BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: SB 1051
S
AUTHOR: Huff
B
AMENDED: April 27, 2010
HEARING DATE: May 5, 2010
1
CONSULTANT:
0
Orr/
5 1
FOR
VOTE ONLY
SUBJECT
Emergency medical assistance: administration of diastat.
SUMMARY
This bill would allow non-medical school personnel who
undergo voluntary training to administer diastat to a pupil
suffering an epileptic seizure.
CHANGES TO EXISTING LAW
Existing federal law:
The Americans with Disabilities Act of 1990 prohibits
discrimination on the basis of disability by employers,
public accommodations, state and local governments, public
and private transportation, and in telecommunications.
The Individuals with Disabilities Education Act (IDEA)
governs Individualized Educational Programs (IEPs) and the
special education process. IDEA guarantees children with
disabilities a "free appropriate public education" (FAPE)
in the least restrictive environment (LRE).
Section 504 of the Rehabilitation Act of 1973 provides
federal financial assistance to state and local education
Continued---
STAFF ANALYSIS OF SENATE BILL 1051 (Huff) Page 2
agencies to guarantee special education and related
services to eligible children with disabilities. Requires
school districts to provide FAPE to each qualified person
with a disability who is in the school district's
jurisdiction, regardless of the nature or severity of the
person's disability, which includes reasonable
accommodations required for the management of chronic
medical conditions.
Existing state law:
Requires the governing board of any school district to give
diligent care to the health and physical development of
pupils, which may include employing properly certified
persons for the work.
Provides that each pupil who is required to take, during
the regular school day, medication prescribed for him or
her by a physician, may be assisted by the school nurse or
other designated school personnel if the school district
receives a written statement from the physician detailing
the method, amount, and time schedules by which the
medication is to be taken, and a written statement from the
parent or guardian of the pupil indicating the desire that
the school district assist the pupil in the matters set
forth in the physician's statement.
Provides that notwithstanding any provision of any law, no
school district, officer of any school district, school
principal, physician, or hospital treating any child
enrolled in any school in any district shall be held liable
for the reasonable treatment of a child without the consent
of a parent or guardian, when the child is ill or injured
during regular school hours, requires reasonable medical
treatment, and the parent or guardian cannot be reached,
unless the parent or guardian has previously filed with the
school district a written objection to any medical
treatment other than first aid.
Provides that a school district or county office of
education may provide emergency epinephrine auto-injectors
to trained personnel, and trained personnel may utilize
those epinephrine auto-injectors to provide emergency
medical aid to persons suffering from an anaphylactic
reaction.
Authorizes a school district to provide voluntary emergency
STAFF ANALYSIS OF SENATE BILL 1051 (Huff) Page 3
medical training to school personnel, as defined, to
administer emergency medical assistance to pupils with
diabetes suffering from severe hypoglycemia, subject to
specified conditions, in the absence of a credentialed
school nurse or other licensed nurse.
Sets forth the scope of practice for nursing through the
Nursing Practice Act, which includes the administration of
medication, and prohibits any person from engaging in the
practice of nursing without a license.
This bill:
Until January 1, 2016, authorizes a school district to
provide school employees with voluntary emergency medical
training to provide emergency medical assistance to pupils
with epilepsy suffering from seizures, in the absence of a
credentialed nurse onsite.
Allows a parent or guardian of a pupil with epilepsy who
has been prescribed diastat to request that one or more
school employees be trained to administer the drug when a
nurse is not available. Requires schools to notify these
parents or guardians of their child's potential eligibility
for services or accommodations through Section 504 of the
Rehabilitation Act of 1973, and encourage the parents and
guardians to pursue that option. Schools may ask parents or
guardians to sign a notice verifying they are aware of the
504 option and may request a 504 plan at any time.
Provides that if a 504 plan is not used, schools may create
individualized health plans, seizure action plans, or any
other appropriate health plan designed to acknowledge and
prepare for a child's health care needs in school, which
may involve trained school volunteers. If no employees
volunteer, then the school must re-notify the parents or
guardians of the pupil's potential for a 504 plan.
Requires schools that choose to train unlicensed volunteers
in the administration of diastat to develop a school plan.
Specifies the information to be included in the plan.
Requires schools to retain all records related to the
administration of diastat. Requires pupil's parents or
guardians to provide all materials necessary for the
administration of diastat.
