Amended in Assembly July 1, 2014

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 BillNo. 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.

(1) 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 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.

This bill would instead require school districts, county offices of education, and charter schools to provide emergency epinephrine auto-injectors to school nurses and trained personnel who have volunteered, as specified, and would authorizebegin delete studentend deletebegin insert schoolend insert nurses and trained personnel to use epinephrine auto-injectors to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an anaphylactic reaction. The bill would require school districts, county offices of education, and charter schools to distribute a notice requesting volunteers at least once a year. The bill would require abegin delete school nurse or, if the school has a volunteer, a school administratorend deletebegin insert qualified supervisor of health, as specified,end insert to obtain the prescription for epinephrinebegin delete auto-injectors,end deletebegin insert auto-injectors from an authorizing physician and surgeon, as defined,end insert and would authorize the prescription to be filled by local or mail order pharmacies or epinephrine auto-injector manufacturers. The bill would require epinephrine auto-injectors to bebegin insert stocked andend insert restocked bybegin delete 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 schoolsend deletebegin insert a qualified supervisor of health, or a schoolsite employee, if there is no qualified supervisor of health,end insert in accordance with specified provisions. By imposing additional duties on local educational agencies, the bill would impose a state-mandated local program.

(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.

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 bill would 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. 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 state agency, the State Department of Education, or a public school to accept gifts, grants, and donations from any source for the support of the public school carrying outbegin delete theseprovisions.end deletebegin insert these provisions.end insert By requiring local educational agencies to perform additional duties related to epinephrine auto-injectors, the bill would impose a state-mandated local program.

(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.

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

(4) 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:

P3    1

SECTION 1.  

Section 4119.2 of the Business and Professions
2Code
is amended to read:

3

4119.2.  

(a) Notwithstanding any other law, a pharmacy may
4furnish epinephrine auto-injectors to a school district, county office
5of education, or charter school pursuant to Section 49414 of the
6Education Code if all of the following are met:

7(1) The epinephrine auto-injectors are furnished exclusively for
8use at a school district site, county office of education, or charter
9school.

10(2) A physician and surgeon provides a written order that
11 specifies the quantity of epinephrine auto-injectors to be furnished.

12(b) Records regarding the acquisition and disposition of
13epinephrine auto-injectors furnished pursuant to subdivision (a)
14shall be maintained by the school district, county office of
15education, or charter school for a period of three years from the
16date the records were created. The school district, county office
17of education, or charter school shall be responsible for monitoring
P4    1the supply of epinephrine auto-injectors and ensuring the
2destruction of expired epinephrine auto-injectors.

3

SEC. 2.  

Section 49414 of the Education Code is amended to
4read:

5

49414.  

(a) School districts, county offices of education, and
6charter schools shall provide emergency epinephrine auto-injectors
7to school nurses or trained personnel who have volunteered
8pursuant to subdivision (d), and school nurses or trained personnel
9may use epinephrine auto-injectors to provide emergency medical
10aid to persons suffering, or reasonably believed to be suffering,
11from an anaphylactic reaction.

12(b) For purposes of this section, the following terms have the
13following meanings:

14(1) “Anaphylaxis” means a potentially life-threatening
15hypersensitivity to a substance.

16(A) Symptoms of anaphylaxis may include shortness of breath,
17wheezing, difficulty breathing, difficulty talking or swallowing,
18hives, itching, swelling, shock, or asthma.

19(B) Causes of anaphylaxis may include, but are not limited to,
20an insect sting, food allergy, drug reaction, and exercise.

begin insert

21(2) “Authorizing physician and surgeon” may include, but is
22not limited to, a physician and surgeon employed by, or contracting
23with, a local educational agency, a medical director of the local
24health department, or a local emergency medical services director.

end insert
begin delete

34 25(2)

end delete

26begin insert(3)end insert “Epinephrine auto-injector” means a disposable drug delivery
27system with a spring-activated needle that is designed for
28emergency administration of epinephrine to provide rapid,
29convenient first aid for persons suffering a potentially fatal reaction
30to anaphylaxis.

begin insert

31(4) “Qualified supervisor of health” may include, but is not
32limited to, a school nurse.

end insert
begin delete

39 33(3)

end delete

34begin insert(5)end insert “Volunteer” or “trained personnel” means an employee who
35has volunteered to administer epinephrine auto-injectors to a person
36if the person is suffering, or reasonably believed to be suffering,
37from anaphylaxis, and has been designated by a school and has
38received training pursuant to subdivision (d).

