BILL ANALYSIS Ó AB 1639 Page 1 Date of Hearing: March 16, 2016 ASSEMBLY COMMITTEE ON EDUCATION Patrick O'Donnell, Chair AB 1639 (Maienschein) - As Amended on March 9, 2016 [Note: This bill is double-referred to the Judiciary Committee and will be heard by that Committee as it relates to issues under its jurisdiction.] SUBJECT: Pupil health: Sudden Cardiac Arrest Prevention Act SUMMARY: Establishes the Sudden Cardiac Arrest Prevention Act; requires the California Department of Education (CDE) to make available specified guidelines and materials on sudden cardiac arrest (SCA); requires pupils and parents to sign informational materials before athletic participation; requires training of coaches; and sets requirements for action in the event a pupil experiences specified symptoms. Specifically, this bill: 1)Establishes the following definitions: a) "Athletic activity" means the following: i) Interscholastic athletics; ii) An athletic contest or competition, other than interscholastic athletics, sponsored by or associated with a school, including cheerleading, club-sponsored sport activities and sports activities sponsored by school-affiliated organizations; iii) Noncompetitive cheerleading sponsored by or AB 1639 Page 2 associated with a school; and, iv) Practices and scrimmages for activities listed under i) through iii). b) "School" means a public school, including a charter school, or a private school with athletic activities. 2)Requires the CDE to develop and post on its Internet Web site guidelines and an information sheet on specified SCA symptoms, risks and warning signs. 3)Requires the materials to be developed using relevant materials and training videos used by the Eric Paredes Save a Live Foundation, the California Interscholastic Federation (CIF) and the National Federation of High Schools (NFHS). 4)Encourages school districts and schools to post these materials on their Internet Web sites. 5)Requires a pupil and the pupil's parent or guardian to sign an acknowledgment of receipt and review of the information sheet developed by the CDE every year before participation in an athletic activity. 6)Authorizes schools to hold informational meetings on SCA before each athletic season. 7)Requires removal from activity any pupil who passes out or faints while participating in or immediately after athletic activity, or who is known to have done so, by an athletic trainer, coach or athletic director. AB 1639 Page 3 8)Authorizes an athletic trainer to remove a pupil from participation if the pupil experiences specified symptoms the trainer reasonably believes are cardiac related. Requires, in the absence of a trainer, a coach observing symptoms of SCA in a pupil to notify a parent or guardian, so that that parent or guardian can determine what treatment, if any, the pupil should seek. 9)Prohibits a pupil who has been removed from activity for SCA symptoms from returning to participation until evaluated and cleared to participate in writing by an appropriate medical professional. 10)Requires biennial SCA training for coaches. 11)Requires, beginning July 1, 2019, suspension of coaches for not removing from activity a pupil who has fainted or passed out, or for not undergoing the yearly training. Requires a coach to be suspended for the remainder of a season, for a first violation; for the remainder of the season and the next season, for a second violation; and permanent suspension from coaching any athletic activity, for a third violation. 12)Limits a coach's civil liability for his or her action or inaction under the Act, other than acting in a grossly negligent or reckless manner. AB 1639 Page 4 13)Encourages the sponsors of youth athletic activities to follow the guidelines in the Act. 14)Makes the Act operative on July 1, 2017. EXISTING LAW: 1)Limits full-contact practices, as defined, for high school and middle school football and urges CIF adoption of rules to implement such guidelines. (Education Code (EC) Section 35179.5) 2)Requires an athlete suspected of sustaining a concussion or head injury during athletic activity to be removed from that activity and not be permitted to return until evaluated and cleared by a licensed health care provider; urges the CIF to develop rules and protocols to implement this; and requires athletes and parents to receive, sign and return a head injury information sheet annually before practice or competition. Excludes the requirements from athletic activities during the regular schoolday or as part of a physical education course. (EC Section 49475) 3)Requires a high school sports coach to complete educational programs developed by his or her school district and the CIF that meet specified guidelines. (EC Section 49032) 4)Authorizes a school district or school to provide comprehensive instruction in first aid or cardiopulmonary resuscitation. (EC Section 49413) AB 1639 Page 5 FISCAL EFFECT: Unknown COMMENTS: This bill requires dispersion of informational materials on SCA, and notification for student athletes and their parents, in order to build awareness of the possible precursors to SCA. This bill also requires training for coaches, establishes procedures to be followed in the event of SCA symptoms, and sets penalties for not following the procedures. Existing law involving athletic activities. California has established laws regulating athletic activities and requirements for coaches, including limiting the number football full-contact practices and requiring coaches to attend a coaching education program. This bill is similar to requirements on concussions among students in interscholastic sports, which were established following increasing awareness of the dangers of head injuries. Current law requires a graduated return-to-play protocol for those pupils who have had a concussion or head injury diagnosed by a licensed health care provider. These rules are for schools with an interscholastic sports program and do not specify penalties for violations. Purpose of the bill. The author's office states that "Sudden Cardiac Arrest (SCA) has emerged as a leading cause of death among people under age 25. According to the American Heart Association, SCA affects nearly 10,000 youth per year." The author's office also states that 72 percent of those who have suffered SCA experienced prior symptoms but did not recognize them as warning signs. The sponsor of this bill, the Eric Paredes Save a Life Foundation, seeks to make more people aware of these warning signs, in the hopes that it will provide the opportunity to prevent fatal cardiac events. Eric Paredes, for whom the sponsor organization was named, was a young athlete who died from a sudden cardiac arrest while at home. Eric's parents hope to use the story of their son's death, AB 1639 Page 6 and those of other young athletes, to