BILL ANALYSIS Ó
SB 1266
Page 1
Date of Hearing: June 17, 2014
ASSEMBLY COMMITTEE ON JUDICIARY
Bob Wieckowski, Chair
SB 1266 (Huff) - As Amended: May 27, 2014
SENATE VOTE : 37-0
SUBJECT : Pupil health: epinephrine auto-injectors
KEY ISSUE : SHOULD existing provisions authorizING public and
private schools in California to make LIFE-SAVING emergency
epinephrine auto-injectors available to trained personnel to
voluntarily provide critically-needed emergency medical aid to
persons, often children, suffering from anaphylactic reaction,
BE MADE MANDATORY FOR PUBLIC SCHOOLS?
SYNOPSIS
This is an important public health measure dealing with
individuals afflicted with anaphylactic reaction. Anaphylaxis
is a potentially lethal allergic reaction. It can happen when a
person, often in this case a child at school, is stung by a bee,
ingests food such as shellfish or nuts, or maybe even just comes
in contact with something as simple as latex. Epinephrine is
the first line of treatment for someone who is experiencing
anaphylaxis. It can be easily administered and has very little
side-effect. Reactions can be so severe, even fatal, without
prompt use of epinephrine.
Existing law authorizes public and private schools in California
to voluntarily make emergency epinephrine auto-injectors
available to trained personnel to voluntarily provide
critically-needed emergency medical aid to persons, often
children, suffering from anaphylactic reaction. This bipartisan
bill would make the existing discretionary provisions mandatory
by requiring public schools to provide emergency epinephrine
auto-injectors to trained personnel who have volunteered to
provide emergency medical aid to persons suffering, or
reasonably believed to be suffering, from an anaphylactic
reaction. The bill also sets forth various procedures for
tracking the use of such auto-injectors in such school
emergencies, and it requires public schools to ensure that each
employee who volunteers is provided defense and indemnification
by the school district, county office of education, or charter
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school for any and all civil liability, as specified. Finally,
the bill would also authorize a public school to accept gifts,
grants, and donations from any source for the support of the
public school carrying out these provisions.
The measure is supported by a broad coalition of medical,
emergency and other groups who state that it will save lives,
especially of children, who are afflicted with anaphylactic
reactions that can cause unnecessary harm and even death without
speedy medical assistance. It is opposed by some teacher groups
who state among other concerns that reactions to epinephrine
could go beyond the scope of training provided to school
personnel, and this bill creates a "one size fits all statute"
by individuals without necessary medical and pharmaceutical
expertise to take into account potential unintended
consequences. The bill received no "no" votes in the Senate.
SUMMARY : Seeks to require public schools to provide emergency
epinephrine auto-injectors to trained personnel who have
volunteered to provide emergency medical aid to persons
suffering, or reasonably believed to be suffering, from an
anaphylactic reaction. Specifically, this bill :
1)Requires school districts, county offices of education, and
charter schools to provide emergency epinephrine
auto-injectors to trained personnel who have volunteered, as
specified, and would authorize trained personnel to use those
epinephrine auto-injectors to provide emergency medical aid to
persons suffering, or reasonably believed to be suffering,
from an anaphylactic reaction.
2)Requires a school nurse, or a school administrator if an
employee has volunteered, as specified, and the school does
not have a school nurse or the school nurse is not onsite or
available, to obtain the prescription for epinephrine
auto-injectors, as specified, and would authorize the
prescription for epinephrine auto-injectors to be filled by
local or mail order pharmacies or epinephrine auto-injector
manufacturers. The bill authorizes a pharmacy to also furnish
epinephrine auto-injectors to a charter school if certain
conditions are met. The bill requires an epinephrine
auto-injector to be restocked as soon as possible after it is
used and before its expiration date.
