BILL ANALYSIS Ó
SB 1266
Page 1
Date of Hearing: June 25, 2014
ASSEMBLY COMMITTEE ON EDUCATION
Joan Buchanan, Chair
SB 1266 (Huff) - As Amended: June 17, 2014
[Note: This bill was double referred to the Judiciary Committee
and was heard by that committee as it relates to issues under
its jurisdiction.]
SENATE VOTE : 37-0
SUBJECT : Pupil health: epinephrine auto-injectors.
SUMMARY : Requires school districts, county offices of
education (COE), and charter schools to provide emergency
epinephrine auto-injectors to school nurses or trained personnel
who have volunteered, and school nurses or trained personnel may
use 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)Authorizes a pharmacy to furnish epinephrine auto-injectors to
a charter school (in addition to a school district or COE) if
all of the following are met:
a) The epinephrine auto-injectors are furnished exclusively
for use at a charter school.
b) A physician and surgeon provides a written order that
specifies the quantity of epinephrine auto-injectors to be
furnished.
2)Specifies that records regarding the acquisition and
disposition of epinephrine auto-injectors furnished shall be
maintained by the school district, COE or charter school for a
period of three years from the date the records were created.
The school district, COE or charter school shall be
responsible for monitoring the supply of epinephrine
auto-injectors and ensuring the destruction of expired
epinephrine auto-injectors.
3)Defines the following:
a) "Anaphylaxis" means a potentially life-threatening
hypersensitivity to a substance. Symptoms of anaphylaxis
may include shortness of breath, wheezing, difficulty
breathing, difficulty talking or swallowing, hives,
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itching, swelling, shock, or asthma. Causes of anaphylaxis
may include, but are not limited to, an insect sting, food
allergy, drug reaction, and exercise.
b) "Epinephrine auto-injector" means a disposable drug
delivery system with a spring-activated needle that is
designed for emergency administration of epinephrine to
provide rapid, convenient first aid for persons suffering a
potentially fatal reaction to anaphylaxis.
c) "Volunteer" or "Trained personnel" means an employee who
has volunteered to administer epinephrine auto-injectors to
a person if the person is suffering, or reasonably believed
to be suffering, from anaphylaxis, and has been designated
by a school and has received training.
4)Requires every five years, or sooner as deemed necessary by
the Superintendent of Public Instruction (SPI), the SPI to
review minimum standards of training for the administration of
epinephrine auto-injectors; and, requires the SPI to consult
with organizations and providers with expertise in
administering epinephrine auto-injectors and administering
medication in a school environment, including, but not limited
to, the State Department of Public Health, the Emergency
Medical Services Authority, the American Academy of Allergy,
Asthma and Immunology, the California School Nurses
Organization, the California Medical Association, the American
Academy of Pediatrics, Food Allergy Research and Education,
the California Society of Allergy, Asthma and Immunology, the
American College of Allergy, Asthma and Immunology, and
others.
5)Requires the training be consistent with the most recent
Voluntary Guidelines for Managing Food Allergies In Schools
and Early Care and Education Programs published by the federal
Centers for Disease Control and Prevention and the most recent
guidelines for medication administration issued by the
department; and, requires the training to include all of the
following:
a) Techniques for recognizing symptoms of anaphylaxis.
b) Standards and procedures for the storage, restocking,
and emergency use of epinephrine auto-injectors.
c) Emergency followup procedures, including calling the
emergency 911 telephone number and contacting, if
possible, the pupil's parent and physician.
d) Recommendation on the necessity of instruction and
certification in cardiopulmonary resuscitation.
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e) Instruction on how to determine whether to use an adult
epinephrine auto-injector or a junior epinephrine
auto-injector, which shall include consideration of the
grade level or age as a guideline of equivalency for the
appropriate pupil weight determination.
f) Written materials covering the information required
under this subdivision.
6)Requires a school district, COE or a charter school, to
distribute a notice at least once per school year to all staff
and that contains the following information:
a) 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.
b) A description of the training that the volunteer will
receive.
7)Requires a school nurse to obtain from a physician and surgeon
employed by or contracting with the local educational agency,
the medical director of the local health department, or the
local emergency medical services director a prescription 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. The prescription may be filled by
local or mail order pharmacies or epinephrine auto-injector
manufacturers.
