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 23, 2014 Consultant: Jacqueline
Wong-Hernandez
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 (as approved on May 23, 2014):
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.
Committee amendments eliminate the requirement that a school
nurse or school administrator be trained to use an EAI, in the
absence of a volunteer. Amendments limit the requirement for
stocking EAIs and providing training to LEAs that have
designated a volunteer to perform the emergency medical
services.