BILL ANALYSIS Ó SB 1266 Page 1 SENATE THIRD READING SB 1266 (Huff) As Amended August 18, 2014 Majority vote SENATE VOTE :37-0 JUDICIARY 10-0 EDUCATION 7-0 ----------------------------------------------------------------- |Ayes:|Wieckowski, Wagner, |Ayes:|Buchanan, Olsen, Chávez, | | |Alejo, Chau, Dickinson, | |Gonzalez, Nazarian, | | |Garcia, Gorell, | |Weber, Williams | | |Maienschein, Muratsuchi, | | | | |Stone | | | | | | | | |-----+--------------------------+-----+--------------------------| | | | | | ----------------------------------------------------------------- APPROPRIATIONS 17-0 ----------------------------------------------------------------- |Ayes:|Gatto, Bigelow, | | | | |Bocanegra, Bradford, Ian | | | | |Calderon, Campos, | | | | |Donnelly, Eggman, Gomez, | | | | |Holden, Jones, Linder, | | | | |Pan, Quirk, | | | | |Ridley-Thomas, Wagner, | | | | |Weber | | | |-----+--------------------------+-----+--------------------------| | | | | | ----------------------------------------------------------------- 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 SB 1266 Page 2 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, 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. d) "Authorizing physician and surgeon" may include, but is not limited to, a physician and surgeon employed by, or contracting with, a local educational agency, a medical director of the local health department, or a local SB 1266 Page 3 emergency medical services director. e) "Qualified supervisor of health" may include, but is not limited to, a school nurse. 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, the Stanford Allergy Center, 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 follow-up 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. 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 SB 1266 Page 4 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 qualified supervisor of health at a school district, a county office of education, or a charter school to obtain from an authorizing physician and surgeon a 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 schools, middle schools, and high schools, if there are no pupils who require a junior epinephrine auto-injector, one regular epinephrine auto-injector; requires a qualified supervisor of health at a school district, a county office of education, or a charter school to be responsible for stocking the epinephrine auto-injector and restocking it if it is used; and, requires if a school district, county office of education, or charter school does not have a qualified supervisor of health, an administrator at the school district, county office of education, or charter school to carry out the duties specified. 8)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 SB 1266 Page 5 reasonably possible, but no later than two weeks from the use; and, requires epinephrine auto-injectors to be restocked before their expiration date. 9)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 aggregate counts to the department in a manner determined by the department, commencing July 1, 2016; and, requires the department to annually publish a summary of the data on its Internet Web site. 10)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 personnel file. 11)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 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 SB 1266 Page 6 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. 3)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 emergency. 4)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) 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 SB 1266 Page 7 above. FISCAL EFFECT : According to the Assembly Appropriations Committee, General Fund/Proposition 98 (1988) state reimbursable mandated costs, potentially in the low millions, for local education agencies 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 two-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 [local education agencies] will also incur costs to notify staff of the ability to volunteer to administer epinephrine and to provide associated volunteer training. 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. This bill requires a qualified supervisor of health at a school district, COE or charter operator to obtain an epinephrine auto-injector. If a school district, COE or charter operator does not have a qualified supervisor of health, this bill requires an administrator to obtain an 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, 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 this bill, 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 this bill 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. SB 1266 Page 8 Analysis Prepared by : Chelsea Kelley / ED. / (916) 319-2087 FN: 0005028