisances.

They are distressing to families. They pose public safety risk, and they negatively affect nearby property values. We must act now to adopt lacking policy to address the growing issue and ensure that sacred spaces are preserved with the dignity and respect they deserve. SB 1312 is a follow-up bill to last year's bill of SB 777 to address the issues of abandoned cemeteries.

SB 1312 would seek to implement the bureau's recommendations after a meeting that they had in March due to the direction of the Chair of this Committee.

Their meeting and this bill now focuses on three key points. Firstly, it would formally define an abandoned endowed care cemetery. Second, it would then establish a mechanism for a city, county, or City County excuse me, for a city or county to declare an endowment care cemetery abandoned to begin the process of title transfer to a new entity.

And then finally, the bill would establish that when a court determines that a cemetery certificate of authority has lapsed or has been suspended, surrendered, abandoned, or revoked, the court shall name the bureau as the conservator of the endowment care fund and take specific actions to take the ultimate actions it would deem appropriate to ensure the continued care, maintenance, embezzlement of the property.

My office and I stay committed and ready to work with all parties as we ensure this bill moves forward and that more importantly, we continue the conversations of the next steps.

This is the first step is to establish. We have to first say and rule that a cemetery is abandoned before work can be done. And then, next steps will follow when I come see you next year on this very important issue. I wanna thank the chairman, the staff, and all of you who've endured my comments about this very important issue, and I appreciate your approach. And with that, I respectfully ask for your Ibill.

Thank you, Senator. Do we have any primary witnesses in support? Seeing none, any but he wants to add on in support of the bill. Nope. Take your time.

Mister Chair members, Paul Yoder on behalf of the county of Marin and strong support. I appreciate the Senator talking about cemeteries because a lot of them are messed up. Her dry vote. Thank you.

Thank you. That's a technical term, messed up. Any primary witnesses in opposition to the bill? Come on up. You've got two minutes.

Good

Just hit hit the little mic button. There you go.

morning, Mister chairman.

Good morning, Mister Chair and members. Marcus Detwiler with the California Special Districts Association, here to oppose SB 1312 unless it is amended to address our concerns. SB 1312 stands up a process whereby an owner of an abandoned endowment care cemetery, privately, run may, wash its hands of the failure of the abandoned cemetery and dump the operational burden of those abandoned cemeteries on local governments. Public cemetery districts, of which CSDA represents, are therefore uniquely harmed by what is proposed in SB 1312.

In its 2024 sunset review report, the cemetery and funeral bureau argued that local governments who initially permitted and zoned these sites for the these private cemeteries should be left with the responsibility ultimately for the perpetual care of these abandoned cemeteries.

A distinction is therefore warranted. Public cemetery districts play no role in the permitting or zoning of these parcels for these operations. And, therefore, public cemetery districts, would be wholly inappropriate targets of leveraging past land use decisions against something that they were uninvolved in and played no role in. Public cemetery districts are also distinct from cities and counties in that they have no general purpose revenues. Public cemetery districts are funded primarily through taxes and assessments or fees for services.

They are ill equipped to absorb the financial shock associated with the sudden transfer and sudden inheritance of an abandoned endowment care cemetery site, and therefore, this bill creates a problematic, endpoint and a problematic dumping point for these abandoned endowment care cemeteries. However, it is not unreasonable to think that some public cemetery districts may be able to appropriately shoulder the burden associated with these abandoned cemetery sites.

In those instances, it is most appropriate that these cemeteries be granted the ability to express their affirmative approval before they are transferred to these abandoned cemeteries and all the rights responsibilities and obligations arising therefrom. Therefore, we believe that SB 1312 should be amended to require the express affirmative consent of a public cemetery district before any such transfer is effectuated. Thank you very much.

Thank you. Any additional witnesses in opposition to the bill who wanna add on? Provide your name come on up. Provide your name, organization you're with, if any, and position on the bill.

Sarah DeCath on behalf of the Rural County representatives of California and the urban counties in California, we're actually a Tweener.

We have concerns based on the timeline this bill is moving and the work that still needs to be done to make sure a lot of the technical issues with implementation are addressed, as well as including other provisions that are missing that were part of the rapport, like making these a memorial park cemetery, which really would address some maintenance issues and some other issues around, the insufficiency of the liability provisions. Thank you.

Thank you. Good morning. Eric Lohr on behalf of the California State Association of Counties. I would align my comments with those of my colleague with RCRC. Appreciate the senators' work.

Looking forward to more of that. Thank you. Thank you.

Any questions or comments from colleagues? Seeing only Democrat colleagues, still no Republicans. Senator, would you like to close?

Normally, I close very rapidly, but I think I do need to respond to the witness's Figureback. Comments, which were he presents well, but I think leaves out some facts. We're actually taking some steps. Today, what we're working to do is, number one, to define officially, legally that when a cemetery becomes a cemetery becomes abandoned, so then the consumer bureau can actually begin to take some action.

Right now, because a private entity would own a property, you first have to go through that legal part before we can do anything because we can't take over someone's property without their knowledge, without due process, and so on.

So, really, much to, my comments of the witness, I would much rather be having the discussion he just had, but we're not there yet. That's next year. Stay tuned, and I look forward to working with you on it.

What the public cemetery district the role of a public cemetery district that we have talked about thus far is and that was not described by the witness is that when a city or county, if they would then be deemed to be responsible for a cemetery, Public cemetery districts exist.

And so what has initially been discussed is if an existing public cemetery exists where a abandoned cemetery is, then there would be the opportunity for it to either, one, go into the existing public cemetery district or to have a new one created.

But it is by no means the suggestion of myself that the public cemetery districts would have to incur that cost themselves. That is stay tuned for next year where we're going to have to discuss what will be the monetary requirements, for public cemetery districts, for counties, for whoever, when we're gonna have to deal with this problem. But right now, we're of identifying legally that a cemetery is in fact abandoned and then to discuss how can we resolve the title.

Because, unfortunately, it would be wrong of us to expect the public cemetery districts to do any work if they actually did not have title to the property. And then finally, it is the intention of the bureau, which is what they currently do, would be to disperse those endowment funds that do exist with some of these cemeteries.

Those endowment funds would be then passed on to the public cemetery district and, hopefully, additional funds that I'll be fighting for to make sure that they'll be able to adequately do their work. So I thank you for the testimony for those who spoke, and I look forward to working with all of them to continue to flush out an effective policy that will certainly incorporate the comments of the witnesses today. And with that, I respectfully ask for your aye vote on this bill, thirteen twelve.

Thank you, Senator Richardson. Yeah. When this committee heard SB 777 last year, our commitment was to consider a bill this year, to pursue a solution to the abandoned cemetery issue following the submission of the bureaus work group report. And Aye, very much appreciate your cooperation through this process. Also, I just wanna say I appreciate you taking on this issue, because it is such a big important issue.

It's only gonna become a bigger issue, in the coming years and decades, and and the it wasn't one that colleagues were tripping over themselves to take on, but it needs to to be addressed. And and so I appreciate you championing, the issue of abandoned cemeteries.

Given the short timeline we have we've been working with, with with the bureau's report just coming out, I think, two weeks ago, I understand that there will still need will still need to be further conversation with local stakeholders, like you like you mentioned, Sender, and that the language in this bill will need to be reconciled with what the bureau has since provided. This bill will be going to local gov after this committee, so there's more time to have those conversations.

And I know a lot of those issues fall under their purview and and not necessarily ours.

So I'm happy to support the bill in BNP today and wish you luck with that conversation in local government. We don't have a quorum yet, but as soon as we do, I'm sure we'll have a motion in a second. Thank you very much. Senator Umberg, good to see you, sir. You've got s p 758 agenda item number one.

I've only been here fourteen years. So, I'm pleased to present SB758. I wanna thank the committee's chief consultant, Robert Sumner, for, his assistance, hard work on this bill. I'll be accepting committee amendments, which remove convenience stores from the nit nitrous oxide sale exemption list. The purpose of SB758 is to restrict the sale of nitrous oxide.

The easy access point of a nitrous oxide at smoke shops and convenience stores has led to rise in harmful misuse over the last decade. Recreational inhalation of nitrous oxide can cause long term neurologic effects, paralysis, and even death. These products are not FDA approved and have raised alarms due to an increase in poison control calls. With me here to testify in support of the bill is Jolina Voorhis with the California League of Cities. Thank you, Mister Chair.

Mister Chair and Members, Jolena Voorhis on behalf of the League of California Cities. We're proud to be a cosponsor of this bill. As the Senator, indicated, nitrous oxide is a odorless gas and is used, is supposed to be used for dentistry and food preparation. Over the past several years, nitrous oxide also known as whippets, laughing gas has emerged as significantly and largely unaddressed concern across United States.

Once considered a relatively obscure issue, recreational abuse of nitrous oxide has increased at alarming rates, particularly among teenagers and young adults.

Despite its legitimate use in dental and medical and culinary context, nitrous oxide is frequently diverted for recreational use due to its low cost and easy accessibility. California law currently prohibits sales for recreational purposes, but however, in practice, what's going on is that at these smoke shocks and convenience stores, they're putting on a label that says it's for food prep and selling it without much restrictions or in in legality.

Medical authorities have documented the serious health risks associated with recreational use of nitrous oxide, including association, pair paralysis, and permanent neurological damage. Probably, approximately 25 cities have already passed bans on nitrous oxide. And when we saw that last year, we thought it would be easier to do a statewide solution than have every city adopt these ordinances.

