Legislature(2005 - 2006)CAPITOL 106

02/15/2005 03:00 PM HEALTH, EDUCATION & SOCIAL SERVICES


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ HB 1 INCREASE AMT OF BASE STUDENT ALLOCATION TELECONFERENCED
Moved CSHB 1(HES) Out of Committee
+ HB 30 APPROP: K-12 EDU OPERATING/DEBT EXPENSES TELECONFERENCED
Moved CSHB 30(HES) Out of Committee
*+ HB 85 PRESCRIBED MEDICATION FOR STUDENTS TELECONFERENCED
Moved CSHB 85(HES) Out of Committee
Bills Previously Heard/Scheduled
HB 85 - PRESCRIBED MEDICATION FOR STUDENTS                                                                                    
                                                                                                                                
4:05:10 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON announced that the  final order of business would be                                                               
HOUSE BILL  NO. 85, "An  Act relating to  self-administration and                                                               
documentation  of certain  types  of medication  prescribed to  a                                                               
child attending school."                                                                                                        
                                                                                                                                
REPRESENTATIVE KEVIN  MEYER, Alaska State  Legislature, testified                                                               
as  sponsor of  HB 85.    He pointed  out that  an estimated  9.2                                                               
million  children in  the U.S.  have asthma,  and they  sometimes                                                               
experience symptoms or asthma attacks  while in school.  He noted                                                               
that  students miss  about 14  million days  of school  each year                                                               
because of  this disease.   With  the attendance  requirements in                                                               
the No Child  Left Behind Act, he noted that  asthma and allergy-                                                               
related absences  can have  a significant  impact on  the child's                                                               
performance in  school.  He said  that a recent survey  of school                                                               
nurses  indicated  that  asthma  was more  disruptive  of  school                                                               
routines than any other chronic condition.                                                                                      
                                                                                                                                
REPRESENTATIVE MEYER  stated that  several children have  died in                                                               
school from  asthma or  allergic reactions  that could  have been                                                               
prevented  if the  students had  their  inhalers with  them.   To                                                               
address  this   issue,  Congress  passed  the   Asthmatic  School                                                               
Children's'  Treatment  and Health  Management  Act  in 2004,  he                                                               
explained, and federal  law requires the Secretary  of Health and                                                               
Human  Services to  give  preference in  awarding  grants to  the                                                               
states that allow students  to self-administer asthma medication,                                                               
and many states have taken advantage of this.                                                                                   
                                                                                                                                
REPRESENTATIVE  MEYER  said  that  the  bill  also  protects  the                                                               
schools,  the  parents,  and  the  children  with  two  essential                                                               
provisions.  He  stated that the first  provision allows children                                                               
with   a  parent   or  guardian   and   health  care   provider's                                                               
certification to  self-administer the medication to  treat asthma                                                               
or  other threatening  allergies.   The school  must allow  self-                                                               
administration if the school  receives written authorization from                                                               
the parent or guardian, written  certification from the student's                                                               
health care  provider that the  student has the  health condition                                                               
and  has  received  instruction  on   how  to  properly  use  the                                                               
medication and  is able  to self-administer  the medication.   He                                                               
remarked that by making the  health care provider provide written                                                               
certification  of the  student's  capability to  self-administer,                                                               
there is insurance that the child is so capable.                                                                                
                                                                                                                                
REPRESENTATIVE MEYER continued:                                                                                                 
                                                                                                                                
     It puts the  decision ... squarely on  the shoulders of                                                                    
     the parents  and the doctors,  and not on  the schools.                                                                    
     ... The second [provision is  that] ... the decision to                                                                    
     allow the  child to self-administer  in schools  is put                                                                    
     on  the  parents  and the  health  care  providers;  it                                                                    
     removes the schools from  any civil liability.... While                                                                    
     HB 85 helps  Alaska qualify for these  federal grants I                                                                    
     mentioned earlier,  the real  purpose behind  this bill                                                                    
     is to  give parents,  doctors, and schools  the ability                                                                    
     to ensure that  our children are safe  as they possibly                                                                    
     can be at school.                                                                                                          
                                                                                                                                
