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          [(3)] (5) "Qualified adult" means a person who:
70          (a) is 18 years of age or older; and
71          (b) (i) for purposes of administering an epinephrine auto-injector, has successfully
72     completed the training program established in Section 26-41-104[.]; and
73          (ii) for purposes of administering stock albuterol, has successfully completed the
74     training program established in Section 26-41-104.1.
75          [(4)] (6) "Qualified epinephrine auto-injector entity":
76          (a) means a facility or organization that employs, contracts with, or has a similar
77     relationship with a qualified adult who is likely to have contact with another person who may
78     experience anaphylaxis; and
79          (b) includes:
80          (i) recreation camps;
81          (ii) an education facility, school, or university;
82          (iii) a day care facility;
83          (iv) youth sports leagues;
84          (v) amusement parks;
85          (vi) food establishments;
86          (vii) places of employment; and
87          (viii) recreation areas.
88          (7) "Qualified stock albuterol entity" means a public or private school that employs,
89     contracts with, or has a similar relationship with a qualified adult who is likely to have contact

90     with another person who may experience an asthma emergency.
91          (8) "Stock albuterol" means a prescription inhaled medication:
92          (a) used to treat asthma; and
93          (b) that may be delivered through a device, including:
94          (i) an inhaler; or
95          (ii) a nebulizer with a mouthpiece or mask.
96          Section 3. Section 26-41-103 is amended to read:
97          26-41-103. Voluntary participation.
98          (1) This chapter does not create a duty or standard of care for:
99          (a) a person to be trained in the use and storage of epinephrine auto-injectors or stock
100     albuterol; or
101          (b) except as provided in Subsection (5), a qualified epinephrine auto-injector entity to
102     store epinephrine auto-injectors or a qualified stock albuterol entity to store stock albuterol on
103     its premises.
104          (2) Except as provided in Subsections (3) and (5), a decision by a person to
105     successfully complete a training program under Section 26-41-104 or 26-41-104.1 and to make
106     emergency epinephrine auto-injectors or stock albuterol available under the provisions of this
107     chapter is voluntary.
108          (3) A school, school board, or school official may not prohibit or dissuade a teacher or
109     other school employee at a primary or secondary school in the state, either public or private,
110     from:
111          (a) completing a training program under Section 26-41-104 or 26-41-104.1;
112          (b) possessing or storing an epinephrine auto-injector or stock albuterol on school
113     property if:
114          (i) the teacher or school employee is a qualified adult; and
115          (ii) the possession and storage is in accordance with the training received under Section
116     26-41-104 or 26-41-104.1; or
117          (c) administering an epinephrine auto-injector or stock albuterol to any person, if:
118          (i) the teacher or school employee is a qualified adult; and
119          (ii) the administration is in accordance with the training received under Section
120     26-41-104 or 26-41-104.1.

121          (4) A school, school board, or school official may encourage a teacher or other school
122     employee to volunteer to become a qualified adult.
123          (5) (a) Each primary or secondary school in the state, both public and private, shall
124     make an emergency epinephrine auto-injector available to any teacher or other school
125     employee who:
126          (i) is employed at the school; and
127          (ii) is a qualified adult.
128          (b) This section does not require a school described in Subsection (5)(a) to keep more
129     than one emergency epinephrine auto-injector on the school premises, so long as it may be
130     quickly accessed by a teacher or other school employee, who is a qualified adult, in the event of
131     an emergency.
132          (6) (a) Each primary or secondary school in the state, both public and private, may
133     make stock albuterol available to any school employee who:
134          (i) is employed at the school; and
135          (ii) is a qualified adult.
136          (b) A qualified adult may administer stock albuterol to a student who:
137          (i) has a diagnosis of asthma by a health care provider;
138          (ii) has a current asthma action plan on file with the school; and
139          (iii) is showing symptoms of an asthma emergency as described in the student's asthma
140     action plan.
141          (c) This Subsection (6) may not be interpreted to relieve a student's parent or guardian
142     of providing a student's medication or create an expectation that a school will have stock
143     albuterol available.
144          [(6)] (7) No school, school board, or school official shall retaliate or otherwise take
145     adverse action against a teacher or other school employee for:
146          (a) volunteering under Subsection (2);
147          (b) engaging in conduct described in Subsection (3); or
148          (c) failing or refusing to become a qualified adult.
149          Section 4. Section 26-41-104 is amended to read:
150          26-41-104. Training in use and storage of epinephrine auto-injector.
151          (1) (a) Each primary and secondary school in the state, both public and private, shall

