FIRSTREGULARSESSION
HOUSEBILLNO.553
103RDGENERALASSEMBLY
INTRODUCEDBYREPRESENTATIVEVIOLET.
1685H.01I DANARADEMANMILLER,ChiefClerk
ANACT
Torepealsections167.627,167.630,190.246,196.990,and321.621,RSMo,andtoenactin
lieuthereoffivenewsectionsrelatingtoepinephrineproducts,withpenalty
provisions.
BeitenactedbytheGeneralAssemblyofthestateofMissouri,asfollows:
SectionA.Sections167.627,167.630,190.246,196.990,and321.621,RSMo,are
2repealedandfivenewsectionsenactedinlieuthereof,tobeknownassections167.627,
3167.630,190.246,196.990,and321.621,toreadasfollows:
167.627.1.Forpurposesofthissection,thefollowingtermsshallmean:
2 (1)"Medication",anymedicineprescribedororderedbyaphysicianforthetreatment
3ofasthmaoranaphylaxis,includingwithoutlimitationinhaledbronchodilators[and],auto-
4injectibleepinephrine, andsingle-useepinephrinenasalspray;
5 (2)"Self-administration",apupil'sdiscretionaryuseofmedicationprescribedbya
6physicianorunderawrittentreatmentplanfromaphysician.
7 2.Eachboardofeducationanditsemployeesandagentsinthisstateshallgrantany
8pupilintheschoolauthorizationforthepossessionandself-administrationofmedicationto
9treatsuchpupil'schronichealthcondition,includingbutnotlimitedtoasthmaoranaphylaxis
10if:
11 (1)Alicensedphysicianprescribedororderedsuchmedicationforusebythepupil
12andinstructedsuchpupilinthecorrectandresponsibleuseofsuchmedication;
13 (2)Thepupilhasdemonstratedtothepupil'slicensedphysicianorthelicensed
14physician'sdesignee,andtheschoolnurse,ifavailable,theskilllevelnecessarytousethe
15medicationandanydevicenecessarytoadministersuchmedicationprescribedorordered;
EXPLANATION—Matterenclosedinbold-facedbrackets[thus] intheabovebillisnotenactedandis
intendedtobeomittedfromthelaw.Matterinbold-facetypeintheabovebillisproposedlanguage. 16 (3)Thepupil'sphysicianhasapprovedandsignedawrittentreatmentplanfor
17managingthepupil'schronichealthcondition,includingasthmaoranaphylaxisepisodesand
18formedicationforusebythepupil.Suchplanshallincludeastatementthatthepupilis
19capableofself-administeringthemedicationunderthetreatmentplan;
20 (4)Thepupil'sparentorguardianhascompletedandsubmittedtotheschoolany
21writtendocumentationrequiredbytheschool,includingthetreatmentplanrequiredunder
22subdivision(3)ofthissubsectionandtheliabilitystatementrequiredundersubdivision(5)of
23thissubsection;and
24 (5)Thepupil'sparentorguardianhassignedastatementacknowledgingthatthe
25schooldistrictanditsemployeesoragentsshallincurnoliabilityasaresultofanyinjury
26arisingfromtheself-administrationofmedicationbythepupilortheadministrationofsuch
27medicationbyschoolstaff.Suchstatementshallnotbeconstruedtoreleasetheschool
28districtanditsemployeesoragentsfromliabilityfornegligence.
29 3.Anauthorizationgrantedundersubsection2ofthissectionshall:
30 (1)Permitsuchpupiltopossessandself-administersuchpupil'smedicationwhilein
31school,ataschool-sponsoredactivity,andintransittoorfromschoolorschool-sponsored
32activity;and
33 (2)Beeffectiveonlyforthesameschoolandschoolyearforwhichitisgranted.
34Suchauthorizationshallberenewedbythepupil'sparentorguardianeachsubsequentschool
35yearinaccordancewiththissection.
36 4.Anycurrentduplicateprescriptionmedication,ifprovidedbyapupil'sparentor
37guardianorbytheschool,shallbekeptatapupil'sschoolinalocationatwhichthepupilor
38schoolstaffhasimmediateaccessintheeventofanasthmaoranaphylaxisemergency.
39 5.Theinformationdescribedinsubdivisions(3)and(4)ofsubsection2ofthis
40sectionshallbekeptonfileatthepupil'sschoolinalocationeasilyaccessibleintheeventof
41anemergency.
