BILL ANALYSIS                                                                                                                                                                                                    Ó



          SENATE COMMITTEE ON HEALTH
                          Senator Ed Hernandez, O.D., Chair

          BILL NO:                    SB 1258             
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          |AUTHOR:        |Huff                                           |
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          |VERSION:       |March 29, 2016                                 |
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          |HEARING DATE:  |April 6, 2016  |               |               |
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          |CONSULTANT:    |Reyes Diaz                                     |
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           SUBJECT  :  Pupil health: food allergies: local educational agency  
          policy

           SUMMARY  :  Requires a school district, county office of education, and  
          charter school to develop a comprehensive policy, as specified,  
          in coordination with specified individuals, to protect pupils  
          with food allergies.
          
          Existing law:
          1)Requires school districts, county offices of education, and  
            charter schools to provide emergency epinephrine  
            auto-injectors (EAIs) to school nurses and trained personnel  
            who have volunteered, as specified, and would authorize school  
            nurses and trained personnel to use EAIs to provide emergency  
            medical aid to persons suffering, or reasonably believed to be  
            suffering, from an anaphylactic reaction.

          2)Requires a qualified supervisor of health or administrator at  
            a school district, county office of education, or charter  
            school to obtain the prescription for EAIs from an authorizing  
            physician and surgeon, as defined, and would authorize the  
            prescription to be filled by local or mail order pharmacies or  
            EAI manufacturers.
          
          This bill:
          1)Requires a school district, county office of education, and  
            charter school to develop a comprehensive policy to protect  
            pupils with food allergies. Requires the policy to include, at  
            a minimum, protocols for pupils with food allergies that  
            pertain to all of the following:

                  a)        School stocking of medication, including  
                    storage of medication in classrooms;







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                  b)        School parties;
                  c)        Lunch time, including seating arrangements;
                  d)        Food served by the local educational agency  
                    (LEA);
                  e)        After-school events;
                  f)        Field trips;
                  g)        Bullying;
                  h)        Recess; and,
                  i)        Teacher and employee training.

          2)Requires a LEA to create the policy in coordination with, at a  
            minimum:

                  a)        A LEA or schoolsite nurse, or if there is no  
                    LEA or schoolsite nurse, the LEA or schoolsite's  
                    designated health personnel;
                  b)        A parent of a pupil with a food allergy;
                  c)        An ad hoc parent; and,
                  d)        A director of food services.

           FISCAL  
          EFFECT  : This bill has not been analyzed by a fiscal committee.
           COMMENTS  :
          1)Author's statement. According to the author, in 2014,  
            recognizing the importance of a new and emerging life  
            threatening health issue, the Legislature acted in a  
            bi-partisan manner and passed SB 1266 (Huff, Chapter 321,  
            Statutes of 2014), which required extra EAIs in public schools  
            in case of emergencies. That landmark legislation helped  
            cement the Legislature's commitment to ensure students with  
            life threatening allergies are safe at school. After my work  
            on SB 1266, it became apparent that schools are lacking in  
            policies and direction on how to accommodate children with  
            food allergies. Whether it be lunch hour seating, field trips,  
            school parties, storage of medication, or bullying, there  
            currently is no comprehensive approach. According to the  
            California School Boards Association (CSBA), approximately 1/3  
            of schools have policies on this issue. This means many  
            schools have no policies at all, leaving parents and teachers  
            in a predicament on how to ensure children are safe during  
            school hours. The lack of consistency on this issue leaves  
            schools open for liability concerns. SB 1258 will require  
            districts to create a policy to address accommodations and  
            safety measures. These policies will help ensure the safety  
            for the student, provide clear direction to teachers, and ease  








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            liability for the district.  
            
