BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                    AB 2007


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          Date of Hearing:  May 3, 2016


           ASSEMBLY COMMITTEE ON ARTS, ENTERTAINMENT, SPORTS, TOURISM, AND  
                                   INTERNET MEDIA


                                  Kansen Chu, Chair


          AB 2007  
          (McCarty) - As Amended April 26, 2016


          SUBJECT:  Youth athletics:  youth sports organizations:   
          concussions or other head injuries.


          SUMMARY:  Would require amateur youth sports organizations to  
          adopt concussion treatment and recognition protocols similar to  
          those in existing law for student athletes, as specified. Would  
          also require youth sports organizations to develop  
          return-to-play protocols, and provide yearly concussion and head  
          injury information sheets and education, as specified.  
          Specifically, this bill:





          1)Declares that a youth sports organization that elects to offer  
            an athletic program shall comply with all the following:

             a)   An athlete who is suspected of sustaining a concussion  
               or other head injury in an athletic activity shall be  
               immediately removed from the athletic activity for the  
               remainder of the day, and shall not be permitted to return  
               to the athletic activity until he or she is evaluated by a  
               licensed health care provider. 








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             b)   The athlete shall not be permitted to return to the  
               athletic activity until he or she receives written  
               clearance to return to the athletic activity from a  
               licensed health care provider. 



             c)   If the licensed health care provider determines that the  
               athlete sustained a concussion or other head injury, the  
               athlete shall also complete a graduated return-to-play  
               protocol of no less than seven days in duration under the  
               supervision of a licensed health care provider.



          2)Provides that if an athlete who is 17 years of age or younger  
            has been removed from athletic activity due to a suspected  
            concussion, the youth sports organization shall notify a   
            parent or guardian of that athlete of the time and date of the  
            injury, the symptoms observed, and any treatment provided for  
            the injury. 



          3)Requires, on a yearly basis, the youth sports organization  
            shall give a concussion and head injury information sheet to  
            each athlete. The information sheet shall be signed and  
            returned by the athlete and, if the athlete is 17 years of age  
            or younger, shall also be signed by the athlete's parent or  
            guardian, before the athlete initiates practice or  
            competition.



          4)Further requires, on a yearly basis, that the youth sports  
            organization shall give concussion and head injury education  








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            or educational materials or both to each coach and  
            administrator of the youth sports organization.



          5)States that the youth sports organization shall identify both  
            of the following: 



             a)   An individual within the youth sports organization who  
               is responsible for ensuring compliance by the organization  
               with the requirements for providing concussion and head  
               injury education contained in paragraph (4). 



             b)   Details of the return-to-play protocol required pursuant  
               to paragraph (1).

          6)Contains the following definitions:



             a)   "Concussion and head injury education and educational  
               materials" and a "concussion and     head injury education  
               information sheet" shall at a minimum include information  
               relating to all of the following:



             b)   Head injuries and their potential consequences.



             c)   The signs and symptoms of concussion.











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             d)   Best practices for removal of an athlete from an  
               athletic activity after a suspected concussion.



             e)   Steps for returning an athlete to school and athletic  
               activity after a concussion or head injury. 



          7)"Licensed health care provider" means a licensed health care  
            provider who is trained in the evaluation and management of  
            concussions and is acting within the scope of his or her  
            practice.



          8)"Youth sports organization" means an organization, which may  
            include, but is not necessarily limited to, a business or  
            nonprofit entity or a local governmental agency, that sponsors  
            or conducts amateur athletic competitions, camps, or clubs in  
            which persons 17 years of age or younger participate.



          9)Declares that this section shall not be construed to prohibit  
            a youth sports organization, or any other appropriate entity,  
            from adopting and enforcing rules intended to provide a higher  
            standard of safety for athletes than the standard established  
            under this section.



          EXISTING LAW:  


          1)Limits full-contact practices, as defined, for high school and  
            middle school football and urges the California  
            Interscholastic Federation (CIF) adoption of rules to  








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            implement such guidelines. (Education Code 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; requires  
            athletes and parents to receive, sign and return a head injury  
            information sheet annually before practice or competition; and  
            excludes athletic activities during the regular school day or  
            as part of a physical education course. (Education Code 49475)

          3)Requires a high school sports coach to complete education  
            programs developed by his or her school district and the CIF  
            and meeting specific guidelines. (Education Code 49032)

          FISCAL EFFECT:  None. The Legislative Counsel has keyed this  
          measure as non-fiscal.


