BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | SB 287| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- UNFINISHED BUSINESS Bill No: SB 287 Author: Hueso (D) Amended: 7/16/15 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 SENATE FLOOR: 28-3, 5/26/15 AYES: Allen, Beall, Block, Cannella, De León, Galgiani, Hancock, Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson, Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell, Monning, Nguyen, Pan, Pavley, Roth, Runner, Stone, Wolk NOES: Anderson, Moorlach, Morrell NO VOTE RECORDED: Bates, Berryhill, Fuller, Gaines, Hall, Nielsen, Vidak, Wieckowski ASSEMBLY FLOOR: 75-1, 8/27/15 - See last page for vote 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, 2017, to have an automated external defibrillator (AED) on the premises. SB 287 Page 2 Assembly Amendments 1) delay the operative date of this bill to January 1, 2017; 2) clarify that the provisions of the bill apply only to occupied buildings and not to structures that are vacant or under construction or renovation; 3) remove storage buildings and high-hazard buildings, and exempt licensed health facilities, as specified, from the requirements of this bill; 4) delete the state-owned or -operated exemption from the bill; and 5) conform the qualifications for immunity from civil liability to those qualifications in existing law. ANALYSIS: Existing law: 1)Classifies, in the California Code of 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; b) Ensures that any person who renders emergency care or treatment by using an AED activates the emergency medical SB 287 Page 3 services (EMS) 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 occupied structures that are constructed on or after January 1, 2017, 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, institutional buildings, and mercantile 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 acquires 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 any local government entity, storage buildings, as defined, high-hazard buildings, as defined, and health facilities, as specified, from the provisions of this bill. SB 287 Page 4 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 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 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 SB 287 Page 5 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: 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 SB 287 Page 6 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. 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 SB 287 Page 7 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, 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 SB 287 Page 8 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." FISCAL EFFECT: Appropriation: No Fiscal Com.:YesLocal: No According to the Assembly Appropriations Committee, likely minor annual state costs, related to the purchase, installation, and maintenance of AEDs and training on their use. These costs would be from the General Fund and various special funds and would depend on the number of applicable state buildings constructed each year. At the state level, this bill mainly impacts the Department of General Services (DGS), the Department of Corrections and Rehabilitation, the University of California, and the California State University. According to DGS, the cost of an AED unit is about $2,000. In addition, DGS provides training on AED operations through a contract costing $5,000 annually. Pending legislation would reduce training requirements, however. DGS notes that best practice is to have one AED on each floor, or if a building is single-story, to have an AED within one-minute walk of where any emergency could occur within the building. While meeting these practices would increase costs, this bill does not contain such requirements. SUPPORT: (Verified8/28/15) American Heart Association American Medical Response American Stroke Association California Business Properties Association California Professional Firefighters SB 287 Page 9 California State Firefighters Association City of Rancho Mirage Madaffer Enterprises Paramedics Plus San Diego City Firefighters Local 145 San Diego Project Heart Beat San Ysidro Health Center Sudden Cardiac Arrest Foundation OPPOSITION: (Verified8/28/15) None received 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. ASSEMBLY FLOOR: 75-1, 8/27/15 AYES: Achadjian, Alejo, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Roger SB 287 Page 10 Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, O'Donnell, Olsen, Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins NOES: Travis Allen NO VOTE RECORDED: Burke, Frazier, Harper, Obernolte Prepared by:Juan Reyes / HEALTH / 8/28/15 17:11:17 **** END ****