Opinion ID: 1408898
Heading Depth: 1
Heading Rank: 2

Heading: the department of health services recommendations

Text: In the proceeding to establish a standard for sulfates, the health department recommended and the Board adopted a standard of 25 micrograms of sulfate per cubic meter of air during a 24-hour period. In the sulfur dioxide proceeding, the health department recommended retention of the existing standard of .04 ppm of air for a 24-hour period. Instead the Board adopted a standard of .05 ppm for a 24-hour period in which there were elevated levels of oxidants or particulates. The trial court concluded that the Board is statutorily required to base its standards upon the health department's recommendations. The court further concluded that, in both proceedings, the Board had failed to follow this statutory mandate. While we agree that section 39606 requires the Board to base its standards on health department recommendations, the evidence does not support the trial court's conclusion that the Board failed to do so. (2a) The trial court concluded that section 39606 should be interpreted literally and that a deviation from the health department recommendations is not, in my opinion, a basing of the standards thereon. (Italics in original.) The court pointed out that there was no requirement of medical expertise for Board membership and reasoned that the assessment of the effects of air pollution upon health requires medical expertise and that the health department, whose members are highly qualified medical doctors, should make such determinations. The Board maintains that, while the statute requires standards relating to health effects to be based on the recommendations of the health department, this does not mean that the standard must be identical to the recommendation. Rather, the recommendation is the starting point and based on the evidence received at its hearing, the Board may depart from the recommendation. Urging that the health department should not be viewed as the only body with medical expertise, the Board points out that it is designated to hold the hearing (§ 39601), and is authorized to conduct studies and evaluate the effects of air pollution upon human life and to coordinate and collect research data on air pollution (§§ 39701, 39703). The Board reasons that there is not much point in its holding the hearing and acting as the coordinator of research if it is ultimately bound by the health department's recommendations. (3) Words such as recommends and recommendations are used in the codes both in a mandatory and advisory sense, and the determination of the legislative intention depends upon the context in which the word is used. ( Hough v. McCarthy (1960) 54 Cal.2d 273, 280 [5 Cal. Rptr. 668, 353 P.2d 276].) When, as here, recommendations is coupled with the mandatory shall (Gov. Code, § 14; Governing Board v. Felt (1976) 55 Cal. App.3d 156, 162 [127 Cal. Rptr. 381]), there is a strong indication that recommendations is used in a mandatory sense. (See Hough v. McCarthy, supra, 54 Cal.2d 273, 280, fn. 5; In re Ferguson (1965) 233 Cal. App.2d 79, 81 [43 Cal. Rptr. 325].) (2b) Other provisions and the legislative history both indicate that health department recommendations are to be binding as to health effects. The provision stating that standards as to health effects shall be based upon department recommendations follows a sentence enumerating matters to be considered by the Board. Prior to 1967, the health department was vested with the authority to adopt ambient air quality standards. (Former § 426.1.) In establishing the Board, the Legislature provided that it should consider a number of factors in setting standards including but not limited to health, and that standards relating to health effects shall be based on the recommendations of the health department. (Former § 39051, subd. (b), present § 39606, subd. (b).) As the trial judge pointed out, physicians and surgeons did not at this time qualify for membership on the Board. The health department, on the other hand, employed qualified health experts. Studies examining the relationship of air pollution to disease involve complex matters, and it is apparent from the record that many studies are of questionable validity. In these circumstances, there is little reason to conclude that the Legislature intended to permit a Board lacking the expertise necessary to evaluate these studies to reject recommendations by the health department as to health effects. The fact that the Board is the agency empowered to conduct the hearing on standards does not persuade us that it may reject health department recommendations. Under section 39606, a number of matters in addition to health effects are to be considered in adopting standards, and it is reasonable for the Legislature to have provided for a single hearing in which all factors, including health effects, would be addressed. Neither is the Board's reliance on its duty to coordinate and collect research on air pollution persuasive in considering whether it may reject health department recommendations. Section 39701 mentions the effects of air pollution on human health only as one of a long list of subjects to be included in research projects. The legislative determination that all air pollution research should be conducted and collected by a single state agency does not vitiate the specific legislative directive that standards relating to health effects be based upon health department recommendations. We conclude that the Board must follow health department recommendations for standards relating to health effects. However, this does not mean that the standards of ambient air quality adopted by the Board must be identical to those recommended by the department. Section 39606 enumerates several matters the Board must consider in addition to health effects, and the Board must take all these factors into account in determining the standards of ambient air quality. What the Board may not do is to substitute its judgment for that of the health department in determining health effects. (4a) The evidence supports the conclusion that the Board followed the recommendations of the health department in each of the proceedings at issue here.
