BILL ANALYSIS Ó
AB 2217
Page 1
Date of Hearing: April 29, 2014
ASSEMBLY COMMITTEE ON JUDICIARY
Bob Wieckowski, Chair
AB 2217 (Melendez) - As Amended: April 24, 2014
As Proposed to be Amended
SUBJECT : PUPIL AND PERSONNEL HEALTH: AUTOMATIC EXTERNAL
DEFIBRILLATORS
KEY ISSUE : SHOULD THE LEGISLATURE Encourage all public schools
to acquire and maintain an automatED external defibrillator
(AED) TO PROTECT STUDENT AND SCHOOL EMPLOYEE SAFETY?
SYNOPSIS
This public health measure is very similar to the author's AB
939 of 2013, which likewise encouraged all public schools to
acquire and maintain an AED. Like this measure, AB 939 provided
immunity from civil damages to the employee of the school
district and to the school district resulting from the use of an
AED. Apparently due to cost concerns, that bill was held on
suspense in the Senate Appropriations Committee. This measure
again follows what has now become a long tradition by the
California Legislature of providing immunity from civil damages
to entities and their personnel who act as Good Samaritans to
try to save other's lives, under reasonable parameters. In this
instance the measure seeks to encourage all public schools to
acquire and maintain these life-saving devices. According to
the author, the majority of California's children spend around
14,000 hours away from their parents and under the supervision
of the state while they receive an education at California's
K-12 public schools. And sadly, some young people have died
during school activities, especially athletic events, due to the
absence of AEDs.
This bill is again intended to provide certainty to school
districts and their employees that if an AED is used during a
school related activity they will normally be protected from any
possible lawsuit (though none have been reported) if they have
the courage to try to assist others in distress through the use
of an AED. Further, this bill permits a school to receive
non-state funds to remove any financial barriers the school may
face in acquiring and maintaining an AED and training their
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employees in the use of an AED. The bill recently was
unanimously approved by the Assembly Education Committee. The
only known opposition is by the California Federation of
Teachers, which expresses concern that school staff is
ill-equipped to use AEDs, and instead the Legislature should
incentivize school districts to hire more full-time nurses and
health professionals to operate AEDs.
SUMMARY : Encourages all public schools to acquire and maintain
an automated external defibrillator (AED) and provides immunity
from civil damages to the school district resulting from civil
damages resulting from the use of an AED. Specifically, this
bill , among other things:
1)States the intent of the Legislature to encourage all public
schools to acquire and maintain at least one automated
external defibrillator (AED).
2)Permits a public school to solicit and receive non-state funds
to acquire and maintain an AED, and provides that these funds
shall only be used to acquire and maintain an AED and to
provide training to school employees regarding use of an AED.
3)Provides immunity from civil liability to school districts and
their employees for damages resulting from any act or omission
in rendering the emergency care or treatment involving the AED
so long as the employee of the school district is in
compliance with Section 1714.21 of the Civil Code which speaks
to the immunity from liability for use of an AED if the
requirements set forth in Health and Safety Code section
1797.196 are met.
4)Specifies that immunity does not apply to those injuries or
deaths that occur as a result of gross negligence or willful
or wanton misconduct on the part of the person who uses,
attempts to use, or maliciously fails to use, an AED to render
emergency care or treatment.
5)Specifies that this section does not alter the requirements of
Health and Safety Code section 1797.196, which speaks to the
immunity from liability if certain conditions pertaining to
the operation and maintenance of the AEDs are met.
EXISTING LAW :
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1)Provides immunity from civil liability resulting from the acts
or omissions in the rendering of emergency care through the
use of an AED so long as specified conditions are met.
(Health and Safety Code Section 1797.196.)
2)Provides that "Any person who, in good faith and not for
compensation, renders emergency care or treatment by the use
of an AED at the scene of an emergency is not liable for any
civil damages resulting from any acts or omissions in
rendering the emergency care." (Civil Code section 1714.21.
(b).)
FISCAL EFFECT : As currently in print this bill is keyed
non-fiscal.
