Senate Health Committee

All right. Thank you so much. Thank you, Madam Chair and members, and I want to start by acknowledging and appreciate the time that you, Madam Chair, have spent with me in all of our conversations. Members, SB 1422 restores access to Medi-Cal for income-eligible undocumented adults beginning January 1, 2027. California has made real progress expanding health coverage, bringing us to the lowest uninsured rate in our state's history. As Medi-Cal expanded, counties were able to scale down indigent care programs, reducing local fiscal burdens, and stabilizing our safety net hospitals and clinics. The 2025-26 budget reversed that progress, or threatens to reverse that progress. It froze new enrollment for adults due only to their immigration status, and now we are seeing the consequences in real time. People who relied on Medi-Cal are trying to enroll and being told they no longer qualify. Others who are eligible are receiving denial notices. This freeze does not eliminate health needs. It shifts responsibility onto counties, already strained hospitals, and overcrowded emergency departments. The freeze creates a two-tiered health care system by forcing undocumented individuals who do not have access to employer-sponsored coverage into a county system of last resort, if those programs are even available to them. That means fragmented access, gaps in care, and fewer real options to get treated. This freeze exacerbates the poor health conditions that undocumented immigrants are already experiencing, and it does so by stripping access to care at a time when our communities those same communities are facing ongoing violent and traumatic attacks through ICE raids And we know exactly what that looks like But what do I mean by worsening health conditions? Detecting diabetes at a routine doctor's visit becomes someone arriving at the emergency room in a diabetic coma. Untreated high blood pressure becomes a stroke. Under federal law, emergency departments must treat everyone regardless of ability to pay, and emergency care can cost up to 10 times more than a physician's visit. So when people lose coverage, those costs don't go away. They are pushed onto counties, hospitals, and ultimately taxpayers. California is already spending approximately $3.5 billion each year on preventable emergency care. Because of the enrollment freeze, hospitals will now see more patients without coverage, less reimbursement for the care they are already required to provide. That loss of revenue has real consequences. In light of H.R. 1, hospitals, especially safety net hospitals, are being forced to cut services, freeze hiring, and in some cases consider closing departments or facilities together, all together. And when those cuts happen, they hit the services communities rely on the most. Emergency care, maternity care, and behavioral health. As a result, the impact is not limited to those who lost coverage. Everyone feels it. Longer wait times, fewer available services, and higher costs across the system. We cannot control those federal decisions, but the The enrollment freeze is a state choice, and we should not compound the damage. SB 1422 is a course correction. It restores a system where care happens earlier, costs less, and keeps our hospital and community stable. It's about dignity and fairness. It's about making our health care system work the way it's supposed to. I'm pleased to have the support of the emergency room physicians, public hospitals, and the people most impacted by this devastating policy. Farm workers, caretakers, hotel and restaurant workers, child care workers. I respectfully ask for your aye vote. and my witnesses, Madam Chair, are David Campos, Deputy County Executive, County of Santa Clara, testifying a co-sponsor of the bill, and on behalf of the urban counties of California, Mara Villas, Director of Policy, Latino Coalition for Healthy California, co-sponsor of the bill.

Thank you. Thank you, Madam Chair, Dr. Weber Pearson, honorable members. My name is David Campos. I am Deputy County Executive for the County of Santa Clara. The County of Santa Clara is the sixth largest of the 58 counties, and we run the largest public hospital system in Northern California and second largest in the state of California. This is a very critical issue for counties, which is why I'm proud to be here, not only on behalf of Santa Clara, but also on behalf of the 14 counties that make up the urban counties system. We believe that what we are talking about is a shift of responsibility from the state to counties. And the reason we support and co SB 1422 so strongly is that we believe that failure to do something to cover the undocumented population of this state means that counties will be left addressing the burden on their own. The reality is that this population in Santa Clara County, we're talking about 70,000 residents, is not going away. And I can tell you from my own experience, my family lived as undocumented people for many years that what happens when you're undocumented and you're not covered by health insurance is that you leave things until the very last minute and you end up waiting until you have to go to the ER. And that means going to emergency rooms throughout the state where counties have to fit the bill. And not only is that questionable from a moral standpoint, but financially and from public health, it makes no sense to force people to delay basic care until the very last minute. We are here to ask for passage of SB 1422 because it moves the state in the right direction. We have made a lot of strides as California in covering undocumented people and other indigent people in the state. By failing to provide coverage under the state Medi-Cal system, We are taking a step backward and we're very grateful to Senator Durazo for this bill and we respectfully request your support. Thank you

please come to the microphone, state your name, your organization, and your position only. Thank you.

Thank you.

Thank you.

Thank you. Angel Lopontis on behalf of Planned Parenthood Affiliates of California in support. Thank you. Nasset Short on behalf of Peach representing Community Safety Net Hospitals, the Alliance of Catholic Healthcare and Adventist Health in support. Thank you. Jesse Hernandez-Reyes on behalf of the California Undocumented Higher Education Coalition, in support. Thank you. Craig Pulsar on behalf of Equality California, in support. Thank you. Johnny Pineda on behalf of the Latino Coalition for Health California, co-sponsor, Lideres Campesinas, TODEC, United for Restartive Good Justice, Regional Power Hubs Network, and over 100 nonprofit organizations reflected on the analysis, in support. Thank you. Thank you. Good afternoon, Chair and members. Connor Gussman on behalf of Teamsters California and Unite here in support. Thank you. Thank you. Good afternoon. Evan Fern with Disability Rights California in support. Thank you. Good afternoon. Rosa Bay on behalf of the East Bay Community Law Center here in support. Thank you. Good afternoon. Sandra Poole on behalf of Western Center on Law and Poverty in support. Thank you. Good afternoon. In support and in partnership with the Health Pro Coalition, these other organizations are also in support. Friends Committee of Legislation of California, California Committee Foundation, California School-Based Health Alliance, Southeast Asia Resource Action Center, and Centro Binocular para los Desarrollos Indígenas Oaxaqueños, CBDIO are also in support of this bill. Thank you. Thank you. Kevin Guzman of the California Medical Association in support. Thank you. Doreena Moreira, Hijas del Campo and Health for All Coalition, in support. Thank you. Andrea Rivera, on behalf of the California Association of Public Hospitals and Health Systems, in support. Thank you. Alexis Heaton, here on behalf of California Coverage and Health Initiatives, in support. Thank you. Arely Tapia, I'm with Hijas del Campo and I support you. Thank you. Christine Smith, Health Access California, proud co-sponsor of the bill with the Health Fraud Coalition. I'm also adding Healthy Contra Costa, California Rural Legal Assistance Foundation, Survivors of Torture International, and organizing rooted in abolition, liberation, and empowerment. All in support. Thank you. Thank you. Hi, Chloe Hermosillo with the California Immigrant Policy Center, proud co-sponsor in support, also registering support for Multifaith Action Coalition, Visione Compromiso, Coalition for Humane Immigrant Rights, CHIRLA, Building Healthy Communities, Kern, all in support. Thanks. Thank you. Good afternoon, Gina Bautista with the United Wiz of California in support. Thank you. Good afternoon, Ryan Suze on behalf of APLA Health and Essential Access Health in support. Thank you. Good afternoon, Carol Gonzalez on behalf of the Hispanas Organized for Political Equality, Hope, and on behalf of our friends at CARESA and the Central American Resource Center in support. Thank you. Jonathan Froxweig on behalf of San Francisco AIDS Foundation in support. Thank you. Anna Alvarez on behalf of the National Council of Jewish Women California, APIs for Civic Empowerment, Alliance San Diego, Greenfield Walking Group, and Comunidades Aliadas Tomando Acción, in support. Thank you. Good afternoon. Austin Smith on behalf of the International Rescue Committee and some more. Thank you. Hello. Clint Carney on behalf of the San Diego Immigrant Rights Consortium and its members, Survivors of Torture International, in support. Thank you. Thank you. Nicole Wardleman on behalf of the Children's Partnership, in support. Thank you. Good afternoon. and Andrea Mavisco on behalf of CPCA Advocates in support. Thank you. Thank you. Tim Madden representing the California Chapter of the Merritt College of Emergency Physicians in support. Thank you. Good afternoon, Chair and members. Elmer Lazardo here on behalf of the California Federation of Labor Unions in support. Thank you. Chair and members, Marvin Pineda on behalf of Homeboy Industries, Children's Hospital of Los Angeles, Asian Law Alliance, El Centro del Pueblo, La Cooperativa Campesina, California Human Development, Los Amigos de la Comunidad, First Aid Foundation, Calexca Bono Center, Social Equity LA, and Central Valley Opportunity Center in support. Thank you. Thank you. Good afternoon, Yasmeen Pellet, on behalf of Justice and Aging, in support. Thank you. Good afternoon, Chair and members. Ed Little, on behalf of Crime Survivors for Safety and Justice, in support. Thank you. Seeing no other individuals in the audience that would like to register their support. If there is anyone who would like to speak and lead opposition to this bill, this is the time to come forward. Seeing no one, if anyone would like to register their opposition to the bill, please come to the mic, state your name, your organization, and your position. Seeing none, I will now turn it back to the committee. Senator Smallwood. Thank you, Madam Chair, and thank you so much to the author. I am thrilled to be a co-author of this bill. I often say if the pandemic taught us anything, it's that disease does not discriminate and that everyone must have health care. It wasn't that long ago when just being near someone could cost you your life. And thank goodness for the health care, the access, the treatments, the education of all Californians. We were able to make it out of the pandemic. And if we don't recognize our history, we're damned to repeat it. And I think this is what this bill is saying, is that we have to ensure that all communities have access to health care. and when we have millions who are at risk and will lose their health care, we know that puts so many more Californians at risk. And I understand that this is a serious issue, and I know the legislature is grappling with it in terms of how do we fund it, where do those resources come But it not a question of if it just a question of how And I think this bill answers the unresoundingly the if and we must protect all Californians particularly because this population, as labor chair, having worked with vulnerable communities for most of my professional life, this is a hardworking population of folks. It is a group of Californians that are highly employed, but also employed in some of the most vulnerable working conditions. And if we have Californians who are helping to drive our economy, who are helping to contribute to our safety nets, we have to find a way to ensure that they have access to all of our collective health care. And denying people their health care is not a viable option. And so I'm happy to support this bill, and I'm happy to move it when the time is right. Thank you. Senator Perez? Thank you. And I, too, want to express my support for SB 1422 and thank the author, Senator Durazo, for authoring this bill and all of the legislation that she's authored before this bill as well to expand this program. Now, I want to make sure that we're having a full discussion about what the expansion of Medi-Cal has looked like through Health for All and read something actually from the staff report, And that is that we saw the last budget bill that was passed in 2022 and the expansion of Medi-Cal through Health for All was fully implemented on January 1st, 2024, making California the first state in the nation to cover all income eligible individuals, regardless of immigration status and its Medicaid program. Now, I highlight this because it's important to recognize that we defunded this very program after only a year of its full implementation throughout the state. Now, the whole nexus, the whole idea and concept behind expanding Medi-Cal coverage to all individuals regardless of documentation status is for two very clear reasons. One that Senator Smallwood Cuevas just acknowledged, which is that there's this very clear public health benefit, right? We all benefit when our neighbors are healthy, when the people standing next to us are healthy. Disease does not discriminate. And so it is very important, especially when we suddenly have a worldwide pandemic or other events like that, that we are taking care of everybody. In addition to that, there is also this anticipated tax benefit that you expect to receive as well. And that is that when somebody is ill, it is better for them to address that illness early on by seeing a primary care provider rather than waiting for that illness to exacerbate to the point when they need to be seen in an emergency room. And when we do not provide people with adequate care, what ends up happening is those same patients that need care either wait and they do not see a doctor. And then by the time that they actually need care, it's now a necessity and they have to go to the ER, which is incredibly expensive. Now this is part of the reason why we saw a pilot program like this be launched in L County back in 2013 I had the pleasure of working on that through the California Endowment through Clinica Romero and several other partners that were working together to make sure that this program was successful. And they expanded it slowly over time, similar to the way that the state did this, as they saw not just the public health benefit but the economic benefit of this. And we saw as we folded in different age groups that while there was an additional cost, right, to increasing the number of folks that were eligible, there was ultimately savings down the road. Now, my frustration with what happened with the budget last year is that we defunded this program before we could even see any of those savings be realized. And so the true kind of picture