The health department recommended a standard of 25 micrograms per cubic meter of air during a 24-hour period; the Board adopted that exact standard. In concluding that the Board did not follow the department recommendation, the trial court looked beyond the ultimate recommendation to the report upon which it was based. Relying upon this background data, the court apparently concluded that the standard adopted did not accurately reflect the health department's recommendation on two different bases. First, the recommendation  viewed in light of the report  was for 25 micrograms in the presence of elevated oxidant pollution such as occurs in the South Coast Air Basin. Second, the information upon which the report relied was based on a study of industrial sulfuric acid levels rather than sulfates. The record in the sulfate hearing clearly establishes that the current state of scientific knowledge on the health effects of air pollution does not permit the establishment of a precise ambient air quality standard such that immediately above the standard deleterious effects are certain to occur and immediately below it deleterious effects are certain not to occur. Instead, the available information permits only approximations of safe sulfate levels. [5] The department's report was based, in part, on toxicological studies of healthy persons exposed to sulfuric acid mist for short periods of time. Health department doctors extrapolated from these studies to arrive at an estimate of the adverse health effects to be expected upon longer term exposures. The doctors also adjusted the figures for sensitive subjects. In addition, the department examined occupational standards for exposure to sulfuric acid mist over an eight-hour day. These standards, too, were extrapolated to reflect a 24-hour day and were adjusted to protect more sensitive persons. The department also considered epidemiological study results showing that sulfates in the air could aggravate the symptoms of persons with respiratory diseases and affect the respiratory function of growing children. Most of these studies were conducted when oxidant levels were also elevated. There was evidence that almost all the sulfates in California air are harmful and that sulfuric acid is the most harmful sulfate compound. The health department's background report pointed out: that the presence of certain sulfates in the air is very dangerous to humans while other sulfate compounds are not harmful; that the Environmental Protection Agency had concluded that development of data and information necessary for a regulatory program could require several years (although the department opined that sufficient scientific information would be available within 15 months); and that the presence of more than 25 micrograms per cubic meter coupled with exposure to elevated oxidant levels had been shown to provide a likelihood of significant harm to the respiratory system. The department stated that because of the urgent need to avoid large summer increases in sulfate levels, regulatory action should be undertaken in the interim. Doctors who prepared the department report testified at the Board hearing as to the contents of the report. We conclude that the health department's recommended standard of 25 micrograms per cubic meter cannot be impeached. The health danger from sulfates was clearly established. While the scientific studies did not permit detailed analyses as to either permissible sulfate levels or methods of meeting the danger, there was a risk that if no steps were taken, substantial health damage would occur. The department made its recommendation on the basis of the best evidence available to it. (See American Textile Mfrs. Inst. v. Donovan (1981) 452 U.S. 490, 528-529 [69 L.Ed.2d 185, 213-214, 101 S.Ct. 2478].) We can ask no more. When a grave risk is identified, substantial decisions must be made to reduce the risk even though our scientific knowledge is insufficient to determine whether the regulation chosen is the best method of meeting the risk. Nor was the department required to recommend a combined standard of 25 micrograms in the presence of elevated oxidant pollution. While the epidemiological studies showing adverse health effects from sulfates may also have involved elevated oxidant levels, the evidence showed that sulfates alone produce deleterious health effects. The 25-microgram figure was based not only on the epidemiological studies but also on extrapolations from toxicological studies and occupational health data, which did not involve elevated oxidant levels. Neither the information contained in the report nor the other evidence received at the hearing established that, in the absence of elevated levels of oxidant, sulfate pollution above the 25-microgram standard is safe. The toxicological studies and the occupational health data were based on studies of sulfuric acid, which is the most harmful of sulfate compounds. But the basis of those studies did not preclude the department's reliance upon them, since other evidence showed that most sulfates occurring in California air are dangerous and that the department's expert opinions were based on judgments as to the sulfate levels in California air. Because sulfates were shown to be dangerous, even absent elevated oxidant levels, the department could reasonably conclude that a standard should be adopted for sulfates alone and that the epidemiological, toxicological and occupational data warranted fixing the level at 25 micrograms. Moreover, it was shown that elevated levels of oxidants were occurring in our state. The trial court's criticisms of the department's use of the data, while supported in a number of respects by expert testimony at the hearing, is in essence an attack on the testimony of those doctors who supported the report. These doctors gave expert opinions as to why the data warranted the standard adopted. The trial court's criticisms, at most, reflect the fact that different conclusions can be drawn from the available data. Accordingly, we must accept the health department's determination that a single standard is appropriate for sulfates and that the data warrants a 25-microgram standard. The standard adopted by the Board was the standard recommended by the health department. The record supports this standard. Further study may someday establish that the sulfates standard should have been fixed at a different level or that the sulfates standard should have been a combined standard. However, having been informed of a major health risk, the Board is statutorily required to act. (5) Courts may not reject the Board's analysis of the available information when that analysis is based upon expert testimony supporting the validity of air pollution studies and interpreting their results. Courts may not substitute their judgment for that of the experts as to the import of the available information. The choice between conflicting expert analyses is for the Board, not the courts. (4b) The trial court's independent evaluation of the underlying evidence was unnecessary and erroneous.
