BILL ANALYSIS Ó
AB 2007
Page 1
Date of Hearing: May 3, 2016
ASSEMBLY COMMITTEE ON ARTS, ENTERTAINMENT, SPORTS, TOURISM, AND
INTERNET MEDIA
Kansen Chu, Chair
AB 2007
(McCarty) - As Amended April 26, 2016
SUBJECT: Youth athletics: youth sports organizations:
concussions or other head injuries.
SUMMARY: Would require amateur youth sports organizations to
adopt concussion treatment and recognition protocols similar to
those in existing law for student athletes, as specified. Would
also require youth sports organizations to develop
return-to-play protocols, and provide yearly concussion and head
injury information sheets and education, as specified.
Specifically, this bill:
1)Declares that a youth sports organization that elects to offer
an athletic program shall comply with all the following:
a) An athlete who is suspected of sustaining a concussion
or other head injury in an athletic activity shall be
immediately removed from the athletic activity for the
remainder of the day, and shall not be permitted to return
to the athletic activity until he or she is evaluated by a
licensed health care provider.
AB 2007
Page 2
b) The athlete shall not be permitted to return to the
athletic activity until he or she receives written
clearance to return to the athletic activity from a
licensed health care provider.
c) If the licensed health care provider determines that the
athlete sustained a concussion or other head injury, the
athlete shall also complete a graduated return-to-play
protocol of no less than seven days in duration under the
supervision of a licensed health care provider.
2)Provides that if an athlete who is 17 years of age or younger
has been removed from athletic activity due to a suspected
concussion, the youth sports organization shall notify a
parent or guardian of that athlete of the time and date of the
injury, the symptoms observed, and any treatment provided for
the injury.
3)Requires, on a yearly basis, the youth sports organization
shall give a concussion and head injury information sheet to
each athlete. The information sheet shall be signed and
returned by the athlete and, if the athlete is 17 years of age
or younger, shall also be signed by the athlete's parent or
guardian, before the athlete initiates practice or
competition.
4)Further requires, on a yearly basis, that the youth sports
organization shall give concussion and head injury education
AB 2007
Page 3
or educational materials or both to each coach and
administrator of the youth sports organization.
5)States that the youth sports organization shall identify both
of the following:
a) An individual within the youth sports organization who
is responsible for ensuring compliance by the organization
with the requirements for providing concussion and head
injury education contained in paragraph (4).
b) Details of the return-to-play protocol required pursuant
to paragraph (1).
6)Contains the following definitions:
a) "Concussion and head injury education and educational
materials" and a "concussion and head injury education
information sheet" shall at a minimum include information
relating to all of the following:
b) Head injuries and their potential consequences.
c) The signs and symptoms of concussion.
AB 2007
Page 4
d) Best practices for removal of an athlete from an
athletic activity after a suspected concussion.
e) Steps for returning an athlete to school and athletic
activity after a concussion or head injury.
7)"Licensed health care provider" means a licensed health care
provider who is trained in the evaluation and management of
concussions and is acting within the scope of his or her
practice.
8)"Youth sports organization" means an organization, which may
include, but is not necessarily limited to, a business or
nonprofit entity or a local governmental agency, that sponsors
or conducts amateur athletic competitions, camps, or clubs in
which persons 17 years of age or younger participate.
9)Declares that this section shall not be construed to prohibit
a youth sports organization, or any other appropriate entity,
from adopting and enforcing rules intended to provide a higher
standard of safety for athletes than the standard established
under this section.
EXISTING LAW:
1)Limits full-contact practices, as defined, for high school and
middle school football and urges the California
Interscholastic Federation (CIF) adoption of rules to
AB 2007
Page 5
implement such guidelines. (Education Code 35179.5)
2)Requires an athlete suspected of sustaining a concussion or
head injury during athletic activity to be removed from that
activity and not be permitted to return until evaluated and
cleared by a licensed health care provider; urges the CIF to
develop rules and protocols to implement this; requires
athletes and parents to receive, sign and return a head injury
information sheet annually before practice or competition; and
excludes athletic activities during the regular school day or
as part of a physical education course. (Education Code 49475)
3)Requires a high school sports coach to complete education
programs developed by his or her school district and the CIF
and meeting specific guidelines. (Education Code 49032)
FISCAL EFFECT: None. The Legislative Counsel has keyed this
measure as non-fiscal.
