BILL ANALYSIS Ó
SENATE JUDICIARY COMMITTEE
Senator Hannah-Beth Jackson, Chair
2015-2016 Regular Session
AB 1719 (Rodriguez)
Version: June 22, 2016
Hearing Date: June 28, 2016
Fiscal: Yes
Urgency: No
RD
SUBJECT
Pupil instruction: cardiopulmonary resuscitation
DESCRIPTION
This bill, commencing with the 2018-19 school year, would
require the governing boards of any school district and any
charter school, offering instruction to pupils in grades 9 to
12, inclusive, to provide instruction in performing
"compression-only" cardiopulmonary resuscitation (CPR) as part
of a course offered in any of grades 9 to 12, as specified, and
would encourage these governing boards to provide to pupils
general information on the use and importance of an automated
external defibrillator (AED). Such instruction would have to be
provided to a pupil only one time. This bill would grant
immunity from civil liability to any local agency, state or
local government entity, or other public or private organization
that sponsors, authorizes, supports, finances, or supervises the
instruction of pupils in compression-only CPR or the use of an
AED pursuant to this bill, as well as any public employee who
provides or facilitates the instruction of pupils in
compression-only CPR or the use of an AED pursuant to this bill,
as specified. Such immunities, however, would not apply in
cases of gross negligence or willful or wanton misconduct.
BACKGROUND
In 1999, the Legislature passed and the Governor signed SB 911
(Figueroa, Ch. 163, Stats. 1999) which created a qualified
immunity from civil liability for trained persons who use
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automatic external defibrillators (AEDs<1>) in good faith and
without compensation when rendering emergency care or treatment
at the scene of an emergency. SB 911 also provided qualified
immunity from liability for building owners who installed AEDs
as long as they ensured that expected AED users completed a
training course. AB 2041 (Vargas, Ch. 718, Stats. 2002)
expanded this immunity by repealing the training requirements
for good faith users and also relaxing the requirement that
building owners must ensure that expected users complete
training as a condition of immunity. AB 2041 was enacted with a
five-year sunset which was extended another five years to
January 1, 2013, by AB 2083 (Vargas, Ch. 85, Stats. 2006). Most
recently, SB 1436 (Lowenthal, Ch. 71, Stats. 2012) was enacted
to delete the sunset, thereby extending the operation of those
provisions indefinitely.
Additionally, in 2005, AB 254 (Nakanishi, Ch. 111, Stats. 2005)
amended the above provisions to specify that, if an AED is
placed in a public or private K-12 school, the school principal
must annually provide school administrators and staff with a
brochure describing the proper use of an AED, post similar
information next to the AED, and designate trained employees to
be available to respond to an emergency that may involve the use
of an AED during normal operating hours. In 2014, AB 2217
(Melendez, Ch. 812, Stats. 2012) was enacted to state the intent
of the Legislature to encourage all public schools to acquire
and maintain at least one AED and allow schools to solicit and
receive nonstate funds for that purpose. That bill also
provided a qualified immunity for a school district and its
employees who use, attempt to use, or do not use an AED to
render emergency care or treatment.
Separately, over the years, California law has been amended to
permit school districts or county offices of education to
provide emergency epinephrine auto-injectors (commonly known as
"epi pens") to trained personnel, and to permit trained
personnel to utilize the auto-injectors to provide emergency
medical aid to persons suffering from an anaphylactic reaction,
as it is not uncommon for children to come into contact with
---------------------------
<1> An AED is a medical device which is 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.
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specific allergens (such as bee stings) or accidentally ingest
foods they are allergic to at school. (See AB 559 (Wiggins, Ch.
458, Stats. 2001); see also SB 1266 (Huff, Ch. 321, Stats.
2014), which was subsequently enacted to require, as opposed to
simply authorize, school districts, county offices of education,
and charter schools to provide emergency epinephrine
auto-injectors to voluntary, trained personnel who, consistent
with existing law, may use the auto-injectors to provide
emergency medical aid to persons suffering from an anaphylactic
reaction.)
