Monday, November 10, 2014


by Kimberly Beltran | SI&A Cabinet Report :: The Essential Resource for Superintendents and the Cabinet

New health mandates pose problems in the field

November 10, 2014  ::  (Calif.) As school district officials work to comply with the Legislature’s annual onslaught of new education laws, two health-related mandates are causing particular concerns for those charged with carrying out new eye testing and issuing protocols for anaphylactic shock treatment.

At issue with SB 1172 is language suggesting that the electronic photo screening equipment used to detect near-vision issues be used under the supervision of an eye doctor.

Guidance on the implementation of SB 1266, which takes effect Jan. 1, is in the works but is more complicated since it deals with training designated school personnel to administer a life-saving injection to a student suffering a severe allergic reaction.

“SB 1172 added the near-vision test and clarified for districts exactly when vision screenings are to be given to students, but there’s that little piece of language in there that needs some additional clarity,” said Cathy Owens, a credentialed school nurse who serves as coordinator of health services at the Murrieta Unified School District.

As a member of the California School Nurses Organization, Owens is also working on behalf of the California Department of Education to update training standards and help streamline new procedures for districts.  Under SB 1266, districts must now stock and be prepared to administer epinephrine auto-injectors, commonly known as EpiPens.

Both measures are among ongoing attempts by the Legislature to boost the academic success of all students by bolstering support services, including health and wellness programs.

Schools have long provided vision screening that assesses a child’s sight over a distance but near-vision screening, while recommended, until now was never mandated. Research, however, linking a child’s future success to his or her early reading skills has focused the state’s attention on impediments to that, including vision problems.

Experts estimate that 15 percent of school children suffer from some form of visual impairment.

There are special eye charts, or cards, to determine near-vision acuity but electronic screeners, many believe, provide a more efficient and effective process for districts, an unknown number of which already use them, according to Owens. With near-vision screening now being mandatory, many more districts are likely to begin use of electronic screeners, which allow testing of vision to be done without needing verbal responses from the patient.

State law now authorizes vision screenings by a school nurse or trained designee. But the bills also add the requirement that the tests “shall be performed, under an agreement with, or the supervision of, an optometrist or ophthalmologist.”

“That particular line has a lot of districts asking whether they now need to engage in an agreement with an optometrist or ophthalmologist,” said Owens. “Again, I don’t know the answer so I’ve been doing my best to try and investigate what exactly this language means.”

A CDE, spokeswoman confirmed that staff “is currently working to examine new legislative requirements for vision screening and will have more information for LEAs by early December.”

Guidance on the new EpiPen law is also in the works but is complicated by the fact that it must address several issues new to many districts, such as training non-medical staff and forging new relationships with doctors since the law requires an authorizing physician to prescribe and monitor stocks of epinephrine auto-injectors used to counter anaphylaxis.

This severe, whole-body allergic reaction to allergens such as food, drugs or insect bites often causes the throat and airways to swell and become blocked. It happens quickly and requires almost immediate attention. The treatment is a large dose of epinephrine, or adrenaline, administered through an auto-injector device containing a spring-loaded needle, which penetrates the recipient’s skin to deliver the medication.

Under current state law, schools may stock and administer the drug but it is an optional program in which many districts do not participate.

In addition to updating training standards – that include teaching designated school staff how to recognize signs of anaphylaxis – Owens said she is contacting various health organizations and agencies who may be able to help districts that do not have any established relationship with a physician.

“School districts often do have relationships with a physician, sometimes through their workers comp programs or sports teams,” said Owens, “so we’re looking at whether schools can have standing orders through these partnerships to be able to move forward with meeting this requirement.”

According to Owens, a major pharmaceutical company has agreed to provide epinephrine auto-injectors to California schools free of charge, substantially reducing costs of the new mandate. According to an earlier analysis of SB 1266, prices vary from between $112 to $192 per two-pack of epinephrine auto-injectors.

Roughly 3 million American children under the age of 18 – four of every 100 children – had food allergies of some sort in 2007, according to the U.S. Centers for Disease Control and Prevention, and the numbers are on the rise. In the decade ending in 2007, the prevalence of food allergies in that age group had risen 18 percent, the CDC said.

The agency also reported that food allergies result in more than 300,000 ambulatory-care visits a year among children under the age of 18.

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