AB 2960 (2023) — Sexually transmitted diseases: testing.

AMENDED IN ASSEMBLY APRIL 29, 2024

AMENDED IN ASSEMBLY APRIL 2, 2024

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

ASSEMBLY BILLNo. 2960

Introduced by Assembly Member Lee

February 16, 2024

An act to add Section 1216.5 to the Health and Safety Code, relating to public health.

Vote: majority Appropriation: no Fiscal committee: yes Local program: no

LEGISLATIVE COUNSEL’S DIGEST

Existing law provides for the licensure and regulation of health facilities, including primary care clinics and general acute care hospitals, by the State Department of Public Health. A violation of these provisions is a crime. Existing law requires the State Department of Health Care Services to investigate conditions affecting the prevention and control of venereal diseases, as defined, and approved procedures for prevention and control, and to disseminate educational information relating to venereal disease. Existing law requires the department to cooperate with specified entities, including clinics and public and private hospitals, to prevent, control and cure venereal diseases, including syphilis.

Existing law requires every licensed physician and surgeon or other person engaged in prenatal care of a pregnant woman, or attending the woman at the time of delivery, to obtain or cause to be obtained a blood specimen of the woman to test for syphilis.

This bill ~~would~~ would, until January 1, 2030, require a licensed primary care clinic or hospital emergency department to offer a syphilis test at least once a year to all patients ~~who can become pregnant.~~ who are sexually active and at least 15 years of age and authorize a licensed primary care clinic or hospital emergency room to offer the test to a patient under 15 years of age, as specified. The bill would exempt the patient’s primary care clinic from these provisions if the patient has been tested, or if they have been offered the test and declined it in the past 12 months. The bill would specifically provide that a primary care clinic or hospital emergency department is not prohibited from charging a patient to cover the cost of the test. The bill would also state the intent of the Legislature to first offer bicillin, the preferred treatment for pregnant persons with syphilis, to those who are pregnant in the case of a shortage of the medication. The bill would exempt a violation of these provisions from being a crime.

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

SECTION 1.

The Legislature finds and declares all of the following:

(a) The epidemic of sexually transmitted infections in California has been growing since 2000.

(b) The most alarming increase has been in the number of all syphilis cases, rising 287 percent in the last 10 years of published data reported by the State Department of Public ~~Health (CDPH).~~ Health.

(d) Particularly tragic is that the persistence of syphilis infections among women in their reproductive years has led to a meteoric rise in congenital syphilis, when the infection is transmitted from the mother to the child during pregnancy. Cases of congenital syphilis increased by 1,500 percent during the last 10 years, leading to hundreds of stillbirths, neonatal deaths, and other symptoms and complications.

(e) According to the United States Centers for Disease Control and ~~Prevention (CDC),~~ Prevention, California has the 11th highest rate of congenital syphilis in the nation, which is 63 percent higher than the national average.

(f) Under existing law, health care providers are required to test a pregnant woman for syphilis at least twice: early in the pregnancy and during the third trimester. However, March of Dimes reports that 15 percent of pregnant persons in California received no or inadequate prenatal care, and the CDC reports that even with timely testing and treatment, 12 percent of congenital syphilis cases still lead to death or other health complications.

(g) The CDPH states that a priority target for syphilis testing and treatment are people who can become pregnant and who face obstacles in obtaining health care.

(h) The CDC recommends screening asymptomatic women who are at increased risk for syphilis infection.

(i) The United States Preventive Services Task Force found convincing evidence that screening for syphilis infection in asymptomatic, nonpregnant persons at increased risk for infection provides a substantial benefit.

(j) The Los Angeles County Department of Public Health states, “Since more than half of all pregnancies in [Los Angeles County] are unplanned, prevention, detection, and treatment of syphilis in women of reproductive age is important to eliminate congenital syphilis. All women of child-bearing age (15-44 years) should be tested for syphilis at least once.”

(k) Routine syphilis testing provides an opportunity to educate people about syphilis, expand awareness among the general public about the adverse impacts of syphilis infection, and identify and treat any existing infections before a person becomes pregnant.

(l) Requiring providers on the front lines of health care services to offer a syphilis test is one known productive route to curb the persistent infection rates.

(m) The United States is currently experiencing a shortage of bicillin, the most effective treatment for congenital syphilis. The CDC and the CDPH are recommending that in the event of a bicillin shortage, medical providers should reserve bicillin for persons who are pregnant and that doxycycline should be the alternative treatment for syphilis in persons who are not pregnant.

SEC. 2.

Section 1216.5 is added to the Health and Safety Code, to read:

1216.5.

(a) At least once per year, a primary care clinic licensed under Section 1204 or a hospital emergency department shall offer a syphilis ~~test to all patients who can become pregnant.~~ test, as outlined in the most recent guidelines published by the Centers for Disease Control and Prevention, to all patients who are sexually active and at least 15 years of age. A primary care clinic or hospital emergency department may offer a syphilis test to a patient under 15 years of age as permitted under Section 6926 of the Family Code. This subdivision shall not apply to a primary care clinic if the patient’s primary care clinic has tested the patient for syphilis or if the patient has been offered a syphilis test and declined the test within the previous 12 months.

(b) This section shall not prohibit a primary care clinic or emergency department from charging a patient to cover the cost of syphilis testing. The primary care clinic or emergency department shall be deemed to have complied with this section if a syphilis test is offered.

(c) It is the intent of the Legislature that if there is a shortage of bicillin, the preferred treatment for pregnant persons with syphilis, bicillin should be provided first to persons who are pregnant.

(d)

(d) This section shall become inoperative on January 1, 2030.