BILL ANALYSIS                                                                                                                                                                                                    



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          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.  








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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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