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AB-619 Lung health.(2021-2022)

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Date Published: 05/24/2021 03:38 PM
AB619:v96#DOCUMENT

Amended  IN  Assembly  May 24, 2021
Amended  IN  Assembly  April 14, 2021
Amended  IN  Assembly  April 12, 2021

CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Assembly Bill
No. 619


Introduced by Assembly Member Calderon
(Coauthors: Assembly Members Mayes, Nazarian, Luz Rivas, and Wood)

February 12, 2021


An act to add Section 8593.25 to the Government Code, and to add Chapter 3 (commencing with Section 104210) to Part 1 of Division 103 of, to add Chapter 1 (commencing with Section 107250) to Part 2 of Division 104 of, to repeal the heading of Chapter 3 (commencing with Section 104210) of Part 1 of Division 103 of, and to repeal the heading of Chapters 1, 2, 3, and 4 of Part 2 of Division 104 of, the Health and Safety Code, relating to public health.


LEGISLATIVE COUNSEL'S DIGEST


AB 619, as amended, Calderon. Lung health.
Existing law requires the State Department of Public Health to award and administer, on a competitive basis, grants for projects directed at the prevention of tobacco-related diseases. Existing law requires the department to conduct statewide surveillance of tobacco-related behaviors, knowledge, and attitudes, evaluate local and state tobacco control programs, evaluate the effectiveness of specified tobacco use prevention education directed at schools, and implement a tobacco use prevention media campaign, as specified.
Existing law requires the department to submit to the State Air Resources Board recommendations for ambient air quality standards reflecting the relationship between the intensity and composition of air pollution and the health, illness, irritation to the senses, and the death of human beings.
Existing law, the California Emergency Services Act, among other things, creates the Office of Emergency Services, which is responsible for the state’s emergency and disaster response services, as specified. Existing law requires the Governor to coordinate the State Emergency Plan and those programs necessary for the mitigation of the effects of an emergency. Existing law requires the governing body of each political subdivision of the state to carry out the provisions of the State Emergency Plan. Existing law requires a county, upon the next update to its emergency plan, to integrate access and functional needs into its emergency plan, among other requirements.

This bill would require the department to conduct a Chronic Obstructive Pulmonary Disease (COPD) Provider Awareness Campaign to increase awareness of COPD, as specified, and to target the COPD Provider Awareness Campaign to, among others, primary care providers and family care providers. The bill would make related findings and declarations.

This bill would require the department to develop a plan, addressing specified issues, with recommendations and guidelines for counties to use in the case of a significant air quality event caused by wildfires or other sources. The bill would require the department to consult with specified stakeholders in developing the plan. The bill would also require the department, in consultation with the State Air Resources Board, to undertake a statewide public educational campaign regarding wildfires and other environmental hazards triggering asthma, COPD, and other respiratory illnesses.
This bill would require a county, in advance of its next emergency plan update, to create a task force to use the air quality plan developed by the department and to develop a county-specific plan that addresses all of the recommendations and guidelines of the department’s air quality plan, as specified. By requiring a county to create an air quality emergency planning task force, this bill would impose a state-mandated local program.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

The people of the State of California do enact as follows:


SECTION 1.

 Section 8593.25 is added to the Government Code, immediately following Section 8593.2, to read:

8593.25.
 (a) (1) A county, including a city and county, shall, in advance of the next update to its emergency plan, create a task force to use the plan developed pursuant to subdivision (a) of Section 107250 of the Health and Safety Code, and to develop a county-specific plan that addresses all of the recommendations and guidelines of the plan developed pursuant to subdivision (a) of Section 107250 of the Health and Safety Code.
(2) A county, including a city and county, shall also assign a role, department, or agency to serve as a lead with regard to each recommendation and guideline in the event of significantly poor air quality caused by wildfires or other sources.
(b) A county, including a city and county, shall, in advance of the next update to its emergency plan, establish criteria, locations, and measurements of effectiveness for public respite facilities during poor air quality and other weather-related events.
(c) A county-specific plan developed pursuant to subdivision (a) shall incorporate a plan to identify personnel to rapidly deploy aid and expertise to disaster areas, and a plan for public outreach to promptly and effectively inform the public about the health threat and what the public should do in response.
(d) A county-specific plan developed pursuant to subdivision (a) shall incorporate a process to provide emergency provisions of protective air filtration masks, air purifiers, medications, and oxygen for people with respiratory and pulmonary diseases, and people suffering symptoms of respiratory and pulmonary diseases.
(e) Two or more counties may establish a multicounty agreement to develop and implement a regional multicounty plan in lieu of each individual county implementing its own plan. A multicounty plan shall be approved by each of the counties’ boards of supervisors.

