By: Johnson, et al. S.B. No. 294
 
  (Klick, Lalani)
 
   
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the use of epinephrine auto-injectors and medication
  designated for treatment of respiratory distress on public and
  private school campuses.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  The heading to Subchapter E, Chapter 38,
  Education Code, is amended to read as follows:
  SUBCHAPTER E. MAINTENANCE AND ADMINISTRATION OF EPINEPHRINE
  AUTO-INJECTORS AND MEDICATION FOR RESPIRATORY DISTRESS [ASTHMA
  MEDICINE]
         SECTION 2.  Section 38.201, Education Code, is amended by
  adding Subdivision (3-a) to read as follows:
               (3-a) "Medication for respiratory distress" means
  albuterol, levalbuterol, or another medication designated by the
  executive commissioner of the Health and Human Services Commission
  for treatment of respiratory distress under Section 38.208(c). 
         SECTION 3.  Section 38.202(a), Education Code, is amended to
  read as follows:
         (a)  The commissioner of state health services shall
  establish an advisory committee to examine and review the
  administration, on a campus of a school district, an
  open-enrollment charter school, a private school, or an institution
  of higher education, of:
               (1)  epinephrine auto-injectors to a person
  experiencing an anaphylactic reaction; and
               (2)  medication for respiratory distress to a person
  experiencing respiratory distress [on a campus of a school
  district, an open-enrollment charter school, a private school, or
  an institution of higher education].
         SECTION 4.  Section 38.207, Education Code, is amended to
  read as follows:
         Sec. 38.207.  ADVISORY COMMITTEE: DUTIES. The advisory
  committee shall advise the commissioner of state health services
  on:
               (1)  the storage and maintenance of epinephrine
  auto-injectors and medication for respiratory distress on school
  campuses and campuses of institutions of higher education;
               (2)  the training of school personnel and school
  volunteers, and of personnel and volunteers at institutions of
  higher education, in the administration of an epinephrine
  auto-injector;
               (3) the training of school personnel and school
  volunteers, and of personnel and volunteers at institutions of
  higher education, in the administration of a medication for
  respiratory distress; and
               (4) [(3)]  a plan for:
                     (A)  one or more school personnel members or
  school volunteers trained in the administration of an epinephrine
  auto-injector to be on each school campus; [and]
                     (B)  one or more school personnel members or
  school volunteers trained in the administration of medication for
  respiratory distress to be on each school campus;
                     (C)  one or more personnel members or volunteers
  of an institution of higher education trained in the administration
  of an epinephrine auto-injector to be on each campus of an
  institution of higher education; and
                     (D)  one or more personnel members or volunteers
  of an institution of higher education trained in the administration
  of medication for respiratory distress to be on each campus of an
  institution of higher education.
         SECTION 5.  The heading to Section 38.208, Education Code,
  is amended to read as follows:
         Sec. 38.208.  MAINTENANCE AND ADMINISTRATION OF EPINEPHRINE
  AUTO-INJECTORS AND MEDICATION FOR RESPIRATORY DISTRESS [ASTHMA
  MEDICINE].
         SECTION 6.  Section 38.208, Education Code, is amended by
  amending Subsections (a-1), (b-1), (c), (e), and (f) and adding
  Subsections (b-2), (b-3), (d-1), (d-2), and (e-1) to read as
  follows:
         (a-1)  Each school district, open-enrollment charter school,
  and private school may adopt and implement a policy regarding the
  maintenance, administration, and disposal of medication for
  respiratory distress [authorizing a school nurse to maintain and
  administer asthma medicine] at each campus in the district or
  school.
         (b-1)  If a policy is adopted under Subsection (a-1), the
  policy must provide that school personnel and school volunteers who
  are authorized and trained [the school nurse] may administer
  medication for respiratory distress [prescription asthma medicine]
  to a person reasonably believed to be experiencing respiratory
  distress on [student only if the school nurse has written
  notification from a parent or guardian of the student that the
  student has been diagnosed as having asthma and stating that the
  school nurse may administer prescription asthma medicine to the
  student. A school nurse may administer the prescription asthma
  medicine only at] a school campus, or at a school-sponsored or
  school-related activity on or off school property.
         (b-2)  If medication for respiratory distress is
  administered to a student whose parent or guardian has not provided
  notification to the school that the student has been diagnosed with
  asthma, the school must refer the student to the student's primary
  care provider on the day the medication for respiratory distress is
  administered and inform the student's parent or guardian regarding
  the referral. The referral must include:
               (1)  the symptoms of respiratory distress observed; 
               (2)  the name of the medication for respiratory
  distress administered to the student; and
               (3)  any patient care instructions given to the
  student.
         (b-3)  If a student who has received medication for
  respiratory distress does not have a primary care provider or the
  parent or guardian of the student has not engaged a primary care
  provider for the student, the student's parent or guardian must
  receive information to assist the parent or guardian in selecting a
  primary care provider for the student.
