Thank you for the opportunity to provide feedback on the proposed fast-track regulation requiring child day centers to implement policies for the possession, storage, and administration of stock epinephrine auto-injectors. As a child care provider, I strongly support measures that prioritize children's health and safety, including robust responses to allergic emergencies. However, I oppose this mandate in its current form, as it imposes unnecessary regulatory burdens, financial strain, and risks without commensurate benefits. Additionally, I oppose advancing this via the fast-track process, which bypasses the thorough public deliberation needed for such a resource-intensive policy.

 

1. Existing regulations and practices already adequately protect children with known allergies.  
   Virginia's child care licensing standards require centers to maintain individualized health care plans, secure prescribed medications (including epinephrine for diagnosed children), and train staff on administration per physician orders. These targeted protocols ensure that children at highest risk—those with documented allergies—receive immediate, appropriate care. A blanket "stock" epinephrine requirement duplicates these safeguards, adding complexity without addressing undiagnosed cases, which are rare and better handled by calling 911 (as already mandated).

2. Mandating administration of prescription medication by non-medical staff raises serious liability and safety risks.  
   Epinephrine is a powerful prescription drug requiring clinical assessment to avoid misuse, such as over-administration or incorrect dosing. Requiring child care providers—most of whom lack specific medical training—to make split-second judgments on undiagnosed symptoms could expose staff, centers, and families to legal liability and put children at risk. Even with free VDOE training, this exceeds the scope of child care roles and could lead to errors in high-stress emergencies, potentially harming children rather than helping them.  I recognize that there is a complimentary law that attempts to protect child care centers from liability, but it does not protect from having to defend a lawsuit -- even one that is ultimately dismissed in the early stages.  This additional liability risk will likely also change the challenging insurance landscape we face in Virginia -- driving up premiums if not forcing more insurers out of Virginia.    

3. The unfunded financial burden is prohibitive, especially for small and low-income providers.  
   At $290–$850 per device, plus recurring replacement costs due to short shelf lives (typically 12–18 months), this mandate would strain already under-resourced programs. Licensed child day centers—particularly nonprofit, rural, or community-based ones—operate on thin margins. These costs would inevitably divert funds from essential areas like staff wages, facility improvements, or expanded access for low-income families, exacerbating inequities in child care availability.    

4. This policy inappropriately shifts medical responsibilities from healthcare professionals to child care educators.  
   Child care providers are trained in basic first aid and emergency response, not advanced diagnostics or pharmacology. Designating them as de facto first responders for potential anaphylaxis blurs critical boundaries between child care and healthcare, potentially overwhelming staff and eroding focus on developmental activities. True medical oversight, such as through school nurses in K–12 settings, is absent in early childhood programs, making this a mismatched solution.

5. The requirements are ill-suited to the diverse structures of early childhood settings.  
   Unlike K–12 schools with on-site medical staff and centralized protocols, child care centers vary widely in size, staffing, and hours. Logistical challenges, including additional epi-pins needed for field trips.  These one-size-fits-all rules overlook the unique needs of smaller programs, where implementation could disrupt daily operations without proportional safety gains.

6. A targeted, collaborative approach—centered on families and medical providers—is more effective and equitable.  
   For children with known allergies, the current system fosters strong partnerships between families, pediatricians, and providers to supply and train on personalized epinephrine. For rare undiagnosed cases, immediate 911 activation and basic life support suffice until EMS arrives. We support additional training in recognizing the signs of an anaphylactic reaction and need to call 911. Mandating universal stock epinephrine overlooks this proven model, ignoring input from child care stakeholders who could help refine less burdensome alternatives, such as voluntary stockpiling or subsidies.

While fast-track regulations are intended for non-controversial updates, this proposal is inherently divisive due to its significant costs, liability implications, and uneven impact on Virginia's diverse child care ecosystem. Rushing it forward without dedicated funding or broader stakeholder engagement—such as town halls with small providers, rural representatives, and allergy experts—risks unintended consequences, like program closures or reduced enrollment in underfunded areas. A standard rulemaking process would allow time to explore cost offsets (e.g., state grants), pilot programs, or amendments to align with existing allergy protocols, ensuring the policy truly enhances safety without harming accessibility. I urge the Virginia Department of Education and Board of Education to withdraw this from fast-track consideration and commit to inclusive, evidence-based revisions.

I appreciate the VDOE's commitment to free training and invite further dialogue to strengthen child health protections in a sustainable way.