So SB 758 would address the proliferation of these illegal sales by prohibiting the by prohibiting the sale of nitrous oxide at those retailers with a tobacco license except for grocery stores. As the Senator said, we're trying to ensure that it still is would be effective at smoke this ban would be effective at smoke shops and convenience stores. And with that, we are pleased to support and urge your aye vote. Thank you.

Thank you. Go ahead.

Morning, Mister Chair members. Ryan Sherman with California Narcotic Officers Association, also a proud co-sponsor of the bill. Agree wholeheartedly with the comments of my colleague and the Senator as well. We're just grateful to be here. Thankful for the author.

Our members see daily the dangers and intoxicating substances posed to our communities, families, children. And for these reasons, we strongly support the bill. I can go on, but I think the point's been made. Thank you, sir.

Thank you very much. Any additional witnesses who wanna add on and support, come on up, provide your name, organization you're with, if any, and position on the bill.

On behalf of the Orange County Board of Supervisors in support.

Thank you.

Kasha Hunt with Political Solutions on behalf of American Academy of Pediatrics in support.

Thank you.

Good morning. On behalf of the city of Carlsbad and, El Cerrito, Kendra Begley in support.

Thank you.

Ashley Walker with Nausman on behalf of the City of Ventura in support.

Thank you. Paul Yoder, good morning, Chairman, Members, on behalf of the counties of Tulare, Kern, and Humboldt, and also the California State Association of Psychiatrists in support. Thank you.

Thank you.

Mandy Strobel on behalf of Rethink Waste in support and apologize for the late letter.

Thank you.

Good morning. Amy Jenkins on behalf of the Rural Counties of California in strong support. Thank you.

Thank you. Any primary witnesses in opposition to the bill? Seeing none. Anyone who wants to add on in opposition to the bill or be a tweener on the bill? Nothing.

Alright. Colleagues, Assemblymember Addis.

Thank you. And thank you so much, Senator for bringing this forward. I just wanna say I appreciate the bill. I'd if you're taking co authors, I'd be happy to co-author the bill. Super important issue.

Thank you. We'd be honored to add you. Thank you.

Thank you. And if we get quorum while I'm here, I'd be happy to move the bill. I don't know if we will, but

Not yet. Fingers crossed. Text your friends. Any additional questions or comments from colleagues? Doctor Jackson, any questions or comments on Senator Enberg's bill?

No. That'll be all.

Alright. Senator, would you like to close?

Thank you. I wanna thank miss Voorhees in the League of Cities as well as Mister Sherman for their support, and I urge and I vote.

Thank you, Senator Umberg and and to your sponsors for your advocacy on this very important issue. This is the second hearing in a row that we've heard, bill, on this really important issue. I absolutely agree that we need a a variety of approaches to address the serious problem of oxide of of nitrous oxide misuse. Totally agree that a statewide approach is always better than 300 plus city by city approaches.

So I'm very happy to support this bill today as part of that holistic effort, and I'm sure you'll have many motions and seconds when we get a quorum.

Thank you, Senator.

Alright. Thank you, Mister Chair. Thank you, Members.

Doctor Weber Pierson, good to see you. You have two bills, SB 849 and SB 1094, and we'll hear them in whatever order you prefer. Great. We're gonna start with SB 1094.

Alright. Well, good morning, and thank you, Chair and committee staff, for working with us to improve this bill. I am planning the to take the amendments and the health and safety and insurance code we'll be taking up in the Assembly Health Committee. This includes some of the issues that, you and I have discussed, Chair Berman, which will require health plans and insurers to notify providers about this bill.

And that beginning 01/01/2027, their patients who are on a reference biologic will be eligible for a pharmacy substitution of biosimilars on the formulary, listing patients and possible substitutions. The intent with this amendment is to let prescribers know in advance that their patients' medications may be substituted at the pharmacy.

And if there are any clinical concerns with this substitution, the provider can reissue the prescription and indicate do not substitute. Other amendments that will be taken in Assembly Health will provide more detail in the required notice to patients and providers when there is a formulary change regarding a b rated generics, biosimilars, and interchangeable biological products, and expand the advance notice from thirty days to sixty days.

Another amendment will prohibit a PBM health plan or insurer or affiliated entity from requiring utilization of only a biosimilar product in which the entity has a direct or indirect financial interest when other biosimilars may also be available. Health care affordability is one of the top concerns here in California. Over half of Californians report health care costs rising faster than their incomes, and 60% report that they or a family member has skipped medical care due to cost.

One of the underlying drivers in rising health care cost is the cost of prescription drugs, which has increased by 72% since 2017. Biological products are particularly expensive, costing hundreds to thousands of dollars per injection. These are critical treatments, but their high price tag are putting a real strain on patients and our health care system in general. Fortunately, lower cost alternatives like generics or biosimilars offer the same clinical result as their brand name counterparts.

But over the past decade, studies have consistently shown that switching from a reference product to a biosimilar is not associated with any clinical significant difference between safety, efficacy, or the immunogenicity.

Despite having many safe, effective, lower cost alternatives available, we are still not using them to their full potential. This bill offers two practical ways to encourage biosimilar use to bring down cost and inject more competition to a system that brand name pharmaceutical manufacturers have controlled for far too long. First, it allows for pharmacists to substitute a lower cost biosimilar for biologic when appropriate, unless a prescriber indicates otherwise by adding do not substitute to the prescription.

And second, it allows health plans to require patients to do to try a generic or biosimilar unless a prescriber indicates otherwise by adding do not substitute to the prescription, and the plan is and this current version is required to provide thirty day advance notice to the provider, which we've stated we will be changing that to sixty days.

This bill only allows health plans to require a patient to try a biosimilar when the net cost of the planned biosimilar is lower than the reference product and the patient's cost sharing is the same or lower than the reference product.

The bill also requires health plans to report on the impact of this policy on premiums and patient cost sharing. According to the superb analysis, this bill is estimated to generate savings for patients and our health care system, including $4,000,000 in cost share cost sharing savings for those patients who switch to a biosimilar and 90,000,000 in savings in the form of reduced premiums for employers, enrollees, and medical. At its core, this bill is about affordability, safety, and access, which are key components for adherence to any treatment.

It is about making sure that Californians can get the care they need without having to choose between their health and their financial stability. With me today to explain how this bill will make health care costs more affordable while maintaining high quality care is Nick Luis- Luizos from California Association of Health Plans and doctor Kiran Birang from Western Health Advantage.

Thank you. And you have two minutes each.

Yep. Thank you, Chair and members. Nick Luizos on behalf of the California Association of Health Plans. We're this proud sponsor of SB 1094 and thank doctor Weber for her leadership on this critical affordability measure. Policymakers have rightly declared affordability a top priority, and I think, most average citizens would agree.

And this is why our association is actively working to promote policies like SB 1094 to drive down spending while expanding access to FDA approved drugs that are safe and effective, thus making health care more affordable and accessible for all Californians who depend on health plans and their providers for their care. The Senator went over the data on rising drug costs, but the independent analysis of this bill is clear.

As the Senator stated, it offsets premiums by tens of millions of dollars and is projected to lower out of pocket costs for patients. And I'll just add, like, in in my two decades of lobbying for this trade association, I've reviewed countless independent reports. And although although one may exist, I can't remember a CHBURP analysis, which is the independent body that looks at these bills showing a decrease in premium growth until this bill.

So, it it's pretty momentous, from that perspective. SB 1094 is very simple. It achieves these results by simply updating outdated statutes to reflect modern science. It aligns California with FDA clinical evolution and Medicare policy, allowing for the automatic substitution of safe, effective, and lower cost biosimilars. This is a common sense update that expands access to life saving medications without compromising safety.

It's carefully crafted with robust consumer protections. And as the author stated, those, protections will be expanded in the next committee, transparent notification rules, and rigorous reporting requirements on on behalf of my members. And that is why you see such a broad and diverse coalition in support of this bill ranging from labor, business, and other advocates. And so we need more solutions like this, and we respectfully urge your vote. Thank you.

Thank you.

Good morning, Chair and members. My name is doctor Karen Firing. I serve as a chief pharmacy officer for Western Health Advantage, and I am here to support SB 1094. As a pharmacist with more than two decades of experiencing, managing medication access and affordability, I have seen firsthand the positive impact biosimilars can have for patients and the health care system. SB 1094 allows pharmacists to substitute FDA approved biosimilars unless the prescriber indicates otherwise.

So I think that's a very important indication the prescriber is still in control. Helping this not only helps our patients receive safe and effective lower costing treatments while preserving the patient and provider autonomy and decision making. At Western Health Advantage last year, we transitioned our entire book of business for patients using Stelara to a FDA approved biosimilar.

Each one of our patients were handheld through the process, through proactive physician engagement, patient education, pharmacist led coordination, and through that, we achieved an exceptionally successful conversion with no member abrasion, no disruption in care, and continued positive clinical outcomes. Our experience demonstrates what evidence has already shown. Biosimilars are safe, effective, and can reduce unnecessary health care spending while maintaining high quality of patient care. SB 1094 provides pharmacists with an important tool to help Californians access these therapies more efficiently and affordably.

For these reasons, I respectfully ask for your support in SB 1094. Thank you for your time and consideration.

Thank you. Any additional witnesses wanna add on in support of the bill? Come on up. Provide your name, organization you're with, if any, and position on the bill.