in terms of this program and the benefit, the public health benefit, the tax benefit, we didn't even get to see. Because by the time we got to full implementation, it was January 1st of 2024. And by 2025, we took that funding away. We need to understand, and this is something that's very difficult. I recognize as somebody that worked in public policy for many years and is now an elected official, it's very hard for government leaders to think past a two-year and four-year election cycle. But the reality is that the economic impacts of the public health benefits of a program like this do not get to be realized in these short year-to-year terms. We have to allow for full implementation. And so I recognize and what you're going to hear is that this is too costly. It's too expensive. That it is too expensive to provide people with health care coverage. And what I would argue to you is that it's more expensive to not do it. But we can't realize the economic benefits of a program like this unless we allow for its implementation. Yes, there are going to be some big costs. And yes, we saw those costs rise because people were enrolling into Medi-Cal. That's what we want. We want folks to utilize that health care coverage and those health care services. So I share all of that because I think as we continue to have this discussion and as these topics continue to get very politically hot for all sorts of reasons, happening beyond this building, it's really important that we center ourselves in fact and in truth. And if we are going to realize the true benefits of this, which is really seeing the impact, the great impact of providing health care to all residents here in California, we're going to have to let this program be implemented and it's going to take a few years. That's not a bad thing. Not every single policy we pass, we're going to immediately see the benefits of within a single year. And I know politically that's not convenient, but that is the reality. And that is how you get true impacts out of something like this. So I'm very proud to support your bill today, Senator Durazo. This is a great effort It been beautiful to watch this since you know it began as small pilot programs now be realized for the rest of the state And look forward to continuing to support your efforts on this front. Thank you. Seeing no other comments. We unfortunately just lost our quorum. I really want to thank you, Senator Durazo, for all of your advocacy around this. You have been a very, very strong hard fighter and a strong, consistent advocate in this area. You and I have had many conversations about this, and I want to thank you because a lot of times people just don't think they need to have conversations. But this is something that you truly believe to your core. And I believe that the vast majority, if not all, senators, legislators, should want for people to have health care coverage. Not only insurance, but access. I talk about access all the time. Just because you have insurance doesn't mean that you have access to comprehensive health care. And that is extremely important as well. So we are in very challenging times, which is one of the reasons why perhaps the decision was made last year. You are 100% correct, and I keep saying this myself. Just because of the cuts that we've made at the state and, unfortunately, the things that we're seeing coming down from the federal government, people are not going to stop getting sick. They're going to continue to get sick, and unfortunately, they're going to have to seek care at this point at some of the places that provide some of the most expensive type of care. Every Californian should be able to access quality, affordable health care. Preventative care is what we really need to be focusing on. The reality is that that does cost. And the question is, do we as a state, as state legislators, have the backbone to really start looking and pushing and passing through new sources of revenue that specifically support our health care system? If we don't, this will not work. I am committed to continuing to talk with you and work with you as we continue to hopefully talk about various sources of revenue, which I am 100% in support of. Because it's not only those that need insurance, it's those that are providing care in the hospital, outside of the hospital, our IHSS workers, every component of our healthcare system needs assistance. And we as a state need to get serious about finding new revenue streams to fund it. I support this bill in concept and will continue to work with you on it. I don't think you need my vote to get it out of committee. If you do, you know you have it. But I really want for us, as we are pushing this through, to also be pushing those revenue streams, those new revenue streams that we have talked about, but this is the time to really get serious about. And with that, Senator Durazo, would you like to close? Thank you again for my colleagues, senators and Madam Chair. I... I appreciate all of the comments today, the conversations we've had leading up to today's hearing. I also want to thank very much everyone who came, everyone who's been supporting, everybody who's building more and expressing more support. Yes, we do have to look at cost. That's part of our responsibility. Today, we're focused more on the policy, but, you know, in our minds we know that we have to address this, and I recognize there's an issue of cost. I'm hoping that that issue of cost, with our help, will be dealt with and will be dealt with in a sincere way. I think we have the people around us to come up with all the possibilities and the options. There's no doubt about it. We've got to give that, as you said, Madam Chair, the courage and the backbone to provide those sources of revenue for the people who need them. And that is all Californians, all Californians. It's not a small group that we could isolate and not worry about on the side. They are part and parcel, everything that happens in this state, what makes California so beautiful. So to me, I just urge you all to vote for this bill as we move forward, not only with the content of the policy, but also with what it's going to take to keep it working as our best health care system in the country. So with that, I respectfully ask for your vote. Thank you, and once we establish quorum, we'll be able to take that up. I strongly encourage any authors of any bills to come down. I will present item number one, Senator Laird's bill. Thank you, Madam Chair. You are recognized when you are ready. We're not going to have quorum. I know we're so close. Good afternoon, committee members. Today I am presenting Senate Bill 1023 on behalf of Senator Laird. Senate Bill 1023 increases access to critical HIV prevention medications called pre-exposure prophylaxis or PrEP. PrEP is highly effective at preventing HIV transmission and can be taken in the form of a daily pill or a long-ejecting injection. Currently, the billing process for long-acting injectable options can be administratively complex if health plans limit reimbursement to the medical benefit. SB 1023 requires insurers that provide PrEP through the medical benefit to also provide PrEP through the pharmacy benefit pathway, which supports timely medication administration. Opening this billing pathway will support smaller community health care providers and make it easier for them to start providing and expanding PrEP services SB 1023 will increase access to crucial HIV medication prevention when global health and LGBTQ rights are under active threat. The bill is sponsored by the California Legislative LGBTQ Caucus, Insurance Commissioner Ricardo Lora, and the California Department of Insurance, San Francisco AIDS Foundation, Equality California APLA Health and Los Angeles LGBTQ Center with me to provide testimony is Jonathan Froxwhite Director of Health Justice Policy with the San Francisco AIDS Foundation. Thank you. You're recognized for five minutes. Thank you. Thank you, Chair. Again, my name is Jonathan Froxwhite, Director of Health Justice Policy for San Francisco AIDS Foundation, which is a co-sponsor of Senate Bill 1023. In the last year for which data is available, almost 5,000 Californians were newly diagnosed with HIV. That number was approximately the same the year before that and the year before. Our state's progress on reducing new HIV infections has stalled out. Although HIV is now a manageable chronic condition, every person diagnosed with the disease must take medication for the rest of their life, manage side effects and complications, and cope with intense stigma. This costs not only individuals, but also our health system. The estimated per patient lifetime cost associated with HIV is more than $850,000. PrEP is one of our most powerful tools for preventing HIV transmission and the introduction of long-acting injectable forms of PrEP has made this tool even more powerful. Unfortunately, the way many commercial insurers pay for injectable PrEP is preventing healthcare providers from prescribing these medications. These insurers only cover injectable PrEP under their medical benefit, meaning they reimburse providers for the medication after the provider has administered it. In practice, this means providers typically must purchase injectable PrEP at their own expense, store the drugs at their own risk, dedicate staff time to billing and appealing improper denials, and wait an average of 26 days to be reimbursed. These are clearly major barriers, especially for providers in settings that lack resources. San Francisco AIDS Foundation is one of the largest PrEP prescribers in California, but we have to turn away patients seeking injectable PrEP if their insurer only covers the drug under their medical benefit. The Los Angeles LGBT Center cannot provide the injectable PrEP drug Lencapavir to commercially insured patients due to difficulties with medical benefit coverage. This issue is repeating itself at clinics across the state, blocking the rollout of a highly promising HIV prevention strategy. SB 1023 will solve the problem by requiring commercial insurers that already cover injectable PrEP under their medical benefit to also cover it under their pharmacy benefit. Because the bill only applies to insurers that already cover injectable PrEP, it does not expand PrEP coverage. It also does not increase insurers' costs. We urge you to advance this simple solution and thus advance California's progress toward ending the HIV epidemic. Thank you. Thank you. We'll now go to anyone else in the room that would like to express their support. Please state your name your organization and your position Katie Van Dyne with Health Access California in support Thank you Good afternoon. Jim Wood, California Strategies, here on behalf of the California Pharmacists Association in support of amended a position. We look forward to continuing to work with the author and the sponsors going forward. Thank you. Kevin Guzman with the California Medical Association in support. Thank you. Department of Insurance here on behalf of Insurance Commissioner Ricardo Lara, proud co-sponsor of the bill and strong support. Thank you. When I move to any key witnesses in opposition, please come forward. You will each have two and a half minutes, and you're recognized when you're ready. Thank you, Chair and members. Cassidy Heckman on behalf of the California Association of Health Plans. I want to start by thanking the author, the sponsor, and his staff for engaging with us early on this issue. However, we remain concerned with the proposed legislation and respectfully have to oppose it today. SB 1023 mandates health plans cover certain antiretroviral drugs used for the prevention of HIV and AIDS as both a medical benefit and an outpatient prescription drug benefit. As noted in the analysis, health plans are already required to cover these drugs without step therapy or prior authorization. Therefore, our primary concern is that SB 1023 sets a concerning precedent regarding a plan's ability to structure their own benefits. Benefit design structure is an area that has traditionally been within a plan's purview and is based on clinical care guidelines, actuarial considerations, and regulatory standards. Legislative mandates that change how plans structure their benefit design is not only costly but creates confusion and reduces flexibility. It also undermines their ability to design benefits in a manner that is clinically appropriate and responsive to patient needs. Unfortunately, we have observed similar approaches in recent legislation, which raises significant concerns for our members, particularly because health plans are already providing their enrollees with broad coverage for these drugs. Additionally, we are concerned about the provisions that expand existing law to drug products and drug devices because this would automatically prohibit newly approved and potentially costly treatments to prior authorization and step therapy when there could be an equally effective and more affordable treatment available. I want to thank the author and sponsor again for engagement with us on this issue, but due to the concerns stated, we must oppose it today. Thank you. Good afternoon, Chair and members. Matt Akin on behalf of the Association of California Life and Health Insurance Companies, also respectfully opposed to SB 23. I would like to align my comments with my colleague at CAP and reiterate we are concerned with the precedent this bill would set regarding a plan or insurer's ability to structure their own benefit designs. Health plans and insurers distinguish between medical and pharmacy benefits based on how and where a drug is administered. Generally, pharmacy benefits are from medications people self-administer, while medical benefits cover drugs given by a provider in a critical setting like a hospital or a physician's office. This bill would blur that longstanding distinction by requiring provider drugs to be treated as outpatient prescription drugs even though they are not self and are delivered in clinical settings This approach departs from established industry standards and will create unnecessary operational and administrative challenges. We are also concerned with the bill's requirement to cover PrEP at out-of-network pharmacies in cases of medical emergencies. PEP is appropriately considered emergency treatment and is already covered under existing emergency requirements. PrEP, however, is not an emergency service, and we are concerned that treating it as such would be a significant new coverage mandate. For these reasons, we respectfully remain opposed, but we appreciate the conversations we've had so far with the author and sponsors and look forward to continued engagement if the bill moves forward today. Thank you. Thank you. I'll now open it up to anyone else in the room that would like to express your opposition. Please say your name, your organization, and your position. Seeing none, we'll bring it back to the committee. No. So I do need some – I was hoping to get to support on this bill. I do need some clarification because, as I understand PrEP, it is currently – and I'm hoping that the sponsor can help me understand this. When it's currently prescribed and administered, that happens within the provider's office. So should this bill pass, the new process would be that the patient would either have to go to the pharmacy, pick up the prescription, bring it back to the provider to be administered, or the provider would have to order it, wait for the pharmacy to bring it back. Is that accurate? So you're correct that