BILL ANALYSIS Ó
------------------------------------------------------------
|SENATE RULES COMMITTEE | SB 161|
|Office of Senate Floor Analyses | |
|1020 N Street, Suite 524 | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
------------------------------------------------------------
THIRD READING
Bill No: SB 161
Author: Huff (R)
Amended: 5/31/11
Vote: 21
SENATE EDUCATION COMMITTEE : 6-1, 3/16/11
AYES: Lowenthal, Runner, Blakeslee, Huff, Liu, Vargas
NOES: Hancock
NO VOTE RECORDED: Alquist, Price, Simitian, Vacancy
SENATE HEALTH COMMITTEE : 7-0, 4/6/11
AYES: Hernandez, Strickland, Anderson, Blakeslee, De León,
Rubio, Wolk
NO VOTE RECORDED: Alquist, DeSaulnier
SENATE APPROPRIATIONS COMMITTEE : 8-0, 5/26/11
AYES: Kehoe, Walters, Alquist, Lieu, Pavley, Price,
Runner, Steinberg
NO VOTE RECORDED: Emmerson
SUBJECT : Emergency medical assistance: administration
of epilepsy
medication
SOURCE : Author
DIGEST : This bill authorizes school districts to provide
non-medical school personnel with voluntary emergency
medical training to provide emergency medical assistance to
pupils with epilepsy suffering from seizures.
CONTINUED
SB 161
Page
2
ANALYSIS :
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" in the
least restrictive environment.
Section 504 of the Rehabilitation Act of 1973 (Section 504)
provides federal financial assistance to state and local
education agencies to guarantee special education and
related services to eligible children with disabilities.
Requires school districts to provide a free appropriate
public education 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
1.Requires the governing board of any school district to
give diligent care to the health and physical development
of students, which may include employing properly
certified persons.
2.Provides that each student who is required to take
prescribed medication 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
student, indicating the desire that the school district
assist the pupil in the matters set forth in the
CONTINUED
SB 161
Page
3
physician's statement.
3.Provides that no school district, officer of any school
district, school principal, physician, or hospital
treating a student 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 objections to any medical
treatment other than first aid.
4.Authorizes non-medical school personnel to administer the
following medication to a student in an emergency, after
receiving specified training:
A. Emergency epinephrine auto-injectors. A
prescription or an auto-injector for a specific
student is not required; the prescription is for the
school.
B. Glucagon may be administered to students with
diabetes suffering from severe hypoglycemia in the
absence of a credentialed school nurse or other
licensed nurse onsite at the school.
5.Authorizes non-medical school personnel to assist or
administer medication to a student on a routine,
non-emergency basis the following:
A. Assisting in the administration of prescribed
medication, or in the self-administration of
prescription auto-injectable epinephrine.
B. Assisting in administration of prescribed
medication or in the self-administration of
prescription inhaled asthma medication.
C. Assisting if the 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 parent provides a written
CONTINUED
SB 161
Page
4
statement initiating a request to have the medication
administered or otherwise assisted in the
administration of the medication.
6.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:
1. Makes various legislative findings and declarations,
including the declaration that the safety and welfare
of a pupil with epilepsy is compromised without
immediate access to an emergency antiseizure
medication.
2. Authorizes a school district to provide school
employees with voluntary medical training to provide
emergency medical assistance training to provide
emergency medical assistance to pupils with epilepsy
suffering from seizures.
3. Requires a school employee with voluntary emergency
medical training to provide this emergency medical
assistance using a training plan approved on the
California Department of Education's (CDEs) Internet
Web site.
4. Prohibits a school employee, who does not volunteer or
who has not been trained, from being required to
provide emergency medical assistance.
5. Authorizes a parent or guardian of a pupil with
epilepsy who has been prescribed an emergency
antiseizure medication to request the school have one
or more of its employees receive training in the
administration of an emergency antiseizure medication.
6. Requires, upon receipt of the parent's or guardian's
request, the school to notify the parent or guardian
that his or her child may qualify for services or
accommodations, pursuant to Section 504. Requires the
school to assist in the exploration of that option, and
CONTINUED
SB 161
Page
5
encourage the parent or guardian to adopt that option
if it is determined that the child is eligible for a
Section 504 plan.
7. Authorizes a school to ask the parent or guardian to
sign a notice verifying they were given information
about Section 504 and they understand it is their right
to request a Section 504 plan at any time.
