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 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 
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 
2003’’.
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) Asthma is the most common cause of 
missed school days, accounting for approximately 
14,000,000 missed school days annually.
(9) Working parents of children with asthma 
lose an estimated $1,000,000,000 a year in produc-
tivity. 
(10) At least 18 States have legislation pro-
tecting the rights of children to carry and self-ad-
minister asthma metered-dose inhalers, and at least 
8 States expand this protection to epinephrine auto-
injectors. 
(11) Mere guidelines do not necessarily protect 
the rights of children in every school—tragic refus-
als of schools to permit students to carry their inhal-
ers and auto-injectable epinephrine have occurred, 
some resulting in death and spawning litigation. 
(12) Schools that restrict or revoke the rights 
of children to carry such inhalers and auto-injectable 
epinephrine put themselves and students with asth-
ma and severe allergic reactions, including anaphy-
laxis, at risk of death. Such schools also put other 
students at risk of witnessing a potentially life-
threatening asthma attack. 
(13) School district medication policies must be 
developed with the safety of all students in mind. 
Easy access to and correct use of asthma inhalers 
are necessary to avoid serious respiratory complica-
tions secondary to acute exacerbation and to im-
prove the quality of life of students with asthma. 
(14) No school should interfere with the pa-
tient-physician relationship. 
(15) 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. 
(16) Because asthma is a condition that often 
arises from allergies, it is critical to include anaphy-
laxis in asthma treatment. Specifically, the res-
piratory problems that arise during an asthma at-
tack usually occur because of a reaction to certain 
allergens, including dust, pollen, molds, and specific 
foods. 
(17) 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.
(18) Avoidance, early recognition, and prompt 
treatment are essential to the management of life-
threatening allergies. There are students and school 
staff who have known life-threatening allergies, and 
those who have not been identified. Prompt interven-
tion with epinephrine is vital to saving lives. 
SEC. 3. PREFERENCE FOR STATES THAT ALLOW STUDENTS 
TO 
SELF-ADMINISTER 
MEDICATION 
TO 
TREAT ASTHMA AND ANAPHYLAXIS. 
(a) PREFERENCE.—The Secretary of Health and 
Human Services, in making any grant that is asthma-re-
lated (as determined by the Secretary) to a State edu-
cational agency or a local educational agency, shall give 
preference to any State educational agency or local edu-
cational agency that is located in a State that satisfies 
the following: 
(1) IN GENERAL.—The State must require that 
each elementary school and secondary school (wheth-
er public or nonpublic) in that State will grant to 
any student in the school an authorization for the 
self-administration of medication to treat that stu-
dent’s asthma or anaphylaxis, if—
(A) a health care practitioner prescribed 
the medication for use by the student during
school hours and instructed the student in the 
correct and responsible use of the medication; 
(B) the student has demonstrated to the 
health care practitioner (or such practitioner’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 prescribed; 
(C) the health care practitioner formulates 
a written treatment plan for managing asthma 
or anaphylaxis episodes of the student and for 
medication use by the student during school 
hours; and 
(D) the student’s parent or guardian has 
completed and submitted to the school any writ-
ten documentation required by the school, in-
cluding the statement required by paragraph 
(5)(B) and the treatment plan formulated 
under subparagraph (C) of this paragraph. 
(2) SCOPE.—An authorization granted under 
paragraph (1) must allow the student involved to 
possess and use his or her medication—
(A) while in school; 
(B) while at a school-sponsored activity;
(C) during normal before-school and after-
school activities, such as before-school or after-
school care on school-operated property; and 
(D) in transit to or from school or school-
sponsored activities. 
(3) DURATION
OF
AUTHORIZATION.—An au-
thorization granted under paragraph (1)—
(A) must be effective only for the school 
year for which it is granted; and 
(B) must be renewed by the parent or 
guardian each subsequent school year in accord-
ance with this section. 
(4) STATE ACTION ON LIABILITY.—As an addi-
tional condition on receipt of a preference by a State 
educational agency or a local educational agency 
under this subsection, the State must address the 
potential liability of schools (including employees 
and agents of schools), parents, and guardians for 
any injury to a student or other individual resulting 
from the use or attempted use of the student’s asth-
ma or anaphylaxis medication. In addressing liability 
under this paragraph, a State must consult with 
stakeholders and interested parties, such as parents, 
representatives from education and health organiza-
tions and agencies (including the State board of edu-
cation, the State school board association, the State 
teacher association, the State medical association, 
and the State nurses association), and others in the 
educational or medical community. 
