Amended in Senate May 6, 2014

Amended in Senate April 21, 2014

Amended in Senate March 24, 2014

Senate Bill No. 1266

Introduced by Senator Huff

(Coauthor: Senator Hill)

February 21, 2014

An act begin insert to amend Section 4119.2 of the Business and Professions Code, and end insert to amend Section 49414 of the Education Code, relating to pupil health.

LEGISLATIVE COUNSEL’S DIGEST

SB 1266, as amended, Huff. Pupil health: epinephrine auto-injectors.

Existing law authorizes a school district or county office of education to provide emergency epinephrine auto-injectors to trained personnel, and authorizes trained personnel to use those epinephrine auto-injectors to provide emergency medical aid to persons suffering from an anaphylactic reaction. Existing law authorizes each public and private elementary and secondary school in the state to designate one or more school personnel on a voluntary basis to receive initial and annual refresher training regarding the storage and emergency use of an epinephrine auto-injector, as specified. Existing law authorizes a school nurse, or a person who has received the training described above if the school does not have a school nurse, to, among other things, obtain a prescription for epinephrine auto-injectors, as specified. begin insert Existing law authorizes a pharmacy to furnish epinephrine auto-injectors to a school district or county office of education if certain requirements are met. end insert

This bill would require school districts, county offices of education, and charter schools to provide emergency epinephrine auto-injectors to trained personnel and would authorize trained personnel to use those epinephrine auto-injectors to provide emergency medical aid to persons begin delete suffering end delete begin insert suffering, or reasonably believed to be suffering, end insert from an anaphylactic reaction. The bill would require each public elementary and secondary school begin delete in the state to designate one or more school personnel on a voluntary basis end delete begin insert , if no school personnel volunteers as a designee, to require a school nurse or, if the school does not have a school nurse or the school nurse is not onsite or available, a school administrator end insert to receive initial and annual refresher training regarding the storage and emergency use of an epinephrine auto-injector, as specified. The bill would require a school nurse, or a school administrator begin delete or his or her designee who has received the training described above end delete if the school does not have a school nurse or the school nurse is not onsite or available, to obtain the prescription for epinephrine auto-injectors, as specified, and would authorize the prescription for epinephrine auto-injectors to be filled by local or mail order pharmacies or epinephrine auto-injector manufacturers. begin insert The bill would authorize a pharmacy to also furnish epinephrine auto-injectors to a charter school if certain conditions are met. end insert The bill would require an epinephrine auto-injector to be restocked as soon as possible after it is used and before its expiration date.

The bill would require the school nurse or begin delete designated end delete begin insert voluntarily designated end insert employee to report any incident of epinephrine auto-injector use to the school district, county office of education, or chartering authority on a form developed by the State Department of Education within 30 days after the last day of each school year. The bill would require the school district, county office of education, or chartering authority to report any incident of epinephrine auto-injector use to the department on those forms and would require the department to annually post the result of those forms on its Internet Web site. The bill would require a school district, county office of education, or charter school to ensure that each employee who volunteers is provided defense and indemnification by the school district, county office of education, or charter school for any and all civil liability, as specified. The bill would authorize a public school to accept gifts, grants, and donations from any source for the support of the public school carrying out these provisions.

By requiring begin delete school districts and county offices of education end delete begin insert local educational agencies end insert to perform additional duties related to epinephrine auto-injectors, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.

The people of the State of California do enact as follows:

begin insert

begin insert SECTION 1. end insert   

end insert

begin insert Section 4119.2 of the end insert begin insert Business and Professions
Code end insert begin insert is amended to read: end insert

4119.2.  

(a) Notwithstanding any other begin delete provision of end delete law, a
pharmacy may furnish epinephrine auto-injectors to a school
begin delete district or end delete begin insert district, end insert county office of education begin insert , or charter school end insert
pursuant to Section 49414 of the Education Code if all of the
following are met:

(1) The epinephrine auto-injectors are furnished exclusively for
use at a school district begin delete site or end delete begin insert site, end insert county office of begin delete education. end delete
begin insert education, or charter school. end insert

(2) A physician and surgeon provides a written order that
specifies the quantity of epinephrine auto-injectors to be furnished.

