Existing law, the California Child Day Care Facilities Act, provides for the licensure and regulation of child day care facilities by the State Department of Social Services. Under the act, child day care facility is defined to mean a facility that provides nonmedical care to children under 18 years of age in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual on less than a 24-hour basis. For purposes of the act, a child day care facility includes a day care center, an employer-sponsored child care center, and a family day care home. The act requires that, as a condition of licensure and in addition to any other required training, at least one director or teacher at each day care center, and each family day care home licensee who provides care, have at least 15 hours of health and safety training, covering specified components, including preventative health practices courses. Under existing law, a violation of the act is a crime.

This bill would require the State Department of Social Services, in consultation with the Emergency Medical Services Authority (EMSA) and State Department of Education, on or before July 1, 2027, to establish an anaphylactic policy that sets forth guidelines and procedures recommended for child day care personnel to prevent a child from suffering from anaphylaxis and to be used during a medical emergency resulting from anaphylaxis. The bill would authorize a child day care facility to implement the anaphylactic policy on and after January 1, 2028, and would, on and after January 1, 2028, require a child day care facility that adopts the anaphylactic policy to notify the parent or guardian of a child of the policy upon enrollment.

This bill would require EMSA to review minimum standards of training for the administration of epinephrine auto-injectors as necessary and notify the department if any changes to the training course, as specified.

The bill would require the State Department of Social Services and the State Department of Education, on or before September 1, 2027, to publish the anaphylactic policy on each of their internet websites.

This bill would require, on and after January 1, 2026, individuals required to receive health and safety training under the act obtain training in a pediatric first aid or pediatric cardiopulmonary resuscitation (CPR) course that includes instruction on the prevention and treatment of anaphylaxis. The bill would require, on and after January 1, 2028, a pediatric first aid and pediatric CPR training course to include instruction in the prevention and treatment of anaphylaxis, including the emergency use of epinephrine auto-injectors.

Because a willful or repeated violation of the bill by a child day care facility would be a crime, 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 no reimbursement is required by this act for a specified reason.

Existing law, the California Child Day Care Facilities Act, provides for the licensure and regulation of child day care facilities by the State Department of Social Services. Under the act, child day care facility is defined to mean a facility that provides nonmedical care to children under 18 years of age in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual on less than a 24-hour basis. For purposes of the act, a child day care facility includes a day care center, an employer-sponsored child care center, and a family day care home. The act requires that, as a condition of licensure and in addition to any other required training, at least one director or teacher at each day care center, and each family day care home licensee who provides care, have at least 15 hours of health and safety training, covering specified components, including preventative health practices courses. Under existing law, a violation of the act is a crime.

This bill would require the State Department of Social Services, in consultation with the Emergency Medical Services Authority (EMSA) and State Department of Education, on or before July 1, 2027, to establish an anaphylactic policy that sets forth guidelines and procedures recommended for child day care personnel to prevent a child from suffering from anaphylaxis and to be used during a medical emergency resulting from anaphylaxis. The bill would authorize a child day care facility to implement the anaphylactic policy on and after January 1, 2028, and would, on and after January 1, 2028, require a child day care facility that adopts the anaphylactic policy to notify the parent or guardian of a child of the policy upon enrollment.

This bill would require EMSA to review minimum standards of training for the administration of epinephrine auto-injectors as necessary and notify the department if any changes to the training course, as specified.

The bill would require the State Department of Social Services and the State Department of Education, on or before September 1, 2027, to publish the anaphylactic policy on each of their internet websites.

This bill would require, on and after January 1, 2026, individuals required to receive health and safety training under the act obtain training in a pediatric first aid or pediatric cardiopulmonary resuscitation (CPR) course that includes instruction on the prevention and treatment of anaphylaxis. The bill would require, on and after January 1, 2028, a pediatric first aid and pediatric CPR training course to include instruction in the prevention and treatment of anaphylaxis, including the emergency use of epinephrine auto-injectors.

Because a willful or repeated violation of the bill by a child day care facility would be a crime, 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 no reimbursement is required by this act for a specified reason.

Existing law, the California Child Day Care Facilities Act, provides for the licensure and regulation of child day care facilities by the State Department of Social Services. Under the act, child day care facility is defined to mean a facility that provides nonmedical care to children under 18 years of age in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual on less than a 24-hour basis. For purposes of the act, a child day care facility includes a day care center, an employer-sponsored child care center, and a family day care home. The act requires that, as a condition of licensure and in addition to any other required training, at least one director or teacher at each day care center, and each family day care home licensee who provides care, have at least 15 hours of health and safety training, covering specified components, including preventative health practices courses. Under existing law, a violation of the act is a crime.

This bill would require the State Department of Social Services, in consultation with the Emergency Medical Services Authority (EMSA) and State Department of Education, on or before July 1, 2027, to establish an anaphylactic policy that sets forth guidelines and procedures recommended for child day care personnel to prevent a child from suffering from anaphylaxis and to be used during a medical emergency resulting from anaphylaxis. The bill would require the anaphylactic policy to include, among other things, a requirement that a parent or guardian demonstrate an understanding of the protections provided for individuals who provide emergency medical or nonmedical care without compensation by signing an acknowledgment of the Good Samaritan Law. The bill would authorize a child day care facility to implement the anaphylactic policy on or before and after January 1, 2028, and would, on and after January 1, 2028, require a child day care facility that adopts the anaphylactic policy to notify the parent or guardian of a child of the policy upon enrollment.

The bill would require the State Department of Social Services to create informational materials detailing the anaphylactic policy and would require the State Department of Social Services and the State Department of Education, on or before September 1, 2027, to post the informational materials publish the anaphylactic policy on each of their internet websites.

Because a willful or repeated violation of the bill by a child day care facility would be a crime, 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 no reimbursement is required by this act for a specified reason.

Existing law, the California Child Day Care Facilities Act, provides for the licensure and regulation of child day care facilities by the State Department of Social Services. Under the act, child day care facility is defined to mean a facility that provides nonmedical care to children under 18 years of age in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual on less than a 24-hour basis. For purposes of the act, a child day care facility includes a day care center, an employer-sponsored child care center, and a family day care home. Under existing law, a violation of the act is a crime.

This bill would require the State Department of Social Services, in consultation with the State Department of Education, on or before July 1, 2027, to establish an anaphylactic policy that sets forth guidelines and procedures recommended for child day care personnel to prevent a child from suffering from anaphylaxis and to be used during a medical emergency resulting from anaphylaxis. This bill would exempt child day care personnel who provide, administer, or assist in the administration of epinephrine in compliance with the anaphylactic policy from liability in a civil action or from criminal prosecution for the persons acts or omissions in administering the epinephrine, except in the case of gross negligence or willful or wanton misconduct. The bill would require the anaphylactic policy to include, among other things, a requirement that a parent or guardian demonstrate an understanding of the protections provided for individuals who provide emergency medical or nonmedical care without compensation by signing an acknowledgment of the Good Samaritan Law. The bill would authorize a child day care facility to implement the anaphylactic policy on or before January 1, 2028, and would, on and after January 1, 2028, require a child day care facility that adopts the anaphylactic policy to notify the parent or guardian of a child of the policy upon enrollment.

The bill would also require an anaphylactic policy for family child care providers to be developed in consultation and coordination with the Joint Labor Management Committee established by the state and Child Care Providers United - California (CCPU). The bill would require the departments Community Care Licensing Division to review minimum standards of training for the administration of epinephrine auto-injectors.

The bill would require the State Department of Social Services to create informational materials detailing the anaphylactic policy and would require the State Department of Social Services and the State Department of Education, on or before September 1, 2027, to post the informational materials each of their internet websites.

Because a willful or repeated violation of the bill by a child day care facility would be a crime, 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 no reimbursement is required by this act for a specified reason.

Existing law, the California Child Day Care Facilities Act, provides for the licensure and regulation of child day care facilities by the State Department of Social Services. Under the act, child day care facility is defined to mean a facility that provides nonmedical care to children under 18 years of age in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual on less than a 24-hour basis. For purposes of the act, a child day care facility includes a day care center, an employer-sponsored child care center, and a family day care home. Under existing law, a violation of the act is a crime.

This bill would require the State Department of Social Services, in consultation with the State Department of Education, on or before July 1, 2027, to establish an anaphylactic policy that sets forth guidelines and procedures recommended for child day care personnel to prevent a child from suffering from anaphylaxis and to be used during a medical emergency resulting from anaphylaxis. This bill would exempt child day care personnel who provide, administer, or assist in the administration of epinephrine in compliance with the anaphylactic policy from liability in a civil action or from criminal prosecution for the persons acts or omissions in administering the epinephrine, except in the case of gross negligence or willful or wanton misconduct. The bill would authorize a child day care facility to implement the anaphylactic policy on or before January 1, 2028, and would, on and after January 1, 2028, require a child day care facility that adopts the anaphylactic policy to notify the parent or guardian of a child of the policy upon enrollment.

The bill would also require an anaphylactic policy for family child care providers to be developed in consultation and coordination with the Joint Labor Management Committee established by the state and Child Care Providers United - California (CCPU).

The bill would require the State Department of Social Services to create informational materials detailing the anaphylactic policy and would require the State Department of Social Services and the State Department of Education, on or before September 1, 2027, to post the informational materials each of their internet websites.

Because a willful or repeated violation of the bill by a child day care facility would be a crime, 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 no reimbursement is required by this act for a specified reason.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 2317

Author:(Stephanie Nguyen)

As Amended Ver:August 23, 2024

Majority vote

SUMMARY

Requires the California Department of Social Services (CDSS), in consultation with the California Department of Education (CDE) and the Emergency Medical Services Authority (EMSA), to establish an anaphylactic policy that sets forth guidelines and procedures recommended for child daycare facility trained staff to prevent a child from suffering from anaphylaxis and to be used during a medical emergency resulting from anaphylaxis. Requires the director or teacher at each day care center, and each family day care home licensee who provides care, to obtain training in a pediatric first aid or pediatric cardiopulmonary resuscitation (CPR) course that includes instruction in the prevention and treatment of anaphylaxis, including the emergency use of epinephrine auto-injectors.

Senate Amendments

1. Require CDSS to consult with EMSA when establishing an anaphylactic policy
2. Require the notification of the anaphylactic policy to include contact information to learn more about the notification of the liability limitations.
3. Add a certified provider organization to the list of representatives who are required to be consulted regarding the anaphylactic policy.
4. Strike the requirement for the anaphylactic policy for family child care providers to be developed in consultation and coordination with the Joint Labor Management Committee established by the state and Child Care Providers United California (CCPU).
5. Strike the requirement for training on the anaphylactic policy to be provided by CDSS's Community Care Licensing Division (CCLD) in consultation with CCPU.
6. Require EMSA, instead of CCLD, to review minimum standards of training for the administration of epinephrine auto-injectors as necessary, and to notify CDSS if any changes to the training course are needed.
7. Add the following elements to the requirements for inclusion in the anaphylactic policy:
8. A process for a child day care facility to solicit volunteers among its employees to be trained and to administer emergency epinephrine auto-injectors to provide emergency medical aid to a child in care who is suffering, or reasonably believed to be suffering, from anaphylaxis.
9. Authorize trained staff to administer emergency epinephrine auto-injectors to provide medical aid to a child in care who is suffering, or reasonably believed to be suffering, from anaphylaxis at a child day care facility during operating hours.
10. Specify provisions that apply to trained staff of a child day care facility who administer emergency epinephrine auto-injectors to a child in care.
11. Clarify that a procedure and treatment plan is required to ensure trained staff have access to an appropriate, weight-based dosage epinephrine auto-injector, if applicable, and to ensure trained staff have access to epinephrine auto-injectors stored in a secure place at the site.
12. Require a training course for child day care facility staff to include instruction on how to determine whether to use a pediatric or adult epinephrine auto-injector.
13. A process for a child day care facility to obtain either of the following from the parent or guardian of each child in care:
14. Prior written consent to the emergency administration of epinephrine auto-injectors by trained staff to the child who is suffering, or reasonably believed to be suffering, from anaphylaxis; or,
15. A written statement objecting to the emergency administration of epinephrine auto-injectors by trained staff to the child who is suffering, or reasonably believed to be suffering, from anaphylaxis.
16. Delete the following elements from inclusion in the anaphylactic policy:
17. Authorization for a volunteer to administer an epinephrine auto injector to a person exhibiting potentially life threatening symptoms of anaphylaxis at a child day care facility during operation hours;
18. For a training course to be provided at no cost to the employee during their regular work hours;
19. For CDSS to consider the feasibility of developing the training course in languages other than English;
20. For CDSS to consider whether the training may be effectively provided through online instruction; and,
21. A communication plan for dissemination of information by CDSS regarding children with a food or other allergy that could result in anaphylaxis, including a discussion of methods, treatments, and therapies to reduce the risk of allergic reactions; a communication plan for discussion about foods that are safe and unsafe and strategies to avoid exposure to unsafe food.
22. Strike requirement for CDSS to create informational materials in multiple languages, and instead require CDSS and CDE to publish the developed anaphylactic policy on each of the departments' websites.
23. Authorize CDSS to implement and administer the changes made by these provisions through letters or similar written instructions that shall have the same force and effect as regulations until regulations are adopted.
24. Establish definitions of "anaphylaxis," "epinephrine auto-injector" and, "trained staff."
25. Require, on and after January 1, 2026, the director or teacher at each day care center, and each family day care home licensee who provides care, to obtain training in a pediatric first aid or pediatric CPR course that includes instruction in the prevention and treatment of anaphylaxis, including the emergency use of epinephrine auto-injectors, as specified.
26. Require persons who, on or before December 31, 2025, have completed a course in pediatric first aid and pediatric CPR that did not include instruction in the prevention and treatment of anaphylaxis, including the emergency use of epinephrine auto-injectors, to comply with 12) above for the next renewal period.
27. State it is the intent of the Legislature that the training required by these provisions will be adopted into the existing training requirements for a child day care facility and will not require additional hours.
28. Require, in the event any additional training hours are required by these provisions, reimbursement of a family child care provider, for any additional training hours to be determined pursuant to the procedures set forth in existing law.
29. Require, on and after January 1, 2028, a pediatric first aid and pediatric CPR training course to include instruction in the prevention and treatment of anaphylaxis, including the emergency use of epinephrine auto-injectors, subject to the requirements of existing law, as specified.
30. Clarify that these provisions shall not be interpreted to prohibit approved online courses in pediatric or preventative health practices.
31. Make technical and clarifying changes.

COMMENTS

Background: What is Anaphylaxis? Anaphylaxis is characterized by a systemic immune response to an allergen that can be life-threatening. Common symptoms include shortness of breath, wheezing, difficulty breathing, difficulty talking or swallowing, hives, itchiness, swelling, shock, or asthma. The onset of symptoms usually occurs within minutes, but can be delayed up to 30 minutes and, although rare, even hours after exposure. Food allergies are the most common cause of anaphylaxis, such as eggs, milk, peanuts, tree nuts, wheat, crustacean shellfish, and soy. Other allergens can trigger anaphylaxis, including insect stings or bites, medications, such as antibiotics, nonsteroidal anti-inflammatory drugs, latex, and even exercise. Twenty-five percent of severe and potentially life-threatening reactions reported at schools happened in children with no previous diagnosis of food allergy.

Treatment of Anaphylaxis. An epinephrine auto-injector (commonly called an "epi-pen") is a medical device utilized to deliver a measured dose of epinephrine via auto-injector technology, primarily used to manage acute allergic reactions and prevent or address the onset of anaphylaxis. Epinephrine auto-injectors are available exclusively by prescription.

California law permits school districts or county offices of education to provide emergency epi-pens to trained personnel and permits trained personnel to utilize the epi-pens to provide emergency medical aid to persons suffering from an anaphylactic reaction. This bill seeks to extend these provisions to child daycare providers and establishes processes around this provision.

Childcare Licensing Regulations on Anaphylaxis. State law and regulations provide guidance for anaphylaxis in K-12 schools, but it does not for childcare providers. This indicates each childcare facility adopts its own practices related to allergen identification, prevention strategies, emergency response procedures, and communication protocols with parents or guardians, further signifying a lack of consistency among childcare facilities. Based on current regulations, many childcare facilities may rely on ad hoc measures for children with unknown allergies and on individual plans for those who have known allergies rather than standardized policies endorsed by regulations or established best practices. Because this bill is permissive and allows childcare facilities to opt out of implementing the anaphylactic policy, the ad hoc measures in treating anaphylactic reactions may persist

According to the Author

"The rate of anaphylaxis is higher in children ages 0-to-4 than in any other age group. Furthermore, California health claims data points to a tremendous rise in anaphylaxis over the past 15 years (approximately 316%) which has led to an average of one in five children with a food allergy reporting one or more allergy-related emergency room visits in the previous year.

"[This bill] is otherwise known as Elijah's Law (passed in the state of New York in 2019) in tribute to Elijah Silvera who suffered from milk allergies and unfortunately lost his life due to anaphylaxis while under the care of daycare provider who fed him a cheese sandwich. Enacting Elijah's Law in California will help to ensure daycare providers are further equipped to:

1. Help prevent life-threatening allergic reactions due to food or venom allergies,
2. Better recognize the signs and symptoms of anaphylaxis and,
3. Treat this condition by utilizing an appropriate weight-based dosage of epinephrine."

Arguments in Support

According to the Natalie Giorgi Sunshine Foundation, "[This bill] will help assure that childcare centers are trained to prevent anaphylaxis, recognize the signs and symptoms of a suspected anaphylactic event, and ensure that the centers have the training to treat an event, utilizing an appropriate weight-based dosage of epinephrine during a medical emergency resulting from anaphylaxis."

Arguments in Opposition

No opposition on file.

FISCAL COMMENTS

According to the Senate Appropriations Committee on August 5, 2024:

1. The CDSS estimates General Fund costs of $967,000 in 2024-25 and $943,000 ongoing thereafter for staffing resources to implement the bill's provisions.
2. The CDE estimates General Fund costs of $176,000 in 2024–25 and $185,000 in 2025-26 for state operations.

