Rep. Michelle Mussman

Filed: 3/29/2016

 

 


 

 


 
09900HB4462ham002LRB099 16680 NHT 46202 a

1
AMENDMENT TO HOUSE BILL 4462

2    AMENDMENT NO. ______. Amend House Bill 4462 by replacing
3everything after the enacting clause with the following:
 
4    "Section 1. Short title. This Act may be cited as the
5Epinephrine Auto-Injector Act.
 
6    Section 5. Definitions. As used in this Act:
7    "Administer" means to directly apply an epinephrine
8auto-injector to the body of an individual.
9    "Authorized entity" means any entity or organization,
10other than a school covered under Section 22-30 of the School
11Code, in connection with or at which allergens capable of
12causing anaphylaxis may be present, including, but not limited
13to, independent contractors who provide student transportation
14to schools, recreation camps, colleges and universities, day
15care facilities, youth sports leagues, amusement parks,
16restaurants, sports arenas, and places of employment. The

 

 

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1Department shall, by rule, determine what constitutes a day
2care facility under this definition.
3    "Department" means the Department of Public Health.
4    "Epinephrine auto-injector" means a single-use device used
5for the automatic injection of a pre-measured dose of
6epinephrine into the human body.
7    "Health care practitioner" means a physician licensed to
8practice medicine in all its branches under the Medical
9Practice Act of 1987, a physician assistant under the Physician
10Assistant Practice Act of 1987 with prescriptive authority, or
11an advanced practice nurse with prescribing authority under
12Article 65 of the Nurse Practice Act.
13    "Pharmacist" has the meaning given to that term under
14subsection (k-5) of Section 3 of the Pharmacy Practice Act.
15    "Undesignated epinephrine auto-injector" means an
16epinephrine auto-injector prescribed in the name of an
17authorized entity.
 
18    Section 10. Prescription to authorized entity; use;
19training.
20    (a) A health care practitioner may prescribe epinephrine
21auto-injectors in the name of an authorized entity for use in
22accordance with this Act, and pharmacists and health care
23practitioners may dispense epinephrine auto-injectors pursuant
24to a prescription issued in the name of an authorized entity.
25Such prescriptions shall be valid for a period of 2 years.

 

 

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1    (b) An authorized entity may acquire and stock a supply of
2undesignated epinephrine auto-injectors pursuant to a
3prescription issued under subsection (a) of this Section. Such
4undesignated epinephrine auto-injectors shall be stored in a
5location readily accessible in an emergency and in accordance
6with the instructions for use of the epinephrine
7auto-injectors. The Department may establish any additional
8requirements an authorized entity must follow under this Act.
9    (c) An employee or agent of an authorized entity or other
10individual who has completed training under subsection (d) of
11this Section may:
12        (1) provide an epinephrine auto-injector to any
13    individual on the property of the authorized entity whom
14    the employee, agent, or other individual believes in good
15    faith is experiencing anaphylaxis, or to the parent,
16    guardian, or caregiver of such individual, for immediate
17    administration, regardless of whether the individual has a
18    prescription for an epinephrine auto-injector or has
19    previously been diagnosed with an allergy; or
20        (2) administer an epinephrine auto-injector to any
21    individual on the property of the authorized entity whom
22    the employee, agent, or other individual believes in good
23    faith is experiencing anaphylaxis, regardless of whether
24    the individual has a prescription for an epinephrine
25    auto-injector or has previously been diagnosed with an
26    allergy.

 

 

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1    (d) An employee, agent, or other individual authorized must
2complete an anaphylaxis training program before he or she is
3able to provide or administer an epinephrine auto-injector
4under this Section. Such training shall be valid for a period
5of 2 years and shall be conducted by a nationally recognized
6organization experienced in training laypersons in emergency
7health treatment or an entity or individual approved by the
8Department. The Department may approve specific entities or
9individuals or may approve classes of entities or individuals
10to conduct training.
11    Training shall include, but is not limited to:
12        (1) how to recognize signs and symptoms of an allergic
13    reaction, including anaphylaxis;
14        (2) how to administer an epinephrine auto-injector;
15    and
16        (3) a test demonstrating competency of the knowledge
17    required to recognize anaphylaxis and administer an
18    epinephrine auto-injector.
19    Training may also include, but is not limited to:
20        (A) a review of high-risk areas on the authorized
21    entity's property and its related facilities;
22        (B) steps to take to prevent exposure to allergens;
23        (C) emergency follow-up procedures; and
24        (D) other criteria as determined in rules adopted
25    pursuant to this Act.
26    Training may be conducted either online or in person. The