bring attention to heart screening and possible warning signs they say could save the lives of other children. The Foundation has worked extensively to produce and distribute information on SCA, and to promote training videos for coaches. Supporters consider this bill a first effort in preventing future deaths through information and risk assessment. One supporter, Heartfelt Cardiac Projects, states, "This bill is an inaugural step in educating youth, parents and coaches about the potential warning signs and risk factors of sudden cardiac arrest and about the cardiac chain of survival that could save a life." Similar requirements under CIF. The CIF, working with a panel of medical professionals, established policies related to SCA which went into effect in 2015. These policies cover most students playing interscholastic sports, including 1,600 schools with 1.8 million students. CIF added SCA information to their existing training requirements for coaches. The CIF also added protocols similar to those in this bill. They include removal from athletic activity after a pupil passes out or faints during or right after activity, with a medical clearance required to return to activity. Similarly, pupils must be cleared if they are held out for exhibiting signs or symptoms associated with SCA. The policy requires a pupil and his or her parent or guardian to receive and sign a Sudden Cardiac Information sheet each year. The sponsors feel an information sheet serves the purpose of educating pupils and parents regarding symptoms that might otherwise be ignored. Given that the CIF implemented coaching training rules and a protocol for SCA in 2015, many of the informational and care guidelines in this bill already apply to the great majority of student athletes. To add another form for these same students seems duplicative. The sponsor would like to extend these guidelines to cover children in all grades and all school-sponsored sports, with coach training required, including at an elementary level, every two years. As written, the bill AB 1639 Page 7 appears to include any athletic activity occurring at a school, including independent club sports using school facilities and elementary school "field day" type competitions. Ideally, the sponsors have said, they would like every child screened, as SCA does not affect only athletes. Penalties. This bill's sponsors believe sanctions are needed to provide an incentive for coaches to follow the guidelines when they conflict with a desire to win. The CIF protocol on SCA does not contain sanctions. According to the CIF, coaches are employees of the school district, not the CIF. Existing law for concussions also do not contain sanctions. While current law on coaches speaks of the need for coaches to be trained in safety, including cardiopulmonary resuscitation requirements, it is silent on punishments for noncompliance in any area. Unintended consequence? Cardiologists writing in the American Heart Association publication, "Circulation", have noted that the number of specifically athletic sudden cardiac deaths among young people is "relatively small, with (about) 100 to 150 competitive deaths during sports in the United States annually." These cardiologists also suggested that "significant gaps in evidence exist related to effectiveness of preventing sudden death in the athlete with preparticipation screening strategies." The publication raised concern as to whether screening could inappropriately lead to students becoming less active - a known health risk. Committee amendments: 1)Because the definition of athletic activity is broad and somewhat unspecific, staff recommends that Section 33281(a)(2) be amended to more narrowly define athletic activity. This definition should include those activities sponsored by a school, but exclude those activities "associated with a school" or "sponsored by school-affiliated organizations." The Committee may consider further focusing the bill's requirements on schools with an athletic program. AB 1639 Page 8 2)Staff recommends that Section 33482(a) be amended to delete the requirement that the CDE be required to develop materials and to clarify that CDE is simply required to post specified informational material on its Web site. 3)To avoid duplication of notices, staff recommends that Section 33483 be amended to require, for athletic activities governed by CIF, that schools retain a copy of each signed SCA information sheet required by CIF; and that a pupil and parent or guardian participating in a sport not governed by CIF be required to sign and return to the school an acknowledgement of receipt and review of the information material made available on the CDE's website. 4)Staff recommends adding language consistent with that currently applied to concussion protection, stating, "This section does not apply to an athlete engaging in an athletic activity during the regular schoolday or as part of a physical education course required pursuant to subdivision (d) of Section 51220." (Physical education requirements) 5)Staff recommends changing, in Section 33485, "appropriate medical professional" to "licensed health care provider" to be more specific and consistent with concussion protections. 6)Staff recommends amending Section 33487 to delete penalties for violating Section 33485 and, for violations of Section 33486, to require suspension of a coach until completion of required training. The Committee may also consider striking Section 33487(b) with this amendment. AB 1639 Page 9 Related legislation. AB 1719 (Rodriguez), pending in this Committee, requires high school students to receive instruction in cardiopulmonary resuscitation and the use of an automated external defibrillator as part of a course required for graduation. A similar bill by this author was held in the Appropriations Committee suspense file in 2015. AB 2182 (Mullin), pending in this Committee, requires neurocognitive testing, as defined, for any pupil participating in interscholastic athletics before competitions have taken place and after any head injury. The bill also requires collecting and maintaining data on injuries, with reporting to the appropriate county office of education for compilation and retention. REGISTERED SUPPORT / OPPOSITION: Support Eric Paredes Save a Life Foundation (sponsor) American Academy of Pediatrics, California Children's Cardiomyopathy Foundation Heartfelt Cardiac Projects Mike Whitmarsh Memorial Foundation AB 1639 Page 10 Olivia's Heart Project San Diego City Councilmember Chris Cate San Diego City Councilmember Mark Kersey San Diego County Supervisor Ron Roberts Travis R. Roy Sudden Cardiac Arrest Fund Numerous individuals Opposition None on file Analysis Prepared by:Carlos Alcala and Sophia Kwong Kim / ED. / (916) 319-2087 AB 1639 Page 11