108TH CONGRESS
2D SESSION
H. R. 2023
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 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 asth-
ma; 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 per-
cent of all asthma deaths are in the African-Amer-
ican population.
(5) In 2000, there were 1,800,000 asthma-re-
lated 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 Con-
trol 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-ad-
minister asthma metered-dose inhalers, and at least
18 States expand this protection to epinephrine
auto-injectors.
(11) Tragic refusals of schools to permit stu-
dents to carry their inhalers and auto-injectable epi-
nephrine 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 serious respiratory complications and improve
health care outcomes.
(13) No school should interfere with the pa-
tient-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,
Asthma, and Immunology, people who have experi-
enced 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. An-
aphylaxis 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 sub-
section (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 re-
quire 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 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 prac-
titioner’s designee) and the school nurse (if
available) the skill level necessary to use
the medication and any device that is nec-
essary to administer such medication as
prescribed;
‘‘(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
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 for-
mulated under clause (iii) and other docu-
ments related to liability.
‘‘(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 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
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 pro-
vided 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 de-
scribed 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 sub-
section:
‘‘(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 pre-
scribe 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 in-
cludes 
inhaled 
bronchodilators 
and 
auto-
injectable epinephrine.
‘‘(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
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 ‘‘Strate-
gies for Addressing Asthma Within a Coordinated
School Program’’ for schools to address asthma; and
(2) encourages all schools to review these strat-
egies and adopt policies that will best meet the needs
of their student population.
Passed the House of Representatives October 5,
2004.
Attest:
Clerk.