BILL ANALYSIS Ó
AB 2182
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Date of Hearing: April 12, 2016
ASSEMBLY COMMITTEE ON ARTS, ENTERTAINMENT, SPORTS, TOURISM, AND
INTERNET MEDIA
Kansen Chu, Chair
AB 2182
(Mullin) - As Amended March 29, 2016
AS PROPOSED TO BE AMENDED IN COMMITTEE
SUBJECT: School athletics: neurocognitive testing.
SUMMARY: Creates a baseline neurocognitive testing pilot
program for concussion and head injury, as defined, applying to
students playing interscholastic sports, as provided, and
requires specified schools to collect, maintain and report on
traumatic brain injuries sustained by any pupil during athletic
competition.
Specifically, this bill:
1)Creates a Neurocognitive Testing Pilot Grant Program, which
would provide grants to schools, subject to appropriation, in
order to do the following:
a) Establish baseline neurocognitive testing of pupils
attending grades 9 through 12, as specified.
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Further requires that this testing must take place at the
beginning of an athletic season before any competitions have
taken place and after any head injury, and shall be repeated at
intervals not exceeding 24 months for as long as the athlete is
enrolled at the school.
b) Provide post injury neurocognitive testing of an athlete
who is suspected of sustaining a concussion or head injury
in an athletic activity.
Mandates post injury neurocognitive tests be conducted within 72
hours of the occurrence of the injury.
c) Train personnel or to consult with experts on the
interpretation of post injury test results.
d) Report to the county office of education data that
includes an overview of the baseline neurocognitive testing
conducted for each of the sports covered under the program,
and an overview of normal, abnormal, and follow-up post
injury neurocognitive tests. The data shall also include
the number of athletes who discontinue participation in the
sport following a concussion and post injury testing.
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2)States that the grant funds shall be used for testing of
pupils participating in interscholastic athletics in any of
the following sports:
a) Baseball.
b) Basketball.
c) Cheerleading.
d) Field hockey.
e) Football.
f) Ice hockey.
g) Lacrosse.
h) Rugby.
i) Soccer.
j) Softball.
aa) Volleyball.
bb) Wrestling.
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3)Declares that the department shall develop an application for
school districts interested in participating in the pilot
program.
4)Requires that school districts interested in participation
must commit to participating in the pilot for four years in
order to track students tested in grade 9 through high school.
5)Defines "Neurocognitive testing" to mean: a comprehensive
evaluation of a person's cognitive status by specific
neurologic domains, including, but not necessarily limited to,
memory, attention, problem solving, language, visuospatial,
processing speed, motor, and emotion.
6)Requires the department to submit a report, as specified,
within six months after the conclusion of the grant program to
the appropriate policy committees of the Legislature with the
following information:
a) The number of athletes who received the baseline tests.
b) The number of athletes who received the post injury
tests.
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c) The number of athletes who had taken the tests and
discontinued participation in any of the sports covered
under the program due to concussion injuries.
7)Requires school districts, charter schools, or private schools
to collect and maintain data on traumatic brain injuries and
concussions sustained by any of its pupils during an athletic
competition.
8)Provides that this data shall be reported periodically to the
appropriate county office of education, but the names of the
injured pupils shall be kept confidential. The county office
of education shall compile and retain the data for summary and
analysis as it deems necessary.
9)Declares the bill's provisions will sunset January 1, 2022.
10)Makes related findings and declarations.
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
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
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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: Unknown
COMMENTS:
1)Author's statement in support and need for legislation.
According to the author, "A concussion is a traumatic brain
injury (TBI) caused by a bump, blow, or jolt to the head.
Although concussions are generally considered mild TBIs, they
can have serious consequences if not properly diagnosed and
managed. Athletes who sustain concussions are at greater risk
of chronic traumatic encephalopathy, depression, early onset
dementia, and long-term brain damage.
"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 TBIs.
However, research shows that it is likely that self-reported
concussion symptoms are under diagnosed, which may lead
athletes to return to play prematurely."