More recently, in 2013, California law was expanded to also
permit certain Good Samaritans (specifically, prehospital
emergency medical care persons or lay rescuers), to obtain and
administer epinephrine auto-injectors to provide emergency
medical aid to persons suffering from anaphylactic shock. (SB
669 (Huff, Ch. 725, Stats. 2013).) In doing so, the legislation
granted such individuals, acting in good faith and not for
compensation, immunity for any civil damages resulting from any
acts or omissions in administering the auto-injector to a person
who appears to be experiencing anaphylaxis at the scene of an
emergency, as long as the person did not act with gross
negligence or willful or wanton misconduct, and otherwise
complies with certain requirements and standards, including
training requirements.
This bill would now require schools offering instruction to
pupils in grades 9-12, inclusive, to provide instruction in
performing "compression-only" CPR as part of a course at the
school. For these purposes, this bill would grant qualified
immunities similar to those provided to various individuals in
in the AED and epi-pen contexts, above, to: (1) any local
agency, entity of state or local government, or other public or
private organization that sponsors, authorizes, supports,
finances, or supervises the instruction of pupils in
compression-only CPR or the use of an AED pursuant to this bill;
and (2) any public employee who provides or facilitates the
instruction of pupils in compression-only CPR or the use of an
AED pursuant to this bill, as specified.
This bill was heard in the Senate Education Committee on June
15, 2016, and passed out on a vote of 9-0.
CHANGES TO EXISTING LAW
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Existing law requires school districts, county offices of
education, and charter schools to provide emergency epinephrine
auto-injectors to school nurses or trained personnel who have
volunteered, as specified, and provides that school nurses or
trained personnel may use epinephrine auto-injectors to provide
emergency medical aid to persons suffering, or reasonably
believed to be suffering, from an anaphylactic reaction.
Existing law provides for the defense and indemnification of any
employees who volunteer under this law, from any and all civil
liability, in accordance with, but not limited to, the
Government Tort Claims Act, as specified. (Ed. Code Sec.
49414(a), (j).)
Existing law provides that an authorizing physician and surgeon
shall not be subject to professional review, be liable in a
civil action, or be subject to criminal prosecution for the
issuance of a prescription or order, for the above purposes,
unless the physician and surgeon's issuance of the prescription
or order constitutes gross negligence or willful or malicious
conduct. (Ed. Code Sec. 49414(g)(4).)
Existing law provides that any prehospital emergency medical
care person or lay rescuer who administers an epinephrine
auto-injector, in good faith and not for compensation, to
another person who appears to be experiencing anaphylaxis at the
scene of an emergency situation is not liable for any civil
damages resulting from his or her acts or omissions in
administering the epinephrine auto-injector, if that person has
complied with the requirements and standards of the Health and
Safety Code, as specified. This protection from civil liability
does not apply in a case of personal injury or wrongful death
that results from the gross negligence or willful or wanton
misconduct of the person who renders emergency care treatment by
the use of an epinephrine auto-injector. (Civ. Code Sec.
1714.23(b), (c).)
Existing law provides that a person or entity that acquires an
automatic external defibrillator (AED) for emergency use is not
liable for any civil damages resulting from any acts or
omissions when the AED is used to render emergency care,
provided that the person or entity has complied with certain
notice, maintenance, and other reasonable care requirements
under the Health and Safety Code, as specified. (Civ. Code Sec.
1714.21(d)(1).)
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Existing law provides that the qualified immunities described
above do not apply in the case of personal injury or wrongful
death which results from the gross negligence or willful or
wanton misconduct of the person who uses the AED to render
emergency care. (Civ. Code Sec. 1714.21(f).)
Existing law establishes high school graduation requirements,
including three years in English, two years in math, and two
years of physical education, and permits school districts to
establish graduation requirements which exceed those required by
the state. (Ed. Code Sec. 51225.3.)
Existing law requires, through the adopted course of study, that
schools provide instruction at the appropriate grade levels on
personal and public safety and accident prevention, including
emergency first aid instruction, instruction in hemorrhage
control, treatment for poisoning, resuscitation techniques, and
CPR when appropriate equipment is available. (Ed. Code Sec.
51202.)
