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2023 - 2024 LEGISLATURE
2023 ASSEMBLY BILL 9
February 7, 2023 - Introduced by Representatives SORTWELL, GOEBEN, SHANKLAND,
BRANDTJEN, BROOKS, CABRERA, KNODL, MOSES, MURPHY, ROZAR, SUBECK, TITTL,
TUSLER, WICHGERS and VINING, cosponsored by Senators JACQUE, BALLWEG,
COWLES, SPREITZER and WANGGAARD. Referred to Committee on Health, Aging
and Long-Term Care.
***AUTHORS SUBJECT TO CHANGE***
AN ACT to repeal 118.29 (1) (bm), 118.292 (1g) (b), 118.292 (1g) (bm), 118.2925
(1) (d), 118.2925 (1) (fm), 255.07 (1) (c) and 255.07 (1) (e); to amend 118.29 (2)
(a) 2m., 118.292 (1r) (intro.), 118.292 (1r) (a), 118.292 (2) (a), 118.292 (2) (b),
118.2925 (1) (h), 118.2925 (3), 118.2925 (4) (a), (b) and (c), 118.2925 (4m) (a),
118.2925 (4m) (b), 118.2925 (5), 255.07 (2) (a), 255.07 (2) (b), 255.07 (3), 255.07
(4), 255.07 (5) (a) 2., 255.07 (5) (a) 3., 255.07 (6) (a) (intro.), 255.07 (6) (a) 1., 2.
and 3., 255.07 (6) (b), 255.07 (6) (d), 255.07 (6) (e), 255.07 (6) (f), 448.03 (2) (q)
and 450.11 (4) (a) 5. d.; and to create 118.29 (1) (br), 118.292 (1g) (bg), 118.2925
(1) (dm) and 255.07 (1) (cm) of the statutes; relating to: use of epinephrine
delivery systems and standing orders for epinephrine.
Analysis by the Legislative Reference Bureau
This bill amends current law authority related to the possession,
administration, and dispensing of epinephrine auto-injectors and prefilled syringes
of epinephrine to instead include all epinephrine delivery systems. Under the bill,
“epinephrine delivery system” is defined to mean a device that is approved by the
federal Food and Drug Administration, that contains a dose of epinephrine, and that
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is used to administer epinephrine into the human body to prevent or treat a
life-threatening allergic reaction.
Current law allows designated school personnel, school nurses, and other
authorized entities and individuals who have completed a training program to
provide or administer epinephrine auto-injectors and prefilled syringes to pupils
and other individuals. “Authorized entities” are those entities or organizations that
operate or participate in a business, activity, or event where anaphylaxis-causing
allergens may be present. Authorized entities include restaurants, camps,
institutions of higher education, places of employment, amusement parks, and
sports leagues and arenas. The bill allows the same individuals and entities to
provide or administer any epinephrine delivery system.
Under current law, pupils are also allowed to possess and use an epinephrine
auto-injector or a prefilled syringe in certain circumstances while in school,
participating in a school-sponsored activity, or under supervision by a school. Under
the bill, pupils are allowed to possess and use any epinephrine delivery system under
those same circumstances.
In addition, current law allows prescribers to prescribe epinephrine
auto-injectors and prefilled syringes in the name of the school or the name of the
authorized entity or individual. The bill provides prescribing authority for any
epinephrine delivery system.
Finally, current law allows any prescriber to issue a standing order or a
statewide standing order for the dispensing of epinephrine auto-injectors or
prefilled syringes for use by trained individuals. The bill allows prescribers to issue
a standing order or statewide standing orders for any epinephrine delivery system
for use by trained individuals.
For further information see the state and local fiscal estimate, which will be
printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SECTION 1. 118.29 (1) (bm) of the statutes is repealed.
SECTION 2. 118.29 (1) (br) of the statutes is created to read:
118.29 (1) (br) “Epinephrine delivery system” means a device that is approved
by the federal food and drug administration, that contains a dose of epinephrine, and
that is used to administer epinephrine into the human body to prevent or treat a
life-threatening allergic reaction.
SECTION 3. 118.29 (2) (a) 2m. of the statutes is amended to read:
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118.29 (2) (a) 2m. Except for epinephrine administered under subd. 2., may use
an epinephrine auto-injector, or prefilled syringe, as defined in s. 118.292 (1g) (bm),
epinephrine delivery system to administer epinephrine to any pupil who appears to
be experiencing a severe allergic reaction if, as soon as practicable, the school bus
operator, employee or volunteer reports the allergic reaction by dialing the telephone
number “911" or, in an area in which the telephone number “911" is not available, the
telephone number for an emergency medical service provider.
