[House Report 106-634]
[From the U.S. Government Publishing Office]



106th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     106-634

======================================================================



 
                  CARDIAC ARREST SURVIVAL ACT OF 2000

                                _______
                                

  May 23, 2000.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

  Mr. Bliley, from the Committee on Commerce, submitted the following

                              R E P O R T

                        [To accompany H.R. 2498]



  The Committee on Commerce, to whom was referred the bill 
(H.R. 2498) to amend the Public Health Service Act to provide 
for recommendations of the Secretary of Health and Human 
Services regarding the placement of automatic external 
defibrillators in Federal buildings in order to improve 
survival rates of individuals who experience cardiac arrest in 
such buildings, and to establish protections from civil 
liability arising from the emergency use of the devices, having 
considered the same, report favorably thereon with an amendment 
and recommend that the bill as amended do pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     2
Purpose and Summary..............................................     4
Background and Need for Legislation..............................     5
Hearings.........................................................     6
Committee Consideration..........................................     7
Committee Votes..................................................     7
Committee Oversight Findings.....................................     7
Committee on Government Reform Oversight Findings................     7
New Budget Authority, Entitlement Authority, and Tax Expenditures     7
Committee Cost Estimate..........................................     7
Congressional Budget Office Estimate.............................     8
Federal Mandates Statement.......................................     8
Advisory Committee Statement.....................................     8
Constitutional Authority Statement...............................     8
Applicability to Legislative Branch..............................     8
Section-by-Section Analysis of the Legislation...................     8
Changes in Existing Law Made by the Bill, as Reported............    10

                               Amendment

  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 ``Cardiac Arrest Survival Act of 2000''.

SEC. 2. FINDINGS.

  The Congress finds as follows:
          (1) Over 7 lives are lost every day to sudden cardiac arrest 
        in the United States alone.
          (2) Two out of every three sudden cardiac deaths occur before 
        a victim can reach a hospital.
          (3) More than 95 percent of these cardiac arrest victims will 
        die, many because of lack of readily available life saving 
        medical equipment.
          (4) With current medical technology, up to 30 percent of 
        cardiac arrest victims could be saved if victims had access to 
        immediate medical response, including defibrillation and 
        cardiopulmonary resuscitation.
          (5) Once a victim has suffered a cardiac arrest, every minute 
        that passes before returning the heart to a normal rhythm 
        decreases the chance of survival by 10 percent.
          (6) Most cardiac arrests are caused by abnormal heart rhythms 
        called ventricular fibrillation. Ventricular fibrillation 
        occurs when the heart's electrical system malfunctions, causing 
        a chaotic rhythm that prevents the heart from pumping oxygen to 
        the victim's brain and body.
          (7) Communities that have implemented programs ensuring 
        widespread public access to defibrillators, combined with 
        appropriate training, maintenance, and coordination with local 
        emergency medical systems, have improved the survival rates 
        from cardiac arrest to as much as 20 percent.
          (8) Automated external defibrillator devices have proven safe 
        and effective, even when used by lay people, since the devices 
        are designed not to allow a user to administer a shock until 
        after the device has analyzed a victim's heart rhythm and 
        determined that an electric shock is required.
          (9) Increasing public awareness regarding automated external 
        defibrillator devices and encouraging their use in Federal 
        buildings will greatly facilitate their adoption.
          (10) Limiting the liability of Good Samaritans in emergency 
        situations may encourage the use of automated external 
        defibrillator devices, and result in saved lives.

SEC. 3. RECOMMENDATIONS AND GUIDELINES OF SECRETARY OF HEALTH AND HUMAN 
                    SERVICES REGARDING AUTOMATED EXTERNAL 
                    DEFIBRILLATORS FOR FEDERAL BUILDINGS.

