[House Report 105-456]
[From the U.S. Government Publishing Office]



105th Congress                                                   Report
 2d Session             HOUSE OF REPRESENTATIVES                105-456
_______________________________________________________________________


 
                AVIATION MEDICAL ASSISTANCE ACT OF 1998

                                _______
                                

 March 20, 1998.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______


 Mr. Shuster, from the Committee on Transportation and Infrastructure, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 2843]

      [Including cost estimate of the Congressional Budget Office]

  The Committee on Transportation and Infrastructure, to whom 
was referred the bill (H.R. 2843) to direct the Administrator 
of the Federal Aviation Administration to reevaluate the 
equipment in medical kits carried on, and to make a decision 
regarding requiring automatic external defibrillators to be 
carried on, aircraft operated by air carriers, and for other 
purposes, having considered the same, report favorably thereon 
with an amendment and recommend that the bill as amended do 
pass.
  The amendment is as follows:
  Strike out all after the enacting clause and insert in lieu 
thereof the following:

SECTION 1. SHORT TITLE.

  This Act may be cited as the ``Aviation Medical Assistance Act of 
1998''.

SEC. 2. MEDICAL KIT EQUIPMENT AND TRAINING.

  Not later than 1 year after the date of the enactment of this Act, 
the Administrator of the Federal Aviation Administration shall 
reevaluate regulations regarding (1) the equipment required to be 
carried in medical kits of aircraft operated by air carriers, and (2) 
the training required of flight attendants in the use of such 
equipment, and, if the Administrator determines that such regulations 
should be modified as a result of such reevaluation, shall issue a 
notice of proposed rulemaking to modify such regulations.

SEC. 3. REPORTS REGARDING DEATHS ON AIRCRAFT.

  (a) In General.--During the 1-year period beginning on the 90th day 
following the date of the enactment of this Act, a major air carrier 
shall make a good faith effort to obtain, and shall submit quarterly 
reports to the Administrator of the Federal Aviation Administration on, 
the following:
          (1) The number of persons who died on aircraft of the air 
        carrier, including any person who was declared dead after being 
        removed from such an aircraft as a result of a medical incident 
        that occurred on such aircraft.
          (2) The age of each such person.
          (3) Any information concerning cause of death that is 
        available at the time such person died on the aircraft or is 
        removed from the aircraft or that subsequently becomes known to 
        the air carrier.
          (4) Whether or not the aircraft was diverted as a result of 
        the death or incident.
          (5) Such other information as the Administrator may request 
        as necessary to aid in a decision as to whether or not to 
        require automatic external defibrillators in airports or on 
        aircraft operated by air carriers, or both.
  (b) Format.--The Administrator may specify a format for reports to be 
submitted under this section.

SEC. 4. DECISION ON AUTOMATIC EXTERNAL DEFIBRILLATORS.

  (a) In General.--Not later than 120 days after the last day of the 1-
year period described in section 3, the Administrator of the Federal 
Aviation Administration shall make a decision on whether or not to 
require automatic external defibrillators on aircraft operated by 
passenger air carriers and whether or not to require automatic external 
defibrillators at airports.
  (b) Form of Decision.--A decision under this section shall be in the 
form of a notice of proposed rulemaking requiring automatic external 
defibrillators in airports or on aircraft operated by air passenger 
carriers, or both, or a recommendation to Congress for legislation 
requiring such defibrillators or a notice in the Federal Register that 
such defibrillators should not be required in airports or on such 
aircraft. If a decision under this section is in the form of a notice 
of proposed rulemaking, the Administrator shall make a final decision 
not later than the 120th day following the date on which comments are 
due on the notice of proposed rulemaking.
  (c) Contents.--If the Administrator decides that automatic external 
defibrillators should be required--
          (1) on aircraft operated by air passenger carriers, the 
        proposed rulemaking or recommendation shall include--
                  (A) the size of the aircraft on which such 
                defibrillators should be required;
                  (B) the class flights (whether interstate, overseas, 
                or foreign air transportation or any combination 
                thereof) on which such defibrillators should be 
                required;
                  (C) the training that should be required for air 
                carrier personnel in the use of such defibrillators; 
                and
                  (D) the associated equipment and medication that 
                should be required to be carried in the aircraft 
                medical kit; and
          (2) at airports, the proposed rulemaking or recommendation 
        shall include--
                  (A) the size of the airport at which such 
                defibrillators should be required;
                  (B) the training that should be required for airport 
                personnel in the use of such defibrillators; and
                  (C) the associated equipment and medication that 
                should be required at the airport.
  (d) Limitation.--The Administrator may not require automatic external 
defibrillators on helicopters and on aircraft with a maximum payload 
capacity (as defined in section 119.3 of title 14, Code of Federal 
Regulations) of 7,500 pounds or less.
  (e) Special Rule.--If the Administrator decides that automatic 
external defibrillators should be required at airports, the proposed 
rulemaking or recommendation shall provide that the airports are 
responsible for providing the defibrillators.

