Legislature(2005 - 2006)CAPITOL 120
03/07/2005 01:00 PM JUDICIARY
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|HB148 || HB101|
* first hearing in first committee of referral
= bill was previously heard/scheduled
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HB 85 - PRESCRIBED MEDICATION FOR STUDENTS 3:33:23 PM CHAIR McGUIRE announced that the next 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." [Before the committee was CSHB 85(HES).] REPRESENTATIVE KEVIN MEYER, Alaska State Legislature, sponsor, informed the committee that it's estimated that 9.2 million children have asthma in the United States, and that young people with asthma miss approximately 14 million days of school each year. In fact, according to a national survey of nurses, asthma- or allergy-related absences have a significant impact on school performance and that asthma is more disruptive to school routines than any other chronic condition. However, he opined, being disruptive to school routines is of secondary concern because asthma can be fatal to schoolchildren. REPRESENTATIVE MEYER said that school children have died in schools due to asthma attacks and schools have been held liable for millions of dollars because of these deaths. Therefore, Congress passed the Asthmatic Schoolchildren's Treatment and Health Management Act of 2004, which requires that the Secretary of the U.S. Department of Health and Human Services (DHHS) provide preference when awarding grants to those states that allow students to self administer their asthma medication. He highlighted that HB 85 brings Alaska into compliance with the provisions of the aforementioned federal law and provides schools, parents, and children protection from potentially life- threatening conditions and consequences by requiring schools to allow self-administration of medication by a student if the school receives written authorization from the parent or guardian and written certification from the student's healthcare provider that the student has the health condition, has a written treatment plan, has received instruction on how to properly use the medication, and is able to self-administer the medication. REPRESENTATIVE MEYER said that HB 85 places the decision for self-administration of medication by a student squarely on the shoulders of parents and healthcare [providers]. The student could carry his/her own inhaler so that he/she would have access to treatment without having to go to the nurse. He noted that HB 85 also exempts schools from any liability related to the self-administration of medication. In conclusion, he specified that the real purpose behind HB 85 is to provide parents, doctors, and schools the ability to ensure that children are as safe as possible at school and have medication when necessary. 3:36:48 PM REPRESENTATIVE GARA inquired as to why this is not currently the law. REPRESENTATIVE MEYER informed the committee that there isn't a statewide policy on this matter, and therefore each school's policy seems to be a bit different with regard to asthma medication, though many schools want all medications to be kept with the school nurse. 3:37:29 PM MARGE LARSON, Director of Programs, American Lung Association; Steering Committee Member, Alaska Asthma Coalition, informed the committee that she is an asthmatic as well as the parent of an asthmatic child. She further informed the committee that asthma is on the rise and no one knows why or what causes asthma, and that there is no known cure. Ms. Larson echoed Representative Meyer's testimony regarding the fact that asthma is the leading cause of missed school days, which negatively impacts school performance, and regarding the fact that an asthma attack at any age can be fatal. Ms. Larson relayed that the Centers for Disease Control and Prevention Asthma Control Program recommends that states build and sustain a statewide asthma coalition in order to address this growing public health issue. MS. LARSON noted that the Alaska Asthma Coalition began work in 2004 and is developing a statewide plan to address asthma, including scientific interventions that are clinically and environmentally based. She relayed that HB 85 is supported by the following organizations: 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 the American Academy of Pediatrics; the Asthma and Allergy Foundation of America - Alaska Chapter; the American Lung Association - Alaska Chapter; and the Alaska Asthma Coalition. In conclusion, Ms. Larson urged the committee to join all these organizations in supporting this asthma-friendly policy for Alaska's students. 3:39:41 PM FRANK TURNEY offered his understanding that HB 85 has no bearing on the Child Medication Safety Act, H.R. 1170, which was passed in U.S. House of Representatives, regarding psychiatric drugs. He noted that Senator Bettye Davis has introduced SB 48 regarding psychiatric drugs as well. Mr. Turney asked if he is correct that HB 85 only applies to a child's ability to self- administer [asthma- and other allergy-related] medication in school. CHAIR McGUIRE concurred with Mr. Turney's understanding. REPRESENTATIVE COGHILL specified that the parents must give written permission for a child to self-administrator asthma medication. In further response to Mr. Turney, Representative Coghill confirmed that the aforementioned [receipt of the written permission] will be documented. MR. TURNEY expressed hope that the House would sponsor legislation similar to that sponsored by Senator Davis. He relayed his concern with the reports that there are an overwhelming number of children on anti-depressant drugs and other drugs such as Ritalin. 3:43:41 PM RICHARD MANDSAGER, M.D., Director, Central Office, Division of Public Health, Alaska Department of Health and Social Services (DHSS), remarked that as a pediatrician he believes the legislature would be well advised to pass HB 85. He said that he has been fortunate to practice in Anchorage where the school district is usually cooperative with school nurses, physicians, and parents when children are ready to self-administer medication. This legislation will establish a state law that will protect school districts, he opined, and posited that the threat of litigation is one of the reasons why granting permission to self-administer medication isn't the practice already. This legislation is written such that if the child misuses the medication, he/she will lose the right [to self- administer the medication], he noted, and characterized HB 85 as a huge advance. Dr. Mandsager opined that asthma medicines are so advanced that children shouldn't miss any school because of asthma. 