REPRESENTATIVE MEYER  mentioned that he  had heard from a  lot of                                                               
doctors, school  nurses, parents,  and advocacy groups  about the                                                               
importance of the bill.                                                                                                         
                                                                                                                                
4:10:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   SEATON   pointed  out   that   "life-threatening                                                               
illness"  is used  in Section  1,  page 1,  lines 8  and 14,  and                                                               
compared  this with  Section 1,  page 2,  line 13  which mentions                                                               
inhalers and autoinjectable  epinephrine.  He asked  if these two                                                               
medications would be the only  ones allowed in the classification                                                               
of  other potentially  life-threatening  illnesses; he  commented                                                               
that   this  might   be  too   restrictive  for   such  a   broad                                                               
classification.                                                                                                                 
                                                                                                                                
MICHAEL PAWLOWSKI,  Staff to  Representative Meyer,  Alaska State                                                               
Legislature, explained  that the language  of the bill  was based                                                               
on a similar bill that was passed in Hawaii.  He said:                                                                          
                                                                                                                                
     Part of  it was  to give leeway  to new  and developing                                                                    
     medications, and to cover  illnesses that carry similar                                                                    
     thresholds of  a life-threatening illness, and  so they                                                                    
     were included  in the bill.  ... Because [the  bill is]                                                                    
     being  generic  with  "life-threatening  illness,"  the                                                                    
     statute  didn't  go  into  detail  on  every  potential                                                                    
     different  type  of medication  you  might  be able  to                                                                    
     carry.     That  might  be   left  to   regulation  and                                                                    
     discussion.                                                                                                                
                                                                                                                                
CHAIR WILSON clarified that the  epinephrine is usually called an                                                               
EpiPen and is  portable.  She gave an example:  if someone who is                                                               
allergic  to bees  is stung  by a  bee, it  is possible  that the                                                               
anaphylactic shock  would start  so quickly  that it  could close                                                               
off the  airway and the  child would not  be able to  breathe and                                                               
could die.                                                                                                                      
                                                                                                                                
4:13:16 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON, in response to  Representative Gardner, stated that                                                               
an  EpiPen would  also be  useful  in the  case of  a child  with                                                               
severe food allergies.                                                                                                          
                                                                                                                                
REPRESENTATIVE  GARDNER concluded  that the  term "autoinjectable                                                               
epinephrine" applies to a variety of substance reactions.                                                                       
                                                                                                                                
REPRESENTATIVE  SEATON  stated  that  he is  concerned  that  the                                                               
language in  Section 1, page 2,  line 13 would restrict  the type                                                               
of medication so  that if a child had  a life-threatening illness                                                               
and  needed to  take pills  that were  prescribed by  the doctor,                                                               
they won't  be able to  carry the  pills under this  bill because                                                               
the  bill only  allows  for the  inhaler  and the  autoinjectable                                                               
epinephrine.                                                                                                                    
                                                                                                                                
4:15:08 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MEYER  responded that inhalers  and autoinjectable                                                               
epinephrine  are  listed  in  the   bill  because  they  have  an                                                               
immediate  effect,  whereas  pills  take some  time  to  have  an                                                               
effect.                                                                                                                         
                                                                                                                                
REPRESENTATIVE MCGUIRE  remarked, "It  ... gets  to the  point of                                                               
absurdity that we  have to introduce legislation to  do this. ...                                                               
This is  a life-saving use  of an  inhaler and an  EpiPen..., and                                                               
it's  obviously  the  result   of  litigation."    Representative                                                               
McGuire pointed to  Section 1, page 2, line 3:  "is able to self-                                                               
administer the medication safely."   She said that her concern is                                                               
that  it might  give rise  to  litigation in  a way  that no  one                                                               
anticipated.   She  said that  the  language in  the federal  law                                                               
states  "the   student  has  demonstrated  to   the  health  care                                                               
practitioner  or  the  practitioner's designee  the  skill  level                                                               
necessary  to  use  this  medication   and  any  device  that  is                                                               
necessary to administer such medication."                                                                                       
                                                                                                                                
CHAIR WILSON  commented that  the bill will  also go  through the                                                               
House Judiciary Standing Committee.                                                                                             
                                                                                                                                
REPRESENTATIVE MCGUIRE remarked that Section  1, page 2, line 15,                                                               
may be misinterpreted to exclude other misuses.                                                                                 
                                                                                                                                
