BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | SB 1266| |Office of Senate Floor Analyses | | |1020 N Street, Suite 524 | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- UNFINISHED BUSINESS Bill No: SB 1266 Author: Huff (R), et al. Amended: 8/21/14 Vote: 21 SENATE EDUCATION COMMITTEE : 7-0, 4/2/14 AYES: Liu, Wyland, Correa, Galgiani, Hueso, Huff, Monning NO VOTE RECORDED: Block, Hancock SENATE HEALTH COMMITTEE : 9-0, 4/24/14 AYES: Hernandez, Morrell, Beall, De León, DeSaulnier, Evans, Monning, Nielsen, Wolk SENATE JUDICIARY COMMITTEE : 7-0, 4/29/14 AYES: Jackson, Anderson, Corbett, Lara, Leno, Monning, Vidak SENATE APPROPRIATIONS COMMITTEE : 7-0, 5/23/14 AYES: De León, Walters, Gaines, Hill, Lara, Padilla, Steinberg SENATE FLOOR : 37-0, 5/28/14 AYES: Anderson, Beall, Berryhill, Block, Cannella, Corbett, Correa, De León, DeSaulnier, Evans, Fuller, Gaines, Galgiani, Hancock, Hernandez, Hill, Hueso, Huff, Jackson, Knight, Lara, Leno, Lieu, Liu, Mitchell, Monning, Morrell, Nielsen, Padilla, Pavley, Roth, Steinberg, Torres, Vidak, Walters, Wolk, Wyland NO VOTE RECORDED: Calderon, Wright, Yee ASSEMBLY FLOOR : 76-0, 8/27/14 - See last page for vote SUBJECT : Epinephrine auto-injectors CONTINUED SB 1266 Page 2 SOURCE : Food Allergy Research and Education DIGEST : This bill 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, 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. Assembly Amendments clarify the definitions for qualified supervisor of health and volunteer; clarify training requirements to include dosing weight training and CPR (cardiopulmonary resuscitation) evaluation; add a volunteer solicitation piece; removed reporting requirement; clarify who can give epinephrine and obtain the school prescription; and add the Stanford Allergy Center as a collaborator on the training standards. ANALYSIS : 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. CONTINUED SB 1266 Page 3 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 emergency. 5. Requires the Superintendent of Public Instruction (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. CONTINUED SB 1266 Page 4 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. B. Emergency anti-seizure medication may be administered to students with epilepsy suffering from seizures. This bill requires school districts, COE, 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. 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 provide a written order that specifies the quantity of epinephrine auto-injectors to be furnished. 2. Requires that records regarding the acquisition and disposition of epinephrine auto-injectors furnished to 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 terms anaphylaxis, epinephrine auto-injector, volunteer or trained personnel, authorizing physician and surgeon, and qualified supervisor of health, for purposes of the bill. CONTINUED SB 1266 Page 5 4. Requires every five years, or sooner as deemed necessary by the 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, as specified. 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 grade level or age as a guideline of equivalency for the appropriate pupil weight determination. F. Written materials covering the information required under this bill. 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 CONTINUED SB 1266 Page 6 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 COE, 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 COE, 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, a COE, or charter school does not have a qualified supervisor of health, an administrator at the school district, a COE, 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 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. 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, CONTINUED SB 1266 Page 7 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. FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes Local: Yes 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. SUPPORT : (Verified 8/27/14) Food Allergy Research and Education (source) Allergy & Asthma Associates of Southern California Allergy & Asthma Medical Group & Research Center Allergy & Asthma Network Mothers of Asthmatics Allergy and Asthma Associates of Northern California American Academy of Allergy Asthma and Immunology American College of Emergency Physicians American Nurses Association - California Chapter American Red Cross Association of Regional Center Agencies Asthma and Allergy Foundation of America Bay Area Allergy Advisory Board 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 People with Food Allergies CONTINUED SB 1266 Page 8 California Allergy Support & Anaphylaxis Prevention California American College of Emergency Physicians California Pharmacists Association California Physicians United for SB 1266 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 Children's Hospital Los Angeles Epilepsy California Food Allergy and Anaphylaxis Connection Team Food Allergy Support of Sacramento Kids with Food Allergies Lucille Packard Children's Hospital Mercy Medical Group Mylan Natalie Giorgi Sunshine Foundation Northern California Allergy & Asthma Advocates Nut Free Wok Orange County Tax Payers Association San Clemente Food Allergy Support Group San Diego Food Allergy Support Group San Francisco Bay Area Food Allergy Network Sanofi SF Bay Area Food Allergy Network South Orange County Food Allergy Network Stanford Food Allergy & Food Sensitivity Center Community Council Sutter Medical Group The Allergy Station OPPOSITION : (Verified 8/27/14) California Federated of Teachers California Teachers Association ASSEMBLY FLOOR : 76-0, 8/27/14 AYES: Achadjian, Alejo, Allen, Ammiano, Bigelow, Bloom, Bocanegra, Bonilla, Bonta, Bradford, Brown, Buchanan, Ian Calderon, Campos, Chau, Chávez, Chesbro, Conway, Cooley, Dababneh, Dahle, Daly, Dickinson, Donnelly, Eggman, Fong, Fox, Frazier, Beth Gaines, Garcia, Gatto, Gomez, Gonzalez, Gorell, CONTINUED SB 1266 Page 9 Gray, Grove, Hagman, Hall, Roger Hernández, Holden, Jones, Jones-Sawyer, Levine, Linder, Logue, Lowenthal, Maienschein, Mansoor, Medina, Melendez, Mullin, Muratsuchi, Nazarian, Nestande, Olsen, Pan, Patterson, Perea, John A. Pérez, V. Manuel Pérez, Quirk, Quirk-Silva, Rendon, Ridley-Thomas, Rodriguez, Salas, Skinner, Stone, Ting, Wagner, Waldron, Weber, Wieckowski, Wilk, Williams, Atkins NO VOTE RECORDED: Gordon, Harkey, Yamada, Vacancy PQ:d 8/27/14 Senate Floor Analyses SUPPORT/OPPOSITION: SEE ABOVE **** END **** CONTINUED