Existing law authorizes a school district, county office of education, or charter school to provide emergency stock albuterol inhalers, as specified, to school nurses or trained personnel who have volunteered, and authorizes school nurses or trained personnel to use an emergency stock albuterol inhaler to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from respiratory distress, as provided. Existing law authorizes a prescription for emergency stock albuterol inhalers to be filled by local or mail order pharmacies or stock albuterol inhaler manufacturers.

This bill would revise and recast that latter provision by making its provisions also apply to a childcare program, as defined, that is operated by or contracts with a school district, county office of education, or charter school, as provided. This bill would explicitly authorize a pharmacy to furnish stock albuterol inhalers to a local educational agency pursuant to a written order from an authorized prescriber. The bill would authorize a prescription for emergency stock albuterol inhalers also to be filled by stock albuterol wholesalers or distributers.

The bill, for purposes of these provisions, would change references from the Superintendent of Public Instruction to the Education Commissioner in order to implement changes made by AB 181 of the 202526 Regular Session.

Existing law authorizes a school district, county office of education, or charter school to provide emergency stock albuterol inhalers, as specified, to school nurses or trained personnel who have volunteered, and authorizes school nurses or trained personnel to use an emergency stock albuterol inhaler to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from respiratory distress, as provided. Existing law authorizes a prescription for emergency stock albuterol inhalers to be filled by local or mail order pharmacies or stock albuterol inhaler manufacturers.

This bill would revise and recast that latter provision by making its provisions also apply to a childcare program, as defined, that is operated by or contracts with a school district, county office of education, or charter school, as provided. This bill would explicitly authorize a pharmacy to furnish stock albuterol inhalers to a local educational agency pursuant to a written order from an authorized prescriber. The bill would authorize a prescription for emergency stock albuterol inhalers also to be filled by stock albuterol wholesalers or distributers.

The bill, for purposes of these provisions, would change references from the Superintendent of Public Instruction to the Education Commissioner in order to implement changes made by AB 181 of the 202526 Regular Session.

Existing law authorizes a school district, county office of education, or charter school to provide emergency stock albuterol inhalers, as specified, to school nurses or trained personnel who have volunteered, and authorizes school nurses or trained personnel to use an emergency stock albuterol inhaler to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from respiratory distress, as provided. Existing law authorizes a prescription for emergency stock albuterol inhalers to be filled by local or mail order pharmacies or stock albuterol inhaler manufacturers.

This bill would revise and recast that latter provision by making its provisions also apply to a childcare program, as defined, that is operated by or contracts with a school district, county office of education, or charter school, as provided. This bill would explicitly authorize a pharmacy to furnish stock albuterol inhalers to a local educational agency pursuant to a written order from an authorized prescriber. The bill would authorize a prescription for emergency stock albuterol inhalers also to be filled by stock albuterol wholesalers or distributers.

Existing law authorizes a school district, county office of education, or charter school to provide emergency stock albuterol inhalers, as specified, to school nurses or trained personnel who have volunteered, and authorizes school nurses or trained personnel to use an emergency stock albuterol inhaler to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from respiratory distress, as provided.

This bill would revise and recast that latter provision by making its provisions also apply to a childcare program, as defined, that is operated by or contracts with a school district, county office of education, or charter school, as provided. This bill would explicitly authorize a pharmacy to furnish stock albuterol inhalers to a local educational agency pursuant to a written order from an authorized prescriber.

Existing law authorizes a school district, county office of education, or charter school to provide emergency stock albuterol inhalers, as specified, to school nurses or trained personnel who have volunteered, and authorizes school nurses or trained personnel to use an emergency stock albuterol inhaler to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from respiratory distress, as provided.

This bill would revise and recast that latter provision by making its provisions instead apply to local educational agencies and defining a local educational agency to mean a school operated by also apply to a childcare program, as defined, that is operated by or contracts with a school district, county office of education, or charter school. school, as provided.

Existing law authorizes a school district, county office of education, or charter school to provide emergency stock albuterol inhalers, as specified, to school nurses or trained personnel who have volunteered, and authorizes school nurses or trained personnel to use an emergency stock albuterol inhaler to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from respiratory distress, as provided.

This bill would revise and recast that latter provision by making its provisions instead apply to local educational agencies and defining a local educational agency to mean a school operated by a school district, county office of education, or charter school.

 UNFINISHED BUSINESS 

Bill No: SB 1347

Author: Niello (R)

Amended: 8/20/26

Vote: 21

SENATE EDUCATION COMMITTEE: 7-0, 4/8/26

AYES: Pérez, Ochoa Bogh, Cabaldon, Choi, Cortese, Gonzalez, Reyes

SENATE FLOOR: 36-0, 4/30/26

AYES: Allen, Alvarado-Gil, Archuleta, Ashby, Becker, Blakespear, Cabaldon, Cervantes, Choi, Cortese, Dahle, Durazo, Gonzalez, Grayson, Grove, Hurtado, Jones, Laird, Limón, McGuire, McNerney, Menjivar, Niello, Ochoa Bogh, Padilla, Pérez, Reyes, Richardson, Rubio, Seyarto, Smallwood-Cuevas, Stern, Strickland, Umberg, Weber Pierson, Wiener

NO VOTE RECORDED: Arreguín, Caballero, Valladares, Wahab

ASSEMBLY FLOOR: 76-0, 8/27/26 - See last page for vote

SUBJECT: Pupil health: emergency stock albuterol inhalers

SOURCE: Author

DIGEST:

This bill extends the authorization for school districts, county offices of education (COEs), and charter schools to provide and administer emergency stock albuterol inhalers, to apply to childcare programs operated by or under contract with a local educational agency (LEA), as specified, as well as their trained employees. This bill also authorizes pharmacies to furnish albuterol inhalers to an LEA, as specified.

Assembly Amendments

1) authorize pharmacies to furnish stock albuterol inhalers to an LEA pursuant to a written order from an authorized provider, and 2) replaces references to the Superintendent of Public Instruction (SPI) with the Education Commissioner.

ANALYSIS:

Existing law:

1. Authorizes school districts, COEs, and charter schools to provide emergency stock albuterol inhalers, including, if necessary, single-use disposable holding chambers, to school nurses or trained personnel who have volunteered, as specified. Authorizes school nurses or trained personnel to use as emergency stock albuterol inhaler to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from respiratory illness. (Education Code (EC) § 49414.7)
2. Authorizes private elementary and secondary schools in the state to voluntarily determine whether or not to make emergency stock albuterol inhalers and trained personnel available at its school. Specifies that in making this determination, a school shall evaluate the emergency medical response time to the school and determine whether initiating emergency medical services is an acceptable alternative to stock albuterol inhalers and trained personnel. (EC § 49414.7)
3. Authorizes each public school and private elementary and secondary school in the state to designate one or more volunteers to receive initial and annual refresher training based on the standards, as specified, regarding the storage and emergency use of a stock albuterol inhaler from the school nurse or other qualified person designated by an authorizing physician and surgeon. (EC § 49414.7)

This bill:

1. Authorizes a pharmacy to furnish stock albuterol inhalers to an LEA based upon a written order from an authorized prescriber.
2. Authorizes LEAs that operate or contract with a childcare program to provide emergency stock albuterol inhalers, including single-use disposable holding chambers, to school nurses or trained personnel who have volunteered to administer the medication.
3. Defines “childcare program” to mean “a state or federally subsidized childcare program operated by, or under contract with, an LEA, including, but not limited to, a California state preschool program or Head Start program pursuant to Chapter 2 (commencing with Section 8200) of Part 6 of Division 1 of Title 1, or a childcare program, including, but not limited to, general childcare and development programs pursuant to Part 1.8 (commencing with Section 10207) of Division 9 of the Welfare and Institutions Code.
4. Amends the definition of “stock albuterol inhaler” to include albuterol medication in the form of single-use disposable holding chamber.
5. Amends the definition of “volunteer” or “trained personnel” authorized to administer stock albuterol under specified conditions, to include employees of a childcare program who have volunteered, received training, and are subject to liability limitations pursuant to existing law.
6. Authorizes childcare programs operated by or under contract with an LEA to designate one or more volunteers to receive initial and annual refresher training, as specified.
7. Encourages and recommends that childcare programs have a minimum of two trained employees per childcare program site.
8. Adds childcare programs to the existing entities to which LEAs electing to utilize stock albuterol inhalers for emergency aid must distribute specified biannual notices.
9. Recasts the requirement for a qualified supervisor of health of a LEA electing to utilize stock albuterol inhalers for emergency aid to obtain from an authorizing physician and surgeon a prescription for stock albuterol inhaler for each site, to include childcare programs.
   1. Requires those prescriptions to, at a minimum, include appropriate doses of available stock albuterol inhalers for the ages and weights of individuals at each site including any childcare programs.
10. Adds childcare programs operated by or contracted under LEAs to the existing provisions regarding liability for civil damages resulting from any act or omission, other than an act or omission constituting gross negligence or willful and wanton misconduct, in the emergency administration of an albuterol inhaler by any of its school nurses or trained volunteers who have volunteered, as specified.
11. Adds employees of childcare programs that are operated by or under contract with an LEA to the type of employees that shall be provided defense and indemnification by an LEA for any and all civil liability, as specified.
12. Replaces references to the SPI in this section of Education Code with the Education Commissioner and specifies that that replacement does not require the Education Commissioner to establish new minimum standards of training for the administration of stock albuterol inhalers, as specified.

Comments

Need for the bill. According to the author, “In 2023, the Legislature passed on a bi-partisan basis AB 1283 (Chen, 2023), which authorized stock albuterol in public schools. This measure has helped safeguard children and has ensured our school health professionals have the necessary medication on hand at school to provide lifesaving treatment.

“Albuterol is a prescribed medicine used to prevent and treat wheezing, difficulty breathing, chest tightness, and coughing caused by lung diseases such as asthma. Albuterol is in a class of medications called bronchodilators and works by relaxing and opening the air passages to the lungs to make breathing easier.

“Since the passage of AB 1283 (Chen, 2023), the state has made access to preschool a priority and is now expanding to Universal Preschool. This prioritization means the traditional definitions of “school” hasn’t always been clear in the education code whether it included preschool. Some school districts have expressed confusion if they are supposed to be providing the stock albuterol in their preschool programs. Clarity in statute is needed for schools to ensure they do not have any exposed liability for their preschool students. This is consistent with the passage of SB 568 (Niello) in 2025 which clarified the stock epinephrine in schools program also applied to preschool.”