STAFF ANALYSIS OF SENATE BILL 1051 (Huff) Page 4
Provides that school employees shall not be coerced into
volunteering. Provides that the request for volunteers be
sent to school employees electronically. Provides that a
school employee who does not volunteer, or who has not been
trained to provide emergency medical assistance, shall not
be required to provide such assistance.
Requires school employees to notify the district nurse if
diastat is administered. Provides that trained school
employees shall be immune from civil and criminal liability
for perceived or real physical or emotional injuries
resulting from acts or omissions in the administration of
diastat, including but not limited to sex offenses.
Requires schools to compensate volunteers when the
administration of diastat and subsequent monitoring of a
pupil requires volunteers to work beyond their normally
scheduled hours.
Encourages the Epilepsy Foundation of America to develop
performance standards, including specified information and
in cooperation with several other entities, for the
training and supervision of school employees in providing
emergency medical assistance to pupils with epilepsy
suffering from seizures. Requires the Department of Public
Health to approve the standards and make them available
upon request. Establishes that training by a physician,
surgeon, or nurse shall be deemed adequate for the purpose
of the bill.
Makes findings and declarations about the right to a free
appropriate public education and compliance with the
Individuals with Disabilities Education Act.
Declares legislative intent that diastat be administered to
pupils by school nurses whenever possible. Declares
legislative intent to authorize nurses to train and
supervise employees of school districts and county offices
of education to administer diastat to children with
epilepsy in the public schools.
FISCAL IMPACT
This bill has not been analyzed by a fiscal committee.
BACKGROUND AND DISCUSSION
STAFF ANALYSIS OF SENATE BILL 1051 (Huff) Page 5
The author contends that some children with epilepsy are
susceptible to prolonged seizures and require access to a
life-saving emergency medication. Diastat Acudial, a
pre-dosed preparation of diazepam gel, is the standard
out-of-hospital treatment for prolonged seizures. Diastat
is an FDA-approved emergency treatment specifically
designed to be administered by people without medical
training. According to the author, it was common for
California schools to have registered nurses, or where
unavailable, trained non-medical personnel (teachers,
aides, office staff) to administer doctor-prescribed
Diastat in an emergency situation to a student when
suffering a severe, possibly life-threatening seizure.
The author contends that as a result of an advisory by the
Board of Registered Nursing, school nurses are not
presently authorized to train or supervise unlicensed
personnel in the administration of diastat or other
medications. The advisory also claimed there was no
provision in the Nursing Practice Act for unlicensed school
personnel to administer diastat. As a result of this
advisory, the author claims nurses are refusing to train
school personnel, and schools are reluctant to have staff,
even those already trained, administer diastat.
Epilepsy background and statistics
Epilepsy is a neurological condition, affecting the nervous
system. Epilepsy is also known as a seizure disorder,
because it results from the generation of electrical
signals inside the brain, causing recurring seizures. A
seizure is a sudden surge of electrical activity in the
brain that usually affects how a person feels or acts for a
short time. Seizure symptoms vary, and individuals with
seizures can experience temporary confusion, staring spells
uncontrollable jerking movements of the arms and legs, or a
complete loss of consciousness. Sometimes individuals will
have early warning signs before a seizure occurs, for
example: changes in vision or smell, numbness, tingling or
nausea. Seizures can also come without warning. The type of
seizure a person has depends on a variety of things, such
as the part of the brain affected and the underlying cause
of the seizure. The type of medicine individuals with
epilepsy take depends on the type of seizures. The dosage
may need to be adjusted from time to time.
About 2.7 million Americans have been treated for epilepsy
STAFF ANALYSIS OF SENATE BILL 1051 (Huff) Page 6
in the past 5 years, or approximately 8 or 9 out of every
1,000 people. Death or permanent brain damage from seizures
is rare. However, seizures that last for a long time or two
or more seizures that occur close together (status
epilepticus) may cause permanent harm. Status epilepticus
(SE) is a life-threatening condition in which the brain is
in a state of persistent seizure. It is usually defined as
30 minutes of uninterrupted seizure activity, but there is
some evidence that 5 minutes is sufficient to damage
neurons and that seizures are unlikely to self-terminate by
that time. It is always considered a medical emergency.
