Dear Members of the Virginia Department of Education,

I am writing on behalf of child care providers throughout Virginia to express serious concerns regarding the proposed requirement that all child care facilities maintain stock epinephrine auto-injectors (EpiPens) for emergency use. While we share the Department's commitment to child safety, we believe this mandate presents significant practical, financial, and liability challenges that warrant reconsideration.

Our concerns include the following:

Financial Burden: The cost of purchasing and maintaining stock EpiPens represents a substantial financial burden for child care providers, particularly small family-based operations. EpiPens require replacement before expiration dates, creating an ongoing expense that many providers cannot absorb without passing costs on to families already struggling with child care affordability.

Training Requirements and Associated Costs: The specialized training required to properly administer epinephrine represents an additional financial and time burden. Providers must not only pay for initial training but also ensure all staff members are trained and maintain current certifications, multiplying both the cost and logistical complexity.

Lack of Medical Expertise: Child care providers do not possess medical training to accurately diagnose anaphylactic shock, particularly in children without known allergies. The symptoms of anaphylaxis can overlap with other medical emergencies, and providers fear making critical errors in judgment that could have serious consequences. This places an unreasonable medical responsibility on individuals who are educators, not healthcare professionals.

Dosage Concerns: Providers are deeply concerned about the potential for administering incorrect dosages. EpiPens come in different strengths for different age groups and weights, and the risk of administering the wrong dose to a child could result in serious harm. This concern is particularly acute when dealing with children who have no documented allergy history.

Liability and Insurance Coverage: There is significant uncertainty about whether existing liability insurance policies will cover claims arising from the administration of stock epinephrine. Providers need clear assurance that they will be protected from litigation if a child experiences an adverse reaction or if the epinephrine is administered in a situation where it was not needed. Without adequate liability protection, this mandate could expose providers to devastating financial risk.

We respectfully suggest that alternative approaches may better serve the goal of child safety while addressing these concerns. These might include:

- Requiring parents of children with known severe allergies to provide EpiPens specifically prescribed for their child

- Ensuring emergency medical services can respond rapidly to child care facilities

- Providing comprehensive training on recognizing allergic reactions and when to call 911

- Creating a voluntary program with state funding and liability protection for providers who wish to maintain stock epinephrine

We appreciate the Department's dedication to protecting Virginia's children and welcome the opportunity to engage in further dialogue about this important issue. We believe that working together, we can develop policies that enhance child safety while remaining practical and sustainable for child care providers.

Thank you for your consideration of these concerns.

Respectfully,

The Virginia Alliance of Family Child Care Associations

Dr. Regina Washington- President