Bill Summary – FastDemocracy

SECOND REGULAR SESSION
                        HOUSE BILL NO. 1826
                               103RD GENERAL ASSEMBLY


                               INTRODUCED BY REPRESENTATIVE VIOLET.

     3915H.01I                                                                    JOSEPH ENGLER, Chief Clerk


                                                AN ACT
     To repeal sections 167.627, 167.630, 190.246, 196.990, and 321.621, RSMo, and to enact in
            lieu thereof five new sections relating to epinephrine delivery devices, with penalty
            provisions.


     Be it enacted by the General Assembly of the state of Missouri, as follows:

             Section A. Sections 167.627, 167.630, 190.246, 196.990, and 321.621, RSMo, are
 repealed and five new sections enacted in lieu thereof, to be known as sections 167.627,
 167.630, 190.246, 196.990, and 321.621, to read as follows:
             167.627. 1. For purposes of this section, the following terms shall mean:
         (1) "Epinephrine delivery device", a single-use device used for the delivery of a
 premeasured dose of epinephrine into the human body;
         (2) "Medication", any medicine prescribed or ordered by a physician for the treatment
 of asthma or anaphylaxis, including without limitation inhaled bronchodilators and [auto-
 injectible] epinephrine delivery devices;
         [(2)] (3) "Self-administration", a pupil's discretionary use of medication prescribed by
 a physician or under a written treatment plan from a physician.
         2. Each board of education and its employees and agents in this state shall grant any
 pupil in the school authorization for the possession and self-administration of medication to
 treat such pupil's chronic health condition, including but not limited to asthma or anaphylaxis
 if:
         (1) A licensed physician prescribed or ordered such medication for use by the pupil
 and instructed such pupil in the correct and responsible use of such medication;


     EXPLANATION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is
     intended to be omitted from the law. Matter in bold-face type in the above bill is proposed language.
HB 1826                                              2

          (2) The pupil has demonstrated to the pupil's licensed physician or the licensed
 physician's designee, and the school nurse, if available, the skill level necessary to use the
 medication and any device necessary to administer such medication prescribed or ordered;
          (3) The pupil's physician has approved and signed a written treatment plan for
 managing the pupil's chronic health condition, including asthma or anaphylaxis episodes and
 for medication for use by the pupil. Such plan shall include a statement that the pupil is
 capable of self-administering the medication under the treatment plan;
          (4) The pupil's parent or guardian has completed and submitted to the school any
 written documentation required by the school, including the treatment plan required under
 subdivision (3) of this subsection and the liability statement required under subdivision (5) of
 this subsection; and
          (5) The pupil's parent or guardian has signed a statement acknowledging that the
 school district and its employees or agents shall incur no liability as a result of any injury
 arising from the self-administration of medication by the pupil or the administration of such
 medication by school staff. Such statement shall not be construed to release the school
 district and its employees or agents from liability for negligence.
          3. An authorization granted under subsection 2 of this section shall:
          (1) Permit such pupil to possess and self-administer such pupil's medication while in
 school, at a school-sponsored activity, and in transit to or from school or school-sponsored
 activity; and
          (2) Be effective only for the same school and school year for which it is granted.
 Such authorization shall be renewed by the pupil's parent or guardian each subsequent school
 year in accordance with this section.
          4. Any current duplicate prescription medication, if provided by a pupil's parent or
 guardian or by the school, shall be kept at a pupil's school in a location at which the pupil or
 school staff has immediate access in the event of an asthma or anaphylaxis emergency.
          5. The information described in subdivisions (3) and (4) of subsection 2 of this
 section shall be kept on file at the pupil's school in a location easily accessible in the event of
 an emergency.
              167.630. 1. As used in this section, the term "epinephrine delivery device" has
 the same meaning given to the term in section 167.627.
          2. Each school board may authorize a school nurse licensed under chapter 335 who is
 employed by the school district and for whom the board is responsible for to maintain an
 adequate supply of [prefilled auto syringes of] epinephrine [with fifteen-hundredths milligram
 or three-tenths milligram] delivery devices at the school. The nurse shall recommend to the
 school board the number of [prefilled] epinephrine [auto syringes] delivery devices that the
 school should maintain.
HB 1826                                             3