Existing law provides that, in order to encourage citizens to
participate in emergency medical services training programs and
to render emergency medical services to fellow citizens, no
person who has completed a basic CPR course which complies with
specified standards adopted by the American Heart Association or
the American Red Cross, and who, in good faith, renders
emergency CPR at the scene of an emergency, shall be liable for
any civil damages as a result of any acts or omissions by such
person rendering the emergency care, except where his or her
conduct constitutes gross negligence or is provided in exchange
for compensation. (Civ. Code Sec. 1714.2(a)-(b), (e).)
Existing law further provides that, in order to encourage local
agencies and other organizations to train citizens in CPR
techniques, no local agency, entity of state or local
government, or other public or private organization which
sponsors, authorizes, supports, finances, or supervises the
training of citizens in cardiopulmonary resuscitation shall be
liable for any civil damages alleged to result from such
training programs, except where his or her conduct constitutes
gross negligence or is provided in exchange for compensation.
Further, in order to encourage qualified individuals to instruct
citizens in CPR, no person who is certified to instruct in CPR
by either the American Heart Association or the American Red
Cross shall be liable for any civil damages alleged to result
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from the acts or omissions of an individual who received
instruction on cardiopulmonary resuscitation by that certified
instructor, except where his or her conduct constitutes gross
negligence or is provided in exchange for compensation, except
where his or her conduct constitutes gross negligence or is
provided in exchange for compensation. (Civ. Code Sec.
1714.2(b), (c), (d), (e).)
This bill would, commencing with the 2018-19 school year,
require the governing board of a school district, and the
governing body of a charter school, offering instruction to
pupils in grades 9 to 12, inclusive, to provide instruction in
performing compression-only cardiopulmonary resuscitation (CPR)
as part of a course offered in any of grades 9 to 12, inclusive,
as specified. This instruction shall be provided to a pupil only
one time and shall include both of the following:
an instructional program based on national evidence-based
emergency cardiovascular care guidelines for the performance
of compression-only CPR, such as those developed by the
American Heart Association or the American Red Cross; and
instruction to pupils relative to the psychomotor skills, as
defined, necessary to perform compression-only CPR.
This bill would encourage the governing board of a school
district or the governing body of a charter school to provide to
pupils general information on the use and importance of an AED,
but would specify that the physical presence of an AED in the
classroom is not required.
This bill would provide that a local agency, entity of state or
local government, or other public or private organization that
sponsors, authorizes, supports, finances, or supervises the
instruction of pupils in compression-only CPR or the use of an
AED pursuant to this section shall not be liable for any civil
damages alleged to result from the acts or omissions of an
individual who received such instruction.
This bill would also provide that a public employee who provides
or facilitates the instruction of pupils in compression-only CPR
or the use of an AED pursuant to this section shall not be
liable for any civil damages alleged to result from the acts or
omissions of an individual who received such instruction.
This bill would provide that neither of the provisions, above,
shall be construed to grant immunity from civil damages to any
person who provides or facilitates the instruction of pupils in
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compression-only CPR or the use of an AED in a manner that
constitutes gross negligence or willful or wanton misconduct.
COMMENT
1. Stated need for the bill
According to the author:
Sudden cardiac arrest is one of the most lethal public health
threats in the United States and sadly, only ten percent of
people who suffer cardiac arrest outside the hospital survive.
If no CPR is provided or no defibrillation occurs within 3 to
5 minutes of collapse, the chances of survival drop. Effective
bystander CPR provided immediately after sudden cardiac arrest
can double or triple a victim's chance of survival.
Alarmingly, 70 percent of Americans may feel helpless to act
during a cardiac emergency because they do not know how to
perform CPR and only 32 percent of cardiac arrest victims get
CPR from a bystander.
[ . . . ] Existing law, in order to encourage qualified
individuals to instruct citizens in CPR, provides certified
instructors with immunity from liability for any civil damages
alleged to result from the acts or omissions of the persons
they train to perform CPR. (Civil Code Section 1714.2 (d).)
Likewise, any person who has completed a basic CPR course and
who, in good faith and not for compensation, renders emergency
CPR at the scene of an emergency is immune from liability for
any civil damages as a result of doing so. (Civil Code 1714.2
(a).)
