Amended in Assembly January 4, 2016

Amended in Assembly April 16, 2015

Amended in Assembly March 26, 2015

California Legislature—2015–16 Regular Session

Assembly Bill No. 1386

Introduced by Assembly Member Low

February 27, 2015

An act to add Section 4119.4 to the Business and Professions Code, to amend Section 1714.23 of the Civil Code, and to amend Section 1797.197a of the Health and Safety Code, relating to emergency medical care.

LEGISLATIVE COUNSEL’S DIGEST

AB 1386, as amended, Low. Emergency medical care: epinephrine auto-injectors.

(1) Existing law authorizes a prehospital emergency medical care person, first responder, or lay rescuer to use an epinephrine auto-injector to render emergency care to another person, as specified. Existing law begin delete also end delete requires the begin delete California end delete Emergency Medical Services begin delete (EMS) end delete Authority to begin delete establish or end delete approve authorized training providers and begin insert the end insert minimum standards for training and the use and administration of epinephrine begin delete auto-injectors, in consultation with the local emergency medical system agency, the county health department, the manufacturer, the State Department of Health Care Services, and other private organizations. The end delete begin insert auto-injectors. The existing end insert Pharmacy begin delete Law end delete begin insert Law, end insert also authorizes a pharmacy to dispense epinephrine auto-injectors to a prehospital emergency medical care person, first responder, or lay rescuer for the purpose of rendering emergency care in accordance with these provisions. A violation of the Pharmacy Law is a crime.

This bill would begin delete authorize end delete begin insert permit end insert an “authorized entity,” as defined, to use an epinephrine auto-injector to render emergency care to another person in accordance with these provisions. The bill would also authorize a pharmacy to furnish epinephrine auto-injectors to an authorized entity pursuant to those provisions. Because a violation of these provisions would be a crime, the bill would impose a state-mandated local program. The bill would begin delete also end delete require an authorized entity to begin insert create and maintain a specified operations plan relating to its use of epinephrine auto-injectors, and would require those entities to end insert submit a report to the State Department of Public Health on incidents related to the administration of epinephrine begin delete auto-injectors, and for end delete begin insert auto-injectors. The bill would also require end insert the department to issue an annual report summarizing and analyzing the reports submitted to begin delete it. end delete begin insert the department pursuant to the bill’s provisions. end insert

(2)  Under existing law, everyone is generally responsible, not only for the result of his or her willful acts, but also for an injury occasioned to another by his or her want of ordinary care or skill in the management of his or her property or person, except so far as the latter has, willfully or by want of ordinary care, brought the injury upon himself or herself. Existing law also provides that a prehospital emergency care person, first responder, or lay rescuer who administers an epinephrine auto-injector to another person who appears to be experiencing anaphylaxis at the scene of an emergency situation, in good faith and not for compensation, is not liable for any civil damages resulting from his or her acts or omissions in administering the epinephrine auto-injector, if that person has complied with specified certification and training requirements and standards.

This bill would provide that employees, agents, or other trained individuals of an authorized entity who administers an epinephrine auto-injector to another person who appears to be experiencing anaphylaxis at the scene of an emergency situation, in good faith and not for compensation, is not liable for any civil damages resulting from his or her acts or omissions in administering the epinephrine auto-injector, if that person has complied with specified certification and training requirements and standards. The bill would also provide that an authorized entity located in this state shall not be liable, in this state, for any injuries or related damages that result from the provision or administration of an epinephrine auto-injector by its employees or agents outside of this state if the entity or its employee or agent would not have been liable for those injuries or related damages had the provision or administration occurred within this state.

begin delete

The

end delete

begin insert (3)The end insert California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: yes.

The people of the State of California do enact as follows:

SECTION 1.  

Section 4119.4 is added to the Business and
Professions Code, to read:

4119.4.  

(a) Notwithstanding any other law, a pharmacy may
furnish epinephrine auto-injectors to an authorized entity, as
defined by Section 1797.197a of the Health and Safety Code, if
both of the following requirements are met:

(1) The epinephrine auto-injectors are furnished exclusively for
use at or in connection with an authorized entity.