VOTES:

ASM HUMAN SERVICES: 7-0-0

YES: Lee, Essayli, Calderon, Gipson, Jackson, Ta, Ortega

ASM EDUCATION: 7-0-0

YES: Muratsuchi, Addis, Alvarez, Bonta, Flora, Hoover, McCarty

ASM APPROPRIATIONS: 15-0-0

YES: Wicks, Sanchez, Arambula, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Grayson, Haney, Hart, Jim Patterson, Pellerin, Ta, Villapudua

ASSEMBLY FLOOR: 73-0-7

YES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Chen, Connolly, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Rendon, Reyes, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Robert Rivas

ABS, ABST OR NV: Cervantes, Megan Dahle, Friedman, Gabriel, Holden, Mathis, Luz Rivas

SENATE FLOOR: 40-0-0

YES: Allen, Alvarado-Gil, Archuleta, Ashby, Atkins, Becker, Blakespear, Bradford, Caballero, Cortese, Dahle, Dodd, Durazo, Eggman, Glazer, Gonzalez, Grove, Hurtado, Jones, Laird, Limón, McGuire, Menjivar, Min, Newman, Nguyen, Niello, Ochoa Bogh, Padilla, Portantino, Roth, Rubio, Seyarto, Skinner, Smallwood-Cuevas, Stern, Umberg, Wahab, Wiener, Wilk

UPDATED

VERSION: August 23, 2024

CONSULTANT: Bri-Ann Hernandez / HUM. S. / (916) 319-2089 FN: 0004892

 THIRD READING  

Bill No: AB 2317

Author: Stephanie Nguyen (D), et al.

Amended: 8/23/24 in Senate

Vote: 21

SENATE HUMAN SERVICES COMMITTEE: 5-0, 6/17/24

AYES: Alvarado-Gil, Ochoa Bogh, Blakespear, Hurtado, Menjivar

SENATE EDUCATION COMMITTEE: 7-0, 7/3/24

AYES: Newman, Ochoa Bogh, Cortese, Glazer, Gonzalez, Smallwood-Cuevas, Wilk

SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/15/24

AYES: Caballero, Jones, Ashby, Becker, Bradford, Seyarto, Wahab

ASSEMBLY FLOOR: 73-0, 5/21/24 - See last page for vote

SUBJECT: Child day care facilities: anaphylactic policy

SOURCE: Author

DIGEST:

This bill requires the Department of Social Services (CDSS), in consultation with the Emergency Medical Services Authority (EMSA) and Department of Education (CDE), on or before July 1, 2027, to establish an anaphylactic policy with guidelines and procedures recommended for child care personnel to prevent a child from suffering from anaphylaxis. This bill authorizes, starting January 1, 2028, a child care facility to implement the anaphylactic policy. This bill requires, starting January 1, 2026, specified staff to receive training that includes instruction on the prevention and treatment of anaphylaxis.

Senate Floor Amendments of 8/23/24 change implementation deadline, change requirements related to child care facility staff training on anaphylaxis, add “certified provider organization” to the list of consultants for the development of an anaphylactic policy for child care facilities.

ANALYSIS:

Existing law:

1. Establishes the California Child Day Care Facilities Act to create a separate licensing category for child day care centers and family day care homes within the existing licensing structure at the CDSS. (Health and Safety Code Section [HSC] 1596.70 et seq.)
2. Defines “child day care facility” to mean a facility that provides nonmedical care to children under 18 years of age in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual on less than a 24-hour basis. Child day care facilities include day care centers, employer-sponsored child care centers, and family daycare homes. (HSC 1596.750)
3. Defines “day care center” to mean a child day care facility other than a family day care home, and includes infant centers, preschools, extended day care facilities, and school age child care centers, and includes child care centers with a single license. (HSC 1596.76)
4. Defines “employer-sponsored child care center” as any child day care facility at the employer’s site of business operated directly or through a provider contract by any person or entity having one or more employees, and available exclusively for the care of children of that employer, and of the officers, managers, and employees of that employer. (HSC 1596.771)
5. Defines “family daycare home” as a facility that regularly provides care, protection, and supervision for 14 or fewer children, in the provider’s own home, for periods of less than 24 hours per day, while the parents or guardians are away, and is either a large family daycare home or a small family daycare home. (HSC 1596.78)
6. Prohibits any person or entity operating a child day care facility from providing care or supervision without a valid license from CDSS. (22 California Code of Regulations (CCR) Section 101156(a))
7. Notwithstanding any other law, allows licensees and staff of a child day care facility to administer inhaled medication to a child under certain requirements, as specified. (HSC 1596.798)
8. Defines “anaphylaxis” as a potentially life-threatening hypersensitivity to a substance. Specifies symptoms of anaphylaxis may include shortness of breath, wheezing, difficulty breathing, difficulty talking or swallowing, hives, itching, swelling, shock, or asthma. Specifies causes of anaphylaxis may include, but are not limited to, an insect sting, food allergy, drug reaction, and exercise. (Education Code Section 49414)
9. Defines “epinephrine auto-injector” as a disposable delivery device designed for the automatic injection of a premeasured dose of epinephrine into the human body to prevent or treat a life-threatening allergic reaction. (Education Code Section 49414)

This bill:

1. Requires the CDSS, on or before July 1, 2027, in consultation with the EMSA and the CDE, to establish an anaphylactic policy that sets forth guidelines and procedures recommended for child day care facility trained staff to prevent a child from suffering from anaphylaxis and to be used during a medical emergency resulting from anaphylaxis.
2. Authorizes, on or after January 1, 2028, a child day care facility to implement the anaphylactic policy developed by the CDSS.
3. Requires a child day care facility, on or after January 1, 2028, upon enrollment of a child at a child day care facility, and annually thereafter, to notify the parent or guardian of the anaphylactic policy developed by the CDSS, if the facility has adopted a policy. Requires the notice to include contact information for a parent or guardian to engage further with the facility to learn more about the policy and notification of the liability limitations set forth in HSC 1799.102 and Civil Code 1714.23.
4. Requires the policy to be developed in consultation with representatives from the following:
   1. Pediatric physicians and other health care providers, as specified.
   2. Parents of children with life-threatening allergies.
   3. Child day care facility administrators and staff.
   4. Not-for-profit corporations that represent allergic individuals at risk for anaphylaxis.
   5. A certified provider organization.
5. In developing the policy, requires the CDSS to consider existing requirements and current and best practices for child day care facilities on allergies and anaphylaxis. Requires the CDSS to consider any voluntary guidelines issued by the U.S. Department of Health and Human Services for managing food allergies in child day care facilities.
6. Requires the EMSA to review minimum standards of training for the administration of epinephrine auto-injectors, as necessary, and notify CDSS if any changes to the training course are needed. Requires the training to be consistent with the most recent Voluntary Guidelines for Managing Food Allergies In Schools and Early Care and Education Programs published by the federal Centers for Disease Control and Prevention and HSC 1797.197a.
7. Requires the anaphylactic policy to include all of the following:
   1. A process for a child day care facility to solicit volunteers among its employees to be trained and to administer emergency epinephrine auto-injectors to provide emergency medical aid to a child in care who is suffering, or reasonably believed to be suffering, from anaphylaxis. Requires the process to solicit volunteers to include a statement that there shall be no retaliation against any employee who chooses not to volunteer or who rescinds their offer to volunteer, including after receiving training.
   2. A procedure and treatment plan, including emergency protocols and responsibilities, for trained staff responding to a child suffering, or reasonably believed to be suffering, from anaphylaxis. Requires the procedure and treatment plan to ensure trained staff have access to an appropriate weight-based dosaged epinephrine auto-injector, if applicable, as specified in Education Code 49414. Requires the procedure and treatment plan to ensure trained staff have access to epinephrine auto-injectors stored in a secure place at the site.
   3. A training course for child day care facility staff shall include, but not be limited to: techniques for preventing and responding to anaphylaxis; standards and procedures for the storage and emergency use of epinephrine auto-injectors; emergency followup procedures; instruction on how to determine whether to use a pediatric or adult epinephrine auto-injector; and written materials covering the information specified here.
   4. Appropriate guidelines for each child day care facility to develop an individual emergency plan for children with a food or other allergy that could result in anaphylaxis.
   5. A process for a child day care facility to obtain either of the following from the parent or guardian of each child in care: prior written consent, or a written statement objecting to the emergency administration of epinephrine auto-injectors.
   6. Strategies for the reduction of the risk of exposure to children of anaphylactic causative agents, including food and other allergens.
8. Requires, on or before September 1, 2027, the CDSS and the CDE to publish the anaphylactic policy on each of the departments’ internet websites. Requires the anaphylactic policy to be updated by CDSS as necessary, in consultation with the EMSA and the CDE.
9. Specifies this section shall not be construed to preempt, modify, or amend a child day care facility’s requirement to comply with existing federal and state disability laws, or the requirements related to a child’s individualized family service plan or individualized education program.
10. Defines “anaphylaxis”, “epinephrine auto-injector”, and “trained staff”.
11. Requires, on and after January 1, 2026, at least one director or teacher at each day care center, and each family day care home licensee who provides care, to obtain training in a pediatric first aid or pediatric CPR course that includes instruction in the prevention and treatment of anaphylaxis, including the emergency use of epinephrine auto-injectors, subject to the requirements of HSC 1797.197a.
    1. Requires persons who have completed a course on or before December 31, 2025, that did not include instruction on anaphylaxis to comply for the next renewal period.
    2. States the intent of the Legislature that the training required by this section will be adopted into the existing training requirements for a child day care facility and will not require additional hours. In the event any additional hours are required by these provisions, reimbursement of a family child care provider, as defined in the Welfare and Institutions Code Section (WIC) 10421, for any additional training hours shall be determined pursuant to the procedures set forth in WIC Chapter 25.
12. Requires a pediatric first aid and pediatric CPR training course, on and after January 1, 2028, to include instruction in the prevention and treatment of anaphylaxis, including the emergency use of epinephrine auto-injectors, subject to the requirements of HSC 1797.197a.
13. Provides that health and safety training, as specified in HSC 1596.866(a), shall not be interpreted to prohibit approved online courses.
14. Authorizes the CDSS to implement and administer the changes made by this bill through letters or similar written instructions that shall have the same force and effect as regulations until regulations are adopted.

Comments

This bill seeks to establish an anaphylactic policy for child care facilities and corresponding training for child care staff who volunteer, aligning child care facilities with anaphylactic policies for California K-12 schools and other states that have adopted similar laws. Given the high incidence of anaphylaxis for children ages zero through four, it seems reasonable to require that child care facilities be prepared to handle an anaphylactic emergency, especially as young children may be unable to voice or recognize their own symptoms of anaphylaxis.

Background

Anaphylaxis and Epinephrine. Anaphylaxis is a severe allergic reaction that is rapid in onset and may cause death. Food allergies account for 35 to 50 percent of all cases of anaphylaxis in emergency care settings. According to the Allergy & Asthma Network, the rate of anaphylaxis is higher in children ages zero through four than in any other age group. Epinephrine is typically available in the form of an auto-injector, which is a spring loaded syringe used to deliver a measured dose of epinephrine, designed for self-administration by patients or administration by persons untrained in other needle-based forms of epinephrine delivery. Epinephrine can quickly improve a person’s symptoms, but its effects are not long lasting. Even when epinephrine is used, 911 or other emergency medical services must be called so the person can receive further medical treatment and observation. Epinephrine auto-injectors may also be called an “EpiPen” in everyday language.

Child Care Licensing Regulations. The licensure, maintenance, and operation of child day care facilities are governed by the California Child Day Care Facilities Act. This Act and corresponding regulations require a licensed child care facility to maintain a complete and current record for each enrolled child, which must include a medical assessment that includes dietary restrictions and allergies, instructions for action to be taken in case the child’s authorized representative or designated physician cannot be reached in an emergency, and a signed consent form for emergency medical treatment (22 CCR 101220; 22 CCR 101221). In addition, as a condition of licensure, child care personnel must complete health and safety training, which must include pediatric first aid and cardiopulmonary resuscitation (CPR), and may include instruction in sanitary food handling, among other things (HSC 1596.866). Regulations also specify that a child shall not be served any food to which they have an allergy, as indicated in their record on file (22 CCR 101227). There are no further laws or regulations requiring the storage of epinephrine in child care facilities, nor requiring training for child care staff on recognizing symptoms of anaphylaxis or how to administer epinephrine.

Epinephrine Auto-Injectors in California Schools. The language in this bill is similar to existing law for K-12 schools. Existing law requires school districts, county offices of education, and charter schools to provide emergency epinephrine auto-injectors, to be stored in an accessible location upon need for emergency use, and allows school nurses or trained volunteers to use epinephrine auto-injectors to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an anaphylactic reaction (Education Code Section 49414). This bill allows a child day care facility to implement the anaphylactic policy developed by CDSS, in consultation with the CDE and the Joint Labor Management Committee; requires the policy to include a process for a child day care facility to solicit volunteers among its employees to be trained to administer epinephrine auto-injectors; requires a procedure and treatment plan to include the capacity for trained personnel to have access to a secured stock of epinephrine auto-injectors; and requires the child care provider to notify parents of the adopted policy.

Governor Veto of AB 2042. AB 2042 (Villapudua, 2022) was similar to this bill. In his veto message for AB 2042, the Governor expressed concern that the bill would expand the memorandum of understanding between the State and Child Care Providers United union. The Governor encouraged the Legislature to work with CDSS and the Emergency Medical Services Authority on an alternative solution. This bill includes several changes since its last iteration, making it distinct from AB 2042.

Related/Prior Legislation

AB 772 (Jackson, 2023) would exempt a “drop in” day care center from requiring a physician’s assessment upon admission of a child, and require a parent to sign an acknowledgement that they understand a physician’s assessment is not required for any child under the center’s care. The bill is pending on the Senate Floor.

AB 2042 (Villapudua, 2022) was similar to this bill. The bill was vetoed by Governor Newsom.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes

According to the Senate Appropriations Committee analysis,

• “The CDSS estimates General Fund costs of $967,000 in 2024-25 and $943,000 ongoing thereafter for staffing resources to implement the bill’s provisions.”
• “The CDE estimates General Fund costs of $176,000 in 2024–25 and $185,000 in 2025-26 for state operations.”

SUPPORT: (Verified on 8/26/24)

Allergy & Asthma Network
Allergystrong
Association of Regional Center Agencies
Asthma and Allergy Foundation of America
California Society for Respiratory Care
Elijah-alavi Foundation
Food Allergy & Research Education
Natalie Giorgi Sunshine Foundation
National Association of Pediatric Nurse Practitioners
No Nut Traveler INC.
Nut Free Wok

OPPOSITION: (Verified on 8/26/24)

None received

ASSEMBLY FLOOR: 73-0, 5/21/24

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Chen, Connolly, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Rendon, Reyes, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Robert Rivas

NO VOTE RECORDED: Cervantes, Megan Dahle, Friedman, Gabriel, Holden, Mathis, Luz Rivas

Prepared by: Diana Dominguez / HUMAN S. / (916) 651-1524

8/26/24 17:01:06

**** END ****

 THIRD READING  

Bill No: AB 2317

Author: Stephanie Nguyen (D), et al.

Amended: 3/20/24 in Assembly

Vote: 21

SENATE HUMAN SERVICES COMMITTEE: 5-0, 6/17/24

AYES: Alvarado-Gil, Ochoa Bogh, Blakespear, Hurtado, Menjivar

SENATE EDUCATION COMMITTEE: 7-0, 7/3/24

AYES: Newman, Ochoa Bogh, Cortese, Glazer, Gonzalez, Smallwood-Cuevas, Wilk

SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/15/24

AYES: Caballero, Jones, Ashby, Becker, Bradford, Seyarto, Wahab

ASSEMBLY FLOOR: 73-0, 5/21/24 - See last page for vote

SUBJECT: Child day care facilities: anaphylactic policy

SOURCE: Elijah-Alavi Foundation

DIGEST:

This bill requires the Department of Social Services (CDSS), in consultation with the Department of Education (CDE), on or before July 1, 2027, to establish an anaphylactic policy with guidelines and procedures recommended for child care personnel to prevent a child from suffering from anaphylaxis. This bill allows, on or before January 1, 2028, a child care facility to implement the anaphylactic policy. This bill requires the policy to be developed in consultation and coordination with the Joint Labor Management Committee, and requires training to be provided by CDSS in consultation with Child Care Providers United.

ANALYSIS:

Existing law:

1. Establishes the California Child Day Care Facilities Act to create a separate licensing category for child day care centers and family day care homes within the existing licensing structure at the CDSS. (Health and Safety Code [HSC] 1596.70 et seq.)
2. Defines “child day care facility” to mean a facility that provides nonmedical care to children under 18 years of age in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual on less than a 24-hour basis. Child day care facilities include day care centers, employer-sponsored child care centers, and family daycare homes. (HSC 1596.750)
3. Defines “day care center” to mean a child day care facility other than a family day care home, and includes infant centers, preschools, extended day care facilities, and school age child care centers, and includes child care centers with a single license. (HSC 1596.76)
4. Defines “employer-sponsored child care center” as any child day care facility at the employer’s site of business operated directly or through a provider contract by any person or entity having one or more employees, and available exclusively for the care of children of that employer, and of the officers, managers, and employees of that employer. (HSC 1596.771)
5. Defines “family daycare home” as a facility that regularly provides care, protection, and supervision for 14 or fewer children, in the provider’s own home, for periods of less than 24 hours per day, while the parents or guardians are away, and is either a large family daycare home or a small family daycare home. Defines “large family daycare home” as a facility that provides care, protection, and supervision for 7 to 14 children, inclusive, including children under 10 years of age who reside at the home. Defines “small family daycare home” as a facility that provides care, protection, and supervision for 8 or fewer children, including children under 10 years of age who reside at the home. (HSC 1596.78)
6. Prohibits any person or entity operating a child day care facility from providing care or supervision without a valid license from CDSS. (22 CCR 101156(a))
7. Notwithstanding any other law, allows licensees and staff of a child day care facility to administer inhaled medication to a child under certain requirements, as specified. (HSC 1596.798)
8. Defines “anaphylaxis” as a potentially life-threatening hypersensitivity to a substance. Specifies symptoms of anaphylaxis may include shortness of breath, wheezing, difficulty breathing, difficulty talking or swallowing, hives, itching, swelling, shock, or asthma. Specifies causes of anaphylaxis may include, but are not limited to, an insect sting, food allergy, drug reaction, and exercise. (Education Code 49414)
9. Defines “epinephrine auto-injector” as a disposable delivery device designed for the automatic injection of a premeasured dose of epinephrine into the human body to prevent or treat a life-threatening allergic reaction. (Education Code 49414)

This bill:

