BILL ANALYSIS Ó
SB 1266
Page 1
Date of Hearing: August 6, 2014
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
SB 1266 (Huff) - As Amended: August 4, 2014
Policy Committee: JudiciaryVote:10-0
Education 7-0
Urgency: No State Mandated Local Program:
Yes Reimbursable: Yes
SUMMARY
This bill requires school districts, county offices of education
(COEs), and charter schools to provide emergency epinephrine
auto-injectors to school nurses or trained personnel who have
volunteered, as specified. Authorizes school nurses or trained
personnel to use the epinephrine auto-injectors to provide
emergency medical aid to persons suffering, or reasonably
believed to be suffering, from an anaphylactic reaction.
Specifically, this bill:
1)Requires the Superintendent of Public Instruction (SPI) every
five years, or sooner as deemed necessary the SPI, to review
minimum standards of training for the administration of
epinephrine auto-injectors. Further requires the SPI to
consult with specified organizations and providers with
expertise in administering epinephrine auto-injectors and
administering medication in a school environment and sets
forth guidance for the provision of training.
2)Requires a school district, COE or a charter school, to
distribute a notice at least once per school year to all staff
that contains a description of the volunteer request, stating
that the request is for volunteers to be trained to administer
epinephrine auto-injector to a pupil if the pupil is
suffering, or reasonably believed to be suffering from
anaphylaxis and a description of the training that the
volunteer will receive.
3)Requires a school district, COE or a charter school operator
to obtain from an authorizing physician and surgeon, a
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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 or middle schools and high
schools, if there are no pupils who require a junior
epinephrine auto-injector, one regular epinephrine
auto-injector. Authorizes the prescription to be filled by
local or mail order pharmacies or epinephrine auto-injector
manufacturers.
4)Requires the epinephrine auto-injector to be restocked as soon
as reasonably possible, but no later than two weeks from the
use; and, requires epinephrine auto-injectors to be restocked
before their expiration date. Makes the school district, COE
or charter operator responsible for stocking and restocking
the epinephrine auto-injector.
5)Requires a volunteer to initiate emergency medical services or
other appropriate medical follow-up (calling 911) in
accordance with the training materials; and, requires, no
later than 72 hours after an incident, the school nurse or
volunteer, in conjunction with a school administrator, to
report the incident to the school district, COE, or chartering
authority on a form developed by the department, California
Nurses Association, the California Emergency Medical Services
Authority and the American Academy of Pediatrics. Requires the
school district, COE or chartering authority to report the
data using the California Longitudinal Pupil Achievement Data
System, and requires the department to annually publish a
summary of the data on its Internet Web site.
6)Requires a school district, COE, or charter school to ensure
that each employee who volunteers under this section is
provided defense and indemnification by the school district,
COE, or charter school for any and all civil liability, and
specifies this information shall be reduced to writing,
provided to the volunteer, and retained in the volunteer's
personnel file.
7)Authorizes a state agency, the department or a public school,
to accept gifts, grants, and donations from any source,
including, but not limited to, the acceptance of epinephrine
auto-injectors from a manufacturer or wholesaler.
FISCAL EFFECT
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1)Potential General Fund/Proposition 98 annual state
reimbursable mandated costs in the low millions of dollars for
school districts, charter schools and COEs to purchase and
replenish epinephrine auto-injectors, recruit and train
volunteers, and report data.
There are over 9,000 schools and over 1,000 charter schools.
Costs range from $112 to $192 per 2-pack of epinephrine
auto-injectors. Costs will vary depending on use at each
school site. These costs could be partially offset to the
extent schools are able to access free pens through certain
manufacturers, for example, the EpiPen4Schools program. LEAs
will also incur costs to notify staff of the ability to
volunteer to administer epinephrine and to provide associated
volunteer training.
2)General Fund costs of approximately $10,000 to CDE to collect
information on the incidences of epinephrine auto-injector
through the CALPADS database. Additional state mandated costs
to local education agencies to collect data and modify
existing student information systems to report data through
CALPADS.
COMMENTS
1)Background . 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.
Current law authorizes school districts or county offices of
education to provide emergency epinephrine auto-injectors to
trained personnel and permits LEAs to train personnel to
utilize the auto-injectors to provide emergency medical aid to
persons suffering from an anaphylactic reaction. This bill
would instead require school districts, COEs, and charter
schools to provide emergency epinephrine auto-injectors to
school nurses or trained personnel who have volunteered to
provide emergency medical aid to persons suffering, or
reasonably believed to be suffering, from an anaphylactic
reaction.
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2)Purpose. According to the sponsor, Food Allergy Research &
Education (FARE), children may not know they are allergic and
may 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. FARE further states
that 24% of epinephrine use in a school district is on persons
without a previous diagnosis of a food allergy.
3)EpiPen4Schools program. The EpiPen4Schools program, offered by
Mylan, the marketer and distributor of EpiPen Auto-Injectors,
began in 2012 and has been authorized through 2015. In order
to obtain four free pens, a school district must submit a
prescription from a doctor working with the district.
Districts can re-apply each year and each school can receive
their choice of two adult pens, two junior pens or one of
each.
4)School Access to Emergency Epinephrine Act. In 2013, Congress
passed and President Obama signed the federal School Access to
Emergency Epinephrine Act. The Act gives preference for
grants awarded under the children's asthma treatment grants
program or other asthma-related federal grants to states that
do all of the following:
a) Provide civil liability protection to trained personnel
in elementary or secondary schools who administer
epinephrine.
b) Require each public elementary and secondary school in
the state to maintain a supply of epinephrine.
c) Permit trained personnel of the school to administer
epinephrine to any student reasonably believed to be having
an anaphylactic reaction.
d) Have a plan in place for having one or more trained
personnel on the premises during operating hours.
While there may be the potential for receiving preference when
applying for asthma-related federal funding if this bill is
enacted, it is not clear if this funding could be used to
purchase epi-pens for schools. According to the Legislative
Analyst's Office, the Centers for Disease Control and
Prevention (CDC) provides asthma-related funding to states
under the Asthma Grant Program. The California Department of
Public Health (DPH) does not currently receive any federal
asthma-related funding, though DPH is in the process of
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applying for a five-year cycle of asthma-related funding from
CDC which would provide $800,000 a year for five years.
5)CALPADs data collection concerns . CALPADS is the state's
longitudinal pupil achievement database system. All data that
is collected and maintained in CALPADS is done on a
student-level basis and the information is tied to an
individual student's educational records. CALPADS does not
collect any health specific related data. CDE has expressed
concerns in complying with the federal Family Educational
Rights and Privacy Act (FERPA) and note that reporting such
information would require either annual parent notification
that epi-pen incidences involving their child will be shared
with the state-including a provision for parents to opt out of
such reporting or parental consent prior to the sharing of
information with the state for each epi-pen incident.
Another option is for the state to collect information on the
use of epi-pens in schools through the aggregate data
collection system known as California Basic Educational Data
System (CBEDS). Through CBEDS, the state could require schools
to report the count of incidences during a school year though
not by individual student. CDE also indicates costs would be
minor/absorbable to the department to aggregate this data.
School districts may still have potential state mandated
costs, but costs should be minor since they would not need to
make structural changes to their local student information
system. Staff recommends an amendment to report aggregate
data through CBEDS rather than CALPADS.
6)Opposition . The California Teachers Association and the
California Federation of Teachers are opposed to this bill.
They cite fiscal concerns related to the stocking, restocking
and disposal of epinephrine auto-injectors. They also cite
fiscal concerns associated with identifying volunteers and the
associated training.
Analysis Prepared by : Misty Feusahrens / APPR. / (916)
319-2081