1     
STUDENT ASTHMA RELIEF AMENDMENTS

2     
2019 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Mark A. Wheatley

5     
Senate Sponsor: Ronald Winterton

6     

7     LONG TITLE
8     General Description:
9          This bill enacts provisions governing the administration of stock albuterol by certain
10     entities to an individual.
11     Highlighted Provisions:
12          This bill:
13          ▸     enacts definitions;
14          ▸     permits a school to make stock albuterol available to certain employees for
15     administering to certain students;
16          ▸     enacts provisions governing training provided by the Department of Health on the
17     use and storage of stock albuterol;
18          ▸     authorizes a qualified adult to obtain a prescription for stock albuterol and
19     administer stock albuterol to certain individuals;
20          ▸     enacts immunity provisions for a qualified stock albuterol entity;
21          ▸     requires the Department of Health to adopt rules establishing the storage of stock
22     albuterol by a qualified stock albuterol entity; and
23          ▸     makes technical and conforming changes.
24     Money Appropriated in this Bill:
25          None
26     Other Special Clauses:
27          This bill provides a special effective date.
28     Utah Code Sections Affected:
29     AMENDS:

30          26-41-101, as enacted by Laws of Utah 1998, Chapter 17
31          26-41-102, as last amended by Laws of Utah 2017, Chapter 106
32          26-41-103, as last amended by Laws of Utah 2015, Chapter 332
33          26-41-104, as last amended by Laws of Utah 2015, Chapter 332
34          26-41-105, as last amended by Laws of Utah 2015, Chapter 332
35          26-41-106, as last amended by Laws of Utah 2018, Chapter 415
36          26-41-107, as enacted by Laws of Utah 2015, Chapter 332
37     ENACTS:
38          26-41-104.1, Utah Code Annotated 1953
39     REPEALS:
40          53G-9-503, as renumbered and amended by Laws of Utah 2018, Chapter 3
41     

42     Be it enacted by the Legislature of the state of Utah:
43          Section 1. Section 26-41-101 is amended to read:
44     
CHAPTER 41. EMERGENCY RESPONSE FOR LIFE-THREATENING

45     
CONDITIONS

46          26-41-101. Title.
47          This chapter is known as [the "Emergency Injection for Anaphylactic Reaction Act."]
48     "Emergency Response for Life-threatening Conditions."
49          Section 2. Section 26-41-102 is amended to read:
50          26-41-102. Definitions.
51          As used in this chapter:
52          (1) "Anaphylaxis" means a potentially life-threatening hypersensitivity to a substance.
53          (a) Symptoms of anaphylaxis may include shortness of breath, wheezing, difficulty
54     breathing, difficulty talking or swallowing, hives, itching, swelling, shock, or asthma.
55          (b) Causes of anaphylaxis may include insect sting, food allergy, drug reaction, and
56     exercise.
57          (2) "Asthma action plan" means a written plan:

58          (a) developed with a school nurse, a student's parent or guardian, and the student's
59     health care provider to help control the student's asthma; and
60          (b) signed by the student's:
61          (i) parent or guardian; and
62          (ii) health care provider.
63          (3) "Asthma emergency" means an episode of respiratory distress that may include
64     symptoms such as wheezing, shortness of breath, coughing, chest tightness, or breathing
65     difficulty.
66          [(2)] (4) "Epinephrine auto-injector" means a portable, disposable drug delivery device
67     that contains a measured, single dose of epinephrine that is used to treat a person suffering a
68     potentially fatal anaphylactic reaction.
69          (5) "Health care provider" means an individual who is licensed as:
70          (a) a physician under Title 58, Chapter 67, Utah Medical Practice Act;
71          (b) a physician under Title 58, Chapter 68, Utah Osteopathic Medical Practice Act;
72          (c) an advanced practice registered nurse under Section 58-31b-302; or
73          (d) a physician assistant under Title 58, Chapter 70a, Physician Assistant Act.
74          [(3)] (6) "Qualified adult" means a person who:
75          (a) is 18 years of age or older; and
76          (b) (i) for purposes of administering an epinephrine auto-injector, has successfully
77     completed the training program established in Section 26-41-104[.]; and
78          (ii) for purposes of administering stock albuterol, has successfully completed the
79     training program established in Section 26-41-104.1.
80          [(4)] (7) "Qualified epinephrine auto-injector entity":
81          (a) means a facility or organization that employs, contracts with, or has a similar
82     relationship with a qualified adult who is likely to have contact with another person who may
83     experience anaphylaxis; and
84          (b) includes:
85          (i) recreation camps;

