When the school year begins in less than 10 days, some Washington County Public Schools employees are expected to have one more duty and it’s one that has some school system officials concerned.
Due to a new state law that took effect this summer, local school systems must train some school personnel to administer auto-injectable epinephrine and to diagnose anaphylaxis when it’s needed, Anthony Trotta, the school board’s chief legal counsel, told the board during its Aug. 7 meeting.
The epinephrine auto-injectors, or epi pens, are to be used when a student “is determined to be or perceived to be in anaphylaxis,” according to the proposed school board policy. Anaphylaxis is a severe, possibly life-threatening allergic reaction that can be triggered in a variety of ways, including a food allergy or a bee sting.
The board voted 6-0 Aug. 7 to approve the first reading of the epi pen policy. Board member Karen Harshman was absent. The board is expected to vote on the second reading of the new policy during its Aug. 21 meeting, said Board Vice President Jacqueline Fischer, who chairs the board’s Policy Committee.
The employees most likely to receive the training are principals and assistant principals, according to an Aug. 10 email from Assistant Superintendent Mike Markoe.
Previously, epinephrine couldn’t be given to a student by a school nurse unless the student had a prescription or a prior history of allergies that necessitated its use, Trotta said.
The new state law authorizes school nurses and school personnel to administer epinephrine, “if available, to a student who is determined to be or perceived to be in anaphylaxis,” regardless of whether the student has been identified as having an anaphylactic allergy or has a prescription for epinephrine, according to the approved bill.
“We’re expecting an individual who’s not a licensed or trained health care professional to make a medical diagnosis. But the Maryland legislature has determined that they’re going to allow that to occur in Maryland,” Trotta told the school board last week.
“I’ve got so many concerns with this,” Board President Wayne Ridenour said.
“I shudder to think if, if this is injected into a child that has reaction to the drug ... it causes a problem instead of solving a problem,” Ridenour said.
Board member W. Edward Forrest, who is a pharmacist and the father of a child who is allergic to peanuts and tree nuts, asked if parents could opt out of epinephrine.
Benadryl is all his son needs for his allergy, said Forrest, calling epinephrine “a pretty aggressive treatment” for his son’s type of allergy.
Trotta said, by general rule, parents could notify school officials that they are not authorized to administer medical assistance in that type of situation.
However, another state law dealing with emergency situations allows a parents’ wishes to be overridden and a “health care provider could provide emergency care,” Trotta said.
Ridenour said he also was “terrified by liability” issues.
Trotta noted that the Good Samaritan provision of Maryland law would apply to “insulate” a person from liability if a lawsuit occurs. While there is no case law in regard to whether the epinephrine is administered by a trained or untrained person, the “good immunity protection” would apply to a trained person, he said.
Ridenour said any attorney “is going to try to rip to shreds our training ... and our decision-making in any case where some child is injured.”
“So it might offer some protection, but once it walks into a court of law, it’s going to be an expensive proposition no matter what happens,” Ridenour said.
“It’s a good idea that I just don’t think has been thought out particularly well. Just feel like ... It’s been dumped on us,” Ridenour said.
Trotta said he is seeking clarification from the state attorney general’s office whether the state law requires epi pens to be available in schools.
While the plan is to have them in every county public school, Trotta said the law calls for it to be administered to students if it’s available but the law does not “expressly require” epi pens to be available in schools.
Trotta said the Maryland State Department of Education recently issued guidelines stating the law requires epi pens to be in schools.
While the new state law does not include a deadline, Trotta said school system officials want to be ready for the start of school, which is Aug. 22.
The school board also discussed the cost of epi pens.
A pair of epi pens can cost $210, Markoe told the board. School system officials are still deciding how many epi pens each school should have.
Forrest said epi pens, which are “highly susceptible to light,” are expensive and have a short shelf life. After the board meeting, he said they can last from a year to 14 months.
Forrest told fellow board members that 99.9 percent of the epi pens will probably be tossed at the end of a year.
After the meeting, Markoe said there is a Baltimore pharmacy that charges $216 for a pair of epi pens and will credit more than half the initial cost for expired epi pens.