SECTION 4. 118.292 (1g) (b) of the statutes is repealed.
SECTION 5. 118.292 (1g) (bg) of the statutes is created to read:
118.292 (1g) (bg) “Epinephrine delivery system” means a device that is
approved by the federal food and drug administration, that contains a dose of
epinephrine, and that is used to administer epinephrine into the human body to
prevent or treat a life-threatening allergic reaction.
SECTION 6. 118.292 (1g) (bm) of the statutes is repealed.
SECTION 7. 118.292 (1r) (intro.) of the statutes is amended to read:
118.292 (1r) (intro.) While in school, at a school-sponsored activity or under
the supervision of a school authority, a pupil may possess and use an epinephrine
auto-injector or prefilled syringe epinephrine delivery system if all of the following
are true:
SECTION 8. 118.292 (1r) (a) of the statutes is amended to read:
118.292 (1r) (a) The pupil uses the epinephrine auto-injector or prefilled
syringe epinephrine delivery system to prevent the onset or alleviate the symptoms
of an emergency situation.
SECTION 9. 118.292 (2) (a) of the statutes is amended to read:
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118.292 (2) (a) A pupil as a result of using an epinephrine auto-injector or
prefilled syringe epinephrine delivery system under sub. (1r).
SECTION 10. 118.292 (2) (b) of the statutes is amended to read:
118.292 (2) (b) Any person as a result of a pupil possessing or using an
epinephrine auto-injector or prefilled syringe epinephrine delivery system under
sub. (1r).
SECTION 11. 118.2925 (1) (d) of the statutes is repealed.
SECTION 12. 118.2925 (1) (dm) of the statutes is created to read:
118.2925 (1) (dm) “Epinephrine delivery system” means a device that is
approved by the federal food and drug administration, that contains a dose of
epinephrine, and that is used to administer epinephrine into the human body to
prevent or treat a life-threatening allergic reaction.
SECTION 13. 118.2925 (1) (fm) of the statutes is repealed.
SECTION 14. 118.2925 (1) (h) of the statutes is amended to read:
118.2925 (1) (h) “Self-administer" means to administer an epinephrine
auto-injector or prefilled syringe epinephrine delivery system to one's own body.
SECTION 15. 118.2925 (3) of the statutes is amended to read:
118.2925 (3) PRESCRIPTIONS FOR SCHOOLS. A physician, an advanced practice
nurse prescriber, or a physician assistant may prescribe epinephrine auto-injectors
or prefilled syringes epinephrine delivery systems in the name of a school that has
adopted a plan under sub. (2) (a), to be maintained by the school for use under sub.
(4).
SECTION 16. 118.2925 (4) (a), (b) and (c) of the statutes are amended to read:
118.2925 (4) (a) Provide an epinephrine auto-injector or prefilled syringe
epinephrine delivery system to a pupil to self-administer the epinephrine
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auto-injector or prefilled syringe epinephrine delivery system in accordance with a
prescription specific to the pupil that is on file with the school.
(b) Administer an epinephrine auto-injector or prefilled syringe epinephrine
delivery system to a pupil in accordance with a prescription specific to the pupil that
is on file with the school.
(c) Administer an epinephrine auto-injector or prefilled syringe epinephrine
delivery system to a pupil or other person who the school nurse or designated school
personnel in good faith believes is experiencing anaphylaxis in accordance with a
standing protocol from a physician, an advanced practice nurse prescriber, or a
physician assistant, regardless of whether the pupil or other person has a
prescription for an epinephrine auto-injector or prefilled syringe epinephrine
delivery system. If the pupil or other person does not have a prescription for an
epinephrine auto-injector or prefilled syringe, epinephrine delivery system, or the
person who administers the epinephrine auto-injector or prefilled syringe
epinephrine delivery system does not know whether the pupil or other person has a
prescription for an epinephrine auto-injector or prefilled syringe epinephrine
delivery system, the person who administers the epinephrine auto-injector or
prefilled syringe epinephrine delivery system shall, as soon as practicable, report the
administration by dialing the telephone number “911" or, in an area in which the
telephone number “911" is not available, the telephone number for an emergency
medical service provider.