86          (ii) an education facility, school, or university;
87          (iii) a day care facility;
88          (iv) youth sports leagues;
89          (v) amusement parks;
90          (vi) food establishments;
91          (vii) places of employment; and
92          (viii) recreation areas.
93          (8) "Qualified stock albuterol entity" means a public or private school that employs,
94     contracts with, or has a similar relationship with a qualified adult who is likely to have contact
95     with another person who may experience an asthma emergency.
96          (9) "Stock albuterol" means a prescription inhaled medication:
97          (a) used to treat asthma; and
98          (b) that may be delivered through a device, including:
99          (i) an inhaler; or
100          (ii) a nebulizer with a mouthpiece or mask.
101          Section 3. Section 26-41-103 is amended to read:
102          26-41-103. Voluntary participation.
103          (1) This chapter does not create a duty or standard of care for:
104          (a) a person to be trained in the use and storage of epinephrine auto-injectors or stock
105     albuterol; or
106          (b) except as provided in Subsection (5), a qualified epinephrine auto-injector entity to
107     store epinephrine auto-injectors or a qualified stock albuterol entity to store stock albuterol on
108     its premises.
109          (2) Except as provided in Subsections (3) and (5), a decision by a person to
110     successfully complete a training program under Section 26-41-104 or 26-41-104.1 and to make
111     emergency epinephrine auto-injectors or stock albuterol available under the provisions of this
112     chapter is voluntary.
113          (3) A school, school board, or school official may not prohibit or dissuade a teacher or

114     other school employee at a primary or secondary school in the state, either public or private,
115     from:
116          (a) completing a training program under Section 26-41-104 or 26-41-104.1;
117          (b) possessing or storing an epinephrine auto-injector or stock albuterol on school
118     property if:
119          (i) the teacher or school employee is a qualified adult; and
120          (ii) the possession and storage is in accordance with the training received under Section
121     26-41-104 or 26-41-104.1; or
122          (c) administering an epinephrine auto-injector or stock albuterol to any person, if:
123          (i) the teacher or school employee is a qualified adult; and
124          (ii) the administration is in accordance with the training received under Section
125     26-41-104 or 26-41-104.1.
126          (4) A school, school board, or school official may encourage a teacher or other school
127     employee to volunteer to become a qualified adult.
128          (5) (a) Each primary or secondary school in the state, both public and private, shall
129     make an emergency epinephrine auto-injector available to any teacher or other school
130     employee who:
131          (i) is employed at the school; and
132          (ii) is a qualified adult.
133          (b) This section does not require a school described in Subsection (5)(a) to keep more
134     than one emergency epinephrine auto-injector on the school premises, so long as it may be
135     quickly accessed by a teacher or other school employee, who is a qualified adult, in the event of
136     an emergency.
137          (6) (a) Each primary or secondary school in the state, both public and private, may
138     make stock albuterol available to any school employee who:
139          (i) is employed at the school; and
140          (ii) is a qualified adult.
141          (b) A qualified adult may administer stock albuterol to a student who:

142          (i) has a diagnosis of asthma by a health care provider;
143          (ii) has a current asthma action plan on file with the school; and
144          (iii) is showing symptoms of an asthma emergency as described in the student's asthma
145     action plan.
146          (c) This Subsection (6) may not be interpreted to relieve a student's parent or guardian
147     of providing a student's medication or create an expectation that a school will have stock
148     albuterol available.
149          [(6)] (7) No school, school board, or school official shall retaliate or otherwise take
150     adverse action against a teacher or other school employee for:
151          (a) volunteering under Subsection (2);
152          (b) engaging in conduct described in Subsection (3); or
153          (c) failing or refusing to become a qualified adult.
154          Section 4. Section 26-41-104 is amended to read:
155          26-41-104. Training in use and storage of epinephrine auto-injector.
156          (1) (a) Each primary and secondary school in the state, both public and private, shall
157     make initial and annual refresher training, regarding the storage and emergency use of an
158     epinephrine auto-injector, available to any teacher or other school employee who volunteers to
159     become a qualified adult.
160          (b) The training described in Subsection (1)(a) may be provided by the school nurse, or
161     other person qualified to provide such training, designated by the school district physician, the
162     medical director of the local health department, or the local emergency medical services
163     director.
164          (2) A person who provides training under Subsection (1) or (6) shall include in the
165     training:
166          (a) techniques for recognizing symptoms of anaphylaxis;
167          (b) standards and procedures for the storage and emergency use of epinephrine
168     auto-injectors;
169          (c) emergency follow-up procedures, including calling the emergency 911 number and

