BILL ANALYSIS Ó AB 25 Page 1 Date of Hearing: March 16, 2011 ASSEMBLY COMMITTEE ON EDUCATION Julia Brownley, Chair AB 25 (Hayashi) - As Amended: January 31, 2011 SUBJECT : Athletics: concussions and head injuries. SUMMARY : Requires a school district that elects to offer athletics, to implement a concussion and head injury identification process; and, requires compliance with this process from all organizations the district authorizes to use school facilities under the Civic Center Act (CCA). Specifically, this bill requires: 1)A school district to comply with both of the following if they elect to offer an athletic program: a) An athlete who is suspected of sustaining a concussion or head injury in an athletic activity shall be immediately removed from the activity, and shall not be permitted to return to the activity until he or she is evaluated by a licensed health care provider, trained in the management of concussions, acting within the scope of his or her practice; and, the athlete shall not be permitted to return to the activity until he or she receives written clearance to return to the activity from a licensed health care provider. b) On a yearly basis, a concussion and head injury information sheet shall be signed and returned by the athlete and the athlete's parent or guardian prior to the start of the athlete's season of practice or competition. 2)Organizations that utilize school district facilities under the CCA for recreational activities, to sign a statement of compliance with the same policies for the management of concussion and head injury that school districts must follow, before school districts can authorize them to use their facilities. EXISTING LAW : 1)Authorizes school district governing boards to grant the use of school facilities to various organizations and groups, AB 25 Page 2 under the CCA. (Education Code 38131) 2)Requires school district governing boards to grant the use of school facilities to the Girl Scouts, Boy Scouts, Camp Fire, Inc., Parent-teachers' associations, and School-community advisory councils when an alternative location is not available. Specifies the liability of the school district and the groups and organizations, respectively. Specifies any school district authorizing the use of school facilities or grounds shall be liable for any injury resulting from the negligence of the district in the ownership and maintenance of those facilities or grounds. Specifies any group using school facilities or grounds shall be liable for any injury resulting from the negligence of that group during the use of those facilities or grounds. (Education Code 38134) 3)Requires each high school sports coach to complete a coaching education program developed by his or her school district or the California Interscholastic Federation (CIF) that meets the guidelines set forth by the High School Coaching Education and Training Program (HSCTP). (Education Code 49032 and Education Code 35179.1) FISCAL EFFECT : This bill is keyed non-fiscal, however, the Assembly Appropriations Committee has requested to hear this bill. If this bill is passed by the Assembly Education Committee, it will be referred to the Committee on Appropriations to consider the fiscal implications. COMMENTS : Concussions have serious immediate and long-term effects. A concussion is a brain injury caused by a blow to the head or body or from hitting a hard surface, and in only 10% of cases is it evident from loss of consciousness. This bill seeks to ensure that K-12 athletes and their parents are aware of the signs and symptoms of a concussion in order to prevent further injury. This bill requires that an athlete and their parent or guardian sign and return a concussion and head injury information sheet on a yearly basis prior to the start of the athletic season. This bill also requires that student athletes suspected of having a concussion are evaluated by a medical professional before returning to practice, play, or competition. The bill requires that all participants of youth recreational activities that take place on school district grounds through the CCA are aware of signs and symptoms of a concussion and that they comply with the same medical professional evaluation AB 25 Page 3 procedures. This bill promotes awareness of the signs and symptoms of serious head injuries, especially for young athletes who are more vulnerable to greater injury. This increased understanding provides youth participating in athletics with safeguards against long-term injuries that result from concussion and head injury. One important safeguard the bill provides is in bringing attention to parents of the signs and symptoms of concussion, which helps parents advocate for their children when these health issues arise and assists parents manage head injury outside of school. In addition to educating student-athletes and parents on concussion and head injury, the bill further protects athletes by ensuring that they will be removed from practice or play if they sustain a concussion or head injury. Current CIF policy ensures student-athletes do not return to practice or competition until evaluated by a healthcare professional; however this only covers about 1 million students between 14-18 years old. The bill widens this policy to include the 3 million students between 6-14 years old playing youth sports. Return to Play Policies in California : CIF recently adopted a policy requiring high school students suspected of sustaining a concussion to be removed from practice or competition and not return to play until they are appropriately evaluated. This is because more severe symptoms of concussion may not be apparent until hours after impact. The CIF rules however, only govern grade 9-12 athletics, while this bill implements a similar policy for all K-12 athletics, as well as for all recreational activities held on school grounds. Specifically, CIF's by-laws state, "A student-athlete who is suspected of sustaining a concussion or head injury in a practice or game shall be removed from competition at that time for the remainder of the day. A student-athlete who has been removed from play may not return to play until the athlete is evaluated by a licensed health care provider trained in the evaluation and management of concussion and receives written clearance to return to play from that health care provider." CIF's rules are slightly different than what is required by this bill in that students must be removed from play for the rest of the day if they are suspected of concussion or head injury. To ensure the safety of youth suspected of experiencing a concussion or head injury, staff recommends the bill be amended to mirror CIF's rules and explicitly specify that students should be removed for the AB 25 Page 4 remainder of the day. Coaches Training : The bill creates the preventive measure of requiring coaches and supervisors to be aware of athletes who they suspect of having sustained a concussion or head injury and to remove them from practice or games to undergo evaluation by a doctor. The bill however, does not require coaches to receive training in identifying signs of concussion or head injury. Previous legislation such as AB 1646 (Hayashi) from 2010 included mandated training for coaches in concussion and head injury. CIF's coaches training program under the HSCTP does not