This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives.
STORAGE NAME: h0883e.HHS
DATE: 2/16/2024
HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/CS/HB 883 Short-acting Bronchodilator Use in Public and Private Schools
SPONSOR(S): Health & Human Services Committee, Choice & Innovation Subcommittee, Koster
TIED BILLS: None. IDEN./SIM. BILLS: SB 962
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Choice & Innovation Subcommittee 16 Y, 0 N, As CS Dixon Sleap
2) PreK-12 Appropriations Subcommittee 11 Y, 0 N Potvin Potvin
3) Health & Human Services Committee 17 Y, 0 N, As CS Osborne Calamas
SUMMARY ANALYSIS
To provide access to life-saving interventions during a student’s respiratory distress at a public or private
school, the bill authorizes a public or private school to acquire and stock a supply of short-acting
bronchodilators and components from a wholesale distributor or to enter into an arrangement with a wholesale
distributor or manufacturer, for short-acting bronchodilators and components at fair-market, free, or reduced
prices. The bill specifies the requirements for storing and maintaining the stock supply of short-acting
bronchodilators and components.
The bill authorizes specified health care practitioners to prescribe short-acting bronchodilators and components
in the name of a public school or private school. Additionally, the bill authorizes a licensed pharmacist to
dispense short-acting bronchodilators and components to a prescription issued in the name of a public or
private school.
The bill allows public and private schools to acquire and stock a supply of short-acting bronchodilators and
components from a wholesale distributor or to enter into an arrangement with a wholesale distributor or
manufacturer, for short-acting bronchodilators and components at fair-market, free, or reduced prices. Under
the bill, a public or private school may also accept short-acting bronchodilators and components as a donation
or transfer if the items meet the U.S. Food and Drug Administration regulations and are in a new, unexpired,
manufactured-sealed condition.
The bill outlines criteria for individuals authorized to administer short-acting bronchodilators and components to
students at public and private schools and requires schools to inform parents of the school’s adopted protocol
and obtain parental permission before administering short-acting bronchodilators to a student in respiratory
distress emergencies.
The bill establishes immunity from civil and criminal liability for schools, trained school personnel, and health
care practitioners who act in accordance with the provisions of the bill.
The bill has no fiscal impact on state government and may have an insignificant, indeterminate, negative fiscal
impact on school districts. See Fiscal Analysis.
The bill provides an effective date of July 1, 2024.
STORAGE NAME: h0883e.HHS PAGE: 2
DATE: 2/16/2024
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Present Situation
Management of Childhood Asthma in Schools
Asthma is a chronic condition that involves inflammation of the airways. Individuals with asthma
experience hyperresponsive airways, meaning their reactions to triggers such as colds, cigarette
smoke, and exercise are faster and more intense than those with normal airways. This heightened
reactivity leads to inflammation of the airway lining, tightening of surrounding muscles, airway
narrowing, and increased production of mucus cells. These reactions reduce the airflow into the lungs
and make breathing more challenging.
1
In Florida, approximately 1 in 8 adults and 1 in 9 children have asthma.
2
Nationally, asthma stands as
one of the most common chronic childhood diseases, impacting the daily lives of millions of American
children.
3
As children with asthma attend school, their safety and the management of their condition
becomes the shared responsibility of the family, their healthcare providers, and school personnel.
4
While most schools are very cognizant of the seriousness of asthma, the distance from the classroom
or playing field to the school health room can be perilously far for a child struggling to breathe.
5
As
approximately 10 percent of school children have asthma and spend a significant amount of time at
school, having access to a rescue inhaler is important.
6
Rescue inhalers, known as short-acting
bronchodilators, are used for sudden, acute asthma symptoms and includes beta 2-agonists, which
quickly open airways to stop asthma symptoms. Referred to as “reliever” or “rescue” medicines, they
are the most effective for treating sudden, severe, or new asthma symptoms, working within 15 to 20
minutes and lasting for four to six hours.