170     contacting, if possible, the student's parent and physician; and
171          (d) written materials covering the information required under this Subsection (2).
172          (3) A qualified adult shall retain for reference the written materials prepared in
173     accordance with Subsection (2)(d).
174          (4) A public school shall permit a student to possess an epinephrine auto-injector or
175     possess and self-administer an epinephrine auto-injector if:
176          (a) the student's parent or guardian signs a statement:
177          (i) authorizing the student to possess or possess and self-administer an epinephrine
178     auto-injector; and
179          (ii) acknowledging that the student is responsible for, and capable of, possessing or
180     possessing and self-administering an epinephrine auto-injector; and
181          (b) the student's health care provider provides a written statement that states that:
182          (i) it is medically appropriate for the student to possess or possess and self-administer
183     an epinephrine auto-injector; and
184          (ii) the student should be in possession of the epinephrine auto-injector at all times.
185          (5) The [Utah Department of Health] department, in cooperation with the state
186     superintendent of public instruction, shall design forms to be used by public and private
187     schools for the parental and health care providers statements described in Subsection (4).
188          (6) (a) The department:
189          (i) shall approve educational programs conducted by other persons, to train:
190          (A) people under Subsection (6)(b) of this section, regarding the proper use and storage
191     of emergency epinephrine auto-injectors; and
192          (B) a qualified epinephrine auto-injector entity regarding the proper storage and
193     emergency use of epinephrine auto-injectors; and
194          (ii) may, as funding is available, conduct educational programs to train people
195     regarding the use of and storage of emergency epinephrine auto-injectors.
196          (b) A person who volunteers to receive training as a qualified adult to administer an
197     epinephrine auto-injector under the provisions of this Subsection (6) shall demonstrate a need

198     for the training to the department, which may be based upon occupational, volunteer, or family
199     circumstances, and shall include:
200          (i) camp counselors;
201          (ii) scout leaders;
202          (iii) forest rangers;
203          (iv) tour guides; and
204          (v) other persons who have or reasonably expect to have contact with at least one other
205     person as a result of the person's occupational or volunteer status.
206          Section 5. Section 26-41-104.1 is enacted to read:
207          26-41-104.1. Training in use and storage of stock albuterol.
208          (1) (a) Each primary and secondary school in the state, both public and private, shall
209     make initial and annual refresher training regarding the storage and emergency use of stock
210     albuterol available to a teacher or school employee who volunteers to become a qualified adult.
211          (b) The training described in Subsection (1)(a) shall be provided by the department.
212          (2) A person who provides training under Subsection (1) or (6) shall include in the
213     training:
214          (a) techniques for recognizing symptoms of an asthma emergency;
215          (b) standards and procedures for the storage and emergency use of stock albuterol;
216          (c) emergency follow-up procedures, and contacting, if possible, the student's parent;
217     and
218          (d) written materials covering the information required under this Subsection (2).
219          (3) A qualified adult shall retain for reference the written materials prepared in
220     accordance with Subsection (2)(d).
221          (4) (a) A public or private school shall permit a student to possess and self-administer
222     asthma medication if:
223          (i) the student's parent or guardian signs a statement:
224          (A) authorizing the student to self-administer asthma medication; and
225          (B) acknowledging that the student is responsible for, and capable of,

226     self-administering the asthma medication; and
227          (ii) the student's health care provider provides a written statement that states:
228          (A) it is medically appropriate for the student to self-administer asthma medication and
229     be in possession of asthma medication at all times; and
230          (B) the name of the asthma medication prescribed or authorized for the student's use.
231          (b) Section 53G-8-205 does not apply to the possession and self-administration of
232     asthma medication in accordance with this section.
233          (5) The department, in cooperation with the state superintendent of public instruction,
234     shall design forms to be used by public and private schools for the parental and health care
235     provider statements described in Subsection (4).
236          (6) The department:
237          (a) shall approve educational programs conducted by other persons to train:
238          (i) people under Subsection (6)(b), regarding the proper use and storage of stock
239     albuterol; and
240          (ii) a qualified stock albuterol entity regarding the proper storage and emergency use of
241     stock albuterol; and
242          (b) may conduct educational programs to train people regarding the use of and storage
243     of stock albuterol.
244          Section 6. Section 26-41-105 is amended to read:
245          26-41-105. Authority to obtain and use an epinephrine auto-injector or stock
246     albuterol.
247          (1) A qualified adult who is a teacher or other school employee at a public or private
248     primary or secondary school in the state, or a school nurse, may obtain from the school district
249     physician, the medical director of the local health department, or the local emergency medical
250     services director a prescription for epinephrine auto-injectors or stock albuterol.
251          (2) A qualified adult may obtain from a physician, pharmacist, or any other person or
252     entity authorized to prescribe or dispense prescription drugs, a prescription for an epinephrine
253     auto-injector or stock albuterol.

