BILL ANALYSIS                                                                                                                                                                                                    Ó






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          |SENATE RULES COMMITTEE            |                       AB 1748|
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                                   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:  










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          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:  







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           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.








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           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  







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                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.   









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           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  







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             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.







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              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  







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                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  







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          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)









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          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  ****