Asthma prevalence in children. According to Tracking California, a program of the Public Health Institute partnered with California Breathing, in 2021-2022, an estimated 9.9% of California children ages 0-17 had been diagnosed with asthma at some point in their lives. For those aged 0-4, that number stands at an estimated 2.9%. While asthma does not result in hospitalization for most children, there were 6822 hospitalizations for asthma among children ages 0-17 statewide in 2023, with roughly 3223 of those involving children ages 0-4.

Asthma is one of the most common chronic diseases among children in the U.S. and a leading cause of pediatric hospitalization. It is also the top reason for missed school days, accounting for more than 5.2 million absences annually. Asthma rates vary by region, demographics, environment, physician diagnostic practices, and access to care. Although identifying the impact of independent risk factors for asthma is difficult, children of color and those from low-income families are disproportionately at high risk for severe symptoms, missed school days, and hospital visits.

The management of asthma in California schools. The California Department of Public Health (CDPH) “Guidelines for the Management of Asthma in California Schools” and “Asthma Action Plan for Schools and Families” assist schools in effectively managing this chronic disease. The “Guidelines for the Management of Asthma in California Schools” were developed jointly by health professionals in the California Department of Education (CDE) and the California Asthma Public Health Initiative in statewide collaboration with asthma experts and stakeholders.

Further, the CDPH, in partnership with the CDE and the Department of Health Care Access and Information (HCAI), has issued a statewide standing order for albuterol to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from respiratory distress in California schools. Using the online form, LEAs can generate a standing order to use as a prescription for albuterol to ensure the safety and well-being of persons experiencing respiratory distress in schools or during school activities. CDPH states in its Albuterol Standing Order Frequently Asked Questions page that existing law authorizes some preschools to develop a stock albuterol program if they are co-located on a TK–12 site.

Finally, according to its website, CalRx, in partnership with the CDPH Office of School Health, has announced plans to launch a centralized ordering system to supply California’s TK–12 schools with albuterol inhalers and single-use disposable spacers at no cost over a three-year period beginning in Summer 2026.

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

SUPPORT: (Verified 8/27/26)

American Medical Response West

California School Nurses Organization

California Society for Allergy, Asthma and Immunology

California Society for Respiratory Care

Small School Districts Association

OPPOSITION: (Verified 8/27/26)

None received

ASSEMBLY FLOOR: 76-0, 8/27/26

AYES: Addis, Aguiar-Curry, Ahrens, Alanis, Alvarez, Arambula, Ávila Farías, Bains, Bennett, Berman, Boerner, Bonta, Bryan, Calderon, Caloza, Carrillo, Castillo, Chen, Connolly, Davies, DeMaio, Dixon, Elhawary, Ellis, Flora, Fong, Gabriel, Garcia, Gipson, Jeff Gonzalez, Mark González, Hadwick, Haney, Harabedian, Hart, Hoover, Irwin, Johnson, Kalra, Krell, Lackey, Lee, Lowenthal, Macedo, Muratsuchi, Nguyen, Ortega, Pacheco, Papan, Patel, Patterson, Pellerin, Petrie-Norris, Quirk-Silva, Ramos, Ransom, Celeste Rodriguez, Michelle Rodriguez, Rogers, Blanca Rubio, Sanchez, Schiavo, Schultz, Sharp-Collins, Solache, Soria, Stefani, Ta, Tangipa, Valencia, Wallis, Ward, Wicks, Wilson, Zbur, Rivas

NO VOTE RECORDED: Bauer-Kahan, Jackson, McKinnor

Prepared by: Therresa Austin / ED. / (916) 651-4105

11/6/26 14:31:15

**** END ****

Date of Hearing: August 25, 2026

ASSEMBLY COMMITTEE ON BUSINESS AND PROFESSIONS

Marc Berman, Chair

SBPCA Bill Id:SB 1347

Author:(Niello) – As Amended Ver:August 20, 2026

NOTE: This bill is being heard pursuant to Assembly Rule 77.2.

SENATE VOTE: 36-0

SUBJECT: Pupil health: emergency stock albuterol inhalers

SUMMARY: Authorizes a pharmacy to furnish stock albuterol inhalers to a local educational agency (LEA) pursuant to a written order from an authorized prescribe and extends the current authorization for LEAs to provide and administer emergency stock albuterol inhalers to childcare programs operated by or under contract with an LEA, as well as their trained employees.

EXISTING LAW:

1. Establishes the California State Board of Pharmacy (BOP) within the Department of Consumer Affairs to administer and enforce the Pharmacy Law. (Business and Professions Code (BPC) §§ 4000 et seq.)
2. Defines “pharmacy” as an area, place, or premises licensed by the BOP in which the profession of pharmacist is practiced and where prescriptions are compounded, including any where controlled substances, dangerous drugs, or dangerous devices are stored, possessed, prepared, manufactured, derived, compounded, or repackaged, and from which the controlled substances, dangerous drugs, or dangerous devices are furnished, sold, or dispensed at retail. (BPC § 4037)
3. Declares pharmacist practice to be a dynamic, patient-oriented health service that applies a scientific body of knowledge to improve and promote patient health by means of patient-care activities to optimize appropriate drug use, drug-related therapy, disease management and prevention, and communication for clinical and consultative purposes. (BPC § 4050)
4. Authorizes a pharmacist to perform specified functions and provide specified services as part of their scope of practice, including furnishing certain medications, performing certain procedures, administering drugs and biological products, ordering and interpreting tests, and providing consultation, training, and education to patients. (BPC § 4052)
5. Prohibits the furnishing of any dangerous drug or device, except upon the prescription of a physician, dentist, podiatrist, optometrist, veterinarian, or naturopathic doctor. (BPC § 4059)
6. Authorizes a pharmacy to furnish epinephrine delivery systems to a local educational agency if specified conditions are met. (BPC § 4119.2)
7. Authorizes a pharmacy to furnish naloxone hydrochloride or another opioid antagonist to a school district, county office of education, or charter school if specified conditions are met. (BPC § 4119.8)
8. Requires LEAs 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. (Education Code (EDC) § 49414)
9. Authorizes LEAs to provide emergency naloxone hydrochloride or another opioid antagonist to school nurses or trained personnel who have volunteered to administer the medication, and allows for those school nurses or trained personnel to use naloxone hydrochloride or another opioid antagonist to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from an opioid overdose. (EDC § 49414.3)
10. Authorizes school districts, county offices of education, and charter schools to provide emergency stock albuterol inhalers, including, if necessary, single-use disposable holding chambers, to school nurses or trained personnel who have volunteered to administer the medication, and authorizes those school nurses or trained personnel to use an emergency stock albuterol inhaler to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from respiratory distress. (EDC § 49414.7)

THIS BILL:

1. Allows for a pharmacy to furnish stock albuterol inhalers to an LEA pursuant to a written order from an authorized prescriber pursuant to provisions of the Education Code allowing school nurses or trained volunteer personnel to use emergency stock albuterol inhalers.
2. Expands the authority of LEAs to provide and administer emergency stock albuterol inhalers to include childcare programs operated by or under contract with an LEA, as well as their trained employees.
3. Amends the definition of volunteer or trained personnel authorized to administer stock albuterol under specified conditions to include employees of a childcare program who have volunteered, received training, and are subject to liability limitations pursuant to existing law.
4. Authorizes childcare programs operated by or under contract with an LEA to designate one or more volunteers to receive initial and annual refresher training, as specified.
5. Adds childcare programs to the existing entities to which LEAs electing to utilize stock albuterol inhalers for emergency aid must distribute specified biannual notices.
6. Requires that a prescription provided by an authorizing physician and surgeon include appropriate doses of available stock albuterol inhalers for the ages and weights of individuals at each school and childcare program site.
7. Amends the definition of volunteer or trained personnel, authorized to administer stock albuterol under specified conditions, to include employees of a childcare program who have volunteered, received training, and are subject to liability limitations pursuant to existing law.
8. Defines “childcare program” as a state or federally subsidized childcare program operated by, or under contract with, an LEA, including specified programs.

FISCAL EFFECT: This bill is keyed nonfiscal by the Legislative Counsel.

COMMENTS:

Purpose. This bill is sponsored by the author. According to the author:

In 2023, the Legislature passed on a bi-partisan basis AB 1283 (Chen), which authorized stock albuterol in public schools. This measure has helped safeguard children and has ensured our school health professionals have the necessary medication on hand at school to provide lifesaving treatment. Since the passage of AB 1283 (Chen, 2023), the state has made access to preschool a priority and is now expanding to Universal Preschool. This prioritization means the traditional definitions of “school” hasn’t always been clear in the education code whether it included preschool. Some school districts have expressed confusion if they are supposed to be providing the stock albuterol in their preschool programs and other programs. Clarity in statute is needed for schools to ensure they do not have any exposed liability for their students. This is consistent with the passage of SB 568 (Niello) in 2025 which clarified the stock epinephrine in schools program also applied to preschool.

Background.

California State Board of Pharmacy. The BOP is the regulatory body responsible for overseeing pharmacies and pharmacist practice in California. As of 2025, the BOP is estimated to regulate over 50,700 pharmacists, 1,300 advanced practice pharmacists, 4,400 intern pharmacists, and 65,700 pharmacy technicians across 32 distinct licensing programs. In addition to regulating professionals, the BOP licenses and oversees pharmacies, clinics, wholesalers, third-party logistic providers, and automated drug delivery systems.

As one of approximately three dozen boards and bureaus under the Department of Consumer Affairs, the BOP plays an important role in the regulatory ecosystem that oversees the healing arts. In the face of persistent concerns such as the opioid crisis, the BOP is empowered to ensure that dangerous drugs and controlled substances are dispensed and furnished only under lawful circumstances. Under regulations enforced by the BOP, pharmacists are tasked with a corresponding responsibility for ensuring that the prescriptions they fill are legitimate and not for purposes of abuse. Entrusted with administering and enforcing the state’s Pharmacy Law, statute provides that “protection of the public shall be the highest priority for the California State Board of Pharmacy in exercising its licensing, regulatory, and disciplinary functions.”

Furnishing Directly to Local Education Agencies. The Pharmacy Law generally requires the furnishing of drugs or devices by a pharmacist to be pursuant to a valid prescription for a specific patient. However, there are several exceptions that allow for a pharmacy to furnish specified drugs or devices directly to a local agency so that it may be administered to an unidentified individual who may later be in need. For example, current law authorizes a pharmacy to furnish epinephrine delivery systems to a local educational agency. The Pharmacy Law similarly allows a pharmacy to furnish naloxone hydrochloride or another opioid antagonist to an LEA or a law enforcement agency, subject to respective conditions.

Access to Asthma Medication in Schools. The Legislature enacted AB 1283 (Chen) in 2023, which authorized an LEA to make emergency stock albuterol inhalers available at school districts, county offices of education, and charter schools. The bill additionally authorized school nurses or trained personnel who have volunteered to administer an albuterol inhaler to persons suffering from, or reasonably believed to be suffering from, respiratory distress. The provisions of the bill were voluntary, but schools were encouraged and recommended to have a minimum of two trained school employees.

