BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 1748|
|Office of Senate Floor Analyses | |
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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:
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:
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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.
AB 1748
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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.
AB 1748
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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
AB 1748
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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)
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
8/17/16 16:28:18
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