7
According to the American Lung Association, despite all 50 states and the District of Columbia having
laws allowing students to carry and use asthma inhalers at school, it is still crucial for schools to move
fast to save the life of a child during asthma emergencies. Situations may arise that can keep a child
from getting the medications they need in a timely manner, such as forgetting an inhaler at home or
facing financial constraints preventing the family from affording a second inhaler to keep at school.
8
Given the unpredictable and potentially life-threatening nature of asthma exacerbations in children,
timely access to rescue inhalers becomes a matter of life-saving significance. Addressing these
concerns, in a 2021 policy statement on ensuring access to albuterol in schools, the American Thoracic
1
Florida Department of Health, What is Asthma? Available at https://www.floridahealth.gov/diseases-and-conditions/asthma/what-is-
asthma.html (last visited February 5, 2024).
2
Id.
3
Asthma and Allergy Foundation of America, Childhood Asthma. Available at https://asthmaandallergies.org/asthma-
allergies/childhood-asthma/ (last visited February 5, 2024).
4
American Lung Association, Improving Access to Asthma Medications in Schools (2014). Available at
https://www.lung.org/getmedia/872c9b6a-5379-4321-8913-102d53182e29/improving-access-to-asthma.pdf.pdf (last visited February 5,
2024).
5
Id.
6
American Academy of Allergy, Asthma & Immunology, School stock inhaler program (2021). Available at https://www.aaaai.org/tools-
for-the-public/latest-research-summaries/the-journal-of-allergy-and-clinical-immunology/2021/school-inhaler (last visited February 5,
2024).
7
Cleveland Clinic, Bronchodilator. Available at https://my.clevelandclinic.org/health/treatments/17575-bronchodilator (last visited
February 5, 2024). The inhaled forms of short-acting beta 2-agonists medications include Albuterol, Levalbuterol, or a combination of
albuterol and ipratropium bromide.
8
American Lung Association, Why Schools Should Stock Asthma Inhalers (2023). Available at https://www.lung.org/blog/why-schools-
should-stock-inhalers (last visited February 5, 2024). STORAGE NAME: h0883e.HHS PAGE: 3
DATE: 2/16/2024
Society and others,
9
stated that for children with asthma, access to quick-relief medications is critical to
minimizing morbidity and mortality. The policy statement included an approach a state legislature could
take to ensure access at school through stock albuterol policies whereby a school maintains a supply of
stock albuterol that can be used by any student who experiences respiratory distress. The statement
concluded that stock albuterol in schools is a safe, practical, and potentially life-saving option for
children with asthma, whether asthma is diagnosed or undiagnosed, who lack access to their personal
quick-relief medication.
10
School Stock Albuterol Policies – Other States Efforts
Several states
11
have passed legislation and guidelines addressing asthma management in schools.
While many state policies allow asthmatic students to carry an inhaler with them at school, some states
have implemented policies which allow schools to stock quick-relief medications to respond to a
student in a respiratory distress emergency.
For example, Virginia law requires each local school board to adopt and implement policies for the
possession and administration of stock albuterol inhalers and valved holding chambers in every public
school in the local school division.
12
Authorized personnel, such as a school nurse or employee of the
school board, are responsible for administering the albuterol. In 2023, the Virginia Legislature
expanded on those who could administer the albuterol inhalers to include authorized licensed athletic
trainers under contract with a local school division.
13
In 2022, the Arizona Legislature authorized school districts and charter schools to accept monetary
donations or apply for grants to purchase inhalers and spacers or holding chambers. Alternatively, the
school districts and charter schools may directly accept donations of these items from the product
manufacturer.
14
In Illinois, public and nonpublic schools are authorized to maintain a supply of asthma medication in
any secure location that is accessible before, during, or after school where a person is most at risk.
15
Authorized personnel, such as school nurse or trained personnel, may administer the asthma
medication to any person that the individual believed in good faith was in respiratory distress.
