II 

108TH CONGRESS 

2D SESSION S. 2815

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 SENATE OF THE UNITED STATES 

SEPTEMBER 20, 2004

Mr. DEWINE (for himself and Mr. KENNEDY) introduced the following bill; 

which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

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 Congress finds the following: 
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1 (1) Asthma is a chronic condition requiring life2 time, ongoing medical intervention. 

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

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

5 and 6,300,000 children under age 18 had asthma. 

6 (4) The prevalence of asthma among African7 American children was 40 percent greater than 

8 among Caucasian children, and more than 26 per9 cent of all asthma deaths are in the African-Amer10 ican population. 

11 (5) In 2000, there were 1,800,000 asthma-re12 lated visits to emergency departments (more than 

13 728,000 of these involved children under 18 years of 

14 age). 

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

16 hospitalizations (214,000 of these involved children 

17 under 18 years of age). 

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

19 and of these 223 were children. 

20 (8) According to the Centers for Disease Con21 trol and Prevention, asthma is a common cause of 

22 missed school days, accounting for approximately 

23 14,000,000 missed school days annually. 

24 (9) According to the New England Journal of 

25 Medicine, working parents of children with asthma 
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1 lose an estimated $1,000,000,000 a year in produc2 tivity. 

3 (10) At least 30 States have legislation pro4 tecting the rights of children to carry and self-ad5 minister asthma metered-dose inhalers, and at least 

6 18 States expand this protection to epinephrine 

7 auto-injectors. 

8 (11) Tragic refusals of schools to permit stu9 dents to carry their inhalers and auto-injectable epi10 nephrine have occurred, some resulting in death and 

11 spawning litigation. 

12 (12) School district medication policies must be 

13 developed with the safety of all students in mind. 

14 The immediate and correct use of asthma inhalers 

15 and auto-injectable epinephrine are necessary to 

16 avoid serious respiratory complications and improve 

17 health care outcomes. 

18 (13) No school should interfere with the pa19 tient-physician relationship. 

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

21 systemic allergic reaction that can kill within min22 utes. Anaphylaxis occurs in some asthma patients. 

23 According to the American Academy of Allergy, 

24 Asthma, and Immunology, people who have experi25 enced symptoms of anaphylaxis previously are at 
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1 risk for subsequent reactions and should carry an 

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

3 prescribed. 

4 (15) An increasing number of students and 

5 school staff have life-threatening allergies. Exposure 

6 to the affecting allergen can trigger anaphylaxis. An7 aphylaxis requires prompt medical intervention with 

8 an injection of epinephrine. 

9 SEC. 3. PREFERENCE FOR STATES THAT ALLOW STUDENTS 

10 TO SELF-ADMINISTER MEDICATION TO 

11 TREAT ASTHMA AND ANAPHYLAXIS. 

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

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

14 (1) by redesignating subsection (d) as sub15 section (e); and 

16 (2) by inserting after subsection (c) the fol17 lowing: 

18 ‘‘(d) PREFERENCE FOR STATES THAT ALLOW STU19 DENTS TO SELF-ADMINISTER MEDICATION TO TREAT

20 ASTHMA AND ANAPHYLAXIS.—

21 ‘‘(1) PREFERENCE.—The Secretary, in award22 ing any grant under this section or any other grant 

23 that is asthma-related (as determined by the Sec24 retary) to a State, shall give preference to any State 

25 that satisfies the following:
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1 ‘‘(A) IN GENERAL.—The State must re2 quire that each public elementary school and 

3 secondary school in that State will grant to any 

4 student in the school an authorization for the 

5 self-administration of medication to treat that 

6 student’s asthma or anaphylaxis, if—

7 ‘‘(i) a health care practitioner pre8 scribed the medication for use by the stu9 dent during school hours and instructed 

10 the student in the correct and responsible 

11 use of the medication; 

12 ‘‘(ii) the student has demonstrated to 

13 the health care practitioner (or such prac14 titioner’s designee) and the school nurse (if 

15 available) the skill level necessary to use 

16 the medication and any device that is nec17 essary to administer such medication as 

18 prescribed; 

19 ‘‘(iii) the health care practitioner for20 mulates a written treatment plan for man21 aging asthma or anaphylaxis episodes of 

22 the student and for medication use by the 

23 student during school hours; and 

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

25 has completed and submitted to the school 
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1 any written documentation required by the 

2 school, including the treatment plan for3 mulated under clause (iii) and other docu4 ments related to liability. 

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

6 under subparagraph (A) must allow the student 

7 involved to possess and use his or her medica8 tion—

9 ‘‘(i) while in school; 

10 ‘‘(ii) while at a school-sponsored activ11 ity, such as a sporting event; and 

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

13 school-sponsored activities. 

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

15 authorization granted under subparagraph 

16 (A)—

17 ‘‘(i) must be effective only for the 

18 same school and school year for which it is 

19 granted; and 

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

21 or guardian each subsequent school year in 

22 accordance with this subsection. 

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

24 must require that backup medication, if pro25 vided by a student’s parent or guardian, be 
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1 kept at a student’s school in a location to which 

2 the student has immediate access in the event 

3 of an asthma or anaphylaxis emergency. 

4 ‘‘(E) MAINTENANCE OF INFORMATION.—

5 The State must require that information de6 scribed in clauses (iii) and (iv) of subparagraph 

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

8 location easily accessible in the event of an 

9 asthma or anaphylaxis emergency. 

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

11 this subsection creates a cause of action or in any 

12 other way increases or diminishes the liability of any 

13 person under any other law. 

14 ‘‘(3) DEFINITIONS.—For purposes of this sub15 section: 

16 ‘‘(A) ELEMENTARY SCHOOL AND SEC17 ONDARY SCHOOL.—The terms ‘elementary 

18 school’ and ‘secondary school’ have the mean19 ings given to those terms in section 9101 of the 

20 Elementary and Secondary Education Act of 

21 1965. 

22 ‘‘(B) HEALTH CARE PRACTITIONER.—The 

23 term ‘health care practitioner’ means a person 

24 authorized under law to prescribe drugs subject 
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1 to section 503(b) of the Federal Food, Drug, 

2 and Cosmetic Act. 

3 ‘‘(C) MEDICATION.—The term ‘medication’ 

4 means a drug as that term is defined in section 

5 201 of the Federal Food, Drug, and Cosmetic 

6 Act and includes inhaled bronchodilators and 

7 auto-injectable epinephrine. 

8 ‘‘(D) SELF-ADMINISTRATION.—The term 

9 ‘self-administration’ means a student’s discre10 tionary use of his or her prescribed asthma or 

11 anaphylaxis medication, pursuant to a prescrip12 tion or written direction from a health care 

13 practitioner.’’. 

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

15 section shall apply only with respect to grants made on 

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

17 enactment of this Act. 

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

19 STRATEGIES FOR ADDRESSING ASTHMA 

20 WITHIN A COORDINATED SCHOOL HEALTH 

21 PROGRAM. 

22 It is the sense of Congress—

23 (1) to commend the Centers for Disease Control 

24 and Prevention for identifying and creating ‘‘Strate-
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1 gies for Addressing Asthma Within a Coordinated 

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

3 (2) to encourage all schools to review these 

4 strategies and adopt policies that will best meet the 

5 needs of their student population.

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