Amended in Senate August 1, 2016

Amended in Senate June 20, 2016

Amended in Assembly May 11, 2016

Amended in Assembly April 25, 2016

Amended in Assembly April 14, 2016

Amended in Assembly March 18, 2016

California Legislature—2015–16 Regular Session

Assembly Bill No. 1748

Introduced by Assembly Member Mayes

February 2, 2016

An act to add Section 4119.8 to the Business and Professions Code, and to add Section 49414.3 to the Education Code, relating to pupils.

LEGISLATIVE COUNSEL’S DIGEST

AB 1748, as amended, Mayes. Pupils: pupil health: opioid antagonist.

(1) Existing law authorizes a pharmacy to furnish epinephrine auto-injectors to a school district, county office of education, or charter school if certain conditions are met. Existing law requires the school district, county office of education, or charter school to maintain records regarding the acquisition and disposition of epinephrine auto-injectors furnished by the pharmacy for a period of 3 years from the date the records were created.

This bill would authorize a pharmacy to furnish naloxone hydrochloride or another opioid antagonist to a school district, county office of education, or charter school if certain conditions are met. The bill would require the school district, county office of education, or charter school to maintain records regarding the acquisition and disposition of naloxone hydrochloride or another opioid antagonist furnished by the pharmacy for a period of 3 years from the date the records were created.

(2) Under existing law, the governing board of a school district is required to give diligent care to the health and physical development of pupils and may employ properly certified persons for that work. Existing law requires school districts, county offices of education, and charter schools to provide emergency epinephrine auto-injectors to school nurses or trained volunteer personnel and authorizes school nurses and trained personnel to use epinephrine auto-injectors to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an anaphylactic reaction, as provided.

This bill would authorize a school district, county office of education, or charter school to provide emergency naloxone hydrochloride or another opioid antagonist to school nurses and trained personnel who have volunteered, as specified, and authorizes school nurses and trained personnel to use naloxone hydrochloride or another opioid antagonist to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an opioid overdose. The bill would expressly authorize each public and private elementary and secondary school in the state to voluntarily determine whether or not to make emergency naloxone hydrochloride or another opioid antagonist and trained personnel available at its school and to designate one or more school personnel to receive prescribed training regarding naloxone hydrochloride or another opioid antagonist from individuals in specified positions. begin delete The end delete

begin insert The end insert bill would require the Superintendent of Public Instruction to establish minimum standards of training for the administration of naloxone hydrochloride or another opioid antagonist, to review these standards every 5 years or sooner as specified, and to consult with organizations and providers with expertise in administering naloxone hydrochloride or another opioid antagonist and administering medication in a school environment in developing and reviewing those standards. The bill would require the State Department of Education to include on its Internet Web site a clearinghouse for best practices in training nonmedical personnel to administer naloxone hydrochloride or another opioid antagonist to pupils. begin delete The end delete

begin insert The end insert bill would require a school district, county office of education, or charter school choosing to exercise the authority to provide emergency naloxone hydrochloride or another opioid antagonist to provide the training for the volunteers at no cost to the volunteers and during the volunteers’ regular working hours. The bill would require a qualified supervisor of health or administrator at a school district, county office of education, or charter school electing to utilize naloxone hydrochloride or another opioid antagonist for emergency medical aid to obtain the prescription for naloxone hydrochloride or another opioid antagonist from an authorizing physician and surgeon, as defined, and would authorize the prescription to be filled by local or mail order pharmacies or naloxone hydrochloride or another opioid antagonist manufacturers. begin delete The end delete

begin insert The end insert bill would authorize school nurses or, if the school does not have a school nurse, a person who has received training regarding naloxone hydrochloride or another opioid antagonist to immediately administer naloxone hydrochloride or another opioid antagonist under certain circumstances. The bill would provide that volunteers may administer naloxone hydrochloride or another opioid antagonist only by nasal spray or by auto-injector, as specified. begin delete The end delete

begin insert The end insert bill would prohibit an authorizing physician and surgeon from being subject to professional review, being liable in a civil action, or being subject to criminal prosecution for any act in the issuing of a prescription or order, pursuant to these provisions, unless the act constitutes gross negligence or willful or malicious conduct. The bill would prohibit a person trained under these provisions who administers naloxone hydrochloride or another opioid antagonist, in good faith and not for compensation, to a person who appears to be experiencing an opioid overdose from being subject to professional review, being liable in a civil action, or being subject to criminal prosecution for this administration.

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

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

SECTION 1.  

Section 4119.8 is added to the Business and
Professions Code, to read:

4119.8.  

(a) Notwithstanding any other law, a pharmacy may
furnish naloxone hydrochloride or another opioid antagonist to a
school district, county office of education, or charter school
pursuant to Section 49414.3 of the Education Code if all of the
following are met:

(1) The naloxone hydrochloride or another opioid antagonist is
furnished exclusively for use at a school district schoolsite, county
office of education schoolsite, or charter school.

