```

[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2023 Introduced in House (IH)]

108th CONGRESS
  1st Session
                                H. R. 2023

  To give a preference regarding States that require schools to allow 
 students to self-administer medication to treat that student's asthma 
                or anaphylaxis, and for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                              May 7, 2003

 Mr. Stearns (for himself, Mr. Kennedy of Rhode Island, Mr. Towns, Mr. 
   Barton of Texas, Mr. Issa, Mrs. Christensen, and Mr. Smith of New 
   Jersey) introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
Education and the Workforce, for a period to be subsequently determined 
 by the Speaker, in each case for consideration of such provisions as 
        fall within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL

 
  To give a preference regarding States that require schools to allow 
 students to self-administer medication to treat that student's asthma 
                or anaphylaxis, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Asthmatic Schoolchildren's Treatment 
and Health Management Act of 2003''.

SEC. 2. FINDINGS.

    The Congress finds the following:
            (1) Asthma is a chronic condition requiring lifetime, 
        ongoing medical intervention.
            (2) In 1980, 6,700,000 Americans had asthma.
            (3) In 2001, 20,300,000 Americans had asthma; 6,300,000 
        children under age 18 had asthma.
            (4) The prevalence of asthma among African-American 
        children was 40 percent greater than among Caucasian children, 
        and more than 26 percent of all asthma deaths are in the 
        African-American population.
            (5) In 2000, there were 1,800,000 asthma-related visits to 
        emergency departments (more than 728,000 of these involved 
        children under 18 years of age).
            (6) In 2000, there were 465,000 asthma-related 
        hospitalizations (214,000 of these involved children under 18 
        years of age).
            (7) In 2000, 4,487 people died from asthma, and of these 
        223 were children.
            (8) Asthma is the most common cause of missed school days, 
        accounting for approximately 14,000,000 missed school days 
        annually.
            (9) Working parents of children with asthma lose an 
        estimated $1,000,000,000 a year in productivity.
            (10) At least 18 States have legislation protecting the 
        rights of children to carry and self-administer asthma metered-
        dose inhalers, and at least 8 States expand this protection to 
        epinephrine auto-injectors.
            (11) Mere guidelines do not necessarily protect the rights 
        of children in every school--tragic refusals of schools to 
        permit students to carry their inhalers and auto-injectable 
        epinephrine have occurred, some resulting in death and spawning 
        litigation.
            (12) Schools that restrict or revoke the rights of children 
        to carry such inhalers and auto-injectable epinephrine put 
        themselves and students with asthma and severe allergic 
        reactions, including anaphylaxis, at risk of death. Such 
        schools also put other students at risk of witnessing a 
        potentially life-threatening asthma attack.
            (13) School district medication policies must be developed 
        with the safety of all students in mind. Easy access to and 
        correct use of asthma inhalers are necessary to avoid serious 
        respiratory complications secondary to acute exacerbation and 
        to improve the quality of life of students with asthma.
            (14) No school should interfere with the patient-physician 
        relationship.
            (15) Anaphylaxis, or anaphylactic shock, is a systemic 
        allergic reaction that can kill within minutes. Anaphylaxis 
        occurs in some asthma patients. According to the American 
        Academy of Allergy, Asthma, and Immunology, people who have 
        experienced symptoms of anaphylaxis previously are at risk for 
        subsequent reactions and should carry an epinephrine auto-
        injector with them at all times, if prescribed.
            (16) Because asthma is a condition that often arises from 
        allergies, it is critical to include anaphylaxis in asthma 
        treatment. Specifically, the respiratory problems that arise 
        during an asthma attack usually occur because of a reaction to 
        certain allergens, including dust, pollen, molds, and specific 
        foods.
            (17) An increasing number of students and school staff have 
        life-threatening allergies. Exposure to the affecting allergen 
        can trigger anaphylaxis. Anaphylaxis requires prompt medical 
        intervention with an injection of epinephrine.
            (18) Avoidance, early recognition, and prompt treatment are 
        essential to the management of life-threatening allergies. 
