Existing law requires school districts, county offices of education, and charter schools to provide emergency epinephrine auto-injectors to school nurses and trained personnel who have volunteered, as specified, and authorizes school nurses and trained personnel to use epinephrine auto-injectors to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an anaphylactic reaction.

This bill would require each school district, county office of education, and charter school local educational agency, as defined, to develop, in coordination with specified individuals, and have in place, beginning with the 201718 school year, a comprehensive policy with specified protocols to protect pupils with food allergies. By imposing additional duties on local educational agencies, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.

Existing law requires school districts, county offices of education, and charter schools to provide emergency epinephrine auto-injectors to school nurses and trained personnel who have volunteered, as specified, and authorizes school nurses and trained personnel to use epinephrine auto-injectors to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an anaphylactic reaction.

This bill would require each school district district, county office of education, and charter school to develop, in coordination with specified individuals, a comprehensive policy with specified protocols to protect pupils with food allergies. By imposing additional duties on school districts, local educational agencies, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.

Existing law requires school districts, county offices of education, and charter schools to provide emergency epinephrine auto-injectors to school nurses and trained personnel who have volunteered, as specified, and authorizes school nurses and trained personnel to use epinephrine auto-injectors to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an anaphylactic reaction.

This bill would require each school district to develop, in coordination with specified individuals, a comprehensive policy with specified protocols to protect pupils with food allergies. By imposing additional duties on school districts, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to these statutory provisions.

SENATE COMMITTEE ON APPROPRIATIONS

Senator Ricardo Lara, Chair

2015 - 2016 Regular Session

SB 1258 (Huff) - Pupil health: food allergies: local educational agency policy

This bill meets the criteria for referral to the Suspense File.

Bill Summary:

This bill requires each local educational agency (LEA) to develop and have in place, beginning with the 2017-18 school year, a comprehensive policy to protect students with food allergies.

Fiscal Impact:

• One-time reimbursable state mandate costs to create the required policies in coordination with specific individuals potentially in the low millions. Significant cost pressures to LEAs to implement the policies which could also potentially be interpreted to be a reimbursable state mandate by the Commission on State Mandates. To the extent the Commission determines the requirements of this bill to be a reimbursable state mandate, it would create pressure to increase the K-12 mandate block grant. (Proposition 98)
• The California Department of Education (CDE) cites minimal costs to provide technical assistance. (General Fund)

Background:

Existing law:

• Requires LEAs to provide emergency epinephrine auto-injectors to school nurses or trained personnel who have volunteered, and authorizes school nurses or trained personnel to use the epinephrine auto-injectors to provide emergency medical aid to a person suffering from an anaphylactic reaction. (Education Code § 49414)
  
• Authorizes students to carry and self-administer prescribed inhaled asthma or auto-injectable epinephrine medication while at school. (EC § 49423 and § 49423.1)
  
• Authorizes, in the absence of a credentialed school nurse or other licensed nurse onsite at the school, non-medical school personnel to administer medication to a pupil in an emergency, after receiving specified training.
  • Glucagon may be administered to students with diabetes suffering
    from severe hypoglycemia. (EC § 49414.5)
  • Emergency anti-seizure medication may be administered to students with epilepsy suffering from seizures. (EC § 49414.7)

Federal law requires schools to provide substitutions or modifications in the National School Lunch Program and School Breakfast Program for students whose disabilities restrict their diets (e.g. the food allergy or food intolerance substantially limits one or more major life activities). Schools are authorized to provide special meals and/or accommodations for students who do not have a disability that requires a restricted diet but who do have a food intolerance or other medication condition.

According to the author’s office, these policies will help ensure the safety for the student, provide clear direction to teachers, and ease liability for the district. This bill builds upon the author’s previous legislation, SB 1266 (Chapter 321, Statutes of 2014), requiring extra epinephrine injectors to be in public schools in case of emergencies.

Proposed Law:

This bill requires each LEA to develop and have in place, beginning with the 2017-18 school year, a comprehensive policy to protect students with food allergies. LEAs must develop the plan in coordination with certain individuals, including, a school nurse or designated health personnel, a parent of a child with a food allergy, and a director of food services. Protocols for students with food allergies must at a minimum include the following topics:

• School stocking of medication, including storage of medication in classrooms;
• School parties;
• Lunch time, including seating arrangements;
• Food served by the LEA;
• After school events;
• Field trips;
• Bullying;
• Recess; and
• Teacher and employee training.