Morning, Chair and members. John Shuriken on behalf of the Association of California Life and Health Insurance Companies in support. Thank you.

Good morning, Chair and members. Beth Malnowski registering support on behalf of SCU California, also registering support for health access. Thank you.

Thank you.

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

Thank you.

Alexis Rodriguez with California Chamber of Commerce in support. Thank you.

Thank you. Thank

you, Mister Chair members. David Gonzalez on behalf of America's Physician Groups in support. Thank you.

Good morning, Mister Chair and members. Andres Ramirez with Blue Shield of California in support. Thank you.

Morning, Mister Chair and members. Sean Hoffman with the Pharmaceutical Care Management Association in support.

Thank you.

Chair members, John Wenger on behalf of America's Health Insurance Plans in support. Thank you.

Good morning. Al Austin on behalf of AFSCME California and AFSCME Council fifty seven in strong support. Thank you. Good morning. Justin Faizal on behalf of CVS Health in support.

Thank you. Any primary witnesses in opposition to the bill? Come on up. You have two minutes each.

Chairs and Members, I'm doctor Michelle Min. I was recently appointed medical director of my dermatology department, and I prescribe biologics numerous times a week. In addition to skin cancer, dermatologists treat chronic inflammatory skin diseases. For severe disease, we previously relied on cumbersome in hospital treatments for broad immunosuppressants, so biologics have been a game changer.

I'm here today on behalf of Calderm, which has an oppose unless amended position on this bill because it increases patient risk by allowing pharmacists to substitute any biosimilar, not Joseph's, that are interchangeable.

To clarify, I overall support biosimilars and appreciate their cost savings, but the decision about which drug to prescribe to which patient should remain the physicians. Increasingly, non providers are making medical decisions for patients they've never met based on cost. A switch in therapy can flare disease due to gaps or inferior efficacy even if slight. I want to introduce you to a woman with hidradenitis, a horrible condition that impacts young patients. She initially had painful, foul smelling, draining lumps of her chest and groin.

She regularly missed work and refused to date. After years, we finally found the right biologic. However, once she was doing well, her insurer switched her to a biosimilar, which we lay later realized was on back order, so not available, forcing us to go through lengthy paperwork again. With a gap in therapy, she flared. When we finally did start a biosimilar, she didn't respond the same.

And because biosimilars are not exact copies, new problems can arise. One of my patients with Crohn's disease had been doing well on Humira for years, but was then forced to switch to a biosimilar. Not only did his Crohn's flare, he also developed new painful ulcerating rash of his legs requiring hospitalization. His new treatments have caused depression, trouble breathing, and liver toxicity, and now insurance won't approve the next biologic.

Finally, I add that because the nature of biologic switching back is not that simple, time off biologics can lead to antibody development and resistance.

My patients trust me to make decisions based on their individual cases. We believe allowing substitution by a pharmacist for biosimilars increases risk to our patients. Thank you.

Thank you.

Thank you, Chair and Members. Tim Madden representing the California Rheumatology Alliance with an opposed and less amended position. The analysis for SB 1094 does an excellent job at pointing out the policy concerns rheumatologists have with the bill. To illustrate the complexity in treating patients with rheumatoid arthritis, there are over 100 medications that can be utilized to treat the treat the disease. There are 10 distinct biologic types, which include brandings like Humira, Enbrel, and Remicade.

If you include the biosimilars of these biologics, the number is more than 25. This helps explain why it can take months, if not years, of patients trying different medications to find the right one to help them be free from the pain that they've been suffering. Once the patient is free from the painful symptoms, it doesn't mean that they're cured. They're simply in remission. They are one flare up away from being right back where they started when they first got went to the the rheumatologist.

This is why it is so important for a physician to be involved when a pharmacist intends to switch a patient to a different medication. That involvement before a switch is made does not happen today. And with SB 1094 allowing the pharmacist to switch non interchangeable biosimilars, it becomes even more important. The proponents and author respond to this by saying, if the physician is concerned about switching, they should just mark the do not substitute box. This option is an illusion of choice.

Speaking with multiple rheumatologists, each of them share stories of marking the do not substitute only to then have the prescription denied by the health plan. Once the prescription is denied, the physician is then forced to go back through the prior authorization process that adds delays to the patient receiving their medication, risking a flare up. Many times, it also ends up with the health plan only approving a different medication than what was initially prescribed when marking the do not substitute box.

If the intent is for if the intent for checking the do not substitute box is to prevent a substitution, SB 1094 should simply be amended to state that protection very clearly. It does not do that right now.

Until the bill is amended, to accomplish this along with our other suggested amendments, we respectfully ask for your no vote.

Thank you. Any additional witnesses wanna add on in opposition to the bill? Come on up. Provide your name, organization you're with, if any, in position on the bill.

Jennifer Snyder with Capital Advocacy on behalf of the Biotechnology Innovation Organization. We have an opposed unless amended position.

Thank you.

Good morning. Alex Khan on behalf of the California Chronic Care Coalition in a respectful opposition.

Thank you.

Robert Laura here with BioCom with an opposed unless amended position.

Thank you.

Matt Baque representing Osteopathic Physicians and Amgen, both opposed.

Thank you. Any additional witnesses? Seeing none, bringing back to colleagues for questions or oh, excuse me. We have a quorum. Wanna take a little break to establish the quorum.

Madam secretary, please call the roll.

[Roll Call]

Great. We have a quorum. I'm gonna go to Assemblymember Pellerin and then Bauer-Kahan. Got a motion?

Thank you. So thank you. While I appreciate the goal of lowering prescription drug cost, can you just explain to me the specific safeguards in SB 1094 that what they provide to ensure that patients who are stable on a medication are not harmed by this nonmedical switch and how patients can effectively appeal or opt out of that switch when their physician believes it's not in their best interest.

Thank you. Thank you so much for that. And I'm not sure if everyone was here or was listening to me at the beginning when I was talking about the amendments that we are taking. Because of timing, we're gonna have to take it in health committee. But, ensuring that providers have the final say as a provider myself who treats many of these conditions like HS, is has always been extremely important to me.

And so we've been trying to work on making sure that we, at every possible angle, the provider will get a chance to state whether or not he or she would like their patients switched. So what the amendments will do is that 60 prior to the medication being placed on the formulary, the insurance company will inform the doctor of the switch and not just the basic generic information that we get right now when something's coming on the formulary.

It will actually tell the doctor, your patients, John, Jane, and Jim, will have this on their new formulary and may be switched over. That will let the patient the doctor know, oh, John, Jane, and Jim. John shouldn't be switched.

Let me go in and change his prescription and put do not substitute. In this bill, because of issues that happen even now, if, you know, if I do do not substitute on a generic, I may have to go through hoops and bounds to get that done. On this bill, if a provider puts do not substitute, he or she does not have to go back for an authorization and the pharmacist will not substitute. So that is in this bill in the amendment.

So some of the concerns that you were raising, we've already addressed with the amendments.

So that's sixty days prior to any, switch happening. The providers will always be notified of a new change of the formulary. Now another issue that came up when I was speaking to, Chair Berman is that currently, there are already some biosimilars on formularies, and so there would be no switch notification. And that's why I stated at the beginning, 01/01/2027, all providers who have patients on reference biologics will get a notification of the new law and any patients that may be switched as a result of that.

So there will be ample notification, the ability for providers to determine whether or not their individual patients should be switched over to a biosimilar.

And the fact that once they put do not substitute, that must be honored and there will be no extra hoops that they must go through in order to get it approved. Okay.

I appreciate that. And then what about the situation when you come in to get a refill of your medication that's not substituted but it's not available? Is there a way in an emergency like that I'm especially concerned about people with mental health medications that have to stay on track. And at that point, can it be back to substituting as a catchall in the event that the original medication is not available, but with

So I'll turn that over to the pharmacist. That has nothing really to do with this bill because that's just an issue that we have now. Right? Whether or not a drug is actually available that is not particular to this bill, but I will let the pharmacist talk about what happens when you go to a pharmacy and your medication is not available.

Very important question, and I appreciate the question because, you know, if you've been following pharmacies, you know that through the Covid pandemic, there have been significant shortages in medications. When there is a shortage, it is the pharmacist's due diligence to ensure the patient continues to have access. So things that we allow pharmacists to do, they can transfer that prescription to another pharmacy that will have available stock.

They can work with the patient to identify alternatives which would require them to have a new prescription from a provider. So let's say the medication's not available, we searched high and low, we searched home delivery, it's not available.

We as a pharmacist cannot switch the patient without a provider being engaged and prescribing that requested alternative drug. And the last thing I wanted to just touch on the DAW, which is the do not dispense as written. Pharmacists are licensed in the state of California. If a DAW oops. Sorry.

Phil Chen did it.

If dispense as written is selected by the provider, by law, a pharmacist cannot override that, and they are required to dispense what was written and requested by that provider. So

If I can speak to that. Unfortunately oh.

Sorry. My first time doing this. Unfortunately, that's just not our reality. So when you do a prior authorization, it is based on individual brands for the biosimilars. And and these medications are not coming from your local pharmacy. Because they're expensive meds, they're dispensed by

a specialty pharmacy. So it's not like you can dispensed by a specialty pharmacy. So it's not like you can just go to a different branch and and pick it up. If it's on back order, it's on a national back order. It's just not available.