As discussed in the Assembly Committee on Education, asthma is a chronic lung disease and the leading cause of absenteeism for students, affecting approximately 10 percent of school-aged children nationwide and accounting for 5.2 million absences annually. The California Department of Public Health (CDPH) reports that one in seven Californians have asthma, and that one in three children with asthma miss school due to asthma-related illness. The CDPH states that people with uncontrolled asthma may need to visit the emergency department in order to receive help with managing an asthma attack; in 2024, asthma was the primary reason for 145,000 emergency department visits in California.

In August 2026, Governor Gavin Newsom announced the CalRx School Albuterol Access Initiative, a partnership with Amneal Pharmaceuticals intended to create “a simple statewide system to supply public and charter schools with emergency albuterol inhalers and spacers at no cost for three years.” The press release further announced that CalRx would partner with the California School Nurses Organization to provide asthma and stock albuterol training guidelines to public school districts at no cost. The director of CDPH has issued an albuterol “standing order” for school use, replacing the need for schools to obtain an individual prescription from a physician.

Existing law authorizes an LEA, including a school district, county office of education, or charter school, to provide emergency stock albuterol inhalers to school nurses or trained personnel and authorizes those individuals to use an emergency stock albuterol inhaler to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from respiratory distress. This bill would extend that same authority to childcare programs operated by or under contract with an LEA, such as a California state preschool program, Head Start program, or a general childcare and development program. The bill provides liability protection to the childcare staff administering the medication. This language falls within the jurisdiction of the Assembly Committee on Education, which previously considered and passed this bill.

Additionally, this bill now authorizes a pharmacy to furnish stock albuterol inhalers to an LEA pursuant to a written order from an authorized prescriber pursuant to the Education Code. This authority would mirror existing provisions for pharmacies to furnish epinephrine delivery systems and opioid antagonists to LEAs. The author believes that this additional authority will enhance the ability of LEAs to stock and administer albuterol inhalers in school settings when needed, consistent with the state’s broader efforts to address asthma among students.

Prior Related Legislation. AB 1283 (Chen), Chapter 574, Statutes of 2023 authorized an LEA to make emergency stock albuterol inhalers available at school districts, county offices of education, and charter schools and authorized school nurses or trained personnel who have volunteered to administer an albuterol inhaler to persons suffering from, or reasonably believed to be suffering from, respiratory distress.

AB 1748 (Mayes) authorized a pharmacy to furnish naloxone hydrochloride or another opioid antagonist to an LEA.

AB 559 (Wiggins) authorized a pharmacy to furnish epinephrine auto-injectors to an LEA.

ARGUMENTS IN SUPPORT:

The California School Nurses Organization supports this bill, writing: “Current California law permits schools to stock emergency inhalers, but ambiguities in the statutory framework have left some program operators uncertain about whether they are authorized to do so. As a result, children in certain school settings may have no access to treatment at all if they either forget their own inhaler or have a new or previously undiagnosed case of asthma. Clarifying the law to affirmatively authorize all school programs to stock and administer albuterol inhalers ensures that school nurses and trained staff can act confidently during a medical emergency without administrative confusion. The bill also maintains this provision as an authorization, rather than a requirement, maintaining local flexibility and allowing for communities to decide what is best for them.”

ARGUMENTS IN OPPOSITION:

There is no opposition on file.

REGISTERED SUPPORT:

Alameda County Office of Education
Alameda County School Nurse Network
American Medical Response West
Association of California School Administrators
Asthma and Allergy Foundation of America
California School Nurses Organization
California Society for Allergy, Asthma and Immunology
California Society for Respiratory Care
Small School Districts Association

REGISTERED OPPOSITION:

None on file

Analysis Prepared by: Robert Sumner / B. & P. / (916) 319-3301

 UNFINISHED BUSINESS  

Bill No: SB 1347

Author: Niello (R)

Amended: 8/20/26

Vote: 21

SENATE EDUCATION COMMITTEE: 7-0, 4/8/26

AYES: Pérez, Ochoa Bogh, Cabaldon, Choi, Cortese, Gonzalez, Reyes

SENATE FLOOR: 36-0, 4/30/26

AYES: Allen, Alvarado-Gil, Archuleta, Ashby, Becker, Blakespear, Cabaldon, Cervantes, Choi, Cortese, Dahle, Durazo, Gonzalez, Grayson, Grove, Hurtado, Jones, Laird, Limón, McGuire, McNerney, Menjivar, Niello, Ochoa Bogh, Padilla, Pérez, Reyes, Richardson, Rubio, Seyarto, Smallwood-Cuevas, Stern, Strickland, Umberg, Weber Pierson, Wiener

NO VOTE RECORDED: Arreguín, Caballero, Valladares, Wahab

ASSEMBLY FLOOR: Passed, 8/27/26

SUBJECT: Pupil health: emergency stock albuterol inhalers

SOURCE: Author

DIGEST:

This bill extends the authorization for school districts, county offices of education (COEs), and charter schools to provide and administer emergency stock albuterol inhalers, to apply to childcare programs operated by or under contract with a local educational agency (LEA), as specified, as well as their trained employees. This bill also authorizes pharmacies to furnish albuterol inhalers to an LEA, as specified.

Assembly Amendments

1) authorize pharmacies to furnish stock albuterol inhalers to an LEA pursuant to a written order from an authorized provider, and 2) replaces references to the Superintendent of Public Instruction (SPI) with the Education Commissioner.

ANALYSIS:

Existing law:

1. Authorizes school districts, COEs, and charter schools to provide emergency stock albuterol inhalers, including, if necessary, single-use disposable holding chambers, to school nurses or trained personnel who have volunteered, as specified. Authorizes school nurses or trained personnel to use as emergency stock albuterol inhaler to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from respiratory illness. (Education Code (EC) § 49414.7)
2. Authorizes private elementary and secondary schools in the state to voluntarily determine whether or not to make emergency stock albuterol inhalers and trained personnel available at its school. Specifies that in making this determination, a school shall evaluate the emergency medical response time to the school and determine whether initiating emergency medical services is an acceptable alternative to stock albuterol inhalers and trained personnel. (EC § 49414.7)
3. Authorizes each public school and private elementary and secondary school in the state to designate one or more volunteers to receive initial and annual refresher training based on the standards, as specified, regarding the storage and emergency use of a stock albuterol inhaler from the school nurse or other qualified person designated by an authorizing physician and surgeon. (EC § 49414.7)

This bill:

1. Authorizes a pharmacy to furnish stock albuterol inhalers to an LEA based upon a written order from an authorized prescriber.
2. Authorizes LEAs that operate or contract with a childcare program to provide emergency stock albuterol inhalers, including single-use disposable holding chambers, to school nurses or trained personnel who have volunteered to administer the medication.
3. Defines “childcare program” to mean “a state or federally subsidized childcare program operated by, or under contract with, an LEA, including, but not limited to, a California state preschool program or Head Start program pursuant to Chapter 2 (commencing with Section 8200) of Part 6 of Division 1 of Title 1, or a childcare program, including, but not limited to, general childcare and development programs pursuant to Part 1.8 (commencing with Section 10207) of Division 9 of the Welfare and Institutions Code.
4. Amends the definition of “stock albuterol inhaler” to include albuterol medication in the form of single-use disposable holding chamber.
5. Amends the definition of “volunteer” or “trained personnel” authorized to administer stock albuterol under specified conditions, to include employees of a childcare program who have volunteered, received training, and are subject to liability limitations pursuant to existing law.
6. Authorizes childcare programs operated by or under contract with an LEA to designate one or more volunteers to receive initial and annual refresher training, as specified.
7. Encourages and recommends that childcare programs have a minimum of two trained employees per childcare program site.
8. Adds childcare programs to the existing entities to which LEAs electing to utilize stock albuterol inhalers for emergency aid must distribute specified biannual notices.
9. Recasts the requirement for a qualified supervisor of health of a LEA electing to utilize stock albuterol inhalers for emergency aid to obtain from an authorizing physician and surgeon a prescription for stock albuterol inhaler for each site, to include childcare programs.
   1. Requires those prescriptions to, at a minimum, include appropriate doses of available stock albuterol inhalers for the ages and weights of individuals at each site including any childcare programs.
10. Adds childcare programs operated by or contracted under LEAs to the existing provisions regarding liability for civil damages resulting from any act or omission, other than an act or omission constituting gross negligence or willful and wanton misconduct, in the emergency administration of an albuterol inhaler by any of its school nurses or trained volunteers who have volunteered, as specified.
11. Adds employees of childcare programs that are operated by or under contract with an LEA to the type of employees that shall be provided defense and indemnification by an LEA for any and all civil liability, as specified.
12. Replaces references to the SPI in this section of Education Code with the Education Commissioner and specifies that that replacement does not require the Education Commissioner to establish new minimum standards of training for the administration of stock albuterol inhalers, as specified.

Comments

Need for the bill. According to the author, “In 2023, the Legislature passed on a bi-partisan basis AB 1283 (Chen, 2023), which authorized stock albuterol in public schools. This measure has helped safeguard children and has ensured our school health professionals have the necessary medication on hand at school to provide lifesaving treatment.

“Albuterol is a prescribed medicine used to prevent and treat wheezing, difficulty breathing, chest tightness, and coughing caused by lung diseases such as asthma. Albuterol is in a class of medications called bronchodilators and works by relaxing and opening the air passages to the lungs to make breathing easier.

“Since the passage of AB 1283 (Chen, 2023), the state has made access to preschool a priority and is now expanding to Universal Preschool. This prioritization means the traditional definitions of “school” hasn’t always been clear in the education code whether it included preschool. Some school districts have expressed confusion if they are supposed to be providing the stock albuterol in their preschool programs. Clarity in statute is needed for schools to ensure they do not have any exposed liability for their preschool students. This is consistent with the passage of SB 568 (Niello) in 2025 which clarified the stock epinephrine in schools program also applied to preschool.”

Asthma prevalence in children. According to Tracking California, a program of the Public Health Institute partnered with California Breathing, in 2021-2022, an estimated 9.9% of California children ages 0-17 had been diagnosed with asthma at some point in their lives. For those aged 0-4, that number stands at an estimated 2.9%. While asthma does not result in hospitalization for most children, there were 6822 hospitalizations for asthma among children ages 0-17 statewide in 2023, with roughly 3223 of those involving children ages 0-4.

