Amended in Assembly August 21, 2014

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 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.

(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 a qualified supervisor of health or administrator at a school district, county office of education, or charter school 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 the qualified supervisor of health or administrator 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 begin insert delete the requirement for creating a plan, would end insert revise the training requirements, and would require the Superintendent to review the minimum standards of training at least every 5 years. begin delete 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. end delete 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:

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.

(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.

(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, 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 an authorizing physician and
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, the Stanford Allergy Center, 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) Recommendations 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 qualified supervisor of health at a school district,
county office of education, or charter school 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 at a school district,
county office of education, or charter school 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
school does not have a qualified supervisor of health, an
administrator at the school district, county office of education, or
charter school shall carry out the duties specified in paragraph (1).

(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).

begin delete

(j) (1) 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 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.

end delete begin delete

(2) Beginning July 1, 2016, the school district, county office of
education, or charter school shall annually report the aggregate
data of incidents of epinephrine auto-injector use to the department
in a manner determined by the department. The department shall
annually publish a summary of the data on its Internet Web site.

end delete begin delete

(k)

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

(l)

end delete

begin insert (k) end insert  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.