Legislature(2005 - 2006)BUTROVICH 205
04/22/2005 08:30 AM JUDICIARY
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HB 85-PRESCRIBED MEDICATION FOR STUDENTS CHAIR RALPH SEEKINS announced HB 85 to be up for consideration. 8:43:33 AM REPRESENTATIVE KEVIN MEYER introduced HB 85, which proposes to allow children to carry their own inhalers (commonly known as Epipen®). Not having their medication readily available puts children at risk. Some children have died because their medication was in the school nurse's office. HB 85 would allow a parent or guardian to sign a release of liability provided the healthcare provider submit a written consent treatment plan and certify that the child is capable of using the medication. HB 85 would qualify Alaska for federal grants under the Asthmatic Schoolchildren's Treatment Act of 2004. Thirty-seven states have passed similar legislation. It protects the schools from liabilities and it would potentially reduce absences. 8:46:17 AM SENATOR GRETCHEN GUESS asked Representative Meyer to explain why pharmacist is listed under the definition of healthcare provider. REPRESENTATIVE MEYER explained the reason is pharmacists often train children to use their inhalers. 8:49:03 AM MR. MIKE PAWLOWSKI, legislative aide, reiterated Representative Meyer's assertion that pharmacists are the ones who teach children how to use their medication. The Department of Public Health (DPH) supports adding pharmacists. SENATOR GUESS asserted HB 85 allows pharmacists to write a treatment plan. CHAIR SEEKINS said he would feel more comfortable if backup medicine was available in the school nurse's office. REPRESENTATIVE MEYER advised under HB 85 children could still leave backup medication with the nurse. 8:52:42 AM REPRESENTATIVE MEYER continued families couldn't always afford two inhalers so he would be hesitant to require a backup. 8:54:38 AM Senator Gene Therriault joined the committee. SENATOR CHARLIE HUGGINS expressed concern over children passing their inhalers around. REPRESENTATIVE MEYER stated the school would not be liable. SENATOR HUGGINS said he was worried about children causing the death of other children by sharing inhalers. REPRESENTATIVE MEYER countered inhalers wouldn't kill a child although they might make someone hyperactive. 8:56:21 AM SENATOR HUGGINS asked the definition of advanced nurse practitioner. SENATOR HOLLIS FRENCH advised all nurse practitioners are advanced nurse practitioners. CHAIR SEEKINS agreed and stated licensed nurse would be included. The difference is a licensed nurse who is not a nurse practitioner would not be able to prescribe medications. SENATOR FRENCH asked Mr. Pawlowski to explain Epipen®. MR. PAWLOWSKI advised it is short for epinephrine injector, which is a self-administered injection. SENATOR FRENCH asked whether the use of epinephrine inhalers among schoolchildren was common. 8:58:47 AM CHAIR SEEKINS replied yes. He explained epinephrine is a form of adrenaline. 8:59:36 AM SENATOR THERRIAULT asked the recourse if a child lets a friend take a dose of the medication. MR. PAWLOWSKI replied discipline according to the school code would govern that situation. 9:01:36 AM SENATOR THERRIAULT asked the recourse when children pass inhalers around to get each other high. MR. PAWLOWSKI responded the debate occurred in the House and it was decided disciplinary action by the schools should be adequate. CHAIR SEEKINS mentioned a person can buy some types of inhalers over the counter and there is no present issue of children buying inhalers. He asserted it is serious when someone has an asthma attack. 9:03:35 AM CHAIR SEEKINS said his only concern was if a student were to forget to bring their medication. He prefers to have a backup in place. He read a statement from the Alaska Nurses Association that asked to require a student to have an extra inhaler stored in the school nurse's office. MR. PAWLOWSKI commented that was included in Section 5. A healthcare provider could include that stipulation in the written treatment plan. SENATOR FRENCH said it could be included in the list under "doses of medications needed." 9:05:27 AM SENATOR GUESS advised it would be beneficial to keep the option so as not to mandate families to always have two inhalers. Some families may not be able to afford two inhalers. 9:07:40 AM CHAIR SEEKINS said it is not his intent to put someone who can't afford the medication in risk of violating the law. However, a serious case of asthma needs to be considered. 9:08:55 AM MS. PATRICIA SENNER, nurse practitioner, testified in support of HB 85. She maintained school nurses are having trouble with managing inhalers. Children often forget them or they run out of medication. She suggested to stipulate under Section 5 the healthcare provider state what back up is needed. 