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AB-3224 Local health department workforce assessment.(2019-2020)

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Date Published: 05/04/2020 09:00 PM
AB3224:v98#DOCUMENT

Amended  IN  Assembly  May 04, 2020

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 3224


Introduced by Assembly Member Rodriguez

February 21, 2020


An act to add Section 120513 100190 to the Health and Safety Code, relating to public health, and making an appropriation therefor. health.


LEGISLATIVE COUNSEL'S DIGEST


AB 3224, as amended, Rodriguez. Sexually transmitted diseases. Local health department workforce assessment.
Existing law establishes the State Department of Public Health to implement various programs throughout the state relating to public health, including licensing and regulating health facilities, control of infectious diseases, and implementing programs relating to chronic health issues like cancer and heart disease. Existing law authorizes the department to implement the required programs through, or with the assistance of, local health departments. Existing law requires the department, after consultation with and approval by the California Conference of Local Health Officers, to establish standards of education and experience for professional and technical personnel employed in local health departments and for the organization and operation of the local health departments.
This bill would require the department to contract with an appropriate and qualified entity to conduct an evaluation of the adequacy of the local health department infrastructure, and to make recommendations for future staffing, workforce needs, and resources, in order to accurately and adequately fund local public health, as specified. The bill would also require the department to convene an advisory group to oversee the process of selecting an entity to conduct the evaluation and to provide oversight of, and technical assistance to, that entity. The bill would require the department to report the findings and recommendations of the evaluation to the appropriate policy and fiscal committees of the Legislature on or before July 1, 2022.

Existing law requires the State Department of Public Health to allocate funds to local health jurisdictions for sexually transmitted disease prevention and control activities in accordance with specified priorities and activities that include, among others, community-based testing and disease investigation. Existing law suspends this program on December 31, 2021, unless the May Revision required to be released by May 14, 2021, projects specified General Fund revenues. Existing law states the intent of the Legislature to consider alternative solutions to restore this program, should the suspension take effect.

This bill would establish a statewide program to direct and support local health departments in providing specified services to individuals experiencing reinfections of syphilis, chlamydia, and gonorrhea, including assessing the health and social needs of those individuals. The bill would authorize a local health department to apply for funding to participate in the program by submitting a spending plan to be approved by the department and would specifically prohibit the department from providing funding unless the department approves the local health department’s spending plan.

The bill would appropriate $15,000,000 from the General Fund to the State Department of Public Health for the purpose of funding this program.

Vote: TWO_THIRDSMAJORITY   Appropriation: YESNO   Fiscal Committee: YES   Local Program: NO  

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


SECTION 1.

 The Legislature finds and declares all of the following:
(a) Local health departments are the first line of defense against public health threats, including novel pandemics like COVID-19. These organizations rely on trained public health professionals, including epidemiologists, communicable disease investigators, public health nurses, laboratorians, and health educators.
(b) Year after year of federal, state, and local public agencies being underfunded has left the United States ill-prepared for the COVID-19 pandemic. The Trust for America’s Health estimated in April 2019 that public health efforts nationally were underfunded by $4.5 billion and that nationally 55,000 positions were eliminated from public health between 2008 and 2017.
(c) According to the California Future Health Workforce Commission’s February 2019 report, the public health workforce in California is chronically underfunded and most local public health agencies lack personnel with expertise in key areas, including epidemiology and the essential skills to design, implement, and evaluate comprehensive approaches to community health improvement.
(d) In California, both state and local public health agencies face increasing competition with the private sector, which provides higher pay and amenities such as updated technology. Additionally, many public health leaders are nearing retirement.
(e) There are no federal or state guidelines for public health staffing, nor does any state or national organization provide information or data on the composition and training levels of the governmental public health workforce.
(f) Many local health departments in California report challenges in recruiting and retaining well-qualified workers, citing a lack of tools for recruiting, limited options for advancement, and instability of funded positions.
(g) Based on urgent workforce shortages and demographic trends, the California Future Health Workforce Commission’s February 2019 report identified the following priority professions in the field of prevention and public health:
(1) State and local health department staff, including, but not limited to, epidemiologists, public health nutritionists, infectious disease experts, and disaster preparedness specialists.
(2) Public health nurses.
(3) Data analysts.
(4) Health administrators.
(5) Community health workers and promoters.
(6) Community health educators.
(h) It is the intent of the Legislature to prepare for the workforce challenges facing public health, and for the next emergency or pandemic, by creating a comprehensive plan to address urgent workforce and infrastructure needs of local health departments.

SEC. 2.