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This bill stems in part from events in the author's district,
where some school districts in San Mateo County have sought
stronger protections for student athletes and have, in some
cases, paid for neurocognitive testing. Following on this, the
San Mateo County Civil Grand Jury studied the issue and
recommended, among other things, that all districts in the
county serving high school students provide neurocognitive
testing for all student athletes, and recommended that the
districts seek funding and collect data. The grand jury report
noted that a leading purveyor of the tests charges school
districts $1,200 for 800 baseline tests. These tests are
computerized, with results received automatically by the
testing company.
2)Background: 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) A representative of the National Football League
testified that there is a connection between football and
chronic traumatic encephalopathy.
b) Women's soccer standout Brandi Chastain announced she
would donate her brain to science for research into head
injuries.
c) Ivy League schools announced they would eliminate
full-contact practices for football.
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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.
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).
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
seen in the brains of Alzheimer's patients. CTE symptoms can
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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)Education Committee amendments will be taken in this
committee. This measure was heard in the Committee on
Education April 6, 2016, and in that hearing the author
accepted substantial amendments. Due to the approaching
deadline for hearing of fiscal bills and committee schedules
these amendments could not be put in print within the time
allowed by the Joint Rules, and therefore they will be adopted
and put into the measure in this committee. The following
describes the amendments:
a) The bill now creates a pilot project. Committee staff
expressed concern that requiring all school districts to
implement neurocognitive testing of all athletes
participating in the specified sports will create a
significant mandate, noting that there are 1.8 million
students participating in California Interscholastic
Federation sports alone. The amendments strike that
requirement and establish a four-year grant program in
three districts (one in northern, one in central and one in
southern California) based on the parameters of the bill.
According to the Education Committee analysis, operating the
pilot for four years would allow districts to track first year
high school students through potentially four years of sports
activities. Districts interested in participating in the pilot
shall receive funds for administering baseline and post-injury
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neurocognitive tests to high school students participating in
the specified sports identified in the bill and to pay for
training of personnel or to consult with experts on the
interpretation of post-injury test results.
Selection shall be based on a district's commitment to
participate in the pilot for four years, a commitment to submit
specified data to the county office of education (COE) and other
criteria established by the California Department of Education
(CDE). Within six months after the conclusion of the pilot, the
CDE shall, based on data provided by COEs located in the
districts participating in the pilot program, submit a report to
the appropriate policy committees of the Legislature on the
number of athletes that received the baseline tests and the
post-injury tests, and the number of athletes who had taken the
tests and stopped playing a sport due to concussion injuries.
b) Other amendments:
i) Amend the findings and declarations section to
replace "physicians" with "licensed health care
providers."
ii) Revise various parameters of the bill for
implementation through a pilot program, such as deleting
charter schools and private schools from the bill,
deleting the requirement that school districts pay for
the tests, and deleting specific requirements as to who
administers and interprets the tests.
iii) Revise the provision requiring submission of
neurocognitive testing data to the COE to instead require
all school districts and charter schools to submit data
on the number of athletes sustaining brain injuries and
concussions to the COE.
5)Committee conforming language amendment suggested.
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The pilot program language and reporting requirements
contained in Section 1 of the bill refer to injuries sustained
during "athletic activities," which would include injuries
which were suffered during both competition and practices.
However, the injury report language contained in section 2 of
the bill refers only to injuries sustained during "athletic
competition." The author has agreed to amend the bill in order
to conform the language of these two sections, and will amend
page 5, line 6, to strike the word "competition" and replace
it with "activity."
6)Prior and related legislation.
a) AB 2007 (McCarty), Legislation of 2016, would protect
youth sports participants from severe injury by requiring
the same protocols to be in place as those in place for
high school athletes. AB 2007 is currently pending before
this 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, extends
requirements relating to students who sustain, or are
suspected of sustaining, a concussion during a
school-sponsored athletic activity to charter schools and
private schools.
d) AB 25 (Hayashi), Chapter 456, Statues of 2011, among
other things, requires an athlete suspected of sustaining a
concussion or head injury to be removed from activity
immediately, requires written clearance from a medical
health care provider for the athlete's return and requires
a yearly information sheet be signed by an athlete and the
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athlete's parent or guardian.
REGISTERED SUPPORT / OPPOSITION:
Support
California Psychological Association
Consumer Attorneys of California
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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