Existing law establishes the State Department of Public Health in state government. Existing law vests within the department certain duties and powers to protect and preserve the public health.

This bill would require the State Department of Public Health to collaborate with representatives of various groups and adopt, develop, on or before June 1, 2018, a state data collection plan and uniform standards and protocols that establish a uniform incident site report requirement for purposes of collecting statewide information on unintentional injury incidents. The bill would require those standards and protocols to be implemented on a statewide basis by every county, as prescribed. The bill would require the department to periodically reconvene the representatives, when necessary, to modify the standards and protocols. incidents, as specified. The bill would specify that its provisions not be construed to require data collection beyond that required by existing law.

Existing law establishes the State Department of Public Health in state government. Existing law vests within the department certain duties and powers to protect and preserve the public health. Existing law establishes the Emergency Medical Services Authority in state government.

This bill would require the State Department of Public Health and the Emergency Medical Services Authority to, by regulation, adopt standards and protocols to to collaborate with representatives of various groups and adopt, on or before June 1, 2018, standards and protocols that establish a uniform incident site report requirement for purposes of collecting statewide information on unintentional injury incidents. The bill would require those regulations standards and protocols to be implemented on a statewide basis by every county, as prescribed. The bill would require the department to periodically reconvene the representatives, when necessary, to modify the standards and protocols.

By imposing additional duties on local entities, this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.

Existing law establishes the State Department of Public Health in state government. Existing law vests within the department certain duties and powers to protect and preserve the public health. Existing law establishes the Emergency Medical Services Authority in state government.

This bill would require the State Department of Public Health and the Emergency Medical Services Authority to, by regulation, adopt standards and protocols to establish a uniform incident site report requirement for purposes of collecting statewide information on unintentional injury incidents. The bill would require those regulations to be implemented on a statewide basis by every county, as prescribed.

By imposing additional duties on local entities, this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.

ASSEMBLY THIRD READING

ATR Bill Id:

Author:(Brown)

As Amended Ver:May 31, 2016

Majority vote

SUMMARY: Requires the Department of Public Health (DPH), on or before June 1, 2018, to develop a state data collection plan (plan) focused on the 10 leading causes of death and hospitals due to injuries involving children and youth between zero and 19 years of age. Specifically, this bill:

1. Requires DPH to do the following:
   1. Develop a plan that does the following:
      1. Identify the incident site attributes, including environmental factors, situational variables, and special inherent risks that would better inform California's unintentional injury prevention policies, programs, and strategies;
      2. Include recommendations for data collection and evaluation, including additions to the existing data sources, and continued prudent maintenance of data currently collected; and,
      3. Require DPH to periodically reconvene practitioners and experts to update the plan and make modifications to address evolving dangers, as needed.
   2. Develop uniform standards and protocols for incident site reports for purposes of collecting data on unintentional injury incidents involving children and youth between zero to 19 years of age, that result in death or hospitalization. Requires the standards and protocols to do the following:
      1. Identify appropriate reporting entities; and,
      2. Include the following:
         1. 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, if that reporting is practical and does not distract the existing state data systems, if that reporting is practical and does not distract the existing emergency medical services or health care data collection system from its current function and mission, and to the local health department; and,
         2. Recommendations on how best to capture local unintentional injury incident site report data and information, so the data is accessible by, and can be incorporated into, existing state data systems associated with trauma and unintentional injury prevention programs, and recommendations regarding the timeline for consolidation of the data into existing related data systems.
2. Requires the statewide plan and uniform standards and protocols to be developed in collaboration with representatives from other health and safety state and local agencies, first responders, fire agencies, law enforcement agencies, public health experts and childhood injury prevention experts in order for the department to understand the details at incident sites for various types of unintentional injury involving children and youth between zero to 19 years of age.
3. Specifies that the above provisions do not mandate reporting entities, as specified, to collect or report data beyond that currently required.
4. Defines incident site reports or incident as site reports or incidents that involve unintentional injuries from drownings, near drownings, burns, window falls, bicycle crashes, pedestrian crashes, sleep suffocation, children left in cars, vehicle backovers, vehicle frontovers, sports-related activities, and poisoning.
5. Declares the intent of the Legislature in enacting this bill.

FISCAL EFFECT: According to the Assembly Appropriations Committee:

1. First-year costs to DPH of $700,000 for staff and related expenses and, if necessary, $1.9 million in cost pressure for upgrades to the state's data system.
2. Annual cost pressure to DPH estimated at $1 million General Fund for staffing and data system maintenance.