currently include instruction on concussions. CIF currently offers a free online concussion training course for coaches where they receive an immediate printed certification upon completion. Of the 67,929 coaches in California, 1,714 have taken the online course. The committee should consider how coaches can be expected to know the signs of a concussion if they do not receive training on concussion symptoms. Staff recommends the bill be amended to specify that if a school district elects to offer an athletic program, then coaches shall be required to complete CIF's free online concussion course every two years to ensure coaches have the most up to date concussion information. Civic Center Act (CCA) : The CCA details conditions for the use of school district facilities by groups and organizations. Some examples of groups that use school facilities include, but are not limited to, Girl Scouts, Boy Scouts, Camp Fire, Inc., Parent-Teachers' Associations, Boys and Girls Club, School-community advisory councils, religious organizations, public agencies, and senior citizens' organizations. The CCA also specifies the liability for use of school facilities to both school districts and groups and organizations. Under the CCA, districts are responsible for liability as it relates to the maintenance of the school grounds whereas the outside groups are responsible for liability during the use of the facilities. This bill requires school districts to collect forms stating compliance with the policies for the management of concussion and head injury in athletics from any group using school facilities or grounds. Some districts receive and process a high volume of requests for use of their facilities. For example, the Los Angeles Unified School District (LAUSD) processes over 2,500 school facility requests annually, which AB 25 Page 5 translates to 30,500 daily uses. What would happen if even one of these forms were misplaced or is not collected, by accident? It is unclear whether additional liability, beyond what exists in statute, would fall on districts if someone is injured and the compliance form is misplaced or not collected. In one section of the bill, it requires submission of compliance forms from groups using school district facilities for "supervised recreational activities" and in a separate section, the bill requires the compliance forms from groups using facilities for "any youth athletic activity." Because it is unclear whether "supervised recreational activities" and "youth athletic activities" refer to the same types of groups, staff recommends a technical amendment to conform the term "youth athletic activity" to the current definition of "supervised recreational activity." Other State Laws : According to information provided by the authors' staff, this bill is modeled after recently enacted legislation in Washington State. Washington's "Zackery Lystedt Law" requires all athletes under the age of 18 who are suspected of having a concussion to get written consent from a licensed medical provider trained in evaluating a concussion before returning to play. The Washington State law also requires organizations and groups to show proof of insurance before being allowed to use school district facilities. Arguments in Support : According to the American Federation of State, County and Municipal Employees (AFSCME), "these policies ensure that young athlete's health is most important and that athletes will be prevented from further injury." According to the California Chiropractic Association (CCA), "twenty-one percent of all traumatic brain injuries are sports-related. While not all head injuries can be prevented, the effects can be mitigated by knowing when it is safe to return to play." According to the California State Parent Teacher Association (PTA), "the provisions of this bill that require parents to receive concussion awareness information and sign a receipt acknowledging they have read this information are important steps in protecting our student athletes." Committee Amendments : Staff recommends the bill be amended in the following ways: 1)Prohibit athletes suspected of having experienced a concussion during a game or practice from returning to the practice or AB 25 Page 6 game for the remainder of the day, in order to ensure the athlete's safety. 2)Require CIF to include concussion and head injury training for coaches as part of the California High School Coaching Education and Training Program. 3)If a school district elects to offer an athletic program, then coaches shall be required to obtain a free online concussion and head injury training certificate through the National Federation of State High School Associations (NFHS) every two years to ensure coaches have the most up to date concussion information. 4)Technical and conforming amendments to clarify that "all recreational activities" performed on a school campus under the CCA shall comply with this measure. Previous Legislation : AB 1646 (Hayashi) in 2010, which was held on the Assembly Appropriations Committee suspense file, would have required training for coaches to be able to identify symptoms of head and neck injury. The additional training would have been incorporated into coaches' first aid certification renewal. AB 1647 (Hayashi) which was vetoed by the Governor in 2010, would have established certification and training requirements for athletic trainers. The bill would have also prohibited individuals from calling themselves athletic trainers unless they met those requirements. The Governor vetoed this bill with the following message: This bill is similar to legislation I have vetoed twice before in the past because there is no evidence that regulating the use of the term "certified athletic trainer" poses any threat to the public health and safety. AB 1893 (Hayashi) which was held in the Assembly Education Committee in 2010, would have required all high school spirit activities (HSSA) coaches to have valid certification in CPR and first aid, including an understanding of signs, symptoms, and appropriate emergency action steps regarding potentially catastrophic injury, including but not limited to, head and neck injury and concussion. Pupils participating in HSSA who experience or show signs of trauma or other injury would have needed to obtain a release from the treating provider before resuming spirit activities. AB 25 Page 7 AB 533 (Hayashi) in 2009, which was held on the Assembly Appropriations Committee suspense file, would have required training for coaches to be able to identify symptoms of head and neck injury. The training would have been incorporated into coaches' first aid certification renewal. REGISTERED SUPPORT / OPPOSITION : Support Alameda County Superintendent of Schools, Sheila Jordon American Federation of State, County, and Municipal Employees (AFSCME), AFL-CIO American Red Cross, California Chapters Brain Injury Association of California (BIACAL) California Athletic Trainers' Association (CATA) California Chiropractic Association (CCA) California Parent-Teacher Association (PTA) California School Employees Association (CSEA), AFL-CIO California Teachers Association (CTA) Consumer Attorneys of California The National Football League (NFL) Two Individuals Opposition None on file. Analysis Prepared by : Tania Herrera and Chelsea Kelley / ED. / (916) 319-2087