  Part B of title II of the Public Health Service Act (42 U.S.C. 238 et 
seq.) is amended by adding at the end the following section:
     ``recommendations and guidelines regarding automated external 
                  defibrillators for federal buildings
  ``Sec. 247. (a) Guidelines on Placement.--The Secretary shall 
establish guidelines with respect to placing automated external 
defibrillator devices in Federal buildings. Such guidelines shall take 
into account the extent to which such devices may be used by lay 
persons, the typical number of employees and visitors in the buildings, 
the extent of the need for security measures regarding the buildings, 
buildings or portions of buildings in which there are special 
circumstances such as high electrical voltage or extreme heat or cold, 
and such other factors as the Secretary determines to be appropriate.
  ``(b) Related Recommendations.--The Secretary shall publish in the 
Federal Register the recommendations of the Secretary on the 
appropriate implementation of the placement of automated external 
defibrillator devices under subsection (a), including procedures for 
the following:
          ``(1) Implementing appropriate training courses in the use of 
        such devices, including the role of cardiopulmonary 
        resuscitation.
          ``(2) Proper maintenance and testing of the devices.
          ``(3) Ensuring coordination with appropriate licensed 
        professionals in the oversight of training of the devices.
          ``(4) Ensuring coordination with local emergency medical 
        systems regarding the placement and incidents of use of the 
        devices.
  ``(c) Consultations; Consideration of Certain Recommendations.--In 
carrying out this section, the Secretary shall--
          ``(1) consult with appropriate public and private entities;
          ``(2) consider the recommendations of national and local 
        public-health organizations for improving the survival rates of 
        individuals who experience cardiac arrest in nonhospital 
        settings by minimizing the time elapsing between the onset of 
        cardiac arrest and the initial medical response; and
          ``(3) consult with and counsel other Federal agencies where 
        such devices are to be used.
  ``(d) Date Certain for Establishing Guidelines and Recommendations.--
The Secretary shall comply with this section not later than 180 days 
after the date of the enactment of the Cardiac Arrest Survival Act of 
2000.
  ``(e) Definitions.--For purposes of this section:
          ``(1) The term `automated external defibrillator device' has 
        the meaning given such term in section 248.
          ``(2) The term `Federal building' includes a building or 
        portion of a building leased by a Federal agency, and includes 
        buildings on military installations of the United States.''.

SEC. 4. GOOD SAMARITAN PROTECTIONS REGARDING EMERGENCY USE OF AUTOMATED 
                    EXTERNAL DEFIBRILLATORS.