8)Requires, if the school does not have a school nurse, a school
administrator if an employee has volunteered, to obtain from a
physician and surgeon employed by or contracting with the
local educational agency, the medical director of the local
health department, or the local emergency medical services
director a prescription 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.
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9)Authorizes a school district, COE, or charter operator, on
behalf of the school nurse or administrator in that school
district, county or charter school, to obtain from a physician
and surgeon employed by or contracting with the local
educational agency, the medical director of the local health
department, or the local emergency medical services director a
prescription 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.
10)Authorizes a school nurse, or if the school does not have a
school nurse or the school nurse is not onsite or available, a
volunteer to 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; specifies if the epinephrine
auto-injector is used it shall 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.
11)Requires a volunteer to initiate emergency medical services
or other appropriate medical followup (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.
12)Requires a school district, COE, or charter school to ensure
that each employee who volunteers under this section will be
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
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personnel file.
13)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.
EXISTING LAW :
1)Authorizes a school district or COE to provide emergency
epinephrine auto-injectors to trained personnel, and
authorizes trained personnel to use an epinephrine
auto-injector to provide emergency medical aid to a person
suffering from an anaphylactic reaction.
2)Authorizes public schools to designate at least one school
personnel on a voluntary basis to receive initial and annual
training, based on specific standards, regarding the storage
and emergency use of an epinephrine auto-injector.
3)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 epinephrine auto-injectors
from the school district physician, medical director of the
local health department, or local emergency medical
services director.
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.
4)Requires a school district or COE electing to use epinephrine
auto-injectors for emergency medical aid to create a plan to
address all of the following issues:
a) Designation of the person(s) who will provide the
training.
b) Designation of the school district physician, medical
director of the local health department or local emergency
medical services director who will be consulted for the
prescription for epinephrine auto-injectors.
c) Documentation as to who will obtain the prescription and
the medication.
d) Documentation regarding where the epinephrine
auto-injector is stored and how the epinephrine
auto-injector will be made readily available in case of an
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emergency.
5)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 epinephrine auto-injectors.
c) Emergency follow-up procedures, including calling 911
and contacting, if possible, the student's parents and
physician.
d) Instruction and certification in cardiopulmonary
resuscitation.
e) Written materials covering the information described
above. (Education Code (EC) 49414)
6)Authorizes, in the absence of a credentialed school nurse or
other licensed nurse onsite at the school, non-medical school
personnel to administer medication to a pupil in an emergency,
after receiving specified training:
a) Glucagon may be administered to students with diabetes
suffering from severe hypoglycemia. (EC 49414.5)
b) Emergency anti-seizure medication may be administered to
students with epilepsy suffering from seizures. (EC
49414.7)
FISCAL EFFECT : According to the Senate Appropriations
Committee, "Mandate: Potentially substantial reimbursable state
mandate on local education agencies to provide and maintain
epinephrine auto-injectors, train volunteers, and adhere to
reporting requirements. Annual costs will be in the millions of
dollars (General Fund); the cost of purchasing epinephrine
auto-injectors for the more than 10,000 district schools alone
would exceed $2 million. Standards: Costs to the California
Department of Education (CDE) to review and update minimum
training standards would be minor and absorbable."
COMMENTS : This bill requires school districts, COEs, and
charter schools to provide emergency epinephrine auto-injectors
to school nurses and trained personnel who have volunteered, who
may use the epinephrine auto-injectors to provide emergency
medical aid to persons suffering, or reasonably believed to be
suffering, from an anaphylactic reaction. The bill requires a
school nurse, if they are available and onsite, to obtain an
epinephrine auto-injector. If a school nurse is not available
and onsite, the bill requires an administrator to obtain an
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epinephrine auto-injector, only if there is a volunteer willing
to be responsible for injecting the epinephrine in an emergency.
This bill requires all schools with a school nurse or trained
volunteer to stock epinephrine auto-injectors.
