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Union Calendar No. 364 

108TH CONGRESS 

2D SESSION H. R. 2023 

[Report No. 108–606, Part I] 

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 

JULY 14, 2004 

Reported from the Committee on Energy and Commerce with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

JULY 14, 2004 

Referral to the Committee on Education and the Workforce extended for a 

period ending not later than July 14, 2004 

JULY 14, 2004 

Additional sponsors: Mr. WAXMAN, Ms. WATERS, Mr. BASS, Mr. MCNULTY, 

Mr. ENGEL, Mr. VAN HOLLEN, Mr. FOLEY, Ms. JACKSON-LEE of Texas, 

Mrs. DAVIS of California, Ms. GINNY BROWN-WAITE of Florida, Mr. 

PAUL, Ms. CORRINE BROWN of Florida, Mr. OWENS, Mr. LANTOS, Mr. 

KILDEE, Ms. LOFGREN, Mr. FROST, Mr. WYNN, Mr. WALSH, Ms. 

MILLENDER-MCDONALD, Mr. JENKINS, Mrs. MCCARTHY of New York, 

Mr. KIRK, Mr. WAMP, Mr. GILLMOR, Mr. NORWOOD, Mr. UPTON, Mr. 

FERGUSON, Mr. PALLONE, Mr. ANDREWS, Mr. ROTHMAN, Mr. ROGERS

of Michigan, Ms. NORTON, Mr. PASCRELL, Mr. RANGEL, Mrs. BONO, Mr. 

PAYNE, Ms. BORDALLO, Mr. TERRY, Mr. ACEVEDO-VILA ́, Mr. SAXTON, 
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Mr. MENENDEZ, Mr. HOLT, Mr. ISRAEL, Mr. LEWIS of Georgia, Mr. 

MCDERMOTT, and Mr. LOBIONDO

JULY 14, 2004 

Committee on Education and the Workforce discharged; committed to the 

Committee of the Whole House on the State of the Union and ordered 

to be printed 

[For text of introduced bill, see copy of bill as introduced on May 7, 2003] 

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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Asthmatic School5 children’s Treatment and Health Management Act of 

6 2004’’. 

7 SEC. 2. FINDINGS. 

8 The Congress finds the following: 

9 (1) Asthma is a chronic condition requiring life10 time, ongoing medical intervention. 

11 (2) In 1980, 6,700,000 Americans had asthma. 

12 (3) In 2001, 20,300,000 Americans had asthma; 

13 6,300,000 children under age 18 had asthma. 
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1 (4) The prevalence of asthma among African2 American children was 40 percent greater than 

3 among Caucasian children, and more than 26 percent 

4 of all asthma deaths are in the African-American 

5 population. 

6 (5) In 2000, there were 1,800,000 asthma-related 

7 visits to emergency departments (more than 728,000 

8 of these involved children under 18 years of age). 

9 (6) In 2000, there were 465,000 asthma-related 

10 hospitalizations (214,000 of these involved children 

11 under 18 years of age). 

12 (7) In 2000, 4,487 people died from asthma, and 

13 of these 223 were children. 

14 (8) According to the Centers for Disease Control 

15 and Prevention, asthma is a common cause of missed 

16 school days, accounting for approximately 14,000,000 

17 missed school days annually. 

18 (9) According to the New England Journal of 

19 Medicine, working parents of children with asthma 

20 lose an estimated $1,000,000,000 a year in produc21 tivity. 

22 (10) At least 30 States have legislation pro23 tecting the rights of children to carry and self-admin24 ister asthma metered-dose inhalers, and at least 18 
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1 States expand this protection to epinephrine auto2 injectors. 

3 (11) Tragic refusals of schools to permit students 

4 to carry their inhalers and auto-injectable epineph5 rine have occurred, some resulting in death and 

6 spawning litigation. 

7 (12) School district medication policies must be 

8 developed with the safety of all students in mind. The 

9 immediate and correct use of asthma inhalers and 

10 auto-injectable epinephrine are necessary to avoid se11 rious respiratory complications and improve health 

12 care outcomes. 

13 (13) No school should interfere with the patient14 physician relationship. 

15 (14) Anaphylaxis, or anaphylactic shock, is a 

16 systemic allergic reaction that can kill within min17 utes. Anaphylaxis occurs in some asthma patients. 

18 According to the American Academy of Allergy, Asth19 ma, and Immunology, people who have experienced 

20 symptoms of anaphylaxis previously are at risk for 

21 subsequent reactions and should carry an epinephrine 

22 auto-injector with them at all times, if prescribed. 

23 (15) An increasing number of students and 

24 school staff have life-threatening allergies. Exposure to 

25 the affecting allergen can trigger anaphylaxis. Ana-
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1 phylaxis requires prompt medical intervention with 

2 an injection of epinephrine. 