          COMMENTS:  


          1)Author's statement and supporters: Existing school-based  
            protections for children in sports do not reach amateur youth  
            sports organizations. The author adds that, "With this  
            legislation I intend to mitigate the growing problem of  
            injured athletes by creating awareness of sports-related head  
            injuries and having a proper protocol for concussion  
            detections, treatment, and post-concussion management for  
            youth sports leagues." As need for such protection he points  
            to a 2014 study, wherein the Boston University School of  
            Medicine found former NFL players' who began playing football  
            before age 12 "demonstrate significantly greater impairment"  
            than those who started playing later in life. The bill's  
            sponsors, the California Athletic Trainers' Association state  
            in their support, "This bill will help close many loopholes in  
            concussion management at the youth sports level, and help  
            protect our most vulnerable athletes by providing similar  








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            safeguards that are afforded to high school and college  
            athletes." The California State PTA draw attention in their  
            letter of support to the provisions of the bill which "assure  
            that parents are provided annually with a concussion and head  
            injury information sheet and that young athletes are removed  
            immediately from an athletic activity if they are suspected of  
            sustaining a concussion or other head injury." 



          2)Background: 



             a)   Concussions and Chronic Traumatic Encephalopathy (CTE)  
               making recent news. The dangers of concussions and head  
               injuries in sport have been a growing concern, with  
               frequent news reports of athletes, primarily football  
               players, sustaining traumatic and lasting injuries. On  
               March  1, 2016, this committee participated in a screening  
               of the movie "Concussion" featuring Dr. Bennett Omalu who  
               discussed his ground breaking research into CTE which was  
               the focus of the film, in conjunction with a discussion of  
               the topic of sports safety and concussion prevention by the  
               California Athletic Trainers' Association (CATA). In  
               addition to a major motion picture on the issue, other  
               dramatic news reports in March alone include:

          A Purdue University study in 2015 indicated lasting brain  
          changes among high school football players, even without  
          concussions, and that changes were not completely healed at the  
          end of an off-season. The study used brain scans and changes in  
          brain chemistry to track players more extensively than  
          neurocognitive testing.

               i)     A representative of the National Football League  
                 testified that there is a connection between football and  
                 chronic traumatic encephalopathy.









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               ii)    Women's soccer standout Brandi Chastain announced  
                 she would donate her brain to science for research into  
                 head injuries.

               iii)   Ivy League schools announced they would eliminate  
                 full-contact practices for football.

          The growing awareness of concussion dangers has led California  
          to enact a series of bills to protect students by limiting  
          full-contact practices; requiring education and information for  
          coaches, pupils and their parents; and protocols for removing  
          students from activity after injury and for returning them to  
          play (See comment 5 below).

             b)   Concussions have greater adverse effect on younger  
               athletes: As this committee learned in hearing AB 2182  
               (Mullin), at our last hearing, research shows that the  
               human brain does not fully develop until a person's  
               mid-20s. Therefore, young athletes experiencing head  
               injuries are at greater risk of long-term brain damage if  
               injured during the critical stages of brain development.  
               From 2002 to 2012 the number of reported sports-related  
               concussions among student athletes doubled. This increase  
               in reported concussions is attributed to various factors,  
               including greater awareness and recognition of traumatic  
               brain injuries. However, research shows that it is likely  
               that self-reported concussion symptoms are under diagnosed,  
               which may lead athletes to return to play prematurely.

               According to recent research, "Although most (80-90%)  
               concussions resolve within 7-10 days, the recovery process  
               can be longer and more complicated in children and  
               adolescents. Furthermore, younger athletes have a higher  
               risk of severe symptoms and cognitive decline?Due to the  
               more complex recovery process in young athletes, they need  
               protection when they are most vulnerable." (Mukland and  
               Serra, Concussions and Brain Injuries in Youth Sports,  
               December 2015, Rhode Island Medical Journal).  









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               In addition, studies show that the risk of a second  
               concussion if an athlete returns to play too soon is  
               greater for youth, both in likelihood and severity.  
               "Athletes who return to play before their concussions have  
               fully resolved may place themselves at an increased risk  
               for prolonged recovery. Although very rare, the potential  
               for catastrophic head injuries, including what is sometimes  
               called 'second impact syndrome' is the primary concern.  
               While catastrophic head injury is uncommon, it may occur  
               more frequently in younger athletes between the ages of 12  
               to 18 years." (Graham, Rivara, et al, Sports-Related  
               Concussions in Youth: Improving the science, changing the  
               culture, 2014, National Academy of Sciences).


          3)What is CTE and how is it related to concussions? According to  
            information on the website of the Bennett Omalu Foundation,  
            "Chronic Traumatic Encephalopathy (CTE) is a progressive  
            degenerative disease that afflicts the brain of people who  
            have suffered repeated concussions and traumatic brain  
            injuries (TBI). Though Bennet Omalu first discovered CTE in  
            the brain of NFL Hall of Famer Mike Webster in 2002, it was  
            previously thought to have existed in boxers, and was referred  
            to as dementia pugilistica. It has since been found in the  
            brains of more than ninety NFL players, and other athletes,  
            including wrestlers and hockey players. It has also been  
            identified in the brains of deceased military veterans,  
            domestic abuse victims, and others.