(2) A physician and surgeon provides a written order that
specifies the quantity of naloxone hydrochloride or another opioid
antagonist to be furnished.

(b) Records regarding the acquisition and disposition of
naloxone hydrochloride or another opioid antagonist furnished
pursuant to subdivision (a) shall be maintained by the school
district, county office of education, or charter school for a period
of three years from the date the records were created. The school
district, county office of education, or charter school shall be
responsible for monitoring the supply of naloxone hydrochloride
or another opioid antagonist and ensuring the destruction of expired
naloxone hydrochloride or another opioid antagonist.

SEC. 2.  

Section 49414.3 is added to the Education Code, to
read:

49414.3.  

(a) School districts, county offices of education, and
charter schools may provide emergency naloxone hydrochloride
or another opioid antagonist to school nurses or trained personnel
who have volunteered pursuant to subdivision (d), and school
nurses or trained personnel may use naloxone hydrochloride or
another opioid antagonist to provide emergency medical aid to
persons suffering, or reasonably believed to be suffering, from an
opioid overdose.

(b) For purposes of this section, the following terms have the
following meanings:

(1) “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 emergency medical services director.

(2) “Auto-injector” means a disposable delivery device designed
for the automatic injection of a premeasured dose of an opioid
antagonist into the human body and approved by the federal Food
and Drug Administration for layperson use.

(3) “Opioid antagonist” means naloxone hydrochloride or
another drug approved by the federal Food and Drug
Administration that, when administered, negates or neutralizes in
whole or in part the pharmacological effects of an opioid in the
body, and has been approved for the treatment of an opioid
overdose.

(4) “Qualified supervisor of health” may include, but is not
limited to, a school nurse.

(5) “Volunteer” or “trained personnel” means an employee who
has volunteered to administer naloxone hydrochloride or another
opioid antagonist to a person if the person is suffering, or
reasonably believed to be suffering, from an opioid overdose, has
been designated by a school, and has received training pursuant
to subdivision (d).

(c) Each public and private elementary and secondary school
in the state may voluntarily determine whether or not to make
emergency naloxone hydrochloride or another opioid antagonist
and trained personnel available at its school. In making this
determination, a school shall evaluate the emergency medical
response time to the school and determine whether initiating
emergency medical services is an acceptable alternative to naloxone
hydrochloride or another opioid antagonist and trained personnel.
A private elementary or secondary school choosing to exercise the
authority provided under this subdivision shall not receive state
funds specifically for purposes of this subdivision.

(d) (1) Each public and private elementary and secondary school
in the state may designate one or more volunteers to receive initial
and annual refresher training, based on the standards developed
pursuant to subdivision (e), regarding the storage and emergency
use of naloxone hydrochloride or another opioid antagonist from
the school nurse or other qualified person designated by an
authorizing physician and surgeon. A benefit shall not be granted
to or withheld from any individual based on his or her offer to
begin delete volunteer end delete begin insert volunteer, end insert and there shall be no retaliation against any
individual for rescinding his or her offer to volunteer, including
after receiving training. Any school district, county office of
education, or charter school choosing to exercise the authority
provided under this subdivision shall provide the training for the
volunteers at no cost to the volunteer and during the volunteer’s
regular working hours.

(2) An employee who volunteers pursuant to this section may
rescind his or her offer to administer emergency naloxone
hydrochloride or another opioid antagonist at any time, including
after receipt of training.

(e) (1) The Superintendent shall establish minimum standards
of training for the administration of naloxone hydrochloride or
another opioid antagonist that satisfies the requirements of
paragraph (2). Every five years, or sooner as deemed necessary
by the Superintendent, the Superintendent shall review minimum
standards of training for the administration of naloxone
hydrochloride or other opioid antagonists that satisfy the
requirements of paragraph (2). For purposes of this subdivision,
the Superintendent shall consult with organizations and providers
with expertise in administering naloxone hydrochloride or another
opioid antagonist and administering medication in a school
environment, including, but not limited to, the begin delete State Department
of Public Health, end delete begin insert California Society of Addiction Medicine, end insert the
Emergency Medical Services Authority, the California School
Nurses Organization, the California Medical Association, the
American Academy of Pediatrics, and others.

(2) Training established pursuant to this subdivision shall include
all of the following:

(A) Techniques for recognizing symptoms of an opioid
overdose.

(B) Standards and procedures for the storage, restocking, and
emergency use of naloxone hydrochloride or another opioid
antagonist.