First aid guidelines for seizures state that an ambulance
should be called for seizures lasting longer than five
minutes. The mortality rate of status epilepticus is high
(at least 20%), especially if treatment is not intiated
quickly. Status epilepticus is most common in the very
young and the very old, with the lowest incidence at ages
15-40.
Diastat
Diastat AcuDial (diastat) is a gel formulation of Diazepam
(valium) that is administered rectally. Diazepam is used to
treat a wide range of conditions and has been one of the
most frequently prescribed medications in the world for the
past 40 years. It is sometimes prescribed for people who
have experienced acute repetitve seizures, or "cluster"
seizures, which are intermittent periods of unusually
increased seizure activity. It is the only FDA-approved,
at-home medication for the treatment of cluster seizures.
In addition to seizures, Diazepam is commonly used for
treating anxiety, insomnia, muscle spasms, restless legs
syndrome, obsessive compulsive disorder, alcohol
withdrawal, and other conditions. Dosages should be
determined on an individual basis, depending upon the
condition to be treated, the severity of symptoms, the body
weight of the patient, and any comorbid conditions the
patient may have.
The manufacturer of diastat claims that it was specifically
developed to be administered by people without medical
training. Diastat is intended to be kept handy so that if
another cluster begins, a caregiver can attempt to stop it
by administering the drug relatively quickly. The rectal
delivery system includes a plastic applicator with a
flexible, molded tip and is provided in fixed unit-doses of
5, 10, 15 and 20 mg. It is recommended that diastat be used
STAFF ANALYSIS OF SENATE BILL 1051 (Huff) Page 7
to treat no more than five episodes per month and no more
than one episode every five days. Common side-effects
include drowsiness, impaired motor function (i.e.
coordination, balance, etc.), impaired learning and nausea,
among others.
Health care needs in schools
In regular classrooms throughout California, there are
numerous children with special medical needs, including
gastronomy feeding tubes, oxygen administration, tracheal
suctioning and monitoring for seizures. According to the
California Teacher's Association, 1 in every 300-600
children, or approximately 15,000 school-age children in
California is diagnosed with diabetes. An estimated 13.7
percent to 16.3 percent of California children between 6
and 17 years of age have been diagnosed with asthma,
representing approximately one million children. In 2001,
nearly 136,000 California adolescents with asthma missed
one or more days of school per month. During the 2002-2003
school year, there were 6,244,403 children in the public
schools and 2,466 school nurses, a ratio of one
credentialed school nurse to every 2,532 students.
Nursing Practice Act
The practice of nursing, as defined in statute, includes
but is not limited to those functions, including basic
health care, that help people cope with difficulties in
daily living that are associated with their health or
illness problems or the treatment thereof. This may include
direct and indirect patient care services that ensure the
safety, comfort, personal hygiene, and protection of
patients. These functions may require a substantial amount
of scientific knowledge or technical skill, and can include
observation of signs and symptoms of illness and/or
reactions to treatment, and based on observed
abnormalities, can also include implementation of
appropriate reporting, referral, or changes in treatment
regimen in accordance with standardized procedures, or the
initiation of emergency procedures. These functions also
include, but are not limited to, the administration of
medications and therapeutic agents necessary to implement a
treatment, disease prevention, or rehabilitative regimen
ordered by a physician, dentist, podiatrist, or clinical
psychologist. The Legislature recognizes that the practice
of nursing is a dynamic field and is continually evolving
to include more sophisticated patient care activities.
STAFF ANALYSIS OF SENATE BILL 1051 (Huff) Page 8
Federal laws and 504 plans
Two federal anti-discrimination statutes, Section 504 of
the Rehabilitation Act of 1973 (Section 504) and Title II
of the Americans with Disabilities Act of 1990 (ADA),
together establish rights for eligible students in
California's public schools. They serve to protect students
from discrimination based upon their disability. The two
statutory schemes are often treated synonymously. In
general, a student will be determined to have a disability
under Section 504 if he/she has a mental or physical
impairment that substantially limits one or more major life
activities, such as eating, breathing, caring for oneself,
performing manual tasks, hearing, speaking, walking, and
learning.
The U.S. Department of Education (ED) enforces Section 504
in programs and activities that receive funds from ED.
Recipients of these funds include public school districts,
institutions of higher education, and other state and local
education agencies.
The Act stipulates that all qualified persons with
disabilities within the jurisdiction of a school district
are entitled to a free appropriate public education (FAPE).
