BILL ANALYSIS                                                                                                                                                                                                    


          |SENATE RULES COMMITTEE            |                    SB 96|
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                              UNFINISHED BUSINESS

          Bill No:  SB 96
          Author:   Alpert (D), et al
          Amended:  8/24/04
          Vote:     21


           ASSEMBLY FLOOR  :  Not available

           SUBJECT  :    Public water systems:  fluoridation

           SOURCE  :     Author

           DIGEST  :     Assembly amendments  gut the bill.  Previously  
          the bill appropriated $2,445,095.90 from various funds to  
          pay 468 claims against 37 state agencies.

          This bill now strengthens the requirement that public water  
          systems (PWS) with at least 10,000 service connections must  
          meet for the fluoridation of public water.

           ANALYSIS  :    This bill:  
          1. Makes findings and declarations related to the  
             protection and maintenance of dental health through the  
             fluoridation of drinking water and the intent of the  
             Legislature to preempt initiatives that would prohibit  
             or restrict the fluoridation of drinking water and  
             decrease the burden of Medi-Cal and Denti-Cal on the  
             state's limited funds. 



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          2. Clarifies that a PWS with at least 10,000 service  
             connections and natural level of fluorides that is less  
             than the minimum established by regulations is required  
             to be fluoridated. 

          3. Requires a PWS with at least 10,000 service connections  
             to provide the Department of Health Services (DHS) with  
             an estimate of the total capital costs to install  
             fluoridation treatment at ten-year intervals, unless one  
             has been installed. 

          4. Specifies that the purpose of the schedule required for  
             the fluoridation of PWSs and established under  
             regulations is not  to mandate the order in which PWSs  
             receiving funding from private sources must fluoridate  
             their water.  Permits available funds to be offered to  
             any system on the schedule.  

          5. Requires estimates of the total capital and associated  
             costs related to fluoridation treatments, as specified,  
             provided by a PWS to DHS to be reasonable, as determined  
             by DHS, and prohibits intangible or speculative costs.   
             Requires a registered civil engineer recognized or  
             employed by DHS who is familiar with the design,  
             construction, operation and maintenance of fluoridation  
             systems to determine whether costs are reasonable.  

          6. Defines "cost" as only those costs that require an  
             actual expenditure of funds or resources, and do not  
             include costs that are intangible or speculative,  
             including, but not limited to, opportunity or  
             indemnification costs.  

          7. Exempts a PWS with multiple water sources, when funding  
             is not received to fluoridate all sources, from  
             maintaining required fluoride levels in areas receiving  
             any non-fluoridated water until funding is received to  
             fluoridate the entire water system and the system is  
             installed and operational.  

          8. Exempts a PWS from being required to fluoridate if: 

             A.   The PWS has been offered, pursuant to a binding  
               contractual offer, the capital and associated funds  


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               necessary for fluoridation, as specified, and has  
               completed the installation of a fluoridation system,  
               however, in any given fiscal year funding is not  
               available to the PWS sufficient to pay the noncapital  
               operation and maintenance costs, as specified, from  
               any outside source, as specified.  Renders a PWS  
               unqualified for an exemption for a particular year if  
               a binding contractual offer to provide funds for  
               twelve months, without regard to fiscal year, of  
               noncapital operation and maintenance costs is  

             B.   Funding provided by an outside source for capital  
               and associated costs is depleted prior to completion  
               of the installation of a fluoridation system, and  
               funds sufficient to complete the installation have not  
               been offered pursuant to a binding contractual offer  
               to the PWS system by an outside source.  Requires, in  
               the event of a disagreement between a PWS and an  
               outside funding source about the  reasonableness of  
               additional capital and associated costs, a registered  
               civil engineer recognized or employed by DHS who is  
               familiar with the design, construction, operation and  
               maintenance of fluoridation systems to determine  
               whether the costs are reasonable.  

          10.Requires a PWS to fluoridate if funds are offered for  
             that purpose.  

          According to the author's office, San Diego is the largest  
          city in the nation without community water fluoridation.   
          In June 2003, the City Attorney advised the City Council  
          that the pending contract to fluoridate could not be signed  
          by the City because of language in the original ordinance,  
          which, according to his interpretation, precludes the City  
          from spending any money on any future legal issues stemming  
          from fluoridation.  The City Attorney stated that the City  
          needs to be indemnified to compensate for possible losses  
          due to potential lawsuits.  According to the California  
          Dental Association Foundation and the San Diego  
          Fluoridation Coalition, the San Diego City Attorney is  
          falling back on the original city ordinance to halt the  
          progress of fluoridating the water supply.  This bill is a  
          clean-up measure that closes a number of loopholes that  


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          localities have used to avoid fluoridating their water.

          AB 733 (Speier), Chapter 660, Statutes of 1995, required  
          DHS to adopt regulations to require the fluoridation of all  
          large PWSs.  A PWS scheduled to fluoridate is not required  
          to comply until funds sufficient to pay capital and  
          associated costs for the system have become available from  
          any source other than ratepayers, shareholders, local  
          taxpayers, or bondholders of the public water system.  In  
          1998, the California Endowment awarded the California  
          Dental Association Foundation $15 million to implement the  
          provisions of AB 733.  Since then, many cities have  
          fluoridated or begun the process while there have also been  
          several legal and initiative efforts to curtail  

          The current debate around whether or not fluoride should be  
          added to drinking water centers on a few major issues,  
          including the effectiveness of fluoridation of water on  
          dental health and adverse health effects resulting from  
          fluoridation.  Supporters of fluoridation generally assert  
          that it is an issue of public health importance, and cite  
          the Centers for Disease Control and  Prevention's (CDC)  
          recognition that fluoridation is "one of ten great public  
          health achievements of the twentieth century."  They also  
          contend that the benefits of fluoridation are well  
          documented and have been shown to improve the oral health  
          of the community and to decrease the overall cost of dental  
          treatment.  Opponents of fluoridation generally assert that  
          fluoride added to water supplies is publicized to save  
          money and prevent tooth decay.  However, they believe that  
          data supporting these claims is absent and that the dental  
          health of residents of fluoridation communities are often  
          times worse than in non-fluoridated communities.  A review  
          of available literature and data published in the British  
          Medical Journal in 2000 found that water fluoridation was  
          associated with an increased proportion of children without  
          cavities and a reduction in the number of teeth affected by  
          decay.  Additionally, there was no clear evidence of other  
          potential adverse effects from fluoridation.  One caveat  
          the authors of the study made, however, was that the  
          quality of studies reviewed was "low to moderate."

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    


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          Local:  No


           SUPPORT  :   (Verified  8/26/04)

          California Dental Association

           OPPOSITION  :    (Verified  8/27/04)

          Sierra Club
          California Citizens for Health Freedom
          Citizens for Safe Drinking Water
          International Academy of Oral Medicine and Toxicology

          CP:nl  8/27/04   Senate Floor Analyses 

                         SUPPORT/OPPOSITION:  SEE ABOVE

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