Legislature(2005 - 2006)CAPITOL 120

03/07/2005 01:00 PM JUDICIARY

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Moved CSHB 85(JUD) Out of Committee
Heard & Held
Heard & Held
Heard & Held
Bills Previously Heard/Scheduled
Moved CSHB 95(JUD) Out of Committee
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
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                                                               
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                                                               
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                                                               
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                                                               
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                                                               
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                                                               
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                                                               
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                                                                                                     
          "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                                                                        
                    (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                                                               
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                                                               
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                                                               
[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                                                               

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