for injectable PrEP that's administered in a clinic, in the provider's office, but this bill would not change how injectable PrEP is administered. It only affects the billing process. the drug would be shipped from a specialty pharmacy to the provider and be administered to the patient there, which is when the drug is covered under the pharmacy benefit. So from the health plans, what is my description accurate in terms of how a patient would access the treatment or prescription? Yeah, that's my understanding as well. And I think our primary concern is, as I stated, the precedent that's being set in this bill. It could start with one drug and then it can move to others. And my understanding from our plans is that this could create a bifurcated process where, you know, typically they go into a doctor's office. It's a medical bill. And then you have a situation now where they're going into the doctor's office for a medical visit. But then there's an additional bill for the pharmacy or for the prescription drug. So then there would have to be some reconciliation on the back end that, according to our plans, would cost them and have some administrative burdens. So I'm trying to decipher if it's administrative burdens. I think the whole purpose and intent should be offering an ease of care. And I'm not quite sure if this helps it or hurts it, which if it's simply administrative, I mean, y'all figure out a lot of complex things very well. but I'm worried that it could postpone treatment, prolong treatment for a patient. And that's what concerns me about the bill. I'm going to lay off of it, and hopefully you guys can work together to find a middle ground. And when I see it hopefully on the floor, maybe I can get to a yes. But I just need some clarification on that. So if I can interject, and this isn't my bill. Do you want to see your clothes? I just want to address your concern. Oh, okay, perfect. Yeah. The issue of patients coming in and... And bringing their medications to be injected is not something that is new. I have had patients that pick up their medication from a pharmacy or get it somewhere else, and they come into the clinic, and my nurse will inject it. So whatever kind of administrative burden they're talking about, it's been done in the past. They can't figure it out. I think one of the issues, though, is about the ability for more people to be able to access this medication. When you look at a medical benefit, the actual provider or clinic essentially has to put the money up front before they can get the medication versus them getting the medication from a pharmacy benefit, right, and the patient can come in. And so the question is, especially in certain areas, providers may or may not be able to put up the funds, wait for reimbursement, and those kind of things. So it really actually does improve access. From my standpoint, it doesn't slow it. Thank you. Would you like to close? Oh, sure. On behalf of Senator Laird, just respectfully ask for an aye vote on SB 1023. Thank you. Thank you. We do not have a quorum, so we will now move. We'll move to file item number three. Thank you. We are now on file item 3, SB 1071. Senator Ochoa Poe, you may begin when you are ready. Thank you, Madam Chair and members. Senate Bill 1071 provides a legal path for families to amend a loved one's death certificate when a court has determined the death of a homicide, which will ensure California's public records accurately reflect those legal findings. Under current law, next of kin may request certain corrections to a death certificate, including typographical errors or amendments to the cause of death with a physician's certification. However, there is no process to amend the manner of death, even when a court of law has ruled a death a homicide. slide. SB 1071 would allow a victim's next of kin, after an appellate rights have been exhausted, to request an amendment so the official death certificate reflects the court's legal determination. I'd like to make clear that SB 1071 does not allow any changes to the medical examiner's or the coroner's opinion on the manner of death, which will remain documented in the autopsy protocol or other medical documents that were produced at the time of death. It's also important to note that while the cause of death requires certification by the medical examiner or coroner the manner of death does not require certification on the death certificate SB 1071 only allows an amendment to the manner of death on the state official legal document recording a person death and only after a legal determination of homicide All medical opinions in medical records are preserved and all certified medical opinions on the death certificate are preserved. Joining me today are Ivy Fitzpatrick, Chief Deputy District Attorney with Riverside County DA's office, and Candace Leitner, founder of We Save Lives and MAD, and co-founder of Not an Accident Campaign. Thank you, Senator. You will have a total of five minutes for your presentation today. Did I push? Go ahead. You're good. Did it work? Okay. Hi. Thank you. I'm here today on behalf of thousands of victims and survivors of impaired driving and drug poisonings in California to thank you for hearing SB 1071, a bill that finally brings truth and honesty to our loved ones' death certificates. My daughter Carrie, right here, Forever 13, was killed on May 3, 1980 while walking to a school carnival. She was hit from behind, thrown 125 feet, and left in the road to die. In my grief, I tried to share her organs so another life might be saved, but her body was so badly damaged that nothing was salvageable, nothing. I later learned the man who killed her was out on bail from another hit-and-run drunk driving crash the night before and had three prior drunk driving convictions in four years, yet still held a valid California driver's license. Unfortunately, my daughter's story is not unique. Precious Rosenda Rose Elizabeth Smiley, forever 14, was killed on May 25, 2024, also by a multiple repeat offender drunk driver who had signed the Watson advisement on his first and second convictions. He is now charged with murder. Yet her death certificate also says accident. There are so many more heartbreaking stories. For decades, I have worked to remove the inaccurate, inappropriate word accident from our language and our laws, launching the Crash Not Accident campaign at We Save Lives. Calling these deaths accidents misrepresents what happened, blurs the line between tragedy and wrongdoing, and helps negligent and reckless drivers evade full accountability. Imagine my shock when I saw my own daughter's death certificate and read accident under manner of death. Wrong. Carrie was killed in a drunk driving crime, a violent crime by a drunk driver, a criminal who was convicted of vehicular manslaughter. And they want to say under manner of death accident? It was a homicide. SB 1071 gives families a way to correct this injustice. Victims deserve honesty. Families deserve records that reflect what really happened, not language that erases culpability. And as policymakers, you deserve accurate data because accurate data saves lives and inaccurate data costs them. I urge you please vote aye on SB 1071 for truth and for every family whose loved one was not lost in an accident but killed by someone who chose to break the law. Thank you. Good afternoon Madam Chair Honorable Committee members My name is Ivy Fitzpatrick I a Chief Deputy District Attorney at the Riverside County District Attorney Office In simplest terms this bill would provide a mechanism to amend the manner of death on a death certificate after a final determination regarding the same. When a person dies and an autopsy is performed, there is both a cause and a manner of death listed on the death certificate. Cause is the literal medical scientific cause of that person's death, and that cause of death is certified appropriately by a physician on the death certificate. Manner of death is much different, however. Unlike cause, manner is not certified on the death certificate. And also unlike cause, manner is also not purely medical or scientific. It is derived from the medical legal death investigation, taking into account the circumstances surrounding the death that are known at the point in the death investigation, which is two, three days or so after the death, including the decedent's intent, as well as the actor's intent in causing the decedent's death, such as whether there were volitional harmful acts or intent to kill. The example of vehicular homicides demonstrates the problem that this bill seeks to solve. Currently, when a victim is killed by an impaired driver, the coroner typically classifies the manner of death at that time as an accident, not a homicide. This is not altogether surprising because the coroner will not have all of the information necessary to rule at a homicide at the time of the autopsy given the early stage of the investigation. However, after the death investigation is complete, there's been a trial, or in most situations with these crimes, there is a plea, and an appellate court has upheld the court's legal determination. All due process has been afforded to the defendant, and there is a final legal determination of homicide. We not only have all of the information, we also have an official legal determination of the manner of death, which is homicide, not an accident. SB 1071 seeks to have the state's official legal document regarding a person's death and the death certificate reflect the legal determination of the manner of death. Thank you. For this reason, I ask for your aye vote respectfully. Thank you. If there's anyone else in the audience that would like to register their support, please come to the microphone. State your name, your organization, and your position only. Thank you. Good afternoon. I'm Dr. Fillmore Smiley. I represent Not an Accident Campaign, but I really represent my daughter Rose, who was murdered by a drunk driver before they took her lifeless body away that day. The man who killed her had been charged with murder, yet she was still categorized as an accident. Her death was not an accident. Thank you. Thank you. Just a reminder, your name, your organization, and your position, please. Thank you. My name is Kelly Nalavaya with Not an Accident. My son was murdered on November 23rd. We ask for your aye vote on this bill for justice. Thank you. Sorry. It's okay. My name is Carol Schweiger. I a founding member of the Not an Accident Campaign And I like your support on SB 1071 Thank you Thank you My name is Matt Capilouto. I'm here in support of this bill on behalf of the organization Stop Drug Homicide, on behalf of the Not an Accident Campaign, and on behalf of my daughter Alexandra Capilouto, whose death certificate wrongfully states accident despite a man being held liable for her death and in prison today. Thank you. Thank you. My name is Regina Leah Chavez. This is my beautiful girl. I'm also with the Empower and Resilience Project in Placer County. My daughter, her case got the first murder conviction for fentanyl poisoning. I strongly, strongly support this bill, and I hope you all do, too. Thank you. Good afternoon, Lieutenant Julio DeLeon. I'm here on behalf of the Riverside County Sheriff's Office and Elected Sheriff Chad Bianco in support. Thank you. Good afternoon. My name is Lorena Espino. My daughter Brianna was murdered by fentanyl poisoning and a man was convicted. But yet her death certificate lists her death as an accident. So I need this matter to be considered very urgent. Thank you. Thank you. I'm Laura Didier, mother of Zach Didier, Forever 17. We also have a conviction I strongly support this bill. Thank you. My name is Charmaine Apodaca. On behalf of This is Not an Accident, this is our son, Keanu Apodaca. It was not an accident by fentanyl poisoning. I support the bill. Thank you. Hi, my name is Carol Flores Wilson, and I am here in support of representing my daughter, Melissa Wilson. This was not an accident, and I'm in strong, very, very strong support of this bill, SB 1071. This was not an accident, so thank you very much. Thank you. My name is Marica Cole, and I'm in strong support of this bill. My son was autistic and conserved, but he was killed by carfentanil in a drink form by somebody he knew. His death was not an accident. It was homicide, so please, I respectfully ask for your aye vote. Thank you. Good afternoon, Madam Chair and members. Ryan Sherman with the California Narcotic Officers Association. in strong support of the bill, along with the other law enforcement associations listed in the analysis. Thank you. Thank you. Seeing no other individuals that would like to speak in support of this bill, we will now move to lead witnesses in opposition. If you wish to speak and lead opposition in opposition, please come to the table at this time. You have a total of five minutes and you may begin. Thank you. Madam Chair and members, Corey Sauzillo on behalf of the California State Coroners Association, expressing sympathy to the families here today, obviously, and this is not a reflection of any sort of judgment on whether or not the criminal acts that underlie all these awful cases should be considered homicides in the eyes of the law. We appreciate the intent of the bill to provide families with a mechanism to reflect the judicial outcomes in a particular case, but this bill fundamentally blurs the critical distinction between medical determinations and legal findings resulting in significant unintended consequences. Death certification is a medical determination grounded in forensic science, professional expertise, and independent investigation. The matter of death is determined by a qualified medical examiner or coroner based on established principles and the totality of investigative findings at the time. A judicial verdict often rendered years later and under a different evidentiary standard serves a distinct legal purpose and should not retroactively alter a medical certification. The bill permits amendments to death certificates through the state registrar who is not medically or forensically trained and is not involved in the death investigation directly. This process created by SB 1071 would override the independent judgment of the certifying official and undermine the scientific foundation of death certification. Also, allowing legal outcomes to dictate changes in manner of death would compromise the accuracy and reliability of public health data. Death certificate information is used at local, state, and national levels, including by the CDC, to guide public health policy, allocate resources, and secure federal funding. Artificial alterations to manner of death classifications would introduce inconsistencies and distort critical data sets. Our system depends on maintaining a clear separation between forensic medical findings and judicial proceedings. This bill moves in the opposite direction by conflating these roles, increasing the risk of perceived or actual conflicts of interest, and undermining public trust in the death investigation process. Additionally, retroactively amending death certificates based on judicial outcomes could create discrepancies between autopsy reports and official records, leading to confusion for families, legal entities, and financial institutions. There are already established protocols for reviewing and, when appropriate, amending death certificates. These decisions properly reside with the investigating medical legal agency. The outcome of a criminal prosecution is not and should not become a