By: Johnson, Menéndez S.B. No. 294
(In the Senate - Filed December 16, 2022; February 15, 2023,
read first time and referred to Committee on Education;
April 3, 2023, reported adversely, with favorable Committee
Substitute by the following vote: Yeas 12, Nays 0; April 3, 2023,
sent to printer.)
Click here to see the committee vote
COMMITTEE SUBSTITUTE FOR S.B. No. 294 By: Menéndez
A BILL TO BE ENTITLED
AN ACT
relating to the use of epinephrine auto-injectors and medication
designated for treatment of respiratory distress on public and
private school campuses.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. The heading to Subchapter E, Chapter 38,
Education Code, is amended to read as follows:
SUBCHAPTER E. MAINTENANCE AND ADMINISTRATION OF EPINEPHRINE
AUTO-INJECTORS AND MEDICATION FOR RESPIRATORY DISTRESS [ASTHMA
MEDICINE]
SECTION 2. Section 38.201, Education Code, is amended by
adding Subdivision (3-a) to read as follows:
(3-a) "Medication for respiratory distress" means
albuterol, levalbuterol, or another medication designated by the
executive commissioner of the Health and Human Services Commission
for treatment of respiratory distress under Section 38.208(c).
SECTION 3. Section 38.202(a), Education Code, is amended to
read as follows:
(a) The commissioner of state health services shall
establish an advisory committee to examine and review the
administration, on a campus of a school district, an
open-enrollment charter school, a private school, or an institution
of higher education, of:
(1) epinephrine auto-injectors to a person
experiencing an anaphylactic reaction; and
(2) medication for respiratory distress to a person
experiencing respiratory distress [on a campus of a school
district, an open-enrollment charter school, a private school, or
an institution of higher education].
SECTION 4. Section 38.207, Education Code, is amended to
read as follows:
Sec. 38.207. ADVISORY COMMITTEE: DUTIES. The advisory
committee shall advise the commissioner of state health services
on:
(1) the storage and maintenance of epinephrine
auto-injectors and medication for respiratory distress on school
campuses and campuses of institutions of higher education;
(2) the training of school personnel and school
volunteers, and of personnel and volunteers at institutions of
higher education, in the administration of an epinephrine
auto-injector;
(3) the training of school personnel and school
volunteers, and of personnel and volunteers at institutions of
higher education, in the administration of a medication for
respiratory distress; and
(4) [(3)] a plan for:
(A) one or more school personnel members or
school volunteers trained in the administration of an epinephrine
auto-injector to be on each school campus; [and]
(B) one or more school personnel members or
school volunteers trained in the administration of medication for
respiratory distress to be on each school campus;
(C) one or more personnel members or volunteers
of an institution of higher education trained in the administration
of an epinephrine auto-injector to be on each campus of an
institution of higher education; and
(D) one or more personnel members or volunteers
of an institution of higher education trained in the administration
of medication for respiratory distress to be on each campus of an
institution of higher education.
SECTION 5. The heading to Section 38.208, Education Code,
is amended to read as follows:
Sec. 38.208. MAINTENANCE AND ADMINISTRATION OF EPINEPHRINE
AUTO-INJECTORS AND MEDICATION FOR RESPIRATORY DISTRESS [ASTHMA
MEDICINE].
SECTION 6. Section 38.208, Education Code, is amended by
amending Subsections (a-1), (b-1), (c), (e), and (f) and adding
Subsections (b-2), (b-3), (d-1), (d-2), and (e-1) to read as
follows:
(a-1) Each school district, open-enrollment charter school,
and private school may adopt and implement a policy regarding the
maintenance, administration, and disposal of medication for
respiratory distress [authorizing a school nurse to maintain and
administer asthma medicine] at each campus in the district or
school.
(b-1) If a policy is adopted under Subsection (a-1), the
policy must provide that school personnel and school volunteers who
are authorized and trained [the school nurse] may administer
medication for respiratory distress [prescription asthma medicine]
to a person reasonably believed to be experiencing respiratory
distress on [student only if the school nurse has written
notification from a parent or guardian of the student that the
student has been diagnosed as having asthma and stating that the
school nurse may administer prescription asthma medicine to the
student. A school nurse may administer the prescription asthma
medicine only at] a school campus, or at a school-sponsored or
school-related activity on or off school property.
(b-2) If medication for respiratory distress is
administered to a student whose parent or guardian has not provided
notification to the school that the student has been diagnosed with
asthma, the school must refer the student to the student's primary
care provider on the day the medication for respiratory distress is
administered and inform the student's parent or guardian regarding
the referral. The referral must include:
(1) the symptoms of respiratory distress observed;
(2) the name of the medication for respiratory
distress administered to the student; and
(3) any patient care instructions given to the
student.
(b-3) If a student who has received medication for
respiratory distress does not have a primary care provider or the
parent or guardian of the student has not engaged a primary care
provider for the student, the student's parent or guardian must
receive information to assist the parent or guardian in selecting a
primary care provider for the student.
