Public Health Committee

JOINT FAVORABLE REPORT

Bill No.:

SB-257

Title:

AN ACT CONCERNING HEPATITIS C TESTING.

Vote Date:

3/21/2014

Vote Action:

Joint Favorable Substitute

PH Date:

3/14/2014

File No.:

SPONSORS OF BILL:

Public Health Committee

REASONS FOR BILL:

To require primary care providers to offer to provide or order a Hepatitis C screening or diagnostic test for certain patients born between 1945 an d1965.

RESPONSE FROM ADMINISTRATION/AGENCY:

State Senator Cathy Osten: I am in favor of SB 257. This bill would require health care providers to offer Hepatitis C testing to patients born between 1945 and 1965, an age group that is highly susceptible to this disease. Currently Hepatitis C, a serious liver disease, affects over three million people in the United States. The Centers for Disease Control estimates that death due to this disease will double or triple in the next ten to fifteen years. Veterans especially are four times more likely to be diagnosed and thousand die each year from this disease.

I am emphasizing that this test will ultimately save the Connecticut's healthcare system many millions of dollars by providing early diagnosis and treatment. Twelve states are currently in discussion with similar legislation.

NATURE AND SOURCES OF SUPPORT:

AARP: is a nonpartisan social mission organization with an age 50+ membership of nearly 37 million nationwide, and over 602,000 here in Connecticut. We are dedicated to the health and well-being our members and the 50+ population in general. That's why we support legislation requiring that primary care providers offer Hepatitis C screening for “Baby Boomers” based on recommendations from the Centers for Disease Control.

Testing is a crucial factor in disease prevention and many people infected with Hepatitis C show no symptoms. AARP applaud the Public Health Committee for raising legislation to expand access to Hepatitis C testing and we urge support for SB 257.

Carol Steinke, Public Health Nursing Supervisor, City of Hartford Health and Human Services Department: We are a PSCI Model Clinic (Program Collaboration and Service Integration) offering Sexually Transmitted Disease, HIV, Tuberculosis and Hepatitis C services. We provide Hepatitis C testing at our Sexually Transmitted Disease Clinic and also offer Rapid Hepatitis C testing from our mobile van for high risk individuals along with “Baby Boomers”, consistent with the recommendations from the Centers for Disease Control.

The 2010 US Census data indicates that there are 1,019,049 Baby Boomers in CT. Baby Boomers disproportionately represent 28.5% of CT's population; therefore placing CT among the top five states with the highest Baby Boomer population rates. Based on these estimates, the CT HCV registry has captured 44% of the Baby Boomers exposed to HCV; therefore approximately 12,090 (36%) Baby Boomers still need to be identified. Over the past 9 months we have identified 42 Hepatitis C positive individuals and 36% of those were “Baby Boomers”.

Hepatitis C is a silent killer were most people have no symptoms, don't know they are infected, and don't seek treatment. We have determined through counseling newly diagnosed individuals that may have contracted the disease; from a blood transfusion they received prior to 1992, a one-time experimental drug use in the 70's, or unregulated tattooing (shared needle).

Please support the passage of SB 257 to ensure more individuals get tested for Hepatitis C. In Connecticut alone, we can help identify the estimated 12,090 individuals who are not aware they have Hepatitis C, link them to care, treatment, and a longer life.

Rev. Michael Christie, MDiv: As an African American clergy doing ministry in Stamford, I have witnessed the tremendous health disparities that affect people of color. In almost every health category African American have a higher cost of care and a poorer prognosis than other groups. And while there are many reasons for the lack of access or care we know that lowering the barrier for screening can have a significant impact on families.

The landscape for HIV was radically changed by better therapy and better access to testing. I believe we have the opportunity to do the same for what is sometime called the “silent epidemic”. SB 257 is consistent with the guidelines issued by the Centers for Disease Control and Prevention (CDC).

Harm Reduction Coalition: Our national organization was founded in 1991 and incorporated in 1994 by a working group of needle exchange providers, advocates and drug users. Today, we are strengthened by an extensive and diverse network of allies who challenge the persistent stigma faced by people who used drugs and advocate for policy and public health reform.

Hepatitis C infection is the most common chronic blood borne infection in the United States. It affects 3.2 million people, yet 45-85 percent of HCV cases in the United States remain undiagnosed. According to the CDC, if everyone born between 1945 and 1965 were tested, over 800,000 cases would be identified, and up to 121,000 deaths could be avoided. Connecticut can take a major step in ending the Hepatitis C epidemic by promoting cost-effective guidelines for the screening of baby boomers.

Gloria Searson, President, Coalition on Positive Health Empowerment (COPE): COPE is a membership organization dedicated to empowering people living with the Hepatitis C to be their own healthcare advocates. We work with underserved communities that are often disproportionately affected by viral hepatitis and similar illnesses. COPE accomplishes this by offering various levels of service through both direct to client services and expert's training.

