BILL ANALYSIS
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|Hearing Date:June 14, 2010 |Bill No:AB |
| |1937 |
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SENATE COMMITTEE ON BUSINESS, PROFESSIONS
AND ECONOMIC DEVELOPMENT
Senator Gloria Negrete McLeod, Chair
Bill No: AB 1937Author:Fletcher
As Amended:May 25, 2010 Fiscal: No
SUBJECT: Pupil health: immunizations.
SUMMARY: This bill is an Urgency Measure which expands the health
care practitioners who are authorized to administer immunizations to
students with a written parental consent to include physician
assistants, nurse practitioners, licensed vocational nurses, and
nursing students acting under the supervision of an Registered Nurse;
applies existing requirements that apply to nurses in the
administration of immunizations to these health care practitioners.
Existing law:
1)Establishes the Nurse Practice Act to govern the practice of nurses
and nurse practitioners under the Board of Registered Nursing.
2)Establishes the Physician Assistant Committee within the Medical
Board of California to license and regulate the practice of
physician assistants.
3)Establishes the Board of Vocation Nursing and Psychiatric
Technicians to license and regulate the practice of vocational
nurses.
4)Establishes the Communicable Disease Control Branch within the
Department of Public Health (DPH) to monitor, identify, prevent, and
control infectious diseases that pose a threat to public health.
5)Establishes the educational and child care facility immunization
requirements to provide a means of total immunization of appropriate
age groups against specified childhood diseases including
diphtheria, hepatitis B, measles, mumps, pertussis, rubella,
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tetanus, varicella (chicken pox), and any other diseases that is
consistent with the most current recommendations of the United
States Public Health Services' Centers for Disease Control
Immunization Practices Advisory Committee and the American Academy
of Pediatrics Committee of Infectious Diseases, and deemed
appropriate by DPH.
6)Requires students in grades K - 12 to obtain specified immunizations
prior to their first admission into an educational institution.
States that immunizations may be obtained from any public or private
source desired if the immunization is administered and records are
made, as specified.
7)Requires DPH, in consultation with the Department of Education, to
adopt and enforce these immunization requirements.
8)Requires the governing board of any school district to cooperate
with the local health officer if necessary for the prevention and
control of communicable diseases in school age children. Allows the
board to use any funds, property, and personnel of the district, and
may permit any licensed physician and surgeon, or a Registered Nurse
acting under the direction of a supervising physician and surgeon,
to administer an immunizing agent to any pupil with written parental
consent.
9)Allows a Registered Nurse, acting under the direction of a
supervising physician and surgeon, to perform immunization
techniques within the course of a school immunization program
provided that the administration of an immunizing agent is upon the
standing orders of a supervising physician and surgeon and in
accordance with written regulations adopted by the Department of
Health.
10)Defines supervising physician and surgeon for purposes of item #8)
above as the physician and surgeon of the local health department or
school district that is directing the school immunization program.
11)States that the supervising physician and surgeon shall require a
nurse who administers immunizations pursuant to item #8) above,
under his or her direction, to do both the following:
a) Satisfactorily demonstrate competence in the administration of
immunizing agents, including knowledge of all indications and
contraindications for the administration of such agents, and in
the recognition and treatment of any emergency reactions to such
agents which constitute a danger to the health or life of the
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person receiving the immunization.
b) Possess such medications and equipment as required, in the
medical judgment of the supervising physician and surgeon, to
treat any emergency conditions and reactions caused by the
immunizing agents and which constitute a danger to the health or
life of the person receiving the immunization, and to demonstrate
the ability to administer such medications and to utilize such
equipment as necessary.
12)States that a school nurse is a Registered Nurse licensed by the
Board of Registered Nursing, as specified. Allows a school nurse,
if authorized by the local governing board, to perform specific
services including conducting immunization programs, as specified,
assessing and evaluating the health and developmental status of
pupils, counseling regarding health-related attendance problems, and
designing and implementing health maintenance plans, as specified.
