BILL ANALYSIS Ó
AB 2425
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Date of Hearing: April 27, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
AB
2425 (Brown) - As Amended April 5, 2016
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Urgency: No State Mandated Local Program: YesReimbursable: Yes
SUMMARY:
This bill requires the California Department of Public Health
(CDPH) to establish a uniform incident site report for
unintentional injury incidents, and authorizes CDPH to require
data collection and reporting. Specifically, this bill:
1)Requires CDPH, on or before June 1, 2018, to adopt standards and
protocols to establish a uniform incident site report
requirement for the collection of statewide information on
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unintentional injury, and requires inclusion of specified
stakeholders in the development of standards and protocols.
2)Requires the standards and protocols to be implemented by every
county for use by the appropriate local reporting entities, and
authorizes CDPH to define the appropriate reporting entity.
3)Requires the standards and protocols to include the following:
a) A requirement that a reporting entity use an incident site
reporting best practices form and incident site investigation
protocol, specific to each type of unintentional injury, to
report information to existing local, regional, and statewide
data systems and to the local health department; and,
b) A requirement that the county health department be
responsible for submitting the data received to the state's
EpiCenter data system, no later than 60 days after receipt of
the incident site report.
4)Defines "incident site reports" or "incident" to include, among
others, site reports or incidents that involve unintentional
injuries from drowning, near drowning, burns, window falls,
bicycle crashes, pedestrian crashes, sleep suffocation, kids
left in cars, vehicle backovers, vehicle frontovers,
sports-related activities, and poisoning.
FISCAL EFFECT:
1)First-year costs to CDPH of $2.6 million GF, including $1.9
million for upgrades to the state's data system and $700,000 for
staff and related expenses.
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2)Annual costs to CDPH estimated at $1 million GF for staffing and
data system maintenance.
3)This bill contains two separate provisions that could result in
state-reimbursable mandate costs:
a) Potential for significant costs for site investigation
and data collection. This bill requires "reporting
entities" to report to existing local, regional, and state
data systems using the protocols developed by CDPH.
Mandate costs would depend on which entities are designated
as reporting entities and what the protocols require. For
example, if CDPH designates local public agencies, such as
local law enforcement agencies, as reporting entities,
local staff costs and state-reimbursable mandate costs
could be significant. If incurred, it is reasonable to
assume this cost could exceed $1 million annually and
potentially be much larger, depending on the protocols
defined by CDPH, which would in turn drive the number of
injuries subject to reporting.
b) Significant costs for local health department
reporting. Once data is collected by local investigators,
this bill specifies local health departments are
responsible to submit data to the state's data system,
resulting in significant state-reimbursable mandate costs.
It is reasonable to assume this cost could exceed $1
million annually and potentially be much larger, depending
on the protocols defined by CDPH.
COMMENTS:
1)Purpose. According to the author, California lacks a uniform
standard for collecting data from unintentional injury incident
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sites involving children and youth 0-19 years of age. Several
counties have developed best practice incident report forms, but
most counties do not have the resources to research and develop
unintentional injury incident forms and data collection. The
author indicates without uniform collection of incident and site
reporting, California does not have the information it needs to
plan for and adjust our unintentional injury prevention programs
and incident responses. This bill would provide such standards
and require data to be collected, in order to inform preventive
strategies.
2)Unintentional injury is common and prevalent. The Centers for
Disease Control and Prevention reports that for 2013, there were
31 million emergency department visits for unintentional
injuries, representing nearly one in ten people every year. A
subset of these injuries result in hospitalization, and an even
smaller subset result in deaths.
According to CDPH, unintentional injury is the leading cause of
hospitalizations and deaths for California's children and youth
ages one to19 years old. The U.S. Department of Health and Human
Services has identified reduction of unintentional injuries
age-adjusted death rate as a priority objective of the Healthy
People 2020 national health improvement plan.
CDPH maintains on its Website the EPICenter data system, which
includes information on overall injury surveillance and includes
data on all types of injuries that result in death,
hospitalizations, or an emergency department visit. Data on
unintentional injuries has informed many policy changes and
recommendations the public now takes for granted, including
seatbelt laws, playground safety standards, teen driver
restrictions, and infant sleep suffocation recommendations.
3)Support. This bill is sponsored by the California Coalition for
Children's Safety and Health and is supported by the American
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College of Emergency Physicians, California Chapter and the
Child Abuse Prevention Center.
4)Opposition. The Emergency Medical Services Administrators
Association of California states in opposition they are
concerned that this bill may delay the transport of critically
injured patients to trauma centers and encumber limited
emergency medical services resources by requiring personnel and
providers to conduct mandated injury prevention investigations
while at the scene of a medical emergency. The County Health
Executives Association of California (CHEAC) is also in
opposition, noting this requirement is duplicative of current
reporting, including required reporting to trauma registries.
CHEAC explains requiring local health departments (LHDs) to
collect these incident reports and report them to CDPH is both
redundant of current practice as well as an unfunded mandate on
local jurisdictions. Furthermore, they note, the sheer number of
these potential incidents could create a huge workload for local
health departments
The California Chamber of Commerce and California Attractions
and Parks have taken an oppose unless amended position based on
potential burden and concerns of litigation, seeking amendments
to clarify data will be provided on an aggregate basis and will
otherwise be confidential, limiting the collection to incidents
occurring to children ages 0-19, and eliminating duplicative
reporting.
5)Prior legislation.
a) AB 299 (Brown) of 2015 required DPH to develop a
submersion incident form to collect standardized information
regarding drowning or nonfatal-drowning events, as specified.
AB 299 was held on the Suspense File of this committee.
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b) AB 540 (Pan) of 2013 authorized CDPH to establish and
maintain a system for collecting data on violent deaths in
the state. AB 540 was held on the Suspense File of the
Senate Appropriations Committee.
6)Staff Comments. As drafted, the bill applies to unintentional
injuries for people of all ages. However, supporting background
information, as well as findings and declarations, are relevant
only to children ages 0-19. This bill provides broad authority
to CDPH to require unknown public or private entities to collect
and report an unknown volume of information. This bill also does
not specify what threshold of seriousness an injury would need
to meet in order to be subject to data collection and reporting.
This uncertainty of scope makes it difficult to assess costs
and benefits of data collection. Finally, although
investigations of serious incidents are often conducted by local
entities, requiring data collection and reporting in statute
makes the activity subject to mandate claims from public
entities.
The author may wish to consider narrowing the bill to the
development of standards and protocols, and the revision of
existing CDPH data systems to align with such protocols. The
stakeholder process required in the bill would likely elucidate
the extent to which voluntary compliance with best practices for
incident data collection and reporting could offer an
alternative to a potentially costly statutory mandate. In
addition, if the intent is to focus on incidents involving
children, this should be specified. Finally, the author may
wish to consider how the state can best reconcile data
collection and reporting as envisioned here with existing
related or duplicative statutory requirements to promote
efficiency and minimize overall burden.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081
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