(2) An authorized health care provider provides a prescription
that specifies the quantity of epinephrine auto-injectors to be
furnished.

begin insert

(b) The pharmacy shall label each epinephrine auto-injector
dispensed with all of the following:

end insert begin insert

(1) The name of the person or entity to whom the prescription
was issued.

end insert begin insert

(2) The designations “Section 1797.197a Responder” and “First
Aid Purposes Only.”

end insert begin insert

(3) The dosage, use, and expiration date.

end insert begin insert

(c) Each dispensed prescription shall include the manufacturer’s
product information sheet for the epinephrine auto-injector.

end insert begin delete

(b)

end delete

begin insert (d) end insert  Records regarding the acquisition and disposition of
epinephrine auto-injectors furnished pursuant to subdivision (a)
shall be maintained by the authorized entity for a period of three
years from the date the records were created. The authorized entity
shall be responsible for monitoring the supply of epinephrine
auto-injectors and ensuring the destruction of expired epinephrine
auto-injectors.

begin insert

(e) The epinephrine auto-injector dispensed pursuant to this
section may be used only for the purpose, and under the
circumstances, described in Section 1797.197a of the Health and
Safety Code.

end insert

SEC. 2.  

Section 1714.23 of the Civil Code is amended to read:

1714.23.  

(a) For purposes of this section, the following
definitions shall apply:

(1) “Anaphylaxis” means a potentially life-threatening
hypersensitivity or allergic reaction to a substance.

(A) Symptoms of anaphylaxis may include shortness of breath,
wheezing, difficulty breathing, difficulty talking or swallowing,
hives, itching, swelling, shock, or asthma.

(B) Causes of anaphylaxis may include, but are not limited to,
insect stings or bites, foods, drugs, and other allergens, as well as
idiopathic or exercise-induced anaphylaxis.

(2) “Epinephrine auto-injector” means a disposable drug delivery
system with a spring-activated concealed needle that is designed
for emergency administration of epinephrine to provide rapid,
convenient first aid for persons suffering from anaphylaxis.

(b) (1) Any person described in subdivision (b) of Section
1797.197a of the Health and Safety Code or employees, agents,
or other trained individuals of an authorized entity, as defined by
paragraph (2) of subdivision (a) of Section 1797.197a of the Health
and Safety Code, who administers an epinephrine auto-injector,
in good faith and not for compensation, to another person who
appears to be experiencing anaphylaxis at the scene of an
emergency situation is not liable for any civil damages resulting
from his or her acts or omissions in administering the epinephrine
auto-injector, if that person has complied with the requirements
and standards of Section 1797.197a of the Health and Safety Code.

(2) An authorized health care provider that prescribes begin insert or
dispenses end insert an epinephrine auto-injector begin insert or a pharmacist that
dispenses an epinephrine auto-injector end insert to a person described in
subdivision (b) of Section 1797.197a of the Health and Safety
Code or an authorized entity is not liable for any civil damages
resulting from any act or omission related to the provision of an
epinephrine auto-injector.

(3) A person that conducts the training described in subdivision
(c) of Section 1797.197a of the Health and Safety Code is not
liable for any civil damages resulting from any act or omission
related to the acquisition, possession, administration, or provision
of an epinephrine auto-injector.

(4) An authorized entity located in this state shall not be liable,
in this state, for any injuries or related damages that result from
the provision or administration of an epinephrine auto-injector by
its employees or agents outside of this state if the entity or its
employee or agent would not have been liable for those injuries
or related damages had the provision or administration occurred
within this state.

begin insert

(5) An authorized entity that possesses and makes available
epinephrine auto-injectors, including third parties that facilitate
the availability of epinephrine auto-injectors to an authorized
entity, is not liable for any injuries or related damages that result
from any act or omission taken pursuant to this section.

end insert begin delete

(5)

end delete

begin insert (6) end insert  This subdivision does not eliminate, limit, or reduce any
other immunity or defense that may otherwise be available under
state law.

(c) The protection specified in subdivision (b) shall not apply
in a case of personal injury or wrongful death that results from the
gross negligence or willful or wanton misconduct of the person
who renders emergency care treatment by the use of an epinephrine
auto-injector.

(d) Nothing in this section relieves a manufacturer, designer,
developer, distributor, or supplier of an epinephrine auto-injector
of liability under any other applicable law.

SEC. 3.  

Section 1797.197a of the Health and Safety Code is
amended to read:

1797.197a.  