 

 

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1Department shall approve training programs and list permitted
2training programs on the Department's Internet website.
 
3    Section 15. Costs. Whichever entity initiates the process
4of obtaining undesignated epinephrine auto-injectors and
5providing training to personnel for carrying and administering
6undesignated epinephrine auto-injectors shall pay for the
7costs of the undesignated epinephrine auto-injectors.
 
8    Section 20. Limitations. The use of an undesignated
9epinephrine auto-injector in accordance with the requirements
10of this Act does not constitute the practice of medicine or any
11other profession that requires medical licensure.
12    Nothing in this Act shall limit the amount of epinephrine
13auto-injectors that an authorized entity or individual may
14carry or maintain a supply of.
 
15    Section 85. Rulemaking. The Department shall adopt any
16rules necessary to implement and administer this Act.
 
17    Section 90. The School Code is amended by changing Section
1822-30 as follows:
 
19    (105 ILCS 5/22-30)
20    Sec. 22-30. Self-administration and self-carry of asthma
21medication and epinephrine auto-injectors; administration of

 

 

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1undesignated epinephrine auto-injectors; administration of an
2opioid antagonist.
3    (a) For the purpose of this Section only, the following
4terms shall have the meanings set forth below:
5    "Asthma inhaler" means a quick reliever asthma inhaler.
6    "Epinephrine auto-injector" means a single-use device used
7for the automatic injection of a pre-measured dose of
8epinephrine into the human body.
9    "Asthma medication" means a medicine, prescribed by (i) a
10physician licensed to practice medicine in all its branches,
11(ii) a licensed physician assistant with prescriptive
12authority, or (iii) a licensed advanced practice nurse with
13prescriptive authority for a pupil that pertains to the pupil's
14asthma and that has an individual prescription label.
15    "Opioid antagonist" means a drug that binds to opioid
16receptors and blocks or inhibits the effect of opioids acting
17on those receptors, including, but not limited to, naloxone
18hydrochloride or any other similarly acting drug approved by
19the U.S. Food and Drug Administration.
20    "School nurse" means a registered nurse working in a school
21with or without licensure endorsed in school nursing.
22    "Self-administration" means a pupil's discretionary use of
23his or her prescribed asthma medication or epinephrine
24auto-injector.
25    "Self-carry" means a pupil's ability to carry his or her
26prescribed asthma medication or epinephrine auto-injector.

 

 

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1    "Standing protocol" may be issued by (i) a physician
2licensed to practice medicine in all its branches, (ii) a
3licensed physician assistant with prescriptive authority, or
4(iii) a licensed advanced practice nurse with prescriptive
5authority.
6    "Trained personnel" means any school employee or volunteer
7personnel authorized in Sections 10-22.34, 10-22.34a, and
810-22.34b of this Code who has completed training under
9subsection (g) of this Section to recognize and respond to
10anaphylaxis.
11    "Undesignated epinephrine auto-injector" means an
12epinephrine auto-injector prescribed in the name of a school
13district, public school, or nonpublic school.
14    (b) A school, whether public or nonpublic, must permit the
15self-administration and self-carry of asthma medication by a
16pupil with asthma or the self-administration and self-carry of
17an epinephrine auto-injector by a pupil, provided that:
18        (1) the parents or guardians of the pupil provide to
19    the school (i) written authorization from the parents or
20    guardians for (A) the self-administration and self-carry
21    of asthma medication or (B) the self-carry of asthma
22    medication or (ii) for (A) the self-administration and
23    self-carry of an epinephrine auto-injector or (B) the
24    self-carry of an epinephrine auto-injector, written
25    authorization from the pupil's physician, physician
26    assistant, or advanced practice nurse; and

