BILL ANALYSIS Ó
SENATE COMMITTEE ON EDUCATION
Senator Carol Liu, Chair
2015 - 2016 Regular
Bill No: AB 1748
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|Author: |Mayes |
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|Version: |May 11, 2016 Hearing |
| |Date: June 15, 2016 |
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|Urgency: |No | Fiscal: |Yes |
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|Consultant:|Lynn Lorber |
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Subject: Pupils: pupil health: opioid antagonist
NOTE: This bill has been referred to the Committees on
Education and Judiciary. A "do pass" motion should include
referral to the Committee on Judiciary.
SUMMARY
This bill authorizes local educational agencies to provide an
emergency opioid antagonist to school nurses or trained
personnel and authorizes a school nurse or trained personnel to
administer an opioid antagonist to a person suffering from an
opioid overdose.
BACKGROUND
Existing law:
1) Requires a school district or county office of education to
provide emergency epinephrine auto-injectors to voluntarily
trained personnel, and authorizes a school nurse or trained
personnel to use an epinephrine auto-injector to provide
emergency medical aid to a person suffering from an
anaphylactic reaction. (Education Code § 49414)
2) Authorizes a pharmacy to furnish epinephrine auto-injectors
to a school district, county office of education, or
charter school if certain conditions are met. (Business &
Professions Code § 4119.2)
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3) Authorizes, in the absence of a credentialed school nurse
or other licensed nurse onsite at the school, non-medical
school personnel, who volunteer to do so, to administer
medication to a student in an emergency, after receiving
specified training:
a) Glucagon may be administered to students with
diabetes suffering
from severe hypoglycemia. (EC § 49414.5)
b) Emergency anti-seizure medication may be
administered to students with epilepsy suffering from
seizures. (EC § 49414.7)
4) Authorizes a licensed health care provider who is
authorized by law to prescribe an opioid antagonist to
prescribe and subsequently dispense or distribute an opioid
antagonist to a person at risk of an opioid-related
overdose or to a family member, friend, or other person in
a position to assist a person at risk of an opioid-related
overdose. (Civil Code §1714.22)
ANALYSIS
This bill authorizes local educational agencies to provide an
emergency opioid antagonist to school nurses or trained
personnel and authorizes a school nurse or trained personnel to
administer an opioid antagonist to a person suffering from an
opioid overdose. Specifically, this bill:
1) Authorizes school districts, county offices of education,
and charter schools to provide emergency naloxone
hydrochloride or another opioid antagonist to school nurses
or trained personnel who have volunteered, pursuant to
#4-7.
2) Authorizes school nurses or trained personnel to use
naloxone hydrochloride or another opioid antagonist to
provide emergency medical aid to a person suffering, or
reasonably believed to be suffering, from an opioid
overdose.
3) Limits the method of administration of naloxone
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hydrochloride or another opioid antagonist to nasal spray.
Volunteers
4) Authorizes each public and private school to voluntarily
determine whether or not to make emergency naloxone
hydrochloride or another opioid antagonist and trained
personnel available at its school. This bill requires
schools, in making this determination, to 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. This bill
prohibits a private school from receiving state funds
specifically for the purposes of this bill.
5) Authorizes each public and private school to designate one
or more volunteers to receive initial and annual refresher
training, based on the standards developed pursuant to #8,
from the school nurse or other qualified person designated
by an authorizing physician and surgeon.
6) Authorizes an employee who volunteers to rescind his or her
offer to administer emergency naloxone hydrochloride or
another opioid antagonist at any time, including after the
receipt of training.
7) Prohibits a benefit from being granted to or withheld from
any individual based on his or her offer to volunteer and
prohibits retaliation against any individual for rescinding
the offer to volunteer, including after receiving training.
Training
8) Requires the Superintendent of Public Instruction (SPI) to
establish minimum standards of training for the
administration of naloxone hydrochloride or another opioid
antagonist that satisfies the requirements of #9. This
bill requires the SPI to review minimum standards of
training every five years or sooner as deemed necessary by
the Superintendent of Public Instruction (SPI).
9) Requires training to include all of the following:
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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 follow-up 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
911 and to contact the student's parent or guardian.
This bill prohibits the requirement to call 911 from
requiring the student to be transported to an
emergency room.
d) Recommendations on the necessity of instruction
and certification in cardiopulmonary resuscitation.
e) Written materials covering the information from
the training, and requires schools to retain the
written materials for reference.
10) Requires the California Department of Education (CDE) to
include on its Web site a clearinghouse for best practices
in training non-medical personnel to administer naloxone
hydrochloride or another opioid antagonist to students.
