Amended in Assembly June 17, 2014

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.

begin delete

Existing

end delete

begin insert (1) end insert begin insert   end insert begin insert Existing end insert 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 begin delete those end delete 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 begin delete 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. end delete begin insert auto-injectors. end insert

This bill would begin insert instead end insert require school districts, county offices of education, and charter schools to provide emergency epinephrine auto-injectors to begin insert school nurses and end insert trained personnel who have volunteered, as specified, and would authorize begin insert student nurses and end insert trained personnel to use begin delete those end delete epinephrine auto-injectors to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an anaphylactic reaction. begin insert The bill would end insert begin insert require school districts, county offices of education, and charter schools to distribute a notice requesting volunteers at least once a year. end insert The bill would require a school begin delete nurse, end delete begin insert nurse end insert or begin insert , if the school has a volunteer, end insert a school begin delete administrator if an employee has volunteered, as specified, and the school does not have a school nurse or the school nurse is not onsite or available, end delete begin insert administrator end insert to obtain the prescription for epinephrine auto-injectors, begin delete as specified, end delete and would authorize the prescription begin delete for epinephrine auto-injectors end delete to be filled by local or mail order pharmacies or epinephrine auto-injector manufacturers. begin delete The bill would authorize a pharmacy to also furnish epinephrine auto-injectors to a charter school if certain conditions are met. end delete The bill would require begin delete an end delete epinephrine begin delete auto-injector end delete begin insert auto-injectors end insert to be restocked begin delete as soon as possible after it is used and before its expiration date. end delete begin insert by the school nurse or school administrator, or the school district or county office of education on behalf of a school nurse or school administrator of any school in the school district or county, or by a charter operator on behalf of charter schools in accordance with specified provisions. By imposing additional duties on local educational agencies, the bill would impose a state-mandated local program. end insert

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(2) Existing law requires the Superintendent of Public Instruction to establish minimum standards of training for the administration of epinephrine auto-injectors, as specified, and requires a school district or county of office of education to create a plan relating to their use.

end insert begin delete

The

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begin insert This bill would revise the training requirements, and would require the Superintendent to review the minimum standards of training at least every 5 years. The end insert bill would begin delete 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 forms. end delete begin insert delete the requirement for creating a plan, and would impose specified reporting requirements relating to the use of epinephrine auto-injectors on specified school employees, local educational agencies, and the State Department of Education. 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 begin insert state agency, the State Department of Education, or a end insert public school to accept gifts, grants, and donations from any source for the support of the public school carrying out these begin delete provisions. end delete

begin delete By end delete begin insert provisions. By end insert requiring local educational agencies to perform additional duties related to epinephrine auto-injectors, the bill would impose a state-mandated local program.

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(3) 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 begin insert

This bill would also authorize a pharmacy to furnish epinephrine auto-injectors to charter schools pursuant to those provisions.

end insert begin delete

The

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begin insert (4) end insert begin insert   end insert begin insert The end insert 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 the 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 epinephrine auto-injectors and ensuring the
destruction of expired epinephrine 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 begin insert school nurses or end insert trained personnel who have volunteered
pursuant to subdivision (d), and begin insert school nurses or end insert trained personnel
may use begin delete those end delete 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.

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(3) “Volunteer” or “trained personnel” means an employee
who has volunteered to administer epinephrine auto-injectors to
a person if the person is suffering, or reasonably believed to be
suffering, from anaphylaxis, and has been designated by a school
and has received training pursuant to subdivision (d).

end insert

(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 begin delete school personnel on a
voluntary basis end delete begin insert volunteers end insert to receive initial and annual refresher
training, based on the standards developed pursuant to subdivision
(e), regarding the storage and emergency use of an epinephrine
auto-injector from the school nurse or other qualified person
designated by the begin insert physician and surgeon employed by or
contracting with the end insert local educational begin delete agency physician, end delete begin insert agency, end insert
the medical director of the local health department, or the local
emergency medical services director.

