June 21, 2019 Edition
We are pleased to announce that the Merced County Public
Health Department was awarded accreditation status by the Public Health
Accreditation Board (PHAB) this week. Merced County becomes the 15th local
health department awarded PHAB recognition in California, in addition to the
California Department of Public Health (CDPH).
Please join us in congratulating all of the hard work of our colleagues in Merced County. Additional information on PHAB, as well as the press release, is available here.
This week, the
California Legislature maintained a steady pace of committee hearings, bill
negotiations, and amendments. Agendas for committee hearings over the next
several weeks are becoming quite lengthy as legislators approach the next round
of deadlines in early July prior to their month-long summer recess set to begin
on July 12.
highlight significant actions of interest on legislative bills this week. For a
full update, the CHEAC Weekly Bill Chart is available here.
SB 276 (Pan)
as amended June 18,
2019 – SUPPORT
In a tense
hearing on Thursday, the Assembly Health Committee convened solely to hear SB
276 by Senator Richard Pan, which tightens current law governing medical
exemptions for immunizations. Senator Pan gave an impassioned opening during
the hearing about how his bill was intended to protect the safety of
California’s children, particularly infants and those that are medically
fragile. Dr. Pan thanked both Governor Newsom and California Health and Human
Services Secretary, Dr. Mark Ghaly, for their assistance in crafting a
“California solution” that would ensure the safety of children who truly
require a medical exemption to enroll in school (a summary of the new
amendments negotiated with the Administration are outlined below). He also
noted that schools that have large medical exemptions on file or where their
immunization rate has fallen below the disease immunity threshold represent
“the tinder for a disease wildfire that could harm the broader community.”
touted the support of the California Medical Association (CMA), the American
Academy of Pediatrics and Vaccinate California, the sponsors of the bill, as
well as the California State PTA, Children Now, the March of Dimes, CSAC, CHEAC
and HOAC among others. Testifying in support of the bill were Jenni Balck, a
mother of a child who had received a heart transplant and cannot receive
immunizations, Dr. Margaret Parsons, a CMA Board of Trustees member, and Dr.
Erica Pan, Alameda County’s interim health officer. Opposition testimony
included Dr. Bob Sears, a prominent pediatrician from Southern California, and
Stephanie Fetzer, representing a grassroots organization, Parents United for
Kids. Robert F. Kennedy, Jr, was also present as an opponent, but the time
allotted for testimony ran out before he could state his concerns. Opposition
testimony was then followed by a nearly two-hour stream of hundreds of individuals
and families from throughout the state.
testimony concluded, the discussion moved back to the members of the Assembly
Health Committee. Members focused on a variety of issues that the bill
addressed with the new amendments, either to their satisfaction or not enough.
Provisions discussed were the inclusion of consideration of a child’s family
medical history and the expansion of factors considered for exemptions, the
California Medical Board’s current practice regarding physicians who have complaints
lodged against them for approving an excess of medical exemptions, and the
bill’s impact on exemptions issued prior to the new requirements.
On a 9-2 vote,
with four members of the committee abstaining, SB 276 passed out of committee
with amendments (pending) and now heads to the Assembly Appropriations
As noted above,
amendments were negotiated with the Newsom Administration and significantly
restructure the process of medical exemptions. With these amendments, Governor
Newsom has indicated a willingness to now sign the bill, should it reach his
desk. Amendments include:
- California Department of Public Health (CDPH) remains
the designated state agency responsible for reviewing medical exemptions.
- Standardized electronic forms, created by CDPH, would
now be submitted by physicians through the California Immunization
Registry (CAIR) beginning January 1, 2021.
- Exemption forms must also be printed, signed, and
submitted directly to a child’s school or governing authority.
- Forms must include information from the physician
including the name of the primary care physician of the child if different
from the physician issuing the exemption. Physicians must certify they
have physically examined the child, describe the medical basis for the
exemption, whether the exemption is permanent or temporary (not to exceed
one year). Physicians must authorize CDPH to contact them directly with
questions on the exemption as well as authorize the release of relevant
medical records to both CDPH and the Medical Board of California.
- CDPH is tasked with creating a standardized system to
monitor immunization levels in schools and to monitor patterns of
unusually high exemption form submissions by physicians, surgeons, or
- Requires CDPH to annually review immunization reports
from all schools to identify medical exemption forms from schools with an
immunization rate of less than 95% and for physicians/surgeons who have
submitted five or more medical exemptions in a calendar year.
- Allows CDPH, on the discretion of clinically trained
immunization branch staff, to accept a medical exemption that is based on
other contraindications or precautions, including consideration of family
medical history, if the physician provides written documentation
supporting the exemption consistent with the relevant standard of care.
Expands the criteria used to evaluate medical exemptions to include
applicable CDC, ACIP, or American Academy of Pediatrics criteria for
appropriate medical exemptions.
- CDPH required to notify an issuing physician, the
school, and the local health officer with jurisdiction over the school of
a denial or revocation of an exemption.