 

 

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1        (2) the parents or guardians of the pupil provide to
2    the school (i) the prescription label, which must contain
3    the name of the asthma medication, the prescribed dosage,
4    and the time at which or circumstances under which the
5    asthma medication is to be administered, or (ii) for the
6    self-administration or self-carry of an epinephrine
7    auto-injector, a written statement from the pupil's
8    physician, physician assistant, or advanced practice nurse
9    containing the following information:
10            (A) the name and purpose of the epinephrine
11        auto-injector;
12            (B) the prescribed dosage; and
13            (C) the time or times at which or the special
14        circumstances under which the epinephrine
15        auto-injector is to be administered.
16The information provided shall be kept on file in the office of
17the school nurse or, in the absence of a school nurse, the
18school's administrator.
19    (b-5) A school district, public school, or nonpublic school
20may authorize the provision of a student-specific or
21undesignated epinephrine auto-injector to a student or any
22personnel authorized under a student's Individual Health Care
23Action Plan, Illinois Food Allergy Emergency Action Plan and
24Treatment Authorization Form, or plan pursuant to Section 504
25of the federal Rehabilitation Act of 1973 to administer an
26epinephrine auto-injector to the student, that meets the

 

 

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1student's prescription on file.
2    (b-10) The school district, public school, or nonpublic
3school may authorize a school nurse or trained personnel to do
4the following: (i) provide an undesignated epinephrine
5auto-injector to a student for self-administration only or any
6personnel authorized under a student's Individual Health Care
7Action Plan, Illinois Food Allergy Emergency Action Plan and
8Treatment Authorization Form, or plan pursuant to Section 504
9of the federal Rehabilitation Act of 1973 to administer to the
10student, that meets the student's prescription on file; (ii)
11administer an undesignated epinephrine auto-injector that
12meets the prescription on file to any student who has an
13Individual Health Care Action Plan, Illinois Food Allergy
14Emergency Action Plan and Treatment Authorization Form, or plan
15pursuant to Section 504 of the federal Rehabilitation Act of
161973 that authorizes the use of an epinephrine auto-injector;
17(iii) administer an undesignated epinephrine auto-injector to
18any person that the school nurse or trained personnel in good
19faith believes is having an anaphylactic reaction; and (iv)
20administer an opioid antagonist to any person that the school
21nurse or trained personnel in good faith believes is having an
22opioid overdose.
23    (c) The school district, public school, or nonpublic school
24must inform the parents or guardians of the pupil, in writing,
25that the school district, public school, or nonpublic school
26and its employees and agents, including a physician, physician

 

 

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1assistant, or advanced practice nurse providing standing
2protocol or prescription for school epinephrine
3auto-injectors, are to incur no liability or professional
4discipline, except for willful and wanton conduct, as a result
5of any injury arising from the administration of asthma
6medication, an epinephrine auto-injector, or an opioid
7antagonist regardless of whether authorization was given by the
8pupil's parents or guardians or by the pupil's physician,
9physician assistant, or advanced practice nurse. The parents or
10guardians of the pupil must sign a statement acknowledging that
11the school district, public school, or nonpublic school and its
12employees and agents are to incur no liability, except for
13willful and wanton conduct, as a result of any injury arising
14from the administration of asthma medication, an epinephrine
15auto-injector, or an opioid antagonist regardless of whether
16authorization was given by the pupil's parents or guardians or
17by the pupil's physician, physician assistant, or advanced
18practice nurse and that the parents or guardians must indemnify
19and hold harmless the school district, public school, or
20nonpublic school and its employees and agents against any
21claims, except a claim based on willful and wanton conduct,
22arising out of the administration of asthma medication, an
23epinephrine auto-injector, or an opioid antagonist regardless
24of whether authorization was given by the pupil's parents or
25guardians or by the pupil's physician, physician assistant, or
26advanced practice nurse.

