BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 287
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|AUTHOR: |Hueso |
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|VERSION: |February 19, 2015 |
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|HEARING DATE: |April 15, 2015 | | |
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|CONSULTANT: |Juan Reyes |
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SUBJECT : Automated external defibrillators (AEDs)
SUMMARY : Requires certain buildings with capacities of 200 persons or
greater, as specified, constructed on or after January 1, 2016,
to have an automated external defibrillator (AED) on the
premises.
Existing law:
1.Classifies, in the California Code of Regulations
(Regulations), all buildings and structures as to use and
occupancy, and requires a room or space that is intended to be
occupied at different times for different purposes to comply
with all of the requirements that are applicable to each of
the purposes for which the room or space will be occupied.
2.Provides, in the Civil Code, immunity from civil liability for
the acts or omissions of any person who, in good faith and not
for compensation, renders emergency care or treatment by the
use of an AED at the scene of an emergency.
3.Provides, in the Civil Code, immunity from civil liability for
any acts or omissions in the rendering of emergency care by
the use of an AED for a person or entity that acquires an AED
for emergency use, if that person or entity has complied with
certain specified requirements in the Health and Safety Code.
4.Provides, in the Health and Safety Code, immunity from civil
liability for a person or entity that acquires an AED for any
acts or omissions in the rendering of emergency care if that
person or entity meets various requirements, including:
a. Ensures that the AED is checked for readiness after each
use and at least once every 30 days;
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b. Ensures that any person who renders emergency care or
treatment by using an AED activates the emergency medical
services system as soon as possible and reports the use to
the licensed physician and to the local EMS agency;
c. Ensures that for every AED unit acquired up to five
units, no less than one employee per AED unit, and one
employee for every additional five units, complete a
training course in cardiopulmonary resuscitation (CPR) and
AED use, as specified.
d. Ensure that tenants in a building where an AED is placed
receive a brochure describing the proper use of an AED and
are notified once a year of the location of AEDs.
This bill:
1.Requires the following structures that are constructed on or
after January 1, 2016, to have an AED on the premises subject
to the existing requirements listed in the Health and Safety
Code related to training and maintenance:
a. Assembly buildings, as defined, with an
occupancy of greater than 300;
b. Business buildings, educational buildings,
factory buildings, high-hazard buildings,
institutional buildings, mercantile buildings, and
storage buildings, as each of these buildings are
defined, and if they have occupancies of 200 or more;
and,
c. Residential buildings with occupancy of 200 or
more, excluding single-family and multi-family
dwelling units.
2.Provides immunity from civil liability for a person or entity
that supplies an AED pursuant to this bill, as specified in
existing provisions of law that condition immunity on meeting
certain requirements related to training and maintenance of
the AEDs.
3.Excludes structures owned or operated by the state or any
local entity from the provisions of this bill.
FISCAL
EFFECT : This bill has been keyed non-fiscal.
COMMENTS :
1.Author's statement. According to the author, an estimated
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350,000 individuals in the United States will suffer this year
from a Sudden Cardiac Arrest (SCA). For every minute an
individual goes without receiving defibrillation from an AED,
an individual's chances of surviving from SCA go down by 10
percent. Brain death and permanent death start to occur 4-6
minutes after someone experiences cardiac arrest. The use of
an AED in a timely manner can increase an individual's
probability of survival by 70 percent. By requiring AED
devices in newly constructed buildings with large occupancies,
we can ensure that more individuals will be located within 4
minutes of an AED, substantially increasing their chance of
survival. In my district, the City of San Diego has
implemented a similar ordinance, and has supported Project
Heartbeat, which provides AEDs and has saved 123 individuals.
2.Background. According to the American Heart Association
(AHA), an AED is a lightweight, portable device that delivers
an electric shock through the chest to the heart. The shock
can stop an irregular rhythm and allow a normal rhythm to
resume in a heart in sudden cardiac arrest. Sudden cardiac
arrest is an abrupt loss of heart function. If it is not
treated within minutes, it quickly leads to death. The AED has
a built-in computer which assesses the patient's heart rhythm,
determines whether the person is in cardiac arrest, and
signals whether to administer the shock. Audible cues guide
the user through the process.
According to the AHA, each year in the U.S., there are
approximately 359,400 Emergency Medical Services
(EMS)-assessed cardiac arrests outside of a hospital setting
and on average, less than 10 percent of victims survive. Early
defibrillation, along with CPR, is the only way to restore the
victim's heart rhythm to normal in a lot of cases of cardiac
arrest. For every minute that passes without CPR and
defibrillation, however, the chances of survival decrease by 7
to 10 percent. The 2013 Update of AHA's Heart Disease and
Stroke Statistics shows that 23 percent of out-of-hospital
cardiac arrests are "shockable" arrhythmias, or those that
respond to a shock from an AED, making AEDs in public places
highly valuable. Yet, AHA states there are not enough AEDs and
persons trained in using them and performing CPR to provide
this life-saving treatment, resulting in lost opportunities to
save more lives. Communities with comprehensive AED programs
that include CPR and AED training for rescuers have achieved
survival rates of nearly 40 percent for cardiac arrest
SB 287 (Hueso) Page 4 of ?
victims. AHA states on its website that it supports placing
AEDs in targeted public areas such as sports arenas, gated
communities, office complexes, doctor's offices, and shopping
malls. When AEDs are placed in the community or a business or
facility, AHA strongly encourages that they be part of a
defibrillation program which includes notification to the
local EMS office when an AED is acquired, that a licensed
physician or medical authority provides medical oversight to
ensure quality control, and that persons responsible for using
the AED are trained in CPR and how to use an AED.
