BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                            



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                                 UNFINISHED BUSINESS


          Bill No:  SB 669
          Author:   Huff (R), et al.
          Amended:  7/3/13
          Vote:     21

           
           SENATE HEALTH COMMITTEE  :  8-0, 4/17/13
          AYES:  Hernandez, Anderson, Beall, De León, DeSaulnier, Monning,  
            Nielsen, Wolk
          NO VOTE RECORDED:  Pavley

           SENATE JUDICIARY COMMITTEE  :  7-0, 4/30/13
          AYES:  Evans, Walters, Anderson, Corbett, Jackson, Leno, Monning

           SENATE APPROPRIATIONS COMMITTEE  :  7-0, 5/23/13
          AYES:  De León, Walters, Gaines, Hill, Lara, Padilla, Steinberg

           SENATE FLOOR  :  38-0, 5/29/13
          AYES:  Anderson, Beall, Berryhill, Block, Calderon, Cannella,  
            Corbett, Correa, De León, DeSaulnier, Emmerson, Evans, Fuller,  
            Gaines, Galgiani, Hancock, Hernandez, Hill, Hueso, Huff,  
            Jackson, Lara, Leno, Lieu, Liu, Monning, Nielsen, Padilla,  
            Pavley, Price, Roth, Steinberg, Torres, Walters, Wolk, Wright,  
            Wyland, Yee
          NO VOTE RECORDED:  Knight, Vacancy

           ASSEMBLY FLOOR  :  77-0, 9/9/13 - See last page for vote


           SUBJECT  :    Emergency medical care:  epinephrine auto-injectors

           SOURCE  :     Conference of California Bar Associations

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           DIGEST  :    This bill (1) authorizes a trained pre-hospital  
          emergency medical care person, first responder, or lay rescuer  
          to obtain and use epinephrine auto-injectors to render emergency  
          care to another person, pursuant to specified requirements, and  
          grants them qualified immunity from liability, as specified,  
          unless their conduct in rendering emergency care is grossly  
          negligent; (2) among other things, provides minimal training  
          requirements and requires that the Emergency Medical Services  
          Authority (EMSA) establish and approve authorized training  
          providers and minimum standards for training and the use and  
          administration of epinephrine auto-injectors; (3) authorizes the  
          director of the EMSA to deny, suspend, or revoke any approval or  
          place any approved training provider on probation upon a finding  
          by the director of an imminent threat to public health and  
          safety, as prescribed; (4) creates the Specialized First Aid  
          Training Program Approval Fund (Fund), and requires the EMSA to  
          assess a fee, to be deposited into the fund, to cover the  
          reasonable costs incurred by the EMSA for the ongoing review and  
          approval of training and certification; and (5) requires  
          epinephrine auto-injectors obtained by pre-hospital emergency  
          medical care personnel to be used only when functioning outside  
          the course of the person's occupational duties, or as a  
          volunteer, as specified.

           Assembly Amendments  (1) authorize the director of the EMSA to  
          deny, suspend, or revoke any approval or place any approved  
          training provider on probation upon a finding by the director of  
          an imminent threat to public health and safety, as prescribed,  
          (2) create the Fund, and require the EMSA to assess a fee, to be  
          deposited into the Fund, to cover the reasonable costs incurred  
          by the EMSA for the ongoing review and approval of training and  
          certification, (3) require epinephrine auto-injectors obtained  
          by prehospital emergency medical care personnel to be used only  
          when functioning outside the course of the person's occupational  
          duties, or as a volunteer, as specified, and (4) make other  
          technical changes.

           ANALYSIS  :    

          Existing law:

          1. Permits a school district or county office of education to  
             provide emergency epinephrine auto-injectors to trained  

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             personnel, and permits trained personnel to utilize these  
             epinephrine auto-injectors to provide emergency medical aid  
             to persons suffering from an anaphylactic reaction.

          2. Permits each elementary and secondary school to designate one  
             or more school personnel on a voluntary basis to receive  
             initial and annual refresher training, based on standards  
             developed by the Superintendent of Public Instruction in  
             consultation with organizations with expertise, including the  
             EMSA.

          3. Permits a school nurse, or if the school does not have a  
             nurse then the person who has received the training, to  
             obtain from the school district physician, the medical  
             director of the local health department, or the local  
             emergency medical services director a prescription for  
             epinephrine auto-injectors.

