EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
Underlining indicates amendments to bill.
Strike out indicates matter stricken from the bill by amendment or deleted from the law by
amendment.
*hb0266*
HOUSE BILL 266
F1 3lr1374
HB 384/22 – W&M
By: Delegates Boyce, Amprey, Bridges, Edelson, Embry, Healey, Kaufman,
Lehman, McCaskill, Phillips, Rosenberg, Ruth, Smith, and Stewart
Introduced and read first time: January 25, 2023
Assigned to: Ways and Means
Committee Report: Favorable with amendments
House action: Adopted
Read second time: March 1, 2023
CHAPTER ______
AN ACT concerning 1
Public and Nonpublic Schools – Bronchodilator and Epinephrine Availability 2
and Use – Policies 3
FOR the purpose of requiring each county board of education and authorizing nonpublic 4
schools in the State, before a certain school year, to establish a policy to obtain, 5
administer, and train certain school nurses and authorize a school nurse or certain 6
other school personnel to administer in emergency situations bronchodilators to a 7
student who is determined to have asthma and is experiencing asthma–related 8
symptoms or is perceived to be in respiratory distress by a school nurse or any other 9
school personnel; requiring each county board and authorizing nonpublic schools in 10
the State to update their policies to require certain school nurses and other school 11
personnel to complete certain training before they are authorized to administer 12
auto–injectable epinephrine to a student who is determined to be, or is perceived to 13
be, in anaphylaxis; requiring the State Department of Education, in consultation 14
with certain groups, to identify or develop training for certain school personnel to 15
identify symptoms of anaphylaxis, asthma, or respiratory distress in students; a 16
bronchodilator to a student who is experiencing asthma, reactive airway disease, or 17
asthma–related symptoms; requiring a policy to include certain limitations on the 18
administration of a bronchodilator, provisions authorizing a school nurse to obtain 19
and store bronchodilators, and procedures for a school nurse to designate certain 20
other school personnel to respond to a student who is experiencing asthma, reactive 21
airway disease, or asthma–related symptoms; requiring the State Department of 22
Education and the Maryland Department of Health jointly to update certain asthma 23
guidelines in a certain manner on or before a certain date; requiring each county 24 2 HOUSE BILL 266
board to make a good faith effort to adopt certain guidelines before the start of a 1
certain school year; and generally relating to bronchodilator and epinephrine 2
availability and use policies in public and nonpublic schools in the State. 3
BY repealing and reenacting, with amendments, 4
Article – Education 5
Section 7–426.2 and 7–426.3 6
Annotated Code of Maryland 7
(2022 Replacement Volume) 8
BY adding to 9
Article – Education 10
Section 7–426.6 and 7–426.7 11
Annotated Code of Maryland 12
(2022 Replacement Volume) 13