(b) Records regarding the acquisition and disposition of
epinephrine auto-injectors furnished pursuant to subdivision (a)
shall be maintained by begin delete both the end delete begin insert a end insert school begin delete district or end delete begin insert district, end insert county
office of education begin insert , or charter school end insert for a period of three years
from the date the records were created. The school begin delete district or end delete
begin insert district, end insert county office of education begin insert , or charter school end insert shall be
responsible for monitoring the supply of auto-injectors and assuring
the destruction of expired auto-injectors.

begin delete SECTION 1. end delete
begin insert SEC. 2. end insert   

Section 49414 of the Education Code is amended to
read:

49414.  

(a) School districts, county offices of education, and
charter schools shall provide emergency epinephrine auto-injectors
to trained personnel, and trained personnel may use those
epinephrine auto-injectors to provide emergency medical aid to
persons suffering begin insert , or reasonably believed to be suffering, end insert from an
anaphylactic reaction.

(b) For purposes of this section, the following terms have the
following meanings:

(1) “Anaphylaxis” means a potentially life-threatening
hypersensitivity to a substance.

(A) Symptoms of anaphylaxis may include shortness of breath,
wheezing, difficulty breathing, difficulty talking or swallowing,
hives, itching, swelling, shock, or asthma.

(B) Causes of anaphylaxis may include, but are not limited to,
an insect sting, food allergy, drug reaction, and exercise.

(2) “Epinephrine auto-injector” means a disposable drug delivery
system with a spring-activated needle that is designed for
emergency administration of epinephrine to provide rapid,
convenient first aid for persons suffering a potentially fatal reaction
to anaphylaxis.

(c) Each 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 shall 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. A
private elementary or secondary school choosing to exercise the
authority provided under this subdivision shall not receive state
funds specifically for purposes of this subdivision.

(d) Each public begin delete elementary and secondary school in the state
shall, end delete and begin delete each end delete private elementary and secondary school in the
state begin delete may, end delete begin insert may end insert designate one or more school personnel on a
voluntary basis to receive initial and annual refresher training,
based on the standards developed pursuant to subdivision begin delete (e), end delete begin insert (f), end insert
regarding the storage and emergency use of an epinephrine
auto-injector from the school nurse or other qualified person
designated by the local educational agency physician, the medical
director of the local health department, or the local emergency
medical services director. begin delete However, each public school shall
designate and have trained at least one person for the purposes
listed in subdivisions (f), (g), and (h). end delete

begin insert

(e) Each public elementary and secondary school, including
each charter school, shall, if no school personnel volunteers as a
designee pursuant to subdivision (d), require a school nurse or, if
the school does not have a school nurse or the school nurse is not
onsite or available, a school administrator to receive initial and
annual refresher training, based on the standards developed
pursuant to subdivision (f), regarding the storage and emergency
use of an epinephrine auto-injector and for the purposes listed in
subdivisions (g), (h), and (i).

end insert begin delete

(e)

end delete

begin insert (f) end insert  (1) Every five years, or sooner as deemed necessary by the
Superintendent, the Superintendent shall review minimum
standards of training for the administration of epinephrine
auto-injectors that satisfy the requirements of paragraph (2). For
purposes of this subdivision, the Superintendent shall consult with
organizations and providers with expertise in administering
epinephrine auto-injectors and administering medication in a school
environment, including, but not limited to, the State Department
of begin delete Health Care Services, end delete begin insert Public Health, end insert the Emergency Medical
Services Authority, the American Academy of Allergy, begin delete Asthma, end delete
begin insert Asthma end insert and Immunology, the California School Nurses
Organization, the California Medical Association, the American
Academy of Pediatrics, Food Allergy Research and Education, the
California Society of Allergy, Asthma and Immunology, the
American College of Allergy, Asthma and Immunology, and
others.

(2) Training established pursuant to this subdivision shall include
all of the following:

(A) Techniques for recognizing symptoms of anaphylaxis.

(B) Standards and procedures for the begin delete storage end delete begin insert storage, restocking, end insert
and emergency use of epinephrine auto-injectors.

(C) Emergency follow-up procedures, including calling the
emergency 911 begin delete phone end delete begin insert telephone end insert number and contacting, if possible,
the pupil’s parent and physician.

(D) Instruction and certification in cardiopulmonary
resuscitation.

(E) Instruction on how to determine whether to use an adult
epinephrine auto-injector or a junior epinephrine auto-injector.

(F) Written materials covering the information required under
this subdivision.

(3) Training established pursuant to this subdivision shall be
consistent with the most recent Voluntary Guidelines for Managing
Food Allergies In Schools and Early Care and Education Programs
published by the federal Centers for Disease Control and
Prevention and the most recent guidelines for medication
administration issued by the department.