3:44:49 PM CHAIR McGUIRE after ascertaining that no one else wished to testify, closed public testimony on HB 85. CHAIR McGUIRE asked about an amendment that she offered in the House Health, Education and Social Services Standing Committee that would allow the school nurse to keep, if the child and parents agreed, autoinjectable epinephrine ["Epi Pen"] or an inhaler in the nurse's office in the event that the child forgets his/her medication. MICHAEL PAWLOWSKI, Staff to Representative Kevin Meyer, House Finance Committee, Alaska State Legislature, sponsor, offered his understanding that Chair McGuire's suggestion was not offered as a formal amendment in the House Health, Education and Social Services Standing Committee. He mentioned that one of the concerns regarding that suggestion centered on whether certain families could afford two of the same inhaler or two Epi Pens. CHAIR McGUIRE indicated that she would be offering her suggestion as an amendment in this committee. She said that it would not be mandatory that families keep extra medication with the school nurse; rather, it would be an option. REPRESENTATIVE GARA asked whether the original bill included "the same rights with regard to insulin for kids who have diabetes." REPRESENTATIVE MEYER said that after the discussion in the prior committee, he felt that diabetes is such a different disease that it [shouldn't be] incorporated into HB 85. REPRESENTATIVE GARA asked whether different school districts have different rules with regard to children self administering insulin. MR. PAWLOWSKI offered his understanding that different school districts do have different rules regarding insulin. CHAIR McGUIRE mentioned that there was discussion in the prior committee regarding needles and the difficulty in getting an insulin dose just right. CHAIR McGUIRE made a motion to adopt Conceptual Amendment 1, to say that if the parents and the child agree, they can have an Epi Pen or an inhaler on hand in the nurse's office in case the child forgets his/her medication and needs it. 3:48:29 PM REPRESENTATIVE MEYER characterized Conceptual Amendment 1 as an excellent idea. CHAIR McGUIRE asked whether there were any objections to Conceptual Amendment 1. There being none, Conceptual Amendment 1 was adopted. CHAIR McGUIRE made a motion to adopt Amendment 2, which read [original punctuation provided]: To page 2, lines 27 Insert: "pharmacist," following "village health aide," REPRESENTATIVE COGHILL objected for purposes of discussion. He asked whether [pharmacists] wouldn't already be covered elsewhere in the bill. REPRESENTATIVE MEYER said that Amendment 2 was engendered by the discussion that occurred in the House Health, Education and Social Services Standing Committee. MR. PAWLOWSKI indicated that the explicit list in the healthcare provider provision of the definition section does not yet include pharmacists, and noted that it's often the pharmacist who does most of the training, who shows a child how to use the medication. Therefore, when the bill specifies that a healthcare provider must certify that a child is able and competent to administer a medication, the pharmacist often plays a very important role in that process. REPRESENTATIVE COGHILL removed his objection. CHAIR McGUIRE asked whether there were any further objections to Amendment 2. There being none, Amendment 2 was adopted. 3:51:18 PM CHAIR McGUIRE referred to Amendment 3, which read [original punctuation provided]: To page 2, lines 20-25 Delete: "as long as the pupil does not endanger any person through the misuse of the inhaler. Misuse of an inhaler includes exceeding the prescribed dosage of the medication. An inhaler includes metered-dose, breath-activated, and dry powder inhalers, and spacers and holding chambers. (d) The school may confiscate a self- administered medication if a pupil misuses the medication." Insert: ". (d) If a student uses his/her prescribed medication in a manner other than as prescribed, disciplinary action according to school codes may be imposed upon him/her. The imposes disciplinary action cannot limit or restrict the students' immediate access to his/her prescribed medication." CHAIR McGUIRE offered her understanding that Amendment 3 is intended to address the concern that the language currently in the bill regarding confiscation of medication could be "a death sentence for child." She noted that the bill is now limited to Epi Pens and inhalers. CHAIR McGUIRE made a motion to adopt Amendment 3. REPRESENTATIVE DAHLSTROM objected [for the purpose of discussion]. MR. PAWLOWSKI relayed that the national organization, Allergy & Asthma Network Mothers of Asthmatics (AANMA) had a concern with the original version of the bill because it made a broad policy statement that confiscation of medication due to misuse could be appropriate. And although the House Health, Education and Social Services Standing Committee limited the bill in that regard, it is believed that there is still an oversight in the bill because action more appropriate than simply confiscating a lifesaving medication can be taken. "Taking the medication away from a child gets to the root of the reason we were offering the bill in the first place," he remarked. CHAIR McGUIRE clarified that Amendment 3 removes confiscation as a disciplinary action but allows for other disciplinary action to be taken in the case of medication misuse. REPRESENTATIVE DAHLSTROM removed her objection. CHAIR McGUIRE asked whether there were any further objections to Amendment 3. There being none, Amendment 3 was adopted. 3:53:12 PM REPRESENTATIVE GRUENBERG referred to page 2, lines 27-28, and asked why the bill doesn't just say "licensed nurse" instead of specifying advanced nurse practitioners and public health nurses. REPRESENTATIVE MEYER remarked that a change to "licensed nurse" sounds logical. MR. PAWLOWSKI asked that Dr. Mandsager be allowed to comment. DR. MANDSAGER indicated that using the term "licensed nurse" would be acceptable. REPRESENTATIVE GRUENBERG made a motion to adopt Amendment 4 to strike "advanced nurse practitioner" and "public health nurse" from page 2, lines 27-28, and insert "licensed nurse". There being no objection, Amendment 4 was adopted. REPRESENTATIVE GRUENBERG asked whether anything else ought to be included in the definition section, for example, institutions or naturopaths. [No response was audible.] 3:55:33 PM REPRESENTATIVE COGHILL moved to report CSHB 85(HES), as amended, out of committee with individual recommendations and the accompanying zero fiscal notes. There being no objection, CSHB 85(JUD) was reported from the House Judiciary Standing Committee.