11) Requires the SPI to 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 State Department of Public Health,
the Emergency Medical Services Authority, the California
School Nurses Organization, the California Medical
Association, the American Academy of Pediatrics, and
others.
12) Requires any local educational agency (LEA) choosing to
provide an emergency opioid antagonist and trained
personnel to provide the training for the volunteers at no
costs to the volunteer and during the volunteer's regular
working hours.
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13) Requires training to be consistent with the most recent
guidelines for medication administration issued by the CDE.
Employee protections
14) Requires an LEA to ensure that each employee who volunteers
will be provided defense and indemnification by the LEA for
any and all civil liability. This bill requires this
information to be reduced to writing, provided to the
volunteer, and retained in the volunteer's personnel file.
15) Prohibits a person who has been trained and who administers
naloxone hydrochloride or another opioid antagonist, in
good faith and not for compensation, from being subject to
professional review, be liable in a civil action, or be
subject to criminal prosecution for acts or omissions in
administering the naloxone hydrochloride and another opioid
antagonist.
16) Prohibits the protection in #15 from applying 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.
Prescription
17) Authorizes a pharmacy to furnish naloxone hydrochloride or
another opioid antagonist to a local educational agency
(LEA) if all of the following are met:
a) The naloxone hydrochloride or another opioid
antagonist is furnished exclusively for use at an LEA.
b) A physician and surgeon provide a written order
that specifies the quantity of naloxone hydrochloride
or another opioid antagonist to be furnished.
18) Requires records regarding the acquisition and disposition
of naloxone hydrochloride or another opioid antagonist to
be maintained by the LEA for a period of three years from
the date the records were created.
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19) Requires a qualified supervisor of health at an LEA that
elects to use naloxone hydrochloride or another opioid
antagonist for emergency aid to obtain from an authorizing
physician and surgeon a prescription for each school. This
bill requires a qualified supervisor of health to be
responsible for stocking the naloxone hydrochloride or
another opioid antagonist and restocking it if it is used.
This bill requires the naloxone hydrochloride or another
opioid antagonist to be restocked as soon as reasonably
possible, but no later than two weeks after it is used, and
requires it to be restocked before its expiration date.
20) Requires the LEA to 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.
21) Requires an administrator at the LEA to carry out the
duties in #19 if there is no qualified supervisor of
health.
22) Authorizes a prescription to be filled by local or mail
order pharmacies or manufacturers of naloxone hydrochloride
or another opioid antagonist.
23) Prohibits an authorizing physician and surgeon from being
subject to professional review, be liable in a civil
action, or be subject to criminal prosecution for the
issuance of a prescription or order, unless the physician
and surgeon's issuance of the prescription or order
constitutes gross negligence or willful or malicious
conduct.
Miscellaneous
24) Requires any local educational agency (LEA) electing to use
naloxone hydrochloride or another opioid antagonist for
emergency aid to distribute a notice at least once per
school year to all staff that contains the following
information:
a) A description of the volunteer request stating
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that the request is for volunteers to be trained to
administer naloxone hydrochloride or another opioid
antagonist to a person who is suffering, or reasonably
believed to be suffering, from an opioid overdose.
b) A description of the training that the volunteer
will receive.
c) The right of an employee to rescind the offer to
volunteer.
d) A statement that no benefit will be granted to or
withheld from any person based on his or her offer to
volunteer and that there will be no retaliation
against any person for rescinding the offer to
volunteer, including after receiving training.
25) Provides that any public employee who volunteers to
administer naloxone hydrochloride or another opioid
antagonist is not providing emergency medical care "for
compensation" notwithstanding the fact that the person is a
paid public employee.
26) Authorizes a state agency, the California Department of
Education, or a public school to accept gifts, grants, and
donations from any source for the support of carrying out
the provisions of this bill, including but not limited to
the acceptance of naloxone hydrochloride or another opioid
antagonist from a manufacturer or wholesaler.
27) Includes the following definitions:
a) "Authorizing physician and surgeon" may include
but is not limited to, a physician and surgeon
employed by, or contracting with, an LEA, a medical
director of the local health department, or a local
emergency medical services director.
b) "Opioid antagonist" as 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.
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c) "Qualified supervisor of health" may include but
is not limited to, a school nurse.
d) "Volunteer" or "trained personnel" as 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
assigned by a school, and has received training
pursuant to #9.