          4. Permits a school nurse, or if the school does not have a  
             nurse then the person who has received the training, to  
             immediately administer an epinephrine auto-injector to a  
             person exhibiting potentially life-threatening symptoms of  
             anaphylaxis at school or a school activity when a physician  
             is not immediately available.

          5. Provides civil liability immunity, with certain restrictions,  
             to persons who complete a basic cardiopulmonary resuscitation  
             course and who, in good faith, renders emergency  
             cardiopulmonary resuscitation at the scene of an emergency.
           
          6. Provides civil liability immunity to any person who, in good  
             faith and not for compensation, renders emergency care or  
             treatment by the use of an automated external defibrillator  
             at the scene of an emergency.  Specifies that the protections  
             in this bill do not apply in the case of personal injury or  
             wrongful death that result from the gross negligence or  
             willful or wanton misconduct of the person who renders  
             emergency care by the use of an automated external  
             defibrillator.

          7. Provides civil liability immunity, as part of a pilot project  
             in seven counties, to a person who administers an opioid  
             antagonist, who is not otherwise licensed to do so, in an  
             emergency without fee if the person has received specified  

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             training.  Sunsets this provision on January 1, 2016.

          8. Establishes the EMSA within the California Health and Human  
             Services Agency, and requires EMSA, among other things, to  
             develop planning and implementation guidelines for emergency  
             medical services systems which address specified components,  
             including manpower and training, communications,  
             transportation, system organization and management, data  
             collection and evaluation, and disaster response.

          9. Defines pre-hospital emergency medical personnel as any of  
             the following: authorized registered nurse or mobile  
             intensive care nurse, emergency medical technician (EMT)-I  
             EMT-II, EMT-paramedic, lifeguard, firefighter, or peace  
             officer, as defined, or a physician who provides pre-hospital  
             emergency medical care or rescue services.

          This bill:

          1. Authorizes a pre-hospital emergency medical care person, or  
             lay rescuer to use an epinephrine auto-injector to render  
             emergency care to another person, as specified. 

          2. Requires the EMSA to establish and approve authorized  
             training providers and minimum standards for training and the  
             use and administration of epinephrine auto-injectors.   
             Permits EMSA to designate existing training standards.

          3. Authorizes the director of the EMSA authority to deny,  
             suspend, or revoke any approval or place any approved  
             training provider on probation upon a finding by the director  
             of an imminent threat to public health and safety, as  
             prescribed.

          4. Creates the Fund, and requires the authority to assess a fee,  
             to be deposited into the fund, to cover the reasonable costs  
             incurred by the authority for the ongoing review and approval  
             of training and certification.

          5. Clarifies these provisions do not apply to a school district  
             or county office of education, or its personnel, that  
             provides and utilizes epinephrine auto-injectors to provide  
             emergency medical care, as specified. 


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          6. Clarifies that these provisions do not limit or restrict the  
             ability of pre-hospital emergency medical care personnel,  
             under any other statute or regulation, to administer  
             epinephrine, or to require additional training or  
             certification, beyond what is already required.

          7. Authorizes a pharmacy to dispense epinephrine auto-injectors  
             to a pre-hospital emergency medical care person, first  
             responder, or lay rescuer for the purpose of rendering  
             emergency care in accordance with these provisions. 

          8. Requires epinephrine auto-injectors obtained by pre-hospital  
             emergency medical care personnel to be used only when  
             functioning outside the course of the person's occupational  
             duties, or as a volunteer, as specified.

          9. Provides that a pre-hospital emergency medical care person,  
             first responder, or lay rescuer who administers an  
             epinephrine auto-injector, in good faith and not for  
             compensation, to another person who appears to be  
             experiencing anaphylaxis at the scene of an emergency  
             situation is not liable for any civil damages resulting from  
             his/her acts or omissions in administering the epinephrine  
             auto-injector, if that person has complied with specified  
             certification and training requirements and standards, except  
             as specified. 

           Background
           
           Anaphylaxis  .  According to the National Institutes of Health,  
          anaphylaxis is a severe, whole-body allergic reaction to a  
          chemical that has become an allergen.  After being exposed to a  
          substance such as bee sting venom, the person's immune system  
          becomes sensitized to it.  When the person is exposed to that  
          allergen again, an allergic reaction may occur.  This causes the  
          airways to tighten and leads to other symptoms.  Anaphylaxis can  
          occur in response to any allergen.  Anaphylaxis is  
          life-threatening and can occur at any time. Risks include a  
          history of any type of allergic reaction.