        There are students and school staff who have known life-
        threatening allergies, and those who have not been identified. 
        Prompt intervention with epinephrine is vital to saving lives.

SEC. 3. PREFERENCE FOR STATES THAT ALLOW STUDENTS TO SELF-ADMINISTER 
              MEDICATION TO TREAT ASTHMA AND ANAPHYLAXIS.

    (a) Preference.--The Secretary of Health and Human Services, in 
making any grant that is asthma-related (as determined by the 
Secretary) to a State educational agency or a local educational agency, 
shall give preference to any State educational agency or local 
educational agency that is located in a State that satisfies the 
following:
            (1) In general.--The State must require that each 
        elementary school and secondary school (whether public or 
        nonpublic) in that State will grant to any student in the 
        school an authorization for the self-administration of 
        medication to treat that student's asthma or anaphylaxis, if--
                    (A) a health care practitioner prescribed the 
                medication for use by the student during school hours 
                and instructed the student in the correct and 
                responsible use of the medication;
                    (B) the student has demonstrated to the health care 
                practitioner (or such practitioner's designee) and the 
                school nurse (if available) the skill level necessary 
                to use the medication and any device that is necessary 
                to administer such medication as prescribed;
                    (C) the health care practitioner formulates a 
                written treatment plan for managing asthma or 
                anaphylaxis episodes of the student and for medication 
                use by the student during school hours; and
                    (D) the student's parent or guardian has completed 
                and submitted to the school any written documentation 
                required by the school, including the statement 
                required by paragraph (5)(B) and the treatment plan 
                formulated under subparagraph (C) of this paragraph.
            (2) Scope.--An authorization granted under paragraph (1) 
        must allow the student involved to possess and use his or her 
        medication--
                    (A) while in school;
                    (B) while at a school-sponsored activity;
                    (C) during normal before-school and after-school 
                activities, such as before-school or after-school care 
                on school-operated property; and
                    (D) in transit to or from school or school-
                sponsored activities.
            (3) Duration of authorization.--An authorization granted 
        under paragraph (1)--
                    (A) must be effective only for the school year for 
                which it is granted; and
                    (B) must be renewed by the parent or guardian each 
                subsequent school year in accordance with this section.
            (4) State action on liability.--As an additional condition 
        on receipt of a preference by a State educational agency or a 
        local educational agency under this subsection, the State must 
        address the potential liability of schools (including employees 
        and agents of schools), parents, and guardians for any injury 
        to a student or other individual resulting from the use or 
        attempted use of the student's asthma or anaphylaxis 
        medication. In addressing liability under this paragraph, a 
        State must consult with stakeholders and interested parties, 
        such as parents, representatives from education and health 
        organizations and agencies (including the State board of 
        education, the State school board association, the State 
        teacher association, the State medical association, and the 
        State nurses association), and others in the educational or 
        medical community.
            (5) School action on liability, indemnification.--A 
        condition for an authorization under paragraph (1) is that, 
        except for willful and wanton conduct--
                    (A) the school must, in writing, inform the parent 
                or guardian of the student that the school (including 
                its employees and agents) is to incur no liability as a 
                result of any injury arising from self-administration 
                of medication within the scope described in paragraph 
                (2); and
                    (B) the parent or guardian of the student must sign 
                a statement acknowledging that notwithstanding any 
                provision of State law to the contrary--
                            (i) the school (including its employees and 
                        agents) is to incur no liability as a result of 
                        any injury arising from such self-
                        administration of medication; and
                            (ii) the parent or guardian must indemnify 
                        and hold harmless the school (including its 
                        employees and agents) against any claim arising 
                        out of such self-administration of medication.
            (6) Backup medication.--The State must require that backup 
        medication, if provided by a student's parent or guardian, be 
        kept at a student's school in a location easily accessible to 
        the student in the event of an asthma or anaphylaxis emergency.