And, unfortunately, there is often a there is a gap in communication between actually, just to the provider, whether it's coming from the pharmacist or from the patient. And sometimes patients don't realize right away. So we find out weeks later. This has happened a couple of times with the biosimilars. We'll find out weeks later.

We will put in for another brand that was listed as as as favored by the insurer, and then we have to do a paperwork again for the prior authorization. And then on on top of that, you can consider it urgent, but your insurer might disagree with you and say that's not urgent. Patient's not gonna die or is not in the ICU. So they can actually decline the fact that you think that it's urgent, and then take another, whatever, thirty business days.

And so all that time, the patient doesn't have their MET, and they're flaring.

So it is problematic. In an ideal world, I don't think there is a problem with back order, but we don't live in an ideal world. And and the reality is harsh. And as for the DAW marking, if you put that, the pharmacist can't dispense, but the payer can say, well, I don't want that that medication. Here are the other ones that we want you to do instead.

So even if the pharmacist can't dispense it, the payer may not cover it, and these are expensive meds, which is what we're talking about today.

And that is probably one of the reasons why you should support the bill because in this bill with the amendment for this particular situation when you're dealing with biologics and biosimilars, if you put do not substitute, dispense as written, whatever you wanna call it, not only do you not have to go through those hoops to get an author another authorization, but you also the insurer has to continue to cover it.

Thank you for those answers. I appreciate it.

Assembly Member Bauer-Kahan.

Thank you so much to the author. And I will say that I appreciate you authoring this because I think I know, just serving with you all these years, that you're gonna put the patients first, which I think is the goal of everybody here on this committee. And so I have a family member who has a rare condition. This is one of the treatments. So I live in this world, and I also live in the world of insurance denials that go hand in hand with any rare condition.

The days and hours I have spent every time they deny something, which honestly is every time we have a treatment because, sadly, the people in the insurance company don't understand this. There are only so many experts in the world on this.

And so, you know, I want I wanted to make sure, and I think that I really appreciate the clarification you gave to us, Emily, about Pellerin, because if you have someone who is in treatment on a biologic and is thriving, it isn't clear to me and I would really want there's no one I trust more in the world than the doctor I get to work with. I would want her to be the one making the determination of what is best for the patient.

And then I don't wanna put the patients in the position where they're having to go back through the pre authorization process, deal with the I love the letters I get that's like, you have seventy two hours or else you're gonna owe all this money.

Like, it's just a nightmare for especially working people. And so, you know, I do think it's really critical that that piece that you mentioned today is part of this.

That not only is the doctor in charge, but the patients are not also then on the hook to have to deal with the fact that the the plans are trying to save a little bit of money. And Aye, you know, I hope this part, we can't guarantee, but I do hope that your goal here is achieved that those, savings are passed on to California consumers and not just to the shareholders in the plans.

Something we can't guarantee, but, you know, obviously, we're trying to cut health care costs. And if the provider does determine that it's fine and, you know, just as well for the patient, I think this is appropriate.

But I appreciate the amendments that are coming because I think not only do we need to make sure that the physicians who know their bodies best are the ones making the determination and that the patients aren't stuck in the doom loop of preauthorization and denials that I know you as a physician dealt with as my physician is all the time.

So thank you for this, and I'll be supporting it today and looking forward to those amendments.

Thank you. And, yes, I know we can't control what will happen with the finances at the end. However, what we will be getting is a report to see where that money is going. And that was extremely important to me because the whole purpose of this is to deal with the cost of health care, particularly for our constituents. And if they're not seeing real savings, then where is that money going?

Because we know that savings are occurring. And because of that, that's why we put in the bill the fact that we must have that report every year. If people's premiums did not significantly decrease, then you need to show us what it would have been had you not had this opportunity versus what it is now. And so, that way we have more transparency than we have now with a lot of the things that we're able to do.

Assembly Member Hart.

My questions were answered by the conversation, so I appreciate it.

Thank you. Assembly Member Addis. Oh, excuse me. I apologize. Assembly Member Addis. Vice Chair Patterson. And then Assembly Member Addis.

Well, thank you. Temporary Vice Chair Patterson. Well, I appreciate, you know, the amendments that, you know, you're taking and and worked on with committee. I think they're really important. You know, in in my quest to remove hormones from our list of controlled substances in California, last year, I did legislation to remove human chorionic gonadotropin, from our list controlled substances.

We're one of nine states, you know, that had it on there. And, unfortunately, it's the law, but, I mean, it's a very common fertility drug for both men and women. And it is now a biologic. You know, that is a new development, but it is a biologic. And in other countries in the world, you know, they have biosim well, they're equivalent of a biosimilar to this.

And one might argue in those other countries that it's it isn't exactly the same, you know, it's similar. But, the effect is is the same. And I can see this is actually now we don't have the approval process in The United States is so robust that it's actually not approved in The United States. But if it was, I would feel confident saying, hey. Look.

You can substitute this in the cases in which they arise, and I think saving, Health Care Dollars is is is a good reason to do so if for the patient, it has this the same effect. And so I think this bill balances, you know, the, you know, the need to save health care cost dollars with also treating the patient with with what they need.

And I do agree if a biosimilar is not you know, might not be as effective or might potentially harm the the patient, then I think the amendments have, you know, safeguards to that. And so I think it I really appreciate you working on that. I get to see this again in health committee, and, you know, we'll look forward to reading those amendments, but I feel very comfortable supporting it today.

So thank you.

Thank you, Mister Patterson. Assembly Member Addis.

Thank you. And thank you so much to the author. I think, there's maybe no one more in the legislature who understands these issues both from your personal experience as well as, your chairship over in the Senate, but I share a lot of those same concerns that have already been been brought up. I think one of the things that makes the public frustrated both with private industry, insurance, government is when something's working. Sometimes we have a tendency to break it.

And I'm wanting to really make sure that if a patient has a medication and they've been on it and it's working, that that is not interrupted. I understand that you've done some things to try to make movement in that area and to try to ensure that when patients have a product that's working, that their treatment's not interrupted.

I think the other concern I have in another place the public gets really frustrated with us is when we talk about affordability and we talk about savings in the tens of millions of dollars. And for regular Californians, that doesn't really mean much. They're thinking about, you know, how much will this save me every single month.

And when I look at the Chbarp report, it saves people every month somewhere between 0 and $25. And $25 is not nothing if you're living on a budget. Like, $25 is important. But if you're that person who's saving $0 or $1 in exchange for, potential issues with people getting our medication, that's a whole different story.

And so I just I think we need to be really thoughtful when we throw figures out around affordability of how we talk about that so that we're really delivering on the promise.

We're not saying to people it's gonna save x amount of dollars in the system, but, really, that report comes out. And it looks to me like the average, enrollee who does not take this medication at according to Chipperp, when that report comes out, they'll save between 0 and $6, actually. So people might be frustrated if if what this report is saying is accurate. So those are just my my general concerns. I'm gonna see it again in health.

Also, I'm gonna support today. I appreciate your expertise and your and your work on this, but I would love for us to drill down and make sure that if we're talking about affordability that there really is that Californians are truly gonna feel that affordability. And I'll just add the concerns my colleagues have mentioned as, you know, how will these savings actually be passed to patients? What happens if they're not? What happens if the report shows these savings actually didn't go to patients?

What's our mechanism gonna be at that point to rectify the situation? So thank you. Those are just my comments.

Thank you. And I'll let my witness from the health insurance plans talk about what will happen if the the patients don't actually see the savings. But, you know, as you pointed out, the 0 to $6 are for patients who aren't currently on bio biologics. Right? So they're not, you know, having some of these high cost, and yet they still do they still will see savings even if it is a dollar or 2.

But the reality is, as I stated at the beginning, since 2017, our health care costs have gone up by 72%. And anything that we can do to to have some savings is better than nothing. The vast majority of the bills that we do actually add cost to our our ever growing cost of our health care system. I think this is the first bill that I have had that actually saves anything.

And so, you know, when we talk about health care cost savings, yes, we want to touch individuals as well, but we're also talking about an entire system where some people happen to be contributing more.

Some people may be on different types of medications and having to pay out of their pocket more. And so you're not gonna see an equal balance across everyone here in California. But the reality is that we need to do something, and this is a part of that something. But I will turn it over.

Thank you, Senator. I mean, the only thing that I would add to that is we believe that the cost savings associated with this bill would probably grow over time. There are about a 188, I believe, is a number of biologics that are going off patents. And so those, will be open to competition. And so the more biosimilars there are on the market, the greater opportunities there will be for savings.

And so I think the CHBURP analysis is a snapshot in time, and I think those savings will grow over the years.

Through through the Chair, can I ask yep, please? I guess the on that, and I certainly appreciate the idea of competition in the market. It's, the concern though is, you know, say the report comes out, the the savings haven't been passed on to patients. I love having an annual report on things, and of course, we want the data. But, ultimately, as we're lowering costs, we are making changes for people's lives.

And so they're gonna wanna know that that positively affected their pocketbook if there's something they're giving up. And so over time with competition in the market, how does that how do we make sure that patients actually get that and that doesn't just become absorbed by the kind of, quote, unquote, rising cost of health care that, you know, supposedly, we can't do anything about.

No. I is that question to me? Or

Any anyone on the dais. Happy to happy to take an answer from any Yeah.