basis for altering a medical determination. The bottom line is that a court's abstract of judgment and a death certificate can and should exist independently. I'm concerned that we're implying with this bill that truth and honesty are not hallmarks of what the physician medical examiner coroner is working with in this. And again, the death certificate is not, and it's not meant to be an indication of criminal culpability. It's a different standard and a different process. And homicide in a death certificate, that means death at the hands of another. It's a neutral determination. And when a court says homicide, that's based on a different standard, based on the introduction of facts and the finding of fact by a jury or a judge. So, again, with sympathy to the proponents of this bill, we respectfully ask for your no vote. Thank you. Thank you If anyone else would like to register their opposition please come to the microphone state your name your organization and your position Seeing none we bring it back to the committee Senator Caballero Thank you Madam Chair I want to thank everybody for coming here today. I really appreciate the pain and the concern that you've raised here. Let me ask a question of the opposition because I understand what you're talking about. But as I look at the form, what's being proposed here is a change. And change is always difficult. And I get the, you want a, what the form is stating are the facts that they find in regards, in this instance, in regards to someone who is deceased who comes in and the coroner is trying to figure out how did they die, right? So the death caused by is where the coroner looks at the details of the injury and makes a determination of what caused the death. And I don't think anybody has any disagreement that that should not be touched. What is being discussed here is the specific reason for why the deceased died the way they are. and accident doesn't tell us much as we collect data because you don't know what kind of accident. Did they fall off a cliff? Were they hit by a car? And so it's a category that is so broad that it really doesn't tell you much. And if the space was big enough, it could say vehicular homicide. In other words, a detail could be articulated. And I get that a coroner can't make that kind of analysis because there isn't data in front of them to do that. if a court is making a determination, what is the problem with having the court issue an order as part of the homicide decision? Usually it's by plea or a jury trial. that the death certificate should be amended to show that it was a vehicular homicide that was the real cause of death. And I'm looking at here because one says cause and one is – Manner. Cause is the one above, and the other one is – Manner. Manner. That's right, manner. I'm sorry. Thank you for that. what's the problem with that, I guess, if we're collecting data, and this is what's important as part of this, and what the problem with the data being specific so that we know how do we compare to other states and what laws do we need to change or what are the things that we need to I guess I just have a hard this is a document that we prepare, that is prepared, as part of what will follow that individual for the rest of their lives. I'm looking at going back into my family to figure out lineage and DNA and the death certificates and birth certificates are really principal when you look. And this stays with the family forever. What's the problem with if a court has reached a determination and using this requirement to link it so that it can't be changed just because someone calls up and says, I want you to change it. The only way it gets changed is by a court order. And the clerk can't do it all by themselves. You said a number of objections, and I'm just trying to get down to the one that I think is the biggest or the naughtiest problem is what really is the problem. I get it. The coroners don't want anybody messing with their documents. But the only way you can do that would be with a court order. Through the chair. The problem is that the death certificate is not intended to be the final legal explainer of what happened. That's just not what the document is. As you said, the death certificate relays the cause and manner of death that causes the medical situation, cardiac arrest or massive loss of blood, whatever the doctor is going to determine is the physical reason why the person is no longer alive. The manner of death, the coroner or the medical examiner is limited to five choices, suicide, homicide, natural, accident, or undefined. And that's the way it is. And there have been discussions for decades about is that the appropriate list? Should it be expanded? Should we have an additional category? Should we, you know, and candidly, that's a different discussion. But the problem is you've got a different finder of fact, right? So you have a finder of fact in the beginning, which is the corner of the medical examiner, saying based on my medical knowledge and my investigative skills, I'm making a determination that with the information I have before me, that this was a death, and let's take an example in a car accident, that it was an accident. I can't determine that there was a criminal level of culpability that raises this to a homicide. Was this at the hands of another, or was this because of the circumstances? Now, a court can go back and say, look, we have legal standards for what constitutes a homicide, And we can say with all the facts that are presented by both sides, witness accounts, whatever the case may be, a finder of fact will then say, in our opinion, this is a homicide. This is a murder. This is a Watson murder. This is a vehicular manslaughter. This is a poisoning via fentanyl. And the court can say this is a homicide. But there's what we haven't heard is a sort of a, and I'll try not to answer a question with a question, but what is the necessity of those two documents saying exactly the same thing? They're not meant to be the same document. No, I get it. So what, what, what would be the situation if a court makes a determination sends it to the corner and the corner has problems with the changing of the document and can communicate that to a court I'm just trying to figure out. I have a hard time understanding why we wouldn't want to do it, and I get the different contexts, and maybe we need to expand the different categories so that we have a little bit more information. But I'm struggling to understand. You're struggling to understand why they'd want it, and I'm trying to understand why. And I apologize. I need to run, but I'm trying to get. Through the chair, I understand the desire to have the medical documents say, look, my son or daughter was killed by a person. This was a Watson murder. This was a drunk driving, a fentanyl poisoning, whatever the case is. I get that. What I don't necessarily understand is why this sort of notion that these two documents have to reflect the same exact conclusion. They're not based on and they're not determined at the same point in time. The death certificate is understood to be this is what the doctor and the investigator's findings are at the time of death or, you know, very closely proximate to the time of death. And that the abstract of judgment that says guilty of 187 penal code homicide, that could be years and years down the line. So then a court comes back and says, you know, petition, we're ordering a change to the death certificate. So now you've got autopsy reports and medical finding and testing that everything that goes to accident or whatever the case may be. And then you've got an abstract of judgment that says homicide. And so now if the death certificate is then replaced, now you've got all this stuff that sort of leads up to accident, and then the death certificate says homicide. So you have this internal consistency on the front end of the medical documents. And that's part of the concern on the part of the medical. And I guess my response to that is as long as they're not inconsistent, then it changed. But they are. They're necessarily going to be inconsistent. Well, an accident is just an assumption based on a body coming in that looks pretty messed up and the information that they pulled the individual out of a car. It's not based on anything else, and that could be consistent with having been run over by someone who's intoxicated. And that may even be in the police report that the coroner looks at when they're doing the autopsy, because all of that information gets received by the coroner. So I understand where you're coming from, and I do apologize. I need to run. If I may just really quickly respond to Senator Caballeros' question. A couple of things that was mentioned, and I think we need to clarify. First of all, there's two options right there with regards to, and the differentiation being, the cause of death, which is a medical interpretation certified by the coroner. The manner of death is not certified by the coroner. So we're not questioning the cause of death because they're working with what they have at the time. What we want to have clarity on is the manner of that, what was originally considered an accident based on the evidence at the time, to be clear. and reflect the truth of an outcome after investigations have been completed. Clarifying the manner of death, which is not certified by the coroners or the medical examiners. So there has to be clarity. There's got to be clarity. We're not changing anything that has been certified by an authority in place. We're just clarifying. And I usually don't. I just need to ask a clarifying question because now I'm confused about something. So you just stated that the manner of death is not certified by the coroner or the physician. Is it not on the death certificate? I'll have my. Is the manner of death on the death certificate? Yes. If you read. I believe you have the death certificate. Yeah, so I'm confused because who signs the death certificate? Right. So if we look to section, it says, well, this is an older one, but it'll say on there cause. I have a recent death certificate. It says on this one. Mine is highlighted 29. Right here. There's cause of death, which is on section 107. Do you see this on this? That's an older one, the one that is the copy of Carrie's. but this one, see the cause of death? And then if you go down here to the, it says, I certify, to the best of my knowledge, that the death occurred at the hour, date, and place stated from the causes stated. From the causes stated. It doesn't say I certify the manner. It's very similar to the birth certificate. If we look at the birth certificate, the physician at the time of the birth, it says, and probably the doctor here knows better than I do, but it says date, time, place, and it was a live birth, right, or something like that. It doesn't certify the name, the gender, you know, all these sorts of things on there, meaning what is actually at the certification line are those things. So what we have before us is not an actual death certificate. This is an older version of it. If you would like to see, Madam Chair, I can see the new one. Yeah, okay. This is the modern. I guess they've changed since my daughter was killed. Sorry, I wasn't aware it changed so much. Can you bring it up? Yes, I can bring it up. If we look at Section 107, if it's in a hospital, right below that is, I think it's 109, is by the corner, Madam Chair. So he doesn't certify the manner. All right. But what I'm seeing here is that there is someone who certifies the cause of death on this one, but the coroner still certifies the manner of death. It says on there, I certify what the certification language is, is I certify the time. I know how I'm in front of you now, but time, place, something, and causes of death. So they're writing. I certify that, in my opinion, death occurred at the hour, date, and place, stated from the causes stated, manner of death, and then you check. So from my interpretation, whoever the coroner is, is certifying the manner of death because they are signing under that But I just I going to turn it back over I just wanted to get clarification on that because if they weren certifying it then where's, you know, why were they signing it? But it looks from the new ones that they do actually certify the manner of death. But go ahead. So thank you, Madam Chair. You kind of answered some of my questions here, but when I am a co-author of this spirit bill, it's a necessary for honesty, for truth, for dignity. for closure for families. I'm going to see this bill again in judiciary, so a lot of the legal questions I'll ask there, but I want to kind of focus on the health implications. And the two most important government documents are a birth certificate and a death certificate. And the certificate of death does not belong to the corner. It belongs to the individual. It belongs to the people of the state of California and or the county. And I think it is so vitally important that we have the most accurate data that is going to live beyond today, tomorrow. It's going to live beyond news articles. It's going to live beyond family stories so that we better understand the health data and reason for deaths 100 years from now, 200 years from now, if that's the case. And having the most accurate information, even if that information needs to be updated after determination from a court, is vitally important for our understanding of health needs in the state of California, which is why I'll be supporting this bill. I would like to ask that you – I think we could probably make this better. There's probably a bigger conversation to have. So I would ask that you continue to engage with the author to make sure that we're getting this right. Senator Durazo. So, yeah, I've got lots of questions, which I don't think can all be answered today. But I've always assumed that the death certificate was more along the lines of a medical document than anything else. and a lot of questions about what impact could this have if we merge them more. I think that's what you're asking, to merge more of the information, what potential that it could have on the court or the legal proceedings. You know, when you change something that's been done in a certain way for so long, How does that, you know, let's just say that there are criminal proceedings or charges filed. How does this impact that legal process if it's going to be used, if you're going to use both of them at the same time? I know I'm probably asking this in a very confusing way because it's, one, I've always just understood, One is one, it's medical, and the other one documents our legal court proceedings. They have different purposes. They have different, you know, they don't have this, they're not looking for the same outcome. So I hesitant to make these changes because I don know what all the impact is going to be way beyond just changing some words This isn just changing words This is changing potential outcomes that affect a lot of people So it's just very unclear to me all those potential impacts that it could have. And I just don't have enough information in front of me to be able to make such a solid decision. But if you were to get this passed, there's got to be a way of fixing it because it's not clear enough that we should take the risks to move forward with it, in my opinion. Thank you. I'm sure, if I may. I think it was very well stated by our sheriff in Riverside that spoke this morning that said, you know, the only two documents that a family has will be the birth certificate and the death certificate