SB 25-FN - AS INTRODUCED
2015 SESSION
15-0621
04/09
SENATE BILL 25-FN
AN ACT relative to epinephrine administered in schools.
SPONSORS: Sen. D'Allesandro, Dist 20
This bill allows schools and certain authorized entities to acquire and maintain a supply of epinephrine auto-injectors, requires designated school personnel to receive training in the administration of an epinephrine auto-injector, establishes immunity from civil liability for the good faith acts of individuals administering an epinephrine auto-injector to a student, and establishes an exemption from criminal liability for pharmacists to prescribe epinephrine for use in the schools.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
15-0621
04/09
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Fifteen
AN ACT relative to epinephrine administered in schools.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Sections; Pupil Use of Epinephrine Auto-Injectors; Definitions. Amend RSA 200 by inserting after section 44 the following new sections:
200:44-a Definitions. As used in RSA 200:44-b through RSA 200:44-e:
I. “Administer” means the direct application of an epinephrine auto-injector to the body of an individual.
II. “Authorized entity” means any entity or organization, other than a school, in which allergens capable of causing anaphylaxis may be present, including recreation camps, colleges, universities, and day care facilities.
III. “Designated school personnel” means an employee, agent, or volunteer of a school designated by the governing authority of the school who has completed the training required under RSA 200:44-d to provide or administer an epinephrine auto-injector.
IV. “Epinephrine auto-injector” means a single-use device used for the automatic injection of a premeasured dose of epinephrine into the human body.
V. “Health care practitioner” means a person who is lawfully entitled to prescribe, administer, dispense, or distribute controlled drugs.
VI. “Provide” means the supply of one or more epinephrine auto-injectors to an individual.
VII. “School” means any elementary, junior high, or senior high school.
VIII. “Self-administration” means a student or other person’s discretionary use of an epinephrine auto-injector, whether provided by the student or by a school nurse or designated school personnel pursuant to this subdivision.
200:44-b School Supply of Epinephrine Auto-Injectors.
I. A health care practitioner may prescribe epinephrine auto-injectors in the name of a school for use in accordance with RSA 200:44-c and pharmacists may dispense epinephrine auto-injectors pursuant to a prescription issued in the name of a school. A school may maintain a supply of epinephrine auto-injectors for use in accordance with this section.
II. A school may enter into arrangements with manufacturers of epinephrine auto-injectors or third-party suppliers of epinephrine auto-injectors to obtain epinephrine auto-injectors at fair-market, free, or reduced prices.
III. A school that possesses and makes available a supply of epinephrine auto-injectors pursuant to this section shall submit to the department of education, on a form developed by the department of education, a report of each incident that involves a severe allergic reaction or the administration of an epinephrine auto-injector. The department of education shall annually publish a report that summarizes and analyzes all reports submitted to it under this paragraph.
200:44-c Emergency Administration. School nurses and designated school personnel may, upon authorization by the school district, use epinephrine auto-injectors prescribed pursuant to RSA 200:44-b to:
I. Provide an epinephrine auto-injector to a student for self-administration in accordance with a prescription specific to the student on file with the school;
II. Administer an epinephrine auto-injector to a student in accordance with a prescription specific to the student on file with the school; and
III. Administer an epinephrine auto-injector to any student or other individual, on school premises, at school-sponsored events, or at any other time the student or individual is subject to the school’s jurisdiction or supervision, who the school nurse or designated school personnel believes in good faith is experiencing anaphylaxis in accordance with a standing protocol from a health care practitioner, regardless of whether the student or other individual has a prescription for an epinephrine auto-injector or has previously been diagnosed with an allergy.
200:44-d Training and School Policies.
I.(a) Designated school personnel shall complete an anaphylaxis training program prior to providing or administering an epinephrine auto-injector made available by a school and at least every 2 years following completion of the initial anaphylaxis training program. Such training shall be conducted by a nationally recognized organization experienced in training laypersons in emergency health treatment or an entity or individual approved by the department of health and human services. Training may be conducted online or in person and, at a minimum, shall cover:
(1) Techniques on how to recognize symptoms of severe allergic reactions, including anaphylaxis.
(2) Standards and procedures for the storage and administration of an epinephrine auto-injector.
(3) Emergency follow-up procedures.
(b) The entity that conducts the training shall issue a certificate, on a form developed or approved by the department of health and human services, to each person who successfully completes the anaphylaxis training program.