I know. I mean, so so this is one puzzle piece, in the affordability equation. We strongly believe in the, independent report plainly lays out that this will offset premiums by hundreds of millions of dollars and, result in costs sharing, savings to the consumer. The first step towards, you know, the goal that you're talking about is transparency, which is why, we we agreed at the author's insistence to have this report. And so we'll we'll we already do a drug prescription drug pricing report.

It's called the s p 17 report that's been in place for a number of years. And so, our plans already provide data to the Department of Managed Health Care about drug spending and what that means. It also includes, like, you know, what what the savings are, what the offsets to premiums are as a result of rebates. So I imagine the way the report would come out would also show, you know, a line for biosimilars. So

Thank you.

Any additional oh, please. Assembly Member Irwin.

Thank you. And this you have a very broad range of support. It's not often that you see the the chamber and the unions coming up at the same time, so I certainly appreciate that, and and my colleagues asked very good questions. I have a big concern about the do not substitute, and and you certainly have answered that. We do know now that if a physician says do not substitute, that there are a lot of, hoops that they have to, jump through.

But as we're talking about cost savings, what is, what is now the physician's motivation to to agree to a biosimilar if, you know, with this bill, if they're able to say, let's just keep a stable patient on on the the current drug?

So I think

If no every if they're not seeing the savings or the patient is not seeing the direct savings.

Well, you know, every patient is different. Right? And so you may have a patient that you were able to place on a biosimilar or biologic, and they were stable from day one. They may do just fine switching over. You may have another patient where it is taking you a very long time to get them stable on a particular medication.

You may have had to switch and try multiple things. That's not a patient that I would wanna switch. And so as a provider, you look at each patient and each patient's course differently. And so for me, that's how that's what would drive me is how difficult has it been to get you to a place of stability. And I would not wanna risk switching you over.

Now, unfortunately, fortunately, whatever. You know, my patients are switched every day, unfortunately, to a generic. And so I look at a biosimilars like a generic. Some of my patients do perfectly fine. The vast majority of them do perfectly fine.

Some of them start having some symptoms again. And if I've had a patient that I've had to try many different medications and I don't want them switched, then that is when I'll say do not substitute or, you know, or check the DAW. So it's really dependent on the particular patient and the course that they've had with their treatment.

But but the, again, the physician doesn't have necessarily I understand what you're saying, but the physician doesn't necessarily have the motivation to switch to a lower cost drug when they

We don't for the most part, we don't get into cost because we don't know how much things cost. And we don't know what insure like, when I go and see a patient, I don't look to see what insurance are you on, and do I know what drugs are gonna be covered under your insurance. We don't generally get into that area and say, we're going to prescribe this for you because it's cheaper or this because it's more expensive. We're prescribing based on your condition or your symptoms.

And the financial part is is dealt with outside of us.

So that's not something I don't I don't go in and write a prescription because this medication is cheaper. I don't know if it's cheaper. I don't know if what I'm specifically prescribing your insurance is gonna cover because I don't know if you have Blue Cross, if you have Sharp, if you have a different I don't we don't generally move in that direction. That's not how we practice. Okay.

And if I may, as a pharmacist, we do. We know what formularies our patients are on. We know what drugs are gonna be covered. We know which drugs have prior authorizations. And I think it's what's really important and I emphasize this.

I'm a pharmacist. This is my bread and butter. We are here to work in tandem with our providers. So when my dear colleagues write a prescription that we know is not gonna get approved by the insurance company, that's when we work directly with the the provider to say, hey. This isn't gonna work.

Here's what will what do you think? This bill allows the pharmacist that authority to have those dialogues with the patient, the provider, And then, again, ultimately, the provider has the final authority. Period.

If I may, again, that that would happen in an ideal world. There is not often.

We're not here to argue over what happens at the insurance companies.

I'd like to move the bill because this is too much.

If I may, the pharmacist does not often openly speak with the provider. They don't work in the office, so there isn't that much dialogue. As someone that prescribes lots of biologics, that's different than a generic med. Biosimilars are different than than, than than a generic med. We under do we do understand what the costs are with biologics because we face denials every day for these meds.

It's very rare to get a medication automatically covered within a week or two. We're used to going through a lot of the paperwork, and we understand what's on formulary. So we do understand costs. I will say that that there's a lot of paperwork with these prior authorizations, and that there's a reason we spend lots of money on hiring a biologic coordinators because it's a lot of paperwork. And I think one of my concerns is that it will get lost.

I don't know if you ever seen a denial lever letter for a medication. It's pages long. And so I think a concern is that it won't be that apparent to the provider that if they write the do not substitute. So so I do hope with the amendments that, will be coming, that it will be very clearly marked. It's not gonna be buried in the paragraph, said that do not substitute is an option and will be as powerful as as we hope.

Okay. Thank you. Any additional questions or comments from colleagues? Head of a motion. I think we might have already had a motion.

Doctor Weber Pierson, would you like to close?

Well, thank you. I really wanna thank the committee for this very robust conversation. I think the more people talk about the fact that it's important for providers to be able to have that ability to say do not substitute, the more it helps the outside world understand the importance of it as well. And, you know, we are facing health care affordably affordability crisis in this state, actually, in this nation.

And we need to do all that we can to ensure that we are lowering costs, but at the same time, still able to provide high quality care.

And this bill gives that balance to lower cost, but still gives providers the opportunity to ensure that their patients are on the right medications and actually gives them more ability than what we actually have currently with any other medication, to not have to go through another prior authorization, to not have to jump through hoops, to not have to wonder if when we say do not substitute if that will be honored.

This, bill is stronger than anything that we have currently, in health care practice today here in California. And so with that, I respectfully ask for an ask for an Aye vote. Thank you.

Thank you. I wanna thank you, doctor Weber Pierson, for your work on this bill. And I think we're all in full agreement that health care affordability is more critical now than ever. I also appreciate the conversations that we've had, and, the issues and concerns and personal experiences that have been raised by colleagues, around concerns that there could be instances where a stable patient is switched off their medication without their doctor's knowledge or consent, which could have adverse consequences.

So I appreciate your very thorough commitment to taking amendments to ensure that doctors are notified and have the opportunity to engage prior to any substitution.

I really wanna encourage you two to keep talking as the bill moves through the process and and as some of the details are worked out because, I think, even though you're on separate sides of this bill, you're on the same side in terms of your singular focus and goal on making on on the wellness of of your patients.

And and the fact that we get the opportunity to improve the do not substitute process as a part of this bill, I think, is something that's really helpful for the the profession as a whole. So happy to support the bill in the committee today. Madam secretary, please call the vote.

On SB 1094, Weber Pierson, the motion is due passed to the Committee on Health. [Roll Call]

That bill is out. Thank you very much. Thank you, everybody. Thanks for the I thought really great conversation. Doctor Weber Pierson, I believe you've got another bill.

Alright. Good morning.

They won't have as much conversation as the last bill.

Okay. I'm here to present SB 849, a bill that addresses physician sexual misconduct. I would like to start by accepting the committee amendments. According to the Business and Professions Code section 2001.1, protection of the public shall be the highest priority for the Medical Board of California in exercising its licensing, regulatory, and disciplinary functions. The physician-patient relationship involves significant vulnerability and relies on ethical judgment and integrity.

Patients place extraordinary trust in their physician, and any violation of that trust, especially when it is broken through sexual abuse or harassment, should be disciplined to the greatest extent. In 2022, AB 1636 removed the Medical Board's discretion to reinstate a physician or surgeon who had lost their license due to sexual misconduct with the patient. At that time, the LA Times had reported instances where physicians committed acts of sexual misconduct against their patients.

And in all of the reported instances, the physician had either their license revoked or the physician surrendered their license, but subsequently petitioned the Medical Board of California for license reinstatement. For that reason, the bill removed the board's ability to reinstate those individuals.

But more recently, articles about sexual misconduct within the medical industry brought forth this issue again. AB 849 originally required the Medical Board to automatically revoke the license of a physician or surgeon who had committed specified sexual offenses against a patient and had their license subsequently reinstated by the board on or after 01/01/2020.

Due to concerns from this committee on the risk of litigation and constitutional issues raised, we are removing that particular section, and the bill will now only prevent someone from seeking reinstatement if their license was surrendered while a board accusation was pending against them due to any active sexual misconduct or exploitation with a current or former patient or client. This ensures that a license cannot try to get ahead of the process.

A licensee cannot try to get ahead of the process by surrendering their license before an investigation of misconduct is completed and before their final hearing from the board. Additionally, as mentioned in the committee analysis, I would like to clarify the inability for physicians who have committed improper sexual acts to renew their license. Due to short timing, we were not able to include that clarification in the most recent round of amendments, but we will continue working with the stakeholders to make sure that change is present down the line. Thank you, and I respectfully ask for an aye vote on SB 849.

Thank you, Dr. Weber Pierson. Any primary witnesses in support of the bill? Seeing none, any primary witnesses in opposition to the bill? Oh, anyone who wants to add on in support of the bill? Excuse me.

I skipped that step.

Good morning. George Soares with the California Medical Association in support. Thank you.

Aaron Bone with the Medical Board of California. We're a tweener. We appreciate the committee's analysis and working with the Senator and look forward to collaborating on future law changes to address physician sexual misconduct. Thank you.

Thank you. Any primary witnesses in opposition? Got a motion? Got a second? Anybody wants to add on in opposition?

Seeing none, any questions or comments from colleagues? Assemblymember Addis.