 

 

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1    (c-5) When a school nurse or trained personnel administers
2an undesignated epinephrine auto-injector to a person whom the
3school nurse or trained personnel in good faith believes is
4having an anaphylactic reaction, or administers an opioid
5antagonist to a person whom the school nurse or trained
6personnel in good faith believes is having an opioid overdose,
7notwithstanding the lack of notice to the parents or guardians
8of the pupil or the absence of the parents or guardians signed
9statement acknowledging no liability, except for willful and
10wanton conduct, the school district, public school, or
11nonpublic school and its employees and agents, and a physician,
12a physician assistant, or an advanced practice nurse providing
13standing protocol or prescription for undesignated epinephrine
14auto-injectors, are to incur no liability or professional
15discipline, except for willful and wanton conduct, as a result
16of any injury arising from the use of an undesignated
17epinephrine auto-injector or the use of an opioid antagonist
18regardless of whether authorization was given by the pupil's
19parents or guardians or by the pupil's physician, physician
20assistant, or advanced practice nurse.
21    (d) The permission for self-administration and self-carry
22of asthma medication or the self-administration and self-carry
23of an epinephrine auto-injector is effective for the school
24year for which it is granted and shall be renewed each
25subsequent school year upon fulfillment of the requirements of
26this Section.

 

 

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1    (e) Provided that the requirements of this Section are
2fulfilled, a pupil with asthma may self-administer and
3self-carry his or her asthma medication or a pupil may
4self-administer and self-carry an epinephrine auto-injector
5(i) while in school, (ii) while at a school-sponsored activity,
6(iii) while under the supervision of school personnel, or (iv)
7before or after normal school activities, such as while in
8before-school or after-school care on school-operated property
9or while being transported on a school bus.
10    (e-5) Provided that the requirements of this Section are
11fulfilled, a school nurse or trained personnel may administer
12an undesignated epinephrine auto-injector to any person whom
13the school nurse or trained personnel in good faith believes to
14be having an anaphylactic reaction (i) while in school, (ii)
15while at a school-sponsored activity, (iii) while under the
16supervision of school personnel, or (iv) before or after normal
17school activities, such as while in before-school or
18after-school care on school-operated property or while being
19transported on a school bus. A school nurse or trained
20personnel may carry undesignated epinephrine auto-injectors on
21his or her person while in school or at a school-sponsored
22activity.
23    (e-10) Provided that the requirements of this Section are
24fulfilled, a school nurse or trained personnel may administer
25an opioid antagonist to any person whom the school nurse or
26trained personnel in good faith believes to be having an opioid

 

 

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1overdose (i) while in school, (ii) while at a school-sponsored
2activity, (iii) while under the supervision of school
3personnel, or (iv) before or after normal school activities,
4such as while in before-school or after-school care on
5school-operated property. A school nurse or trained personnel
6may carry an opioid antagonist on their person while in school
7or at a school-sponsored activity.
8    (f) The school district, public school, or nonpublic school
9may maintain a supply of undesignated epinephrine
10auto-injectors in any secure location that is accessible
11before, during, and after school where an allergic person is
12most at risk, including, but not limited to, classrooms and
13lunchrooms. A physician, a physician assistant who has been
14delegated prescriptive authority in accordance with Section
157.5 of the Physician Assistant Practice Act of 1987, or an
16advanced practice nurse who has been delegated prescriptive
17authority in accordance with Section 65-40 of the Nurse
18Practice Act may prescribe undesignated epinephrine
19auto-injectors in the name of the school district, public
20school, or nonpublic school to be maintained for use when
21necessary. Any supply of epinephrine auto-injectors shall be
22maintained in accordance with the manufacturer's instructions.
23    The school district, public school, or nonpublic school may
24maintain a supply of an opioid antagonist in any secure
25location where an individual may have an opioid overdose. A
26health care professional who has been delegated prescriptive

 

 