SEC. 2.The heading of Chapter 3 (commencing with Section 104210) of Part 1 of Division 103 of the Health and Safety Code is repealed.
SEC. 3.Chapter 3 (commencing with Section 104210) is added to Part 1 of Division 103 of the Health and Safety Code, to read:
3.Chronic Obstructive Pulmonary Disease
1.Findings and definitions
104210.

The Legislature hereby declares the following:

(a)COPD is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, and severe adult asthma, and is characterized by increasing difficulty in breathing, coughing up large amounts of mucus, wheezing, shortness of breath, and chest tightening.

(b)COPD is incurable, but it can be managed to slow the progression of the disease.

(c)Approximately 6.4 percent of Americans (an estimated 15.7 million adults) have been diagnosed with COPD. It is estimated that another 15 million are undiagnosed or developing COPD. Approximately 1 in 10 American adults have symptoms of COPD including coughing, wheezing, and shortness of breath.

(d)California alone has an estimated 1,100,000 adults with the disease (4 percent of the state’s population). Three-fifths of Californians with COPD (59.1 percent) are women, compared to 56 percent nationally, and more than two-fifths (43.7 percent) belong to minority populations.

(e)More than one-third of Californians with COPD (35.7 percent) live below 130 percent of the federal poverty level; another 20.5 percent live between 131 and 249 percent of the federal poverty level.

(f)Nationally, COPD is the fourth leading cause of death. In California, it is the fifth. But in southern California, COPD is the fourth leading cause of death in the County of Los Angeles (accounting for nearly 29 out of every 100,000 deaths), and the third leading cause of death in the County of San Bernardino (60 per 100,000 deaths) and the County of Riverside (49 per 100,000 deaths).

(g)Estimates are that as many as 50 percent of those with COPD do not know that they have the disease. Marked underdiagnosis of COPD drives unnecessarily high rates of emergency room visits and hospital admissions for uncontrolled flare-ups. Approximately 43 percent of Los Angeles County residents report having seen a doctor for COPD-related symptoms without a diagnosis over a 12-month period.

(h)Individuals with chronic lung conditions such as COPD are at higher risk for complications, severe illness, and poorer outcomes if they contract COVID-19, as COVID-19 affects the respiratory system. Having existing lung damage from COPD means it is more difficult for a COPD patient’s lungs to fight off an infection.

(i)Increasing awareness among Californians about COPD, particularly those who do not know they may have this chronic disease, is critical to ensuring that vulnerable residents are aware of the need to manage their lung health and take the necessary precautions to remain safe during the worldwide COVID-19 pandemic.

(j)With hospitals facing historic surges of patients due to the COVID-19 pandemic, increasing public awareness of COPD at this time is especially critical, as it will reduce hospital admissions for those with uncontrolled COPD flare-ups, thereby decreasing the burden placed on hospitals and health care providers addressing the pandemic.

(k)The most common cause of COPD is smoking, though exposure to secondhand smoke, air pollution, and occupational chemical fumes or dust may also lead to the disease. A rare genetic condition, known as alpha-1 antitrypsin deficiency, is also known to cause this disease and is usually the cause of COPD in children.

(l)COPD is diagnosed with a simple spirometry test in which a person blows into a tube connected to a small machine called a spirometer that measures how much air an individual’s lungs hold and how quickly each person can exhale. Unfortunately, this inexpensive diagnostic tool remains underutilized. Approximately one-third of California’s adults with COPD (30.4 percent) reported never having received a breathing test (spirometry), which is the only approved method for diagnosing COPD.

