BILL ANALYSIS Ó Senate Appropriations Committee Fiscal Summary Senator Kevin de León, Chair SB 1266 (Huff) - Epinephrine Injectors Amended: May 6, 2014 Policy Vote: Ed 7-0, Health 9-0, Jud 7-0 Urgency: No Mandate: Yes Hearing Date: May 19, 2014 Consultant: Jacqueline Wong-Hernandez This bill meets the criteria for referral to the Suspense File. Bill Summary: SB 1266 removes the authority, and instead requires, school districts, charter schools and county offices of education (COEs) to provide emergency epinephrine auto-injectors (EAIs) to trained personnel to provide emergency medical aid to a person suffering from an anaphylactic reaction. This bill requires local educational agencies (LEAs) to have a trained volunteer to administer EAIs in emergencies and would require that each employee who volunteers is provided defense and indemnification by the LEA for any and all civil liability, as specified. Additionally, the bill would require certain reporting by the school nurse or designated employee, and by the LEA, and specify that the Superintendent of Public Instruction (SPI) must review the minimum training standards for the administration of EAIs at least every 5 years, as specified. Fiscal Impact: Mandate: Potentially substantial reimbursable state mandate on LEAs to provide and maintain EAIs, train volunteers, and adhere to reporting requirements. Annual costs will be in the millions of dollars (General Fund); the cost of purchasing EAIs for the more than 10,000 district schools alone would exceed $2 million. Standards: Costs to the the California Department of Education (CDE) to review and update minimum training standards would be minor and absorbable. Background: Existing law authorizes LEAs to provide emergency EAIs to trained personnel, and authorizes trained personnel to use an EAI to provide emergency medical aid to a person suffering from an anaphylactic reaction. It further authorizes public schools to designate at least one school employee on a SB 1266 (Huff) Page 1 voluntary basis to receive initial and annual training, based on specific standards, regarding the storage and emergency use of an EAI. Existing law further authorizes a school nurse, or if the school does not have a nurse, a person who has received training, to: a) obtain a prescription for EAIs, as specified; and, b) immediately administer an EAI to a person exhibiting potentially life threatening symptoms of anaphylaxis at school or a school activity, as specified. Existing law also requires the SPI to develop minimum standards of training, and requires the training to include all of the following: a) techniques for recognizing symptoms of anaphylaxis; b) standards and procedures for the storage and emergency use of EAIs; c) emergency follow-up procedures, as specified; d) instruction and certification in cardiopulmonary resuscitation; and, e) written materials covering the information described above. (Education Code § 49414) Proposed Law: This bill would require school districts, COEs, and charter schools to provide emergency EAIs to designated, trained personnel and would authorize trained personnel to use those EAIs to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an anaphylactic reaction. This bill would require each public elementary and secondary school, if no school personnel volunteer as a designee, to require a school nurse or school administrator to receive initial and annual refresher training regarding the storage and emergency use of an EAI, as specified. This bill would require a school nurse or school administrator to obtain the prescription for EAIs, as specified, and would require an EAI to be restocked as soon as possible after it is used and before its expiration date. LEAs must also ensure that each employee who volunteers is provided defense and indemnification by the school district, COE, or charter school for any and all civil liability, as specified. This bill would also require the school nurse or voluntarily designated employee to report any incident of EAI use to the school district, COE, or chartering authority on a form developed by the CDE within 30 days after the last day of each SB 1266 (Huff) Page 2 school year and require the CDE to annually post the result of those forms on its website. Related Legislation: SB 669 (Huff) Ch. 725/2013, among other things, authorized a trained pre-hospital emergency medical care person, first responder, or lay rescuer to obtain and use EAIs to render emergency care to another person, pursuant to specified requirements, and granted them limited liability, as specified. SB 161 (Huff) Ch. 560/2011 authorized LEAs to participate in a program to provide nonmedical school employees with voluntary emergency medical training to provide, in the absence of a credentialed school nurse or other licensed nurse onsite at the school or charter school, emergency medical assistance to pupils with epilepsy suffering from seizures, in accordance with specified guidelines. SB 161 also provided each employee who volunteers under the bill's provisions with defense and indemnification by the LEA for any and all civil liability, as specified. Staff Comments: This bill replaces LEA authority under existing law to stock and use EAIs, with a state mandate on all LEAs to: a) develop plans for implementing these provisions, including the provision of training and compliance with employee and LEA reporting requirements; b) designate a volunteer employee or, absent a volunteer, an administrator or school nurse to administer an EAI, as specified; c) provide training to that employee on EAI storage, use, and replacement; d) provide indemnification and defense to the employee, as specified; e) require the designated employee to obtain an EAI prescription, as specified; and, f) require that employee to report any incident of EAI use to the school district or chartering authority, and require that entity to report the same information to the CDE. This bill mandates numerous new activities of LEAs and of employees designated to carry out the required activities. While the actual use of an EAI in an emergency situation is not mandated, all of the tasks to prepare for and report on incidents of EAI use are required actions. Each of those requirements (e.g. completing training, replacing EAIs before they expire, reporting instances of use, etc.) will likely be deemed a reimbursable state mandate by the Commission on State SB 1266 (Huff) Page 3 Mandates. The staff time alone will likely cost millions of dollars statewide. Even if some LEAs are already engaging in activities that will be required by this bill, mandating those tasks makes the workload reimbursable for those LEAs as well. The costs of EAIs varies, and EAIs can often be purchased in bulk or at a discounted rate for schools, allowing LEAs to purchase them for well below the $300-$400 retail price for a 2-pack. (EAIs are generally sold in 2-packs because incidents can require 2 administrations). Nonetheless, even if the approximately 10,000 district schools were to purchase EAIs at only $200, it would cost approximately $2 million statewide annually. EAIs are typically only good for one year before they need to be replaced, and schools may require more each year if they have cause to use them.