II. Not later than July 1, 2015, the department of education, in consultation with the department of health and human services, shall develop and make available to all schools guidelines for the management of students with life-threatening food allergies. The guidelines shall include, but not be limited to education and training for school personnel on the management of students with life-threatening allergies, including training related to the administration of an epinephrine auto-injector; procedures for responding to life-threatening allergic reactions; a process for the development of individualized health care and allergy action plans for every student with a known life-threatening allergy; and protocols to prevent exposure to allergens. Not later than January 1, 2016, each school district shall implement a plan based on the guidelines developed pursuant to this section for the management of students with life-threatening allergies enrolled in the schools under its jurisdiction, and make such plan available on the school district’s public Internet website or the public Internet website of each school under the school district’s jurisdiction, or if such websites do not exist, make such plan publicly available through other practicable means as determined by the school district.
200:44-e Authorized Entities.
I. A health care practitioner may prescribe epinephrine auto-injectors in the name of an authorized entity for use in accordance with RSA 200:44-b through RSA 200:44-d, and pharmacists and health care practitioners may dispense epinephrine auto-injectors pursuant to a prescription issued in the name of an authorized entity.
II. An authorized entity may acquire and maintain a supply of epinephrine auto-injectors pursuant to a prescription issued in accordance with this section. Such epinephrine auto-injectors shall be stored in a location readily accessible in an emergency and in accordance with the instructions for use, and any additional requirements that may be established by the department of health and human services. An authorized entity shall designate employees or agents who have completed the training required by RSA 200:44-d to be responsible for the storage, maintenance, control, and general oversight of epinephrine auto-injectors acquired by the authorized entity.
III. An employee or agent of an authorized entity, or other individual, who has completed the training required by RSA 200:44-d may use epinephrine auto-injectors prescribed pursuant to this section to:
(a) Provide an epinephrine auto-injector to any individual who the employee agent or other individual believes in good faith is experiencing anaphylaxis, or the parent, guardian, or caregiver of such individual, for immediate administration, regardless of whether the individual has a prescription for an epinephrine auto-injector or has previously been diagnosed with an allergy.
(b) Administer an epinephrine auto-injector to any individual who the employee, agent, or other individual believes in good faith is experiencing anaphylaxis, regardless of whether the individual has a prescription for an epinephrine auto-injector or has previously been diagnosed with an allergy.
IV.(a) An employee, agent, or other individual described in paragraph III shall complete an anaphylaxis training program at least every 2 years, following completion of the initial anaphylaxis training program. Such training shall be conducted by a nationally recognized organization experienced in training laypersons in emergency health treatment or an entity or individual approved by the department of health and human services. The department of health and human services may approve specific entities or individuals or may approve classes of entities or individuals to conduct training. Training may be conducted online or in person and, at a minimum, shall cover:
(1) How to recognize signs and symptoms of severe allergic reactions, including
anaphylaxis;
(2) Standards and procedures for the storage and administration of an epinephrine auto-injector; and
(3) Emergency follow-up procedures.
(b) The entity that conducts the training shall issue a certificate, on a form developed or approved by the department of health and human services, to each person who successfully completes the anaphylaxis training program.
V. No authorized entity that possesses and makes available epinephrine auto-injectors and its employees, agents, and other individuals, or health care practitioner that prescribes or dispenses epinephrine auto-injectors to an authorized entity, or pharmacist or health care practitioner that dispenses epinephrine auto-injectors to an authorized entity, or individual or entity that conducts the training described in RSA 200:44-d, shall be liable for any injuries or related damages that result from any act or omission pursuant to this section, unless such injury or damage is the result of willful or wanton misconduct. The administration of an epinephrine auto-injector in accordance with this section shall not be considered to be the practice of medicine or any other profession that otherwise requires licensure. This section shall not be construed to eliminate, limit, or reduce any other immunity or defense that may be available under state law. An entity located in this state shall not be liable for any injuries or related damages that result from the provision or administration of an epinephrine auto-injector outside of this state if the entity would not have been liable for such injuries or related damages had the provision or administration occurred within this state, or is not liable for such injuries or related damages under the law of the state in which such provision or administration occurred.
VI. An authorized entity that possesses and makes available epinephrine auto-injectors shall submit to the department of health and human services, on a form developed by the department of health and human services, a report of each incident on the authorized entity’s premises that involves the administration of an epinephrine auto injector pursuant to RSA 200:44-c. The department of health and human services shall annually publish a report that summarizes and analyzes all reports submitted to it under this section.
2 Pupil Use of Epinephrine Auto-Injectors; Immunity. Amend RSA 200:45 to read as follows:
200:45 Immunity.