  Part B of title II of the Public Health Service Act, as amended by 
section 3 of this Act, is amended by adding at the end the following 
section:
       ``liability regarding emergency use of automated external 
                             defibrillators
  ``Sec. 248. (a) Good Samaritan Protections Regarding AEDs.--Except as 
provided in subsection (b), any person who uses an automated external 
defibrillator device on a victim of a perceived medical emergency is 
immune from civil liability for any harm resulting from the use of such 
device; and in addition, any person who acquired the device is immune 
from such liability, if the harm was not due to the failure of such 
acquirer of the device--
          ``(1) to notify local emergency response personnel or other 
        appropriate entities of the most recent placement of the device 
        within a reasonable period of time after the device was placed;
          ``(2) to properly maintain and test the device; or
          ``(3) to provide appropriate training in the use of the 
        device to an employee or agent of the acquirer when the 
        employee or agent was the person who used the device on the 
        victim, except that such requirement of training does not apply 
        if--
                  ``(A) the employee or agent was not an employee or 
                agent who would have been reasonably expected to use 
                the device; or
                  ``(B) the period of time elapsing between the 
                engagement of the person as an employee or agent and 
                the occurrence of the harm (or between the acquisition 
                of the device and the occurrence of the harm, in any 
                case in which the device was acquired after such 
                engagement of the person) was not a reasonably 
                sufficient period in which to provide the training.
  ``(b) Inapplicability of Immunity.--Immunity under subsection (a) 
does not apply to a person if--
          ``(1) the harm involved was caused by willful or criminal 
        misconduct, gross negligence, reckless misconduct, or a 
        conscious, flagrant indifference to the rights or safety of the 
        victim who was harmed; or
          ``(2) the person is a licensed or certified health 
        professional who used the automated external defibrillator 
        device while acting within the scope of the license or 
        certification of the professional and within the scope of the 
        employment or agency of the professional; or
          ``(3) the person is a hospital, clinic, or other health care 
        entity, and the harm was caused by an employee or agent of the 
        entity who used the device while acting within the scope of the 
        employment or agency of the employee or agent; or
          ``(4) the person is an acquirer of the device who leased the 
        device to a health care entity (or who otherwise provided the 
        device to such entity for compensation without selling the 
        device to the entity), and the harm was caused by an employee 
        or agent of the entity who used the device while acting within 
        the scope of the employment or agency of the employee or agent.
  ``(c) Rules of Construction.--
          ``(1) In general.--The following applies with respect to this 
        section:
                  ``(A) This section does not establish any cause of 
                action, or require that an automated external 
                defibrillator device be placed at any building or other 
                location.
                  ``(B) With respect to a class of persons for which 
                this section provides immunity from civil liability, 
                this section supersedes the law of a State only to the 
                extent that the State has no statute or regulations 
                that provide persons in such class with immunity for 
                civil liability arising from the use by such persons of 
                automated external defibrillator devices in emergency 
                situations (within the meaning of the State law or 
                regulation involved).
                  ``(C) This section does not waive any protection from 
                liability for Federal officers or employees under--
                          ``(i) section 224; or
                          ``(ii) sections 1346(b), 2672, and 2679 of 
                        title 28, United States Code, or under 
                        alternative benefits provided by the United 
                        States where the availability of such benefits 
                        precludes a remedy under section 1346(b) of 
                        title 28.
          ``(2) Civil actions under federal law.--
                  ``(A) In general.--The applicability of subsections 
                (a) and (b) includes applicability to any action for 
                civil liability described in subsection (a) that arises 
                under Federal law.
                  ``(B) Federal areas adopting state law.--If a 
                geographic area is under Federal jurisdiction and is 
                located within a State but out of the jurisdiction of 
                the State, and if, pursuant to Federal law, the law of 
                the State applies in such area regarding matters for 
                which there is no applicable Federal law, then an 
                action for civil liability described in subsection (a) 
                that in such area arises under the law of the State is 
                subject to subsections (a) through (c) in lieu of any 
                related State law that would apply in such area in the 
                absence of this subparagraph.
  ``(d) Federal Jurisdiction.--In any civil action arising under State 
law, the courts of the State involved have jurisdiction to apply the 
provisions of this section exclusive of the jurisdiction of the courts 
of the United States.
  ``(e) Definitions.--
          ``(1) Perceived medical emergency.--For purposes of this 
        section, the term `perceived medical emergency' means 
        circumstances in which the behavior of an individual leads a 
        reasonable person to believe that the individual is 
        experiencing a life-threatening medical condition that requires 
        an immediate medical response regarding the heart or other 
        cardiopulmonary functioning of the individual.
          ``(2) Other definitions.--For purposes of this section:
                  ``(A) The term `automated external defibrillator 
                device' means a defibrillator device that--
                          ``(i) is commercially distributed in 
                        accordance with the Federal Food, Drug, and 
                        Cosmetic Act;
                          ``(ii) is capable of recognizing the presence 
                        or absence of ventricular fibrillation, and is 
                        capable of determining without intervention by 
                        the user of the device whether defibrillation 
                        should be performed;
                          ``(iii) upon determining that defibrillation 
                        should be performed, is able to deliver an 
                        electrical shock to an individual; and
                          ``(iv) in the case of a defibrillator device 
                        that may be operated in either an automated or 
                        a manual mode, is set to operate in the 
                        automated mode.
                  ``(B)(i) The term `harm' includes physical, 
                nonphysical, economic, and noneconomic losses.
                  ``(ii) The term `economic loss' means any pecuniary 
                loss resulting from harm (including the loss of 
                earnings or other benefits related to employment, 
                medical expense loss, replacement services loss, loss 
                due to death, burial costs, and loss of business or 
                employment opportunities) to the extent recovery for 
                such loss is allowed under applicable State law.
                  ``(iii) The term `noneconomic losses' means losses 
                for physical and emotional pain, suffering, 
                inconvenience, physical impairment, mental anguish, 
                disfigurement, loss of enjoyment of life, loss of 
                society and companionship, loss of consortium (other 
                than loss of domestic service), hedonic damages, injury 
                to reputation and all other nonpecuniary losses of any 
                kind or nature.''.

                          Purpose and Summary

    H.R. 2498, The Cardiac Arrest Survival Act, contains two 
significant provisions--the creation of guidelines for 
placement of automated external defibrillators (AEDs) in 
federal buildings, and the establishment of limited immunity 
protections for people who use or acquire AEDs. The first part 
of the bill encourages the Federal Government to be a role 
model for the private sector, directing the Secretary of Health 
and Human Services to develop guidelines for placing AEDs in 
Federal buildings, and to publish in the Federal Register its 
recommendations for appropriate training courses, maintenance 
and testing of AEDs, training for AED use, and coordination 
with local emergency medical systems (EMS) regarding the 
placement and notification of incidents of use of AEDs.
    The second part of the bill establishes so-called ``Good 
Samaritan'' protections from liability for people who use or 
acquire AEDs. Immunity for acquirers applies only if the harm 
is not caused by the acquirer's failure to notify local EMS of 
the devices' placement within a reasonable period of time, to 
properly maintain and test the devices, or to provide 
appropriate training in certain instances. Furthermore, the 
immunity does not apply if the harm was caused by a person's 
willful or criminal or reckless misconduct, gross negligence, 
or a conscious, flagrant indifference to the rights or safety 
of the victim. It also does not apply if the AED is being used 
by a doctor or nurse or other licensed professional in their 
scope of employment, if it is being used by a hospital or other 
health care entity, or if it is being used by an acquirer 
leasing the AEDs to such a health care entity.
    H.R. 2498 does not create any new causes of action and does 
not impose any new regulations on the private sector, nor does 
the bill require that AEDs be placed at any building or 
location. State laws are not superseded if the State has or 
enacts a statute or regulation providing immunity for the 
applicable persons.