4:18:35 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GARDNER  pointed  out   that  the  committee  has                                                               
written  testimony from  Patricia Senner  from the  Alaska Nurses                                                               
Association, and she read the following from it:                                                                                
                                                                                                                                
     It  might be  advisable to  add a  section to  the bill                                                                    
     that  would  allow the  school  district  to require  a                                                                    
     student to provide a back-up  inhaler to be left in the                                                                    
     office.                                                                                                                    
                                                                                                                                
REPRESENTATIVE GARDNER asked  if it was necessary to  add that as                                                               
an amendment  to the bill to  require it, because it  can be done                                                               
without it being part of the legislation.                                                                                       
                                                                                                                                
REPRESENTATIVE MEYER replied  that it wouldn't hurt to  add it to                                                               
the bill.                                                                                                                       
                                                                                                                                
CHAIR  WILSON  commented that  there  is  a cost  involved;  some                                                               
people may only be able to afford one.                                                                                          
                                                                                                                                
REPRESENTATIVE GARDNER  agreed and  said that in  mild conditions                                                               
one inhaler may be adequate.                                                                                                    
                                                                                                                                
4:20:27 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON asked  if there is a part in  the bill that                                                               
requires  the doctor  to  notify  the school  about  the type  of                                                               
medication the child will be self-administering.                                                                                
                                                                                                                                
MR. PAWLOWSKI  said, "I don't  believe there is a  specificity on                                                               
the exact medication ... within the bill."                                                                                      
                                                                                                                                
REPRESENTATIVE  SEATON  said  that  the  sponsor  might  want  to                                                               
consider adding  a notification  to the  school so  that everyone                                                               
knows what medication  the doctor is prescribing  and allowing to                                                               
be self-administered.                                                                                                           
                                                                                                                                
REPRESENTATIVE MCGUIRE  said that  in the  federal act  there are                                                               
two additional requirements; the  health care provider formulates                                                               
a  written treatment  plan for  managing  asthma and  anaphylaxis                                                               
episodes for the student and  the medication during school hours.                                                               
[She would  like to add  this into HB 85  as an Amendment.]   The                                                               
second amendment she  offered would be that  the student's parent                                                               
or guardian  must complete and  submit to the school  any written                                                               
documentation that is required by the school.                                                                                   
                                                                                                                                
4:23:04 PM                                                                                                                    
                                                                                                                                
CHAIR  WILSON asked  that Representative  McGuire identify  where                                                               
she is finding this information.                                                                                                
                                                                                                                                
REPRESENTATIVE MCGUIRE  clarified that  this information  is from                                                               
H.R. 2023 from the 108TH Congress 2D Session.                                                                                   
                                                                                                                                
4:23:36 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE MCGUIRE  moved to adopt Conceptual  Amendment 1 to                                                               
HB  85  to  have  the  bill language  comport  with  the  federal                                                               
language.  She explained the amendment:                                                                                         
                                                                                                                                
     New [subparagraph]  (C), we would delete  out, "is able                                                                    
     to self-administer the  medication safely", and insert,                                                                    
     "has  demonstrated  to  the health  care  provider  the                                                                    
     skill  necessary to  use the  medication in  any device                                                                    
     that  is necessary  to  administer  such medication  as                                                                    
     prescribed."  ...  (D)  would   be,  "the  health  care                                                                    
     practitioner  formulates a  written treatment  plan for                                                                    
     managing   asthma  or   anaphylaxis  episodes   of  the                                                                    
     student, and  for medication use by  the student during                                                                    
     the school hours."   And subsection (e)  would be, "the                                                                    
     student's   parent  or   guardian  has   completed  and                                                                    
     submitted  to  the  school  any  written  documentation                                                                    
     required by  the school"  ... "including  the treatment                                                                    
     plan  formulated  under"  ...   "Section  D  and  other                                                                    
     documents."                                                                                                                
                                                                                                                                
4:25:14 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON asked if there were any objections.  There being no                                                                
objection, [Conceptual Amendment 1] was adopted.                                                                                
                                                                                                                                