3)Requires the school nurse or voluntarily designated employee
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to report any incident of epinephrine auto-injector use to the
school district, county office of education, or chartering
authority on a form developed by the State Department of
Education within 30 days after the last day of each school
year. The bill requires the school district, county office of
education, or chartering authority to report any incident of
epinephrine auto-injector use to the department on those
forms. The bill requires 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
authorizes a public school to accept gifts, grants, and
donations from any source for the support of the public school
carrying out these provisions.
EXISTING LAW :
1)Under the Government Tort Claims Act, specifies rules of civil
liability that apply to public entities and public employees
in California. (Gov. Code Sec. 810 et seq.)
2)In relevant part, permits a school district or county office
of education to provide emergency epinephrine auto-injectors
to trained personnel, and permits trained personnel to utilize
those epinephrine auto-injectors to provide emergency medical
aid to persons suffering from an anaphylactic reaction.
Prohibits any school district or county office of education
choosing to exercise this authority from receiving funds
specifically for these purposes. (Ed. Code Sec. 49414(a).)
3)In relevant part, authorizes each public and private
elementary and secondary school in the state to voluntarily
determine, as specified, whether or not to make emergency
epinephrine auto-injectors and trained personnel available at
its school. (Ed. Code Sec. 49414(c).)
4)Permits each public and private school to designate one or
more personnel on a voluntary basis to receive initial and
annual refresher training, based on specified standards,
regarding the storage and emergency use of an epinephrine
auto-injector from the school nurse or other qualified person
designated by the school district physician, the medical
director of the local health department, or the local
emergency medical services director. Existing law prohibits
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any school choosing to exercise this authority from receiving
state funds for these purposes. (Ed. Code Sec. 49414(d).)
5)Permits a school nurse, or if the school does not have a
school nurse, a person who has received training, as
specified, to do the following:
a) Obtain from the school district physician, the medical
director of the local health department, or the local
emergency medical services director a prescription for
epinephrine auto-injectors; and
b) Immediately 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. (Ed. Code Sec. 49414(f).)
6)Requires the Superintendent of Public Instruction to establish
minimum standards of training for the administration of
epinephrine auto-injectors that satisfy the minimum statutory
training requirements, as specified. Requires that the
Superintendent consult with specified organizations and
providers with expertise in administering epinephrine
auto-injectors and administering medication in a school
environment. (Ed. Code Sec. 49414(e)(1).) Also provides
minimum training requirements and standards, as specified.
(Ed. Code Sec. 49414(e)(2).)
7)Authorizes a school district, county office of education, or
charter school, in the absence of a credentialed school nurse
or other licensed nurse onsite at the school, to participate
in a program, as specified, to allow non-medical school
personnel to administer anti-seizure medication to a pupil
with epilepsy in an emergency, after receiving certain
training. (Ed. Code Sec. 49414.7.)
8)Provides that if a school district, county office of
education, or charter school elects to participate pursuant to
this section, the school district, county office of education,
or charter school shall ensure that each employee who
volunteers 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 under the Government Tort Claims
Act. This information shall be reduced to writing, provided
to the volunteer, and retained in the volunteer's personnel
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file. (Ed. Code Sec. 49414.7(i).)
FISCAL EFFECT : As currently in print this bill is keyed fiscal.
COMMENTS : An epinephrine auto-injector is a disposable medical
drug delivery device that delivers a single measured dose of
epinephrine, most frequently for the treatment of acute allergic
reactions to avoid or treat the onset of anaphylactic shock.
Anaphylactic shock can quickly result in death if untreated.
Epinephrine auto-injectors can be obtained by prescription only,
and California law does not authorize non-physicians to
administer an epinephrine auto-injector to another person,
except in limited circumstances.
In recent years, California law has been amended to, among other
things, permit school districts or county offices of education
to provide emergency epinephrine auto-injectors to trained
personnel, and to permit trained personnel to utilize the
auto-injectors to provide emergency medical aid to persons
suffering from an anaphylactic reaction, as it is not uncommon
for children to come into contact with specific allergens (such
as bee stings) or accidentally ingest foods they are allergic to
at school. (AB 559 (Wiggins, Ch. 458, Stats. 2001).)