            "The brain of an individual who suffers from CTE gradually  
            deteriorates and begins to lose mass. Brain trauma can also  
            cause the accumulation of a type of protein called tau, which  
            significantly interferes with brain function. As CTE  
            progresses, it can cause memory loss, impulsive and erratic  
            behavior, difficulty with balance, impaired judgment, and  
            behavioral disturbances including aggression, depression, and  
            increased suicidality. Ultimately, CTE progresses to the onset  
            of dementia. A similar accumulation of tau protein is also  








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            seen in the brains of Alzheimer's patients. CTE symptoms can  
            manifest months or years after brain trauma, and a definitive  
            diagnosis of CTE can only be made after death by analyzing  
            brain tissue at autopsy.

            "The CDC estimates that up to 3.8 million concussions occur  
            each year, with up to ten percent of high school athletes  
            suffering from post-concussion syndrome. Trauma is also often  
            repeated: an athlete who sustains a concussion is four to six  
            times more likely to sustain a second concussion. It's not  
            well understood how these incidents of trauma progress to CTE  
            and currently there is no cure."

          4)Return-to-Play Protocol: This bill would prohibit an athlete  
            who is suspected of sustaining a concussion from returning to  
            the athletic activity in which he or she suffered the  
            concussion until the athlete has completed a return-to-play  
            protocol of not less than 7 days in duration.  This bill makes  
            no reference to any particular protocol; however the United  
            States' Center for Disease Control (CDC) describes a  
            Return-To-Play Protocol, (RTP) which consists of 5 "steps"  
            following a complete physical and the absence of concussion  
            symptoms for a period of 24 hours. The steps progress from  
            light aerobic exercise for 5-10 minutes, to moderate exercise,  
            to non-contact but more intense exercise, a reintegration into  
            full practice, and finally a return to play. The CDC  
            emphasizes the need for each of these steps to be monitored  
            for a return of concussion symptoms. In addition to the CDC  
            protocol, the California Interscholastic Federation has  
            similar guidelines for RTP which are in place for high school  
            athletics.


          5)Prior and related legislation:


             a)   AB 2127 (Mullin), of 2016, would create a baseline  
               neurocognitive testing pilot program for concussion and  
               head injury, as defined, applying to students playing  








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               interscholastic sports, as provided, and requires specified  
               schools to collect, maintain and report on traumatic brain  
               injuries sustained by any pupil during athletic  
               competition. That measure passed out of this committee on a  
               7-0 vote and is currently pending before the Assembly  
               Appropriations Committee.



             b)   AB 2127 (Cooley), Chapter 165, Statutes of 2014, among  
               other things, limits full-contact practices for high school  
               and middle school football teams for concussion and head  
               injury prevention, and requires that a return-to-play  
               protocol after concussion or head injury be no less than  
               seven days in duration.



             c)   AB 588 (Fox), Chapter 423, Statutes of 2013, applies  
               existing law relating to students who sustain, or are  
               suspecting of sustaining, a concussion during a  
               school-sponsored athletic activity to charter schools and  
               private schools.  



             d)   AB 1451 (Hayashi), Chapter 173, Statutes of 2012,  
               includes a basic understanding of the signs and symptoms of  
               concussions and the appropriate response to concussions  
               within the HSCET, administered by school districts.



             e)   AB 1449 (Hayashi), of 2012, would have required the SPI  
               to develop and make available a sample concussion and head  
               injury information sheet for use by school districts. That  
               measure was held in the Assembly Education Committee.










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             f)   AB 25 (Hayashi), Chapter 465, Statutes of 2011, requires  
               a school district that elects to offer athletic programs to  
               immediately remove an athlete who is suspected of  
               sustaining a concussion or head injury during that  
               activity; prohibits the return of the athlete to that  
               activity until he or she is evaluated by, and receives  
               written clearance from, a licensed health care provider;  
               requires, on a yearly basis, a concussion and head injury  
               information sheet to be signed and returned by the athlete  
               and the athlete's parent or guardian before the athlete's  
               initiating practice or competition. 



             g)   AB 1646 (Hayashi) of 2010, would have required training  
               for coaches to be able to identify symptoms of head and  
               neck injury. That measure was held in the Assembly  
               Appropriations Committee suspense file.



             h)   AB 1893 (Hayashi), of 2010, would have required all high  
               school spirit activities coaches to have valid  
               certification in CPR and first aid, including an  
               understanding of signs, symptoms, and appropriate emergency  
               action steps regarding potentially catastrophic injury,  
               including but not limited to, head and neck injury and  
               concussion. Pupils participating in this activity who  
               experience or show signs of trauma or other injury must  
               obtain a release from the treating provider before resuming  
               these activities. That measure was held in the Assembly  
               Education Committee



             i)   AB 533 (Hayashi), of 2009, would have required training  
               for coaches to be able to identify symptoms of head and  
               neck injury. That measure was held in the Assembly  








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               Appropriations Committee suspense file.
          REGISTERED SUPPORT / OPPOSITION:




          Support


          California Athletic Trainers Association (Sponsor)


          California School Nurses Association


          California State Parent Teacher Association (PTA)


          The Child Abuse Prevention Center




          Opposition


          There is no opposition on file.




          Analysis Prepared by:Dana Mitchell / A.,E.,S.,T., & I.M. / (916)  
          319-3450














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