School Health Services in Florida
School health services are an important component of the public health system and help assure that
Florida’s students are healthy and ready to learn. School health services are intended to minimize
health barriers to learning for public school students in grades prekindergarten through twelve in all 67
Florida counties.
16
Asthma
9
The policy statement was a joint effort made by the American Thoracic Society (ATS), The Allergy and Asthma Network Mothers of
Asthmatics (AANMA), American Lung Associations (ALA), and the National Association of School Nurses (NASN).
10
Anna Volerman, et al., Ensuring Access to Albuterol in Schools: From Policy to Implementation. An official ATS/AANMA/ALA/NASN
Policy Statement, 204 American Journal of Respiratory and Critical Care Medicine 5 (2021). Available at
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8491259/pdf/rccm.202106-1550ST.pdf (last visited February 5, 2024).
11
Examples of states that passed legislation and guidelines addressing asthma management in schools include Arkansas, ARK.
CODE. § 6-18-707(d)-(h) (2019), California, CAL. CIVIL CODE § 49414.7 (2023), 105., Indiana, IND. CODE § 16-41-43-1, 16-41-43-
3.5, 20-34-4.5-0.2, and 20-34-4.5-0.6 (2017), Iowa, IOWA CODE § 280.16 (2022), Montana, MO. REV. STAT. § 167.635 (2012), New
Hampshire, N.H. REV. STAT. § 200:53 (2016), New Mexico, N.M. REV. STAT. ANN. § 24-31-1 (2018), Ohio, OHIO REV. CODE.
ANN. § 3313.7113 (2023), Oklahoma, OKLA. STAT. tit. 70, §70-1-116.3 (2020), Texas, TEX. General-LAW MUNICIPALITY CODE
ANN. § 38.001 (2007), Utah, UTAH CODE ANN. § 26-41-101 to 107 (2020).
12
VA CODE.ANN. § 22.1-274.2, Virginia Law, Code of Virginia, § 22.1-274.2. Available at https://law.lis.virginia.gov/vacode/22.1-
274.2/ (last visited February 11, 2024).
13
VA CODE. ANN. § 8.01-225 (2023)
14
ARIZ. REV. STAT. § 15-158 and § 22.1-274.2 (2022)
15
Ill. COMP. STAT. 5/22-30 and 27A-5 (2017), see also Illinois Public Act, SB3015 Enrolled. Available at
https://www.ilga.gov/legislation/publicacts/100/PDF/100-0726.pdf (last visited February 11, 2024).
16
Florida Department of Education, School Health Services. Available at https://www.fldoe.org/schools/k-12-public-schools/sss/sch-
health-serv.stml (last visited February 11, 2024). Service are provided in accordance with a local school health services plan under s.
381.0056(4)(a), F.S. STORAGE NAME: h0883e.HHS PAGE: 4
DATE: 2/16/2024
In accordance with Florida law, asthmatic students attending public school may carry a metered dose
inhaler with them while in school, provided they have obtained approval from both their parent and
physician. The school principal must be provided a copy of the parent’s and physician’s approval.
17
Current law does not expressly authorize an asthmatic student attending a private school to carry a
metered dose inhaler with them while at school.
Epinephrine Use and Supply
Florida law also addresses the use of epinephrine auto-injectors for public and private K-12 students, at
risk of life-threatening allergic reactions, known as anaphylaxis.
A public school student may carry and self-administer an epinephrine auto-injector and self-administer
epinephrine by auto-injector while in school, participating in school-sponsored activities, or in transit to
or from school or school-sponsored activities if the school has been provided with parental and
physician authorization.
18
For each public school student authorized to carry an epinephrine auto-
injector, the school nurse must develop an annual child-specific action plan for an anticipated health
emergency in the school setting.
19
Additionally, both K-12 public and private schools in Florida may purchase and maintain a supply of
epinephrine auto-injectors in a secure, locked location on school premises for use if a student has an
anaphylactic reaction.
20
A participating school district or private school is required to adopt a protocol
developed by a licensed physician for administration of the epinephrine by school personnel.
