BILL ANALYSIS Ó
SB 161
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Date of Hearing: August 17, 2011
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
SB 161 (Huff) - As Amended: July 13, 2011
Policy Committee: Business and
Professions Vote: 7-1
Education 6-3
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill authorizes a school district to participate in a
program to allow nonmedical employees to volunteer to provide
medical assistance to pupils with epilepsy suffering from
seizures, as specified. Sunsets the provisions of this measure
on January 1, 2017.
FISCAL EFFECT
1)GF/98 cost pressure, of approximately $10 million, to school
districts to implement this measure. This cost is associated
with conducting training, developing an individualized health
plan and school district plan, and record keeping. These are
not state reimbursable mandated costs because the provisions
of this bill are not required by school districts. A
parent/guardian may request nonmedical personnel administer
the antiseizure medication, as specified.
Actual costs will depend on the number of school districts
that choose to participate and the number of parents/guardians
who make a request. Even if one parent/guardian makes this
request and school districts implement this request, districts
will likely incur a significant amount of work/cost because it
is likely protocols will be put in place districtwide.
Approximately 3 million people in the U.S. have some form of
epilepsy. About 200,000 new cases of seizure disorders and
epilepsy are diagnosed each year. According to the Epilepsy
Foundation, as many as 325,000 school age children, ages 5-14,
have epilepsy. Epilepsy affects more than 90,000 children
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across California. There were 6.2 million children enrolled
in California schools in 2009-10. It is unclear how many
children with epilepsy are prescribed Diastat as their
antiseizure medication.
2)One-time GF administrative costs, likely between $150,000 and
$250,000, to the State Department of Education (SDE) to
develop guidelines and establish a best practices
clearinghouse, as specified in this measure. Currently, the
bill states a voluntary school employee "shall use a training
plan approved on the department's Internet website." It is
unclear if this language requires SDE to approve all district
training plans. If so, the administrative cost to SDE will
increase significantly.
SUMMARY CONTINUED
Specifically, this bill:
1)Requires a school district, if it elects to participate in
this program, to provide volunteer school employees with
emergency medical training consistent with the training
guidelines established in this measure. Further requires a
trained school employee to provide the medical assistance
using a training plan approved on SDE's Internet website and
the performance instructions set forth by the licensed health
care provider of the pupil.
2)Prohibits a school employee who does not volunteer or who has
not been trained from being required to provide emergency
medical assistance. Further prohibits a district from
directly or indirectly using or attempting to use authority or
influence for the purpose of threatening, coercing, or
attempting to intimidate, threaten, or coerce any staff member
who does not volunteer.
3)Authorizes a parent/guardian to request his or her pupil's
school to have one or more of its employees receive training
in the administration of an emergency antiseizure medication
in the event the pupil suffers a seizure when a nurse is not
available, as specified.
4)Defines emergency antiseizure medication as diazepam rectal
gel and emergency medications approved by the federal Food and
Drug Administration (FDA) for patients with epilepsy for the
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management of seizures by persons without medical credentials.
This medication is known as Diastat.
5)Requires the school to notify the parent/guardian that his or
her child may qualify for services/accommodations under the
federal law, including the Individuals with Disabilities
Education Act (IDEA), as specified. Authorizes the school to
ask the parent/guardian to sign a notice verifying he or she
was given this information and understands his or her pupil's
rights under federal law.
6)Authorizes, if a parent/guardian does not choose to have his
or her pupil assessed under federal law, 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.
7)Requires a school district to ensure voluntary employees
receive training from a licensed health care professional
regarding the administration of an emergency antiseizure
medication. Further requires SDE, in consultation with the
Department of Public Health to develop guidelines for the
training and supervision of school employees in providing
medical assistance to pupils with epilepsy and post this
information on SDE's Internet website by July 1, 2012.
8)Prohibits a volunteer from being required to administer the
medication until completion of the training program adopted by
the district and documentation of completion is recorded in
his or her personnel file.