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 14
That the Laws of Maryland read as follows: 15
Article – Education 16
7–426.2. 17
(a) (1) In this section the following words have the meanings indicated. 18
(2) “Anaphylaxis” means a sudden, severe, and potentially life–threatening 19
allergic reaction that occurs when an individual is exposed to an allergen. 20
(3) “Auto–injectable epinephrine” means a portable, disposable drug 21
delivery device that contains a premeasured single dose of epinephrine that is used to treat 22
anaphylaxis in an emergency situation. 23
(b) Each county board shall establish a policy for public schools within its 24
jurisdiction to authorize the school nurse and other school personnel to administer 25
auto–injectable epinephrine, if available, to a student who is determined BY AN 26
INDIVIDUAL WHO HAS U NDERGONE THE TRAININ G PROVIDED IN SUBSEC TION (C) OF 27
THIS SECTION, IF AVAILABLE, to be or perceived to be in anaphylaxis, regardless of 28
whether the student: 29
(1) Has been identified as having an anaphylactic allergy, as defined in § 30
7–426.1 of this subtitle; or 31
(2) Has [a prescription for] BEEN PRESCRIBED epinephrine [as 32
prescribed] by an authorized licensed health care practitioner under the Health 33
Occupations Article. 34
HOUSE BILL 266 3
(c) (1) THE DEPARTMENT , IN CONSULTATION WITH THE MARYLAND 1
DEPARTMENT OF HEALTH, THE AMERICAN LUNG ASSOCIATION, AND THE ASTHMA 2
AND ALLERGY FOUNDATION OF AMERICA, SHALL IDENTIFY OR DE VELOP TRAINING 3
TO: 4
(I) IDENTIFY THE SYMPTOMS OF ASTHMA AND RESPIRATORY 5
DISTRESS; 6
(II) IDENTIFY THE SYMPTOMS OF ANAPHYLAXIS ; AND 7
(III) DISTINGUISH BETWEEN A NAPHYLAXIS AND ASTHM A OR 8
RESPIRATORY DISTRESS . 9
(2) THE TRAINING IDENTIFI ED OR DEVELOPED UNDE R PARAGRAPH 10
(1) OF THIS SUBSECTION S HALL BE PROVIDED TO SCHOOL N URSES AND VOLUNTARY 11
SCHOOL PERSONNEL WHO ARE DESIGNATED BY A SCHOOL NURSE AND , IN THE 12
CLINICAL JUDGMENT OF THE SCHOOL NURSE , ARE APPROPRIATE RECI PIENTS OF 13
THE TRAINING. 14
(3) THE TRAINING PROVIDED UNDER THIS SUBSECTIO N SHALL BE A 15
PAID PROFESSIONAL DEVELOP MENT TRAINING . 16
(D) The policy established under subsection (b) of this section shall include: 17
(1) [Training for school personnel on how to recognize the symptoms of 18
anaphylaxis] THE TRAINING IDENTIFI ED OR DEVELOPED UNDE R SUBSECTION (C) OF 19
THIS SECTION; 20
(2) Procedures for the emergency administration of auto –injectable 21
epinephrine BY A SCHOOL NURSE OR DESIGNATED VOLUNTEER ; 22
(3) The proper follow–up emergency procedures; 23
(4) A provision authorizing a school nurse to obtain and store at a public 24
school auto–injectable epinephrine to be used in an emergency situation; and 25
(5) A requirement that each public school develop and implement a method 26
for notifying the parents or guardians of students of the school’s policy under this section 27
at the beginning of each school year. 28
(E) (1) AN AUTHORIZED LICENSE D HEALTH CARE PRACTI TIONER MAY 29
PROVIDE AUTO –INJECTABLE EPINEPHRI NE TO A SCHOOL NURSE OR DESIGNATED 30