21
The
epinephrine auto-injectors may be administered by school personnel or self-administered by the
student.
22
K-12 public and private schools, their employees, agents, and physicians who provide the standing
protocol are exempted from liability for any injury arising from the use of an epinephrine auto-injector if
the epinephrine auto-injector is administered by trained school personnel who follows the protocol and
reasonably believes that the student is having an anaphylactic reaction.
23
Florida law provides that the
liability protections apply:
24
Even if the student’s parent has not been provided notice or has not signed a statement
acknowledging that the school district is not liable; and
Regardless of whether authorization has been given by the student’s parent or the student’s
physician.
However, the liability protections do not apply if the trained school personnel’s action is willful and
wanton.
25
Prescribing and Dispensing Short-acting Bronchodilators
Under current law, short-acting bronchodilators and components must be prescribed to a patient by a
licensed health care practitioner who is duly authorized to prescribe drugs, such as allopathic and
osteopathic physicians, and, in certain circumstances, physician assistants
26
and advanced practice
17
S. 1002.20(3)(h), F.S.
18
S. 1002.20(3)(i)1., F.S.; see also rule 6A-6.0251, F.A.C.
19
Rule 6A-6.0251, F.A.C.; see also rule 64F-6.004, F.A.C.
20
Ss. 1002.20(3)(i)2., F.S. and 1002.42(17)(a), F.S.
21
Id.
22
Id.
23
Ss. 1002.20(3)(i)3., F.S. and 1002.42(17)(b), F.S.
24
Id.
25
Id.
26
Physician assistants may prescribe drugs as delegated by a supervising physician. See, ss. 459.022(4)(e) and 458.347(4)(e), F.S. STORAGE NAME: h0883e.HHS PAGE: 5
DATE: 2/16/2024
registered nurses.
27
A pharmacist may then dispense
28
the short-acting bronchodilators and
components according to the prescriber’s directions. A pharmacist may not alter a prescriber’s
directions, diagnose or treat any disease, initiate any drug therapy, or practice medicine or osteopathic
medicine, except as expressly permitted by law.
29
In certain circumstances, a pharmacist may order and dispense a drug without a pre-existing
prescription. For example, pharmacists are authorized to order and dispense drugs that are included in
a limited formulary developed by a committee composed of members of the Board of Medicine, the
Board of Osteopathic Medicine, and the Board of Pharmacy.
30
The formulary does not include short-
acting bronchodilators and components.
31
A pharmacist who has received the appropriate certification and training may also order and dispense
specific drugs pursuant to a collaborative practice agreement with a licensed physician.
32
Collaborative
practice agreements allow qualified pharmacists to actively assist in the maintenance and care of
patients with chronic conditions, such as asthma. Under current law, pharmacists may not dispense
short-acting bronchodilators and components without a prescription, unless they are expressly
authorized to do so under a collaborative practice agreement with a physician.
33
Florida’s Good Samaritan Act
The Good Samaritan Act (the Act) is established under s. 768.13, F.S. The Act provides civil immunity
to any person, including those licensed to practice medicine, who gratuitously and in good faith renders
emergency care or treatment in direct response an emergency situation.
34
Under the Act, a person may
not be held liable for any civil damages resulting from such care or treatment, or failure to act in
providing further medical treatment where the person acted as a reasonable person would.
Effect of Proposed Changes
CS/CS/HB 883 authorizes public and private schools to stock short-acting bronchodilators and
components in order to provide efficient access to life-saving interventions during respiratory distress
for children in school.
The bill authorizes licensed physicians,
35
physician assistants,
36
and advanced practice registered
nurse practitioners
37
to prescribe short-acting bronchodilators and components in the name of a public
school or private school. The bill also allows a licensed pharmacist to dispense short-acting
bronchodilators and components pursuant to a prescription issued in the name of a public or private
school.