1. Requires, on or before July 1, 2027, CDSS, in consultation with the CDE, to establish an anaphylactic policy that sets forth guidelines and procedures recommended for child day care personnel to prevent a child from suffering from anaphylaxis and to be used during a medical emergency resulting from anaphylaxis.
2. Allows, on or before January 1, 2028, a child day care facility to implement the anaphylactic policy developed by the CDSS.
3. Requires, on or after January 1, 2028, upon enrollment of a child at a child day care facility, and annually thereafter, a child day care provider to notify the parent or guardian of the anaphylactic policy, if the facility has adopted a policy. Requires the notice to include contact information for a parent or guardian to engage further with the provider to learn more about the policy.
4. Requires the policy to be developed in consultation with representatives from all of the following:
   1. Pediatric physicians and other health care providers with expertise in treating children with anaphylaxis.
   2. Parents of children with life-threatening allergies.
   3. Child day care administrators and personnel, including local educational agency employees employed in child care programs, and the labor organizations representing those employees.
   4. Not-for-profit corporations that represent allergic individuals at risk for anaphylaxis.
5. Requires, in developing the policy, the CDSS to consider existing requirements and current and best practices for child day care providers on allergies and anaphylaxis. Requires the CDSS to consider any voluntary guidelines issued by the U.S. Department of Health and Human Services for managing food allergies in child day care facilities.
6. Requires an anaphylactic policy for family child care providers to be developed in consultation and coordination with the Joint Labor Management Committee established by the state and Child Care Providers United - California. Requires training on the anaphylactic policy to be provided by the CDSS Community Care Licensing Division in consultation with Child Care Providers United pursuant to the agreement, for all family child care providers who wish to participate, regardless of union status. Requires the CDSS Community Care Licensing Division to review minimum standards of training for the administration of epinephrine auto-injectors that satisfy the requirements of the training course described in 7) below, as necessary. Requires training to be consistent with the most recent Voluntary Guidelines for Managing Food Allergies In Schools and Early Care and Education Programs published by the federal Centers for Disease Control and Prevention.
7. Requires the anaphylactic policy to include all of the following:
   1. A process for a child day care facility to solicit volunteers among its employees to be trained and to administer epinephrine auto-injectors to a child having an anaphylactic reaction. Allows a volunteer to administer an epinephrine auto-injector to a person exhibiting potentially life-threatening symptoms of anaphylaxis at a child day care facility during operating hours. Requires the process to solicit volunteers to include a statement that there shall be no retaliation against any employee who chooses not to volunteer or who rescinds their offer to volunteer, including after receiving training.
   2. A procedure and treatment plan, including emergency protocols and responsibilities, for child day care personnel responding to a child suffering from anaphylaxis. Requires the procedure and treatment plan to include the capacity for trained personnel to have access to an undesignated stock of an appropriate weight-based dosaged epinephrine auto-injector in a secured place at the site and to carry and administer it to a child believed in good faith to be having an anaphylactic reaction. States the procedure and treatment plan shall require a parent or guardian to demonstrate an understanding of the protections provided for individuals who provide emergency medical or nonmedical care without compensation by signing a document acknowledging the Good Samaritan Law (HSC 1799.102).
   3. Requires the training course to be provided at no cost to the employee during their regular working hours. Requires the CDSS to consider the feasibility of developing the training course in languages other than English, and whether the training may be effectively provided through online instruction. Requires a training course for child day care personnel to include specified information and materials.
   4. Guidelines for each child day care facility to develop an individual emergency health care plan for children with an allergy that could result in anaphylaxis.
   5. A communication plan for dissemination of information by the CDSS regarding children with an allergy that could result in anaphylaxis.
   6. Strategies for the reduction of the risk of exposure to children of anaphylactic causative agents.
   7. A communication plan for discussion with children that have developed adequate verbal communication and comprehension skills, and with the parents or guardians of all children, about foods that are safe and unsafe and strategies to avoid exposure to unsafe food.
8. Requires the CDSS to create informational materials, in multiple languages, as applicable, detailing the anaphylactic policy. Requires the CDSS and the CDE, on or before September 1, 2027, to post the informational materials on each of the departments’ internet websites. Requires the anaphylactic policy to be updated by the CDSS as necessary.
9. Specifies this section shall not be construed to preempt, modify, or amend a child day care provider’s requirement to comply with existing federal and state disability laws, or the requirements related to a child’s individualized family service plan or individualized education program.
10. Defines the terms “anaphylaxis” and “epinephrine auto-injector as having the same meaning provided in Education Code 49414.
11. Defines “volunteer” or “trained personnel” means an employee who has volunteered to administer epinephrine auto-injectors to a person if the person is suffering, or reasonably believed to be suffering, from anaphylaxis, has been designated by a child care center or family daycare home, and has received training pursuant to 6) above.

Background

Anaphylaxis and Epinephrine

According to the Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs published by the federal Centers for Disease Control and Prevention, anaphylaxis is a severe allergic reaction that is rapid in onset and may cause death. Food allergies account for 35 to 50 percent of all cases of anaphylaxis in emergency care settings. According to the Allergy & Asthma Network, the rate of anaphylaxis is higher in children ages zero through four than in any other age group.

Epinephrine is typically available in the form of an auto-injector, which is a spring loaded syringe used to deliver a measured dose of epinephrine, designed for self-administration by patients or administration by persons untrained in other needle-based forms of epinephrine delivery. Epinephrine can quickly improve a person’s symptoms, but its effects are not long lasting. Even when epinephrine is used, 911 or other emergency medical services must be called so the person can receive further medical treatment and observation. Epinephrine auto-injectors may also be called an “EpiPen” in everyday language.

Child Care Licensing Regulations

The licensure, maintenance, and operation of child day care facilities are governed by the California Child Day Care Facilities Act. This Act and corresponding regulations require a licensed child care facility to maintain a complete and current record for each enrolled child, which must include a medical assessment that includes dietary restrictions and allergies, instructions for action to be taken in case the child’s authorized representative or designated physician cannot be reached in an emergency, and a signed consent form for emergency medical treatment (22 CCR 101220; 22 CCR 101221). In addition, as a condition of licensure, child care personnel must complete health and safety training, which must include pediatric first aid and cardiopulmonary resuscitation (CPR), and may include instruction in sanitary food handling, among other things (HSC 1596.866). Regulations also specify that a child shall not be served any food to which they have an allergy, as indicated in their record on file (22 CCR 101227). There are no further laws or regulations requiring the storage of epinephrine in child care facilities, nor requiring training for child care staff on recognizing symptoms of anaphylaxis or how to administer epinephrine.

Epinephrine Auto-Injectors in California Schools

The language in this bill is similar to existing law for K-12 schools. Existing law requires school districts, county offices of education, and charter schools to provide emergency epinephrine auto-injectors, to be stored in an accessible location upon need for emergency use, and allows school nurses or trained volunteers to use epinephrine auto-injectors to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an anaphylactic reaction (Education Code 49414). This bill allows a child day care facility to implement the anaphylactic policy developed by CDSS, in consultation with the CDE and the Joint Labor Management Committee; requires the policy to include a process for a child day care facility to solicit volunteers among its employees to be trained to administer epinephrine auto-injectors; requires a procedure and treatment plan to include the capacity for trained personnel to have access to a secured stock of epinephrine auto-injectors; and requires the child care provider to notify parents of the adopted policy.

Governor Veto of AB 2042

AB 2042 (Villapudua, 2022) would have been similar to this bill. In his veto message for AB 2042, the Governor expressed concern that the bill would expand the memorandum of understanding between the State and Child Care Providers United union. The Governor encouraged the Legislature to work with CDSS and the Emergency Medical Services Authority on an alternative solution. This bill includes several changes since its last iteration, making it distinct from AB 2042. These changes are outlined in the Senate Human Services Committee analysis of this bill.

Comments

This bill seeks to establish an anaphylactic policy for child care facilities and corresponding training for child care staff who volunteer, aligning child care facilities with anaphylactic policies for California K-12 schools and other states that have adopted similar laws. Given the high incidence of anaphylaxis for children ages zero through four, it seems reasonable to require that child care facilities be prepared to handle an anaphylactic emergency, especially as young children may be unable to voice or recognize their own symptoms of anaphylaxis.

This bill requires CDSS to establish an anaphylactic policy, but makes adoption of the policy voluntary for child care facilities. This could potentially lead to an uneven application of the policy, in which some facilities establish anaphylactic policies while others do not. Without appropriate policies and procedures in place, child care personnel may lack the necessary training and resources to prevent and mitigate anaphylactic reactions effectively, which can lead to delays in treatment, increased risk of adverse outcomes, and potential legal liabilities for child care licensees. However, imposing additional licensure and training requirements without commensurate reimbursement may not be feasible for child care licensees and staff.

Related/Prior Legislation

AB 772 (Jackson, 2023) exempts a “drop in” day care center from requiring a physician’s assessment upon admission of a child, and require a parent to sign an acknowledgement that they understand a physician’s assessment is not required for any child under the center’s care. The bill is pending on the Senate Floor.

AB 2042 (Villapudua, 2022) would have been similar to this bill. The bill was vetoed by Governor Newsom.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: Yes

According to the Senate Appropriations Committee,

• “The CDSS estimates General Fund costs of $967,000 in 2024-25 and $943,000 ongoing thereafter for staffing resources to implement the bill’s provisions.”
• “The CDE estimates General Fund costs of $176,000 in 2024–25 and $185,000 in 2025-26 for state operations.”

SUPPORT: (Verified 8/16/24)

Elijah-alavi Foundation (source)

Allergy & Asthma Network
Allergystrong
Association of Regional Center Agencies
Asthma and Allergy Foundation of America
California Society for Respiratory Care
Food Allergy & Research Education
Natalie Giorgi Sunshine Foundation
No Nut Traveler INC.
Nut Free Wok

OPPOSITION: (Verified 8/16/24)

None received

ASSEMBLY FLOOR: 73-0, 5/21/24

AYES: Addis, Aguiar-Curry, Alanis, Alvarez, Arambula, Bains, Bauer-Kahan, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Juan Carrillo, Wendy Carrillo, Chen, Connolly, Davies, Dixon, Essayli, Flora, Mike Fong, Vince Fong, Gallagher, Garcia, Gipson, Grayson, Haney, Hart, Hoover, Irwin, Jackson, Jones-Sawyer, Kalra, Lackey, Lee, Low, Lowenthal, Maienschein, McCarty, McKinnor, Muratsuchi, Stephanie Nguyen, Ortega, Pacheco, Papan, Jim Patterson, Joe Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Rendon, Reyes, Rodriguez, Blanca Rubio, Sanchez, Santiago, Schiavo, Soria, Ta, Ting, Valencia, Villapudua, Waldron, Wallis, Ward, Weber, Wicks, Wilson, Wood, Zbur, Robert Rivas

NO VOTE RECORDED: Cervantes, Megan Dahle, Friedman, Gabriel, Holden, Mathis, Luz Rivas

Prepared by: Diana Dominguez / HUMAN S. / (916) 651-1524

8/18/24 9:07:34

**** END ****

SENATE COMMITTEE ON

Senator Anna Caballero, Chair

2023 - 2024 Regular Session

AB 2317 (Stephanie Nguyen) - Child day care facilities: anaphylactic policy

Bill Summary:

AB 2317 would require the California Department of Social Services (CDSS), in consultation with the California Department of Education (CDE), to establish an anaphylactic policy that sets forth guidelines and procedures recommended for child day care personnel to prevent a child from suffering from anaphylaxis and to be used during a medical emergency resulting from anaphylaxis.

Fiscal Impact:

• The CDSS estimates General Fund costs of $967,000 in 2024-25 and $943,000 ongoing thereafter for staffing resources to implement the bill’s provisions.
• The CDE estimates General Fund costs of $176,000 in 2024–25 and $185,000 in 2025-26 for state operations.

Background:

The CDSS is responsible for the licensure of child day care facilities, which includes general health and safety requirements, staff-to-child ratios, and provider training requirements. The CDSS ensures licensed child care facilities meet health and safety standards through technical assistance, inspections, and partnerships with providers and the child care community.

Regulations require a licensed child care facility to maintain a complete and current record for each enrolled child, which must include a medical assessment that includes, among other things, dietary restrictions and allergies, instructions for action to be taken in case the child’s authorized representative or designated physician cannot be reached in an emergency, and a signed consent form for emergency medical treatment. In addition, as a condition of licensure, child care personnel must complete health and safety training, which must include pediatric first aid and cardiopulmonary resuscitation (CPR), and may include instruction in sanitary food handling, among other things. Regulations also specify that a child may not be served any food to which they have an allergy, as indicated in their record on file. There are no further laws or regulations requiring the storage of epinephrine in child care facilities, nor requiring training for child care staff on recognizing symptoms of anaphylaxis or how to administer epinephrine.

Current law requires school districts, county offices of education, and charter schools to provide emergency epinephrine auto-injectors, to be stored in an accessible location upon need for emergency use, and allows school nurses or trained volunteers to use epinephrine auto-injectors to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an anaphylactic reaction.

Proposed Law:

Specific provisions of the bill would:

• Require, on or before July 1, 2027, the CDSS, in consultation with the CDE, to establish an anaphylactic policy that sets forth guidelines and procedures recommended for child day care personnel to prevent a child from suffering from anaphylaxis and to be used during a medical emergency resulting from anaphylaxis.
• Provide that on or before January 1, 2028, a child day care facility may implement the anaphylactic policy developed by the CDSS.
• Require, on and after January 1, 2028, upon enrollment of a child at a child day care facility, and annually thereafter, the child day care provider to notify the parent or guardian of the anaphylactic policy, if the facility has adopted a policy.
• Require that an anaphylactic policy for family child care providers must be developed in consultation and coordination with the Joint Labor Management Committee established by the state and Child Care Providers United - California (CCPU) pursuant to the agreement effective July 26, 2021, to July 1, 2023, between the state and CCPU.
• Require the CDSS to create informational materials, in multiple languages, as specified; and require the CDSS and the CDE to post the informational materials on each of the departments’ internet websites.

Related Legislation:

AB 2042 (Villapudua, 2022) was similar to this bill. The bill was vetoed by the Governor.

-- END --

SENATE COMMITTEE ON EDUCATION

Senator Josh Newman, Chair

2023 - 2024 Regular

Bill No: Hearing Date: July 3, 2024

Subject: .

SUMMARY

Requires State Department of Social Services (DSS) and the California Department of Education (CDE) to develop anaphylactic policy guidelines, as specified for child day care providers, on or before July 1, 2027, and allows child day care providers to implement an anaphylactic policy developed by the DSS and the CDE, on or before January 1, 2028.

BACKGROUND

Existing law:

Education Code (EC)

1. Permits each public and private school to designate one or more volunteers to receive initial and annual refresher training, based on specified standards, regarding the storage and emergency use of an epinephrine auto-injector from the school nurse or other qualified person designated by an authorizing physician or surgeon. (EC § 49414(d))
2. Requires a school district or county office of education (COE) to provide emergency epinephrine auto-injectors to school nurses or trained volunteers, and allows those individuals to utilize epinephrine auto-injectors to provide emergency medical aid to persons suffering from an anaphylactic reaction. (EC § 49414(a))
3. Requires a school district, COE, or charter school to ensure that each employee who volunteers under this section will be provided defense and indemnification by the school district, COE, or charter school for any and all civil liability, in accordance with, but not limited to, that provided in Government Code 810, this information shall be reduced to writing, provided to the volunteer, and retained in the volunteer’s personnel file. (EC § 49414(j) and 49414.7(i))
4. Authorizes students to carry and self-administer prescribed inhaled asthma or auto-injectable epinephrine medication while at school. (EC § 49423 and 49423.1)
5. Authorizes each public and private elementary and secondary school in the state to voluntarily determine, as specified, whether or not to make emergency epinephrine auto-injectors and trained personnel available at its school. (EC § 49414(c))
6. Requires the Superintendent to review, every five years, or sooner as deemed necessary by the Superintendent, standards of training for the administration of epinephrine auto-injectors by consulting with organizations and providers with expertise in administering epinephrine auto-injectors and administering medication in a school environment and set minimum standards for training. (EC § 49414(e)(1) – (3))

Health and Safety Code (HSC)

1. Provides that no person who, in good faith, and not for compensation, renders emergency medical or nonmedical care at the scene of an emergency shall be liable for any civil damages resulting from any act or omission other than an act or omission constituting gross negligence or willful or wanton misconduct. (HSC § 1799.102)
2. Establishes the “California Child Day Care Facilities Act” creating a separate licensing category for child day care centers and family day care homes within CDSS’s existing licensing structure. (HSC § 1596.70 et seq.)

Government Code (GOV)

1. Under the Government Tort Claims Act, specifies rules of civil liability that apply to public entities and public employees in California. (GOV § 810)

ANALYSIS

This bill:

Requires DSS and CDE to Establish Anaphylactic Policies Guidelines For Child Day Care Providers

1. Requires, on or before, January 1, 2027, DSS, in consultation with the CDE to establish an anaphylactic policy that sets forth guidelines and procedures recommended for child day care personnel to prevent a child from suffering from anaphylaxis and to be used during a medical emergency resulting from anaphylaxis. The policy developed, should include the following:
   1. Pediatric physicians and other health care providers with expertise in treating children with anaphylaxis.
   2. Parents of children with life-threatening allergies.
   3. Child day care administrators and personnel, including LEA employees employed in childcare programs, and the labor organizations representing those employees.
   4. Not-for-profit corporations that represent allergic individuals at risk for anaphylaxis.
2. Requires, in developing the policy, for DSS to consider existing requirements and current and best practices for child day care providers on allergies and anaphylaxis. And consider any voluntary guidelines issued by the United States Department of Health and Human Services for managing food allergies in child day care facilities.
3. Requires an anaphylactic policy for family child care to be developed in consultation and coordination with the Joint Labor Management Committee established by the state and Child Care Providers United - California (CCPU) pursuant to the agreement effective July 26, 2021, to July 1, 2023, between the state and CCPU.
4. Allows, on or before January 1, 2028, a child day care facility to implement a anaphylactic policy developed by the DSS and the CDE and requires the child day care provider, upon a child enrolling, to notify the parent or guardian of the anaphylactic policy, if the facility has adopted a policy with information for a parent or guardian to engage further with the child day care provider to learn more about the policy.
5. Requires the DSS to create informational materials, in multiple languages, as specified in federal law detailing the anaphylactic policy, and requires DSS and CDE on or before September 1, 2027, the department and the State Department of Education shall post the informational materials on each of the departments’ internet websites.
6. Requires the DSS to update the anaphylactic policy as necessary and for anaphylactic policy to not be construed to preempt, modify, or amend a child day care provider’s requirement to comply with existing federal and state disability laws, or the requirements related to a child’s individualized family service plan or individualized education program.

