I 

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.

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 2003’’. 
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1 SEC. 2. FINDINGS. 

2 The Congress finds the following: 

3 (1) Asthma is a chronic condition requiring life4 time, ongoing medical intervention. 

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

6 (3) In 2001, 20,300,000 Americans had asth7 ma; 6,300,000 children under age 18 had asthma. 

8 (4) The prevalence of asthma among African9 American children was 40 percent greater than 

10 among Caucasian children, and more than 26 per11 cent of all asthma deaths are in the African-Amer12 ican population. 

13 (5) In 2000, there were 1,800,000 asthma-re14 lated visits to emergency departments (more than 

15 728,000 of these involved children under 18 years of 

16 age). 

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

18 hospitalizations (214,000 of these involved children 

19 under 18 years of age). 

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

21 and of these 223 were children. 

22 (8) Asthma is the most common cause of 

23 missed school days, accounting for approximately 

24 14,000,000 missed school days annually. 
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1 (9) Working parents of children with asthma 

2 lose an estimated $1,000,000,000 a year in produc3 tivity. 

4 (10) At least 18 States have legislation pro5 tecting the rights of children to carry and self-ad6 minister asthma metered-dose inhalers, and at least 

7 8 States expand this protection to epinephrine auto8 injectors. 

9 (11) Mere guidelines do not necessarily protect 

10 the rights of children in every school—tragic refus11 als of schools to permit students to carry their inhal12 ers and auto-injectable epinephrine have occurred, 

13 some resulting in death and spawning litigation. 

14 (12) Schools that restrict or revoke the rights 

15 of children to carry such inhalers and auto-injectable 

16 epinephrine put themselves and students with asth17 ma and severe allergic reactions, including anaphy18 laxis, at risk of death. Such schools also put other 

19 students at risk of witnessing a potentially life20 threatening asthma attack. 

21 (13) School district medication policies must be 

22 developed with the safety of all students in mind. 

23 Easy access to and correct use of asthma inhalers 

24 are necessary to avoid serious respiratory complica-
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1 tions secondary to acute exacerbation and to im2 prove the quality of life of students with asthma. 

3 (14) No school should interfere with the pa4 tient-physician relationship. 

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

6 systemic allergic reaction that can kill within min7 utes. Anaphylaxis occurs in some asthma patients. 

8 According to the American Academy of Allergy, 

9 Asthma, and Immunology, people who have experi10 enced symptoms of anaphylaxis previously are at 

11 risk for subsequent reactions and should carry an 

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

13 prescribed. 

14 (16) Because asthma is a condition that often 

15 arises from allergies, it is critical to include anaphy16 laxis in asthma treatment. Specifically, the res17 piratory problems that arise during an asthma at18 tack usually occur because of a reaction to certain 

19 allergens, including dust, pollen, molds, and specific 

20 foods. 

21 (17) An increasing number of students and 

22 school staff have life-threatening allergies. Exposure 

23 to the affecting allergen can trigger anaphylaxis. An24 aphylaxis requires prompt medical intervention with 

25 an injection of epinephrine. 
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1 (18) Avoidance, early recognition, and prompt 

2 treatment are essential to the management of life3 threatening allergies. There are students and school 

4 staff who have known life-threatening allergies, and 

5 those who have not been identified. Prompt interven6 tion with epinephrine is vital to saving lives. 

7 SEC. 3. PREFERENCE FOR STATES THAT ALLOW STUDENTS 

8 TO SELF-ADMINISTER MEDICATION TO 

9 TREAT ASTHMA AND ANAPHYLAXIS. 

10 (a) PREFERENCE.—The Secretary of Health and 

11 Human Services, in making any grant that is asthma-re12 lated (as determined by the Secretary) to a State edu13 cational agency or a local educational agency, shall give 

14 preference to any State educational agency or local edu15 cational agency that is located in a State that satisfies 

16 the following: 

17 (1) IN GENERAL.—The State must require that 

18 each elementary school and secondary school (wheth19 er public or nonpublic) in that State will grant to 

