BILL ANALYSIS ------------------------------------------------------------ |SENATE RULES COMMITTEE | AB 1937| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ------------------------------------------------------------ CONSENT Bill No: AB 1937 Author: Fletcher (R), et al Amended: 6/23/10 in Senate Vote: 27 - Urgency SENATE BUSINESS, PROF. & ECON. DEV. COMMITTEE : 7-0, 6/14/10 AYES: Negrete McLeod, Aanestad, Calderon, Correa, Florez, Walters, Yee NO VOTE RECORDED: Wyland, Oropeza SENATE EDUCATION COMMITTEE : 8-0, 6/30/10 AYES: Romero, Huff, Alquist, Emmerson, Hancock, Liu, Price, Simitian NO VOTE RECORDED: Wyland ASSEMBLY FLOOR : 72-1, 5/6/10 - See last page for vote SUBJECT : Pupil health: immunizations SOURCE : Author DIGEST : This bill expands the health care practitioners who are authorized to administer immunizations to students with a written parental consent to include physician assistances, nurse practitioners, licensed vocational nurses, and nursing students acting under the supervision of a Registered Nurse, and applies existing requirements that apply to nurses in the administration of immunizations to these health care practitioners. CONTINUED AB 1937 Page 2 ANALYSIS : Existing law 1. 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. 2. 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, 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. 3. 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. 4. Requires DPH, in consultation with the Department of Education, to adopt and enforce these immunization requirements. 5. 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. 6. Allows a Registered Nurse, acting under the direction of CONTINUED AB 1937 Page 3 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. 7. States that the supervising physician and surgeon shall require a nurse who administers immunizations pursuant to item #5) above, under his/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 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. 8. 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, CONTINUED AB 1937 Page 4 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) 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 immunization 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 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. CONTINUED AB 1937 Page 5 Background 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 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 CONTINUED AB 1937 Page 6 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. FISCAL EFFECT : Appropriation: No Fiscal Com.: No Local: No SUPPORT : (Verified 6/30/10) BayBio California Academy of Family Physicians California Medical Association California School Nurses Organization County Health Executives Association of California Health Officers Association of California Kaiser Permanente MedImmune, Inc ARGUMENTS IN SUPPORT : According to the author's office, 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 provides the option to utilize nursing professionals to assist with certain school based vaccination programs ASSEMBLY FLOOR : AYES: Adams, Ammiano, Anderson, Arambula, Beall, Bill Berryhill, Tom Berryhill, Blakeslee, Blumenfield, Bradford, Brownley, Buchanan, Caballero, Charles CONTINUED AB 1937 Page 7 Calderon, Carter, Chesbro, Conway, Cook, Coto, Davis, De Leon, DeVore, Emmerson, Eng, Evans, Feuer, Fletcher, Fong, Fuentes, Fuller, Gaines, Galgiani, Garrick, Hagman, Hall, Harkey, Hayashi, Hernandez, Hill, Huber, Huffman, Jeffries, Jones, Knight, Lieu, Logue, Bonnie Lowenthal, Ma, Miller, Monning, Nava, Nestande, Niello, Norby, V. Manuel Perez, Portantino, Ruskin, Salas, Saldana, Silva, Skinner, Smyth, Solorio, Audra Strickland, Swanson, Torlakson, Torres, Torrico, Tran, Villines, Yamada, John A. Perez NOES: Nielsen NO VOTE RECORDED: Bass, Block, De La Torre, Furutani, Gilmore, Mendoza, Vacancy JJA:do 7/2/10 Senate Floor Analyses SUPPORT/OPPOSITION: SEE ABOVE **** END **** CONTINUED