of a child. What we want to ensure is that there is clarity on the outcome manner in which a person died. manner, which cannot be fully defined at the time of the initial inspection of a body. It's important on the basis that the manner of death on birth certificates is what we use in data in analyzing what is happening in our state. It is that data reflected on the manner of death and birth certificates that we use to legislate, to create policy that keeps Californians safe. That's why it's important. Once again there are five options and I will defer if the chair will allow I will defer to my expert witness here but there are only five ways in which a manner death can occur right now. Five manners in which the the coroner at the time with the initial body that it has before it can certify the cause of death, one of them being an accident. But that accident can be clarified, can be changed from an accident to a different manner of death only after it's been investigated. And that manner of death, per this bill, will only happen after all legal proceedings have been concluded. So once that is completed, then we, through the courts, through an investigative process, a constitutional process, can we actually have clarity on that manner of death? and our records in our state including our family should have clarity and truth and honesty on what that manner of death is That's why it's important. It's important to have the ability to actually amend it to have clarity of what has happened, and then also for our own purposes, because this is what we use to literally gather data in our state that directs policy in public safety. I may just defer to if there's anything that I missed. I think we're okay. Okay. So I do have a question for the opposition around data collection. You mentioned that there are five choices. Are these five choices that California has chosen? Are these national five choices? What are we looking at here? It's my understanding, Madam Chair, that those five choices are generally accepted through the medical examiner profession that those are national standards. And that's important to me. as a provider, as someone that looks at data, because if we're looking at data points, then they must be consistent. If we're changing ours and adding six, seven, eight categories, potentially I'm just saying, which doesn't align with the other 49 states, then when we are looking at national data, and the reason why this peaked was because you were talking about statistics from the Center for Disease Control and that they look at these things to determine national trends, not just state trends. And so if we are going in a different direction, it's going to be challenging for California to be able to be a part of any national data collection from a health standpoint, and that is of concern for me. I do want to mention that there are a number of other states interested now in doing this. And I appreciate the interest. What I look for is movement, right? So, again, if it's not a national change, then the national data will be skewed. I thoroughly appreciate you bringing this bill forward. I thought, to be quite honest, it was a lot more straightforward than what I am learning today during the hearing. I want to thank all of those who came to speak and support. It is not easy to come and share your story. And as a mother, my heart breaks with each and every one of your losses. I'm not sure what is going to happen with the bill today. We still don't have a quorum, so we can't vote on it. But I feel like even if this isn't the method, there must be something that we can do to ensure that whatever the coroner or the physician and that data set isn't disturbed, but we're still able to somehow provide the updated, accurate information for the families. So I appreciate you bringing the bill forward. Would allow for you to close and at the appropriate time. you know, will vote. And if it doesn't get out of committee today, I would love to sit down and talk with you about some other potential options. Okay. So on that manner of death, just for clarity, we're not adding categories to the manner of death. That is not the intent of the bill. It's not to add categories, ma'am. What we're trying to do is when one of those options state an accident, and it is determined legally that it was not an accident, the family has the ability to amend that original statement of an accident into homicide, which is already one of the five already matters of death within that certificate. So we're not adding anything. We're not changing anything from the original examination. All we want to do is that when one of those five, which includes an accident, is determined legally that it was, in fact, not an accident, the families have the ability to amend and reflect the updated, accurate reflection of that manner of death, which, quite frankly, our coroners would have no idea that that would be the case at the time because not all evidence was there. So that is important to note. Accurate death certificate data. And by the way, we would be leading the nation on this effort. It's not something, and then once, and the response that we, that the organization has received as far as ensuring that people are aware, because I think most people, just as an FYI, the average person, when they think of a death certificate, they think that it reflects the actual manner of death. As a matter of fact, the majority of folks that I have spoken with about this bill or have read about this bill are absolutely shocked that that's not the case. So we all assume that it does that, but it actually doesn't, which is why we want to make sure that we are able to literally modify that original misinterpretation, or not misinterpretation, but just, I guess misinterpretation, that's the only word I can think of. Huh? Mislabeled. Mislabeled. Thank you. Mislabeled. And so very, very much important to delineate that. So accurate death certificate data does more than just provide closure to families. The information is transmitted to the state registrar and the California Department of Public Health. where it forms the basis for certified debt certificates and statewide vital statistics. This is why it's so important. Those statistics directly inform public health research, guide criminal justice policy decisions, and shape statewide data systems that lawmakers and agencies rely on when addressing, in this case, such an example, impaired driving and other preventable deaths. This bill is about truth and justice for victims and their families Drunk and impaired driving deaths are up in California and death certificates should accurately categorize these deaths as homicides not accidents I respectfully ask for an aye vote Thank you, Senator. Unfortunately, as I stated, we still do not have a quorum. Once we have a quorum, I believe the motion had been made, and so we'll be able to take it up at Thank you, Madam Chair. All right, so we will now move back in file order to file number 2, SB1057 by Senator Becker. Senator Becker, you may begin when you're ready. Thank you. Good afternoon, Chair and members. First, this bill comes out of an experience of a friend of mine. SB 1057 represents a common-sense shift towards restorative justice in the health care sector. This bill modernizes the certification process for certified nurse assistants and home health aides. It moves the states away from a rigid automatic denial system for individuals with criminal records and works towards a discretionary rehabilitation first model. By prioritizing current character and proven rehabilitation over past mistakes, California can build a stronger, equitable, and sustainable workforce. Currently, California is facing a massive shortage of frontline caregivers. by removing permanent barriers for qualified rehabilitated individuals, this bill expands the labor pool for nursing homes and home health agencies without compromising safety. Rather than a blanket ban, SB 1057 requires the Department of Public Health to perform an individualized assessment based on three specific factors. One, the actual nature and gravity of the offense. Two, the amount of time that has elapsed since conviction. and three, concrete evidence of rehabilitation, such as recent work history and character references. Further, the bill lines health care licensing with our state's broader fair chance employment goals. If the judicial system has recognized individuals' rehabilitation, our licensing board should do the same. Supporting this bill means supporting the dignity of our workers, and most importantly, the quality of care for California seniors and those with disabilities. With me today, testify in support is Ed Little with Californians for Safety and Justice. Thank you. Thank you. You have a total of five minutes. Thank you. Good afternoon, Chair and Committee members. My name is Ed Little, and I'm the Government Affairs Manager with Californians for Safety and Justice and proud co-sponsor of SB 1057. Californians living with past convictions face lasting barriers to sustainable work, safe housing, education, and other opportunities to succeed. This bill would increase access to direct care workers, jobs for people with past records by aligning Department of Public Health certification standards related to conviction history with those of other healing professions under existing law. AB 2138, passed by the legislature in 2018, established critical protections and greatly improved access to licensure for people with records, including for registered and vocational nurses, physicians and surgeons, clinical social workers and more. However under existing law today people seeking certifications for similar patient care roles such as certified nursing assistants and home health aides are not afforded the same protections This bill seeks to close that gap. This bill is a critical step toward not only ensuring fair opportunity for people with past records to pursue meaningful caregiving careers, but also addressing California's direct care workforce shortages. Extending accepted standards and practices for considering conviction history and other health care giving fields to CNA and home health aid certifications will help achieve these goals. For these reasons, we ask for your aye vote on SB 1057. Thank you. Thank you. If there's anyone else in the audience that would like to register their support, please come to the microphone, state your name, your organization, and your position. Seeing none, if anyone would like to speak as a lead witness in opposition, this is your time to come forward. Seeing none, if anyone would like to register their opposition, please come to the microphone. State your name, your organization, and your position. I sorry, support Andrea Mavisca on behalf of CPCA advocates in support of the bill. Thank you. Seeing no further individuals that would like to speak, we'll bring it back to committee. Not seeing any questions or comments. Senator Becker, would you like to close? Well, thank you. I think, you know, you can see this was a bill that we wrote in conjunction with some of the organizations mentioned because it's interesting to have a specific problem that I've seen myself and hoping that today we can move this forward and continue to move it forward in the process and accomplish the goals, which are to allow people who have been through rehabilitation to serve in these capacities that are much needed. So with that, I respectfully ask for an aye vote. Thank you, Senator Becker. And once we get a quorum, we'll be able to take this up. We will now move to file item number four, SB1088 by Senator Blakespear. Senator, you are recognized when you are ready. Okay, thank you. Thank you, Chair and colleagues. I am pleased to author SB1088, which is sponsored by the Coalition for Compassionate Care of California. This bill will help ensure people receive the medical treatment they desire at the end of their lives or when they are no longer able to express their wishes. As a former Wills Trust and Estate Planning attorney, I worked with clients who care deeply about charting their own exit, and I've seen firsthand the deep significance of advanced planning. Advanced care planning is the process where a person declares and documents the type of care and medical treatment that they want and that they don't want should they become incapacitated. There are three legal tools for communicating one's care preferences. Advanced health care directives, pre-hospital do-not-resuscitates, or DNRs, and physician orders for life-sustaining treatment, which is otherwise known as a PULST. Advanced health care directives allow a person to designate someone to make medical decisions on their behalf and explain what medical treatment should be done if they lose decision-making abilities as a health care agent. However, an advanced health care directive expresses preferences. These are not medical orders. The instructions can be vague, and providers and the designated decision maker may view them as general guidance rather than clear and compelling instructions. The other two tools are the pre do not resuscitate DNR and the PULST While a DNR limits resuscitation attempts following cardiopulmonary arrest a PULST allows a patient to decline interventions like CPR ventilators and feeding tubes during any life-threatening emergency. Both pre-hospital DNRs and PULSTs are highly specific, standardized, and signed by a medical provider, making them binding medical orders that other health care providers are required to follow. SB 1088 aligns the three planning tools and makes important modernization updates. First, in recognition that physician assistants and nurse practitioners can sign a PULST, it updates the name of PULST to be Portable Orders Listing Scope of Treatment and allows those providers to also sign a hospital DNR. It also clarifies that PULST and pre-hospital DNR forms are entirely voluntary and that care cannot be conditioned on completing one. It clarifies who can sign a PULST on behalf of an incapacitated patient, which is a health care agent, a conservator, or a surrogate. It creates a presumption of validity for a PULST executed in another state. And it allows electronic signatures to be used to facilitate electronic completion, storage, and retrieval of PULST forms. These are modern and reasonable reforms that help people plan for their end of lives. With me, I have Jennifer Moore-Balantin on behalf of the Coalition for Compassionate Care of California. Thank you very much, Madam Chair and committee members. My name is Jennifer Ballantyne, CEO of the Coalition for Compassionate Care of California. CCCC introduced the POLST program to enhance California's advanced care planning toolkit in 2009. Since then, we have supported the program and sponsored several bills to improve access to POLST and develop a statewide electronic registry. In 2024, we undertook a statewide survey to assess the quality of POLST processes. The survey amounted to a test of POLST knowledge and practice, and we received more than 3,600 responses across the spectrum of care settings and healthcare disciplines. The results of that survey highlighted a number of persistent lapses in POLST use, several of which originated in gaps or confusions in the POLST DNR statute. So this bill is narrowly focused to address those issues. Notably, less than 1% of respondents to the survey, a quarter of whom were emergency service personnel, could correctly identify the operational differences between POLST and the pre-hospital DNR, including which form can be signed