BILL ANALYSIS
AB 1430
Page 1
Date of Hearing: May 12, 2009
ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS
Mary Hayashi, Chair
AB 1430 (Swanson) - As Amended: April 27, 2009
SUBJECT : Pupil health: licensed nurses.
SUMMARY : Requires any necessary medication to be administered
to a student by a licensed health care professional operating
within the scope of his or her practice. Specifically, this
bill :
1)Requires any necessary medication, excluding self-administered
auto-injectable epinephrine or self-administered inhaled
asthma medication, that is administered to a pupil during the
regular schoolday, to be administered by a licensed health
care professional operating within the scope of his or her
practice.
2)States that nothing in the bill prohibits an individual from
rendering emergency medical aid in any of the following
circumstances:
a) Pupils suffering from an anaphylactic reaction or pupils
with diabetes suffering from severe hypoglycemia;
b) When it appears to the individual that the child is in
clear and present danger; or,
c) In the event of an emergency, including an epidemic or
public disaster.
3)States that nothing in this section prevents unlicensed
personnel from assisting pupils with medication as provided by
law.
4)Permits a school nurse to administer medication to a pupil or
otherwise assist a pupil in the administration of medication
as allowed by law and in keeping with applicable standards of
professional practice.
5)Permits other designated school personnel to administer
medication to pupils or otherwise assist pupils in the
administration of medication as allowed by law and, if they
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are licensed health care professionals, in keeping with
applicable standards of professional practice for their
license.
6)Permits the pupil's parent or legal guardian to administer
medication to the pupil or otherwise assist the pupil in the
administration of medication as allowed by law.
7)Permits an individual designated by the parent or legal
guardian, who shall not be an employee of the local
educational agency, to administer medication to the pupil or
otherwise assist the pupil in administration of medication as
allowed by law.
8)Makes Legislative findings and declarations.
EXISTING LAW :
1)Provides that any pupil who is required to take, during the
regular schoolday, medication prescribed for him or her by a
physician and surgeon may be assisted by the school nurse or
other designated school personnel, or may carry and
self-administer prescription auto-injectable epinephrine if
the school district receives the appropriate written
statements, as prescribed, from the physician and the parent,
foster parent, or guardian of the pupil. Existing regulations
of the State Department of Education specify procedures to be
followed in the administration of medication to a pupil.
2)Defines "administration" as "the direct application of a drug
or device to the body of a patient or research subject by
injection, inhalation, ingestion, or other means."
FISCAL EFFECT : Unknown. This bill is keyed non-fiscal.
COMMENTS :
Purpose of this bill . According to the author's office, this
bill "would require that any medication that is administered to
a pupil who is required to take, during the regular schoolday,
medication prescribed for him or her by a physician or surgeon
be administered by a licensed healthcare professional operating
within the scope compliance with the Nursing Practice Act."
Background . Type 1 diabetes, usually diagnosed in early
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childhood, occurs when the body does not produce its own
insulin, a hormone made in the pancreas that helps convert sugar
from foods into energy. Without proper treatment, blood sugar
levels can rise or fall dangerously, so diabetics must closely
monitor their blood sugar and the carbohydrates they eat. Long
term complications include heart and kidney disease, blindness
and amputation.
Currently, according to an American Nurses Association (ANA),
the nurse-to-student ratio in California schools is 1:2700, one
of the lowest in the nation. California has a shortage of
nurses in its schools and some districts have no nurses at all.
Present law authorizes the administration of insulin to a
student only by a licensed health care professional acting
within his or her scope of practice, or certain other unlicensed
persons under specific circumstances.
The genesis of this bill was the 2008 decision of the Sacramento
Superior court in American Nurses Association v. Jack O'Connell.
This case struck down the authority of a Legal Advisory,
developed as part of a settlement between the American Diabetes
Association (ADA) and the California Department of Education,
that permitted unlicensed school employees who are "adequately
trained to administer insulin pursuant to the student's treating
physician's orders" to administer the drug in state schools.
The intent of the settlement, according to James Wood, the
attorney representing the ADA, was to lessen the burden of
parents, guardians, and grandparents whose diabetic children
attended a public school without a school nurse. However, the
ANA contested the settlement, and the court determined that
schools must comply with the existing statutory requirement that
only licensed and certain unlicensed individuals may administer
insulin, regardless of "nursing shortages and fiscal
constraints." Judge Lloyd G. Connely stated:
The court must enforce the legislative policy choices
in the existing statutes delineating the personnel
authorized to administer insulin and may not rewrite
the statutes to include other school personnel, even
if those other personnel have been adequately trained
to administer insulin and even though evidence
presented in this proceeding indicates that unlicensed
persons with adequate training may safely administer
insulin.
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Some individuals disappointed with the ruling applauded the
intent, but lamented the practical implications. Jeffrey
Ehrlich, a Claremont lawyer and a father of a diabetic child
stated, "I'd love to have a nurse at every school, but the idea
that nurses are the only ones that can help diabetic kids manage
their health is ridiculous," he said. "It's not rocket
science." Due to present restraints, many are concerned that if
nurses are the only school personnel permitted to administer
insulin, then, significant numbers of students with diabetes
will not be able to receive insulin when they need it, thereby
jeopardizing their long-term health and immediate safety.
This bill goes further than the question of insulin
administration, and requires any necessary medication be
administered by licensed health care professional operating
within the scope of his or her practice, as specified.
Increasing the access to licensed healthcare professionals in
California's schools may have a greater effect beyond proper
medication administration, however. According to a report by
the Children's Advocacy Institute at the University of San Diego
School of law, school-age children make up approximately 25% of
the population of the state, and of these, approximately 763,000
are uninsured and low-income. Advocates argue that increasing
the numbers of school nurses could help address basic health
needs by targeting children at school. Approximately 25% of
California students are overweight, and almost 40% are
considered "unfit." Proper health training and early
intervention may prevent the numbers of diabetic children in the
future.
Arguments in support . "As sponsors of AB 1430 (Swanson), the
California School Nurses Organization urges your support. This
bill simply reiterates the language from another section of
California law? and places it into the Education Code. Over the
years, educators and parents have been unaware of language in
the Business and Professions Code and its application to the
school site. Many unfortunate and sometimes unlawful decisions
have been made over the years by school district boards and
administrators, simply because they have not been aware of or
understood the implications of any Code besides the Education
Code. Still other school districts have knowingly ignored the
law, choosing to put the safety and health of students - some
medically fragile - at risk."
AB 1430
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Arguments in opposition . "The American Diabetes believes
non-medical personnel can be trained to administer insulin
safely. Several other states have passed laws to allow
non-medical school personnel to administer insulin to students
with diabetes. The Association's position has been endorsed by
leading medical organizations, including the American Academy of
pediatrics, the American Association of Clinical
Endocrinologists, the American Association of Diabetes
Educators, the American Dietetic Association, the Lawson Wilkins
Pediatric Endocrine Society, and the Pediatric Endocrine Nursing
Society. The American Diabetes Association believes AB 1430 is
bad policy and urges you to withdraw this legislation from
consideration."
REGISTERED SUPPORT / OPPOSITION :
California School Nurses Organization (sponsor)
California Federation of Teachers, American Federation of
Teachers, AFL-CIO
California Nurses Association
California Teachers Association
Numerous individuals
Opposition
American Diabetes Association
California Academy of Family Physicians
Diabetes Coalition of California
Disability Rights Education & Defense Fund
Special Education Local Plan Area Administrators
Numerous individuals
Analysis Prepared by : Sarah Huchel / B. & P. / (916) 319-3301