Amended in Assembly August 18, 2014

Amended in Assembly August 4, 2014

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 authorize 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 abegin insert qualified supervisor of health or administrator at aend insert school district, county office of education, or charterbegin delete operatorend deletebegin insert schoolend insert to obtain the prescription for epinephrine 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 thebegin delete school district, county office of education, or charter operator,end deletebegin insert qualified supervisor of health or administratorend 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 office of education to create a plan relating to its 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 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:

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
11specifies 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.

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.

25(3) “Epinephrine auto-injector” means a disposable drug delivery
26system with a spring-activated needle that is designed for
27 emergency administration of epinephrine to provide rapid,
28convenient first aid for persons suffering a potentially fatal reaction
29to anaphylaxis.

30(4) “Qualified supervisor of health” may include, but is not
31limited to, a school nurse.

32(5) “Volunteer” or “trained personnel” means an employee who
33has volunteered to administer epinephrine auto-injectors to a person
34if the person is suffering, or reasonably believed to be suffering,
35from anaphylaxis, has been designated by a school, and has
36received training pursuant to subdivision (d).

37(c) Each private elementary and secondary school in the state
38may voluntarily determine whether or not to make emergency
39epinephrine auto-injectors and trained personnel available at its
40school. In making this determination, a school shall evaluate the
P5    1emergency medical response time to the school and determine
2whether initiating emergency medical services is an acceptable
3alternative to epinephrine auto-injectors and trained personnel. A
4private elementary or secondary school choosing to exercise the
5authority provided under this subdivision shall not receive state
6funds specifically for purposes of this subdivision.

7(d) Each public and private elementary and secondary school
8in the state may designate one or more volunteers to receive initial
9and annual refresher training, based on the standards developed
10pursuant to subdivision (e), regarding the storage and emergency
11use of an epinephrine auto-injector from the school nurse or other
12qualified person designated by an authorizing physician and
13surgeon.

14(e) (1) Every five years, or sooner as deemed necessary by the
15Superintendent, the Superintendent shall review minimum
16standards of training for the administration of epinephrine
17auto-injectors that satisfy the requirements of paragraph (2). For
18purposes of this subdivision, the Superintendent shall consult with
19organizations and providers with expertise in administering
20epinephrine auto-injectors and administering medication in a school
21environment, including, but not limited to, the State Department
22of Public Health, the Emergency Medical Services Authority, the
23American Academy of Allergy, Asthma and Immunology, the
24California School Nurses Organization, the California Medical
25Association, the American Academy of Pediatrics, Food Allergy
26Research and Education, the California Society of Allergy, Asthma
27and Immunology, the American College of Allergy, Asthma and
28Immunology, the Stanford Allergy Center, and others.

29(2) Training established pursuant to this subdivision shall include
30all of the following:

31(A) Techniques for recognizing symptoms of anaphylaxis.

32(B) Standards and procedures for the storage, restocking, and
33emergency use of epinephrine auto-injectors.

34(C) Emergency followup procedures, including calling the
35emergency 911 telephone number and contacting, if possible, the
36pupil’s parent and physician.

37(D) Recommendations on the necessity of instruction and
38certification in cardiopulmonary resuscitation.

39(E) Instruction on how to determine whether to use an adult
40epinephrine auto-injector or a junior epinephrine auto-injector,
P6    1which shall include consideration of a pupil’s grade level or age
2as a guideline of equivalency for the appropriate pupil weight
3determination.

4(F) Written materials covering the information required under
5this subdivision.

6(3) Training established pursuant to this subdivision shall be
7consistent with the most recent Voluntary Guidelines for Managing
8Food Allergies In Schools and Early Care and Education Programs
9published by the federal Centers for Disease Control and
10Prevention and the most recent guidelines for medication
11administration issued by the department.

12(4) A school shall retain for reference the written materials
13prepared under subparagraph (F) of paragraph (2).

14(f) A school district, county office of education, or charter school
15shall distribute a notice at least once per school year to all staff
16that contains the following information:

17(1) A description of the volunteer request stating that the request
18is for volunteers to be trained to administer an epinephrine
19auto-injector to a person if the person is suffering, or reasonably
20believed to be suffering, from anaphylaxis, as specified in
21subdivision (b).

22(2) A description of the training that the volunteer will receive
23pursuant to subdivision (d).

24(g) (1) Abegin insert qualified supervisor of health at aend insert school district,
25county office of education, or charterbegin delete operatorend deletebegin insert schoolend insert shall obtain
26from an authorizing physician and surgeon a prescription for each
27school for epinephrine auto-injectors that, at a minimum, includes,
28for elementary schools, one regular epinephrine auto-injector and
29one junior epinephrine auto-injector, and for junior high schools,
30middle schools, and high schools, if there are no pupils who require
31a junior epinephrine auto-injector, one regular epinephrine
32auto-injector.begin delete Theend deletebegin insert A qualified supervisor of health at aend insert school
33district, county office of education, or charterbegin delete operatorend deletebegin insert school end insert
34 shall be responsible for stocking the epinephrine auto-injector and
35restocking it if it is used.

begin insert

36(2) If a school district, county office of education, or charter
37school does not have a qualified supervisor of health, an
38administrator at the school district, county office of education, or
39charter school shall carry out the duties specified in paragraph
40(1).

end insert
begin delete

P7   1 P7    1(2)

end delete

2begin insert(3)end insert A prescription pursuant to this subdivision may be filled by
3local or mail order pharmacies or epinephrine auto-injector
4manufacturers.

5(h) A school nurse or, if the school does not have a school nurse
6or the school nurse is not onsite or available, a volunteer may
7administer an epinephrine auto-injector to a person exhibiting
8potentially life-threatening symptoms of anaphylaxis at school or
9a school activity when a physician is not immediately available.
10If the epinephrine auto-injector is used it shall be restocked as soon
11as reasonably possible, but no later than two weeks after it is used.
12Epinephrine auto-injectors shall be restocked before their expiration
13date.

14(i) A volunteer shall initiate emergency medical services or
15other appropriate medical followup in accordance with the training
16materials retained pursuant to paragraph (4) of subdivision (e).

17(j) begin insert(1)end insertbegin insertend insertNo later than 72 hours after an incident of epinephrine
18auto-injector use, the school nurse or the volunteer, in conjunction
19with the school administrator, shall report the incident to the school
20district, county office of education, or charter school on a form
21developed by the department in conjunction with the California
22School Nurses Organization, the California Emergency Medical
23Services Authority, and the American Academy of Pediatrics.begin delete The
24schoolend delete

25begin insert(2)end insertbegin insertend insertbegin insertBeginning July 1, 2016, the schoolend insert district, county office of
26education, or charter school shall annually report the begin delete data using
27the California Longitudinal Pupil Achievement Data System.end delete

28begin insert aggregate data of incidents of epinephrine auto-injector use to the
29department in a manner determined by the department.end insert
The
30department shall annually publish a summary of the data on its
31Internet Web site.

32(k) A school district, county office of education, or charter
33school shall ensure that each employee who volunteers under this
34section will be provided defense and indemnification by the school
35district, county office of education, or charter school for any and
36all civil liability, in accordance with, but not limited to, that
37provided in Division 3.6 (commencing with Section 810) of Title
381 of the Government Code. This information shall be reduced to
39writing, provided to the volunteer, and retained in the volunteer’s
40personnel file.

P8    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.



O

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