152     make initial and annual refresher training, regarding the storage and emergency use of an
153     epinephrine auto-injector, available to any teacher or other school employee who volunteers to
154     become a qualified adult.
155          (b) The training described in Subsection (1)(a) may be provided by the school nurse, or
156     other person qualified to provide such training, designated by the school district physician, the
157     medical director of the local health department, or the local emergency medical services
158     director.
159          (2) A person who provides training under Subsection (1) or (6) shall include in the
160     training:
161          (a) techniques for recognizing symptoms of anaphylaxis;
162          (b) standards and procedures for the storage and emergency use of epinephrine
163     auto-injectors;
164          (c) emergency follow-up procedures, including calling the emergency 911 number and
165     contacting, if possible, the student's parent and physician; and
166          (d) written materials covering the information required under this Subsection (2).
167          (3) A qualified adult shall retain for reference the written materials prepared in
168     accordance with Subsection (2)(d).
169          (4) A public school shall permit a student to possess an epinephrine auto-injector or
170     possess and self-administer an epinephrine auto-injector if:
171          (a) the student's parent or guardian signs a statement:
172          (i) authorizing the student to possess or possess and self-administer an epinephrine
173     auto-injector; and
174          (ii) acknowledging that the student is responsible for, and capable of, possessing or
175     possessing and self-administering an epinephrine auto-injector; and
176          (b) the student's health care provider provides a written statement that states that:
177          (i) it is medically appropriate for the student to possess or possess and self-administer
178     an epinephrine auto-injector; and
179          (ii) the student should be in possession of the epinephrine auto-injector at all times.
180          (5) The [Utah Department of Health] department, in cooperation with the state
181     superintendent of public instruction, shall design forms to be used by public and private
182     schools for the parental and health care providers statements described in Subsection (4).

183          (6) (a) The department:
184          (i) shall approve educational programs conducted by other persons, to train:
185          (A) people under Subsection (6)(b) of this section, regarding the proper use and storage
186     of emergency epinephrine auto-injectors; and
187          (B) a qualified epinephrine auto-injector entity regarding the proper storage and
188     emergency use of epinephrine auto-injectors; and
189          (ii) may, as funding is available, conduct educational programs to train people
190     regarding the use of and storage of emergency epinephrine auto-injectors.
191          (b) A person who volunteers to receive training as a qualified adult to administer an
192     epinephrine auto-injector under the provisions of this Subsection (6) shall demonstrate a need
193     for the training to the department, which may be based upon occupational, volunteer, or family
194     circumstances, and shall include:
195          (i) camp counselors;
196          (ii) scout leaders;
197          (iii) forest rangers;
198          (iv) tour guides; and
199          (v) other persons who have or reasonably expect to have contact with at least one other
200     person as a result of the person's occupational or volunteer status.
201          Section 5. Section 26-41-104.1 is enacted to read:
202          26-41-104.1. Training in use and storage of stock albuterol.
203          (1) (a) Each primary and secondary school in the state, both public and private, shall
204     make initial and annual refresher training regarding the storage and emergency use of stock
205     albuterol available to a teacher or school employee who volunteers to become a qualified adult.
206          (b) The training described in Subsection (1)(a) shall be provided by the department.
207          (2) A person who provides training under Subsection (1) or (6) shall include in the
208     training:
209          (a) techniques for recognizing symptoms of an asthma emergency;
210          (b) standards and procedures for the storage and emergency use of stock albuterol;
211          (c) emergency follow-up procedures, and contacting, if possible, the student's parent;
212     and
213          (d) written materials covering the information required under this Subsection (2).

214          (3) A qualified adult shall retain for reference the written materials prepared in
215     accordance with Subsection (2)(d).
216          (4) (a) A public or private school shall permit a student to possess and self-administer
217     asthma medication if:
218          (i) the student's parent or guardian signs a statement:
219          (A) authorizing the student to self-administer asthma medication; and
220          (B) acknowledging that the student is responsible for, and capable of,
221     self-administering the asthma medication; and
222          (ii) the student's health care provider provides a written statement that states:
223          (A) it is medically appropriate for the student to self-administer asthma medication and
224     be in possession of asthma medication at all times; and
225          (B) the name of the asthma medication prescribed or authorized for the student's use.
226          (b) Section 53G-8-205 does not apply to the possession and self-administration of
227     asthma medication in accordance with this section.
228          (5) The department, in cooperation with the state superintendent of public instruction,
229     shall design forms to be used by public and private schools for the parental and health care
230     provider statements described in Subsection (4).
231          (6) The department:
232          (a) shall approve educational programs conducted by other persons to train:
233          (i) people under Subsection (6)(b), regarding the proper use and storage of stock
234     albuterol; and
235          (ii) a qualified stock albuterol entity regarding the proper storage and emergency use of
236     stock albuterol; and
237          (b) may conduct educational programs to train people regarding the use of and storage
238     of stock albuterol.
239          Section 6. Section 26-41-105 is amended to read:
240          26-41-105. Authority to obtain and use an epinephrine auto-injector or stock
241     albuterol.
242          (1) A qualified adult who is a teacher or other school employee at a public or private
243     primary or secondary school in the state, or a school nurse, may obtain from the school district
244     physician, the medical director of the local health department, or the local emergency medical

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

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

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