Staff Comments:

This bill creates a reimbursable state mandate for all LEAs to develop a policy to protect students with food allergies, in coordination with certain individuals. Assuming one director of food service, one school nurse, and one teacher, together at a rate of $165 per hour including benefits, spending 10 to 20 hours developing the required policy and consulting with parents, one-time reimbursable costs would be between $1.6 million and $3.3 million for all school districts and county offices of education. Actual costs would vary by district and county. Even though some LEAs may already have policies in place, they could also submit a claim for reimbursement for any costs related to changing the policy to comply with the requirements of this bill. To the extent LEAs take advantage of model policies currently available, this could reduce the staff time needed to develop their own policies. Charter schools would also incur similar costs but are not eligible for reimbursement.

The Commission on State Mandates has addressed a related reimbursable mandate, called the Comprehensive School Safety Plan II. School districts and county offices of education are required to develop and update policies covering a number of topics ranging from bullying to disaster preparedness. Costs incurred by LEAs to implement this mandate have historically been between $3 million and $4 million.

Though creating and updating the safety plans are reimbursable mandated activities, the Commission found that the test claim statutes did not require school sites or school districts to implement their safety plans. This bill does not appear to specifically require implementation of the policies developed by the LEA and therefore might also not be eligible for reimbursement. However, there is certainly a local cost pressure to implement the developed food allergy policies.

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SENATE COMMITTEE ON EDUCATION

Senator Carol Liu, Chair

2015 - 2016 Regular

Bill No:

Subject:

SUMMARY

This bill requires each school district, county office of education, and charter school to develop a comprehensive policy to protect students with food allergies.

BACKGROUND

Existing law:

1. Requires local educational agencies (LEAs) to provide emergency epinephrine auto-injectors to school nurses or trained personnel who have volunteered, and authorizes school nurses or trained personnel to use the epinephrine auto-injectors to provide emergency medical aid to a person suffering from an anaphylactic reaction. (Education Code § 49414)
   
2. Authorizes students to carry and self-administer prescribed inhaled asthma or auto-injectable epinephrine medication while at school.

(EC § 49423 and § 49423.1)

1. Authorizes, in the absence of a credentialed school nurse or other licensed nurse onsite at the school, non-medical school personnel to administer medication to a pupil in an emergency, after receiving specified training:
   
   1. Glucagon may be administered to students with diabetes suffering
      from severe hypoglycemia. (EC § 49414.5)
      
   2. Emergency anti-seizure medication may be administered to students with epilepsy suffering from seizures. (EC § 49414.7)

ANALYSIS

This bill requires each school district, county office of education, and charter school to develop a comprehensive policy to protect students with food allergies. Specifically, this bill:

1. Requires each school district, county office of education, and charter school to develop a comprehensive policy to protect students with food allergies.
   
2. Requires the policy to include, at a minimum, protocols for students with food allergies that pertain to all of the following:
   
   1. School stocking of medication, including storage of medication in classrooms.
      
   2. School parties.
      
   3. Lunch time, including seating arrangements.
      
   4. Food served by the local educational agency.
      
   5. After school events.
      
   6. Field trips.
      
   7. Bullying.
      
   8. Recess.
      
   9. Teacher and employee training.
      
3. Requires a local educational agency (LEA) to create the policy in coordination with, at a minimum, all of the following individuals:
   
   1. A LEA or schoolsite nurse, or if there is no LEA or schoolsite nurse, the LEA or schoolsite’s designated health personnel.
      
   2. A parent of a student with a food allergy.
      
   3. An ad hoc parent.
      
   4. A director of food services.

STAFF COMMENTS

1. Need for the bill. According to the author, “The prevalence of life threatening allergies today is growing and at an alarming rate. The Centers for Disease Control reports an increase of 50 percent from 1997-2011. In 2014, recognizing the importance of this new and emerging life threatening health issue, the Legislature acted in a bi-partisan manner passing SB 1266 requiring extra epinephrine injectors be on hand in public schools in case of emergencies. After my work on SB 1266, it became apparent that schools are lacking in policies and direction on how to accommodate children with this condition. Whether it be lunch hour seating, field trips, school parties, storage of medication, or bullying, there seems to be no comprehensive approach. Many schools have no policies at all leaving parents and teachers in a predicament on how to ensure children are safe during school hours. The lack of consistency on this issue also leaves schools open for liability concerns.”
   
