BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 1937|
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CONSENT
Bill No: AB 1937
Author: Fletcher (R), et al
Amended: 6/23/10 in Senate
Vote: 27 - Urgency
SENATE BUSINESS, PROF. & ECON. DEV. COMMITTEE : 7-0,
6/14/10
AYES: Negrete McLeod, Aanestad, Calderon, Correa, Florez,
Walters, Yee
NO VOTE RECORDED: Wyland, Oropeza
SENATE EDUCATION COMMITTEE : 8-0, 6/30/10
AYES: Romero, Huff, Alquist, Emmerson, Hancock, Liu,
Price, Simitian
NO VOTE RECORDED: Wyland
ASSEMBLY FLOOR : 72-1, 5/6/10 - See last page for vote
SUBJECT : Pupil health: immunizations
SOURCE : Author
DIGEST : This bill expands the health care practitioners
who are authorized to administer immunizations to students
with a written parental consent to include physician
assistances, nurse practitioners, licensed vocational
nurses, and nursing students acting under the supervision
of a Registered Nurse, and applies existing requirements
that apply to nurses in the administration of immunizations
to these health care practitioners.
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ANALYSIS :
Existing law
1. Establishes the Communicable Disease Control Branch
within the Department of Public Health (DPH) to monitor,
identify, prevent, and control infectious diseases that
pose a threat to public health.
2. Establishes the educational and child care facility
immunization requirements to provide a means of total
immunization of appropriate age groups against specified
childhood diseases including diphtheria, hepatitis B,
measles, mumps, pertussis, rubella, tetanus, varicella
(chicken pox), and any other diseases that is consistent
with the most current recommendations of the United
States Public Health Services' Centers for Disease
Control Immunization Practices Advisory Committee and
the American Academy of Pediatrics Committee of
Infectious Diseases, and deemed appropriate by DPH.
3. Requires students in grades K-12 to obtain specified
immunizations prior to their first admission into an
educational institution. States that immunizations may
be obtained from any public or private source desired if
the immunization is administered and records are made,
as specified.
4. Requires DPH, in consultation with the Department of
Education, to adopt and enforce these immunization
requirements.
5. 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.
6. Allows a Registered Nurse, acting under the direction of
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a supervising physician and surgeon, to perform
immunization techniques within the course of a school
immunization program provided that the administration of
an immunizing agent is upon the standing orders of a
supervising physician and surgeon and in accordance with
written regulations adopted by the Department of Health.
7. States that the supervising physician and surgeon shall
require a nurse who administers immunizations pursuant
to item #5) above, under his/her direction, to do both
the following:
A. Satisfactorily demonstrate competence in the
administration of immunizing agents, including
knowledge of all indications and contraindications
for the administration of such agents, and in the
recognition and treatment of any emergency
reactions to such agents which constitute a danger
to the health or life of the person receiving the
immunization.
B. Possess such medications and equipment as
required, in the medical judgment of the
supervising physician and surgeon, to treat any
emergency conditions and reactions caused by the
immunizing agents and which constitute a danger to
the health or life of the person receiving the
immunization, and to demonstrate the ability to
administer such medications and to utilize such
equipment as necessary.
8. States that a school nurse is a Registered Nurse
licensed by the Board of Registered Nursing, as
specified. Allows a school nurse, if authorized by the
local governing board, to perform specific services
including conducting immunization programs, as
specified, assessing and evaluating the health and
developmental status of pupils, counseling regarding
health-related attendance problems, and designing and
implementing health maintenance plans, as specified.
This bill:
1. Authorizes the following health care practitioners,
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acting under the direction of a supervising physician
and surgeon, to administer an immunizing agent within
the course of a school immunization program:
A. Physician assistant (PA)
B. Nurse practitioner (NP)
C. Licensed vocational nurse (LVN)
D. A nursing student acting under the supervision of
a Registered Nurse (RN), to administer immunizations
within the course of a school immunization program.
2. States that a PA, NP, LVN, and a nursing student acting
under the supervision of an RN may administer an
immunizing agent if ordered by a supervising physician
and surgeon, and the administration is in accordance
with any written regulations that the DPH may adopt.
3. Applies the following existing requirements that apply
to RNs in the administration of a school immunization 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 DPH may adopt.
