BILL ANALYSIS Ó
SENATE COMMITTEE ON PUBLIC SAFETY
Senator Loni Hancock, Chair
2015 - 2016 Regular
Bill No: AB 1864 Hearing Date: June 14, 2016
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|Author: |Cooley |
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|Version: |March 17, 2016 |
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|Urgency: |No |Fiscal: |Yes |
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|Consultant:|JRD |
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Subject: Inquests: Sudden Unexplained Death In Childhood
HISTORY
Source: Sudden Unexplained Death in Childhood Foundation
Prior Legislation:AB 2029 (Cooley) - 2013-2014, vetoed by
Governor
Support: Several individuals
Opposition:California State Coroners' Association
Assembly Floor Vote: 78 - 0
PURPOSE
The purpose of this bill is to define "sudden unexplained death
in childhood" (SUDC), and require a coroner to notify the
parents or responsible adult of a child that comes within the
definition of the importance of taking tissue samples, as
specified.
Existing law requires a coroner to investigate the
circumstances, manner, and cause of specified types of deaths,
including violent, sudden, or unusual deaths; unattended deaths;
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and deaths where the deceased has not been attended to by a
physician within 20 days before the death occurred. Existing
law affords the coroner with the discretion to determine the
extent of the inquiry into a death occurring under natural
circumstances, and allows the coroner to authorize a physician
to sign the certificate of death if the physician has sufficient
knowledge to reasonably state the cause of a death occurring
under natural circumstances. (Government Code § 27491.)
Existing law provides that a coroner shall within 24 hours, or
as soon as feasible thereafter, where the suspected cause of
death is sudden infant death syndrome, take possession of the
body, and make or cause to be made a postmortem examination or
autopsy thereon, and the detailed medical findings resulting
from an examination of the body or autopsy by an examining
physician must either be reduced to writing, or permanently
preserved, as specified. (Government Code § 27491.4(a).)
Existing defines "sudden infant death syndrome" (SIDS) to mean
the sudden death of an infant that is unexpected by the history
of the infant and where a thorough postmortem fails to
demonstrate an adequate cause of death. (Government Code §
27491.49(a).)
Existing law requires that an autopsy conducted where it is
suspected that the cause of death is SIDS be conducted pursuant
to a standardized protocol developed by the State Department of
Public Health. The protocol shall be developed and approved by
July 1, 1990. (Government Code § 27491.41(d.).)
Existing law requires that all coroners, throughout the state,
follow the established protocol when conducting autopsies where
the suspected cause of death is SIDS, and requires a coroner to
state on the certificate of death that sudden infant death
syndrome was the cause of death when the findings are
consistent with the definition of SIDS. (Government Code §
27491.41(e).)
Existing law requires a coroner to perform or arrange for an
autopsy on a decedent upon a written request of the surviving
spouse, or in certain circumstances, a child, parent, or other
legal next-of-kin; and requires the cost of the autopsy to be
borne by the person requesting the autopsy. (Government Code §
27520.)
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This bill defines "sudden unexplained death in childhood" as the
sudden death of a child one year of age or older but under 18
years of age that is unexplained by the history of the child and
where a thorough post mortem exam fails to demonstrate adequate
cause for the death.
This bill requires the coroner to notify the parents or
responsible adult of a child that comes within the SUDC
definition of the importance of taking tissue samples.
This bill states that a coroner shall not be liable for damages
in a civil action for any act or omission in compliance with the
above provision.
RECEIVERSHIP/OVERCROWDING CRISIS AGGRAVATION
For the past several years this Committee has scrutinized
legislation referred to its jurisdiction for any potential
impact on prison overcrowding. Mindful of the United States
Supreme Court ruling and federal court orders relating to the
state's ability to provide a constitutional level of health care
to its inmate population and the related issue of prison
overcrowding, this Committee has applied its "ROCA" policy as a
content-neutral, provisional measure necessary to ensure that
the Legislature does not erode progress in reducing prison
overcrowding.
On February 10, 2014, the federal court ordered California to
reduce its in-state adult institution population to 137.5% of
design capacity by February 28, 2016, as follows:
143% of design bed capacity by June 30, 2014;
141.5% of design bed capacity by February 28, 2015; and,
137.5% of design bed capacity by February 28, 2016.
In December of 2015 the administration reported that as "of
December 9, 2015, 112,510 inmates were housed in the State's 34
adult institutions, which amounts to 136.0% of design bed
capacity, and 5,264 inmates were housed in out-of-state
facilities. The current population is 1,212 inmates below the
final court-ordered population benchmark of 137.5% of design bed
capacity, and has been under that benchmark since February
2015." (Defendants' December 2015 Status Report in Response to
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February 10, 2014 Order, 2:90-cv-00520 KJM DAD PC, 3-Judge
Court, Coleman v. Brown, Plata v. Brown (fn. omitted).) One
year ago, 115,826 inmates were housed in the State's 34 adult
institutions, which amounted to 140.0% of design bed capacity,
and 8,864 inmates were housed in out-of-state facilities.
(Defendants' December 2014 Status Report in Response to February
10, 2014 Order, 2:90-cv-00520 KJM DAD PC, 3-Judge Court, Coleman
v. Brown, Plata v. Brown (fn. omitted).)