Ensures Minimum Training Standards Related to Epinephrine Auto-Injector

1. Requires training on the anaphylactic policy to be provided to DSS’s CCLD in consultation with CCPU pursuant to that agreement, and any extension or renewal of that agreement, for all family child care providers who wish to participate, regardless of union status.
2. Requires DSS’s CCLD to review minimum standards of training for the administration of epinephrine auto-injectors that satisfy the requirements of the anaphylactic policy in 7) below, as necessary, and requires training related to the administration of epinephrine auto-injectors is consistent with the most recent Voluntary Guidelines for Managing Food Allergies In Schools and Early Care and Education Programs published by the federal Centers for Disease Control and Prevention.
3. Requires the anaphylactic policy to include all of the following:

• 1. A process for a child daycare facility to solicit volunteers among its employees to be trained and to administer epinephrine auto-injectors to a child having an anaphylactic reaction. A volunteer may administer an epinephrine auto-injector to a person exhibiting potentially life-threatening symptoms of anaphylaxis at a child daycare facility during operating hours. The process to solicit volunteers shall include a statement that there shall be no retaliation against any employee who chooses not to volunteer or who rescinds their offer to volunteer, including after receiving training.
  2. A procedure and treatment plan, including emergency protocols and responsibilities, for child day care personnel responding to a child suffering from anaphylaxis and specifies that the 1) procedure and treatment plan must include the capacity for trained personnel to have access to an undesignated stock of an appropriate weight-based dosage epinephrine auto-injector in a secured place at the site and to carry and administer it to a child believed in good faith to be having an anaphylactic reaction and 2) the procedure and treatment require a parent or guardian to demonstrate an understanding of the protections provided for individuals who provide emergency medical or nonmedical care without compensation by signing a document acknowledging the Good Samaritan Law.
  3. A training course for child daycare personnel shall include all of the following:
     1. Techniques for preventing, recognizing the symptoms of, and responding to anaphylaxis.
     2. Standards and procedures for the storage, restocking, and emergency use of epinephrine auto-injectors.
     3. Emergency follow up procedures, including calling the emergency 911 telephone number and contacting, if possible, the child’s parent and health care provider.
     4. Written materials covering the information.

And specifies that the training course must be provided at no cost to the employee during their regular working hours, the feasibility of developing the training course in languages other than English to meet the needs of providers

for the department to consider whether the training may be effectively provided through online instruction.

1. Appropriate guidelines for each child day care facility to develop an individual emergency health care plan for children with a food or other allergy that could result in anaphylaxis.
2. A communication plan for dissemination of information by the department regarding children with a food or other allergy that could result in anaphylaxis, including a discussion of methods, treatments, and therapies to reduce the risk of allergic reactions.
3. Strategies for the reduction of the risk of exposure to children of anaphylactic causative agents, including food and other allergens.
4. A communication plan for discussion with children that have developed adequate verbal communication and comprehension skills, and with the parents or guardians of all children, about foods that are safe and unsafe and strategies to avoid exposure to unsafe food.

Definitions

1. Defines “Anaphylaxis” to mean a potentially life-threatening hypersensitivity to a substance.
2. Defines “Epinephrine auto-injector” to mean a disposable delivery device designed for the automatic injection of a premeasured dose of epinephrine into the human body to prevent or treat a life-threatening allergic reaction.
3. Defines “Volunteer” or “trained personnel” means an employee who has volunteered to administer epinephrine auto-injectors to a person if the person is suffering, or reasonably believed to be suffering, from anaphylaxis, has been designated by a child care center or family daycare home, and has received training.

STAFF COMMENTS

1. Need for the bill. According to the author, “The rate of anaphylaxis is higher in children ages 0-to-4 than in any other age group. Furthermore, California health claims data points to a tremendous rise in anaphylaxis over the past 15 years (approximately 316%) which has led to an average of one in five children with a food allergy reporting one or more allergy-related emergency room visits in the previous year.

AB 2317 is otherwise known as Elijah's Law (passed in the state of New York in 2019) in tribute to Elijah Silvera who suffered from milk allergies and unfortunately lost his life due to anaphylaxis while under the care of daycare provider who fed him a cheese sandwich. Enacting Elijah's Law in California will help to ensure daycare providers are further equipped to:

- Help prevent life-threatening allergic reactions due to food or venom allergies,

- Better recognize the signs and symptoms of anaphylaxis and,

- Treat this condition by utilizing an appropriate weight-based dosage of epinephrine.

To ensure the health and well-being of the 976,000+ California children cared for in the approximately 13,000 daycare settings throughout the state, we should enact AB 2317.”

1. California’s Child Daycare System. California has a multifaceted system of licensed child daycares. The Early Childhood Development Act of 2020 authorized the transfer of most childcare programs to the DSS from CDE effective July 1, 2021. CDE continues to operate the California State Preschool Program (CSPP), which is administered through LEAs, colleges, community-action agencies, and private nonprofit agencies. CSPP serves eligible children ages three and four for both part-day and full-day services and is the largest state-funded preschool program in the nation. CDSS’s CCLD has the responsibility of licensing and monitoring the state’s 12,768 daycare centers, which have a capacity to serve 663,454 children. There are an additional 2,201 licensed school-age daycare facilities with a capacity to serve 139,610 children.
2. 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.
3. Food Allergy Among U.S. Children. According to the FARE website, eight foods account for 90 percent 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 percent between 1997 and 2011. FARE’s website 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. The California School Board Association (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.
4. Related Legislation.

AB 2042 (Villapudua, 2022) would have required the DSS to establish an anaphylactic policy that sets guidelines and procedures to be followed by child daycare personnel to prevent a child from suffering from anaphylaxis and to be used during a medical emergency by July 1, 2024.

AB 2640 (Valladares, Chapter 794, Statutes of 2022) requires the CDE to create the California Food Allergy Resource internet web page to provide voluntary guidance to LEAs to help protect pupils with food allergies.

SB 1258 (Huff, 2016) would have required requires each school district, COE, and charter school to develop a comprehensive policy to protect students with food allergies. This bill was held in Senate Appropriations.

SB 738 (Huff, Chapter 132, Statutes of 2015) provides qualified immunity to a physician who issues a prescription for an epinephrine auto-injector to a school district, COE, or charter school.

SB 1266 (Huff, Chapter 321, Statutes of 2014) requires school districts, COE, and charter schools to provide emergency epinephrine auto-injectors to school nurses or trained personnel who have volunteered and allows school nurses or trained personnel to use the epinephrine auto-injectors to provide emergency medical aid to persons.

AB 559 (Wiggins, Chapter 458, Statutes of 2001) established provisions of law that permit a school district or COE to provide emergency epinephrine auto-injectors to trained personnel, and permit trained personnel to utilize these epinephrine auto-injectors to provide emergency medical aid to persons suffering from an anaphylactic reaction at a school or during a school activity.

SUPPORT

Elijah-Alavi Foundation (Sponsor)

Allergy & Asthma Network

AllergyStrong

Association of Regional Center Agencies

No Nut Traveler

Nut Free Wok

OPPOSITION

None received

-- END --

SENATE COMMITTEE ON HUMAN SERVICES

Senator Alvarado-Gil, Chair

2023 - 2024 Regular

Subject: Child day care facilities: anaphylactic policy

SUMMARY

This bill requires the Department of Social Services (CDSS), in consultation with the Department of Education, on or before July 1, 2027, to establish an anaphylactic policy with guidelines and procedures recommended for child care personnel to prevent a child from suffering from anaphylaxis. This bill allows, on or before January 1, 2028, a child care facility to implement the anaphylactic policy, and requires a provider to notify a parent or guardian of the policy upon enrollment of a child. This bill requires the policy to be developed in consultation and coordination with the Joint Labor Management Committee established pursuant to the State’s agreement with the Child Care Providers United - California union, and requires training to be provided by CDSS in consultation with Child Care Providers United. This bill requires the policy to include certain information and consider best practices and federal guidance.

ABSTRACT

Existing Law:

1. Establishes the California Child Day Care Facilities Act to create a separate licensing category for child day care centers and family day care homes within the existing licensing structure at the CDSS. (Health and Safety Code [HSC] 1596.70 et seq.)
2. Defines “child day care facility” to mean a facility that provides nonmedical care to children under 18 years of age in need of personal services, supervision, or assistance essential for sustaining the activities of daily living or for the protection of the individual on less than a 24-hour basis. Child day care facilities include day care centers, employer-sponsored child care centers, and family daycare homes. (HSC 1596.750)
3. Defines “day care center” to mean a child day care facility other than a family day care home, and includes infant centers, preschools, extended day care facilities, and school age child care centers, and includes child care centers with a single license. (HSC 1596.76)
4. Defines “employer-sponsored child care center” as any child day care facility at the employer’s site of business operated directly or through a provider contract by any person or entity having one or more employees, and available exclusively for the care of children of that employer, and of the officers, managers, and employees of that employer. (HSC 1596.771)
5. Defines “family daycare home” as a facility that regularly provides care, protection, and supervision for 14 or fewer children, in the provider’s own home, for periods of less than 24 hours per day, while the parents or guardians are away, and is either a large family daycare home or a small family daycare home. Defines “large family daycare home” as a facility that provides care, protection, and supervision for 7 to 14 children, inclusive, including children under 10 years of age who reside at the home. Defines “small family daycare home” as a facility that provides care, protection, and supervision for 8 or fewer children, including children under 10 years of age who reside at the home. (HSC 1596.78)
6. Prohibits any person or entity operating a child day care facility from providing care or supervision without a valid license from CDSS. (22 CCR 101156(a))
7. Notwithstanding any other law, allows licensees and staff of a child day care facility to administer inhaled medication to a child under certain requirements, as specified. (HSC 1596.798)
8. Defines “anaphylaxis” as a potentially life-threatening hypersensitivity to a substance. Specifies symptoms of anaphylaxis may include shortness of breath, wheezing, difficulty breathing, difficulty talking or swallowing, hives, itching, swelling, shock, or asthma. Specifies causes of anaphylaxis may include, but are not limited to, an insect sting, food allergy, drug reaction, and exercise. (Education Code 49414)
9. Defines “epinephrine auto-injector” as a disposable delivery device designed for the automatic injection of a premeasured dose of epinephrine into the human body to prevent or treat a life-threatening allergic reaction. (Education Code 49414)

This Bill:

1. Requires, on or before July 1, 2027, CDSS, in consultation with the Department of Education, to establish an anaphylactic policy that sets forth guidelines and procedures recommended for child day care personnel to prevent a child from suffering from anaphylaxis and to be used during a medical emergency resulting from anaphylaxis.
2. Allows, on or before January 1, 2028, a child day care facility to implement the anaphylactic policy developed by the CDSS.
3. Requires, on or after January 1, 2028, upon enrollment of a child at a child day care facility, and annually thereafter, a child day care provider to notify the parent or guardian of the anaphylactic policy, if the facility has adopted a policy. Requires the notice to include contact information for a parent or guardian to engage further with the provider to learn more about the policy.
4. Requires the policy to be developed in consultation with representatives from all of the following:
   1. Pediatric physicians and other health care providers with expertise in treating children with anaphylaxis.
   2. Parents of children with life-threatening allergies.
   3. Child day care administrators and personnel, including local educational agency employees employed in child care programs, and the labor organizations representing those employees.
   4. Not-for-profit corporations that represent allergic individuals at risk for anaphylaxis.
5. In developing the policy, requires the CDSS to consider existing requirements and current and best practices for child day care providers on allergies and anaphylaxis. Requires the CDSS to consider any voluntary guidelines issued by the U.S. Department of Health and Human Services for managing food allergies in child day care facilities.
6. Requires an anaphylactic policy for family child care providers to be developed in consultation and coordination with the Joint Labor Management Committee established by the state and Child Care Providers United - California pursuant to the agreement effective July 26, 2021, to July 1, 2023, between the state and Child Care Providers United. Requires training on the anaphylactic policy to be provided by the CDSS Community Care Licensing Division in consultation with Child Care Providers United pursuant to the agreement, and any extension or renewal of that agreement, for all family child care providers who wish to participate, regardless of union status. Requires the CDSS Community Care Licensing Division to review minimum standards of training for the administration of epinephrine auto-injectors that satisfy the requirements of the training course described in 7) below, as necessary. Requires training to be consistent with the most recent Voluntary Guidelines for Managing Food Allergies In Schools and Early Care and Education Programs published by the federal Centers for Disease Control and Prevention.
7. Requires the anaphylactic policy to include all of the following:
   1. A process for a child day care facility to solicit volunteers among its employees to be trained and to administer epinephrine auto-injectors to a child having an anaphylactic reaction. Allows a volunteer to administer an epinephrine auto-injector to a person exhibiting potentially life-threatening symptoms of anaphylaxis at a child day care facility during operating hours. Requires the process to solicit volunteers to include a statement that there shall be no retaliation against any employee who chooses not to volunteer or who rescinds their offer to volunteer, including after receiving training.
   2. A procedure and treatment plan, including emergency protocols and responsibilities, for child day care personnel responding to a child suffering from anaphylaxis. Requires the procedure and treatment plan to include the capacity for trained personnel to have access to an undesignated stock of an appropriate weight-based dosaged epinephrine auto-injector in a secured place at the site and to carry and administer it to a child believed in good faith to be having an anaphylactic reaction. States the procedure and treatment plan shall require a parent or guardian to demonstrate an understanding of the protections provided for individuals who provide emergency medical or nonmedical care without compensation by signing a document acknowledging the Good Samaritan Law enumerated in HSC 1799.102.
   3. Requires the training course to be provided at no cost to the employee during their regular working hours. Requires the CDSS to consider the feasibility of developing the training course in languages other than English to meet the needs of providers. Requires the CDSS consider whether the training may be effectively provided through online instruction. Requires a training course for child day care personnel to include all of the following:
      1. Techniques for preventing, recognizing the symptoms of, and responding to anaphylaxis.
      2. Standards and procedures for the storage, restocking, and emergency use of epinephrine auto-injectors.
      3. Emergency follow up procedures, including calling the emergency 911 telephone number and contacting, if possible, the child’s parent and health care provider.
      4. Written materials covering the information required by this subparagraph.
   4. Appropriate guidelines for each child day care facility to develop an individual emergency health care plan for children with a food or other allergy that could result in anaphylaxis.
   5. A communication plan for dissemination of information by the department regarding children with a food or other allergy that could result in anaphylaxis, including a discussion of methods, treatments, and therapies to reduce the risk of allergic reactions.
   6. Strategies for the reduction of the risk of exposure to children of anaphylactic causative agents, including food and other allergens.
   7. A communication plan for discussion with children that have developed adequate verbal communication and comprehension skills, and with the parents or guardians of all children, about foods that are safe and unsafe and strategies to avoid exposure to unsafe food.
8. Requires the CDSS to create informational materials, in multiple languages, as applicable, pursuant to federal and state law, detailing the anaphylactic policy. Requires the CDSS and the CDE, on or before September 1, 2027, to post the informational materials on each of the departments’ internet websites. Requires the anaphylactic policy to be updated by the CDSS as necessary.
9. Specifies this section shall not be construed to preempt, modify, or amend a child day care provider’s requirement to comply with existing federal and state disability laws, or the requirements related to a child’s individualized family service plan or individualized education program.
10. For the purposes of this section, specifies the following terms shall have the following meanings:
    1. “Anaphylaxis” has the same meaning as provided in Education Code 49414.
    2. “Epinephrine auto-injector” has the same meaning as provided in Education Code 49414.
    3. “Volunteer” or “trained personnel” means an employee who has volunteered to administer epinephrine auto-injectors to a person if the person is suffering, or reasonably believed to be suffering, from anaphylaxis, has been designated by a child care center or family daycare home, and has received training pursuant to 6) above.

FISCAL IMPACT

According to the Assembly Appropriations Committee analysis:

1. “Estimated ongoing General Fund costs in the low hundreds of thousands of dollars annually, for additional staff at CDSS to comply with the bill’s requirements in establishing an anaphylactic policy, including coordinating with stakeholders, developing the policy, guidelines and procedures, assisting with development of materials for implementation, subsequent outreach, and ongoing technical assistance on anaphylaxis policy.”
2. “Costs to CDE to consult with CDSS in the development of the anaphylaxis policy and to post materials on its internet website are likely to be minor and absorbable.”

“According to the Legislative Analyst’s Office, the General Fund faces a structural deficit in the tens of billions of dollars over the next several fiscal years.”

BACKGROUND AND DISCUSSION

Purpose of the Bill:

According to the author, “The rate of anaphylaxis is higher in children ages 0 to 4 than in any other age group. Furthermore, California health claims data points to a tremendous rise in anaphylaxis over the past 15 years (approximately 316%) which has led to an average of one in five children with a food allergy reporting one or more allergy-related emergency room visits in the previous year. AB 2317 is otherwise known as Elijah’s Law (passed in the state of New York in 2019) in tribute to Elijah Silvera who suffered from milk allergies and unfortunately lost his life due to anaphylaxis while under the care of daycare provider who fed him a cheese sandwich. Enacting Elijah's Law in California will help to ensure daycare providers are further equipped to: Help prevent life-threatening allergic reactions due to food or venom allergies, Better recognize the signs and symptoms of anaphylaxis and, Treat this condition by utilizing an appropriate weight-based dosage of epinephrine. To ensure the health and well-being of the 976,000+ California children cared for in the approximately 13,000 daycare settings throughout the state, we should enact AB 2317.”

Elijah’s Law

Elijah’s Law is named after 3-year-old Elijah-Alavi Silvera. Elijah suffered from milk allergies and lost his life due to anaphylaxis while under the care of a daycare provider who fed him a cheese sandwich. Elijah’s Law requires the staff or a staff member at a child care facility to be trained in managing food allergies, including identification and treatment of anaphylaxis; allows child care facilities to have a stock of epinephrine on site and ensures staff are trained to administer epinephrine in case of an emergency; and requires child care facilities to have policies for clear communication of allergy information. As of April 2024, New York, Illinois, Virginia, and Maryland have passed Elijah’s Law legislation.

Anaphylaxis and Epinephrine

According to the Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs^[1] published by the federal Centers for Disease Control and Prevention, anaphylaxis is a severe allergic reaction that is rapid in onset and may cause death. Food allergies account for 35 to 50 percent of all cases of anaphylaxis in emergency care settings. According to the Allergy & Asthma Network, the rate of anaphylaxis is higher in children ages zero through four than in any other age group.

Epinephrine administered by injection rapidly improves breathing, increases heart rate, and reduces swelling of the face, lips, and throat. Epinephrine is typically available in the form of an auto-injector, which is a spring loaded syringe used to deliver a measured dose of epinephrine, designed for self-administration by patients or administration by persons untrained in other needle-based forms of epinephrine delivery. Epinephrine can quickly improve a person’s symptoms, but its effects are not long lasting. Even when epinephrine is used, 911 or other emergency medical services must be called so the person can receive further medical treatment and observation. Epinephrine auto-injectors may also be called an “EpiPen” in everyday language.

Child Care Licensing Regulations

The licensure, maintenance, and operation of child day care facilities are governed by the California Child Day Care Facilities Act. This Act and corresponding regulations establish, among other things, general health and safety requirements, staff-to-child ratios, and provider training requirements for licensed child care. CDSS’s Child Care Licensing Program within the Community Care Licensing Division is charged with ensuring licensed child care facilities meet health and safety standards through technical assistance, inspections, and partnerships with providers and the child care community.