4:26:45 PM                                                                                                                    
                                                                                                                                
MARGE LARSON, Program Director, American Lung Association of                                                                    
Alaska, stated that she was testifying on behalf of the Alaska                                                                  
Asthma Coalition.  She said:                                                                                                    
                                                                                                                                
     Asthma is on the  rise and we don't know why.   No one knows                                                               
     for sure what  causes asthma and there's no  known cure, and                                                               
     an asthma  attack at any  age can  be fatal.   Data indicate                                                               
     that pediatric asthma  has increased by 40  percent over the                                                               
     last four  years.  And we  know asthma is the  leading cause                                                               
     of  missed   school  days,  negatively   impacting  academic                                                               
     performance.    Asthma is  a  disease  that when  triggered,                                                               
     restricts the airways  to the lungs, making  it difficult to                                                               
     breathe.   And  ...  when you  can't  breathe, nothing  else                                                               
     matters.   The  Center  for Disease  Control and  Prevention                                                               
     (CDC) Asthma  Control Program  recommends that  states build                                                               
     and  sustain statewide  asthma  coalitions  as an  effective                                                               
     strategy  to  address  this  growing  public  health  issue.                                                               
     Under  CDC guidance  and with  funding from  a congressional                                                               
     earmark,  American Lung  Association  of Alaska  spearheaded                                                               
     the generation  of the Alaska  Asthma Coalition a  year ago.                                                               
     The long-term  goals of the  Alaska Asthma Coalition  are to                                                               
     reduce morbidity  and mortality,  control the cost  of care,                                                               
     and improve  the quality  of life  for Alaskan  patients and                                                               
     families  affected by  asthma.   With members  across Alaska                                                               
     and  in partnership  with the  Department of  Public Health,                                                               
     the coalition is developing a  state plan to address asthma,                                                               
     including  scientific  interventions,  both  clinically  and                                                               
     environmentally  based,  as  well  as  surveillance,  public                                                               
     provider and  patient education, and  asthma-friendly policy                                                               
     changes.                                                                                                                   
                                                                                                                                
MS. LARSON continued:                                                                                                           
                                                                                                                                
     In  2004, ...  Congress passed  legislation encouraging  the                                                               
     states to  enact asthma-friendly  laws allowing  students to                                                               
     carry asthma inhalers  and EpiPens.  Asthma  cannot be cured                                                               
     but  it  can be  controlled.    There are  safe  medications                                                               
     available and simple  steps people can take  to reduce their                                                               
     exposure  to  environmental  asthma triggers.    But  rescue                                                               
     inhalers  for  immediate  relief  of  asthma  symptoms  will                                                               
     continue  to  be  a life-saving,  critical  part  of  asthma                                                               
     management.   Consistent with  patient asthma  education, at                                                               
     Asthma Camp  we teach  children as young  as seven  to carry                                                               
     their rescue  medications at all  times, and we give  them a                                                               
     fanny pack to  carry them in.... However, right  now not all                                                               
     Alaskan students can  follow that advice at  the place where                                                               
     they spend a great deal of their  time: at school.  HB 85 is                                                               
     supported by  the Association of  Alaska School  Boards, the                                                               
     Alaska Nurses  Association, the Allergy and  Asthma Network,                                                               
     Mothers' of  Asthmatics, the National Association  of School                                                               
     Nurses,   the  Alaska   Chapter  of   American  Academy   of                                                               
     Pediatrics,  the Asthma  and Allergy  Foundation of  America                                                               
     Alaska  Chapter,  and  the   American  Lung  Association  of                                                               
     Alaska, in addition to the Alaska Asthma Coalition.                                                                        
                                                                                                                                
4:30:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  asked if  there are any  other medications                                                               
that Ms. Larson thought should be incorporated into the bill.                                                                   
                                                                                                                                
MS. LARSON deferred to the  chair of the Alaska Asthma Coalition,                                                               
who is a pediatrician.                                                                                                          
                                                                                                                                
