BILL ANALYSIS
SENATE COMMITTEE ON EDUCATION
Gloria Romero, Chair
2009-2010 Regular Session
BILL NO: AB 1937
AUTHOR: Fletcher
AMENDED: June 23, 2010
FISCAL COMM: No HEARING DATE: June 30, 2010
URGENCY: Yes CONSULTANT:Lynn Lorber
SUBJECT : Administration of Immunizations
KEY POLICY ISSUE
Should health care professionals who are authorized by the
Business & Professions Code to give immunizations also be
authorized to give immunizations as part of a school
immunization program?
SUMMARY
This bill, an urgency measure, expands the pool of health
care practitioners, in addition to physicians, surgeons and
registered nurses, who may administer immunizations to pupils
as part of a school immunization program.
BACKGROUND
The Nursing Practice Act sets forth the scope of practice for
nursing, which specifically includes the performance of
immunization techniques, and prohibits any person from
engaging in the practice of nursing without a license.
(Business & Professions Code 2725 and 2732)
Current law:
1) Permits the following health care practitioners to
administer immunizations:
a) Registered nurses. (B&P 2725)
b) Nurse practitioners. (B&P 2725)
c) Physician assistants. (B&P 3502)
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d) Licensed vocational nurses. (B&P 2860.7)
e) Medical assistants. (B&P 2069)
f) Pharmacists. (B&P 4052)
g) Paramedics.
2) Requires the governing board of any school district to
cooperate with the local health officer if necessary for
the prevention and control of communicable diseases in
school age children. Allows the board to use any funds,
property, and personnel of the district, and may permit
any licensed physician and surgeon, or a registered
nurse acting under the direction of a supervising
physician and surgeon, to administer an immunizing agent
to any pupil with written parental consent. (Education
Code 49403)
3) States that a school nurse is a registered nurse
licensed by the Board of Registered Nursing, and who has
completed the additional educational requirements for,
and possesses a current credential in, school nursing.
A school nurse may, if authorized by the school district
governing board, to perform specific services including
conducting immunization programs, assessing and
evaluating the health and developmental status of
pupils, counseling regarding health-related attendance
problems, and designing and implementing health
maintenance plans. (EC 49426)
ANALYSIS
This bill , an urgency measure, expands the pool of health
care practitioners, in addition to registered nurses, who may
administer immunizations to pupils as part of a school
immunization program. Specifically, this bill:
1) Authorizes the following health care practitioners,
acting under the direction of a supervising physician
and surgeon, to administer immunizations within the
course of a school immunization program:
a) A physician assistant (PA).
b) A nurse practitioner (NP).
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c) A licensed vocational nurse (LVN).
d) A nursing student acting under the
supervision of a Registered Nurse (RN).
2) Applies the following requirements that currently apply
to RNs in the administration of school immunizations to
PAs, NPs, LVNs, and a nursing student acting under the
supervision of an RN:
a) The administration of an immunizing agent
is upon the standing orders of a supervising
physician and surgeon and in accordance with any
written regulations that the Department of Public
Health may adopt.
b) The school nurse is notified and he or she
maintains control, as necessary, as supervisor of
health.
3) Limits the administration of immunizations by these
health care practitioners for the prevention and control
of any of the following:
a) Annual seasonal influenza.
b) Influenza pandemic episodes.
c) Other diseases that represent a current or
potential outbreak as declared by a federal, state,
or local public health officer.
4) States that this is an urgency statute necessary to
provide greater access to immunizations for school
children in time for the 2010-11 influenza season.
STAFF COMMENTS
1) Need for the bill . According to the author, "over the
past several years and most recently with the H1N1
outbreak, public health officials (including current
U.S. Health and Human Services Secretary Kathleen
Sebelius) have supported schools as alternative
vaccination sites - since it is impossible for the
number of children needing an influenza vaccine to be
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accommodated in a physician's office. Unfortunately,
with drastic cuts to school district budgets, many
California schools lack a school nurse on site or enough
nurses in the district available to handle a district
wide or all K-5 school vaccination program. As an
alternative option schools would like the ability to
utilize other licensed healthcare professionals such as
pharmacists to assist with a school based vaccination
program."
2) Already authorized to administer immunizations . The
Education Code permits only a licensed physician and
surgeon or a licensed registered nurse, acting under the
direction of a supervising physician and surgeon, to
administer immunizations to pupils. However, the
Business and Professions Code authorizes a wider range
of health care professionals to administer vaccinations
according to their scopes of practice. This bill would
more closely reconcile the two codes relating to health
professionals' practice scopes, although this bill does
not authorize pharmacists and paramedics to administer
shots as part of a school immunization program.
3) What this bill does not do . This bill does not require
pupils to receive an influenza vaccine, nor does it add
influenza to the list of diseases which children need to
be vaccinated against before attending school or child
care programs.
4) How many schools have a nurse ? California's
nurse-to-pupil ratio is approximately 1:2,200.
According to the California Basic Educational Data
System (CBEDS), about one-half of school districts do
not have a school nurse. In those areas, the county
office of education should provide a nurse but it is
possible that no nursing coverage exists for some school
districts.
5) Prior and related legislation .
a) SB 1051 (Huff, 2010) would have authorized
a school district, until January 1, 2016, to
provide non-medical school employees with voluntary
training for the emergency administration of
Diastat to a pupil suffering from an epileptic
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seizure, in the absence of licensed personnel. SB
1051 was held on the Senate Appropriations
Committee's suspense file.
b) AB 1802 (Hall, 2010) would have authorized
a parent of a pupil with diabetes to designate a
non-medical school employee to administer insulin
to the pupil under specified conditions. AB 1802
failed passage in the Assembly Business and
Professions Committee.
c) AB 426 (Hall, 2009) would have required the
California Department of Education, in consultation
with specified entities, to recommend to the
Legislature ways to address specific health-related
needs of pupils on school campuses, including but
not limited to, diabetes, asthma and
obesity-related diseases. AB 426 was never heard.
d) AB 1430 (Swanson, 2009) would have provided
that only a licensed health care professional may
administer medication to pupils, but did
specifically allow non-medical school personnel to
administer epinephrine via auto-injector to pupils
suffering from an anaphylactic reaction and
glucagon to pupils with diabetes suffering from
severe hypoglycemia. AB 1430 was never heard.
SUPPORT
BayBio
California Academy of Family Physicians
California Medical Association
California School Nurses Organization
County Health Executives Association of California
Health Officers Association of California
Kaiser Permanente Medical Care Program
MedImmune, Inc.
OPPOSITION
None received.