Asthma is one of the most common chronic diseases among children in the U.S. and a leading cause of pediatric hospitalization. It is also the top reason for missed school days, accounting for more than 5.2 million absences annually. Asthma rates vary by region, demographics, environment, physician diagnostic practices, and access to care. Although identifying the impact of independent risk factors for asthma is difficult, children of color and those from low-income families are disproportionately at high risk for severe symptoms, missed school days, and hospital visits.

The management of asthma in California schools. The California Department of Public Health (CDPH) “Guidelines for the Management of Asthma in California Schools” and “Asthma Action Plan for Schools and Families” assist schools in effectively managing this chronic disease. The “Guidelines for the Management of Asthma in California Schools” were developed jointly by health professionals in the California Department of Education (CDE) and the California Asthma Public Health Initiative in statewide collaboration with asthma experts and stakeholders.

Further, the CDPH, in partnership with the CDE and the Department of Health Care Access and Information (HCAI), has issued a statewide standing order for albuterol to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from respiratory distress in California schools. Using the online form, LEAs can generate a standing order to use as a prescription for albuterol to ensure the safety and well-being of persons experiencing respiratory distress in schools or during school activities. CDPH states in its Albuterol Standing Order Frequently Asked Questions page that existing law authorizes some preschools to develop a stock albuterol program if they are co-located on a TK–12 site.

Finally, according to its website, CalRx, in partnership with the CDPH Office of School Health, has announced plans to launch a centralized ordering system to supply California’s TK–12 schools with albuterol inhalers and single-use disposable spacers at no cost over a three-year period beginning in Summer 2026.

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

SUPPORT: (Verified 8/27/26)

American Medical Response West

California School Nurses Organization

California Society for Allergy, Asthma and Immunology

California Society for Respiratory Care

Small School Districts Association

OPPOSITION: (Verified 8/27/26)

None received

Prepared by: Therresa Austin / ED. / (916) 651-4105

8/27/26 16:35:33

**** END ****

SENATE THIRD READING

STR Bill Id:SB 1347

Author:(Niello)

As Amended Ver:August 20, 2026

Majority vote

SUMMARY

Extends the authorization for school districts, county offices of education (COEs), and charter schools to provide and administer emergency stock albuterol inhalers, to apply to childcare programs operated by or under contract with a local educational agency (LEA), as well as their trained employees. Also authorizes pharmacies, as well as stock albuterol wholesalers and distributors to furnish stock albuterol inhalers to LEAs.

Major Provisions

1. Authorizes LEAs that operate or contract with a childcare program to provide emergency stock albuterol inhalers, including single-use disposable holding chambers, to school nurses or trained personnel who have volunteered to administer the medication.
2. Amends the definition of volunteer or trained personnel, authorized to administer stock albuterol under specified conditions, to include employees of a childcare program who have volunteered, received training, and are subject to liability limitations pursuant to existing law.
3. Authorizes childcare programs operated by or under contract with an LEA to designate one or more volunteers to receive initial and annual refresher training, as specified.
4. Adds childcare programs to the existing entities to which LEAs electing to utilize stock albuterol inhalers for emergency aid must distribute specified biannual notices.
5. Encourages and recommends each LEA, childcare program, and private school to have a minimum of two trained employees per school or childcare program site.
6. Requires that a prescription provided by an authorizing physician and surgeon include appropriate doses of available stock albuterol inhalers for the ages and weights of individuals at each school and childcare program site.
7. Amends the definition of volunteer or trained personnel, authorized to administer stock albuterol under specified conditions, to include employees of a childcare program who have volunteered, received training, and are subject to liability limitations pursuant to existing law.
8. Authorizes a pharmacy as well as a stock albuterol wholesaler or distributor to furnish stock albuterol inhalers to an LEA based upon a written order from an authorized prescriber.
9. Defines "childcare program" as a state or federally subsidized childcare program operated by, or under contract with, an LEA, including, but not limited to, a California state preschool program (CSPP) or Head Start program, or a childcare program, including but not limited to, general childcare and development (CCTR).

COMMENTS

Asthma in school-aged children. Asthma is a chronic lung disease and the leading cause of absenteeism for students. It affects 10% of school-aged children nationwide and accounts for 5.2 million absences annually. The California Department of Public Health (CDPH) reports that 1 in 7 Californians have asthma, and that 1 in 3 children with asthma miss school due to asthma-related illness. Asthma is the leading cause of chronic disease-related school absenteeism and is linked to lower academic performance, particularly in urban minority children. (O'Rourke, 2020)

Asthma often starts during childhood as children's immune systems are still developing. While the exact cause of asthma is unknown, certain factors combined can contribute to a child developing asthma.

According to the Author

"In 2023, the Legislature passed on a bi-partisan basis AB 1283 (Chen) [Chapter 574, Statutes of 2023] which authorized stock albuterol in public schools. This measure has helped safeguard children and has ensured our school health professionals have the necessary medication on hand at school to provide lifesaving treatment. According to the Allergy and Asthma Foundation of America (AFFA), as many as 1 million California children suffer from asthma. In a classroom of 30 children, about 3 are likely to have asthma according to the CDC.

Albuterol is a prescribed medicine used to prevent and treat wheezing, difficulty breathing, chest tightness, and coughing caused by lung diseases such as asthma. Albuterol is in a class of medications called bronchodilators and works by relaxing and opening the air passages to the lungs to make breathing easier.

Since the passage of AB 1283 (Chen, 2023), the state has made access to preschool a priority and is now expanding to Universal Preschool. This prioritization means the traditional definitions of "school" hasn't always been clear in the education code whether it included preschool. Some school districts have expressed confusion if they are supposed to be providing the stock albuterol in their preschool programs. Clarity in statute is needed for schools to ensure they do not have any exposed liability for their preschool students. This is consistent with the passage of SB 568 (Niello) in 2025 which clarified the stock epinephrine in schools program also applied to preschool."

Arguments in Support

The California School Nurses Organization writes, "Asthma is one of the most prevalent chronic conditions affecting school-age children in the United States, and California is no exception. As health care providers on the front lines, school nurses see firsthand how quickly respiratory distress can escalate. Approximately 1 in 12 children has asthma, and schools are among the most common settings where acute asthma attacks occur. A child experiencing a severe asthma attack who cannot immediately access a bronchodilator like albuterol faces a serious risk of hospitalization, or worse.

Current California law permits schools to stock emergency inhalers, but ambiguities in the statutory framework have left some program operators uncertain about whether they are authorized to do so. As a result, children in certain school settings may have no access to treatment at all if they either forget their own inhaler or have a new or previously undiagnosed case of asthma. Clarifying the law to affirmatively authorize all school programs to stock and administer albuterol inhalers ensures that school nurses and trained staff can act confidently during a medical emergency without administrative confusion. The bill also maintains this provision as an authorization, rather than a requirement, maintaining local flexibility and allowing for communities to decide what is best for them."

Arguments in Opposition

None on file

FISCAL COMMENTS

This bill has been keyed non-fiscal by the Office of Legislative Counsel.

VOTES

SENATE FLOOR: 36-0-4

YES: Allen, Alvarado-Gil, Archuleta, Ashby, Becker, Blakespear, Cabaldon, Cervantes, Choi, Cortese, Dahle, Durazo, Gonzalez, Grayson, Grove, Hurtado, Jones, Laird, Limón, McGuire, McNerney, Menjivar, Niello, Ochoa Bogh, Padilla, Pérez, Reyes, Richardson, Rubio, Seyarto, Smallwood-Cuevas, Stern, Strickland, Umberg, Weber Pierson, Wiener

ABS, ABST OR NV: Arreguín, Caballero, Valladares, Wahab

ASM EDUCATION: 8-0-1

YES: Patel, Hoover, Ahrens, Bonta, Castillo, Garcia, Lowenthal, Pellerin

ABS, ABST OR NV: Zbur

ASM BUSINESS AND PROFESSIONS: 19-0-0

YES: Berman, Johnson, Addis, Ahrens, Alanis, Bains, Bauer-Kahan, Caloza, Chen, Elhawary, Hadwick, Haney, Hart, Irwin, Jackson, Lowenthal, Macedo, Nguyen, Pellerin

UPDATED

VERSION: August 20, 2026

CONSULTANT: Debbie Look / ED. / (916) 319-2087 FN: 0004256

SENATE THIRD READING

STR Bill Id:SB 1347

Author:(Niello)

As Amended Ver: July 7, 2026

Majority vote

SUMMARY

Extends the authorization for school districts, county offices of education (COEs), and charter schools to provide and administer emergency stock albuterol inhalers, to apply to childcare programs operated by or under contract with a local educational agency (LEA), as well as their trained employees. Also authorizes a pharmacy to furnish stock albuterol inhalers to an LEA.

Major Provisions

1. Authorizes LEAs that operate or contract with a childcare program to provide emergency stock albuterol inhalers, including single-use disposable holding chambers, to school nurses or trained personnel who have volunteered to administer the medication.
2. Amends the definition of volunteer or trained personnel, authorized to administer stock albuterol under specified conditions, to include employees of a childcare program who have volunteered, received training, and are subject to liability limitations pursuant to existing law.
3. Authorizes childcare programs operated by or under contract with an LEA to designate one or more volunteers to receive initial and annual refresher training, as specified.
4. Adds childcare programs to the existing entities to which LEAs electing to utilize stock albuterol inhalers for emergency aid must distribute specified biannual notices.
5. Requires that a prescription provided by an authorizing physician and surgeon include appropriate doses of available stock albuterol inhalers for the ages and weights of individuals at each school and childcare program site.
6. Amends the definition of volunteer or trained personnel, authorized to administer stock albuterol under specified conditions, to include employees of a childcare program who have volunteered, received training, and are subject to liability limitations pursuant to existing law.
7. Authorizes a pharmacy to furnish stock albuterol inhalers to an LEA based upon a written order from an authorized prescriber.
8. Defines "childcare program" as a state or federally subsidized childcare program operated by, or under contract with, an LEA, including, but not limited to, a California state preschool program (CSPP) or Head Start program, or a childcare program, including but not limited to, general childcare and development (CCTR).

COMMENTS

Asthma in school-aged children. Asthma is a chronic lung disease and the leading cause of absenteeism for students. It affects 10% of school-aged children nationwide and accounts for 5.2 million absences annually. The California Department of Public Health (CDPH) reports that 1 in 7 Californians have asthma, and that 1 in 3 children with asthma miss school due to asthma-related illness. Asthma is the leading cause of chronic disease-related school absenteeism and is linked to lower academic performance, particularly in urban minority children. (O'Rourke, 2020)

Asthma often starts during childhood as children's immune systems are still developing. While the exact cause of asthma is unknown, certain factors combined can contribute to a child developing asthma.