                  Background and Need for Legislation

    Sudden cardiac arrest is one of the leading causes of death 
in the United States, killing more than 250,000 Americans every 
year. Unlike a heart attack, which is the death of a muscle 
tissue from loss of blood supply, many victims of sudden 
cardiac arrest have no prior symptoms. Unfortunately, two out 
of every three sudden cardiac deaths occur before a victim can 
reach a hospital, and more than 95 percent of these cardiac 
arrest victims will die because of lack of readily available 
life saving medical equipment.
    At the May 9, 2000 hearing on H.R. 2498 in the Subcommittee 
on Health and Environment, Mr. Robert T. Adams, Esq., testified 
that he had been in perfect health, as certified by numerous 
doctor examinations for his part-time work as an NCAA 
basketball referee, when he was victimized by a sudden cardiac 
arrest at Grand Central Station in New York. He testified that 
he probably would not be alive today if the station had not 
purchased an automated external defibrillator just one day 
before, which was used to save his life while emergency medical 
services personnel were in transit.
    Once a victim has suffered a cardiac arrest, every minute 
that passes before returning the heart to a normal rhythm 
decreases the chance of survival by 10 percent. Most cardiac 
arrests are caused by abnormal heart rhythms called ventricular 
fibrillation. Ventricular fibrillation occurs when the heart's 
electrical system malfunctions,causing a chaotic rhythm that 
prevents the heart from pumping oxygen to the victim's brain and body.
    Automated external defibrillators are medical devices that 
can restart a heart that has stopped beating effectively. AEDs 
are subject to FDA approval, and can only be sold with a 
prescription by a licensed individual. AED devices have been 
shown to be safe and effective, even when used by lay people, 
since the devices are designed so as not to allow a user to 
administer a shock until after the device has analyzed a 
victim's heart rhythm and determined that an electric shock is 
required. AED training courses are provided by the American Red 
Cross, the American Heart Association, local emergency medical 
services groups, and other public health and safety 
institutions.
    Richard Hardman, Ph.D., NREMT-P, and EMS Training 
Coordinator for the Clark County Fire Department, testified at 
the May 9th hearing that after widespread placement of AEDs and 
implementation of AED training in Las Vegas casinos, survival 
rates for sudden cardiac arrest increased from less than 10% to 
an astounding 57%. Other experts estimate survival rates 
increasing to 30--40% where victims have access to immediate 
medical response including defibrillation and cardiopulmonary 
resuscitation.
    Mr. Richard A. Lazar and other witnesses at the 
Subcommittee hearing testified that unfortunately, AED usage 
has been hindered by fears of liability exposure. People who 
design and implement training programs may be reluctant to 
volunteer or otherwise offer their services if they are thereby 
exposing themselves to significant financial liability. 
Similarly, acquirers and users of AEDs may be reluctant to 
purchase or use the devices if subjected to liability. Mr. 
Lazar testified that,

          We are not seeing [AEDs] widely deployed, 
        notwithstanding their ease of use, their relatively low 
        cost, and the clear public health interest in them 
        being widely deployed. One of the critical reasons why 
        that is is because there is this perception among 
        would-be purchasers and users of AEDs that if they do 
        this they are going to get sued. Now, statistically, 
        and if you look in the courts, that is not really 
        justified. But you know what, perception is reality, 
        and perception is, indeed, creating a huge barrier to 
        the widespread deployment and adoption of AED programs.