(a) For purposes of this section, the following
definitions shall apply:

(1) “Anaphylaxis” means a potentially life-threatening
hypersensitivity or allergic reaction to a substance.

(A) Symptoms of anaphylaxis may include shortness of breath,
wheezing, difficulty breathing, difficulty talking or swallowing,
hives, itching, swelling, shock, or asthma.

(B) Causes of anaphylaxis may include, but are not limited to,
insect stings or bites, foods, drugs, and other allergens, as well as
idiopathic or exercise-induced anaphylaxis.

(2) “Authorized entity” means any entity or organization in
connection with, or at which, allergens capable of causing
anaphylaxis may be present, including, but not limited to, recreation
camps, colleges and universities, day care facilities, youth begin delete sport end delete
begin insert sports end insert leagues, amusement parks, restaurants, places of
employment, and sports arenas.

(3) “Epinephrine auto-injector” means a disposable drug delivery
system with a spring-activated concealed needle that is designed
for emergency administration of epinephrine to provide rapid,
convenient first aid for persons suffering from anaphylaxis.

(4) “Lay rescuer” means any person who has met the training
standards and other requirements of this section but who is not
otherwise licensed or certified to use an epinephrine auto-injector
on another person.

(5) “Prehospital emergency medical care person” has the same
meaning as defined in paragraph (2) of subdivision (a) of Section
1797.189.

(b) A prehospital emergency medical care person, lay rescuer,
or employees, agents, or other trained individuals of an authorized
entity may use an epinephrine auto-injector to render emergency
care to another person if all of the following requirements are met:

(1) The epinephrine auto-injector is legally obtained by
prescription from an authorized health care provider or from an
authorized entity that acquired the epinephrine auto-injector
pursuant to subdivision (e). An authorized health care provider
may issue a prescription for an epinephrine auto-injector to a person
described in this subdivision for the purpose of rendering
emergency care to another person, upon presentation of current
certification demonstrating that person is trained and qualified to
administer an epinephrine auto-injector as a prehospital emergency
medical care person or lay rescuer, pursuant to this section or any
other statute or regulation.

(2) The epinephrine auto-injector is used on another, with the
expressed or implied consent of that person, to treat anaphylaxis.

(3) The epinephrine auto-injector is stored and maintained as
directed by the manufacturer’s instructions for that product.

(4) The person using the epinephrine auto-injector has
successfully completed a course of training with an authorized
training provider, as described in subdivision (c), and has current
certification of training issued by the provider.

(5) The epinephrine auto-injectors obtained by prehospital
emergency medical care personnel pursuant to Section 4119.3 of
the Business and Professions Code shall be used only when
functioning outside the course of the person’s occupational duties,
or as a volunteer, pursuant to this section.

(6) The Emergency Medical Services System is activated as
soon as practicable when an epinephrine auto-injector is used.

(c) (1) The authorized training providers shall be approved,
and the minimum standards for training and the use and
administration of epinephrine auto-injectors pursuant to this section
shall be established and approved, by the begin delete California Emergency
Medical Services (EMS) Authority. end delete begin insert authority. end insert The authority may
designate existing training standards for the use and administration
of epinephrine auto-injectors by prehospital emergency medical
care personnel to satisfy the requirements of this section.

(2) The minimum training and requirements shall include all of
the following components:

(A) Techniques for recognizing circumstances, signs, and
symptoms of anaphylaxis.

(B) Standards and procedures for proper storage and emergency
use of epinephrine auto-injectors.

(C) Emergency followup procedures, including activation of
the Emergency Medical Services System, by calling the emergency
9-1-1 telephone number or otherwise alerting and summoning
more advanced medical personnel and services.

(D) Compliance with all regulations governing the training,
indications, use, and precautions concerning epinephrine
auto-injectors.

(E) Written material covering the information required under
this provision, including the manufacturer product information
sheets on commonly available models of epinephrine auto-injectors.

(F) Completion of a training course in cardiopulmonary
resuscitation and the use of an automatic external defibrillator
(AED) for infants, children, and adults that complies with
regulations adopted by the begin delete EMS Authority end delete begin insert authority end insert and the
standards of the American Heart Association or the American Red
Cross, and a current certification for that training.

(3) Training certification shall be valid for no more than two
years, after which recertification with an authorized training
provider is required.

