BILL ANALYSIS                                                                                                                                                                                                    Ó



          SENATE COMMITTEE ON EDUCATION
                              Senator Carol Liu, Chair
                                2015 - 2016  Regular 

          Bill No:             AB 2182            
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          |Author:    |Mullin                                               |
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          |Version:   |May 31, 2016                             Hearing     |
          |           |Date:     June 22, 2016                              |
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          |Urgency:   |No                     |Fiscal:     |Yes             |
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          |Consultant:|Lenin DelCastillo                                    |
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          Subject:  School athletics:  neurocognitive testing


            SUMMARY
          
          This bill, contingent upon an appropriation, establishes the  
          Neurocognitive Testing Pilot Grant Program to provide funds to  
          Title I schools for the purpose of neurocognitive testing.  As  
          part of the pilot program, this bill requires school districts,  
          charter schools, and private schools that elect to offer sports  
          programs to collect and maintain data on traumatic brain  
          injuries and concussions sustained during these activities.

            BACKGROUND
          
          Existing law:

             1)   Requires a school district, charter school, or private  
               school that elects to offer an athletic program to  
               immediately remove from athletic activity for the remainder  
               of the day an athlete who is suspected of sustaining a  
               concussion or head injury.  Prohibits the athlete from  
               returning to the activity until he or she has been  
               evaluated by a licensed health care provider and receives a  
               written clearance from the health care provider.  

             2)   Provides that if the licensed health care provider  
               determines that the athlete sustained a concussion or a  
               head injury, the athlete shall complete a graduated  
               return-to-play protocol of no less than seven days in  







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               duration under the supervision of a licensed health care  
               provider.  

             3)   Annually requires a concussion and head injury  
               information sheet to be signed by the athlete's parent  
               prior to participation in athletic activity.  
               (Education Code § 49475)

             4)   Requires each high school sports coach to complete a  
               coaching education program developed by the employing  
               school district or the California Interscholastic  
               Federation that meets specified guidelines.  
          (Education Code § 49032)

             5)   Requires high school athletic coaches to complete  
               training regarding the identification of concussions.   
               (Education Code § 35179.1)



           ANALYSIS
          
          This bill:


          1)   Establishes the Neurocognitive Testing Pilot Grant Program  
               to provide grant funding to Title I schools for the  
               purposes of neurocognitive testing.


          2)   Requires the California Department of Education (CDE) to  
               establish an application process for school districts to  
               apply on behalf of Title I schools interested in  
               participating in the pilot program.  Requires the grants to  
               be apportioned under the pilot program to a total of three  
               school districts, which shall comprise one school district  
               in each of the following regions of the state:  southern,  
               central, and northern.  Requires each school district to  
               commit to participating in the pilot program for four  
               school years in order to track pupils tested in grade 9  
               through completion of high school.  


          3)   Requires the grant funds to be used for the following:








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                    a)             Baseline and postinjury neurocognitive  
                    testing of pupils attending a Title I school serving  
                    any of grades nine to 12, inclusive, participating in  
                    interscholastic athletics in any of the following  
                    sports:  baseball, basketball, cheerleading, field  
                    hockey, football, ice hockey, lacrosse, rugby, soccer,  
                    softball, volleyball, and wrestling.  The baseline  
                    neurocognitive testing shall 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, provided that the athlete is  
                    still participating in one or more of the 12 specified  
                    sports.  The baseline and postinjury neurocognitive  
                    testing shall be administered by individuals who have  
                    been trained to administer these tests.  These  
                    individuals may include, but are not necessarily  
                    limited to, employees of a participating school  
                    district.


                    b)             Postinjury neurocognitive testing of an  
                    athlete who is suspected of sustaining a concussion or  
                    head injury in an interscholastic athletic activity.   
                    Postinjury neurocognitive tests shall be conducted  
                    within 72 hours of the occurrence of the injury.


                    c)             Training of personnel or to consult  
                    with experts on the interpretation of postinjury test  
                    results.  The parent or guardian of each athlete  
                    participating in any of the sports shall also be  
                    notified, in writing, that the results of baseline and  
                    postinjury neurocognitive testing conducted on his or  
                    her child are available to the child's parent or  
                    guardian upon request.  These neurocognitive testing  
                    results may also be shared with the athlete's  
                    physician upon the request of the athlete's parent or  
                    guardian.










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                    d)             Reporting to the county office of  
                    education data that includes an overview of the  
                    baseline neurocognitive testing conducted for each of  
                    the sports specified in the bill and an overview of  
                    normal, abnormal, and follow-up postinjury  
                    neurocognitive tests.  The data shall also include the  
                    number of athletes who discontinue participation in  
                    the sport following a concussion and postinjury  
                    testing.


