Passionate fight over anti-seizure drug for epileptics

The Senate is the last hurdle to the governor’s desk for a bill that represents one of the year’s oddest and most passionate political fights – the question of whether school workers who aren’t medically trained can administer anti-seizure medicine to epileptic students.

The bill, SB 161 by Sen. Bob Huff, R-Diamond Bar, emerged this week from the Assembly and waits a final vote in the Senate, where it was approved earlier in a slightly different version. Supporters of the Republican Huff’s bill included numerous Democrats, who traditionally side with labor on many issues. It is Huff’s second attempt to get the proposal through the Legislature.

The issue brought sharp opposition from some in organized labor – mainly nurses and teachers – and the state Democratic Party itself, who said the state would be better off having more nurses in the public schools than having staff members deliver medications.

But backers of the bill said it was necessary in order to allow an epileptic student in the grip of a potentially fatal seizure to get the medicine called Diastat in an emergency. The basic issue was the life-or-death possibility for a child, not job protection.

Huff argued that even if there were a school nurse at every school, his bill would still be needed, because the goal of administering the drug is to stop seizures quickly, within the first five minutes. In many schools, the nurse could be on the other side of campus and further away than that, he said.

In July, Capitol Weekly reported details of the issue.

Students carry a pre-prepared dose specific to their body weight in a plastic syringe with a soft rubber nipple, along with a blanket to cover them from being seen by bystanders, as the drug is administered rectally. The federal Food and Drug Administration approved Diastat administration by non-medical personnel in 2005. This decision cited research showing that the drug was effective 85 percent of the time, and hospitalizations dropped by two-thirds among epileptics carrying the drug with them in situations where there was someone around trained to administer it.

The California Medical Association was among those supporting SB 161 while the California School Nurses Organization is one of the leading groups opposing it.

Estimates show that about 64,000 children in California suffer from epilepsy. About 16,000 have the severe form that would warrant a Diastat prescription – although California Teachers Association, which opposes Huff’s bill, disputes the figures.

Earlier, an analysis by the legal department of the state Department of Consumer Affairs (DCA) – which oversees the nursing board – noted  that barring “a modification of the law,” giving Diastat “constitutes the practice of nursing,” and argued that a nurse who teaches someone else how to give the drug may be subject “to discipline for aiding and abetting the unlicensed practice of nursing.”

The memo said those giving Diastat wouldn’t be subject to protections offered under the state’s good Samaritan laws, and said the Nursing Practices Act (NPA) would trump seemingly contradictory language in the California Education Code, saying that giving the drug to someone having a seizure “does not fall within any of the exemptions from the NPA.”

One of those exemptions is “in case of an emergency,” a key policy disagreement between rivals over the bill. A definition of emergency “includes an epidemic or public disaster.”
Huff’s unsuccessful earlier bill, SB 1051 — similar to his current SB 161 – was introduced in January 2010 and sponsored by the Orange County Unified School District, a major supporter of SB 161. It stalled in the Senate Health Committee, where seven out of nine senators didn’t cast a vote on it. In May, the earlier bill died in the Senate Appropriations Committee after Senate Pro Tem Darrell Steinberg, D-Sacramento, and others gave passionate floor speeches against it.

Supporters said medical and legal opinions show Diastat is safe. In 2007, School and College Legal Services of California delivered an opinion that found “the ‘emergency’ exception would appear to apply to a student who is suffering a seizure” and that Diastat administration is a “routine” procedure that poses “little potential harm to the student.”
In 2008, the University of California, Berkeley School of Public Health issued a 47-page case study on medical care in schools. It found that the lack of nurses in schools was a major problem, but recommended that non-medical personnel be trained to perform some procedures, as long as there was no coercion.

The bill’s supporters say opponents have failed to show instances of the potential harm they cite, such as breathing problems or perforated rectums. Kankor said that some of the amendments the opponents have pushed, such as a mandatory 911 call, would actually make things worse. For instance, she said, in one of the small number of cases where they cite depressed breathing, the problem was caused when paramedics injected more valium into the student, not by the original dose of Diastat. She said the Diastat dose is calibrated so that patients can withstand three doses without a fear of respiratory problems.

As for Scott Wetch, a leading supporter of Huff’s bill, the issues were clear.

Wetch, a lobbyist who usually represents labor groups, is the parent of a 7-year-old epileptic daughter with a Diastat prescription, he has become a leading pro bono advocate for the bill. He also said that life-threatening overdoses of the drug are basically unheard of.

“You know what the training is?” Wetch said. “You talk to the pharmacist for two minutes. It’s not rocket science. Just give it to them. There’s no downside.”

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