          [2.] 3. To obtain [prefilled] epinephrine [auto syringes] delivery devices for a school
 district, a prescription written by a licensed physician, a physician's assistant, or nurse
 practitioner is required. For such prescriptions, the school district shall be designated as the
 patient, the nurse's name shall be required, and the prescription shall be filled at a licensed
 pharmacy.
          [3.] 4. A school nurse, contracted agent trained by a nurse, or other school employee
 trained by and supervised by the nurse shall have the discretion to use an epinephrine [auto
 syringe] delivery device on any student the school nurse, trained employee, or trained
 contracted agent believes is having a life-threatening anaphylactic reaction based on the
 training in recognizing an acute episode of an anaphylactic reaction. The provisions of
 section 167.624 concerning immunity from civil liability for trained employees administering
 lifesaving methods shall apply to trained employees administering [a prefilled auto syringe]
 an epinephrine delivery device under this section. Trained contracted agents shall have
 immunity from civil liability for administering [a prefilled auto syringe] an epinephrine
 delivery device under this section.
              190.246. 1. As used in this section, the following terms shall mean:
          (1) "Eligible person, firm, organization or other entity", an ambulance service or
 emergency medical response agency, an emergency medical responder, or an emergency
 medical technician who is employed by, or an enrolled member, person, firm, organization or
 entity designated by, rule of the department of health and senior services in consultation with
 other appropriate agencies. All such eligible persons, firms, organizations or other entities
 shall be subject to the rules promulgated by the director of the department of health and senior
 services;
          (2) "Emergency health care provider":
          (a) A physician licensed pursuant to chapter 334 with knowledge and experience in
 the delivery of emergency care; or
          (b) A hospital licensed pursuant to chapter 197 that provides emergency care;
          (3) "Epinephrine delivery device", a single-use device used for the delivery of a
 premeasured dose of epinephrine into the human body.
          2. Possession and use of epinephrine [auto-injector] delivery devices shall be limited
 as follows:
          (1) No person shall use an epinephrine [auto-injector] delivery device unless such
 person has successfully completed a training course in the use of epinephrine [auto-injector]
 delivery devices approved by the director of the department of health and senior services.
 Nothing in this section shall prohibit the use of an epinephrine [auto-injector] delivery
 device:
HB 1826                                             4

          (a) By a health care professional licensed or certified by this state who is acting
 within the scope of his or her practice; or
          (b) By a person acting pursuant to a lawful prescription;
          (2) Every person, firm, organization and entity authorized to possess and use
 epinephrine [auto-injector] delivery devices pursuant to this section shall use, maintain and
 dispose of such devices in accordance with the rules of the department; and
          (3) Every use of an epinephrine [auto-injector] delivery device pursuant to this
 section shall immediately be reported to the emergency health care provider.
          3. (1) Use of an epinephrine [auto-injector] delivery device pursuant to this section
 shall be considered first aid or emergency treatment for the purpose of any law relating to
 liability.
          (2) Purchase, acquisition, possession or use of an epinephrine [auto-injector] delivery
 device pursuant to this section shall not constitute the unlawful practice of medicine or the
 unlawful practice of a profession.
          (3) Any person otherwise authorized to sell or provide an epinephrine [auto-injector]
 delivery device may sell or provide it to a person authorized to possess it pursuant to this
 section.
          4. Any person, firm, organization or entity that violates the provisions of this section
 is guilty of a class B misdemeanor.
              196.990. 1. As used in this section, the following terms shall mean:
          (1) "Administer", the direct application of an epinephrine [auto-injector] delivery
 device to the body of an individual;
          (2) "Authorized entity", any entity or organization at or in connection with which
 allergens capable of causing anaphylaxis may be present including, but not limited to,
 qualified first responders, as such term is defined in section 321.621, facilities licensed
 under chapter 198, restaurants, recreation camps, youth sports leagues, child care facilities,
 amusement parks, and sports arenas. "Authorized entity" shall not include any public school
 or public charter school;
          (3) "Epinephrine [auto-injector] delivery device", a single-use device used for the
 [automatic injection] delivery of a premeasured dose of epinephrine into the human body;
          (4) "Physician", a physician licensed in this state under chapter 334;
          (5) "Provide", the supply of one or more epinephrine [auto-injectors] delivery
 devices to an individual;
          (6) "Self-administration", a person's discretionary use of an epinephrine [auto-
 injector] delivery device.
          2. A physician may prescribe epinephrine [auto-injectors] delivery devices in the
 name of an authorized entity for use in accordance with this section, and pharmacists,
HB 1826                                            5