VOLUNTEER FOR USE IN ACCORDANCE WITH THIS SECTION. 31
4 HOUSE BILL 266
(2) AUTO–INJECTABLE EPINE PHRINE USED UNDER TH IS SECTION 1
MUST BE FROM A LICEN SED PHARMACY OR MANU FACTURER. 2
(3) A COUNTY BOARD OR PUBL IC SCHOOL MAY ACCEPT DONATED 3
AUTO–INJECTABLE EPINEPHRI NE FROM A LICENSED P HARMACY OR 4
MANUFACTURER . 5
(4) A COUNTY BOARD MAY APP LY FOR GRANTS TO O BTAIN FUNDING 6
FOR THE PURCHASE OF AUTO–INJECTABLE EPINEPHRI NE FROM A LICENSED 7
PHARMACY OR MANUFACT URER. 8
[(d)] (F) Except for any willful or grossly negligent act, a school nurse or other 9
school personnel who respond in good faith to the anaphylactic reaction of a child in 10
accordance with this section may not be held personally liable for any act or omission in the 11
course of responding to the reaction. 12
[(e)] (G) (1) Each public school shall submit, on the form that the Department 13
requires, a report to the Department on each incident at the school or at a related school 14
event that required the use of auto–injectable epinephrine. 15
(2) The Department shall develop and disseminate a standard form to 16
report each incident requiring the use of auto–injectable epinephrine at a public school. 17
7–426.3. 18
(a) (1) In this section the following words have the meanings indicated. 19
(2) “Anaphylaxis” means a sudden, severe, and potentially life–threatening 20
allergic reaction that occurs when an individual is exposed to an allergen. 21
(3) “Auto–injectable epinephrine” means a portable, disposable drug 22
delivery device that contains a premeasured single dose of epinephrine that is used to treat 23
anaphylaxis in an emergency situation. 24
(4) “School personnel” means individuals who are employed by a nonpublic 25
school, including part–time employees, teachers and substitute teachers employed by the 26
school for at least 7 days each school year, a school nurse, registered nurse case manager, 27
delegating nurse, and administrative staff. 28
(b) Each nonpublic school in the State may establish a policy authorizing school 29
personnel to administer auto–injectable epinephrine, if available, to a student who is 30
determined BY AN INDIVIDUAL WHO HAS UNDERGONE THE TR AINING PROVI DED 31
UNDER § 7–426.6(C) OF THIS SUBTITLE , IF AVAILABLE, to be or perceived to be in 32
anaphylaxis, regardless of whether the student: 33
HOUSE BILL 266 5
(1) Has been identified as having an anaphylactic allergy, as defined in § 1
7–426.1 of this subtitle; or 2
(2) Has [a prescription for] BEEN PRESCRIBED epinephrine [as 3
prescribed] by an authorized licensed health care practitioner under the Health 4
Occupations Article. 5
(c) The policy established under subsection (b) of this section shall include: 6
(1) [Training for school personnel on how to recognize the signs and 7
symptoms of anaphylaxis by a licensed health care practitioner who is authorized to 8
administer auto–injectable epinephrine and who has been trained in an established 9
protocol on how to recognize the signs and symptoms of anaphylaxis] THE TRAINING 10
