BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                            



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                                 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

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           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.


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             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.

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          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.

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          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  

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                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,  

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             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 

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          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,  

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            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

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