TESTIMONY OF THE MAINE MEDICAL ASSOCIATION

IN OPPOSITION TO

L.D 1491, AN ACT TO ALLOW TRAINED, NONMEDICAL EMPLOYEES IN SCHOOLS

TO ADMINISTER EMERGENCY MEDICATIONS

Joint Standing Committee on Education and Cultural Affairs
Room 202, Cross State Office Building
Monday, January 11, 2016, 10:00 a.m.

Good morning Senator Langley, Representative Kornfield, and Members of the Joint Standing Committee on Education and Cultural Affairs. I am Peter Michaud, Staff Attorney for the Maine Medical Association (MMA) and a registered nurse. I live in Readfield, and I am speaking in opposition to LD 1491, An Act to Allow Trained, Nonmedical Employees in Schools to Administer Emergency Medications.

The MMA is a professional association representing more than 3,800 physicians, residents, and medical students in Maine whose mission is to support Maine physicians, advance the quality of medicine in Maine, and promote the health of all Maine citizens. We represent physicians from all medical specialties and primary care.

This bill presents several reasons for serious concern. First, it does not define “emergency medications.” In Title 20-A, Section 254 “emergency medication” is limited to epinephrine pens and asthma inhalers, but there is no similar limitation in this bill.

Perhaps equally important, this bill does not limit the type of administration, what we in nursing call the “route.” As written, LD 1491 would allow minimally trained school employees to administer intravenous (IV) and intramuscular (IM) medications, as well as rectal medications. IV administration requires not only training, but also practice. A person gets rusty if he doesn’t do it regularly. Furthermore, starting an IV for or administering an IV med to a child is hard. Their veins are small, and children tend to move. A child experiencing a seizure would be a very difficult subject for IV medication administration, even for an experienced nurse who does that kind of thing all the time. This

is not a minimal skill, nor one that is easy to learn. Training nonmedical school personnel to perform those procedures is unrealistic at best and dangerous at worst.

Another area of major concern is that the bill does not provide for any kind of professional assessment of the patient after administration of the medication. Medications that must be administered on an emergency basis tend to be quite powerful, and it is essential that the patient be assessed as soon as possible after the administration. The dose may not be sufficient, or it may be too much. The condition may not be responding to the medication. The patient may have an adverse reaction. Again, patient assessment is a skill that requires a combination of training and experience. School employees who have only minimal emergency training will not have the level of knowledge necessary to perform that essential function. It must be done by a physician, a nurse or a PA.

Finally, the bill seems to provide that a patient need not be sent to an emergency department after the administration of an emergency medication. That is not good medical or nursing practice, and it presents a serious risk to the patient. If a professional, trained and experienced nurse sends a patient to the emergency department for evaluation after administration of certain medications, how can we in good conscience allow a school employee to skip that essential action?

LD 1491 would not be good law, and it presents several risks to the children it seeks to help.

Thank you for considering the MMA’s perspective on LD 1491, and I respectfully ask you to vote the bill “Ought Not to Pass.” I would be happy to respond to any questions you may have.