BILL ANALYSIS                                                                                                                                                                                                   
                                                                   AB 3128


                          ASSEMBLY THIRD READING

           AB 3128 (Speier) - As Introduced:  February 23, 1994

ASSEMBLY ACTIONS: 

COMMITTEE JUD.       VOTE 8-0 COMMITTEE                VOTE         

DIGEST

Existing law requires applicants for a public marriage license to present 
ša Marital Health Certificate (MHC), signed by a physician, stating that: 

1)  The male has had a physical examination within the past 30 days, as 
    well as a blood test for syphilis. 

2)  The female has had a physical examination within the past 30 days, as 
    well as a blood test for syphilis and rubella. 

3)  Both applicants have been provided the option of HIV testing and 
š    information regarding this disease.

This bill repeals the Family Code sections regarding premarital 
šexaminations, thus eliminating the requirement for an MHC and any 
špremarital blood testing. 

FISCAL EFFECT

None

COMMENTS

1)   The sponsors of this bill, the Health Officer's Association of 
     California and the California Association of County Clerks, state that 
     the evidence is clear that the premarital blood test provisions are no 
     longer medically justified, or cost effective.  Vaccines have all but 
     wiped out congenital rubella and treatment with penicillin has removed 
     the health threat of syphilis.

     As of 1993, California is one of only 17 states that still have 
     premarital testing requirements.

2)   In California, couples may obtain either a confidential or a public 
     marriage license.  A public marriage license requires applicants to 
     obtain a marriage health certificate (MHC).  The MHC requires:  a) 
     both applicants to have a physical examination (not more than 30 days 
     old) and a blood test for syphilis, and to be provided with optional 
     HIV testing and information; and b) the female is additionally 
     required to be tested for rubella.  The requirement to obtain a 
     premarital blood test prior to obtaining a marriage license was 
     enacted as part of the Family Law Act, created by SB 252 (Grunsky), 
     Chapter 1608, Statutes of 1969. 


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     In the early 1900s there was a significant increase in syphilis in the
     U.S. that created a public health hazard.  As a result of this, states
     began enacting premarital testing requirements.  By the mid-1940s, 43 
     of the 48 states had a requirement for premarital syphilis testing.

     In 1943, with the discovery that penicillin was an effective treatment 
     for syphilis, the syphilis infection rate declined significantly.  
     However, about the same time, it was discovered that infection of a 
     pregnant woman with rubella was a cause of congenital malformation.  
     In the 1970's, the rubella vaccine was made widely available.  
     Thereafter, 14 states added a requirement for premarital rubella 
     testing.  One intent of the rubella testing was to identify women who 
     had not been immunized, with the hope that providing them additional 
     information about the potential health hazards would encourage them to 
     get the needed immunization.

3)   In 1978, a study in New York City was made of the efficacy of 
     premarital blood tests.  The study demonstrated that of the 116,000 
     premarital tests performed at an overall cost of $2.3 million to 
     marriage license applicants, only 39 cases of syphilis were detected.  
     This resulted in a cost-per-confirmed case of almost $60,000.

     The California Department of Health Service conducted a statewide 
     survey in 1992, and found that of the 614 laboratories that completed 
     the surveys (97% of the laboratories statewide performing testing) 
     laboratory testing revealed:

    a) There were only 37 new cases of syphilis (0.013 of the premarital 
š        population), and 95% of the premarital population had been 
       immunized against rubella (90% of the general population). 

    b) The cost for the premarital screening program in 1992 was in excess 
š       of $20  million, while the direct benefit was only $.6 million.  
       (The direct benefit was defined as the savings in medical costs 
       derived from prevented cases.) 

    c) The cost of finding one case of syphilis was $413,122.

     As the result of a Grand Jury investigation of the efficacy of 
     premarital screening, San Diego County found that the cost in 1992-93 
     for discovering the two cases detected was $245,889.  San Diego also 
     found that a large percentage of people were applying for confidential 
     marriage licenses in order to avoid the blood test requirement.  In 
     1992-93, 61% of the 23,132 marriages in San Diego County were 
     confidential marriages.




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