COMMENTS: According to the author, California lacks a uniform standard for collecting data from unintentional injury incident sites involving children and youth ages through 19 years. 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, and each leading cause of unintentional injury has important variations on what types of incident data needs to be collected. 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. The author state that this bill sets up the means to keep California on target in its data and knowledge about the changing underlying causes of unintentional injury.

The Centers for Disease Control and Prevention reports that for 2013, there were 31 million emergency department visits for unintentional injuries and unintentional injuries accounted for 130,557 deaths that year. According to DPH's Web site, unintentional injury is the leading cause of hospitalizations and deaths for California's children and youth ages one to19 years old and the leading cause of injury related deaths for babies and infants under one year of age. Unintentional injury deaths result from a variety of causes such as motor vehicle traffic crashes, falls, firearms, drownings, suffocations, bites, stings, sports/recreational activities, natural disasters, fires or burns and poisonings. From 2000 to 2010, California's top three fatal unintentional injuries include motor vehicle traffic crashes (36.2%), poisoning and exposure to noxious substances (including drugs and other substances) (26.7%), and falls (16.2%). These three causes totaled 79.1% of all unintentional injury deaths. In 2010, unintentional deaths ranked as the sixth leading cause of death in California. Males account for more unintentional injury deaths than females. Drowning was the most common unintentional injury cause of death for those aged one to four years. Motor vehicle traffic crashes were the most frequent unintentional injury deaths for those aged five to 24 years old. Poisonings (including drugs and other substances) were the most common unintentional injury death for people aged 25 to 64. Falls were the most prevalent unintentional injury cause of death for individuals over 65. Due to the prevalence of unintentional injury deaths in this country, the United States Department of Health and Human Services (HHS), one of the objectives of the Healthy People 2020 is the reduction of unintentional injuries age-adjusted death rate to no more than 36 per 100,000 population.

DPH maintains on its Web site 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.

Analysis Prepared by: Rosielyn Pulmano / HEALTH / (916) 319-2097 FN: 0003291

Date of Hearing: April 27, 2016

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez, Chair

ABPCA Bill Id:AB 2425

Author:(Brown) – As Amended Ver:April 5, 2016

Urgency: No State Mandated Local Program: Yes Reimbursable: 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 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:
   1. 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,
   2. 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.
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:
   1. 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.
   2. 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 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.

1. Support. This bill is sponsored by the California Coalition for Children’s Safety and Health and is supported by the American College of Emergency Physicians, California Chapter and the Child Abuse Prevention Center.
2. 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.

1. Prior legislation.
   1. 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.
   2. 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.
2. 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

Date of Hearing: April 12, 2016

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 2425

Author:(Brown) – As Amended Ver:April 5, 2016

SUBJECT: Public health: incident site reports.

SUMMARY: Requires the Department of Public Health (DPH) to establish a uniform incident site report for the purpose of unintentional injury incidents. Specifically, this bill:

1. Requires DPH, 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 unintentional injury incidents.
2. Requires the standards and protocols to be developed in collaboration with representatives from other health and safety state and local agencies, first responders, fire agencies, law enforcement agencies, public health experts, and childhood injury prevention experts in order for DPH to understand the details at incident sites for various types of unintentional injury. Authorizes DPH to periodically reconvene these representatives when necessary to modify the standards and protocols.
3. Requires the standards and protocols to be implemented by every county for use by the appropriate local reporting entities. Defines a reporting entity the reporting entity identified in the standards and protocols developed by DPH.
4. Requires the standards and protocols to include the following:
   1. A requirement that a reporting entity utilize an incident site reporting best practices from an 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,
   2. 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.
5. Defines “incident site reports” or “incident” to include, among others, site reports or incidents that involve unintentional injuries from drownings, near drownings, burns, window falls, bicycle crashes, pedestrian crashes, sleep suffocation, kids left in cars, vehicle backovers, vehicle frontovers, sports-related activities, and poisoning.
6. Finds and declares the Legislature’s intent for DPH to take a lead role in establishing statewide best practice guidelines, standards, and incident site information collection tools, as specified.

EXISTING LAW:

1. Requires the registration of each live birth, fetal death, death, and marriage that occurs in the state.
   
2. Requires that deaths be registered with the local registrar of births and deaths in the district in which the death was officially pronounced or the body was found, within eight calendar days after death and prior to any disposition of the human remains.
   