39(c) Each private elementary and secondary school in the state
40may voluntarily determine whether or not to make emergency
P5    1epinephrine auto-injectors and trained personnel available at its
2school. In making this determination, a school shall evaluate the
3emergency medical response time to the school and determine
4whether initiating emergency medical services is an acceptable
5alternative to epinephrine auto-injectors and trained personnel. A
6private elementary or secondary school choosing to exercise the
7authority provided under this subdivision shall not receive state
8funds specifically for purposes of this subdivision.

9(d) Each public and private elementary and secondary school
10in the state may designate one or more volunteers to receive initial
11and annual refresher training, based on the standards developed
12pursuant to subdivision (e), regarding the storage and emergency
13use of an epinephrine auto-injector from the school nurse or other
14qualified person designated bybegin delete theend deletebegin insert an authorizingend insert physician and begin delete15 surgeon employed by or contracting with the local educational
16agency, the medical director of the local health department, or the
17local emergency medical services director.end delete
begin insert surgeon.end insert

18(e) (1) Every five years, or sooner as deemed necessary by the
19Superintendent, the Superintendent shall review minimum
20standards of training for the administration of epinephrine
21auto-injectors that satisfy the requirements of paragraph (2). For
22purposes of this subdivision, the Superintendent shall consult with
23organizations and providers with expertise in administering
24epinephrine auto-injectors and administering medication in a school
25environment, including, but not limited to, the State Department
26of Public Health, the Emergency Medical Services Authority, the
27American Academy of Allergy, Asthma and Immunology, the
28California School Nurses Organization, the California Medical
29Association, the American Academy of Pediatrics, Food Allergy
30Research and Education, the California Society of Allergy, Asthma
31and Immunology, the American College of Allergy, Asthma and
32Immunology, and others.

33(2) Training established pursuant to this subdivision shall include
34all of the following:

35(A) Techniques for recognizing symptoms of anaphylaxis.

36(B) Standards and procedures for the storage, restocking, and
37emergency use of epinephrine auto-injectors.

38(C) Emergency followup procedures, including calling the
39emergency 911 telephone number and contacting, if possible, the
40pupil’s parent and physician.

P6    1(D) Recommendation on the necessity of instruction and
2certification in cardiopulmonary resuscitation.

3(E) Instruction on how to determine whether to use an adult
4epinephrine auto-injector or a junior epinephrine auto-injector,
5which shall include consideration of a pupil’s grade level or age
6as a guideline of equivalency for the appropriate pupil weight
7determination.

8(F) Written materials covering the information required under
9this subdivision.

10(3) Training established pursuant to this subdivision shall be
11consistent with the most recent Voluntary Guidelines for Managing
12Food Allergies In Schools and Early Care and Education Programs
13published by the federal Centers for Disease Control and
14Prevention and the most recent guidelines for medication
15administration issued by the department.

16(4) A school shall retain for reference the written materials
17prepared under subparagraph (F) of paragraph (2).

18(f) A school district, county office of education, or charter school
19shall distribute a notice at least once per school year to all staff
20that contains the following information:

21(1) A description of the volunteer request stating that the request
22is for volunteers to be trained to administer an epinephrine
23auto-injector to a person if the person is suffering, or reasonably
24believed to be suffering, from anaphylaxis, as specified in
25subdivision (b).

26(2) A description of the training that the volunteer will receive
27pursuant to subdivision (d).

begin delete

28(g) (1) A school nurse, if the school nurse is onsite or available,
29shall obtain from a physician and surgeon employed by or
30contracting with the local educational agency, the medical director
31of the local health department, or the local emergency medical
32services director a prescription for epinephrine auto-injectors that,
33at a minimum, includes, for elementary schools, one regular
34epinephrine auto-injector and one junior epinephrine auto-injector,
35and for junior high or middle schools and high schools, if there
36are no pupils who require a junior epinephrine auto-injector, one
37regular epinephrine auto-injector. The school nurse shall be
38responsible for stocking and restocking epinephrine auto-injectors
39in accordance with this section.