This bill does not affect the certification requirement for
instructors, or the training requirement for rescuers in
current law that apply to regular CPR in Civil Code Section
1714.2, above. For compression-only CPR, there is no
certification required to teach. According to both the
American Heart Association and American Red Cross,
compression-only CPR can be taught by anyone as long as they
are using an evidence-based instructional program.
AB 1719 requires compression-only instruction in a state or
locally required high school course. The bill also includes
civil liability protections for a local agency, state or local
government entity or public employee who provides or
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facilitates instruction in compression-only CPR.
In support, the Association of California Health Care Districts
writes that "[b]y expanding CPR training to children in grades
9-12, California is ensuring that we add to our pool of
Americans that are able to perform life-saving techniques in any
situation."
2. Qualified immunities under this bill follow models used for
AEDs and epi-pens
As a general rule, California law provides that everyone is
responsible, not only for the result of his or her willful acts,
but also for an injury occasioned to another by his or her want
of ordinary care or skill in the management of his or her
property or person, except so far as the latter has, willfully
or by want of ordinary care, brought the injury upon himself or
herself. (Civ. Code Sec. 1714(a).) Although immunity
provisions are rarely preferable because they, by their nature,
prevent an injured party from seeking a particular type of
recovery, the Legislature has in limited scenarios approved
limited immunity from liability (as opposed to blanket
immunities) to promote other policy goals that could benefit the
public. Along these lines, this Legislature has on multiple
occasions enacted legislation that encourages the use of life
saving medications or medical interventions (such as automatic
external defibrillators (AEDs), epinephrine auto-injectors
(epi-pens), and opioid antagonists) in order to avoid
preventable deaths by limiting the liability of "Good
Samaritans," as long as certain minimal requirements are met.
In doing so, however, the Legislature has consistently ensured
that the qualified immunity does not apply in the case of
personal injury or wrongful death which results from the gross
negligence or willful or wanton misconduct by the person who
renders the care. (See Civ. Code Sec. 1714.21.)
With respect to epi-pens, specifically, as noted in the
Background, California law already encourages the use of this
life-saving medication to avoid preventable deaths in both
schools and in the general public. In this vein, the Civil Code
provides certain Good Samaritans-namely, prehospital emergency
care persons and lay persons, as defined-acting in good faith
and not for compensation, qualified immunity from civil damages
for any of their acts or omissions in administering the epi-pen
to a person who appears to be suffering from anaphylaxis at the
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scene of emergency, if the person complies with certain
requirements and standards, including training requirements. As
mentioned above, this immunity is, however, qualified (i.e.,
limited), insofar as it does not apply to protect the person
from civil damages in any personal injury or wrongful death case
involving gross negligence or willful or wanton misconduct in
rendering emergency care treatment by use of the auto-injector.
Similarly, California law provides that, in order to encourage
local agencies and other organizations to train citizens in CPR
techniques, no local agency, entity of state or local
government, or other public or private organization which
sponsors, authorizes, supports, finances, or supervises the
training of citizens in cardiopulmonary resuscitation shall be
liable for any civil damages alleged to result from such
training programs, except where his or her conduct constitutes
gross negligence or is provided in exchange for compensation.
Similarly, in order to encourage qualified individuals to
instruct citizens in CPR, California law provides that no person
who is certified to instruct in CPR by either the American Heart
Association or the American Red Cross shall be liable for any
civil damages alleged to result from the acts or omissions of an
individual who received instruction on cardiopulmonary
resuscitation by that certified instructor, except where his or
her conduct constitutes gross negligence or is provided in
exchange for compensation. (See Civ. Code Sec. 1714.2.)