by which health care providers, allowing NPs and PAs to sign the pre-hospital DNR will eliminate this confusion and create consistency between the forms. Less than 4% of respondents could correctly identify who would be authorized to sign a POLST or DNR for an already incapacitated patient. Clarifying who under what authority can sign a POLST or DNR will help providers correctly identify authorized signers of the POLST and exclude those not authorized to sign. We frequently hear reports of POLST being required for admission to nursing facilities. This is contrary to the standard that any advanced care planning document must be voluntary. In the POLST survey, barely half of skilled nursing facility personnel correctly understood that the use of POLST is voluntary. Explicitly stating this crucial principle in the law is essential to prevent inappropriate use of POLST or the DNR in all settings. As noted, the California Emergency Medical Services Authority is currently developing a statewide electronic registry of POLST. Many health systems already use electronic medical health records, and yet the POLST DNR statute does not define nor authorize electronic signature of the form. This amendment will bring the law into alignment with current practice and eliminate confusion on an essential feature of the form's validity. Finally, visitors and temporary residents in California should have confidence that their documented wishes will be honored by our health care systems. Existing law allows recognition of advanced health care directives from other states. We believe the same should hold for POLST and pre-hospital DNRs. Thank you for your attention and your support of the bill. I'm happy to answer any questions. Thank you. If there are any members of the audience that would like to come and register your support for this bill, please come to the mic, State your name, your organization, and your position. Nasset Short on behalf of the Alliance of Catholic Health Care and Support. Thank you. Madam Chair and members, Monica Miller on behalf of Alzheimer's San Diego, Alzheimer's Orange County, and Alzheimer's Los Angeles in support. Thank you. Thank you. Yvonne Chung on behalf of the California Association of Health Facilities. We are the Trade Association for Skilled Nursing Facilities in support. Thank you. Natalie Pita on behalf of the California Academy of Family Physicians in support. Thank you. All right, if there's anyone in the audience that would like to speak and lead opposition, please come forward now to the table. This is your time. Thank you. Thank you. Thank you, and you will both have a combined five minutes. Thank you, Madam Chair. Roxanne Gould, representing the California Association of Clinical Nurse Specialists. We apologize to the Senator for our late opposition when we discovered the bill was going to be on consent. We felt it was rather urgent that we not send the message to future committees that the bill is ready and our objective is that clinical nurse specialists should be included in the bill, that there are more than 3,000 clinical nurse specialists in California. They have a minimum of a master's. Most have a doctorate, and they have nearly four years of training after that specialty. and, in fact, those clinical nurse specialists train many of the nurse practitioners that actually currently are authorized assigned in the POLST. So our objective is not with the bill as it stands. We think the bill would be better if we would include those 3,000 clinical nurse specialists as authorized signatories to the POLST. Hi, thank you. So my name is Colleen Vega. I am a clinical nurse specialist, and I serve as the lead advanced practice provider at a large academic center in the Bay Area. In this role, I provide direct care to patients overseeing and mentoring clinical nurse specialists, nurse practitioners, and physician assistants. I'm here today to advocate for the expansion of the authorized signatures on the Pulse for clinical nurse specialists. Like other advanced practice providers, including nurse practitioners, clinical nurse specialists practice under the standardized procedures and are prepared through graduate study level application. They possess extensive clinical expertise in areas such as critical care, oncology, geriatrics, and palliative care. CNSs are licensed regulated professionals who assess diagnose and manage complex patient conditions In both the rural and academic settings CNS lead coordination care treatment decisions and facilitate deeply personal discussions about patient's goals of care. In my academic role, I also train and educate nurse practitioners and physician assistants who are authorized to sign Pulse, but I am not. Unfortunately, under this constitute right now, even with the SB 1088, I would not be able to sign a pulse with a patient who I have connection with and treating. This creates unnecessary barriers for patients, particularly those in undeserved or rural communities where access to authorized providers may be limited, leading to more delays in documentation of the patient's wishes or worse, resulting in care that does not align with the wishes of the patient. There are many ways that we think that this can be accomplished by adding clinical nurse specialists to this bill. First, it improves access, which I think is what we're hopeful for this bill, but improving it. If I can't sign the bill, even though a patient can, I'd have to find someone to be able to sign the bill who had not been having those conversations with the patient. Second, enhances continuity of care. CNSs often develop long-standing relationships with patients and families, placing them in an ideal position to have meaningful conversations about end-of-life preferences and ensuring that their wishes are accurately documented. And third, it strengthens our health-based workforce, recognizing CNSs as authorized pulse signatures acknowledges their expertise and aligns with California with a growing number of states that are empowering advanced passers, nurses to look at the full extent of their license and training. As our population of adult patients with chronic illnesses continue to grow, we'll need more health care providers like CNSs to provide centered care and facilitate patients' end of wishes through the completion of Pulse. Adding CNSs complements the collaborative and team-based approach that defines modern health care. It ensures that qualified professionals can act in the best interest of their patients without unnecessary administrative constraints. We appreciate that the bill SB 1088 looks to improve access for patients completing the pulse, but we think that we can go further than that and by including CNSs as authorized signatures. We appreciate you taking the time to hear us out about this. Thank you. If there's anyone else in the audience that would like to register their opposition, please come to the microphone, state your name, your organization, and your position. Seeing none, I'll bring it back to the committee. Seeing no questions. Senator Blakespeare, would you like to close? Oh, I just wanted to ask about the CNS's concerns. Yeah. Yeah, I mean, so essentially this is not a scope of practice bill. I mean, what we're doing here is we're modernizing the pulse with very specific things. Like, for example, a pulse from out of state is recognized in this state. If there are two dates, the more recent date is the one that's valid. You know, a number of very specific things related to the PULST itself, but we're not, this is not a scope of practice bill where we're getting involved in a dispute among California Medical Association, PAs, NPs, clinical nurse specialists about what, who should be doing what within medicine. And I think I very much appreciate the testimony and the reality that they are dealing with the same patient population and they have a trusted relationship. But simply stated, that would be a different bill. And it would be also to be honest a different fight around you know what kind of disputes are we doing with this bill And what we trying to do is modernize the pulse and it narrowly tailored to be within that lane not to be expanding the scope of practice Thank you. Seeing no other questions or comments, I want to thank you, Senator Blake Spear, for bringing this bill forward. appreciate the fact of you trying to keep it within this lane. If it was a scope of practice bill, it would not be something that we would be hearing or dealing with in this particular committee anyway. But if you would like to close, this is your time. All right. Well, thank you. And I respectfully ask for your aye vote. Thank you. We still don't have a quorum. But when we do, we'll take it out. So members of the health committee, We are now hearing our last health bill. Would really appreciate for members to come down so we can establish a quorum and we can start voting on these bills. Sorry, this is your vote. Thank you. We will now move to file item number 6, SB 869, by Senator Weber Pearson. Senator, you were recognized when you were ready. Thank you. Good afternoon, members of the committee. I am here to present SB 869, and we'll be accepting the committee amendments. Senator, I'm going to pause you right there so we can establish quorum. Secretary, do you please call? Senators Weber Pearson? Here. Weber Pearson here. Valadeiras? Here. Valadeiras here. Caballero? Caballero here. DeRazzo? Here. DeRazzo, here. Gonzalez? Grove? Here. Grove, here. Menjavar? Padilla? Perez? Rubio? Smallwood Cuevas? Here. Smallwood Cuevas, here. Senator, we have established quorum. Thank you. Okay. Well, good afternoon, members of the committee. I am here to present SB 869, and we'll be accepting committee amendments, and would like to thank committee staff for their work on this bill. Every day, millions of Californians walk into restaurants and food facilities and order beverages without realizing just how much added sugar they're consuming. It is estimated that about half of all adults and two of all youth here in the United States consume sugar beverages every single day These decisions are made quickly at a counter at a drive on a digital screen And in those moments, consumers deserve clear, easy-to-understand information about what they're taking into their bodies. We have known for many years about the link between excessive added sugar consumption and diabetes. In fact, in many communities, having diabetes is referred to as having the sugar. We also know that the rates of type 2 diabetes in adults and children and prediabetes in both groups has risen over the last few decades. But what research is also showing is that excessive added sugar consumption is directly linked to obesity, heart disease, other chronic illnesses. And recently, studies have shown that excessive added sugar can double your risk of developing dementia or Alzheimer's disease. Sugary drinks are one of the largest sources of added sugar in the American diet. This drink my staff purchased at a popular chain coffee restaurant this morning. It has 163 grams of sugar. The daily recommended allowance for adults is no more than 50 grams. And for kids between the age of 2 and 18, it is no more than 25 milligrams of added sugar. When people purchase these drinks, they have no idea how much sugar they're consuming. SB 869 addresses this gap by requiring large chain restaurants to display a clear, easy to recognize, added sugar icon next to beverages that exceed 50% of the daily recommended limit for adults of sugar, and that icon will be labeled on the menu at the point of purchase. As I just stated, this would only apply to large chain restaurants, meaning those that have more than 20 locations. Before I introduce my witnesses who will speak in support of this bill, I would like to address some of the concerns from the opposition. One of their concerns that they list in their letter is that they already provide nutritional information on food and drinks. That is true. But tell me, when was the last time you went into a coffee shop or you went to a restaurant and you looked at the menu and it told you right there how much sugar you would be consuming. You can't tell me. Because the reality is that this nutritional information is hidden in an app, hoping that you have it, or online, hoping that you have access to it, but it is not readily available when you're purchasing that item. They also talk about the fact that if we did this, it would add to crowding the menu. And I state that a superscript icon of a sugar cube does not crowd a menu any more than a V next to a vegan dish, a VEG next to a vegetarian dish. dish, a GF next to a gluten-free dish, nor does the tiny script at the bottom that would say contains more than 50% of daily recommended sugar differ from what we already have. They also mention the fact that they've worked a lot with their kids' meals and ensure that the default beverage is not the sugary one. And for that, I say thank you. That does not mean that that child or that parent for that child cannot order a sugary drink. And right now, when they look at the menu, they won't know whether or not that sugary drink has an excessive amount of added sugars. Additionally, many adults and children don't order off of kids' meals. They also talk about the fact that we have caused more difficulty because of the crushing wage increases that specifically target restaurants because we've passed a law requiring them to provide a livable wage. Although I didn't want to bring cost into this, let's not forget about the high cost to our health care system impacting everyone when we treat these conditions that are caused or exacerbated by high added sugar intake, many of which could be prevented. Finally, they mention the fact that we recently passed a bill that they supported to allow for allergen, food allergen labeling, which will go into effect in July of this year. This bill, my bill, SB 869, is not scheduled to go into effect until January of 2028, giving them a whole year and a half. And I appreciate the fact that they acknowledge the seriousness of food allergens, because that impacts around 6% to 10% of the U.S. population, and that transparency is important. But let's take that 6% and multiply it or double it by 2. That's 12%. 