According to the Author

"In 2023, the Legislature passed on a bi-partisan basis AB 1283 (Chen) [Chapter 574, Statutes of 2023] which authorized stock albuterol in public schools. This measure has helped safeguard children and has ensured our school health professionals have the necessary medication on hand at school to provide lifesaving treatment. According to the Allergy and Asthma Foundation of America (AFFA), as many as 1 million California children suffer from asthma. In a classroom of 30 children, about 3 are likely to have asthma according to the CDC.

Albuterol is a prescribed medicine used to prevent and treat wheezing, difficulty breathing, chest tightness, and coughing caused by lung diseases such as asthma. Albuterol is in a class of medications called bronchodilators and works by relaxing and opening the air passages to the lungs to make breathing easier.

Since the passage of AB 1283 (Chen) [Chapter 574, Statutes of 2023], the state has made access to preschool a priority and is now expanding to Universal Preschool. This prioritization means the traditional definitions of "school" hasn't always been clear in the education code whether it included preschool. Some school districts have expressed confusion if they are supposed to be providing the stock albuterol in their preschool programs. Clarity in statute is needed for schools to ensure they do not have any exposed liability for their preschool students. This is consistent with the passage of SB 568 (Niello) [Chapter 322, Statutes of] 2025 which clarified the stock epinephrine in schools program also applied to preschool."

Arguments in Support

The California School Nurses Organization writes, "Asthma is one of the most prevalent chronic conditions affecting school-age children in the United States, and California is no exception. As health care providers on the front lines, school nurses see firsthand how quickly respiratory distress can escalate. Approximately 1 in 12 children has asthma, and schools are among the most common settings where acute asthma attacks occur. A child experiencing a severe asthma attack who cannot immediately access a bronchodilator like albuterol faces a serious risk of hospitalization, or worse.

Current California law permits schools to stock emergency inhalers, but ambiguities in the statutory framework have left some program operators uncertain about whether they are authorized to do so. As a result, children in certain school settings may have no access to treatment at all if they either forget their own inhaler or have a new or previously undiagnosed case of asthma. Clarifying the law to affirmatively authorize all school programs to stock and administer albuterol inhalers ensures that school nurses and trained staff can act confidently during a medical emergency without administrative confusion. The bill also maintains this provision as an authorization, rather than a requirement, maintaining local flexibility and allowing for communities to decide what is best for them."

Arguments in Opposition

None on file

FISCAL COMMENTS

This bill has been keyed non-fiscal by the Office of Legislative Counsel.

VOTES

SENATE FLOOR: 36-0-4

YES: Allen, Alvarado-Gil, Archuleta, Ashby, Becker, Blakespear, Cabaldon, Cervantes, Choi, Cortese, Dahle, Durazo, Gonzalez, Grayson, Grove, Hurtado, Jones, Laird, Limón, McGuire, McNerney, Menjivar, Niello, Ochoa Bogh, Padilla, Pérez, Reyes, Richardson, Rubio, Seyarto, Smallwood-Cuevas, Stern, Strickland, Umberg, Weber Pierson, Wiener

ABS, ABST OR NV: Arreguín, Caballero, Valladares, Wahab

ASM EDUCATION: 8-0-1

YES: Patel, Hoover, Ahrens, Bonta, Castillo, Garcia, Lowenthal, Pellerin

ABS, ABST OR NV: Zbur

UPDATED

VERSION: July 2, 2026

CONSULTANT: Debbie Look / ED. / (916) 319-2087 FN: 0003274

SENATE THIRD READING

STR Bill Id:SB 1347

Author:(Niello)

As Amended Ver:April 6, 2026

Majority vote

SUMMARY

Extends the authorization for school districts, county offices of education (COEs), and charter schools to provide and administer emergency stock albuterol inhalers, to apply to childcare programs operated by or under contract with a local educational agency (LEA), as well as their trained employees.

Major Provisions

1. Authorizes LEAs that operate or contract with a childcare program to provide emergency stock albuterol inhalers, including single-use disposable holding chambers, to school nurses or trained personnel who have volunteered to administer the medication.
2. Amends the definition of volunteer or trained personnel, authorized to administer stock albuterol under specified conditions, to include employees of a childcare program who have volunteered, received training, and are subject to liability limitations pursuant to existing law.
3. Authorizes childcare programs operated by or under contract with an LEA to designate one or more volunteers to receive initial and annual refresher training, as specified.
4. Adds childcare programs to the existing entities to which LEAs electing to utilize stock albuterol inhalers for emergency aid must distribute specified biannual notices.
5. Requires that a prescription provided by an authorizing physician and surgeon include appropriate doses of available stock albuterol inhalers for the ages and weights of individuals at each school and childcare program site.
6. Amends the definition of volunteer or trained personnel, authorized to administer stock albuterol under specified conditions, to include employees of a childcare program who have volunteered, received training, and are subject to liability limitations pursuant to existing law.
7. Defines "childcare program" as a state or federally subsidized childcare program operated by, or under contract with, an LEA, including, but not limited to, a California state preschool program (CSPP) or Head Start program, or a childcare program, including but not limited to, general childcare and development (CCTR).

COMMENTS

Asthma in school-aged children. Asthma is a chronic lung disease and the leading cause of absenteeism for students. It affects 10% of school-aged children nationwide and accounts for 5.2 million absences annually. The California Department of Public Health (CDPH) reports that 1 in 7 Californians have asthma, and that 1 in 3 children with asthma miss school due to asthma-related illness. Asthma is the leading cause of chronic disease-related school absenteeism and is linked to lower academic performance, particularly in urban minority children. (O'Rourke, 2020)

Asthma often starts during childhood as children's immune systems are still developing. While the exact cause of asthma is unknown, certain factors combined can contribute to a child developing asthma.

According to the Author

"In 2023, the Legislature passed on a bi-partisan basis AB 1283 (Chen) [Chapter 574, Statutes of 2023] which authorized stock albuterol in public schools. This measure has helped safeguard children and has ensured our school health professionals have the necessary medication on hand at school to provide lifesaving treatment. According to the Allergy and Asthma Foundation of America (AFFA), as many as 1 million California children suffer from asthma. In a classroom of 30 children, about 3 are likely to have asthma according to the CDC.

Albuterol is a prescribed medicine used to prevent and treat wheezing, difficulty breathing, chest tightness, and coughing caused by lung diseases such as asthma. Albuterol is in a class of medications called bronchodilators and works by relaxing and opening the air passages to the lungs to make breathing easier.

Since the passage of AB 1283 (Chen, 2023), the state has made access to preschool a priority and is now expanding to Universal Preschool. This prioritization means the traditional definitions of "school" hasn't always been clear in the education code whether it included preschool. Some school districts have expressed confusion if they are supposed to be providing the stock albuterol in their preschool programs. Clarity in statute is needed for schools to ensure they do not have any exposed liability for their preschool students. This is consistent with the passage of SB 568 (Niello) in 2025 which clarified the stock epinephrine in schools program also applied to preschool."

Arguments in Support

The California School Nurses Organization writes, "Asthma is one of the most prevalent chronic conditions affecting school-age children in the United States, and California is no exception. As health care providers on the front lines, school nurses see firsthand how quickly respiratory distress can escalate. Approximately 1 in 12 children has asthma, and schools are among the most common settings where acute asthma attacks occur. A child experiencing a severe asthma attack who cannot immediately access a bronchodilator like albuterol faces a serious risk of hospitalization, or worse.

Current California law permits schools to stock emergency inhalers, but ambiguities in the statutory framework have left some program operators uncertain about whether they are authorized to do so. As a result, children in certain school settings may have no access to treatment at all if they either forget their own inhaler or have a new or previously undiagnosed case of asthma. Clarifying the law to affirmatively authorize all school programs to stock and administer albuterol inhalers ensures that school nurses and trained staff can act confidently during a medical emergency without administrative confusion. The bill also maintains this provision as an authorization, rather than a requirement, maintaining local flexibility and allowing for communities to decide what is best for them."

Arguments in Opposition

None on file

FISCAL COMMENTS

This bill has been keyed non-fiscal by the Office of Legislative Counsel.

VOTES

SENATE FLOOR: 36-0-4

YES: Allen, Alvarado-Gil, Archuleta, Ashby, Becker, Blakespear, Cabaldon, Cervantes, Choi, Cortese, Dahle, Durazo, Gonzalez, Grayson, Grove, Hurtado, Jones, Laird, Limón, McGuire, McNerney, Menjivar, Niello, Ochoa Bogh, Padilla, Pérez, Reyes, Richardson, Rubio, Seyarto, Smallwood-Cuevas, Stern, Strickland, Umberg, Weber Pierson, Wiener

ABS, ABST OR NV: Arreguín, Caballero, Valladares, Wahab

ASM EDUCATION: 8-0-1

YES: Patel, Hoover, Ahrens, Bonta, Castillo, Garcia, Lowenthal, Pellerin

ABS, ABST OR NV: Zbur

UPDATED

VERSION: April 6, 2026

CONSULTANT: Debbie Look / ED. / (916) 319-2087 FN: 0003212

Date of Hearing: June 17, 2026

ASSEMBLY COMMITTEE ON EDUCATION

Darshana R. Patel, Chair

SBPCA Bill Id:SB 1347

Author:(Niello) – As Amended Ver:April 6, 2026

SENATE VOTE: 36-0

SUBJECT: Pupil health: emergency stock albuterol inhalers

SUMMARY: Extends the authorization for school districts, county offices of education (COEs), and charter schools to provide and administer emergency stock albuterol inhalers, to apply to childcare programs operated by or under contract with a local educational agency (LEA), as well as their trained employees. Specifically, this bill:

1. Authorizes LEAs that operate or contract with a childcare program to provide emergency stock albuterol inhalers, including single-use disposable holding chambers, to school nurses or trained personnel who have volunteered to administer the medication.
2. Amends the definition of volunteer or trained personnel, authorized to administer stock albuterol under specified conditions, to include employees of a childcare program who have volunteered, received training, and are subject to liability limitations pursuant to existing law.
3. Authorizes childcare programs operated by or under contract with an LEA to designate one or more volunteers to receive initial and annual refresher training, as specified.
4. Adds childcare programs to the existing entities to which LEAs electing to utilize stock albuterol inhalers for emergency aid must distribute specified biannual notices.
5. Requires that a prescription provided by an authorizing physician and surgeon include appropriate doses of available stock albuterol inhalers for the ages and weights of individuals at each school and childcare program site.
6. Amends the definition of volunteer or trained personnel, authorized to administer stock albuterol under specified conditions, to include employees of a childcare program who have volunteered, received training, and are subject to liability limitations pursuant to existing law.
7. Defines “childcare program” as a state or federally subsidized childcare program operated by, or under contract with, an LEA, including, but not limited to, a California state preschool program (CSPP) or Head Start program, or a childcare program, including but not limited to, general childcare and development (CCTR).

