BILL NUMBER: SB 1266 AMENDED
BILL TEXT
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
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 authorize student
school 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 a school nurse or, if the school has a volunteer, a
school administrator qualified supervisor of health,
as specified, to obtain the prescription for epinephrine
auto-injectors, auto-injectors from an
authorizing physician and surgeon, as defined, 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 be stocked and
restocked 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 a qualified supervisor of health, or a
schoolsite employee, if there is no qualified supervisor of health,
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 out
theseprovisions. 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.
(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:
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
school nurses or trained personnel who have volunteered pursuant to
subdivision (d), and school nurses or trained personnel may use
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) "Authorizing physician and surgeon" may include, but is not
limited to, a physician and surgeon employed by, or contracting with,
a local educational agency, a medical director of the local health
department, or a local emergency medical services director.
(2)
(3) "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.
(4) "Qualified supervisor of health" may include, but is not
limited to, a school nurse.
(3)
(5) "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).
(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 volunteers 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 an authorizing
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.
surgeon.
(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) Recommendation on the necessity of 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,
which shall include consideration of a pupil's grade level or age as
a guideline of equivalency for the appropriate pupil weight
determination.
(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).
(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:
(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).
(2) A description of the training that the volunteer will receive
pursuant to subdivision (d).
(g) (1) A school nurse, if the school nurse is onsite or
available, 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 nurse shall be responsible for
stocking and restocking epinephrine auto-injectors in accordance
with this section.
(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.
(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).
(g) (1) A qualified supervisor of health at a school district, a
county office of education, or a charter operator shall obtain from
an authorizing physician and surgeon a prescription for each school
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 schools, middle
schools, and high schools, if there are no pupils who require a
junior epinephrine auto-injector, one regular epinephrine
auto-injector. A qualified supervisor of health shall be responsible
for stocking the epinephrine auto-injector and restocking it if it is
used.
(2) If a school district, county office of education, or charter
operator does not have a qualified supervisor of health, the school
district, county office of education, or charter operator shall
designate a schoolsite-level employee to carry out the duties
specified in paragraph (1).
(4)
(3) A prescription pursuant to this subdivision may be
filled by local or mail order pharmacies or epinephrine auto-injector
manufacturers.
(h) A school nurse, or if the school does not have a school nurse
or the school nurse is not onsite or available, a volunteer, 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, but no later than two weeks after it is used.
Epinephrine auto-injectors shall be restocked before their expiration
date.
(i) A volunteer shall initiate emergency medical services or other
appropriate medical followup in accordance with the training
materials retained pursuant to paragraph (4) of subdivision (e).
(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 charter school 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
charter school shall annually 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.
(k) 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.
(l) A state agency, the department, or 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.