           Epinephrine auto-injector  .  An epinephrine auto-injector is a  
          medical device used to deliver a measured dose of epinephrine  
          (also known as adrenaline) using auto-injector technology, most  
          frequently for the treatment of acute allergic reactions to  

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          avoid or treat the onset of anaphylaxis.  The EpiPen (and the  
          version for smaller children, the EpiPen Jr.) are commonly used  
          epinephrine auto-injectors.  The devices are intended to be  
          injected into the middle of the outer thigh, and patients are  
          directed not to inject the device into a vein, buttock, fingers,  
          toes, hands or feet.

           Prior legislation
           
          AB 559 (Wiggins, Chapter 458, Statutes of 2001), established  
          provisions of law that permit a school district or county office  
          of education to provide emergency epinephrine auto-injectors to  
          trained personnel, and permit trained personnel to utilize these  
          epinephrine auto-injectors to provide emergency medical aid to  
          persons suffering from an anaphylactic reaction at a school or  
          during a school activity.

           FISCAL EFFECT  :    Appropriation:  No   Fiscal Com.:  Yes    
          Local:  Yes


          According to the Senate Appropriations Committee:


           One-time costs of $450,000 for the adoption and amendment of  
            regulations by the EMSA(General Fund).

           Ongoing costs of $250,000 for training and oversight by the  
            EMSA (General Fund).

           SUPPORT  :   (Per Assembly Judiciary Committee analysis of  
          8/13/13) (Unable to reverify)

          Conference of California Bar Associations (source)
          American Academy of Pediatrics
          Association of Regional Center Agencies
          California Advocates, Inc.
          California Association of Joint Powers Authorities
          California Hospital Association
          California Medical Association
          Civil Justice Association of America
          Civil Justice Association of California
          Food Allergy Research and Education
          Hospital Corporation of America

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           ARGUMENTS IN SUPPORT  :    This bill is sponsored by the  
          Conference of California Bar Associations (CCBA), representing  
          more than 25 metropolitan, regional and specialty bar  
          associations. CCBA states that like almost all states,  
          California has responded to the dangers of anaphylaxis in our  
          schools by enacting legislation to permit school districts or  
          county offices of education to provide emergency epinephrine  
          auto-injectors to trained personnel, and to permit those  
          personnel to utilize these auto-injectors to provide emergency  
          medical aid to students suffering from an anaphylactic reaction.  
           CCBA states that this bill would enable California to join a  
          growing group of states that provide training in the proper use  
          of epinephrine auto-injectors and which makes these  
          auto-injectors available by prescription to individuals who have  
          successfully completed the training.  

          This bill is supported by the California Hospital Association  
          (CHA), which states that death from anaphylaxis remains a real  
          and widespread problem.  Currently, anaphylaxis leads to  
          500-1,000 deaths per 2.4 million in the United States. While  
          mortality rates have decreased, the incidence of anaphylaxis  
          appears to be increasing from 20 per 100,000 per year in the  
          1980s to 50 per 100,000 in the 1990s.  CHA states that there is  
          no effective treatment to prevent anaphylactic cardiac arrest in  
          the community unless the victim has an epinephrine auto-injector  
          and is able to self-administer the injection before losing  
          consciousness.


           ASSEMBLY FLOOR  :  77-0, 9/9/13
          AYES:  Achadjian, Alejo, Allen, Ammiano, Atkins, Bigelow, Bloom,  
            Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian  
            Calderon, Campos, Chau, Chávez, Chesbro, Conway, Cooley,  
            Dahle, Daly, Dickinson, Eggman, Fong, Fox, Frazier, Beth  
            Gaines, Garcia, Gatto, Gomez, Gonzalez, Gordon, Gorell, Gray,  
            Grove, Hagman, Hall, Harkey, Roger Hernández, Holden, Jones,  
            Jones-Sawyer, Levine, Linder, Logue, Lowenthal, Maienschein,  
            Mansoor, Medina, Melendez, Mitchell, Morrell, Mullin,  
            Muratsuchi, Nazarian, Nestande, Olsen, Pan, Patterson, Perea,  
            V. Manuel Pérez, Quirk, Quirk-Silva, Rendon, Salas, Skinner,  
            Stone, Ting, Wagner, Waldron, Weber, Wieckowski, Wilk,  
            Williams, Yamada, John A. Pérez
          NO VOTE RECORDED:  Donnelly, Vacancy, Vacancy

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          JL:AL:d  9/9/13   Senate Floor Analyses 

                           SUPPORT/OPPOSITION:  SEE ABOVE

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