EXISTING LAW:

1. Authorizes school districts, COEs, and charter schools to provide emergency stock albuterol inhalers, including, if necessary, single-use disposable holding chambers, to school nurses or trained personnel who have volunteered, as specified. Authorizes school nurses or trained personnel to use as emergency stock albuterol inhaler to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from respiratory illness. (Education Code (EC) 49414.7)
2. Authorizes pupils to carry and self-administer inhaled asthma medication during the schoolday if specified materials in writing are submitted to the LEA. (EC 49423.1)
3. Requires school districts, COEs, 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. (EC 49414)
4. Requires the SPI to review minimum standards of training every five years or sooner for the administration of epinephrine auto-injectors. (EC 49414)

FISCAL EFFECT: This bill has been keyed non-fiscal by the Office of Legislative Counsel.

COMMENTS:

Need for the bill. According to the author, “In 2023, the Legislature passed on a bi-partisan basis AB 1283 (Chen), which authorized stock albuterol in public schools. This measure has helped safeguard children and has ensured our school health professionals have the necessary medication on hand at school to provide lifesaving treatment. According to the Allergy and Asthma Foundation of America (AFFA), as many as 1 million California children suffer from asthma. In a classroom of 30 children, about 3 are likely to have asthma according to the CDC.

Albuterol is a prescribed medicine used to prevent and treat wheezing, difficulty breathing, chest tightness, and coughing caused by lung diseases such as asthma. Albuterol is in a class of medications called bronchodilators and works by relaxing and opening the air passages to the lungs to make breathing easier.

Since the passage of AB 1283 (Chen, 2023), the state has made access to preschool a priority and is now expanding to Universal Preschool. This prioritization means the traditional definitions of “school” hasn’t always been clear in the education code whether it included preschool. Some school districts have expressed confusion if they are supposed to be providing the stock albuterol in their preschool programs. Clarity in statute is needed for schools to ensure they do not have any exposed liability for their preschool students. This is consistent with the passage of SB 568 (Niello) in 2025 which clarified the stock epinephrine in schools program also applied to preschool.”

This bill authorizes, but does not require, childcare programs operated by or under contract with an LEA, to maintain stock albuterol inhalers to provide to childcare personnel who have volunteered and been trained to administer the medication to children suffering from asthma. The bill provides liability protection to the childcare staff administering the medication.

The ability to stock and administer albuterol is currently authorized for LEAs serving students in TK to 12^th grade, and this bill would extend this authorization to those childcare programs, such as CSPP, Head Start, or general childcare program operated by or under contract with the LEA.

What is respiratory distress? Respiratory distress occurs when a person is experiencing a restriction in oxygen and is struggling to breathe. Various causes of respiratory distress include an infection, a blocked airway, and asthma. Uncontrolled asthma can lead to an asthma attack in which the airways become swollen and inflamed to a point where they contract, producing extra mucus, causing the breathing or bronchial tubes to narrow. A person will experience coughing, wheezing, and trouble breathing. With prompt treatment, symptoms can improve, but a severe asthma attack, or a flare-up, which does not improve with quick treatment, can become a life-threatening emergency.

Asthma in school-aged children. Asthma is a chronic lung disease and the leading cause of absenteeism for students. It affects 10% of school-aged children nationwide and accounts for 5.2 million absences annually. The California Department of Public Health (CDPH) reports that 1 in 7 Californians have asthma, and that 1 in 3 children with asthma miss school due to asthma-related illness. Asthma is the leading cause of chronic disease-related school absenteeism and is linked to lower academic performance, particularly in urban minority children. (O’Rourke, 2020)

Asthma often starts during childhood as children’s immune systems are still developing. While the exact cause of asthma is unknown, certain factors combined can contribute to a child developing asthma, including:

• Family history (parent or sibling having asthma);
• Exposure to things in the environment (allergens such as cigarette smoke or pollution); and
• Viral infections (which affect the lungs).

Asthma can also be triggered or set off by various elements such as:

• Indoor allergens (pet dander or dust mites);
• Outdoor allergens (mold or pollens);
• Physical activity;
• Infections (colds, influenza, or COVID-19);
• Poor air quality or very cold air; and
• Certain medications, such as pain relievers.

Management of symptoms and cost of treatment for asthma. While there is no cure for asthma, treatment meant to alleviate symptoms include quick relief and long-term treatments. Treatments range from taking pills, utilizing a nebulizer (a machine that turns liquid medicine into mist to be more easily inhaled), to using an inhaler (a handheld, portable device that delivers medication to the user’s lungs).

CDPH states that people with uncontrolled asthma may need to visit the emergency department (ED) in order to receive help with managing an asthma attack. More severe cases may require a person to be hospitalized. In 2024, asthma was the primary reason for 145,000 ED visits in California and 15,000 hospital stays.

Side effects of albuterol. According to the American Academy of Pediatrics, Albuterol may cause side effects, including but not limited to excitement, nervousness, tremor, anxiety, hyperactive behavior, and insomnia. Excitement, nervousness, and insomnia may be more frequent in younger pediatric patients (2 to 6 years).

Stock albuterol is authorized for use in U.S. schools in many states. According to the Asthma and Allergy Foundation of America (AAFA), since 2012, most states have passed laws that allow or require schools to keep a supply of epinephrine auto-injectors for use in allergy emergencies. While all 50 states have laws that ensure children can self-carry and administer their prescribed asthma medication (California enacted the self-carry asthma medication law in 2004), it is estimated that as few as 14% of children have access to quick relief medication at school (Volerman, 2021). Common barriers include difficulty accessing health care, forgetting to refill the prescription, and challenges with obtaining asthma action plans and inhalers or valved holding chambers.

Stock albuterol provides numerous benefits. Ensuring prompt and reliable administration of asthma rescue medication is key to managing asthma in schools where children spend most of their day. Medication is more readily available for children who may have forgotten their medication and for students with previously undiagnosed asthma.

Stock albuterol policies authorize schools to maintain unassigned albuterol for administration to students with asthma symptoms by trained staff members. Research demonstrates that stock albuterol policies makes asthma medication more accessible, resulting in alleviated anxiety, reduced 911 calls, reductions in daytime asthma symptoms, and allows children with asthma symptoms to return to class. (O’Rourke, 2020)

State and federal programs to help schools better manage asthma. Recognizing that asthma is a leading cause of absenteeism, the California Department of Education (CDE) developed the document, “Guidelines for the Management of Asthma in California Schools,” in collaboration with asthma experts and stakeholders. The CDE references guidelines on the website of California Breathing, the asthma program in the CDPH that “works to improve the respiratory health of Californians and reduce asthma-related health disparities through education and environmental interventions where we live, work, learn, and play.”

On the federal level, House Resolution 2468 (Public Law 116-292), known as the School-Based Allergies and Asthma Management Program Act, was signed in 2021. It establishes preferences for grants under the children’s asthma treatment program for states that require schools to establish allergy and asthma management programs and include individual action plans for students diagnosed with allergies or asthma.

Arguments in support. The California School Nurses Organization writes, “Asthma is one of the most prevalent chronic conditions affecting school-age children in the United States, and California is no exception. As health care providers on the front lines, school nurses see firsthand how quickly respiratory distress can escalate. Approximately 1 in 12 children has asthma, and schools are among the most common settings where acute asthma attacks occur. A child experiencing a severe asthma attack who cannot immediately access a bronchodilator like albuterol faces a serious risk of hospitalization, or worse.

Current California law permits schools to stock emergency inhalers, but ambiguities in the statutory framework have left some program operators uncertain about whether they are authorized to do so. As a result, children in certain school settings may have no access to treatment at all if they either forget their own inhaler or have a new or previously undiagnosed case of asthma. Clarifying the law to affirmatively authorize all school programs to stock and administer albuterol inhalers ensures that school nurses and trained staff can act confidently during a medical emergency without administrative confusion. The bill also maintains this provision as an authorization, rather than a requirement, maintaining local flexibility and allowing for communities to decide what is best for them.”

Related legislation. SB 568 (Niello) Chapter 322, Statutes of 2025, updates terminology from “epinephrine auto-injectors” to “epinephrine delivery systems” in sections of Education Code related to an LEAs requirement to provide emergency epinephrine to school nurses or trained personnel; specifically includes programs operated by or under contract with LEAs in existing provisions; and expands existing provisions to also apply to state or federally subsidized childcare programs operated by or under contract with LEAs.

AB 1283 (Chen) Chapter 574, Statutes of 2023, authorizes a LEA to make emergency stock albuterol inhalers available at school districts, COEs, and charter schools, and authorizes school nurses or trained personnel who have volunteered to administer an albuterol inhaler to persons suffering from, or reasonably believed to be suffering from, respiratory distress.

AB 743 (Eduardo Garcia), Chapter 101, Statutes of 2019, requires a school district to accept the written statement from a physician who is contracted with a binational health plan for the purposes of authorizing a pupil to carry and self-administer inhaled asthma medication that the pupil is required to administer during the regular schoolday.

AB 1748 (Mayes) Chapter 557, Statutes of 2016, authorizes school nurses and other trained personnel to use naloxone hydrochloride or another opioid antagonist to provide emergency medical aide to persons suffering, or reasonably believed to be suffering, from an opioid overdose.

SB 738 (Huff) Chapter 132, Statutes of 2015, requires a school district to accept the written statement from a physician who is contracted with a binational health plan for the purposes of authorizing a pupil to carry and self-administer inhaled asthma medication that the pupil is required to administer during the regular school day.

AB 2132 (Reyes) Chapter 832, Statutes of 2004, authorizes a student to carry and self-administer medication, including inhaled asthma medication, or to receive assistance from school personnel, if the school district receives written statements, as specified.

AB 2185 (Frommer) Chapter 711, Statutes of 2004, requires specified health care service plans to provide coverage for equipment for treating pediatric asthma and coverage for pediatric asthma outpatient self-management training and education.

REGISTERED SUPPORT / OPPOSITION:

Support

Opposition

None on file

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

 THIRD READING  

Bill No: SB 1347

Author: Niello (R)

Amended: 4/6/26

Vote: 21

SENATE EDUCATION COMMITTEE: 7-0, 4/8/26

AYES: Pérez, Ochoa Bogh, Cabaldon, Choi, Cortese, Gonzalez, Reyes

SUBJECT: Pupil health: emergency stock albuterol inhalers

SOURCE: Author

DIGEST:

This bill extends the authorization for school districts, county offices of education (COEs), and charter schools to provide and administer emergency stock albuterol inhalers, to apply to childcare programs operated by or under contract with a local educational agency (LEA), as specified, as well as their trained employees.