12% of the U.S. population with diabetes. Let's take that 6% and multiply it by 7. Over 42% of the U.S. population has obesity. And if you include those who are considered overweight in the U.S. population, we're talking up to 70%. All of these are serious conditions that can be prevented or mitigated by having readily available information to make healthier choices. California has long been a leader in public health, and this bill continues that legacy by prioritizing transparency, empowering consumers, and taking practical steps towards addressing chronic disease. You know, we often say that we are what we eat, and the truth is, in addition to that, we are what we drink. With me today, serving as a witness is Christine Falabel with the American Diabetes Association and Dr. J, an emergency room physician and local American Heart Association volunteer. Thank you. Thank you. You're both recognized for two and a half minutes. Good afternoon, Madam Chair and members of the committee. Thank you for taking the time to hear such an important issue today My name is Christine Fallabel and I the Director of State Government Affairs for the American Diabetes Association I here today to speak in support of Senate Bill 869 and the ADA is a proud co For too long, we've asked people to make better choices without giving them the tools or the truth that they need to actually do that. Sugary beverages are one of the clearest examples of this gap. They're marketed as refreshing, energizing, and even healthy at times. But what's often missing is simple, honest transparency about how these drinks impact our bodies, especially for communities already facing higher rates of chronic conditions like type 2 diabetes and obesity. And this is where Senate Bill 869 comes in. This bill is not about taking choices away. It's about making those choices real and transparent. When a parent picks up a drink for their child, they deserve to understand what they're giving them. When kids visit a coffee shop after school, they deserve to know what exactly they're drinking and how it will impact them. When someone is trying to manage their weight, their blood sugar, or their overall health, they shouldn't have to decode labels or rely on guesswork or even ask a busy barista to find an old nutrition label in the back corners of their business. Transparency levels the playing field. It replaces confusion with clarity and empowers people to make decisions that align with their health goals. We know that small daily choices add up. A single beverage may not seem like much, but over time it can significantly impact someone's health trajectory. Studies show that adding even one 12-ounce sugary drink daily increases the risk of developing type 2 diabetes by roughly 25%. Senate bill 869 is a step toward respect for consumers for families and for communities and acknowledges that people can make good decisions when they're given honest information and we're asking for that transparency with transparency comes trust and better health outcomes for all Californians. We support Senate bill 869 and encourage you to vote. Yes. Thank you for your time and consideration. Good afternoon, Madam Chair and members of the committee. My name is Arthur Jay, and I'm an emergency medicine physician at one of the local hospitals, and I volunteer at the American Heart Association. Thank you for the opportunity for me to speak to you today regarding Senate Bill 869 and the importance of offering clear icons to stand the standard beverage menu items that contain high levels of sugars. By introducing these standards, SB 869, it takes an important step towards improving the dietary environment of Californians and protecting them from early risk factors to type 1 diabetes, type 2 diabetes, obesity, and cardiovascular disease. I mean, as a physician who cares for patients with diabetes, I see every day how challenging this disease can be. Many of my patients are really trying to do their best, yet still frustrated and overwhelmed by trying to manage their own health. If I was in their position, I would feel exactly the same way. Without transparency, patients have a harder time making informed decisions about their health. Restaurants are a frequent source of food in American families in the United States, with the average family eating out four to five times a week. restaurants foods can have high levels of salt and sugar including sugary drinks and sugary drinks are the highest highest instigator of sugar in the diet some of them have more than the 50 grams of sugar in a single serving Consuming too many sugary drinks can lead to heart disease, dental caries, and type 2 diabetes, including obesity. Personally, my mother has diabetes, and I've seen firsthand the highs and lows that come with managing this disease. It's not just about the treatment. It's about the daily decisions and challenges that come with trying to stay healthy. This bill does not restrict choice. It simply ensures transparency, giving consumers like me, my mother, my patients, and all of our families the information they need to control their own health. California deserves to have a clear and easy to read understanding of the information in front of them at time of purchase. For these reasons, we respectfully ask you to vote aye on SB 869. Thank you for your opportunity to speak. Thank you. We'll now move to anyone else in the room that would like to express their support. Please state your name, your organization, and your position. Thank you, Chair and members. Keshav Kumar with Lighthouse Public Affairs. On behalf of the California Academy of Registered Nutrition and Dietetics, We are the largest association of registered dietitians in the state, and we are strongly in support and appreciate the author's work. Kevin Guzman with the California Medical Association in support. My name is Dr. Sarita Sepathy, and I'm with District 8 and part of CMA, and I fully support this. Dr. John Ma, I'm the chair of the California American Heart Association Advocacy Committee in strong support. Good afternoon. My name is Dr. Devin Fordyce. I am a clinical education specialist as well as a professor of nursing as well as an actual on the AHA committee volunteer. I as well very much support this bill. Thank you so much. Thank you. We'll now move to any key witnesses in opposition that would like to come forward. And if we could make some room here, please. Thank you. Thank you. You're recognized when you're ready for five minutes. Thank you. I'm Matt Sutton with the California Restaurant Association, and we are, unfortunately, in respectful opposition. The chair has laid out some of our arguments, and I'd just like to take a minute or two just to expand upon some of those. We, of course, take the issue of nutrition and sugar seriously, and we believe we've been a productive partner in this building on that for quite a long time. myself primarily. CRA has been an industry leader on a lot of these disclosure fronts. It was mentioned that the restaurants in the scope of this labeling mandate are already subject to menu labeling laws. We actually went out on a limb and worked with then-Senator Alex Padilla, of course now U.S. Senator Alex Padilla, on the initial menu labeling law that became later adopted by the federal government and is now a model for the nation. As the chair mentioned, it does include some disclosure of sugar, but not the disclosure of sugar that's sought after in this bill. In 2018, we again worked with the Senate on replacing sugar-sweetened beverages in kids' meals. This committee of course deliberated the allergen menu labeling law from last year that Senator Menjavar did so well in navigating through the legislature and working with us Now we find ourselves three months out from the effective date of that bill with restaurants finalizing their menus to be compliant with that July 1st And we have a new menu labeling, on-menu labeling mandate. So that's sort of the cumulative effect that our members are a little fatigued over on the menu labeling front. It is indeed costly to replace menus, menu boards, drive-through boards, and all of the menu resources. That is not our primary concern. Our primary concern is that we, as you can see, we're already adding new disclosures when we're three months out from the effective date of the last disclosure mandate. So these are coming quick and fast, and these are hard to deal with, no doubt. So again, I think we'd be happy to continue to have discussions about disclosure methods, appropriate disclosure methods, but that's what our base is feeling when it comes to the impacted restaurants that are affected by this bill and the predecessors. So it's a lot, it's a lot quickly, and there's a number of different ways to disclose this type of information to folks, and I would argue that more and more, especially since the pandemic, so much has changed in the restaurant space in terms of electronics and technology and disclosure, QR codes, all these things that I don't think they're as buried as people allege. And I think they are incredible resources for restaurant patrons. And I think there's probably a healthy discussion about appropriate ways to disclose. But we do object to this proposal and we do object to the on-menu mandate. Thank you. Thank you. Now, I would love to open up to the audience. Anyone else who is here in opposition, please state your name, your organization, and your position. Well, to clarify, we're tweeners. We have concerns. So Dennis Albiani, Half American Beverage Association. One of our issues, and we mentioned this with the staff and the member, is the warning icon that some beverages with sugar would be uniquely harmful versus other things. So that's an issue that remains as well as the information and how to best articulate that information. Thank you. Thank you. We will now move it to the committee. Senator Dudazo? Well, I want to say it makes a big difference to me when I see specific information about what's, you know, in the food I'm about to eat. This is about chain restaurants, right? So this is chain restaurants, many of which are in low-income communities or sell, you know, less expensive food, which is fine, except that's where we really need to, I think, make sure and focus being on the information that's needed. and at least it gives us an opportunity to look at the menu and say, this is how much sugar, this is how many calories, this is how much fat. I mean, all these things that are just bad for our health. I do hear you, sir, from the Restaurant Association, you know, the continuous thing. So maybe that's room for a working group or something to say, what are the things that we should take on and sort of do a package of how to do them so that you're not continuously doing them. Or time when it's implemented. I'm just throwing out those seem to be... The specific things, you're not saying you never ever want to do it, but how it's impacting the restaurants. I'm sympathetic to that. But it makes a huge difference, whether in a restaurant or you're seeing the menu up on the top. I know I've caught myself many times saying, okay, that looks really good. And then, boom, I see what it contains, and it holds me back from buying certain things. I'm hiding my Pepsi right here. But there's no sugar. But I do think that we have to watch out. We were just discussing, the senator and I, about what was it like many decades ago. Well, we did a lot more cooking at home because we didn't need everybody in the household working. Now we have to eat out more, which is a good thing. I'm not opposed to it. But the culture of eating has changed tremendously. And if you earn enough income to eat in nicer restaurants, you don't have to worry about this as much. But I think the lower the income level, then we have to watch out for those. And that's where we have the worst, I think, percentages of diabetes and other illnesses. So, you know, I'm supportive, but I'm sympathetic. I don't know if anything more should be done with this particular bill, but those are just my thoughts for now. Thank you to the author. Thank you. Cheers, Senator Dudasso. Senator Smallwood-Crabas. Thank you very much, Madam Vice Chair, and I want to thank the author for bringing this bill forward to really appreciate the intent of this bill. And, you know, the more you know, the more you know. And the way science is moving, we're learning a lot. And it's important for having partnership, right, because these are the same consumers who are going to purchase, and that's not going to stop anytime soon. They will just have more choices. And those are the businesses that will benefit from those consumer and consumer choices. So I think that this is about partnership, and that raises a question for me because one of the things that I have seen about my time here in the state legislature is that we do create these regulations and then it costs to actually deliver in terms of implementation. And so often that cost is shifted to the consumer, and we are in a time where affordability is a real issue. And so my question is, as we think about the implementation of this, how do we ensure that we can work with industry to not pass on additional costs for making sure that folks are informed and healthy? and I wonder is there, you know, do you have any thoughts about that as the author on this because we want to address issues and I have family that have struggled with diabetes and other conditions in my family and I'm so grateful now that we have this information that is easily accessible to everyone and certainly even to the point of purchase. But how do we ensure that we aren't fixing our problem here and creating another problem in terms of people being able to afford all of this amazing food and drink and the things that we want to consume Right Thank you so much for that question And so I want to point out once again that this bill would not go into effect until January of 2028 And so that gives, again, the restaurants over a year and a half to prepare if this bill is passed and signed into law. And, you know, one of the things that you know about restaurants, we all go to restaurants, we all go to coffee shops, is that they are constantly changing their menus. And when you go to a restaurant and they have paper menus, or even if they're laminated, they're still changing them. You know, it's sometimes seasonal things that are on there, sometimes things that they're removing for a variety of different reasons. And so to think that a menu that a restaurant has is permanent and does not change is not consistent with reality. And when they do change, they're not passing those costs onto the consumers. And again, I would hate to start talking about cost with a bill that deals with health, but the cost to our health care system and our health care structure with the vast number of people getting diabetes, high blood pressure, our youth getting diabetes, obesity. I remember when I was in medical school, which was not, you know, I'm not young, but it wasn't that long ago. Type 2 diabetes was not something that we talked about in children. That was an adult condition. Now the number of children that have type 2 diabetes is skyrocketed. It's actually doubled over the last two decades. And so when we're talking about cost, and we have been grappling with the cost of our health care, grappling with the cost of new medications. Do we cover GLP-1s? What do we do? These are things that have a very, very minuscule cost in comparison to the cost that we are having to put out as a result of what excessive added sugar is doing to our bodies, our families, our communities, our state, and quite frankly, this nation. Thank you, Senator. Did you? Senator Grove. Thank you. Thank you. Thank you, Madam Vice Chair and Madam Chair, for the bill that you're bringing forward. I do have a couple of questions. I was wanting to address the concerns that you have, but you just did in the last statement that it doesn't take place until January 2028. I appreciate that. But I also know that more and more when I go to restaurants, there are no menus. there are some in some places but most of the time you go and there's a QR code on the table and you can order yourself and then they bring it out to the table I think that's to eliminate wait staff because of cost of doing business with you know payroll and all of that but so is there an opportunity to look at it and like printed menus are very seldom used right so when you look at the bill it's not just printed menus it's also digital ones or it's any menu at the point of purchase. So if you are doing a QR code and the menu comes up, just like if you were looking and you'd see like a V for a vegan, you would see that superscript sugar icon. Okay. That's all I want to know. Thank you. Senator Perez. Well, I certainly appreciate the direction of your bill, Senator, and also