COMMENTS : This bill is very similar to the author's AB 939 of
2013, which likewise encouraged all public schools to acquire
and maintain an AED. Like this measure, AB 939 provided
immunity from civil damages to the employee of the school
district and to the school district resulting from the use of an
AED. Apparently due to cost concerns, that bill was held on
suspense in the Senate Appropriations Committee. This measure
again follows what has now become a long tradition by the
California Legislature of providing immunity from civil damages
to entities and their personnel who act as Good Samaritans to
try to save other's lives, under reasonable parameters. In this
instance the measure seeks to encourage all public schools to
acquire and maintain these life-saving devices. According to
the author, the majority of California's children spend around
14,000 hours away from their parents and under the supervision
of the state while they receive an education at California's
K-12 public schools. And sadly, some young people have died
during school activities, especially athletic events, due to the
absence of AEDs.
This bill is again intended to provide certainty to school
districts and their employees that if an AED is used during a
school related activity they will normally be protected from any
possible lawsuit (though none have been reported) if they have
the courage to try to assist others in distress through the use
of an AED. Further, this bill permits a school to receive
non-state funds to remove any financial barriers the school may
face in acquiring and maintaining an AED and training their
employees in the use of an AED. The bill recently was
unanimously approved by the Assembly Education Committee.
AB 2217
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Background : According to the American Heart Association, sudden
cardiac arrest kills over 300,000 people a year and is the
leading cause of death in the United States. 5,760 of these
deaths are children under the age of 18. Medical experts opine
that the key to survival is timely initiation of a "chain of
survival", including CPR and the use of an AED. Trained
non-medical personnel can use these simplified electronic
machines to treat a person in cardiac arrest. The AED device
guides the user through the process by audible or visual prompts
without requiring any discretion or judgment. The American
Heart Association notes that at least 20,000 lives could be
saved annually by prompt use of AEDs. Ultimately, with broad
deployment of AEDs among trained responders, as many as 50,000
deaths due to sudden cardiac arrest - including school children
and school personnel -- could be prevented each year.
The Legislature's Continuing Efforts to Encourage the
Proliferation of AEDs to Save Lives : This bill follows what has
now become a long tradition by the California Legislature (see
"Prior Related Legislation Section" below) of providing immunity
from civil damages to entities and their personnel who act as
Good Samaritans to try to save other's lives, under reasonable
parameters. In this instance the measure seeks to encourage all
public schools to acquire and maintain these life-saving
devices. The bill is intended to provide certainty to school
districts and their employees if an AED is used on campus that
they will normally be protected from a possible lawsuit if they
have the courage to try to assist others in distress through the
use of an AED. Further, this bill permits a school to receive
non-state funds to remove any financial barriers the school may
face in acquiring and maintaining an AED and training their
employees in the use of an AED.
AEDs In General : An AED is a medical device used to administer
an electric shock through the chest wall to the heart after
someone suffers cardiac arrest. Built-in computers assess the
patient's heart rhythm, determine whether the person is in
cardiac arrest, and signal whether to administer the shock.
Audible cues guide the user through the process. Portable AEDs
are available upon a prescription from a medical authority.
Their general cost is between $1,500 and $2,000 according to the
American Heart Association (AHA).
Apparent Lack Of Risk of Accidental Misuse, According To The
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American Heart Association : According to the AHA, AEDs contain
microcomputers to accurately identify sudden cardiac arrests and
make extensive use of audible prompting and signals to provide
operators with clear and concise instruction, making their use
uncomplicated, intuitive, and nearly foolproof. Safeguards are
built in to protect both operator and victim and to ensure that
the AED will only deliver a shock if, in fact, the device
affirmatively determines that a victim is in sudden cardiac
arrest. Further, the device does not allow for manual
overrides, in the event a panicked operator tries to administer
the shock even when the device finds that the victim is not in
cardiac arrest.
AED Availability : According to staff research, the move in the
last few years to increase the number of AEDs available to first
responder units such as police and fire, as well as in
high-traffic areas, such as airports and casinos, has been met
with overwhelming community support. A survey of worldwide news
sources indicates that AEDs have been responsible for many saved
lives after cardiac arrest incidents and that AEDs are in such
high demand that schools and local communities have taken to
outside fundraising to purchase the equipment.
Across the United States there has been a major push for wide
spread access to AEDs, especially where children are concerned.
A high school student in New York State had a heart attack after
competing in a wrestling match. A bystander trained in both CPR
and AED use came to his aid and attempted CPR but did not get a
response. She then called for the AED, which are mandated by
New York Law in every school, and was able to bring the young
man back.
The AEDs have been used successfully in such places as
California's Ontario Airport, and Connecticut's Foxwoods Casino.
