II 

108TH CONGRESS 

2D SESSION H. R. 2023 

IN THE SENATE OF THE UNITED STATES 

OCTOBER 6, 2004 

Received 

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. 

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

2 This Act may be cited as the ‘‘Asthmatic School3 children’s Treatment and Health Management Act of 

4 2004’’. 

5 SEC. 2. FINDINGS. 

6 The Congress finds the following: 

7 (1) Asthma is a chronic condition requiring life8 time, ongoing medical intervention. 

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

10 (3) In 2001, 20,300,000 Americans had asth11 ma; 6,300,000 children under age 18 had asthma. 

12 (4) The prevalence of asthma among African13 American children was 40 percent greater than 

14 among Caucasian children, and more than 26 per15 cent of all asthma deaths are in the African-Amer16 ican population. 

17 (5) In 2000, there were 1,800,000 asthma-re18 lated visits to emergency departments (more than 

19 728,000 of these involved children under 18 years of 

20 age). 

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

22 hospitalizations (214,000 of these involved children 

23 under 18 years of age). 

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

25 and of these 223 were children. 
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1 (8) According to the Centers for Disease Con2 trol and Prevention, asthma is a common cause of 

3 missed school days, accounting for approximately 

4 14,000,000 missed school days annually. 

5 (9) According to the New England Journal of 

6 Medicine, working parents of children with asthma 

7 lose an estimated $1,000,000,000 a year in produc8 tivity. 

9 (10) At least 30 States have legislation pro10 tecting the rights of children to carry and self-ad11 minister asthma metered-dose inhalers, and at least 

12 18 States expand this protection to epinephrine 

13 auto-injectors. 

14 (11) Tragic refusals of schools to permit stu15 dents to carry their inhalers and auto-injectable epi16 nephrine have occurred, some resulting in death and 

17 spawning litigation. 

18 (12) School district medication policies must be 

19 developed with the safety of all students in mind. 

20 The immediate and correct use of asthma inhalers 

21 and auto-injectable epinephrine are necessary to 

22 avoid serious respiratory complications and improve 

23 health care outcomes. 

24 (13) No school should interfere with the pa25 tient-physician relationship. 
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1 (14) Anaphylaxis, or anaphylactic shock, is a 

2 systemic allergic reaction that can kill within min3 utes. Anaphylaxis occurs in some asthma patients. 

4 According to the American Academy of Allergy, 

5 Asthma, and Immunology, people who have experi6 enced symptoms of anaphylaxis previously are at 

7 risk for subsequent reactions and should carry an 

8 epinephrine auto-injector with them at all times, if 

9 prescribed. 

10 (15) An increasing number of students and 

11 school staff have life-threatening allergies. Exposure 

12 to the affecting allergen can trigger anaphylaxis. An13 aphylaxis requires prompt medical intervention with 

14 an injection of epinephrine. 

15 SEC. 3. PREFERENCE FOR STATES THAT ALLOW STUDENTS 

16 TO SELF-ADMINISTER MEDICATION TO 

17 TREAT ASTHMA AND ANAPHYLAXIS. 

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

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

20 (1) by redesignating subsection (d) as sub21 section (e); and 

22 (2) by inserting after subsection (c) the fol23 lowing: 
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1 ‘‘(d) PREFERENCE FOR STATES THAT ALLOW STU2 DENTS TO SELF-ADMINISTER MEDICATION TO TREAT

3 ASTHMA AND ANAPHYLAXIS.— 

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

5 any grant under this section or any other grant that 

6 is asthma-related (as determined by the Secretary) 

7 to a State, shall give preference to any State that 

8 satisfies the following: 

9 ‘‘(A) IN GENERAL.—The State must re10 quire that each public elementary school and 

11 secondary school in that State will grant to any 

12 student in the school an authorization for the 

13 self-administration of medication to treat that 

14 student’s asthma or anaphylaxis, if— 

15 ‘‘(i) a health care practitioner pre16 scribed the medication for use by the stu17 dent during school hours and instructed 

18 the student in the correct and responsible 

19 use of the medication; 

20 ‘‘(ii) the student has demonstrated to 

21 the health care practitioner (or such prac22 titioner’s designee) and the school nurse (if 

23 available) the skill level necessary to use 

24 the medication and any device that is nec-
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1 essary to administer such medication as 

2 prescribed; 

3 ‘‘(iii) the health care practitioner for4 mulates a written treatment plan for man5 aging asthma or anaphylaxis episodes of 

6 the student and for medication use by the 

7 student during school hours; and 

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

9 has completed and submitted to the school 

10 any written documentation required by the 

11 school, including the treatment plan for12 mulated under clause (iii) and other docu13 ments related to liability. 

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

15 under subparagraph (A) must allow the student 

16 involved to possess and use his or her medica17 tion— 

18 ‘‘(i) while in school; 

19 ‘‘(ii) while at a school-sponsored activ20 ity, such as a sporting event; and 

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

22 school-sponsored activities. 

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

24 authorization granted under subparagraph 

25 (A)— 
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1 ‘‘(i) must be effective only for the 

2 same school and school year for which it is 

3 granted; and 

4 ‘‘(ii) must be renewed by the parent 

5 or guardian each subsequent school year in 

6 accordance with this subsection. 

7 ‘‘(D) BACKUP MEDICATION.—The State 

8 must require that backup medication, if pro9 vided by a student’s parent or guardian, be 

10 kept at a student’s school in a location to which 

11 the student has immediate access in the event 

12 of an asthma or anaphylaxis emergency. 

13 ‘‘(E) MAINTENANCE OF INFORMATION.— 

14 The State must require that information de15 scribed in subparagraphs (A)(iii) and (A)(iv) be 

16 kept on file at the student’s school in a location 

17 easily accessible in the event of an asthma or 

18 anaphylaxis emergency. 

19 ‘‘(2) RULE OF CONSTRUCTION.—Nothing in 

20 this subsection creates a cause of action or in any 

21 other way increases or diminishes the liability of any 

22 person under any other law. 

23 ‘‘(3) DEFINITIONS.—For purposes of this sub24 section: 
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1 ‘‘(A) The terms ‘elementary school’ and 

2 ‘secondary school’ have the meaning given to 

3 those terms in section 9101 of the Elementary 

4 and Secondary Education Act of 1965. 

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

6 means a person authorized under law to pre7 scribe drugs subject to section 503(b) of the 

8 Federal Food, Drug, and Cosmetic Act. 

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

10 as that term is defined in section 201 of the 

11 Federal Food, Drug, and Cosmetic Act and in12 cludes inhaled bronchodilators and auto13 injectable epinephrine. 

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

15 a student’s discretionary use of his or her pre16 scribed asthma or anaphylaxis medication, pur17 suant to a prescription or written direction 

18 from a health care practitioner.’’. 

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

20 section shall apply only with respect to grants made on 

21 or after the date that is 9 months after the date of the 

22 enactment of this Act. 
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1 SEC. 4. SENSE OF CONGRESS COMMENDING CDC FOR ITS 

2 STRATEGIES FOR ADDRESSING ASTHMA 

3 WITHIN A COORDINATED SCHOOL HEALTH 

4 PROGRAM. 

5 The Congress— 

6 (1) commends the Centers for Disease Control 

7 and Prevention for identifying and creating ‘‘Strate8 gies for Addressing Asthma Within a Coordinated 

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

10 (2) encourages all schools to review these strat11 egies and adopt policies that will best meet the needs 

12 of their student population. 

Passed the House of Representatives October 5, 

2004. 

Attest: JEFF TRANDAHL, 

Clerk.