SECTION 17. 118.2925 (4m) (a) of the statutes is amended to read:
118.2925 (4m) (a) The authority to self-administer an epinephrine
auto-injector or prefilled syringe epinephrine delivery system under sub. (4) (a) is
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independent of the authorized possession and use of an epinephrine auto-injector or
prefilled syringe epinephrine delivery system under s. 118.292 (1r).
SECTION 18. 118.2925 (4m) (b) of the statutes is amended to read:
118.2925 (4m) (b) The authority to administer an epinephrine auto-injector or
prefilled syringe epinephrine delivery system under sub. (4) (b) and (c) is
independent of the authority to administer an epinephrine auto-injector
epinephrine delivery system under s. 118.29 (2) (a) 2. and 2m.
SECTION 19. 118.2925 (5) of the statutes is amended to read:
118.2925 (5) IMMUNITY FROM CIVIL LIABILITY; EXEMPTION FROM PRACTICE OF
MEDICINE. A school and its designated school personnel, and a physician, advanced
practice nurse prescriber, or physician assistant who provides a prescription or
standing protocol for school epinephrine auto-injectors or prefilled syringes
epinephrine delivery systems, are not liable for any injury that results from the
administration or self-administration of an epinephrine auto-injector or prefilled
syringe epinephrine delivery system under this section, regardless of whether
authorization was given by the pupil's parent or guardian or by the pupil's physician,
physician assistant, or advanced practice nurse prescriber, unless the injury is the
result of an act or omission that constitutes gross negligence or willful or wanton
misconduct. The immunity from liability provided under this subsection is in
addition to and not in lieu of that provided under s. 895.48.
SECTION 20. 255.07 (1) (c) of the statutes is repealed.
SECTION 21. 255.07 (1) (cm) of the statutes is created to read:
255.07 (1) (cm) “Epinephrine delivery system” means a device that is approved
by the federal food and drug administration, that contains a dose of epinephrine, and
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that is used to administer epinephrine into the human body to prevent or treat a
life-threatening allergic reaction.
SECTION 22. 255.07 (1) (e) of the statutes is repealed.
SECTION 23. 255.07 (2) (a) of the statutes is amended to read:
255.07 (2) (a) A health care practitioner may prescribe an epinephrine
auto-injector or prefilled syringe epinephrine delivery system in the name of an
authorized entity or an authorized individual for use in accordance with this section.
A health care practitioner may issue to one or more persons a standing order
authorizing the dispensing of epinephrine auto-injectors or prefilled syringes
epinephrine delivery systems for use under sub. (4) by an authorized individual or
by an employee or agent of an authorized entity who has completed the training
required by sub. (5).
SECTION 24. 255.07 (2) (b) of the statutes is amended to read:
255.07 (2) (b) A health care provider with prescribing authority who is
employed by or under contract with the department may issue a statewide standing
order for the dispensing of epinephrine auto-injectors or prefilled syringes
epinephrine delivery systems for use under sub. (4) by authorized individuals or by
employees or agents of authorized entities who have completed the training required
by sub. (5).
SECTION 25. 255.07 (3) of the statutes is amended to read:
255.07 (3) AUTHORIZED ENTITIES OR INDIVIDUALS PERMITTED TO MAINTAIN SUPPLY.
An authorized entity or an authorized individual may acquire and maintain a supply
of epinephrine auto-injectors and prefilled syringes epinephrine delivery systems
pursuant to a prescription issued in accordance with this section. The authorized
entity or authorized individual shall store an epinephrine auto-injector or prefilled
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syringe epinephrine delivery system in a location readily accessible in an emergency
and in accordance with the epinephrine auto-injector's or prefilled syringe's
epinephrine delivery system's instructions for use. An authorized entity shall
designate an employee or agent who has completed the training required in sub. (5)
to be responsible for the storage, maintenance, control, and general oversight of
epinephrine auto-injectors or prefilled syringes epinephrine delivery systems
acquired by the authorized entity.
SECTION 26. 255.07 (4) of the statutes is amended to read:
255.07 (4) USE OF EPINEPHRINE. An employee or agent of an authorized entity
who has completed the training required by sub. (5) or an authorized individual may
use an epinephrine auto-injector or prefilled syringe epinephrine delivery system
prescribed under sub. (2) to do any of the following:
(a) Provide one or more epinephrine auto-injectors or prefilled syringes
epinephrine delivery systems to any individual who the employee, agent, or
authorized individual believes in good faith is experiencing anaphylaxis, or to the
parent, guardian, or caregiver of that individual for immediate administration,
regardless of whether the individual has a prescription for an epinephrine
auto-injector or prefilled syringe epinephrine delivery system or has previously been
diagnosed with an allergy.