An appropriate education may comprise education in regular
classes, education in regular classes with the use of
related aids and services, or special education and related
services in separate classrooms for all or portions of the
school day. Special education may include specially
designed instruction in classrooms, at home, or in private
or public institutions, and may be accompanied by related
services such as speech therapy, occupational and physical
therapy, psychological counseling, and medical diagnostic
services necessary to the child's education.
Once a local education agency (LEA) determines that a
student is entitled to Section 504 protections, services
and accommodations are determined through the Section 504
planning process, and documented in a Section 504 plan. To
be appropriate, education programs for students with
disabilities must be designed to meet their individual
needs to the same extent that the needs of nondisabled
students are met. Students with disabilities may not be
excluded from participating in nonacademic services and
extracurricular activities on the basis of disability.
STAFF ANALYSIS OF SENATE BILL 1051 (Huff) Page 9
Public elementary and secondary schools must employ
procedural safeguards regarding the identification,
evaluation, or educational placement of persons who,
because of disability, need or, are believed to need,
special instruction or related services.
Students who qualify for services under the Individuals
with Disabilities in Education Act, also known as IDEA,
will have an Individualized Education Program (IEP) instead
of a Section 504 plan. IEPs are required for students
participating in the special education programs of
recipients of funding under the IDEA. Typically, an IEP is
more specific than a 504 Plan with regard to the student's
academic needs. Unlike IDEA, Section 504 requires only
notice, not consent, for evaluation. Districts are not
required to obtain parental consent for a 504 plan, but it
is recommended.
Related legal issues with diabetes care in schools
The requirement to provide FAPE under Section 504 has been
applied in the context of the administration of medication
in general and diabetes-based related services in
particular. In finding that a plaintiff in Fraser v.
Goodale, (9th Cir. 2003) had presented evidence that she
was substantially limited in eating, the Ninth Circuit
Court of Appeals determined that diabetes is a "physical
impairment" and noted that the plaintiff was required to be
vigilant about testing blood glucose levels and adjusting
food intake, insulin and physical activity accordingly. To
avoid fluctuations in blood glucose levels, students with
diabetes must also be vigilant about exercise and
administration of medication. Fluctuations in blood glucose
levels in students with diabetes can impact concentration
and comprehension, as well as have significant and
potentially life-threatening short- and long-term health
implications. The Office for Civil Rights of the United
States Department of Education (OCR) has found students
with diabetes to be "disabled" under Section 504. A student
with diabetes is considered disabled under Section 504 when
close monitoring of diet, behavior, and activities is
necessary at all times in order for to be able to attend
school.
In 2005, the American Diabetes Association sued the State
of California (K.C., et al. vs. Jack O'Connell, et al)
asking the court to compel public school officials to
comply with federal law by providing the assistance that
STAFF ANALYSIS OF SENATE BILL 1051 (Huff) Page 10
California students with diabetes require to manage their
diabetes during the school day. The California Department
of Education (CDE) entered into a settlement with them and,
as a part of the settlement, CDE issued a Legal Advisory
that declared unlicensed but adequately trained school
employees may administer insulin under the treating
physician's orders and in accordance with the student's
Section 504 Plan or IEP, in the absence of available
licensed health care professionals. Several nursing groups
sued to overturn this portion of the Legal Advisory
(American Nurses Assoc. v. Jack O'Connell), and in November
2008 a trial court judge ruled in their favor. Following
the court ruling, ADA and CDE filed an appeal of the court
ruling, and in April 2009, a California Court of Appeals
ruled that the lower court's ruling is "stayed" during the
appeal. While this is not a decision on the merits of the
case, it does mean that the lower court's ruling has no
effect until the appeal is decided, therefore, the CDE may
continue to advise districts that non-medical school
personnel are authorized to administer insulin (based on
the K.C., et al settlement) while the Nursing Practices Act
continues to prohibit the same (nothing in statute
specifically allows anyone other than licensed nurses to
administer insulin).
According to the Legal Advisory, only the following seven
categories of persons are expressly authorized under state
law to administer insulin in schools:
1) The student, with authorization of the student's
licensed health care provider and parent/guardian.
2) A school nurse or school physician employed by the LEA.
3) An appropriately licensed school employee such as a
registered nurse or licensed vocational nurse, supervised
by a school physician, school nurse, or other appropriate
person.