Regulations require a licensed child care facility to maintain a complete and current record for each enrolled child, which must include a medical assessment that includes, among other things, dietary restrictions and allergies, instructions for action to be taken in case the child’s authorized representative or designated physician cannot be reached in an emergency, and a signed consent form for emergency medical treatment (22 CCR 101220; 22 CCR 101221). In addition, as a condition of licensure, child care personnel must complete health and safety training, which must include pediatric first aid and cardiopulmonary resuscitation (CPR), and may include instruction in sanitary food handling, among other things (HSC 1596.866). Regulations also specify that a child shall not be served any food to which they have an allergy, as indicated in their record on file (22 CCR 101227). There are no further laws or regulations requiring the storage of epinephrine in child care facilities, nor requiring training for child care staff on recognizing symptoms of anaphylaxis or how to administer epinephrine.

Epinephrine Auto-Injectors in California Schools

The language in this bill is similar to existing law for K-12 schools, which requires school districts, county offices of education, and charter schools to provide emergency epinephrine auto-injectors, to be stored in an accessible location upon need for emergency use, and allows school nurses or trained volunteers to use epinephrine auto-injectors to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an anaphylactic reaction (Education Code 49414). This bill allows a child day care facility to implement the anaphylactic policy developed by CDSS, requires the policy to include a process for a child day care facility to solicit volunteers among its employees to be trained to administer epinephrine auto-injectors, requires a procedure and treatment plan to include the capacity for trained personnel to have access to a secured stock of epinephrine auto-injectors, and requires the child care provider to notify parents of the adopted policy.

Existing law requires the Superintendent of Public Instruction to review minimum standards of training for the administration of epinephrine auto-injectors every five years, or sooner, as deemed necessary by the Superintendent (Education Code 49414). This bill requires the CDSS to develop an anaphylactic policy in consultation with the Department of Education and the Joint Labor Management Committee established pursuant to the union agreement with Child Care Providers United. This bill requires anaphylactic policy training similar to the training outlined in the Education Code.

Governor Veto and Changes Since AB 2042

AB 2042 (Villapudua, 2022) was similar to this bill. AB 2042 would have required CDSS, in consultation with the Department of Education, to establish an anaphylactic policy for child day care personnel, and allow day care facilities to adopt the anaphylactic policy. AB 2042 was vetoed by Governor Newsom. In his veto message, the Governor wrote: “It is important for all children in a child care setting to be cared for by staff who are trained to assist with their unique needs, including being able to recognize and respond to symptoms of anaphylaxis. While I appreciate the author’s attention to this matter, the bill before me creates a number of implementation concerns, including establishing multiple processes and expanding the memorandum of understanding (MOU) between the State and the Child Care Providers United union. I encourage the Legislature to work with the Department of Social Services and the Emergency Medical Services Authority, who have the expertise to develop health and safety standards, on a workable alternative that is uniform and addresses these issues.”

This bill includes several changes since its last iteration, making it distinct from AB 2042. These changes include:

1. Revises the date that CDSS, in consultation with CDE, must establish an anaphylactic policy by from on or before July 1, 2024 to on or before July 1, 2027.
2. Revises the date that a facility may implement the anaphylactic policy from on or before January 1, 2025, to on or before January 1, 2028. Revises the date a child care provider must notify a parent or guardian of the anaphylactic policy from on or after January 1, 2025, to on or after January 1, 2028.
3. Requires the CDSS Community Care Licensing Division to review minimum standards of training for the administration of epinephrine auto-injectors, and requires training to be consistent with recent voluntary guidelines published by the federal Centers for Disease Control and Prevention.
4. Allows a volunteer to administer an epinephrine auto-injector to a person exhibiting potentially life-threatening symptoms of anaphylaxis at a child day care facility during operating hours, instead of requiring at least volunteer who is trained in administering an epinephrine auto-injector to be present during operating hours.
5. Removes a provision specifying that child care personnel who administer epinephrine using an auto-injector in compliance with anaphylactic policy and in good faith to a child who appears to be suffering from anaphylaxis shall not be liable in a civil action, nor subject to criminal prosecution for their acts in administering the epinephrine.
6. Removes a provision specifying any local educational agency that designates volunteers shall ensure each employee who volunteers will be provided with defense and indemnification by the local education agency for any and all civil liability, in accordance with Division 3.6 of Title 1 of the Government Code.
7. Requires a parent or guardian to demonstrate an understanding of the protections provided for individuals who provide emergency medical or nonmedical care without compensation by signing a document acknowledging the Good Samaritan Law, as provided in HSC 1799.102.
8. Specifies that a training course for child day care personnel shall include all of the following:
   1. Techniques for preventing, recognizing the symptoms of, and responding to anaphylaxis.
   2. Standards and procedures for the storage, restocking, and emergency use of epinephrine auto-injectors.
   3. Emergency follow up procedures, including calling the emergency 911 telephone number and contacting, if possible, the child’s parent and health care provider.
   4. Written materials covering the information required by this provision.
9. Requires CDSS to update the anaphylactic policy as necessary, instead of once every three years.
10. Defines “anaphylaxis”, “epinephrine auto-injector”, and “volunteer” or “trained personnel”.

Related/Prior Legislation:

AB 772 (Jackson, 2023) would exempt a “drop in” day care center from requiring a physician’s assessment upon admission of a child, and require a parent to sign an acknowledgement that they understand a physician’s assessment is not required for any child under the center’s care. AB 772 is set to be heard by this committee on June 17, 2024.

AB 2042 (Villapudua, 2022) was similar to this bill. AB 2042 was vetoed by Governor Newsom.

AB 1532 (Bauer-Kahan, Chapter 131, Statutes of 2019) established the “Natalie Giorgi Sunshine Act,” which requires, on or before January 1, 2021, a food handler training course to include instruction on the elements of major food allergens, foods identified as major food allergens, the symptoms a major food allergen could cause, and safe handling food practices for major food allergens.

AB 3342 (Bauer-Kahan, 2020) would have required CDSS to authorize child day care facilities to keep emergency epinephrine auto-injectors onsite for administration by trained volunteer personnel in cases when an individual is suffering from an anaphylactic reaction. AB 3342 would also have required CDSS to develop a training program for participating personnel, incorporating various components, such as techniques for identifying symptoms of anaphylaxis and emergency follow-up protocols. AB 3342 was held in the Assembly Human Services Committee.

SB 1266 (Huff, Chapter 321, Statutes of 2014) required school districts, county offices of education, and charter schools to provide emergency epinephrine auto-injectors to school nurses or trained volunteer personnel to administer epinephrine auto-injectors to provide emergency medical aid to persons suffering from an anaphylactic reaction.

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

COMMENTS

This bill seeks to establish an anaphylactic policy for child care facilities and corresponding training for child care staff who volunteer, aligning child care facilities with anaphylactic policies for California K-12 schools and other states that have adopted Elijah’s Law. Given the high incidence of anaphylaxis for children ages zero through four, it seems reasonable to require that child care facilities be prepared to handle an anaphylactic emergency, especially as young children may be unable to voice or recognize their own symptoms of anaphylaxis.

This bill requires CDSS to establish an anaphylactic policy, but makes adoption of the policy voluntary for child care facilities. This could potentially lead to an uneven application of the policy, in which some facilities establish anaphylactic policies while others do not. Without appropriate policies and procedures in place, child care personnel may lack the necessary training and resources to prevent and mitigate anaphylactic reactions effectively, which can lead to delays in treatment, increased risk of adverse outcomes, and potential legal liabilities for child care licensees. However, imposing additional licensure and training requirements without commensurate reimbursement may not be feasible for child care licensees and staff. This is a trade-off the author may wish to consider.

This bill requires CDSS to establish an anaphylactic policy in consultation with CDE, and also requires the policy to be developed in consultation and coordination with the Joint Labor Management Committee established pursuant to the State’s agreement with Child Care Providers United. This bill also requires training on the policy to be provided by CDSS in consultation with Child Care Providers United. The author may wish to consider the following: Is the Joint Labor Management Committee the most appropriate entity to consult on the development of a statewide anaphylactic policy?

PRIOR VOTES

POSITIONS

Support:

Elijah-alavi Foundation (Sponsor)

Allergy & Asthma Network
Allergystrong
Association of Regional Center Agencies
Asthma and Allergy Foundation of America
California Society for Respiratory Care
Food Allergy & Research Education
Natalie Giorgi Sunshine Foundation
No Nut Traveler INC.
Nut Free Wok

Oppose:

None

-- END --

1. https://www.cdc.gov/healthyschools/foodallergies/pdf/20_316712-A_FA_guide_508tag.pdf ↑

ASSEMBLY THIRD READING

ATR Bill Id:AB 2317

Author:(Stephanie Nguyen)

As Amended Ver:March 20, 2024

Majority vote

SUMMARY

Requires the California Department of Social Services (CDSS), in consultation with the California Department of Education (CDE), to establish an anaphylactic policy that sets forth guidelines and procedures recommended for child daycare personnel to prevent a child from suffering from anaphylaxis and to be used during a medical emergency resulting from anaphylaxis.

Major Provisions

1. Requires CDSS, on or before July 1, 2027, and in consultation with CDE, to establish an anaphylactic policy that sets forth guidelines and procedures recommended for child daycare personnel to prevent a child from suffering from anaphylaxis and to be used during a medical emergency resulting from anaphylaxis.
2. Permits a child daycare facility to implement the anaphylactic policy developed by CDSS on or before January 1, 2028.
3. Upon enrollment of a child at a child daycare facility, requires the child daycare provider on and after January 1, 2028, and annually thereafter, to notify the parent or guardian of the anaphylactic policy if the facility has adopted a policy. Requires the notice to include contact information for a parent or guardian to engage further with the child daycare provider to learn more about the policy.
4. Requires the policy to be developed in consultation with representatives from all of the following:
   1. Pediatric physicians and other healthcare providers with expertise in treating children with anaphylaxis;
   2. Parents of children with life-threatening allergies;
   3. Child daycare administrators and personnel, including local educational agency employees employed in childcare programs, and the labor organizations representing those employees; and,
   4. Not-for-profit corporations that represent allergic individuals at risk for anaphylaxis.
5. In developing the policy, requires CDSS to consider existing requirements and current and best practices for child daycare providers on allergies and anaphylaxis. Further requires CDSS to consider any voluntary guidelines issued by the United States Department of Health and Human Services for managing food allergies in child daycare facilities.
6. Requires an anaphylactic policy for family childcare providers to be developed in consultation and coordination with the Joint Labor Management Committee (JLMC) established by the state and Child Care Providers United - California (CCPU) pursuant to the agreement effective July 26, 2021, to July 1, 2023, between the state and CCPU.
7. Requires training on the anaphylactic policy be provided by CDSS' Community Care Licensing Division (CCLD) in consultation with CCPU pursuant to that agreement, and any extension or renewal of that agreement, for all family childcare providers who wish to participate, regardless of union status.
8. Requires CDSS' CCLD to review minimum standards of training for the administration of epinephrine auto-injectors, as necessary. Requires training to be consistent with the most recent Voluntary Guidelines for Managing Food Allergies In Schools and Early Care and Education Programs published by the federal Centers for Disease Control and Prevention (CDC).
9. Requires the anaphylactic policy to include all of the following:
   1. A process for a child daycare facility to solicit volunteers among its employees to be trained and to administer epinephrine auto-injectors to a child having an anaphylactic reaction. Permits a volunteer to administer an epinephrine auto-injector to a person exhibiting potentially life-threatening symptoms of anaphylaxis at a child daycare facility during operating hours. Requires the process to solicit volunteers to include a statement that there shall be no retaliation against any employee who chooses not to volunteer or who rescinds their offer to volunteer, including after receiving training;
   2. A procedure and treatment plan, including emergency protocols and responsibilities, for child daycare personnel responding to a child suffering from anaphylaxis;
   3. Requires the procedure and treatment plan to include the capacity for trained personnel to have access to an undesignated stock of an appropriate weight-based dosage epinephrine auto-injector in a secured place at the site and to carry and administer it to a child believed in good faith to be having an anaphylactic reaction;
   4. Requires a parent or guardian to demonstrate an understanding of the protections provided for individuals who provide emergency medical or nonmedical care without compensation by signing a document acknowledging the Good Samaritan law enumerated in existing law;
   5. Requires a training course for child daycare personnel to include all of the following:
10. Techniques for preventing, recognizing the symptoms of, and responding to anaphylaxis;
    • • 1. Standards and procedures for the storage, restocking, and emergency use of epinephrine auto-injectors;
        2. Emergency follow-up procedures, including calling the emergency 911 telephone number and contacting, if possible, the child's parent and healthcare provider; and,
        3. Written materials covering the information required under this subdivision.
    1. Requires the training course to be provided at no cost to the employee during their regular working hours. Further requires CDSS to consider the feasibility of developing the training course in languages other than English to meet the needs of providers and to consider whether the training may be effectively provided through online instruction;
    2. Appropriate guidelines for each child daycare facility to develop an individual emergency healthcare plan for children with a food or other allergy that could result in anaphylaxis;
    3. A communication plan for dissemination of information by CDSS regarding children with food or other allergy that could result in anaphylaxis, including a discussion of methods, treatments, and therapies to reduce the risk of allergic reactions;
    4. Strategies for the reduction of the risk of exposure to children of anaphylactic causative agents, including food and other allergens; and,
    5. A communication plan for discussion with children who have developed adequate verbal communication and comprehension skills, and with the parents or guardians of all children, about foods that are safe and unsafe and strategies to avoid exposure to unsafe food.
11. Requires CDSS to create informational materials, in multiple languages, pursuant to federal and state law, detailing the anaphylactic policy. Requires CDSS and CDE to post the informational materials on each of the departments' internet websites on or before September 1, 2027.
12. Requires the anaphylactic policy to be updated by CDSS as necessary.
13. Provides that 1) to 11) above shall not be construed to preempt, modify, or amend a child daycare provider's requirement to comply with existing federal and state disability laws, or the requirements related to a child's individualized family service plan or individualized education program.
14. Defines the following terms:
    1. "Anaphylaxis" as a potentially life-threatening hypersensitivity to a substance. Symptoms include shortness of breath, wheezing, difficulty breathing, difficulty talking or swallowing, hives, itching, swelling, shock, or asthma. Causes of anaphylaxis may include, but are not limited to, an insect sting, food allergy, drug reaction, and exercise.
    2. "Epinephrine auto-injector" is a disposable delivery device designed for the automatic injection of a premeasured dose of epinephrine into the human body to prevent or treat a life-threatening allergic reaction.
    3. "Volunteer" or "trained personnel" as an employee who has volunteered to administer epinephrine auto-injectors to a person if the person is suffering, or reasonably believed to be suffering, from anaphylaxis, has been designated by a childcare center or family daycare home and has received training.

COMMENTS

Background: What is Anaphylaxis? Anaphylaxis is characterized by a systemic immune response to an allergen that can be life-threatening. Common symptoms include shortness of breath, wheezing, difficulty breathing, difficulty talking or swallowing, hives, itchiness, swelling, shock, or asthma. The onset of symptoms usually occurs within minutes, but can be delayed up to 30 minutes and, although rare, even hours after exposure. Food allergies are the most common cause of anaphylaxis, such as eggs, milk, peanuts, tree nuts, wheat, crustacean shellfish, and soy. Other allergens can trigger anaphylaxis, including insect stings or bites, medications, such as antibiotics, nonsteroidal anti-inflammatory drugs, latex, and even exercise. Twenty-five percent of severe and potentially life-threatening reactions reported at schools happened in children with no previous diagnosis of food allergy.

Treatment of Anaphylaxis. An epinephrine auto-injector (commonly called an "epi-pen") is a medical device utilized to deliver a measured dose of epinephrine via auto-injector technology, primarily used to manage acute allergic reactions and prevent or address the onset of anaphylaxis. Epinephrine auto-injectors are available exclusively by prescription.

California law permits school districts or county offices of education to provide emergency epi-pens to trained personnel and permits trained personnel to utilize the epi-pens to provide emergency medical aid to persons suffering from an anaphylactic reaction. This bill seeks to extend these provisions to child daycare providers and establishes processes around this provision.

Childcare Licensing Regulations on Anaphylaxis. State law and regulations provide guidance for anaphylaxis in K-12 schools, but it does not for childcare providers. This indicates each childcare facility adopts its own practices related to allergen identification, prevention strategies, emergency response procedures, and communication protocols with parents or guardians, further signifying a lack of consistency among childcare facilities. Based on current regulations, many childcare facilities may rely on ad hoc measures for children with unknown allergies and on individual plans for those who have known allergies rather than standardized policies endorsed by regulations or established best practices. Because this bill is permissive and allows childcare facilities to opt out of implementing the anaphylactic policy, the ad hoc measures in treating anaphylactic reactions may persist.

According to the Author

"The rate of anaphylaxis is higher in children ages 0-to-4 than in any other age group. Furthermore, California health claims data points to a tremendous rise in anaphylaxis over the past 15 years (approximately 316%) which has led to an average of one in five children with a food allergy reporting one or more allergy-related emergency room visits in the previous year.

"[This bill] is otherwise known as Elijah's Law (passed in the state of New York in 2019) in tribute to Elijah Silvera who suffered from milk allergies and unfortunately lost his life due to anaphylaxis while under the care of daycare provider who fed him a cheese sandwich. Enacting Elijah's Law in California will help to ensure daycare providers are further equipped to:

1. Help prevent life-threatening allergic reactions due to food or venom allergies,
2. Better recognize the signs and symptoms of anaphylaxis and,
3. Treat this condition by utilizing an appropriate weight-based dosage of epinephrine."

Arguments in Support

According to the Natalie Giorgi Sunshine Foundation, "[This bill] will help assure that childcare centers are trained to prevent anaphylaxis, recognize the signs and symptoms of a suspected anaphylactic event, and ensure that the centers have the training to treat an event, utilizing an appropriate weight-based dosage of epinephrine during a medical emergency resulting from anaphylaxis."

Arguments in Opposition

No opposition on file.

FISCAL COMMENTS

According to the Assembly Committee on Appropriations on April 22, 2024:

1. Estimated ongoing General Fund (GF) costs in the low hundreds of thousands of dollars annually, for additional staff at CDSS to comply with the bill's requirements in establishing an anaphylactic policy, including coordinating with stakeholders, developing the policy, guidelines and procedures, assisting with development of materials for implementation, subsequent outreach, and ongoing technical assistance on anaphylaxis policy.
2. Costs to CDE to consult with CDSS in the development of the anaphylaxis policy and to post materials on its internet website are likely to be minor and absorbable.

According to the Legislative Analyst's Office, the General Fund faces a structural deficit in the tens of billions of dollars over the next several fiscal years.