SEC. 5. LIMITATIONS ON LIABILITY.

  (a) Liability of Air Carriers.--An air carrier shall not be liable 
for damages in any action brought in a Federal or State court arising 
out of the performance of the air carrier in obtaining or attempting to 
obtain the assistance of a passenger in an in-flight medical emergency, 
or out of the acts or omissions of the passenger rendering the 
assistance, if the carrier in good faith believes that the passenger is 
a medically qualified individual and not an employee or agent of the 
carrier.
  (b) Liability of Individuals.--An individual shall not be liable for 
damages in any action brought in a Federal or State court arising out 
of the acts or omissions of the individual in providing or attempting 
to provide assistance in the case of an in-flight medical emergency 
unless the individual, while rendering such assistance, is guilty of 
gross negligence or willful misconduct.

SEC. 6. DEFINITIONS.

  In this Act--
          (1) the terms ``air carrier'', ``aircraft'', ``airport'', 
        ``interstate air transportation'', ``overseas air 
        transportation'', and ``foreign air transportation'' have the 
        meanings such terms have under section 40102 of title 49, 
        United States Code;
          (2) the term ``major air carrier'' means an air carrier 
        certificated under section 41102 of title 49, United States 
        Code, that accounted for at least 1 percent of domestic 
        scheduled-passenger revenues in the 12 months ending March 31 
        of the most recent year preceding the date of the enactment of 
        this Act, as reported to the Department of Transportation 
        pursuant to part 241 of title 14 of the Code of Federal 
        Regulations; and
          (3) the term ``medically qualified individual'' includes any 
        person who is licensed, certified, or otherwise qualified to 
        provide medical care in a State, including a physician, nurse, 
        physician assistant, paramedic, and emergency medical 
        technician.

                               BACKGROUND

Current regulatory status

    In 1986, the Federal Aviation Administration (FAA) first 
established regulations requiring air carriers to place medical 
kits on board their aircraft. These regulations (51 FR 1223, 
January 9, 1986) applied to air carriers carrying passengers 
under FAA's rule Part 121 (more than 30 seats) and those 
operating aircraft with more than 19 passengers seats under 
Part 135.
    Prior to this, air carriers were required to have first-aid 
kits for treatment of injuries or medical emergencies that 
might occur during flight time or in minor accidents. First aid 
kits are required to have such items as bandages, antiseptic 
swabs, splints, adhesive tape, and scissors. Equipment placed 
in medical kits are more comprehensive and include such items 
as a stethoscope, blood pressure measuring device, airways, 
drugs for allergic reactions, and the basic instruction for use 
of the drugs.
    Federal Aviation Regulations addressing medical kits were 
not amended until October 18, 1994. This amendment required the 
addition of disposable latex gloves to the medical kits. On 
January 19, 1996, these regulations were further amended to 
require commuter aircraft that have passenger configurations of 
10 to 30 seats to carry medical kits on board.