20 any student in the school an authorization for the 

21 self-administration of medication to treat that stu22 dent’s asthma or anaphylaxis, if—

23 (A) a health care practitioner prescribed 

24 the medication for use by the student during 
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1 school hours and instructed the student in the 

2 correct and responsible use of the medication; 

3 (B) the student has demonstrated to the 

4 health care practitioner (or such practitioner’s 

5 designee) and the school nurse (if available) the 

6 skill level necessary to use the medication and 

7 any device that is necessary to administer such 

8 medication as prescribed; 

9 (C) the health care practitioner formulates 

10 a written treatment plan for managing asthma 

11 or anaphylaxis episodes of the student and for 

12 medication use by the student during school 

13 hours; and 

14 (D) the student’s parent or guardian has 

15 completed and submitted to the school any writ16 ten documentation required by the school, in17 cluding the statement required by paragraph 

18 (5)(B) and the treatment plan formulated 

19 under subparagraph (C) of this paragraph. 

20 (2) SCOPE.—An authorization granted under 

21 paragraph (1) must allow the student involved to 

22 possess and use his or her medication—

23 (A) while in school; 

24 (B) while at a school-sponsored activity; 
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1 (C) during normal before-school and after2 school activities, such as before-school or after3 school care on school-operated property; and 

4 (D) in transit to or from school or school5 sponsored activities. 

6 (3) DURATION OF AUTHORIZATION.—An au7 thorization granted under paragraph (1)—

8 (A) must be effective only for the school 

9 year for which it is granted; and 

10 (B) must be renewed by the parent or 

11 guardian each subsequent school year in accord12 ance with this section. 

13 (4) STATE ACTION ON LIABILITY.—As an addi14 tional condition on receipt of a preference by a State 

15 educational agency or a local educational agency 

16 under this subsection, the State must address the 

17 potential liability of schools (including employees 

18 and agents of schools), parents, and guardians for 

19 any injury to a student or other individual resulting 

20 from the use or attempted use of the student’s asth21 ma or anaphylaxis medication. In addressing liability 

22 under this paragraph, a State must consult with 

23 stakeholders and interested parties, such as parents, 

24 representatives from education and health organiza25 tions and agencies (including the State board of edu-
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1 cation, the State school board association, the State 

2 teacher association, the State medical association, 

3 and the State nurses association), and others in the 

4 educational or medical community. 

5 (5) SCHOOL ACTION ON LIABILITY, INDEM6 NIFICATION.—A condition for an authorization 

7 under paragraph (1) is that, except for willful and 

8 wanton conduct—

9 (A) the school must, in writing, inform the 

10 parent or guardian of the student that the 

11 school (including its employees and agents) is 

12 to incur no liability as a result of any injury 

13 arising from self-administration of medication 

14 within the scope described in paragraph (2); 

15 and 

16 (B) the parent or guardian of the student 

17 must sign a statement acknowledging that not18 withstanding any provision of State law to the 

19 contrary—

20 (i) the school (including its employees 

21 and agents) is to incur no liability as a re22 sult of any injury arising from such self23 administration of medication; and 

24 (ii) the parent or guardian must in25 demnify and hold harmless the school (in-
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1 cluding its employees and agents) against 

2 any claim arising out of such self-adminis3 tration of medication. 

4 (6) BACKUP MEDICATION.—The State must re5 quire that backup medication, if provided by a stu6 dent’s parent or guardian, be kept at a student’s 

7 school in a location easily accessible to the student 

8 in the event of an asthma or anaphylaxis emergency. 

9 (7) MAINTENANCE OF INFORMATION.—The 

10 State must require that information described in 

11 paragraphs (1)(C) and (1)(D) be kept on file at the 

12 student’s school in a location easily accessible in the 

13 event of an asthma or anaphylaxis emergency. 

14 (b) DEFINITIONS.—For purposes of this section: 

15 (1) The terms ‘‘elementary school’’ and ‘‘sec16 ondary school’’ have the meaning given to those 

17 terms in section 9101 of the Elementary and Sec18 ondary Education Act of 1965 (20 U.S.C. 7801). 