8. Authorizes a school to create an individualized health
plan, seizure action plan, or other appropriate health
plan designed to acknowledge and prepare for the
child's health care needs in school if the parent
chooses to not have the pupil assessed for a Section
504 plan. The plan may include the involvement of
trained volunteer school employees or a licensed
vocational nurse.
9. If a school elects to train employees, the school
shall ensure the following:
A. A volunteer receives training from a licensed
health care professional regarding the
administration of an emergency antiseizure
medication. A staff member who has completed
training shall, if he or she has not administered an
emergency antiseizure medication within the prior
two years and thee is a pupil enrolled in the school
who may need the administration of an antiseizure
medication, attend a new training program to retain
the ability to administer an emergency antiseizure
medication.
B. Any agreement by an employee to administer an
emergency antiseizure medication is voluntary; and
an employee of the school or school district shall
not directly or indirectly use or attempt to use his
or her authority to influence for the purpose of
intimidating, threatening, coercing, or attempting
to intimidate, threaten, or coerce any staff member
who does not choose to volunteer, including, but not
limited to, direct contact with the employee.
C. Any employee who volunteers may rescind his or
CONTINUED
SB 161
Page
6
her offer to administer an emergency antiseizure
medication up to three days after the completion of
the training. After that time, a volunteer may
rescind his or her offer to administer an emergency
antiseizure medication with a two-week notice, or
until a new individual health plan or Section 504
plan has been developed for an affected pupil,
whichever is less.
D. The school di strict shall distribute an
electronic notice to all staff that states the
following information in bold print:
(1) A description of the volunteer request,
stating that the request is for volunteers to
administer an emergency antiseizure medication
to a pupil experiencing a severe epileptic
seizure, in the absence of a school nurse, and
that this emergency antiseizure medication is a
FDA-approved, predosed, rectally administered
gel that reduces the severity of epileptic
seizures.
(2) A description of the training that the
volunteer will receive.
(3) A description of the voluntary nature of
the volunteer program.
(4) The volunteer rescission timelines.
10. Provides that the electronic notice shall be the only
means by which a school district solicits volunteers.
11. Provides that an employee who volunteers shall not be
required to administer an emergency antiseizure
medication until completion of the training program
adopted by the school and documentation of completion
is recorded in his or her personnel file.
12. Provides that if a school elects to participate, the
school shall ensure that each volunteer will be
provided defense and indemnification by the school.
This information will be reduced to writing, provided
CONTINUED
SB 161
Page
7
to the volunteer, and retained in the volunteer's
personnel file.
13. Requires a school to re-notify the pupil's parent or
guardian of the Section 504 options if there are no
volunteers.
14. Requires a school that elects to train school
employees to have in place a school plan that includes,
but not be limited to, all of the following:
A. Identification of existing licensed staff within
the district or region who could be trained in the
administration of an emergency antiseizure
medication and could be available to respond to an
emergency need to administer an emergency
antiseizure medication.
B. Identification of pupils who may require the
administration of an emergency antiseizure
medication.
C. Written authorization from the parent or
guardian for a non-medical school employee to
administer an emergency antiseizure medication.
D. A requirement that the parent or guardian notify
the school if the pupil has had an emergency
antiseizure medication administered within the past
four hours on a school day.
E. Notification to the parent or guardian that an
emergency antiseizure medication has been
administered.
F. A written statement from the pupil's health care
practitioner that shall include all of the
following:
(1) The pupil's name.
(2) The name and purpose of the medication.
(3) The prescribed dosage.
(4) Detailed seizure symptoms, including
frequency, type, or length of seizures that
CONTINUED
SB 161
Page
8
identify when the administration of an emergency
antiseizure medication becomes necessary.
(5) The method of administration.
(6) The frequency with which the medication
may be administered.
(7) The circumstances under which the
medication may be administered.
(8) Any potential adverse responses by the
pupil and recommended actions, including when to
call emergency services.
(9) A protocol for observing the pupil after
a seizure.
(10) Following the seizure, the pupil's parent
or guardian and the school nurse shall be
contacted to continue the observation plan.
15. Requires a school the elects to allow volunteers to
administer an emergency antiseizure medication to
compensate a volunteer when the administration of an
emergency antiseizure medication and subsequent
monitoring of a pupil requires the person to work
beyond his or her normally scheduled hours.
16. Requires the Department of Public Health, in
consultation with the CDE, to develop guidelines for
the training and supervision of school employees in
providing emergency medical assistance to pupils with
epilepsy suffering from seizures. The guidelines maybe
developed in cooperation interested organizations.