4:31:08 PM                                                                                                                    
                                                                                                                                
GAIL WHITE, School  Nurse, commented that HB 85 is  a great bill.                                                               
She  noted,  "(Medication)  only  works when  the  children  have                                                               
remembered  to   bring  their   inhaler  and   their  epinephrine                                                               
EpiPens."  She  also remarked that the  committee should consider                                                               
how a child  can be protected in a situation  where the child has                                                               
lost the  inhaler when it is  needed.  She emphasized  that it is                                                               
important for  children to have  a backup inhaler in  the nurse's                                                               
office, and mentioned  the idea of legislation  allowing a school                                                               
nurse to  keep a general  albuterol rescue inhaler in  the office                                                               
for use by any child who  is a known asthmatic who has permission                                                               
to carry an inhaler, but who may have lost or forgotten it.                                                                     
                                                                                                                                
MS.  WHITE,  in response  to  CHAIR  WILSON,  noted that  in  the                                                               
Anchorage  School  District  students are  currently  allowed  to                                                               
carry  EpiPens  and  inhalers  with   parental  and  health  care                                                               
provider authorization.  She stated  that in the 1998-1999 school                                                               
year  in the  Anchorage School  District there  were 57  students                                                               
with EpiPens at school.  In  the 2003-2004 school year there were                                                               
338 students with EpiPens at school.                                                                                            
                                                                                                                                
MS.  WHITE commented  that she  read  a study  showing that,  for                                                               
children   who  had   experienced  anaphylactic   reactions,  the                                                               
children are more likely to die  at school because a reaction was                                                               
not recognized quickly.                                                                                                         
                                                                                                                                
4:36:07 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  asked if  the designation of  inhalers and                                                               
EpiPens  fully covers  the variety  of treatments  that a  doctor                                                               
might want  a student to  self-administer.  He asked  if diabetes                                                               
injections or any other medications  should also be covered under                                                               
this bill.                                                                                                                      
                                                                                                                                
MS. WHITE  stated that she  thinks all students who  have EpiPens                                                               
at school also  should have oral Benadryl at  school because some                                                               
allergic reactions  are strictly skin  reactions or rashes.   She                                                               
noted that a diabetes injection can only be given by a nurse.                                                                   
                                                                                                                                
4:39:09 PM                                                                                                                    
                                                                                                                                
RICHARD  MANDSAGER, M.D.,  Director, Division  of Public  Health,                                                               
Alaska  Department of  Health and  Social  Services, stated  that                                                               
this  is a  very  important issue.   He  commented  that when  he                                                               
worked as a pediatrician in  Anchorage, he saw about 125 patients                                                               
with asthma  and he was thankful  that the children were  able to                                                               
carry their medications to school.  He said:                                                                                    
                                                                                                                                
     I have suggested that if  this bill passes, that one of                                                                    
     the ways  the Division of  Public Health could  help is                                                                    
     that  the forms  that have  been developed  between the                                                                    
     asthma  groups in  Anchorage and  the school  nurses in                                                                    
     the  Anchorage School  District  and the  pediatricians                                                                    
     could be  modified for statewide  use and could  ... be                                                                    
     hosted on  the website,  potentially, and  other school                                                                    
     districts  could  then  use  them.    For  example,  in                                                                    
     Anchorage we've  been using something called  an Asthma                                                                    
     Action  Plan  that goes  to  the  school nurse  at  the                                                                    
     beginning of  the year that  lists all the  medicines a                                                                    
     child is on,  which ones that it's  recommended they be                                                                    
     able to  self-administer, which  ones the  school nurse                                                                    
     should keep. ... The school  nurse knows what medicines                                                                    
     the child is on, in  addition to the ones they're self-                                                                    
     administering.  ...  Our  goal  for  kids  with  asthma                                                                    
     should be zero days lost from  school due to asthma.  I                                                                    
     think  the medicines  are good  enough,  and that  with                                                                    
     education   of    kids   and   parents    in   avoiding                                                                    
     environmental triggers as much  as possible, that ought                                                                    
     to be our goal.                                                                                                            
                                                                                                                                
DR. MANDSAGER remarked that he thinks this bill is a substantial                                                                
improvement over the status quo.  He stated:                                                                                    
                                                                                                                                