            (7) Maintenance of information.--The State must require 
        that information described in paragraphs (1)(C) and (1)(D) be 
        kept on file at the student's school in a location easily 
        accessible in the event of an asthma or anaphylaxis emergency.
    (b) Definitions.--For purposes of this section:
            (1) The terms ``elementary school'' and ``secondary 
        school'' have the meaning given to those terms in section 9101 
        of the Elementary and Secondary Education Act of 1965 (20 
        U.S.C. 7801).
            (2) The term ``health care practitioner'' means a person 
        authorized under law to prescribe drugs subject to section 
        503(b) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 
        353(b)).
            (3) The term ``medication'' means a drug as that term is 
        defined in section 201 of the Federal Food, Drug, and Cosmetic 
        Act (21 U.S.C. 321) and includes inhaled bronchodilators, 
        inhaled corticosteroids, and auto-injectable epinephrine.
            (4) The term ``Secretary'' means the Secretary of Health 
        and Human Services.
            (5) The term ``self-administration'' means a student's 
        discretionary use of his or her prescribed asthma or 
        anaphylaxis medication, pursuant to prescription or written 
        direction from a health care practitioner.

SEC. 4. SENSE OF CONGRESS REGARDING CDC'S STRATEGIES FOR ADDRESSING 
              ASTHMA WITHIN A COORDINATED SCHOOL HEALTH PROGRAM.

    (a) Findings.--The Congress finds as follows:
            (1) Possession and administration of medication is only 1 
        component of asthma and anaphylaxis management.
            (2) The Centers for Disease Control and Prevention has 
        identified 6 strategies for addressing asthma within a 
        coordinated school health program. These strategies consist of 
        the following:
                    (A) Establishing management and support systems for 
                asthma-friendly schools.
                    (B) Providing appropriate school health and mental 
                health services for students with asthma.
                    (C) Providing asthma education and awareness 
                programs for students and school staff.
                    (D) Providing a safe and healthy school environment 
                to reduce asthma triggers.
                    (E) Providing safe, enjoyable physical education 
                and activity opportunities for students with asthma.
                    (F) Coordinating school, family, and community 
                efforts to better manage asthma symptoms and reduce 
                school absences among students with asthma.
            (3) Providing appropriate school health and mental health 
        services for students with asthma includes the following:
                    (A) Obtaining a written asthma action plan for all 
                students with asthma, which plan--
                            (i) should be developed by a primary care 
                        provider and provided by parents; and
                            (ii) should include individualized 
                        emergency protocol, medications, peak flow 
                        monitoring, environmental triggers, and 
                        emergency contact information.
                    (B) Sharing the plan with appropriate faculty and 
                staff in accordance with guidelines under section 444 
                of the General Education Provisions Act (20 U.S.C. 
                1232g; commonly referred to as the ``Family Educational 
                Rights and Privacy Act of 1974'') or with parental 
                permission.
                    (C) Ensuring that--
                            (i) at all times students have options for 
                        immediate access to medications, as prescribed 
                        by a physician and approved by parents; and
                            (ii) specific options, such as allowing 
                        students to self-carry and self-administer 
                        medications, are determined on a case-by-case 
                        basis with input from the physician, parent, 
                        and school.
                    (D) Using standard emergency protocols for students 
                in respiratory distress if they do not have their own 
                asthma action plan.
                    (E) Ensuring that case management is provided for 
                students with frequent school absences, school health 
                office visits, emergency department visits, or 
                hospitalizations due to asthma.
                    (F) Providing a full-time registered nurse all day, 
                every day for each school.
                    (G) Ensuring access to a consulting physician for 
                each school.
                    (H) Referring students without a primary care 
                provider to child health insurance programs and 
                providers.
                    (I) Providing and coordinating school-based 
                counseling, psychological, and social services for 
                students with asthma, as appropriate.
                    (J) Coordinating with community services.
    (b) Expression of Support.--The Congress supports the goals and 
ideals of the strategies identified by the Centers for Disease Control 
and Prevention for addressing asthma within a coordinated school health 
program.
                                 <all>
```