(b) Administer an epinephrine auto-injector or prefilled syringe epinephrine
delivery system to any individual who the employee, agent, or authorized individual
believes in good faith is experiencing anaphylaxis, regardless of whether the
individual has a prescription for an epinephrine auto-injector or prefilled syringe
epinephrine delivery system or has previously been diagnosed with an allergy.
SECTION 27. 255.07 (5) (a) 2. of the statutes is amended to read:
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255.07 (5) (a) 2. Standards and procedures for the storage and administration
of an epinephrine auto-injector and, if applicable, a prefilled syringe epinephrine
delivery system.
SECTION 28. 255.07 (5) (a) 3. of the statutes is amended to read:
255.07 (5) (a) 3. Emergency follow-up procedures after an epinephrine
auto-injector or prefilled syringe epinephrine delivery system is administered,
including the necessity of calling the telephone number “911" or another telephone
number for an emergency medical service provider.
SECTION 29. 255.07 (6) (a) (intro.) of the statutes is amended to read:
255.07 (6) (a) (intro.) All of the following are not liable for any injury that
results from the administration or failure to administer an epinephrine
auto-injector or prefilled syringe epinephrine delivery system under this section,
unless the injury is the result of an act or omission that constitutes gross negligence
or willful or wanton misconduct:
SECTION 30. 255.07 (6) (a) 1., 2. and 3. of the statutes are amended to read:
255.07 (6) (a) 1. An authorized entity or authorized individual that possesses
and makes available an epinephrine auto-injector or prefilled syringe epinephrine
delivery system and employees, agents, and authorized individuals that store,
maintain, control, oversee, provide, or use an epinephrine auto-injector or prefilled
syringe epinephrine delivery system.
2. A health care practitioner who prescribes or dispenses an epinephrine
auto-injector or prefilled syringe epinephrine delivery system to an authorized
entity or authorized individual.
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3. A pharmacist or other person who dispenses an epinephrine auto-injector
or prefilled syringe epinephrine delivery system to an authorized entity or
authorized individual.
SECTION 31. 255.07 (6) (b) of the statutes is amended to read:
255.07 (6) (b) The use of an epinephrine auto-injector or prefilled syringe
epinephrine delivery system under this section does not constitute the practice of
medicine or of any other health care profession that requires a credential to practice.
SECTION 32. 255.07 (6) (d) of the statutes is amended to read:
255.07 (6) (d) A person is not liable for any injuries or related damages that
result from providing or administering an epinephrine auto-injector or prefilled
syringe epinephrine delivery system outside of this state if the person satisfies any
of the following criteria:
1. The person would not have been liable for injuries or damages if the
epinephrine auto-injector or prefilled syringe epinephrine delivery system was
provided or administered in this state.
2. The person is not liable for injuries or damages under the law of the state
in which the epinephrine auto-injector or prefilled syringe epinephrine delivery
system was provided or administered.
SECTION 33. 255.07 (6) (e) of the statutes is amended to read:
255.07 (6) (e) Nothing in this section creates or imposes any duty, obligation,
or basis for liability on any authorized entity, or employees, agents, or authorized
individuals, to acquire or make available an epinephrine auto-injector or prefilled
syringe epinephrine delivery system.
SECTION 34. 255.07 (6) (f) of the statutes is amended to read:
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255.07 (6) (f) Nothing in this section creates or imposes any duty, obligation,
or basis for liability on any employer or any other person to supervise or exercise
control over an individual's provision or administration of an epinephrine
auto-injector or prefilled syringe epinephrine delivery system, if the employer or
other person reasonably believes the individual is acting as an authorized individual
under this section.
SECTION 35. 448.03 (2) (q) of the statutes is amended to read:
448.03 (2) (q) The administration of an epinephrine auto-injector or prefilled
syringe epinephrine delivery system in accordance with s. 118.2925 or 255.07.
SECTION 36. 450.11 (4) (a) 5. d. of the statutes is amended to read:
450.11 (4) (a) 5. d. For an epinephrine auto-injector or prefilled syringe
prescribed epinephrine delivery system under s. 118.2925 (3) or 255.07 (2), the name
of the school, authorized entity, authorized individual, or other person specified
under s. 255.07 (3).
(END)
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