     The  other  thing I  think  this  is important  for  is                                                                    
     helping kids  more toward self-management.   This isn't                                                                    
     a disease  that is likely  going to go away;  they need                                                                    
     to learn how to take care  of this illness, and as they                                                                    
     move through their school years,  to learn to take care                                                                    
     of  it [themselves].    This is  an  important part  of                                                                    
     their  self-management   skills.     The  age   ...  is                                                                    
     variable; some  kids very young,  some kids  as seventh                                                                    
     graders ...  it's an individual decision.   Finally ...                                                                    
     I  do   think  that  diabetes   is  an  example   of  a                                                                    
     potentially   life-threatening    illness.      Insulin                                                                    
     management  today, kids,  especially high  school kids,                                                                    
     are  self-administering;  some   of  them  are  turning                                                                    
     pumps,  where  they have  a  needle  in all  the  time.                                                                    
     Others  are   self-administering  insulin   every  four                                                                    
     hours. ...  That's the only  other example I  can think                                                                    
     of ... where immediate treatment is necessary.                                                                             
                                                                                                                                
REPRESENTATIVE SEATON asked if the addition of insulin injection                                                                
device to the bill would cover the diabetes cases.                                                                              
                                                                                                                                
DR. MANDSAGER answered that this is correct.                                                                                    
                                                                                                                                
4:43:22 PM                                                                                                                    
                                                                                                                                
CHAIR WILSON remarked that the bill language should cover                                                                       
students who attend schools without school nurses as well.                                                                      
                                                                                                                                
DR. MANDSAGER commented that his understanding is that the                                                                      
Department of Education also supports this bill.                                                                                
                                                                                                                                
4:44:11 PM                                                                                                                    
                                                                                                                                
THAD WOODARD,  M.D., President, Asthma and  Allergy Foundation of                                                               
America,  and the  Alaska Asthma  Coalition, stated  that he  has                                                               
been a  practicing pediatrician in  Anchorage for over  20 years.                                                               
He  said, "I  can  only  echo what's  been  said  to this  point.                                                               
Everybody is  right on except  for some  of the details  that ...                                                               
you're working  on."  He  also remarked, "The amendment  that was                                                               
recommended  makes infinite  sense to  me so  that there  is some                                                               
very clear guidelines on what medications are being discussion."                                                                
He pointed out that any  time medications are being discussed the                                                               
risks  need to  be evaluated;  there are  some hazards  with kids                                                               
being able  to self-administer.   However he  said that  it's far                                                               
riskier to not have the medication available.                                                                                   
                                                                                                                                
DR. WOODARD  pointed out that  self-administering insulin  is far                                                               
more dangerous than the inhalers  and EpiPens.  He commented that                                                               
he cannot think of any other  types of medication used in a life-                                                               
threatening situation  other than insulin.   He said that  a full                                                               
definition of a  life-threatening illness may need  to be spelled                                                               
out in the bill.  He recommended that the bill be passed.                                                                       
                                                                                                                                
4:47:40 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  ANDERSON mentioned  that after  an epileptic  fit                                                               
medication needs to be administered to the patient.                                                                             
                                                                                                                                
DR. WOODWARD  replied that those  medications would not  be self-                                                               
administered.                                                                                                                   
                                                                                                                                
REPRESENTATIVE ANDERSON  commented on the idea  of full coverage,                                                               
where the  school nurse holds  a second  EpiPen or inhalers.   He                                                               
asked  if perhaps  that  type of  policy should  be  left to  the                                                               
school boards.                                                                                                                  
                                                                                                                                
DR.  WOODARD  noted  that  10   to  15  percent  of  anaphylactic                                                               
reactions  will start  up again  15 minutes  to two  hours later.                                                               
Therefore having  the ability  to evacuate the  child to  a safer                                                               
situation  or to  have the  ability to  administer epinephrine  a                                                               
second  time would  be  very  important.   He  commented that  he                                                               
wasn't  sure if  the school  district should  supply the  back-up                                                               
medications or if the parents should be responsible for it.                                                                     
                                                                                                                                
4:50:00 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  GARDNER  stated that  if  the  committee were  to                                                               
incorporate  the parts  of the  federal law  regarding a  written                                                               
treatment  plan,  that could  include  the  follow up  for  those                                                               
conditions in which the child might have a second episode.                                                                      
                                                                                                                                
4:51:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON, referring to  testimony, asked Dr. Woodard                                                               
if Benadryl should be kept in  the nurse's office or if it should                                                               
be included in the bill.                                                                                                        
                                                                                                                                