9)Requires the training to include basic emergency follow-up
procedures, including the requirement for the schoolsite
personnel to call 911 and contact the pupil's parent/guardian
10)Requires a school district to ensure each employee who
volunteers to be provided with defense and indemnification by
the school district for any civil liability. Requires this
information to be reduced to writing and retained in the
voluntary employee's personnel file.
11)Requires a school district that participates in this program
to have a plan that includes, but is not limited to, the
following:
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a) Identification of existing licensed staff within the
district or region who could be trained in the
administration of antiseizure medication and available to
respond to an emergency situation, as specified.
b) Identification of pupils who may require the
administration of this medication and written authorization
from the parent/guardian for a nonmedical school employee
to administer the medication.
c) Notification by the parent/guardian to the school
district and vice versa as to whether or not the pupil was
administered antiseizure medication, as specified.
d) A written statement from the pupil's health care
practitioner that includes purpose of medication;
prescribed dosage, detailed seizure symptoms, method of
administration, frequency in which the medication can be
administered, any potential adverse responses by the pupil,
and a protocol for observing the pupil after the seizure.
12)Requires a school district that participates in this program
to compensate a volunteer in accordance with the employee's
volunteer pay scale when the administration of medication and
subsequent monitoring of the pupil requires the volunteer to
work beyond his or her normal schedule.
13)Requires SDE to include a clearinghouse of best practices in
training nonmedical personnel to administer an emergency
antiseizure mediation to pupils on its website.
COMMENTS
1)Background . Existing law authorizes nonmedical school
personnel to administer medication to a pupil in an emergency,
after receiving specified training. Specifically, statute
authorizes nonmedical personnel to provide medical assistance
to pupils with diabetes suffering from severe hypoglycemia.
In this instance, this medical assistance can only be provided
in the absence of a credentialed school nurse or other
licensed nurse at the school. Likewise, current law
authorizes nonmedical personnel to administer emergency
epinephrine auto-injectors to aid persons suffering from an
anaphylactic reaction.
Current law also authorizes nonmedical personnel to assist or
administer medication to a pupil on a routine basis (not an
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emergency). These provisions are associated with the
assistance of auto-injectable epinephrine and asthma
medication. Statute also authorizes these personnel to assist
in the administration of other medication if the pupil's
health care provider provides a written statement with
specific information, such as the type of medication, dosage,
and the period of time during which the medication is to be
taken. This assistance can only occur 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.
Statute also establishes the Nursing Practices Act, which
prohibits any person from engaging in the practice of nursing,
which is defined as basic health care and direct/indirect
patient care, as specified. Further specifies a person who
attempts to practice nursing without certification is guilty
of a public offense punishable by a fine not exceeding $10,000
and potential imprisonment.
2)Purpose . According to the author, "For over ten years it was
common in California schools to have registered nurses, or
where unavailable, trained nonmedical 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. In October 2009,
however, a nursing education consultant to the Board of
Registered Nursing (BRN) advised that there is no provision in
the Nursing Practice Act for unlicensed school personnel to
administer Diastat. As a consequence of Ýthe BRN letter],
nurses are refusing to train school personnel, and schools are
reluctant to have staff, even those already trained,
administer Diastat."
According to a June 2007 Journal of School Nursing article
entitled: Emergency Management of Seizures in the School
Setting, "Reducing the time between seizure onset and medical
treatment will significantly improve a student's outcome
(Alldredge, Wall, & Ferriero, 1995). Appropriate first aid and
implementation of the emergency treatment plan should begin at
the onset of seizures. Medical intervention may involve
administering rectal medication if the child experiences
prolonged or repetitive seizures. Diazepam rectal gel is
currently the only U.S. Food and Drug Administration (FDA)
approved portable rescue medication that can be administered
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by nonmedical caregivers outside the hospital setting.
Where permitted, the option of training nonmedical personnel
to administer diazepam rectal gel is advantageous in a school
setting when a school nurse is not immediately available
during a seizure episode. Major advantages of this medication
are safety, efficacy, and the potential for the student to be
able to return to the classroom following treatment (Dreifuss
et al., 1998; Pellock, 2004)."
