Facing pushback from the medical community, Assemblyman Vince Fong, R-Bakersfield, withdrew a bill late last month that would have required doctors to order specific types of lab tests when they suspect valley fever, a respiratory disease found throughout the southwestern United States.
Assembly Bill 1881 would have encouraged medical providers, including city and county public health laboratories, to use two specific blood tests when determining whether a patient has valley fever. Fong and some valley fever advocates asserted that encouraging such a test would have created consistency in lab reporting across the state, and that it would have led to faster case counts of a disease that’s been poorly tracked.
Some doctors and public health officials, however, had been skeptical of the bill, questioning whether elected officials should legislate the nitty-gritty details of disease reporting, including the types of tests used.
Kern County Public Health Services Department Epidemiology Manager Kim Hernandez questioned in January whether there was a precedent for such legislation and worried that it would discourage doctors from ordering any tests for valley fever, an already under-diagnosed disease.
“I’m afraid if we say they must order tests that they won’t order them, and if there’s a repercussion for them not ordering, that will really impinge on the medical provider’s decision-making,” Hernandez said in January.
Some critics also worried the legislation would have created problems if a new, more efficient test was developed, while doctors were still mandated by state law to use an outdated one.
“We are proud they looked to the testing we do here in our public health lab as a best practice for valley fever, but we also want to ensure that innovation remains a priority,” said Kern County Public Health spokeswoman Michelle Corson, whose department had discussions with Fong’s office about the legislation as it was rolled out.
Fong said in an emailed statement Tuesday that he remains committed to working with local health authorities “to ensure best practices are utilized and we are maxing all of our resources to help treat this epidemic. Our efforts have been focused on ensuring collaboration and innovation is a top priority in fighting this disease.”
Valley fever is caused by the Coccidioides fungus, which grows in the loamy soil of the southwestern United States. When disturbed, often through agricultural tilling, construction and high wind, microscopic fungal spores can become airborne and, once inhaled, cause valley fever. Most people are asymptomatic, but others develop flu-like symptoms, including fever, cough, headaches and chills. In some cases, when left untreated, the fungal spore can spread throughout the body and cause a lifetime of health issues, and in rare cases, death.
Fong’s bill was one of six introduced this year taking aim at the valley fever epidemic, along with a bipartisan $7 million budget request that would be used to fund research and treatment. It comprises the most robust legislative package introduced in California to address the orphan disease, which has increasingly infected people outside of traditional high-risk areas. California public health officials counted more than 5,100 provisional cases through October 2017, and disease experts say that number could be much higher when final cases are tallied this year.
Fong introduced two bills, and Assemblyman Rudy Salas, D-Bakersfield, authored four others. Fong’s other bill, AB 1880, which would have required medical personnel tasked with reporting cases to the state to undergo mandatory training on that procedure, and set a reporting deadline of April 1, was merged late last month with one of Salas’ bills. The mandatory training was dropped in the merge.
That means four bills remain to work through the legislative process, all of which are authored by Salas. They are:
- AB 1787 (annual reporting deadline): This bill would set an annual reporting deadline of March 1 for local health officers to report to the California Department of Public Health all cases of valley fever. Currently, there is not an established annual deadline.
- AB 1788 (laboratory testing diagnosis): This bill would authorize the CDPH to confirm cases of valley fever through laboratory testing alone, without the need for costly clinical criteria. Currently, the state requires both the laboratory component and clinical criteria for diagnosis.
- AB 1789 (worker safety):This bill would strengthen protections for workers by requiring Cal/OSHA, the state Division of Occupational Safety and Health, to adopt occupational safety and health standards for all state public works projects to prevent and control valley fever. Workers are particularly at risk due to the nature of new construction projects that require the disruption of soil.
- AB 1790 (physician training): This bill would establish enhanced physician training in the prevention, diagnosis and treatment of valley fever to increase accurate diagnoses; reduce delays; and improve treatment for patients suffering from infection.
Those four bills are moving forward, and all but AB 1790 have made it through their first rounds of committee hearings, Salas said.
So far, they’ve encountered no formal opposition — a departure from what Salas experienced last year when introducing a bill that would have overhauled reporting guidelines, brought millions of dollars of funding for the disease and established a state awareness program. It was opposed by the California Department of Public Health and later vetoed by Governor Jerry Brown for lack of funding.
“They’re really concerned with the costs. They want the money allocation — I don’t think they were opposed to the policy of it,” Salas said, adding that he’s been working closely with California Public Health Director Dr. Karen Smith on the legislation.
“This year, they’re more engaged. I think our legislation last year set the stage for this year,” Salas said.
AB 1790, however, which has not yet had a committee hearing, could face the same pushback that Fong’s legislation met because requires doctors to take continuing education courses on the disease. Salas said that could reduce the risk of misdiagnosis of patients who live outside of high-risk areas, catch the disease while traveling, and then return home to be treated by doctors who are unfamiliar with valley fever.
Officials at the California Medical Association, an advocacy organization that represents more than 43,000 physicians, have expressed reservations about the bill, Salas said.
“They also know something needs to be done about this,” Salas said.