Upon development of the guidelines, the CDE shall
approve the guidelines for distribution and shall make
those guidelines available upon request.
17. Allows the CDE to include, on its Internet Web site, a
clearinghouse for best practices in training nonmedical
personnel to administer an emergency antiseizure
medication to pupils.
18. Requires the training to include the following:
A. Recognition and treatment of different types of
seizures.
B. Administration of an emergency antiseizure
medication.
CONTINUED
SB 161
Page
9
C. Basic emergency follow-up procedures including,
calling 911 and contacting the pupil's parent or
guardian.
D. Techniques and procedures to ensure pupil
privacy.
20. Provides that any written materials used in the
training shall be retained by the school.
21. Requires training to be conducted by one or more of
the following:
A. A physician and surgeon.
B. A physician assistant.
C. A credentialed school nurse.
D. A registered nurse.
E. A certificated public health nurse.
22. Deems training provided in accordance with the
manufacturer's instructions, the pupil's health care
provider's instructions and guidelines as adequate
training.
23. Requires a school employee to notify the credentialed
school nurse assigned to the school district if an
emergency antiseizure medication is administered. If a
credentialed school nurse is not assigned to the school
district, the school employee shall notify the
superintendent of the school district, or his or her
designee.
24. Requires a school to retain all records relating to
the administration of an emergency antiseizure
medication.
25. Requires the pupil's parent or guardian to provide all
materials necessary to administer an emergency
antiseizure medication.
26 An "emergency antiseizure medication" means diazepam
rectal and emergency medications approved by the
federal Food and Drug Administration for patients with
epilepsy for the management of seizures by persons
without medical credentials.
CONTINUED
SB 161
Page
10
27. Sunsets the provisions of this bill on January 1,
2017.
( FOR A DETAILED BACKGROUND AND DISCUSSION, PLEASE REFER TO
THE SENATE HEALTH COMMITTEE ANALYSIS)
Related/Prior Legislation
SB 65 (Strickland), 2011-12 Session, authorizes any pupil
who has been diagnosed with cystic fibrosis and is required
to take, during the regular school day, medication
prescribed for him or her by a physician or surgeon, to be
assisted by the school nurse or other designated school
personnel, or may carry and self-administer prescription
pancreatic enzymes if the school district receives
specified written statements. (In Senate Education
Committee)
SB 1051 (Huff), 2009-10 Session, was very similar to this
bill. (Held on Senate Appropriations Committee's Suspense
File)
AB 1802 (Hall), 2009-10 Session, would have authorized 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)
SB 1200 (Leno), 2009-10 Session, would have required 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. (Failed passage in
Assembly Appropriations Committee)
AB 2454 (Torlakson), 2009-10 Session, would have required
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
CONTINUED
SB 161
Page
11
bill would have required registered nurses and vocational
nurses to provide health care services to pupils under the
supervision of a school nurse. (Failed passage in Assembly
Appropriations Committee)
AB 1430 (Swanson), 2009-10 Session, 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. (Failed passage in the Assembly Business,
Professions, and Consumer Protection Committee)
AB 426 (Hall), 2009-10 Session, would have required the
CDE, in consultation with specified entities, to recommend
to the Legislature ways to address specific health-related
needs of pupils on school campuses, including but not
limited to, diabetes, asthma, and obesity-related diseases.
(Died in Assembly Education Committee)
AB 942 (Leno), Chapter 444, Statutes of 2003, authorizes
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
Department of Health Services,' Diabetes Control Program,
in the absence of a credentialed school nurse or other
licensed nurse. Passed the Senate with a vote of 38-0 on
September 3, 2003.