This bill authorizes a school district to participate in a
program to allow nonmedical employees to volunteer to
administer antiseizure mediation (Diastat) to pupils, upon the
request by a parent/guardian, as specified.
3)Opposition . Opponents of this measure (the California School
Nurses Organization (CNO), California Teachers Association,
California Federation of Teachers, the California Nurses
Association, the California School Employees Association,
United Teachers of Los Angeles, SEIU, and ASFCME) argue
nonmedical personnel are not the appropriate individuals to
administer antiseizure medication. Specifically, these
organizations argue nonmedical personnel do not have the
medical background to administer this medication and
anticipate or appropriately handle any complications that may
arise. In essence, opponents argue by allowing nonmedical
personnel to perform this duty pupils are at risk of severe
complications due to a lack of medical training and knowledge.
Specifically, CNO states: "Emergency antiseizure medications
require an extensive plan to assure they are given
appropriately. With the principal or unlicensed employee
understand an order that requires the medication be given two
minutes of seizure activity, and the various steps that
follow? Will they be able to recognize seizure symptoms when
each child presents differently?"
The California School Employees Association states: "Diastat
is a serious medication that should only be administered by an
appropriately licensed professional. Injecting a child who is
in the middle of a seizure is a challenging thing to do even
for a licensed medical professional. Diastat is a valium that
is injected rectally while a child is in the middle of a
violent seizure, wherever the child may be. If this child is
on the playground, bus, in the lunch line, or the classroom,
the unlicensed employee would have to disrobe the child to
this rectal injection in the presence Ýof others]."
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4)Should this bill apply to all public schools ? Currently, this
bill requires school districts to establish a plan for
allowing nonmedical personnel to administer antiseizure
medication to pupils, upon request. This bill, however, does
not authorize county offices of education (COEs) or charter
schools to implement these provisions. COEs have juvenile
court and community day schools under their jurisdiction.
Shouldn't parents at COE schools and charter schools have the
same option? The committee may wish to consider this issue.
5)Nonmedical personnel administering insulin to pupils . In
October 2005, four elementary school students, along with the
American Diabetes Association, filed a suit against the
Superintendent of Public Instruction (Jack O'Connell), SDE,
members of the State Board of Education, the San Ramon Valley
Unified School District, the Fremont Unified School District,
and their Superintendents and Boards of Trustees. The suit
asked that public school officials comply with federal law by
providing the assistance that California students with
diabetes require to manage their diabetes during the school
day.
In August 2007, the parties reached a settlement agreement,
which required SDE to issue a legal advisory explicitly
stating that school districts have an obligation to provide
insulin administration and related services to eligible
students who need the assistance, including allowing
nonmedical personnel to administer insulin to pupils.
In December 2008, the Sacramento Superior Court overturned a
portion of this settlement related to the administration of
insulin by nonmedical personnel. This decision was appealed.
In June 2010, the 3rd District Court of Appeal ruled that the
Superior Court ruling correctly determined the portion of
CDE's legal advisory is inconsistent with California law and
is therefore, invalid. This ruling was appealed to the
California Supreme Court in July 2010. Until the appeal is
resolved, the Superior Court ruling is stayed, which means SDE
may continue to advise districts that non-medical school
personnel are authorized to administer insulin (based on the
settlement agreement).
6)Existing law requires a school nurse to have the following:
(a) Bachelor of Science (BS) in nursing, (b) RN license, and
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(c) a school nurse credential. An individual is issued a
preliminary school nurse credential for five years. After
completing two years as a school nurse and completing a school
nursing program, the individual qualifies for a clear
credential. According to the Commission on Teacher
Credentialing, 1,472 preliminary and clear school nurse
credentials were issued 2005 and 2010.
In 2008-09, there were 6.3 million pupils enrolled in
California schools. According to the State Department of
Education, there was one nurse for every 2,249 pupils in
2008-09.
Analysis Prepared by : Kimberly Rodriguez / APPR. / (916)
319-2081