VOTES

ASM HUMAN SERVICES: 7-0-0

YES: Lee, Essayli, Calderon, Gipson, Jackson, Ta, Ortega

ASM EDUCATION: 7-0-0

YES: Muratsuchi, Addis, Alvarez, Bonta, Flora, Hoover, McCarty

ASM APPROPRIATIONS: 15-0-0

YES: Wicks, Sanchez, Arambula, Bryan, Calderon, Wendy Carrillo, Dixon, Mike Fong, Grayson, Haney, Hart, Jim Patterson, Pellerin, Ta, Villapudua

UPDATED

VERSION: March 20, 2024

CONSULTANT: Bri-Ann Hernández / HUM. S. / (916) 319-2089 FN: 0003193

Date of Hearing: April 24, 2024

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

ABPCA Bill Id:AB 2317

Author:(Stephanie Nguyen) – As Amended Ver:March 20, 2024

Urgency: No State Mandated Local Program: Yes Reimbursable: No

SUMMARY:

This bill requires the California Department of Social Services (CDSS), in consultation with the State Department of Education (CDE), to establish an anaphylactic policy for child daycare personnel to prevent a child from suffering from anaphylaxis.

Specifically, this bill:

1. Requires CDSS, by July 1, 2027, in consultation with CDE, to establish an anaphylactic policy that sets guidelines and procedures recommended for child daycare personnel to prevent a child from suffering from anaphylaxis and to be used during a medical emergency caused by anaphylaxis.
2. Authorizes, but does not require, a child daycare facility to implement the anaphylactic policy developed by CDSS by January 1, 2028.
3. Requires the childcare provider, on or after January 1, 2028, upon enrollment of a child at a child daycare facility, to notify the parent or guardian of the anaphylactic policy, if the facility has adopted a policy.
4. Requires CDSS to develop the anaphylactic policy in consultation with representatives from pediatric physicians and other health care providers with expertise in treating children with anaphylaxis, parents of children with life-threatening allergies, child daycare administrators and personnel, and other specified stakeholders.
5. Requires CDSS to develop the anaphylactic policy for family childcare providers in coordination with the Joint Labor Management Committee established by the state and Child Care Providers United - California (CCPU) pursuant to the agreement between the state and CCPU. Requires training on the anaphylactic policy be provided by CDSS’ Community Care Licensing Division (CCLD) in consultation with CCPU pursuant to that agreement for all family childcare providers who wish to participate, regardless of union status.
6. Specifies the requirements of the anaphylactic policy, including a process for a child daycare facility to solicit volunteers among its employees to be trained, a procedure and treatment plan, and a training course for child daycare personnel to be provided at no cost to the employee during their regular working hours, among other requirements.
7. Requires CDSS to create informational materials, in multiple languages, on the anaphylactic policy and requires, by September 1, 2027, CDSS and CDE to post the informational materials on each of the departments’ internet websites.
8. Requires CDSS to update the anaphylactic policy as necessary.

FISCAL EFFECT:

1. Estimated ongoing General Fund (GF) costs in the low hundreds of thousands of dollars annually, for additional staff at CDSS to comply with the bill’s requirements in establishing an anaphylactic policy, including coordinating with stakeholders, developing the policy, guidelines and procedures, assisting with development of materials for implementation, subsequent outreach, and ongoing technical assistance on anaphylaxis policy.
2. Costs to CDE to consult with CDSS in the development of the anaphylaxis policy and to post materials on its internet website are likely to be minor and absorbable.

According to the Legislative Analyst’s Office, the General Fund faces a structural deficit in the tens of billions of dollars over the next several fiscal years.

COMMENTS:

1. Purpose. According to the author:

[This bill] will increase awareness for the signs and symptoms, among daycare settings, of this potentially life-threatening allergic reaction. Anaphylaxis is a concern in daycare settings as the rate of anaphylaxis is higher in children ages 0-to-4 than in any other age group. Furthermore, California health claims data points to a rise in anaphylaxis over the past 15 years (approximately 316%) which has led to an average of one in five children with a food allergy reporting one or more allergy-related emergency room visits in the previous year.

1. Background. Anaphylaxis occurs when a person is exposed to something they are allergic to and it causes a severe, potentially life-threatening reaction to the allergy. Anaphylaxis requires administration of epinephrine and a follow-up trip to the emergency room.

An epinephrine auto-injector (commonly called an “epi-pen”) is a disposable medical drug delivery device that delivers a single measured dose of epinephrine, most frequently for the treatment of acute allergic reactions to avoid or treat the onset of anaphylactic shock. Anaphylactic shock can quickly cause death if untreated. Epinephrine auto-injectors may be obtained by prescription only.

California law permits school districts or county offices of education (COEs) to provide emergency epi-pens to trained personnel and permits trained personnel to utilize the epi-pens to provide emergency medical aid to persons suffering from an anaphylactic reaction. This bill seeks to extend these provisions to child daycare providers and establishes processes around this provision.

1. Related Legislation. AB 2714 (Wallis), of this legislative session, would replace references to “emergency epinephrine auto-injectors” with “emergency epinephrine delivery systems” in referring to the authority of schools to store the medication, to have trained volunteers available to administer it to students suffering from anaphylaxis, and for students to carry and self-administer the medication. AB 2714 is pending in this committee.
2. Prior Legislation. AB 2042 (Villapudua), of the 2021-22 Legislative Session, was substantially similar to this bill. AB 2042 was vetoed by Governor Newsom who cited implementation concerns, including establishing multiple processes and expanding the memorandum of understanding (MOU) between the State and the CCPU. The author of this bill has made changes to address these concerns.

Analysis Prepared by: Jennifer Swenson / APPR. / (916) 319-2081

Date of Hearing: April 10, 2024

ASSEMBLY COMMITTEE ON EDUCATION

Al Muratsuchi, Chair

ABPCA Bill Id:AB 2317 (

Author:Stephanie Nguyen) – As Amended Ver:March 20, 2024

[This bill was double referred to the Assembly Human Services Committee and was heard by that Committee as it relates to issues under its jurisdiction.]

SUBJECT: Child day care facilities: anaphylactic policy

SUMMARY: Requires by July 1, 2027, the State Department of Social Services (DSS) to establish an anaphylactic policy that sets guidelines and procedures to be followed by child daycare personnel to prevent a child from suffering from anaphylaxis and to be used during a medical emergency resulting from anaphylaxis, and authorizes a child daycare facility to implement the anaphylactic policy by January 1, 2028, and to notify the parent or guardian of a policy upon enrollment of their child. Specifically, this bill:

1. Requires the DSS to, on or before July 1, 2027, in consultation with the California Department of Education (CDE) to establish an anaphylactic policy that sets guidelines and procedures to be followed by childcare personnel to prevent a child from suffering anaphylaxis and to be used during a medical emergency caused by anaphylaxis.
2. Authorizes, but does not require, a childcare center to implement the anaphylactic policy developed by the DSS as of January 1, 2028.
3. Requires, if the childcare center has adopted an anaphylactic policy, the childcare provider to notify the parents or guardians of children upon their enrollment in the program and annually thereafter of the anaphylactic policy and include contact information for the parent or guardian to engage further with the provider to learn more about the policy.
4. Requires the policy to be developed by the DSS to include consultation with representatives of all of the following:
   1. Pediatric physicians and other health care providers with expertise in treating children with anaphylaxis;
   2. Parents of children with life-threatening allergies;
   3. Childcare center administrators and personnel; and
   4. Not-for-profit corporations that represent allergic individuals at risk for anaphylaxis.
5. Requires the DSS, in developing the policy, to consider existing requirements and current and best practices for childcare providers on allergies and anaphylaxis, as well as voluntary guidelines issued by the United States Department of Health and Human Services for managing food allergies in childcare facilities.
6. Requires the anaphylactic policy to include all of the following:
   1. A process for childcare center providers to solicit volunteers among its employees to be trained to administer epinephrine auto-injectors to a child having an anaphylactic reaction and authorize volunteers to administer an epinephrine auto-injector to a person exhibiting potentially life-threatening symptoms of anaphylaxis at a childcare center during operating hours;
   2. A procedure and treatment plan, including emergency protocols and responsibilities, for childcare personnel responding to a child suffering from anaphylaxis, and a requirement that personnel have access to an undesignated stock of an appropriate weight-based dosage of epinephrine auto-injector in a secure place at the site, and to carry and administer it to a child believed in good faith to be having an anaphylactic reaction;
   3. A requirement that a parent or guardian sign a document acknowledging an understanding of the protections provided for individuals who provide emergency medical or nonmedical care without compensation and the Good Samaritan Law;
   4. A training course for childcare center personnel to include all of the following:
7. Techniques for preventing, recognizing the symptoms of, and responding to anaphylaxis;
8. Standards and procedures for the storage, restocking, and emergency use of epinephrine auto-injectors;
9. Emergency follow-up procedures, including calling the emergency 911 telephone number and contacting, if possible, the child’s parent and health care provider; and
10. Written materials covering the information required by this subparagraph.
    1. A requirement that the training course be provided at no cost to the employee during their working hours;
    2. A requirement that DSS consider the feasibility of developing the training course in languages other than English, and whether the training may be effectively provided through online instruction to meet the needs of providers;
    3. Appropriate guidelines for each childcare facility to develop an individual emergency health care plan for children with a food or other allergy that could result in anaphylaxis; and
    4. A communications plan for discussion with children that have developed adequate verbal communication and comprehension skills, and the parents or guardians of all children, about foods that are safe and unsafe and strategies to avoid exposure to unsafe foods.
11. Requires the DSS to create informational materials in multiple languages as required by federal and state law, detailing the anaphylactic policy developed, and requires by September 1, 2027, the DSS and the CDE to post the informational materials on their respective websites.
12. Requires an anaphylactic policy for family childcare providers to be developed in consultation and coordination with the Joint Labor Management Committee established by the state and Child Care Providers United (CCPU) pursuant to the agreement between the state and the CCPU; requires that training on the policy be provided by the DSS’s Community Care Licensing Division (CCLD) in consultation with CCPU for all family childcare providers who wish to participate regardless of union status; and requires the CCLD to review minimum standards of training for the administration of epinephrine auto-injectors; and requires that training be consistent with the most recent Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs published by the federal Centers for Disease Control and Prevention (CDC);
13. Prohibits these provisions from being construed to preempt, modify, or amend a childcare provider’s requirement to comply with existing federal and state disability laws or the requirements of a child’s individualized family service plan (IFSP) or individualized education program (IEP).
14. Defines the following terms for purposes of this measure:
15. “Anaphylaxis” as a potentially life-threatening hypersensitivity to a substance;
16. “Epinephrine auto-injector” as a disposable delivery device designed for the automatic injection of a premeasured dose of epinephrine into the human body to prevent or treat a life-threatening allergic reaction; and
17. “Volunteer” or “trained personnel” as an employee who has volunteered to administer epinephrine auto-injectors to a person suffering, or reasonably believed to be suffering, from anaphylaxis, has been designated by a childcare center or family daycare home and has received training, as specified.

EXISTING LAW:

1. Requires the governing board of any school district to give diligent care to the health and physical development of pupils, which may include employing properly certified persons for the work. (Education Code (EC) Section 49400)
2. Establishes the “California Child Day Care Facilities Act,” creating a separate licensing category for child daycare centers and family daycare homes within DSS’s existing licensing structure. (Health and Safety Code (HSC) 1596.70)
3. Defines “child daycare facility” to mean a facility that provides nonmedical care to children under 18 years of age, as specified, including daycare centers, employer-sponsored childcare centers, and family daycare homes. (HSC 1596.750)
4. Requires child daycare centers to obtain a written medical assessment of the child within 30 calendar days following the enrollment of a child that cannot be older than one year. Further requires the medical assessment to provide the following:
   1. A record of any infectious or contagious disease that would preclude care of the child by the licensee;
   2. Results of a test for tuberculosis;
   3. Identification of the child’s special problems and needs;
   4. Identification of any prescribed medications being taken by the child;
   5. Ambulatory status; and,
   6. Health information, such as dietary restrictions and allergies, instructions for action to be taken in case the child’s authorized representative, or the physician designated by the authorized representative, cannot be reached in an emergency; and a signed consent form for emergency medical treatment unless the child’s authorized representative has signed a statement. (22 California Code of Regulations (CCR) 101221(b)(8); 22 (CCR) 101220; HSC 1597.05)
5. Requires a child not to be served any food to which the child’s record indicates a known allergy. (22 CCR § 101227(a)(7)(B))
6. Requires a school district, county office of education (COE), and charter school to provide emergency epinephrine auto-injectors to school nurses or trained volunteers, and allows those individuals to utilize epinephrine auto-injectors to provide emergency medical aid to persons suffering from an anaphylactic reaction. (EC 49414)
7. Authorizes each public and private elementary and secondary school in the state to voluntarily determine, as specified, whether or not to make emergency epinephrine auto-injectors and trained personnel available at its school. (EC 49414)
8. Permits each public and private school to designate one or more volunteers to receive initial and annual refresher training, based on specified standards, regarding the storage and emergency use of an epinephrine auto-injector from the school nurse or other qualified person designated by an authorizing physician or surgeon. (EC 49414)
9. Requires a school nurse, or if the school does not have a school nurse or the school nurse is not onsite or available, a school administrator, to obtain from the school district physician, the medical director of the local health department, or the local emergency medical services director a prescription for epinephrine auto-injectors. (EC 49414)
10. Requires the Superintendent of Public Instruction (SPI) to review, every five years, or sooner, standards of training for the administration of epinephrine auto-injectors by consulting with organizations and providers with expertise in administering epinephrine auto-injectors and administering medication in a school environment. (EC 49414)
11. Sets minimum requirements for the training described above, requiring certain topics about anaphylaxis and procedures for rendering emergency treatment to be included in the training, and for the training to be consistent with guidelines of the CDC. (EC 49414)
12. Requires a school district, COE, or charter school to ensure that each employee who volunteers be provided defense and indemnification by the school district, COE, or charter school for any and all civil liability, as specified, and requires that this information be provided in writing and retained in the volunteer’s personnel file. (EC 49414)
13. Defines “volunteer” and “trained personnel” for purposes of this section as an employee who has volunteered to administer epinephrine auto-injectors to a person suffering, or reasonably believed to be suffering, from anaphylaxis and who has been designated by a school and has received training. (EC 49414)
14. Requires the United States Secretary of Health and Human Services, in consultation with the United States Secretary of Education, to develop guidelines to be used on a voluntary basis to develop plans for individuals to manage the risk of food allergy and anaphylaxis in schools and early childhood education programs and make such guidelines available to LEAs, schools, early childhood education programs, and other interested entities and individuals, to be implemented on a voluntary basis only. (Section 112 of the Food and Drug Administration (FDA) Food Safety Modernization Act, 2011.12)
15. Requires school districts to provide a free appropriate public education to each qualified person with a disability who is in the school district’s jurisdiction, regardless of the nature or severity of the person’s disability, which includes reasonable accommodations required for the management of chronic medical conditions. (Section 504 of the Rehabilitation Act of 1973)
16. Prohibits discrimination by a daycare center or educational entity when admitting a child with disabilities into the program. (Title III of the Americans with Disabilities Act of 1990 (42 U.S.C. 12181 et seq.))

FISCAL EFFECT: Unknown

COMMENTS:

Need for the bill. According to the author, “AB 2317 will increase awareness for the signs and symptoms, among daycare settings, of this potentially life-threatening allergic reaction. Anaphylaxis is a concern in daycare settings as the rate of anaphylaxis is higher in children ages 0-to-4 than in any other age group. Furthermore, California health claims data points to a rise in anaphylaxis over the past 15 years (approximately 316%) which has led to an average of one in five children with a food allergy reporting one or more allergy-related emergency room visits in the previous year.

AB 2317 is otherwise known as Elijah’s Law (passed in the state of New York in 2019) in tribute to Elijah Silvera who suffered with milk allergies and unfortunately lost his life due to anaphylaxis while under the care of daycare provider who fed him a cheese sandwich. Enacting Elijah’s Law in California will help to ensure daycare providers are further equipped to: prevent possibly life-threatening allergic reactions due to food or venom allergies; recognize the signs and symptoms of anaphylaxis; and, treat anaphylaxis by utilizing an appropriate weight-based dosage of epinephrine.

To ensure the health and well-being of the 976,000 California children cared for in the approximately 13,000 daycare settings throughout the state, we should enact AB 2317.”

What is anaphylaxis? According to the Mayo Clinic, allergies take place when an individual’s immune system reacts to a foreign substance, produces antibodies to identify a particular allergen as harmful, and responds to the allergy, which can then manifest in the skin, digestive system, or airways. Anaphylaxis occurs when a person is exposed to something that they are allergic to, and it causes a severe, potentially life-threatening reaction to the allergy. This type of reaction can cause an individual to go into shock, a sudden drop in blood pressure, and swelling of the airway, which blocks breathing. Anaphylaxis requires administration of epinephrine and a follow-up trip to the emergency room. The onset of symptoms usually occurs within minutes but can be delayed up to 30 minutes and, although rare, even hours after exposure. Nationally, pediatric emergency room visits for children with anaphylaxis increased from 5.7 to 11.7 per 10,000 visits from 2009 to 2013. (Farbman, 2016)

What is a food allergy? According to the CDC, a food allergy is defined as an adverse health effect arising from a specific immune response that occurs upon exposure to a given food. The immune response can be severe and life-threatening. Although the immune system normally protects people from germs, in people with food allergies, the immune system mistakenly responds to food as if it were harmful. One way that the immune system causes food allergies is by making a protein antibody called immunoglobulin E (IgE) in response to the ingested food. The substance in foods that causes this reaction is called a food allergen. When exposed to the food allergen, the IgE antibodies alert cells to release powerful substances, such as histamine, that cause symptoms that can affect the respiratory system, gastrointestinal tract, skin, or cardiovascular system and lead to a life-threatening reaction called anaphylaxis.

Incidence of severe food allergy among children and youth. According to the Asthma and Allergy Foundation of America, approximately 5.6 million children, or 7.6% have food allergies. In 2018, 4.8 million children under 18 years of age had food allergies over the previous 12 months. Foods are the leading cause of anaphylaxis in children. Milk is the most common allergen for children, followed by eggs and peanuts. (Gupta, 2018)

An international study of food allergies concluded that the best available evidence indicates that food allergies have increased in many westernized countries. (Tang, 2016) According to the CDC, food allergies among children increased by 50% between 1997 and 2011. Today, one in 13 children has food allergies, and nearly 40% of these children have already experienced a severe allergic reaction. Many of these reactions happen at school.