         (c)  The executive commissioner of the Health and Human
  Services Commission, in consultation with the commissioner of
  education, and with advice from the advisory committee as
  appropriate, shall adopt rules regarding the maintenance,
  administration, and disposal of an epinephrine auto-injector at a
  school campus subject to a policy adopted under Subsection (a) and
  the maintenance, [and] administration, and disposal of medication
  for respiratory distress [asthma medicine] at a school campus
  subject to a policy adopted under Subsection (a-1). The rules must
  establish:
               (1)  the number of epinephrine auto-injectors
  available at each campus;
               (2)  the amount of medication for respiratory distress 
  [prescription asthma medicine] available at each campus;
               (3)  the process for each school district,
  open-enrollment charter school, and private school to check the
  inventory of epinephrine auto-injectors and medication for
  respiratory distress [asthma medicine] at regular intervals for
  expiration and replacement; [and]
               (4)  the amount of training required for school
  personnel and school volunteers to administer:
                     (A)  an epinephrine auto-injector; or
                     (B)  medication for respiratory distress; and
               (5)  the types of medication that may be administered
  under Subsection (b-1) to persons experiencing respiratory
  distress, based on a review of the best available medical evidence.
         (d-1)  Each school district, open-enrollment charter school,
  and private school that adopts a policy under Subsection (a-1) must
  require that each campus have one or more school personnel or school
  volunteers authorized and trained to administer medication for
  respiratory distress present during regular school hours.
         (d-2)  A school personnel member or school volunteer may not
  be subject to any penalty or disciplinary action for refusing to
  administer or receive training to administer epinephrine
  auto-injectors or medication for respiratory distress, as
  applicable, in accordance with a policy adopted under Subsection
  (a) or (a-1).
         (e)  The supply of epinephrine auto-injectors at each campus
  must be stored in a secure location and be easily accessible to
  school personnel and school volunteers authorized and trained to
  administer an epinephrine auto-injector. [The supply of asthma
  medicine at each campus must be stored in a secure location and be
  easily accessible to the school nurse.]
         (e-1)  The supply of medication for respiratory distress at
  each campus must be stored in a secure location and be easily
  accessible to authorized school personnel and school volunteers.
         (f)  The policy described by Subsection (a-1) may not require
  a school district, open-enrollment charter school, or private
  school to purchase medication for respiratory distress 
  [prescription asthma medicine] or require any other expenditure
  related to the maintenance or administration of medication for
  respiratory distress [asthma medicine] that would result in a
  negative fiscal impact on the district or school.
         SECTION 7.  Subchapter E, Chapter 38, Education Code, is
  amended by adding Section 38.2091 to read as follows:
         Sec. 38.2091.  REPORT ON ADMINISTERING MEDICATION FOR
  RESPIRATORY DISTRESS. (a) Not later than the 10th business day
  after the date a school personnel member or school volunteer
  administers medication for respiratory distress to a person
  experiencing respiratory distress in accordance with a policy
  adopted under Section 38.208(a-1), the school shall report the
  information required under Subsection (b) to:
               (1)  the school district, the charter holder if the
  school is an open-enrollment charter school, or the governing body
  of the school if the school is a private school;
               (2)  the physician or other person who prescribed the
  medication for respiratory distress; and
               (3)  the commissioner of state health services.
         (b)  The report required under this section must include:
               (1)  the age of the person who received the
  administration of the medication for respiratory distress;
               (2)  whether the person who received the administration
  of the medication for respiratory distress was a student, a school
  personnel member or school volunteer, or a visitor;
               (3)  the dosage of the medication for respiratory
  distress administered;
               (4)  the title of the person who administered the
  medication for respiratory distress; and
               (5)  any other information required by the commissioner
  of education.
         SECTION 8.  Section 38.210, Education Code, is amended by
  amending Subsections (a) and (b) and adding Subsection (a-1) to
  read as follows:
         (a)  Each school district, open-enrollment charter school,
  and private school that adopts a policy under Section 38.208(a) is
  responsible for training school personnel and school volunteers in
  the administration of an epinephrine auto-injector. The training
  must include information on:
               (1)  recognizing the signs and symptoms of anaphylaxis;
               (2)  administering an epinephrine auto-injector;
               (3)  implementing emergency procedures, if necessary,
  after administering an epinephrine auto-injector; and
               (4)  properly disposing of used or expired epinephrine
  auto-injectors.
         (a-1)  Each school district, open-enrollment charter school,
  and private school that adopts a policy under Section 38.208(a-1)
  is responsible for training school personnel and school volunteers
  in the administration of medication for respiratory distress. The
  training must include information on:
               (1)  recognizing the signs and symptoms of respiratory
  distress;
               (2)  administering medication for respiratory
  distress;
               (3)  implementing emergency procedures, if necessary,
  after administering medication for respiratory distress; and
               (4)  proper sanitization, reuse, and disposal of
  medication for respiratory distress.
         (b)  Training required under this section must be provided:
               (1)  [include information on:
                     [(A)  recognizing the signs and symptoms of
  anaphylaxis;
                     [(B)  administering an epinephrine auto-injector;
                     [(C)  implementing emergency procedures, if
  necessary, after administering an epinephrine auto-injector; and
                     [(D)  properly disposing of used or expired
  epinephrine auto-injectors;
               [(2) be provided] in a formal training session or
  through online education; and
               (2)  [(3) be provided] in accordance with the policy
  adopted under Section 21.4515.