(C) Basic emergency followup procedures, including, but not
limited to, a requirement for the school or charter school
administrator or, if the administrator is not available, another school
staff member to call the emergency 911 telephone number and to
contact the pupil’s parent or guardian. begin delete The requirement for the
school or charter school administrator or other school staff member
to call the emergency 911 telephone number shall not require a
pupil to be transported to an emergency room. end delete

(D) Recommendations on the necessity of instruction and
certification in cardiopulmonary resuscitation.

(E) Written materials covering the information required under
this subdivision.

(3) Training established pursuant to this subdivision shall be
consistent with the most recent guidelines for medication
administration issued by the department.

(4) A school shall retain for reference the written materials
prepared under subparagraph (E) of paragraph (2).

(5) The department shall include on its Internet Web site a
clearinghouse for best practices in training nonmedical personnel
to administer naloxone hydrochloride or another opioid antagonist
to pupils.

(f) Any school district, county office of education, or charter
school electing to utilize naloxone hydrochloride or another opioid
antagonist for emergency aid shall distribute a notice at least once
per school year to all staff that contains the following information:

(1) A description of the volunteer request stating that the request
is for volunteers to be trained to administer naloxone hydrochloride
or another opioid antagonist to a person if the person is suffering,
or reasonably believed to be suffering, from an opioid overdose.

(2) A description of the training that the volunteer will receive
pursuant to subdivision (d).

(3) The right of an employee to rescind his or her offer to
volunteer pursuant to this section.

(4) A statement that no benefit will be granted to or withheld
from any individual based on his or her offer to volunteer and that
there will be no retaliation against any individual for rescinding
his or her offer to volunteer, including after receiving training.

(g) (1) A qualified supervisor of health at a school district,
county office of education, or charter school electing to utilize
naloxone hydrochloride or another opioid antagonist for emergency
aid shall obtain from an authorizing physician and surgeon a
prescription for each school for naloxone hydrochloride or another
opioid antagonist. A qualified supervisor of health at a school
district, county office of education, or charter school shall be
responsible for stocking the naloxone hydrochloride or another
opioid antagonist and restocking it if it is used.

(2) 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 shall carry out the duties specified in paragraph (1).

(3) A prescription pursuant to this subdivision may be filled by
local or mail order pharmacies or naloxone hydrochloride or
another opioid antagonist manufacturers.

(4) An authorizing physician and surgeon shall not be subject
to professional review, be liable in a civil action, or be subject to
criminal prosecution for the issuance of a prescription or order
pursuant to this section, unless the physician and surgeon’s issuance
of the prescription or order constitutes gross negligence or willful
or malicious conduct.

(h) (1) A school nurse or, if the school does not have a school
nurse or the school nurse is not onsite or available, a volunteer
may administer naloxone hydrochloride or another opioid
antagonist to a person exhibiting potentially life-threatening
symptoms of an opioid overdose at school or a school activity
when a physician is not immediately available. If the naloxone
hydrochloride or another opioid antagonist is used it shall be
restocked as soon as reasonably possible, but no later than two
weeks after it is used. Naloxone hydrochloride or another opioid
antagonist shall be restocked before its expiration date.

(2) Volunteers may administer naloxone hydrochloride or
another opioid antagonist only by nasal spray or by auto-injector.

(3) A volunteer shall be allowed to administer naloxone
hydrochloride or another opioid antagonist in a form listed in
paragraph (2) that the volunteer is most comfortable with.

(i) A school district, county office of education, or charter school
electing to utilize naloxone hydrochloride or another opioid
antagonist for emergency aid shall ensure that each employee who
volunteers under this section will be provided defense and
indemnification by the school district, county office of education,
or charter school for any and all civil liability, in accordance with,
but not limited to, that provided in Division 3.6 (commencing with
Section 810) of Title 1 of the Government Code. This information
shall be reduced to writing, provided to the volunteer, and retained
in the volunteer’s personnel file.

(j) (1) Notwithstanding any other law, a person trained as
required under subdivision (d), who administers naloxone
hydrochloride or another opioid antagonist, in good faith and not
for compensation, to a person who appears to be experiencing an
opioid overdose shall not be subject to professional review, be
liable in a civil action, or be subject to criminal prosecution for
his or her acts or omissions in administering the naloxone
hydrochloride or another opioid antagonist.

(2) The protection specified in paragraph (1) shall not apply in
a case of gross negligence or willful and wanton misconduct of
the person who renders emergency care treatment by the use of
naloxone hydrochloride or another opioid antagonist.

(3) Any public employee who volunteers to administer naloxone
hydrochloride or another opioid antagonist pursuant to subdivision
(d) is not providing emergency medical care “for compensation,”
notwithstanding the fact that he or she is a paid public employee.

(k) A state agency, the department, or a public school may
accept gifts, grants, and donations from any source for the support
of the public school carrying out the provisions of this section,
including, but not limited to, the acceptance of naloxone
hydrochloride or another opioid antagonist from a manufacturer
or wholesaler.