Opinion ID: 1038649
Heading Depth: 3
Heading Rank: 4

Heading: Failed Legislation.

Text: Despite the foregoing evidence to the contrary, amici curiae supporting the Nurses urge us to infer from a variety of failed bills that the Legislature believes further, specific legislation is necessary before unlicensed school personnel may administer insulin. Because section 49423 and its implementing regulations plainly do authorize such personnel to administer prescription medications and were in fact adopted for that purpose, “to undertake the problematic exercise of inferring legislative intent from subsequent, failed legislation seems especially inappropriate . . . .” (Martin v. Szeto (2004) 32 Cal.4th 445, 451-452.) In any event, we find nothing in the failed bills‟ history that supports amici curiae‟s argument. Assembly Bill No. 481 (2001-2002 Reg. Sess.) would have required school administrators and other designated, unlicensed personnel to be trained to administer insulin and required them to administer it, in the absence of a school nurse, in accordance with guidelines on diabetes care to be developed by a group of seven state and private organizations. The Governor vetoed the bill, explaining his reasons as follows: “Existing law already provides that any pupil who is required to take prescription medication during the regular school day may be assisted by school personnel if a written statement is obtained from a physician and a written request is made by the pupil‟s parent/guardian. [¶] This bill, while well-intentioned, would create a costly new state reimbursable mandate estimated by the Department of Finance to be potentially tens of millions of dollars. Neither this bill, nor the 2002 Budget Act contains an appropriation for this purpose.” (Governor‟s veto message to Assem. on Assem. Bill No. 481 (Sept. 26, 2002) 6 Assem. J. (2001-2002 Reg. Sess.) pp. 8872-8873 [in relevant part].) 19 This history does not show the Legislature in 2002 — let alone in 1968 and 1976 when it enacted and reenacted the operative language of section 49423 — believed that further, more specific legislation was required to permit unlicensed school personnel to administer any prescription medication. To the contrary, the Legislative Counsel‟s Digest of the vetoed 2002 bill noted that “[e]xisting law provides that any pupil who is required to take . . . medication . . . may be assisted by the school nurse or other designated school personnel,” and explained that the bill “would specifically make those provisions applicable to a pupil with diabetes” under guidelines to be developed later. (Legis. Counsel‟s Dig., Assem. Bill. No. 481 (2001-2002 Reg. Sess.), italics added.) The bill was, thus, analogous to other statutes in which the Legislature has imposed, for particular medications (e.g., epinephrine, glucagon and antiseizure medication), additional restrictions on schools‟ use of the general authority concerning medications granted in section 49423. The Legislature‟s unsuccessful attempt to impose comparable restrictions on insulin did not abrogate the existing general authority. Three additional failed bills did not come to a vote. Senate Bill No. 1487 (2007-2008 Reg. Sess.) would have amended section 49414.5, which permits unlicensed school personnel with special training to administer glucagon in emergencies, to administer insulin under similar conditions. (Assem. Bill No. 1487, supra, § 1.) Another bill, Assembly Bill No. 1802 (2009-2010 Reg. Sess.), while expressly authorizing unlicensed personnel to administer insulin, would have permitted parents, rather than school administrators, to designate the school employees who would be allowed to administer insulin. (Ibid., § 2.) Finally, Assembly Bill No. 1430 (2009-2010 Reg. Sess.) would have provided that no one other than licensed health care providers would be allowed to administer any medications in schools, except in emergencies. (Id., § 2.) Because none of these bills came to a vote, and because the Legislature‟s cursory deliberations on them 20 postdated section 49423‟s enactment by decades, none provides a sound basis for inferring the 1968 and 1976 Legislatures‟ intents on the question whether section 49423 permits unlicensed personnel to administer insulin. 5. The Department’s 2005 and 2006 Advisory Statements. In 2005 and 2006, the Department issued advisory statements recommending that school personnel other than licensed health care providers not administer medications by injection generally (2005) or insulin in particular (2006). (State Dept. of Ed., Program Advisory on Medication Administration (May 2005) p. 7 < http://www.cde.ca.gov/ls/he/hn/documents/medadvisory.pdf > [as of Aug. 12, 2013] (2005 Program Advisory); State Dept. of Ed., Medication Administration Assistance in California . . . Frequently Asked Questions (2006) p. 1 (2006 FAQ).) The Nurses contend we should defer to these recommendations as authoritative interpretations of section 49423 by an agency charged with its enforcement. But the Department‟s advisory statements are not entitled to the same judicial deference as the binding, quasi-legislative regulations formally adopted by the Board. (Tit. 5, §§ 600-611; see § 49423.6 [regulatory authority].) “An agency interpretation of the meaning and legal effect of a statute is entitled to consideration and respect by the courts; however, unlike quasi-legislative regulations adopted by an agency to which the Legislature has confided the power to „make law,‟ and which, if authorized by the enabling legislation, bind this and other courts as firmly as statutes themselves, the binding power of an agency‟s interpretation of a statute or regulation is contextual: Its power to persuade is both circumstantial and dependent on the presence or absence of factors that support the merit of the interpretation.” (Yamaha Corp. of America v. State Bd. of Equalization (1998) 19 Cal.4th 1, 7.) Reviewing the 2005 Program Advisory and the 2006 FAQ under these principles, we find they lack persuasive force. Before explaining that conclusion, 21 however, we note those documents do not reflect the Department‟s current position. In their amicus curiae brief to this court, the Department and the Superintendent maintain that section 49423 and its implementing regulations (tit. 5, §§ 600-611), in combination with the NPA‟s medical-orders exception (Bus. & Prof. Code, § 2727, subd. (e)), do indeed permit unlicensed school personnel to administer insulin. With that clarification, we turn to the documents