19 (2) The term ‘‘health care practitioner’’ means 

20 a person authorized under law to prescribe drugs 

21 subject to section 503(b) of the Federal Food, Drug, 

22 and Cosmetic Act (21 U.S.C. 353(b)).

23 (3) The term ‘‘medication’’ means a drug as 

24 that term is defined in section 201 of the Federal 

25 Food, Drug, and Cosmetic Act (21 U.S.C. 321) and 
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1 includes inhaled bronchodilators, inhaled 

2 corticosteroids, and auto-injectable epinephrine. 

3 (4) The term ‘‘Secretary’’ means the Secretary 

4 of Health and Human Services. 

5 (5) The term ‘‘self-administration’’ means a 

6 student’s discretionary use of his or her prescribed 

7 asthma or anaphylaxis medication, pursuant to pre8 scription or written direction from a health care 

9 practitioner. 

10 SEC. 4. SENSE OF CONGRESS REGARDING CDC’S STRATE11 GIES FOR ADDRESSING ASTHMA WITHIN A 

12 COORDINATED SCHOOL HEALTH PROGRAM. 

13 (a) FINDINGS.—The Congress finds as follows: 

14 (1) Possession and administration of medication 

15 is only 1 component of asthma and anaphylaxis 

16 management. 

17 (2) The Centers for Disease Control and Pre18 vention has identified 6 strategies for addressing 

19 asthma within a coordinated school health program. 

20 These strategies consist of the following: 

21 (A) Establishing management and support 

22 systems for asthma-friendly schools. 

23 (B) Providing appropriate school health 

24 and mental health services for students with 

25 asthma. 
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1 (C) Providing asthma education and 

2 awareness programs for students and school 

3 staff. 

4 (D) Providing a safe and healthy school 

5 environment to reduce asthma triggers. 

6 (E) Providing safe, enjoyable physical edu7 cation and activity opportunities for students 

8 with asthma. 

9 (F) Coordinating school, family, and com10 munity efforts to better manage asthma symp11 toms and reduce school absences among stu12 dents with asthma. 

13 (3) Providing appropriate school health and 

14 mental health services for students with asthma in15 cludes the following: 

16 (A) Obtaining a written asthma action 

17 plan for all students with asthma, which plan—

18 (i) should be developed by a primary 

19 care provider and provided by parents; and 

20 (ii) should include individualized 

21 emergency protocol, medications, peak flow 

22 monitoring, environmental triggers, and 

23 emergency contact information. 

24 (B) Sharing the plan with appropriate fac25 ulty and staff in accordance with guidelines 
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1 under section 444 of the General Education 

2 Provisions Act (20 U.S.C. 1232g; commonly re3 ferred to as the ‘‘Family Educational Rights 

4 and Privacy Act of 1974’’) or with parental 

5 permission. 

6 (C) Ensuring that—

7 (i) at all times students have options 

8 for immediate access to medications, as 

9 prescribed by a physician and approved by 

10 parents; and 

11 (ii) specific options, such as allowing 

12 students to self-carry and self-administer 

13 medications, are determined on a case-by14 case basis with input from the physician, 

15 parent, and school. 

16 (D) Using standard emergency protocols 

17 for students in respiratory distress if they do 

18 not have their own asthma action plan. 

19 (E) Ensuring that case management is 

20 provided for students with frequent school ab21 sences, school health office visits, emergency de22 partment visits, or hospitalizations due to asth23 ma. 

24 (F) Providing a full-time registered nurse 

25 all day, every day for each school. 
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1 (G) Ensuring access to a consulting physi2 cian for each school. 

3 (H) Referring students without a primary 

4 care provider to child health insurance pro5 grams and providers. 

6 (I) Providing and coordinating school7 based counseling, psychological, and social serv8 ices for students with asthma, as appropriate. 

9 (J) Coordinating with community services. 

10 (b) EXPRESSION OF SUPPORT.—The Congress sup11 ports the goals and ideals of the strategies identified by 

12 the Centers for Disease Control and Prevention for ad13 dressing asthma within a coordinated school health pro14 gram.

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