254          (3) A qualified adult:
255          (a) may immediately administer an epinephrine auto-injector to a person exhibiting
256     potentially life-threatening symptoms of anaphylaxis when a physician is not immediately
257     available; and
258          (b) shall initiate emergency medical services or other appropriate medical follow-up in
259     accordance with the training materials retained under Section 26-41-104 after administering an
260     epinephrine auto-injector.
261          (4) If a school nurse is not immediately available, a qualified adult:
262          (a) may immediately administer stock albuterol to an individual who:
263          (i) has a diagnosis of asthma by a health care provider;
264          (ii) has a current asthma action plan on file with the school; and
265          (iii) is showing symptoms of an asthma emergency as described in the student's asthma
266     action plan; and
267          (b) shall initiate appropriate medical follow-up in accordance with the training
268     materials retained under Section 26-41-104.1 after administering stock albuterol.
269          [(4)] (5) (a) A qualified entity that complies with Subsection [(4)] (5)(b) or (c), may
270     obtain from a physician, pharmacist, or any other person [or entity] authorized to prescribe or
271     dispense prescription drugs, a prescription for a supply of epinephrine auto-injectors or stock
272     albuterol, respectively, for:
273          (i) storing:
274          (A) the epinephrine auto-injectors on the qualified epinephrine auto-injector entity's
275     premises; and
276          (B) stock albuterol on the qualified stock albuterol entity's premises; and
277          (ii) use by a qualified adult in accordance with Subsection (3) or (4).
278          (b) A qualified epinephrine auto-injector entity shall:
279          (i) designate an individual to complete an initial and annual refresher training program
280     regarding the proper storage and emergency use of an epinephrine auto-injector available to a
281     qualified adult; and

282          (ii) store epinephrine auto-injectors in accordance with the standards established by the
283     department in Section 26-41-107.
284          (c) A qualified stock albuterol entity shall:
285          (i) designate an individual to complete an initial and annual refresher training program
286     regarding the proper storage and emergency use of stock albuterol available to a qualified
287     adult; and
288          (ii) store stock albuterol in accordance with the standards established by the department
289     in Section 26-41-107.
290          Section 7. Section 26-41-106 is amended to read:
291          26-41-106. Immunity from liability.
292          (1) The following, if acting in good faith, are not liable in any civil or criminal action
293     for any act taken or not taken under the authority of this chapter with respect to an anaphylactic
294     reaction or asthma emergency:
295          (a) a qualified adult;
296          (b) a physician, pharmacist, or any other person or entity authorized to prescribe or
297     dispense prescription drugs;
298          (c) a person who conducts training described in Section 26-41-104[; and] or
299     26-41-104.1;
300          (d) a qualified epinephrine auto-injector entity[.]; and
301          (e) a qualified stock albuterol entity.
302          (2) Section 53G-9-502 does not apply to the administration of an epinephrine
303     auto-injector or stock albuterol in accordance with this chapter.
304          (3) This section does not eliminate, limit, or reduce any other immunity from liability
305     or defense against liability that may be available under state law.
306          Section 8. Section 26-41-107 is amended to read:
307          26-41-107. Administrative rulemaking authority.
308          The department shall adopt rules in accordance with Title 63G, Chapter 3, Utah
309     Administrative Rulemaking Act, to:

310          (1) establish and approve training programs in accordance with [Section] Sections
311     26-41-104 and 26-41-104.1;
312          (2) establish a procedure for determining who is eligible for training as a qualified
313     adult under Subsection 26-41-104(6)(b)(v); and
314          (3) establish standards for storage of:
315          (a) emergency auto-injectors by a qualified epinephrine auto-injector entity under
316     Section 26-41-104[.]; and
317          (b) stock albuterol by a qualified stock albuterol entity under Section 26-41-104.1.
318          Section 9. Repealer.
319          This bill repeals:
320          Section 53G-9-503, Self-administration of asthma medication.
321          Section 10. Effective date.
322          This bill takes effect July 1, 2020.