(m)Compared to Californians without COPD, twice as many Californians with COPD reported that the cost of health care was an obstacle to receiving medical care (27.7 percent versus 14.7 percent).

(n)Among Californians with COPD, 19.4 percent do not have a personal health care provider. Californians with COPD fare less well than their counterparts without COPD.

(o)Around two-fifths (42.9 percent) of Californians with COPD have seen a doctor for symptoms related to COPD, and 17.5 percent have visited an emergency room or been admitted to the hospital due to COPD, in the last 12 months.

(p)Approximately two-fifths (42.8 percent) of surveyed Californians with COPD report poor or fair health status, compared to 17.4 percent among those without COPD.

(q)Nearly one-third (29 percent) of surveyed Californians with COPD report poor mental health, compared to 10.5 percent among those without COPD.

(r)While one-third of adults with COPD in California are 65 years of age and older, one-fourth (25.4 percent) of adults with COPD in California are under 45 years of age.

104212.

For purposes of this chapter:

(a)“Chronic obstructive pulmonary disease” (COPD) is an umbrella term used to describe progressive lung diseases, most commonly caused by smoking, and include emphysema, chronic bronchitis, and severe adult asthma, and is characterized by increasing difficulty in breathing, coughing up large amounts of mucus, wheezing, shortness of breath, and chest tightening.

(b)“Department” means the State Department of Public Health.

2.Outreach and Awareness
104215.

(a)Subject to subdivision (b), the department shall conduct the COPD Provider Awareness Campaign to improve provider education aimed at promoting early diagnosis of COPD, options for screening and testing, current research on the causes of COPD, current research on COPD triggers, the ease and minimal cost of using spirometry testing to diagnose individuals with COPD, the importance of testing COPD patients for Alpha-1 Antitrypsin Deficiency as recommended by the National Heart, Lung and Blood Institute’s COPD National Action Plan, and the much lower cost to treat patients diagnosed with stage 1 or mild COPD versus those diagnosed at a later stage.

(b)The department may partner with, or subcontract to, local, regional, or California-based national nonprofit organizations to conduct the COPD Provider Awareness Campaign. These organizations shall have experience providing public and provider education on COPD. The department shall maximize reliance on existing provider communication opportunities, potentially including, but not limited to, seeking partnerships to do all of the following:

(1)Include information in newsletters or guidance to providers that is issued by the department or other state or local agencies.

(2)Include information in publications published by provider membership organizations.

(3)Enhance COPD-related educational offerings by providers of continuing medical education.

104216.

The department shall target the COPD Provider Awareness Campaign, as required by Section 104215, to primary care providers, including primary care physicians and physician assistants, to increase knowledge of COPD diagnosis and treatment among primary care providers.

SEC. 4.SEC. 2.

 The heading of Chapter 1 of Part 2 of Division 104 of the Health and Safety Code is repealed.

SEC. 5.SEC. 3.

 Chapter 1 (commencing with Section 107250) is added to Part 2 of Division 104 of the Health and Safety Code, to read:
CHAPTER  1. Air Quality Health Planning