Recent studies and actions

    In recent years, there has been growing debate outside and 
within the aviation industry as to whether or not current 
medical kits are adequate. Several foreign air passenger 
carriers have extensive medical kits, including defibrillators, 
on-board their overseas flights.
    American, United, Delta, Alaska Airlines, and American 
Trans Air have recently announced that they will place 
defibrillators on some flights. The other carriers that carry 
these systems include Qantas Airlines from Australia, Virgin 
Atlantic from England, and Air Zimbabwe from Africa.
    An Automated External Defibrillator (AED) is a device that 
when placed on the chest of a person suffering from ventricular 
fibrillation can shock that person's heart back into the proper 
rhythm. Although they used to be bulky and complex, recent 
technology improvements in these defibrillators has made them 
portable, compact, and easy to use. This has enabled air 
carriers to consider installing them on their aircraft in order 
to address cardiac emergencies.
    Although there have been a number of short-term data 
collections and assumptions from various sources, there does 
not appear to be enough historical data on the number and types 
of medical emergencies to determine trends that would be 
helpful in assessing the scope and extent of in-flight 
emergencies.
    According to the FAA, at the present time, there is no way 
to actually monitor the incidence of in-flight medical 
emergencies because airlines are not required to report them. 
The FAA receives reports of accidents, incidents, and 
diversions; however, the diversion information is only 
maintained for a 30-day period. The available data for air 
carriers are from multiple sources, are collected and 
classified differently and often use different categorizations.
    The FAA's Civil Aeromedical Institute issued a report in 
February 1997, which noted the difficulties mentioned above, 
stating that the in-flight medical emergency rate appeared to 
have nearly doubled between 1990 and 1993, the interval covered 
by the study.
    According to a study of 120 airlines conducted from 1977 to 
1984 and published in the Journal of the American Medical 
Association in 1988, about 72 deaths occur aboard aircraft each 
year. In many years, this is more than the number of deaths 
from airline crashes in the U.S. The study states that about 
63% of the deaths were due to sudden, unexpected cardiac 
problems, and that the most likely victims were middle-age men.
    Qantas Airlines placed defibrillators on all of its 53 
international route airplanes and throughout Qantas airport 
terminals in 1991. From September 1991 to August 1996, the 
defibrillators were used on 87 occasions; 47 times for 
monitoring an acutely ill passenger, and 40 times for cardiac 
arrest; 22 episodes of cardiac arrest occurred on the 
airplanes. Qantas aircraft diverted on 17 occasions during this 
five-year period.
    Most airlines do not keep records of passenger deaths. 
However, according to American Airlines, cardiopulmonary 
resuscitation is a good indicator as to when a defibrillator 
would be necessary.
    From 1991 through 1996, American Airlines indicated that 
CPR related incidents on board aircraft have almost tripled. In 
1991, there were 12 reports of CPR being administered while in 
1996 there were 33 cases reported. Moreover, the Chicago 
Tribune reported that American Airlines recorded 4,800 in-
flight medical emergencies over the last two years and, in 1994 
and 1995, Northwest Airlines made 171 emergency medical 
landings and American Airlines made 285.
    The most common in-flight medical occurrences for American 
Airlines from 1991 through 1996, by percentage, are as follows:

                                                                 Percent
cardiac events....................................................    40
unconscious.......................................................    17
seizures..........................................................    14
unknown...........................................................     9
psychiatric.......................................................     7
gastrointestinal..................................................     7
bleeding..........................................................     6
obstetrical.......................................................     6
asthma............................................................     3
turbulence........................................................     3
diabetes..........................................................     2
infections........................................................     1

Crew medical training

    Some question the current medical training of flight 
attendant personnel as well as the liability concerns of the 
airlines and their employees. There are also debates about the 
level of medical training flight attendants should receive or 
be held responsible for during flights.
    Under current Federal Aviation Regulations, crew member 
training programs must provide instruction in first-aid 
equipment and its proper use and familiarization with the 
emergency medical kit.

Subcommittee hearing

    On May 21, 1997, the Subcommittee held a hearing on Medical 
Kits aboard Commercial Aircraft. At that hearing, the new 
smaller defibrillator was demonstrated. The Subcommittee was 
impressed with its ease of use. However, it was apparent that 
there was still a lack of data to determine the extent of 
medical problems aboard commercial aircraft. It was also 
unclear whether defibrillators could safely be used on all 
sizes and types of aircraft. There were indications that there 
could be problems if these devices were installed on smaller 
aircraft. The Subcommittee was also concerned about the minimal 
training airline crews seemed to be receiving in dealing with 
medical emergencies.
    It has been reported that cardiac arrest kills an estimated 
350,000 to 400,000 Americans each year. To be effective, 
defibrillation must usually occur within the first few minutes 
of the event. It will usually not be possible to land that 
quickly and obtain medical help when the plane is at 20 or 30 
thousand feet. And the cost to divert is not inconsequential to 
the airline involved.