AB 559 (Wiggins), Chapter 458, Statues of 2001, authorized
a school district or county office of education to provide
emergency epinephrine auto-injectors to trained personnel,
and authorized the trained personnel to utilize those
epinephrine auto-injectors to provide emergency medical aid
to persons suffering from an anaphylactic reaction. Passed
the Senate with a vote of 40-0 on August 27, 2001.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
CONTINUED
SB 161
Page
12
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13
2013-14 Fund
CDE consultation/ Potentially significant costs to
participate General
approval
CDE Web site -- Minor and
absorbable -- General
information
SUPPORT : (Verified 6/1/11)
Association of Regional Center Agencies
California Association of Joint Powers Authorities (if
amended)
California Association of School Business Officials
California Association of Suburban School Districts
California County Superintendents Educational Services
Association
California School Boards Association
Children's Specialty Care Coalition
Democrats for Education Reform
Developmental Disabilities Area Board 10
Disability Rights California
Epilepsy Foundation, California
Health Officers Association of California
Humboldt County Office of Education
Kern County Superintendent of Schools
Los Angeles County Office of Education
Los Angeles Unified School district
Orange County Department of Education
Riverside County School Superintendents' Association
Riverside Unified School District
Saddleback Valley Unified School District
San Bernardino County District Advocates for Better Schools
Small School Districts' Association
OPPOSITION : (Verified 6/1/11)
CONTINUED
SB 161
Page
13
American Nurses Association-California,
California Labor Federation
The California Federation of Teachers
California Association for Nurse Practitioners
California Nurses Association
California School Employees Association
California School Nurses Organization
California School Employees Association
California Teachers Association
Laborers International Union of North America, Local 777
Service Employees International Union-Nurses Alliance of
California
United Nurses Associations of CA-Union of Health Care
Professionals
United Teachers Los Angeles
ARGUMENTS IN SUPPORT : Supporters write that Diastat is a
safe and effective drug and allowing trained school
personnel to administer Diastat could save an epileptic
child from very serious injury. The Health Officers
Association of California (HOAC) writes that without SB
161, school personnel would have to wait for the child's
parent or an ambulance to arrive in order for the drug to
be administered. Epilepsy California writes a student
suffering from prolonged seizures that is prescribed and
yet denied access to Diastat risks permanent brain damage
or death. After five minutes, seizures are life
threatening. The California Association of Suburban School
Districts writes that Diastat is the first and only
FDA-approved, acute layperson-administered medication and
is the best option for providing a safe educational
environment for students.
Disability Rights of California (DRC) contends SB 161 is an
important step to providing children with epilepsy with a
free appropriate education. DRC writes access to
medication is important for children with disabilities who
need it to be able to receive an education in the least
restrictive environment with their peers. Riverside
Unified School District writes SB 161 is a critical
component of the overall medical and welfare care the
district provides to special needs students.
CONTINUED
SB 161
Page
14
The Riverside County School Superintendents' Association
writes that it is the unfortunate fiscal reality that we
will not have nurses in our schools and we must adapt to
that fiscal reality in a manner that provides the most
health protection to the students.
Supporters state that it has been common practice for over
10 years for trained non-medical personnel to have the
authority to administer doctor-prescribed Diastat to a
student suffering a severe and possibly life threatening
seizure. Supporters further contend that this bill is
patterned after two existing laws which allow non-medical
school personnel to administer drugs, Epinephrine and
Glucagon. Supporters argue these medications must also be
given in a specified and extremely short amount of time
from the onset of the episode. Supporters argue Diastat,
like Epinephrine and Glucagon, is a life-saving measure.
If Diastat is administered incorrectly, the medication is
not life-threating, but a significant delay in receiving
treatment can be.
ARGUMENTS IN OPPOSITION : A coalition of union groups
including, the California Teachers Association, California
School Employees Association, American Nurses
Association-California, California Nurses Association,
California Labor Federation, Service Employees
International Union - Nurses Alliance of California, and
the California Federation of Teachers are opposed to this
bill writing that Diastat is a dangerous medication that
must be administered rectally to control seizures. The
coalition writes that because a seizure is unpredictable,
providing for any level of privacy is nearly impossible.
The coalition further argues that school employees face
legal liability if something goes wrong as school districts
generally do not cover punitive damages. Opponents also
argue that this bill does not require 911 to be called and
in medical emergencies, a 911 call must be required.
The coalition supports having licensed, appropriately
trained health care personnel provide the high quality care
that is required to assure that not only children with
disabilities but all school children have access to a free,
fair and appropriate education.
CONTINUED
SB 161
Page
15
The United Nurses Association of California-Union of Health
Care Professionals writes in opposition to SB 161, arguing
the bill will "deskill the role of school nurses" at a risk
to children.
Opponents further argue that if an employee is named in a
lawsuit, they will have to go to court to defend themselves
and there are no protections against punitive damages or
criminal prosecution.
The California School Employees Association (CSEA) argues
that training will be inadequate if provided at all, as the
bill does not provide funding for any training. CSEA
writes that if a Registered Nurse is not available to
perform this duty, Licensed Vocational Nurses (LVNs) can
and should be used as they are appropriately licensed and
have the skills and ability to help epileptic students.
CPM:cm 6/1/11 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
**** END ****
CONTINUED