This bill:
1)Authorizes the following health care practitioners, acting under the
direction of a supervising physician and surgeon, to administer an
immunizing agent within the course of a school immunization program:
a) physician assistant (PA),
b) nurse practitioner (NP),
c) licensed vocational nurse (LVN), and,
d) a nursing student acting under the supervision of a Registered
Nurse (RN), to administer immunizations within the course of a
school immunization program
2)States that a PA, NP, LVN, and a nursing student acting under the
supervision of an RN may administer an immunizing agent if ordered
by a supervising physician and surgeon, and the administration is in
accordance with any written regulations that the DPH may adopt.
3)Applies the following existing requirements that apply to RNs in the
administration of a school immunizations to PAs, NPs, LVNs, and a
nursing student acting under the supervision of an RN:
a) The administration of an immunizing agent is upon the standing
orders of a supervising physician and surgeon and in accordance
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with any written regulations that the DPH may adopt.
b) The school nurse is notified and he or she maintains control,
as necessary, as supervisor of health, as specified.
4)Limits the administration of immunizations for the prevention and
control of any of the following: annual seasonal influenza,
influenza pandemic episodes, and other diseases that represent a
current or potential outbreak as declared by a federal, state, or
local public health officer.
5)States that it is the intent of the Legislature to encourage
school-based immunization programs, when feasible, to use the
California Immunization Registry to assist providers to track
patient records, reduce missed opportunities, and to help fully
immunize all children in California.
FISCAL EFFECT: None. This bill is keyed "non-fiscal" by the
Legislative Counsel.
COMMENTS:
1.Purpose. According to the Author who is the sponsor of this
measure, over the past several years and most recently with the H1N1
outbreak, public health officials, including current U.S. Health and
Human Services Secretary Kathleen Sebelius, have supported schools
as alternative vaccination sites. Unfortunately, with drastic cuts
to school district budgets, many California schools lack a school
nurse on site or have enough nurses available to handle a district
wide vaccination program should they wish to undertake such an
endeavor. In order to supplement the work of school nurses, this
bill would provide the option to utilize nursing professionals to
assist with certain school based vaccination programs
2.Background.
a) California School Immunization Law. According to the DPH,
whenever children are brought into group settings, there is a
potential for the spread of infectious diseases. To prevent some
of the most serious infections, existing law, commonly referred
to as California School Immunization Law, requires children
enrolled in Grades K-12, child care centers, day nurseries,
family day care homes or developmental centers to be immunized
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prior to admission into these institutions. These required
immunizations include diphtheria, tetanus, pertussis, polio,
measles, mumps, rubella, hepatitis B, and varicella (chicken
pox). In addition, the law requires that the immunization
records of all children enrolled must be maintained by these
institutions and to submit reports to the health department.
To ensure that health care providers have rapid access to complete
and up-to-date immunization records, the California Immunization
Information Registry (registry) was created as a collaboration of
immunization registries that ensures the secure, electronic
exchange of immunization records to support the elimination of
vaccine preventable diseases. The goal of the registry is to
improve immunization rates for all California children through an
innovative public-private partnership. It is a collaborative
effort involving local health departments, the DPH's Immunization
Branch, and a spectrum of key stakeholders across the state. The
registry is working to develop an integrated, statewide
computerized registry to network each child's full immunization
history. A major objective is to eliminate both missed
opportunities to immunize and unnecessary duplicative
immunizations.
Current law also requires the governing board of a school district
to cooperate with the local health officer in measures necessary
for the prevention and control of communicable diseases in school
age children. Governing boards are authorized to use any funds,
property, and personnel of the district, and may permit any
physician and surgeon, or a licensed Registered Nurse acting
under the direction of a supervising physician and surgeon, to
administer an immunizing agent to any pupil whose parents have
consented in writing to the administration of such immunizing
agent. A Registered Nurse that administers immunizations must
satisfactorily demonstrate competence in the administration of
immunizing agents, as specified, and possess such medications and
equipment as required, in the medical judgment of the supervising
physician and surgeon, to treat emergency conditions and
reactions caused by the immunizing agents, and to demonstrate the
ability to administer such medications and to utilize such
equipment as necessary.