IDENTIFIED OR DEVELO PED UNDER § 7–426.2(C) OF THIS SUBTITLE FOR SCHOOL 11
NURSES AND VOLUNTARY SCHOOL PERSONNEL WHO ARE DESIGNATED BY A SCHOOL 12
NURSE AND , IN THE CLINICAL JUDG MENT OF THE SCHOOL N URSE, ARE 13
APPROPRIATE RECI PIENTS OF THE TRAINI NG; 14
(2) Procedures for the emergency administration of auto –injectable 15
epinephrine BY A SCHOOL NURSE OR DESIGNATED VOLUNTEER ; 16
(3) The proper follow–up emergency procedures; 17
(4) A provision authorizing a school nurse or other licensed health care 18
practitioner to obtain and, school personnel to store, at a nonpublic school auto–injectable 19
epinephrine to be used in an emergency situation; 20
(5) A requirement that the nonpublic school develop and implement a 21
method for notifying the parents or guardians of students of the school’s policy under this 22
section at the beginning of each school year; and 23
(6) An ongoing process for oversight and monitoring by a licensed health 24
care practitioner of the implementation of the policy established under subsection (b) of this 25
section. 26
(D) (1) AN AUTHORIZED LICENSE D HEALTH CARE PRACTI TIONER MAY 27
PROVIDE AUTO –INJECTABLE EPINEPHRI NE TO A SCHOOL NURSE OR DESIGNATED 28
VOLUNTEER FOR USE IN ACCORDANCE WITH THIS SECTION. 29
(2) AUTO–INJECTABLE EPINEPH RINE USED UNDER THIS SECTION 30
MUST BE FROM A LICEN SED PHARMACY OR MANU FACTURER. 31
(3) A NONPUBLIC SCHOOL MAY ACCEPT DONATED AUTO –INJECTABLE 32
EPINEPHRINE FROM A L ICENSED PHARMACY OR MANUFACTURER . 33
6 HOUSE BILL 266
(4) A NONPUBLIC SCHOOL MAY APPLY FOR GRANTS TO OBTAIN 1
FUNDING FOR THE PURCHASE OF AUTO–INJECTABLE EPINEPHRI NE FROM A 2
LICENSED PHARMACY OR MANUFACTURER . 3
[(d)] (E) Except for any willful or grossly negligent act, school personnel who 4
respond in good faith to the anaphylactic reaction of a child in accordance with this section 5
may not be held personally liable for any act or omission in the course of responding to the 6
reaction. 7
7–426.6. 8
(A) (1) IN THIS SECTION THE F OLLOWING WORDS HAVE THE MEANINGS 9
INDICATED. 10
(2) “ASTHMA” MEANS A CHRONIC LUNG DISEASE THAT INFLAMES 11
AND NARROWS AIR PASS AGES, CAUSING RECURRING PE RIODS OF WHEEZING , CHEST 12
TIGHTNESS, SHORTNESS OF BREATH , AND COUGHING . 13
(3) “BRONCHODILATOR ” MEANS MEDICATION THA T RELAXES 14
BRONCHIAL MUSCLES , RESULTING IN THE EXP ANSION OF BRONCHIAL AIR 15
PASSAGES TO P ROVIDE FAST TREATMEN T OF ASTHMA –RELATED SYMPTOMS AND 16
SYMPTOMS OF RESPIRAT ORY DISTRESS. 17
(4) “SCHOOL PERSONNEL ” MEANS INDIVIDUALS WH O ARE EMPLOYED 18
BY A PUBLIC SCHOOL , INCLUDING PART –TIME EMPLOYEES , TEACHERS AND 19
SUBSTITUTE TEACHERS EMPLOYED BY THE SCHO OL FOR AT LEAST 7 DAYS EACH 20
SCHOOL YEAR , REGISTERED NURSE CAS E MANAGERS , DELEGATING NURSES , AND 21
ADMINISTRATIVE STAFF . 22
(B) (1) EXCEPT AS PROVIDED IN PARAGRAPH (2) OF THIS SUBSECTION , 23
EACH COUNTY BOARD SH ALL ESTABLISH A POLI CY FOR PUBLIC SCHOOL S WITHIN ITS 24
JURISDICTION TO AUTHOR IZE THE SCHOOL NURSE AND OTHER SCHOOL PER SONNEL 25
TO ADMINISTER A BRON CHODILATOR TO A STUD ENT WHO IS DETERMINE D BY AN 26