    In 1997, Congress enacted the Volunteers Protection Act 
(P.L. 105-19; 42 U.S.C. Sec. 14501) to grant immunity from 
liability for Americans who volunteered their services for a 
nonprofit organization or a governmental entity. The Cardiac 
Arrest Survival Act will extend similar liability protections 
to people who voluntarily acquire or use AEDs to help save 
victims of sudden cardiac arrest. This immunity from unfair 
lawsuits will help protect ``Good Samaritans'' who use AEDs to 
help save the lives of our fellow Americans, as well as 
businesses and land owners who acquire the devices to make 
their buildings or offices safer for the public.

                                Hearings

    The Subcommittee on Health and Environment held a hearing 
on H.R. 2498 on May 9, 2000. The Subcommittee received 
testimony from: Richard Hardman, Ph.D., NREMT-P, EMS Training 
Coordinator, Clark County Fire Department, Las Vegas, Nevada; 
Robert T. Adams, Esq., Partner, Wilson, Elser, Moskowitz, 
Edelman, & Dicker, L.L.P., New York City; Mr. Scott Conner, 
Vice President, Health, Safety, & Community Services, American 
Red Cross, Washington, DC; and Richard A. Lazar, Esq., 
Portland, Oregon.

                        Committee Consideration

    On May 9, 2000, the Subcommittee on Health and Environment 
met in open markup session and approved H.R. 2498 for Full 
Committee consideration, as amended, by a voice vote. On May 
17, 2000, the Full Committee met in open markup session and 
approved H.R. 2498, as amended, by a voice vote.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the record votes 
on the motion to report legislation and amendments thereto. 
There were no record votes taken in connection with ordering 
H.R. 2498 reported. A motion by Mr. Bliley to order H.R. 2498 
reported to the House, as amended, was agreed to by a voice 
vote.

                      Committee Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee held a legislative 
hearing and made findings that are reflected in this report.

           Committee on Government Reform Oversight Findings

    Pursuant to clause 3(c)(4) of rule XIII of the Rules of the 
House of Representatives, no oversight findings have been 
submitted to the Committee by the Committee on Government 
Reform.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee finds that H.R. 
2498, the Cardiac Arrest Survival Act of 2000, would result in 
no new or increased budget authority, entitlement authority, or 
tax expenditures or revenues.

                        Committee Cost Estimate

    Pursuant to clause 3 of rule XIII of the Rules of the House 
of Representatives, the Committee provides the following 
estimate of the costs of H.R. 2498:
    H.R. 2498 directs the Secretary of Health and Human 
Services to develop guidelines for placing AEDs in Federal 
buildings, and to publish in the Federal Register its 
recommendations for appropriate training courses, maintenance 
and testing of AEDs, training for AED use, and coordination 
with local emergency medical systems (EMS) regarding the 
placement and notification of incidents of use of AEDs. The 
bill also establishes so-called ``Good Samaritan'' protections 
from liability for people who use or acquire AEDs.
    The Committee estimates that enacting H.R. 2498 would have 
no significant impact on the Federal budget. Implementing the 
bill would require far less than $500,000 a year in 
discretionary spending during the 2000-2005 period. The 
Committee also finds that H.R. 2498 would not affect direct 
spending, so pay-as-you-go procedures would not apply.

                  Congressional Budget Office Estimate

    The cost estimate provided by the Congressional Budget 
Office pursuant to section 402 of the Congressional Budget Act 
of 1974 was not timely submitted to the Committee.

                       Federal Mandates Statement

    An estimate of Federal mandates prepared by the Director of 
the Congressional Budget Office pursuant to section 423 of the 
Unfunded Mandates Reform Act was not timely submitted to the 
Committee. Accordingly, the Committee finds that H.R. 2498 
contains no intergovernmental or private-sector mandates as 
defined in the Unfunded Mandates Reforms Act and would not 
affect the budgets of State, local, or tribal governments.

                      Advisory Committee Statement

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

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds that the 
Constitutional authority for this legislation is provided in 
Article I, section 8, clause 3, which grants Congress the power 
to regulate commerce with foreign nations, among the several 
States, and with the Indian tribes.

                  Applicability to 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.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 designates the short title of the legislation as 
the ``Cardiac Arrest Survival Act of 2000.''

Section 2. Findings

    Section 2 sets forth certain findings.

