Date of Hearing: April 24, 2019

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Lorena Gonzalez, Chair

ABPCA Bill Id:AB 691

Author:(McCarty) – As Amended Ver:March 21, 2019

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY:

This bill requires the California Department of Public Health (CDPH) to develop a protocol that may be used as a guideline by persons performing autopsies on children to assist coroners and others who perform autopsies in the identification of child abuse or neglect, in the determination of whether child abuse or neglect contributed to death or whether child abuse or neglect had occurred prior to death but was not the actual cause of death.

FISCAL EFFECT:

Costs (GF) of at least $224,000 annually for CDPH to create an autopsy protocol and for staff to convene an expert advisory committee and facilitate the autopsy protocol development. DPH estimates the need to hire at least one research scientist and one program analyst to perform the workload required by this bill.

COMMENTS:

1. Purpose. According to the author:

AB 691 builds upon the great success of our local child death review teams in creating educational campaigns, to educate the public of frequent causes of child deaths. This measure will ensure we are acting in the interest of our children’s safety and protection.

1. Background. The primary purpose of child death review teams is to prevent future child deaths. At the county level, these teams produce educational materials so that the more common causes of child death can be prevented. The statewide child death review council is responsible for collecting data and information from the counties and turning it into reports to the public and the Legislature.
2. Prior Legislation.
   1. AB 1098 (McCarty), of the 2017-2018 Legislative Session, would have required counties to establish interagency child death review teams. AB 1098 was held on the Senate Appropriations Committee Suspense File.
   2. AB 1737 (McCarty), of the 2015-2016 Legislative Session, would have mandated counties establish an interagency child death review team. AB 1737 was held on the Assembly Appropriations Committee Suspense File.

Analysis Prepared by: Kimberly Horiuchi / APPR. / (916) 319-2081

Date of Hearing: April 9, 2019

Chief Counsel: Gregory Pagan

ASSEMBLY COMMITTEE ON PUBLIC SAFETY

Reginald Byron Jones-Sawyer, Sr., Chair

ABPCA Bill Id:AB 691

Author:(McCarty) – As Amended Ver:March 21, 2019

SUMMARY:

Requires the State Department of Public Health (DPH) to develop a protocol that may be used as a guideline by persons performing autopsies on children to assist coroners and other persons who perform autopsies in the identification of child abuse or neglect. Specifically, this bill:

1. Requires DPH to develop a protocol that may be used as a guideline by persons performing autopsies on children to assist coroners and other persons who perform autopsies in the identification of child abuse or neglect, in the determination of whether child abuse or neglect contributed to death or whether child abuse or neglect had occurred prior to but was not the actual cause of death.
   
2. States that DPH may consult with the Counties of Los Angeles and Sacramento in developing the protocol.
   
3. Requires DPH to provide access to the protocol, free of charge, to any county that requests a copy, and requires that the protocol include data collection, confidentiality, and reporting provisions.
   
4. Requires a child death review team to implement a data collection process that includes, but is not limited to, all of the following information about a deceased child: race, gender, cause of death, and age.
   
5. Increases the time between reports that the child death review teams must make their findings public from yearly to once every three years.

EXISTING LAW:

1. Allows counties to establish interagency child death review teams to assist local agencies in identifying and reviewing suspicious child deaths and facilitating communication among persons who perform autopsies and the various persons and agencies involved in child abuse or neglect cases, but does not require counties to establish child death review teams. (Pen. Code, § 11174.32.)
2. States that interagency child death teams have been used successfully to ensure that incidents of child abuse or neglect are recognized and other siblings and non-offending family members receive the appropriate services in cases where a child has expired. (Pen. Code, § 11174.32, subd. (a).)
3. States that each county may develop a protocol that may be used as a guideline by persons performing autopsies on children to assist coroners and other persons who perform autopsies in the identification of child abuse or neglect, in the determination of whether child abuse or neglect contributed to death or whether child abuse or neglect had occurred prior to but was not the actual cause of death, and in the proper written reporting procedures for child abuse or neglect, including the designation of the cause and mode of death. (Pen. Code, § 11174.32, subd. (b).)
4. States that in developing an interagency child death team and an autopsy protocol, each county, working in consultation with local members of the California State Coroner's Association and county child abuse prevention coordinating councils, may solicit suggestions and final comments from persons, including, but not limited to, the following:
   1. Experts in the field of forensic pathology;
   2. Pediatricians with expertise in child abuse;
   3. Coroners and medical examiners;
   4. Criminologists;
   5. District attorneys;
   6. Child protective services staff;
   7. Law enforcement personnel;
   8. Representatives of local agencies which are involved with child abuse or neglect reporting;
   9. County health department staff who deals with children's health issues; and
   10. Local professional associations of persons described in paragraphs (1) to (9), inclusive. (Pen. Code, § 11174.32, subd. (c).)
5. Clarifies that records exempt from disclosure to third parties pursuant to state or federal law shall remain exempt from disclosure when they are in the possession of a child death review team. (Pen. Code, § 11174.32, subd. (d).)
6. Requires no less than once each year, each child death review team to make available to the public findings, conclusions and recommendations of the team, including, aggregate statistical data on the incidences and causes of child deaths. In its report, the team is required to withhold the last name of the child that is the subject to a review, except as specified. (Pen. Code, § 11174.32, subd. (f)(1)&(2).)