DR. WOODARD answered that keeping  Benadryl in the nurse's office                                                               
would be [sufficient].                                                                                                          
                                                                                                                                
4:51:40 PM                                                                                                                    
                                                                                                                                
JANIS  BATES,  Supervisor  of  School  Nurses,  Anchorage  School                                                               
District noted that she is  also the Director of Health Services,                                                               
a  board  member  for  AFFA   [ph]  Alaska,  and  on  the  Asthma                                                               
Coalition.  She  stated that she supported the  bill, however she                                                               
did not think  that insulin should be included in  the bill.  She                                                               
recommended   that   the   phrase  "or   other   life-threatening                                                               
conditions" should be removed from the bill.  She said:                                                                         
                                                                                                                                
     What  you're talking  about with  asthma is  a metered-                                                                    
     dose inhaler;  there's no  measurement involved.   When                                                                    
     you're talking  about an  EpiPen, you're  talking about                                                                    
     an  autoinjector;  there's   no  measurement  involved.                                                                    
     With  a  dosage  of  insulin  you're  talking  about  a                                                                    
     specific  skill where  a child  has to  draw back  on a                                                                    
     syringe, has  to draw back  a specific number  of units                                                                    
     to be able to inject the  insulin. ... When you use ...                                                                    
     an  insulin  pump  there  are  carbohydrates  that  are                                                                    
     calculated based  on the food intake.   There's usually                                                                    
     some counseling  with the parent  about what  was eaten                                                                    
     earlier.   The  nurse also  works with  the carb  count                                                                    
     with  the   child,  and  then  a   specific  dosage  is                                                                    
     administered with the  pump with insulin.  So  I do not                                                                    
     feel that insulin and diabetes  belong in this bill.  I                                                                    
     think that we can deal  with that by simply taking out,                                                                    
     "or other potentially  life-threatening conditions" and                                                                    
     deal with this bill from  the perspective of why it was                                                                    
     introduced;  it  was  introduced  for  asthma  and  for                                                                    
     anaphylaxis,  two  conditions   where  we  have  rescue                                                                    
     medications   that  are   readily   available  in   the                                                                    
     marketplaces and  that children can be  taught to self-                                                                    
     administer.    Yes, children  can  be  taught to  self-                                                                    
     administer   insulin,   but   that's  after   lots   of                                                                    
     counseling and lots  of teaching ... and  it requires a                                                                    
     lot more  skill.  It  is a  lot more dangerous  if it's                                                                    
     injected into someone else.   I really believe that the                                                                    
     bill  as it's  written  for asthma  and anaphylaxis  is                                                                    
     appropriate.  Adding other  medications such as insulin                                                                    
     I  don't  think is  appropriate.    I'm also  in  total                                                                    
     support of  the written  treatment plan and  the parent                                                                    
     or the  guardian submitting the documentation.   I also                                                                    
     like  the  idea  of  the   demonstrated  skill  to  the                                                                    
     provider....                                                                                                               
                                                                                                                                
MS. BATES continued:                                                                                                            
                                                                                                                                