COMMENTS:
1)Author's statement and supporters: Existing school-based
protections for children in sports do not reach amateur youth
sports organizations. The author adds that, "With this
legislation I intend to mitigate the growing problem of
injured athletes by creating awareness of sports-related head
injuries and having a proper protocol for concussion
detections, treatment, and post-concussion management for
youth sports leagues." As need for such protection he points
to a 2014 study, wherein the Boston University School of
Medicine found former NFL players' who began playing football
before age 12 "demonstrate significantly greater impairment"
than those who started playing later in life. The bill's
sponsors, the California Athletic Trainers' Association state
in their support, "This bill will help close many loopholes in
concussion management at the youth sports level, and help
protect our most vulnerable athletes by providing similar
AB 2007
Page 6
safeguards that are afforded to high school and college
athletes." The California State PTA draw attention in their
letter of support to the provisions of the bill which "assure
that parents are provided annually with a concussion and head
injury information sheet and that young athletes are removed
immediately from an athletic activity if they are suspected of
sustaining a concussion or other head injury."
2)Background:
a) Concussions and Chronic Traumatic Encephalopathy (CTE)
making recent news. The dangers of concussions and head
injuries in sport have been a growing concern, with
frequent news reports of athletes, primarily football
players, sustaining traumatic and lasting injuries. On
March 1, 2016, this committee participated in a screening
of the movie "Concussion" featuring Dr. Bennett Omalu who
discussed his ground breaking research into CTE which was
the focus of the film, in conjunction with a discussion of
the topic of sports safety and concussion prevention by the
California Athletic Trainers' Association (CATA). In
addition to a major motion picture on the issue, other
dramatic news reports in March alone include:
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.
i) A representative of the National Football League
testified that there is a connection between football and
chronic traumatic encephalopathy.
AB 2007
Page 7
ii) Women's soccer standout Brandi Chastain announced
she would donate her brain to science for research into
head injuries.
iii) Ivy League schools announced they would eliminate
full-contact practices for football.
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 (See comment 5 below).
b) Concussions have greater adverse effect on younger
athletes: As this committee learned in hearing AB 2182
(Mullin), at our last hearing, research shows that the
human brain does not fully develop until a person's
mid-20s. Therefore, young athletes experiencing head
injuries are at greater risk of long-term brain damage if
injured during the critical stages of brain development.
From 2002 to 2012 the number of reported sports-related
concussions among student athletes doubled. This increase
in reported concussions is attributed to various factors,
including greater awareness and recognition of traumatic
brain injuries. However, research shows that it is likely
that self-reported concussion symptoms are under diagnosed,
which may lead athletes to return to play prematurely.
According to recent research, "Although most (80-90%)
concussions resolve within 7-10 days, the recovery process
can be longer and more complicated in children and
adolescents. Furthermore, younger athletes have a higher
risk of severe symptoms and cognitive decline?Due to the
more complex recovery process in young athletes, they need
protection when they are most vulnerable." (Mukland and
Serra, Concussions and Brain Injuries in Youth Sports,
December 2015, Rhode Island Medical Journal).
AB 2007
Page 8
In addition, studies show that the risk of a second
concussion if an athlete returns to play too soon is
greater for youth, both in likelihood and severity.
"Athletes who return to play before their concussions have
fully resolved may place themselves at an increased risk
for prolonged recovery. Although very rare, the potential
for catastrophic head injuries, including what is sometimes
called 'second impact syndrome' is the primary concern.
While catastrophic head injury is uncommon, it may occur
more frequently in younger athletes between the ages of 12
to 18 years." (Graham, Rivara, et al, Sports-Related
Concussions in Youth: Improving the science, changing the
culture, 2014, National Academy of Sciences).
3)What is CTE and how is it related to concussions? According to
information on the website of the Bennett Omalu Foundation,
"Chronic Traumatic Encephalopathy (CTE) is a progressive
degenerative disease that afflicts the brain of people who
have suffered repeated concussions and traumatic brain
injuries (TBI). Though Bennet Omalu first discovered CTE in
the brain of NFL Hall of Famer Mike Webster in 2002, it was
previously thought to have existed in boxers, and was referred
to as dementia pugilistica. It has since been found in the
brains of more than ninety NFL players, and other athletes,
including wrestlers and hockey players. It has also been
identified in the brains of deceased military veterans,
domestic abuse victims, and others.
"The brain of an individual who suffers from CTE gradually
deteriorates and begins to lose mass. Brain trauma can also
cause the accumulation of a type of protein called tau, which
significantly interferes with brain function. As CTE
progresses, it can cause memory loss, impulsive and erratic
behavior, difficulty with balance, impaired judgment, and
behavioral disturbances including aggression, depression, and
increased suicidality. Ultimately, CTE progresses to the onset
of dementia. A similar accumulation of tau protein is also
AB 2007
Page 9
seen in the brains of Alzheimer's patients. CTE symptoms can
manifest months or years after brain trauma, and a definitive
diagnosis of CTE can only be made after death by analyzing
brain tissue at autopsy.