The bill allows public and private schools to acquire and stock a supply of short-acting bronchodilators
and components from a wholesale distributor
38
or to enter into an arrangement with a wholesale
distributor or manufacturer,
39
for short-acting bronchodilators and components at fair-market, free, or
27
APRNs may prescribe drugs within the framework of a physician’s supervisory protocol, or without such protocol if they are registered
for autonomous practice. See, ss. 464.003(2) and 464.012(3), F.S.
28
Dispensing a drug includes the assessment of the prescription for potential adverse effects and counseling the patient regarding the
drug; see, S. 465.003(13), F.S.
29
S. 465.003, F.S.
30
S. 456.186, F.S.
31
Rule 64B16-27.220, F.A.C.
32
S. 465.1865, F.S.
33
See, s. 465.1865, F.S.
34
S. 768.113(2)(a) and (b), F.S., in this context, an emergency situation includes those arising out of a public health emergency
declared pursuant to s. 381.00315, a state of emergency which has been declared pursuant to s. 252.36 or at the scene of an
emergency outside of a medical facility.
35
Licensed under Chs. 458 or 459, F.S.
36
Id.
37
Licensed under Ch. 464, F.S.
38
S. 499.003(49), F.S. Wholesale distributor means a person, other than a manufacturer, a manufacturer’s co-licensed partner, a third-
party logistics provider, or a repackager, who is engaged in wholesale distribution.
39
S. 499.003(29), F.S. Manufacturer means a person who holds a New Drug Application, an Abbreviated New Drug Application, a
Biologics License Application, or a New Animal Drug Application approved under the federal act or license issued under s. 351 of the STORAGE NAME: h0883e.HHS PAGE: 6
DATE: 2/16/2024
reduced prices. The bill also allows public and private schools to accept short-acting bronchodilators
and components as a donation or transfer if they are new, unexpired, manufacturer-sealed, not subject
to recall, unadulterated, and in compliance with relevant regulations adopted by the United States Food
and Drug Administration. A school which has elected to stock a supply of short-acting bronchodilators
and components must maintain the supply in a secure location on the school's premises.
The participating public or private school must adopt a protocol developed by a licensed physician
40
for
administration of short-acting bronchodilators or components by school personnel who are trained to
recognize symptoms of respiratory distress and to administer a short-acting bronchodilator and
components. Each school or school district that adopts such a protocol must provide written notice of
the protocol to the parent of each student enrolled in the school. The school must receive prior
permission from a student’s parent to administer a short-acting bronchodilator or components in a
respiratory distress emergency.
A school nurse or other school personnel may only administer a short-acting bronchodilator or
components if they have successfully completed the training and believe in good faith that the student
is experiencing respiratory distress. The student does not need to have been diagnosed with asthma or
have a pre-existing prescription in order for a short-acting bronchodilator or components to be
administered under the provisions of the bill.
Under the bill, school nurses and other appropriately trained school personnel who administer, or
attempts to administer, a short-acting bronchodilator or components in compliance with the provisions
of the bill and the Good Samaritan Act,
41
as well as the school district or private school that employs
such individual, are immune from civil or criminal liability resulting from such administration.
The bill grants immunity from civil and criminal liability for any authorized healthcare practitioner who
prescribes, or pharmacist who fills, a prescription for a short-acting bronchodilator and components to a
school under the provisions of this bill, and acts in good faith and exercises reasonable care, similarly
the bill grants immunity from licensure discipline on the same basis.
The bill updates the terminology for the type of device an asthmatic public school student may carry
from a metered-dose inhaler to a short-acting bronchodilator and component and authorizes an
asthmatic private school student, similar to a public school student, to carry a short-acting
bronchodilator and components while in school. The private school student’s parent and physician must
provide their approval to the private school’s principal.
The bill defines the following terms:
"Administer" to mean to give or to directly apply a short-acting bronchodilator or components
to a student.
"Asthma" to mean a chronic lung disease that inflames and narrows the airways, which can
manifest as wheezing, chest tightness, shortness of breath, and coughing.