I just want to appreciate you for bringing this bill. I'd be honored to coauthor if you're taking coauthors. Just thank you for, excuse me, thank you for doing work in this space.

Any additional questions or comments from colleagues? Seeing none, Dr. Weber Pierson, would you like to close?

Thank you for your time and would respectfully ask for an aye vote on SB 849.

Thank you. As said, thank you for your leadership on this important issue. We strongly support what you're trying to accomplish, and so really appreciate you working with the committee on the constitutional issue that got addressed in the accepted amendments. And with that, happy to support the bill today. Madam Secretary, please call the vote.

[Roll Call]

That bill is out. Thank you very much. Senator Ochoa Bogh. I see you've got agenda item number three, SB 993.

Ready whenever you are.

And maybe just hit the little microphone button.

Thank you.

There you go.

Good morning, Mister Chair, vice Chair, and, members of the committee. I'm pleased to present SB 993, a bill that will restore previous protections for mental health professionals working in certain correctional and psychiatric settings by allowing these employers to limit the routine disclosure of a mental health provider's identifying information to patients. Mental health professionals working in correctional settings and other facilities face unique concerns as they work in some of our state's most challenging environments.

They often work with individuals experiencing serious mental health challenges or with patients who have a history of violence. Providers should not have to face unnecessary personal safety safety risk simply because they choose to serve a population who needs critical care.

Rather than waiting for safety concerns arise, SB 993 limits a routine disclosure of their information, but also preserves accountability by requiring these facilities to provide an accessible complaint process for patients in correctional and psychiatric settings. Let me be clear. SB 993 does not remove any of the accountability procedures these facilities already have in place. Patients will continue to have access to a complaint process and licensing oversight will remain unchanged.

These new safety measures will simply allow therapists and other professionals to feel safe enough to continue their work with vulnerable populations.

California needs to recruit and retain qualified mental health professionals, which makes establishing safe working conditions and continued protection for our providers essential. With me is Carl Miller, president of the American Federation of State, County, and Municipal Employees Local twenty six twenty, the sponsor of the bill.

Alright. The button's off. Good morning, Mister Chair and members of the committee. My name is Carl Miller, and I am president of AFSCME, local twenty six twenty. And I represent more than 5,000 health and social service workers employed by the state of California.

I am also a frontline licensed clinical social worker at the California health care facility in Stockton. And I thank you, Senator, for asking me to come to speak on this. Our members provide mental health services throughout California's correctional system, and we strongly support SB 993. SB 993 restores critical safety and privacy protections for mental health professionals working in CDCR and d s DSH facilities.

While SB 1024 was well intentioned and appropriate for most therapeutic settings, it unintentionally removed longstanding safeguards that correctional Clinicians have relied on for our safety.

This bill helps protect Clinicians from harassment, threats, and stalking by restoring appropriate professional boundaries. These protections are not theoretical concerns. A colleague of mine continues to recount the fear and distress she experienced experienced after an incarcerated individual obtained information about her, stalked her, sent packages and other individuals to her home, and she ended up having to move. SB 993 also supports recruitment and retention of qualified mental health professionals.

California's correctional facilities already face significant staffing shortages, and it will become increasingly difficult to attract and retain Clinicians if they do not feel their personal safety and privacy are protected.

Importantly, SB 993 maintains accountability and preserves patients' ability to file complaints without unnecessarily exposing us Clinicians to safety risks. It strikes the right balance between transparency, accountability, and workplace safety. A strong mental health workforce is essential to the effective operation of California's correctional care system. By protecting the safety, privacy, and professional integrity of our Clinicians, SB 993 helps ensure that we can continue to provide high quality care to those we serve.

For these reasons, AFSCME local twenty six twenty respectfully urges your support for SB993, and ask for an aye vote.

Thank you.

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

Good morning, Mister Chair and members. Malik Bynum with the County Behavioral Health Directors Association in support. Thank you. Thank you.

Good morning. Bindu Macamla on behalf of the National Association of Social Workers, California's chapter in support.

Thank you.

Good morning. My name is Eileen Seagala. I'm a licensed clinical social worker at California Department of Corrections. I'm in support.

Thank you.

My name is Carla Tyson. I work in one of the biggest psychiatric inpatient yards in the state of California, and I urge you guys to please support this bill.

Thank you.

Good morning. Al Austin on behalf of AFSCME California and AFSCME Council fifty seven in strong support. Thank you.

Thank you. Got a motion. Got a second. Any additional question excuse me. Any primary witnesses in opposition to the bill?

Seeing none. Anyone who wants to add on in opposition to the bill? Still seeing none. Bring it back to colleagues for questions or comments. Already have a motion and a second.

Senator, would you like to close?

I hope you'll join me in supporting mental health professionals who deliver critical care that leads to positive outcomes for individuals in correctional facilities. I respectfully ask for an aye vote.

Thank you very much. I wanna thank you for bringing this important bill forward. You know, as someone who's had my personal home information shared publicly, you know, I know how scary that is. And and we need to do everything that we can to make sure that that doesn't happen, especially for our mental health professionals, you know, who need more people to go into that profession. So really appreciate you bringing the bow forward today.

Happy to support it. Madam Secretary, please call the vote.

On SB 993, Ochoa Bog, the motion is do passed to the committee on appropriations. Berman?

Berman, aye. Patterson? Patterson, aye. Addis? Aye.

Aye.

Addis, aye. Aaron? Aaron's, aye. Alanis? Baines?

Barakaham? Kaloza? Chen Chen I Alohouri? Aye. Alohouri.

Aye, Hedwick. Aye. Hedwick. Aye, Haney. Hart.

Aye. Hart, Aye. Erwin. Erwin, Aye, Jackson.

Jackson, Aye. Lontal. Faceto. Faceto. Faceto.

Aye.

Aye. Nguyen.

That bill is out. Thank you very much.

Thank you very much.

Senator Niello, I see you've got agenda item number four SB1002.

Thank you. Thank you, Mister Chair and, and Members. Appreciate the opportunity to present SB102. This bill is important, but it really is just a modest extent extension of the David Hall Act of 2023 That allows for eligible patients to access out of state care, excuse me, via telehealth with eligible providers. Under the David Hall Act, an eligible patient is someone who with an immediately life threatening diagnosis, meaning there is a reasonable likelihood that death will occur in a matter of months.

An eligible physician and surgeon is required to be licensed in another state, in good standing with no history of prior discipline, and their medical expertise must be that of the eligible patient's illness. SB102 seeks to allow patients that at one point qualified to receive out of state telehealth care under that act to continue seeing that previously established provider via telehealth if they receive remission. The bill is about access to care and continuum of care for these patients while preserving existing safeguards.

Now I am aware that some are concerned with any broader expansion of out of state tele telehealth care availability. This bill, however, deals with a very specific, very personal patient issue with significant, very significant emotional and vital care issues.

Imagine imagine being given a cancer related death sentence, Then finding an out of state physician who treated you as allowed by the David Hall Act, and you went into remission. Imagine that joy without AB102, that joy would then be crushed. Crushed when you find out that you can no longer you can no longer rely on that lifeline with a now very trusted doctor.

That, I'm afraid, is not only very poor consumer affairs treatment, it is totally insensitive and a complete disservice to the patient. That's why SB102 has had bipartisan support passing unopposed out of the Senate Business Professions and Economic Development Committee as well as the Senate floor.

So with me this morning, I'll pass this over in support of the bill to Robin Cloth, the of the senior as a member of the senior Assembly.

You have two minutes.

Good excuse me. Good morning, Chair and members. My name is Robin Clow, and I'm I live in Santa Clarita and Campbell. I was wheeled into the Operating Room for thyroid surgery that was scheduled to take three hours. Nine-and-a-half hours later, I was wheeled out to discover that my life would be forever changed.

I was diagnosed with a rare, excuse me, an aggressive type of thyroid cancer known as anaplastic. The typical survival time for this cancer is four to six months. My daughter was expecting our first grandchild. I underwent seven weeks of simultaneous radiation and care chemotherapy at Cedars Sinai in Los Angeles. When the cancer returned, my my physicians supported my decision to seek care at MD Anderson Cancer Center in Houston.

I received a newly discovered targeted therapy that so far has been successful for me. It is uncommon for a bill to undergo a test run-in public before enactment, but this is true for SB1002. The pandemic led to federal and state executive orders allowing telehealth visits, which enabled doctors and patients to communicate about health issues across state lines. These executive orders have expired though, leaving patients like me without life saving expertise from specialists practicing outside of California.

There are times when I have been too ill or weak to travel.

And because I am immunocompromised, I was at risk of exposure to other illness. Excuse me. Telehealth visits are truly a lifeline. Patients in my anaplastic cancer support groups are desperate to receive care from specialists beyond California when needed. Some of us are in remission or with no evidence of disease.

This does not mean we are cured. We're still in jeopardy of recurrence and require careful ongoing monitoring by our out of state specialists. Continuity of care is critical. I survived over three years and now not only have a grandson, but I have a granddaughter and just learned there's another granddaughter on the way. So please allow Californians struggling with cancer and other life threatening diseases to receive the care they need.

Thank you.

Thank you very much. Any additional witnesses who wanna add on in support of the bill? Come on up. Provide your name, organization you're with, if any, and position on the bill.

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

Good morning. Donna Matias on behalf of Pacific Legal Foundation here in support.

Thank you.