4) A contracted registered nurse or licensed vocational
nurse from a private agency or registry, or by contract
with a public health nurse through the county health
department.
5) A parent/guardian who chooses to administer the insulin.
6) A designee of the parent guardian who volunteers to
administer the insulin and who is not a school employee.
7) An unlicensed voluntary school employee with appropriate
training, in emergencies. An LEA may train a voluntary
STAFF ANALYSIS OF SENATE BILL 1051 (Huff) Page 11
school district employee to administer insulin to a student
with diabetes during school and school-related activities
if his or her IEP or Section 504 Plan so requires and if no
person expressly authorized by categories 1-7 is available.
According to CDE, financial burden or other difficulty to a
local education agency is not a valid defense for not
providing school health services required under a child's
IEP or Section 504 Plan. If no school nurse is available,
the district must use reasonable efforts to contract with a
registered nurse or licensed vocational nurse from a
private agency or registry, or to contract with a public
health nurse through the county health department. If an
LEA has determined that a nurse is not available, then it
must train a voluntary school employee to provide such
services. School placement decisions may not be based upon
the unwillingness of a district to provide needed related
services to a child with "other health impaired" (OHI)
diabetes disability at the school that the child would
otherwise attend. A district may not require the parent to
waive any rights, hold the district harmless, or agree to
any particular placement or related services as a condition
of administering medication or assisting a student in the
administration of medication at school.
Exceptions to the Nursing Practice Act
Existing law provides that any pupil who is required to
take medication prescribed for him or her by a physician
and surgeon during the regular schoolday may be assisted by
the school nurse or other designated school personnel. In
order for a pupil to be assisted by a school nurse or other
designated school personnel, the school district must
obtain both a written statement from the physician
detailing the name of the medication, method, dosage, and
time schedules by which the medication is to be taken, and
a written statement from the parent or guardian indicating
the desire that the school district assist the pupil in the
matters set forth in the physician's statement. Existing
regulations of CDE specify procedures to be followed in the
administration of medication to a pupil.
Existing law allows pupils to carry and self-administer
prescription auto-injectable epinephrine to be used in case
of life-threatening allergic reactions, and/or inhaled
asthma medication if the school district receives the
STAFF ANALYSIS OF SENATE BILL 1051 (Huff) Page 12
appropriate written statements from the physician and the
parent or guardian of the pupil.
Any public and private elementary and secondary school in
the state may voluntarily determine whether or not to make
emergency epinephrine auto-injectors and trained personnel
available at its school. In making this determination, a
school must evaluate the emergency medical response time to
the school and determine whether initiating emergency
medical services is an acceptable alternative to
epinephrine auto-injectors and trained personnel.
In the absence of a credentialed school nurse or other
licensed nurse onsite at the school, existing law allows
each school district to provide school personnel with
voluntary emergency medical training to provide emergency
medical assistance to pupils with diabetes suffering from
severe hypoglycemia. Volunteer personnel must provide this
emergency care in accordance with specified standards and
the performance instructions set forth by the licensed
health care provider of the pupil. A school employee who
does not volunteer or who has not been trained may not be
required to provide emergency medical assistance.
Related bills
SB 1200 (Leno) of 2010 would require the Department of
Managed Health Care and the Insurance Commissioner to
develop regulations to ensure timeliness of care for school
age children who must receive medically necessary services
during school hours. Pending in the Senate Appropriations
Committee.
AB 1802 (Hall) of 2010 would authorize a parent or guardian
of a pupil with diabetes
to designate one or more school employees as
parent-designated school employees for the purpose of
administering insulin to the pupil as necessary during the
regular school day when a credentialed school nurse or
other health care professional is not immediately available
onsite at the school. Failed passage in Assembly Business,
Professions, and Consumer Protection Committee.
AB 2454 (Torlakson) of 2010 would require the governing
board of a school district to employ at least one school
nurse, registered nurse, or licensed vocational nurse for
every 750 pupils on and after July 1, 2020. The bill would
STAFF ANALYSIS OF SENATE BILL 1051 (Huff) Page 13
require registered nurses and licensed vocational nurses to
provide health care services to pupils under the
supervision of a school nurse. Pending in Assembly
Appropriations Committee.
