Amended in Senate April 15, 2015

Senate BillNo. 738


Introduced by Senator Huff

February 27, 2015


An act to amend Section 49414 of the Education Code, relating to pupil health.

LEGISLATIVE COUNSEL’S DIGEST

SB 738, as amended, Huff. Pupil health: epinephrine auto-injectors: liability limitation.

Existing law requires school districts, county offices of education, and charter schools to provide emergency epinephrine auto-injectors to school nurses and trained personnel who have volunteered, as specified, and authorizes school nurses and trained personnel to use epinephrine auto-injectors to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an anaphylactic reaction. Existing law requires a qualified supervisor of health or administrator at a school district, county office of education, or charter school to obtain the prescription for epinephrine auto-injectors from an authorizing physician and surgeon, as defined, and authorizes the prescription to be filled by local or mail order pharmacies or epinephrine auto-injector manufacturers.

This bill would prohibit an authorizing physician and surgeon from being subject to professional review, being liable in a civil action, or being subject to criminal prosecution forbegin delete any act inend delete thebegin delete issuingend deletebegin insert issuanceend insert of a prescription or order, pursuant to these provisions, unless thebegin delete actend deletebegin insert physician and surgeon’s issuanceend insert constitutes gross negligence or willful or malicious conduct.

Vote: majority. Appropriation: no. Fiscal committee: no. State-mandated local program: no.

The people of the State of California do enact as follows:

P2    1

SECTION 1.  

Section 49414 of the Education Code is amended
2to read:

3

49414.  

(a) School districts, county offices of education, and
4charter schools shall provide emergency epinephrine auto-injectors
5to school nurses or trained personnel who have volunteered
6pursuant to subdivision (d), and school nurses or trained personnel
7may use epinephrine auto-injectors to provide emergency medical
8aid to persons suffering, or reasonably believed to be suffering,
9from an anaphylactic reaction.

10(b) For purposes of this section, the following terms have the
11following meanings:

12(1) “Anaphylaxis” means a potentially life-threatening
13hypersensitivity to a substance.

14(A) Symptoms of anaphylaxis may include shortness of breath,
15 wheezing, difficulty breathing, difficulty talking or swallowing,
16hives, itching, swelling, shock, or asthma.

17(B) Causes of anaphylaxis may include, but are not limited to,
18an insect sting, food allergy, drug reaction, and exercise.

19(2) “Authorizing physician and surgeon” may include, but is
20not limited to, a physician and surgeon employed by, or contracting
21with, a local educational agency, a medical director of the local
22health department, or a local emergency medical services director.

23(3) “Epinephrine auto-injector” means a disposable drug delivery
24system with a spring-activated needle that is designed for
25emergency administration of epinephrine to provide rapid,
26convenient first aid for persons suffering a potentially fatal reaction
27to anaphylaxis.

28(4) “Qualified supervisor of health” may include, but is not
29limited to, a school nurse.

30(5) “Volunteer” or “trained personnel” means an employee who
31has volunteered to administer epinephrine auto-injectors to a person
32if the person is suffering, or reasonably believed to be suffering,
33from anaphylaxis, has been designated by a school, and has
34received training pursuant to subdivision (d).

P3    1(c) Each private elementary and secondary school in the state
2may voluntarily determine whether or not to make emergency
3epinephrine auto-injectors and trained personnel available at its
4school. In making this determination, a school shall evaluate the
5emergency medical response time to the school and determine
6whether initiating emergency medical services is an acceptable
7alternative to epinephrine auto-injectors and trained personnel. A
8private elementary or secondary school choosing to exercise the
9authority provided under this subdivision shall not receive state
10funds specifically for purposes of this subdivision.

11(d) Each public and private elementary and secondary school
12in the state may designate one or more volunteers to receive initial
13and annual refresher training, based on the standards developed
14pursuant to subdivision (e), regarding the storage and emergency
15use of an epinephrine auto-injector from the school nurse or other
16qualified person designated by an authorizing physician and
17surgeon.

18(e) (1) Every five years, or sooner as deemed necessary by the
19Superintendent, the Superintendent shall review minimum
20standards of training for the administration of epinephrine
21auto-injectors that satisfy the requirements of paragraph (2). For
22purposes of this subdivision, the Superintendent shall consult with
23organizations and providers with expertise in administering
24epinephrine auto-injectors and administering medication in a school
25environment, including, but not limited to, the State Department
26of Public Health, the Emergency Medical Services Authority, the
27American Academy of Allergy, Asthma and Immunology, the
28California School Nurses Organization, the California Medical
29Association, the American Academy of Pediatrics, Food Allergy
30Research and Education, the California Society of Allergy, Asthma
31and Immunology, the American College of Allergy, Asthma and
32Immunology, the Stanford Allergy Center, and others.