Good morning. Doctor Graham Press on behalf of the National Vehicle Residency Coalition here in strong support. Thank you.

Good morning. Veronica Zaire, retired United States Army, in support.

Thank you.

Thank you.

Heidi Hannaman, El Dorado County resident, breast cancer survivor in support.

Thank you. Any primary witnesses in opposition to the bill? Come on up. You have two minutes each.

Thank you, Mister Chairman. Aaron Bone with the Medical Board of California. We understand the goal of the bill, but the board is respectfully opposed to SB102 as we believe that licensure is a vital form of consumer protection and ensures that physicians practicing in this state have met the relevant statutory requirements to treat patients here.

We appreciate the committee's analysis, which indicates that without a license in the state, the board would be unable to discipline a physician who fails to treat our residents outside of the standard of care and points out the existing law that facilitates access to out of state physicians and their ability to consult with them on a diagnosis and treatment plan alongside a California licensed physician who is in charge of the patient's care. Furthermore, an out of state physician could simply seek a license from the board.

Although we are opposed to this measure, we do appreciate the dialogue with the office office and the sponsors, and we are open to collaborating on other law changes that would increase access to care while also preserving licensure requirements and related consumer protections. At this time, though, we must respectfully request a no vote. Thank you.

Good morning, Chair and Members. George Soares with the California Medical Association. We're here respectfully opposed unless amended to SB1002 by Senator Niello. We understand that this legislation is well intended, but it would dangerously expand existing law, which was intended for people with life threatening diseases who have not been accepted into a clinical trial in California. In general, granting license exemptions risk introducing physicians who may not be familiar with California's laws, regulations, and standards of care.

As noted, out of state physicians who seek to provide care to California residents can apply for temporary license with the medical board. This bill creates an unnecessary loophole to that process. We understand the desire for some patients in remission to continue dialogue with out of state physicians.

We believe our proposed amendments would allow for patients to consult with out of state physicians regarding medical opinions, such as receiving a second opinion, while protecting patients from a physician who would, otherwise not be eligible to practice, medicine under California law. For these reasons, we're respectfully, opposed unless amended to this bill, and I'm

happy to answer questions. Thank you. Thank you.

Please, assemble your head work.

Hi. I wanna really thank the author for this bill. I my mother-in-law had glioblastoma. She was lasted ten months, and we went to three or six hospitals in three states. I live in Modoc County.

My district borders Oregon and Nevada. Most of my constituents go out of state, especially for specialty care. Towards the end, for months, we had to take her every other day to appointments for transfusions or to simply be have them look at her to see what she looked like. And telehealth would have been amazing, but we were in different states. Sometimes, we would have to drive over the border just to do a telehealth appointment.

And when you're in those last months, it is not something that's comfortable for someone that's trying to survive and just wants to spend time with their family, with the time they have left. I live three hours from a major hospital, so all doctor's appointments cost us more money in my district. And so when the price of gas goes up, when the price of medical bills go up, price of food goes up, it literally kills people in my district because they can't afford to get there.

And we have some services for that, but I. I think many of my colleagues live in areas that they are blessed to have hospitals very close and specialty care that's easy to get, and that's just not a reality in my district. So I'm happy to support this bill and would love to be added as a co author.

Thank you. Vice Chair Patterson?

Great. Thank you. To my good friend from the medical board who I've known for many, many years, don't take offense to this, but I have the privilege of saying this often in housing committee and before natural resources committee. But something gives me a visceral reaction, and that's when administrative agencies show up to oppose policies in the legislature because I philosophically believe it's our role to create the policies, for the state of California.

I mean, that's, like, actually, in the constitution that that is what exactly what we're supposed to do.

And while I think the opinion of administrative agencies is important, I, I really think, you know, when agencies show up to oppose legislation, it just it just really, really gets me the wrong way because this is our job. That said, I've I've had the privilege of leaving those comments to the Coastal Commission in the past and hope to keep it with them in the future. But, you know, my, I, I'm happy to support this bill.

I mean, it's a a a very obvious bill that we should be supporting if, you know, well, in some ways, we should still continue to breed a free country. We have trained and, and licensed physicians that have been assisting patients in their life threatening diseases and conditions.

And if a person is in remission and, you know, thank thank God on that, but to the extent that that continues to occur, they should continue to be able to see said physician until such time that treatment's no longer needed. But, so I think this is a great bill. You know, obviously, I understand that we wanna encourage people to see, practitioners here in California.

I'm a big proponent of that, but in these very unique circumstances, you know, it's hard to deny care and access to whom the patient is not only been helped by already, but is most comfortable with and will, improve the longevity and the livelihood of that patient. So I look forward to supporting this bill today.

Thank you, Mister vice Chair. I think we've oh, got a motion in a second. Any questions or comments? Any additional questions or comments? Seeing none, Senator, would you like to close?

Thank you. I also have known both of the opposing witnesses for a while, and I will second the comments of my my my friend and a person with whom I share representation in Placer County. But here's the deal with regard to their position. It's fundamentally clinical, and I get that. They're concerned about any expansion, any broader expansion of the David Hall Act.

I'm pretty sure that they were opposed to the David Hall Act in the first place, so that's perfectly consistent. But it's clinical. They would probably say that this patient to whom I sort of fictitiously brought up, but is backed up by reality, in any case, could get equally equal quality care by a licensed physician located physically in the state of California. And I won't challenge that necessarily.

But recovery for health issues, especially one as serious as cancer, and I would say I am uniquely sensitive to that myself.

My wife has had two bouts with cancer, so I've experienced that up close and personal. It is emotional. It is clinical, yes, but it is emotional. And if you destroy the emotional part of that, you significantly compromise the ability for the clinical approach to be truly effective. And I just repeat again.

Imagine you are a patient that qualified for the David Hall Act, and had out of state care, and went into remission, and then found out that that trusted lifeline that brought you, you believe brought you to remission, that may not in fact clinically be true, but it is emotionally true, and you can't use that anymore. Now maybe if you can afford to travel, there's an equity issue there. I just don't see, and it's a very narrow expansion.

I just can't see how we could deny that patient the emotional comfort of continuing to deal with that trusted provider. I ask for an aye vote.

Thank you, Senator, and I appreciate your presentation and the testimony of your sponsors. Unfortunately, I, I cannot support the bill today, which you knew before today. Licensing and oversight of health professionals is the cornerstone of our laws to protect patients, to protect California patients, and ensure the, quality care.

And while I did support the prior legislation to exempt physicians from licensure in urgent cases where conditions are immediately life threatening, this committee made it known at that time that this was meant to be a rare and, and narrow exception. To be clear, under what this bill proposes, no licensing board in the state of California, zero licensing board in the state of California would oversee care being indefinitely provided to California patients.

And that is not something that I support. And, and I wanna reiterate that there are multiple ways that out of state doctors can continue, to provide care to in state residents. The doctor can get a license from the medical board of California through a streamlined process. The patient can travel to where the doctor is licensed to practice. But, really, the most used option is that the patient's California licensed doctor can consult with that out of state doctor.

And if an out of state doctor is truly the only good expert on a rare condition, then they can still be part of the patient's treatment as long as the California doctor is ultimately responsible for that care. And that California doctor is responsible to the licensing boards in the state of California to make sure that that patient is not is is treated with the quality care that that we've determined California should be treated within California.

So I appreciate the, the passion and the emotion, but I cannot support the bill today. And I advise a no vote on the bill. Madam secretary, please call the vote.

[Roll call]

We'll leave that open. Thank you, Senator.

Thank you. I'd like to request reconsideration if the eventual vote is

You bet. Absolutely. For a time, Emeritus Maguire. Ready when you are. You've got agenda item number six, SB1263.

Ready when you are, sir.

Hey. Good morning, Mister Chair, Mister vice Chair. Good morning, committee. I hope

just hit that little I know you've got a booming voice as is, but hit that mic button for us.

You helped to do the damn mic.

Thank you, sir.

Alright. Hey. Good morning, Mister Chair, Mister vice Chair, to the committee. Thank you so much for allowing us to be able to present SB 1263. Mister Chair, I wanna say thank you to your staff's work, to your work on this, and, of course, we're gonna accept the committee amendments.

SB 1263 is our latest measure to be able to protect wildfire survivors from unscrupulous contractors and better prepare the state for large scale post disaster community cleanups. We've passed legislation over the last several years with bipartisan support that's increased the statue of limitations for unscrupulous contractors to perform shoddy work on post disaster home rebuilds. We've required the state through CalRecycle to prequalify large contractors to perform wildfire debris cleanup and removal work, which has now expedited statewide debris cleanup efforts.

And now we are in front of you with twelve sixty three, which has received bipartisan support thus far. It's pretty damn straightforward.

It mandates only licensed general engineering, earthwork, paving, building, and demolition, along with general building contractors can perform post disaster residential debris removal work. The bill also ensures that these three categories of contractors meet the baseline safety and training standards that protect workers as we refer to HAZWOPER. I know that is one of the chair's favorite terms. So, we're working, Mister Chair, directly with the contractor state license board on this measure. I'm grateful to the head of the board, Dave Fote, who is here today.

He's gonna be testifying. And I also wanna take a moment to say thank you to operating engineers local three who are always on the ground after these disasters. And representing Local three today, we have Mike Pickens. I will respectfully ask for an IPO.

Thank you. You have two minutes each.