 physicians, and other persons authorized to dispense prescription medications may dispense
 epinephrine [auto-injectors] delivery devices under a prescription issued in the name of an
 authorized entity.
         3. An authorized entity may acquire and stock a supply of epinephrine [auto-
 injectors] delivery devices under a prescription issued in accordance with this section. Such
 epinephrine [auto-injectors] delivery devices shall be stored in a location readily accessible
 in an emergency and in accordance with the epinephrine [auto-injector's] delivery device's
 instructions for use and any additional requirements established by the department of health
 and senior services by rule. An authorized entity shall designate employees or agents who
 have completed the training required under this section to be responsible for the storage,
 maintenance, and general oversight of epinephrine [auto-injectors] delivery devices acquired
 by the authorized entity.
         4. An authorized entity that acquires a supply of epinephrine [auto-injectors] delivery
 devices under a prescription issued in accordance with this section shall ensure that:
         (1) Expected epinephrine [auto-injector] delivery device users receive training in
 recognizing symptoms of severe allergic reactions including anaphylaxis and the use of
 epinephrine [auto-injectors] delivery devices from a nationally recognized organization
 experienced in training laypersons in emergency health treatment or another entity or person
 approved by the department of health and senior services;
         (2) All epinephrine [auto-injectors] delivery devices are maintained and stored
 according to the epinephrine [auto-injector's] delivery device's instructions for use;
         (3) Any person who provides or administers an epinephrine [auto-injector] delivery
 device to an individual who the person believes in good faith is experiencing anaphylaxis
 activates the emergency medical services system as soon as possible; and
         (4) A proper review of all situations in which an epinephrine [auto-injector] delivery
 device is used to render emergency care is conducted.
         5. Any authorized entity that acquires a supply of epinephrine [auto-injectors]
 delivery devices under a prescription issued in accordance with this section shall notify the
 emergency communications district or the ambulance dispatch center of the primary provider
 of emergency medical services where the epinephrine [auto-injectors] delivery devices are to
 be located within the entity's facility.
         6. No person shall provide or administer an epinephrine [auto-injector] delivery
 device to any individual who is under eighteen years of age without the verbal consent of a
 parent or guardian who is present at the time when provision or administration of the
 epinephrine [auto-injector] delivery device is needed. Provided, however, that a person may
 provide or administer an epinephrine [auto-injector] delivery device to such an individual
 without the consent of a parent or guardian if the parent or guardian is not physically present
HB 1826                                           6

 and the person reasonably believes the individual shall be in imminent danger without the
 provision or administration of the epinephrine [auto-injector] delivery device.
         7. The following persons and entities shall not be liable for any injuries or related
 damages that result from the administration or self-administration of an epinephrine [auto-
 injector] delivery device in accordance with this section that may constitute ordinary
 negligence:
         (1) An authorized entity that possesses and makes available epinephrine [auto-
 injectors] delivery devices and its employees, agents, and other trained persons;
         (2) Any person who uses an epinephrine [auto-injector] delivery device made
 available under this section;
         (3) A physician that prescribes epinephrine [auto-injectors] delivery devices to an
 authorized entity; or
         (4) Any person or entity that conducts the training described in this section.
69
Such immunity does not apply to acts or omissions constituting a reckless disregard for the
safety of others or willful or wanton conduct. The administration of an epinephrine [auto-
injector] delivery device in accordance with this section shall not be considered the practice
of medicine. The immunity from liability provided under this subsection is in addition to and
not in lieu of that provided under section 537.037. An authorized entity located in this state
shall not be liable for any injuries or related damages that result from the provision or
administration of an epinephrine [auto-injector] delivery device by its employees or agents
outside of this state if the entity or its employee or agent is not liable for such injuries or
related damages under the laws of the state in which such provision or administration
occurred. No trained person who is in compliance with this section and who in good faith and
exercising reasonable care fails to administer an epinephrine [auto-injector] delivery device
shall be liable for such failure.
       8. All basic life support ambulances and stretcher vans operated in the state shall be
equipped with epinephrine [auto-injectors] delivery devices and be staffed by at least one
individual trained in the use of epinephrine [auto-injectors] delivery devices.
       9. The provisions of this section shall apply in all counties within the state and any
city not within a county.
       10. Nothing in this section shall be construed as superseding the provisions of section
167.630.
           321.621. 1. For the purposes of this section, the following terms mean:
       (1) "Epinephrine delivery device", a single-use device used for the delivery of a
premeasured dose of epinephrine into the human body;
HB 1826                                              7

          (2) "Qualified first responder" [shall mean], any state and local law enforcement
 agency staff, fire department personnel, fire district personnel, or licensed emergency medical
 technician who is acting under the directives and established protocols of a medical director
 who comes in contact with a person suffering from an anaphylactic reaction and who has
 received training in recognizing and responding to anaphylactic reactions and the
 administration of epinephrine [auto-injector] delivery devices to a person suffering from
 an apparent anaphylactic reaction[.];
          (3) "Qualified first responder agencies" [shall mean], any state or local law
 enforcement agency, fire department, or ambulance service that provides documented training
 to its staff related to the administration of epinephrine [auto-injector] delivery devices in an
 apparent anaphylactic reaction.
          2. The director of the department of health and senior services, if a licensed
 physician, may issue a statewide standing order for epinephrine [auto-injector] delivery
 devices for adult patients to fire protection districts in nonmetropolitan areas in Missouri as
 such areas are determined according to the United States Census Bureau's American
 Community Survey, based on the most recent of five-year period estimate data in which the
 final year of the estimate ends in either zero or five. If the director of the department of health
 and senior services is not a licensed physician, the department of health and senior services
 may employ or contract with a licensed physician who may issue such a statewide order with
 the express consent of the director.
          3. Possession and use of epinephrine [auto-injector] delivery devices for adult
 patients shall be limited as follows:
          (1) No person shall use an epinephrine [auto-injector] delivery device pursuant to this
 section unless such person has successfully completed a training course in the use of
 epinephrine [auto-injector] delivery devices for adult patients approved by the director of t