According to a Foxwoods' security director, the casino has 15
AEDs on the property and has used them more than 40 times in the
last four years, and more than 300 security personnel and
emergency medical technicians at the casino are trained to use
the machines. In the Minneapolis Airport, passengers waiting
for flights can receive basic training on how to use the machine
in about 5 minutes. The passengers are trained by firefighters
at stations in the airport and the program is funded by
Medtronic which makes AEDs. The goal of all these programs is
to make AEDs as familiar as fire extinguishers and as readily
available to the general public. The FDA has even approved of
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their over-the-counter purchase without a prescription.
No Known Lawsuits Against Users of AEDs : A search of the Lexis
Nexis database continues to reveal no news articles, or
successful federal or state cases, suing for liability against
users of AEDs. Committee staff research indicates that these
devices are virtually "fail-safe" and easy enough for a child to
use (although this is not generally recommended). No negative
reaction has been found regarding the use of the AEDs, or any
suit filed against someone using the AEDs. This is most likely
due to the design programming that will not allow the user to
administer an electric shock needlessly, therefore creating
little chance of user-error in administering the AED. The only
possible negative comment was that, hypothetically speaking,
someone with a living will/Do Not Resuscitate (DNR) order may be
in public and suffer a cardiac episode. A bystander, unable to
know the person has a DNR, or what his/her specific medical
wishes are, may administer the AED against his/her wishes.
ARGUMENTS IN SUPPORT : The Emergency Medical Services
Administrators Association writes in support of the measure,
noting that in many instances throughout California, it is not
physically possible for EMS first-responders to be at the side
of a student, faculty member, or visitor on the school campus
within 4 to 8 minutes of collapse -- the time typically needed
to save lives. They note that most people may think a young
person could not possibly be a cardiac arrest victim.
Unfortunately, this very situation occurs more often than many
think. For example, the organization notes of the following
recent events involving young people or school employees whose
lives were actually saved by the availability and proximity of
AED's:
Male, aged 13, December 14, 2010, Rincon middle school,
Escondido, cardiac arrest while attending school, bystander
CPR, school use of AED - outcome: survived.
Junior high school student, December 1, 2010, Lexington
junior high school, Cypress, cardiac arrest while attending
school, AED brought to the scene by Cypress police
officer-- outcome, survived.
Male, age 34, coach/faculty, July 2007, Marina high
school, Huntington Beach, cardiac arrest while coaching
baseball, bystander CPR and school AED used - outcome:
survived.
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Sadly, the organization also highlights a painfully long list of
young people and school employees who passed away from cardiac
arrest without the availability and proximity of AED's.
The Association of California School Administrators writes in
support, noting:
Most school districts are self-insured. As a result,
the self-insurance companies have advised school
districts not to purchase or accept AEDs for fear of
liability. A number of school sites in the state have
been offered AEDs free of charge, only to be advised
not to accept the device. Currently, individuals
receive Good Samaritan protection from the use of an
AED; however, it has been unclear whether school
districts are covered with this same protection.
School sites are one of the busiest public buildings
in a community. They are utilized by students and
adults during the day, evening, and throughout the
entire year. Tragically, over 300,000 people die every
year from sudden cardiac death and many deaths occur
on school sites. Many heart diseases are undetected
until an autopsy. Even participating in school P.E.
has resulted in blunt trauma and heat stroke causing a
heart to go out of rhythm and sudden death. No one
wants to believe an otherwise healthy child could
collapse at school and die, but it happens and it
isn't uncommon.
AEDs have evolved to a point of being extremely simple
to use. They are located at airports, on airplanes,
shopping malls, grocery stores, gas stations, athletic
stadiums, concert halls, etc. Why shouldn't they be on
every school site where our most precious resource,
our children, spend a significant amount of time each
day?
The Civil Justice Association of California also writes in
support, noting:
[This bill] will provide protection from lawsuits for
school employees and school districts if an AED is
used in an effort to save a life. Current law already
provides civil immunity to businesses and trained
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operators of automatic external defibrillators.
California has a strong policy of encouraging the
provision of emergency assistance (Health and Safety
Code Section 1797.5-6). Accordingly, existing law
protects providers of emergency services by limiting
lawsuits against them when providing assistance during
an emergency (Health Safety Code Sections 1797.6,
1799.107, 1799.102, 1714.2 and Section 1714.21).
The bill is consistent with other California law that
provides immunity to "Good Samaritans" who act at the
scene of an emergency. Encouraging the provision of a
life-saving treatment without fear of unnecessary
lawsuits may help save lives.
