Asthmatic Schoolchildren's Treatment and Health Management Act of 2004
PL 108-377 (H.R.2023), enacted 10/30/2004

118 STAT. 2202
PUBLIC LAW 108–377—OCT. 30, 2004
Public Law 108–377
108th Congress
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 purposes.
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Asthmatic Schoolchildren’s Treat-
ment and Health Management Act of 2004’’.
SEC. 2. FINDINGS.
The Congress finds the following:
(1) Asthma is a chronic condition requiring lifetime, 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 chil-
dren 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 hospitaliza-
tions (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 productivity.
(10) At least 30 States have legislation protecting the rights
of children to carry and self-administer 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 epinephrine have occurred,
some resulting in death and spawning litigation.
42 USC 280g
note.
42 USC 201 note.
Asthmatic
Schoolchildren’s
Treatment and
Health
Management Act
of 2004.
Oct. 30, 2004
[H.R. 2023]
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118 STAT. 2203
PUBLIC LAW 108–377—OCT. 30, 2004
(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 patient-physician
relationship.
(14) Anaphylaxis, or anaphylactic shock, is a systemic
allergic reaction that can kill within minutes. Anaphylaxis
occurs in some asthma patients. According to the American
Academy of Allergy, Asthma, 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. Anaphylaxis 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 following:
‘‘(d) PREFERENCE FOR STATES THAT ALLOW STUDENTS 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 pref-
erence 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-administration of medication to treat that stu-
dent’s asthma or anaphylaxis, if—
‘‘(i) a health care practitioner prescribed the medi-
cation for use by the student 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 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;
‘‘(iii) the health care practitioner formulates a writ-
ten 
treatment 
plan 
for 
managing 
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 com-
pleted and submitted to the school any written docu-
mentation required by the school, including the treat-
ment plan formulated under clause (iii) and other docu-
ments related to liability.
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118 STAT. 2204
PUBLIC LAW 108–377—OCT. 30, 2004
‘‘(B) SCOPE.—An authorization granted under subpara-
graph (A) must allow the student involved to possess and
use his or her medication—
‘‘(i) while in school;
‘‘(ii) while at a school-sponsored activity, such as
a sporting event; and
‘‘(iii) in transit to or from school or school-spon-
sored 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 provided 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 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
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 subsection:
‘‘(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 prescribe 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 includes inhaled bronchodilators and
auto-injectable epinephrine.
‘‘(D) The term ‘self-administration’ means a student’s
discretionary use of his or her prescribed asthma or
anaphylaxis medication, pursuant to a prescription or writ-
ten 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 Preven-
tion for identifying and creating ‘‘Strategies for Addressing
Asthma Within a Coordinated School Program’’ for schools to
address asthma; and
42 USC 280g
note.
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118 STAT. 2205
PUBLIC LAW 108–377—OCT. 30, 2004
LEGISLATIVE HISTORY—H.R. 2023 (S. 2815):
HOUSE REPORTS: No. 108–606, Pt. 1 (Comm. on Energy and Commerce).
SENATE REPORTS: No. 108–395 accompanying S. 2815 (Comm. on Health,
Education, Labor, and Pensions).
CONGRESSIONAL RECORD, Vol. 150 (2004):
Oct. 5, considered and passed House.
Oct. 11, considered and passed Senate.
(2) encourages all schools to review these strategies and
adopt policies that will best meet the needs of their student
population.
Approved October 30, 2004.
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