(c) The executive commissioner of the Health and Human
Services Commission, in consultation with the commissioner of
education, and with advice from the advisory committee as
appropriate, shall adopt rules regarding the maintenance,
administration, and disposal of an epinephrine auto-injector at a
school campus subject to a policy adopted under Subsection (a) and
the maintenance, [and] administration, and disposal of medication
for respiratory distress [asthma medicine] at a school campus
subject to a policy adopted under Subsection (a-1). The rules must
establish:
(1) the number of epinephrine auto-injectors
available at each campus;
(2) the amount of medication for respiratory distress
[prescription asthma medicine] available at each campus;
(3) the process for each school district,
open-enrollment charter school, and private school to check the
inventory of epinephrine auto-injectors and medication for
respiratory distress [asthma medicine] at regular intervals for
expiration and replacement; [and]
(4) the amount of training required for school
personnel and school volunteers to administer:
(A) an epinephrine auto-injector; or
(B) medication for respiratory distress; and
(5) the types of medication that may be administered
under Subsection (b-1) to persons experiencing respiratory
distress, based on a review of the best available medical evidence.
(d-1) Each school district, open-enrollment charter school,
and private school that adopts a policy under Subsection (a-1) must
require that each campus have one or more school personnel or school
volunteers authorized and trained to administer medication for
respiratory distress present during regular school hours.
(d-2) A school personnel member or school volunteer may not
be subject to any penalty or disciplinary action for refusing to
administer or receive training to administer epinephrine
auto-injectors or medication for respiratory distress, as
applicable, in accordance with a policy adopted under Subsection
(a) or (a-1).
(e) The supply of epinephrine auto-injectors at each campus
must be stored in a secure location and be easily accessible to
school personnel and school volunteers authorized and trained to
administer an epinephrine auto-injector. [The supply of asthma
medicine at each campus must be stored in a secure location and be
easily accessible to the school nurse.]
(e-1) The supply of medication for respiratory distress at
each campus must be stored in a secure location and be easily
accessible to authorized school personnel and school volunteers.
(f) The policy described by Subsection (a-1) may not require
a school district, open-enrollment charter school, or private
school to purchase medication for respiratory distress
[prescription asthma medicine] or require any other expenditure
related to the maintenance or administration of medication for
respiratory distress [asthma medicine] that would result in a
negative fiscal impact on the district or school.
SECTION 7. Subchapter E, Chapter 38, Education Code, is
amended by adding Section 38.2091 to read as follows:
Sec. 38.2091. REPORT ON ADMINISTERING MEDICATION FOR
RESPIRATORY DISTRESS. (a) Not later than the 10th business day
after the date a school personnel member or school volunteer
administers medication for respiratory distress to a person
experiencing respiratory distress in accordance with a policy
adopted under Section 38.208(a-1), the school shall report the
information required under Subsection (b) to:
(1) the school district, the charter holder if the
school is an open-enrollment charter school, or the governing body
of the school if the school is a private school;
(2) the physician or other person who prescribed the
medication for respiratory distress; and
(3) the commissioner of state health services.
(b) The report required under this section must include:
(1) the age of the person who received the
administration of the medication for respiratory distress;
(2) whether the person who received the administration
of the medication for respiratory distress was a student, a school
personnel member or school volunteer, or a visitor;
(3) the dosage of the medication for respiratory
distress administered;
(4) the title of the person who administered the
medication for respiratory distress; and
(5) any other information required by the commissioner
of education.
SECTION 8. Section 38.210, Education Code, is amended by
amending Subsections (a) and (b) and adding Subsection (a-1) to
read as follows:
(a) Each school district, open-enrollment charter school,
and private school that adopts a policy under Section 38.208(a) is
responsible for training school personnel and school volunteers in
the administration of an epinephrine auto-injector. The training
must include information on:
(1) recognizing the signs and symptoms of anaphylaxis;
(2) administering an epinephrine auto-injector;
(3) implementing emergency procedures, if necessary,
after administering an epinephrine auto-injector; and
(4) properly disposing of used or expired epinephrine
auto-injectors.
(a-1) Each school district, open-enrollment charter school,
and private school that adopts a policy under Section 38.208(a-1)
is responsible for training school personnel and school volunteers
in the administration of medication for respiratory distress. The
training must include information on:
(1) recognizing the signs and symptoms of respiratory
distress;
(2) administering medication for respiratory
distress;
(3) implementing emergency procedures, if necessary,
after administering medication for respiratory distress; and
(4) proper sanitization, reuse, and disposal of
medication for respiratory distress.