3.California Code of Regulations Building Classification. In
California's Building Standards Code, Part 2, Chapter 3,
buildings and structures are classified with respect to use
and occupancy in each of the groups as follows:
a. Defines Assembly Group A occupancy as including,
among others, the use of a building or structure, or
portion thereof, for the gathering of persons for
purposes such as civic, social, or religious functions;
recreation, food, or drink consumption or motion picture
and television production sound stages, approved
production facilities and production locations.
b. Defines Business Group B occupancy as including,
among others, the use of a building or structure, or
portion thereof, for office, professional, or
service-type transactions, including storage of records
and accounts.
c. Defines Educational Group E occupancy as including,
among others, the use of a building or structure, or
portion thereof, by more than six persons at any one time
for educational purposes through the 12th grade, except a
residence used as a home school for the children who
normally reside at the residence.
d. Defines Factory Industrial Group F occupancy as
including, among others, the use of a building or
structure, or portion thereof, for assembling,
disassembling, fabricating, finishing, manufacturing,
packaging, repair or processing operations that are not
classified as a Group H hazardous or Group S storage
occupancy.
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e. Defines High-hazard Group H occupancy as including,
among others, the use of a building or structure, or
portion thereof, that involves the manufacturing
processing, generation or storage of materials that
constitute a physical or health hazard in quantities in
excess of those allowed in control areas, as further
defined.
f. Defines Institutional Group I occupancy as
including, among others, the use of a building or
structure, or portion thereof, in which care or
supervision is provided to persons who are or are not
capable of self-preservation without physical assistance
or in which persons are detained for penal or
correctional purposes or in which the liberty of the
occupants is restricted.
g. Defines Mercantile Group M occupancy as including,
among others, the use of a building or structure, or
portion thereof, for the display and sale of merchandise
and involves stocks of goods, wares or merchandise
incidental to such purposes and accessible to the public.
h. Defines Residential Group R occupancy as including,
among others, the use of a building or structure, or
portion thereof, for sleeping purposes when not
classified as Group I occupancy or when not regulated by
the California Residential Code.
i. Defines Storage Group S occupancy as including,
among others, the use of a building or structure, or
portion thereof, for storage that is not classified as a
hazardous occupancy.
4.Verdugo v. Target. On August 31, 2008, Mary Ann Verdugo was
shopping at a large Target store in Pico Rivera with her
mother and brother when she suffered a sudden cardiac arrest
and collapsed. In response to a 911 call, paramedics were
dispatched from a nearby fire station. It took the paramedics
several minutes to reach the store and a few additional
minutes to reach Verdugo inside the store. The paramedics
attempted to revive Verdugo but were unable to do so; Verdugo
was 49 years of age at the time of her death. Target did not
have an AED in its store.
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The Verdugo family filed a lawsuit alleging Target breached
the duty of care that it owed to its business customers,
including Mary Ann, by failing to have an AED for use in a
medical emergency. After moving the case from the Los Angeles
County Superior Court to the federal district court, the
federal district court dismissed the case after concluding
Target had no duty to acquire and make available an AED for
the use of its customers. The plaintiffs appealed to the Ninth
Circuit Court of Appeals, at which point the panel turned to
the California Supreme Court "as better positioned to address
[this] major question of California tort law than this court."
The California Supreme Court construed the Ninth Circuit
Court of Appeals' question as "whether, under California law,
the common law duty of reasonable care that defendant Target
Corporation owes to its business customers includes an
obligation to obtain and make available on its business
premises an [AED] for use in a medical emergency." On June 23,
2014, the California Supreme Court answered the question by
ruling that, "[U]nder California law, Target's common law duty
of care to its customers does not include a duty to acquire
and make available an AED for use in a medical emergency." On
October 28, 2014, the Ninth Circuit Court of Appeals,
following the guidance of the California Supreme Court,
affirmed the federal district court's ruling that Target had
no common law duty to provide an AED in its stores.
Judge Pregerson, a panelist of the Ninth Circuit Court of
Appeals, in a separate opinion, wrote:
"The California Supreme Court has spoken. This decision
holds that 'under California law, Target's common law duty
of care to its customers does not include a duty to acquire
and make available an AED for use in a medical emergency.'