(4) The director begin delete of the authority end delete may, in accordance with
regulations adopted by the authority, deny, suspend, or revoke any
approval issued under this subdivision or may place any approved
training provider on probation upon a finding by the director of
an imminent threat to public health and safety, as evidenced by
any of the following:

(A) Fraud.

(B) Incompetence.

(C) The commission of any fraudulent, dishonest, or corrupt
act that is substantially related to the qualifications, functions, or
duties of training program directors or instructors.

(D) Conviction of any crime that is substantially related to the
qualifications, functions, or duties of training program directors
or instructors. The record of conviction or a certified copy of the
record shall be conclusive evidence of the conviction.

(E) Violating or attempting to violate, directly or indirectly, or
assisting in or abetting the violation of, or conspiring to violate,
any provision of this section or the regulations promulgated by the
authority pertaining to the review and approval of training
programs in anaphylaxis and the use and administration of
epinephrine auto-injectors, as described in this subdivision.

(d) (1) The authority shall assess a fee pursuant to regulation
sufficient to cover the reasonable costs incurred by the authority
for the ongoing review and approval of training and certification
under subdivision (c).

(2) The fees shall be deposited in the Specialized First Aid
Training Program Approval Fund, which is hereby created in the
State Treasury. All moneys deposited in the fund shall be made
available, upon appropriation, to the authority for purposes
described in paragraph (1).

(3) The authority may transfer unused portions of the Specialized
First Aid Training Program Approval Fund to the Surplus Money
Investment Fund. Funds transferred to the Surplus Money
Investment Fund shall be placed in a separate trust account, and
shall be available for transfer to the Specialized First Aid Training
Program Approval Fund, together with the interest earned, when
requested by the authority.

(4) The authority shall maintain a reserve balance in the
Specialized First Aid Training Program Approval Fund of 5 percent
of annual revenues. Any increase in the fees deposited in the
Specialized First Aid Training Program Approval Fund shall be
effective upon determination by the authority that additional
moneys are required to fund expenditures pursuant to subdivision
(c).

(e) An authorized health care provider may prescribe epinephrine
auto-injectors to an authorized entity or to an employee or agent
of begin delete which that end delete begin insert an authorized entity who end insert holds a begin delete current end delete begin insert valid end insert
certification demonstrating that the person is trained and qualified
to administer an epinephrine auto-injector as a lay rescuer.
Epinephrine auto-injectors acquired by an authorized entity shall
be stored in a location readily accessible in an emergency and in
accordance with the epinephrine auto-injectors instructions for use
and any additional requirements that may be established by the
begin delete EMS Authority. end delete begin insert authority. end insert

(f) An authorized entity that possesses and makes available
epinephrine auto-injectors shall begin delete submit end delete begin insert do both of the following: end insert

begin insert

(1) Create and maintain on its premises an operations plan that
includes all of the following:

end insert begin insert

(A) The name and contact number for the authorized health
care provider who prescribed the epinephrine auto-injector.

end insert begin insert

(B) Where and how the epinephrine auto-injector will be stored.

end insert begin insert

(C) The names of the designated employees or agents who have
completed the training program required by this section and who
are authorized to administer the epinephrine auto-injector.

end insert begin insert

(D) How and when the epinephrine auto-injector will be
inspected for an expiration date.

end insert begin insert

(E) The process to replace the expired epinephrine auto-injector,
including the proper disposal of the expired epinephrine
auto-injector.

end insert

begin insert (2) end insert begin insert   end insert begin insert Submit end insert to the State Department of Public Health, on a form
developed by the State Department of Public Health, a report of
each incident on the authorized entity’s premises that involves the
administration of an epinephrine auto-injector. The State
Department of Public Health shall annually publish a report that
summarizes and analyzes all reports submitted to it under this
subdivision.

(g) This section shall not apply to a school district or county
office of education, or its personnel, that provides and utilizes
epinephrine auto-injectors to provide emergency medical aid
pursuant to Section 49414 of the Education Code.

(h) This section shall not be construed to limit or restrict the
ability of prehospital emergency medical care personnel, under
any other statute or regulation, to administer epinephrine, including
the use of epinephrine auto-injectors, or to require additional
training or certification beyond what is already required under the
other statute or regulation.

SEC. 4.  

No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of
the Government Code, or changes the definition of a crime within
the meaning of Section 6 of Article XIII B of the California
Constitution.