          4)   Defines "neurocognitive testing" as 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.


          5)   Requires the California Department of Education (CDE) to,  
               based on the data collected by the county office of  
               education located in the area of participating school  
               districts, prepare a report including, but not necessarily  
               limited to, all of the following information:


               a)        The number of athletes who received the baseline  
               tests.


               b)        The number of athletes who received the  
               postinjury tests.


                    c)             The number of athletes who had taken  
                    the tests and discontinued participation in any of the  
                    specified sports due to concussion injuries.


          6)   Requires the report to be submitted to the appropriate  
               policy committees of the Legislature on or before December  
               31, 2021, and to comply with Government Code Section 9795.


          7)   Specifies that the operation of this bill is contingent  








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               upon the appropriation of funds in the annual Budget Act or  
               another statute.  


          8)   Specifies that the program shall remain in effect until  
               January 1, 2022, unless a later enacted statute, that is  
               enacted before January 1, 2022, deletes or extends that  
               date.


          9)   Requires a school district, charter school, or private  
               school that elects to offer an interscholastic athletic  
               program to collect and maintain data on traumatic brain  
               injuries and concussions sustained by any of its pupils  
               during an interscholastic athletic activity.  Requires this  
               data to be reported periodically to the appropriate county  
               office of education, but provides that the names of the  
               injured pupils be kept confidential.  Requires the county  
               office of education to compile and retain the data for  
               summary and analysis as it deems necessary.

          STAFF COMMENTS
          
          1)   Need for the bill.   The author indicates that the number  
               of reported sports-related concussions among student  
               athletes has risen dramatically, including a doubling  
               between 2002 and 2012.  Further, "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-20's and  
               therefore, young athletes experiencing head injuries are at  
               greater risk of long-term brain damage if injured during  
               the critical stages of brain development."   This bill is  
               intended to generate data to provide a better understanding  
               of the frequency of sports-related head injuries among  
               athletes.

          2)   What is neurocognitive testing?    The bill defines  
               neurocognitive testing as 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.  It is used to  








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               evaluate brain processing and can be conducted with pencil  
               and paper, or with computerized testing.  Testing can be  
               used as a baseline to gauge an athlete's condition  
               post-injury relative to performance before injury.  As  
               such, it can be a factor in making decisions as to whether  
               and when an athlete should return to activity and what  
               kinds of activity may be safe for that athlete. 
          
          3)   Concussions in sports.  The dangers of concussions and head  
               injuries in sports have been a growing concern, with  
               frequent news reports of athletes, primarily football  
               players, sustaining traumatic and lasting injuries.  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.


               A few school districts in San Mateo County have sought  
               stronger protections for student athletes and have, in some  
               cases, paid for neurocognitive testing.  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.


          4)   Limits on practice and full-contact.  The California  
               Interscholastic Federation (CIF) governs competitive  
               athletics in grades 9-12.  The CIF is comprised of 10  
               Sections across the State; each Section has a governing  








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               body that, among other things, adopts rules and regulations  
               in addition to those promulgated by the State CIF.  Each  
               Section establishes its own rules governing the scope of  
               team practice.  It appears that five of the Sections allow  
               football teams to conduct full-contact practice during the  
               off-season while five do not allow full-contact practice  
               during the off-season.  For example, the Sac-Joaquin  
               Section allows full-contact football camp during the summer  
               and the Southern Section prohibits full-contact practice or  
               camps during the summer.  

               The CIF recently adopted Bylaw 506 which, effective August  
               1, 2014, limits all athletic teams to no more than 18 hours  
               of practice time per week and no more than four hours in  
               any single day.


          5)   Fiscal impact.  According to the Assembly Appropriations  
               Committee, this bill would result in the following:

               a)        Proposition 98/General Fund cost pressures,  
                    potentially in the tens of thousands to fund the pilot  
                    program. The program is contingent upon an  
                    appropriation in the budget act. 

               b)        General Fund costs to the California Department  
                    of Education (CDE) of approximately $264,000 to  
                    administer the grant program for four years.  The CDE  
                    would be required to develop, implement, monitor,  
                    collect and analyze data, and prepare reports to the  
                    Legislature on the findings for each grant awarded. 

               c)        Unknown, potentially reimbursable Proposition  
                    98/General Fund state mandated costs, likely in the  
                    thousands of dollars, for county offices of education  
                    to compile and retain data for summary and analysis. 

            SUPPORT
          
          California Concussion Institute
          California Optometric Association
          California Psychological Association
          Consumer Attorneys of California
          San Mateo Union High School District








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            OPPOSITION
           
           None received.

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