9:10:29 AM MS. SENNER advised the committee albuterol inhalers run about twenty dollars while steroid inhalers run close to one hundred dollars. She expressed concern with children carrying Epipens®, however school nurses report they have not had trouble with abuse, although there are instances of sharing. The side effects of albuterol are minimal unless the person suffers from a heart condition. The Anchorage school districts do have Epipen® backups. 9:12:08 AM MS. SENNER admitted the Alaska Nurses Association has a problem with the definition of healthcare provider. The problem with adding pharmacists is they do not have personal knowledge of the child. She suggested restricting the description of healthcare provider to those people who legally have the authority to diagnose and treat. 9:13:54 AM MS. SENNER suggested leaving out licensed nurse and pharmacists. SENATOR FRENCH asked whether all inhalers have the same active ingredient. MS. SENNER replied the most common are rescue inhalers, which contain albuterol. There are a variety of others. SENATOR FRENCH asked which kind would work in an emergency situation. MS. SENNER stated albuterol. SENATOR FRENCH asked the reason children bring inhalers to school. MS. SENNER informed albuterol is often taken four times per day and most other inhalers are twice a day medications. 9:15:59 AM SENATOR FRENCH asked what kind of emergency inhaler a school would select. MS. SENNER affirmed it would be albuterol. SENATOR FRENCH asked the danger from using someone else's inhaler. MS. SENNER said the main thing would be a contagious disease through the transfer of germs. SENATOR FRENCH asked whether any children have died because of asthma attacks. MS. SENNER replied she is not aware of any. 9:17:33 AM MS. STEPHANIE BIRCH, chief of the women and children's health section, Division of Public Health (DPH), offered support for HB 85 and also offered to answer questions. MS. MARGE LARSEN, American Lung Association of Alaska testified in support. She reminded the committee not every school in Alaska has a school nurse. The intent of HB 85 is for school children have access to their medication. Most people who die from asthma are mild asthmatics who do not manage their asthma. Rescue medication is a necessary and critical part of asthma management. 9:20:12 AM SENATOR GUESS asked the procedure when a school has no school nurse. MS. LARSON advised the medications are locked up in the principal's office. The LIO connection was lost and so Chair Seekins announced a brief recess at 9:22:08 AM. Chair Seekins reconvened the meeting at 9:42:27 AM. CHAIR SEEKINS proposed Amendment 1. Page 2, line 19 after the word "permitted to" insert "personally" and following the word "nurse" insert "or other school official". Hearing no objections the motion carried. 9:44:15 AM CHAIR SEEKINS proposed Amendment 2. Page 2, line 25 state "in this section, healthcare provider means a person with prescriptive authority in this state." SENATOR GUESS objected for the purpose of discussion. She asked whether a village health aide would fall under that definition. MS. BIRCH said a village health aide has delegated prescriptive authority. She suggested adding wording on line 26 to state "within their state regulations." This would allow for them to practice within their occupational licensing regulations. CHAIR SEEKINS said a pharmacist might be the person best capable of showing the child how to use the inhaler device. 9:49:48 AM MR. PAWLOWSKI suggested a pharmacist might attempt to do something outside their authority, such as write a prescription. SENATOR GUESS expressed concern the definition of healthcare provider is being used as a catchall. 9:51:36 AM CHAIR SEEKINS withdrew Amendment 2 and proposed Amendment 3, which defines healthcare provider. Hearing no objection, the motion carried. 9:52:32 AM SENATOR HUGGINS moved Amendment 4, which inserts a permissive requirement that medication must be kept with a designated school official. Hearing no objections, the motion carried. 9:54:41 AM SENATOR GUESS inferred the committee should clarify HB 85 in regards to public versus private school. MR. PAWLOWSKI referred to a legal memo included in the packet dated April 6, 2005 from legislative legal. There is a concern that the word school is not specific enough. It is problematic for the state to require a private school to do anything. It is limited under AS 14.45.100. The sponsor suggested inserting the word "public" to clarify. CHAIR SEEKINS moved Amendment 5, insert the word "public." SENATOR THERRIAULT objected for the purpose of discussion. 9:57:47 AM SENATOR GUESS noted the drafter might have had a reason not to specify public school. MR. PAWLOWSKI admitted that was true. The drafter described it as not expressly necessary. 10:02:30 AM SENATOR THERRIAULT suggested asking the drafters for a memo clarifying the intent that HB 85 addresses public schools and not private schools. 10:05:11 AM CHAIR SEEKINS announced he wanted to be on record that it was not his intent to force private schools to adhere to HB 85. 10:06:38 AM Amendment 5 was adopted. CHAIR SEEKINS announced the committee would wait for a clean version of the amended bill before going further.