BILL ANALYSIS
SENATE COMMITTEE ON EDUCATION
John Vasconcellos, Chair
2003-2004 Regular Session
BILL NO: AB 942
AUTHOR: Leno
AMENDED: April 24, 2003
FISCAL COMM: Yes HEARING DATE: June 25, 2003
URGENCY: No CONSULTANT:Marlene L. Garcia
SUBJECT : Emergency Medical Services: diabetes
SUMMARY
This bill authorizes school districts, in the absence of an
on site credentialed school nurse or other licensed nurse,
to provide school personnel with voluntary emergency
medical training to assist pupils with diabetes who are
suffering from severe hypoglycemia. The bill also requires
the development of performance standards, as specified, for
the training and supervision of school personnel providing
the specified emergency services.
BACKGROUND
Current law requires that the school districts give
diligent care to the health and physical development of
pupils, and may employ properly certified persons for the
work.
Current law permits a student who is required to take
medication during the school day to be assisted by a school
nurse or designated school personnel if the school district
receives written statements from the pupil's parent or
guardian and healthcare provider.
Current law also protects state and local government
agencies or other public or private organizations that
train individuals to provide emergency medical services
from liability for any civil damages alleged to result from
those training programs. The purpose of this statute is to
encourage training and remove fear of liability. This law
excludes physicians, surgeons, registered nurses, and
licensed vocational nurses, as defined. It is presumed
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that these professionals have extensive training and
therefore are held accountable for their performance. All
licensed nurses are required to obtain professional
liability insurance.
The incidence of childhood diabetes is on the rise. There
are approximately 15,000 children in California with
diabetes, a figure that is expected to double in the next
20 years.
A diabetic child experiencing severe hypoglycemia may
become unconscious or develop seizures or convulsions,
requiring prompt medical attention. Trained school
personnel must immediately administer glucagon, a
life-saving medication used to treat severe hypoglycemia.
Hypoglycemia occurs when blood glucose levels are too low.
Glucagon raises blood glucose levels immediately.
ANALYSIS
The bill :
1) Permits a school district, in the absence of an on
site credentialed school nurse or other licensed
nurse, to provide volunteer school personnel with
emergency medical training to assist students with
diabetes suffering from severe hypoglycemia. The bill
specifies that school personnel providing this
emergency care must do so in accordance with the
standards to be developed as specified in the bill.
2) Requires the Department of Health Services (DHS) to
approve the performance standards for the training and
supervision of school personnel who provide emergency
medical assistance to students suffering from severe
hypoglycemia. DHS is required to make the standards
available for distribution upon request.
3) Requires the development of performance standards by
American Diabetes Association in cooperation with the
State Department of Education (SDE), the California
School Nurses Organization, the California Medical
Association, and the American Academy of Pediatrics.
4) Requires the training to include recognition and
treatment of hypoglycemia, administration of glucagon,
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and basic emergency follow-up procedures, as
specified.
5) Requires that training be provided only by a
physician, credentialed school nurse, registered
nurse, or certificated public health nurse, as
specified.
6) Requires a school employee to notify the credentialed
school nurse assigned to the school district if they
administer glucagon, as specified.
7) Requires the parent or guardian of a pupil to supply
all materials necessary to administer glucagon.
8) Specifies that students who are able to self-test
their blood sugar levels be allowed to do so in the
classroom or anywhere else on campus, as specified,
upon written request of the parent and authorization
of the licensed health care provider of the pupil.
9) Defines "school personnel" as any one or more
employees of a school district who volunteer to be
trained to administer emergency medical assistance to
a pupil. The bill defines "emergency medical
assistance" as the administration of glucagon when a
pupil is suffering from severe hypoglycemia.
STAFF COMMENTS
1) Rationale for the 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,
which 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 pupils'
emergency health needs. This bill would address this
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problem for diabetic students who may require
medication in emergency situations."
2) School nursing shortage . There is a severe nursing
shortage in California, especially in K-12 schools.
As a result of funding reductions, cash-strapped
schools are hiring fewer school nurses. According to
the California School Nurses Organization, there are
only 2,695 credentialed school nurses who serve more
than 6 million children in the California public
school system.
According to surveys conducted by the California PTA,
California schools with full-time nurses fell from 7
percent in 1998 to 5 percent this year. Schools with
part-time nurses fell from 75 percent to 69 percent,
and schools with no nurse at all increased from 19
percent to 26 percent in 2003. Most school nurses now
are "roaming" nurses and are not full-time at any one
particular school.
Additionally, schools were a part-time non-medical person
handles student health care increased from 44 percent
to 66 percent during this same time period.
3) Previous legislation . AB 481 (Firebaugh) of 2002 was
vetoed which would have required properly trained
teachers and school administrators, in the absence of
a credentialed school nurse or other licensed nurse,
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 Governor's veto message stated in
pertinent part:
"This bill 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."
4) The National Diabetes Education Program (NDEP). The
NDEP has recently completed a template of recommended
standards for diabetes management in schools, titled,
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"Helping the Student with Diabetes Succeed: A guide
for school personnel". The NDEP developed the guide
in conjunction with more than 200 partner
organizations, including such organizations as the
National School Nurses Association, the American
Academy of Pediatrics, the American Diabetes
Association, the U.S. Department of Education along
with numerous other national education associations.
Should the bill urge those responsible for developing
performance standards in California build on the work
of this national standards model?
5) Who should train school personnel to administer
emergency medical services ? The bill currently
requires that training be conducted only by
physicians, credentialed school nurses, Registered
Nurses (RN's), or certificated public health nurses to
administer this training. The California School
Nurses Association argues that not all RN's have
sufficient education to provide the training required
in the bill. They believe many RN's have not been
trained in school site nursing or diabetes education.
On the other hand, a credentialed school nurse and a
public health nurse have been trained to work on a
school site, and to train and supervise school
personnel in emergency treatment of glucagon. The
sponsors of the bill, the American Diabetes
Association (ADA), believe a licensed RN is qualified
to train school personnel on how to respond to
diabetes medical emergencies. Because of the current
nursing shortage, the ADA does not want to further
limit the pool of nurses who are capable of
administering the training required in the bill.
Currently, there are 279,377 active RN's in
California.
6) What if a school district does not have an assigned
school nurse ? The bill requires a school employee to
notify the credentialed school nurse assigned to the
school district if they administer glucagon to a
pupil. However, there are many school districts that
do not have an assigned school nurse. Staff
recommends the bill be amended to state:
Page 3, line 21, insert after district:
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or if there is no credentialed school nurse assigned to the
district, the school employee is required to notify
the school district superintendent, or such person
designated by the superintendent
SUPPORT
American Diabetes Association
California School Boards Association
California State PTA
Diabetes Coalition of California
OPPOSITION
American Nurses Association of California
California School Nurses Organization