And so, in this diversity case, that holding controls. But
that decision troubles me. Therefore, I write separately
hoping that big box stores like Target will, at the very
least, recognize their moral obligation to make AEDs
available for use in a medical emergency. Should that not
come to pass, I hope that our California Legislature takes
a hard look at this issue and considers a statutory
standard of care that will protect consumers by requiring
big box stores to make life-saving AEDs available."
5.Other jurisdictions. In November 2008, the San Diego City
Council passed legislation with requirements nearly identical
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to the provisions of this bill. Over the last six years, the
Oregon State Legislature has passed several pieces of
legislation relating to AEDs. In 2009, Oregon passed
legislation requiring certain places of public assembly,
defined as a facility of 50,000 square feet or more and at
least 50 individuals congregated on a normal business day, to
have automated external defibrillators. In 2010, Oregon also
passed a law requiring each school campus in a school
district, private school campus and public charter school
campus to have at least one AED on premises. Community
colleges and public universities are also required to have at
least one AED on the campus in Oregon.
6.Double referral. This bill is double referred. Should it pass
out of this committee, it will be referred to the Senate
Judiciary Committee.
7.Related legislation. SB 658 (Hill), repeals various
requirements relating to persons or entities who acquire
automated external defibrillators (AEDs), including
requirements that employees complete training and that the
AEDs be checked every 30 days, and makes the civil liability
immunity in existing law for persons or entities who acquire
an AED no longer conditional upon meeting specified
requirements. This bill was heard in this committee on April
8, 2015 and passed 9-0. This bill is pending in the Senate
Judiciary Committee.
8.Prior legislation. SB 1436 (Lowenthal), Chapter 71, Statutes
of 2012, removed the sunset date, thereby making permanent,
the existing protections that provide immunity from civil
damages in connection with the use of AEDs.
SB 127 (Calderon), Chapter 500, Statutes of 2010, removed the
July 1, 2012 sunset date for existing requirements that every
health studio acquires and maintains an AED and trains
personnel in its use thereby extending these requirements
indefinitely.
SB 63 (Price), of 2011, would have stated the intent of the
Legislature that all public high schools acquire and maintain
at least one AED and would require schools that decide to
acquire and maintain an AED, or to continue to use and
maintain an existing AED, to comply with specified
requirements. SB 63 was held in the Senate Appropriations
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Committee.
AB 2083 (Vargas), Chapter 85, Statutes of 2006, extended the
sunset date from 2008 to 2013 on the operative provisions of
existing law which provide immunity from civil damages for
persons or entities that acquire AEDs and comply with
maintenance, testing, and training requirements.
AB 1507 (Pavley), Chapter 431, Statutes of 2005, required all
health studios in the state to have automatic external
defibrillators (AEDs) available with properly trained
personnel until July 1, 2012.
AB 2041 (Vargas), Chapter 718, Statutes of 2002, expanded the
immunity protections for the use or purchase of an AED, and
included a sunset date of 2008.
SB 911 (Figueroa), Chapter 163, Statutes of 1999, created
qualified immunity from civil liability for trained persons
who use in good faith and without compensation an AED in
rendering emergency care or treatment at the scene of an
emergency.
9.Support. The California Professional Firefighters supports
this bill, stating that when an AED is used to treat cardiac
arrest, it serves as a life-saving device given that cardiac
arrest is a sudden condition that can be fatal if not treated
within a few minutes. Paramedics Plus, Alameda's 911 EMS
ambulance provider, also supports this bill, stating that AEDs
are inexpensive, easy to use, and save lives. Paramedics Plus
states that having access to an AED in a timely manner can
increase an individual's probability of a heart attack by as
much as 70 percent. Paramedics Plus also suggests an amendment
to the bill which would coordinate the location of each AED in
911 EMS dispatch centers. By identifying the location of AEDs,
Paramedics Plus believes response times will be cut in
emergencies thus saving even more lives. The Sudden Cardiac
Arrest Foundation supports this bill by stating that by
requiring the deployment of AEDs as part of an emergency
response plan, there will be a more effective and efficient
emergency response system in California commercial properties.
10.Opposition. The California Business Properties Association,
Building Owners and Managers Association of California,
Commercial Real Estate Development Association, and
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International Council of Shopping Centers all oppose this
bill, stating that advancements in technology in the use of
AEDs has made the existing standards for training and testing
obsolete. These opponents note that SB 648 (Hill), which
passed this committee on April 8, 2015, proposes to reform
these outdated requirements that have become barriers to
installation. Opponents state that mandating installation
before this reform has been enacted will put property owners
and tenants in an untenable position where they may be forced
to install a device but physically cannot comply with the
training requirements required by statute. Opponents also
state that building code has traditionally applied equally to
all structures based on occupancy, regardless of ownership.
SUPPORT AND OPPOSITION :
Support: California Professional Firefighters
Paramedics Plus
Sudden Cardiac Arrest Foundation
Oppose: California Business Properties Association
Building Owners and Managers Association of California
Commercial Real Estate Development Association, NAIOP
of California
International Council of Shopping Centers
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