Amended in Senate May 27, 2014

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 to amend Section 4119.2 of the Business and Professions Code, and 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. Existing law authorizes a pharmacy to furnish epinephrine auto-injectors to a school district or county office of education if certain requirements are met.

This bill would require school districts, county offices of education, and charter schools to provide emergency epinephrine auto-injectors to trained personnel begin insert who have volunteered, as specified, end insert and would authorize trained personnel to use those epinephrine auto-injectors to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an anaphylactic reaction. begin delete The bill would require each public elementary and secondary school, 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 to receive initial and annual refresher training regarding the storage and emergency use of an epinephrine auto-injector, as specified. end delete The bill would require a school nurse, or a school administrator if begin insert an employee has volunteered, as specified, and end insert 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. The bill would authorize a pharmacy to also furnish epinephrine auto-injectors to a charter school if certain conditions are met. 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 voluntarily designated 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 begin delete forms and would require the department to annually post the result of those forms on its Internet Web site. end delete begin insert forms. end insert 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 local educational agencies 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:

SECTION 1.  

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

4119.2.  

(a) Notwithstanding any other law, a pharmacy may
furnish epinephrine auto-injectors to a school district, county office
of education, or charter school 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 site, county office of education, or charter
school.

(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 a end delete begin insert the end insert school district, county office of
education, or charter school for a period of three years from the
date the records were created. The school district, county office
of education, or charter school shall be responsible for monitoring
the supply of begin insert epinephrine end insert auto-injectors and begin delete assuring end delete begin insert ensuring end insert the
destruction of expired begin insert epinephrine end insert auto-injectors.

SEC. 2.  

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 begin delete personnel, end delete begin insert personnel who have volunteered pursuant to
subdivision (d), end insert and trained personnel may use those epinephrine
auto-injectors to provide emergency medical aid to persons
suffering, or reasonably believed to be suffering, 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 and private elementary and secondary school
in the state may 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 (f), end delete begin insert (e), 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

(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 delete begin delete

(f)

end delete

begin insert (e) 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 Public Health, the Emergency Medical Services Authority, the
American Academy of Allergy, Asthma 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 storage, restocking, and
emergency use of epinephrine auto-injectors.

(C) Emergency followup procedures, including calling the
emergency 911 telephone 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

(g)

end delete

begin insert (f) 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 begin delete administrator, end delete
begin insert administrator if an employee has volunteered pursuant to
subdivision (d), 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, includes, for
elementary schools, one regular epinephrine auto-injector and one
junior epinephrine 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 auto-injector.
The prescription may be filled by local or mail order pharmacies
or epinephrine auto-injector manufacturers.

begin delete

(h)

end delete

begin insert (g) 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 begin delete school administrator
or his or her voluntary end delete begin insert volunteer end insert designee who has received training
pursuant to subdivision (d), 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

(i)

end delete

begin insert (h) end insert  A person who has received training as set forth in
begin delete subdivisions (d) and (e) end delete begin insert subdivision (d) 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 (f). end delete begin insert (e). end insert

begin delete

(j)

end delete

begin insert (i) end insert  No later than 30 days after the last day of each school year,
the school nurse or voluntarily designated 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. begin delete Without violating federal and state
privacy laws, the department shall annually publish the results of
the submitted forms on its Internet Web site. end delete

begin delete

(k) 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
(g).

(3) Documentation as to which individual, the school nurse or
school administrator, 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, when
the medication was restocked, and how the medication will be
made readily available in case of an emergency.

end delete begin delete

(l)

end delete

begin insert (j) 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

(m)

end delete

begin insert (k) 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.

SEC. 3.  

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.