Prior legislation
AB 1430 (Swanson) of 2009 would have required, with certain
exceptions, that any medication that is administered to a
pupil who is required to take, during the regular school
day, medication prescribed for him or her by a physician or
surgeon be administered by a health care professional
operating within the scope of his or her
practice. Died in Assembly Business and Professions
Committee.
AB 942 (Leno) Chapter 684, Statutes of 2003, authorized
each school district to provide voluntary emergency medical
training to school personnel, as defined, to administer
emergency medical assistance to pupils with diabetes
suffering from severe hypoglycemia, if certain performance
standards for training and supervision are developed by the
American Diabetes Association in cooperation with several
other entities for approval and distribution by the State
Department of Health Services' Diabetes Control Program, in
the absence of a credentialed school nurse or other
licensed nurse.
AB 559 (Wiggins), Chapter 458, Statutes of 2001, authorizes
a school district or county office of education to provide
emergency epinephrine auto-injectors to trained personnel,
and would authorize the trained personnel to utilize those
epinephrine auto-injectors to provide emergency medical aid
to persons suffering from an anaphylactic reaction.
Arguments in support
The Orange County Department of Education, which has a
large special education program, is sponsoring this bill
because they believe legislation is needed to carve out
another rare exception to the Nursing Practice Act for the
safety of children in schools. They cite the advisory by
the Board of Registered Nursing prohibiting school nurses
from training or supervising unlicensed personnel to
administer diastat. As a result, parents of children with
epilepsy are being told they must be available to come to
their child's school to administer the drug. According to
the sponsor, parents are also being told that the school
STAFF ANALYSIS OF SENATE BILL 1051 (Huff) Page 14
will call 911 or, in some cases, are transferring the
student to a school where a nurse is available, without
regard to the educational needs of the student.
Epilepsy California supports the bill on behalf of the
93,000 students with epilepsy currently enrolled in
California school districts and categorical programs. The
organization claims to have received numerous complaints
from parents, teachers, school nurses, and medical
providers regarding children being denied access to diastat
in the school setting. They believe this bill will preserve
the right for children to participate in the education
process and prevent some of the documented consequences of
prolonged seizures, specifically brain injury and death.
Arguments in opposition
Numerous labor groups strongly oppose any legislative
effort to change the law to allow unlicensed school
personnel to administer diastat to school children. They
cite that with budget cuts to education, school employees
are being asked to do more with less, and school employees
face legal liability if something goes wrong. The
California Labor Federation claims that this bill fails
children with epilepsy by allowing schools to enlist
personnel with no medical expertise to administer a
potentially dangerous medication, instead of requiring
school districts to provide adequate medical care.
The California School Nurses Organization believes this
bill is being used as a means to skirt existing state law
in the Nurse Practice Act. Current federal law mandates
that school districts provide safe and appropriate care for
students with chronic illnesses such as seizures, and they
believe that safe and appropriate care includes licensed
nursing care. The California State PTA recognizes the
importance of treating children experiencing a seizure, but
does not believe unlicensed staff will ever have the
expertise to properly assess which circumstances warrant
the use of diastat. They also believe that it is
unreasonable to expect overworked school staff to be
responsible for inspecting the medication according to the
manufacturers directions. They believe the health of
children at schools should be one of the school districts'
priorities, and believe licensed nurses are the only
alternatives to ensure the safety of children.
STAFF ANALYSIS OF SENATE BILL 1051 (Huff) Page 15
COMMENTS
1. Reconsideration granted. This bill was heard in Senate
Health Committee on April 21, 2010. It failed passage in
the committee on a 1-1 vote. It was granted reconsideration
by the Health Committee, and was subsequently granted a
rule waiver by the Senate to be heard after the fiscal bill
deadline. The bill will be before the Health Committee for
vote only on May 5.
2. Amendments in Education and Health Committees. The
following summarizes amendments that were agreed to by the
author in the Senate Education and Health Committees and
were adopted by the Health Committee when the bill was
first heard on April 21. The amendments are reflected in
the bill as amended April 27.
a. Declares the intent of the Legislature
that diastat be administered by a school nurse
whenever possible.
b. Allows a parent or guardian of a pupil
with epilepsy who has been prescribed diastat to
request that one or more school employees be
trained to administer the drug when a nurse is
not available. Schools can notify staff of the
request for volunteers electronically, and no one
shall be threatened, coerced, or intimidated into
volunteering.
c. Schools must notify parents or guardians
of their child's potential eligibility for
services or accommodations through a 504 plan,
and encourage the parents and guardians to pursue
that option. Schools may ask parents or guardians
to sign a notice verifying they are aware of the
504 plan option and may request a 504 plan at any
time.
d. If a 504 plan is not used, schools may
create individualized health plans, seizure
action plans, or any other appropriate health
plan designed to acknowledge and prepare for a
child's health care needs in school. These plans
may include the use of trained school volunteers.