This bill would require, as opposed to simply authorize, school
districts, county offices of education, and charter schools to
public schools to provide emergency epinephrine auto-injectors
to trained personnel who have volunteered to provide emergency
medical aid to persons suffering, or reasonably believed to be
suffering, from an anaphylactic reaction. The bill also sets
forth various procedures for tracking the use of such
auto-injectors in such school emergencies, and it requires
public schools 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. Finally, the bill would also
authorize a public school to accept gifts, grants, and donations
from any source for the support of the public school carrying
out these provisions.
According to the author:
Approximately 6 million children under the age of 18 suffer
from life threatening allergies. That is one in every 13
children - or [two] in every classroom. Approximately 25
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percent of first time allergic reactions that require
epinephrine happen at school. Because they have no
knowledge of this, they do not have the necessary
lifesaving medication on hand. Also, children with known
allergies are being sent to school without epinephrine for
several reasons including cost, non-understanding of the
severity of the allergy by parents, the prohibitive nature
of the school process for leaving medication.
Anaphylaxis is a potentially lethal allergic reaction. It
can happen when a person is stung by a bee, ingests food
such as shellfish or nuts, or maybe even just comes in
contact with something as simple as latex. Epinephrine is
the first line of treatment for someone who is experiencing
anaphylaxis. It can be easily administered and has very
little side-effect. Reactions can be so severe, even
fatal, without prompt use of epinephrine.
Current law requires prescription for epinephrine be made
to a specific student in order for the medication to be
stored at schools so it can be used in case of a
anaphylactic reaction during school hours. Current
California law also allows schools to stock epinephrine,
but has not required it.
SB 1266 will require extra epinephrine injectors be
prescribed as a "standing order" so epinephrine can be on
hand in all public schools in the event of an severe
allergic reaction. SB 1266 will allow volunteers to be
trained for identifying anaphylaxis and administering the
necessary medication, epinephrine. It will also provide
defense and indemnification for those volunteering to
administer (this language came from existing law as
provided under [Ed. Code Sec.] 49414.7 (i)).
The sponsor of this bill, Food Allergy Research & Education
(FARE), adds, "[e]pinephrine is the only medication that can
arrest the symptoms of a severe reaction." FARE cites a study
in a medical journal (Pediatrics) that "showed that 24 percent
of epinephrine use in a school district was on those without a
previous diagnosis of food allergy. Many children may not know
they are allergic and do not have prescribed epinephrine.
Precious minutes can be lost waiting for emergency responders.
There are no counter-indications to administering epinephrine,
but delaying its use may have catastrophic results."
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Indemnification And Defense For Volunteers : As noted, all
private and public schools in this state are authorized under
existing California law to voluntarily determine whether or not
to make epinephrine available at their schools. This bill would
not modify this existing authorization for private schools but
would require all public schools to provide emergency
epinephrine auto-injectors to trained personnel who have
volunteered to provide emergency medical aid to persons
suffering, or reasonably believed to be suffering, from an
anaphylactic reaction.
As noted above, this bill would require that a school district,
county office of education, or charter school ensure that each
employee who volunteers be provided defense and indemnification
by the school district, county office of education, or charter
school for any and all civil liability. This language is
modeled upon an existing provision of the Education Code that
provides authorization for schools to allow nonmedical employees
to administer medical assistance to pupils with epilepsy
suffering from seizures. (See Ed. Code Sec. 49414.7(i).) The
language would appear to preserve any recourse that the students
and their families might have under existing law for injuries
suffered as a result of the administration of the epinephrine
auto-injector, while still affording adequate protection from
the costs of litigation and any liability for damages thereof to
volunteering employees who attempt to render life-saving
emergency care in accordance with their training.
