BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | SB 287| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- THIRD READING Bill No: SB 287 Author: Hueso (D) Introduced:2/19/15 Vote: 21 SENATE HEALTH COMMITTEE: 9-0, 4/15/15 AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen, Pan, Roth, Wolk SENATE JUDICIARY COMMITTEE: 4-2, 5/12/15 AYES: Jackson, Hertzberg, Leno, Monning NOES: Moorlach, Anderson NO VOTE RECORDED: Wieckowski SUBJECT: Automated external defibrillators SOURCE: Author DIGEST: This bill 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. ANALYSIS: Existing law: 1)Classifies, in the California Code of Regulations, all SB 287 Page 2 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; 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 SB 287 Page 3 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. Comments 1)Author's statement. According to the author, "an estimated 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)According to the American Heart Association (AHA), an AED is a SB 287 Page 4 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 SCA. SCA 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% 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%. The 2013 Update of AHA's Heart Disease and Stroke Statistics shows that 23% 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% for cardiac arrest victims. AHA states on its Web site 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. 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: SB 287 Page 5 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. 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. SB 287 Page 6 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 SCA 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. 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, SB 287 Page 7 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 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 AEDs. 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. Related Legislation SB 658 (Hill), as amended April 27, 2015, repeals and revises various requirements relating to persons or entities who acquire SB 287 Page 8 AEDs and makes the civil liability immunity in existing law for persons or entities who acquire an AED no longer conditional upon meeting specified requirements. 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, 2011) would have stated the intent of the Legislature that all public high schools acquire and maintain at least one AED and would have 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 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 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. FISCAL EFFECT: Appropriation: No Fiscal Com.:NoLocal: No SB 287 Page 9 SUPPORT: (Verified5/14/15) American Medical Response California Professional Firefighters California State Firefighters' Association Madaffer Enterprises, Inc. Paramedics Plus San Diego City Fire Fighters Local 145 San Ysidro Health Center Sudden Cardiac Arrest Foundation OPPOSITION: (Verified5/14/15) Building Owners and Managers Association of California California Business Property Association Commercial Real Estate Development Association, NAIOP of California International Council of Shopping Centers ARGUMENTS IN 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%. Paramedics Plus also suggests an amendment to this 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. SB 287 Page 10 ARGUMENTS IN OPPOSITION: The California Business Properties Association, Building Owners and Managers Association of California, Commercial Real Estate Development Association, and 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, 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. Prepared by:Juan Reyes / HEALTH / 5/15/15 15:24:27 **** END ****