INDIVIDUAL WHO HAS U NDERGONE THE TRAININ G PROVIDED IN SUBSEC TION (C) OF 27
THIS SECTION TO HAVE ASTHMA, IS EXPERIENCING AST HMA–RELATED SYMPTOMS , 28
OR IS PERCEIVED TO B E IN RESPIRATORY DIS TRESS, REGARDLESS OF WHETHE R THE 29
STUDENT: 30
(I) HAS BEEN DIAGNOSED WI TH ASTHMA OR REACTIV E AIRWAY 31
DISEASE; OR 32
(II) HAS BEEN PRESCRIBED A BRONCHODILATOR BY AN 33
AUTHORIZED LICENSED HEALTH CARE PRACTITIONER UN DER THE HEALTH 34
OCCUPATIONS ARTICLE. 35 HOUSE BILL 266 7
(2) NEITHER A SCHOOL NURS E NOR ANY OTHER SCHO OL PERSONNEL 1
MAY ADMINISTER A BRONCHO DILATOR TO A PREKIND ERGARTEN STUDENT UNL ESS 2
THE STUDENT HAS BEEN DIAGNOSED WITH ASTHM A OR A REACTIVE AIRW AY DISEASE 3
AND HAS A PRESCRIPTI ON FOR A BRONCHODILA TOR AS PRESCRIBED BY THE 4
STUDENT’S HEALTH CARE PRACTI TIONER. 5
(C) (1) THE TRAINING IDENTIFI ED OR DEVELOPED UNDE R § 7–426.2(C) 6
OF THIS SUBTITLE SHA LL BE PROVIDED TO SC HOOL NURSES AND OTHE R 7
VOLUNTARY SCHOOL PER SONNEL WHO ARE DESIGNATED B Y A SCHOOL NURSE AND , 8
IN THE CLINICAL JUDG MENT OF THE SCHOOL N URSE, ARE APPROPRIATE 9
RECIPIENTS OF THE TR AINING. 10
(2) THE TRAINING PROVIDED UNDER THIS SUBSECTIO N SHALL BE A 11
PAID PROFESSIONAL DE VELOPMENT TRAINING . 12
(D) THE POLICY ESTA BLISHED UNDER SUBSEC TION (B) OF THIS SECTION 13
SHALL INCLUDE : 14
(1) THE TRAINING REQUIRED UNDER SUBSECTION (C) OF THIS 15
SECTION; 16
(2) PROCEDURES FOR THE EM ERGENCY ADMINISTRATI ON OF A 17
BRONCHODILATOR BY A SCHOOL NURSE OR DESI GNATED VOLUNTEER ; 18
(3) THE PROPER FOLLOW –UP EMERGENCY PROCEDU RES; 19
(4) A PROVISION AUTHORIZIN G A SCHOOL NURSE TO OBTAIN AND 20
STORE AT A PUBLIC SC HOOL BRONCHODILATORS AND MODES OF DELIVER Y, 21
INCLUDING INHALERS W ITH SPACERS, TO BE USED IN AN EME RGENCY SITUATION ; 22
AND 23
(5) A REQUIREM ENT THAT EACH PUBLIC SCHOOL DEVELOP AND 24
IMPLEMENT A METHOD F OR NOTIFYING THE PAR ENTS OR GUARDIANS OF STUDENTS 25
OF THE SCHOOL ’S POLICY UNDER THIS SECTION AT THE BEGIN NING OF EACH 26
SCHOOL YEAR . 27
(E) (1) AN AUTHORIZED LICENSE D HEALTH CARE PRACTI TIONER MAY 28
PROVIDE BRONCHODILATORS TO A SCHOOL NURSE OR DESIGNATED VOLUNTEER 29
FOR USE IN ACCORDANC E WITH THIS SECTION . 30
(2) BRONCHODILATORS AND M ODES OF ADMINISTRATI ON, 31
INCLUDING INHALERS W ITH SPACERS, USED BY A SCHOOL NUR SE OR ANY OTHER 32
SCHOOL PERSONNEL MUS T BE FROM A LICENSED PHARMACY OR MANUFACT URER. 33 8 HOUSE BILL 266
(3) A COUNTY BOARD OR PUBL IC SCHOOL MAY ACCEPT DONATED 1
BRONCHODILATORS AND MODES OF ADMINISTRAT ION, INCLUDING INHALERS W ITH 2
SPACERS, FROM A LICENSED PHAR MACY OR MANUFACTURER . 3
(4) A COUNTY BOARD MAY APP LY FOR GRANTS TO OBT AIN FUNDING 4
FOR THE PURCHASE OF BRONCHODILATORS AND MODES OF ADMINISTRAT ION, 5
INCLUDING INHALERS W ITH SPACERS. 6
(B) (1) SUBJECT TO PARAGRAPH (2) OF THIS SUBSECTION , BEFORE THE 7
2024–2025 SCHOOL YEAR , EACH COUNTY BOARD SHALL ESTABLIS H A POLICY FOR 8
PUBLIC SCHOOLS WITHI N ITS JURISDICTION T O AUTHORIZE A SCHOOL NURSE OR 9
OTHER SCHOOL PERSONN EL DESIGNATED BY THE SCHOOL NURSE TO ADMI NISTER A 10