Section 3. Recommendations and guidelines of Secretary of Health and 
        Human Services regarding automated external defibrillators for 
        Federal buildings

    Section 3 encourages the Federal government to be a role 
model for the private sector in implementing automated external 
defibrillator programs by directing the Secretary of Health and 
Human Services to develop guidelines for placing AEDs in 
Federal buildings, and to publish in the Federal Register its 
recommendations for appropriate training courses, maintenance 
and testing of AEDs, training for AED use, and coordination 
with local emergency medical systems regarding the placement 
and notification of incidents of use of AEDs. The Secretary is 
required to consult with appropriate public and private 
entities, such as other Federal agencies where AEDs may be 
recommended to be placed, entities that own buildings or land 
rented or leased by Federal agencies, and various local and 
private sector health care groups that have traditionally been 
involved or that may become involved under the Secretary's 
guidelines in promoting or implementing AED use. The Secretary 
is also directed to consider various recommendations of 
national and local public-health organizations to achieve 
additional improvements in the survival rates of individuals 
experiencing cardiac arrest, and to minimize the time elapsing 
between the onset of cardiac arrest and the initial medical 
response of such individuals. The Secretary is directed to 
issue such guidelines and publish such recommendations within 
180 days after the date of enactment of this legislation.

Section 4. Good Samaritan protections regarding emergency use of 
        automated external defibrillators

    Section 4 establishes so-called ``Good Samaritan'' 
protections from liability for people who use or acquire AEDs. 
Users of AEDs are protected from liability for using an AED on 
an individual so long as the individual's behavior could lead a 
reasonable person to believe that such individual is 
experiencing a life-threatening medical condition that requires 
an immediate medical response regarding the heart or other 
cardiopulmonary functioning of the individual. This provision 
is intended by the Committee to be a reasonable good faith 
test, since there are very few outward symptoms of a cardiac 
arrest for which victims require immediate medical attention, 
and the AEDs will not administer a shock until after an 
individual's heart rate is measured and a shock determined 
appropriate. Thus, if a person reasonably believes that an 
individual is suffering cardiac arrest, this provision is 
intended to provide immunity from liability to encourage such 
person to utilize an AED on such individual. If a person uses 
an AED on an individual whom a reasonable lay person could 
clearly recognize was not suffering from a heart condition 
requiring immediate medical attention, then the liability 
protections of this Act do not apply.
    Physicians and other licensed or certified health 
professionals who are using an AED within the scope of their 
health employment or agency are also excluded from immunity 
protection. Thus, a nurse using an AED at the nurse's place of 
employment while on duty would not be covered, but the same 
nurse if acting in a lay capacity as a bystander outside of a 
hospital would receive protection.
    The immunity provision is further limited to cases where 
any harm caused by improper use of an AED is not due to the 
user's willful or criminal misconduct, gross negligence, 
reckless misconduct, or conscious and flagrant indifference to 
the rights or safety of the harmed individual. This standard is 
taken from the Volunteers Protection Act, and is intended to 
reflect a good faith standard that provides significantly more 
protection for Good Samaritans than the regular negligence 
standard common in most States.
    Acquirers of AEDs are also granted immunity from liability 
related to the AEDs, so long as any harm caused by the use of 
an AED is not a result of the acquirer's failure to notify 
local emergency medical systems personnel or other appropriate 
entities of the devices'placement within a reasonable period of 
time after a placement of the device, failure to properly maintain and 
test the AED, or failure to provide appropriate AED training to an 
employee or agent who used the device on the victim in cases where the 
employee or agent would have been reasonably expected to use the device 
and the acquirer had a reasonable opportunity to train the user from 
the time at which the person could reasonably be expected to use the 
device.
    Acquirers are subject to the same standard as good faith 
users (the harm was not caused by willful or criminal 
misconduct, etc.). However, the immunity provision does not 
protect hospitals and other health care entities where the harm 
from an AED use was caused by an employee or agent of the 
health entity using the AED while acting in the scope of their 
employment. This exclusion is similar to that for doctors and 
nurses acting within the scope of their employment, and is 
intended to exclude from immunity those entities holding 
themselves out as health care providers who are accordingly 
held to a higher standard of care then a person not acting in 
an official health care capacity.
    The liability immunity protections do not apply to 
acquirers who lease, or rent, or otherwise hold title to an AED 
provided to a health care entity in cases where the AED is used 
by an employee or agent of a health care entity while acting 
within the scope of their employment or agency for such entity. 
This exclusion is intended to cover instances where hospitals 
and other health entities are using AEDs as part of the health 
care services they are providing, but where they are not the 
actual acquirers of the AED.
    The rules of construction provide that this bill does not 
create any new cause of action, and does not require that an 
AED be placed at any building or other location. State laws are 
not superseded if the State has or enacts a statute or 
regulation providing immunity for the applicable class of 
persons. Additional existing protections from liability for 
Federal employees are not affected by this Act, including those 
in the Federal Tort Claims Act. However, the additional 
protections provided by this Act do apply to any action for 
civil liability arising under Federal law. The protections also 
apply to users and acquirers in military bases and other 
Federal jurisdictions that have adopted the laws of a 
surrounding State regarding matters where no other applicable 
Federal law exists.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