The health department concluded: that sulfur dioxide alone is not likely to produce significant health effects within the range of likely exposures, but that sulfur dioxide had produced effects in combination with particulate matter and could produce effects in combination with photochemical oxidants; that no report had indicated health effects at concentrations less than .10 ppm averaged over 24 hours; and that, at slightly greater concentrations, long-term exposures were associated with the development and exacerbation of chronic respiratory conditions. The department report concluded it was reasonable to apply a margin of safety in setting an air quality objective. However, the report found there was no scientific basis for establishing a particular margin of safety below the level of the .10 standard, and that the margin of safety was a value judgment or a policy matter for the Board. Nonetheless, the department stated the present air quality standard of .04 ppm SO[2] for 24 hours average, is reasonable in light of what is known about human health effects and with a margin of safety as determined by the Air Resources Board. [6] The Board adopted a standard for ambient air of .05 ppm of air for a 24-hour period in the presence of an excessive level of oxidants or particulates. What level of oxidants or particulates was excessive was to be determined by reference to existing state standards for these pollutants. In other words, the sulfur dioxide standard would not be exceeded unless the 24-hour average for sulfur dioxide exceeded .05 ppm and the state standard for particulate matter or oxidants was also met or exceeded. The trial court concluded that the Board did not have authority to include a safety factor and that in any event the record did not support the safety factor which the Board adopted. Concluding that the Board did not have authority to impose a safety factor, the trial court pointed out that the federal Clean Air Act expressly mandated an adequate margin of safety, that the Legislature must have been aware of the Clean Air Act provision but did not mention a safety margin, and that to adopt the Board's position that it could establish a safety margin without regard to its economic effect would frustrate the legislative purpose of protecting public health without destroying industry. The language of section 39606, directing the Board to adopt standards in consideration of the public health, safety, and welfare, reflects the breadth of matters to be considered by the Board. Considerations of health and safety necessarily include safety margins where appropriate. The Board's duty includes the protection of the health of the citizens of the state (§§ 39000, 39001), not merely the correction of unhealthy conditions. The Board therefore should not be required to wait until substantial adverse health effects are scientifically verified before adopting appropriate standards. Rather, the Board must establish its standards based on the available scientific evidence in a rapidly developing area of research. It may not ignore the possibility that further research may reveal that substantial health effects occur at lower levels of pollution than indicated by present studies. The provisions of sections 39000, 39001 and 39606 were adopted prior to the federal Clean Air Act. Although the statutes were amended subsequent to the act, the fact that the Clean Air Act, unlike our statute, specifically mentions safety margins is not entitled to weight in view of the broad language of our statutes. The evidence supports the safety factor chosen by the Board. The health department report recommended application of a margin of safety to the .10 ppm level and stated that the existing standard of .04 ppm was reasonable. A number of doctors urged adoption of a safety factor. The staff report summarized the practices of a number of federal agencies in imposing safety factors, including one in which the National Academy of Sciences recommended a standard for nitrogen oxide of one-half the lowest level at which adverse health effects are observed. The trial judge concluded that this evidence should be disregarded because it did not deal with sulfur dioxide. But the staff report, the department report  which itself is evidence  and the expert testimony together provide a sufficient evidentiary basis for the safety factor adopted here.