Anaphylaxis can develop in students with known allergies, but first-time reactions on school premises are possible as well. Safety measures at schools include allergen avoidance, staff training to identify the signs and symptoms of anaphylaxis, and availability of epinephrine auto-injectors to allow prompt initiation of treatment. Collaboration between the caregiver, physician, school staff, school nurse, and student is critical for effective care of those at risk for anaphylaxis in the school setting. (Ramsey, 2020)

Epinephrine auto-injectors. An epinephrine auto-injector (commonly called an “epi-pen” because its size and shape is similar to a writing pen) is a disposable medical drug delivery device that delivers a single measured dose of epinephrine, most frequently for the treatment of acute allergic reactions to avoid or treat the onset of anaphylactic shock. Anaphylactic shock can quickly cause death if untreated. Epinephrine auto-injectors can be obtained by prescription only.

California law has been amended to, among other things, permit school districts or COEs to provide emergency epinephrine auto-injectors to trained personnel, and to permit trained personnel to utilize the auto-injectors to provide emergency medical aid to persons suffering from an anaphylactic reaction.

California’s childcare system. California has a multifaceted system of licensed childcare programs. The Early Childhood Development Act of 2020 authorized the transfer of most childcare programs to the DSS from the CDE effective July 1, 2021. The CDE continues to operate the California State Preschool Program (CSPP), which is administered through local educational agencies (LEAs), colleges, community-action agencies, and private nonprofit agencies. CSPP serves eligible children ages three and four for both part-day and full-day services and is the largest state-funded preschool program in the nation.

Under DSS, California offers multiple types of subsidized childcare and development programs: voucher-based childcare, direct contracts – Title 5 subsidized childcare, and the California Head State Collaboration Office. Childcare may be offered through these programs at a childcare center or in a family childcare home.

DSS’s CCLD has the responsibility of licensing and monitoring the state’s 12,768 daycare centers, which have a capacity to serve 663,454 children. There are an additional 2,201 licensed school-age daycare facilities with a capacity to serve 139,610 children.

Childcare Licensing Regulations on Anaphylaxis. Anaphylaxis poses a significant risk to children attending childcare facilities, particularly those with known allergies. State law and regulations provide guidance for anaphylaxis in K-12 schools, but not for childcare providers. Childcare centers are required to obtain a written medical assessment of the child within 30 calendar days after enrollment and cannot be older than one year. This assessment includes various health information, such as dietary restrictions and allergies, as well as instructions for handling emergencies when the child’s authorized representative cannot be reached. Additionally, a signed consent form for emergency treatment must be included unless the child’s authorized representative has signed a statement. One regulation in the CCR also requires that a child with a documented allergy must not be served any food known to trigger anaphylaxis. However, there are no further regulations regarding anaphylaxis prevention for both childcare centers and family daycare homes. This indicates each childcare facility adopts its own practices related to allergen identification, prevention strategies, emergency response procedures, and communication protocols with parents or guardians, further signifying a lack of consistency among childcare facilities. Based on current regulations, many childcare facilities may rely on ad hoc measures for children with unknown allergies and on individual plans for those who have known allergies rather than standardized policies endorsed by regulations or established best practices. The Committee may wish to consider that because this bill is permissive and allows childcare facilities to opt out of implementing the anaphylactic policy, ad hoc measures for treating anaphylactic reactions may persist.

Additionally, current regulations require at least one director or teacher at each childcare facility to have at least 15 hours of health and safety training and, if applicable, at least one additional hour of childhood nutrition training as part of the preventative health practices course. Topics in the training include pediatric first aid, pediatric cardiopulmonary resuscitation (CPR), and a preventative health practices course. This course includes instruction in identifying, managing, and preventing infectious disease, including immunizations, and preventing childhood injuries. Training may also include instruction in sanitary food handling, emergency preparedness and evacuation, and caring for children with special needs. However, the training does not include any topics addressing anaphylaxis prevention for both childcare centers and family daycare homes. Without appropriate policies and procedures in place, daycare personnel may lack the necessary training and resources to prevent and mitigate anaphylactic reactions effectively, which can lead to delays in treatment, increased risk of adverse outcomes, and potential legal liabilities for daycare centers.

For childcare facilities that choose to adopt the anaphylactic policy, this bill requires a parent or guardian to demonstrate an understanding of the protections provided for individuals who provide emergency medical or nonmedical care without compensation by signing a document acknowledging the Good Samaritan law enumerated in statute.

Licensed childcare facilities are subject to federal and state disability laws. According to the DSS guidance, Best practices related to the provision of incidental medical services (IMS) in childcare centers and family childcare homes, posted on February 4^th, 2022, licensed childcare centers and providers are places of public accommodation and are subject to federal and state disability laws including the Americans with Disabilities Act (ADA), the California Unruh Civil Rights Act, and the California Disabled Persons Act. Child daycare providers of children with disabilities who have an IEP for children 3 years of age and older, or an IFSP for children from birth to 36 months of age, are required to provide modifications for children with disabilities. Licensed childcare centers and providers are responsible for ensuring that each child’s needs can be met when the child is admitted into their care and throughout their attendance at that facility. Childcare providers may be required to undertake an individualized assessment if the provider receives a request to provide IMS which is the administration of medication to a child, as an accommodation for a child with disabilities.

Section 504 of the 1973 Rehabilitation Act applies to schools and programs that receive federal money and entitles students to accommodations for a wide range of health conditions, including a life-threatening food allergy. The U.S. Department of Education’s Office for Civil Rights lists allergy as an example of a hidden disability for the purpose of Section 504 and further explains how a food allergy, for many children, would be considered a disability under 504. Protections under Section 504 have been reinforced by the Americans with Disabilities Act of 1990 (ADA) and the ADA Amendments Act of 2008.

As stated in the DSS provider information notice, Best practices, state law permits IMS in childcare centers and family childcare homes in the case of emergency, including the administration of an epinephrine auto-injector to prevent or treat a life-threatening allergic reaction. Although DSS clearly states that childcare providers permits IMS in the case of administering an epinephrine auto-injector to treat an allergic reaction, it is not explicitly required in state law.

Arguments in support. The Elijah Alavi Foundation, sponsor of the bill writes, “Born in the wake of Elijah-Alavi Silvera’s untimely passing due to an anaphylactic reaction, our foundation channels our profound loss into a fervent crusade for change. We are the vanguard of advocacy, relentlessly pushing for pivotal legislation that fortifies the defenses of childcare environments against the silent threat of food allergies. Through comprehensive education, we empower communities with the knowledge to identify, understand, and act against the risks associated with food allergies. Our hands-on training initiatives equip caregivers and institutions with the life-saving skills and protocols necessary to ensure no child’s laughter is stifled by preventable tragedy. Supporting AB 2317 means you're not just voting for a bill; you're endorsing a shield that guards our little ones against a threat that can take them from us in a matter of minutes. You're helping providing peace of mind to parents who will rest a little easier, knowing their child is in safe hands.”

Related legislation. AB 2714 (Wallis) of the 2023-24 Session would replace references to “emergency epinephrine auto-injectors” with “emergency epinephrine delivery systems” in referring to the authority of schools to store the medication, to have trained volunteers available to administer it to students suffering from anaphylaxis, and for students to carry and self-administer the medication.

AB 1651 (Sanchez) Chapter 588, Statutes of 2023, extends the definition of “volunteer” and “trained personnel” to include the holder of an Activity Supervisor Clearance Certificate (ASCC) who may administer an emergency epinephrine auto-injector, as specified, and requires an LEA, COE, and a charter school to store epinephrine auto-injectors in an accessible location upon the need for emergency use.

AB 2042 (Villapudua) of the 2021-22 Session would have required the DSS, in consultation with the CDE, to establish an anaphylactic policy that sets forth guidelines and procedures recommended for child daycare personnel to prevent a child from suffering from anaphylaxis and to be used during a medical emergency resulting from anaphylaxis. This bill was vetoed by the Governor with the following message:

It is important for all children in a childcare setting to be cared for by staff who are trained to assist with their unique needs, including being able to recognize and respond to symptoms of anaphylaxis. While I appreciate the author's attention to this important matter, the bill before me creates a number of implementation concerns, including establishing multiple processes and expanding the memorandum of understanding between the State and the CCPU.

I encourage the Legislature to work with the Department of Social Services and the Emergency Medical Services Authority, who have the expertise to develop health and safety standards, on a workable alternative that is uniform and addresses these issues.

AB 2640 (Valladares) Chapter 794, Statutes of 2022 requires the CDE to create the “California Food Allergy Resource Guide” for voluntary use by LEAs to protect pupils with food allergies within schools and early education centers.

AB 3342 (Bauer-Kahan) of the 2019-20 Session would have required the DSS to authorize child daycare facilities to keep emergency epinephrine auto-injectors onsite to be administered by trained, volunteer personnel to provide emergency medical aid to a person who is suffering, or reasonably believed to be suffering, from an anaphylactic reaction; would also have required the DSS to develop a training program for the participating personnel, which would include components, including, but not limited to, techniques for recognizing symptoms of anaphylaxis and emergency follow-up procedures. This bill was held in the Assembly Human Services Committee.

AB 1386 (Low) Chapter 374, Statutes of 2016, permits a pharmacy to furnish epinephrine auto-injectors to an authorized entity if they are furnished exclusively for use at or in connection with an authorized entity; an authorized health care provider provides a prescription; and, the records are maintained by the authorized entity for three years. Specifies that authorized entities include, but are not limited to, daycare facilities, colleges and universities, summer and day camps, sports leagues, scout troops, before and after school programs, recreational parks and other places where children and adults could come into contact with potentially life-threatening allergens.

SB 738 (Huff) Chapter 132, Statutes of 2015, provides qualified immunity to physicians who issue prescriptions for epinephrine auto-injectors to school districts for emergency use on individuals afflicted with anaphylactic reaction.

SB 1266 (Huff) Chapter 321, Statutes of 2014, requires school districts, COEs, and charter schools to provide emergency epinephrine auto-injectors to school nurses or trained personnel who have volunteered. Authorizes school nurses or trained personnel to use the epinephrine auto-injectors to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an anaphylactic reaction.

REGISTERED SUPPORT / OPPOSITION:

Support

Association of Regional Center Agencies

Asthma and Allergy Foundation of America

California Society for Respiratory Care

Elijah-Alavi Foundation

Food Allergy and Research Education

Natalie Giorgi Sunshine Foundation

National Association of Pediatric Nurse Practitioner

No Nut Traveler

8 individuals

Opposition

None on file

Analysis Prepared by: Debbie Look / ED. / (916) 319-2087

Date of Hearing: April 2, 2024

ASSEMBLY COMMITTEE ON HUMAN SERVICES

Alex Lee, Chair

ABPCA Bill Id:AB 2317 (

Author:Stephanie Nguyen) – As Amended Ver:March 20, 2024

SUBJECT: Child day care facilities: anaphylactic policy

SUMMARY: Requires the California Department of Social Services (CDSS), in consultation with the California Department of Education (CDE), to establish an anaphylactic policy that sets forth guidelines and procedures recommended for child daycare personnel to prevent a child from suffering from anaphylaxis and to be used during a medical emergency resulting from anaphylaxis. Specifically, this bill:

1. Requires CDSS, on or before July 1, 2027, and in consultation with CDE, to establish an anaphylactic policy that sets forth guidelines and procedures recommended for child daycare personnel to prevent a child from suffering from anaphylaxis and to be used during a medical emergency resulting from anaphylaxis.
2. Permits a child daycare facility to implement the anaphylactic policy developed by CDSS on or before January 1, 2028.
3. Upon enrollment of a child at a child daycare facility, requires the child daycare provider on and after January 1, 2028, and annually thereafter, to notify the parent or guardian of the anaphylactic policy if the facility has adopted a policy. Requires the notice to include contact information for a parent or guardian to engage further with the child daycare provider to learn more about the policy.
4. Requires the policy to be developed in consultation with representatives from all of the following:
   1. Pediatric physicians and other healthcare providers with expertise in treating children with anaphylaxis;
   2. Parents of children with life-threatening allergies;
   3. Child daycare administrators and personnel, including local educational agency employees employed in childcare programs, and the labor organizations representing those employees; and,
   4. Not-for-profit corporations that represent allergic individuals at risk for anaphylaxis.
5. In developing the policy, requires CDSS to consider existing requirements and current and best practices for child daycare providers on allergies and anaphylaxis. Further requires CDSS to consider any voluntary guidelines issued by the United States Department of Health and Human Services for managing food allergies in child daycare facilities.
6. Requires an anaphylactic policy for family childcare providers to be developed in consultation and coordination with the Joint Labor Management Committee (JLMC) established by the state and Child Care Providers United - California (CCPU) pursuant to the agreement effective July 26, 2021, to July 1, 2023, between the state and CCPU.
7. Requires training on the anaphylactic policy be provided by CDSS’ Community Care Licensing Division (CCLD) in consultation with CCPU pursuant to that agreement, and any extension or renewal of that agreement, for all family childcare providers who wish to participate, regardless of union status.
8. Requires CDSS’ CCLD to review minimum standards of training for the administration of epinephrine auto-injectors, as necessary. Requires training to be consistent with the most recent Voluntary Guidelines for Managing Food Allergies In Schools and Early Care and Education Programs published by the federal Centers for Disease Control and Prevention (CDC).
9. Requires the anaphylactic policy to include all of the following:
   1. A process for a child daycare facility to solicit volunteers among its employees to be trained and to administer epinephrine auto-injectors to a child having an anaphylactic reaction. Permits a volunteer to administer an epinephrine auto-injector to a person exhibiting potentially life-threatening symptoms of anaphylaxis at a child daycare facility during operating hours. Requires the process to solicit volunteers to include a statement that there shall be no retaliation against any employee who chooses not to volunteer or who rescinds their offer to volunteer, including after receiving training;
   2. A procedure and treatment plan, including emergency protocols and responsibilities, for child daycare personnel responding to a child suffering from anaphylaxis;
   3. Requires the procedure and treatment plan to include the capacity for trained personnel to have access to an undesignated stock of an appropriate weight-based dosage epinephrine auto-injector in a secured place at the site and to carry and administer it to a child believed in good faith to be having an anaphylactic reaction;
   4. Requires a parent or guardian to demonstrate an understanding of the protections provided for individuals who provide emergency medical or nonmedical care without compensation by signing a document acknowledging the Good Samaritan law enumerated in existing law;
   5. Requires a training course for child daycare personnel to include all of the following:
10. Techniques for preventing, recognizing the symptoms of, and responding to anaphylaxis;
    • • 1. Standards and procedures for the storage, restocking, and emergency use of epinephrine auto-injectors;
        2. Emergency follow-up procedures, including calling the emergency 911 telephone number and contacting, if possible, the child’s parent and healthcare provider; and,
        3. Written materials covering the information required under this subdivision.
    1. Requires the training course to be provided at no cost to the employee during their regular working hours. Further requires CDSS to consider the feasibility of developing the training course in languages other than English to meet the needs of providers and to consider whether the training may be effectively provided through online instruction;
    2. Appropriate guidelines for each child daycare facility to develop an individual emergency healthcare plan for children with a food or other allergy that could result in anaphylaxis;
    3. A communication plan for dissemination of information by CDSS regarding children with food or other allergy that could result in anaphylaxis, including a discussion of methods, treatments, and therapies to reduce the risk of allergic reactions;
    4. Strategies for the reduction of the risk of exposure to children of anaphylactic causative agents, including food and other allergens; and,
    5. A communication plan for discussion with children who have developed adequate verbal communication and comprehension skills, and with the parents or guardians of all children, about foods that are safe and unsafe and strategies to avoid exposure to unsafe food.
11. Requires CDSS to create informational materials, in multiple languages, pursuant to federal and state law, detailing the anaphylactic policy. Requires CDSS and CDE to post the informational materials on each of the departments’ internet websites on or before September 1, 2027.
12. Requires the anaphylactic policy to be updated by CDSS as necessary.
13. Provides that 1) to 11) above shall not be construed to preempt, modify, or amend a child daycare provider’s requirement to comply with existing federal and state disability laws, or the requirements related to a child’s individualized family service plan or individualized education program.
14. Defines the following terms:
    1. “Anaphylaxis” as a potentially life-threatening hypersensitivity to a substance. Symptoms include shortness of breath, wheezing, difficulty breathing, difficulty talking or swallowing, hives, itching, swelling, shock, or asthma. Causes of anaphylaxis may include, but are not limited to, an insect sting, food allergy, drug reaction, and exercise.
    2. “Epinephrine auto-injector” is a disposable delivery device designed for the automatic injection of a premeasured dose of epinephrine into the human body to prevent or treat a life-threatening allergic reaction.
    3. “Volunteer” or “trained personnel” as an employee who has volunteered to administer epinephrine auto-injectors to a person if the person is suffering, or reasonably believed to be suffering, from anaphylaxis, has been designated by a childcare center or family daycare home and has received training.

EXISTING LAW:

1. Establishes the “Child Care and Development Services Act” to provide childcare and development services as part of a coordinated, comprehensive, and cost-effective system serving children from birth to 13 years of age and their parents including a full range of supervision, health, and support services through full- and part-time programs. (Welfare & Institutions Code [WIC] § 10207 et seq.)
2. Establishes the “California Child Day Care Facilities Act”, creating a separate licensing category for child daycare centers and family daycare homes within CDSS’s existing licensing structure. (Health and Safety Code [HSC] § 1596.70 et seq.)
3. Defines “child daycare facility” to mean a facility that provides nonmedical care to children under 18 years of age, as specified, including daycare centers, employer-sponsored childcare centers, and family daycare homes. (HSC § 1596.750)
4. Requires child daycare centers to obtain a written medical assessment of the child within 30 calendar days following the enrollment of a child that cannot be older than one year. Further requires the medical assessment to provide the following:
   1. A record of any infectious or contagious disease that would preclude care of the child by the licensee;
   2. Results of a test for tuberculosis (TB);
   3. Identification of the child’s special problems and needs;
   4. Identification of any prescribed medications being taken by the child;
   5. Ambulatory status; and,
   6. Health information, such as dietary restrictions and allergies, instructions for action to be taken in case the child’s authorized representative, or the physician designated by the authorized representative, cannot be reached in an emergency; and, a signed consent form for emergency medical treatment unless the child’s authorized representative has signed a statement. (22 California Code of Regulations [CCR] §§ 101221(b)(8); 22 CCR § 101220; HSC § 1597.05)
5. Requires a child not to be served any food to which the child’s record indicates a known allergy. (22 CCR § 101227(a)(7)(B))
6. Requires school districts, county offices of education, and charter schools to provide emergency epinephrine auto-injectors to school nurses or trained personnel who have volunteered to provide emergency medical aid to persons suffering or reasonably believed to be suffering from an anaphylactic reaction. Further provides guidelines for implementing these provisions. (Education Code [EDC] § 49414)
7. Requires a qualified health supervisor at a school district, county office of education, or charter school to obtain, at minimum, one regular and one junior epinephrine auto-injector, and requires the schools to be responsible for stocking and restocking the epinephrine auto-injectors. (EDC § 49414(g)(1))
8. Provides that any authorized person, as defined, who administers an epinephrine auto-injector, in good faith and not for compensation, to another person who appears to be experiencing anaphylaxis at the scene of an emergency situation is not liable for any civil damages resulting from their acts or omissions in administering the epinephrine auto-injector, if that person has complied with specified requirements and standards. (Civil Code § 1714.23(b)(1); HSC § 1799.102)

Federal law:

1. Requires the United States Secretary of Health and Human Services, in consultation with the United States Secretary of Education, to develop guidelines to be used on a voluntary basis to develop plans for individuals to manage the risk of food allergy and anaphylaxis in schools and early childhood education programs and make such guidelines available to local educational agencies, schools, early childhood education programs, and other interested entities and individuals, to be implemented on a voluntary basis only. (Public Law 111-353)
2. Prohibits discrimination by a daycare center or educational entity when admitting a child with disabilities into the program under Title III of the Americans with Disabilities Act of 1990. (42 United States Code § 12181 et seq.)