(e) (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)  begin delete Instruction end delete begin insert Recommendation on the necessity of instruction end insert
and certification in cardiopulmonary resuscitation.

(E) Instruction on how to determine whether to use an adult
epinephrine auto-injector or a junior epinephrine begin delete auto-injector. end delete
begin insert auto-injector, which shall include consideration of a pupil’s grade
level or age as a guideline of equivalency for the appropriate pupil
weight determination. end insert

(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 insert

(f) A school district, county office of education, or charter school
shall distribute a notice at least once per school year to all staff
that contains the following information:

end insert begin insert

(1) A description of the volunteer request stating that the request
is for volunteers to be trained to administer an epinephrine
auto-injector to a person if the person is suffering, or reasonably
believed to be suffering, from anaphylaxis, as specified in
subdivision (b).

end insert begin insert

(2) A description of the training that the volunteer will receive
pursuant to subdivision (d).

end insert begin delete

(f)

end delete

begin insert (g) end insert begin insert   end insert begin insert (1) end insert  A school begin delete nurse or, if the school does not have a school
nurse or the end delete begin insert nurse, if the end insert school nurse is begin delete not end delete onsite or available, begin delete a
school administrator if an employee has volunteered pursuant to
subdivision (d), end delete shall obtain from begin delete the local educational agency
physician, end delete a physician begin insert and surgeon employed by or end insert 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. begin delete The prescription may be filled by local
or mail order pharmacies or epinephrine auto-injector
manufacturers. end delete begin insert The school nurse shall be responsible for stocking
and restocking epinephrine auto-injectors in accordance with this
section. end insert

begin insert

(2) If a school nurse is not onsite or available and the school
has a volunteer, the school administrator shall obtain from a
physician and surgeon employed by or 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 school administrator shall be
responsible for stocking and restocking the epinephrine
auto-injectors in accordance with this section.

end insert begin insert

(3) Notwithstanding paragraphs (1) and (2), a school district
or county office of education, on behalf of the school nurse or
school administrator of any school, in that school district or county,
may obtain the prescriptions for epinephrine auto-injectors
required in paragraphs (1) and (2), and a charter operator, on
behalf of he school nurse or school administrator of any charter
school in the school district or county, may obtain the prescriptions
for epinephrine auto-injectors required in paragraphs (1) and (2).
The school district or county office of education, or, for a charter
school, the charter operator, may stock and restock the epinephrine
auto-injectors in accordance with the requirements specified in
paragraphs (1) and (2).

end insert begin insert

(4) A prescription pursuant to this subdivision may be filled by
local or mail order pharmacies or epinephrine auto-injector
manufacturers.

end insert 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 begin delete volunteer designee
who has received training pursuant to subdivision (d), end delete begin insert volunteer, 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 begin delete possible. end delete begin insert possible, but no later than two weeks after
it is used. end insert Epinephrine auto-injectors shall be restocked before
their expiration date.

begin delete

(h)

end delete

begin insert (i) end insert  A begin delete person who has received training as set forth in subdivision
(d) end delete begin insert volunteer 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 (e).

begin delete

(i) 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.

end delete begin insert

(j) No later than 72 hours after an incident of epinephrine
auto-injector use, the school nurse or the volunteer, in conjunction
with the school administrator, shall report the incident to the
school district, county office of education, or chartering authority
on a form developed by the department in conjunction with the
California School Nurses Organization, the California Emergency
Medical Services Authority, and the American Academy of
Pediatrics. The school district, county office of education, or
chartering authority shall report the data using the California
Longitudinal Pupil Achievement Data System. The department
shall annually publish a summary of the data on its Internet Web
site.

end insert begin delete

(j)

end delete

begin insert (k) 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

(k)

end delete

begin insert (l) end insert  A begin insert state agency, the department, or a end insert 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.