If no employees volunteer, then the school must
re-notify the parents or guardians of the pupil's
potential for a 504 plan.
e. Requires schools that choose to train
unlicensed volunteers in the administration of
STAFF ANALYSIS OF SENATE BILL 1051 (Huff) Page 16
diastat to develop a school plan. The plan should
include the following: 1) Identification of
existing local licensed personnel who could be
available to respond to an emergency need to
administer diastat. 2) Identification of pupils
who may require the administration of diastat. 3)
Written authorization from the parent or guardian
authorizing a non-medical school employee to
administer diastat. 4) A written statement from
the pupil's health care practitioner including
specified information and instructions. 5)
Requires parents and guardians to notify the
school when the pupil received diastat within the
prior four hours, and requires the school to
notify the parent or guardian when diastat is
administered.
f. Provides that school volunteers are
protected from civil and criminal liability for
perceived or real physical or emotional injuries
resulting from the administration of diastat
including, but not limited to, sex offenses.
g. Provides that school volunteers shall be
compensated when the administration of diastat
and subsequent monitoring of a pupil requires the
volunteer to work beyond his or her normally
scheduled hours.
h. Adds techniques and procedures to assure
student privacy adheres to the training developed
by the Epilepsy Foundation.
i. Requires schools to retain all records
related to the administration of diastat.
j. Requires pupil's parents or guardians to
provide all materials necessary for the
administration of diastat.
aa. Adds a five-year sunset.
3. Nursing Practice Act. The Nursing Practice Act does not
prohibit nursing services in case of an emergency. As used
in the act, "emergency" includes an epidemic or natural
disaster, but does not expressly exclude other situations
that could be described as emergencies. Also, the
interpretation of the Board of Registered Nursing claimed
it is unlawful for a nurse to train or supervise unlicensed
personnel in the administration of medication. It is not
clear if there are similar statutes to prohibit physicians
or other qualified non-nurse medical providers to provide
STAFF ANALYSIS OF SENATE BILL 1051 (Huff) Page 17
the training.
PRIOR ACTIONS
Senate Education Committee5-1
Senate Health Committee 1-1 (Fail)
Senate Health Committee 5-0 (Reconsideration)
POSITIONS
Support: California Association of Joint Powers Authorities
Los Angeles County Office of Education
Ventura County Office of Education
Support prior version
Orange County Office of Education (sponsor)
Association of California Neurologists
California Chronic Care Coalition (CCCC)
California NeuroAlliance
Comprehensive Epilepsy Program, UCLA
Comprehensive Epilepsy Program, USC
Disability Rights California
Disability Rights Education and Defense Fund
El Dorado County Superintendent of Schools
Epilepsy California
Epilepsy Center
Epilepsy Center of Excellence, VA Greater Los
Angeles Healthcare System
Epilepsy Foundation
Epilepsy Foundation of Greater Los Angeles
Epilepsy Foundation Northern California
Health Officers Association of California
Humboldt County Office of Education
Orange County School Nurse Organization
Pediatric Epilepsy Program, UCLA
Pediatric Neurology Division, UCLA
Riverside Unified School District
Saddleback Valley Unified School District
San Bernardino County District Advocates for Better
Schools (SANDABS)
Small School Districts' Association
Sonoma County Office of Education
Ventura County Office of Education
Over 500 hundred individuals
STAFF ANALYSIS OF SENATE BILL 1051 (Huff) Page 18
Oppose: American Federation of State, County and Municipal
Employees, AFL-CIO
California Teachers Association
Oppose prior version
American Nurses Association\California
Consumer Attorneys of California
California Federation of Teachers
California Labor Federation
California School Employees Association
California School Nurses Organization
California State PTA
California Teachers Association
Service Employees International Union- Nurses
Alliance of California
United Nurses Associations of California/Union of
Health Care Professionals
(UNAC/UHCP)
Several individuals
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