- Includes provisions on suspending a physician’s
ability to issue medical exemptions and notifying the California Medical
Board and the Osteopathic Board when exemptions from physicians are denied
- Allows a parent or guardian of a child denied a
medical exemption the opportunity to appeal to the Secretary of the
California Health and Human Services Agency (CHHS). CHHS Secretary
directed to establish an independent expert review panel, consisting of
three licensed physicians, who are primary care providers or immunization
experts to review all exemption appeals. CHHS Secretary must issue a final
decision, consistent with the findings of the expert panel, and that
decision is not subject to further administrative review.
Disease Prevention & Wellness Promotion
AB 388 (Limón) as amended June 12, 2019 – SUPPORT
AB 388 by
Assembly Member Monique Limón was heard in the Senate Health Committee on
Wednesday. The measure would require the California Department of Public Health
(CDPH) to implement action agenda items from the U.S. Centers for Disease
Control and Prevention (CDC) Healthy Brain Initiative, as well as award
one-time competitive grants up to eight local health jurisdictions for local
planning and preparation activities consistent with the CDC Healthy Brain
Initiative Action Agenda. Recall, funding for these grants was included in the
2019-20 Budget Act which was passed by the Legislature last week. AB 388 was
unanimously approved by the Senate Health Committee on a 9-0 vote. The measure
now heads to the Senate Appropriations Committee.
AB 1031 (Nazarian) as amended May 17, 2019 – SUPPORT
Adrin Nazarian’s AB 1031 would establish the Youth Substance Use Disorder
Treatment and Recovery Program Act and direct the Department of Health Care
Services (DHCS), in collaboration with counties and SUD services providers, to
establish regulations of community-based nonresidential and residential
treatment and recovery programs for youth under 21 years of age. DHCS is also
directed to seek funding for this purpose for all services covered by Medi-Cal
and to use additional funding from cannabis tax revenues available to DHCS. AB
1031 was heard in the Senate Health Committee on Wednesday and was unanimously
advanced to the Senate Appropriations Committee on a 9-0 vote.
SB 445 (Portantino) as amended June 11, 2019 – SUPPORT
445 by Senator Anthony Portantino would require DHSC to convene an expert panel
and adopt regulations based on the expert panel’s recommendations to establish
youth SUD treatment, early intervention, and prevention quality standards for
California youth. The measure would also require each county to designate a
single public agency responsible for administering youth SUD treatment services
within the county and require that agency to comply with standards adopted by
DHCS. SB 445 was heard in the Assembly Health Committee on Tuesday and was
advanced to the Assembly Appropriations Committee on a 14-0 vote with one
member not voting.
Medical Services (EMS)
SB 438 (Hertzberg) as amended June 18, 2019 – OPPOSE
SB 438, by
Senator Robert Hertzberg, which would undermine local EMS agency medical
control and place restrictions on contracting EMS 9-1-1 dispatch services, was
amended this week. CHEAC, along with a coalition of county organizations
including CSAC, UCC, RCRC, EMSAAC, and EMDAC are all opposed to the measure.
- Restrict a county’s ability to contract with a private
entity for 9-1-1 dispatch services unless the contract was with a JPA that
existed prior to January 1, 2019, or would allow a private contract,
established prior to 1/1/19, to continue if the public safety agencies
that provide EMS consent to renegotiate and adopt a new contract.
- Allows public safety agency EMS dispatch to recover
costs from EMS providers for providing connections to their dispatch
center, including defining connections to that dispatch center to include
ring down lines, intercoms, radio or other means of notifications.
- Allows a public safety agency to implement Emergency
Medical Dispatch (EMD) or advanced life support programs within 60 days
unless LEMSA’s take an action to the contrary.
- Defines in statute that a public safety agency’s
adherence to a LEMSA’s policies, procedures, and protocols does not
constitute a transfer of the public safety agency’s authorities regarding
the administration of EMS. Also eliminates LEMSA medical authority over
the processing and administration of 9-1-1 dispatch calls for public
encourage counties to review provisions in this bill, consult with your EMS
Administrators and EMS Medical Directors regarding the impact to your
jurisdictions, and provide any additional feedback to Betsy Armstrong at email@example.com.
AB 166 (Gabriel) as amended April 30, 2019 – SUPPORT
Jesse Gabriel’s AB 166 would direct DHCS to develop and implement services
targeted at reducing injury recidivism among Medi-Cal beneficiaries who have
been violently injured. The measure would also create a covered benefit within
Medi-Cal fee-for-service and managed care for a beneficiary who has received
treatment for a violent injury and those who have been determined to be at an
elevated risk of violent reinjury or retaliation and referred by a health care
provider to participate in a violence preventive services program. AB 166 was
advanced in the Senate Health Committee to the Senate Appropriations Committee
on Wednesday on a 7-2 vote.
AB 645 (Irwin) as amended March 6, 2019 – SUPPORT
AB 645 by
Assembly Member Jacqui Irwin was heard in the Senate Public Safety Committee on
Tuesday. The measure would add to existing warning labels on firearms and
signage at licensed firearm dealer premises to include language stating, “If
you or someone you know is contemplating suicide, please call the National
Suicide Prevention Lifeline,” with the phone number. The measure would also
require the Department of Justice (DOJ) firearm safety certificate course and
written acknowledgement to cover the topic of suicide prevention. AB 645 was
advanced from the Senate Public Safety Committee to the Senate Appropriations
Committee on a 5-1 vote with one member not voting.
