BILL ANALYSIS
AB 942
Page 1
Date of Hearing: April 29, 2003
ASSEMBLY COMMITTEE ON HEALTH
Dario Frommer, Chair
AB 942 (Leno) - As Amended: April 24, 2003
SUBJECT : Emergency medical services: diabetes.
SUMMARY : Authorizes school staff to provide emergency medical
assistance to diabetic pupils suffering from severe
hypoglycemia. Specifically, this bill :
1)Requires that the American Diabetes Association, in
cooperation with the State Department of Education (SOE),
California School Nurses Organization, California Medical
Association, and American Academy of Pediatrics, to develop
performance standards for the training and supervision of
school personnel in providing emergency medical assistance to
pupils with diabetes suffering from severe hypoglycemia
2)Requires the Department of Health Services' (DHS) Diabetes
Prevention and Control Program to approve the above standards
and to make them available upon request.
3)Authorizes school districts to provide personnel with
voluntary training in accordance with the above standards in
the absence of a credentialed school nurse or other licensed
nurse.
4)Specifies that the training include recognition and treatment
of hypoglycemia, administration of glucagon, and basic
emergency follow-up procedures.
5)Authorizes trained personnel to administer emergency medical
assistance to pupils with diabetes suffering from severe
hypoglycemia.
6)Requires a school employee to notify the school nurse when
he/she administers glucagon and specifies that all materials
necessary to administer glucagon be provided by the student's
parent or guardian.
7)Permits a diabetic student to test his/her blood glucose level
with a written request of a parent or guardian and
authorization from the student's health care provider.
AB 942
Page 2
EXISTING LAW
1)Requires that school districts give diligent care to the
health and physical development of pupils and permits school
districts to employ properly certified personnel for this
purpose.
2)Permits a student who is required to take medication to be
assisted by the school nurse or other designated school
personnel if the school district receives written statements
from the student's parent or guardian and health care
provider.
FISCAL EFFECT : Unknown
AB 942
Page 3
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, there is
significant confusion over who can administer medication in
schools, which leads to inconsistent school health policies.
Many argue only licensed nurses can administer medication in
schools and results in a situation where, when there is no
school nurse on site, a child must go without necessary
medication. Existing California law has led to a disconnect,
where schools are required to meet pupil health needs but only
certified persons are permitted to fulfill such obligations.
School districts are not required to employ these certified
persons, and many do not. Consequently, many California
schools have no staff to attend to pupil's emergency health
needs. This bill would address this problem for diabetic
students who may require medication in emergency situations.
2)HYPOGLYCEMIA . Hypoglycemia, also called low blood sugar,
occurs when blood sugar levels drop too low to provide enough
energy for the body. After a meal, glucose is absorbed into
the bloodstream and carried to cells. If more glucose is
taken in than the body needs, it stores the extra glucose in
the liver and muscles in a form called glycogen and uses it as
needed. When blood glucose begins to fall, glucagon signals
the liver to break down glycogen and release glucose, causing
levels in the blood to rise. In the diabetic person, this
glucagon response to hypoglycemia may be impaired, making it
harder for glucose levels to return to the normal range.
Symptoms of hypoglycemia include hunger, shakiness,
perspiration, dizziness, sleepiness, confusion, difficulty
speaking, and weakness. In severe cases, a person may become
unconscious or experience convulsions. Glucagon raises blood
glucose levels immediately, but in severe cases cannot be
self-administered.
3)SELF-TESTING OF BLOOD SUGAR . To properly manage their
disease, diabetics must monitor the level of sugar in their
blood. Diet, medicines, physical activity, sickness, and
stress can affect blood sugar levels. Knowing blood sugar
levels helps diabetics control the disease on a daily basis as
well as informs their health care provider's decisions
regarding treatment plans. Testing is relatively simple and
usually involves pricking a finger to obtain a small amount of
blood, placing the blood on a test strip, and inserting the
test strip into a blood sugar meter.
AB 942
Page 4
4)NURSING SHORTAGE . California is in the midst of a nursing
shortage, especially in public schools. Public schools lack
the funding to employ school nurses or other licensed health
professionals. According to the California School Nurses
Organization, there are 2,469 credentialed school nurses for
over six million public school children. Many of these school
nurses are "roaming" nurses and not full-time at any one
particular school. There are approximately 15,000 children
in California with diabetes, and prevalence rates are
particularly high in Latino, African-American, Native American
and Asian/Pacific Islander populations.
5)PREVIOUS LEGISLATION . AB 481 (Firebaugh) of 2002 would have
required properly trained teachers to administer insulin or
glucagon and perform testing and monitoring of a pupil's blood
glucose level in the absence of a school nurse. The bill also
prohibited school personnel from being required to provide
assistance to diabetic pupils unless the parent or guardian
has signed a waiver of liability and authorized pupils to test
their blood glucose level and provide diabetes self-care. The
bill was vetoed by the Governor because it "?would create a
costly new state reimbursable mandate estimated by the
Department of Finance to be potentially tens of millions 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."
6)EDUCATION COMMITTEE ACTION . This bill was heard in the
Assembly Committee on Education on April 2, 2003, and was
approved by a vote of 9 - 0.
REGISTERED SUPPORT / OPPOSITION :
Support
American Diabetes Association (Sponsor)
California State PTA
California Medical Association
Diabetes Coalition of California
Juvenile Diabetes Research Foundation
Latino Coalition for a Health California
University of California, San Francisco Diabetes Center
Two individuals
AB 942
Page 5
Opposition
American Nurses Association California
Analysis Prepared by : Melanie Moreno / HEALTH / (916)
319-2097