I understand the devastation attached to the stigma and discrimination often associated with chronic illness not only because I work in this field; but because I am one of the millions of Americans who live with Hepatitis C. Hepatitis C is curable. Requiring primary health care providers to offer the Hepatitis C test to baby boomers is crucial to our communities.

Shawn M. Lang, Director of Public Policy, AIDS Connecticut: AIDS Connecticut is Connecticut's only statewide HIV/AIDS organization. We work to ensure that the 10,000 people living with HIV/AIDS in our state have the housing, care and support services they need in order to live in dignity.

I am in support of SB 257 with a friendly amendment:

Substitute language for Section 1, #1, lines 304 “Hepatitis C screening test”

means a laboratory test that detects the presence of hepatitis C virus antibodies in the blood”.

There are a tremendous number of parallels between HIV and Hepatitis C. Routine assessment and screening of Hepatitis C in baby boomers, like routine HIV testing, helps to identify people who are infected and may be completely unaware of their status. Hepatitis wreaks havoc on their liver and other systems, which, eventually, can lead to cancer or, if left untreated, death. Co-infection of HIV and Hepatitis C is common (50-90%, according to the CDC) among HIV positive injecting drug users. A recent CT research study found that 40.5% of the participants (n=462) in the study were Hep C+, and of those, only 43% were aware of their status.

Please support SB 257 so we can detect Hepatitis C early on, and save lives.

Dan Mussen, PA, Connecticut Academy of Physician Assistants(ConnAPA):

ConnAPA represents the interests of nearly 2000 practicing physician assistants who are key providers of primary care.

Physician Assistants should be included in the language of this bill since PAs currently test for Hepatitis C as a part of routine medical care. If Physician Assistants are not included as primary care providers in this bill, an unintended exemption will occur. We do not believe this is the intent of the proposed legislation.

Connecticut Hospital Assocation (CHA): CHA supports the intent and goals of the bill but has concerns about the bill as written. SB 257 as drafted contains some technical errors that will likely reduce it effectiveness. Here are our specific concerns:

● In line 10, the use of the term “nurse practitioner” is misplaced, and should be deleted. The term “advance practice registered nurse” (APRN), which is already used in the section, is the correct licensure category.

● In lines 17-18, the bill states that a primary care provider “shall offer to provide a hepatitis C screening test or hepatitis C diagnostic test:” But in fact the provider will be “offering” to send the patient to a lab for a test, not providing the test. Various tests are available in the primary care provider's office, but testing for Hepatitis C is no one of them. Requiring physicians and APRNs to personally provide the testing would be an extreme and unnecessary waste of healthcare resources.

● Lines 28-33 attempt to instruct a physician or APRN on what clinical steps he or she must implement for a patient, without regard for a patient choice or sound medical judgment. Such decisions are best left to medical professionals acting within their scope of practice.

Note: There were two additional statements of support submitted by:

● Ronni Marks, Founder/Executive Director, The Hepatitis C Mentor and Support Group, Inc.

● Ryan Clary, Executive Director, National Viral Hepatitis Roundtable

NATURE AND SOURCES OF OPPOSITION:

Roberta Silbert, MPH: I am in opposition to the bill. I have been in the health care field for 49 years. I believe the proposed legislation came as a result of the encouragement from corporations and drug companies and others that make money from lab testing and especially selling drugs like those being marked now for Hepatitis C.

The less expensive screening for liver damage from Hepatitis C virus would probably be a liver function test. If that was abnormally high then screening may be a0ppropriate. Some people with antibodies and even some people that have the virus in their blood have very little liver damage. After determination of actual damage in the present of the virus one would be able to make a risk/benefit assessment of opting for treatment at a particular time.

Treating people for Hepatitis C can be costly (from $70,000 and up) mainly on the “up” side and the response rate to clear the virus is still only 80%. Also, there are tremendous side effects, many of which require more medication and injections and boost the costs.

Connecticut State Medical Society (CSMS) & Connecticut Chapter of the American College of Physicians (APA): We are in opposition to SB 257. Not only is the bill unnecessary, it codifies a medical protocol and interferes with the physician patient relationship. We feel resources would be better spent educating physicians and the public of the need for hepatitis screening for citizen born between those years as well as others at high risk, rather than mandated protocols.

Multiple separate and distinct national organizations currently support and have recommendation for the screenings contained in the bill. Recommendations from the Centers for Disease Control (CDC) and the United States Prevention Services Task Force (USPSTF) carry significant weight with physicians when developing practice protocols. Most physicians integrate these protocols into practice and adhere to them when providing care for their patients.

Reported by: Virginia Monteiro

Date: March 26, 2014