I. No school district, member of a school board, or school district employee shall be liable in a suit for damages as a result of any act or omission related to a pupil’s use of an epinephrine auto-injector pursuant to RSA 200:43, if the provisions of RSA 200:42 have been met, unless the damages were caused by willful or wanton conduct or disregard of the criteria established in that section for the possession and self-administration of an epinephrine auto-injector by a pupil.
II. No school that possesses and makes available epinephrine auto-injectors, member of its school board, school nurse, school district employee, agents or volunteers, no health care practitioner that prescribes epinephrine auto-injectors to a school, and no person that conducts the training described in RSA 200:44-d shall be liable for damages as a result of the administration or self-administration of an epinephrine auto-injector, the failure to administer an epinephrine auto-injector, or any other act or omission related to the possession or use of an epinephrine auto-injector, unless the damages were caused by willful or wanton misconduct.
III. The administration of an epinephrine auto-injector in accordance with this section shall not constitute the practice of medicine or any other profession that otherwise requires licensure.
IV. This section shall not be construed to eliminate, limit, or reduce any other immunity or defense that may be available under state law.
3 Regulation of Pharmacies; Dealing in or Possessing Drugs. Amend RSA 318:42, VII-a to read as follows:
VII-a. The possession and administration, with written parental authorization, of flu vaccine, immunizations, and mantoux tests for the purpose of disease prevention and tuberculosis screening by registered nurses employed or contracted by public school systems. The possession, provision, and administration of epinephrine for the emergency treatment of anaphylaxis by licensed practical nurses or registered nurses employed or contracted by public school systems, or other school personnel pursuant to RSA 200:44-b and RSA 200:44-c, or authorized entities and their employees, agents, and other individuals pursuant to RSA 200:44-e.
4 Effective Date. This act shall take effect 60 days after its passage.
LBAO
15-0621
Revised 02/18/15
SB 25-FN FISCAL NOTE
AN ACT relative to epinephrine administered in schools.
FISCAL IMPACT:
The Department of Education and Department of Health and Human Services state this bill, as introduced, may increase state and local expenditures by an indeterminable amount in FY 2016 and each year thereafter. There will be no impact on county expenditures or state, county, and local revenue.
METHODOLOGY:
The Department of Education states this bill allows schools and authorized entities to develop policies and maintain a supply of auto-injectable epinephrine for a trained designee to administer to any individual they believe is experiencing anaphylaxis. The Department of Education, in consultation with the Department of Health and Human Services, must develop and make available to all school districts by July 1, 2015 guidelines for the management of students with life-threatening food allergies; procedures for responding to life-threatening allergic reactions; a process for developing allergy action plans for applicable students; and protocols to prevent allergen exposure. Each school district is required to implement a plan based on the aforementioned guidelines for the management of students with life-threatening allergies and make such plan publically available by January 1, 2016. This bill requires school nurses and designated personnel to biannually complete an anaphylaxis training program approved by the Department of Health and Human Services. Upon completion, such individuals may administer epinephrine auto-injectors and not be liable for any injuries or related damages that are not the result of wilful or wanton misconduct. Schools using epinephrine auto-injectors, pursuant to this bill, must submit a report involving each incident of their use to the Department of Education which must annually publish a report summarizing all such incidents. Authorized entities using auto-injectors must submit a report involving each incident of their use to the Department of Health and Human Services which must annually publish a report summarizing all such incidents.
The Department of Education states this bill may increase state and local expenditures by an indeterminable amount. The Department is unable to estimate the costs associated with developing epinephrine use guidelines or the annual reporting requirement. The Department cannot estimate how many schools will acquire and maintain a supply of epinephrine auto-injectors. Participating schools may need to pay for bi-annual anaphylaxis training and epinephrine auto-injectors which cost approximately $200 each and expire after less than two years.
The Department of Health and Human Services states this bill may increase state expenditures by an indeterminable amount. The Department is unable to estimate how much time will be spent developing state guidelines for the use auto-injectable epinephrine or the required annual report. Postsecondary educational institutions, operated by the State, may choose to develop policies for the emergency administration of auto-injectable epinephrine and maintain a supply of epinephrine which could increase expenditures. However, the Department is unable to predict whether any postsecondary education institutions will choose to do so. The Department states this bill will add additional requirements for training and competency for nursing staff. Finally, this bill could result in the Board of Nursing having to conduct an unknown number of investigations and proceedings for any violations of this bill.