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  








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          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  








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          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  








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          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.