BILL ANALYSIS Ó
Senate Appropriations Committee Fiscal Summary
Senator Kevin de León, Chair
AB 588 (Fox) - School Athletics: Concussions
Amended: May 13, 2013 Policy Vote: Education 9-0
Urgency: No Mandate: No
Hearing Date: August 30, 2013
Consultant: Jacqueline Wong-Hernandez
SUSPENSE FILE.
Bill Summary: AB 588 extends existing concussion policies to
private and charter schools, and requires the currently-required
concussion and head injury information sheet to contain specific
information.
Fiscal Impact:
Head injury requirements: Potentially significant workload
for charter schools and private schools.
Medi-Cal: Potentially significant ongoing state costs, to
the extent that affected students are enrolled in Medi-Cal.
Background: Existing law, enacted by AB 25 (Hayashi) Ch.
456/2011 requires any school district which offers athletics to
require that an athlete suspected of sustaining a concussion or
head injury to be removed from the activity, and be evaluated
and cleared by a licensed health care provider before returning
to the activity.
Proposed Law: This bill requires any charter school or private
school, if it offers an athletic program, to immediately remove
an athlete from an athletic activity for the remainder of the
day if he or she is suspected of sustaining a concussion or head
injury, and prohibits the athlete from returning to the activity
until the athlete is evaluated by a licensed health care
provider, trained in the management of concussions, and acting
within the scope of his or her practice, and the athlete
receives written clearance from the licensed health care
provider to return to the activity. This bill also requires that
all schools and school districts subject to these requirements
provide, on a yearly basis, a concussion and head injury
information sheet which includes, at a minimum, information
regarding concussions and their symptoms, to be signed and
AB 588 (Fox)
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returned by the athlete and athlete's parent or guardian before
the athlete's initiating practice or competition.
Staff Comments: This bill requires a charter school or a private
school that offers athletics to comply with recently-enacted
statutory requirements concerning head injuries and concussions
(which currently apply only to school districts).
Specifically, this bill requires that an athlete suspected of
sustaining head injury or concussion: A) be removed from the
activity for the remainder of the day; and B) 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.
This bill specifies that the athlete shall not be permitted to
return to the activity until he or she receives written
clearance to return to the activity from that licensed health
care provider. Enforcement would be done by individual schools,
at the local level, and any enforcement activities would be
costs to those entities. Staff notes, however, that charter
schools are primarily funded by Proposition 98/General Fund, and
this bill would add cost pressure to school budgets. This bill
also sets minimum requirements for notification content, which
are unlikely to drive any significant additional costs.
The provisions of this bill will result in increased workload
for charter schools. While the provisions of this bill do not
constitute a reimbursable state mandate, both because charter
schools are not currently eligible for mandate reimbursement and
they are not required to offer athletics, it functionally
mandates new activities for any charter school which provide
athletics; they must either comply or cancel their athletics
programs.
These requirements are virtually identical to the California
Interscholastic Federation (CIF) Bylaw 313, which all high
schools who are members of CIF (virtually all California high
schools participating in athletics) are required to follow as a
condition of membership and competition. A clarification listed
below Bylaw 313 in CIF's published rules indicates that the
scope of practice for a "licensed health care provider" will
limit the evaluation to a medical doctor or doctor of
osteopathy. Schools already in compliance with CIF rules should
not incur additional costs for this provision.
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While most participating high schools likely comply with the CIF
bylaws, this bill is intended to give greater force to the
specified safety measures. The intent is to increase compliance
by raising the issue to a state law rather than a competition
membership requirement; the practice would have force of law.
This bill also applies to elementary and middle schools; most
middle schools (and some elementary schools) also offer
athletics, but are not CIF members (as its jurisdiction is over
high school athletics). It is not known how many middle or
elementary school students suffer head injuries during
athletics, but these students would be subject to the new
requirements. Staff further notes that the medical evaluation
requirements apply to any student who "is suspected of
sustaining a head injury," not only students suspected of
sustaining concussions.
By increasing the enforcement of medical examinations for middle
and high school athletes, this bill will likely result increased
state costs in the Medi-Cal program; this program provides
no-cost medical coverage for children whose families meet
certain income eligibility requirements. There are more than 2
million school-aged children enrolled in Medi-Cal statewide, and
enrollment is projected to increase as most of the 850,000
children currently served by the Healthy Families program are
moved from that program to Medi-Cal as part of the
implementation of the federal Affordable Care Act. Medi-Cal
generally receives 50% federal and 50% state (General Fund)
funding.
It is not known how many of these school-aged Medi-Cal
participants attend charter schools or private schools - private
school attendance is likely very low. It is also not known how
many of those students participate in school athletics programs,
nor how many of them sustain head injuries each year and would,
thus, require doctors' evaluations. To the extent that
additional office visits are required of children enrolled in
Medi-Cal, those costs would be borne in part by the General
Fund.