BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 1748| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- THIRD READING Bill No: AB 1748 Author: Mayes (R) Amended: 8/1/16 in Senate Vote: 21 SENATE EDUCATION COMMITTEE: 9-0, 6/15/16 AYES: Liu, Block, Hancock, Huff, Leyva, Mendoza, Monning, Pan, Vidak SENATE JUDICIARY COMMITTEE: 7-0, 6/28/16 AYES: Jackson, Moorlach, Anderson, Hertzberg, Leno, Monning, Wieckowski SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/11/16 AYES: Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen ASSEMBLY FLOOR: 74-3, 5/23/16 - See last page for vote SUBJECT: Pupils: pupil health: opioid antagonist SOURCE: Author DIGEST: 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. ANALYSIS: AB 1748 Page 2 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) 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) This bill: AB 1748 Page 3 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 hydrochloride or another opioid antagonist to nasal spray or auto-injector, and states that a volunteer shall be allowed to administer naloxone hydrochloride or another opioid antagonist in a form that the volunteer is most comfortable with. 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. AB 1748 Page 4 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 SPI. 9) Requires training to 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 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. d) Recommendations on the necessity of instruction and AB 1748 Page 5 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 California Society of Addiction Medicine, 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. 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. AB 1748 Page 6 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 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. 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 AB 1748 Page 7 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 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 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. AB 1748 Page 8 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 CDE, 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) "Auto-injector" as a disposable delivery device designed for the automatic injection of a premeasured dose AB 1748 Page 9 of an opioid antagonist into the human body and approved by the federal Food and Drug Administration (FDA) for layperson use. c) "Opioid antagonist" as naloxone hydrochloride or another drug approved by the federal FDA 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. d) "Qualified supervisor of health" may include but is not limited to, a school nurse. e) "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. Comments 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 AB 1748 Page 10 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 LEAs to provide defense and indemnification, and authorizes the volunteer to rescind his or her offer to administer medication. FISCAL EFFECT: Appropriation: No Fiscal Com.:YesLocal: No According to the Senate Appropriations Committee: The 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 Web site for best practices in training nonmedical personnel to administer an emergency opioid antagonist. (General Fund) Minor ongoing costs to review the minimum standards at least every five years. SUPPORT: (Verified8/13/16) California State PTA County Behavioral Health Directors Association OPPOSITION: (Verified8/12/16) AB 1748 Page 11 None received ASSEMBLY FLOOR: 74-3, 5/23/16 AYES: Achadjian, Alejo, Travis Allen, Atkins, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Frazier, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Quirk, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Wagner, Waldron, Weber, Wilk, Williams, Wood, Rendon NOES: Medina, Thurmond, Ting NO VOTE RECORDED: Arambula, Eggman, Patterson Prepared by:Lynn Lorber / ED. / (916) 651-4105 8/15/16 20:26:55 **** END ****