2. Existing policies. According to the California School Boards Association (CSBA), approximately 1/3 of school districts currently have a food allergy policy in place. It is unclear how many county offices of education and charter schools have adopted a food allergy policy. The CSBA provides a sample policy related to food allergies; it does not appear that the sample policy includes every component that is required by this bill, such the stocking or storage of medication, or information specifically addressing recess, field trips or after school events.
   
3. Are schools required to accommodate students with food allergies? Federal law requires schools to provide substitutions or modifications in the National School Lunch Program and School Breakfast Program for students whose disabilities restrict their diets (e.g. the food allergy or food intolerance substantially limits one or more major life activities). Schools are authorized to provide special meals and/or accommodations for students who do not have a disability that requires a restricted diet but who do have a food intolerance or other medication condition.
   
   The CDE has issued guidelines for accommodating students, with and without disabilities, with special dietary needs: http://www.cde.ca.gov/ls/nu/sn/mbcnp102015.asp
   
4. Technical amendments. This bill applies to each school district, county office of education, and charter school. Staff recommends an amendment to define “local educational agency” as a school district, county office of education, and charter school, and consistently use the term “local educational agency” throughout the bill.
   
   This bill requires each school district, county office of education, and charter school to develop a policy but does not specify a date by which the policies are to be in place. Staff recommends an amendment to specify that local educational agencies are to have a food allergy policy developed and in place beginning with the 2017-18 school year.
   
5. Heard in the Senate Health Committee. This bill was heard in the Senate Health Committee on April 6, where it was passed on consent, with a vote of 9-0.
   
6. Prior legislation. AB 2287 (Pan, 2014) authorized, but did not require, a school district or county superintendent of schools to include information on the availability of gluten-free meals in the free or reduced price meal application packet or notification of eligibility for the free and reduced price meal program. AB 2287 was held in the Senate Rules Committee because of its permissive nature, and was eventually referred to this Committee, two days before the last hearing of the 2013-14 Legislative Session. Therefore, AB 2287 was never heard by this Committee.
   

SUPPORT

California State PTA

Food Allergy Research & Education

Murrieta Valley Unified School District, Student Support Services

OPPOSITION

None received.

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SENATE COMMITTEE ON HEALTH

Senator Ed Hernandez, O.D., Chair

BILL NO: SB 1258

SUBJECT: Pupil health: food allergies: local educational agency policy

SUMMARY:

Requires a school district, county office of education, and charter school to develop a comprehensive policy, as specified, in coordination with specified individuals, to protect pupils with food allergies.

Existing law:

1. Requires school districts, county offices of education, and charter schools to provide emergency epinephrine auto-injectors (EAIs) to school nurses and trained personnel who have volunteered, as specified, and would authorize school nurses and trained personnel to use EAIs to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an anaphylactic reaction.
2. Requires a qualified supervisor of health or administrator at a school district, county office of education, or charter school to obtain the prescription for EAIs from an authorizing physician and surgeon, as defined, and would authorize the prescription to be filled by local or mail order pharmacies or EAI manufacturers.

This bill:

1. Requires a school district, county office of education, and charter school to develop a comprehensive policy to protect pupils with food allergies. Requires the policy to include, at a minimum, protocols for pupils with food allergies that pertain to all of the following:
   1. School stocking of medication, including storage of medication in classrooms;
   2. School parties;
   3. Lunch time, including seating arrangements;
   4. Food served by the local educational agency (LEA);
   5. After-school events;
   6. Field trips;
   7. Bullying;
   8. Recess; and,
   9. Teacher and employee training.
2. Requires a LEA to create the policy in coordination with, at a minimum:
   1. A LEA or schoolsite nurse, or if there is no LEA or schoolsite nurse, the LEA or schoolsite’s designated health personnel;
   2. A parent of a pupil with a food allergy;
   3. An ad hoc parent; and,
   4. A director of food services.