This bill, modeled upon such statutes, would now add similar
protection from civil liability for: (1) any local agency,
entity of state or local government, or other public or private
organization that sponsors, authorizes, supports, finances, or
supervises the instruction of pupils in compression-only CPR or
the use of an AED pursuant to this bill shall not be liable for
any civil damages alleged to result from the acts or omissions
of an individual who received such instruction; and (2) any
public employee who provides or facilitates the instruction of
pupils in compression-only CPR or the use of an AED pursuant to
this bill shall not be liable for any civil damages alleged to
result from the acts or omissions of an individual who received
such instruction. At the same time, like the previous qualified
immunities provided in the context of epi-pens and AEDs, this
protection from liability would also specify that the immunity
shall not be construed to grant immunity from civil damages to
any person who provides or facilitates the instruction of pupils
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in compression-only CPR or the use of an AED in a manner that
constitutes gross negligence or willful or wanton misconduct.
As stated by co-sponsor American Heart Association/American
Stroke Association [AHA/ASA], "CPR is already included in
California's Health Education Content Standards and AB 1719
would simply add hand-only psychomotor CPR into a state or local
required high school course. There is no certification.
Schools have great flexibility on how the training is
conducted-from partnering with healthcare professionals or the
local fire department as many other states have done, to
incorporating the training into a health or [physical education]
class."
By increasing the number of individuals who have received such
instruction, the proponents of the bill hope to facilitate the
instruction of compression-only CPR in schools to help increase
the likelihood that lives will be saved by bystanders. The
author asserts that, "[a]ccording to the American Heart
Association, 326,000 out-of-hospital sudden cardiac arrests
occur each year and only 32 [percent] of those cases receive CPR
from a bystander. Sadly, only 10 [percent] survive.
[Thirty-three] other states have passed similar legislation.
Although it is too soon for quantitative data to show an
improvement in sudden cardiac arrest survival rates, there are
numerous anecdotal examples of students who have learned CPR in
school and saved a life because of the skills they learned."
To this end, AHA/ASA adds that "immediate CPR and defibrillation
can more than double a victim's change of survival. Three to
five minutes is a matter of life and death for sudden cardiac
arrest victims. Every minute without life-saving CPR and
defibrillation, chances of survival decrease 7 [percent] - 10
[percent]." As noted by Dignity Health, in support of the bill,
"[g]iven the right way, CPR doubles or triples survival rates.
Incorporating hands-only psychomotor CPR into a required high
school course could save thousands of lives by filling our
communities with young adults trained to give cardiac arrest
victims the immediate help they need to survive until EMTs
arrive."
Support : American Federation of State, County and Municipal
Employees (AFSCME) AFL-CIO; American Nurses
Association\California; Association of California Healthcare
Districts; California Ambulance Association; California
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Association for Health, Physical Education, Recreation and
Dance; California Chapter of the American College of Emergency
Physicians; California Chapters of the American College of
Physicians; California Nursing Students' Association; California
School Nurses Organization; California State PTA; City of Los
Angeles; City of Los Angeles - Council President Pro Tempore,
Twelfth District, Mitchell Englander; City of San Diego -
Council President Pro Tem, Ninth District, Marti Emerald;
Dignity Health; League of California Cities; Olivia's Heart
Project; San Francisco Fire Department; Service Employees
International Union; numerous individuals
Opposition : None Known
HISTORY
Source : American Heart Association/American Stroke Association;
American Red Cross
Related Pending Legislation :
AB 1748 (Mayes, 2016) would, among other things, authorize
school nurses or, if the school does not have a school nurse, a
person who has received training regarding opioid antagonists,
as specified, to immediately administer the medication under
certain circumstances. The bill would provide for various
immunities, as specified. AB 1748 is also set for hearing
before this Committee.
AB 1386 (Low, 2016) would permit "authorized entities," defined
to include both private and government entities, to obtain
epinephrine auto-injectors for the use of any one of their
employees, volunteers, or agents, who is a lay rescuer, as
specified, to render emergency care to another person, and would
provide various immunities for these purposes. AB 1386 was
recently approved by this Committee.
Prior Legislation : See Background
Prior Vote :
Senate Education Committee (Ayes 9, Noes 0)
Assembly Floor (Ayes 77, Noes 1)
Assembly Appropriations Committee (Ayes 20, Noes 0)
Assembly Judiciary Committee (Ayes 10, Noes 0)
Assembly Education Committee (Ayes 6, Noes 0)
AB 1719 (Rodriguez)
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