167.630.1.Eachschoolboardmayauthorizeaschoolnurselicensedunderchapter
2335whoisemployedbytheschooldistrictandforwhomtheboardisresponsibleforto
3maintainanadequatesupplyofprefilledautosyringesofepinephrinewithfifteen-hundredths
4milligramorthree-tenthsmilligramdelivery, orsingle-useepinephrinenasalspraydevices,
5attheschool.Thenurseshallrecommendtotheschoolboardthenumberofprefilled
6epinephrineautosyringesorsingle-useepinephrinenasalspraydevicesthattheschool
7shouldmaintain.
8 2.Toobtainprefilledepinephrineautosyringesorsingle-useepinephrinenasal
9spraydevicesforaschooldistrict,aprescriptionwrittenbyalicensedphysician,a
10physician'sassistant,ornursepractitionerisrequired.Forsuchprescriptions,theschool
HB553 2 11districtshallbedesignatedasthepatient,thenurse'snameshallberequired,andthe
12prescriptionshallbefilledatalicensedpharmacy.
13 3.Aschoolnurse,contractedagenttrainedbyanurse,orotherschoolemployee
14trainedbyandsupervisedbythenurseshallhavethediscretiontouseanepinephrineauto
15syringeorsingle-useepinephrinenasalsprayonanystudenttheschoolnurse,trained
16employee,ortrainedcontractedagentbelievesishavingalife-threateninganaphylactic
17reactionbasedonthetraininginrecognizinganacuteepisodeofananaphylacticreaction.
18Theprovisionsofsection167.624concerningimmunityfromcivilliabilityfortrained
19employeesadministeringlifesavingmethodsshallapplytotrainedemployeesadministeringa
20prefilledautosyringeorsingle-useepinephrinenasalsprayunderthissection.Trained
21contractedagentsshallhaveimmunityfromcivilliabilityforadministeringaprefilledauto
22syringeorsingle-useepinephrinenasalsprayunderthissection.
190.246.1.Asusedinthissection,thefollowingtermsshallmean:
2 (1)"Eligibleperson,firm,organizationorotherentity",anambulanceserviceor
3emergencymedicalresponseagency,anemergencymedicalresponder,oranemergency
4medicaltechnicianwhoisemployedby,oranenrolledmember,person,firm,organizationor
5entitydesignatedby,ruleofthedepartmentofhealthandseniorservicesinconsultationwith
6otherappropriateagencies.Allsucheligiblepersons,firms,organizationsorotherentities
7shallbesubjecttotherulespromulgatedbythedirectorofthedepartmentofhealthandsenior
8services;
9 (2)"Emergencyhealthcareprovider":
10 (a)Aphysicianlicensedpursuanttochapter334withknowledgeandexperiencein
11thedeliveryofemergencycare;or
12 (b)Ahospitallicensedpursuanttochapter197thatprovidesemergencycare.
13 2.Possessionanduseofepinephrineauto-injectordevicesandsingle-use
14epinephrinenasalspraydevicesshallbelimitedasfollows:
15 (1)Nopersonshalluseanepinephrineauto-injectordeviceorsingle-use
16epinephrinenasalspraydeviceunlesssuchpersonhassuccessfullycompletedatraining
17courseintheuseofepinephrineauto-injectordevicesorsingle-useepinephrinenasalspray
18devices,asappropriate,approvedbythedirectorofthedepartmentofhealthandsenior
19services.Nothinginthissectionshallprohibittheuseofanepinephrineauto-injectordevice
20orsingle-useepinephrinenasalspraydevice:
21 (a)Byahealthcareprofessionallicensedorcertifiedbythisstatewhoisacting
22withinthescopeofhisorherpractice;or
23 (b)Byapersonactingpursuanttoalawfulprescription;
24 (2)Everyperson,firm,organizationandentityauthorizedtopossessanduse
25epinephrineauto-injectordevicesorsingle-useepinephrinenasalspraydevicespursuantto
HB553 3 26thissectionshalluse,maintainanddisposeofsuchdevicesinaccordancewiththerulesofthe
27department;and
28 (3)Everyuseofanepinephrineauto-injectordeviceorsingle-useepinephrinenasal
29spraydevicepursuanttothissectionshallimmediatelybereportedtotheemergencyhealth
30careprovider.
31 3.(1)Useofanepinephrineauto-injectordeviceorsingle-useepinephrinenasal
32spraydevicepursuanttothissectionshallbeconsideredfirstaidoremergencytreatmentfor
33thepurposeofanylawrelatingtoliability.