STAFF COMMENTS
1) Need for the bill. According to the author, "According to
the Centers for Disease Control and Prevention, the number
of deaths resulting from opioid overdoses has been steadily
increasing over the past decade. In California, the number
of drug overdose deaths is not 50% higher than the number
of deaths resulting from automobile accidents. Naloxone
(sold under the brand name Narcan) is a medication that can
block the effects of opioid overdoses. In November 2015,
the FDA approved an easy-to-use variant, administered by
nasal spray, and in January 2016, at the Clinton Health
Matters Summit, the manufacturer offered two free doses of
Narcan nasal spray to every high school in the United
States. Unfortunately, current California law does not
provide clear authority for schools to accept, stock, or
administer opioid overdose antidotes."
2) Opioids. According to the Centers for Disease Control and
Prevention (CDCP), opioids are a class of drugs used to
reduce pain. Opioid such as oxycodone (OxyContin),
hydrocodone (Vicodin), morphine, and methadone may be
prescribed by a physician. Fentanyl is a synthetic opioid
pain reliever that is many times more powerful than other
opioids and is approved for treating severe pain, typically
advanced cancer pain. Illegally made and distributed
fentanyl has been on the rise in several states. Heroin is
an illegal opioid. Symptoms of opioid intoxication may
include confusion or delirium, very slow breathing, extreme
sleepiness, vomiting and small pupils.
Also according to the (CDCP), more people died from drug
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overdoses in 2014 than in any year on record. The majority
of drug overdose deaths (more than six out of ten) involve
an opioid. Since 1999, the rate of overdose deaths
involving opioids (including prescription opioids and
heroin) nearly quadrupled. From 2000 to 2014, nearly half
a million people died from drug overdoses. Seventy eight
Americans die every day from an opioid overdose.
3) Very similar to existing law for other medications. This
bill is modeled after existing provisions allowing school
nurses or trained personnel to use epinephrine
auto-injectors to provide emergency medical aid to a person
suffering, or reasonably believed to be suffering, from an
anaphylactic reaction. However, this bill authorizes
schools to obtain a prescription while existing law
requires schools to obtain a prescription for epinephrine
auto-injectors.
This bill is also very similar to existing provisions
authorizing non-medical school personnel who volunteer, in
the absence of a credentialed school nurse or other
licensed nurse onsite at the school, to administer
medication to a student in an emergency, after receiving
specified training. Those provisions relate to the
administration of glucagon to students with diabetes
suffering
from severe hypoglycemia, and emergency anti-seizure medication
to students with epilepsy suffering from seizures. In both
scenarios, the medication must be prescribed for that
student.
Existing law, as well as provisions in this bill, protects
volunteering school personnel from liability, as specified,
requires local educational agencies (LEA) to provide
defense and indemnification, and authorizes the volunteer
to rescind his or her offer to administer medication.
4) Nasal spray only. This bill limits the method of
administration of naloxone hydrochloride or another opioid
antagonist to nasal spray. A prior version of this bill
permitted volunteers to administer naloxone hydrochloride
or other opioid antagonist in the form the volunteer is
most comfortable with (i.e. syringe, auto-injector or nasal
spray). Amendments taken in the Assembly Judiciary
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Committee deleted and replaced this provision with language
specifying that volunteers may only administer naloxone
hydrochloride or another opioid antagonist by nasal spray,
and not in any other form. These amendments address
various concerns raised by the California School Employee
Association about the rights and responsibilities of their
members. The federal Food and Drug Administration has
approved an opioid antagonist auto-injector, which does not
have an exposed needle or require the measuring of dosage.
Existing law authorizes trained non-medical school
personnel to administer an epinephrine auto-injector to
provide emergency medical aid to a person suffering from an
anaphylactic reaction. The author is continuing to work
with the school employees on this issue.
5) How many nurses. According to data files maintained by the
California Department of Education, there were a total of
2,391 school nurses for California's 6.2 million students,
and about one-half of school districts do not have a school
nurse. In those areas, the county office of education
should provide a nurse but it is possible that no nursing
coverage exists for some school districts. Some schools
have a school nurse but only on a part-time basis.
6) School staff currently administering medication. No data
is maintained by the State as to the number of school
districts that choose to allow staff to receive training to
administer, or assist with the administration of,
medication to pupils.
7) Fiscal impact. According to the Assembly Appropriations
Committee analysis, this bill imposes General Fund
administrative costs to the California Department of
Education (CDE) of approximately $60,000 in the first year
of implementation to develop minimum standards of training
and to provide a clearinghouse for best practices in
training. Ongoing costs of approximately $12,000 (General
Fund) for the CDE to review and update standards as
necessary.
SUPPORT
American Nurses Association/California
California Pharmacists Association
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California School Nurses Organization
California Society of Addiction Medicine
Drug Policy Alliance
OPPOSITION
California Teachers Association
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