3 SEC. 3. PREFERENCE FOR STATES THAT ALLOW STUDENTS 

4 TO SELF-ADMINISTER MEDICATION TO TREAT 

5 ASTHMA AND ANAPHYLAXIS. 

6 (a) AMENDMENTS.—Section 399L of the Public Health 

7 Service Act (42 U.S.C. 280g) is amended— 

8 (1) by redesignating subsection (d) as subsection 

9 (e); and 

10 (2) by inserting after subsection (c) the fol11 lowing: 

12 ‘‘(d) PREFERENCE FOR STATES THAT ALLOW STU13 DENTS TO SELF-ADMINISTER MEDICATION TO TREAT

14 ASTHMA AND ANAPHYLAXIS.— 

15 ‘‘(1) PREFERENCE.—The Secretary, in making 

16 any grant under this section or any other grant that 

17 is asthma-related (as determined by the Secretary) to 

18 a State, shall give preference to any State that satisfies 

19 the following: 

20 ‘‘(A) IN GENERAL.—The State must require 

21 that each public elementary school and secondary 

22 school in that State will grant to any student in 

23 the school an authorization for the self-adminis24 tration of medication to treat that student’s asth25 ma or anaphylaxis, if— 
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1 ‘‘(i) a health care practitioner pre2 scribed the medication for use by the stu3 dent during school hours and instructed the 

4 student in the correct and responsible use of 

5 the medication; 

6 ‘‘(ii) the student has demonstrated to 

7 the health care practitioner (or such practi8 tioner’s designee) and the school nurse (if 

9 available) the skill level necessary to use the 

10 medication and any device that is necessary 

11 to administer such medication as pre12 scribed; 

13 ‘‘(iii) the health care practitioner for14 mulates a written treatment plan for man15 aging asthma or anaphylaxis episodes of the 

16 student and for medication use by the stu17 dent during school hours; and 

18 ‘‘(iv) the student’s parent or guardian 

19 has completed and submitted to the school 

20 any written documentation required by the 

21 school, including the treatment plan formu22 lated under clause (iii) and other documents 

23 related to liability. 

24 ‘‘(B) SCOPE.—An authorization granted 

25 under subparagraph (A) must allow the student 
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1 involved to possess and use his or her medica2 tion— 

3 ‘‘(i) while in school; 

4 ‘‘(ii) while at a school-sponsored activ5 ity, such as a sporting event; and 

6 ‘‘(iii) in transit to or from school or 

7 school-sponsored activities. 

8 ‘‘(C) DURATION OF AUTHORIZATION.—An 

9 authorization granted under subparagraph 

10 (A)— 

11 ‘‘(i) must be effective only for the same 

12 school and school year for which it is grant13 ed; and 

14 ‘‘(ii) must be renewed by the parent or 

15 guardian each subsequent school year in ac16 cordance with this subsection. 

17 ‘‘(D) BACKUP MEDICATION.—The State 

18 must require that backup medication, if provided 

19 by a student’s parent or guardian, be kept at a 

20 student’s school in a location to which the stu21 dent has immediate access in the event of an 

22 asthma or anaphylaxis emergency. 

23 ‘‘(E) MAINTENANCE OF INFORMATION.—The 

24 State must require that information described in 

25 subparagraphs (A)(iii) and (A)(iv) be kept on 
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1 file at the student’s school in a location easily 

2 accessible in the event of an asthma or anaphy3 laxis emergency. 

4 ‘‘(2) RULE OF CONSTRUCTION.—Nothing in this 

5 subsection creates a cause of action or in any other 

6 way increases or diminishes the liability of any per7 son under any other law. 

8 ‘‘(3) DEFINITIONS.—For purposes of this sub9 section: 

10 ‘‘(A) The terms ‘elementary school’ and ‘sec11 ondary school’ have the meaning given to those 

12 terms in section 9101 of the Elementary and 

13 Secondary Education Act of 1965. 

14 ‘‘(B) The term ‘health care practitioner’ 

15 means a person authorized under law to pre16 scribe drugs subject to section 503(b) of the Fed17 eral Food, Drug, and Cosmetic Act. 

18 ‘‘(C) The term ‘medication’ means a drug 

19 as that term is defined in section 201 of the Fed20 eral Food, Drug, and Cosmetic Act and includes 

21 inhaled bronchodilators and auto-injectable epi22 nephrine. 

23 ‘‘(D) The term ‘self-administration’ means 

24 a student’s discretionary use of his or her pre25 scribed asthma or anaphylaxis medication, pur-
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1 suant to a prescription or written direction from 

2 a health care practitioner.’’. 

3 (b) APPLICABILITY.—The amendments made by this 

4 section shall apply only with respect to grants made on or 

5 after the date that is 9 months after the date of the enact6 ment of this Act. 

7 SEC. 4. SENSE OF CONGRESS COMMENDING CDC FOR ITS 

8 STRATEGIES FOR ADDRESSING ASTHMA 

9 WITHIN A COORDINATED SCHOOL HEALTH 

10 PROGRAM. 

11 The Congress— 

12 (1) commends the Centers for Disease Control 

13 and Prevention for identifying and creating ‘‘Strate14 gies for Addressing Asthma Within a Coordinated 

15 School Program’’ for schools to address asthma; and 

16 (2) encourages all schools to review these strate17 gies and adopt policies that will best meet the needs 

18 of their student population. 
Union Calendar No. 364 

108TH CONGRESS 

2D SESSION H. R. 2023 

[Report No. 108–606, Part I] 

A BILL 

To give a preference regarding States that require 

laxis, and for other purposes. cation to treat that student’s asthma or anaphyschools to allow students to self-administer mediJULY 14, 2004 

Reported from the Committee on Energy and Commerce 

with an amendment 

JULY 14, 2004 

Referral to the Committee on Education and the Work14, 2004 force extended for a period ending not later than July 

JULY 14, 2004 

Committee on Education and the Workforce discharged; 

the State of the Union and ordered to be printed committed to the Committee of the Whole House on