 Section 100190 is added to the Health and Safety Code, to read:

100190.
 (a) The State Department of Public Health shall contract with an appropriate and qualified entity to conduct an evaluation of the adequacy of the local health department infrastructure, and to make recommendations for future staffing, workforce needs, and resources, in order to accurately and adequately fund local public health. This evaluation shall, at a minimum, accomplish all of the following:
(1) Evaluate the public health workforce, including identification of barriers and recommendations for adequate staffing of local health departments, appropriate credentialing, access to training and workforce development, recruitment and retention supports, and incentivizing a pipeline of professionals to work in public health.
(2) Assess the efficacy of health information tools utilized by local health departments.
(3) Evaluate the state’s public health laboratory capacity and make recommendations for laboratories to better meet the needs of local health departments.
(4) Evaluate recent trends with federal and state funding streams provided to local health departments and the resources needed to sustain the work of local health departments.
(b) The evaluation and recommendations shall consider all of the following:
(1) The current state and federal statutory and regulatory environment for public health.
(2) The capacity needed on an ongoing basis to meet the demands in a public health emergency.
(3) Additional factors adding to the work of public health, including social determinants of health, health inequities, climate change, natural disasters, and unique local conditions.
(c) The department shall convene an advisory group that shall include representatives of the Emergency Medical Services Authority, County Health Executives Association of California, California Conference of Local Health Officers, public health laboratory directors, public health nurses, communicable disease controllers, the exclusive representatives of public health workers, local emergency medical services administrators, schools of public health, and organizations aimed at addressing health disparities in California. The advisory group shall do both of the following:
(1) Oversee the process of selecting an entity to conduct an evaluation under subdivision (a).
(2) Provide oversight of, and technical assistance to, the entity selected to conduct the evaluation under subdivision (a).
(d) (1) The department shall report the findings and recommendations of the evaluation to the appropriate policy and fiscal committees of the Legislature on or before July 1, 2022.
(2) The requirement for submitting a report imposed under this subdivision is inoperative on July 1, 2026, pursuant to Section 10231.5 of the Government Code.
(3) A report to be submitted pursuant to this subdivision shall be submitted in compliance with Section 9795 of the Government Code.

SECTION 1.

(a)The Legislature finds and declares all of the following:

(1)In 2018, the number of reported sexually transmitted disease (STD) cases in California was 25,344 for syphilis (all stages), which is 265 percent more than 10 years ago, 79,397 for gonorrhea, which is 211 percent more than 10 years ago, and 232,181 for chlamydia, which is 56 percent more than 10 years ago.

(2)STDs are increasing in all regions of the state, among all people.

(3)Disparities in STD rates persist throughout the state, with the highest among young people (15 to 24 years of age), African American people, people who are gay or bisexual, and men who have sex with men.

(4)Syphilis is a major public health problem in the state and has increased in all regions of the state, among all people. In 2018, according to the federal Centers for Disease Control and Prevention (CDC), California was ranked second in the nation for primary and secondary syphilis rates.

(5)In 2018, the number of infants born with congenital syphilis in the state had increased for the 6th year in a row. Congenital syphilis can cause severe illness in infants, including premature birth, low birth weight, birth defects, blindness, and hearing loss. Congenital syphilis can also lead to stillbirth and infant death. In 2018, according to the CDC, California ranks fifth in the nation for congenital syphilis rates.

(6)Chlamydia and gonorrhea are the most commonly reported STDs in the state. Although these STDs are curable, they often do not show symptoms and go undetected, which can lead to serious complications including infertility. Chlamydia and gonorrhea disproportionately impact people in their teens and twenties.

(7)Emerging antibiotic resistance among gonorrhea is a concern. Gonorrhea is among the CDC’s top three urgent threats for developing drug resistance.

(8)There are many underlying drivers of the increase in STDs, and thus, there is no simple solution. STD risk is fueled by poverty, homelessness, substance use, disparities in access to care, changes in sexual behaviors, and the exchange of sex for money, housing, and other resources.

(9)State and local public health departments are uniquely qualified to control the spread of communicable disease. Furthermore, state and local public health staff are actively engaged with clients, medical providers, community partners, and others working to stem the rising tide of STDs.

(b)It is the intent of the Legislature to address the rise in the number of sexually transmitted diseases in California, with a particular focus on preventing reoccurrence among individuals who experience reinfections.

SEC. 2.Section 120513 is added to the Health and Safety Code, to read:
120513.

(a)The department shall establish a statewide program to direct and support local health departments in providing the following services to individuals experiencing reinfections of syphilis, chlamydia, and gonorrhea:

(1)Assessing the health and social needs of clients.

(2)Identifying and resolving client risk factors and obstacles to care.

(3)Establishing routine contact with clients, including those who may be difficult locate.

(4)Coordinating referrals and connections to address health and social needs, including behavioral health services, housing, homeless assistance, and harm reduction counseling and services.

(5)Ensuring clients receive care and followup in a timely manner, including followup with primary care providers.

(6)Providing outreach and navigation services to the client’s sexual partners.

(7)Routine followup education and access to prevention and screening services.

(b)(1)A local health department may voluntarily apply for funds to participate in the program established by this section by submitting a spending plan for the department’s approval. A spending plan shall demonstrate how funds will support the services listed in subdivision (a). The department may require a spending plan to be submitted in a specified format.

(2)The department shall not provide funding to a local health department for participation in the program established by this section unless the department approves the local health department’s spending plan submitted pursuant to paragraph (1).

SEC. 3.

The sum of fifteen million dollars ($15,000,000) is hereby appropriated from the General Fund to the State Department of Public Health for the purpose of funding the program established in Section 120513 of the Health and Safety Code.