ARGUMENTS IN OPPOSITION : The California Federation of Teachers
has written the Committee to express their opposition to this
legislation on principle. CFT is concerned that school staff is
ill-equipped to use AEDs on the basis that these
responsibilities are outside their scope of work or educational
training. CFT rather urges the Legislature to incentivize the
hiring of more full-time nurses and health professionals to
operate AEDs.
CLARIFYING AMENDMENT : The author has prudently agreed to the
following amendments in order to clarify that a school district
is immune from liability only so long as an AED is properly
maintained:
On page 2, line 12, strike:
the school district and
On page 2, between lines 14-15, insert:
(d) If a school or a school district complies with the
requirements of Health & Safety Code Section 1797.196,
then the school or the school district is covered by
Civil Code 1714.21 and shall not be liable for any
civil damages resulting from any act or omission in
the rendering of the emergency care or treatment.
PRIOR RELATED LEGISLATION : AB 939 (Melendez) of 2013, would
have encouraged all public schools to acquire and maintain an
AED and provided immunity from civil damages to the employee of
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the school district and to the school district resulting from
the use of an AED. That bill was held on suspense in the Senate
Appropriations Committee.
SB 1436 (Lowenthal), of 2012, Ch. 17 of 2012, extended
indefinitely, the operative provisions of existing law which
provide immunity from civil damages for persons or entities that
acquire automated external defibrillators (AEDs) and comply with
maintenance, testing, and training requirements.
SB 63 (Price) of 2011, would have required that all public high
schools acquire and maintain at least one AED. This bill died
in the Senate Appropriations Committee.
SB 127 (Calderon) of 2010, Ch. 500 of 2010, clarified that
Section 104113 of the Health and Safety Code requires all health
studios to ensure that a trained staff member proficient in the
use of an AED is available during staffed operating hours.
AB 142 (Hayashi) was introduced in 2009. That measure sought to
establish requirements for 24 hour clubs that allow access
during unstaffed hours. That bill was held in the Senate
Judiciary Committee.
AB 1312 (Swanson) was also introduced in 2009. That measure
sought to extend the sunset in the existing law governing health
studios, and to extend the requirements to golf courses and
amusement parks. That measure was vetoed by the Governor.
AB 2130 (Hayashi) of 2008, would have exempted health studios
that do not maintain personnel on the premises from the
requirements of maintaining personnel trained in AED at all
times on site. The bill would have required, as a condition of
that exemption, that such studios have a telephone on premises;
as well as signs that (a) warn of the potential health and
safety risks of exercising alone, (b) provide instructions in
CPR and AED use, and (c) indicate the location of all AEDs on
the premises. The bill died in the Senate Judiciary Committee.
AB 2083 (Vargas) of 2006, Ch. 85 of 2006, extends the sunset
date for another five years on the operative provisions of
existing law which provide immunity from civil damages for
persons or entities that acquire automated external
defibrillators (AEDs) and comply with maintenance, testing, and
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training requirements.
AB 1507 (Pavley) of 2005, Ch. 431 of 2005, for a five-year
period beginning July 7, 2007, requires a health studio, as
defined, to acquire, maintain, and train personnel in the use of
automated external defibrillators, as specified.
AB 2041 (Vargas) of 2002, Ch. 718 of 2002, broadened the current
immunity for the use or purchase of an AED in an effort to
encourage their purchase and use, repealed the CPR and AED use
training requirement for a Good Samaritan user of an AED in
rendering emergency care, and substantially relaxed the
requirement that building owners and others who acquire AEDs
ensure that expected AED users complete an accepted CPR and AED
course as a condition of immunizing the building owners from
liability arising from the use of the AED.
SB 911 (Figueroa) of 1999, Ch. 163 of 1999, provided for
qualified immunity to "Good Samaritans" who voluntarily apply
AEDs at the scene of an emergency to try to save heart victim's
lives, so long as those persons had training in the use of an
AED.
REGISTERED SUPPORT / OPPOSITION :
Support
Association of California School Administrators
Brain Injury Association of California
Civil Justice Association of California
Contra Costa County Board of Supervisors
Emergency Medical Services Administrators Association of
California
Murrieta Valley Unified School District
Olivia's Heart Project
Opposition
California Federation of Teachers (CFT)
Analysis Prepared by : Drew Liebert and Vignesh Ganapathy / JUD.
/ (916) 319-2334
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