BILL ANALYSIS Ó Senate Appropriations Committee Fiscal Summary Senator Christine Kehoe, Chair SB 161 (Huff) Hearing Date: 05/23/2011 Amended: 05/17/2011 Consultant: Jacqueline Wong-HernandezPolicy Vote: Education 6-1, Health 7-0 _________________________________________________________________ ____ BILL SUMMARY: SB 161 would authorize a school district to provide school employees with voluntary emergency medical training to provide, in the absence of a nurse, to provide emergency medical assistance to pupils with epilepsy suffering from seizures, according to specified guidelines. This bill would allow the parent/guardian of a pupil who has been prescribed an emergency antiseizure medication, as defined, to request the pupil's school have one or more employees receive voluntary training to administer the medication. This bill outlines notification and training procedures for school districts and employees that elect to provide this training and authority. This bill encourages the Epilepsy Foundation of America to develop guidelines for the training and supervision of school employees in providing emergency medical assistance, as specified, and authorizes the California Department of Education (CDE) to include on its website a clearinghouse of best practices for training nonmedical personnel to administer emergency antiseizure medication. This bill makes legislative findings and declarations. _________________________________________________________________ ____ Fiscal Impact (in thousands) Major Provisions 2011-12 2012-13 2013-14 Fund CDE consultation/approval Potentially significant costs to participate General CDE website information --- Minor and absorbable --- General _________________________________________________________________ ____ STAFF COMMENTS: This bill meets the criteria for referral to the Suspense File. Under existing law, the Nursing Practice Act sets forth the SB 161 (Huff) Page 1 scope of practice for nursing, which specifically includes the administration of medication, and prohibits any person from engaging in the practice of nursing without a license. Current law authorizes non-medical school personnel to administer certain medications (epinephrine auto-injectors, glucagon) to a pupil in an emergency, as specified. Current law allows non-medical school personnel to assist or administer medication to a pupil on a routine basis in certain cases, regarding epinephrine, inhaled asthma medication, or in cases where the pupil's health care provider gives a written statement with specific information, such as the medication the pupil is to take, the dosage, and the period of time during which the medication is to be taken, and if the pupil's parent provides a written statement initiating a request to have the medication administered to the pupil or to have the pupil otherwise assisted in the administration of the medication. This bill would authorize a school district to provide school employees with voluntary training for the provision of emergency medical assistance to certain pupils suffering from an epileptic seizure, in accordance with "a training plan approved on the department's Internet Web site" and to "the performance instructions set forth by the licensed health care provider of the pupil." The bill provides that the parent of a pupil that is prescribed emergency antiseizure medication may request the school to have one or more employees trained to administer the drug when a nurse is not available. Upon receipt of the request, the school would be required to notify the parent that the pupil may qualify for a Section 504 plan (under the federal Rehabilitation Act of 1973) and can be assessed at the parent's request. If the parent does not choose to have the pupil assessed for a 504 plan, the school may opt to create an individualized health plan to prepare to meet the pupil's needs. If the school district had chosen to allow participation, a school under its jurisdiction may solicit volunteers to be trained to administer emergency antiseizure medication in the absence of licensed professional, as specified. If there are no volunteers, the school would re-notify the parent of the option to be assessed for a 504 plan, pursuant to federal law. The school plan would include the identification of existing licensed personnel that could be trained to administer the SB 161 (Huff) Page 2 medication, identification of pupils who may require the administration, written authorization from the parent that nonmedical personnel may administer the emergency antiseizure medication to the pupil, and a written statement from the pupil's health care practitioner specifying the proper dosage, appropriate time for administration, and other specified protocols. While this bill specifically provides for school districts to decide whether or not to provide this training (and thus, participate), it is unclear whether a school administrator, upon receiving a request, could decide whether his or her school would participate in seeking and providing specified volunteers. This bill specifies that an individual who has volunteered to administer emergency antiseizure medication may rescind his or her offer to do so with a two-week notice, as specified. It is unclear what the consequences of violating this provision would be. If a volunteer were, for example, to decide to that he or she did not feel comfortable administering the medication in a moment of necessity, it is unclear what would happen. Participating schools would be required to provide indemnification and legal defense for volunteers for actions they volunteered to take on, but it is unclear whether that would be provided if a volunteer decides not to perform activities for which he or she was trained and which were part of a pupil's seizure plan at the school. Any costs incurred by the district for the training of personnel and administration of the drug would be at local discretion or pursuant to Section 504, so there should be no increase in state costs for those activities. To the extent that a voluntary process is successfully implemented as an alternative to a likely more expensive Section 504 accommodation, there may be significant local savings for schools with pupils who have been prescribed emergency antiseizure medication. This bill encourages the Epilepsy Foundation of America (Epilepsy Foundation) to develop guidelines for the training and supervision of school employees in providing emergency medical assistance to pupils with epilepsy suffering from seizures, and provides that the guidelines may be developed in cooperation with the State Department of Education, the California School Nurses Organization, the California Medical Association, and the American Academy of Pediatrics. Upon development of the SB 161 (Huff) Page 3 guidelines, the CDE is authorized to review and approve them for distribution and to make those guidelines available upon request. The CDE is also permitted to post guidelines and a clearinghouse of best practices. This bill specifically provides that volunteers will follow a training plan posted on the CDE website. Thus, implementation presumes that these permitted activities (involving both the Epilepsy Foundation and the CDE) will occur. As drafted, this bill's implementation could be delayed or stopped by the foundation or CDE's decisions and time tables for completing voluntary activities. CDE participation in developing and approving training guidelines could result in significant costs to the department, depending on its level of participation and the extent of the guideline development process. This process is likely to be complex and potentially contentious, depending on the stakeholders involved. Requiring CDE participation in order to implement the voluntary provisions of this bill creates cost pressure to the CDE to review and approve guidelines. This would likely involve significant staff time for existing departmental staff, and could require contracting a part-time nurse or other medical professional to advise CDE in its approval process. The CDE has indicated it will submit a Budget Change Proposal requesting an additional position should it determine one is necessary to implement this provision. Staff notes that while litigation costs are not typically considered in this committee, this bill is likely to invite litigation against the CDE if guidelines are approved and posted for administering specified antiseizure medication. Similar scope of practice issues are currently being litigated between the American Nurses Association and the CDE, with regard to administering insulin injections. American Nurses Association v. Jack O'Connell, Superintendent of Public Instruction and American Diabetes Association is before the California Supreme Court, and the CDE expects the case will be decided late this year. SB 161 (Huff) Page 4