FISCAL EFFECT:

This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. Author’s statement. According to the author, in 2014, recognizing the importance of a new and emerging life threatening health issue, the Legislature acted in a bi-partisan manner and passed SB 1266 (Huff, Chapter 321, Statutes of 2014), which required extra EAIs in public schools in case of emergencies. That landmark legislation helped cement the Legislature’s commitment to ensure students with life threatening allergies are safe at school. After my work on SB 1266, it became apparent that schools are lacking in policies and direction on how to accommodate children with food allergies. Whether it be lunch hour seating, field trips, school parties, storage of medication, or bullying, there currently is no comprehensive approach. According to the California School Boards Association (CSBA), approximately 1/3 of schools have policies on this issue. This means many schools have no policies at all, leaving parents and teachers in a predicament on how to ensure children are safe during school hours. The lack of consistency on this issue leaves schools open for liability concerns. SB 1258 will require districts to create a policy to address accommodations and safety measures. These policies will help ensure the safety for the student, provide clear direction to teachers, and ease liability for the district.
2. Background. According to the Food Allergy Research & Education (FARE) Web site, eight foods account for 90% of all reactions: milk, eggs, peanuts, tree nuts, soy, wheat, fish, and shellfish. Even trace amounts of a food allergen can cause a reaction. Researchers estimate that up to 15 million Americans have food allergies. This potentially deadly disease affects one in every 13 children (under 18 years of age) in the U.S., equaling roughly two in every classroom. According to a study released in 2013 by the Centers for Disease Control and Prevention, food allergies among children increased approximately 50% between 1997 and 2011. FARE’s Web site state’s the economic cost of children’s food allergies is nearly $25 billion per year. Teenagers and young adults with food allergies are at the highest risk of fatal food-induced anaphylaxis. CSBA has a sample policy that addresses students’ food allergies and special dietary needs, including the development of guidelines that address things such as strategies for identifying students at risk for allergic reactions, avoidance measures, education of staff regarding typical symptoms, and actions to be taken in the event of a severe allergic reaction. CSBA notes in the sample policy that it is prohibited to exclude students from school activities or otherwise discriminate against, harass, intimidate, or bully them because of their food allergies.
3. What is anaphylaxis? According to the National Institutes of Health, anaphylaxis is a severe, whole-body allergic reaction to a chemical that has become an allergen. After being exposed to a substance, such as bee sting venom, the person's immune system becomes sensitized to it. When the person is exposed to that allergen again, an allergic reaction may occur. Anaphylaxis happens quickly after the exposure, is severe, and involves the whole body. Tissues in different parts of the body release histamine and other substances. This causes the airways to tighten and leads to other symptoms. Some drugs (such as morphine,

x-ray dye, and aspirin) may cause an anaphylactic-like reaction when people are first exposed to them. These reactions are not the same as the immune system response that occurs with true anaphylaxis. However, the symptoms, risk for complications, and treatment are the same for both types of reactions. Risks include a history of any type of allergic reaction. According to Food Allergy Research & Education (FARE), approximately 25% of first-time allergic reactions that require epinephrine happen at school.

1. Double referral. Should this bill pass out of this Committee, it will be referred to the Senate Education Committee.
2. Prior legislation. SB 738 (Huff, Chapter 132, Statutes of 2015), prohibits an authorizing physician and surgeon from being subject to professional review, being liable in a civil action, or being subject to criminal prosecution for the issuance of a prescription or order, unless the physician and surgeon’s issuance of the prescription or order constitutes gross negligence or willful or malicious conduct.

SB 1266, requires school districts, county offices of education, and charter schools to provide emergency EAIs to school nurses and trained personnel who have volunteered, as specified, and would authorize school nurses and trained personnel to use EAIs to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an anaphylactic reaction.

SB 669 (Huff, Chapter 725, Statutes of 2013), permits a prehospital emergency medical care person or lay rescuer to obtain and use an EAI in emergency situations with certification of training, as specified.

SB 1069 (Pavley, Chapter 512, Statutes of 2010), in addition to expanding the scope of practice for physician assistants in other instances, added physician assistants, in addition to physician and surgeons, from whom a school pupil must obtain a written statement in order to carry and self-administer a prescription EAI.

SB 1912 (Ashburn, Chapter 846, Statutes of 2004), permits pupils to carry and self-administer inhaled asthma medication or an EAI at school, as specified.

AB 559 (Wiggins, Chapter 458, Statutes of 2001), permits a school district or county office of education to provide emergency EAIs to trained personnel, and permits trained personnel to utilize these EAIs to provide emergency medical aid to persons suffering from an anaphylactic reaction at a school or during a school activity.

SUPPORT AND OPPOSITION:

Support: None received

Oppose: None received

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