BRONCHODILATOR TO A STUDENT WHO IS EXPER IENCING ASTHMA , REACTIVE 11
AIRWAY DISEASE , OR ASTHMA–RELATED SYMPTOMS . 12
(2) THE POLICY ESTABLISHE D UNDER THIS SUBSECT ION SHALL 13
LIMIT THE ADMINISTRA TION OF A BRONCHODIL ATOR TO CASES IN WHI CH A 14
STUDENT HAS BEEN PRE SCRIBED A BRONCHODIL ATOR BY AN AUTHORIZE D, 15
LICENSED HEALTH CARE PRACTITIONER IN ACCO RDANCE WITH THE HEALTH 16
OCCUPATIONS ARTICLE. 17
(C) THE POLICY REQUIRED U NDER SUBSECTION (B) OF THIS SECTION 18
SHALL INCLUDE : 19
(1) PROVISIONS AUTHORIZIN G A SCHOOL NURSE TO OBTAIN AND 20
STORE AT A PUBLIC SC HOOL BRONCHODILATORS TO BE USED IN AN EME RGENCY 21
SITUATION; AND 22
(2) PROCEDURES FOR THE DE SIGNATION OF SCHOOL PERSONNEL BY 23
A SCHOOL NURSE , IN ACCORDANCE WITH T HE HEALTH OCCUPATIONS ARTICLE, TO 24
RESPOND TO A STUDENT EXPERIENCING ASTHMA , REACTIVE AIRWAY DISE ASE, OR 25
ASTHMA–RELATED SYMPTOMS IN AN EMERGENCY SETTING . 26
(F) (D) EXCEPT FOR ANY WILLFU L OR GROSSLY NEGLIGE NT ACT, A 27
SCHOOL NURSE OR ANY OTHER SCHOOL PERSONN EL WHO RESPOND IN GO OD FAITH 28
TO THE ASTHMA ATTACK OR RESPIRATORY DISTR ESS OF A CHILD IN AC CORDANCE 29
WITH THIS SECTION MA Y NOT BE HELD PERSON ALLY LIABLE FO R ANY ACT OR 30
OMISSION IN THE COUR SE OF RESPONDING TO THE CHILD IN DISTRES S. 31
(G) (E) (1) (I) FOR EACH INCIDENT AT THE SCHOOL OR AT A 32
RELATED SCHOOL EVENT THAT RE QUIRES THE USE OF A BRONCHODILATOR , EACH 33
PUBLIC SCHOOL SHALL : 34
HOUSE BILL 266 9
1. NOTIFY THE STUDENT ’S PARENT OR LEGAL 1
GUARDIAN OF THE INCI DENT; AND 2
2. MAKE A RECORD OF THE INCIDENT, ON THE FORM 3
THAT THE DEPARTMENT REQUIRES , AND FILE THE FORM IN THE STUDENT’S SCHOOL 4
MEDICAL RECORD . 5
(II) EACH PUBLIC SCHOOL SH ALL SUBMIT TO THE 6
DEPARTMENT A REPORT , ON THE FORM AND SCHE DULE REQUIRED BY THE 7
DEPARTMENT , ON THE NUMBER OF INC IDENTS AT THE SCHOOL OR AT A RELATED 8
SCHOOL EVENT THAT RE QUIRED THE USE OF A BRONCHODILATOR IN ACCORDANCE 9
WITH THE COUNTY B OARD’S POLICY UNDER SUBSE CTION (B) OF THIS SECTION. 10
(2) THE DEPARTMENT SHALL DEVE LOP AND DISSEMINATE 11
STANDARD FORMS TO RE CORD EACH INCIDENT A ND REPORT INCIDENTS REQUIRING 12
THE USE OF A BRONCHO DILATOR IN ACCORDANCE WITH T HE COUNTY BOARD ’S 13
POLICY UNDER SUB SECTION (B) OF THIS SECTION AT A PUBLIC SCHOOL . 14
7–426.7. 15
(A) (1) IN THIS SECTION THE F OLLOWING WORDS HAVE THE MEANINGS 16
INDICATED. 17
(2) “ASTHMA” MEANS A CHRONIC LUNG DISEASE THAT INFLAME S 18
AND NARROWS AIR PASS AGES, CAUSING RECURRING PE RIODS OF WHEEZING , CHEST 19
TIGHTNESS, SHORTNESS OF BREATH , AND COUGHING . 20
(3) “BRONCHODILATOR ” MEANS MEDICATION THA T RELAXES 21
BRONCHIAL MUSCLES , RESULTING IN THE EXP ANSION OF BRONCHIAL AIR 22
PASSAGES TO PROVIDE FAST TREATMENT OF AS THMA–RELATED SYMPTOMS AND 23
SYMPTOMS OF RESPIRAT ORY DISTRESS. 24
(4) “SCHOOL PERSONNEL ” MEANS INDIVIDUALS WH O ARE EMPLOYED 25
BY A NONPUBLIC SCHOO L, INCLUDING PART –TIME EMPLOYEES , TEACHERS AND 26
SUBSTITUTE TEACHERS EMPLOYED BY THE SCHO OL FOR AT LEAST 7 DAYS EACH 27
SCHOOL YEAR , REGISTERED NURSE CAS E MANAGERS , DELEGATING NURSES , AND 28
