BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 942|
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THIRD READING
Bill No: AB 942
Author: Leno (D)
Amended: 8/28/03 in Senate
Vote: 21
SENATE EDUCATION COMMITTEE : 10-0, 6/25/03
AYES: Vasconcellos, McPherson, Alarcon, Alpert, Chesbro,
Denham, Karnette, Romero, Scott, Vincent
NO VOTE RECORDED: Knight, Sher, Speier
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 76-0, 5/27/03 - See last page for vote
SUBJECT : Emergency medical services
SOURCE : American Diabetes Association
DIGEST : 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. This bill also
encourages the development of performance standards, as
specified, for the training and supervision of school
personnel providing the specified emergency services.
ANALYSIS : 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.
CONTINUED
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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
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.
This 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. This 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. A school employee who does
not volunteer or who has not been trained may not be
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required to provide this assistance.
2. Encourages the American Diabetes Association to develop
performance standards for the training and supervision
of school personnel who provide emergency medical
assistance to students suffering from severe
hypoglycemia.
3. Specifies the development of performance standards shall
be 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. Provides the performance standards would be approved and
made available by the State Department of Health
Services (DHS).
5. Requires the training to include recognition and
treatment of hypoglycemia, administration of glucagon,
and basic emergency follow-up procedures, as specified.
6. Requires that training be provided only by a physician,
credentialed school nurse, registered nurse, or
certificated public health nurse, as specified.
7. Requires a school employee to notify the credentialed
school nurse assigned to the school district if they
administer glucagon, as specified.
8. Specifies that if a credentialed school nurse is not
assigned to the school district, the school employee
shall notify the superintendent of the district if he or
she administers the glucagon.
9. Requires the parent or guardian of a pupil to supply all
materials necessary to administer glucagon.
10.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.
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11.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.
This bill defines "emergency medical assistance" as the
administration of glucagon when a pupil is suffering
from severe hypoglycemia.
Comments
According to the author's office, "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 problem for diabetic students who may require
medication in emergency situations."
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 six million children in the
California public school system.
According to surveys conducted by the California PTA,
California schools with full-time nurses fell from seven
percent in 1998 to five 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
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percent during this same time period.
The National Diabetes Education Program (NDEP) has recently
completed a template of recommended standards for diabetes
management in schools, titled, "Helping the Student with
Diabetes Succeed: A guide for school personnel". 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, and the
United States Department of Education along with numerous
other national education associations.
Previous legislation . AB 481 (Firebaugh) of 2002, which
was vetoed, 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."
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 8/28/03)
American Diabetes Association (source)
California School Boards Association
California State PTA
Diabetes Coalition of California
OPPOSITION : (Verified 8/28/03)
American Nurses Association of California
California School Nurses Association
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ARGUMENTS IN SUPPORT : 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.
ARGUMENTS IN OPPOSITION : 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.
ASSEMBLY FLOOR :
AYES: Aghazarian, Bates, Benoit, Berg, Bermudez, Bogh,
Calderon, Canciamilla, Chan, Chu, Cogdill, Cohn, Corbett,
Correa, Cox, Daucher, Diaz, Dutra, Dutton, Dymally,
Firebaugh, Frommer, Garcia, Hancock, Harman, Haynes,
Jerome Horton, Shirley Horton, Houston, Jackson, Keene,
Kehoe, Koretz, La Malfa, La Suer, Laird, Leno, Leslie,
Levine, Lieber, Liu, Longville, Lowenthal, Maddox,
Maldonado, Matthews, Maze, McCarthy, Montanez, Mountjoy,
Mullin, Nakanishi, Nakano, Nation, Negrete McLeod, Nunez,
Oropeza, Parra, Pavley, Plescia, Reyes, Richman,
Ridley-Thomas, Runner, Salinas, Samuelian, Simitian,
Spitzer, Steinberg, Strickland, Vargas, Wiggins, Wolk,
Wyland, Yee, Wesson
NC:mel 8/28/03 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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