(4) A school shall retain for reference the written materials
prepared under subparagraph (F) of paragraph (2).

begin delete

(f)

end delete

begin insert (g) end insert  A school begin delete nurse, or end delete begin insert nurse or, end insert if the school does not have a
school nurse or the school nurse is not onsite or available, a school
begin delete administrator or his or her designee who has received training
pursuant to subdivision (d), end delete begin insert administrator, end insert shall obtain from the
local educational agency physician, a physician contracting with
the local educational agency, the medical director of the local
health department, or the local emergency medical services director
a prescription for epinephrine auto-injectors that, at a minimum,
begin delete includes one adult end delete begin insert includes, for elementary schools, one regular end insert
epinephrine auto-injector and one junior epinephrine begin insert auto-injector,
and for junior high or middle schools and high schools, if there
are no pupils who require a junior epinephrine auto-injector, one
regular epinephrine end insert auto-injector. The prescription may be filled
by local or mail order pharmacies or epinephrine auto-injector
manufacturers.

begin delete

(g)

end delete

begin insert (h) end insert  A school nurse, or if the school does not have a school nurse
or the school nurse is not onsite or available, a school administrator
or his or her begin insert voluntary end insert designee who has received training pursuant
to subdivision (d) begin insert , end insert may 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. If the epinephrine auto-injector is used it
shall be restocked as soon as reasonably possible. Epinephrine
auto-injectors shall be restocked before their expiration date.

begin delete

(h)

end delete

begin insert (i) end insert  A person who has received training as set forth in begin delete subdivision end delete
begin delete (d) or a school nurse end delete begin insert subdivisions (d) and (e) end insert shall initiate
emergency medical services or other appropriate medical followup
in accordance with the training materials retained pursuant to
paragraph (4) of subdivision begin delete (e). end delete begin insert (f). end insert

begin delete

(i)

end delete

begin insert (j) end insert  No later than 30 days after the last day of each school year,
the school nurse or begin delete designated end delete begin insert voluntarily designated end insert employee
shall report any incident of epinephrine auto-injector use to the
school district, county office of education, or chartering authority
on a form developed by the department. The school district, county
office of education, or chartering authority shall report any incident
of epinephrine auto-injector use to the department on the form
developed by the department. Without violating federal and state
privacy laws, the department shall annually publish the results of
the submitted forms on its Internet Web site.

begin delete

(j)

end delete

begin insert (k) end insert  A school district, county office of education, or charter
school using epinephrine auto-injectors for emergency medical
aid shall create a plan to address all of the following issues:

(1) Designation of the individual or individuals who will provide
the training pursuant to subdivision (d).

(2) Designation of the local educational agency physician, the
medical director of the local health department, or the local
emergency medical services director that the school district, county
office of education, or charter school will consult for the
prescription for epinephrine auto-injectors pursuant to subdivision
begin delete (f). end delete begin insert (g). end insert

(3) Documentation as to which individual, the school nurse or
begin delete other trained person pursuant to subdivision (f), end delete begin insert school
administrator, end insert in the school district, county office of education,
or charter school will obtain the prescription from the physician
and the medication from a pharmacist.

(4) Documentation as to where the medication is stored begin insert , when
the medication was restocked, end insert and how the medication will be
made readily available in case of an emergency.

begin delete

(k)

end delete

begin insert (l) end insert  A school district, county office of education, or charter school
shall ensure that each employee who volunteers under this section
will be provided defense and indemnification by the school district,
county office of education, or charter school for any and all civil
liability, in accordance with, but not limited to, that provided in
Division 3.6 (commencing with Section 810) of Title 1 of the
Government Code. This information shall be reduced to writing,
provided to the volunteer, and retained in the volunteer’s personnel
file.

begin delete

(l)

end delete

begin insert (m) end insert  A public school may accept gifts, grants, and donations
from any source for the support of the public school carrying out
the provisions of this section, including, but not limited to, the
acceptance of epinephrine auto-injectors from a manufacturer or
wholesaler.

begin delete SEC. 2. end delete
begin insert SEC. 3. end insert   

If the Commission on State Mandates determines that
this act contains costs mandated by the state, reimbursement to
local agencies and school districts for those costs shall be made
pursuant to Part 7 (commencing with Section 17500) of Division
4 of Title 2 of the Government Code.