in question. In its 2005 Program Advisory, the Department confirmed that unlicensed personnel may administer medications generally but “recommend[ed] that . . . unlicensed staff member[s] . . . not administer medications that must be administered by injection . . . .” (Id., at p. 7.) The 2005 Program Advisory‟s recommendations are nonbinding, both because the document so states (id., at p. 1) and as a matter of law. (See § 33308.5 [“Program guidelines issued by the [Department] shall be designed to serve as a model or example, and shall not be prescriptive”]; tit. 5, § 611 [“The [Department], with the approval of the [Board], may issue and periodically update an advisory providing non-binding guidance on the administration of medication . . . . The advisory shall be a program guideline under . . . section 33308.5 . . . .”].) The 2005 document offers no discussion or analysis of its recommendation concerning injections and cites no authority that might support it. The document does cite section 49423 and sections 600, 601 and 604 of title 5 (2005 Program Advisory, at p. 6), which, as we have seen, were specifically intended to permit unlicensed personnel to administer medications, and none of which forbids administration by injection. The document also cites statutes describing the specific licensure required of physicians, nurses and other health care providers employed as such in the schools (§§ 44871, 44873-44878), and also section 49422, which provides that only licensed health care providers and certain other persons with relevant credentials “shall be . . . employed or permitted to supervise the health and physical development of pupils . . . .” (2005 22 Program Advisory, at p. 6.) As already noted, however, section 49422 cannot mean that only licensed health care providers may administer medications in schools because section 49423 expressly applies “[n]otwithstanding Section 49422.” (§ 49423, subd. (a).) Unlike the 2005 Program Advisory, which the Department issued with the Board approval required for such documents (see § 33308.5 and tit. 5, § 611), the Department apparently issued the 2006 FAQ unilaterally. In that document, the Department flatly asserts that unlicensed school personnel may not administer insulin. (2006 FAQ, at p. 1.) Ignoring its own conclusion just one year earlier that unlicensed personnel may administer medications generally, even if not by injection, the Department in the 2006 FAQ wrote that “[n]o . . . California statute” other than sections 49414 (epinephrine auto-injectors) and 49414.5 (glucagon) “allows an unlicensed school employee to administer any other medication in California public schools, even if the unlicensed school employee is trained and supervised by a school nurse or other similarly licensed nurse.” (2006 FAQ, at p. 1, italics added.) In attempting to justify this conclusion, the Department inexplicably cited section 49423 (2006 FAQ, at p. 2, fn. 2) and omitted any reference to the statute‟s implementing regulations (e.g., tit. 5, § 604, subd. (b) [“Other designated school personnel may administer medication to pupils”]). In its 2006 FAQ, the Department also invoked the NPA as authority for the following assertion: “California law states, with a few clearly specified legal exceptions, that only a licensed nurse or physician may administer medication. In the school setting, these exceptions are situations where [¶] The student selfadministers the medication, [¶] A parent or parent designee, such as a relative or close friend, administers the medication, or [¶] There is a public disaster or epidemic.” (2006 FAQ, at p. 1, fns. omitted.) The noted exceptions reflect statutory exceptions to the NPA. (Bus. & Prof. Code, § 2727, subds. (a) 23 [gratuitous nursing by friends or family members], (d) [nursing services in emergencies].) But the document entirely overlooks the medical-orders exception, which expressly permits “any person [to perform] . . . such duties as required in . . . carrying out medical orders prescribed by a licensed physician . . . .” (Id., subd. (e).) Viewing the 2005 Program Advisory and the 2006 FAQ in their full legal context, we conclude the documents‟ recommendations are not entitled to judicial deference to the extent they might be thought to preclude unlicensed school personnel from administering insulin. The 2005 Program Advisory makes no serious effort to reconcile its recommendation concerning injections with the applicable statutes (§§ 49423, 49423.6) and binding regulations (tit. 5, §§ 601611), and ignores the NPA‟s medical-orders exception (Bus. & Prof. Code, § 2727, subd. (e)). The 2006 FAQ shares these faults and, in addition, both contradicts the 2005 Program Advisory‟s correct conclusion that unlicensed personnel may administer medications generally and also lacks the Board approval required for program guidelines. (See § 33308.5; tit. 5, § 611.) Under these circumstances, the documents‟ recommendations lack persuasive force on the question before us, and we thus do not defer to them. (Yamaha Corp. of America v. State Bd. of Equalization, supra, 19 Cal.4th 1, 7.) We recognize, however, that the 2005 Program Advisory constitutes an important source of advice for local education agencies on matters beyond the scope of this case, and we emphasize that we reject that document‟s recommendations only to the extent they contradict the views set out in this opinion. 6. Conclusion. Finding no merit in the arguments to the contrary, we conclude California law does permit trained, unlicensed school personnel to administer prescription medications, including insulin, in accordance with written statements of individual 24 students‟ treating physicians, with parental consent (Ed. Code, §§ 49423, 49423.6; tit. 5, §§ 600-611), and that persons who act under this authority do not violate the NPA (see Bus. & Prof. Code, § 2727, subd. (e)). Because schools may administer prescription medications only in accordance with physicians‟ written statements (§ 49423; tit. 5, § 600, subd. (a)), state law in effect delegates to each student‟s physician the decision whether insulin may safely and appropriately be administered by unlicensed school personnel or instead whether a particular student‟s medical needs can be met only by a licensed health care provider. State law, however, presents no categorical obstacle to the use of unlicensed personnel for this purpose. In view of this conclusion, we need not address the Association‟s contention that federal law would preempt a contrary rule.