B. The school nurse is notified and he or she
maintains control, as necessary, as supervisor of
health, as specified.
4. Limits the administration of immunizations for the
prevention and control of any of the following: annual
seasonal influenza, influenza pandemic episodes, and
other diseases that represent a current or potential
outbreak as declared by a federal, state, or local
public health officer.
5. States that it is the intent of the Legislature to
encourage school-based immunization programs, when
feasible, to use the California Immunization Registry to
assist providers to track patient records, reduce missed
opportunities, and to help fully immunize all children
in California.
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Background
California School Immunization Law . According to the DPH,
whenever children are brought into group settings, there is
a potential for the spread of infectious diseases. To
prevent some of the most serious infections, existing law,
commonly referred to as California School Immunization Law,
requires children enrolled in Grades K-12, child care
centers, day nurseries, family day care homes or
developmental centers to be immunized prior to admission
into these institutions. These required immunizations
include diphtheria, tetanus, pertussis, polio, measles,
mumps, rubella, hepatitis B, and varicella (chicken pox).
In addition, the law requires that the immunization records
of all children enrolled must be maintained by these
institutions and to submit reports to the health
department.
To ensure that health care providers have rapid access to
complete and up-to-date immunization records, the
California Immunization Information Registry (registry) was
created as a collaboration of immunization registries that
ensures the secure, electronic exchange of immunization
records to support the elimination of vaccine preventable
diseases. The goal of the registry is to improve
immunization rates for all California children through an
innovative public-private partnership. It is a
collaborative effort involving local health departments,
the DPH's Immunization Branch, and a spectrum of key
stakeholders across the state. The registry is working to
develop an integrated, statewide computerized registry to
network each child's full immunization history. A major
objective is to eliminate both missed opportunities to
immunize and unnecessary duplicative immunizations.
Current law also requires the governing board of a school
district to cooperate with the local health officer in
measures necessary for the prevention and control of
communicable diseases in school age children. Governing
boards are authorized to use any funds, property, and
personnel of the district, and may permit any physician and
surgeon, or a licensed Registered Nurse acting under the
direction of a supervising physician and surgeon, to
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administer an immunizing agent to any pupil whose parents
have consented in writing to the administration of such
immunizing agent. A Registered Nurse that administers
immunizations must satisfactorily demonstrate competence in
the administration of immunizing agents, as specified, and
possess such medications and equipment as required, in the
medical judgment of the supervising physician and surgeon,
to treat emergency conditions and reactions caused by the
immunizing agents, and to demonstrate the ability to
administer such medications and to utilize such equipment
as necessary.
FISCAL EFFECT : Appropriation: No Fiscal Com.: No
Local: No
SUPPORT : (Verified 6/30/10)
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
MedImmune, Inc
ARGUMENTS IN SUPPORT : According to the author's office,
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.
Unfortunately, with drastic cuts to school district
budgets, many California schools lack a school nurse on
site or have enough nurses available to handle a district
wide vaccination program should they wish to undertake such
an endeavor. In order to supplement the work of school
nurses, this bill provides the option to utilize nursing
professionals to assist with certain school based
vaccination programs
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Anderson, Arambula, Beall, Bill
Berryhill, Tom Berryhill, Blakeslee, Blumenfield,
Bradford, Brownley, Buchanan, Caballero, Charles
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Calderon, Carter, Chesbro, Conway, Cook, Coto, Davis, De
Leon, DeVore, Emmerson, Eng, Evans, Feuer, Fletcher,
Fong, Fuentes, Fuller, Gaines, Galgiani, Garrick, Hagman,
Hall, Harkey, Hayashi, Hernandez, Hill, Huber, Huffman,
Jeffries, Jones, Knight, Lieu, Logue, Bonnie Lowenthal,
Ma, Miller, Monning, Nava, Nestande, Niello, Norby, V.
Manuel Perez, Portantino, Ruskin, Salas, Saldana, Silva,
Skinner, Smyth, Solorio, Audra Strickland, Swanson,
Torlakson, Torres, Torrico, Tran, Villines, Yamada, John
A. Perez
NOES: Nielsen
NO VOTE RECORDED: Bass, Block, De La Torre, Furutani,
Gilmore, Mendoza, Vacancy
JJA:do 7/2/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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