AB 377 (E. Garcia) as amended May 20, 2019 – SUPPORT
Eduardo Garcia’s AB 377 was advanced from the Senate Health Committee to the
Senate Appropriations Committee on Wednesday on a 7-2 vote. AB 377 is the
cleanup measure to AB 626 (Chapter 470, Statutes of 2018) which established microenterprise home
kitchen operations. The measure provides clarifying and technical amendments
around jurisdictional opt-in procedures, local permitting and inspection
activities, and exempted food safety and sanitation provisions. CHEAC remains
concerned with the potential for increased risk to the public’s health and
safety through the operation of microenterprise home kitchens; however, CHEAC
supports AB 377 as the measure provides greater clarity of critical provisions
enacted through AB 626.
SB 8 (Glazer) as introduced December 3, 2018 – SUPPORT
SB 8 by Senator
Steven Glazer would ban the smoking and disposal of all cigar and cigarette
waste at al state coastal beaches and state parks. SB 8 was heard in the
Assembly Water, Parks, and Wildlife Committee on Tuesday and advanced to the
Assembly Appropriations Committee on a 10-3 vote.
This week, the
Legislature acted on several budget trailer bills that followed last week’s
passage of AB 74, the 2019-20 Budget Act. A chart
reflecting the status of all budget trailer bills is available here.
health omnibus budget trailer bills are now in print, detailing implementation
actions of health- and public health-related funding appropriated through the
2019-20 Budget Act. CHEAC has developed a detailed summary of items included in
the two health omnibus bills that can be found below.
Omnibus I (AB 78/SB
Omnibus II (AB
Trailer Bills of Interest
(as of June 21, 2019)
requirement for bills to be in print for a minimum of 72 hours prior to being
acted upon, the Legislature is expected to act on the additional trailer bills
the Ninth U.S. Circuit Court of Appeals invalidated nationwide injunctions previously put into place by lower
court judges in Oregon, Washington, and California, clearing the way for the
Trump Administration to enforce its new rules governing the Title X family
planning program. Recall, the Trump Administration issued a final rule in March
prohibiting Title X providers from referring patients to certain reproductive
health services and limiting sites that are eligible to receive Title X funds.
The rule further specified that clinics that refer patients to other facilities
for abortion services would no longer qualify for Title X funds to provide
low-income women with comprehensive family planning and preventive health
issuance of the final Title X rule by the Trump Administration, several states,
including California, and reproductive health and medical organizations filed
lawsuits challenging the overhaul of Title X, resulting in the issuance of the
ruling by the three-judge appeals court panel granted the Trump
Administration’s request to remove the nationwide injunction while those
lawsuits continue. In its 3-0 ruling, the judges indicated, “Absent a stay, HHS
will be forced to allow taxpayer dollars to be spend in a manner that is has
concluded violates the law, as well as the Government’s important policy
interest in ensuring that taxpayer dollars do not go to fund or subsidize
abortions.” The judges also determined the Trump Administration’s new approach
to Title X was a “reasonable interpretation” of the federal family planning
program and was likely to succeed in the ongoing legal challenges.
Attorney General Xavier Becerra has indicated as a result of the removal of the
injunctions, some provisions of the Trump Administration’s final rule,
including the ban on abortion services referrals, will take effect immediately,
while others, including the requirement for Title X grant recipients to
physically and financially separate abortion services and Title X-funded
services, will take effect next year. In a statement, Governor Gavin Newsom
expressed his disappointment in the Ninth Circuit ruling, stating, “The Trump
Administration’s Title X rule was never about protecting women’s health – it is
designed to promote a backwards agenda at the expense of women and their
doctors. Title X is a critical lifeline for nearly four million low-income
women around the country – one million here in California – who trust the
program for quality care and life-saving screenings and now face immediate
eight LHDs are Title X subgrantees, delivering reproductive health services to
residents at 46 sites in those jurisdictions. LHDs that are not subgrantees
work closely with community-based Title X providers to ensure access to
essential health services.
brought the lawsuit against the Trump Administration on Thursday reiterated
their commitment to challenging the new Title X rules, though their next steps
were unclear. A different panel of Ninth Circuit judges will soon hear
arguments on the merits of cases brought by states and organizations, and other
ongoing legal challenges are expected to continue while the Trump
Administration may now enforce its new rules governing the program.
Bureau of Cannabis Control (BCC) launched a public information campaign, “Get
#weedwise”, this week to educate cannabis consumers about the dangers of
purchasing cannabis from unlicensed businesses. Some of the messages include
information on the dangers of using or ingesting cannabis that has not been
tested which may include dangerous foreign material such as chemicals, mold, or
fecal matter. The campaign is multilingual and will use a variety of
advertising methods. The campaign will also include alerts to illegal
businesses informing them that they could face confiscation of cash or cannabis
by engaging in unlicensed activity.
information on the campaign can be found here.