"Authorized health care practitioner" to mean a physician, a physician assistant or an
advanced practice registered nurse, each licensed as defined under the law.
"Components" to mean devices used as part of clinically recommended use of short-acting
bronchodilators, which may include spacers, valved holding chambers, or nebulizers.
"Respiratory distress" to refer to an individual experiencing difficulty breathing, which can be
caused by a multitude of medical factors, including chronic diseases such as asthma.
"Short-acting bronchodilator" to mean a beta-2 agonist, such as albuterol, used for the quick
relief of asthma symptoms and recommended by the National Heart, Lung, and Blood
Institute's National Asthma Education and Prevention Program Guidelines for the Treatment
Public Health Ser vice Act, 42 U.S.C. s. 262, for such drug or biologics, or if such drug or biologics are not the subject of an approved
application or license, the person who manufactured the drug or biologics, a co-licensed partner or affiliates, and those manufacturing
devices or cosmetics.
40
Such physician must be either an allopathic physician licensed under Ch. 458, F.S., or an osteopathic physician licensed under Ch.
459, F.S.
41
S. 768.13, F.S. STORAGE NAME: h0883e.HHS PAGE: 7
DATE: 2/16/2024
of Asthma. These bronchodilators may include an orally inhaled medication that contains a
premeasured single dose of albuterol or albuterol sulfate delivered by a nebulizer or by a
pressured metered-dose inhaler used to treat respiratory distress, including, but not limited
to, wheezing, shortness of breath, and difficulty breathing, or another dosage of a short-
acting bronchodilator recommended in the Guidelines for the Treatment of Asthma.
The bill provides an effective date of July 1, 2024.
B. SECTION DIRECTORY:
Section 1: Amends s. 1002.20, F.S., relating to K-12 student and parent rights.
Section 2: Amends s. 1002.42, F.S., relating to private schools.
Section 3: Provides an effective date of July 1, 2024
II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT
A. FISCAL IMPACT ON STATE GOVERNMENT:
1. Revenues:
None.
2. Expenditures:
None.
B. FISCAL IMPACT ON LOCAL GOVERNMENTS:
1. Revenues:
None.
2. Expenditures:
See Fiscal Comments.
C. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR:
None.
D. FISCAL COMMENTS:
Schools that choose to act under the authority granted by the bill may incur costs associated with
implementing the provisions of the bill. Schools that choose to exercise this authority may incur costs
related to acquiring and storing a supply of short-acting bronchodilators and components, providing
written notice to parents, and training personnel to administer the bronchodilators and their
components.
III. COMMENTS
A. CONSTITUTIONAL ISSUES:
1. Applicability of Municipality/County Mandates Provision:
None.
2. Other:
None.
B. RULE-MAKING AUTHORITY: STORAGE NAME: h0883e.HHS PAGE: 8
DATE: 2/16/2024
None.
C. DRAFTING ISSUES OR OTHER COMMENTS:
None.
IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES
On January 18, 2024, the Choice & Innovation Subcommittee adopted one amendment and reported the
bill favorably as a committee substitute. The amendment authorizes a private school, similar to a public
school, to accept short-acting bronchodilators and components as a donation or transfer if they are new,
unexpired, manufacturer-sealed, not subject to recall, unadulterated, and in compliance with relevant
regulations adopted by the United States Food and Drug Administration.
On February 15, 2024, the Health & Human Services Committee adopted one amendment and reported
the bill favorably as a committee substitute. The amendment:
Revised the immunity provisions for schools, school personnel, health care practitioners and
pharmacists related to the prescribing, dispensing and administration of short-acting
bronchodilators.
Specifies that the physician developing the protocol for the administration of a short-acting
bronchodilator for schools must be a licensed allopathic or osteopathic physician.
Revised the definition of authorized health care practitioner to include advanced practice registered
nurses rather than registered nurses.
The analysis is drafted to the committee substitute adopted by the Health & Human Services Committee.