While significant gains have been made in reducing the prison
population, the state must stabilize these advances and
demonstrate to the federal court that California has in place
the "durable solution" to prison overcrowding "consistently
demanded" by the court. (Opinion Re: Order Granting in Part and
Denying in Part Defendants' Request For Extension of December
31, 2013 Deadline, NO. 2:90-cv-0520 LKK DAD (PC), 3-Judge Court,
Coleman v. Brown, Plata v. Brown (2-10-14). The Committee's
consideration of bills that may impact the prison population
therefore will be informed by the following questions:
Whether a proposal erodes a measure which has contributed
to reducing the prison population;
Whether a proposal addresses a major area of public safety
or criminal activity for which there is no other
reasonable, appropriate remedy;
Whether a proposal addresses a crime which is directly
dangerous to the physical safety of others for which there
is no other reasonably appropriate sanction;
Whether a proposal corrects a constitutional problem or
legislative drafting error; and
Whether a proposal proposes penalties which are
proportionate, and cannot be achieved through any other
reasonably appropriate remedy.
COMMENTS
1.Need for This Legislation
According to the author:
In any case where an infant dies and the suspected cause of
death is Sudden Infant Death Syndrome, existing law
requires a coroner to perform an autopsy within twenty-four
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hours, or as soon as is feasibly possible. The coroner is
allowed to take samples, but is also required to inform the
infant's parent or guardian about the importance of taking
tissue samples for the purpose of further investigation.
Similar laws do not exist to require rapid investigation or
encourage proper management of the sudden and unexplained
deaths of child no longer in infancy.
2.Effect of This Legislation
According to the Sudden Unexplained Death in Childhood Program's
(SUDCP) website, SUDC is a rare condition that occurs in
children over the age of 12 months. According to the SUDCP, SUDC
is a diagnosis of exclusion that is given when all known and
possible causes of death have been ruled out. The SUDCP states
that the incidence of SUCD is approximately 1.3 deaths per
100,000 children, compared to 57 deaths per 100,000 live births
for SIDS in 2002. (http://sudc. org/About/FAQs.) The website
additionally, states, with regard to the collection of tissue:
If available to you, SUDC encourages the banking of your
child's DNA to provide you with options to pursue more
information about your child's death. As clinical testing
advances and research options improve, you may want to
access these opportunities. Securing a genetic specimen
(DNA) from your child may provide:
§ the opportunity for genetic testing to uncover specific
cause of death and appropriate testing of family
§ the opportunity for genetic testing to provide negative
results - which may assist in decreasing some anxiety
§ the opportunity for storing a genetic specimen -banking
DNA
§ Instill hope for cases that currently defy
understanding
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§ Allow for participation in present or future
research
§ Allow families to benefit from potential benefit of
future discoveries
(http://sudc.org/Research/Securing-and-Banking-DNA-after-SUD
C.)
According to the author, "reasons to take samples in SUDC cases
include observing tissues for abnormalities or damage, and
banking DNA for further investigation." To this end, this
legislation would require the coroner to notify the parents of
the importance of taking tissue samples.
1.Veto Message
AB 2029 (Cooley) of the 2013-2014 Legislative Session was
identical to this bill in that it required a coroner to advise
the parents of a child who has died of SUDC of the importance of
taking tissue samples. AB 2029 was vetoed by the Governor:
The bill would add a statutory definition of 'sudden
unexplained death in childhood' and require coroners to
notify parents or responsible parties about the importance
of taking tissue samples when such an unexplained death
occurs.
Rather than creating a state mandate at this juncture, we
should rely on coroners to use their best professional
judgment to provide appropriate and relevant information to
next of kin for this difficult circumstance.
4. Argument in Opposition
According to the California State Coroners' Association:
The death of a child is always handled as one of our
highest priority cases. Regardless of age, all
undetermined causes of death are taken extremely seriously
and investigated accordingly by the attending coroner.
Adding "sudden unexpected death in childhood" (SUDC) to
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statute suggest it, like SIDS, is a syndrome and creates a
new label absent scientific vetting or validation. There
is no syndrome of this type-it is a broad label given to
unidentified cause of death. While well intentioned, we
see this as problematic.
When a coroner or medical examiner signs a death
certificated, what appears in the certificate for cause of
death needs to be able to be coded to a "standard"
contained in the ICD-10 manual. The ICD-10 is used to code
and classify mortality dates from death certificated. The
ICD-10 is copyrighted by the World Health Organization
which owns and publishes the classification. The ICD-10
was developed following a thorough evaluation by a
Technical Advisory Panel and extensive additional
consultation with physician groups, clinical coders, and
other to assure clinical accuracy and utility.
It is important to note that Sudden Infant Death Syndrome
(SIDS) appears as an ICD-10 code. No such code appears for
the newly proposed Sudden Unexplained Death in Childhood
(SUDC). Therefore, it is extremely problematic to define
it as a new "standard" in statue without it having been
vetted for purposes of inclusion in the ICD-10.
Consequently, this bill establishes a definition in statute
which puts us at odds with existing international
classifications of diseases and causes of death.
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