FISCAL EFFECT: Unknown, this bill has not been analyzed by a fiscal committee.

COMMENTS:

Background: Licensed Childcare. The California Child Day Care Facilities Act governs the licensure, maintenance, and operation of child daycare centers and family daycare homes in the state. This law and the associated regulations found in Title 22 of the CCR establish, among other things, general health and safety requirements, staff-to-child ratios, and provider training requirements. CDSS’s Community Care Licensing Division (CCLD) has the responsibility of licensing and monitoring the state’s 10,481 childcare centers and 25,205 family childcare homes in 2021. As of January 2024, 158,959 children were served in licensed family childcare homes, 124,708 in childcare centers, and 82,704 in license-exempt settings in fiscal year 2022-23. CCLD is required to conduct unannounced site visits of all licensed child daycare facilities. These visits include random inspections of 30% of facilities annually and each facility must be visited at least once every three years, with certain exceptions warranting more frequent inspections.

What is Anaphylaxis? Anaphylaxis is characterized by a systemic immune response to an allergen that can be life-threatening, causing the body to go into shock, blood pressure drop suddenly and the airways to narrow. Common symptoms include shortness of breath, wheezing, difficulty breathing, difficulty talking or swallowing, hives, itchiness, swelling, shock, or asthma. The onset of symptoms usually occurs within minutes, but can be delayed up to 30 minutes and, although rare, even hours after exposure. Food allergies are the most common cause of anaphylaxis, such as eggs, milk, peanuts, tree nuts, wheat, crustacean shellfish, and soy. According to CDC’s National Center for Health Statistics, approximately one in five children in California have seasonal allergies and 5.8% have a food allergy in 2021. Boys are slightly more likely to have seasonal allergies than girls, and among racial and ethnic groups, Black children have a higher prevalence of food allergies.

Other allergens can trigger anaphylaxis, including insect stings or bites, medications, such as antibiotics, nonsteroidal anti-inflammatory drugs, latex, and even exercise. The severity of the reaction can vary depending on factors such as the individual’s sensitivity to the allergen and the amount of exposure. In the United States, hospitalizations for anaphylaxis have steadily increased over the past 10 years, with one out of 20 anaphylaxis cases requiring hospitalizations. Nationally, pediatric emergency room visits for children with anaphylaxis increased from 5.7 to 11.7 per 10,000 visits from 2009 to 2013. Twenty-five percent of severe and potentially life-threatening reactions reported at schools happened in children with no previous diagnosis of food allergy.

Certain risk factors increase the likelihood of experiencing anaphylaxis, such as a history of allergies or asthma, previous anaphylactic reactions, and family history of allergic conditions. The prevalence of anaphylaxis has been increasing in recent years, with children disproportionately affected. Childcare settings present unique challenges in allergen management due to the potential for cross-contamination and exposure to various allergens. Shared spaces, communal snacks, and group activities increase the likelihood of accidental allergen exposure, heightening the risk of anaphylactic reactions. Anaphylaxis not only poses immediate health risks but also has long-term implications for children’s quality of life, affecting their social interactions, dietary habits, and emotional well-being. Fear of allergic reactions can lead to anxiety and avoidance behaviors, impacting children’s participation in everyday activities and social gatherings.

Recognizing the specific risk factors and prevalence of anaphylaxis in children is crucial for developing targeted prevention and management strategies within childcare facilities. This bill seeks to develop a comprehensive anaphylactic policy that includes procedures, a treatment plan, and training of volunteer personnel to provide guidance on allergen avoidance, emergency preparedness, and individualized care plans to effectively protect children with allergies from the potentially life-threatening consequences of anaphylaxis.

Treatment of Anaphylaxis. Anaphylaxis requires prompt recognition and immediate intervention to prevent progression to a life-threatening condition. According to guidelines from the National Institute of Allergy and Infectious Disease (NIAID), epinephrine (also known as adrenaline) is recommended as the primary treatment for anaphylaxis and should be promptly administered upon suspicion of an allergic reaction. An epinephrine auto-injector is a medical device utilized to deliver a measured dose of epinephrine via auto-injector technology, primarily used to manage acute allergic reactions and prevent or address the onset of anaphylaxis. Epinephrine auto-injectors are available exclusively by prescription. Commonly used epinephrine auto-injectors include brand names like the EpiPen and EpiPen Jr., which are designed for smaller children. Mylan, the manufacturer of these products, specifies that the EpiPen contains 0.3mg of epinephrine and is intended for individuals weighing 66 pounds or more, while the EpiPen Jr. contains 0.15mg and is suitable for patients weighing between 33 to 66 pounds.

NIAID recommends the use of an inhaler containing a bronchodilator or antihistamines as supplemental treatment following the administration of epinephrine. According to Mayo Clinic, after administering an epinephrine injection, it is necessary to seek immediate follow-up care at an emergency room. In situations when epinephrine is not accessible, prompt transportation to the emergency room is essential to prevent potential fatalities.

Epinephrine Auto-Injector Use in Schools. In 46 states, laws or regulations require the stocking of epinephrine in K-12 schools. A study conducted in Massachusetts in 2005 examined epinephrine use in schools and found that, within two years, 48 out of 109 participating school districts reported administering epinephrine on at least one occasion, totaling 115 administrations during the reporting period. Alarmingly, in 24% of these cases, school staff were unaware that the individual had a life-threatening allergy, and administration was prompted solely by the onset of symptoms.

In California, school districts are required to supply emergency epinephrine auto-injectors to school nurses or trained personnel who have volunteered to administer them to individuals reasonably believed to be experiencing an anaphylactic reaction. Specifically, elementary schools must have at least one regular epinephrine auto-injector and one junior epinephrine auto-injector readily available. Similarly, junior high schools, middle schools, and high schools must have at least one regular epinephrine auto-injector available, unless there are no students requiring a junior epinephrine auto-injector.

This bill requires childcare facilities to maintain adequate supplies of epinephrine auto-injectors, as well as ensure proper storage and accessibility.

Childcare Licensing Regulations on Anaphylaxis. Anaphylaxis poses a significant risk to children attending childcare facilities, particularly those with known allergies. State law and regulations provide guidance for anaphylaxis in K-12 schools, but it does not for childcare providers. Childcare centers are required to obtain a written medical assessment of the child within 30 calendar days after enrollment and cannot be older than one year. This assessment includes various health information, such as dietary restrictions and allergies, as well as instructions for handling emergencies when the child’s authorized representative cannot be reached. Additionally, a signed consent form for emergency treatment must be included unless the child’s authorized representative has signed a statement. One regulation in the CCR also requires that a child with a documented allergy must not be served any food known to trigger anaphylaxis. However, there are no further regulations regarding anaphylaxis prevention for both childcare centers and family daycare homes. This indicates each childcare facility adopts its own practices related to allergen identification, prevention strategies, emergency response procedures, and communication protocols with parents or guardians, further signifying a lack of consistency among childcare facilities. Based on current regulations, many childcare facilities may rely on ad hoc measures for children with unknown allergies and on individual plans for those who have known allergies rather than standardized policies endorsed by regulations or established best practices. Because this bill is permissive and allows childcare facilities to opt out of implementing the anaphylactic policy, the ad hoc measures in treating anaphylactic reactions may persist.

Additionally, current regulations require at least one director or teacher at each childcare facility to have at least 15 hours of health and safety training, and if applicable, at least one additional hour of childhood nutrition training as part of the preventative health practices course. Topics in the training include pediatric first aid, pediatric cardiopulmonary resuscitation (CPR), and a preventative health practices course. This course includes instruction in identifying, managing, and preventing infectious disease, including immunizations, and preventing childhood injuries. Training may also include instruction in sanitary food handling, emergency preparedness and evacuation, and caring for children with special needs. However, the training does not include any topics addressing anaphylaxis prevention for both childcare centers and family daycare homes. Without appropriate policies and procedures in place, daycare personnel may lack the necessary training and resources to prevent and mitigate anaphylactic reactions effectively, which can lead to delays in treatment, increased risk of adverse outcomes, and potential legal liabilities for daycare centers.

For childcare facilities that choose to adopt the anaphylactic policy, this bill requires a parent or guardian to demonstrate an understanding of the protections provided for individuals who provide emergency medical or nonmedical care without compensation by signing a document acknowledging the Good Samaritan law enumerated in statute.

Elijah’s Law. In November 2017, Elijah Silvera was a three-year-old child who lost his life following an anaphylactic reaction to eating a grilled cheese sandwich at his daycare, despite the daycare being aware of his severe dairy allergy. The daycare staff failed to administer the epinephrine auto-injector, and by the time Elijah reached the hospital, medical intervention was unsuccessful in saving his life.

In response to this incident, New York State enacted "Elijah's Law" in June 2019. This law requires that all daycares in the state implement comprehensive food allergy guidelines aimed at preventing, identifying, and responding to anaphylaxis emergencies. These guidelines encompass various measures, including staff training, the development of individualized healthcare plans for children with allergies, effective communication strategies, and initiatives to minimize allergen exposure within daycare settings.

Following New York's lead, Illinois also passed its version of "Elijah's Law" in 2021. This legislation requires childcare centers and schools to establish standards and provide training to staff members to recognize and mitigate the risks associated with anaphylaxis in children and young adults.

Governor’s Veto Message. This bill is substantially similar to AB 2042 (Villapudua) of 2022, which was vetoed by Governor Newsom. The Governor’s veto message stated:

“This bill would require the California Department of Social Services (CDSS), in consultation with the California Department of Education, the Child Care Providers United- California (CCPU) and others, to create two separate anaphylactic policies for child care center staff and family child care home staff. The policies would be established by July 1, 2024 and then be updated every three years and would include specified components, including training.

“It is important for all children in a child care setting to be cared for by staff who are trained to assist with their unique needs, including being able to recognize and respond to symptoms of anaphylaxis. While I appreciate the author's attention to this important matter, the bill before me creates a number of implementation concerns, including establishing multiple processes and expanding the memorandum of understanding (MOU) between the State and the CCPU.

“I encourage the Legislature to work with the Department of Social Services and the Emergency Medical Services Authority, who have the expertise to develop health and safety standards, on a workable alternative that is uniform and addresses these issues.”

In order to address Governor Newsom’s concerns stated above, the author of this bill changed the number of years the policies would need updating from three years to as needed. The bill continues to require developing two distinct anaphylactic policies for childcare center staff and family childcare home staff, each offering unique advantages outlined below.

CDSS plays a crucial role in establishing and enforcing guidelines for anaphylaxis management in childcare facilities. This bill requires CDSS to consult with healthcare professionals, allergy specialists, parents of children with life-threatening allergies, childcare administrators and personnel, and other stakeholders to develop evidence-based policies that prioritize the safety and well-being of children with allergies who attend childcare centers. By implementing standardized protocols and providing adequate training and resources, childcare facilities can create safer environments for children with allergies and mitigate the risks associated with anaphylactic reactions.

Ensuring the safety and well-being of children with allergies extends beyond traditional childcare centers to include family childcare providers who offer services in home-based settings. Recognizing the unique challenges and opportunities presented by family childcare providers, it is imperative to develop inclusive anaphylactic policies that address their specific needs and circumstances. This bill requires CDSS to consult and coordinate with the JLMC established by the state and the CCPU to establish a separate policy for family childcare providers. Collaboration with the CCPU enables family childcare providers to advocate for adequate resources and support services to enhance their capacity in managing anaphylaxis and promoting a safe and supportive environment for children with allergies.

Incorporating family childcare providers into the anaphylactic policy framework demonstrates a commitment to inclusivity and equity in safeguarding the health and well-being of all children in childcare settings. By engaging with providers, offering tailored training and support, and addressing their unique needs, this bill can ensure consistent standards of anaphylaxis management across all childcare settings in California.

Author’s Statement: According to the Author, “The rate of anaphylaxis is higher in children ages 0-to-4 than in any other age group. Furthermore, California health claims data points to a tremendous rise in anaphylaxis over the past 15 years (approximately 316%) which has led to an average of one in five children with a food allergy reporting one or more allergy-related emergency room visits in the previous year.

“[This bill] is otherwise known as Elijah's Law (passed in the state of New York in 2019) in tribute to Elijah Silvera who suffered from milk allergies and unfortunately lost his life due to anaphylaxis while under the care of daycare provider who fed him a cheese sandwich. Enacting Elijah's Law in California will help to ensure daycare providers are further equipped to:

• Help prevent life-threatening allergic reactions due to food or venom allergies,
• Better recognize the signs and symptoms of anaphylaxis and,
• Treat this condition by utilizing an appropriate weight-based dosage of epinephrine.”

Equity Implications: To safeguard the health and well-being of up to 283,667 California children under the care of licensed childcare centers and family daycare homes across the state, enacting this bill is crucial. This bill aims to provide guidelines and procedures for daycare personnel to prevent and manage anaphylactic reactions in children, specifically for children of color who make up the majority of children receiving subsidized childcare services. As previously mentioned, Black children have higher rates of food allergies compared to any other racial and ethnic groups and make up approximately 20% of children enrolled in childcare. By promoting preventative measures and improving emergency response protocols, this bill can mitigate risks associated with anaphylaxis and create a safer and more inclusive environment for all children.

This bill also aims to ensure that daycare personnel are trained in recognizing the signs and symptoms of anaphylaxis and equipped with the knowledge and resources to respond promptly and effectively during a medical emergency. It is crucial to ensure that policies and training materials address cultural and linguistic diversity among childcare providers, families, and children, and should be available in multiple languages to guarantee that information is accessible and understandable to all stakeholders including immigrant and non-English speaking communities, which this bill intends to do.

This bill requires developing an anaphylactic policy that addresses various aspects of allergy management, including allergen identification, emergency response protocols, staff training requirements, and parental communication guidelines. Even if implementing the anaphylactic policy is not required, the bill recognizes the need for standardized anaphylaxis management policies in childcare centers and family daycare homes to ensure consistent and effective practices across all facilities.

Triple referral: Should this bill pass out of this committee, it will be referred to the Assembly Education Committee.

RELATED OR PRIOR LEGISLATION:

AB 2671 (Weber) of the current legislative session, requires licensed family daycare homes to only serve water to children or use water in food preparation that has been filtered with a point-of-use water filtration device and to prioritize providers caring for low-income children. AB 2671 is pending before this committee and set for a hearing on April 9, 2024.

AB 2343 (Schiavo) of the current legislative session, authorizes an administrator of a childcare program providing services during Stage One and Stage Two of the CalWORKs program to provide additional enhanced support and navigation services to those recipients experiencing homelessness, escaping domestic violence, or both. AB 2343 is pending before this committee and set for a hearing on April 23, 2024.

AB 2206 (Addis) of the current legislative session, requires CDSS to revise its fire safety clearance approval regulations to allow children with exceptional needs be accepted and attend a childcare program before the program has obtained a revised fire safety clearance approval to obtain childcare licensure. AB 2206 is pending before this committee and set for a hearing on April 9, 2024.

AB 772 (Jackson) of the current legislative session, exempts “drop-in” daycare centers from verifying, maintaining records, or requiring a physician’s assessment upon admission of a child. AB 772 is pending before the Senate Rules committee.

AB 2042 (Villapudua) of 2022, was similar to this bill, which would have required CDSS, in consultation with CDE, to establish an anaphylactic policy that sets forth guidelines and procedures recommended for child daycare personnel to prevent a child from suffering from anaphylaxis and to be used during a medical emergency resulting from anaphylaxis. AB 2042 was vetoed by Governor Newsom.

AB 1532 (Bauer-Kahan), Chapter 131, Statutes of 2019, established the “Natalie Giorgi Sunshine Act”, which requires on or before January 1, 2021, a food handler training course to include instruction on the elements of major food allergens, foods identified as major allergens, the symptoms a major food allergen could cause, and safe handling food practices for major food allergens.

AB 3342 (Bauer-Kahan) of 2020, would have required CDSS to authorize child daycare facilities to keep emergency epinephrine auto-injectors onsite for administration by trained, volunteer personnel in cases when an individual is suffering, or reasonably believed to be suffering, from an anaphylactic reaction. Would have also required CDSS to develop a training program for participating personnel, incorporating various components, such as techniques for identifying symptoms of anaphylaxis and emergency follow-up protocols. AB 3342 was held in the Assembly Human Services Committee.

AB 1386 (Low), Chapter 374, Statutes of 2016, permitted a pharmacy to furnish epinephrine auto-injectors to an authorized entity if they are furnished exclusively for use at or in connection with an authorized entity; an authorized health care provider provides a prescription; and, the records are maintained by the authorized entity for three years. Specified that authorized entities include, but are not limited to, daycare facilities, colleges and universities, summer and day camps, sports leagues, scout troops, before and after school programs, recreational parks and other places where children and adults could come into contact with potentially life-threatening allergens.

SB 1266 (Huff) of 2014, Chapter 321, Statutes of 2014, required school districts, county offices of education, and charter schools to provide emergency epinephrine auto-injectors to school nurses or trained personnel who have volunteered to administer epinephrine auto-injectors to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an anaphylactic reaction.

AB 559 (Wiggins), Chapter 458, Statutes of 2001, established provisions of law that permit a school district or county office of education to provide emergency epinephrine auto-injectors to trained personnel, and permit trained personnel to utilize these epinephrine auto-injectors to provide emergency medical aid to persons suffering from an anaphylactic reaction at a school or during a school activity.

REGISTERED SUPPORT / OPPOSITION:

Support

Elijah-alavi Foundation (Sponsor)

Association of Regional Center Agencies

Asthma and Allergy Foundation of America

California Society for Respiratory Care

Food Allergy & Research Education

Natalie Giorgi Sunshine Foundation

National Association of Pediatric Nurse Practitioners (NAPNAP)

No Nut Traveler INC

Opposition

None on file.

Analysis Prepared by: Bri-Ann Hernández / HUM. S. / (916) 319-2089