(5) SCHOOL
ACTION
ON
LIABILITY, INDEM-
NIFICATION.—A condition for an authorization 
under paragraph (1) is that, except for willful and 
wanton conduct—
(A) the school must, in writing, inform the 
parent or guardian of the student that the 
school (including its employees and agents) is 
to incur no liability as a result of any injury 
arising from self-administration of medication 
within the scope described in paragraph (2); 
and 
(B) the parent or guardian of the student 
must sign a statement acknowledging that not-
withstanding any provision of State law to the 
contrary—
(i) the school (including its employees 
and agents) is to incur no liability as a re-
sult of any injury arising from such self-
administration of medication; and 
(ii) the parent or guardian must in-
demnify and hold harmless the school (in-
cluding its employees and agents) against 
any claim arising out of such self-adminis-
tration of medication. 
(6) BACKUP MEDICATION.—The State must re-
quire that backup medication, if provided by a stu-
dent’s parent or guardian, be kept at a student’s 
school in a location easily accessible to the student 
in the event of an asthma or anaphylaxis emergency. 
(7) MAINTENANCE
OF
INFORMATION.—The 
State must require that information described in 
paragraphs (1)(C) and (1)(D) be kept on file at the 
student’s school in a location easily accessible in the 
event of an asthma or anaphylaxis emergency. 
(b) DEFINITIONS.—For purposes of this section: 
(1) The terms ‘‘elementary school’’ and ‘‘sec-
ondary school’’ have the meaning given to those 
terms in section 9101 of the Elementary and Sec-
ondary Education Act of 1965 (20 U.S.C. 7801). 
(2) The term ‘‘health care practitioner’’ means 
a person authorized under law to prescribe drugs 
subject to section 503(b) of the Federal Food, Drug, 
and Cosmetic Act (21 U.S.C. 353(b)).
(3) The term ‘‘medication’’ means a drug as 
that term is defined in section 201 of the Federal 
Food, Drug, and Cosmetic Act (21 U.S.C. 321) and
includes 
inhaled 
bronchodilators, 
inhaled 
corticosteroids, and auto-injectable epinephrine. 
(4) The term ‘‘Secretary’’ means the Secretary 
of Health and Human Services. 
(5) The term ‘‘self-administration’’ means a 
student’s discretionary use of his or her prescribed 
asthma or anaphylaxis medication, pursuant to pre-
scription or written direction from a health care 
practitioner. 
SEC. 4. SENSE OF CONGRESS REGARDING CDC’S STRATE-
GIES FOR ADDRESSING ASTHMA WITHIN A 
COORDINATED SCHOOL HEALTH PROGRAM. 
(a) FINDINGS.—The Congress finds as follows: 
(1) Possession and administration of medication 
is only 1 component of asthma and anaphylaxis 
management. 
(2) The Centers for Disease Control and Pre-
vention has identified 6 strategies for addressing 
asthma within a coordinated school health program. 
These strategies consist of the following: 
(A) Establishing management and support 
systems for asthma-friendly schools. 
(B) Providing appropriate school health 
and mental health services for students with 
asthma.
(C) 
Providing 
asthma 
education 
and 
awareness programs for students and school 
staff. 
(D) Providing a safe and healthy school 
environment to reduce asthma triggers. 
(E) Providing safe, enjoyable physical edu-
cation and activity opportunities for students 
with asthma. 
(F) Coordinating school, family, and com-
munity efforts to better manage asthma symp-
toms and reduce school absences among stu-
dents with asthma. 
(3) Providing appropriate school health and 
mental health services for students with asthma in-
cludes the following: 
(A) Obtaining a written asthma action 
plan for all students with asthma, which plan—
(i) should be developed by a primary 
care provider and provided by parents; and 
(ii) 
should 
include 
individualized 
emergency protocol, medications, peak flow 
monitoring, environmental triggers, and 
emergency contact information. 
(B) Sharing the plan with appropriate fac-
ulty and staff in accordance with guidelines
under section 444 of the General Education 
Provisions Act (20 U.S.C. 1232g; commonly re-
ferred to as the ‘‘Family Educational Rights 
and Privacy Act of 1974’’) or with parental 
permission. 
(C) Ensuring that—
(i) at all times students have options 
for immediate access to medications, as 
prescribed by a physician and approved by 
parents; and 
(ii) specific options, such as allowing 
students to self-carry and self-administer 
medications, are determined on a case-by-
case basis with input from the physician, 
parent, and school. 
(D) Using standard emergency protocols 
for students in respiratory distress if they do 
not have their own asthma action plan. 
(E) Ensuring that case management is 
provided for students with frequent school ab-
sences, school health office visits, emergency de-
partment visits, or hospitalizations due to asth-
ma. 
(F) Providing a full-time registered nurse 
all day, every day for each school.
(G) Ensuring access to a consulting physi-
cian for each school. 
(H) Referring students without a primary 
care provider to child health insurance pro-
grams and providers. 
(I) Providing and coordinating school-
based counseling, psychological, and social serv-
ices for students with asthma, as appropriate. 
(J) Coordinating with community services. 
(b) EXPRESSION OF SUPPORT.—The Congress sup-
ports the goals and ideals of the strategies identified by 
the Centers for Disease Control and Prevention for ad-
dressing asthma within a coordinated school health pro-
gram.
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