ADMINISTRATIVE STAFF . 29
(B) (1) EXCEPT AS PROVIDED IN PARAGRAPH (2) OF THIS SUBSECTION , 30
EACH NONPUBLIC SCHOO L IN THE STATE MAY ESTABLISH A POLICY AUTHORIZING 31
THE SCHOOL NURSE AND OTHER SCHOOL PERSONN EL TO ADMINISTER A 32
BRONCHODILATOR TO A STUDENT WHO IS DETERMINED BY AN IND IVIDUAL WHO HAS 33
UNDERGONE THE TRAINI NG PROVIDED UNDER § 7–426.2(C) OF THIS SUBTITLE TO 34 10 HOUSE BILL 266
HAVE ASTHMA , IS EXPERIENCING ASTH MA–RELATED SYMPTOMS , OR IS PERCEIVED 1
TO BE IN RESPIRATORY DISTRESS, REGARDLESS OF WHETHE R THE STUDENT: 2
(I) HAS BEEN DIAGNOSED WI TH ASTHMA OR REACTIV E AIRWAY 3
DISEASE; OR 4
(II) HAS BEEN PRESCRIBED A BRONCHODILATOR BY AN 5
AUTHORIZED LICENSED HEALTH CARE PRACTITI ONER UNDER THE HEALTH 6
OCCUPATIONS ARTICLE. 7
(2) A SCHOOL NURSE OR ANY OTHER SCHOOL PE RSONNEL MAY NOT 8
ADMINISTER A BRONCHO DILATOR TO A PREKIND ERGARTEN STUDENT UNL ESS THE 9
STUDENT HAS BEEN DIA GNOSED WITH ASTHMA O R A REACTIVE AIRWAY DISEASE 10
AND HAS A PRESCRIPTI ON FOR A BRONCHODILA TOR AS PRESCRIBED BY THE 11
STUDENT’S HEALTH CARE PRACTI TIONER. 12
(C) THE POLICY ESTABLISHE D UNDER SUBSECTION (B) OF THIS SECTION 13
SHALL INCLUDE : 14
(1) THE TRAINING IDENTIFI ED OR DEVELOPED UNDE R § 15
7–426.2(C) OF THIS SUBTITLE FOR SCHOOL NURSES AND VO LUNTARY SCHOOL 16
PERSONNEL WHO ARE DE SIGNATED BY A SCHOOL NURSE AND, IN THE CLINICAL 17
JUDGMENT OF THE SCHO OL NURSE, ARE APPROPRIATE RECI PIENTS OF THE 18
TRAINING; 19
(2) PROCEDURES FOR THE EM ERGENCY ADMINISTRATI ON OF A 20
BRONCHODILATOR BY A SCHOOL NURSE OR DESI GNATED VOLUNTEER ; 21
(3) THE PROPER FOLLOW –UP EMERGENCY PROCEDU RES; 22
(4) A PROVISION AUTHORIZIN G A SCHOOL NURSE OR ANY OTHER 23
LICENSED HEALTH CARE PRACTITIONER TO OBTA IN, AND A SCHOOL NURSE O R ANY 24
OTHER SCHOOL PERSONN EL TO STORE, AT A NONPUBLIC SCHOO L FOR USE IN AN 25
EMERGENCY SITUATION BRONCHODILATORS AND MODES OF DELIVERY , INCLUDING 26
INHALERS WITH SPACER S; 27
(5) A REQUIREMENT THAT THE NONPUBLIC SCHOOL DEV ELOP AND 28
IMPLEMENT A METHOD F OR NOTIFYING THE PAR ENTS OR GUARDIANS OF STUDENTS 29
OF THE SCHOOL ’S POLICY UNDER THIS SECTION AT THE BEGIN NING OF EACH 30
SCHOOL YEAR ; AND 31
(6) AN ONGOING PROCESS FOR OVERSIGHT AND MONITO RING BY A 32
LICENSED HEALTH CARE PRACTITIONER OF THE IMPLEMENTATION OF TH E POLICY 33
ESTABLISHED UNDER SU BSECTION (B) OF THIS SECTION. 34 HOUSE BILL 266 11
(D) (1) AN AUTHORIZED LICENSE D HEALTH CARE PRACTI TIONER MAY 1
PROVIDE BRONCHODILAT ORS TO A SCHOOL NURSE OR DESIGNATED VOLUNTEER 2
FOR USE IN ACCORDANC E WITH THIS SECTION . 3
(2) BRONCHODILATORS AND M ODES OF ADMINISTRATI ON, 4
INCLUDING INHALERS W ITH SPACERS, USED BY A SCHOOL NUR SE OR ANY OTHER 5
SCHOOL PERSONNEL MUS T BE FROM A LICENSED PHARMACY O R MANUFACTURER . 6
(3) A NONPUBLIC SCHOOL MAY ACCEPT DONATED 7
BRONCHODILATORS AND MODES OF ADMINISTRAT ION, INCLUDING INHALERS W ITH 8
SPACERS, FROM A LICENSED PHAR MACY OR MANUFACTURER . 9
(4) A NONPUBLIC SCHOOL MAY APPLY FOR GRANTS TO OBTAIN 10
FUNDING FOR THE P URCHASE OF BRONCHODI LATORS AND MODES OF 11
ADMINISTRATION , INCLUDING INHALERS W ITH SPACERS. 12