PUBLIC HEALTH SERVICE ACT

           *       *       *       *       *       *       *



TITLE II--ADMINISTRATION AND MISCELLANEOUS PROVISIONS

           *       *       *       *       *       *       *



Part B--Miscellaneous Provisions

           *       *       *       *       *       *       *




      recommendations and guidelines regarding automated external 
                  defibrillators for federal buildings


  Sec. 247. (a) Guidelines on Placement.--The Secretary shall 
establish guidelines with respect to placing automated external 
defibrillator devices in Federal buildings. Such guidelines 
shall take into account the extent to which such devices may be 
used by lay persons, the typical number of employees and 
visitors in the buildings, the extent of the need for security 
measures regarding the buildings, buildings or portions of 
buildings in which there are special circumstances such as high 
electrical voltage or extreme heat or cold, and such other 
factors as the Secretary determines to be appropriate.
  (b) Related Recommendations.--The Secretary shall publish in 
the Federal Register the recommendations of the Secretary on 
the appropriate implementation of the placement of automated 
external defibrillator devices under subsection (a), including 
procedures for the following:
          (1) Implementing appropriate training courses in the 
        use of such devices, including the role of 
        cardiopulmonary resuscitation.
          (2) Proper maintenance and testing of the devices.
          (3) Ensuring coordination with appropriate licensed 
        professionals in the oversight of training of the 
        devices.
          (4) Ensuring coordination with local emergency 
        medical systems regarding the placement and incidents 
        of use of the devices.
  (c) Consultations; Consideration of Certain 
Recommendations.--In carrying out this section, the Secretary 
shall--
          (1) consult with appropriate public and private 
        entities;
          (2) consider the recommendations of national and 
        local public-health organizations for improving the 
        survival rates of individuals who experience cardiac 
        arrest in nonhospital settings by minimizing the time 
        elapsing between the onset of cardiac arrest and the 
        initial medical response; and
          (3) consult with and counsel other Federal agencies 
        where such devices are to be used.
  (d) Date Certain for Establishing Guidelines and 
Recommendations.--The Secretary shall comply with this section 
not later than 180 days after the date of the enactment of the 
Cardiac Arrest Survival Act of 2000.
  (e) Definitions.--For purposes of this section:
          (1) The term ``automated external defibrillator 
        device'' has the meaning given such term in section 
        248.
          (2) The term ``Federal building'' includes a building 
        or portion of a building leased by a Federal agency, 
        and includes buildings on military installations of the 
        United States.


