My name is Gabriela Santos, and I am a licensed family child care provider in Virginia. I am writing to respectfully oppose the proposal requiring all child care programs to purchase, stock, and administer epinephrine auto-injectors (EpiPens) for children without known allergies. While I fully support measures that enhance child safety, this mandate creates significant financial, medical, legal, and operational challenges for family child care providers.

Financial Impact

Family child care homes operate with very limited margins, especially those serving subsidy-supported families. Stock EpiPens cost several hundred dollars per set, expire annually or every two years, and must be replaced even if never used. Without guaranteed state funding, this becomes an unfunded and recurring expense that many small programs simply cannot absorb.

In addition to purchasing the medication, providers would face costs for required training, retraining for assistants or substitutes, secure storage, and likely increased insurance premiums. Without full financial support from the Virginia Department of Education or the Department of Planning and Budget, this mandate is not feasible for most family child care programs.

Medical and Safety Concerns

Epinephrine is a powerful medication intended for emergency use under clear medical guidance. The proposal shifts clinical decision-making onto educators who are not trained medical professionals. Identifying anaphylaxis in a child with no known allergies is not a simple task. Symptoms can resemble asthma, choking, panic responses, viral illness, or febrile reactions. Asking child care providers to diagnose a life-threatening condition without medical history or parental guidance places children and providers at risk.

Administering epinephrine unnecessarily can cause serious complications, including elevated heart rate, high blood pressure, and cardiac side effects. These decisions should not be made by non-medical staff without a doctor’s plan.

Liability and Insurance Exposure

This proposal dramatically increases legal exposure for child care providers. Most insurance policies do not cover medical decision-making or medication errors involving prescription-level medication administered without a doctor’s order. A provider who administers epinephrine without clear indication risks malpractice-like claims, uncovered incidents, legal conflict with families, and possible licensure issues. Without strong liability protections, this mandate places child care providers in an unsafe and unfair position.

Operational Challenges

Many family child care homes operate with one provider or one assistant. During an emergency, one adult would need to assess symptoms, administer medication, call 911, supervise the rest of the children, and contact parents—simultaneously. This is not realistic or safe. These environments are not staffed or equipped like medical facilities, and the expectations of this proposal exceed what is feasible in small home-based programs.

Conflicts With Existing Medication Policies and Parental Rights

Current regulations appropriately require parental consent and a physician’s plan for any medication given in a childcare setting. This proposal contradicts those protections by requiring providers to administer a powerful medication without parent permission, without a medical diagnosis, and without individualized instructions. Parents must retain the right to make medical decisions for their children.

Recommendations

I urge the Virginia Department of Education to consider safer and more reasonable alternatives, such as:

• Requiring stock epinephrine only when a child with a documented allergy is enrolled
• Fully funding all medication, replacement cycles, and training if the mandate is kept
• Providing state-funded training conducted by medical professionals
• Offering voluntary participation rather than mandatory implementation
• Establishing strong liability protections for providers

While the intention behind this proposal is understandable, mandating stock epinephrine for all childcare programs—without medical need, parental consent, or state funding—creates significant risks and burdens. Providers are already navigating rising operational costs, staffing challenges, and increased regulatory demands. This mandate, as written, threatens the stability of family child care programs and does not reflect medical best practices.

For these reasons, I respectfully oppose the regulation in its current form.

Thank you for the opportunity to share my concerns.

Gabriela Santos
Licensed Family Child Care Provider
Virginia