BILL ANALYSIS                                                                                                                                                                                                    Ó






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                                   THIRD READING 


          Bill No:  AB 2182
          Author:   Mullin (D) 
          Amended:  5/31/16 in Assembly
          Vote:     21 

           SENATE EDUCATION COMMITTEE:  9-0, 6/22/16
           AYES:  Liu, Block, Hancock, Huff, Leyva, Mendoza, Monning, Pan,  
            Vidak

           SENATE APPROPRIATIONS COMMITTEE:  7-0, 8/11/16
           AYES: Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen

           ASSEMBLY FLOOR:  80-0, 6/2/16 - See last page for vote

           SUBJECT:   School athletics:  neurocognitive testing


          SOURCE:    Author


          DIGEST:  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.


          ANALYSIS:  

          Existing law:








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          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 duration under the supervision of a  
            licensed health care provider.  

          3)Requires, annually, 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)

          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  







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            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:


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







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          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.

          Comments
          
          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.

          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 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  







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          athlete. 
               
          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.


          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 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  







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          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.


          FISCAL EFFECT:   Appropriation:    No          Fiscal  
          Com.:YesLocal:   Yes


          According to the Senate Appropriations Committee, this bill  
          would result in the following:

           Unknown cost pressure to implement this pilot as costs would  
            depend on the size of the school districts awarded.  Costs  
            likely in the tens of thousands to low hundreds of thousands  
            annually, unless the Los Angeles Unified School District is  
            awarded, which would increase costs to about $2 million.

           The CDE estimates costs of about $252,000 spanning across  
            several positions over the life of the pilot for start-up  
            activities, administering the program, and the reporting  
            requirement if the program were to be funded.  (General Fund)

           Cost pressure, potentially in the hundreds of thousands, for  
            all school districts and charter schools that offer an  
            interscholastic athletic program to collect, maintain, and  
            report data on traumatic brain injuries and concussions.   
            Potential minor reimbursable state mandate costs for county  
            offices of education to compile and retain the data.   
            (Proposition 98)

           Significant cost pressure to the extent the pilot is funded,  
            to subsequently expand it statewide.  (Proposition 98)


          SUPPORT:   (Verified8/12/16)


          California Athletics Trainers' Association
          California Concussion Institute







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


          OPPOSITION:   (Verified8/12/16)


          None received

          ASSEMBLY FLOOR:  80-0, 6/2/16
          AYES:  Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker,  
            Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke,  
            Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley,  
            Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth  
            Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto,  
            Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper,  
            Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim,  
            Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis,  
            Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte,  
            O'Donnell, Olsen, Patterson, Quirk, Ridley-Thomas, Rodriguez,  
            Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting,  
            Wagner, Waldron, Weber, Wilk, Williams, Wood, Rendon

          Prepared by:Lenin DelCastillo / ED. / (916) 651-4105
          8/15/16 19:39:46


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