P7    1(2) If a school nurse is not onsite or available and the school
2has a volunteer, the school administrator shall obtain from a
3physician and surgeon employed by or contracting with the local
4educational agency, the medical director of the local health
5department, or the local emergency medical services director a
6prescription for epinephrine auto-injectors that, at a minimum,
7includes, for elementary schools, one regular epinephrine
8auto-injector and one junior epinephrine auto-injector, and for
9junior high or middle schools and high schools, if there are no
10pupils who require a junior epinephrine auto-injector, one regular
11epinephrine auto-injector. The school administrator shall be
12responsible for stocking and restocking the epinephrine
13auto-injectors in accordance with this section.

14(3) Notwithstanding paragraphs (1) and (2), a school district or
15county office of education, on behalf of the school nurse or school
16administrator of any school, in that school district or county, may
17obtain the prescriptions for epinephrine auto-injectors required in
18paragraphs (1) and (2), and a charter operator, on behalf of he
19school nurse or school administrator of any charter school in the
20school district or county, may obtain the prescriptions for
21epinephrine auto-injectors required in paragraphs (1) and (2). The
22school district or county office of education, or, for a charter
23school, the charter operator, may stock and restock the epinephrine
24auto-injectors in accordance with the requirements specified in
25paragraphs (1) and (2).

end delete
begin insert

26(g) (1) A qualified supervisor of health at a school district, a
27county office of education, or a charter operator shall obtain from
28an authorizing physician and surgeon a prescription for each
29school for epinephrine auto-injectors that, at a minimum, includes,
30for elementary schools, one regular epinephrine auto-injector and
31one junior epinephrine auto-injector, and for junior high schools,
32middle schools, and high schools, if there are no pupils who require
33a junior epinephrine auto-injector, one regular epinephrine
34auto-injector. A qualified supervisor of health shall be responsible
35for stocking the epinephrine auto-injector and restocking it if it is
36used.

end insert
begin insert

37(2) If a school district, county office of education, or charter
38operator does not have a qualified supervisor of health, the school
39district, county office of education, or charter operator shall
P8    1designate a schoolsite-level employee to carry out the duties
2specified in paragraph (1).

end insert
begin delete

37 3(4)

end delete

4begin insert(3)end insert A prescription pursuant to this subdivision may be filled by
5local or mail order pharmacies or epinephrine auto-injector
6manufacturers.

7(h) A school nurse, or if the school does not have a school nurse
8or the school nurse is not onsite or available, a volunteer, may
9administer an epinephrine auto-injector to a person exhibiting
10potentially life-threatening symptoms of anaphylaxis at school or
11a school activity when a physician is not immediately available.
12If the epinephrine auto-injector is used it shall be restocked as soon
13as reasonably possible, but no later than two weeks after it is used.
14Epinephrine auto-injectors shall be restocked before their expiration
15date.

16(i) A volunteer shall initiate emergency medical services or
17other appropriate medical followup in accordance with the training
18materials retained pursuant to paragraph (4) of subdivision (e).

19(j) No later than 72 hours after an incident of epinephrine
20auto-injector use, the school nurse or the volunteer, in conjunction
21with the school administrator, shall report the incident to the school
22district, county office of education, orbegin delete chartering authorityend deletebegin insert charter
23schoolend insert
on a form developed by the department in conjunction with
24the California School Nurses Organization, the California
25Emergency Medical Services Authority, and the American
26Academy of Pediatrics. The school district, county office of
27education, orbegin delete chartering authorityend deletebegin insert charter schoolend insert shallbegin insert annuallyend insert
28 report the data using the California Longitudinal Pupil
29 Achievement Data System. The department shall annually publish
30a summary of the data on its Internet Web site.

31(k) A school district, county office of education, or charter
32school shall ensure that each employee who volunteers under this
33section will be provided defense and indemnification by the school
34district, county office of education, or charter school for any and
35all civil liability, in accordance with, but not limited to, that
36provided in Division 3.6 (commencing with Section 810) of Title
371 of the Government Code. This information shall be reduced to
38writing, provided to the volunteer, and retained in the volunteer’s
39personnel file.

P9    1(l) A state agency, the department, or a public school may accept
2gifts, grants, and donations from any source for the support of the
3public school carrying out the provisions of this section, including,
4but not limited to, the acceptance of epinephrine auto-injectors
5from a manufacturer or wholesaler.

6

SEC. 3.  

If the Commission on State Mandates determines that
7this act contains costs mandated by the state, reimbursement to
8local agencies and school districts for those costs shall be made
9pursuant to Part 7 (commencing with Section 17500) of Division
104 of Title 2 of the Government Code.



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