ANALYSIS:

Existing law:

1. Authorizes school districts, COEs, and charter schools to provide emergency stock albuterol inhalers, including, if necessary, single-use disposable holding chambers, to school nurses or trained personnel who have volunteered, as specified. Authorizes school nurses or trained personnel to use as emergency stock albuterol inhaler to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from respiratory illness. (Education Code (EC) § 49414.7)
2. Authorizes private elementary and secondary schools in the state to voluntarily determine whether or not to make emergency stock albuterol inhalers and trained personnel available at its school. Specifies that in making this determination, a school shall evaluate the emergency medical response time to the school and determine whether initiating emergency medical services is an acceptable alternative to stock albuterol inhalers and trained personnel. (EC § 49414.7)
3. Authorizes each public school and private elementary and secondary school in the state to designate one or more volunteers to receive initial and annual refresher training based on the standards, as specified, regarding the storage and emergency use of a stock albuterol inhaler from the school nurse or other qualified person designated by an authorizing physician and surgeon. (EC § 49414.7)

This bill:

1. Adds childcare programs that are operated by or contracted under an LEA, as well as their employees who have volunteered and received appropriate training, to the existing list of entities authorized to receive emergency stock albuterol from an LEA and use said emergency stock albuterol to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from respiratory distress.
2. Changes references from “school district, COE, or charter school” to “local educational agency.”
3. Defines “childcare program” to mean “a state or federally subsidized childcare program operated by, or under contract with, an LEA, including, but not limited to, a California state preschool program or Head Start program pursuant to Chapter 2 (commencing with Section 8200) of Part 6 of Division 1 of Title 1, or a childcare program, including, but not limited to, general childcare and development programs pursuant to Part 1.8 (commencing with Section 10207) of Division 9 of the Welfare and Institutions Code.”
4. Changes references from “private elementary and secondary school” to “private school.”
5. Amends the definition of volunteer or trained personnel, authorized to administer stock albuterol under specified conditions, to include employees of a childcare program who have volunteered, received training, and are subject to liability limitations pursuant to existing law.
6. Authorizes childcare programs operated by or under contract with an LEA to designate one or more volunteers to receive initial and annual refresher training, as specified.
7. Adds childcare programs to the existing entities to which LEAs electing to utilize stock albuterol inhalers for emergency aid must distribute specified biannual notices.
8. Recasts the requirement for a qualified supervisor of health of a LEA electing to utilize stock albuterol inhalers for emergency aid to obtain from an authorizing physician and surgeon a prescription for stock albuterol inhaler for each site, to include childcare programs.
   1. Requires those prescriptions to, at a minimum, include appropriate doses of available stock albuterol inhalers for the ages and weights of individuals at each site including any childcare programs.
9. Adds childcare programs operated by or contracted under LEAs to the existing provisions regarding liability for civil damages resulting from any act or omission, other than an act or omission constituting gross negligence or willful and wanton misconduct, in the emergency administration of an albuterol inhaler by any of its school nurses or trained volunteers who have volunteered, as specified.
10. Adds employees of childcare programs that are operated by or under contract with an LEA to the type of employees that shall be provided defense and indemnification by an LEA for any and all civil liability, as specified.

Comments

Need for the bill. According to the author, “In 2023, the Legislature passed on a bi-partisan basis AB 1283 (Chen), which authorized stock albuterol in public schools. This measure has helped safeguard children and has ensured our school health professionals have the necessary medication on hand at school to provide lifesaving treatment.

“Albuterol is a prescribed medicine used to prevent and treat wheezing, difficulty breathing, chest tightness, and coughing caused by lung diseases such as asthma. Albuterol is in a class of medications called bronchodilators and works by relaxing and opening the air passages to the lungs to make breathing easier.

“Since the passage of AB 1283 (Chen, 2023), the state has made access to preschool a priority and is now expanding to Universal Preschool. This prioritization means the traditional definitions of “school” hasn’t always been clear in the education code whether it included preschool. Some school districts have expressed confusion if they are supposed to be providing the stock albuterol in their preschool programs. Clarity in statute is needed for schools to ensure they do not have any exposed liability for their preschool students. This is consistent with the passage of SB 568 (Niello) in 2025 which clarified the stock epinephrine in schools program also applied to preschool.”

Asthma prevalence in children. According to Tracking California, a program of the Public Health Institute partnered with California Breathing, in 2021-2022, an estimated 9.9% of California children ages 0-17 had been diagnosed with asthma at some point in their lives. For those aged 0-4, that number stands at an estimated 2.9%. While asthma does not result in hospitalization for most children, there were 6822 hospitalizations for asthma among children ages 0-17 statewide in 2023, with roughly 3223 of those involving children ages 0-4.

Asthma is one of the most common chronic diseases among children in the U.S. and a leading cause of pediatric hospitalization. It is also the top reason for missed school days, accounting for more than 5.2 million absences annually. Asthma rates vary by region, demographics, environment, physician diagnostic practices, and access to care. Although identifying the impact of independent risk factors for asthma is difficult, children of color and those from low-income families are disproportionately at high risk for severe symptoms, missed school days, and hospital visits.

The management of asthma in California schools. The California Department of Public Health (CDPH) “Guidelines for the Management of Asthma in California Schools” and “Asthma Action Plan for Schools and Families” assist schools in effectively managing this chronic disease. The “Guidelines for the Management of Asthma in California Schools” were developed jointly by health professionals in the California Department of Education (CDE) and the California Asthma Public Health Initiative in statewide collaboration with asthma experts and stakeholders.

Further, the CDPH, in partnership with the CDE and the Department of Health Care Access and Information (HCAI), has issued a statewide standing order for albuterol to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from respiratory distress in California schools. Using the online form, LEAs can generate a standing order to use as a prescription for albuterol to ensure the safety and well-being of persons experiencing respiratory distress in schools or during school activities. CDPH states in its Albuterol Standing Order Frequently Asked Questions page that existing law authorizes some preschools to develop a stock albuterol program if they are co-located on a TK–12 site.

Finally, according to its website, CalRx, in partnership with the CDPH Office of School Health, has announced plans to launch a centralized ordering system to supply California’s TK–12 schools with albuterol inhalers and single-use disposable spacers at no cost over a three-year period beginning in Summer 2026.

Dosage considerations for small children. This bill expands the stocking and provision responsibilities of an LEA that elects to utilize emergency stock albuterol inhalers, to include provisions for childcare programs that it operates or contracts with. Among these responsibilities is the requirement to obtain the necessary prescriptions from an authorizing physician or surgeon for stock albuterol inhalers that, at a minimum, include appropriate doses of available inhalers for the ages and weights of individuals at each site including any childcare programs.

Albuterol dosage is typically determined based on a combination of factors, including age, weight, dosage forms, and strength of medicine. By extending existing authorizations that LEAs have to the childcare setting, this bill inherently extends the age ranges of children who may be administered emergency stock albuterol inhalers by a school nurse or trained volunteer if they are suffering, or reasonably believed to be suffering, from respiratory distress. This bill requires that the prescriptions retained by the LEA, at a minimum, include appropriate doses of available stock albuterol inhalers for the ages and weights of individuals at each participating childcare site.

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

SUPPORT: (Verified 4/8/26)

American Medical Response West
California School Nurses Organization

California Society for Allergy, Asthma and Immunology
California Society for Respiratory Care
Small School Districts Association

OPPOSITION: (Verified 4/8/26)

None received

Prepared by: Therresa Austin / ED. / (916) 651-4105

4/10/26 12:30:54

**** END ****

SENATE COMMITTEE ON EDUCATION

Senator Sasha Renée Pérez, Chair

2025 - 2026 Regular

Bill No: Hearing Date: April 8, 2026

Subject: .

SUMMARY

This bill extends the authorization for school districts, county offices of education (COEs), and charter schools to provide and administer emergency stock albuterol inhalers, to apply to childcare programs operated by or under contract with a local educational agency (LEA), as specified, as well as their trained employees.

BACKGROUND

Existing law:

1. Authorizes school districts, COEs, and charter schools to provide emergency stock albuterol inhalers, including, if necessary, single-use disposable holding chambers, to school nurses or trained personnel who have volunteered, as specified. Authorizes school nurses or trained personnel to use as emergency stock albuterol inhaler to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from respiratory illness. (Education Code (EC) § 49414.7)
2. Authorizes private elementary and secondary schools in the state to voluntarily determine whether or not to make emergency stock albuterol inhalers and trained personnel available at its school. Specifies that in making this determination, a school shall evaluate the emergency medical response time to the school and determine whether initiating emergency medical services is an acceptable alternative to stock albuterol inhalers and trained personnel. (EC § 49414.7)
3. Authorizes each public school and private elementary and secondary school in the state to designate one or more volunteers to receive initial and annual refresher training based on the standards, as specified, regarding the storage and emergency use of a stock albuterol inhaler from the school nurse or other qualified person designated by an authorizing physician and surgeon. (EC § 49414.7)
4. Authorizes a pupil who is required to take, during the regular school day, medication prescribed for the pupil by a physician or surgeon, to be assisted by the school nurse or other designated school personnel or may carry and self-administer inhaled asthma medication if the school district receives the appropriate written statement from the physician or surgeon detailing the name of the medication, method, amount, and time schedules by which the medication is to be taken and a written statement from the parent, foster parent, or guardian of the pupil requesting that the school district assist the pupil in the matters set forth in the statement of the physician or surgeon. (EC § 49423.1)
5. Specifies in order for a pupil to carry and self-administer prescription inhaled asthma medication, the school district shall obtain both a written statement from the physician or surgeon detailing the name of the medication, method, amount, and time schedules by which the medication is to be taken, and confirming that the pupil is able to self-administer inhaled asthma medication, and a written statement from the parent, foster parent, or guardian of the pupil consenting to the self-administration, providing a release for the school nurse or other designated school personnel to consult with the health care provider of the pupil regarding any questions that may arise with regard to the medication, and releasing the school district and school personnel from civil liability if the self-administering pupil suffers an adverse reaction by taking medication pursuant to this section. (EC § 49423.1)
6. Requires the governing board of any school district to give diligent care to pupils’ health and physical development and authorizes it to employ properly certified persons to conduct this work. (EC § 49400)

ANALYSIS

This bill adds childcare programs that are operated by or contracted under an LEA, as well as their employees who have volunteered and received appropriate training existing list of entities authorized to receive emergency stock albuterol from an LEA and use said emergency stock albuterol to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from respiratory distress. Specifically, this bill:

1. Changes references from “school district, COE, or charter school” to “local educational agency.”
2. Defines “childcare program” to mean “a state or federally subsidized childcare program operated by, or under contract with, an LEA, including, but not limited to, a California state preschool program or Head Start program pursuant to Chapter 2 (commencing with Section 8200) of Part 6 of Division 1 of Title 1, or a childcare program, including, but not limited to, general childcare and development programs pursuant to Part 1.8 (commencing with Section 10207) of Division 9 of the Welfare and Institutions Code.”
3. Changes references from “private elementary and secondary school” to “private school.”
4. Amends the definition of volunteer or trained personnel, authorized to administer stock albuterol under specified conditions, to include employees of a childcare program who have volunteered, received training, and are subject to liability limitations pursuant to existing law.
5. Authorizes childcare programs operated by or under contract with an LEA to designate one or more volunteers to receive initial and annual refresher training, as specified.
6. Adds childcare programs to the existing entities to which LEAs electing to utilize stock albuterol inhalers for emergency aid must distribute specified biannual notices.
7. Recasts the requirement for a qualified supervisor of health of a LEA electing to utilize stock albuterol inhalers for emergency aid to obtain from an authorizing physician and surgeon a prescription for stock albuterol inhaler for each site, to include childcare programs.
   1. Requires those prescriptions to, at a minimum, include appropriate doses of available stock albuterol inhalers for the ages and weights of individuals at each site including any childcare programs.
8. Adds childcare programs operated by or contracted under LEAs to the existing provisions regarding liability for civil damages resulting from any act or omission, other than an act or omission constituting gross negligence or willful and wanton misconduct, in the emergency administration of an albuterol inhaler by any of its school nurses or trained volunteers who have volunteered, as specified.
9. Adds employees of childcare programs that are operated by or under contract with an LEA to the type of employees that shall be provided defense and indemnification by an LEA for any and all civil liability, as specified.