34 (2)Purchase,acquisition,possessionoruseofanepinephrineauto-injectordeviceor
35single-useepinephrinenasalspraydevicepursuanttothissectionshallnotconstitutethe
36unlawfulpracticeofmedicineortheunlawfulpracticeofaprofession.
37 (3)Anypersonotherwiseauthorizedtosellorprovideanepinephrineauto-injector
38deviceorsingle-useepinephrinenasalspraydevicemaysellorprovideittoaperson
39authorizedtopossessitpursuanttothissection.
40 4.Anyperson,firm,organizationorentitythatviolatestheprovisionsofthissection
41isguiltyofaclassBmisdemeanor.
196.990.1.Asusedinthissection,thefollowingtermsshallmean:
2 (1)"Administer",thedirectapplicationofanepinephrineauto-injectortothebodyof
3anindividualorthesprayingofanepinephrinenasalsprayintothenostrilofan
4individual;
5 (2)"Authorizedentity",anyentityororganizationatorinconnectionwithwhich
6allergenscapableofcausinganaphylaxismaybepresentincluding,butnotlimitedto,
7qualifiedfirstresponders,assuchtermisdefinedinsection321.621,restaurants,recreation
8camps,youthsportsleagues,amusementparks,andsportsarenas."Authorizedentity"shall
9notincludeanypublicschoolorpubliccharterschool;
10 (3)"Authorizedepinephrineproduct",anepinephrineauto-injectoror
11epinephrinenasalspray;
12 (4)"Epinephrineauto-injector",asingle-usedeviceusedfortheautomaticinjection
13ofapremeasureddoseofepinephrineintothehumanbody;
14 [(4)](5)"Epinephrinenasalspray",asingle-usenasalspraydeviceusedforthe
15administrationofasingledoseofepinephrineintothehumanbodythroughanostril;
16 (6)"Physician",aphysicianlicensedinthisstateunderchapter334;
17 [(5)](7)"Provide",thesupplyofoneormoreauthorizedepinephrine[auto-
18injectors] productstoanindividual;
19 [(6)](8)"Self-administration",aperson'sdiscretionaryuseofanauthorized
20epinephrine[auto-injector] product.
HB553 4 21 2.Aphysicianmayprescribeauthorizedepinephrine[auto-injectors] productsin
22thenameofanauthorizedentityforuseinaccordancewiththissection,andpharmacists,
23physicians,andotherpersonsauthorizedtodispenseprescriptionmedicationsmaydispense
24authorizedepinephrine[auto-injectors] productsunderaprescriptionissuedinthenameof
25anauthorizedentity.
26 3.Anauthorizedentitymayacquireandstockasupplyofauthorizedepinephrine
27[auto-injectors] productsunderaprescriptionissuedinaccordancewiththissection.Such
28authorizedepinephrine[auto-injectors] productsshallbestoredinalocationreadily
29accessibleinanemergencyandinaccordancewiththeauthorizedepinephrine[auto-
30injector's] product'sinstructionsforuseandanyadditionalrequirementsestablishedbythe
31departmentofhealthandseniorservicesbyrule.Anauthorizedentityshalldesignate
32employeesoragentswhohavecompletedthetrainingrequiredunderthissectiontobe
33responsibleforthestorage,maintenance,andgeneraloversightofauthorizedepinephrine
34[auto-injectors] productsacquiredbytheauthorizedentity.
35 4.Anauthorizedentitythatacquiresasupplyofauthorizedepinephrine[auto-
36injectors] productsunderaprescriptionissuedinaccordancewiththissectionshallensure
37that:
38 (1)Expected[epinephrineauto-injector] usersofauthorizedepinephrineproducts
39receivetraininginrecognizingsymptomsofsevereallergicreactionsincludinganaphylaxis
40andtheuseofepinephrineauto-injectorsorepinephrinenasalsprays,asappropriate
41basedonthesupply,fromanationallyrecognizedorganizationexperiencedintraining
42laypersonsinemergencyhealthtreatmentoranotherentityorpersonapprovedbythe
43departmentofhealthandseniorservices;
44 (2)Allauthorizedepinephrine[auto-injectors] productsaremaintainedandstored
45accordingtotheauthorizedepinephrine[auto-injector's] product'sinstructionsforuse;
46 (3)Anypersonwhoprovidesoradministersanauthorizedepinephrine[auto-
47injector] producttoanindividualwhothepersonbelievesingoodfaithisexperiencing
48anaphylaxisactivatestheemergencymedicalservicessystemassoonaspossible;and
49 (4)Aproperreviewofallsituationsinwhichanauthorizedepinephrine[auto-
50injector] productisusedtorenderemergencycareisconducted.
