BILL ANALYSIS                                                                                                                                                                                                    Ó



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          SENATE THIRD READING
          SB 1266 (Huff)
          As Amended  August 18, 2014
          Majority vote 

           SENATE VOTE  :37-0  
           
           JUDICIARY           10-0        EDUCATION           7-0         
           
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          |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                     |     |                          |
          |-----+--------------------------+-----+--------------------------|
          |     |                          |     |                          |
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           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  








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            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  








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               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  








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               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  








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            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  








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               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  








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               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.








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           Analysis Prepared by  :    Chelsea Kelley / ED. / (916) 319-2087    
                     


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