         SECTION 9.  The heading to Section 38.211, Education Code,
  is amended to read as follows:
         Sec. 38.211.  PRESCRIPTION OF EPINEPHRINE AUTO-INJECTORS
  AND MEDICATION FOR RESPIRATORY DISTRESS [ASTHMA MEDICINE].
         SECTION 10.  Sections 38.211(a), (b), (c), (e), and (f),
  Education Code, are amended to read as follows:
         (a)  A physician or person who has been delegated
  prescriptive authority under Chapter 157, Occupations Code, may
  prescribe epinephrine auto-injectors or medication for respiratory
  distress [asthma medicine] in the name of a school district,
  open-enrollment charter school, or private school.
         (b)  A physician or other person who prescribes epinephrine
  auto-injectors or medication for respiratory distress [asthma
  medicine] under Subsection (a) shall provide the school district,
  open-enrollment charter school, or private school with a standing
  order for the administration of, as applicable:
               (1)  an epinephrine auto-injector to a person
  reasonably believed to be experiencing anaphylaxis; or
               (2)  medication for respiratory distress [asthma
  medicine] to a person reasonably believed to be experiencing
  respiratory distress [a symptom of asthma and who has provided
  written notification and permission as required by Section
  38.208(b-1)].
         (c)  The standing order under Subsection (b) is not required
  to be patient-specific, and the epinephrine auto-injector or
  medication for respiratory distress [asthma medicine] may be
  administered to a person without a previously established
  physician-patient relationship.
         (e)  An order issued under this section must contain:
               (1)  the name and signature of the prescribing
  physician or other person;
               (2)  the name of the school district, open-enrollment
  charter school, or private school to which the order is issued;
               (3)  as applicable, the quantity of epinephrine
  auto-injectors or the quantity and types of medications for
  respiratory distress [asthma medicine] to be obtained and
  maintained under the order; and
               (4)  the date of issue.
         (f)  A pharmacist may dispense an epinephrine auto-injector
  or medication for respiratory distress [asthma medicine] to a
  school district, open-enrollment charter school, or private school
  without requiring the name or any other identifying information
  relating to the user.
         SECTION 11.  Section 38.212, Education Code, is amended to
  read as follows:
         Sec. 38.212.  NOTICE TO PARENTS; WRITTEN CONSENT. (a) If a
  school district, open-enrollment charter school, or private school
  implements a policy under this subchapter, the district or school
  shall:
               (1)  provide written notice of the policy to a parent or
  guardian of each student enrolled in the district or school; and
               (2)  obtain written consent from a parent or guardian
  of each student on the student's enrollment in the district or
  school to administer an epinephrine auto-injector or medication for
  respiratory distress, as applicable, to the student in accordance
  with the policy.
         (b)  Notice required under Subsection (a)(1) [this section]
  must be provided before a policy is implemented by the district or
  school under this subchapter and before the start of each school
  year.
         (c)  Subsection (a)(2) does not prohibit a school personnel
  member or school volunteer from administering in good faith an
  epinephrine auto-injector to a student reasonably believed to be
  experiencing anaphylaxis or medication for respiratory distress to
  a student reasonably believed to be experiencing respiratory
  distress, as applicable, in accordance with a policy implemented
  under this subchapter, regardless of whether the student's parent
  or guardian has provided written consent under Subsection (a)(2).
         SECTION 12.  Section 38.215(a), Education Code, is amended
  to read as follows:
         (a)  A person who in good faith takes, or fails to take, any
  action under this subchapter is immune from civil or criminal
  liability or disciplinary action resulting from that action or
  failure to act, including:
               (1)  issuing an order for epinephrine auto-injectors or
  medication for respiratory distress [asthma medicine];
               (2)  supervising or delegating the administration of an
  epinephrine auto-injector or medication for respiratory distress
  [asthma medicine];
               (3)  possessing, maintaining, storing, or disposing of
  an epinephrine auto-injector or medication for respiratory
  distress [asthma medicine];
               (4)  prescribing an epinephrine auto-injector or
  medication for respiratory distress [asthma medicine];
               (5)  dispensing:
                     (A)  an epinephrine auto-injector; or
                     (B)  medication for respiratory distress [asthma
  medicine, provided that permission has been granted as provided by
  Section 38.208(b-1)];
               (6)  administering, or assisting in administering, an
  epinephrine auto-injector or medication for respiratory distress
  [asthma medicine, provided that permission has been granted as
  provided by Section 38.208(b-1)];
               (7)  providing, or assisting in providing, training,
  consultation, or advice in the development, adoption, or
  implementation of policies, guidelines, rules, or plans; or
               (8)  undertaking any other act permitted or required
  under this subchapter.
         SECTION 13.  This Act takes effect immediately if it
  receives a vote of two-thirds of all the members elected to each
  house, as provided by Section 39, Article III, Texas Constitution.  
  If this Act does not receive the vote necessary for immediate
  effect, this Act takes effect September 1, 2023.