Legislation

    Therefore, on November 6, 1997, Aviation Subcommittee 
Chairman Duncan introduced H.R. 2843, the Aviation Medical 
Assistance Act. Congressmen Lipinski, Blunt, Fox, Cooksey, and 
Congresswoman Kennelly are cosponsors of this bill. The 
American Medical Association (AMA) has announced that it 
supports it.
    The bill would require major airlines to report their on-
board medical incidents to the FAA. The FAA would then use the 
data to decide whether to require defibrillators aboard 
passenger aircraft, and if so, which types of passenger 
aircraft. Cargo aircraft are not affected.
    There was testimony at the hearing indicating that 
defibrillators would only be appropriate for long flights and 
only on large aircraft although there was some disagreement 
over what exactly would constitute a large enough aircraft. The 
reported bill specifies that this equipment cannot be required 
on helicopters or aircraft with payload capacity of 7,500 
pounds or less (about 30 seats or less). With respect to 
aircraft of more than 7,500 pounds, the Committee has chosen to 
leave it to the detailed analysis by the FAA as to where to 
draw the line.
    However, the Committee is aware that there are many 
aircraft in regional service with payloads of more than 7,500 
pounds. Most have only a single flight attendant. The typical 
characteristics of these aircraft are relatively narrow aisles 
and limited open floor space at the entry door and in the 
service areas. The lack of open floor space could make 
positioning of the sick person and the application of the 
defibrillator difficult. In addition, most of the regional 
aircraft involved have between 32 and 50 passenger seats. At 
typical load factors of about 55%, it is less likely that there 
will be a medical professional on board. Moreover, most of 
these smaller aircraft require less runway to land safely and 
are able to divert more quickly into many more airports than 
larger jet aircraft in the event of an onboard medical 
emergency. The Committee urges the FAA to consider these 
factors in deciding where to draw the line.
    The time periods in this bill will enable that agency to 
consult with aerospace medicine practitioners, other clinical 
specialists, airlines, and the public before making its 
decision. The Committee does note with approval that some major 
U.S. airlines with narrow body aircraft have already chosen to 
equip their fleet with the new defibrillators.
    The reported bill gives the FAA authority to require 
defibrillators at airports. As with airlines, the FAA must 
decide the size of the airport at which defibrillators should 
be required, the training that should be required of airport 
personnel, and the related equipment and medication that should 
be required at the airport. The Committee would expect FAA to 
take a similar judicious approach in drawing the line with 
respect to airports as it does with airlines and not require 
them at airports which are too small to justify the expense 
such as general aviation airports or small commercial ones that 
do not have crash/fire/rescue equipment. If the FAA does 
require defibrillators at airports, the reported bill makes 
clear that it is the airport owner or operator and not the 
airlines operating there that will be responsible for providing 
the equipment.
    The reported bill would also direct FAA to consider 
upgrading the medical equipment on aircraft and improving 
flight attendant training. The FAA now requires carriers to 
instruct flight attendants in the location, function, and 
operation of first aid equipment and first aid oxygen. The 
Committee is concerned that FAA rules do not mandate a standard 
training program that will ensure that flight attendants can 
perform first-aid procedures necessary to effectively deal with 
the medical emergencies that occur aboard aircraft. The 
Committee expects the FAA, in the reevaluation of flight 
attendant training required by this bill, to consider making 
changes to address this issue.
    Finally, the bill includes a ``Good Samaritan'' provision 
to protect those who help in a medical emergency. The provision 
protects an individual (such as a passenger, pilot, or flight 
attendant) from legal liability for helping in a medical 
emergency unless that individual is guilty of gross negligence 
or willful misconduct. The provision also protects the airline 
from liability for the negligence of a passenger who volunteers 
to help in a medical emergency but only if (1) that passenger 
is not an employee of the airline and (2) the airline in good 
faith believed that that passenger was qualified to provide 
that help (such as where the crew believed that the passenger 
was a doctor, nurse, or was otherwise experienced in dealing 
with medical emergencies).
    Nothing in the good Samaritan provision should be construed 
to affect the liability of an air carrier with respect to harm 
caused to a passenger by that carrier's employee or agent who 
provides or attempts to provide assistance during an in-flight 
medical emergency. The provision is intended to limit the 
liability only of individual passengers and employees, not the 
vicarious liability of the airline they may work for. The 
airline is not a good Samaritan but rather is a common carrier 
that, by law, has a duty to provide safe transportation to 
those who have paid for it.
    Also, this provision should not affect situations such as 
the one that arose in Krys v. Lufthansa German Airlines, 119 
F.3d 1515 (11th Cir. 1997). The provision in the reported bill 
ensures that airlines will not be held liable for the acts or 
omissions of passengers who are not its employees and who they 
do not control. However, in Krys, the airline was held liable 
there not because of acts or omissions of the passenger 
rendering assistance but rather because the airline's employees 
failed to divert the flight and land when its own policy as 
well as standard industry practice indicated that it should 
have done so.