(b) Training required under this section must be provided:
(1) [include information on:
[(A) recognizing the signs and symptoms of
anaphylaxis;
[(B) administering an epinephrine auto-injector;
[(C) implementing emergency procedures, if
necessary, after administering an epinephrine auto-injector; and
[(D) properly disposing of used or expired
epinephrine auto-injectors;
[(2) be provided] in a formal training session or
through online education; and
(2) [(3) be provided] in accordance with the policy
adopted under Section 21.4515.
SECTION 9. The heading to Section 38.211, Education Code,
is amended to read as follows:
Sec. 38.211. PRESCRIPTION OF EPINEPHRINE AUTO-INJECTORS
AND MEDICATION FOR RESPIRATORY DISTRESS [ASTHMA MEDICINE].
SECTION 10. Sections 38.211(a), (b), (c), (e), and (f),
Education Code, are amended to read as follows:
(a) A physician or person who has been delegated
prescriptive authority under Chapter 157, Occupations Code, may
prescribe epinephrine auto-injectors or medication for respiratory
distress [asthma medicine] in the name of a school district,
open-enrollment charter school, or private school.
(b) A physician or other person who prescribes epinephrine
auto-injectors or medication for respiratory distress [asthma
medicine] under Subsection (a) shall provide the school district,
open-enrollment charter school, or private school with a standing
order for the administration of, as applicable:
(1) an epinephrine auto-injector to a person
reasonably believed to be experiencing anaphylaxis; or
(2) medication for respiratory distress [asthma
medicine] to a person reasonably believed to be experiencing
respiratory distress [a symptom of asthma and who has provided
written notification and permission as required by Section
38.208(b-1)].
(c) The standing order under Subsection (b) is not required
to be patient-specific, and the epinephrine auto-injector or
medication for respiratory distress [asthma medicine] may be
administered to a person without a previously established
physician-patient relationship.
(e) An order issued under this section must contain:
(1) the name and signature of the prescribing
physician or other person;
(2) the name of the school district, open-enrollment
charter school, or private school to which the order is issued;
(3) as applicable, the quantity of epinephrine
auto-injectors or the quantity and types of medications for
respiratory distress [asthma medicine] to be obtained and
maintained under the order; and
(4) the date of issue.
(f) A pharmacist may dispense an epinephrine auto-injector
or medication for respiratory distress [asthma medicine] to a
school district, open-enrollment charter school, or private school
without requiring the name or any other identifying information
relating to the user.
SECTION 11. Section 38.212, Education Code, is amended to
read as follows:
Sec. 38.212. NOTICE TO PARENTS; WRITTEN CONSENT. (a) If a
school district, open-enrollment charter school, or private school
implements a policy under this subchapter, the district or school
shall:
(1) provide written notice of the policy to a parent or
guardian of each student enrolled in the district or school; and
(2) obtain written consent from a parent or guardian
of each student on the student's enrollment in the district or
school to administer an epinephrine auto-injector or medication for
respiratory distress, as applicable, to the student in accordance
with the policy.
(b) Notice required under Subsection (a)(1) [this section]
must be provided before a policy is implemented by the district or
school under this subchapter and before the start of each school
year.
(c) Subsection (a)(2) does not prohibit a school personnel
member or school volunteer from administering in good faith an
epinephrine auto-injector to a student reasonably believed to be
experiencing anaphylaxis or medication for respiratory distress to
a student reasonably believed to be experiencing respiratory
distress, as applicable, in accordance with a policy implemented
under this subchapter, regardless of whether the student's parent
or guardian has provided written consent under Subsection (a)(2).
SECTION 12. Section 38.215(a), Education Code, is amended
to read as follows:
(a) A person who in good faith takes, or fails to take, any
action under this subchapter is immune from civil or criminal
liability or disciplinary action resulting from that action or
failure to act, including:
(1) issuing an order for epinephrine auto-injectors or
medication for respiratory distress [asthma medicine];
(2) supervising or delegating the administration of an
epinephrine auto-injector or medication for respiratory distress
[asthma medicine];
(3) possessing, maintaining, storing, or disposing of
an epinephrine auto-injector or medication for respiratory
distress [asthma medicine];
(4) prescribing an epinephrine auto-injector or
medication for respiratory distress [asthma medicine];
(5) dispensing:
(A) an epinephrine auto-injector; or
(B) medication for respiratory distress [asthma
medicine, provided that permission has been granted as provided by
Section 38.208(b-1)];
(6) administering, or assisting in administering, an
epinephrine auto-injector or medication for respiratory distress
[asthma medicine, provided that permission has been granted as
provided by Section 38.208(b-1)];
(7) providing, or assisting in providing, training,
consultation, or advice in the development, adoption, or
implementation of policies, guidelines, rules, or plans; or
(8) undertaking any other act permitted or required
under this subchapter.
SECTION 13. This Act takes effect immediately if it
receives a vote of two-thirds of all the members elected to each
house, as provided by Section 39, Article III, Texas Constitution.
If this Act does not receive the vote necessary for immediate
effect, this Act takes effect September 1, 2023.
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