BILL ANALYSIS
AB 942
Page 1
Date of Hearing: April 2, 2003
As Proposed To Be Amended
ASSEMBLY COMMITTEE ON EDUCATION
Jackie Goldberg, Chair
AB 942 (Leno) - As Amended: March 26, 2003
SUBJECT : Emergency medical services: Diabetes
[Note: This bill has been referred to the Assembly Health
Committee and will be heard as it relates to the issues under
its jurisdiction. This analysis will focus on the K-12
education aspects of the bill.]
SUMMARY : Authorizes, in the absence of a credentialed school
nurse or other licensed nurse onsite the school, each school
district to provide school personnel with voluntary emegency
medical training to provide emergency medical assistance to
pupils with diabetes in accordance with the standards set forth
in the bill and the instructions set forth by the physician of
the pupil. Specifically, this bill :
1)Requires the State Department of Health Services' Diabetes
Control Program, in cooperation with the following entities,
to establish standards of training and supervision for school
personnel in providing emergency medical assistance to pupils
with diabetes:
a) Board of Registered Nursing;
b) State Department of Education;
c) American Diabetes Association;
d) California School Nurses Association;
e) California Medical Association; and
f) American Academy of Pediatrics.
2)Requires the training established above to include:
a) Recognition and treatment of hypoglycemia;
b) Administration of glucagon; and
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c) Basic emergency follow-up procedures, including calling
the emergency 911 phone number and contacting, if possible,
the pupils parent and physician.
3)Specifies that training by physician, credentialed nurse, or
other licensed nurse according to these standards to be deemed
adequate training of school personnel.
4)Requires a school employee to notify the credentialed school
nurse assigned to the school district whenever he or she
administers glucagon.
5)Requires the materials necessary for glucagon administration
to be provided by the parent or guardian of the pupil.
6)Permits a pupil with diabetes who is able to self-test and
monitor his or her blood gluclose level, upon written request
of the parent or guardian, and with authorization of the
licensed health care provider of the pupil, to test his or her
blood gluclose level and to otherwise provide self-care in the
classroom, in any area of the school or school grounds, during
any school-related activity, and, upon specific request by a
parent or guardian, a private location.
7)Defines the following terms:
a) "School personnel" is any one or more employees of a
school district who volunteer to be trained to administer
emergency medical assistance to a pupil with diabetes.
b) "Emergency medical assistance" is the administration of
glucagon when a pupil is suffering from severe
hypoglycemia.
EXISTING LAW provides that each pupil who is required to take,
during the regular schoolday, medication prescribed for him or
her by a physician, may be assisted by the school nurse or other
designated school personnel if the school district receives a
written statement from the physician detailing the method,
amount and time schedules by which the medication is to be taken
and a written statement from the parent or guardian of the pupil
indicating the desire that the school district assist the pupil
in the matters set forth in the physician's statement.
FISCAL EFFECT : Unknown
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COMMENTS :
Are there dangers to authorizing any school personnel to
administer glucagon? Individuals suffering from severe
hypoglycemia may be unconscious or having a seizure or
convulsions. In these severe cases, glucagon can be given to
raise blood glucose levels immediately. Glucagon cannot be
self-administered and must be administered through injection,
however, according to the American Diabetes Association,
glucagon is a safe medication and there is no danger of
overdose.
School district liability . The bill authorizes trained personnel
to provide "emergency medical assistance". There are several
provisions that protect individuals who assist during an
emergency situation. The education code provides that no school
district, officer of a school district, principal, physician, or
hospital treating any child enrolled in any school shall be held
liable for the reasonable treatment of a child without the
consent of a parent or guardian when the child is ill or injured
during regular school hours, requires reasonable medical
treatment, and the parent or guardian cannot be reached.
Therefore, liability should not be an issue with this bill.
Prior legislation.
AB 481 (Firebaugh) of 2002 would have required a credentialed
school nurse or other licensed nurse, or in the absence of a
nurse, teachers who have volunteered and school administrators
with appropriate DHS-approved training, to administer insulin or
glucagon and perform testing and monitoring of a pupil's blood
glucose level in accordance with instructions set forth by the
pupil's physician. The bill also prohibited designated school
personnel from being required to administer assistance to pupils
with diabetes unless the parent or guardian has signed a waiver
of liability. In addition, the bill authorized pupils to test
their blood glucose level and provide diabetes self-care in any
area of the school or during school-related activities at the
request of a parent or guardian and with physician
authorization.
The bill was vetoed because, according to the Governor, the bill
"would create a costly new state reimbursable mandate estimated
by the Department of Finance to be potentially tens of millions
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of dollars. In addition, I am advised by school district
personnel that the immunity from liability language may protect
neither the school district or school personnel from liability."
Arguments in support. According to the author, "There is much
confusion over whether school personnel can actually administer
medication, which has led to inconsistent school health policies
across the state. Many argue only licensed nurses can
administer medication in schools and this has resulted in all
too many situations where, when the school has no school nurse
on site, the child is forced to simply go without necessary
medication. AB 942 would address this problem for diabetic
students who may require medication in emergency situations by
allowing a school that is attended by a child with diabetes to
train personnel to administer glucagon, a life-saving
medication, used to treat severe hypoglycemia. AB 942 would also
require students who are able to self-test their blood sugar
levels be allowed to do so in the classroom or anywhere else on
campus."
Arguments in opposition. The American Nurses Association of
California is opposed to the bill unless the following
amendments are taken:
1)"School personnel means any one or more employees of a school
district who volunteer to be trained to administer emergency
medical assistance to pupils with diabetes. In addition, the
designated school personnel should have a current certificate
in Basic Care Life Support."
Rational: The BCLS programs offered by the Red Cross educate
the participant to recognize and respond to respiratory and/or
cardiac emergencies in infants, children and adults. This CPR
Certification provides training for the one or two person CPR
protocol.
2)"Training by a physician, credentialed school nurse, or other
licensed nurse certificated public health nurse or registered
nurse."
Rational: We believe the training should be provided by
someone with a background and experience in nursing and/or
medicine. When training lay school personnel to provide this
training and particularly when there is no supervision, we
believe someone with the aforementioned background and
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experience would be more appropriate to address the issues
that might arise.
REGISTERED SUPPORT / OPPOSITION :
Support
American Diabetes Association (sponsor)
California County Boards of Education
California Medical Association
Diabetes Coalition of California
Opposition
California Association for Health, Physical Education,
Recreation and Dance
California Federation of Teachers
Analysis Prepared by : Misty Padilla / ED. / (916) 319-2087