     One of the  things that I think is  really important in                                                                    
     looking at  this bill is  teaching the child  that they                                                                    
     need   to  tell   someone  when   they've  used   their                                                                    
     medication.   In  a breathing  or an  allergy emergency                                                                    
     ... they made need to  use the inhaler again, sometimes                                                                    
     in 20 minutes.   Same thing with an EpiPen.  ... In the                                                                    
     Anchorage  School   District  we  do   currently  allow                                                                    
     students  to self-administer  inhalers and  medications                                                                    
     for  anaphylaxis.   The reason  that there  still is  a                                                                    
     need  for  the  bill  is  that  we're  dealing  with  a                                                                    
     community of educators that is  not trained in medicine                                                                    
     and  oftentimes as  part of  the authoritative  role, a                                                                    
     principal may say  that all students have  to bring the                                                                    
     medication to  the office, not  knowing the  nuances of                                                                    
     the fact that Section 504  of the Rehabilitation Act of                                                                    
     1973 allows  children to be  able to  carry medications                                                                    
     that may  assist them  in school.   And by  having this                                                                    
     bill it will  take away some of the gray  area where an                                                                    
     administrator may impose a  school site-based policy on                                                                    
     a family,  which resulted  in the death  of a  child in                                                                    
     California when there was an  unwritten policy that ...                                                                    
     the  children could  carry an  inhaler there,  and this                                                                    
     eleven year old  boy, his mother didn't know  it and he                                                                    
     ended up  dying. ... In settlement  the school district                                                                    
     paid $2.2 million  for that mistake, and  I'm sure that                                                                    
     every parent  is notified now  that children  can carry                                                                    
     inhalers.  I  also read about another  situation in the                                                                    
     state of Washington  where a child had  both asthma and                                                                    
     anaphylaxis to peanuts.   And the child was  on a field                                                                    
     trip.  Both  of the medications were on  the field trip                                                                    
     but the child was only  treated for the asthma; he died                                                                    
     from  the  anaphylaxis,  which  really  speaks  to  the                                                                    
     importance   of   ...   training   children,   training                                                                    
     teachers,  training  people  about what  to  look  for.                                                                    
     There  are  a  lot  of  skills  that  are  involved  in                                                                    
     identification of an emergency  problem and some people                                                                    
     may know some of the  information.  Getting children to                                                                    
     wear identification  bracelets is important and  ... we                                                                    
     could have  that as part of  the bill to make  it safer                                                                    
     for children. ... Students with  asthma or other airway                                                                    
     constricting  diseases   need  to  be  able   to  self-                                                                    
     administer  their  medication  upon approval  of  their                                                                    
     parents  and  the  prescribing physician.    These  are                                                                    
     potentially  life-saving medications  for students.   I                                                                    
     don't  recommend adding  any other  medications to  the                                                                    
     bill.                                                                                                                      
                                                                                                                                
4:58:17 PM                                                                                                                    
                                                                                                                                
DR. MANDSAGER, in response  to Representative Seaton, recommended                                                               
that the bill should be limited to asthma and anaphylaxis.                                                                      
                                                                                                                                
MS. WHITE commented  that not even registered  nurses are allowed                                                               
to administer  insulin without  the dosage  being confirmed  by a                                                               
colleague.    She  added that  the  Massachusetts  Department  of                                                               
Education has a document  called, "Managing Life-Threatening Food                                                               
Allergies in School," which she  said is excellent and accessible                                                               
on the internet.                                                                                                                
                                                                                                                                
5:01:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  moved to  [adopt Conceptual  Amendment 2],                                                               
which he explained as follows:                                                                                                  
                                                                                                                                
     Strike   ",  or   other  potentially   life-threatening                                                                    
     illnesses"  on  page   1,  line  8,  and   also  ",  or                                                                    
     potentially  life-threatening illnesses"  lines 13  and                                                                    
     14 on page 1.                                                                                                              
                                                                                                                                
There being no objection, [Conceptual Amendment 2 was adopted].                                                                 
                                                                                                                                
REPRESENTATIVE GARDNER  noted that  on lines 7  and 13  the comma                                                               
after "asthma" would need to be removed.                                                                                        
                                                                                                                                
REPRESENTATIVE  ANDERSON pointed  out that  legal services  would                                                               
take care of this since it is a conceptual amendment.                                                                           
                                                                                                                                
REPRESENTATIVE  MCGUIRE asked  Representative  Meyer to  consider                                                               
language  that   would  include  an  amendment   to  reflect  the                                                               
testimony regarding standing  orders from families to  be kept on                                                               
file with school  nurses.  These standing orders  would allow for                                                               
the inhalers or  injections to be administered in  the event that                                                               
a child  forgets the medication  at home.   She also  stated that                                                               
she would like  to hear if the school nurses  think anything else                                                               
should be addressed  "in the area of liability  and exposure that                                                               
they face."                                                                                                                     
                                                                                                                                
CHAIR WILSON  reminded the  committee that  not all  schools have                                                               
school nurses.                                                                                                                  
                                                                                                                                
5:04:59 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  moved to  report HB 85  as amended  out of                                                               
committee  with individual  recommendations and  the accompanying                                                               
fiscal  note.    There  being  no  objection,  CSHB  85(HES)  was                                                               
reported  from the  House Health,  Education and  Social Services                                                               
Standing Committee.                                                                                                             

Document Name Date/Time Subjects