33(2) Training established pursuant to this subdivision shall include
34all of the following:

35(A) Techniques for recognizing symptoms of anaphylaxis.

36(B) Standards and procedures for the storage, restocking, and
37emergency use of epinephrine auto-injectors.

38(C) Emergency followup procedures, including calling the
39emergency 911 telephone number and contacting, if possible, the
40pupil’s parent and physician.

P4    1(D) Recommendations on the necessity of instruction and
2certification in cardiopulmonary resuscitation.

3(E) Instruction on how to determine whether to use an adult
4epinephrine auto-injector or a junior epinephrine auto-injector,
5which shall include consideration of a pupil’s grade level or age
6as a guideline of equivalency for the appropriate pupil weight
7determination.

8(F) Written materials covering the information required under
9this subdivision.

10(3) Training established pursuant to this subdivision shall be
11 consistent with the most recent Voluntary Guidelines for Managing
12Food Allergies In Schools and Early Care and Education Programs
13published by the federal Centers for Disease Control and
14Prevention and the most recent guidelines for medication
15administration issued by the department.

16(4) A school shall retain for reference the written materials
17prepared under subparagraph (F) of paragraph (2).

18(f) A school district, county office of education, or charter school
19shall distribute a notice at least once per school year to all staff
20that contains the following information:

21(1) A description of the volunteer request stating that the request
22is for volunteers to be trained to administer an epinephrine
23auto-injector to a person if the person is suffering, or reasonably
24believed to be suffering, from anaphylaxis, as specified in
25subdivision (b).

26(2) A description of the training that the volunteer will receive
27pursuant to subdivision (d).

28(g) (1) A qualified supervisor of health at a school district,
29county office of education, or charter school shall obtain from an
30authorizing physician and surgeon a prescription for each school
31for epinephrine auto-injectors that, at a minimum, includes, for
32elementary schools, one regular epinephrine auto-injector and one
33junior epinephrine auto-injector, and for junior high schools, middle
34schools, and high schools, if there are no pupils who require a
35junior epinephrine auto-injector, one regular epinephrine
36auto-injector. A qualified supervisor of health at a school district,
37county office of education, or charter school shall be responsible
38for stocking the epinephrine auto-injector and restocking it if it is
39used.

P5    1(2) If a school district, county office of education, or charter
2school does not have a qualified supervisor of health, an
3administrator at the school district, county office of education, or
4charter school shall carry out the duties specified in paragraph (1).

5(3) A prescription pursuant to this subdivision may be filled by
6local or mail order pharmacies or epinephrine auto-injector
7manufacturers.

8(4) An authorizing physician and surgeon shall not be subject
9to professional review, be liable in a civil action, or be subject to
10criminal prosecution forbegin delete any act inend delete thebegin delete issuingend deletebegin insert issuanceend insert of a
11prescription or order pursuant to this section, unless thebegin delete actend delete
12begin insert physician and surgeon’s issuanceend insert constitutes gross negligence or
13willful or malicious conduct.

14(h) A school nurse or, if the school does not have a school nurse
15or the school nurse is not onsite or available, a volunteer may
16administer an epinephrine auto-injector to a person exhibiting
17potentially life-threatening symptoms of anaphylaxis at school or
18a school activity when a physician is not immediately available.
19If the epinephrine auto-injector is used it shall be restocked as soon
20as reasonably possible, but no later than two weeks after it is used.
21Epinephrine auto-injectors shall be restocked before their expiration
22date.

23(i) A volunteer shall initiate emergency medical services or
24other appropriate medical followup in accordance with the training
25materials retained pursuant to paragraph (4) of subdivision (e).

26(j) A school district, county office of education, or charter school
27shall ensure that each employee who volunteers under this section
28will be provided defense and indemnification by the school district,
29county office of education, or charter school for any and all civil
30liability, in accordance with, but not limited to, that provided in
31Division 3.6 (commencing with Section 810) of Title 1 of the
32Government Code. This information shall be reduced to writing,
33provided to the volunteer, and retained in the volunteer’s personnel
34file.

35(k) A state agency, the department, or a public school may
36accept gifts, grants, and donations from any source for the support
37of the public school carrying out the provisions of this section,
P6    1including, but not limited to, the acceptance of epinephrine
2auto-injectors from a manufacturer or wholesaler.



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