51 5.Anyauthorizedentitythatacquiresasupplyofauthorizedepinephrine[auto-
52injectors] productsunderaprescriptionissuedinaccordancewiththissectionshallnotifythe
53emergencycommunicationsdistrictortheambulancedispatchcenteroftheprimaryprovider
54ofemergencymedicalserviceswheretheauthorizedepinephrine[auto-injectors] products
55aretobelocatedwithintheentity'sfacility.
56 6.Nopersonshallprovideoradministeranauthorizedepinephrine[auto-injector]
57producttoanyindividualwhoisundereighteenyearsofagewithouttheverbalconsentofa
HB553 5 58parentorguardianwhoispresentatthetimewhenprovisionoradministrationofthe
59authorizedepinephrine[auto-injector] productisneeded.Provided,however,thataperson
60mayprovideoradministeranauthorizedepinephrine[auto-injector] producttosuchan
61individualwithouttheconsentofaparentorguardianiftheparentorguardianisnot
62physicallypresentandthepersonreasonablybelievestheindividualshallbeinimminent
63dangerwithouttheprovisionoradministrationoftheauthorizedepinephrine[auto-injector]
64product.
65 7.Thefollowingpersonsandentitiesshallnotbeliableforanyinjuriesorrelated
66damagesthatresultfromtheadministrationorself-administrationofanauthorized
67epinephrine[auto-injector] productinaccordancewiththissectionthatmayconstitute
68ordinarynegligence:
69 (1)Anauthorizedentitythatpossessesandmakesavailableauthorizedepinephrine
70[auto-injectors] productsanditsemployees,agents,andothertrainedpersons;
71 (2)Anypersonwhousesanauthorizedepinephrine[auto-injector] productmade
72availableunderthissection;
73 (3)Aphysicianthatprescribesauthorizedepinephrine[auto-injectors] productsto
74anauthorizedentity;or
75 (4)Anypersonorentitythatconductsthetrainingdescribedinthissection.
76
77Suchimmunitydoesnotapplytoactsoromissionsconstitutingarecklessdisregardforthe
78safetyofothersorwillfulorwantonconduct.Theadministrationofanauthorized
79epinephrine[auto-injector] productinaccordancewiththissectionshallnotbeconsidered
80thepracticeofmedicine.Theimmunityfromliabilityprovidedunderthissubsectionisin
81additiontoandnotinlieuofthatprovidedundersection537.037.Anauthorizedentity
82locatedinthisstateshallnotbeliableforanyinjuriesorrelateddamagesthatresultfromthe
83provisionoradministrationofanauthorizedepinephrine[auto-injector] productbyits
84employeesoragentsoutsideofthisstateiftheentityoritsemployeeoragentisnotliablefor
85suchinjuriesorrelateddamagesunderthelawsofthestateinwhichsuchprovisionor
86administrationoccurred.Notrainedpersonwhoisincompliancewiththissectionandwhoin
87goodfaithandexercisingreasonablecarefailstoadministeranauthorizedepinephrine
88[auto-injector] productshallbeliableforsuchfailure.
89 8.Allbasiclifesupportambulancesandstretchervansoperatedinthestateshallbe
90equippedwithauthorizedepinephrine[auto-injectors] productsandbestaffedbyatleast
91oneindividualtrainedintheuseofauthorizedepinephrine[auto-injectors] products.
92 9.Theprovisionsofthissectionshallapplyinallcountieswithinthestateandany
93citynotwithinacounty.
HB553 6 94 10.Nothinginthissectionshallbeconstruedassupersedingtheprovisionsofsection
95167.630.
321.621.1.Forthepurposesofthissection,"qualifiedfirstresponder"shallmean
2anystateandlocallawenforcementagencystaff,firedepartmentpersonnel,firedistrict
3personnel,orlicensedemergencymedicaltechnicianwhoisactingunderthedirectivesand
4establishedprotocolsofamedicaldirectorwhocomesincontactwithapersonsufferingfrom
5ananaphylacticreactionandwhohasreceivedtraininginrecognizingandrespondingto
6anaphylacticreactionsandtheadministrationofepinephrineauto-injectordevicesorsingle-
7useepinephrinenasalspraydevicestoapersonsufferingfromanapparentanaphylactic
8reaction."Qualifiedfirstresponderagencies"shallmeananystateorlocallawenforcement
9agency,firedepartment,orambulanceservicethatprovidesdocumentedtrainingtoitsstaff
10relatedtotheadministrationofepinephrineauto-injectordevicesorsingle-useepinephrine
11nasalspraydevicesinanapparentanaphylacticreaction.