appreciate that you included language that also differentiates and doesn't apply this right to some of those small businesses because I think we recognize single small mom and pop shops are maybe facing different challenges than let say a very large corporation like Starbucks And as someone whose family has come up through the restaurant industry, I know how significant that is. So appreciate you doing this. I do think it would be really interesting as we continue to explore models like this. In other countries, they don't just flag things that have excessive sugar, but they also flag healthy options for folks. And I think to your point earlier in terms of, you know, when families are there with their children and they're just trying to choose what's best for their family, it's easier when you have what is healthiest already highlighted and indicated for you, especially if there are health precautions that you need to take into account, like allergies and other things. Making that easy to use as you're navigating a menu can make all the difference in the world, especially when you're a parent and, you know, you're just trying to get your kids to eat. There's so much on your plate already. You don't want to have to go through a nutrition facts label. It's so much more helpful when it's just easily laid out there for you. So I appreciate the direction of this bill and look forward to seeing how this goes. Thank you, Senator Perez. I could not agree with you more, which is why I had a bill last year that specifically would have required every restaurant that has a kids' meal, a menu, to have a healthy option for a meal. That was something that was unanimously supported, bipartisan support. Unfortunately, at the time, our governor felt different, but it's coming back this year. So I'm struggling with this bill, and I'm struggling because I'm a former bartender and server. I remember when restaurants were going through having to pay the very costly price of understanding the calories and the menus that they were serving. This is a little bit different. I'm also struggling because I'm a parent. I'm a mom, and my daughter's nine. If I were to let her drink sugary drinks all day long, she would love it. But I make her drink water. Or we like the honest little juice boxes, the portion size and the calories. I like the ease of being able to read calories or sugars, even though I still chose the Coke today. It is a point of ease when you're trying to monitor either your sugar intake or your calorie intake. But I also come from a small business background, which while the bill intends to only impact businesses or restaurants with 20 or more, I think we often forget that our franchise owners are usually lumped in with that. and you may, whether you're a McDonald's franchise owner, Chick-fil-A, or not Chick-fil-A, I think they're very limited on the amount of restaurants they can own. They're impacted by this as well, but they are a small business. So can I just get one, some clarification from the Restaurant Association, from Matt, on how this would impact your smaller franchise owners? Thank you, Senator Baudi-Darris. we're talking about these larger chain restaurants, and we're talking about the quick serve side of things, not the table service, but the quick serve side of things. You have some models, brands that are franchise models and others that aren Those that are franchise models you right You have these neighborhood restaurants where a man or a woman may own one or two and those are small businesses And while they get some and I say very limited support from the brand a lot of the costs they are dealing with And so I don't know exactly, but these mandates would fall on those individual franchisees. They would have to update their stores and menus and things. So that is a concern. It's a concern we've been raising. But it gets to the point of sort of, you know, what is the local impact on those restaurants? And I also think of restaurants like King Taco, who's, you know, everyone in SoCal knows and loves King Taco. They have 22 restaurants. So they're right at that cusp of having to take on this new regulation. And I'm just struggling right now because I also feel like we add regulation and layer upon layer on every business in the state, Which almost forces the cost of food and healthy food to go up, which forces people living in underserved communities or with really strained budgets right now to pick the cheaper options, right, which are fast food, which are the sugary, sometimes the sugary drinks. So I'm going to hold on this bill. I am struggling right now. When I see it again, I'm hoping to maybe be able to support it. But I'm conflicted right now because of the affordability crisis and how I see it impacting smaller businesses. Would you like to close? Yes, thank you. And as I stated before, restaurants, large chains, small chains often will change their menus and what is on their menu units and what is off their menus. And that is not a price that is trickled down to the individual consumer. But, you know, I completely hear the concerns about the Restaurant Association. I do agree with Senator Smallwood Cuevas that we have to look at this as a partnership. Because the people who are coming to your establishment, it should not be something where you want them to leave sicker than they came. You want them to be able to get the correct information. And, you know, I think it was the opposition in his statement that said, oh, well, these things aren't difficult to find. They are. They are very difficult to find. My staff took an extremely long period of time going to different websites, looking at different apps, trying to get a list of different restaurants, chain restaurants, how much sugar was in their drink. I had a competition in my office to see who could find the drink with the highest sugar content. These things are not easy to find, not even for people who you would think would know this information. So the premise of this bill actually came from my own experience. When I came up here, I always hated coffee, even in residence. I did not drink coffee because it's so bitter. But coming up here, I needed to drink coffee. And so I would get coffee, but it's bitter, so I would get the ones that tasted better for me. and I'm a tall, you know, tall, not the other sizes. And eventually, maybe about like, I don't know, two years into it, my brother was like, do you know how much sugar is in that drink? And I was like, no, I don't. I order from the app, but I don't scroll all the way down and push the button to get the nutrition content. I go into the store. It's not there on the menu. I had no clue that for two years I was consuming so much sugar. and a coffee drink. When we go to a restaurant and we get like a hamburger or french fries, we kind of know that's probably kind of bad, you know, high cholesterol, fatty food, things like that. But you don't necessarily know that about every single drink that you're taking. Some of you who follow me on social media may have seen that over the last week when we were on spring break, I did videos with my family, measuring out sugar contents and various drinks that they drink. And like you, vice chair, my kids primarily drink water. One of my sons, my youngest son, I used to give him a special drink when he wanted it, which was usually like once a week. We'd go by a coffee place and get one of those non-coffee drinks. And then I realized one day, my God, this has like 36 grams of sugar. My oldest, if you watch the video, he was, I said, okay, well, what kind of drinks do you like? Water. I said, okay, well, what else? Apple juice with no added sugar. Okay. But when we go and you buy some, you know, I have to get you an extra. What is it? Oh, yeah, chocolate milk. But it's organic chocolate milk, so it has no sugar. And, you know, he's a teenager. He thinks he knows everything. And I said, okay, well, let's see. Let's measure it out because I have checked myself. And even in that, it was 14 grams of sugar. And he is a very intelligent young man who cares a lot about his health. And so it's not as easy to find as the opposition would like for us to believe. But I think we already know that because we all go into restaurants and we all go into coffee shops. Today I'm asking you to consider a bill that is simple, practical, and urgently needed. Right now, millions of consumers, including children, are drinking beverages that contain more sugar than the recommended limit for an entire day. And they often have no idea. This information is buried in a website or an app that someone may not even have. But we can fix that with this straightforward policy change. The science is not in dispute. Excessive added sugar consumption is strongly linked to type 2 diabetes, heart disease, and rising rates of obesity in children and adults, just to name a few. When these conditions place enormous strain on our health care system, they drive up cost for families, insurers, and our state. When sugary drinks are one of the largest contributors to added sugar in the American diet, transparency becomes not just a health issue, but a fiscal one. This bill does not ban any product. It does not restrict consumer choice. It simply ensures that people have access to clear, visible information at the moment they make the purchase. That is the foundation of a functional marketplace, informed consumers making informed decisions. The opposition argues that labeling requirements burden businesses but we already require labels for allergens and various dietary groups because transparency protects the public and reduces long cost Sugar given its well health impacts deserves the same level of clarity and adding an icon on the menu at the point of purchase is minimal compared to the cost of treating a preventable chronic disease. By passing this bill, we have the opportunity to enact policy that is low-cost, high-impact, and supported by public health experts. It empowers parents, protects children, and strengthens our state's commitment to evidence-based policymaking. Let's choose transparency. Let's choose health. When people have clear information, they are able to make better choices. So let's give them that chance. I respectfully ask for an aye vote on SB 869. Thank you. Thank you, Senator. Do we have a motion? Senator Padilla moves the bill. Secretary, would you please call the roll? The motion is due pass as amended and re-referred to the Committee on Appropriations. Please call the roll. Smallwood Cuevas, aye. 7 to 0 and the item is on call. At this time, we have finished hearing all bills. I'm going to ask for every member of the committee to please come down so we can vote. The consent bill has been moved by Vice Chair. Assistant, please call the roll. Senators Weber-Pearson? Aye. Weber-Pearson, aye. Valadez? Aye. Valadez, aye. Caballero? Aye. Caballero, aye. Durazo? Aye. Godurazo, aye. Gonzalez? Aye. Gonzalez, aye. Grove? Aye. Grove, aye. Menjivar? Aye. Menjivar, aye. Padilla? Aye. Padilla, aye. Perez? Aye. Perez, aye. Rubio? Smallwood, Cuevas? Aye. Smallwood, Cuevas, aye. That is 10-0. We'll place that on call. We'll move to file item 1, SB 1023 by Senator Laird. Can I get a motion? Moved by Senator Gonzalez. The motion is due pass and re-refer to the Committee on Appropriations. Assistant, please call the roll. Senators Weber-Pearson? Aye. Weber-Pearson, aye. Valadares? No. Caballero? Aye. Caballero, aye. Durazo? Aye. Durazo, aye. Gonzalez? Aye. Gonzalez, aye. Grove? Menjivar? Aye. Menjivar, aye. Padilla? Aye. Padilla, aye. Perez? Aye. Perez, aye. Rubio? Smallwood-Cuevas? Aye. Smallwood-Cuevas, aye. That bill is 8-0. We will place that on call We move to file item 2 SB 1057 May I get a motion So moved by Senator Gonzalez The motion is due pass and re-refer to the committee on appropriation. Assistant, please call the roll. Senators Weber-Pearson? Aye. Weber-Pearson, aye. Valadeiras? No. Valadeiras, no. Caballero? Aye. Caballero, aye. Durazo? Aye. Durazo, aye. Gonzalez? Aye. Gonzalez, aye. Grove? No. Grove, no. Menjivar? Aye. Menjivar, aye. Padilla? Aye. Padilla, aye. Perez? Aye. Perez, aye. Rubio? Smallwood-Cuevas? Aye. Smallwood-Cuevas, aye. That bill is 8-2. We'll place it on call. We'll move to file item number three, SB 1071 by Ochoa Bo. Move the bill. That bill has been moved by Senator Valladares. The motion is due pass and re-refer to the Committee on Judiciary. Assistant, please call the roll. Senators Weber Pearson? Aye. Weber Pearson, aye. Valladares? Aye. Valladares, aye. Caballero? Aye. Caballero, aye. Durazo? Aye. Gonzalez, aye. Grove? Aye. Grove, aye. Menjivar? Aye. Menjivar, aye. Padilla? Aye. Padilla, aye. Perez? Aye. Perez, aye. Rubio? Smallwood, Quevas? The bill is 8 to 0. We'll place it on call. We'll now move to file item 4. SB 1088 by Senator Blakespeare, can I get a motion? So moved. Moved by Senator Valladares. Secretary, please call, I'm sorry, Assistant, please call the roll. The motion is due pass and we refer to the Committee on Judiciary. Senators Weber Pearson? Aye. Weber Pearson, aye. Valladares? Aye. Valladares, aye. Caballero? Aye. Caballero, aye. Durazo? Aye. Durazo, aye. Gonzalez? Aye. Gonzalez, aye. Grove? Aye. Grove, aye. Menjivar? Aye. Menjivar, aye. Padilla? Aye. Padilla, aye. Perez, aye. Rubio? Smallwood-Cuevas? Aye. Smallwood-Cuevas, aye. That is 10-0. We'll place that bill on call. We will now move to file item 5, SB 1422 by Senator Durazo. That bill has been moved by Senator Smallwood Cuevas. The motion is due pass and re-refer to the Committee on Appropriation. Assistant, please call the roll. Senators Weber-Pearson? Aye. Weber-Pearson, aye. Valadeiras? No. Valadeiras, no. Caballero? Aye. Caballero, aye. Durazo? Aye. Durazo, aye. Gonzalez? Aye. Gonzalez, aye. Grove? No. Grove, no. Menjabar? Aye. Menjabar, aye. Padilla? Aye. Padilla, aye. Perez? Aye. Perez, aye. Rubio? Smallwood-Quebas? Aye Smallwood aye So 8 on call The bill is 8 That will be placed on call I want to thank the committee members who are here. And we will keep the roll open for another... We will keep the roll open until 4-30. We will lift the call on file item 6, SB 869. Assistant, please call the roll. Senators Valadez, Grove, Menjivar. Menjivar, aye. Rubio. That is 9-0. We will 8-0. We will place that back on call. Thank you. Thank you. We're going to open up the roll and start with the consent calendar. Assistant, please call the roll. Senators Rubio? Aye. Rubio, aye. 11-0. 11-0. 11-0, the consent calendar is out. We will go back to file item 1, SB 1023. Assistant, please call the members. Senators Valadez, Grove, Rubio. Aye. Rubio, aye. 9-0, out. 9 that bill is out File item number 2 SB 1057 by Senator Becker Assistant please call the roll Senator Rubio Aye Rubio aye 9 9-2. That bill is out. We'll move to file item number 3, SB 1071 by Senator Ochoa-Bow. Assistant, please call the roll. Senators Durazo? Rubio? Aye. Rubio, aye. Smallwood, Coilas? 9-0. 9-0. That bill is out. Move to file item 4, SB 1088 by Senator Blakespear. Assistant, please call the absent members. Senator Rubio? Aye. Rubio, aye. 11-0. 11-0. That bill is out. File item 5, SB 1422 by Senator Durazzo. Please call the roll. Senator Rubio? Aye. Rubio, aye. That's a 9-2. 9-2, that bill is out. And file item number 6, SB 869 by Senator Weber Pearson. Please call the roll. Senators Valadez, Grove, Rubio. Aye. Rubio, aye. That's 9-0. 9-0, that bill is out. This concludes Senate hearing for today. I want to thank all the members on the committee, all those who presented bills, our committee staff. We will see you next week. Thank you.