FISCAL EFFECT:

Unknown

COMMENTS:

1. Author's Statement: According to the author, “It is devastating to see children die, more so by causes that could be prevented.  AB 691 builds upon the great success of our local child death review teams in creating educational campaigns, to educate the public of frequent causes of child deaths. This measure will ensure we are acting in the interest of our children’s safety and protection.”
   
2. Need for the Bill: The author’s background on this bill states, “The child death review teams in California began as informal gatherings of concerned parents and professionals that wanted to take proper steps in order to review child deaths and learn from them in order to save other children’s lives.
   
   “In 1988, California legislation was enacted to establish child death review teams in order to investigate suspicious child deaths and facilitate communication among the various entities that could provide useful information for the annual report.

“Today, the Centers for Disease Control and Prevention and World Health Organization found that there were over 20,360 child and adolescent deaths in the United States for 2016. In California, the Department of Social Services (CDSS) reported that 88 child fatalities resulted from abuse and/or neglect for 2014, but a complete summary of child death reports had not been finalized at the time the data was collected. Despite efforts to produce an annual child death report, there are only an estimated 22 active child death review teams throughout the state, leaving many counties without a reporting mechanism. We believe that one reason for the lack of participation in every county that people do not have the tools to necessarily carry out the report. It is the intent of this legislation to create uniformity among counties by specifying what should be included in the data collection but also ensuring that smaller counties are able to connect with counties like Sacramento and Los Angeles which have successful teams and data collection.”

1. Background on Child Death Review Teams: The primary purpose of child death review teams is to prevent future child deaths. At the county level, these teams produce educational materials so that the more common causes of child death can be prevented. For example, according to the author, in Sacramento “The Sacramento County Child Death Review Team, which reviews the deaths of every child that dies in Sacramento County, has used the report’s findings in order to create public awareness campaigns. The recommendations have translated to the Shaken Baby Syndrome Prevention Campaign, the Infant Safe Sleep Campaign, and the Drowning Prevention Campaign to reduce preventable deaths.” However, each county’s experience is different. This is where statewide child death review can help prevent counties from duplicating efforts.
   
   The statewide child death review council is responsible for collecting data and information from the counties and turning it into reports to the public and the Legislature. Part of the statutory scheme that created child death review teams included creation of the Child Death Review Council "to coordinate and integrate state and local efforts to address fatal child abuse or neglect, and to create a body of information to prevent child deaths." (Penal Code Section 11174.34(a)(1).) The Child Death Review Council is required to "[a]nalyze and interpret state and local data on child death in an annual report to be submitted to local child death review teams with copies to the Governor and the Legislature, no later than July 1 each year. Copies of the report shall also be distributed to California public officials who deal with child abuse issues and to those agencies responsible for child death investigation in each county. The report shall contain, but not be limited to, information provided by state agencies and the county child death review teams for the preceding year." (Penal Code Section 11174.34(d)(1).) Therefore, a report analyzing the data collected by each local child death review team is currently a public document. Requiring each local child death review team to also make public its own data appears to be consistent with the overall objectives of the teams, i.e., creating a body of information on the causes of child deaths to help prevent such tragedies. Increased transparency may also enhance the public's trust in local child death review.
   
2. Change in Reporting Requirement from One to Three Years: This bill would change the reporting requirements for public findings, conclusions, and recommendations issued by a child death review team, including aggregate statistical data on the incidences and causes of child deaths and recommendations to prevent future deaths. Current law requires release of this information ever year. One fundamental purpose of the reporting requirement is to give the public timely access to the conclusions of the child death review teams. By increasing the reporting requirement to only every three years, this bill would substantially diminish the value of information reported. Moreover, because this information is already in the aggregate, reports of yearly, aggregated data will be much less precise.
   
   The Sacramento County Blue Ribbon Commission reported in 2013 that there is a disproportionate number child deaths in the African American committee. The Steering Committee on Reduction of African American Child Deaths for Sacramento County released an implementation plan in 2015 with the goal of reducing “the disproportionate African

American child mortality rate in Sacramento County.” In its report, the committee the importance of the yearly reporting of the committee’s findings in maintaining public awareness of the issue of child deaths, monitoring trends in African American child deaths, and ultimately reducing the disproportionate African American child death rate in Sacramento County from 10% to 20%.

Should the Legislature consider retaining the yearly reporting requirement?

1. Prior Legislation:
   
   1. AB 1098 (McCarty), of the 2017-2018 Legislative Session, was substantially similar to this bill. AB 1098 was held in the Senate Appropriations Committee.
      
   2. AB 2083 (Chu), Chapter 297, Statutes of 2016, authorizes the voluntary disclosure of specified information, including mental health records, criminal history information, and child abuse reports, by an individual or agency to an interagency child death review team.
      
   3. AB 1737 (McCarty), of the 2015-2016 Legislative Session, would have mandated that counties establish an interagency child death review team. AB 1737 was held in the Assembly Appropriations Committee.
      
   4. SB 39 (Migden), Chapter 468, Statutes of 2007, requires the custodian of records within a county welfare agency or department to disclose, within five days from a request, or upon substantiation, specified records, subject to the redaction of certain identifying personal information, of child abuse or neglect that results in the death of a child. Requires all county welfare agencies and departments to notify the State Department of Social Services, as provided, of all child fatalities that occurred within its jurisdiction that were the result of child abuse or neglect, and requires the State Department of Social Services to establish a procedure for, and annually report on, that notification, as specified.
      

REGISTERED SUPPORT / OPPOSITION:

Support

None

Opposition

None

Analysis Prepared by:

Gregory Pagan / PUB. S. / (916) 319-3744