IB 
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 anaphy-
laxis, 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 Edu-
cation and the Workforce, for a period to be subsequently determined by 
the Speaker, in each case for consideration of such provisions as fall with-
in 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,
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 pur-
poses. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Asthmatic School-
children’s Treatment and Health Management Act of 
2004’’. 
SEC. 2. FINDINGS. 
The Congress finds the following: 
(1) Asthma is a chronic condition requiring life-
time, 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 produc-
tivity. 
(10) At least 30 States have legislation pro-
tecting the rights of children to carry and self-admin-
ister 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 epineph-
rine have occurred, some resulting in death and 
spawning litigation. 
(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 se-
rious 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 min-
utes. Anaphylaxis occurs in some asthma patients. 
According to the American Academy of Allergy, Asth-
ma, 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. Ana-
phylaxis requires prompt medical intervention with 
an injection of epinephrine. 
SEC. 3. PREFERENCE FOR STATES THAT ALLOW STUDENTS 
TO SELF-ADMINISTER 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 fol-
lowing: 
‘‘(d) PREFERENCE FOR STATES THAT ALLOW STU-
DENTS
TO
SELF-ADMINISTER
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-adminis-
tration of medication to treat that student’s asth-
ma or anaphylaxis, if—
‘‘(i) a health care practitioner pre-
scribed the medication for use by the stu-
dent 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 practi-
tioner’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 pre-
scribed; 
‘‘(iii) the health care practitioner for-
mulates a written treatment plan for man-
aging asthma or anaphylaxis episodes of the 
student and for medication use by the stu-
dent 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 formu-
lated under clause (iii) and other documents 
related to liability. 
‘‘(B) SCOPE.—An authorization granted 
under subparagraph (A) must allow the student
involved to possess and use his or her medica-
tion— 
‘‘(i) while in school; 
‘‘(ii) while at a school-sponsored activ-
ity, 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 grant-
ed; and 
‘‘(ii) must be renewed by the parent or 
guardian each subsequent school year in ac-
cordance 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 stu-
dent 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 anaphy-
laxis 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 per-
son under any other law. 
‘‘(3) DEFINITIONS.—For purposes of this sub-
section: 
‘‘(A) The terms ‘elementary school’ and ‘sec-
ondary 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 pre-
scribe drugs subject to section 503(b) of the Fed-
eral Food, Drug, and Cosmetic Act. 
‘‘(C) The term ‘medication’ means a drug 
as that term is defined in section 201 of the Fed-
eral Food, Drug, and Cosmetic Act and includes 
inhaled bronchodilators and auto-injectable epi-
nephrine. 
‘‘(D) The term ‘self-administration’ means 
a student’s discretionary use of his or her pre-
scribed asthma or anaphylaxis medication, pur-
suant 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 enact-
ment 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 ‘‘Strate-
gies for Addressing Asthma Within a Coordinated 
School Program’’ for schools to address asthma; and 
(2) encourages all schools to review these strate-
gies and adopt policies that will best meet the needs 
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 
schools to allow students to self-administer medi-
cation to treat that student’s asthma or anaphy-
laxis, and for other purposes. 
JULY 14, 2004 
Reported from the Committee on Energy and Commerce 
with an amendment 
JULY 14, 2004 
Referral to the Committee on Education and the Work-
force extended for a period ending not later than July 
14, 2004 
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