ARGUMENTS IN SUPPORT : The measure is supported by a broad
coalition of medical, emergency and other groups who state that
it will save lives, especially of children, who are afflicted
with anaphylactic reactions that can cause unnecessary harm and
even death without speedy medical assistance. Reflecting these
organizations' support, the California School Nurses
Organization writes that "[t]his bill will serve to protect
those children who are not known to have allergies by providing
a safety mechanism-the epinephrine auto-injectors (epi-pens)
which will protect them from any severe reaction. Many school
children fall prey to undiagnosed allergies and those with
asthma or poorly controlled asthma are at a higher risk of
allergic reactions."
Another supporter of the bill, the CA Allergy Support &
Anaphylaxis Prevention argues that even though California law
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authorizes school districts to stock epinephrine in schools,
"very few have actually taken advantage of implementing this."
An organization stating that it writes on behalf of Californian
families and individuals living with food allergies, California
Advocates for people with Food Allergies (CAFA), states among
other things that:
Anaphylaxis is a severe medical condition that is
unfortunately reaching epidemic proportions, with 1 in
13 children being diagnosed with life-threatening
allergies that can lead to anaphylaxis. Our community
as a whole needs to become more proactive in caring
for people with food allergies, especially vulnerable
children in schools? The best outcome for someone
experiencing anaphylaxis occurs when epinephrine is
administered as soon as anaphylaxis is noticed. If
California school children experience anaphylaxis and
do not have their own medication, the cost can be
enormous, with loss of life or permanent disability
being potential outcomes?
ARGUMENTS IN OPPOSITION : Two organizations, the California
Teachers Association (CTA) and the California Federation of
Teachers continue to oppose the bill. CTA's letter raises
concerns that: (1) reactions to epinephrine could go beyond the
scope of training provided to school personnel; (2) probationary
or temporary and/or classified employees could be "highly
encouraged" to volunteer against their will; and (3) this bill
creates a "one size fits all statute" by individuals without
necessary medical and pharmaceutical expertise to take into
account potential unintended consequences. The California
Federation of Teachers continues to contend that a mandate
requiring all schools to have this device, where they are
already authorized to do so, is unnecessary and costly.
Prior Legislation : SB 669 (Huff, Ch. 725, Stats. 2013), among
other things, authorized a trained pre-hospital emergency
medical care person, first responder, or lay rescuer to obtain
and use epinephrine auto-injectors to render emergency care to
another person, pursuant to specified requirements, and granted
them limited liability, as specified.
SB 161 (Huff, Ch. 560, Stats. 2011) authorized a school
district, county office of education, or charter school to
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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 with defense and
indemnification by the school district, county office of
education, or charter school, for any and all civil liability,
as specified.
AB 559 (Wiggins, Ch. 458, Stats. 2001), See above.
AB 1791 (Wiggins, 1999) was similar to AB 559, above, but was
ultimately vetoed by the Governor.
REGISTERED SUPPORT / OPPOSITION :
Support
American Academy of Allergy, Asthma and Immunology (AAAI)
American Red Cross
Asthma and Allergy Foundation of America (AAFA)
Bay Area Allergy Advisory Board
Bay Area Food Allergy 5k Walk/Run in Memory of BJ HOM
California Advocates for people with Food Allergies (CAFA)
California Allergy Support & Anaphylaxis Prevention (CAASAP)
California Chapter of the American College of Emergency
Physicians (California ACEP)
California Society of Allergy, Asthma and Immunology (CSAAI)
California School Nurses Organization (CSNO)
Food Allergy and Anaphylaxis Connection Team (FAACT)
Food Allergy Support of Sacramento (FASS)
Kids with Food Allergies (KFA)
Natalie Giorgi Sunshine Foundation
Northern California Allergy & Asthma Advocates (NCAAA)
Nut Free Wok
Orange County Taxpayers Association
San Diego Food Allergy Support Group
San Francisco Bay Area Food Allergy Network
Sanofi
South Orange County Food Allergy Network
San Clemente Food Allergy Support Group
Stanford Food Allergy & Food Sensitivity Center Community
Council
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Sutter Medical Group
Numerous individuals
Opposition
California Federation of Teachers
California Teachers Association
Analysis Prepared by : Drew Liebert / JUD. / (916) 319-2334