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1authority for opioid antagonists in accordance with Section
25-23 of the Alcoholism and Other Drug Abuse and Dependency Act
3may prescribe opioid antagonists in the name of the school
4district, public school, or nonpublic school, to be maintained
5for use when necessary. Any supply of opioid antagonists shall
6be maintained in accordance with the manufacturer's
7instructions.
8    (f-3) Whichever entity initiates the process of obtaining
9undesignated epinephrine auto-injectors and providing training
10to personnel for carrying and administering undesignated
11epinephrine auto-injectors shall pay for the costs of the
12undesignated epinephrine auto-injectors.
13    (f-5) Upon any administration of an epinephrine
14auto-injector, a school district, public school, or nonpublic
15school must immediately activate the EMS system and notify the
16student's parent, guardian, or emergency contact, if known.
17    Upon any administration of an opioid antagonist, a school
18district, public school, or nonpublic school must immediately
19activate the EMS system and notify the student's parent,
20guardian, or emergency contact, if known.
21    (f-10) Within 24 hours of the administration of an
22undesignated epinephrine auto-injector, a school district,
23public school, or nonpublic school must notify the physician,
24physician assistant, or advanced advance practice nurse who
25provided the standing protocol or prescription for the
26undesignated epinephrine auto-injector of its use.

 

 

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1    Within 24 hours after the administration of an opioid
2antagonist, a school district, public school, or nonpublic
3school must notify the health care professional who provided
4the prescription for the opioid antagonist of its use.
5    (g) Prior to the administration of an undesignated
6epinephrine auto-injector, trained personnel must submit to
7their his or her school's administration proof of completion of
8a training curriculum to recognize and respond to anaphylaxis
9that meets the requirements of subsection (h) of this Section.
10Training must be completed annually. Trained personnel must
11also submit to his or her school's administration proof of
12cardiopulmonary resuscitation and automated external
13defibrillator certification. The school district, public
14school, or nonpublic school must maintain records related to
15the training curriculum and trained personnel.
16    Prior to the administration of an opioid antagonist,
17trained personnel must submit to their school's administration
18proof of completion of a training curriculum to recognize and
19respond to an opioid overdose, which curriculum must meet the
20requirements of subsection (h-5) of this Section. Training must
21be completed annually. Trained personnel must also submit to
22the school's administration proof of cardiopulmonary
23resuscitation and automated external defibrillator
24certification. The school district, public school, or
25nonpublic school must maintain records relating to the training
26curriculum and the trained personnel.

 

 

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1    (h) A training curriculum to recognize and respond to
2anaphylaxis, including the administration of an undesignated
3epinephrine auto-injector, may be conducted online or in
4person.
5    Training shall include, but is not limited to:
6        (1) how to recognize signs and symptoms of an allergic
7    reaction, including anaphylaxis;
8        (2) how to administer an epinephrine auto-injector;
9    and
10        (3) a test demonstrating competency of the knowledge
11    required to recognize anaphylaxis and administer an
12    epinephrine auto-injector.
13    Training may also include, but is not limited to:
14        (A) a review of high-risk areas within a school and its
15    related facilities;
16        (B) steps to take to prevent exposure to allergens;
17        (C) emergency follow-up procedures;
18        (D) how to respond to a student with a known allergy,
19    as well as a student with a previously unknown allergy; and
20        (E) other criteria as determined in rules adopted
21    pursuant to this Section. It must include, but is not
22    limited to:
23        (1) how to recognize symptoms of an allergic reaction;
24        (2) a review of high-risk areas within the school and
25    its related facilities;
26        (3) steps to take to prevent exposure to allergens;

 

 

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1        (4) how to respond to an emergency involving an
2    allergic reaction;
3        (5) how to administer an epinephrine auto-injector;
4        (6) how to respond to a student with a known allergy as
5    well as a student with a previously unknown allergy;
6        (7) a test demonstrating competency of the knowledge
7    required to recognize anaphylaxis and administer an
8    epinephrine auto-injector; and
9        (8) other criteria as determined in rules adopted
10    pursuant to this Section.
11    In consultation with statewide professional organizations
12representing physicians licensed to practice medicine in all of
13its branches, registered nurses, and school nurses, the State
14Board of Education shall make available resource materials
15consistent with criteria in this subsection (h) for educating
16trained personnel to recognize and respond to anaphylaxis. The
17State Board may take into consideration the curriculum on this
18subject developed by other states, as well as any other
19curricular materials suggested by medical experts and other
20groups that work on life-threatening allergy issues. The State
21Board is not required to create new resource materials. The
22State Board shall make these resource materials available on
23its Internet website.
24    (h-5) A training curriculum to recognize and respond to an
25opioid overdose, including the administration of an opioid
26antagonist, may be conducted online or in person. The training