"The CDC estimates that up to 3.8 million concussions occur
each year, with up to ten percent of high school athletes
suffering from post-concussion syndrome. Trauma is also often
repeated: an athlete who sustains a concussion is four to six
times more likely to sustain a second concussion. It's not
well understood how these incidents of trauma progress to CTE
and currently there is no cure."
4)Return-to-Play Protocol: This bill would prohibit an athlete
who is suspected of sustaining a concussion from returning to
the athletic activity in which he or she suffered the
concussion until the athlete has completed a return-to-play
protocol of not less than 7 days in duration. This bill makes
no reference to any particular protocol; however the United
States' Center for Disease Control (CDC) describes a
Return-To-Play Protocol, (RTP) which consists of 5 "steps"
following a complete physical and the absence of concussion
symptoms for a period of 24 hours. The steps progress from
light aerobic exercise for 5-10 minutes, to moderate exercise,
to non-contact but more intense exercise, a reintegration into
full practice, and finally a return to play. The CDC
emphasizes the need for each of these steps to be monitored
for a return of concussion symptoms. In addition to the CDC
protocol, the California Interscholastic Federation has
similar guidelines for RTP which are in place for high school
athletics.
5)Prior and related legislation:
a) AB 2127 (Mullin), of 2016, would create a baseline
neurocognitive testing pilot program for concussion and
head injury, as defined, applying to students playing
AB 2007
Page 10
interscholastic sports, as provided, and requires specified
schools to collect, maintain and report on traumatic brain
injuries sustained by any pupil during athletic
competition. That measure passed out of this committee on a
7-0 vote and is currently pending before the Assembly
Appropriations Committee.
b) AB 2127 (Cooley), Chapter 165, Statutes of 2014, among
other things, limits full-contact practices for high school
and middle school football teams for concussion and head
injury prevention, and requires that a return-to-play
protocol after concussion or head injury be no less than
seven days in duration.
c) AB 588 (Fox), Chapter 423, Statutes of 2013, applies
existing law relating to students who sustain, or are
suspecting of sustaining, a concussion during a
school-sponsored athletic activity to charter schools and
private schools.
d) AB 1451 (Hayashi), Chapter 173, Statutes of 2012,
includes a basic understanding of the signs and symptoms of
concussions and the appropriate response to concussions
within the HSCET, administered by school districts.
e) AB 1449 (Hayashi), of 2012, would have required the SPI
to develop and make available a sample concussion and head
injury information sheet for use by school districts. That
measure was held in the Assembly Education Committee.
AB 2007
Page 11
f) AB 25 (Hayashi), Chapter 465, Statutes of 2011, requires
a school district that elects to offer athletic programs to
immediately remove an athlete who is suspected of
sustaining a concussion or head injury during that
activity; prohibits the return of the athlete to that
activity until he or she is evaluated by, and receives
written clearance from, a licensed health care provider;
requires, on a yearly basis, a concussion and head injury
information sheet to be signed and returned by the athlete
and the athlete's parent or guardian before the athlete's
initiating practice or competition.
g) AB 1646 (Hayashi) of 2010, would have required training
for coaches to be able to identify symptoms of head and
neck injury. That measure was held in the Assembly
Appropriations Committee suspense file.
h) AB 1893 (Hayashi), of 2010, would have required all high
school spirit activities coaches to have valid
certification in CPR and first aid, including an
understanding of signs, symptoms, and appropriate emergency
action steps regarding potentially catastrophic injury,
including but not limited to, head and neck injury and
concussion. Pupils participating in this activity who
experience or show signs of trauma or other injury must
obtain a release from the treating provider before resuming
these activities. That measure was held in the Assembly
Education Committee
i) AB 533 (Hayashi), of 2009, would have required training
for coaches to be able to identify symptoms of head and
neck injury. That measure was held in the Assembly
AB 2007
Page 12
Appropriations Committee suspense file.
REGISTERED SUPPORT / OPPOSITION:
Support
California Athletic Trainers Association (Sponsor)
California School Nurses Association
California State Parent Teacher Association (PTA)
The Child Abuse Prevention Center
Opposition
There is no opposition on file.
Analysis Prepared by:Dana Mitchell / A.,E.,S.,T., & I.M. / (916)
319-3450
AB 2007
Page 13