12 2.Thedirectorofthedepartmentofhealthandseniorservices,ifalicensed
13physician,mayissueastatewidestandingorderforepinephrineauto-injectordevicesor
14single-useepinephrinenasalspraydevicesforadultpatientstofireprotectiondistrictsin
15nonmetropolitanareasinMissouriassuchareasaredeterminedaccordingtotheUnited
16StatesCensusBureau'sAmericanCommunitySurvey,basedonthemostrecentoffive-year
17periodestimatedatainwhichthefinalyearoftheestimateendsineitherzeroorfive.Ifthe
18directorofthedepartmentofhealthandseniorservicesisnotalicensedphysician,the
19departmentofhealthandseniorservicesmayemployorcontractwithalicensedphysician
20whomayissuesuchastatewideorderwiththeexpressconsentofthedirector.
21 3.Possessionanduseofepinephrineauto-injectordevicesandsingle-use
22epinephrinenasalspraydevicesforadultpatientsshallbelimitedasfollows:
23 (1)Nopersonshalluseanepinephrineauto-injectordeviceorsingle-use
24epinephrinenasalspraydevicepursuanttothissectionunlesssuchpersonhas
25successfullycompletedatrainingcourseintheuseofepinephrineauto-injectordevicesor
26single-useepinephrinenasalspraydevices,asappropriate,foradultpatientsapprovedby
27thedirectorofthedepartmentofhealthandseniorservices.Nothinginthissectionshall
28prohibittheuseofanepinephrineauto-injectordeviceorsingle-useepinephrinenasal
29spraydevice:
30 (a)Byahealthcareprofessionallicensedorcertifiedbythisstatewhoisacting
31withinthescopeofhisorherpractice;or
32 (b)Byapersonactingpursuanttoalawfulprescription;
33 (2)Everyperson,firm,organizationandentityauthorizedtopossessanduse
34epinephrineauto-injectordevicesorsingle-useepinephrinenasalspraydevicesforadult
HB553 7 35patientspursuanttothissectionshalluse,maintainanddisposeofsuchdevicesforadult
36patientsinaccordancewiththerulesofthedepartment;and
37 (3)Everyuseofanepinephrineauto-injectordeviceorsingle-useepinephrinenasal
38spraydevicepursuanttothissectionshallimmediatelybereportedtotheemergencyhealth
39careproviderasdefinedinsection190.246.
40 4.(1)Useofanepinephrineauto-injectordeviceorsingle-useepinephrinenasal
41spraydevicepursuanttothissectionshallbeconsideredfirstaidoremergencytreatmentfor
42thepurposeofanylawrelatingtoliability.
43 (2)Purchase,acquisition,possessionoruseofanepinephrineauto-injectordeviceor
44single-useepinephrinenasalspraydevicepursuanttothissectionshallnotconstitutethe
45unlawfulpracticeofmedicineortheunlawfulpracticeofaprofession.
46 (3)Anypersonotherwiseauthorizedtosellorprovideanepinephrineauto-injector
47deviceorsingle-useepinephrinenasalspraydevicemaysellorprovideittoaperson
48authorizedtopossessitpursuanttothissection.
49 5.(1)Thereisherebycreatedinthestatetreasurythe"Epinephrine[Auto-injector]
50DevicesforFirePersonnelFund",whichshallconsistof[moneycollectedunderthissection]
51moneysappropriatedtothefund. Thestatetreasurershallbecustodianofthefund.In
52accordancewithsections30.170and30.180,thestatetreasurermayapprovedisbursements.
53Themoneysinthefundassetforthinthissectionshallbesubjecttoappropriationbythe
54generalassemblyfortheparticularpurposeforwhichcollected.Thefundshallbea
55dedicatedfundandmoneyinthefundshallbeusedsolelybythedepartmentofhealthand
56seniorservicesforthepurposesofprovidingepinephrineauto-injectordevicesandsingle-
57useepinephrinenasalspraydevicesforadultpatientstoqualifiedfirstresponderagencies
58asusedinthissection.
59 (2)Notwithstandingtheprovisionsofsection33.080tothecontrary,anymoneys
60remaininginthefundattheendofthebienniumshallnotreverttothecreditofthegeneral
61revenuefund.
62 (3)Thestatetreasurershallinvestmoneysinthefundinthesamemannerasother
63fundsareinvested.Anyinterestandmoneysearnedonsuchinvestmentsshallbecreditedto
64thefund.
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HB553 8