According to the author, "SB 1266 will require extra epinephrine
injectors be stocked at schools when there is a volunteer
willing to be trained to administer. The stocking of extra
epinephrine injectors will allow for the administration of the
medication if necessary to someone who is not aware of their
life threatening condition. By requiring stock epinephrine, as
described in SB 1266, we are enabling our State to possibly
compete for federal dollars and provide our school health
professionals the necessary tools and peace of mind to keep
children safe. Ultimately, we know with certainty SB 1266 WILL
be saving lives as there is ample evidence from schools that
have stocked it, have had occasion to use it and in turn has
resulted in saving the lives of children."
Epinephrine Auto-Injector Dosing : Epinephrine auto-injectors are
designed in two doses. One dose is designed for children between
33 pounds and 66 pounds and another dose is designed for
children and adults over 66 pounds. The side effects of
epinephrine include a fast/pounding heartbeat, nervousness,
dizziness and shakiness, among others. If a full strength dose
epinephrine auto-injector is used on a child less than 66
pounds, they may have more of these side effects, but should not
experience any serious side effects unless they have a rare
cardiac defect. Therefore it is safe to give a child less than
66 pounds the full strength dose of epinephrine. In fact, many
allergists recommend the full dose epinephrine to children more
than 50 pounds. With this in mind, the bill requires the expert
panel to consider grade level guidelines so that employees are
not faced with determining the approximate weight of a child and
instead could determine with dose of epinephrine to give based
on their grade level, or a combination of those things.
EpiPen 4 Schools Program : EpiPen currently operates a program
that offers four free EpiPen or EpiPen Jr Auto-Injectors to
public and private schools in the United States, with a
prescription. The program is scheduled to run until 2015, and
the company is currently considering whether to extend the
program beyond 2015.
Committee Amendments : Staff recommends the following
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amendments:
1)Clarify that qualified supervisors of health, or a designee,
at school districts, COEs and charter operators shall be
responsible for obtaining and stocking epinephrine
auto-injectors for the schools they operate.
2)Clarify that the school district, COE or chartering school
shall annually report the data regarding the use of
epinephrine auto-injectors to the department.
3)Correct a drafting error by deleting references to surgeons in
the bill.
Arguments in Support : The Asthma and Allergy Foundation of
America supports the bill and states, "SB 1266 would help ensure
that all students, regardless of where they attend school, are
protected in the event of a severe allergic reaction.
Approximately 25% of epinephrine injections in schools involve a
student with a previously undiagnosed allergy. Requiring
schools to stock epinephrine auto-injectors would not only
protect students with diagnosed food allergies, but also
students who have an allergic reaction for the first time at
school."
Arguments in Opposition : The California Teachers Association
oppose the bill and states, "SB 1266 does not sufficiently
address costs associated with identifying potential volunteers,
satisfactory training modules that lead to volunteer
recruitment, or the level of training necessary to understand
the consequences of potential negative unintended consequences."
REGISTERED SUPPORT / OPPOSITION :
Support
Allergy & Asthma Association of Northern California
Allergy & Asthma Association of Southern California
Allergy & Asthma Medical Group & Research Center, A.P.C.
Allergy Station @ Sacramento
American Academy of Allergy Asthma and Immunology
American Nurses Association\California chapter
American Red Cross
Asthma and Allergy Foundation of America
Bay Area Food Allergy 5k Walk/Run in Memory of BJ HOM
California Academy of Family Physicians
California Academy of Physician Assistants
California Advocates for Food Allergies
California Chapter of American College of Emergency Physicians
California Physicians United
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California School Nurses Organization
California Society of Allergy, Asthma and Immunology
California Society of Health-System Pharmacists
California State PTA
Capital Allergy & Respiratory Disease Center
Food Allergy and Anaphylaxis Connection Team
Food Allergy Research and Education, sponsor
Food Allergy Support of Sacramento
Kids with Food Allergies
Mylan
Natalie Giorgi Sunshine Foundation
Northern California Allergy & Asthma Advocates (NCAAA)
Nut Free Wok
Orange County Tax Payers Association
San Clemente Food Allergy Support Group
San Diego Food Allergy Support Group
SF Bay Area Food Allergy Network
Sanofi
School Employers Association of California
South Orange County Food Allergy Network
Stanford Food Allergy & Food Sensitivity Center Community
Council
Sutter Medical Group
Numerous individuals
Opposition
California Federation of Teachers
California Teachers Association
Analysis Prepared by : Chelsea Kelley / ED. / (916) 319-2087