                       SECTION-BY-SECTION SUMMARY

    Section 1 is the short title.
    Section 2 gives the FAA 1 year to reevaluate its rules 
regarding the contents of aircraft medical kits on commercial 
aircraft and the training required in the use of that equipment 
and, if warranted, to propose changes in those rules.
    Section 3 requires major airlines to provide quarterly 
reports over a 1-year period to the FAA that include the 
following information--
          The number of people who died on their aircraft.;
          The age of that person;
          Any available information about the cause of death;
          Whether the aircraft was diverted as a result of the 
        death or incident; and
          Such other information as the FAA may require.
    This section also permits FAA to specify a format for the 
quarterly reports. However, airlines must still file the 
reports quarterly with the required information even if FAA has 
not specified a format. If FAA chooses to specify a format, the 
Committee suggests the following:

----------------------------------------------------------------------------------------------------------------
              Date                      Flight        Passenger ID & age        ?Divert       Medical/death info
----------------------------------------------------------------------------------------------------------------
                                                                                                                

    Section 4 requires FAA to make a decision on whether 
automatic external defibrillators should be required in 
airports and on commercial passenger aircraft. The FAA is given 
120 days after receiving the airline quarterly reports to make 
the decision on the defibrillators. This decision could take 
the form of either the issuance of a notice of proposed rule-
making (NPRM), a recommendation to Congress, or a notice that 
no further action should be taken. If FAA takes the NPRM 
approach, it would have 120 days after comments are received to 
issue a final rule. If FAA decides that defibrillators should 
be required, the agency would be expected to decide the size of 
the aircraft on which defibrillators should be required, the 
type of flights (domestic, international), the training that 
should be required of flight attendants, and the related 
equipment and medication that should be carried in the aircraft 
medical kit. Similar decisions would have to be made with 
respect to airports.
    Section 5 is the Good Samaritan provision. It protects the 
airline against liability for the actions of a passenger 
rendering assistance in an in-flight medical emergency if the 
passenger is not an employee or agent of the airline and if the 
airline in good faith believed that the passenger was qualified 
to render such assistance. It also protects an individual (such 
as a passenger or member of the crew) from liability for 
rendering assistance unless that person engaged in gross 
negligence or willful misconduct.
    Section 6 defines terms.

                    HEARINGS AND LEGISLATIVE HISTORY

    The Subcommittee on Aviation held a hearing on ``Medical 
Kits on Commercial Airlines'' on May 21, 1997 (Committee 
document 105-23). H.R. 2843 was introduced on November 6, 1997. 
The Committee has not held hearings on the reported 
legislation.

                        COMMITTEE CONSIDERATION

    On March 5, 1998, the Subcommittee on Aviation reported the 
bill, by unanimous voice vote, to the Committee on 
Transportation and Infrastructure. On March 11, 1998 the 
Committee met in open session and ordered the bill reported, 
with an amendment, by voice vote with a quorum present. There 
were no recorded votes taken during Committee consideration of 
H.R. 2843.

                             ROLLCALL VOTES

    Clause 2(l)(2)(B) of rule XI requires each committee report 
to include the total number of votes cast for and against on 
each rollcall vote on a motion to report and on any amendment 
offered to the measure, and the names of those members voting 
for and against. There were no recorded votes taken in 
connection with ordering H.R. 2843 reported. A motion by Mr. 
Duncan to order H.R. 2843 reported to the House was agreed to 
by voice vote, a quorum being present.

