H. R. 2023

One Hundred Eighth Congress

of the

United States of America

AT THE SECOND SESSION

Begun and held at the City of Washington on Tuesday,

the twentieth day of January, two thousand and four

An Act

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 2004’’.

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) According to the Centers for Disease Control and

Prevention, asthma is a common cause of missed school days,

accounting for approximately 14,000,000 missed school days

annually.

(9) According to the New England Journal of Medicine,

working parents of children with asthma lose an estimated

$1,000,000,000 a year in productivity.

(10) At least 30 States have legislation protecting the rights

of children to carry and self-administer asthma metered-dose

inhalers, and at least 18 States expand this protection to

epinephrine auto-injectors.

(11) Tragic refusals of schools to permit students to carry

their inhalers and auto-injectable epinephrine have occurred,

some resulting in death and spawning litigation.
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(12) School district medication policies must be developed

with the safety of all students in mind. The immediate and

correct use of asthma inhalers and auto-injectable epinephrine

are necessary to avoid serious respiratory complications and

improve health care outcomes.

(13) No school should interfere with the patient-physician

relationship.

(14) 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.

(15) 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.

SEC. 3. PREFERENCE FOR STATES THAT ALLOW STUDENTS TO SELFADMINISTER MEDICATION TO TREAT ASTHMA AND

ANAPHYLAXIS.

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

Act (42 U.S.C. 280g) is amended—

(1) by redesignating subsection (d) as subsection (e); and

(2) by inserting after subsection (c) the following:

‘‘(d) PREFERENCE FOR STATES THAT ALLOW STUDENTS TO SELFADMINISTER MEDICATION TO TREAT ASTHMA AND ANAPHYLAXIS.—

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

under this section or any other grant that is asthma-related

(as determined by the Secretary) to a State, shall give preference to any State that satisfies the following:

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

public elementary school and secondary school 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—

‘‘(i) 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;

‘‘(ii) 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;

‘‘(iii) 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

‘‘(iv) the student’s parent or guardian has completed and submitted to the school any written documentation required by the school, including the treatment plan formulated under clause (iii) and other documents related to liability.
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‘‘(B) SCOPE.—An authorization granted under subparagraph (A) must allow the student involved to possess and

use his or her medication—

‘‘(i) while in school;

‘‘(ii) while at a school-sponsored activity, such as

a sporting event; and

‘‘(iii) in transit to or from school or school-sponsored activities.

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

granted under subparagraph (A)—

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

and school year for which it is granted; and

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

each subsequent school year in accordance with this

subsection.

‘‘(D) 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

to which the student has immediate access in the event

of an asthma or anaphylaxis emergency.

‘‘(E) MAINTENANCE OF INFORMATION.—The State must

require that information described in subparagraphs (A)(iii)

and (A)(iv) be kept on file at the student’s school in a

location easily accessible in the event of an asthma or

anaphylaxis emergency.

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

creates a cause of action or in any other way increases or

diminishes the liability of any person under any other law.

‘‘(3) DEFINITIONS.—For purposes of this subsection:

‘‘(A) 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.

‘‘(B) 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.

‘‘(C) The term ‘medication’ means a drug as that term

is defined in section 201 of the Federal Food, Drug, and

Cosmetic Act and includes inhaled bronchodilators and

auto-injectable epinephrine.

‘‘(D) The term ‘self-administration’ means a student’s

discretionary use of his or her prescribed asthma or

anaphylaxis medication, pursuant to a prescription or written direction from a health care practitioner.’’.

(b) APPLICABILITY.—The amendments made by this section shall

apply only with respect to grants made on or after the date that

is 9 months after the date of the enactment of this Act.

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

FOR ADDRESSING ASTHMA WITHIN A COORDINATED

SCHOOL HEALTH PROGRAM.

The Congress—

(1) commends the Centers for Disease Control and Prevention for identifying and creating ‘‘Strategies for Addressing

Asthma Within a Coordinated School Program’’ for schools to

address asthma; and
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(2) encourages all schools to review these strategies and

adopt policies that will best meet the needs of their student

population.

Speaker of the House of Representatives.

Vice President of the United States and

President of the Senate.