 liability regarding emergency use of automated external defibrillators


  Sec. 248. (a) Good Samaritan Protections Regarding AEDs.--
Except as provided in subsection (b), any person who uses an 
automated external defibrillator device on a victim of a 
perceived medical emergency is immune from civil liability for 
any harm resulting from the use of such device; and in 
addition, any person who acquired the device is immune from 
such liability, if the harm was not due to the failure of such 
acquirer of the device--
          (1) to notify local emergency response personnel or 
        other appropriate entities of the most recent placement 
        of the device within a reasonable period of time after 
        the device was placed;
          (2) to properly maintain and test the device; or
          (3) to provide appropriate training in the use of the 
        device to an employee or agent of the acquirer when the 
        employee or agent was the person who used the device on 
        the victim, except that such requirement of training 
        does not apply if--
                  (A) the employee or agent was not an employee 
                or agent who would have been reasonably 
                expected to use the device; or
                  (B) the period of time elapsing between the 
                engagement of the person as an employee or 
                agent and the occurrence of the harm (or 
                between the acquisition of the device and the 
                occurrence of the harm, in any case in which 
                the device was acquired after such engagement 
                of the person) was not a reasonably sufficient 
                period in which to provide the training.
  (b) Inapplicability of Immunity.--Immunity under subsection 
(a) does not apply to a person if--
          (1) the harm involved was caused by willful or 
        criminal misconduct, gross negligence, reckless 
        misconduct, or a conscious, flagrant indifference to 
        the rights or safety of the victim who was harmed; or
          (2) the person is a licensed or certified health 
        professional who used the automated external 
        defibrillator device while acting within the scope of 
        the license or certification of the professional and 
        within the scope of the employment or agency of the 
        professional; or
          (3) the person is a hospital, clinic, or other health 
        care entity, and the harm was caused by an employee or 
        agent of the entity who used the device while acting 
        within the scope of the employment or agency of the 
        employee or agent; or
          (4) the person is an acquirer of the device who 
        leased the device to a health care entity (or who 
        otherwise provided the device to such entity for 
        compensation without selling the device to the entity), 
        and the harm was caused by an employee or agent of the 
        entity who used the device while acting within the 
        scope of the employment or agency of the employee or 
        agent.
  (c) Rules of Construction.--
          (1) In general.--The following applies with respect 
        to this section:
                  (A) This section does not establish any cause 
                of action, or require that an automated 
                external defibrillator device be placed at any 
                building or other location.
                  (B) With respect to a class of persons for 
                which this section provides immunity from civil 
                liability, this section supersedes the law of a 
                State only to the extent that the State has no 
                statute or regulations that provide persons in 
                such class with immunity for civil liability 
                arising from the use by such persons of 
                automated external defibrillator devices in 
                emergency situations (within the meaning of the 
                State law or regulation involved).
                  (C) This section does not waive any 
                protection from liability for Federal officers 
                or employees under--
                          (i) section 224; or
                          (ii) sections 1346(b), 2672, and 2679 
                        of title 28, United States Code, or 
                        under alternative benefits provided by 
                        the United States where the 
                        availability of such benefits precludes 
                        a remedy under section 1346(b) of title 
                        28.
          (2) Civil actions under federal law.--
                  (A) In general.--The applicability of 
                subsections (a) and (b) includes applicability 
                to any action for civil liability described in 
                subsection (a) that arises under Federal law.
                  (B) Federal areas adopting state law.--If a 
                geographic area is under Federal jurisdiction 
                and is located within a State but out of the 
                jurisdiction of the State, and if, pursuant to 
                Federal law, the law of the State applies in 
                such area regarding matters for which there is 
                no applicable Federal law, then an action for 
                civil liability described in subsection (a) 
                that in such area arises under the law of the 
                State is subject to subsections (a) through (c) 
                in lieu of any related State law that would 
                apply in such area in the absence of this 
                subparagraph.
  (d) Federal Jurisdiction.--In any civil action arising under 
State law, the courts of the State involved have jurisdiction 
to apply the provisions of this section exclusive of the 
jurisdiction of the courts of the United States.
  (e) Definitions.--
          (1) Perceived medical emergency.--For purposes of 
        this section, the term ``perceived medical emergency'' 
        means circumstances in which the behavior of an 
        individual leads a reasonable person to believe that 
        the individual is experiencing a life-threatening 
        medical condition that requires an immediate medical 
        response regarding the heart or other cardiopulmonary 
        functioning of the individual.
          (2) Other definitions.--For purposes of this section:
                  (A) The term ``automated external 
                defibrillator device'' means a defibrillator 
                device that--
                          (i) is commercially distributed in 
                        accordance with the Federal Food, Drug, 
                        and Cosmetic Act;
                          (ii) is capable of recognizing the 
                        presence or absence of ventricular 
                        fibrillation, and is capable of 
                        determining without intervention by the 
                        user of the device whether 
                        defibrillation should be performed;
                          (iii) upon determining that 
                        defibrillation should be performed, is 
                        able to deliver an electrical shock to 
                        an individual; and
                          (iv) in the case of a defibrillator 
                        device that may be operated in either 
                        an automated or a manual mode, is set 
                        to operate in the automated mode.
                  (B)(i) The term ``harm'' includes physical, 
                nonphysical, economic, and noneconomic losses.
                  (ii) The term ``economic loss'' means any 
                pecuniary loss resulting from harm (including 
                the loss of earnings or other benefits related 
                to employment, medical expense loss, 
                replacement services loss, loss due to death, 
                burial costs, and loss of business or 
                employment opportunities) to the extent 
                recovery for such loss is allowed under 
                applicable State law.
                  (iii) The term ``noneconomic losses'' means 
                losses for physical and emotional pain, 
                suffering, inconvenience, physical impairment, 
                mental anguish, disfigurement, loss of 
                enjoyment of life, loss of society and 
                companionship, loss of consortium (other than 
                loss of domestic service), hedonic damages, 
                injury to reputation and all other nonpecuniary 
                losses of any kind or nature.

                                
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