BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 1748 (Mayes) - Pupils: pupil health: opioid antagonist
-----------------------------------------------------------------
| |
| |
| |
-----------------------------------------------------------------
|--------------------------------+--------------------------------|
| | |
|Version: August 1, 2016 |Policy Vote: ED. 9 - 0, JUD. 7 |
| | - 0 |
| | |
|--------------------------------+--------------------------------|
| | |
|Urgency: No |Mandate: No |
| | |
|--------------------------------+--------------------------------|
| | |
|Hearing Date: August 1, 2016 |Consultant: Jillian Kissee |
| | |
-----------------------------------------------------------------
This bill meets the criteria for referral to the Suspense File.
Bill
Summary: This bill authorizes local educational agencies (LEAs)
to provide an emergency opioid antagonist to school nurses or
trained personnel to administer an opioid antagonist to a person
suffering from an opioid overdose.
Fiscal
Impact:
The California Department of Education (CDE) anticipates
one-time costs to implement this bill of about $60,000 for a
half of a position. This position would develop the minimum
training standards, consult with specified entities in
developing those standards, and develop a clearinghouse on its
website for best practices in training nonmedical personnel to
administer an emergency opioid antagonist. (General Fund)
AB 1748 (Mayes) Page 1 of
?
Minor ongoing costs to review the minimum standards at least
every five years.
Background: 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 for an emergency opioid antagonist which may be
injected or administered by nasal spray, 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, protect
volunteering school personnel from liability, require LEAs to
provide defense and indemnification, and authorize the volunteer
to rescind his or her offer to administer medication.
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, and now exceeds 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 federal Food and Drug
Administration 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
AB 1748 (Mayes) Page 2 of
?
antidotes.
Proposed Law:
This bill authorizes LEAs to provide an opioid antagonist to
school nurses or trained personnel to administer an opioid
antagonist to a person suffering, or reasonably believed to
suffering, from an opioid overdose.
This bill authorizes each elementary and secondary public and
private school to voluntarily determine whether or not to make
available at its school: (1) an emergency opioid antagonist, and
(2) trained personnel.
This bill defines "opioid antagonist" as naloxone hydrochloride
or another drug approved by the federal Food and Drug
Administration that, when administered, neutralizes the
pharmacological effects of an opioid in the body, and has been
approved for the treatment of an opioid overdose.
Volunteer Training
Each school may designate one or more volunteers to receive
initial and annual training from the school nurse or other
qualified person, as specified. The LEA is required to provide
this training for the volunteers at no cost and during the
volunteer's regular working hours.
This bill requires the Superintendent to establish minimum
standards of training and review these standards at least every
five years.
The training must include:
Techniques for recognizing symptoms of an opioid overdose.
AB 1748 (Mayes) Page 3 of
?
Procedures for the storage and emergency use of an opioid
antagonist.
Basic emergency follow-up procedures such as calling 911 and
contacting the student's parent or guardian.
Recommendations on the necessity of instruction and
certification in cardiopulmonary resuscitation (CPR).
Relevant written materials.
The CDE is also required to include a clearinghouse on its
website for best practices in training nonmedical personnel to
administer an opioid antagonist to students.
An LEA electing to utilize an opioid antagonist for emergency
aid is required to distribute a notice at least once a year to
all staff that contains specified information such as a
description of the volunteer request, a description of the
training the volunteer will receive, and the right to rescind an
offer to volunteer.
Employee and Physician Protections
This bill provides trained volunteers with immunity from civil
liability, except where there has been gross negligence or
willful or wanton misconduct of the person rendering the
emergency care. It requires that volunteers be provided defense
and indemnification by the LEA for any and all civil liability,
as specified. This bill would also ensure that 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, unless the
AB 1748 (Mayes) Page 4 of
?
physician and surgeon's issuance of the prescription or order
constitutes gross negligence or willful or malicious conduct.
Prescription
This bill authorizes a pharmacy to furnish an opioid antagonist
to an LEA if certain conditions are met. A qualified supervisor
of health (i.e. a nurse) at an LEA is required to obtain a
prescription from a physician and surgeon for each school for an
opioid antagonist.
Related Legislation: AB 1719 (Rodriguez, 2016) requires CPR
instruction in grades 9 through 12 and provides for various
legal immunities relating to the instruction of students in
compression-only CPR or use of an automatic external
defibrillator. AB 1719 pending in this committee.
Staff
Comments: Opioid overdoses are characterized by central nervous
system and respiratory depression, leading to coma and death.
Once administered, naloxone takes effect after around a minute,
with effects lasting around 45 minutes, potentially saving the
person's life.
This bill provides schools with the discretion to obtain and
administer an opioid antagonist consistent with the requirements
of this bill. Therefore any costs incurred to take advantage of
this authority would not be eligible for reimbursement as a
state mandated activity. This bill allows a state agency or a
public school to accept gifts, grants, and donations from any
source to implement this bill, including but not limited to the
acceptance of naloxone hydrochloride or another opioid
antagonist from a manufacturer or wholesaler.
-- END --
AB 1748 (Mayes) Page 5 of
?