Short Version

Subject: Opposition to Proposed Fast-Track Regulation Requiring Stock Epinephrine Auto-Injectors in Child Day Centers

Thank you for the opportunity to comment on the proposed fast-track regulation mandating that child day centers possess, store, and permit administration of stock epinephrine auto-injectors.

As a licensed child care provider, I strongly support protecting children from severe allergic reactions. However, I respectfully but firmly oppose this mandate in its current form and urge its removal from the fast-track process.

1. Existing regulations already adequately protect children with known allergies through required individualized health care plans, parent-provided epinephrine, staff training, and physician-authorized administration.

2. Mandating non-medical child care staff to assess symptoms and administer a powerful prescription drug to children without a diagnosed allergy significantly increases liability exposure. In an industry already struggling with skyrocketing liability insurance premiums, this new risk will drive premiums even higher — further threatening the financial viability of small, rural, nonprofit, and family child care programs.

3. The regulation imposes substantial unfunded costs ($290–$850 per device + frequent replacements every 12–18 months), diverting scarce resources from staff wages, facility needs, and serving low-income families.

4. It inappropriately shifts medical decision-making and pharmacological responsibilities onto early childhood educators who lack clinical training and oversight (unlike K-12 settings with school nurses).

5. A one-size-fits-all mandate fails to account for the extreme diversity of Virginia’s child care settings — from large centers to small family homes — creating logistical, storage, privacy, and operational burdens with minimal added safety for the rare undiagnosed case.

6. Current protocols — parent/physician-provided epinephrine for known allergies + immediate 911 activation for any suspected reaction — are proven, targeted, and sufficient. Voluntary programs, subsidies, or enhanced recognition training would achieve the same goal without punishing providers.

This proposal is highly controversial due to its significant cost, liability, insurance-premium, and equity implications. Fast-tracking bypasses the thorough stakeholder engagement, cost-mitigation exploration, and standard rulemaking process that such a resource-intensive mandate requires. Rushing forward risks program closures and reduced access in underserved communities.

I urge you to withdraw this proposal from fast-track consideration, pursue standard rulemaking, and work collaboratively with child care providers, insurers, and medical experts to develop sustainable, fully funded, or voluntary alternatives that enhance safety without jeopardizing the stability of Virginia’s child care system.

I welcome continued dialogue and can be reached at [your email/phone].

Thank you for your consideration.

Sincerely,  
[Your Name]  
[Your Center Name / License #]
[City/Town, VA]

Long Version

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.

Reasons to Oppose the Proposed Regulation

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—many of whom lack 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.

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. Requiring secure storage, constant access, and parental notifications for family homes operating in private residences introduces privacy concerns and logistical challenges. 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.

Reasons to Oppose the Fast-Track Process

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. Please feel free to contact me at [your email/phone] for additional input.

Thank you for your consideration.

Sincerely,  
[Your Name]  
[Your Center Name / License #]
[City/Town, VA]