107250.
 (a) The State Department of Public Health shall develop a plan with recommendations and guidelines for counties to use in the case of a significant air quality event caused by wildfires or other sources. The plan shall address all of the following:
(1) Establishing policies and procedures that address air filtration masks and other protective equipment and devices, including, but not limited to, all of the following:
(A) Whether to make air filtration masks and other protective equipment and devices available to county residents.
(B) Whether to have stockpiles of air filtration masks and other protective equipment and devices available for distribution.
(C) Where to obtain air filtration masks and other protective equipment and devices if stockpiling.
(D) How to distribute air filtration masks and other protective equipment and devices if stockpiling.
(E) How to educate the public on when to use air filtration masks and other protective equipment and devices.
(F) Educating the public on keeping air filtration masks and other protective equipment in their homes, offices, and cars.
(2) Making available air filtration masks and other protective equipment and devices to residents that are sensitive receptors and are at risk of serious illness or complications resulting from inhaling highly polluted air from a significant air quality event caused by wildfires or other sources.
(3) Providing information to residents on what they should do if the air quality index hits a significant threshold.
(4) Providing information to residents regarding the health impacts of inhaling air pollution during a significant air quality event caused by wildfires or other sources.
(5) Developing prevention strategies to assist residents in avoiding inhalation of air pollutants.
(6) Disseminating the information in this subdivision to the public.
(b) The recommendations in the plan developed pursuant to subdivision (a) shall include guidance about how a county, including a city and county, informs its residents about all of the following:
(1) Unhealthy air quality.
(2) The Air Quality Index.
(3) The effect of air pollution on an individual’s health, including the symptoms someone may experience and where to go for medical assistance.
(4) Where an individual can obtain protective air filtration masks and other protective equipment.
(5) How and when to use air filtration masks and other protective equipment.
(6) How and when an individual needing oxygen or respiratory medications can obtain oxygen or respiratory medications.
(7) How to protect children, seniors, the disabled, the homebound, the homeless, those working outdoors, tourists, visitors, non-English speakers, and any others who may have difficulty obtaining or using masks or other protective equipment without assistance.
(8) Any other information that is useful for an individual to protect their health, and the health of their loved ones, in the case of significantly poor air quality caused by wildfires or other sources.
(c) The plan developed pursuant to subdivision (a) shall also include best practices and recommended protocols for reaching out to inform the general public about the recommendations and guidelines and shall include best practices and recommended protocols for reaching out specifically to vulnerable populations, such as the homeless, elderly, disabled, and homebound.
(d) The department shall develop the plan, pursuant to subdivision (a), in consultation with key stakeholders, including, but not limited to, representatives of all of the following:
(1) Governor’s Office of Emergency Services.
(2) State Air Resources Board.
(3) Governor’s Office of Planning and Research.
(4) California Department of Aging.
(5) State Department of Developmental Services.
(6) Office of Environmental Health Hazard Assessment.
(7) Medical professionals focused on respiratory health, pulmonology, pediatrics, and emergency medicine.
(8) Small and large air pollution districts.
(9) Counties.
(10) Cities.
(11) Hospitals.
(12) Business organizations.
(13) Advocacy organizations involved in respiratory health.
(14) Advocacy organizations working on behalf of issues for individuals with disabilities.
(15) Advocacy organizations working on behalf of issues for the homeless.
(16) Advocacy organizations working on behalf of issues for seniors.

107256.

(a)The State Department of Public Health, in consultation with the State Air Resources Board, shall undertake a statewide public educational campaign regarding wildfires and other environmental hazards triggering asthma, Chronic Obstructive Pulmonary Disease (COPD), and other respiratory illnesses.

(b)The department shall contract with local nonprofit organizations focused on respiratory health to conduct public events and workshops to screen people for lung diseases and to educate the public about all of the following:

(1)Impact of wildfires on lung health.

(2)Connection of wildfires to asthma and COPD.

(3)Impact of smoking, including, but not limited to, tobacco smoke, on the connection between wildfires and lung health, including asthma and COPD.

(4)Preventative measures that people can take to reduce the risk of wildfires causing health issues.

(5)Medical referrals.

(c)To be eligible to enter into a contract with the department to conduct public events and workshops pursuant to subdivision (b), a nonprofit organization must have conducted lung health screenings or peak flow testing at more than 20 different locations during the previous 24 months.

SEC. 6.SEC. 4.

 The heading of Chapter 2 of Part 2 of Division 104 of the Health and Safety Code is repealed.

SEC. 7.SEC. 5.

 The heading of Chapter 3 of Part 2 of Division 104 of the Health and Safety Code is repealed.

SEC. 8.SEC. 6.

 The heading of Chapter 4 of Part 2 of Division 104 of the Health and Safety Code is repealed.

SEC. 9.SEC. 7.

 If the Commission on State Mandates determines that this act contains costs mandated by the state, reimbursement to local agencies and school districts for those costs shall be made pursuant to Part 7 (commencing with Section 17500) of Division 4 of Title 2 of the Government Code.