Thank you, Mister Chair. Thank you, Mister Chair, Mister vice Chair, and members of the board. My name is Mike Pickens. I'm the district rep for the operating engineers local three. I cover Snowmobile Lake, Marin, and Mendocino Counties.

My area has been devastated by wildfires and disaster throughout throughout the recent years here. We represent over 40,000 men and women in the construction industry who do this work, heavy equipment, keep our infrastructure running in Northern California. O e three is proud to support SB 1263.

We've worked hand in hand with Senator McGuire on several bills and legislation in the past, along with our efforts to ensure that this work is done to the safety of our workers and the fellow trades who are involved in that, as well as the residents and the citizens in the affected areas. In the aftermath of those events, we saw an influx about estate contractors.

None more importantly or more that stands out more to me than the Tubbs Fire in Sonoma County. That we saw an influx of out of state contractors, and what we saw when we went out there and looked at the job sites was truly scary to see the these these contractors put these workers in that kind of environment to work in without the proper protections.

And this bill will ensure that those laws and standards are the level playing field, the bare minimum that contractors must do and to secure, you know, the safety of not only the workforce, but the residents. Make sure there's no runoff. Make sure that the particular matter is being dealt with and watered down and not being dispersed into the atmosphere.

For for us, worker safety is paramount. That's what unions were built on. That's where the eight hour workday come from, minimum safety standards that we enjoy today. So to see to have a a friend like Senator McGuire champion that for us is truly been a blessing for Local three. For the reasons I have stated, Operation Healers Local three respectfully request an aye vote, and we hope we encounter your support.

Thank you.

Thank you very much.

Good morning, Chair Berman and members of the business professions committee. I'm David Fotge the registrar for the contractor state license board. Protecting consumers that have been harmed by a wildfire or other declared disasters vitally important to the CSLB. We want to thank Senator McGuire for his authorship of this conserved protection bill. This bill accomplishes very significant public protection goals.

It ensures there will be enough licensed contractors available to meet debris removal needs. Currently, more than 135,000 licensed contractors hold the classifications that are specified in the bill. The bill requires CSLB licensed contractors to obtain obtain CSLB's hazardous substance removal certification and meet hazardous waste operations and emergency response requirements. Of course, that's otherwise known as the HAZWOPER training that is so vitally important for the workers that are handling this hazardous material.

Just some of the requirements though for this to kick in would be that it's a residential property that has been damaged or destroyed by a declared emergency or natural disaster.

That a CSLB contractor's license is required to perform the debris removal work. So what that really means is it's gonna require excavation, not just there's a pile of debris out in the street. It's gonna require that the surface be altered in some way. That a permit is required for removal of debris containing hazardous materials. And that's very important because these hazardous materials typically will include asbestos, lead, mercury, other things that are not only dangerous to the worker, but to the surrounding community.

So it's vitally important the person performing that work has the required training. And just to close, we work very closely with LA County Public Works Officials in our in our recent wildfires that occurred in Los Angeles County and Los Angeles City And County.

And we found that by requiring the certification that educated the licensed contractor and they need to have the house of opera training for their employees, that the workers were being protected, that we didn't have the degree of unlicensed practice or unprotected workers that we've seen in prior wildfire disasters. So we really appreciate your consideration of this important public safety measure. Thank you.

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

Thank you, Chair and members. Matt Kremens here on behalf of the California Nevada Conference of Operating Engineers. Proud to be here in strong support.

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

Thank you, Mister Chair members. The mic has been hard to use today. I don't know why. Todd Blumstein representing the Southern California Contractors Association. We have an opposed unless amended position on the bill. Let me first state that we agree entirely with the author and the sponsors.

Our members worked on the Palisades fire. We've had members work up in in Paradise as well. One of my members put 100 workers through the HAZWOPER training for the Palisades fire. That's a significant investment in their workforce. HAZWOPER requires forty hours of training, for each individual, and rightly so.

This is dangerous material. We support the idea of trying to prevent out of state fly by night contractors come in. Our opposition is very, very nuanced. The way we read the bill, it requires debris removal, or hazardous let me back up. Hazmat certification is required for any debris removal.

There are instances, and we have contractors right now working in the San Bernardino Mountains, removing mudslides and other material that's come down from the burn scars and have damaged homes. There's no burning. It's simply the removal of dirt. We don't and mud. We don't think it's necessary to require hazmat training or hazmat certificates, for that type of, emergency.

Therefore, we have an opposed and less amended position. We have been in contact with the sponsors. We have been in contact with the authors. We think this is a real simple fix, and we would appreciate it getting fixed. Thank you, Mister Chair.

On behalf of SCCA, we have an opposed and less amended position.

Thank you. Any additional witnesses wanna add on in opposition to the bill?

Thank you, Chair members. Anthony Tannehill with California Special Districts Association. We had a concerns, and I wanted to be here today because we were listed as such in the analysis. And we look forward to seeing the amendments that go into print and reevaluate. And I wanna express my gratitude to the committee and to the author for working with us on our particular issues.

Thank you. Any comments or questions or motions or seconds from colleagues on the committee? Got a motion. Got a question. That's something I remember.

Thank you.

Sorry. I raised my hand at the wrong time. I just wanted to make sure the conversations with the I had the similar concerns. I probably have the only opposed, and I'm hoping to change my mind on the stay on the dias right now. But Mike's concerns were very similar to the opposition and the concerns of the Special Districts Association.

We're very rural in the middle of nowhere, and we are plagued by fires. So often, we run out of of contractors very, very fast. And I'm wondering if, particularly, if there is no hazardous material, if you will have something in there that you can waive that certificate because that's gonna be the one that hangs our people up.

Thank you so much, Assimilman. And I wanna say how grateful I am for your work. I know this has been very personal for you when it comes to wildfire. The amendments when that are in front of the committee that I know that there's been some concern with the special districts, and I don't wanna speak for them. But and thanks to the work of the Chair, the debris removal definition has been refined.

And then tree and palm contractors. And the that's where California Special Districts Association was also concerned, and we have refined that definition in in what activities that they can perform. So I do believe I don't wanna speak for them, but we've heard them loud and clear and working with them to be able to hopefully get them to neutral on this bill, and wanna say thank you to the Chair for engaging on that.

On SCCA, we're gonna continue to have conversations, and our next stop on this train is gonna be emergency management, and know that we're gonna continue those conversations. You have my word on that, assemblywoman, and continue working through.

And and you're absolutely right. It is an issue of definition, and I think we all believe that we can probably get there on the narrowing of the definition. Again, HAZWOPER training is utilized when there is a major disaster and toxic material. So I think we're gonna be able to figure it out.

Okay. Thank you. Thank you so much.

Happy to vote aye today because I'm gonna see it in emergency management. So we'll talk again soon.

Yeah. You better believe it. Thank you so much. Thank you.

Any additional questions or comments or a second? Got a second. Seeing no additional questions or comments, Sender, would you like to close?

Just wanna say thank you, Mister Chair, for your work, your committee's work, and, look forward to the continued conversation. And thank you so much for allowing me to present today, and thank you to our witnesses.

Thank you, sender. You we're definitely closing out the hearing with a HAZWOPER of a bill, but I couldn't help it. I couldn't I'm a new dad. It's dad joke time. Like

It's Father's Day week. The whole thing. Yeah. I'm just gonna lean into it. That's right.

Appreciate your work on this bill. Appreciate your openness to working with with concerned stakeholders and and continue to try to refine different definitions in the bill. Happy to support it today. You've missed a terrible joke. Respectfully ask for an aye vote.

Thank you. Alright. Different sort of adds to me closing for your bill. Happy to support the bill today. Madam secretary, please call the vote.

On SB 1263 Maguire, the motion is do passed as amended to the committee on emergency management. Berman? Aye. Berman, aye. Patterson?

Patterson, aye. Addis? Aye. Addis, aye, Arons. Arons, aye, Alanis.

Aye. Alanis, Aye, Baines. Baines, Aye, Barakahann. Kolozha, Kolozha Aye. Chen, Chen Aye.

Elhorie. Aye. Elhorie. Aye. Hadwick Aye.

Haney. Haney, Aye. Hart, Aye. Erwin. Erwin, I Jackson.

Aye.

Jackson, I Lowenthal. Macedo. Macedo not voting. Nguyen. I'm sorry.

Oh, Nguyen. Nguyen, I Pellerin. Aye. Pellerin, Aye.

That bill is out. Thank you very much. So we have we're gonna open the role for a couple of bills. We're gonna add votes to a lot of bills. Is he yeah. Okay. So we got a this is for a SB 758. Got a motion. Need a second for a bill that the Chair supports. Got a second. Thank you. Madam secretary, please call the vote on SB 758 with a Chair.

[Roll Call]

That bill is out. We're just taking it from the top or Yeah. Okay. Let's we're just gonna take it from the top and run through the the file.

[Roll Call]

Yeah. So this is gonna be, we're gonna open the roll on agenda item number four, SB 1002. The Chair has a no reco on this bill.

[Roll Call]

This is agenda item number four, SB 1002. The Chair has a no reco on this bill.

[Roll Call]

We'll leave that open.

[Roll Call]

So we need a motion and a second for agenda item number seven, SB 1312 by Richardson. Got a motion in a second. Madam secretary, please call a vote.

[Roll Call]

Bill is out. Madam Secretary, please take it from the top again just in case we missed anybody?

[Roll Call]

Thank yes. Thank you everyone. Hearings adjourn.