          2)Background. According to the Food Allergy Research & Education  
            (FARE) Web site, eight foods account for 90% of all reactions:  
            milk, eggs, peanuts, tree nuts, soy, wheat, fish, and  
            shellfish. Even trace amounts of a food allergen can cause a  
            reaction. Researchers estimate that up to 15 million Americans  
            have food allergies. This potentially deadly disease affects  
            one in every 13 children (under 18 years of age) in the U.S.,  
            equaling roughly two in every classroom. According to a study  
            released in 2013 by the Centers for Disease Control and  
            Prevention, food allergies among children increased  
            approximately 50% between 1997 and 2011. FARE's Web site  
            state's the economic cost of children's food allergies is  
            nearly $25 billion per year. Teenagers and young adults with  
            food allergies are at the highest risk of fatal food-induced  
            anaphylaxis.  CSBA has a sample policy that addresses  
            students' food allergies and special dietary needs, including  
            the development of guidelines that address things such as  
            strategies for identifying students at risk for allergic  
            reactions, avoidance measures, education of staff regarding  
            typical symptoms, and actions to be taken in the event of a  
            severe allergic reaction. CSBA notes in the sample policy that  
            it is prohibited to exclude students from school activities or  
            otherwise discriminate against, harass, intimidate, or bully  
            them because of their food allergies. 

          3)What is anaphylaxis? According to the National Institutes of  
            Health, anaphylaxis is a severe, whole-body allergic reaction  
            to a chemical that has become an allergen. After being exposed  
            to a substance, such as bee sting venom, the person's immune  
            system becomes sensitized to it. When the person is exposed to  
            that allergen again, an allergic reaction may occur.  
            Anaphylaxis happens quickly after the exposure, is severe, and  
            involves the whole body. Tissues in different parts of the  
            body release histamine and other substances. This causes the  
            airways to tighten and leads to other symptoms. Some drugs  
            (such as morphine, 
            x-ray dye, and aspirin) may cause an anaphylactic-like  
            reaction when people are first exposed to them. These  
            reactions are not the same as the immune system response that  
            occurs with true anaphylaxis. However, the symptoms, risk for  
            complications, and treatment are the same for both types of  
            reactions. Risks include a history of any type of allergic  
            reaction. According to Food Allergy Research & Education  








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            (FARE), approximately 25% of first-time allergic reactions  
            that require epinephrine happen at school.

          4)Double referral. Should this bill pass out of this Committee,  
            it will be referred to the Senate Education Committee.

          5)Prior legislation. SB 738 (Huff, Chapter 132, Statutes of  
            2015), prohibits an authorizing physician and surgeon from  
            being subject to professional review, being liable in a civil  
            action, or being 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.

            SB 1266, requires school districts, county offices of  
            education, and charter schools to provide emergency EAIs to  
            school nurses and trained personnel who have volunteered, as  
            specified, and would authorize school nurses and trained  
            personnel to use EAIs to provide emergency medical aid to  
            persons suffering, or reasonably believed to be suffering,  
            from an anaphylactic reaction. 

            SB 669 (Huff, Chapter 725, Statutes of 2013), permits a  
            prehospital emergency medical care person or lay rescuer to  
            obtain and use an EAI in emergency situations with  
            certification of training, as specified.   

            SB 1069 (Pavley, Chapter 512, Statutes of 2010), in addition  
            to expanding the scope of practice for physician assistants in  
            other instances, added physician assistants, in addition to  
            physician and surgeons, from whom a school pupil must obtain a  
            written statement in order to carry and self-administer a  
            prescription EAI.

            SB 1912 (Ashburn, Chapter 846, Statutes of 2004), permits  
            pupils to carry and self-administer inhaled asthma medication  
            or an EAI at school, as specified.

            AB 559 (Wiggins, Chapter 458, Statutes of 2001), permits a  
            school district or county office of education to provide  
            emergency EAIs to trained personnel, and permits trained  
            personnel to utilize these EAIs to provide emergency medical  
            aid to persons suffering from an anaphylactic reaction at a  
            school or during a school activity.









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           SUPPORT AND OPPOSITION  :
          Support:  None received
          
          Oppose:   None received
          

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