3. Requires a physician and surgeon, physician assistant, funeral director, or other person to immediately notify the coroner when he or she has knowledge of a death that occurred or has charge of a body in which death occurred under any of the following circumstances: without medical assistance, during the continued absence of the attending physician and surgeon, where the attending physician and surgeon or the physician assistant is unable to state the cause of death; where suicide is suspected; following an injury or an accident; and, under circumstances as to afford a reasonable ground to suspect that the death was caused by the criminal act of another.

FISCAL EFFECT: This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, California lacks a uniform standard for collecting data from unintentional injury incident sites involving children and youth ages through 19 years. 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, and each leading cause of unintentional injury has important variations on what types of incident data needs to be collected. 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. The author state that this bill sets up the means to keep California on target in its data and knowledge about the changing underlying causes of unintentional injury.
2. BACKGROUND. The Centers for Disease Control and Prevention reports that for 2013, there were 31 million emergency department visits for unintentional injuries and unintentional injuries accounted for 130,557 deaths that year. According to DPH’s Website, unintentional injury is the leading cause of hospitalizations and deaths for California’s children and youth ages one to19 years old and the leading cause of injury related deaths for babies and infants under one year of age. Unintentional injury deaths result from a variety of causes such as motor vehicle traffic crashes, falls, firearms, drownings, suffocations, bites, stings, sports/recreational activities, natural disasters, fires or burns and poisonings. From 2000 to 2010, California’s top three fatal unintentional injuries include motor vehicle traffic crashes (36.2%), poisoning and exposure to noxious substances (including drugs and other substances) (26.7%), and falls (16.2%). These three causes totaled 79.1% of all unintentional injury deaths. In 2010, unintentional deaths ranked as the sixth leading cause of death in California. Males account for more unintentional injury deaths than females. Drowning was the most common unintentional injury cause of death for those aged one to four years.  Motor vehicle traffic crashes were the most frequent unintentional injury deaths for those aged five to 24 years old.  Poisonings (including drugs and other substances) were the most common unintentional injury death for people aged 25 to 64.  Falls were the most prevalent unintentional injury cause of death for individuals over 65. Due to the prevalence of unintentional injury deaths in this country, the U.S. Department of Health and Human Services (HHS), one of the objectives of the Healthy People 2020 is the reduction of unintentional injuries age-adjusted death rate to no more than 36 per 100,000 population.
   DPH 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.
3. SUPPORT. The California Coalition for Children’s Safety and Health, a sponsor of this bill, state that this bill will give California a better understanding of the underlying causes of unintentional injuries and assist in developing a better and more effective preventatives strategies. The California Chapter of the American College of Emergency Physicians states that throughout the year, emergency physicians treat patients with injuries resulting from unintentional injury incidents and implementing a statewide incident site report will provide important data that will help reduce injuries by identifying potential hazards and high risk areas.
4. OPPOSE UNLESS AMENDED. The California Chamber of Commerce and California Attractions and Parks have taken an oppose unless amended position and state that as currently drafted, this bill would require employees of private businesses to complete incident site reports for a wide range of incidents should they occur on their property and when an employee is the first to respond. They both believe this requirement is impractical, inappropriate, and in some cases could actually raise liability issues. They propose that the definition of first responder be narrowed to include only the appropriate publicly contracted emergency medical technician service, law enforcement, fire department personnel, and the coroner when appropriate.
5. OPPOSE. The Emergency Medical Services Administrators Association of California states 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.
6. PREVIOUS LEGISLATION.
   1. AB 299 (Brown) of 2015 would have required DPH to develop a submersion incident form to collect standardized information regarding drowning or nonfatal-drowning events, as specified. AB 299 died in Assembly Appropriations Committee.
   2. AB 540 (Pan) of 2013 would have authorized DPH to establish and maintain a system for collecting data on violent deaths in the state. AB 540 died in the Senate Appropriations Committee.

REGISTERED SUPPORT / OPPOSITION:

Support

California Coalition for Children’s Safety and Health (sponsor)

American College of Emergency Physicians, California Chapter

The Child Abuse Prevention Center

Opposition

Emergency Medical Services Administrators Association of California

Analysis Prepared by: Rosielyn Pulmano / HEALTH / (916) 319-2097