                      COMMITTEE OVERSIGHT FINDINGS

    With respect to the requirements of clause 2(l)(3)(A) of 
rule XI of the Rules of House of Representatives, the 
Committee's oversight findings and recommendations are 
reflected in this report.

                        COSTS OF THE LEGISLATION

    Clause 7 of rule XIII of the Rules of the House of 
Representatives does not apply where a cost estimate and 
comparison prepared by the Director of the Congressional Budget 
Office under section 403 of the Congressional Budget Act of 
1974 has been timely submitted prior to the filing of the 
report and is included in the report. Such a cost estimate is 
included in this report.

                     COMPLIANCE WITH HOUSE RULE XI

    1. With respect to the requirement of clause 2(l)(3)(B) of 
rule XI of the Rules of the House of Representatives, and 
section 308(a) of the Congressional Budget Act of 1974, the 
Committee references the report of the Congressional Budget 
Office included below.
    2. With respect to the requirement of clause 2(l)(3)(D) of 
rule XI of the Rules of the House of Representatives, the 
Committee has received no report of oversight findings and 
recommendations from the Committee on Government Reform and 
Oversight on the subject of H.R. 2843.
    3. With respect to the requirement of clause 2(l)(3)(C) of 
rule XI of the Rules of the House of Representatives and 
section 403 of the Congressional Budget Act of 1974, the 
Committee has received the following cost estimate for H.R. 
2843 from the Director of the Congressional Budget Office.

                                     U.S. Congress,
                               Congressional Budget Office,
                                    Washington, DC, March 18, 1998.
Hon. Bud Shuster,
Chairman, Committee on Transportation and Infrastructure, House of 
        Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 2843, the Aviation 
Medical Assistance Act of 1998.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contacts for this 
estimate are Victoria V. Heid (for federal costs), Pepper 
Santalucia (for the state and local impact), and Jean Wooster 
(for the private-sector impact).
            Sincerely,
                                         June E. O'Neill, Director.
    Enclosure.

               congressional budget office cost estimate

H.R. 2843--Aviation Medical Assistant Act of 1998

    Summary: H.R. 2843 would direct the Administrator of the 
Federal Aviation Administration (FAA) to reevaluate regulations 
regarding equipment in medical kits carried on certain aircraft 
and the training required of flight attendants in the use of 
such equipment. Specifically, the bill would direct the FAA to 
consider whether automatic external defibrillators should be 
required. H.R. 2843 also would direct the FAA to evaluate 
whether the agency should require such equipment in airports. 
The bill would require the FAA to announce its decisions within 
19 months of enactment.
    In addition, the bill would direct major air carriers to 
provide information to the FAA about medical incidents 
occurring on aircraft for the purpose of assisting the FAA in 
reevaluating the current regulations. The bill also would limit 
the liability of air carriers and individuals when assisting 
passengers in an in-flight medical emergency.
    CBO estimates that enacting H.R. 2843 would have no 
significant impact on the federal budget. Because H.R. 2843 
would not affect direct spending or receipts, pay-as-you-go 
procedures would not apply.
    H.R. 2843 contains both intergovernmental and private-
sector mandates as defined in the Unfunded Mandates Reform Act 
of 1995 (UMRA), but the expected costs of complying with those 
mandates would be well below the statutory thresholds 
established in UMRA.
    Estimated cost to the Federal Government: Under current 
law, the FAA has the authority to regulate the medical 
equipment carried on aircraft; however, the agency does not 
have the authority to regulate medical equipment at airports, 
and it is unclear whether enacting H.R. 2843 would give the FAA 
authority to do so. CBO estimates that the FAA would incur no 
significant costs to reevaluate medical equipment required on 
aircraft. Assuming that enacting H.R. 2843 would give the FAA 
authority to regulate medical equipment at airports, CBO 
estimates that additional discretionary outlays for the FAA to 
study and review whether such regulations should be proposed 
would total less than $250,000, assuming appropriation of the 
necessary amounts.
    Estimated impact on State, local, and tribal governments: 
The bill contains at least one intergovernmental mandate as 
defined in UMRA. By limiting the liability of air carriers and 
individuals who provide medical assistance during an in-flight 
emergency, the bill would preempt the liability laws of state 
and local governments. CBO estimates that this preemption would 
not impose any significant costs on state or local governments.
    The bill would also direct the FAA to consider whether 
automatic external defibrillators should be required at 
airports, most of which are publicly owned. If imposed, such a 
requirement would be an intergovernmental mandate. Based on 
information from airports and the FAA, CBO estimates that the 
direct costs of such a requirement would be well below the 
statutory threshold for intergovernmental mandates ($50 million 
in 1996, adjusted annually for inflation).
    Estimated impact on the private sector: H.R. 2843 would 
impose a new private-sector mandate, as defined by UMRA, on 
major domestic air carriers. The bill would require 
approximately 10 air carriers to make a good faith effort to 
obtain information on their onboard medical incidents and to 
submit a quarterly report for a one-year period to the FAA. CBO 
estimates that the direct cost of complying with this mandate 
would fall well below the statutory threshold for private-
sector mandates ($100 million in 1996, adjusted annually for 
inflation).
    The bill would also direct the FAA to consider whether 
automatic external defibrillators should be required on 
aircraft and at airports, but this would not be a new private-
sector mandate. The FAA Currently has the authority to require 
medical equipment on aircraft, and CBO expects that no private 
airports would be affected by such a requirement.
    Estimate prepared by: Federal Costs: Victoria V. Heid. 
Impact on State, Local, and Tribal Governments; Pepper 
Santalucia. Impact on the Private Sector: Jean Wooster.
    Estimate approved by: Robert A. Sunshine, Deputy Assistant 
Director for Budget Analysis.