(B) (1) SUBJECT TO PARAGRAPH (2) OF THIS SUBSECTION , BEFORE THE 13
2024–2025 SCHOOL YEAR , EACH NONPUBLIC SCHOO L IN THE STATE MAY ESTABLISH 14
A POLICY FOR PUBLIC SCHOOLS WITHIN ITS JURISDICT ION TO AUTHORIZE THE 15
SCHOOL NURSE OR OTHE R SCHOOL PERSONNEL D ESIGNATED BY THE SCH OOL 16
NURSE TO ADMINISTER A BRONCHODILATOR TO A STUDENT WHO IS EXP ERIENCING 17
ASTHMA, REACTIVE AIRWAY DISE ASE, OR ASTHMA–RELATED SYMPTOMS . 18
(2) A POLICY ESTA BLISHED UNDER THIS S UBSECTION SHALL LIMI T 19
THE ADMINISTRATION O F A BRONCHODILATOR T O CASES IN WHICH A S TUDENT HAS 20
BEEN PRESCRIBED A BR ONCHODILATOR BY AN A UTHORIZED, LICENSED HEALTH 21
CARE PRACTITIONER IN ACCORDANCE WITH THE HEALTH OCCUPATIONS ARTICLE. 22
(C) A POLICY ESTABLISHED U NDER SUBSECTION (B) OF THIS SECTION 23
SHALL INCLUDE : 24
(1) PROVISIONS AUTHORIZIN G A SCHOOL NURSE TO OBTAIN AND 25
STORE AT A NONPUBLIC SCHOOL BRONCHODILATO RS TO BE USED IN AN 26
EMERGENCY SITUATION ; AND 27
(2) PROCEDURES FOR THE DE SIGNATION OF SCHOOL PERSONNEL B Y 28
A SCHOOL NURSE , IN ACCORDANCE WITH T HE HEALTH OCCUPATIONS ARTICLE, TO 29
RESPOND TO A STUDENT EXPERIENCING ASTHMA , REACTIVE AIRWAY DISE ASE, OR 30
ASTHMA–RELATED SYMPTOMS IN AN EMERGENCY SETTING . 31
(E) (D) EXCEPT FOR ANY WILLFU L OR GROSSLY NEGLIGE NT ACT, A 32
SCHOOL NURSE OR ANY OTHER SCHOOL PERSONN EL WHO RESPOND IN GO OD FAITH 33
TO THE ASTHMA ATTACK OR RESPIRATORY DISTR ESS OF A CHILD IN AC CORDANCE 34 12 HOUSE BILL 266
WITH THIS SECTION MA Y NOT BE HELD PERSON ALLY LIABLE FOR ANY ACT OR 1
OMISSION IN THE COUR SE OF RESPONDING TO THE CHILD IN DISTRES S. 2
SECTION 2. AND BE IT FURTHER ENACTED, That: 3
(a) (1) Subject to paragraph (2) of this subsection, on or before August 1, 2023, 4
the State Department of Education and the Maryland Department of Health jointly shall 5
update the Maryland State school health service guidelines for the management of students 6
with asthma. 7
(2) In updating the guidelines under this subsection, the State Department 8
of Education and the Maryland Department of Health shall provide guidance to school 9
nurses and other school personnel on distinguishing between asthma or reactive airway 10
disease and anaphylaxis. 11
(b) Before the start of the 2023–2024 school year, each county board of education, 12
including the Baltimore City Board of School Commissioners, shall make a good faith effort 13
to adopt and implement guidelines in accordance with § 7–426.6 of the Education Article, 14
as enacted by Section 1 of this Act, and following the Maryland State school health service 15
guidelines updated under subsection (a) of this section. 16
SECTION 2. 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 17
July 1, 2023. 18
Approved:
________________________________________________________________________________
Governor.
________________________________________________________________________________
Speaker of the House of Delegates.
________________________________________________________________________________
President of the Senate.