This bill would, in addition to physicians and surgeons and nurses,
allow PAs, NPs, LVNs, and nursing students acting under the
supervision of RNs to administer specified immunizations.
b) Influenza. According to the Centers for Disease Control and
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Prevention, seasonal influenza or the flu is a contagious
respiratory illness caused by influenza viruses. It can cause
mild to severe illness, and at times can lead to death. CDC
recommends getting a flu vaccination each year to prevent the
flu. CDC points out that every year in the United States, on
average: 5% to 20% of the population gets the flu; more than
200,000 people are hospitalized from flu complications; 20,000 of
those hospitalized are children younger than 5 years of age; and
about 36,000 people die from flu. Some people, such as older
people, young children, and people with certain health conditions
(such as asthma, diabetes, or heart disease), are at high risk
for serious flu complications. Viruses spread mainly from
person to person through coughing or sneezing of people with
influenza. Sometimes people may become infected by touching
something with flu viruses on it and then touching their mouth or
nose.
On February 24, 2010, the Advisory Committee on Immunization
Practices (ACIP), a panel of immunization experts which advises
the CDC on vaccine issues, voted on a new recommendation to
expand annual influenza vaccination to include all people aged
6 months and older. The expanded recommendation is to take effect
in the 2010-2011 influenza season. According to the CDC, the new
recommendation seeks to remove barriers to influenza immunization
and signals the importance of preventing influenza across the
entire population.
In April 2009, the H1N1 (sometimes called "swine flu,") a new
influenza virus causing illness in people, was first detected in
people in the United States. The rapid rate of the spread of the
H1N1 caused the World Health Organization to declare on June 11,
2009 that a pandemic of 2009 H1N1 flu was underway.
H1N1 virus was originally referred to as "swine flu" because
laboratory testing showed that many of the genes in the virus
were very similar to influenza viruses that normally occur in
pigs (swine) in North America. But further study has shown that
the 2009 H1N1 is very different from what normally circulates in
North American pigs. It has two genes from flu viruses that
normally circulate in pigs in Europe and Asia and bird (avian)
genes and human genes. Scientists call this a "quadruple
reassortant" virus. Most people who get the flu (either seasonal
or 2009 H1N1) will have mild illness, will not need medical care
or antiviral drugs, and will recover in less than two weeks.
Some people, however, are more likely to get flu complications
that result in being hospitalized and occasionally result in
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death. Pneumonia, bronchitis, sinus infections and ear
infections are examples of flu-related complications. The flu can
also make chronic health problems worse. For example, people
with asthma may experience asthma attacks while they have the
flu, and people with chronic congestive heart failure may have
worsening of this condition that is triggered by the flu.
Children younger than 5, but especially younger than 2 years old,
pregnant women, and adult 65 years and older includes the groups
of people more likely to get flu-related complications if they
get sick from influenza.
CDC recommends influenza vaccination as the first and most
important step in protecting against the flu. Because sporadic
cases of 2009 H1N1 continue to be detected in the United States
and 2009 H1N1 viruses are being reported in other parts of the
world, CDC continues to encourage 2009 H1N1 vaccination for
anyone who wants to protect themselves against 2009 H1N1. Also,
it's possible that the United States could experience early 2009
H1N1 flu activity next season, before seasonal flu vaccine is
available.
3.Arguments in Support. Proponents of this measure, including
MedImmune Inc ., indicate that many of the school districts
throughout California have possibly one or two school nurses [and in
some instances have none readily available] to provide immunizations
to school children. This bill, they maintain, has the potential to
immunize more children, reach more schools in a shorter period of
time, and limit the amount of time a child is actually out of the
classroom. Additionally, the California Academy of Family
Physicians argues that immunizations have proven to be one of the
most successful, safe and cost-effective public health inventions of
the 20th century. It is essential to public safety that
immunizations are accessible, especially to children.
4.Technical Amendments. On page 3, line 3, delete "Section 44926" and
replace with "Section 49426."
NOTE : Double-referral to Education Committee second.
SUPPORT AND OPPOSITION:
Support:
California Academy of Family Physicians
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California Association for Nurse Practitioners
California Medical Association
Health Officers Association of California
MedImmune, Inc
Opposition:
None on file as of June 8, 2010
Consultant: Rosielyn Pulmano