STAFF COMMENTS

1. Need for the bill. According to the author, “In 2023, the Legislature passed on a bi-partisan basis AB 1283 (Chen), which authorized stock albuterol in public schools. This measure has helped safeguard children and has ensured our school health professionals have the necessary medication on hand at school to provide lifesaving treatment.

“Albuterol is a prescribed medicine used to prevent and treat wheezing, difficulty breathing, chest tightness, and coughing caused by lung diseases such as asthma. Albuterol is in a class of medications called bronchodilators and works by relaxing and opening the air passages to the lungs to make breathing easier.

“Since the passage of AB 1283 (Chen, 2023), the state has made access to preschool a priority and is now expanding to Universal Preschool. This prioritization means the traditional definitions of “school” hasn’t always been clear in the education code whether it included preschool. Some school districts have expressed confusion if they are supposed to be providing the stock albuterol in their preschool programs. Clarity in statute is needed for schools to ensure they do not have any exposed liability for their preschool students. This is consistent with the passage of SB 568 (Niello) in 2025 which clarified the stock epinephrine in schools program also applied to preschool.”

1. Asthma prevalence in children. According to Tracking California, a program of the Public Health Institute partnered with California Breathing, in 2021-2022, an estimated 9.9% of California children ages 0-17 had been diagnosed with asthma at some point in their lives. For those aged 0-4, that number stands at an estimated 2.9%. While asthma does not result in hospitalization for most children, there were 6822 hospitalizations for asthma among children ages 0-17 statewide in 2023, with roughly 3223 of those involving children ages 0-4.

Asthma is one of the most common chronic diseases among children in the U.S. and a leading cause of pediatric hospitalization. It is also the top reason for missed school days, accounting for more than 5.2 million absences annually. Asthma rates vary by region, demographics, environment, physician diagnostic practices, and access to care. Although identifying the impact of independent risk factors for asthma is difficult, children of color and those from low-income families are disproportionately at high risk for severe symptoms, missed school days, and hospital visits.

1. What is albuterol? According to the Mayo Clinic, albuterol is an adrenergic bronchodilator that is used to treat or prevent bronchospasm in patients with asthma, bronchitis, emphysema, and other lung diseases. It is also used to prevent bronchospasm caused by exercise. Adrenergic bronchodilators are medicines that are breathed in through the mouth to open up the bronchial tubes (air passages) in the lungs. They relieve cough, wheezing, and trouble breathing by increasing the flow of air through the bronchial tubes. Albuterol is available in powder, solution, and suspension dosage forms.
2. The management of asthma in California schools. The California Department of Public Health (CDPH) “Guidelines for the Management of Asthma in California Schools” and “Asthma Action Plan for Schools and Families” assist schools in effectively managing this chronic disease. The “Guidelines for the Management of Asthma in California Schools” were developed jointly by health professionals in the California Department of Education (CDE) and the California Asthma Public Health Initiative in statewide collaboration with asthma experts and stakeholders.

Further, the CDPH, in partnership with the CDE and the Department of Health Care Access and Information (HCAI), has issued a statewide standing order for albuterol to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from respiratory distress in California schools. Using the online form, LEAs can generate a standing order to use as a prescription for albuterol to ensure the safety and well-being of persons experiencing respiratory distress in schools or during school activities. CDPH states in its Albuterol Standing Order Frequently Asked Questions page that existing law authorizes some preschools to develop a stock albuterol program if they are co-located on a TK–12 site.

Finally, according to its website, CalRx, in partnership with the CDPH Office of School Health, has announced plans to launch a centralized ordering system to supply California’s TK–12 schools with albuterol inhalers and single-use disposable spacers at no cost over a three-year period beginning in Summer 2026.

1. The California State Preschool Program, Head Start, and General Child Care and Development programs. This bill seeks to extend the existing authorization for LEAs to provide emergency stock albuterol inhalers to school nurses and trained volunteers, to include childcare programs and their employees who have volunteered and received specified training. The bill also seeks to extend the authorization for school nurses and trained volunteers at LEAs to use stock albuterol inhalers to provide emergency medical aid to persons suffering, or reasonably believed to be suffering, from respiratory distress, to trained volunteer childcare employees at childcare programs the LEA contracts with or operates. These childcare programs include the CSPP, Head Start, and General Child Care and Development programs.

• The CSPP provides both part-day and full-day services to eligible three-and four-year-olds. These services include developmentally, culturally, and linguistically appropriate curriculum, meals and snacks, parent education, and referrals to health and social services for families.
• Head Start is a federally funded early childhood education program that provides comprehensive services—including education, health, nutrition, and family support—to low-income children (ages 0-5) and their families.
• General Child Care and Development programs, as defined in Part 1.8 (commencing with Section 10207) of Division 9 of the Welfare and Institutions Code, are state and federally funded programs that provide child development services for children from birth through 12 years of age and older children with exceptional needs. These programs provide an educational component that is developmentally, culturally, and linguistically appropriate for the children served, as well as services like meals and snacks, parent education, and referrals to health and social services for families.

While many of these programs can be administered by either public or private agencies, this bill would only extend the existing LEA related authorizations to child care programs that are operated or contracted by an LEA.

1. Dosage considerations for small children. This bill expands the stocking and provision responsibilities of an LEA that elects to utilize emergency stock albuterol inhalers, to include provisions for childcare programs that it operates or contracts with. Among these responsibilities is the requirement to obtain the necessary prescriptions from an authorizing physician or surgeon for stock albuterol inhalers that, at a minimum, include appropriate doses of available inhalers for the ages and weights of individuals at each site including any childcare programs.

Albuterol dosage is typically determined based on a combination of factors, including age, weight, dosage forms, and strength of medicine. The following are typical prescribed dosages, according to the Mayo Clinic:

Inhalation aerosol dosage form (inhaler) for prevention of exercise-induced bronchospasm:

• • • • • Adults and children 4 years of age and older—Two puffs taken 15 to 30 minutes before exercise.
        • Children younger than 4 years of age— Use and dose must be determined by a child’s doctor.

Inhalation powder dosage form (inhaler) for prevention of exercise-induced bronchospasm:

• • • • • Adults and children 4 years of age and older—Two puffs taken 15 to 30 minutes before exercise.
        • Children younger than 4 years of age— Use and dose must be determined by a child’s doctor.

Inhalation solution dosage form (used with a nebulizer) for prevention of bronchospasm:

• • • • • Adults and children older than 12 years of age—2.5 milligrams (mg) in the nebulizer 3 or 4 times per day as needed.
        • Children 2 to 12 years of age—0.63 to 1.25 mg in the nebulizer 3 or 4 times per day as needed.
        • Children younger than 2 years of age—Use and dose must be determined by your child’s doctor.

By extending existing authorizations that LEAs have to the childcare setting, this bill inherently extends the age ranges of children who may be administered emergency stock albuterol inhalers by a school nurse or trained volunteer if they are suffering, or reasonably believed to be suffering, from respiratory distress. This bill requires that the prescriptions retained by the LEA, at a minimum, include appropriate doses of available stock albuterol inhalers for the ages and weights of individuals at each participating child care site.

1. Related Legislation.

SB 1443 (Senate Education Committee, 2026) includes two provisions of this bill: (1) the change of the phrase “school district, county office of education, or charter school” to “local educational agency”, and (2) the change of the phrase private primary and secondary school” to “private school”. SB 1443 is currently in the Senate Education Committee and will be amended to remove those provisions.

SB 568 (Niello, Chapter 322, Statutes of 2025) updates terminology from “epinephrine auto-injectors” to “epinephrine delivery systems” in sections of Education Code related to an LEAs requirement to provide emergency epinephrine to school nurses or trained personnel; (2) specifically includes programs operated by or under contract with LEAs in existing provisions; and, (3) expands existing provisions to also apply to state or federally subsidized child care programs operated by or under contract with LEAs.

AB 1283 (Chen, Chapter 574, Statutes of 2023) authorizes a LEA to make emergency stock albuterol inhalers available at school districts, COEs, and charter schools, and authorizes school nurses or trained personnel who have volunteered to administer an albuterol inhaler to persons suffering from, or reasonably believed to be suffering from, respiratory distress.

SB 738 (Huff, Chapter 132, Statutes of 2015) requires a school district to accept the written statement from a physician who is contracted with a binational health plan for the purposes of authorizing a pupil to carry and self-administer inhaled asthma medication that the pupil is required to administer during the regular school day.

AB 2132 (Reyes, Chapter 832, Statutes of 2004) authorizes a pupil to carry and self-administer medication, including inhaled asthma medication, or to receive assistance from school personnel, if the school district receives written statements, as specified.

AB 2185 (Frommer, Chapter 711, Statutes of 2004) requires specified health care service plans to provide coverage for equipment for treating pediatric asthma and coverage for pediatric asthma outpatient self-management training and education.

AB 2367 (Chan, 2004) would have required school districts that receive an asthma action plan to maintain the plan on file and provide it to teachers. This bill was held in the Assembly Appropriations Committee.

SUPPORT

American Medical Response West
California School Nurses Organization
California Society for Respiratory Care
Small School Districts Association

OPPOSITION

None received

-- END –