 

 

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1must comply with any training requirements under Section 5-23
2of the Alcoholism and Other Drug Abuse and Dependency Act and
3the corresponding rules. It must include, but is not limited
4to:
5        (1) how to recognize symptoms of an opioid overdose;
6        (2) information on drug overdose prevention and
7    recognition;
8        (3) how to perform rescue breathing and resuscitation;
9        (4) how to respond to an emergency involving an opioid
10    overdose;
11        (5) opioid antagonist dosage and administration;
12        (6) the importance of calling 911;
13        (7) care for the overdose victim after administration
14    of the overdose antagonist;
15        (8) a test demonstrating competency of the knowledge
16    required to recognize an opioid overdose and administer a
17    dose of an opioid antagonist; and
18        (9) other criteria as determined in rules adopted
19    pursuant to this Section.
20    (i) Within 3 days after the administration of an
21undesignated epinephrine auto-injector by a school nurse,
22trained personnel, or a student at a school or school-sponsored
23activity, the school must report to the State Board of
24Education in a form and manner prescribed by the State Board
25the following information:
26        (1) age and type of person receiving epinephrine

 

 

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1    (student, staff, visitor);
2        (2) any previously known diagnosis of a severe allergy;
3        (3) trigger that precipitated allergic episode;
4        (4) location where symptoms developed;
5        (5) number of doses administered;
6        (6) type of person administering epinephrine (school
7    nurse, trained personnel, student); and
8        (7) any other information required by the State Board.
9    If a school district, public school, or nonpublic school
10maintains or has an independent contractor providing
11transportation to students who maintains a supply of
12undesignated epinephrine auto-injectors, then the school
13district, public school, or nonpublic school must report that
14information to the State Board of Education upon adoption or
15change of the policy of the school district, public school,
16nonpublic school, or independent contractor, in a manner as
17prescribed by the State Board. The report must include the
18number of undesignated epinephrine auto-injectors in supply.
19    (i-5) Within 3 days after the administration of an opioid
20antagonist by a school nurse or trained personnel, the school
21must report to the State Board, in a form and manner prescribed
22by the State Board, the following information:
23        (1) the age and type of person receiving the opioid
24    antagonist (student, staff, or visitor);
25        (2) the location where symptoms developed;
26        (3) the type of person administering the opioid

 

 

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1    antagonist (school nurse or trained personnel); and
2        (4) any other information required by the State Board.
3    (j) By October 1, 2015 and every year thereafter, the State
4Board of Education shall submit a report to the General
5Assembly identifying the frequency and circumstances of
6epinephrine administration during the preceding academic year.
7Beginning with the 2017 report, the report shall also contain
8information on which school districts, public schools, and
9nonpublic schools maintain or have independent contractors
10providing transportation to students who maintain a supply of
11undesignated epinephrine auto-injectors. This report shall be
12published on the State Board's Internet website on the date the
13report is delivered to the General Assembly.
14    On or before October 1, 2016 and every year thereafter, the
15State Board shall submit a report to the General Assembly and
16the Department of Public Health identifying the frequency and
17circumstances of opioid antagonist administration during the
18preceding academic year. This report shall be published on the
19State Board's Internet website on the date the report is
20delivered to the General Assembly.
21    (k) The State Board of Education may adopt rules necessary
22to implement this Section.
23    (l) Nothing in this Section shall limit the amount of
24epinephrine auto-injectors that any type of school or student
25may carry or maintain a supply of.
26(Source: P.A. 98-795, eff. 8-1-14; 99-173, eff. 7-29-15;

 

 

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199-480, eff. 9-9-15; revised 10-13-15.)".