                applicability to the legislative branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act (Public Law 
104-1).

                       federal mandates statement

    The Committee adopts as its own the estimate of the Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act (Public Law 104-4).

                   constitutional authority statement

    Pursuant to clause (2)(l)(4) of rule XI of the Rules of the 
House of Representatives, committee reports on a bill or joint 
resolution of a public character shall include a statement 
citing the specific powers granted to the Congress in the 
Constitution to enact the measure. The Committee on 
Transportation and Infrastructure finds that Congress has the 
authority to enact this measure pursuant to its powers granted 
under Article I, Section 8 of the Constitution.

                      advisory committee statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

         changes in existing law made by the bill, as reported

    H.R. 2843 does not amend any existing Federal statute.

                          exchange of letters

                          House of Representatives,
                                Committee on the Judiciary,
                                    Washington, DC, March 20, 1998.
Hon. Bud Shuster,
Chairman, Committee on Transportation and Infrastructure, House of 
        Representatives, Washington, DC.
    Dear Bud: I am writing to you regarding the ``Aviation 
Medical Assistance Act of 1997'' (H.R. 2843), legislation that 
was ordered reported by the Committee on Transportation and 
Infrastructure on March 11, 1998.
    Section 5 imposes limitations on the liability of air 
carriers and individuals for injuries caused in the course of 
providing in-flight medical emergency services. This provision 
falls within the Rule X jurisdiction of the Committee on the 
Judiciary.
    The Judiciary Committee does not object to the terms of 
this provision, and for this reason, I am not requesting a 
sequential referral of the bill. However, this should not be 
deemed to be a waiver of this Committee's jurisdiction over the 
subject matters contained therein, or our right to be appointed 
as conferees should this bill go to conference with the Senate.
            Sincerely,
                                           Henry J. Hyde, Chairman.
                                ------                                

                          House of Representatives,
            Committee on Transportation and Infrastructure,
                                    Washington, DC, March 20, 1998.
Hon. Henry J. Hyde,
Chairman, Committee on the Judiciary, Rayburn House Office Building, 
        Washington, DC.
    Dear Henry: Thank you for your letter of March 20, 1998 
concerning the Aviation Medical Assistance Act of 1997, H.R. 
2843. I appreciate your assistance in expediting House 
consideration of this legislation and your comments on section 
5 of the bill which limits the liability of air carriers and 
individuals for injuries resulting from in-flight medical 
emergency services. As you correctly point out, this provision 
falls within the jurisdiction of the Committee on the 
Judiciary.
    As you have requested, it is my intention to insert your 
letter and this response in the report accompanying H.R. 2843. 
Further, I would be pleased to support the representation of 
your Committee in any Conference on H.R. 2843 on matters within 
the jurisdiction of the Committee on the Judiciary.
    With warm personal regards, I am
            Sincerely,
                                             Bud Shuster, Chairman.

                                
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